Janet A. Marvin

Psychological effects of severe burn injuries.

Severe burn injuries provide researchers with an opportunity to study the effects of painful but usually transient trauma on psychological functioning. To that end, this article presents a review of the 3 main areas of this body of literature: (a) premorbid characteristics of people who sustain severe burn injuries, (b) psychological reactions during hospitalization, and (c) long-term adjustment. The general implications of these studies are discussed and then used to illuminate the circumstances under which individuals suffer the most from this type of trauma, the effects of such injuries on personality function, and how meaningful units of measurements can be defined. Potential clinical applications are also described.

Burn depth: A review

Despite the plethora of technologic advances, the most common technique for diagnosing burn depth remains the clinical assessment of an experienced burn surgeon. It is clear that this assessment is accurate for very deep and very shallow burns. But since clinical judgment is not precise in telling whether a dermal burn will heal in 3 weeks, efforts to develop a burn depth indicator are certainly warranted to accurately determine which dermal burns to excise and graft. This review summarizes the considerable literature in which a variety of techniques to determine burn depth have been used.RésuméEn dépit de la pléthore des avances technologiques, la technique la plus utilisée pour le diagnostic de la profondeur des brûlures reste lévaluation clinique par un chirurgien rompu à ce type de pathologie. Il est clair que cette évaluation est précise en ce qui concerne les brûlures très profondes et très superficielles. Mais, comme lévaluation clinique nest pas suffisamment précise pour prédire si une brûlure dermique est capable de cicatriser en moins de 3 semaines, le développement dun moyen dévaluation de la profondeur des brûlures est certainement souhaitable afin de déterminer quelles brúlures il faut exciser et greffer. Cette revue résume la littérature considérable sur le sujet et aborde toute une variété de techniques destinées à déterminer la profondeur des brûlures.ResumenA pesar de la plétora de avances tecnológicos, la técnica más común para diagnosticar la profundidad de una quemadura sigue siendo la valoración clínica por un cirujano experto en quemaduras. Aparece claro que esta valoración clínica es bastante precisa, tanto para las quemaduras muy profundas como para las muy superficiales. Sin embargo, puesto el juicio clínico no tiene precisión en cuanto a determinar si una quemadura térmica habrá de cicatrizar en tres semanas, los esfuerzos por desarrollar un indicador de profundidad de la quemadura están ciertamente justificados por cuanto nos permitiría determinar cual quemadura debe ser resecada e injertada. La presente revisión resume el considerable volumen de literatura que informa el uso de una variedad de técnicas para determinar la profundidad de la quemadura, tales como la biopsia, los colorantes vitales, la fluorometría con fluorescina, la flujometría con doppler laser, la termografía, la resonancia magnética nuclear y la reflectancia luminosa.

Infection control in a burn center.

No consensus has been reached on the ideal isolation technique to prevent hospital-acquired infection in the patient with burns. This study reports four 2-month consecutive periods of microbial surveillance in a burn center intensive care unit. Phase I, the first period of surveillance, demonstrated a unit-acquired colonization rate of 63%, with the marker organisms appearing at 4 to 8 days. Direct observation of isolation technique showed a 51% error rate. A mandatory educational session reviewing the high colonization rates, observed breaks in isolation technique, and principles of infection control failed to decrease the colonization rates as measured in phase II. A simplified isolation technique was adopted, which led to a decrease in unit-acquired colonization, from 63% to 33% in phase III from phase I values (p = 0.0514); and to a significant delay in inception, from 7.8 to 21 days, in those colonized with Pseudomonas aeruginosa (p less than 0.05). The simplified isolation technique decreased isolation costs over a 6-month period from

Pain assessment from patients with burns and their nurses

53,000 to

Relating Mental Health and Physical Function at Discharge to Rehabilitation Status at Three Months Postburn

30,000. To confirm the decrease colonization rates from phase I to phase III, a fourth 2-month surveillance period was undertaken 6 months later. Phase IV demonstrated similar results to those of phase III.

Patient self-reports three months after sustaining a major burn.

We investigated pain experienced during burn wound debridement. Forty-nine adult patients with burns and 27 nurses submitted 123 pairs of visual analog scale pain ratings for burn wound debridements. While patients overall visual analog scale pain scores were found to be evenly distributed, worst pain scores yielded a bimodal distribution with groups centered around means of 2.0 (low pain group) and 7.0 (high pain group). Low and high pain groups did not differ in age, sex, or total body surface area burned. Patient and nurse pain ratings were found to be highly correlated. According to one researchers criteria, 53% of nurse pain ratings were accurate. Accuracy of nurses ratings was unrelated to nursing experience or educational level. Future strategies are presented for comparing high and low pain groups and increasing nurse pain rating accuracy.

Determinants of Donor Site Infections in Small Burn Grafts

Preinjury mental health is said to be a major predictive factor in the rehabilitation progress of burn patients. However, it is unclear which component of rehabilitation (emotional v physical) is predicted by this variable; furthermore, the predictive validity of preinjury mental health has not been compared with physical variables. The present study compared preinjury mental health, physical variables, and length of hospitalization in predicting the rehabilitation progress of 59 major burn patients at three-month follow-up. Preinjury mental health was assessed by the Rand Mental Health Form; physical status, by the Upper Extremity Index (standard measures of upper limb joint mobility); and hospital stay, by the number of days of acute hospitalization. These variables were assessed at the time of discharge. Three-month rehabilitation outcome was measured by the Sickness Impact Profile, a self-report inventory that evaluates patient outcome in 12 different areas. These areas were in turn placed in the categories of disability (ie, difficulties in functioning in activities of daily living; eating) handicap (ie, difficulties in functioning in general areas of living; employment) and mental health status. In predicting mental health status at three months, preinjury mental health was significantly correlated. In predicting physical disability, physical factors were found to be important. Conversely, physical status was not significantly related to mental health outcome, and preinjury mental health was not related to physical disability. The results indicate the importance of defining outcome when attempting to predict rehabilitation progress of burn patients.

Hypnosis for the treatment of burn pain.

As survival rates of patients with major burns increase, it is becoming more important to study the course and quality of their recovery. Few studies of the recovery of these patients exist that use a prospective design and standardized measures. This paper describes a preliminary study of the self-reported health of patients three months after sustaining a major burn. An initial analysis was conducted on selected data gathered from 29 patients as part of a more comprehensive, prospective study of burn rehabilitation outcome. Measurements analyzed included the Sickness Impact Profile (SIP), the Health-Specific Locus of Control Scale (HLC), and the total body surface area burned (TBSA). Findings showed that TBSA was related to the degree to which patients perceived they had control over their health, but few correlations were found between TBSA, and HLC scale, and the SIP scale. On the SIP, most patients reported few or no problems, but a significant minority reported major problems in one or more areas of their lives. The problems that were reported tended to cluster in the areas of vocation and emotional adjustment. These results suggest that patients with major burns should not be considered a homogeneous group with respect to rehabilitation outcome.

Efficacy of continuous passive motion (CPM) devices with hand burns.

Studies indicate no advantage to the early use of systemic antibiotics in patients with burns, but the use of prophylactic antibiotics during excision is still being questioned. The records of 213 patients who required excision and who had less than 20% total body surface area burned were reviewed. We investigated risk factors associated with donor- and graft-site infections and whether or not perioperative antibiotics influenced the incidence of infections. Statistically significant increases in donor-site infections occurred when patients did not receive perioperative antibiotics, when the excision was large, and when the time between injury and excision was prolonged. Age, burn size, or type of dressing did not influence the development of infections. A risk of graft infections in those patients who were not receiving perioperative antibiotics existed, but it was not significant. The time between injury and excision and the actual size of the excision influence the development of donor-site infections. However, perioperative antibiotics seem to decrease the risk of these infections.