Burn injury

About: Burn injury is a research topic. Over the lifetime, 4070 publications have been published within this topic receiving 76452 citations.

Major injury leads to predominance of the T helper-2 lymphocyte phenotype and diminished interleukin-12 production associated with decreased resistance to infection.

Abstract: Objective Patients with serious traumatic injury and major burns and an animal model of burn injury were studied to determine the effect of injury on the production of cytokines typical of the T helper-2 lymphocyte phenotype as opposed to the T helper-1 phenotype and on the production of interleukin-12. Summary Background Data Perturbations of natural and adoptive immunity are related to the increased susceptibility to infection manifested by seriously injured and burn patients. Earlier work has shown that impaired adoptive immunity after injury is characterized by diminished production of interleukin-2 (IL-2), a product of Th lymphocytes. Exposure of naive Th cells to certain antigens and cytokines causes conversion to either the Th-1 or the Th-2 phenotype. Th-1 cells produce IL-2 and interferon-gamma (IFN-τ) and initiate cellular immunity. Th-2 cells secrete interleukin-4 (IL-4) and interleukin-10 (IL-10) and stimulate production of certain antibodies. Conversion to the Th-1 phenotype is facilitated by IL-12, and conversion to the Th-2 phenotype is promoted by IL-4. The authors believed that serious injury might cause conversion of Th cells to the Th-2 as opposed to the Th-1 phenotype rather than generalized Th suppression. Methods The authors studied circulating peripheral blood mononuclear cells (PBMC) from 16 major burn and 8 trauma patients on 32 occasions early after injury and from 13 age- and sex-matched healthy individuals for cytokine production after phytohemagglutinin stimulation. Also studied was a mouse model of 20% burn injury known to mimic the immune abnormalities seen in humans with burns. Splenocytes from burn mice, 10 to 12 per group, were studied after activation by concanavalin A or by the bacterial antigen Staphylococcus aureus Cowan strain I for cytokine production and cytokine messenger RNA expression as determined by reverse transcriptase polymerase chain reaction. Burn mice were compared with sham-burn controls and attention was focused on day 10 after burn injury, a time when IL-2 production and resistance to infection are highly suppressed. Finally, burn and sham-burn animals, 20 per group, were treated in vivo with IL-12 (25 ng daily for 5 days) and observed for mortality after septic challenge (cecal ligation and puncture [CLP]) performed on day 10 after injury. Results Peripheral blood mononuclear cells from burn and trauma patients produced less IFN-τ, the index cytokine of Th-1 cells, than PBMCs from healthy individuals 1 to 14 days after burn injury (SE = 77.6 ± 16 pg/mL patients vs. 141.3 ± 35 pg/mL controls, p < 0.05). However, production of IL-4, the index cytokine of Th-2 cells, by patient PBMCs was increased (51.0 ± 13.0 pg/mL patients vs. 26.9 ± 2.5 controls, p < 0.05). Splenocytes from mice 10 days after burn injury, when compared with sham-burn controls, showed diminished production of IL-2 (1.04 ± 0.91 units/mL burns vs. 5.8 ± 0.55 units/mL controls, p < 0.05) and IFN-τ (1.05 ± 0.7 units/mL burns vs. 12.0 ± 8.9 units/mL controls, p < 0.05). However, burn splenocytes produced more IL-4 (2492 ± 157.0 pg/mL burns vs. 672.0 ± 22.7 pg/mL controls, p < 0.01) and IL-10 (695.2 ± 20.8 pg/mL burns vs. 567.0 ± 16.7 pg/mL controls, p < 0.05). Splenocyte production of IL-12 was also reduced after burn (0.20 ± 0.035 units/mL) as compared with sham burn (0.46 ± 0.08 units/mL, p < 0.05). The reduction in IL-2, IFN-τ, and IL-12 production by burn splenocytes was reflected by a tenfold decrease in expression of their respective cytokine mRNAs.

Severe burn injury in europe: a systematic review of the incidence, etiology, morbidity, and mortality

Abstract: Introduction: Burn injury is a serious pathology, potentially leading to severe morbidity and significant mortality, but it also has a considerable health-economic impact The aim of this study was to describe the European hospitalized population with severe burn injury, including the incidence, etiology, risk factors, mortality, and causes of death Methods: The systematic literature search (1985 to 2009) involved PubMed, the Web of Science, and the search engine Google The reference lists and the Science Citation Index were used for hand searching (snowballing) Only studies dealing with epidemiologic issues (for example, incidence and outcome) as their major topic, on hospitalized populations with severe burn injury (in secondary and tertiary care) in Europe were included Language restrictions were set on English, French, and Dutch Results: The search led to 76 eligible studies, including more than 186,500 patients in total The annual incidence of severe burns was 02 to 29/10,000 inhabitants with a decreasing trend in time Almost 50% of patients were younger than 16 years, and ~60% were male patients Flames, scalds, and contact burns were the most prevalent causes in the total population, but in children, scalds clearly dominated Mortality was usually between 14% and 18% and is decreasing in time Major risk factors for death were older age and a higher total percentage of burned surface area, as well as chronic diseases (Multi) organ failure and sepsis were the most frequently reported causes of death The main causes of early death (<48 hours) were burn shock and inhalation injury Conclusions: Despite the lack of a large-scale European registration of burn injury, more epidemiologic information is available about the hospitalized population with severe burn injury than is generally presumed National and international registration systems nevertheless remain necessary to allow better targeting of prevention campaigns and further improvement of cost-effectiveness in total burn care

Burn incidence and medical care use in the United States: estimates, trends, and data sources

Abstract: Recent estimates related to annual burn incidence and medical care use in the United States include 5500 deaths from fire and burns (1991), 51,000 acute hospital admissions for burn injury (1991 to 1993 average), and 1.25 million total burn injuries (1992). Time trends from 1971 to 1991 reveal significant declines in each estimate. Taking into account the 25% increase in the U.S. population during this period, the rates of decline in deaths attributed to fire and burns and acute hospitalization for burn injury are both about 50%. The rates of decline are similar in sample statistics for all burns receiving medical care and for all burns above a reportable level of severity. In addition to providing current and time-series estimates, this article discusses burn injury coding issues and describes the data sources from which national and state estimates can be derived. The principal objective is to establish and describe a set of burn injury data baselines in a manner that will facilitate future tracking of burn incidence and medical care use at the national and state level by practitioners and researchers.