2022 ABA Annual Meeting Abstracts/Poster

The proceedings contain 7 papers. The topics discussed include: pediatric burn care: how burn camps survived and thrived during the coronavirus pandemic;a retrospective chart review to determine hypophosphatemia incidence and phosphorus supplementation requirements in patients with severe thermal cutaneous injuries receiving high-volume hemofiltration;setting the standard: using the aba burn registry to benchmark risk adjusted mortality;burn injury from smoking electronic cigarettes while on supplemental oxygen;focused wound care handoff improves burn center physician-nursing communication and wound care education;modified frailty index is an independent predictor of death in the burn population: a secondary analysis of the transfusion requirement in burn care evaluation (TRIBE) study;and topical hemostatic agents in burn surgery: a systematic review.

Anesthetic management of toxic epidermal necrolysis: a report of two cases

Toxic epidermal necrolysis (TEN), is an acute, life-threatening emergent disease involving the skin and mucous membranes with serious systemic complications. It is characterized by widespread epidermal sloughing. Drugs are the most common triggers of TEN, but infection, vaccination, radiation therapy and malignant neoplasms can all induce it in susceptible patients. We report two cases in whom a hair dye and a COVID-19 vaccine (BioNTech, Pfizer) were believed to be the causative agents. These patients have to undergo repeated debridements of the necrotic tissue. In this manuscript the anesthetic management of TEN patients is discussed. Detailed preoperative evaluation, aggressive fluid and electrolyte replacement, avoidance of hypothermia during debridement, minimizing anesthetic agents and limiting traumatic procedures are key points in the management.Copyright © 2023 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Emergency Care for Burn Patients-A Single-Center Report.

Burns, one of the main public health problems, lead to significant mortality and morbidity. Epidemiological studies regarding burn patients in Romania are scarce. The aim of this study is to identify the burn etiology, demographics, clinical characteristics, and outcomes in patients requiring treatment in a regional burn unit. DESIGN: We performed a retrospective observational study of 2021. PATIENTS: All patients admitted to our six-bed intensive care unit (ICU) were included. INTERVENTIONS: The following data were collected for further analysis: demographics, burn pattern (etiology, size, depth, affected body region), type of ventilation, ABSI (Abbreviated Burn Severity Index) score, comorbidities, bioumoral parameters, and hospitalization days. RESULTS: There were 93 burned patients included in our study that were divided into two groups: alive patients' group (63.4%) and deceased patients' group (36.6%). The mean age was 55.80 ± 17.16 (SD). There were 65.6% male patients, and 39.8% of the patients were admitted by transfer from another hospital. Further, 59 patients presented third-degree burns, from which 32.3% died. Burns affecting >37% of the total body surface area (TBSA) were noticed in 30 patients. The most vulnerable regions of the body were the trunk (p = 0.003), the legs (p = 0.004), the neck (p = 0.011), and the arms (p = 0.020). Inhalation injury was found in 60.2% of the patients. The risk of death in a patient with an ABSI score > 9 points was 72 times higher. Comorbidities were present in 44.1% of the patients. We observed a median LOS (length of stay) of 23 days and an ICU-LOS of 11 days. Logistic regression analysis showed that admission protein, creatinkinase, and leukocytes were independent risk factors for mortality. The general mortality rate was 36.6%. CONCLUSION: A thermal factor was responsible for the vast majority of burns, 94.6% of cases being accidents. Extensive and full-thickness burns, burns affecting the arms, inhalation injuries, the need for mechanical ventilation, and a high ABSI score represent important risk factors for mortality. Considering the results, it appears that prompt correction of protein, creatinkinase, and leukocytes levels may contribute to improvement in severe burn patients' outcomes.

Impact of COVID-19 on global burn care.

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 pandemic, and whether country´s income, geographical location, COVID-19-transmission pattern, 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, χ2 or Fisher's 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 dedicated nursing staff was reduced (<0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration between 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.

Impact of the COVID-19 pandemic on the epidemiology of severe burns : A single center study from a specialized burn center in Vienna.

INTRODUCTION: Currently, very little detailed information on the epidemiological distribution and specificities of severely burned patients during the coronavirus disease 2019 (COVID-19) pandemic is available. This retrospective study aims to describe and compare this specific patient population based on 114 patients who were treated between March 2019 and March 2021 at the Center for Severe Burn Injuries at the Medical University of Vienna. METHODS: To answer the research questions, a retrospective cohort study has been conducted over a period of 24 months, starting in March 2019 and ending in March 2021. To evaluate the epidemiological differences, the patients were divided into 2 observation periods of 12 months each. RESULTS: In the period from 12 March 2020 to 11 March 2021, a total of 62 patients were admitted to the Center for Severe Burn Injuries. In comparison, only 52 patients were admitted in the same period of the previous year, which corresponds to an increase of 19.2%. In addition, it was noted that during the 2019-2020 observation period, 27% of patients were female and 73% male, whereas during the pandemic the gender distribution was 42% female and only 58% male. During the pre-pandemic observational period, 13 out of 52 patients admitted died (25%), whereas during the pandemic, 17 out of 62 patients succumbed to their injuries (27%). CONCLUSION: Although the severity of the COVID-19 pandemic seems to be decreasing, especially due to the increasing availability of vaccines, there is a need for more data on the impact of the crisis on severely burned patients. In contrast to the current literature, we have seen a greater number of inpatient admissions to the Center for Severe Burn Injuries, as well as significant differences in gender distribution. Our data also suggest that the circumstances of the pandemic have no influence on the likelihood of survival for patients with severe burns.

A Challenging Case of Rapid-Onset Multisystem Organ Failure in a Burn Patient

INTRODUCTION: Burns are significant injuries that cause a cascade of inflammatory responses. Patients with large burns and inhalation injury often experience respiratory failure, renal failure, liver dysfunction, and sepsis. The COVID-19 virus has added a unique challenge as a current or recent COVID-19 infection seems to lend to worse outcomes, However, we do not yet have enough data to understand the full implication of COVID-19 on burn patients. DESCRIPTION: A 41-year-old man with no remarkable medical history was admitted to the Burn Intensive Care Unit (BICU) with 58% body surface area burns with smoke inhalation. He was given appropriate burn resuscitation and placed on the volumetric diffusive respirator (VDR). Admission COVID-19 PCR was negative, and COVID-19 Spike IgG was 12 IU/mL. Both labs and vital signs remained stable and he went to the OR on hospital day 4 for excision and grafting and the first 24 hours post-op were unremarkable. On postop day 1, he had an abrupt rise in lactate with worsening acidosis. Sepsis guidelines were followed and he required initiation of renal replacement therapy (CRRT) along with bedside laparotomy with no significant findings. Repeat lab work showed a COVID-19 Spike IgG level >800. Patient's conditioned worsened despite maximal medical intervention, and he died on hospital day 8. Since the sudden, rapid decline in patient's condition at this point in his hospitalization is somewhat atypical, we theorize that patient was either admitted with COVID-19 infection that was undetectable, or this was a nosocomial infection. Though he had no significant comorbidities, it certainly seems that this new infection unduly stressed his immune system, leading to multi-system organ failure and death. DISCUSSION: Large burn injuries are often challenging to manage, but improved therapies and treatments have led to increasingly good outcomes. The addition of current or recent COVID-19 infection adds a new challenge which needs further study as we learn more about the inflammatory and long-term implications of this disease on lung function and immune systems. Our experience of rapid onset organ failure and death in a burn patient with likely new COVID-19 infection presented a unique burn and critical care management challenge that needs further study.

Changes in the types of patients in Burn Unit: A single center experience

Background Burns are a common concern around the world, with the majority of cases happening in low- and middle-income nations. China is the largest developing country. With the unremitting efforts of domestic colleagues, China has taken the lead in the treatment of burn in the world. With the change of times, we have observed some noteworthy changes in the types of patients that have admitted our Burns and Plastic Surgery, the Affiliated Hospital of Yangzhou University. Methods This retrospective observational study included brought into;all patients reached to our burn unit during 2013-2021. The gathered data were descriptively examined and statistically contrasted with each other year. Results Of 4407 cases admitted to burn unit during 2013-2021, men constituted 56% of such cases, with an average age of 47.3 ± 19.3 years. Moreover, among the patients hospitalized, January and February usually admit fewer than other months. Between 2013 and 2021, both the number of patients admitted to burn unit and the expense of their hospitalization rose yearly. The percentage of burn patients admitted to burn ward of our hospital is decreasing, especially during the period of serious Coronavirus disease (COVID-19) epidemic. We also observed that during the COVID-19 pandemic, patients with superficial masses also dropped off a cliff because of government controls. Conclusion The diseases in the department show the trend of maximizing marginal disciplines, burn surgeons are facing a more complex challenge. Further research addressing the relationship between the change of patient types and economic and social development in burn department will help to foster better pinpoint hospitalization patients need, fine service for hospitalized patients.

DELAYED PRESENTATION OF CHEMICAL PNEUMONITIS AND RELATED RESEMBLANCE TO COVID-19 ASSOCIATED PNEUMONIA IN CT IMAGING: A CASE REPORT

SESSION TITLE: Imaging, ECMO, and other Procedures in the ICU Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Inhalation of various organic and non-organic compounds like toxic fumes, batteries, and dust can result in lung irritation called chemical pneumonitis (1). Chemical Pneumonitis can cause acute complications like secondary pneumonia or long-term complications like bronchiectasis or lung destruction (2). Classical radiograph findings of chemical pneumonitis show pulmonary edema or radiographic opacities (3). This type of injury can initially present as no damage in radiograph scans, and the extent of damage can be difficult to determine initially. Chemical pneumonitis can also be difficult to distinguish from pneumonia caused by bacteria or a virus. CASE PRESENTATION: A 40-year-old male presented to the emergency department with an 18% total body surface area burn to his upper extremities from an oil pump battery explosion that released chemicals he likely aspirated. The patient was intubated and transferred to the Burn ICU where a bedside bronchoscopy was performed. It revealed no soot or signs of inhalation injury. On the day of admission, he had a 100% oxygen dependence. A CT scan was done and showed no lung damage. The patient was extubated and moved to a high-flow nasal cannula of 40 liters per minute. A repeat CT scan was performed of his chest on hospital day 4. The results appeared to be multifocal pneumonia eliciting a possible diagnosis of Covid 19 pneumonia. This delayed his excision and grafting by 5 days. Through aggressive respiratory therapy intervention, oxygen dependence was reduced until the patient was on room air. The patient was discharged to inpatient rehab on hospital day 21. DISCUSSION: There are several factors presented in this case that should be kept in mind when treating a patient exposed to compounds that can cause chemical pneumonitis. Chemical pneumonitis likely has no findings on bronchoscopy. Furthermore, previous literature has suggested that CT chest scans of chemical pneumonitis may initially present with no apparent injury. Regardless of these initial findings, it is important that patients receive intense pulmonary hygiene to avoid delays in other interventions. Chemical pneumonitis injuries can be associated with chemical burns, and it is imperative to avoid delays in interventions including excision and skin grafting. Findings from a chemical pneumonitis injury may present on a CT scan later in a patient's course of injury. The findings of the CT scan could resemble multifocal pneumonia. This may complicate treatment plans as SARS-CoV-2 is also known to cause multifocal pneumonia. CONCLUSIONS: This case highlights the complexity that chemical pneumonitis traumatic injury may present, and the various factors providers should keep in mind. In the aftermath of the COVID-19 pandemic, another factor has emerged: the resemblance of chemical pneumonitis to SARS-CoV-2 multifocal pneumonia. Reference #1: Andujar, P., & Nemery, B. (2009). Pathologies respiratoires aiguës et subaiguës d'origine toxique [Acute and subacute chemical pneumonitis]. Revue des maladies respiratoires, 26(8), 867–885. https://doi.org/10.1016/s0761-8425(09)73682-4 Reference #2: Neill, S., & Dean, N. (2019). Aspiration pneumonia and pneumonitis: a spectrum of infectious/noninfectious diseases affecting the lung. Current opinion in infectious diseases, 32(2), 152–157. https://doi.org/10.1097/QCO.0000000000000524 Reference #3:.White, C. S., & Templeton, P. A. (1992). Chemical pneumonitis. Radiologic clinics of North America, 30(6), 1231–1243. DISCLOSURES: No relevant relationships by Genesy Aickareth No relevant relationships by Deepak Bharadia No relevant relationships by John Griswold No relevant relationships by Alan Pang No relevant relationships by Jad Zeitouni

MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS (MIS-A) FOLLOWING SARS-COV-2 INFECTION PRESENTING AS TOXIC EPIDERMAL NECROLYSIS

SESSION TITLE: COVID-Related Critical Care Cases SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm INTRODUCTION: Multisystem Inflammatory Syndrome in Adult (MIS-A) is a rare hyperinflammatory response occurring 2 to 6 weeks after COVID-19 resembling Kawasaki disease. CASE PRESENTATION: A 23-year-old male presented to the emergency room with fevers, cough, shortness of breath, fatigue and painful rashes all over his body. 3 weeks prior, he was diagnosed with COVID-19 which was managed conservatively at home. He recovered within 3 days. He had received 2 doses of Moderna COVID-19 vaccine 6 months prior. He denied recent drug intake. Vitals were BP 116/78 mmHg, heart rate 164/min, temperature 97.3℉, SpO2 96% on room air. Physical exam revealed macular erythematous rash in his trunk and extremities. Leukocyte count was 4 k/uL, hemoglobin 15.5 g/dL, platelets 99 k/uL, sodium 126 mmol/L, bicarbonate 20 mmol/L, BUN 30 mg/dL, creatinine 2.2 mg/dL, lactate 5.1 mmol/L, ferritin >7500 ng/mL, total bilirubin 7.6 mg/dL, AST 298 U/L, ALT 291 U/L, ALP 106 U/L, procalcitonin 14.71 ng/mL, D-dimer 11.98 FEUug/mL. Troponin-I peaked at 1359 pg/mL. CT angiography of the chest showed clear lung fields without pulmonary embolism. Venous doppler was negative. Echocardiogram showed normal biventricular function and valves. An extensive infectious disease workup was negative. He was suspected to have MIS-A from recent COVID-19. He was started on methylprednisolone 1g/day, intravenous immunoglobulin (IVIG), anakinra and empiric antibiotics. Over the next 2 days, there was progression of rash with sloughing of skin in his trunk, back and extremities with bullae on his legs, and thigh sparing the face (figures). Skin biopsy revealed epidermal necrobiosis with apoptosis consistent with Toxic Epidermal Necrolysis (TEN). On day 3, he had a cardiac arrest from ventricular fibrillation but was successfully resuscitated. Subsequently, he was intubated, and required escalating vasopressor support for shock. On day 5, he also developed non-purulent conjunctivitis. On day 6, he was transferred to a higher center with a burns unit. However, despite aggressive supportive measures he succumbed to refractory shock the following day. DISCUSSION: Our patient fit the criteria for MIS-A outlined by CDC (1) with age ≥21 years, fevers, rash with non-purulent conjunctivitis for primary clinical criteria, hypotension and thrombocytopenia for secondary clinical criteria, several laboratory criteria, negative infectious work-up with a history of recent COVID-19. It is unclear if the COVID-19 vaccine increased his risk of MIS-A. There have been case reports of MIS-A presenting as TEN following COVID-19 and COVID-19 vaccines in the absence of typical triggering drugs. (2,3) MIS-A is treated with high dose steroids, IVIG, tocilizumab and supportive measures. Anakinra was used for our patient because of liver dysfunction. CONCLUSIONS: MIS-A following COVID-19 can also present as life-threatening skin reactions like TEN in the absence of triggering drugs. Reference #1: Retrieved from https://www.cdc.gov/mis/index.html Reference #2: Narang I, Panthagani AP, Lewis M, Chohan B, Ferguson A, Nambi R. COVID-19-induced toxic epidermal necrolysis. Clin Exp Dermatol. 2021;46(5):927-929. Reference #3: Kherlopian A, Zhao C, Ge L, Forward E, Fischer G. A case of toxic epidermal necrolysis after ChAdOx1 nCov-19 (AZD1222) vaccination. Australas J Dermatol. 2022;63(1):e93-e95. DISCLOSURES: No relevant relationships by Fady Jamous No relevant relationships by Swaminathan Perinkulam Sathyanarayanan

CONSULTATION-LIAISON PSYCHIATRY RESPONSE TO THE IMPACT OF BUSHFIRES, VOLCANOS AND COVID-19 ON A STATE-WIDE BURN CENTRE

Background: The Statewide Burns Unit (SWBU) at Royal North Shore Hospital, one of two burns units in NSW, is a 12-bed unit run under the plastics/burns surgical team, nurse unit manager and multidisciplinary allied health team. Consultation-liaison (CL) psychiatry provides a part-time CL psychiatry registrar supervised by a parttime CL psychiatrist, who see and assess all admissions for pre-morbid and/or new and emerging acute mental health (MH) issues. Over 2019-2021 the SWBU saw significant numbers of burn injury patients because of several natural disasters and a spike in self-immolation during Sydney's COVID-19 lockdowns. The traumatic nature of the injuries was challenging for staff to manage over such a prolonged period. Senior team members were aware of the urgent need to (1) increase support for staff to minimise burnout risk and (2) improve access to longer-term psychological treatments for patients after discharge. Objectives: To report on the MH issues managed during this time, the management challenges and the process of significant service development, aiming to address unmet patient need as well as staffing, burnout and vicarious trauma. Methods: Naturalistic file review and NSW Statewide Burns registrar review supplemented by data from interviews with SWBU multidisciplinary team staff members. Conclusion: Trauma-informed and relational care is at the heart of the SWBU multidisciplinary team approach to care, requiring high-level service support and funding. CL psychiatry services can have a significant role in promoting service development, which sits under CanMEDS hats of clinical expert, advocate and leader.

Choosing wisely: The use of clinical criteria to guide blood culturing practices

INTRODUCTION: Fever is a common problem in ICU patients. Despite clinical research and guideline recommendations indicating that clinical criteria and not fever alone should be used to order blood cultures (BC), these cultures are frequently obtained as part of a “fever workup” without careful review of the patient's clinical status. Unnecessary BC increase clinical workload and can lead to inappropriate treatments if the culture is contaminated. The purpose of this quality improvement (QI) initiative was to develop clinical criteria that providers were to review when ordering BC, with a goal to reduce the numbers of inappropriate BC. METHODS: This QI project was completed in a 36-bed surgery/trauma/burn ICU. After reviewing pertinent studies and guidelines, clinical criteria for obtaining blood cultures were developed by a subcommittee and approved by the ICU QI committee. These criteria included a core temperature of 38.3°C on at least two separate readings, evidence of sepsis with worsening physiologic parameters in at least one organ system, no apparent non-infectious cause of fever, at least 48 hours after non-emergency surgery, no BC obtained in the past 36 hours unless positive, and no plans for end of life or comfort care. The protocol was implemented in February, 2021. Numbers of BC were tracked for 5 months after implementation, and compared for the same 5-month periods for 2019 and 2020, to capture trends both before and during the COVID pandemic. RESULTS: The average number of BC/month prior to implementation of clinical criteria were 218 in 2019 and 209 in 2020 (CI 212-225). After implementation of clinical criteria, the number was 184 (CI 139-221) in 2021. This represented a 14% decrease in the number of BC, although this decrease did not achieve statistical significance. CONCLUSIONS: The implementation of clinical criteria for when to obtain BC resulted in a reduced cultures. Further investigation is needed to determine if this decrease is sustainable and will reach statistical significance, if the criteria can be further modified to further decrease inappropriate BC, and to ensure that decreasing the number of BC does not result in delayed recognition of bacteremia or other infections. Following clinical criteria to avoid unnecessary BC could be a helpful tool to help clinicians to choose wisely.

Into the pandemic and out of the fire?

Aim: The Covid-19 pandemic has seen various government restrictions on all aspects of daily life. We assessed whether these lifestyle alterations have affected the number, severity and presentation of burns seen at a Paediatric Burns Unit. Methods: We looked at Paediatric Burns admissions to Plastic Surgery during the Covid-19 pandemic of March 2020 to Jan 2021 (DC), as well as comparison data prior to Covid-19 from April 2019 to February 2020 (PC). We also looked at specific periods of national lockdown. Using data from our electronic records we looked at varying aspects of a patient's journey. Results: In total 788 cases were admitted to the Burn's team from April19 -January21. The mean age of patients both DC and PC were 4.7 years with the mean during the first lockdown of 5. The time to presentation PC was 2.6 days, DC was 1.79 days and 2.4 days during the first lockdown. This was not significant (p=0.2). The median total body surface area (TBSA) was <1% in both PC and DC patients. Scalds made up 53% of the first lockdown injuries, this had no statistically significant difference as compared to PC and DC injuries (48% and 46% respectively). Conclusions: Overall burns admissions during the Covid-19 pandemic did not significantly change as compared to the previous year. This contrasts published adult results, which demonstrates reduced burns admissions during Covid-19. We suggest this may be due to unchanged causative factors in paediatric burns which are predominantly found in domestic lockdown environments.

Characteristics of burn injury during COVID-19 pandemic in Tokyo: A descriptive study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has drastically changed everyday life worldwide. This study aimed to determine how COVID-19 affected the characteristics and outcomes of patients with severe burn injury by examining a city-wide burn database in Tokyo. PATIENTS AND METHODS: A descriptive study was conducted in 14 burn centers using the Tokyo Burn Unit Association registry from 1999-2020. The pandemic started in 2020, while the stay-at-home order lasted from April to May. The demographics, mechanisms, severity, and clinical outcomes were assessed before and during these two time periods. RESULTS: In total, 7061 patients with burn injury were enrolled. During the pandemic, there were less patients during the pandemic than previous years, except for April-May; this decreased toward the end of 2020. There were also more scald/contact burns in the upper extremity, less intended and assault injuries, shorter length of hospital stay, and lower in-hospital mortality. During the stay-at-home order, there was increased incidence of flame burns, inhalation injuries, and in-hospital mortality, as well as higher total body surface area of full-thickness burns. CONCLUSIONS: This study described the characteristics of burns during the COVID-19 pandemic. The association between the stay-at-home order and severity of burns should be further examined.

Changes in the epidemiologic profile of burn patients during the lockdown in Catalonia (Spain): A warning call to strengthen prevention strategies in our community.

BACKGROUND: The worldwide coronavirus disease 2019 (COVID-19) epidemic, caused by the SARS-CoV-2 coronavirus, is the defining global health crisis of our time. Spain has had one of the highest burdens of COVID-19 worldwide. During this period, Vall d'Hebron University Hospital Burn Center (Barcelona) has faced a unique challenge: supporting the hospital response against COVID whilst continued offering an optimal care to the burn patient. OBJECTIVE: The aim of this study is to characterize the clinical and epidemiological characteristics of acute burn patients who received urgent health care or admission to the our Burn Center during the mandatory confinement period in Spain forced by the COVID-19 epidemic. METHODS: We analyzed the medical records of burn patients who received urgent care and/or admission to our Burn Center during the mandatory confinement period in Spain (Period 1: from March 14th to May 9th, 2020) and during the same period of the last year (Period 2: from March 14th to May 9th, 2019). Both groups were compared in order to find differences in the epidemiologic profile of burned patients. RESULTS: A total of 350 burns cases were analyzed. A 36% reduction in the number of emergency department visits was identified during Period 1. However, we found an increase in the rate of hospital admissions in Period 1 (20% of the burn cases) compared with Period 2 (13% of the burn cases). Seventy-six burn-related primary admissions were analyzed: 37 patients were admitted during Period 1 and 39 patients during Period 2. No differences were found between the two periods in the proportion of patients that underwent surgical treatment: 59.5% of patients admitted during Period 1 and 61.5% of patients admitted during Period 2. A statistically significant increase was noted in the rate of paediatric (aged 0-16 years old) admissions during Period 1 (40.54%, n = 15) compared to Period 2 (20.5%, n = 8). Among paediatric patients, an increase in the rate of surgical procedures was noted in Period 1 (47% of children), compared with Period 2 (37% of children). Proportion of patients that were admitted to the Intensive Care Unit was higher among burn children admitted during period 1 (46.7%, n = 7) than those admitted during Period 2 (25%, n = 2). Among the 37 patients admitted during the lockdown period, two positive COVID-19 patients were confirmed. CONCLUSIONS: This study gives an overview of the clinical and epidemiologic profile of burned patients during the stringent lockdown in Spain forced by the COVID-19 epidemic. Our data shows a stable trend in the number of burn-related admissions and burn related-surgeries during the confinement period. A significant increase in the rate of burn children admitted and an increase in the severity of injuries in this population is noted. These data must be taken in account in the development of strategies to ensure the maintenance of Burn Centers function in extremely situations such as the current epidemic. A lack of effective burn prevention campaigns in our environment has been noted and the development of focused prevention strategies is a priority.