The research programme focusses on the diagnosis of infection in burn wounds and the inflammatory response in the small area burn. This includes a key role for the Research Centre in the development of Smartwound™ dressings for paediatric scalds which allow the detection and treatment of infection without dressing removal, and help to prevent bacterial resistance.

Other clinical projects taking place at the Children’s Burns Research Centre include the assessment of volatile organic compounds (gases) emitted from discarded burns dressings as a means of detecting infection at the bedside with the Department of Microbiology at the University of the West of England and the ideal fluid resuscitation formula for children with moderate scalds. There is also a prospective multicentre trial looking at the incidence and cause of post burn illness in children with small scalds and the use of a low friction environment to reduce graft loss after burn injury.

The team received NIHR funding for a 2 year feasibility study to prevent skin graft loss starting in July 2015.

Paediatric Burns Clinical Team at Bristol

The South West Children’s Burns Network is at the forefront of paediatric clinical burn care in the UK. The network caters for a population of five million for small injuries and a ten million population for complex injuries. The Network builds upon an epidemiological database collating clinical data from children seen in the network across the South West of England and South Wales. The Research Team is embedded into the Clinical Team at The Bristol Royal Hospital for Children that cares for 1000 new referrals each year.

The Clinical Research Team at the Children’s Burns Research Centre Team is led by Dr Amber Young (Consultant Paediatric Anaesthetist and Burn Network Children’s Lead) and consists of the Research Centre Coordinator, Senior Research Nurse, Research Nurses, Senior Research Associate, Centre Statistician, Health Economist and Database Manager. Please see the People tab on the website for more details.

University of Bath

The Department of Chemistry and the South West Children’s Burns Network have been involved on joint projects looking at methodologies for detection of burn infections since 2008.

Toby’s Story from University of Bath on Vimeo.

Current research in paediatric burns

EVIDEnT (Ex Vivo Infection DETection)

This is a laboratory observational Ex-Vivo study to investigate the sensitivity and specificity of a Smartwound™ dressing to detect clinically relevant wound infection. A clinical project within a three year programme of work funded by the MRC led by the University of Bath (Professor Toby Jenkins). The vision for the technology is that the diagnostic dressing will respond to clinically relevant wound infection at the point of bacterial toxin release and alert clinicians to the presence of infection via a simple colour change. This will prevent the over-use of pre-emptive broad spectrum antibiotics and enable the prescription of targeted antibiotics (where infection is present) thus combatting antibiotic resistance.

The ex-vivo clinical study led by Dr Amber Young will recruit 452 patients from Bristol, East Grinstead and Chelsea and Westminster burn services to determine the prototype dressing sensitivity and specificity. This study started in October 2016.

This study follows on from the completed Exudate study which looked at developing a new burns dressing using nano-capsules of 100nm in diameter. The dressing releases an indicator dye and/or antimicrobials where infection is detected in a wound.

This project is funded by the MRC and has been adopted onto the NIHR Portfolio.

DRESSVOCS2: Burns wound dressing volatile compounds - continuation study

A recent pilot research study (DRESSVOCS) was completed to analyse the gas above (headspace) discarded wound dressing material from 55 patients. A range of different volatile profiles were detected in the dressings from burn wounds with and without bacteria-positive wound swabs. Collectively, these results highlight the ability to differentiate bacteria by volatile analysis in vitro and that dressing materials from patients with and without bacterial wound presence have different volatile profiles.

The main aim of this study is to further identify volatiles from patient wound dressings (infected/normal healing) and compare with existing volatile libraries and wound swab microbiology as an indication of the patients’ infection status.

This project is funded by The University of the West of England and The Scar Free Foundation and is on the NIHR Portfolio.

COSB (Core Outcomes for Burn Care Research)

This study aims to explore outcomes after burn injury that are important to patients and professional. A Core Outcome Set (COS) is a minimum set of outcomes that are agreed, defined, measured and reported in a standard way. COSs have been developed in other healthcare areas and have been shown to improve the quality of research. A COS is likely to have a similar impact on burn care research and would thus improve the quality of evidence available to patients and professionals for clinical decision-making. This study will also determine how to measure these outcomes in a practical and reliable way.

This study is being led by Dr Amber Young as part of an NIHR Doctoral Research Fellowship. 

Recently completed projects

SILKIE (Skin graftIng Low friKtIon Environment): Can skin grafting success rates in burn patients be improved by using a low friction environment?

Background: Each year approximately 1000 skin grafts are undertaken in England and Wales; around 20% of these skin grafts will fail partially or completely, leaving wounds needing further surgery. Skin graft failure will cause delayed healing, increased scarring, anxiety for patients, longer hospital stay and increased NHS costs. One of the causes of skin graft loss is rubbing the skin or friction between sheets and the wound dressing causing graft movement and failure of attachment to the wound bed.

The SILKIE Study feasibility study aimed to find out if it was feasible to use low friction sheets for burn patients requiring skin grafts.

This project was funded by the NIHR Research for Patient Benefit grant scheme and is on the NIHR UK Clinical Trials Database. 

The MISTIC Study (Morbidity In Small Thermal Injury in Children)

This was a prospective observational study investigating the physiological response to small to moderate sized burns in pre-school children. Young children can become unwell in the days following even a small burn injury, and it may sometimes be difficult to determine if the child is unwell simply because their body is working so hard to heal the wound, or if they have an infection associated with the burn, or toxic shock syndrome.

This study seeked to understand what changes typically happen in a child’s body in response to receiving a burn injury, and to explore ways in which we might be able to identify the cause of post-burn illness. We recruited 696 children, making it the largest study of its kind looking at the physiological response to injury in small burns. This was a multicenter study recruiting at UHB, Chelmsford and Birmingham. 

Future development work is soon to begin on MISTIC2, details to follow soon! 

This project was funded by The Scar Free Foundation with thermometers kindly donated by The Children's Burns Trust. This study was adopted onto the NIHR Portfolio.

BIPPS (Burn Injury Persistent Pain Study): What factors are predictive of persistent pain following full thickness and deep dermal burn injury?

This was a feasibility study in collaboration with Kings College London. We aimed to determine whether retained samples of burn injured skin, debrided (surgically removed) prior to skin graft, could be used to assess tissue pathology. This study established the ability of the team to collect, store, transport, and process these skin samples, which would usually be discarded, to determine innervation density, presence or absence of immune cells and changes in Ribonucleic Acid (RNA) expression in the injured skin. These measures of tissue pathology were related to clinical data from donor patients, such as pain, itch, scar formation and analgesia use, to evaluate whether there are correlations between injury pathology and clinical outcomes in these patients.

Patients who undergo surgical debridement of burn injured skin experience different clinical outcomes with regards to pain, analgesia requirements and scar formation. Some develop pain or itch that persists even once the tissue has healed. Often, this pain/itch cannot be treated adequately. Our ultimate aim is to establish a framework in which to run a full study of persistent pain and itch following burn injury requiring skin graft.

Recruitment is complete and results are currently under analysis at Kings College London.

This project was adopted onto the NIHR portfolio.

A road less travelled: mapping children's and families emotional journey following moderate to severe burn injury

This was our first nurse led research project which captured patient/family and staff experiences of burn care and mapped the psychological and emotional journey following significant burn injury and to assess patient and family needs, current support and identify areas for service improvement.

As part of this study we developed a short film for parents, children and healthcare professionals illustrating emotions and feelings to inform practice, and allow targeted supportive information to be developed with the potential for use within the wider burns community. The video will be used by the burns team at UHBristol.

This project was funded by Roald Dahl’s Marvellous Nurse Inventing Room Children’s Charity.