Open research questions in Burn Injury Management and Outcomes

What the literature leaves open

• Burn injuries have significant physical, emotional, and social consequences. Emotional distress and functional limitations can persist long after the initial injury. There is a lack of effective interventions to address emotional distress in burn survivors.

  Functional Recovery and Emotional Burden After Burn Injury: A Quality of Life Assessment in Romanian Burn Survivors · 2026 · DOI

• There is a lack of data on health-related quality of life in burn survivors, particularly in Eastern Europe. The long-term sequelae of burn injuries are not well understood.

  Functional Recovery and Emotional Burden After Burn Injury: A Quality of Life Assessment in Romanian Burn Survivors · 2026 · DOI

• The clinical score may be limited by inadequate collection of data. The study highlights the potential role for carboxyhaemoglobin concentration estimation when clinical data are lacking.

  Mortality probability in victims of fire trauma: revised equation to include inhalation injury. · 1986 · DOI

• The current mortality probability chart does not account for inhalation injury. There is a need for a revised equation that takes into account the extent of inhalation injury.

  Mortality probability in victims of fire trauma: revised equation to include inhalation injury. · 1986 · DOI

• There is a lack of clinical prediction models for GI dysfunction after severe burns. Prior studies have inconsistent diagnostic criteria and spectrum of related symptoms.

  Interpretable machine learning model predicts the early gastrointestinal dysfunction risk in severely burned patients: a multicenter-based study · 2026 · DOI

• There is a lack of studies on the effectiveness of physiotherapy management with exercise modalities on pain reduction, range of motion improvement, and functional ability in children with grade 2-3 bilateral hand burns.

  PENATALAKSANAAN FISIOTERAPI PADA KASUS LUKA BAKAR GRADE 2-3 BILATERAL TANGAN DENGAN MODALITAS EXERCISE PADA ANAK USIA 12 TAHUN · 2026 · DOI

• The study is a single case study on one 12-year-old patient with bilateral grade 2-3 hand burns; generalization to other burn cases, age groups, and burn locations requires further research with larger sample sizes.

  PENATALAKSANAAN FISIOTERAPI PADA KASUS LUKA BAKAR GRADE 2-3 BILATERAL TANGAN DENGAN MODALITAS EXERCISE PADA ANAK USIA 12 TAHUN · 2026 · DOI

• The data on antimicrobial use were not collected in this study. The results need to be considered with care due to the relatively low number of patients with ESBL-producing bacteria. No strong conclusions can be drawn from the subanalysis of ESBL-producing bacteria.

  Epidemiology of microbiological findings in the lower respiratory tract in mechanically ventilated patients with and without inhalation injury · 2026 · DOI

• Further studies should investigate the effectiveness of physiotherapeutic intervention in different stages of burn rehabilitation. Further studies should explore the impact of physiotherapy on the quality of life and social reintegration of burn patients.

  Atuação da fisioterapia na reabilitação funcional de pacientes adultos com queimaduras moderadas a graves: uma revisão integrativa da literatura · 2026 · DOI

• Atypical presentations of electrocution without exit wounds are not well-documented. The pathophysiological explanations for such presentations are not fully understood.

  Electrocution Fatality Without an Exit Wound: A Medicolegal Forensic Challenge · 2026 · DOI

• CONCLUSION: Although evidence is limited and observational, the data suggest that fixed-dose LMWH frequently leaves burn patients under-anticoagulated, while anti-Xa-guided adjustment can enhance adequacy without increasing bleeding risk.

  Anti-Xa-Guided LMWH Prophylaxis In Adult Burn Patients: A Systematic Review Of Current Evidence With Reconstructive Implications · 2026 · DOI

• The thermal safety of moxibustion therapy in high-risk groups is under-evaluated. There is a lack of awareness of iatrogenic skin injuries in high-risk populations.

  Case Report: Moxibustion-induced burns leading to disseminated methicillin-resistant Staphylococcus aureus infection in a patient with type 2 diabetes mellitus · 2026 · DOI

• Multidrug-resistant Gram-negative bacteria are a growing concern. Limited availability of effective treatments. High mortality rates associated with pneumonia in burn patients.

  Combined therapy with nebulized and intravenous colistin for the treatment of multidrug resistance pneumonia in burn patients: experience from a third referral burn care center in Mexico City · 2026 · DOI

• Limited evidence on the efficacy of nebulized colistin in burn patients with pneumonia caused by multidrug-resistant Gram-negative bacteria. Need for effective treatments against multidrug-resistant Gram-negative bacteria.

  Combined therapy with nebulized and intravenous colistin for the treatment of multidrug resistance pneumonia in burn patients: experience from a third referral burn care center in Mexico City · 2026 · DOI

• Burn injuries are a substantial worldwide health burden, causing a sizable amount of morbidity, mortality, and health care expenditure globally. The epidemiological trends of burn trauma differ widely in different geographic locations and clinical setups. There is a need to improve burn care and reduce mortality rates.

  Epidemiology and Outcomes of Burn Injuries · 2026 · DOI

• There is a lack of research on the patterns, treatment practices, and outcomes of burn injuries in tertiary care centers. There is a need to investigate the factors influencing patient outcomes and mortality trends in burn injuries.

  Epidemiology and Outcomes of Burn Injuries · 2026 · DOI

• The mechanism of action of burn-induced neuroinflammation and cognitive deficits remains poorly understood. The role of HMGB1 in burn-induced hyperinflammation and associated synaptic dysfunction is not well understood.

  Immediate post-injury HMGB1 neutralization prevents synaptic dysfunction in burn and hindlimb unloaded rats · 2026 · DOI

• While our study has yielded valuable insights, it also highlights several key areas for future exploration. We plan to enhance our examination methods by incorporating our well-optimized chem- ical LTP assessment technique - Fluorescence Assisted Single Synaptosome Long Term Potentiation (FASS-LTP) (52). We assess the glutamatergic synaptic integrity in different brain regions in the same animal using crude synaptoneurosomes and flow cytometry for a more profound understanding. Upon successful completion, we can provide a complete picture of how synaptic plasticity is similar or different across the different brain regions following burn injuries. Although morphological changes in burn pathology was not a primary focus due to experimental limitations, we recognize their importance and aim to examine them concur- rently in future work, as structural and functional changes, while not always directly correlated, offer complementary information. Since our present study focused on a therapeutic functional ap- proach, leaving the precise underlying mechanisms as a significant area for further elucidation, our future assessments will precisely differentiate the effects of anti-HMGB1 treatment on pure immo- bilization versus burn-induced effects. We did not observe significant differences among groups, likely because the early post−burn surge in HMGB1 was no longer detectable at this later time point (see Supplementary Figure 5). Post−burn neuroinflammation will be characterized using NGS and IHC approaches to identify key molecular mediators, along with analysis of downstream RAGE/TLR/NF−kB signaling pathways, to f u r t h e r c o n fi r m t h e r o l e o f H M G B 1 i n r e g u l a t i n g neuroinflammatory responses. While neural inflammation is widely accepted as a primary pathway leading to synaptic dysfunc- tion following burn injury, our findings further highlight that prolonged immobilization significantly exacerbates this neural impairment. Though we demonstrated the systemic inflammation markers altered in burn and hindlimb unloaded rats with HMGB1 treatment, future study needs to further explore the direct evidence of neuroinflammation in CNS. Interestingly, our previous work indicated an overlapping and aggravated blood clot pathway in both burn and hindlimb unloading conditions. This suggests that the blood clot pathway could represent an additional, novel mechanism to explore in the interplay between HMGB1, burn injury, and hindlimb unloading.

  Immediate post-injury HMGB1 neutralization prevents synaptic dysfunction in burn and hindlimb unloaded rats · 2026 · DOI

• The study used de-identified patient data from a registry. The analysis was limited to patients treated with either IFSG or SSS. The study was funded by Kerecis LLC.

  Length of Stay in Acute Burn Patients Treated with Intact Fish Skin Graft Versus Synthetic Skin Substitutes · 2026 · DOI

• There is a lack of comparative effectiveness data on dermal substitutes. The choice among available dermal substitutes is guided by institutional tradition or preference rather than evidence.

  Length of Stay in Acute Burn Patients Treated with Intact Fish Skin Graft Versus Synthetic Skin Substitutes · 2026 · DOI

• The PBI may overestimate mortality risk in today's older adults. There is a need for accurate assessment of burn severity in older adults.

  Comparison of Burn Severity and Mortality Evaluation Tools in Older Patients · 2026 · DOI

• There is a lack of studies on dietary practices among severely burned patients in low-and middle-income countries. The nutritional care of severely burned patients is often insufficiently adapted to their increased nutritional requirements.

  ASSESSMENT OF DIETARY PRACTICES AMONG SEVERELY BURNED PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT OF THE ABIDJAN BURN CENTRE (CÔTE D'IVOIRE) · 2026 · DOI

• for by can increase energy requirements to as much as twice the normal levels. According to Jeschke et al. (2008), severe burns trigger a prolonged hypercatabolic response expenditure, energy characterized accelerated and breakdown, protein immunosuppression. Consequently, diets that are insufficiently enriched in protein and calories may expose patients to delayed wound healing, significant muscle wasting, and an increased risk of mortality. increased In the present study, exclusive oral feeding was the predominant nutritional modality, accounting for 80% of cases, whereas early enteral nutrition was almost absent. These findings differ from ESPEN recommendations, which advocate the initiation of enteral nutrition within the first 24 hours after burn injury in order to preserve intestinal mucosal integrity, attenuate hypermetabolism, and improve clinical outcomes.[5,6] The limited use of in our setting may be enteral nutrition observed explained by economic constraints, lack of specialized equipment, and the absence of standardized nutritional protocols, all of which are common challenges in resource-limited environments. Nevertheless, the frequent use of nutritional supplements such as Astymin®, Renutryl®, and spirulina reflects efforts to improve patients’ nutritional intake. Spirulina, in particular, is recognized for its high content of protein, iron, and antioxidant micronutrients, which may contribute to improving nutritional status. However, the actual effectiveness of these supplements in severely burned patients warrants further investigation through dedicated clinical studies. The Individual Dietary Diversity Score (IDDS) was low across all age groups, with more than two-thirds of patients exhibiting low dietary diversity. According to Swindale and Bilinsky (2006), dietary diversity is an indirect indicator of dietary quality and micronutrient adequacy. In burn patients, poor dietary diversity may limit the intake of vitamins and trace elements that are essential for wound healing and immune function.

  ASSESSMENT OF DIETARY PRACTICES AMONG SEVERELY BURNED PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT OF THE ABIDJAN BURN CENTRE (CÔTE D'IVOIRE) · 2026 · DOI

• Older adults may have limited knowledge of electrical safety and grounding systems. The program needs to be simple, visual, and contextual to be effective. There may be challenges in encouraging families to check their household electrical installations with qualified technicians.

  Edukasi Sistem Grounding sebagai Upaya Peningkatan Keselamatan Listrik dan Mitigasi Risiko Sambaran Petir Pada Kelompok Lansia · 2026 · DOI

• There is a need for effective educational programs to improve electrical safety literacy among older adults. Prior work highlights the importance of grounding systems, but there is a gap in educating older adults on this topic.

  Edukasi Sistem Grounding sebagai Upaya Peningkatan Keselamatan Listrik dan Mitigasi Risiko Sambaran Petir Pada Kelompok Lansia · 2026 · DOI

Most-cited papers in Burn Injury Management and Outcomes

• PHYSIOLOGICAL RESPONSE TO CRYSTALLOID RESUSCITATION OF SEVERE BURNS · Annals of the New York Academy of Sciences · 1968 · 425 citations
• The abbreviated burn severity index · Annals of Emergency Medicine · 1982 · 389 citations
• Adaptive Problems and Mechanisms in Severely Burned Patients† · Psychiatry · 1953 · 102 citations
• Mortality probability in victims of fire trauma: revised equation to include inhalation injury. · BMJ · 1986 · 72 citations
• Pain, depression, and physical functioning following burn injury. · Rehabilitation Psychology · 2009 · 67 citations
• Risk factors for cooking-related burn injuries in children, WHO Global Burn Registry · Bulletin of the World Health Organization · 2021 · 49 citations
• Advancing chronic and acute wound healing with cold atmospheric plasma: cellular and molecular mechanisms, benefits, risks, and future directions · Frontiers in Medicine · 2025 · 40 citations
• A comprehensive treatment program for a fire setting child · Journal of Behavior Therapy and Experimental Psychiatry · 1979 · 37 citations
• “On the Recovery Journey:” An Integrative Review of the Needs of Burn Patients From Immediate Pre‐Discharge to Post‐Discharge Period Using the Omaha System · Journal of Nursing Scholarship · 2020 · 29 citations
• Treatment of burns casualties after fire at Bradford City football ground. · BMJ · 1985 · 28 citations

Most recent work

• High-Dose Intravenous Vitamin C and Mortality and Organ Dysfunction in Severe Burn Injury · JAMA · 2026
• Cleaning Product–Related Injuries Treated in US Emergency Departments: 2007–2022 · PEDIATRICS · 2026
• Interpretable machine learning model predicts the early gastrointestinal dysfunction risk in severely burned patients: a multicenter-based study · International Journal of Surgery · 2026
• PENATALAKSANAAN FISIOTERAPI PADA KASUS LUKA BAKAR GRADE 2-3 BILATERAL TANGAN DENGAN MODALITAS EXERCISE PADA ANAK USIA 12 TAHUN · Jurnal Kesehatan An-Nuur · 2026
• Epidemiology of microbiological findings in the lower respiratory tract in mechanically ventilated patients with and without inhalation injury · Frontiers in Cellular and Infection Microbiology · 2026
• Atuação da fisioterapia na reabilitação funcional de pacientes adultos com queimaduras moderadas a graves: uma revisão integrativa da literatura · Revista ft · 2026
• Frailty-based prognostication of clinical outcomes in geriatric burn patients: a retrospective study · medRxiv · 2026
• A Prospective, Randomized, Multicenter Trial Comparing Lactated Ringer’s Alone or With 5% Albumin for Resuscitation of Large Burns The Acute Burn ResUscitation Multicenter Prospective Trial 2 (ABRUPT2) · Annals of Surgery · 2026
• Microvascular Toe-to-thumb Transfer After High-voltage Electrical Burn: A Case Series and a Narrative Review · PubMed Central · 2026
• An Expanded Access Program with NexoBrid for Treatment of Acute Deep Partial and Full Thickness Burn Injuries in Adult and Pediatric Patients · Journal of Burn Care & Research · 2026

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