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Materials and Methods

Inclusión criteria Exclusion criteria

presence
admission burns not
complete of burns incomplete
head and to the no prior requiring
medical beyond the medical
neck burn. inpatient burns hospital
records head and records
burn unit admission
neck
Methodology

patients admitted
Flame 5938
n = 136; 66.3%
older than 55 years n = 69; 34%
superficial partial
accidental
scald burnsthickness
exposure nn == 32;
166; 80%
196;15.6%
96%
35 to 55 years old
patients with head and neck n
2547 = 50; 24%
deep
Most partial thickness
(nAssault
= 136;
chemical 66%) were male with a meannnage
burns
burns n===20;
26; 12%
of9.7%
5; 40 years
2%
younger than 15 years n = 47; 23%
full
chemicalthickness
contact exposure
burns
patients that met the nn==12;
205 n13, 6%
= 35.8%
15 to 34 years old n = 39; 19%
inclusion
electrical burnscriteria n = 5; 2.4%
TBSA is a primary determinant of
Discussion severity and risk of mortality
When a patient sustains flame
injury to the head and neck,
health care providers should
carefully assess inhalation
injury
Intubation criteria are:
1) respiratory failure
Superficial head(hypoxic
and neckor burns
hypercarbic)
have
If there is2)suspicion
carbon
for serious
monoxide poisoning,
clinical
airway compromise, signs
thenofeye
A fluorescein erythema and pain,
examination is
3) burn larger than 20% TBSA Patients
(intubated should
for painbe examined
intubationwithout
for evidence
airway
completed of blistering.
to assess for corneal
control) for carbon monoxide toxicity
protection should
damage. be
4) deep partial- and full-thickness burns involving the
performed.
entire face and neck
5) stridor or hoarseness at examination.

these patients are placed in a


monitored room to assess vital
signs and airway
conclusions
• The present study showed that superficial partialthickness head and
neck burns were more likely to occur in men older than 55 years and
be caused by accidental exposure to flame. Therefore, preventive
health care resources can be focused on this group of patients. Most
head and neck burns are managed outside the operating room using
local wound debridement and dressing changes. Owing to an increase
in risk and mortality of inhalation injury, airway protection and
respiratory management are critical considerations of head and neck
burn management. This study could help to better stratify risk and
improve management protocols.
Materials and criteria
inclusion methods exclusion criteria

• CaucasianSerum collagen type 1 cross-linked• Pregnancy,


C- renal
telopeptide (CTX) = concentration <695 ng/l
patients over
(RO) 18 or liver failure,
years, with Statistical
a burnanalysis was performed prior vitamin D
serum
usingtype
Blood 1 procollagen
Graphpad wasPrism
samples were N-terminal
(version
from6.0
collected in for
surface area
Informed
(P1NP)
Mac
patients
(BSA)
all
or
consent
=OSX,
7.5–95.4
their atng/
Graphpad
patients
obtained
relativesml (FO)
Inc.,
admission
prior
substitution
San
the
Diego,
(D0)
to enrolment.
were
greater than
serumthe
10%
CA,and
USA).
bone
7th,alkaline
considered
then in the early morning of
phosphatase
14th, 21st and 28th day(b-ALP)
and admitted
concentration
Results are <21 mg/l
expressed
of in-hospital were exclusion
considered
as medians
follow-up. and criteria.
normal.
ranges(FO)
(min-max).
within the first 24
h followingSeruminjury
tartrate-resistant acid phosphatase
5b (TRAP)= 1.5–4.7 U/l. (RO)
were included.
Results

Biological data were measured in 20 patients: 18


men, 2 women (including a post-menopausal).
Median age was 46 [19–86] years old. Definitive
median BSA, as evaluated by a senior intensivist,
reached 15 [7–85] %.

The concept of CD should be more widely used


in clinical studies, especially if comparing
biological changes to clinical outcomes.
Discussion
First, hemodilution following fluid resuscitation may
have negatively influenced D0 results.
Ideally,
Second, bone markers
immunoassays screening
classically could
used to measure
Admittedly,
Clearly, evolution
the population
of bone recruited
markersin was
thenot
present
bone help to detect
markers may alteration
not bewell in bone
suitable in that
case gender
of proteins
study
similar
is heterogeneous.
between patients,
It is withknown
non-linear
metabolism earlierburn
thanand
theresuscitation.
observed
andchanges in relation
fluctuations.
age influence bonetohealth. However, evaluation
consequences on mineral density and
covered only one month and data was analyzed as
Third,finally than the
regarding thetooccurrence
panel of fractures.
ofaavailable bone markers, it
paired
It seems
data, thus hard
limiting define
the influence
globalofprofile
these two
is important
parameters.
regarding to keep
bone in mind
formation or some specific aspects
resorption.
Pamidronate
related to burn - Vitamin D - Oxandrolone

Finally, CTX measurements require specific pre-


analytical conditions that may be met with difficulty
during critical care conditions (such as long fasting in
case of continuous enteral nutrition).
CONCLUSIONS
• considering available data, role and interest of bone markers in
management of burn related bone disease remain unclear. Further
large and integrative studies are urgently needed. They should be
designed with the aim of determining the clinical value of bone
markers in mild to moderate burns but also in severely burned
patients in whom bone loss is thought to be more striking. In that
perspective, it would be important to consider the limitations to the
use of CTX or P1NP.