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Research

The ANZBA Research Committee are facilitating, promoting and advocating for collaborative burn injury research and burn care research throughout Australia and New Zealand. Through collaborative research, we strive to improve the quality of burn care, and evidence-informed practice.

Current burn research studies being undertaken in Australian and New Zealand burn centres can be searched in this file, and are listed below:

Dr Marcus Wagstaff & Tanja Klotz(OT)

marcus.wagstaff@sa.gov.au

Sites: Royal Adelaide Hospital

Inclusions: 18+, adult burn patients with scar-associated complications for reconstruction with laser as assessed in multi-D reconstruction clinic, convenience sample, prospective, any location, time post-injury varies greatly.

Exclusions: inability to provide consent, active infections, previous radiation treatment, pregnancy or lactation, participation in another trial that may affect the outcome, complex locations, use of Accutane in last 6-12m, history of keloid formation.

Outcomes Assessed: Procedure details, demographics, skin type, ROM, MAPS, POSAS-O, POSAS-P, DAS, Dermalab measures: ultrasound for skin thickness, TEWL, colour, elasticity, TEWL with Vapome

Tanja Klotz(OT)

tanja.klotz@sa.gov.au

Sites: Royal Adelaide Hospital

Inclusions: Studies examining the reliability and measurement error of devices that measure trans epidermal water loss (TEWL)

Exclusions: Studies which only report on TEWL outcomes.

Statistical reliability and measurement error, characteristics of study design.

Nick Barry

nicholas.barry@health.nsw.gov.au

Sites: Royal North Shore Hospital, Concord General Repatriation Hospital

Inclusions: Patient age >18 Burn sustained from cryolipolysis undertaken for cosmetic purposes.

Exclusions:

Outcomes Assessed: Burn TBSA % Burn thickness Length of stay Theatre procedures Time to heal

Ruilong Zhao

rzha9073@uni.sydney.edu.au

Sites: Royal North Shore Hospital, Concord General Repatriation Hospital

Inclusions: 18+, 10-80%TBSA, partial or full thickness

Exclusions: pregnant, activate local or systemic infection, other known coagulopathies

Outcomes Assessed: IV fluids, ICU LOS, LOS, number of surgeries, sepsis, mortality

Nicola Clayton

nicola.clayton@health.nsw.gov.au

Sites: Concord General Repatriation Hospital

Inclusions: Any patient admitted to the Concord Burn Service over the age of 75 years with acute burn injury who is treated with the intent for survival

Exclusions: Day admission for surgical procedure only Palliative patients Non-burn admission (e.. nec fasc, TENS)

Outcomes Assessed: Primary endpoints: 1. Functional Oral Intake Scale 2. Dysphagia related complications Secondary endpoints: 1. Age, 2. Gender (male / female), 3. %TBSA burnt, 4. Burn depth per percentage: % Full thickness and % Partial thickness (as defined by medical treatment ie. paraffin / biobrane / graft), 5. BAUX score (calculation based on age and % TBSA burnt), 6. Mechanism of injury, 7. Past medical history, 8. Duration of dysphagia treatment, 9. Duration of enteral supplementation, 10. Duration of oral supplementation, 11. Hospital LOS, 12. ICU LOS, 13. Days of mechanical ventilation, 14. Dependence on others for feeding, 15. Surgical decision for conservative management (by Senior Burns Consultant), 16. Surgical decision for surgical management (by Senior Burns Consultant), 17. Number of surgical procedures requiring General Anaesthetic, 18. Nutritional data: MST (Malnutrition Screening Tool), SGA (Subjective Global Assessment), MNA (Mini Nutritional Assessment), REE (Resting Energy Expenditure) 19. Days of bed rest (as an indicator for muscle wasting) 20. Days to mobilisation (from admission) 21. Contributing new medical condition associated with burn (eg. MI, UTI, delirium), 22. Living arrangement prior to admission (ie. home alone, home with family, nursing home, etc.), 23. Discharge destination (ie. home, nursing home, etc.)

Nicola Clayton

nicola.clayton@health.nsw.gov.au

Sites: Concord General Repatriation Hospital

Inclusions: 1. All patients admitted to the NSW Statewide Burn Injury Service at Concord Hospital and The Victorian Adult Burns Service at The Alfred Hospital for treatment of burn injury with suspected inhalation injury 2. Inhalation burn injury confirmed on nasendoscopy / bronchoscopy 3. ICU admission and intubation may form part of treatment

Exclusions: 1. Previous known laryngeal pathology 2. Previous known dysphonia 3. Patients whose voice function was not assessed due to poor prognosis for survival as determined at admission by the managing Burns Surgeon

Outcomes Assessed: 1. Burn demographic data: %TBSA burn, burn location and mechanism 2. Patient demographic data: Age, gender, duration of intubation, past medical history, ICU and Hospital LOS 3. Voice and laryngeal assessment: Presence of dysphonia defined by (a) clinical assessment, and (b) nasendoscopy 4. Duration of dysphonia: as defined by (a) days to achieve voice, (b) days to return to premorbid vocal function 5. Treatment methods for dysphonia and laryngeal pathology: details regarding compensatory, therapeutic, pharmacological and surgical techniques and their outcomes associated with burn (eg. MI, UTI, delirium), 22. Living arrangement prior to admission (ie. home alone, home with family, nursing home, etc.), 23. Discharge destination (ie. home, nursing home, etc.)

Nicola Clayton

nicola.clayton@health.nsw.gov.au

Sites: Concord General Repatriation Hospital

Inclusions:

Exclusions:

Outcomes Assessed: Swallowing endpoints as defined by Functional Oral Intake Scale, Flexible Endoscopic Evaluation of Swallowing (NZSS, PAS, Yale), Indirect Calorimetry, Peak Expiratory Flow, mechanical ventilation duration, ICU LOS, Hospital LOS.

Helen DeJong

info@perthspc.com.au

Sites: Fiona Stanley Hospital

Inclusions: Adults attending the FSH Adult State Burns Outpatient Clinic at FSH with a burn injury. Assessing healed burn scars from 6 weeks post injury.

Exclusions: Non healed scars/open wounds. Infectious scars.

Outcomes Assessed: Ultrasound based scar thickness, echogenicity, Doppler and shear-wave elastography to quantify scar depth, density, vascularity and stiffness respectively. Also collecting burn depth, VSS, surgical intervention, time since injury, Fitzpatrick Skin Type and basic demographics.

Guy Stanley

Guy.stanley@Gmail.com

Sites: Fiona Stanley Hospital

Inclusions: Adults

Exclusions: Unable to consent

Outcomes Assessed: Delirium Length of stay

Dr Ashley Whitehorn

ashley.whitehorn@adelaide.edu.au

Sites: Royal Brisbane & Women’s Hospital,Queensland Children’s Hospital,Royal North Shore Hospital,Children’s Hospital Westmead,Concord General Repatriation Hospital,Middlemore Hospital,Waikato Hospital,Hutt Hospital,Christchurch Hospital,Royal Hobart Hospital,The Royal Children’s Hospital Melbourne,The Alfred Hospital,Adelaide Women’s & Children’s Hospital,Royal Adelaide Hospital,Fiona Stanley Hospital,Perth Children’s Hospital,Royal Darwin Hospital,Other Hospital Site

Inclusions: One staff member (e.g. nurse, doctor) from each burns unit across Australia and New Zealand with relevant experience in facial burns management will be invited to participate in the survey.

Exclusions:

Outcomes Assessed: Self reported survey responses

Eduardo Deliyannis

ed16630@bristol.ac.uk

Sites: Royal Brisbane & Women’s Hospital,Queensland Children’s Hospital,Royal North Shore Hospital,Children’s Hospital Westmead,Concord General Repatriation Hospital,Middlemore Hospital,Waikato Hospital,Hutt Hospital,Christchurch Hospital,Royal Hobart Hospital,The Royal Children’s Hospital Melbourne,The Alfred Hospital,Adelaide Women’s & Children’s Hospital,Royal Adelaide Hospital,Fiona Stanley Hospital,Perth Children’s Hospital,Royal Darwin Hospital,Other Hospital Site

Inclusions:

Exclusions:

Outcomes Assessed: Assessing the quality of first aid data Assessing the quality of factual information Using a scoring system for websites

Mark Fear

mark@fionawoodfoundation.com

Sites: Perth Children’s Hospital

Inclusions: Paediatric patients who are attending Perth Children’s Hospital for burn care and treatment.

Exclusions: Intentional burn injury, Presence of immunodeficiencies, Conditions where blood collection isn’t safe (eg. blood thinning medication, haemophilia), Unable or unwilling to consent to specimen collection and storage, Diagnosed cognitive impairment, intellectual disability and/or mental illness, Nappy rash if urine collection requires urine bag

Outcomes Assessed: routinely collected clinical data

Fiona Wood

fiona.wood@health.wa.gov.au

Sites: Perth Children’s Hospital

Inclusions: All consecutive paediatric acute burn admissions Child 2 years or older

Exclusions: Significant psychiatric morbidity in parent or social issues requiring professional psychosocial intervention postburn. Not able to read and understand the information Unwilling to take part in the study Comorbidities and/or injuries that influence ability to participate in physical activity measures

Outcomes Assessed: Basic clinical data PedsQL, SDQ, CPSs IWS-R (parents) Physical activity questionnaire BBSIP

Dale Edgar

dale.edgar@health.wa.gov.au

Sites: Fiona Stanley Hospital

Inclusions: Burn Clinical Registry study Adult burn patients > 16 yo

Exclusions: Burn patients managed in ambulatory (outpt) mode

Outcomes Assessed: LOS # surgeries complications (ICD10 coded) Functional outcomes – Lower Limb Functional Index; QuickDASH HRQoL – SF36; BSHS-B

Dr Daniel Riciardello

dricciardello@gmail.com

Sites: Children’s Hospital Westmead

Inclusions: Time Period: January 2004 to December 2019 Cohort: Referred to CHW Burns Unit for burn related to firework or sparkler burns. Including those treated as inpatient and those treated in ambulatory care setting Age: Under 16 years

Exclusions:

Outcomes Assessed: Patient gender, patient age, TBSA%, ICU admission, intubation, operating sessions (n), dressing/debridement, skin grafting, mechanism of injury, location of injury, adequacy of first aid (defined as cool running water for 20 minutes within the first three hours of the injury), presence of parental supervision, and mode of treatment.

Dr Daniel Riciardello

dricciardello@gmail.com

Sites: Children’s Hospital Westmead

Inclusions: Study Period: December 2009 to December 2019 (Retrospective Study) Cohort: Children treated at CHW Burns Unit for a burn injury and required endotracheal intubation Age of patients included: Under the age of 16 years

Exclusions: Patients were excluded if the endotracheal intubation was unrelated to their burn injury.

Outcomes Assessed: Information collected included patient information (age and gender), mechanism of injury, location of injury, percentage total body surface area (%TBSA) affected and number of days intubated.

Madeleine Jacques

madeleine.jacques@health.nsw.gov.au

Sites: Children’s Hospital Westmead

Inclusions: Case Report which involved a 4 year old female who sustained a thermal injury. Child was playing with tubes of superglue whilst sitting in front of a fan heater.

Exclusions:

Outcomes Assessed: Literature review was conducted to identify any other published case reports/series in which children have sustained a burn injury from cyanoacrylate glue. Literature revealed 16 documented cases of glue burns over 11 papers from 2011 to 2020. Outcome measures reported on case at CHW: mechanism of injury, adequacy of first aid, %TBSA, depth of burn, surgery required (grafting), days until healing and scar management.

Madeleine Jacques

Madeleine.jacques@health.nsw.gov.au

Sites: Children’s Hospital Westmead

Inclusions: Study Period: All exhaust contact burn injuries referred to the CHW burns service for consultation and management between January 2009 to December 2019.Patients between 0 to ≤16 years of age will be included for review.

Exclusions:

Outcomes Assessed: Age, sex, home location, geographical treatment location, visits required at tertiary service, total burns surface area, site of injury, mechanism of injury and treatment outcome (days to healing, surgical intervention, scar treatment/management (including contracture release requirements, laser and micro needling treatment)).

Jason Diab

jdmisciali@gmail.com

Sites: Children’s Hospital Westmead

Inclusions: A retrospective review from January 2010 to January 2019 at The Children’s Hospital at Westmead. All barbecue coal burn injuries in children less than 16 years that attended or were referred to the Burns Unit were included.

Exclusions:

Outcomes Assessed: A retrospective review from January 2010 to January 2019 at The Children’s Hospital at Westmead. All barbecue coal burn injuries in children less than 16 years that attended or were referred to the Burns Unit were included.

Jason Diab

jdmisciali@gmail.com

Sites: Children’s Hospital Westmead

Inclusions: A retrospective review from January 2009 – December 2019 at The Children’s Hospital at Westmead Burns Unit. All burn injuries of age less than 16 years that attended or were referred to the Burns Unit were included in this study.

Exclusions:

Outcomes Assessed: Data was collected from the database including information on: sex, ethnicity, residential address, first aid location of injury, total burn surface area (TBSA), operative intervention, length of stay, number of outpatient visits for treatment, infection and surgical complications.

Sonia Tran

Sonia.Tran@health.nsw.gov.au

Sites: Children’s Hospital Westmead

Inclusions: School Age Children (5-16 years of age), Referred to the Burns Unit at The Children’s Hospital at Westmead between January 2005 to January 2019, Both inpatients and children treated in the ambulatory setting were included.

Exclusions:

Outcomes Assessed: Patient age and sex, mechanism of burn injury, place of injury, depth of burn, percentage total body surface area (%TBSA) involved, anatomical area affected, whether an inpatient admission was required, length of stay (LOS), need for skin grafting, and complications (infection and unplanned re-admission).

Madeleine Jacques

madeleine.jacques@health.nsw.gov.au

Sites: Children’s Hospital Westmead

Inclusions: All glue burn injuries referred to the CHW burns service for consultation and management between January 2007 to August 2020. Patients between 0 to ≤16 years of age will be included for review.

Exclusions:

Outcomes Assessed: Primary Outcome Measure: 1. Incidence of glue burns in the NSW paediatric population. Secondary Outcome Measures: 1. Classification of mechanism of injury (was exothermic reaction from glue and cotton recognised?) 2. Time to healing 3. Requirement for surgical intervention 4. Ongoing scar treatment/management requirement

Cheri Templeton

cheri.templeton@health.nsw.gov.au

Sites: Children’s Hospital Westmead

Inclusions: Children that are current outpatients at CHW, Children aged 12months-5 years, Burns with equal to or less than 10% BSA(Body Surface Area) which involve a hand burn, A hand burn that requires skin grafting, Hand burns that take 14 days or longer to heal that require at least 4 months of physiotherapy treatment, Parents and children that are able to speak read and understand English.

Exclusions: Children that have partial or full amputation of a digit, Comorbidities such as rheumatoid arthritis, muscle or nerve conditions, moderate to severe developmental disability that would affect upper limb function or any other comorbidity that in the principle investigators opinion that would significantly affect upper limb function/measurement of outcomes, Burns larger than 10% BSA, Burns that healed in under 14 days, Parents unable to provide written informed consent

Outcomes Assessed: Basic demographic information of participants will be collected from the SBIS at the beginning of the study necessary for determination of inclusion into the study. This includes participant’s name, TBSA, burn distribution, age and gender. Parent filled demographic data questionnaire (information regarding family socioeconomic status and child’s daily activities). Relevant data of medical history will be obtained through an audit of medical records and will include date of injury, burn location, TBSA of burn , depth of burn, mechanism of injury, related surgical interventions and ongoing burn management (exercise, splinting., etc ) necessary for determination of inclusion into the study. PDMS-2 score. ROM flexion and extension/Contracture (goniometry) measurement.

Andrea Mc Kittrick

Andrea.McKittrick@health.qld.gov.au

Sites: Royal Brisbane & Women’s Hospital

Inclusions: Adult patients aged >18 years, patients aged <18 years with parental consent Total Body Surface Area (TBSA) <15% treated with skin grafting Scar present on a limb will be eligible for Vacuum

Exclusions: Patients aged <18 years without parental consent TBSA >50% Pregnancy Inability/unwilling to return for follow up Inability to provide informed consent Non-English speaking Patients with underlying medical or surgical history that is a contraindication to vacuum therapy. Scars to the face, neck or genitals will not be included

Outcomes Assessed: Patient-reported outcome measures will the primary data collected. These outcome measures include the Brisbane Burn Scar Impact Profile (BBSIP), Patient Observer Scar Assessment Scale (POSAS), EQ-5D-5L (Quality of life), Short Assessment of Patient Satisfaction (SAPS). Scar height will be objectively assessed using the DermaLab ® series ultrasound (CORTEX Technology). Sociodemographic details, hospital attendance, resource usage and intervention data and related costs will also be recorded. Data will be collected at baseline, 6 and 12-months post commencement of vacuum therapy.

Andrea Mc Kittrick

Andrea.McKittrick@health.qld.gov.au

Sites: Royal Brisbane & Women’s Hospital

Inclusions: A search of the published literature using electronic data bases MEDLINE, CINAHL, PEDro, OT seeker and PubMed was undertaken. Studies were included if they reported assessment tools and outcome measures used to determine hand function post severe burn injuries; were published in English and available in their full-length.

Exclusions: Studies were excluded if they were related to a group under 18 years of age.

Outcomes Assessed: Thirty-four papers were included in this systematic review. A total of 25 outcome measures were confirmed for inclusion in this paper and each underwent further evaluation to identify their psychometric properties.

Andrea Mc Kittrick

Andrea.McKittrick@health.qld.gov.au

Sites: Royal Brisbane & Women’s Hospital

Inclusions: A cross-sectional study using survey design

Exclusions: Studies were excluded if they were related to a group under 18 years of age.

Outcomes Assessed: Thirty-four papers were included in this systematic review. A total of 25 outcome measures were confirmed for inclusion in this paper and each underwent further evaluation to identify their psychometric properties.

Leila Cuttle

leila.cuttle@qut.edu.au

Sites: Queensland Children’s Hospital,Children’s Hospital Westmead,Perth Children’s Hospital

Inclusions: Opportunistic recruitment of any paediatric burn patients undergoing a procedure whereby blister fluid or blood can be collected, patient age 0-16 years

Exclusions: Unable to provide informed consent for recruitment

Outcomes Assessed: Patient demographics, Wound TBSA/depth/anatomical area/mechanism, first aid treatment, Time until wound re-epithelialisation, POSAS, BBSIP, VSS, scar ultrasound thickness, scar treatment (laser/microneedling/reconstruction), day post-burn sample was collected

Leila Cuttle

leila.cuttle@qut.edu.au

Sites: Queensland Children’s Hospital,Other Hospital Site

Inclusions: Paediatric age 0-16, retrospective data analysis

Exclusions:

Outcomes Assessed: patient demographics, burn TBSA/depth/anatomical area/mechanism, time until presentation, first aid treatment, activity when burn occurred, burn intent, mortality or discharge date.

Nicola Clayton

Sites: Concord General Repatriation Hospital

Inclusions: Admitted to the Concord Repatriation General Hospital Intensive Care Unit, and are treated with the intent to survive; Intubation, tracheostomy and non-invasive ventilation may have formed part of treatment; ICU acquired weakness as defined by: A score of ≤48 on the Medical Research Council for ICU Acquired Weakness; AND Dysphagia as defined by Clinical Swallowing Examination (CSE) and Flexible Endoscopic Evaluation of Swallowing (FEES) with abnormal rating on PAS, Yale or FOIS outcome measure scales

Exclusions: Patients whose swallow function is not suitable to be assessed due to poor prognosis for survival as determined by the managing intensivist; Patients whose swallow function is not suitable to be assessed post extubation for surgical reasons e.g. gastrointestinal surgery; Patients unable to participate in prescribed therapy regime due to inadequate cognitive capacity, delirium, recent H&N surgery, end stage respiratory disease, uncontrolled hypertension; Previous history of dysphagia; Patients who are not able to receive FEES or participate in EMST due to COVID-19 status

Outcomes Assessed: DEMOGRAPHIC: 1. Age, 2. Gender (male / female), 3. Primary medical diagnosis, 4. Hospital length of stay (days), 5. ICU length of stay (days), 6. Presence of tracheostomy (yes/no), 7. Duration of mechanical ventilation (days), 8. APACHE II score, 9. Past medical history, 10. Days of bed rest, 11. Number of aspiration related complications as diagnosed by treating Medical Officer, RESPIRATORY: 1. Peak Expiratory Flow (PEF) in L/min 2. Maximum Expiratory Pressure (MEP) in cm/H2O SWALLOWING: 1. Duration to Initial Speech Pathology Assessment (DSPA) – as defined by days from date of 1st ICU admission to date of 1st Speech Pathology contact; 2. Presence and severity of dysphagia on CSE: For each CSE conducted the following measures will be collected. a) FOIS (severe<4, moderate = 5, mild = 6, none = 7) The FOIS is 7-point scale where: 1=nothing by mouth; 2=tube dependent with minimal attempts of food and fluid; 3=tube dependent with consistent intake of food and fluid; 4=total oral diet of a single consistency; 5=total oral diet with multiple consistencies but requiring special preparation or compensations; 6=total oral with multiple consistencies without special preparation, but with specific food limitations; 7= total oral diet with no restriction. b) International Dysphagia Diet Standardisation Initiative (IDDSI) food and fluid levels: The IDDSI food and fluid scales is a tool designed to provide standardised terminology for different food and fluid textures on an international scale. 3. Presence and severity of dysphagia on FEES: For each FEES conducted the following measures will be collected. a) Secretion rating: The New Zealand Secretion Scale (NZSS) (Miles et al., 2017) is a 7-point scale that describes the presence and severity of secretions retained within the pharynx and larynx b) Aspiration (food and fluid) Aspiration will be rated using the Penetration-Aspiration Scale (PAS) (Rosenbek et al 1996). The PAS is an 8-point scale that describes the presence and severity of food/fluid airway invasion and the patient’s response (1 = no aspiration, 8 = aspiration with no reflexive cough). The worst rating obtained for each food and fluid level will be recorded c) Residue (food and fluid): The Yale pharyngeal residue scale (Neubauer et al., 2015) will be used to rate residue after swallow as a sign of clinical efficiency of the swallow. The Yale scale is a 5-point scale that describes the presence and severity of residue in the valleculae and piriform fossae. The worst rating obtained for each food and fluid level will be recorded 4. Key time points to dysphagia rehabilitation stages: a) Duration to Commencing Dysphagia Rehabilitation (DCDR) – as defined by days from date of 1st ICU admission to date commencing dysphagia rehabilitation b) Duration to Initiate Oral Feeding (DIOF) – as defined by days from date of 1st ICU admission to date of initiation of oral feeding c) Duration to Resolution of Dysphagia (DROD) – as defined by days from date of 1st ICU admission to date of resolution of dysphagia d) Duration of Dysphagia Treatment (DODT) – as defined by days from date of 1st Speech Pathology contact 5. Persistent Dysphagia after discharge. Defined by dichotomous rating (yes/no) at the point of hospital discharge based on clinical swallow examination and the ongoing need for modified food/fluid diet NUTRITION: 1. Resting Energy Expenditure (REE) – as defined by kCal/day 2. Indication for enteral feeding (EF) – as defined by a dichotomous rating (yes/no) 3. Duration of enteral feeding (DOEF) – as defined by days from 1st ICU admission to cessation of enteral feeding

Nicola Clayton

 

Sites: Concord General Repatriation Hospital

Inclusions: Any patient receiving mechanical ventilation with level of alertness sufficient to show communicative intent

Exclusions:

Outcomes Assessed: Communication effectiveness (AusTOMS and structured questionnaire), anxiety (Face Anxiety Scale) and distress (Distress Thermometer) during MV will be evaluated, pre and post implementation of the touch-screen tablet. Additional data on demographics, ICU length of stay, MV hours will also be collected

Dr Yiwei Wang

Sites: Concord General Repatriation Hospital

Inclusions:

Exclusions:

Outcomes Assessed:

Amber Jones

Sites: Royal Brisbane & Women’s Hospital

Inclusions: Adults post burn injury who are consumers of the RBWH Burn Service; RBWH and remote facility staff who are involved with the RBWH Burn Service.

Exclusions:

Outcomes Assessed: Service activity data Qualitative data from surveys / interviews / focus groups