A review of potential biomarkers for assessing physical and psychological trauma in paediatric burns

Abstract

Biological markers that evaluate physical healing as well as psychological impact of a burn are essential for effective treatment of paediatric burns. The objective of this review is to summarize the evidence supporting the use of biomarkers in children with burns. An extensive review of the literature was performed using PubMed. A total of 59 biomarkers were identified relating to burn presence, specifically relating to processes involved in inflammation, wound healing, growth and metabolism. In addition, biomarkers involved in the stress response cascade following a burn trauma were also identified. Although many biomarkers have been identified that are potentially associated with burn-related physical and psychological trauma, an understanding of burn biology is still lacking in children. We propose that future research in the field of children’s burns should be conducted using broad screening methods for identifying potential biomarkers, examine the biological interactions of different biomarkers, utilize child-appropriate biological fluids such as urine or saliva, and include a range of different severity burns. Through further research, the biological response to burn injury may be fully realized and clinically relevant diagnostic tests and treatment therapies utilizing these biomarkers could be developed, for the improvement of healing outcomes in paediatric burn patients.

A Systematic Review of Pediatric Nonaccidental Burns

“…Radiographic studies of the skull, chest, and long bones should be routinely performed on all burned children 46 . Potential biological markers traced in the blood, urine, and saliva in children with burns could be useful in the evaluation of the healing process and psychological impact, as well as the effects on inflammation, metabolism, and stress response; these markers (eg, growth factors, hormones, cytokines) guide individualized treatment based on the physiological response to the burn injury 6,21,51 . Obtaining a thorough relevant history of a burn injury is critical (eg, context leading up to the burn injury, burn source, first aid, etc) 52 …”

“…46 Potential biological markers traced in the blood, urine, and saliva in children with burns could be useful in the evaluation of the healing process and psychological impact, as well as the effects on inflammation, metabolism, and stress response; these markers (eg, growth factors, hormones, cytokines) guide individualized treatment based on the physiological response to the burn injury. 6,21,51 Obtaining a thorough relevant history of a burn injury is critical (eg, context leading up to the burn injury, burn source, first aid, etc). 52 Clinically, the presence of scalds without splash marks, uniformity of the burn depth, "glove or stocking" distribution, 7,36,53 "hole in the doughnut" buttock sign, 41 or "halo" sign 7 should raise a high suspicion of intentional burn injury 7,19 and should arouse suspicion of inflicted burns to the child.…”

“…Children suffer severe deformities and long-term disabilities, which require expert, multidisciplinary, continuous input and rehabilitation 19 . The psychological consequences on developing children can be devastating 20,21 …”

Modern Aspects of Burn Injury Immunopathogenesis and Prognostic Immunobiochemical Markers (Mini-Review)

“…An evaluation of both is essential for understanding wound healing mechanisms and predicting the severity of burn injury patients and the therapy's adequacy. These include biomarkers associated with metabolism, inflammation, and wound healing [24][25][26][27].…”

Predictive value of perioperative monocyte counts for bacteremia and 90-day all-cause mortality in patients with severe burn

“…Some studies have shown that clinicians include in ammatory indicators in early sepsis diagnosis [10,11]. In recent years, an increasing number of cell biochemical indicators, such as CD14 + monocyte phenotype, central adrenomedullin, dipeptidyl peptidase three and changes in peripheral blood cells, have also been found to predict survival after severe burns [12][13][14][15][16][17]. Risk prediction models based on independent risk factors report predictability and sensitivity, but most of them are single-center studies, and the extensibility of the models requires further evaluation.…”