Paediatric post-burn scar management in the UK: A national survey

Liuzzi, Francesca; Chadwick, Stephen; Shah, Mamta

doi:10.1016/j.burns.2014.10.017

Cited by 22 publications

(10 citation statements)

References 15 publications

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“…Numerous treatments are used to reduce or prevent scarring [ 37 , 38 ]. Identifying injuries, which if permitted to heal spontaneously may result in pathological scarring, is important to prevent unnecessary treatment as few treatments are without side effects [ 39 , 40 ].…”

Section: Reviewmentioning

confidence: 99%

The evidence for natural therapeutics as potential anti-scarring agents in burn-related scarring

2016

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Though survival rate following severe thermal injuries has improved, the incidence and treatment of scarring have not improved at the same speed. This review discusses the formation of scars and in particular the formation of hypertrophic scars. Further, though there is as yet no gold standard treatment for the prevention or treatment of scarring, a brief overview is included. A number of natural therapeutics have shown beneficial effects both in vivo and in vitro with the potential of becoming clinical therapeutics in the future. These natural therapeutics include both plant-based products such as resveratrol, quercetin and epigallocatechin gallate as examples and includes the non-plant-based therapeutic honey. The review also includes potential mechanism of action for the therapeutics, any recorded adverse events and current administration of the therapeutics used. This review discusses a number of potential ‘treatments’ that may reduce or even prevent scarring particularly hypertrophic scarring, which is associated with thermal injuries without compromising wound repair.

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Section: Reviewmentioning

confidence: 99%

The evidence for natural therapeutics as potential anti-scarring agents in burn-related scarring

2016

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“…Burn patients could possibly benefit from all those factors in inflammation reduction, wound healing [ 67 ], edema control, scar maturation and improvement of muscle and soft tissue conditions. The most commonly used are paraffin therapy, hydrotherapy [ 68 ], low-frequency electrotherapy [ 69 , 70 ], medium-frequency electrotherapy, microwave therapy, shortwave therapy, air compression therapy [ 71 ], laser [ 72 , 73 ], ultraviolet therapy [ 74 ], ultrasound [ 75 ], and cold therapy [ 76 ], which can be used alone or in combination according to the specific needs and conditions of the patients.…”

Section: Implementation Of Rehabilitation Therapiesmentioning

confidence: 99%

Guidelines for burn rehabilitation in China

Cen

Chai

Chen³

et al. 2015

Burns &Amp; Trauma

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Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.

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“…A survey of 19 paediatric NHS burn services in the UK showed that 18 services routinely use pressure garments for the prevention of hypertrophic scarring following burn injury. 14 …”

Section: Chapter 1 Introduction and Background Bmentioning

confidence: 99%

Pressure garment to prevent abnormal scarring after burn injury in adults and children: the PEGASUS feasibility RCT and mixed-methods study

Moiemen

Mathers

Jones

et al. 2018

Health Technol Assess

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Background Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. Objective To identify the barriers to, and the facilitators of, conducting a randomised controlled trial (RCT) of burn scar management with and without PGT and test whether or not such a trial is feasible. Design Web-based surveys, semistructured individual interviews, a pilot RCT including a health economic evaluation and embedded process evaluation. Setting UK NHS burns services. Interviews and the pilot trial were run in seven burns services. Participants Thirty NHS burns services and 245 staff provided survey responses and 15 staff participated in individual interviews. Face-to-face interviews were held with 24 adult patients and 16 parents of paediatric patients who had undergone PGT. The pilot trial recruited 88 participants (57 adults and 31 children) who were at risk of hypertrophic scarring and were considered suitable for scar management therapy. Interviews were held with 34 participants soon after recruitment, with 23 participants at 12 months and with eight staff from six sites at the end of the trial. Interventions The intervention was standard care with pressure garments. The control was standard care comprising scar management techniques involving demonstration and recommendations to undertake massage three or four times per day with moisturiser, silicone treatment, stretching and other exercises. Main outcome measures Feasibility was assessed by eligibility rates, consent rates, retention in allocated arms, adherence with treatment and follow-up and completion of outcome assessments. The outcomes from interview-based studies were core outcome domains and barriers to, and facilitators of, trial participation and delivery. Results NHS burns services treat 2845 patients per annum (1476 paediatric and 1369 adult) and use pressure garments for 6–18 months, costing £2,171,184. The majority of staff perceived a need for a RCT of PGT, but often lacked equipoise around the research question and PGT as a treatment. Strong views about the use of PGT have the potential to influence the conduct of a full-scale RCT. A range of outcome domains was identified as important via the qualitative research: perceptions of appearance, specific scar characteristics, function, pain and itch, broader psychosocial outcomes and treatment burden. The outcome tools evaluated in the pilot trial did not cover all of these domains. The planned 88 participants were recruited: the eligibility rate was 88% [95% confidence interval (CI) 83% to 92%], the consent rate was 47% (95% CI 40% to 55%). Five (6%) participants withdrew, 14 (16%) were lost to follow-up and 8 (9%) crossed over. Adherence was as in clinical practice. Completion of outcomes was high for adult patients but poorer from parents of paediatric patients, particularly for quality of life. Sections on range of movement and willingness to pay were found to be challenging and poorly completed. Limitations The Brisbane Burn Scar Impact Profile appears more suitable in terms of conceptual coverage than the outcome scales that were used in the trial but was not available at the time of the study. Conclusions A definitive RCT of PGT in burn scar management appears feasible. However, staff attitudes to the use of pressure garments may lead to biases, and the provision of training and support to sites and an ongoing assessment of trial processes are required. Future work We recommend that any future trial include an in-depth mixed-methods recruitment investigation and a process evaluation to account for this. Trial registration Current Controlled Trials ISRCTN34483199. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 36. See the NIHR Journals Library website for further project information

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Paediatric post-burn scar management in the UK: A national survey

Cited by 22 publications

References 15 publications

The evidence for natural therapeutics as potential anti-scarring agents in burn-related scarring

The evidence for natural therapeutics as potential anti-scarring agents in burn-related scarring

Guidelines for burn rehabilitation in China

Pressure garment to prevent abnormal scarring after burn injury in adults and children: the PEGASUS feasibility RCT and mixed-methods study

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