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  • 1.
    Abdelrahman, Islam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Validation of the burn intervention score in a National Burn Centre2018In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, no 5, p. 1159-1166Article in journal (Refereed)
    Abstract [en]

    The Linköping burn score has been used for two decades to calculate the cost to the hospital of each burned patient. Our aim was to validate the Burn Score in a dedicated Burn Centre by analysing the associations with burn-specific factors: percentage of total body surface area burned (TBSA%), cause of injury, patients referred from other (non-specialist) centres, and survival, to find out which of these factors resulted in higher scores. Our second aim was to analyse the variation in scores of each category of care (surveillance, respiration, circulation, wound care, mobilisation, laboratory tests, infusions, and operation).

    We made a retrospective analysis of all burned patients admitted during the period 2000–15. Multivariable regression models were used to analyse predictive factors for an increased daily burn score, the cumulative burn score (the sum of the daily burn scores for each patient) and the total burn score (total sum of burn scores for the whole group throughout the study period) in addition to sub-analysis of the different categories of care that make up the burn score.

    We retrieved 22 301 daily recordings for inpatients. Mobilisation and care of the wound accounted for more than half of the total burn score during the study. Increased TBSA% and age over 45 years were associated with increased cumulative (model R2 0.43, p < 0.001) and daily (model R2 0.61, p < 0.001) burn scores. Patients who died had higher daily burn scores, while the cumulative burn score decreased with shorter duration of hospital stay (p < 0.001).

    To our knowledge this is the first long term analysis and validation of a system for scoring burn interventions in patients with burns that explores its association with the factors important for outcome. Calculations of costs are based on the score, and it provides an indicator of the nurses’ workload. It also gives important information about the different dimensions of the care provided from thorough investigation of the scores for each category.

  • 2.
    Abdelrahman, Islam
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial2020In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 2, p. 465-471Article in journal (Refereed)
    Abstract [en]

    Background

    The pain of a burn mainly results from the inflammatory cascade that is induced by the injured tissue, and is classified as background, breakthrough, procedural and postoperative pain. High doses of opioids are usually needed to treat background pain, so its management includes a combination of types of analgesia to reduce the side effects. Lidocaine given intravenously has been shown in two small, uncontrolled studies to have an appreciable effect on pain after burns.

    Objectives

    In this prospective double-blind controlled trial we aimed to examine and quantify the opioid-sparing effect of a continuous infusion of lidocaine for the treatment of background pain during the early period after a burn.

    Methods

    Adult patients injured with burns of >10 total body surface area burned (TBSA%) and treated with a morphine based patient-controlled analgesia device (PCA) were randomised to have either lidocaine infusion starting with a bolus dose (1 mg lidocaine/kg) followed by continuous infusion (180 mg lidocaine/hour) or a placebo infusion, for seven consecutive days. Total daily consumption of opioids (mg) and amount of pain (visual analogue score, VAS) were recorded.

    Results

    We included 19 patients, 10 of whom were given a lidocaine infusion. There were no differences between groups in VAS, TBSA%, time of enrolment to the study since the initial burn, or duration of hospital stay. The opioid consumption in the lidocaine group declined by roughly 25% during the period of the study.

    Conclusion

    An intravenous infusion of lidocaine was safe and had an opioid-sparing effect when treating background pain in burns.

  • 3.
    Abdelrahman, Islam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Use of the burn intervention score to calculate the charges of the care of burns2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 2, p. 303-309Article in journal (Refereed)
    Abstract [en]

    Background To our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care. Methods All patients admitted with burns during the period 2010–15 were included. We analysed clinical and economic data from the daily burn scores during the acute phase of the burn until discharge from the burn centre. Results Total median charge/patient was US$ 28 199 (10th–90th centiles 4668-197 781) for 696 patients admitted. Burns caused by hot objects and electricity resulted in the highest charges/TBSA%, while charges/day were similar for the different causes of injury. Flame burns resulted in the highest mean charges/admission, probably because they had the longest duration of stay. Mean charges/patient increased in a linear fashion among the different age groups. Conclusion Our intervention-based estimate of charges has proved to be a valid tool that is sensitive to the procedures that drive the costs of the care of burns such as large TBSA%, intensive care, and operations. The burn score system could be reproduced easily in other burn centres worldwide and facilitate the comparison regardless of the differences in the currency and the economic circumstances.

  • 4.
    Abdelrahman, Islam
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Vieweg, Rosa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Irschik, Stefan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Development of delirium: Association with old age, severe burns, and intensive care2020In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 4, p. 797-803Article in journal (Refereed)
    Abstract [en]

    Background Delirium is defined as a disturbance of attention and awareness that develops over a short period of time, is a change from the baseline, and typically fluctuates over time. Burn care involves a high prevalence of known risk factors for delirium such as sedation, inflammation, and prolonged stay in hospital. Our aim was to explore the extent of delirium and the impact of factors associated with it for adult patients who have been admitted to hospital with burns. Methods In this retrospective study, all adult patients who had been admitted with burns during a four-year period were studied, including both those who were treated with intensive care and intermediate care only (no intensive care). Daily records of the assessment of delirium using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with age, sex, the percentage of total body surface area burned, operations, and numbers of wound care procedures under anaesthesia, concentrations of plasma C-reactive protein, and other clinical variables. Logistic regression was used to analyse factors that were associated with delirium and its effect on mortality, and linear regression was used to analyse its effect on the duration of hospital stay. Results Fifty-one patients (19%) of the total 262 showed signs of delirium (Nu-DESC score of 2 or more) at least once during their stay in hospital. Signs of delirium were recorded in 42/89 patients (47%) who received intensive care, and in 9/173 (5%) who had intermediate care. Independent factors for delirium in the multivariable regression were: age over 74 years; number of operations and wound care procedures under anaesthesia; and the provision of intensive care (area under the curve 0.940, 95% CI 0.899–0.981). Duration of hospital stay, adjusted for age and burn size, was 13.2 (95% CI 7.4–18.9, p < 0.001) days longer in the group who had delirium. We found no independent effects of delirium on mortality. Conclusion We found a strong association between delirium and older age, provision ofr intensive care, and number of interventions under anaesthesia. A further 5% of patients who did not receive intensive care also showed signs of delirium, which is a finding that deserves to be thoroughly investigated in the future.

  • 5.
    Aboelnaga, Ahmed
    et al.
    Plastic Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Adly, Osama A.
    Plastic Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Elbadawy, Mohamed A.
    Plastic Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Abbas, Ashraf H.
    Plastic Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Abdelrahman, Islam
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Salah, Omar
    Plastic Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Microbial cellulose dressing compared with silver sulphadiazine for the treatment of partial thickness burns: A prospective, randomised, clinical trial2018In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 8, p. 1982-1988Article in journal (Refereed)
    Abstract [en]

    Background

    The current treatment for partial thickness burns at the trial site is silver sulphadiazine, as it minimises bacterial colonisation of wounds. Its deleterious effect on wound healing, together with the need for repeated, often painful, procedures, has brought about the search for a better treatment. Microbial cellulose has shown promising results that avoid these disadvantages. The aim of this study was therefore to compare microbial cellulose with silver sulphadiazine as a dressing for partial thickness burns.

    Method

    All patients who presented with partial thickness (superficial and deep dermal) burns from October 2014 to October 2016 were screened for this randomised clinical trial. Twenty patients were included in each group: the cellulose group was treated with microbial cellulose sheets and the control group with silver sulphadiazine cream 10 mg/g. The wound was evaluated every third day. Pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale during and after each procedure. Other variables recorded were age, sex, percentage total body surface area burned (TBSA%), clinical signs of infection, time for epithelialisation and hospital stay. Linear multivariable regression was used to analyse the significance of differences between the treatment groups by adjusting for the size and depth of the burn, and the patient’s age.

    Results

    Median TBSA% was 9% (IQR 5.5–12.5). The median number of dressing changes was 1 (IQR 1–2) in the cellulose group, which was lower than that in the control group (median 9.5, IQR 6–16) (p < 0.001). Multivariable regression analysis showed that the group treated with microbial cellulose spent 6.3 (95% CI 0.2–12.5) fewer days in hospital (p = 0.04), had a mean score that was 3.4 (95% CI 2.5–4.3) points lower during wound care (p < 0.001), and 2.2 (95% CI 1.6–2.7) afterwards (p < 0.001). Epithelialisation was quicker, but not significantly so.

    Conclusion

    These results suggest that the microbial cellulose dressing is a better first choice for treatment of partial thickness burns than silver sulphadiazine cream. Fewer dressings of the wound were done and, combined with the low pain scores, this is good for both the patients and the health care system. The differences in randomisation of the area of burns is, however, a concern that needs to be included in the interpretation of the results.

  • 6.
    Abrahams, M
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Oscarsson, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Sundqvist, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology.
    The effects of human burn injury on urinary nitrate excretion. 1999In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 25, p. 29-33Article in journal (Refereed)
  • 7.
    Allorto, Nikki
    et al.
    Univ KwaZulu Natal, South Africa.
    Rencken, Camerin A.
    Brown Univ, RI USA.
    Wall, Shelley
    Univ KwaZulu Natal, South Africa; Univ KwaZulu Natal, South Africa.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Factors impacting time to surgery and the effect on in-hospital mortality2021In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 47, no 4, p. 922-929Article in journal (Refereed)
    Abstract [en]

    Objectives: Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality. Methods: All patients with burns treated with surgery between 2016 and 2019 at the Pietermaritzburg Burn Service, in South Africa, were included in this retrospective study. Early surgery was defined as patients who underwent surgery within 7 days from injury. The population was analyzed descriptively and differences between groups were tested using t-test, and chi(2) test or Fishers exact test, as appropriate. Multivariable logistic regression was used to analyze the effect of delay in surgical treatment on in-hospital mortality, after adjustment for confounders. Results: During the study period, 620 patients with burns underwent surgery. Of them, 16% had early surgery. The early surgery group had a median age and TBSA of 11 years (3-35) and 12.0% (5-22) compared to 7 years (2-32) and 6.0% (3-13) in the late surgery group (p=0.45, p&lt;0.001). In logistic regression, female sex [aOR: 3.30 (95% CI: 1.47-7.41)], TBSA% [aOR: 1.09 (95% CI: 1.05-1.12)], and FTB [aOR: 3.21 (95% CI: 1.43-7.18)] were associated with in-hospital mortality, whereas having early surgery was not [aOR: 1.74 (95% CI: 0.76-3.98)]. Conclusion: This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome. (C) 2020 Elsevier Ltd and ISBI. All rights reserved.

  • 8.
    Almeland, Stian Kreken
    et al.
    Haukeland Hosp, Norway; Univ Bergen, Norway; Norwegian Directorate Hlth, Norway.
    Depoortere, Evelyn
    European Commiss, Belgium.
    Jennes, Serge
    Grand Hop Charleroi, Belgium.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Basanta, J. Alfonso Lozano
    European Commiss, Belgium.
    Zanatta, Sofia
    European Commiss, Belgium.
    Alexandru, Calin
    Minist Internal Affairs, Romania.
    Ramon Martinez-Mendez, Jose
    Hosp Univ La Paz, Spain.
    van der Vlies, Cornelis H.
    Maasstad Hosp, Netherlands; Erasmus MC, Netherlands.
    Hughes, Amy
    Int Network Training Educ & Res Burns, Wales; Barts Hlth NHS Trust, England; Essex & Herts Air Ambulance Charitable Trust, England.
    Barret, Juan P.
    Univ Autonoma Barcelona, Spain.
    Moiemen, Naiem
    Univ Hosp Birmingham Fdn Trust, England; Univ Birmingham, England.
    Leclerc, Thomas
    Percy Mil Teaching Hosp, France.
    Burn mass casualty incidents in Europe: A European response plan within the European Union Civil Protection Mechanism2022In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 48, no 8, p. 1794-1804Article in journal (Refereed)
    Abstract [en]

    Background: Burn care is centralized in highly specialized burn centers in Europe. These centers are of limited capacity and may be overwhelmed by a sudden surge in case of a burn mass casualty incident. Prior incidents in Europe and abroad have sustained high standards of care through well-orchestrated responses to share the burden of care in several burn centers. A burn mass casualty incident in Romania in 2015 sparked an initiative to strengthen the existing EU mechanisms. This paper aims to provide insight into developing a response plan for burn mass casualties within the EU Civil Protection Mechanism. Methods: The European Burns Association drafted medical guidelines for burn mass casualty incidents based on a literature review and an in-depth analysis of the Romanian incident. An online questionnaire surveyed European burn centers and EU States for burn mass casualty preparedness. Results: The Romanian burn mass casualty in 2015 highlighted the lack of a burn-specific mechanism, leading to the late onset of international transfers. In Europe, 71% of respondents had existing mass casualty response plans, though only 35% reported having a burn-specific plan. A burns response plan for burn mass casualties was developed and adopted as a Commission staff working document in preparation for further implementation. The plan builds on the existing Union Civil Protection Mechanism framework and the standards of the WHO Emergency Medical Teams initiative to provide 1) burn assessment teams for specialized in-hospital triage of patients, 2) specialized burn care across European burn centers, and 3) medevac capacities from participating states. Conclusion: The European burn mass casualty response plan could enable the delivery of high-level burn care in the face of an overwhelming incident in an affected European country. Further steps for integration and implementation of the plan within the Union Civil Protection Mechanism framework are needed.

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  • 9.
    Antepohl, Wolfram
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Dahle, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Interleukin-8 is elevated in cerebrospinal fluid following high-voltage electrical injury with late-onset paraplegia suggesting neuronal damage at the microlevel as causative factor2010In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 36, no 3, p. e7-e9Article in journal (Refereed)
    Abstract [en]

    The patient, a 31-year-old male, sustained an electric burn injury (16 kV, AC/DC) while working with electric power lines. He was acutely admitted to a national burn center in Southeast Sweden, where burns equalling 29% of the total body surface area were noted. The burns were located at the front of the abdomen, upper arms bilaterally, and the left hip region, and the lesions were estimated to be mainly of the dermal type, what was believed initially to be caused mainly by an electric flash. There were no obvious entry or exit sites of the electric current. However, myoglobin in plasma was elevated as a sign of muscular degradation, suggesting that at least some current had passed through the tissues. According to the paramedic report there was an episode of a few minutes of unconsciousness immediately after the injury, but the patient was fully awake and alert on admission. There was no concomitant trauma.

  • 10.
    Bak, Zoltan
    et al.
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Unit . Linköping University, Faculty of Health Sciences.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Janerot Sjöberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Cardiac dysfunction after burns2008In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 5, p. 603-609Article in journal (Refereed)
    Abstract [en]

    Objectives

    Using transoesophageal echocardiography (TEE) we investigated the occurrence, and the association of possible abnormalities of motion of the regional wall of the heart (WMA) or diastolic dysfunction with raised troponin concentrations, or both during fluid resuscitation in patients with severe burns.

    Patients and methods

    Ten consecutive adults (aged 36–89 years, two women) with burns exceeding 20% total burned body surface area who needed mechanical ventilation were studied. Their mean Baux index was 92.7, and they were resuscitated according to the Parkland formula. Thirty series of TEE examinations and simultaneous laboratory tests for myocyte damage were done 12, 24, and 36 h after the burn.

    Results

    Half (n = 5) the patients had varying grades of leakage of the marker that correlated with changeable WMA at 12, 24 and 36 h after the burn (p ≤ 0.001, 0.044 and 0.02, respectively). No patient had WMA and normal concentrations of biomarkers or vice versa. The mitral deceleration time was short, but left ventricular filling velocity increased together with stroke volume.

    Conclusion

    Acute myocardial damage recorded by both echocardiography and leakage of troponin was common, and there was a close correlation between them. This is true also when global systolic function is not deteriorated. The mitral flow Doppler pattern suggested restrictive left ventricular diastolic function.

  • 11.
    Cirillo, Marco Domenico
    et al.
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Mirdell, Robin
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Pham, Tuan
    Center for Artificial Intelligence, Prince Mohammad Bin Fahd University, Khobar, Saudi Arabia.
    Improving burn depth assessment for pediatric scalds by AI based on semantic segmentation of polarized light photography images2021In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 47, no 7, p. 1586-1593Article in journal (Refereed)
    Abstract [en]

    This paper illustrates the efficacy of an artificial intelligence (AI) (a convolutional neural network, based on the U-Net), for the burn-depth assessment using semantic segmentation of polarized high-performance light camera images of burn wounds. The proposed method is evaluated for paediatric scald injuries to differentiate four burn wound depths: superficial partial-thickness (healing in 0–7 days), superficial to intermediate partial-thickness (healing in 8–13 days), intermediate to deep partial-thickness (healing in 14–20 days), deep partial-thickness (healing after 21 days) and full-thickness burns, based on observed healing time.

    In total 100 burn images were acquired. Seventeen images contained all 4 burn depths and were used to train the network. Leave-one-out cross-validation reports were generated and an accuracy and dice coefficient average of almost 97% was then obtained. After that, the remaining 83 burn-wound images were evaluated using the different network during the cross-validation, achieving an accuracy and dice coefficient, both on average 92%.

    This technique offers an interesting new automated alternative for clinical decision support to assess and localize burn-depths in 2D digital images. Further training and improvement of the underlying algorithm by e.g., more images, seems feasible and thus promising for the future.

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  • 12.
    Dash, Suvashis
    et al.
    All India Inst Med Sci, India.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Lavrentieva, Athina
    Papanikolaou Hosp, Greece.
    Rogers, Alan David
    Sunnybrook Hlth Sci Ctr, Canada.
    Depetris, Nadia
    CTO Hosp, Italy; Via Zuretti 29 CTO Citta Salute & Sci, Italy.
    Quality indicators in burn care: An international burn care professionals survey to define them2023In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 6, p. 1260-1266Article in journal (Refereed)
    Abstract [en]

    Introduction: Quality indicators (QIs) are tools for improving and maintaining the standard of care. Although burn injuries are a major global health threat, requiring standardized management, there is a lack of worldwide accepted quality indicators for burn care. This study aims to identify the best burn care-specific QIs as perceived by worldwide burn practitioners.Methods: The ISBI Burn Care Committee developed a survey to analyze which burn care specific QIs were relevant to international burn care professionals. The questionnaire was based on the three dimensions of the Donabedian model (i.e., Structure, Process, and Outcome) to evaluate the quality of care. The study was conducted from April to September 2021 and analyzed and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: According to the 124 worldwide respondents, the most relevant QIs were: access to intensive care, burn surgeons, and dedicated burn care nurses (Structure category), 24 hours access to burn services, local protocols based on documented guidelines (Process category), and in-hospital mortality and incidence of severe infections (Outcome category).Conclusions: Specific QIs related to structures, clinical processes, and outcomes are needed to monitor the treatment of burn patients globally, assess the efficiency of the provided treatment, and harmonize the worldwide standard of burn care.

  • 13.
    Droog, Eric
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Steenbergen, W
    Nederländerna.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Measurement of depth of burns by laser Doppler perfusion imaging2001In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 27, no 6, p. 561-568Article in journal (Refereed)
    Abstract [en]

    Laser Doppler perfusion imaging (LDPI), is a further development in laser Doppler flowmetry (LDF). Its advantage is that it enables assessment of microvascular blood flow in a predefined skin area rather than, as for LDF, in one place. In many ways this method seems to be more promising than LDF in the assessment of burn wounds. However, several methodological issues that are inherent in the LDPI technique, and are relevant for the assessment of burn depth, must be clarified. These include the effect of scanning distance, curvature of the tissue, thickness of topical wound dressings, and pathophysiological effects of skin colour, blisters, and wound fluids. Furthermore, we soon realised that to examine the perfusion image generated by LDPI adequately the process of analysis was appreciably improved by the simultaneous use of digital photography. In the present investigation we used both in vitro and in vivo models and also examined burned patients, and found that the listed factors all significantly affected the LDPI output signal. However, if these factors are known to the examiner, most of them can be adjusted for. If the technique is further improved by minimizing such effects and by reducing the practical difficulties of applying it to a burned patient in the burns unit, the technique may find uses in everyday clinical decision-making.

  • 14.
    Elmasry, Moustafa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Egypt.
    Mirdell, Robin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics. Linköping University, Department of Medical and Health Sciences.
    Farnebo, Simon
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Laser speckle contrast imaging in children with scalds: Its influence on timing of intervention, duration of healing and care, and costs2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 4, p. 798-804Article in journal (Refereed)
    Abstract [sv]

    Background

    Scalds are the most common type of burn injury in children, and the initial evaluation of burn depth is a problem. Early identification of deep dermal areas that need excision and grafting would save unnecessary visits and stays in hospital. Laser speckle contrast imaging (LSCI) shows promise for the evaluation of this type of burn. The aim of this study was to find out whether perfusion measured with LSCI has an influence on the decision for operation, duration of healing and care period, and costs, in children with scalds.

    Methods

    We studied a group of children with scalds whose wounds were evaluated with LSCI on day 3–4 after injury during the period 2012–2015. Regression (adjustment for percentage total body surface area burned (TBSA%), age, and sex) was used to analyse the significance of associations between degree of perfusion and clinical outcome.

    Results

    We studied 33 children with a mean TBSA% of 6.0 (95% CI 4.4–7.7)%. Lower perfusion values were associated with operation (area under the receiver-operating characteristic curve 0.86, 95% CI 0.73–1.00). The perfusion cut-off with 100% specificity for not undergoing an operation was ≥191 PU units (66.7% sensitivity and 72.7% accurately classified). Multivariable analyses showed that perfusion was independently associated with duration of healing and care period.

    Conclusion

    Lower perfusion values, as measured with LSCI, are associated with longer healing time and longer care period. By earlier identification of burns that will be operated, perfusion measurements may further decrease the duration of care of burns in children with scalds.

  • 15.
    Elmasry, Moustafa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal University, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Abdelrahman, Islam Mohamedy
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal University, Egypt.
    Olofsson, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Changes in patterns of treatment of burned children at the Linkoping Burn Centre, Sweden, 2009-20142017In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 43, no 5, p. 1111-1119Article in journal (Refereed)
    Abstract [en]

    Introduction: Children are a relatively large group among patients with burns in Sweden. We changed the management of childrens burns to a flexible, outpatient-based plan. The aim was to follow up the outpatient management for childrens burns during the period 20092014, and track it, to find out to what extent the patients had been treated flexibly as outpatients, and to clarify the reasons behind those who did not fit in the plan. Methods: Descriptive retrospective analysis dividing the patients into three groups: inpatients only, flexible management, and outpatients. Other variables recorded included: age, sex, percentage total body surface area burned (TBSA%), percentage full thickness burn (FTB%), cause of burn, county of residence, operations required, number of visits to the outpatient department, costs, and duration of overnight stay in the hospital. Results: The study group included 620 children: nine were managed strictly as inpatients, 204 as flexible outpatients, and 407 strictly as outpatients. Among the total there were 269 children who came from remote areas (43%), and of these 260 were treated as outpatients and flexible outpatients. Median TBSA% in the whole group was 1 (10th-90th centile 0-9) with the biggest median TBSA% 12 (5-38) in the inpatient group. The most common cause of injury was scalds (332/620,-54%). Costs/patient (US$) was lower in the flexible outpatient group than in the inpatient group (median 10 557 (3213-35802) and 35343 (7344-66554), respectively). Conclusion: Based on the results, we expect that the flexible outpatient treatment plan for children with minor to moderate burns can be expanded in the future. The results encourage us to continue the service and to further reduce duration of stay in hospital below the level already achieved (25% of the whole period of care). (C) 2017 Elsevier Ltd and ISBI. All rights reserved.

  • 16.
    Elmasry, Moustafa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal University, Egypt .
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Letter: "Is the length of time in acute burn surgery associated with poorer outcomes?"2014In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 40, no 4, p. 772-773Article in journal (Other academic)
    Abstract [en]

    n/a

  • 17.
    Fransen, Jian
    et al.
    Uppsala University, Sweden.
    Huss, Fredrik R. M.
    Uppsala University, Sweden; University of Uppsala Hospital, Sweden.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Rydell, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Surveillance of antibiotic susceptibility in a Swedish Burn Center 1994-20122016In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 42, no 6, p. 1295-1303Article in journal (Refereed)
    Abstract [en]

    Patients with burn trauma are at risk for infections caused by antibiotic resistant bacteria (ABR) with subsequent increase in morbidity and mortality. As part of the Swedish strategic program against antibiotic resistance in intensive care (ICU-Strama), we have surveyed the distribution of species and ABR in isolates from patients admitted to a Swedish burn center at Linkoping University Hospital from 1994 through 2012. In an international comparison Strama has been successful in reducing the antibiotic consumption among animals and humans in primary care. The aim of this study was to investigate the antibiotic consumption pressure and resistance rates in a Swedish burn unit. Methods: Microbiology data, total body surface area (TBSA), patient days, and mortality were collected from a hospital database for all patients admitted to the Burn Center at the University Hospital of Linkoping from April 1994 through December 2012. Results: A total of 1570 patients were admitted with a mean annual admission rate of 83 patients (range: 57-152). 15,006 microbiology cultures (approximately 10 per patient) were collected during the study period and of these 4531 were positive (approximately 3 per patient). The annual mean total body surface area (TBSA) was 13.4% (range 9.5-18.5) with an annual mortality rate of 5.4% (range 1-8%). The MRSA incidence was 1.7% (15/866) which corresponds to an MRSA incidence of 0.34/1000 admission days (TAD). Corresponding figures were for Escherichia coli resistant to 3rd generation cephalosporins (ESBL phenotype) 8% (13/170) and 0.3/TAD, Klebsiella spp. ESBL phenotype 5% (6/134) and 0.14/TAD, carbapenem resistant Pseudomonas aeruginosa 26% (56/209) and 1.28/TAD, and carbapenem resistant Acinetobacter spp. 3% (2/64) and 0.04/TAD. Conclusions: Our results show a sustained low risk for MRSA and high, although not increasing, risk for carbapenem resistant P. aeruginosa. (C) 2016 Elsevier Ltd and ISBI. All rights reserved.

  • 18.
    Fredriksson, Camilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns . Linköping University, Faculty of Health Sciences.
    Kratz, Gunnar
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Huss, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Burn Unit . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Transplantation of cultured human keratinocytes in single cell suspension: a comparative in vitro study of different application techniques2008In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 2, p. 212-219Article in journal (Refereed)
    Abstract [en]

    Transplantation of autologous cultured keratinocytes in single cell suspension is useful in the treatment of burns. The reduced time needed for culture, and the fact that keratinocytes in suspension can be transported from the laboratory to the patient in small vials, thus reducing the costs involved and be stored (frozen) in the clinic for transplantation when the wound surfaces are ready, makes it appealing. We found few published data in the literature about actual cell survival after transplantation of keratinocytes in single cell suspension and so did a comparative in vitro study, considering commonly used application techniques. Human primary keratinocytes were transplanted in vitro in a standard manner using different techniques. Keratinocytes were counted before and after transplantation, were subsequently allowed to proliferate, and counted again on days 4, 8, and 14 by vital staining. Cell survival varied, ranging from 47% to >90%, depending on the technique. However, the proliferation assays showed that the differences in numbers diminished after 8 days of culture. Our findings indicate that a great number of cells die during transplantation but that this effect is diminished if cells are allowed to proliferate in an optimal milieu. A burned patient’s wounds cannot be regarded as the optimal milieu, and using less harsh methods of transplantation may increase the take rate and wound closing properties of autologous keratinocytes transplanted in a single cell suspension.

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  • 19.
    Frestadius, Andrea
    et al.
    Univ Uppsala Hosp, Sweden.
    Grehn, Filip
    Region Östergötland.
    Kildal, Morten
    Univ Uppsala Hosp, Sweden; Uppsala Univ, Sweden.
    Huss, Fredrik
    Univ Uppsala Hosp, Sweden; Uppsala Univ, Sweden.
    Freden, Filip
    Univ Uppsala Hosp, Sweden; Uppsala Univ, Sweden.
    Intranasal dexmedetomidine and rectal ketamine for young children undergoing burn wound procedures2022In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 48, no 6, p. 1445-1451Article in journal (Refereed)
    Abstract [en]

    Background: Safe and effective methods for sedation and analgesia in pediatric burn patients are strongly warranted. This retrospective study of electronic health care records aims to evaluate the safety and efficacy of intranasal dexmedetomidine combined with rectal ketamine as procedural sedation for young children undergoing dressing changes and debridement of burn wounds.Methods: Documentation was analyzed from 90 procedures in 58 pediatric patients aged &lt;5 years. Safety and efficacy of the method were assessed based on documentation for complications, adverse effects, pain level, level of sedation and preoperative and recovery time.Results: All 90 sedations were completed without significant adverse events with acute airway management or medical intervention. The combination of dexmedetomidine-ketamine produced acceptable analgesia during the procedure and effectively relieved postoperative pain. However, the approach was insufficient for 7/58 patients (7.8%); these patients were converted from the dexmedetomidine-ketamine combination to intravenous anesthesia. In 23% of the cases an extra dose of either ketamine of dexmedetomidine was administered. Moreover, there were two cases of delayed awakening with recovery time &gt;120 min. Conclusion: The drug combination intranasal dexmedetomidine and rectal ketamine is a safe and reliable approach for procedural sedation and analgesia in pediatric patients undergoing burn wound procedures, producing a clinically stable sedative condition requiring only basic monitoring.(c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY -NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  • 20.
    Frew, Quentin
    et al.
    Mid Essex Hosp Trust, England.
    Rennekampff, Hans-Oliver
    Rhein Maas Klinikum, Germany.
    Dziewulski, Peter
    Mid Essex Hosp Trust, England.
    Moiem, Naiem
    Univ Hosp Birmingham NHS Fdn Trust Queen Elisabet, England.
    Zahn, Tobias
    Birken AG, Germany; 3R Pharma Consulting GmbH, Germany.
    Hartmann, Bernd
    Unfallkrankenhaus Berlin, Germany.
    Siemers, Frank
    BG Kliniken Bergmannstrost, Germany.
    Betulin wound gel accelerated healing of superficial partial thickness burns: Results of a randomized, intra-individually controlled, phase III trial with 12-months follow-up2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 4, p. 876-890Article in journal (Refereed)
    Abstract [en]

    Objective: Acceleration of wound healing promises advantages for patients and caregivers in reducing the burden of disease, avoiding complications such as wound infections, and improving the long-term outcome. However, medicines that can accelerate wound healing are lacking. The objective of this open, blindly evaluated, randomized, multicenter phase III study was to compare intra-individually the efficacy and tolerability of Oleogel-S10 with fatty gauze dressing versus Octenilin (R) wound gel with fatty gauze dressing in accelerating the healing of superficial partial thickness burn wounds. Methods: Acute superficial partial thickness burn wounds in adults caused by fire, heat burn or scalding were divided into 2 halves and randomly assigned to treatment with Oleogel-S10 or Octenilin (R) wound gel. Photos for observer-blinded analysis of wound healing were taken at each wound dressing change. Percentages of reepithelialization were assessed at defined intervals. Efficacy and tolerability were evaluated based on a 5-point Likert scale. Results: Of 61 patients that were enrolled, 57 received the allocated intervention and 48 completed treatment. The percentage of patients with earlier wound healing was significantly higher for Oleogel-S10 (85.7%, n=30) compared to Octenilin (R) wound gel (14.3%, n= 5, p amp;lt;0.0001). The mean intra-individual difference in time to wound closure was -1.0 day in favour of Oleogel-S10 (-1.4, -0.6; 95% CI, p amp;lt;0.0001). Most investigators (87.0%) and patients (84.8%) evaluated the efficacy of Oleogel-S10 to be better or much better than that of Octenilin (R) wound gel. Long-term outcome 3 months and 12 months post injury was improved in some patients. Conclusions: Oleogel-S10 (Episalvan) significantly accelerated the healing of superficial partial thickness burn wounds. It was safe and well tolerated. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.

  • 21.
    Gerdin, Bengt
    et al.
    Uppsala University Hospital.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Professor Gösta Arturson (1927–2013): Obituary2013In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 8, p. 1654-1655Article in journal (Other (popular science, discussion, etc.))
    Download full text (pdf)
    fulltext
  • 22.
    Greenhalgh, David G.
    et al.
    Shriners Childrens Northern Calif, CA USA; Univ Calif Davis, CA USA.
    Hill, David M.
    Univ Tennessee, TN USA.
    Burmeister, David M.
    Uniformed Serv Univ Hlth Sci, MD USA.
    Gus, Eduardo I.
    Hosp Sick Children, Canada; Univ Toronto, Canada.
    Cleland, Heather
    Monash Univ, Australia; Alfred Hosp, Australia.
    Padiglione, Alex
    Monash Univ, Australia; Alfred Hosp, Australia.
    Holden, Dane
    Monash Univ, Australia; Alfred Hosp, Australia.
    Huss, Fredrik
    Uppsala Univ, Sweden; Uppsala Univ Hosp, Sweden.
    Chew, Michelle
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Kubasiak, John C.
    Loyola Univ, IL USA.
    Burrell, Aidan
    Monash Univ, Australia; Alfred Hosp, Australia.
    Manzanares, William
    Univ Republ UdelaR, Uruguay.
    Gomez, Maria Chacon
    LGII, Mexico.
    Yoshimura, Yuya
    Hachinohe Municipal Hosp, Japan.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Xie, Wei-Guo
    Wuhan Univ, Peoples R China.
    Egipto, Paula
    Ctr Hosp & Univ Sao Joao, Portugal.
    Lavrentieva, Athina
    Papanikolaou Hosp, Greece.
    Jain, Arpana
    Arizona Burn Ctr, AZ USA.
    Miranda-Altamirano, Ariel
    Hosp Civil Guadalajara, Mexico.
    Raby, Ed
    Fiona Stanley Hosp, Australia.
    Aramendi, Ignacio
    Ctr Nacl Quemados, Uruguay.
    Sen, Soman
    Shriners Childrens Northern Calif, CA USA; Univ Calif Davis, CA USA.
    Chung, Kevin K.
    Uniformed Serv Univ Hlth Sci, MD USA.
    Alvarez, Renata Jennifer Quintana
    Pediat Burn Ctr, Dominican Rep.
    Han, Chunmao
    Zhejiang Univ, Peoples R China.
    Matsushima, Asako
    Nagoya City Univ, Japan.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Liu, Yan
    Shanghai Jiao Tong Univ, Peoples R China.
    Donoso, Carlos Segovia
    Mutual Secur Clin Hosp, Chile.
    Bolgiani, Alberto
    Deutsch Hosp, Argentina.
    Johnson, Laura S.
    Emory Univ, GA USA; Grady Hlth Syst, GA USA.
    Vana, Luiz Philipe Molina
    Univ Fed Sao Paulo, Brazil.
    de Romero, Rosario Valdez Duval
    Pearl F Ort Burn Unit, Dominican Rep.
    Allorto, Nikki
    Univ KwaZulu Natal, South Africa.
    Abesamis, Gerald
    Univ Philippines Manila, Philippines.
    Luna, Virginia Nunez
    Secretaria Salud Ciudad Mexico, Mexico.
    Gragnani, Alfredo
    Fdn Santa Fe Bogota, Colombia.
    Gonzalez, Carolina Bonilla
    Pediat Hosp Prof Dr Juan P Garrahan, Argentina.
    Basilico, Hugo
    Fiona Stanley Hosp, Australia.
    Wood, Fiona
    Univ Calif Irvine, CA USA.
    Jeng, James
    UCL, England.
    Li, Andrew
    Monash Univ, Australia; Alfred Hosp, Australia.
    Singer, Mervyn
    Army Third Mil Med Univ, Peoples R China.
    Luo, Gaoxing
    Med Univ South Carolina, SC USA.
    Palmieri, Tina
    Shriners Childrens Northern Calif, CA USA; Univ Calif Davis, CA USA.
    Kahn, Steven
    Sunnybrook Med Ctr, Canada.
    Joe, Victor
    UCL, England.
    Cartotto, Robert
    Sunnybrook Med Ctr, Canada.
    Surviving Sepsis After Burn Campaign2023In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 7, p. 1487-1524Article in journal (Refereed)
    Abstract [en]

    Introduction: The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. Methods: The International Society for Burn Injuries (ISBI) reached out to regional or na-tional burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and out-come" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC parti-cipants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. Results: The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for in burn should be on a basis. Conclusion: Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients. (c) 2023 Elsevier Ltd and ISBI. All rights reserved.

  • 23.
    Grossmann, Benjamin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Nilsson, Andreas
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Nilsson, Lena
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 5, p. 1081-1088Article in journal (Refereed)
    Abstract [en]

    Background

    Worldwide, ketamine is used during paediatric procedures, but no recommendations are available regarding a suitable dose for rectal administration during procedures involving high levels of pain and/or anxiety such as burn wound dressing change.

    Methods

    We evaluated three different single doses of rectally administered racemic ketamine mixed with a fixed dose of 0.5 mg/kg of midazolam. In total, 90 children – aged 6 months to 4 years – were randomised 1:1:1 to receive 4 mg/kg (K-4 group), 6 mg/kg (K-6 group) or 8 mg/kg (K-8 group) of racemic ketamine for a maximum of three consecutive procedures. Primary outcome measure was procedural pain evaluated by Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. Secondary outcome included feasibility and recovery time. Patient safety was evaluated using surrogate outcomes.

    Results

    In total, 201 procedures in 90 children aged 19 ± 8 months were completed. The median maximum pain was FLACC 0 in all groups (p = 0.141). The feasibility was better for groups K-6 (p = 0.049) and K-8 (p = 0.027) compared with K-4, and the mean recovery time was the longest for group K-8 (36 ± 22 min) compared with groups K-4 (25 ± 15 min; p = 0.003) and K-6 (27 ± 20 min; p = 0.025). Median maximum sedation measured by the University of Michigan Sedation Scale (UMSS) was higher in group K-8 compared with group K-4 (p < 0.0001) and K-6 (p = 0.023). One child in group K-8 had a study drug-related serious adverse event — laryngospasm/airway obstruction. No rescue analgosedative medication was administered for group K-6.

    Conclusions

    A rectally administered mixture of racemic ketamine (6 mg/kg) and midazolam (0.5 mg/kg) during paediatric burn dressing procedures with a duration of approximately 30 min provides optimal conditions regarding pain relief, feasibility, recovery time and patient safety, with no need for rescue analgosedative medication.

  • 24. Gustafson, Carl-Johan
    et al.
    Birgisson, Agust
    Junker, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns.
    Huss, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Salemark, Lars
    Johnson, Hans
    Kratz, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Employing human keratinocytes cultured on macroporous gelatin spheres to treat full thickness-wounds: An in vivo study on athymic rats2007In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 33, no 6, p. 726-735Article in journal (Refereed)
    Abstract [en]

    Providing cutaneous wounds with sufficient epidermis to prevent infections and fluid loss is one of the most challenging tasks associated with surgical treatment of burns. Recently, application of cultured keratinocytes in this context has allowed this challenge to be met without several of the limitations connected with the use of split-thickness skin grafts. The continuous development of this novel approach has now revealed that transplantation of cultured autologous keratinocytes as single-cell suspensions exhibits several advantages over the use of cultured epidermal grafts. However, a number of methodological problems remain to be solved, primarily with regards to the complexity of culturing these cells, loss of viability and other negative effects during their preparation and transportation, the relatively long period of time required following transplantation to obtain a sufficiently protective epidermis. In the present investigation we attempted to eliminate these limitations by culturing the keratinocytes on macroporous gelatin spheres. Accordingly, the efficacies of normal human keratinocytes in single-cell suspension or growing on macroporous gelatin spheres, as well as of split-thickness skin grafts in healing wounds on athymic rats were compared. Human keratinocytes were found to adhere and proliferate efficiently both on the surface and within the pores of such spheres. Transplantation of such cells adherent to the spheres resulted in significantly more rapid formation of a stratified epidermis than did transplantation of single-cell suspensions or spheres alone. Twenty-three days after transplantation, the epidermis formed from the cells bound to the spheres was not as thick as the epidermis on wounds covered with split-thickness skin grafts, but significantly thicker than on wounds to which single-cell suspensions, spheres alone or no transplant at all was applied. Furthermore, fluorescence in situ hybridisation revealed that the transplanted keratinocytes, both those adherent to gelatin spheres and those in single-cell suspension, were components of the newly formed epidermis. These findings indicate that application of biodegradable macroporous spheres may prove to be of considerable value in designing cell-based therapies for the treatment of acute and persistent wounds. © 2006 Elsevier Ltd and ISBI.

  • 25.
    Johansson, Joakim
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Bäckryd, Emmanuel
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Granerus, Göran
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Clinical Physiology UHL.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Urinary excretion of histamine and methylhistamine after burns2012In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 38, no 7, p. 1005-1009Article in journal (Refereed)
    Abstract [en]

    Background: The increased vascular permeability seen after burn contribute to morbidity and mortality as it interferes with organ function and the healing process. Large efforts have been made to explore underlying pathophysiological mechanisms that generate increased vascular permeability after burns. Many different substances have been proposed as mediators of which histamine, serotonin and oxygen radicals are claimed most important. However, no specific blocker has convincingly been shown to be clinically effective. Early work has claimed increased histamine plasma-concentrations in humans after burn and data from animal models pointed at histamine as an important mediator. Modern human clinical studies investigating the role of histamine as a mediator of the generalized post burn increase in vascular permeability are lacking. less thanbrgreater than less thanbrgreater thanMethod: We examined histamine turnover by measuring the urinary excretion of histamine and methyl histamine for 48 h after burns in 8 patients (mean total burn surface area 24%). less thanbrgreater than less thanbrgreater thanResults: Over time, in this time frame and compared to healthy controls we found a small increase in the excretion of histamine, but no increase of its metabolite methylhistamine. less thanbrgreater than less thanbrgreater thanConclusion: Our findings do not support that histamine is an important mediator of the increased systemic vascular permeability seen after burn.

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  • 26.
    Karlsson, Matilda
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Huss, Fredrik
    Uppsala Univ, Sweden; Uppsala Univ Hosp, Sweden.
    Olofsson, Pia
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elawa, Sherif
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Larsson, Alexander
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Biosynthetic cellulose compared to porcine xenograft in the treatment of partial-thickness burns: A randomised clinical trial2022In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 48, no 5, p. 1236-1245Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to compare two dressing treatments for partial-thickness burns: biosynthetic cellulose dressing (BsC) (Epiprotect (R) S2Medical AB, Linkoping, Sweden) and porcine xenograft (EZ Derm (R), Molnlycke Health Care, Gothenburg, Sweden). Methods: Twenty-four adults with partial-thickness burns were included in this randomized clinical trial conducted at The Burn Centers in Linkoping and Uppsala, Sweden between June 2016 and November 2018. Time to healing was the primary outcome. Secondary outcomes were wound infection, pain, impact on everyday life, length of hospital stay, cost, and burn scar outcome (evaluated with POSAS). Results: We found no significant differences between the two dressing groups regarding time to healing, wound infection, pain, impact on everyday life, duration of hospital stay, cost, or burn scar outcome at the first follow up. Burn scar outcome at the 12-month follow up showed that the porcine xenograft group patients scored their scars higher on the POSAS items thickness (p = 0.048) and relief (p = 0.050). This difference was, however, not confirmed by the observer. Conclusions: The results showed the dressings performed similarly when used in adults with burns evaluated as partial thickness. (C) 2021 The Authors. Published by Elsevier Ltd.

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  • 27.
    Karlsson, Matilda
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal Univ, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Olofsson, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Thorfinn, Johan
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 6, p. 1401-1409Article in journal (Refereed)
    Abstract [en]

    Aim: Our aim was to compare two different regimens for the treatment of children with partial-thickness scalds. These were treated with either a porcine xenograft (EZderm (R), Molnlycke Health Care, Gothenburg, Sweden) or a silver-foam dressing (Mepilex (R) Ag, Molnlycke Health Care, Gothenburg, Sweden). Methods: We organised a prospective randomised clinical trial that included 58 children admitted between May 2015 and May 2018 with partial-thickness scalds to The Burn Centre in Linkoping, Sweden. The primary outcome was time to healing. Secondary outcomes were pain, need for operation, wound infection, duration of hospital stay, changes of dressings, and time taken. Results: The patients treated with silver-foam dressing had a significantly shorter healing time. The median time to 97% healing for this group was 9 (7-23) days compared to 15 (9-29) days in the porcine xenograft group (p = 0.004). The median time to complete healing for the silver-foam group was 15 (9-29) days and for the porcine xenograft group 20.5 (11-42) days (p = 0.010). Pain, wound infection, duration of hospital stay, and the proportion of operations were similar between the groups. Number of dressing changes and time for dressing changes were lower in the silver-foam dressing group (p = 0.03 for both variables). Conclusions: We compared two different treatments for children with partial-thickness scalds, and the data indicate that wound healing was faster, fewer dressing changes were needed, and dressing times were shorter in the silver-foam group. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.

  • 28.
    Karlsson, Matilda
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Suprathel® or Mepilex® Ag for treatment of partial thickness burns in children: A case control study2023In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 7, p. 1585-1591Article in journal (Refereed)
    Abstract [en]

    Aim

    The study aim was to investigate if Suprathel® can be an adequate alternative to Mepilex® Ag for the treatment of partial-thickness scalds in children.

    Methods

    A retrospective study including 58 children admitted to The Burn Centre in Linköping, Sweden between year 2015 and 2022. Of the 58 children, 30 were dressed with Suprathel ® and 28 with Mepilex ® Ag. Outcomes investigated were healing time, burn wound infection (BWI), need for operations and number of dressing changes.

    Results

    We found no significant differences in any of the outcomes. In the Suprathel ® group 17 children and in the Mepilex ® Ag group 15 children were healed within 14 days. Ten children from each group received antibiotics for suspected BWI and two from each group underwent an operation with skin grafting. Each group had on median four dressing changes.

    Conclusions

    Two different treatments were compared for children with partial-thickness scalds, and the data indicates that similar results are received with both dressings.

  • 29.
    Karlsson, Matilda
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Olofsson, Pia
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Burn scar outcome at six and 12 months after injury in children with partial thickness scalds: Effects of dressing treatment.2020In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 3, p. 546-551, article id S0305-4179(19)30714-4Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: In line with other researchers in the field of burns' care, we think that research investigating the long-term outcome of scars is largely lacking. As scarring is of the utmost importance to the patient, clinicians who treat burns must aim to find treatments that lead to a good end result. The aim of this study was to study scar outcomes at six and 12 months after injury. It is an extension of a previous randomised controlled trial (RCT) in which two dressings (porcine xenograft and silver foam dressing) were examined with respect to their ability to help heal partial thickness scalds.

    METHOD: Children aged six months - six years with acute partial thickness scalds, on the trunk, or extremities, or both, were included. In the previous study, the silver foam was found to have significantly shorter healing times than the xenograft. Children were assessed at six and 12 months after injury for this study, and photographs were taken of the burn site, and both the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS) were completed and evaluated by blinded observers.

    RESULTS: Of the 58 children from the original RCT, 39 returned to the clinic for evaluation of their scars at six months, and 34 at 12 months after injury. There were no differences in POSAS, VSS total scores, or incidence of hypertrophic scarring between the different dressings. Fifteen children were assessed as having hypertrophic scarring, all of whom had healing times that had extended beyond 14 days.

    CONCLUSIONS: This study compared burn scarring after two different treatments for burns in children with partial-thickness scalds and the data suggested that neither dressing had a more favourable impact on scar outcome. The conclusion is, however, tempered by the non-return of all the patients to the follow up. However, as anticipated, regardless of the dressing used, longer healing times were associated with higher scar scores (more scarring) and hypertrophic scarring.

  • 30.
    Karlsson, Matilda
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Östholm Balkhed, Åse
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Wound infection among children with moderate burns – An explorative review of the association between reported frequency and diagnosis2023In: Burns, ISSN 0305-4179, E-ISSN 1879-1409Article in journal (Refereed)
    Abstract [en]

    Introduction: The Linkoping burn centre in Sweden has, even though being a high income country, reported high burn wound infections (BWI) frequencies in scalded children compared to similar populations in other parts of the world.

    Aim: The aim was to investigate possible explanations for differences in frequency of BWI among children with partial thickness burns treated at the Linköping burn centre in Sweden, and that reported in other studies.

    Method: In order to investigate what BWI criteria that were used in similar studies a literature search on PubMed Central was done along with a retrospective analysis of children previously diagnosed as infected to confirm or reject the high infection frequency reported earlier.

    Result: Of the 34 selected publications reporting on BWI frequency 16 (47%) did not define a criteria for the BWI diagnosis and almost a third did not report on wound culturing. Of those who did report the use a third do not mention any bacterial growth found is these cultures. The retrospective analysis on children at the centre did not show any decrease in infection frequency even with some disagreement on onset for the BWI.

    Conclusion: The reporting of criteria and diagnosis of burn wound infection is highly variable making it difficult to interpret results and come to conclusions. The high frequency of BWI at the centre might be a result of close monitoring due to study participation, use of clean instead of sterile routine at dressing changes or low thresholds for the diagnosis in respect to changes in infection markers.

  • 31.
    Larsson, Alexander
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Briheim, Kristina
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Hanna, Victor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Gustafsson, Karin
    Linköping University, Department of Physics, Chemistry and Biology. Linköping University, The Institute of Technology.
    Starkenberg, Annika
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Vintertun, Hans
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Kratz, Gunnar
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Junker, Johan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Transplantation of autologous cells and porous gelatin microcarriers to promote wound healing2021In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 47, no 3, p. 601-610Article in journal (Refereed)
    Abstract [en]

    Definitive treatment to achieve wound healing in major burns frequently include skin transplantation, where split-thickness skin grafts is considered gold standard. This method is associated with several drawbacks. To overcome these hurdles, efforts have been made to develop tissue engineered skin substitutes, often comprised of a combination of cells and biomaterials. In the present study, we aimed to investigate transplantation of autologous keratinocytes and fibroblasts seeded on porous gelatin microcarriers using a porcine wound model. Pre-seeded microcarriers were transplanted to a total of 168 surgical full-thickness wounds (2 cm diameter) on eight adult female pigs and covered with occlusive dressings. The experimental groups included wounds transplanted with microcarriers seeded with the combination of keratinocytes and fibroblasts, microcarriers seeded with each cell type individually, microcarriers without cells, each cell type in suspension, and NaCl control. Wounds were allowed to heal for one, two, four or eight weeks before being excised and fixated for subsequent histological and immunohistochemical analysis. In vitro, we confirmed that viable cells populate the surface and the pores of the microcarriers. In vivo, the microcarriers were to a large extent degraded after two weeks. After one week, all treatment groups, with the exception of microcarriers alone, displayed significantly thicker neo-epidermis compared to controls. After two weeks, wounds transplanted with microcarriers seeded with cells displayed significantly thicker neo-epidermis compared to controls. After four weeks there was no difference in the thickness of neo-epidermis. In conclusion, the experiments performed illustrate that autologous cells seeded on porous gelatin microcarriers stimulates the re-epithelialization of wounds. This method could be a promising candidate for skin transplantation. Future studies will focus on additional outcome parameters to evaluate long-term quality of healing following transplantation. (c) 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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  • 32.
    Larsson, Alexander
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Karolinska Univ Hosp, Sweden.
    Rakar, Jonathan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Kratz, Gunnar
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Junker, Johan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Amino acid buffered hypochlorite facilitates debridement of porcine infected burn wounds2023In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 6, p. 1363-1371Article in journal (Refereed)
    Abstract [en]

    Introduction: Removal of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn wounds are typically treated on an outpatient basis where surgical capabilities can be limited there is a need for alternative treatment options. In this study we aim to evaluate the use of amino acid buffered hypochlorite (AABH) as a chemical enhancement for wound debridement in a porcine infected burn wound model.Method: A total of 60 full-thickness burn wounds, 3 cm in diameter, were created on four pigs using a standardized burn device. The wounds were inoculated with 107 colonyforming units (CFU) of S. aureus. The experimental groups included wounds debrided with a plastic curette, wounds debrided after pretreatment with AABH, and control wounds wiped with gauze. Wounds were treated twice per week for three weeks. Debridement, healing, and infection parameters were evaluated over time.Results: After one week, but not after two and three weeks, the curette and AABH groups had higher debrided weights compared to control (p &lt; 0.05). Percentage of wound area adequately cleared from necrotic tissue was higher in the AABH-group compared to the curette-group and control, after one week. The earliest healing was measured in the AABH group after two weeks (5 % of wounds), which also had the most healed wounds after three weeks (55 %). In both the AABH and the curette groups, bacterial load had fallen below 10(5) CFU/g after two weeks. No CFU were detectable in the AABH group after three weeks. The AABH-group was also the easiest to debride.Conclusion: Our results indicate that AABH facilitates wound debridement and could be a helpful addition to an effective treatment modality for removal of necrotic tissue in full thickness burns.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  • 33.
    Leclerc, Thomas
    et al.
    Percy Mil Teaching Hosp, France; Val De Grace Mil Med Acad, France.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Jennes, Serge
    Grand Hop Charleroi, Belgium.
    Mendez, Jose Ramon Martinez
    Hosp Univ La Paz, Spain.
    van der Vlies, Cornelis H.
    Maasstad Hosp, Netherlands; Erasmus MC, Netherlands.
    Battistutta, Anna
    European Commiss, Belgium.
    Lozano-Basanta, Alfonso
    European Commiss, Belgium.
    Moiemen, Naiem
    Univ Hosp Birmingham Fdn Trust, England; Univ Birmingham, England.
    Almeland, Stian Kreken
    Haukeland Hosp, Norway; Univ Bergen, Norway; Norwegian Directorate Hlth, Norway.
    European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan2023In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 2, p. 275-303Article in journal (Refereed)
    Abstract [en]

    Background: A European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities. Methods: The European Burns Associations disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of highlevel evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burns Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022. Recommendations: The resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care. (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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  • 34. Liffner, G
    et al.
    Bak, Zoltan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Reske, A
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Inhalation injury assessed by score does not contribute to the development of acute respiratory distress syndrome in burn victims2005In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 31, no 3, p. 263-268Article in journal (Refereed)
    Abstract [en]

    Objective: To establish the incidence, mortality, and time of onset of acute respiratory distress syndrome (ARDS) in relation to extent of burn and inhalation injury in patients who required mechanical ventilation. Design: Data about burn and inhalation injury were recorded prospectively whereas ARDS and multiple organ dysfunction were assessed by review of patient charts. Setting: National burn intensive care unit at Linköping University Hospital, Sweden (a tertiary referral hospital). Patients: Between 1993 and 1999, we studied all patients with thermal injury (n = 553) who required mechanical ventilation for more than two days (n = 91). Measurements and results: Out of the thirty-six burn victims who developed ARDS (40%), 25 (70%) did so early post burn (in less than 6 days). Patients with ARDS had higher multiple organ dysfunction scores (mean 10.5) than those who did not develop ARDS (mean 5.6) (p < 0.01). The probable presence of inhalation injury as assessed by an inhalation lung injury score (ILIS) did not contribute to the development of ARDS. Mortality tended to be higher in patients who developed ARDS (14%) compared to those who did not (6%, p = 0.2). Conclusions: In our burn patients the incidence of ARDS was high whereas mortality was low. We found no association between inhalation injury as assessed using the ILIS and development of ARDS. Our data support a multi-factorial origin of ARDS in burn victims as a part of a multiple organ failure event. © 2004 Elsevier Ltd and ISBI. All rights reserved.

  • 35.
    Lindahl, Filip
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Assessing paediatric scald injuries using Laser Speckle Contrast Imaging2013In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 4, p. 662-666Article in journal (Refereed)
    Abstract [en]

    Background

    The use of objective methods for assessment of burns is limited. Laser Speckle Contrast Imaging (LSCI) is a non-invasive technique for instant measurement of tissue perfusion, making it potentially valuable for early prediction of burn wound outcome.

    Aim

    To evaluate the influence of technical factors on perfusion and to measure perfusion in burns 0–14 days post-burn and compare this with the outcome of the burn wound at 14 days after burn.

    Method

    The effect of room light, camera distance and camera angle was studied using a suspension of polystyrene particles. LSCI measurements were performed on 45 scald burns and 32 uninjured areas 0–14 days after burn.

    Result

    Technical factors had no clinically relevant effect on measured perfusion. Burns that healed within 14 days had a higher perfusion during the first week post-burn than burns that healed after 14 days or underwent surgery. The difference in perfusion was largest 4–7 days after burn.

    Conclusion

    LSCI allows for robust, instant measurement of burns and can easily be applied in a clinical setting. Differences in perfusion during the first week post-burn are related to the outcome after 14 days.

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  • 36.
    Lindahl, Olof Anton
    et al.
    Department of Biomedical Engineering, Umeå University Hospital and Linköping University, Sweden.
    Zdolsek, Joachim
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences.
    Ängquist, Karl-Axel
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Human postburn oedema measured with the impression method1993In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 19, no 6, p. 479-489Article in journal (Refereed)
    Abstract [en]

    The course of tissue swelling in human non-injured skin after burn injury was investigated with a non-invasive impression method that measures force and tissue fluid translocation during mechanical compression of the skin. Time-dependent changes in the fluid translocation and the interstitial-pressure related to impression force were measured on 11 occasions, during 3 weeks, in seven patients postburn. A mathematical model was fitted to the impression force curves and the parameters of the model depicted the time-dependent compartmental fluid shift in the postburn generalized oedema. Tissue fluid translocation increased significantly (P < 0.05) up to a maximum value after 6 days postburn and declined thereafter. This indicated a continuous increase in the generalized postburn oedema for the first 6 days postburn. Impression force at 3 weeks postburn was significantly lower (P < 0.001) as compared with the half-day postburn value, indicating an increased tissue pressure during the first days postburn. Parameter analysis indicated a flux of water-like fluid from the vasculature to the interstitial space during the first 6 days postburn. The spread of the values registered between different measurement sites was, however, large.

  • 37.
    Mirdell, Robin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland.
    Farnebo, Simon
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics. Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences.
    Accuracy of laser speckle contrast imaging in the assessment of pediatric scald wounds2018In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 1, p. 90-98Article in journal (Refereed)
    Abstract [en]

    Background: Changes in microvascular perfusion in scalds in children during the first four days, measured with laser speckle contrast imaging (LSCI), are related to the time to healing and need for surgical intervention. The aim of this study was to determine the accuracy (sensitivity and specificity) of LSCI on different days after injury in the prediction of healing outcome and if the accuracy can be improved by combining an early and a late measurement. Also, the accuracy of LSCI was compared with that of clinical assessment. Methods: Perfusion was measured between 0-24h and between 72-96h using LSCI in 45 children with scalds. On the same occasions, burn surgeons assessed the burns as healing amp;lt; 14days or healing amp;gt; 14days/surgery. Receiver operating characteristic (ROC) curves were constructed for the early and late measurement and for the double measurement (DM) using two different methods. Results: Sensitivity and specificity were 92.3% (95% CI: 64.0-99.8%) and 78.3% (95% CI: 69.985.3%) between 0-24h, 100% (95% CI: 84.6-100%) and 90.4% (95% CI: 83.8-94.9%) between 72-96h, and was 100% (95% CI: 59.0-100%) and 100% (95% CI: 95.1-100%) when combining the two measurements into a modified perfusion trend. Clinical assessment had an accuracy of 67%, Cohens k=0.23. Conclusion: The perfusion in scalds between 72-96h after injury, as measured using LSCI, is highly predictive of healing outcome in scalds when measured. The predictive value can be further improved by incorporating an early perfusion measurement within 24h after injury. (C) 2017 Elsevier Ltd and ISBI. All rights reserved.

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  • 38.
    Mirdell, Robin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Farnebo, Simon
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics. Linköping University, Department of Medical and Health Sciences.
    Interobserver reliability of laser speckle contrast imaging in the assessment of burns2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 6, p. 1325-1335Article in journal (Refereed)
    Abstract [en]

    Objectives: Laser speckle contrast imaging (LSCI) is an emerging technique for the assessment of burns in humans and interobserver differences have not been studied. The aim of this study was to compare assessments of perfusion images by different professional groups regarding (i) perfusion values and (ii) burn depth assessment. Methods: Twelve observers without LSCI experience were included. The observers were evenly recruited from three professional groups: plastic surgeons with experience in assessing burns, nurses with experience in treating burns, and junior doctors with limited experience of burns. Ten cases were included. Each case consisted of one digital photo of the burn with a pre-marked region of interest (ROI) and two unmarked perfusion images of the same area. The first and the second perfusion image was from 24h and 72-96h after injury, respectively. The perfusion values from both perfusion images were used to generate a LSCI recommendation based on the perfusion trend (the derivative between the two perfusion values). As a last step, each observer was asked to estimate the burn depth using their clinical experience and all available information. Intraclass correlation (ICC) was calculated between the different professional groups and among all observers. Results: Perfusion values and perfusion trends between all observers had an ICC of 0.96 (95% CI 0.91-0.99). Burn depth assessment by all observers yielded an ICC of 0.53 (95% CI: 0.31-0.80) and an accuracy of 0.53 (weighted kappa). LSCI recommendations generated by all observers had an ICC of 0.95 (95% CI: 0.90-0.99). Conclusion: Observers can reliably identify the same ROI, which results in observer-independent perfusion measurements, irrespective of burn experience. Extensive burn experience did not further improve burn depth assessment. The LSCI recommendation was more accurate in all professional groups. Introducing LSCI measurements would be likely improve early assessment of burns. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.

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  • 39.
    Mirdell, Robin
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Farnebo, Simon
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Tesselaar, Erik
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Medical radiation physics.
    Using blood flow pulsatility to improve the accuracy of laser speckle contrast imaging in the assessment of burns2020In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 6, p. 1398-1406Article in journal (Refereed)
    Abstract [en]

    Objectives: Measurement of perfusion is an establishedmethod to evaluate the depth of burns. However, high accuracy is only achievable &gt;48 h after injury. The aim of the study was to investigate if measurement of blood flow pulsatility, combined with perfusion measurement, can improve early assessment of burn depth using laser speckle contrast imaging (LSCI). Methods: Perfusion and pulsatility were measured with LSCI in 187 regions of interest in 32 patients, between 0 and 5 days after injury. The reproducibility of pulsatility was tested for recording durations between 1 and 12 s. The most reproducible duration was chosen, and receiver operator characteristics were created to find suitable pulsatility cut-offs to predict surgical need. Results: A measurement duration of 8 s resulted in a good reproducibility of the pulsatility (% CV: 15.9%). Longer measurement durations resulted in a small improvement of the accuracy of the assessment. A pulsatility of &lt;1.45 (Perfusion Units)(2) on day 0-2 after injury predicted surgical need with a sensitivity of 100% (95% CI: 83.2-100%), specificity of 100% (95% CI: 95.2-100%), a positive predictive value of 100%, and a negative predictive value of 100%. Pulsatility was not significantly different when comparing measurements done day 0-2 today 3-5. Perfusion was however significantly higher day 3-5 compared today 0-2 for wound shealing with in 3 weeks. Conclusion: Measurement of pulsatility improves the accuracy of the assessment of burns with LSCI and makes it possible to predict the need for surgery during day 0-2 after injury with a high accuracy. (C) 2020 Elsevier Ltd and ISBI. All rights reserved.

  • 40.
    Mirdell, Robin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Iredahl, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Farnebo, Simon
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Tesselaar, Erik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Microvascular blood flow in scalds in children and its relation to duration of wound healing: A study using laser speckle contrast imaging2016In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 42, no 3, p. 648-654Article in journal (Refereed)
    Abstract [en]

    Background: Microvascular perfusion changes in scalds in children during the first weeks after injury is related to the outcome of healing, and measurements of perfusion, based on laser Doppler imaging, have been used successfully to predict the need for excision and grafting. However, the day-to-day changes in perfusion during the first weeks after injury have not to our knowledge been studied in detail. The aim of this study, based on a conservative treatment model where excision and grafting decisions were delayed to day 14 after injury, was to measure changes in perfusion in scalds using laser speckle contrast imaging (LSCI) during the first three weeks after injury. Methods: We measured perfusion with LSCI in 34 patients at regular intervals between 6 h after injury until complete reepithelialization or surgery. Duration of healing was defined as the time to complete reepithelialization. Results: Less perfusion, between 6 and 96 h after injury, was associated with longer duration of healing with the strongest association occurring between 72 and 96 h. Burns that healed within 14 days had relatively high initial perfusion, followed by a peak and subsequent slow decrease. Both the maximum perfusion and the time-to-peak were dependent on the severity of the burn. Burns that needed excision and grafting had less initial perfusion and a gradual reduction over time. Conclusion: The perfusion in scalds in children shows characteristic patterns during the first weeks after injury depending on the duration of wound healing, the greatest difference between wounds of different severity being on the 4th day. Perfusion should therefore preferably be measured on the fourth day if it is to be used in the assessment of burn depth. (c) 2015 Elsevier Ltd and ISBI. All rights reserved.

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  • 41.
    Nilsson, Andreas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Orwelius, Lotti
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Sveen, Josefin
    Uppsala Univ, Sweden.
    Willebrand, Mimmie
    Uppsala Univ, Sweden.
    Ekselius, Lisa
    Uppsala Univ, Sweden.
    Gerdin, Bengt
    Uppsala Univ, Sweden; Uppsala Burn Ctr, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA). Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Anxiety and depression after burn, not as bad as we think-A nationwide study2019In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 6, p. 1367-1374Article in journal (Refereed)
    Abstract [en]

    Objective: A history of psychiatric disorders is more common among patients who have had burns than in the general population. To try and find out the scale of the problem we have assessed self-reported symptoms of anxiety and depression after a burn. Methods: Consecutive patients with burns measuring more than 10% total body surface area or duration of stay in hospital of seven days or more were included. Personal and clinical details about the patients were extracted from the database at each center. Data were collected from the Hospital Anxiety and Depression Scale, as well as Health-Related Quality of Life (HRQoL; Short Form-36, SF-36) and questionnaires about socioeconomic factors. All results were obtained 12 and 24 months after the burn, and compared with those from a reference group. Results: A total of 156 patients responded to the questionnaires. Mean (SD) age and TBSA (%) were 46 (16.4) years and 23.6 (19.2) %, respectively. There were no differences in incidence between the burn and reference groups in anxiety or depression either 12 or 24 months after the burn. Those who reported higher anxiety and depression scores also had consistently poorer HRQoL as assessed by the SF-36. Conclusion: Seen as a group, people who have had burns report anxiety and depression the same range as a reference group. Some patients, however, express more anxiety and depression, and concomitantly poorer HRQoL. These patients should be identified, and offered additional support. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.

  • 42.
    Nilsson, Andreas
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Bak, Zoltan
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Letter: Patient controlled sedation using a standard protocol for dressing changes in burns: Patients preference, procedural details and a preliminary safety evaluation. Are studies always adequately powered and analyzed? Response2010In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 36, no 6, p. 948-950Article in journal (Other academic)
    Abstract [en]

    n/a

  • 43.
    Nilsson, Andreas
    et al.
    Department of Anesthesiology and Intensive Care Liköping University hospital.
    Steinvall, Ingrid
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Bak, Zoltan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Burn Unit . Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Patient controlled sedation using a standard protocol for dressing changes in burns: Patients' preference, procedural details and a preliminary safety evaluation2008In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 7, p. 929-934Article in journal (Refereed)
    Abstract [en]

    Background: Patient controlled sedation (PCS) enables patients to titrate doses of drugs by themselves during different procedures involving pain or discomfort. Methods: We studied it in a prospective crossover design using a fixed protocol without lockout time to examine it as an alternative method of sedation for changing dressings in burned patients. Eleven patients with >10% total burn surface area (TBSA) had their dressings changed, starting with sedation by an anaesthetist (ACS). The second dressing change was done with PCS (propofol/alfentanil) and the third time the patients had to choose ACS or PCS. During the procedures, data on cardiopulmonary variables, sedation (bispectral index), pain intensity (VAS), procedural details, doses of drugs, and patients' preferences were collected to compare the two sedation techniques. Results: The study data indicated that wound care in burned patients is feasible with a standardized PCS protocol. The patients preferred PCS to ACS on the basis of self-control, and because they had less discomfort during the recovery period. Wound care was also considered adequate by the staff during PCS. No respiratory (respiratory rate/transcutaneous PCO2) or cardiovascular (heart rate/blood pressure) adverse events were recorded at any time during any of the PCS procedures. The doses of propofol and alfentanil and BIS index decrease were less during PCS than ACS. Procedural pain was higher during PCS but lower after the procedure. Conclusion: We suggest that PCS using a standard protocol is an interesting alternative to anaesthetist-provided sedation during dressing changes. It seems effective, saves resources, is safe, and at same time is preferred by the patients. The strength of these conclusions is, however, hampered by the small size of this investigation and therefore further studies are warranted. © 2008 Elsevier Ltd and ISBI.

  • 44.
    Nilsson, Heléne
    et al.
    Region Östergötland, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Jonson, Carl-Oscar
    Region Östergötland, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Vikström, Tore
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Bengtsson, Eva
    Region Östergötland, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Huss, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Kildal, Morten
    Department of Plastic and Maxillofacial Surgery, Akademiska Sjukhuset, Uppsala, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Simulation-assisted burn disaster planning2013In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 6, p. 1122-1130Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System (R) (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.

  • 45.
    Orwelius, Lotti
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Willebrand, M
    Uppsala University, Sweden.
    Gerdin, B
    Uppsala University, Sweden.
    Ekselius, L
    Uppsala University, Sweden.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Long term health-related quality of life after burns is strongly dependent on pre-existing disease and psychosocial issues and less due to the burn itself2013In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 39, no 2, p. 229-235Article in journal (Refereed)
    Abstract [en]

    Background

    Health-related quality of life (HRQoL) is reduced after a burn, and is affected by coexisting conditions. The aims of the investigation were to examine and describe effects of coexisting disease on HRQoL, and to quantify the proportion of burned people whose HRQoL was below that of a reference group matched for age, gender, and coexisting conditions.

    Method

    A nationwide study covering 9 years and examined HRQoL 12 and 24 months after the burn with the SF-36 questionnaire. The reference group was from the referral area of one of the hospitals.

    Results

    The HRQoL of the burned patients was below that of the reference group mainly in the mental dimensions, and only single patients were affected in the physical dimensions. The factor that significantly affected most HRQoL dimensions (n = 6) after the burn was unemployment, whereas only smaller effects could be attributed directly to the burn.

    Conclusion

    Poor HRQoL was recorded for only a small number of patients, and the decline were mostly in the mental dimensions when compared with a group adjusted for age, gender, and coexisting conditions. Factors other than the burn itself, such as mainly unemployment and pre-existing disease, were most important for the long term HRQoL experience in these patients.

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  • 46.
    Othman, Nasih
    et al.
    Sulaimani Polytech University, Iraq.
    Kendrick, Denise
    University of Nottingham, England.
    Al-Windi, Ahmad
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Childhood burns in Sulaimaniyah province, Iraqi Kurdistan: A prospective study of admissions and outpatients2015In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 41, no 2, p. 394-400Article in journal (Refereed)
    Abstract [en]

    Background: While it is globally observed that young children are at a higher risk of burn injuries, little is known about childhood burns in Iraqi Kurdistan. This study was undertaken to describe the epidemiology of burns amongst pre-school children in this region. Methods: A prospective study was undertaken from November 2007 to November 2008 involving all children aged 0-5 years attending the burns centre in Sulaimaniyah province for a new burn injury whether treated as an outpatient or admitted to hospital. Results: 1,122 children attended the bums centre of whom 944 (84%) were interviewed (male 53%, female 47%). Mean age was 1.9 years with children aged 1 year comprising 32% and those aged 2 years comprising 21% of the sample. The incidence of bums was 1044/100,000 person-years (1030 in females and 1057 in males). Mechanisms of injury included scalds (80%), contact burns (12%) flames (6%) and other mechanisms (2%). Almost 97% of burns occurred at home including 43% in the kitchen. Winter was the commonest season (36%) followed by autumn (24%). There were 3 peak times of injury during the day corresponding to meal times. The majority of bums were caused by hot water (44%) and tea (20%) and the most common equipment/products responsible were tea utensils (41%). There were 237 admissions with an admission rate of 95 per 100,000 person-years. Scald injuries accounted for most admissions (84%). Median total body surface area affected by the burn or scald (TBSA) was 11% and median hospital stay was 7 days. In-hospital mortality was 8%. Mortality rate was 4% when TBSA was less than= 25%, and 100% when TBSA was over 50%. Conclusion: Burn incidence is high in young children especially those aged 1-2 years. Preventive interventions targeted at families with young children and focusing on home safety measures could be effective in reducing childhood burns.

  • 47. Parment, Karin
    et al.
    Zetterberg, Anna
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Bakteman, Karin
    Steinwall, Ingrid
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Long-term immunosuppression in burned patients assessed by in vitro neutrophil oxidative burst (Phagoburst®)2007In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 33, no 7, p. 865-871Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the duration and magnitude of immunosuppression induced by burns as measured by the neutrophil oxidative burst in vitro. Design: Prospective exploratory cohort study. Setting: Tertiary referral unit, University Hospital, Linkoping, Sweden (National Burn Unit). Patients and healthy volunteers (controls): Twenty-eight subjects consecutively admitted to the Burn Unit. The mean total burn surface area (TBSA%) was 36 (range 13-87) and mean age 44 years (range 14-89). Patients' data were collected prospectively in the burn unit, which also included sequential organ failure assessment (SOFA) score. Interventions: None. Measurements and results: To assess the changes in the oxidative capacity of neutrophils after the burn, blood samples for the Phagoburst® analysis were taken on admission and at least once every second week for the duration of stay in hospital and thereafter monthly up to 12 months after the burn. Neutrophils were stimulated in vitro by Escherichia coli, phorbol 12-phorbol myristate 13-acetate (PMA), and peptide N-formyl-Met-Leu-Phe (fMLP). Oxidative burst was measured by flow cytometry. Oxidative capacity of the neutrophils decreased similarly for all three stimulants: there was a pathological decrease shortly after admission, with the lowest value occurring between days 7 and 10, followed by a gradual recovery during the ensuing months. Full recovery (to the values of the controls) was seen first 3.5 months after the burn. Using multiple regression, we found that only age and time since the burn significantly (p < 0.05) affected the oxidative burst. White cell count (WCC) and C-reactive protein (CRP) values returned to reference ranges long before the oxidative burst. Conclusions: This study provides evidence that immunosuppression in those injured by burns, as assessed by the in vitro oxidative burst of neutrophils, remains long after the event of the burn (up to 3.5 months after burn). Absence of correlations to TBSA%, FTB%, blood transfusion, opiates provided, and multiple organ failure score and laboratory infection variables together with the finding that decreased oxidative burst was uniform after the injury, suggesting that this immunosuppression is primarily due to the general metabolic response rather than recurring infections. © 2006 Elsevier Ltd and ISBI.

  • 48.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Harvard Med Sch, MA 02115 USA.
    Jose, Adorno
    Reg Hosp, Brazil.
    Nikki, Allorto
    Univ KwaZulu Natal, South Africa; Univ KwaZulu Natal, South Africa.
    Khaled, Altarrah
    Alsabah Hlth Reg, Kuwait.
    Barret, Juan
    Univ Autonoma Barcelona, Spain.
    Jeffery, Carter
    Louisiana State Univ, LA USA.
    Shobha, Chamania
    Choithram Hosp & Res Ctr, India.
    Jack, Chong Si
    Singapore Gen Hosp, Singapore.
    Scott, Corlew
    Harvard Med Sch, MA 02115 USA.
    Nadia, Depetris
    Citta Salute & Sci Torino, Italy.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Liao, Junlin
    Univ Iowa, IA 52242 USA.
    Josef, Haik
    Tel Aviv Univ, Israel; Sheba Med Ctr, Israel.
    Briana, Horwath
    Univ Iowa, IA 52242 USA.
    Sunil, Keswani
    Natl Burns Ctr Airoli, India.
    Tetsuro, Kiyozumi
    Natl Def Med Coll, Japan.
    Jorge, Leon-Villapalos
    Chelsea & Westminster Hosp, England.
    Gaoxing, Luo
    Army Third Mil Med Univ, Peoples R China.
    Hajime, Matsumura
    Tokyo Med Univ, Japan.
    Ariel, Miranda-Altamirano
    Hosp Civil Guadalajara, Mexico.
    Naiem, Moiemen
    Birmingham Womens & Childrens Hosp, England; Univ Birmingham, England.
    Kiran, Nakarmi
    Kirtipur Hosp, Nepal.
    Nawar, Ahmed
    Cairo Univ, Egypt.
    Faustin, Ntirenganya
    Univ Rwanda, Rwanda.
    Anthony, Olekwu
    Fed Med Ctr Owo, Nigeria.
    Tom, Potokar
    Swansea Univ, Wales; Swansea Univ, Wales.
    Liang, Qiao
    Shanghai Jiao Tong Univ, Peoples R China.
    Man, Rai Shankar
    Kirtipur Hosp, Nepal; Natl Acad Med Sci, Nepal.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Ahmed, Tanveer
    Sheikh Hasina Natl Inst Burn & Plast Surg, Bangladesh.
    Molina, Philipe Luiz Vana
    Univ Sao Paulo, Brazil.
    Shelley, Wall
    Univ KwaZulu Natal, South Africa; Univ KwaZulu Natal, South Africa; Univ KwaZulu Natal, South Africa.
    Mark, Fisher
    Univ Iowa, IA 52242 USA.
    Impact of COVID-19 on global burn care2022In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 48, no 6, p. 1301-1310Article in journal (Refereed)
    Abstract [en]

    Background: Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pan-demic, and whether country acute accent s income, geographical location, COVID-19-transmission pat-tern, and levels of specialization of the burn units affected reallocation of resources and access to burn care.Methods: The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, chi 2 or Fishers exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic.Results: The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedi-cated nursing staff was reduced (&lt; 0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p &lt; 0.01), collaboration be-tween burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors.Conclusions: During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care.(c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • 49.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Eladany, Mostafa M.
    Suez Canal Univ, Egypt.
    Abdelrahman, Islam Mohamedy
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Long-term mortality after self-inflicted burns2024In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 50, no 1, p. 252-261Article in journal (Refereed)
    Abstract [en]

    Background: Those with self-inflicted burns are a small but consistent group among burn patients, with large injuries and conflicting findings regarding their in-hospital mortality. Overall, burn survivors have a shorter life expectancy, as compared with national controls, but long-term mortality after self-inflicted burns is understudied. The aim of this retrospective study was to investigate possible differences in long-term mortality among survivors after self-inflicted and accidental burns.Methods: All adult patients with burns admitted at the Linkoping Burn Centre and discharged alive between 2000 and 2017 were included, and end of follow up was April 26, 2021. Those with unknown survival status at that time were excluded. A Cox proportional hazards regression model, adjusted for age and sex, was used to analyse long term mortality.Results: Among the 930 patients included in this study, 37 had self-inflicted burns. Overall, median follow up period was 8.8 years and crude mortality was 24.7%. After adjustment for age and sex, self-inflicted burns were independently associated with long-term mortality, Hazard Ratio= 2.08 (95% CI 1.13-3.83). Post hoc analysis showed that the effect was most pronounced during the first years after discharge although it was noticeable over the whole study period.Conclusion: Long-term risk of mortality after discharge from a burn centre was higher in patients with self-inflicted burns than in patients with accidental burns. The effect was noticeable over the whole study period although it was most pronounced during the first years after discharge.

  • 50.
    Pompermaier, Laura
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Steinvall, Ingrid
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study2018In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 2, p. 280-287Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The Baux score - the sum of age and total body surface area burned (TBSA %) - is a good predictor of mortality has a high specificity but low sensitivity. Our aim was to examine the causes of death in patients who die with Baux scores of <100, which may explain the lower sensitivity and possibly affect the prediction of mortality.

    METHODS: All patients admitted to our centre for burn care from 1993 to 2015 (n=1946) were included in this retrospective, descriptive, exploratory study. The study group comprised those patients who died with Baux scores of <100 (n=23), and their medical charts were examined for the cause of death and for coexisting diseases.

    RESULTS: Crude mortality was 5% (93/1946) for the overall cohort, and a quarter of the patients who died (23/93) had Baux scores of less than 100 (range 64-99). In this latter group, flame burns were the most common (18/23), the median (10th-90th centile) age was 70 (46-86) years and for TBSA 21 (5.0-40.5) %, of which 7 (0-27.0) % of the area was full thickness. The main causes of death in 17 of the 23 were classified as "other than burn", being cerebral disease (n=9), cardiovascular disease (n=6), and respiratory failure (n=2). Among the remaining six (burn-related) deaths, multiple organ failure (predominantly renal failure) was responsible. When we excluded the cases in which the cause of death was not related to the burn, the Baux mortality prediction value improved (receiver operating characteristics area under the curve, AUC) from 0.9733 (95% CI 0.9633-0.9834) to 0.9888 (95% CI 0.9839-0.9936) and the sensitivity estimate increased from 45.2% to 53.9%.

    CONCLUSION: Patients with burns who died with a Baux score <100 were a quarter of all the patients who died. An important finding is that most of these deaths were caused by reasons other than the burn, usually cerebrovascular disease. This may be the explanation why the sensitivity of the Baux score is low, as factors other than age and TBSA % explain the fatal outcome.

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