Shriners Hospitals for Children - Galveston

Weight extremes are linked to morbidity, yet their impact on burn outcomes remains underinvestigated. Prior studies suggest an 'obesity paradox', showing survival benefits and better functional outcomes in obese patients. This study used the global real-world database TriNetX to assess the association between body mass index (BMI) and clinical outcomes in adult burn patients, categorized using WHO definitions. After 1:1 propensity score matching for demographics, burn severity, and smoke inhalation injury, clinical outcomes were analyzed over a six-month period following burn injury. Outcomes included mortality, sepsis, pneumonia, acute kidney injury (AKI), cardiovascular events, graft complications, skin infections, and psychological impairment. After matching, 9736 patients were included in the underweight versus normal weight comparison, 72,274 in overweight versus normal weight, 71,195 in obesity versus normal weight, and 9732 in underweight versus obesity. Underweight patients were associated with higher mortality and increased risks of sepsis, pneumonia, cardiovascular events, and psychological impairment. Overweight and obese patients showed higher survival rates and overall better clinical outcome associations. These findings are consistent with the previously described 'obesity paradox' in burn care and identify underweight burn patients as a distinct high-risk subgroup.

Recombinant human growth hormone (GH) has long been used to promote growth in both children and adults. While its benefits on height and weight gain are well-documented, concerns remain regarding potential adverse effects. This scoping review analyzes placebo-controlled prospective clinical trials, randomized controlled trials, and retrospective studies conducted between January 2013 and December 2024. Here, over summarized 90 studies examine the effects of GH on indices of growth and strength in both pediatric and adult populations. Although GH therapy has shown efficacy in promoting physical growth, it has also been associated with significant adverse events, including cardiac dysfunction and cerebrovascular disease. By summarizing the adverse outcomes reported in recent studies, this review aims to inform clinical decision-making and improve the safety of GH therapy in future patient care.

Abstract Introduction Burn patients have a higher chance of developing thromboembolic complications leading to worsened mortality rates so prophylactic anticoagulation is important. Anticoagulants such as enoxaparin, a low molecular weight heparin (LMWH), and unfractionated heparin (UFH) have been frequently used as chemical prophylactic treatments of thromboembolisms. Enoxaparin has been shown to have lower mortality and higher efficacy in surgical patients and coronary artery disease patients. The aim of the study is to assess mortality and compare the safety of enoxaparin and heparin in acute burn patients. Methods A retrospective cohort study of 26227 burn patients was conducted using the TriNetX database. Patients were divided into two cohorts: those receiving only unfractionated heparin (Cohort 1) and those receiving only enoxaparin (Cohort 2) prophylaxis within 24 hours after burn injury. Cohorts were matched with 1:1 propensity score matching to correct for differences in age, gender, ethnicity, race, burn severity, diabetes mellitus, acute myocardial infarction, stroke, and central line venous catheter placement. Outcomes assessed included mortality and deep vein thrombosis (DVT) within a month (30 days). Results Post-matching, there were 7790 patients in each cohort. The heparin cohort demonstrated a significantly higher 30-day mortality rate compared to the enoxaparin cohort (RR = 2.321, 95% CI [1.878, 2.869], p < 0.05). The relative risk ratio for DVT in heparin cohort was slightly higher but not significant (RR = 1.303, 95% CI [0.572, 2.971], p=0.527). Conclusions Prophylactic anticoagulation with enoxaparin is associated with a significant lower 30-day mortality risk compared to unfractionated heparin. Applicability of Research to Practice The findings of this study provide important clinical insights that can directly influence the management of thromboembolic prophylaxis in burn patients. Given that enoxaparin is associated with significantly lower 30-day mortality compared to unfractionated heparin, burn centers and critical care units should consider incorporating enoxaparin as the preferred anticoagulant in their prophylaxis protocols. Funding for the Study N/A

This unique medical guide focuses on scars. The impact of scars is often underestimated and rarely discussed, although therapies for scars do exist.

While tibia vara is a disorder of the proximal tibial physis, femoral deformity frequently contributes to the overall limb malalignment. Our purpose was to determine how femoral varus deformity in tibia vara responds to growth modulation, with/without lateral tension band plating (LTBP) to the femur. One-hundred twenty-seven limbs undergoing LTBP for tibia vara were reviewed. All had tibial LTBP and 35 limbs also had femoral LTBP for varus. Radiographs were measured for correction of the mechanical lateral distal femoral angle (mLDFA) and mechanical axis deviation (MAD). Preoperative-femoral varus was defined with an age-adjusted guide: mLDFA >95 degrees for 2 to below 4 years and mLDFA >90 degrees for 4 to 18 years. The 35 limbs having femoral LTBP were compared with 50 limbs with femoral varus and no femoral LTBP. In addition, 42 limbs that did not have preoperative-femoral varus were followed. Patients with early-onset (below 7y) tibia vara were compared with those with late-onset (≥8y). Outcome success was based on published age-adjusted mLDFA and MAD norms. Following femoral LTBP, the mean mLDFA decreased from 98.0 to 87.1 degrees. All femurs had some improvement, with 28/35 femurs (80%) achieving complete correction. One limb, with late follow-up, overcorrected, requiring reverse (medial) femoral tension band plating.For the 50 limbs with femoral varus and only tibial LTBP, 16/22 limbs (73%) with early-onset and 11/28 limbs (39%) with late-onset completely corrected their femoral deformities. If the limb had preoperative-femoral varus, femoral LTBP statistically correlated with successful mLDFA correction and improvement of MAD, only in the late-onset group.Forty-two limbs, without preoperative-femoral varus, had no change in their mean mLDFA of 87 degrees. However, 4 femurs (10%) ended with posttreatment varus. Femoral LTBP is effective in correcting femoral varus deformity in the tibia vara. For femoral varus associated with late-onset tibia vara, femoral LTBP should be considered. Those that had femoral LTBP had statistically more successful femoral and overall limb varus correction. However, in early-onset tibia vara, with associated femoral varus, observation is warranted because 73% of femurs are corrected without femoral intervention. This study was underpowered to show additional improvement with femoral LTBP in the early-onset group. Even limbs with normal femoral alignment, should be observed closely for the development of femoral varus, during tibial LTBP treatment for tibia vara. Level III.

Background: Zosyn® (piperacillin-tazobactam; Pfizer Medical, New York, NY), a valuable antibiotic against gram-negative bacteria, combined with vancomycin (Z+V) is known for its high incidence of acute kidney injury (AKI), particularly in the intensive care unit (ICU), leading to the frequent use of alternatives for gram-negative coverage (Alt+V). Because there are limited data describing AKI on these alternative antibiotic agents, a systematic review and meta-analysis was conducted to determine if these regimens were indeed associated with decreased rates of AKI. Patients and Methods: A literature review was performed electronically from its inception to November 1, 2018, screening for relevant literature by title, abstract and full text according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines within the following databases: PubMed/Medline, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials. Studies were included if they contained adults who had been admitted to the ICU for treatment and had received a combination of intravenous Z + V or Alt+V as well as had AKI measured during administration of these antibiotic agents. Studies were excluded if they represented pediatric populations, did not receive care in an ICU during their hospital admission, only received monotherapy for antibiotic treatment or received antibiotic treatment for less than 48 hours. Independent extraction was performed by two reviewers. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) methodology for retrospective studies. Random-effects models were used to calculate any differences between rates of AKI after Z + V or Alt + V. Results: Fourteen articles (totaling 30,399 patients) were included. All studies available were retrospective in design. Compared with Alt + V, Z + V was associated with a higher risk ratio of AKI (1.79; 95% confidence interval [CI], 1.46-2.19; p < 0.001). Cefepime (C + V) was the most common alternative to Zosyn, and Z + V was associated with higher rates of kidney injury compared with C + V (1.70; 95% CI, 1.36-2.12; p < 0.00001). However, there was substantial heterogeneity in the data collected as well as high risk of bias. Conclusions: Zosyn plus vancomycin is associated with more risk of AKI compared with Alt+V coverage in ICU adult populations. However, the conclusions were limited by the retrospective nature of the studies, high bias of included articles, and heterogeneity of the included studies.

Vascularized composite allotransplantation has been successfully employed for burn reconstruction since 2003. However, its safety in this population has been questioned due to high levels of alloimmunization from burn care-related tissue exposures. To investigate this, a systematic review of vascularized composite allotransplantation employed for burn reconstruction was conducted, evaluating literature from January 2000 to September 2019. Articles containing vascularized composite allotransplantation, composite tissue allotransplantation, and burn reconstructive surgery were included; articles without published outcomes were excluded. Observational meta-analysis of pooled mortality and acute rejection episodes relative to allograft type (face vs extremity) and reconstruction type (burn vs non-burn) was performed. Twenty-four of the 63 identified articles met the criteria for inclusion, with 5 more articles added after secondary review. To date, 152 allotransplantations have been performed in 117 patients: 45 face transplants and 107 extremity transplants. Of these, 34 (22%) were performed for burn reconstruction in 25 patients (21%) with an overall higher 1-year mortality rate (12.0% vs 1.1%, P = .030). Of these deaths, 75% received three or more simultaneous allografts. Additionally, more episodes of acute rejection occurred compared to non-burn patients (4.4 vs 2.4, P = .035). Vascularized composite allotransplantation performed for burn reconstruction was found to be associated with a greater risk of 1-year mortality and nearly twice the number of episodes of acute rejection. Future studies should seek to identify unique risk factors of burn patients undergoing this operation and evaluate the relationship between antigenic burden and surgical outcomes.