PURPOSE Friction burns are a distinct yet frequently under-recognised mechanism of burn injury in both adult and paediatric populations. These injuries are commonly underestimated at initial assessment, leading to delayed specialist referral and suboptimal management. The rapid uptake of electric bicycles and scooters has introduced higher-energy mechanisms and evolving risk profiles for friction-related injury. This study aims to characterise contemporary patterns of friction burns and examines emerging trends associated with electric micromobility. METHODS A retrospective cohort study was conducted of patients presenting with friction burns to Western Australia’s State Adult Burn Unit and State Trauma Unit between January 2021 and January 2026. Data collected included demographics, injury mechanism, total body surface area (TBSA), burn depth, anatomical distribution, operative management, referral pathways, and outcomes. RESULTS A total of 87 patients were identified. Burns commonly resulted from wheeled recreational and road-related mechanisms, predominantly affecting the lower limbs and upper extremities. Although median TBSA was modest (5%), a substantial proportion sustained deep dermal or full-thickness injury requiring operative intervention. Electric bikes and scooters accounted for an increasing proportion of injuries, with higher travel velocities and road-surface contact associated with increased burn depth and operative requirements. Under-recognition and delayed referral to specialist burn services remained common. Long-term follow-up demonstrated ongoing morbidity, including hypertrophic scarring and psychosocial distress. CONCLUSION Friction burns remain an under-recognised and underestimated injury despite often limited TBSA. The expanding use of electric micromobility devices appears to be contributing to increasing injury incidence and severity. Improved early recognition, timely referral to specialist services, and targeted prevention strategies are essential to reduce long-term physical and psychosocial sequelae.

Paediatric hand and foot burns are common with secondary scar formation and contracture formation implicating growth and development. Negative Pressure Wound Therapy (NPWT) has been introduced in acute paediatric burn care to decrease the time to re-epithelialisation and therefore scar formation probability. However, there is a perception that NPWT may not be feasible in hand and foot burns resulting in these areas being omitted. The aim of this study was to assess if NPWT use on paediatric hand and foot burns is feasible. Method This single centre, two arm parallel-group, pilot randomised control trial was conducted at a quaternary paediatric burn’s unit in Queensland, Australia from April 2022 to June 2023. Hand and/or foot burns in children <16 years of age were randomised to one of two groups: Mepitel® (silicone) and Acticoat™ (silver nanocrystalline) or Mepitel®, Acticoat™ and NPWT (RENASYS Touch). The primary objective was trial feasibility defined as recruitment, treatment, data collection and study completion. The feasibility, complications and effectiveness of NPWT use on paediatric hand and foot burns was also assessed. Results Thirty-two participants were randomised. The screening percentage was 4.7%. This study met all trial feasibility parameters. There was no difference in clinician or familial perception of implementation feasibility between the two groups. 93.3% of participants stated they would use it again. Mepitel®, Acticoat™ and NPWT had significantly more issues with dressings lifting compared to Mepitel® and Acticoat™ (p=0.05, mean difference 26.7% 95% CI 2.5 – 50.9) however there was no difference in overall issues (p=0.1, mean difference 27.5% 95% CI -4.1 – 59.1). Conclusion This was a feasible trial with no difference in clinician or familial perception of NPWT implementation being demonstrated between the two groups. Concern regarding NPWT burden in paediatric hand and foot burns should therefore not be a barrier to implementation.

Purpose: It is well documented that patients with severe burns are at increased risk of developing hypothermia. However, the time in hypothermia of severe burn patients and the impact of temperature management practices during resuscitation of patients is poorly characterised. This study aimed to investigate factors associated with time in hypothermia of severe burn patients during the first 24-hour resuscitation period and the relationship of time in hypothermia with hospital mortality. Methodology: A 5-year retrospective cohort study was conducted of adult patients (>18 years of age) with severe burns (>20% total body surface area, TBSA) admitted to a burns service hospital. Data was extracted using the Burns Registry of Australia and New Zealand and supplemented with electronic medical records. Hypothermia was defined as a body temperature <36.0°C. Variables investigated included patient demographics, injury characteristics, surgery within 24 hours, frequency of temperature recordings and use of warming devices. Results: 142 patients were eligible and included in analysis. In the first 24 hours since presentation to hospital, 108 patients developed hypothermia and the median time in hypothermia was 315.5 minutes (IQR 23-559). Patients who experienced a longer time in hypothermia were associated with a higher TBSA% burnt (p < 0.001), inhalation injury (p < 0.001), non-accidental intent (p = 0.019), use of forced-air warming blankets (p = 0.021) and infusion of warmed fluids (p = 0.025). Time in hypothermia was significantly associated with hospital mortality (OR 1.002; 95%CI:1.001-1.004; p < 0.001). Conclusion: Hypothermia was commonly observed among patients with severe burns and significantly associated with hospital mortality. Frequent observations of temperature and use of warming devices were not associated with lower time in hypothermia, although use was most likely reactive. Protocolised monitoring of temperature and warming strategies is indicated.

Background: Specialist burns telehealth services are increasingly used to support regional and rural centres; however, limited data describe outcomes for patients initially managed via telehealth who subsequently require operative intervention. This study evaluates surgical timing and outcomes following telehealth referral to a tertiary burns unit, benchmarked against national standards. Methods: A retrospective review was performed of all patients referred via a specialist burns telehealth service who subsequently underwent operative burn management during 2024–2025. Demographics, burn characteristics, timing metrics, operative details, length of stay (LOS), and complications were collected. Outcomes were compared with published Australian and New Zealand Burns Registry (BRANZ) benchmarks where applicable. Results: Forty patients were included (23 in 2024; 17 in 2025). Median burn size was 2.0% TBSA (range 0.1–7.0%). Median time from injury to initial telehealth consultation was 4 days (range 1–42). Median time from telehealth review to surgery was 8 days (range 1–49), with a median time from injury to surgery of 13 days (range 3–60). Median hospital LOS was 8.5 days (range 1–47). The overall complication rate was 15% (6/40), including three patients requiring intravenous antibiotics, one case of Biodegradable Temporising Matrix loss, and two patients requiring regrafting during the index admission. There were no unplanned ICU admissions or mortalities. Surgical timing and LOS were comparable to BRANZ-reported outcomes for small-to-moderate TBSA burns managed operatively. Conclusion: Burns telehealth effectively identifies patients requiring operative management while maintaining acceptable surgical timing and outcomes consistent with national benchmarks. These findings support telehealth as a safe and efficient triage pathway for surgical burns care and highlight its role in improving access to specialist services for regional and rural populations.