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Background & aims: Intensive nutritional therapy is an essential component of burn care. Regardingpost-minor burn injuries, the literature is lacking. The aim of this study was to evaluate documentednutritional therapy in relation to international guidelines after both minor and major burn injuries. The secondary aim of this study was to evaluate the adequacy of energy and protein intake compared toindividual nutritional goals post-burn injury.

Methods: A retrospective observational single-centre study including patients admitted between 2017and 2019 at a burn centre in Sweden was performed. The patients included in the study were >18 years old and in need of hospital care for > 72 h post-burn injury. Information about patients' demographics,nutritional therapy, and clinical characteristics of burn injury was collected. The patients were dividedaccording to total body surface area burnt (TBSA %) into minor burn injuries (TBSA <20%) and major burninjuries (TBSA >20%). Descriptive statistics were used to analyse data. Adherence to guidelines wasestablished by comparing 24 nutritional therapy recommendations to documented treatment. If documented nutritional treatment were in accordance with guidelines, adherence was considered high(>80%), moderate (60-79.9%) or low (<59.9%).

Results: One hundred thirty-four patients were included, 90 patients with minor burn injuries and 44patients with major burn injuries. Documented adherence to the nutritional guideline was overall low.After minor burn injury, 8% (2/24) of nutritional therapy recommendations had a high adherence (fatintake <35% of total energy intake and enteral nutrition as prioritized feeding route), 17% (4/24) amoderate adherence, and 75% (18/24) a low adherence. In patients treated after a major burn injury,there were two recommendations with documented high adherence (Vitamin C and Zinc); 25% (6/24)had moderate adherence, and 67% (16/24) had low adherence. In addition, quite a large amount ofmissing data was found.Adequacy of documented nutritional intake, compared to the individual documented goal, was 78%(±23%) for energy and 66% (±22%) for protein after minor burn injury. After major burn injury, the adequacy was 89% (±21%) for energy and 78% (±19%) for protein, respectively.

Conclusions: This study revealed low adherence to nutritional guidelines in patients treated for minorand major burn injuries. Compared to major burn injuries, lower documented adequacy for both energyand proteins was found in minor burn injuries. Given the disparity between guidelines and documentednutritional therapy, and the lack of specific guidelines for minor burn injuries, there could be aconsiderable risk of inadequate nutritional therapy post-burn injury.

Background & aims Inadequate intake and barriers to nutritional therapy are challenges in burn care. Post-burn injury nutritional care practices are rarely reported, particularly after minor injuries. The aim of this study was to describe nutritional interventions, identify barriers to nutritional intervention, and compare the documentation of nutrition for patients after minor and major burn injuries.

Methods A retrospective single-centre medical record review was conducted on patients aged 18 and older who were admitted for more than 72 h between 2017 and 2019 at one of Sweden's two national burn centres. A content analysis and descriptive statistics were used to analyse the data, and differences were explored between patients with minor and major burn injuries.

Results A total of 134 patients were included in the study: 90 patients had minor burn injuries (mean total burn surface area (TBSA) 8.1 % ± 5.0), and 44 patients had major burn injuries (mean TBSA 37.8 % ± 17.2). Nutritional supplement therapy (93 %) and nutrition prescription (91 %) were the most common interventions. Interventions targeting meals and snacks (43 %) and meal support (40 %), were documented less frequently. Fasting (93 %) and gastrointestinal symptoms (49 %) were the most common barriers.Significantly more interventions (including enteral/parenteral nutrition, and vitamin/mineral supplementation) and barriers (primarily related to enteral nutrition and fasting) were documented for patients with major burn injuries.

Conclusion This study concludes that while most patients have oral intake, vitamin and mineral supplementation and medical nutritional therapy were more frequently documented than meal/snack interventions and meal support. The lack of dietary interventions, whether unperformed or undocumented, needs further investigation. Frequent documentation of barriers to nutritional interventions suggests that patients post-burn injury are at risk of inadequate energy and protein intake. Therefore, emphasising nutritional therapy and its documentation in post-burn care is crucial, regardless of burn severity.

Disease Related Appetite Questionnaire (DRAQ) and Eating Symptom Questionnaire(ESQ) are used to assess nutrition impact symptoms, which are symptoms that can negatively affectthe patients’ food intake. However, these questionnaires have not yet been adapted to the needsof patients recovering from burn injuries. Our aim was therefore to develop DRAQ and ESQ forassessments of nutrition impact symptoms after burn injury. A content validation index (I-CVI) foritems included in DRAQ and ESQ, regarding their relevance for possible nutrition impact symptomsin a burn-injured patient (Likert scale 1–4), was performed by an expert review group. A clarityvalidation by expert and non-expert reviewers was carried out. Two of the eleven questions inDRAQ and eight of the fourteen questions in ESQ were not considered relevant and were thereforeremoved from the questionnaires. Five additional questions were added to DRAQ and two to ESQ.A high degree of consensus on relevance (scale-content validity index average, S-CVI/Ave, 0.86 forDRAQ-burn and 0.83 for ESQ-burn) was reached in the expert group. To conclude, it is suggestedthat we use developed forms of DRAQ and ESQ (DRAQ-burn and ESQ-burn) for the assessment ofnutrition impact symptoms, specifically during the rehabilitation phase of burn-injured patients.

Objectives 

This study aimed to investigate long-term prevalence of nutrition impact symptoms, such as appetite and eating-related issues that may impede food intake, in patients with minor- and major-burn injuries.

Methods

In this prospective longitudinal cohort study, sixty adults participated. Two questionnaires, the Disease-Related Appetite Questionnaire (DRAQ-burn) and the Eating Symptom Questionnaire (ESQ-burn), were completed during follow-up visits at six and 12 months post trauma.

Results

Median burn extent was 4.5% in the post-minor burn group and 24.0% in the post-major burn group. At six months, the median number of symptoms reported in DRAQ-burn was 2.0 for all patients; at 12 months, it was 1.0 post-minor burns and 1.5 post-major burns. Reported symptoms in the ESQ-burn remained stable at a median of 1.0 across both time points and burn severities. Most frequently reported symptoms included fluctuation in appetite/eating, never/rarely feeling hungry, tiredness affecting appetite/eating and nausea. No statistically significant differences were found between burn severity groups or over time.

Conclusion

Overall, although the nutrition impact symptoms were reported to be more mild than severe in nature, they persisted for up to a year post burn, highlighting the need for ongoing nutritional follow-up to mitigate the risk of malnutrition.