Stem cells and burns: review and therapeutic implications.

Despite significant advances in burn resuscitation and wound care over the past 30 years, morbidity and mortality from thermal injury remain high. Limited donor skin in severely burned patients hinders effective wound excision and closure, leading to infectious complications and prolonged hospitalizations. Even with large-volume fluid resuscitation, the systemic inflammatory response syndrome compromises end-organ perfusion in burn patients, with resultant multiorgan failure. Stem cells, which enhance wound healing and counteract systemic inflammation, now offer potential therapies for these challenges. Through a review of the literature, this article seeks to illustrate applications of stem cell therapy to burn care and to highlight promising areas of research.

Burn injury reduces neutrophil directional migration speed in microfluidic devices.

Thermal injury triggers a fulminant inflammatory cascade that heralds shock, end-organ failure, and ultimately sepsis and death. Emerging evidence points to a critical role for the innate immune system, and several studies had documented concurrent impairment in neutrophil chemotaxis with these post-burn inflammatory changes. While a few studies suggest that a link between neutrophil motility and patient mortality might exist, so far, cumbersome assays have prohibited exploration of the prognostic and diagnostic significance of chemotaxis after burn injury. To address this need, we developed a microfluidic device that is simple to operate and allows for precise and robust measurements of chemotaxis speed and persistence characteristics at single-cell resolution. Using this assay, we established a reference set of migration speed values for neutrophils from healthy subjects. Comparisons with samples from burn patients revealed impaired directional migration speed starting as early as 24 hours after burn injury, reaching a minimum at 72-120 hours, correlated to the size of the burn injury and potentially serving as an early indicator for concurrent infections. Further characterization of neutrophil chemotaxis using this new assay may have important diagnostic implications not only for burn patients but also for patients afflicted by other diseases that compromise neutrophil functions.

Admissions across state lines: harnessing the insight of the National Burn Repository for the healthcare accessibility, fiscal, and legislative concerns facing the American Burn Association.

One of the most significant data collection efforts undertaken by the American Burn Association, the National Burn Repository (NBR) now encompasses more than 180,000 admissions. The Government Affairs Committee designated the prevalence of across-state-line burn admissions as one of its initial major inquiries to be made of the NBR. This line of inquiry could have bearings on healthcare access, legislative advocacy, and burn center solvency. The NBR Advisory Committee provided a specifically abstracted report after the 2005 call for data. Because of patient confidentiality concerns the file only contained admission frequencies by state-of-injury:state-of-care pairs. Nevertheless we were able to produce suggestive summary statistics and national maps for interpretations. This abstracted data encompasses records between 1995 and 2005, during which 8157 cross-state border admissions occurred, 6714 of which were to non-Shriner's hospitals. The rate of border crossing ranged from 0 to 202 patients annually. The highest rates were from the northernmost western states, northernmost New England states, and several southern states. Utah, West coast, and Great Lakes states sent relatively few admissions to other states. Twenty-seven states received no out-of-state admissions whereas several states had very high hosting rates. Although mapping cross-state burn admissions is an elementary exercise it demonstrated the value of the NBR for the Committees on Organization and Delivery, Government Affairs, and other facets of the American Burn Association. Anticipated access to ZIP Code data will permit: 1) granular identification of underserved areas, 2) documentation and prediction of reimbursement challenges, 3) mapping of de facto burn center referral markets, 4) mass disaster capacity planning, and 5) community-level burn risk factor analyses.