Fiona Wood Foundation

INTRODUCTION: Reported first aid application, frequency and practices around the world vary greatly. Based primarily on animal and observational studies, first aid after a burn injury is considered to be integral in reducing scar and infection, and the need for surgery. The current recommendation for optimum first aid after burn is water cooling for 20 minutes within three hours. However, compliance with this guideline is reported as poor to moderate at best and evidence exists to suggest that overcooling can be detrimental. This prospective cohort study of a bi-national burn patient registry examined data collected between 2009 and 2012. The aim of the study was to quantify the magnitude of effects of water cooling first aid after burn on indicators of burn severity in a large human cohort. METHOD: The data for the analysis was provided by the Burn Registry of Australia and New Zealand (BRANZ). The application of first aid cooling prior to admission to a dedicated burn service, was analysed for its influence on four outcomes related to injury severity. The patient related outcomes were whether graft surgery occurred, and death while the health system (cost) outcomes included total hospital length of stay and admission to ICU. Robust regression analysis using bootstrapped estimation adjusted using a propensity score was used to control for confounding and to estimate the strength of association with first aid. Dose-response relationships were examined to determine associations with duration of first aid. The influence of covariates on the impact of first aid was assessed. RESULTS: Cooling was provided before Burn Centre admission for 68% of patients, with at least twenty minutes duration for 46%. The results indicated a reduction in burn injury severity associated with first aid. Patients probability for graft surgery fell by 0.070 from 0.537 (13% reduction) (p = 0.014). The probability for ICU admission fell by 0.084 from 0.175 (48% reduction) (p<0.001) and hospital length of stay (LOS) fell by 2.27 days from 12.9 days (18% reduction) (p = 0.001). All outcomes except death showed a dose-response relationship with the duration of first aid. The size of burn and age interacted with many of the relationships between first aid and outcome and these are described and discussed. DISCUSSION & CONCLUSION: This study suggests that there are significant patient and health system benefits from cooling water first aid, particularly if applied for up to 20 minutes. The results of this study estimate the effect size of post-burn first aid and confirm that efforts to promote first aid knowledge are not only warranted, but provide potential cost savings.

< 0.05). This signature supports a systemic metabolic phenoconversion following infection, indicating possible neurotoxicity and neurological disruption (elevations of 3-hydroxykynurenine and quinolinic acid) and liver dysfunction (reduction in Fischer's ratio and elevation of taurine). Finally, we report correlations between the key metabolite changes observed in the disease with concentrations of proinflammatory cytokines and chemokines showing strong immunometabolic disorder in response to SARS-CoV-2 infection.

OBJECTIVE: To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury. DESIGN: Systematic review of quantitative and qualitative studies. DATA SOURCES: Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020. DATA EXTRACTION AND SYNTHESIS: Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies. RESULTS: Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality. CONCLUSIONS: Our findings highlight paediatric burn patients as a particularly vulnerable population following a burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed. Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.

AIM: To investigate the impact of regular exposure to paediatric medical trauma on multidisciplinary teams in a paediatric hospital and the relationships between psychological distress, resilience and coping skills. METHOD: Symptoms of post-traumatic stress disorder, secondary traumatic stress, depression, anxiety, stress, burnout, compassion satisfaction, resilience and coping skills were measured in 54 health professionals and compared with published norms. RESULTS: Participants experienced more symptoms of secondary traumatic stress (P < 0.01), showed less resilience (P = 0.05) and compassion satisfaction (≥ 0.01), more use of optimism and sharing as coping strategies, and less use of dealing with the problem and non-productive coping strategies than comparative groups. Non-productive coping was associated with more secondary traumatic stress (r = 0.50, P = 0.05), burnout (r = 0.45, P = 0.01), post-traumatic stress disorder (r = 0.41, P = 0.05), anxiety (r = 0.42, P = 0.05), depression (r = 0.54, P = 0.01), and stress (r = 0.52, P = 0.01) and resilience was positively associated with optimism (r = 0.48, P = 0.01). Health professionals <25 years old used more non-productive coping strategies (P = 0.05), less 'sharing as a coping strategy' (P = 0.05) and tended to have more symptoms of depression (P = 0.06). CONCLUSION: Paediatric medical trauma can adversely affect a health professional's well-being, particularly those <25 years of age who make less use of positive coping strategies and more use of non-productive coping. These findings will assist the development of effective and meaningful interventions for health professionals working in paediatric hospitals.

Age is well-known to be a significant factor in both disease pathology and response to treatment, yet the molecular changes that occur with age in humans remain ill-defined. Here, using transcriptome profiling of healthy human male skin, we demonstrate that there is a period of significantly elevated, transcriptome-wide expression changes occurring predominantly in middle age. Both pre and post this period, the transcriptome appears to undergo much smaller, linear changes with increasing age. Functional analysis of the transient changes in middle age suggest a period of heightened metabolic activity and cellular damage associated with NF-kappa-B and TNF signaling pathways. Through meta-analysis we also show the presence of global, tissue independent linear transcriptome changes with age which appear to be regulated by NF-kappa-B. These results suggest that aging in human skin is associated with a critical mid-life period with widespread transcriptome changes, both preceded and proceeded by a relatively steady rate of linear change in the transcriptome. The data provides insight into molecular changes associated with normal aging and will help to better understand the increasingly important pathological changes associated with aging.

[Formula: see text] Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesised that scar severity increases commensurate to the increase in time to healing (TTH) of the wound. Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area – burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account for potential bias from missing independent variable data. The sample had a median age of 34 years, TTH of 24 days, TBSA of 3% and length of stay of five days, 70% were men and 71% had burn surgery. For each additional day of TTH, the mVSS score increased by 0.11 points ( P ≤ 0.001) per day in the first 21 days and 0.02 points per day thereafter ( P = 0.004). The relationship remained stable in spite of TBSA or surgical intervention. Investigation of the effect of missing data revealed the primary model underestimated the strength of the association. An increase in TTH within 21 days of injury is associated with an increase in mVSS or reduced scar quality. The results confirm that efforts should be directed toward healing burn wounds as early as possible.

INTRODUCTION: Heterotopic ossification (HO) is the formation of lamellar bone within connective and other tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. The aim of this comprehensive review, therefore, was to synthesise the available evidence on the development and treatment of HO after acute burn injury. METHODS: The review was based on a systematic search of five electronic databases PubMed, EMBASE, CINAHL, LILACS and Scopus. RESULTS: Synthesis and analysis of the data highlighted that, despite the passage of time, little translatable evidence is available to guide any prevention, screening, diagnostic or pharmacological or physical management protocols. DISCUSSION: Causes of HO remain confounded, therefore prevention is difficult. Although spontaneous resolution is possible, surgical resection remains the recommended treatment when ROM and activities of daily living are severely affected. CONCLUSION: The findings from this review indicate that multicentre data pooling is needed to understand the optimum pathway to prevention, identification and treatment of HO in acute burn patients.

OBJECTIVE: To investigate the risk of cancer and potential gender effects in persons hospitalised with burn injury. DESIGN: Population-based retrospective cohort study using record-linkage systems in Scotland and Western Australia. PARTICIPANTS: Records of 37 890 and 23 450 persons admitted with a burn injury in Scotland and Western Australia, respectively, from 1983 to 2008. Deidentified extraction of all linked hospital morbidity records, mortality and cancer records were provided by the Information Service Division Scotland and the Western Australian Data Linkage Service. MAIN OUTCOME MEASURES: Total and gender-specific number of observed and expected cases of total ('all sites') and site-specific cancers and standardised incidence ratios (SIRs). RESULTS: From 1983 to 2008, for female burn survivors, there was a greater number of observed versus expected notifications of total cancer with 1011 (SIR, 95% CI 1.3, 1.2 to 1.4) and 244 (SIR, 95% CI 1.12, 1.05 to 1.30), respectively, for Scotland and Western Australia. No statistically significant difference in total cancer risk was found for males. Significant excesses in observed cancers among burn survivors (combined gender) in Scotland and Western Australian were found for buccal cavity, liver, larynx and respiratory tract and for cancers of the female genital tract. CONCLUSIONS: Results from the Scotland data confirmed the increased risk of total ('all sites') cancer previously observed among female burn survivors in Western Australia. The gender dimorphism observed in this study may be related to the role of gender in the immune response to burn injury. More research is required to understand the underlying mechanism(s) that may link burn injury with an increased risk of some cancers.

Dysregulated lipid metabolism underpins many chronic diseases including cardiometabolic diseases. Mass spectrometry-based lipidomics is an important tool for understanding mechanisms of lipid dysfunction and is widely applied in epidemiology and clinical studies. With ever-increasing sample numbers, single batch acquisition is often unfeasible, requiring advanced methods that are accurate and robust to batch-to-batch and interday analytical variation. Herein, an optimized comprehensive targeted workflow for plasma and serum lipid quantification is presented, combining stable isotope internal standard dilution, automated sample preparation, and ultrahigh performance liquid chromatography-tandem mass spectrometry with rapid polarity switching to target 1163 lipid species spanning 20 subclasses. The resultant method is robust to common sources of analytical variation including blood collection tubes, hemolysis, freeze-thaw cycles, storage stability, analyte extraction technique, interinstrument variation, and batch-to-batch variation with 820 lipids reporting a relative standard deviation of <30% in 1048 replicate quality control plasma samples acquired across 16 independent batches (total injection count = 6142). However, sample hemolysis of ≥0.4% impacted lipid concentrations, specifically for phosphatidylethanolamines (PEs). Low interinstrument variability across two identical LC-MS systems indicated feasibility for intra/inter-lab parallelization of the assay. In summary, we have optimized a comprehensive lipidomic protocol to support rigorous analysis for large-scale, multibatch applications in precision medicine. The mass spectrometry lipidomics data have been deposited to massIVE: data set identifiers MSV000090952 and 10.25345/C5NP1WQ4S.

BACKGROUND/AIM: Resistance training is beneficial for rehabilitation in many clinical conditions, though this has not been systematically reviewed in burns. The objective was to determine the effectiveness of resistance training on muscle strength, lean mass, function, quality of life and pain, in children and adults after burn injury. METHODS: Medline & EMBASE, PubMed, CINAHL and CENTRAL were searched from inception to October 2016. Studies were identified that implemented resistance training in rehabilitation. Data were combined and included in meta-analyses for muscle strength and lean mass. Otherwise, narrative analysis was completed. The quality of evidence for each outcome was summarised and rated using the GRADE framework. RESULTS: Eleven studies matched our inclusion criteria. Primary analysis did not demonstrate significant improvements for increasing muscle strength (SMD 0.74, 95% CI -0.02 to 1.50, p=0.06). Sensitivity analysis to correct an apparent anomaly in published data suggested a positive effect (SMD 0.37, 95% CI 0.08-0.65, p=0.01). Psychological quality of life demonstrated benefit from training (MD=25.3, 95% CI 3.94-49.7). All studies were rated as having high risk of bias. The quality of the evidence was rated as low or very low. CONCLUSION: Further research with robust methodology is recommended to assess the potential benefit suggested in this review.

This study investigated the ability for magnetic nanoparticles to influence cellular migration in the presence of an external magnetic field. We found that the direction of migrating keratinocytes can be controlled and the migration speed of fibroblasts can be increased with the internalisation of these nanoparticles in the presence of a magnetic field. The possibility of shepherding cells towards a region of interest through the use of internalized nanoparticles is an attractive prospect for cell tracking, cell therapies, and tissue engineering applications.

Burn injuries can be devastating, with life-long impacts including an increased risk of hospitalization for a wide range of secondary morbidities. One area that remains not fully understood is the impact of burn trauma on the central nervous system (CNS). This review will outline the current findings on the physiological impact that burns have on the CNS and how this may contribute to the development of neural comorbidities including mental health conditions. This review highlights the damaging effects caused by burn injuries on the CNS, characterized by changes to metabolism, molecular damage to cells and their organelles, and disturbance to sensory, motor and cognitive functions in the CNS. This damage is likely initiated by the inflammatory response that accompanies burn injury, and it is often long-lasting. Treatments used to relieve the symptoms of damage to the CNS due to burn injury often target inflammatory pathways. However, there are non-invasive treatments for burn patients that target the functional and cognitive damage caused by the burn, including transcranial magnetic stimulation and virtual reality. Future research should focus on understanding the mechanisms that underpin the impact of a burn injury on the CNS, burn severity thresholds required to inflict damage to the CNS, and acute and long-term therapies to ameliorate deleterious CNS changes after a burn.

BACKGROUND: Despite the medical and surgical improvements of paediatric burn injuries, burn injuries can be a painful and traumatic experience for the child and their family. It is therefore important to explore the experiences of caregivers who support their child throughout the burn journey. Thus, the purpose of this study was to explore the traumatic nature of paediatric burns on the family from a caregiver's perspective. METHODS: This study used a descriptive qualitative approach to conduct online semi-structured interviews with caregivers (18 years and older) of children (aged four to 17 years) that had previously been admitted with an unintentional acute burn injury to a paediatric burns unit in Western Australia. Interviews explored the child's and caregiver's experiences throughout the burn journey from the perspective of the caregiver and were digitally recorded and transcribed verbatim. Transcripts were analysed using Braun and Clarke's six stages of reflexive thematic analysis. RESULTS: Eleven mothers participated in the interviews and identified a range of poor psychological and psychosocial outcomes that themselves and their child experienced. Three overarching themes were elaborated from the interviews: Child and caregiver mental health difficulties during and after the burn (including medical trauma, mental health outcomes and caregiver guilt); Lifestyle and physical changes following the burn (including disruptions to routine, appearance concerns and puberty); and factors supporting or inhibiting the recovery journey (including personality factors, coping strategies, family dynamics and support). FINAL CONSIDERATIONS: This study has presented the difficulties that children, young people, and their family face throughout a paediatric burn injury, which makes the implementation of timely and effective family centred interventions imperative. Meeting the needs and supporting these families with their mental health throughout this traumatic recovery journey, can ensure positive psychosocial outcomes and adaptive coping strategies are adopted early on.

BACKGROUND: Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands. METHODS: Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD). RESULTS: The combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup < 5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0-1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands. CONCLUSIONS: This project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the application is valid in low- and middle- income countries.

PURPOSE: Posttraumatic growth (PTG) is "the subjective experience of positive psychological change reported as a result of the struggle with trauma". Very few studies have explored PTG after burn injury. The Posttraumatic Growth Inventory (PTGI) is a 21-item questionnaire which assesses five domains in which PTG has been found. First, the aim of this study was to assess how PTG presented after a severe burn, and second, whether it could be measured by the PTGI in Australian burn survivors. METHODS: A mixed method approach was used. Seventeen patients who had a severe burn injury at least 2 years previously were interviewed and completed the PTGI. The interviews were analyzed, then compared to the PTGI responses. RESULTS: PTG in burn survivors had similarities to PTG arising from other trauma. Burn-specific context such as heat intolerance and functional problems influenced the type of changes made. Barriers to PTG in relationships were related to guilt burden and visible scarring. CONCLUSION: PTG presents similarly after burn to other trauma types, but has other features to consider when devising intervention strategies. The PTGI is a 5-min screening tool that adequately identifies the presence or absence of PTG in burn survivors in Western Australia, and can guide intervention. IMPLICATIONS FOR REHABILITATION: The Posttraumatic Growth Inventory is a 5-min screening tool that adequately identifies the degree of PTG in burn survivors in Western Australia. It is a quick and easy tool to use to identify the need for clinical intervention. It will also evaluate the effectiveness of strategies designed to target PTG. A mean score of 2.5 can be used as a threshold to guide intervention strategy.

As a part of an abnormal healing process of dermal injuries and irritation, keloid scars arise on the skin as benign fibroproliferative tumors. Although the etiology of keloid scarring remains unsettled, considerable recent evidence suggested that keloidogenesis may be driven by epigenetic changes, particularly, DNA methylation. Therefore, genome-wide scanning of methylated cytosine-phosphoguanine (CpG) sites in extracted DNA from 12 keloid scar fibroblasts (KF) and 12 control skin fibroblasts (CF) (six normal skin fibroblasts and six normotrophic fibroblasts) was conducted using the Illumina Human Methylation 450K BeadChip in two replicates for each sample. Comparing KF and CF used a Linear Models for Microarray Data (Limma) model revealed 100,000 differentially methylated (DM) CpG sites, 20,695 of which were found to be hypomethylated and 79,305 were hypermethylated. The top DM CpG sites were associated with TNKS2, FAM45B, LOC723972, GAS7, RHBDD2 and CAMKK1. Subsequently, the most functionally enriched genes with the top 100 DM CpG sites were significantly (p ≤ 0.05) associated with SH2 domain binding, regulation of transcription, DNA-templated, nucleus, positive regulation of protein targeting to mitochondrion, nucleoplasm, Swr1 complex, histone exchange, and cellular response to organic substance. In addition, NLK, CAMKK1, LPAR2, CASP1, and NHS showed to be the most common regulators in the signaling network analysis. Taken together, these findings shed light on the methylation status of keloids that could be implicated in the underlying mechanism of keloid scars formation and remission.

Restoration of the quality of life (QoL) of trauma injury survivors is the aim of trauma rehabilitation. It is generally acknowledged that sexuality is an important component of QoL; however, rehabilitation services frequently fall short of including sexuality as a matter of routine. The literature was reviewed to examine the experiences of trauma survivors from three groups: spinal cord injury (SCI), traumatic brain injury (TBI) and burns. The focus was on the impact of trauma on the QoL to identify future research directions and to advocate for the inclusion of sexuality as an integral part of rehabilitation. Databases searched were Proquest, Ovid, Cinahl, Medline, PsycInfo and Cochrane Central Register of controlled trials. A total of 36 eligible studies were included: SCI (n = 25), TBI (n = 6), burns (n = 5). Four themes were identified across the three trauma groups that were labeled as physiological impact of trauma on sexuality, cognitive-genital dissociation (CGD), sexual disenfranchisement (SD) and sexual rediscovery (SR). Trauma injury has a significant impact on sexuality, which is not routinely addressed within rehabilitation services. Further sexuality research is required among all trauma groups to improve rehabilitation services and in turn QoL outcomes for all trauma survivors.

Burn injuries are traumatic experiences that can detrimentally impact an individual's psychological and emotional wellbeing. Despite this, some survivors adapt to psychosocial challenges better than others despite similar characteristics relating to the burn. Positive adaptation is known as resilience or posttraumatic growth, depending on the trajectory and process. This review aimed to describe the constructs of resiliency and growth within the burn injury context, examine the risk factors that inhibit resilience or growth after burn (barriers), the factors that promote resilience or growth after burn (enablers), and finally to assess the impact of interventions that have been tested that may facilitate resilience or growth after burn. This review was performed according to the recently updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. An electronic search was conducted in November 2021 on the databases PubMed, Medline (1966-present), Embase (1974-present), PsycINFO for English-language peer-reviewed academic articles. There were 33 studies included in the review. Findings were mixed for most studies; however, there were factors related to demographic information (age, gender), burn-specific characteristics (TBSA, time since burn), person-specific factors (personality, coping style), psychopathology (depression, PTSD), and psychosocial factors (social support, spirituality/religion, life purpose) that were evidenced to be related to resilience and growth. One qualitative study evaluated an intervention, and this study showed that a social camp for burn patients can promote resilience. This study has presented a variety of factors that inhibit or encourage resilience and growth, such as demographic, individual, and social factors. We also present suggestions on interventions that may be used to promote growth following this adverse event, such as improving social support, coping styles and deliberate positive introspection.

AIM: To describe a tailored qualitative research methodology for exploring the complex interaction of factors driving non-urgent care seeking in the emergency department. DESIGN: Qualitative descriptive design with a literature informed semi-structured interview and analysis structure. Triangulation with the State-Trait Anxiety Inventory allows expedited exploration of biopsychosocial factors. Consolidated criteria for reporting qualitative research requirements integrated. METHODS: With a short 10- to 15-min interview and a low-inference analysis process, this methodology offers a structured way to explore the "go to ED" decision, to understand the patient perspective on their healthcare needs and feed into the development of suitable local services that meet patient healthcare needs. RESULTS: This methodology offers a structured way for clinician-researchers to explore the factors that influence patients seeking care in the emergency departments for non-urgent conditions that are specific to their local health service environment. The described methodology is accessible to novice qualitative researchers and includes the semi-structured interview, coding and analysis frameworks.

Globally, burns are a significant cause of injury that can cause substantial acute trauma as well as lead to increased incidence of chronic comorbidity and disease. To date, research has primarily focused on the systemic response to severe injury, with little in the literature reported on the impact of nonsevere injuries (<15% total burn surface area; TBSA). To elucidate the metabolic consequences of a nonsevere burn injury, longitudinal plasma was collected from adults (n = 35) who presented at hospital with a nonsevere burn injury at admission, and at 6 week follow up. A cross-sectional baseline sample was also collected from nonburn control participants (n = 14). Samples underwent multiplatform metabolic phenotyping using 1H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry to quantify 112 lipoprotein and glycoprotein signatures and 852 lipid species from across 20 subclasses. Multivariate data modeling (orthogonal projections to latent structures-discriminate analysis; OPLS-DA) revealed alterations in lipoprotein and lipid metabolism when comparing the baseline control to hospital admission samples, with the phenotypic signature found to be sustained at follow up. Univariate (Mann–Whitney U) testing and OPLS-DA indicated specific increases in GlycB (p-value < 1.0e–4), low density lipoprotein-2 subfractions (variable importance in projection score; VIP > 6.83e–1) and monoacyglyceride (20:4) (p-value < 1.0e–4) and decreases in circulating anti-inflammatory high-density lipoprotein-4 subfractions (VIP > 7.75e–1), phosphatidylcholines, phosphatidylglycerols, phosphatidylinositols, and phosphatidylserines. The results indicate a persistent systemic metabolic phenotype that occurs even in cases of a nonsevere burn injury. The phenotype is indicative of an acute inflammatory profile that continues to be sustained postinjury, suggesting an impact on systems health beyond the site of injury. The phenotypes contained metabolic signatures consistent with chronic inflammatory states reported to have an elevated incidence postburn injury. Such phenotypic signatures may provide patient stratification opportunities, to identify individual responses to injury, personalize intervention strategies, and improve acute care, reducing the risk of chronic comorbidity.