Trial reportJournal of the American College of Surgeons2014
Impact of stress-induced diabetes on outcomes in severely burned children.
Trial report in Journal of the American College of Surgeons, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Systematic review of clinical outcome reporting in randomised controlled trials of burn care.BMJ open · 2019Pooled it
- Reduced Postburn Hypertrophic Scarring and Improved Physical Recovery With Yearlong Administration of Oxandrolone and Propranolol.Annals of surgery · 2018Trial
- Reversal of Growth Arrest With the Combined Administration of Oxandrolone and Propranolol in Severely Burned Children.Annals of surgery · 2016Trial
- Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults.Critical care (London, England) · 2015Trial
- Predictive Value of IL-8 for Sepsis and Severe Infections After Burn Injury: A Clinical Study.Shock (Augusta, Ga.) · 2015Trial
- Metabolic and Hormonal Changes in Pediatric Burn Patients: Mechanisms, Evidence, and Care Strategies.European burn journal · 2025Review
- The efficacy of topical insulin application on rat model with burn wounds treated with adipose-derived stem cells.International journal of burns and trauma · 2020Article
- Malnutrition and Associated Risk Factors Among Disabled Children. Special Considerations in the Pediatric Surgical "Fragile" Patients.Frontiers in pediatrics · 2019Article
- The Long-Term Impact of Severe Burn Trauma on Musculoskeletal Health.Journal of burn care & research : official publication of the American Burn Association · 2018Review
- Contemporary Burn Survival.Journal of the American College of Surgeons · 2018Article
- The clinically used PARP inhibitor olaparib improves organ function, suppresses inflammatory responses and accelerates wound healing in a murine model of third-degree burn injury.British journal of pharmacology · 2018Article
- The P50 Research Center in Perioperative Sciences: How the investment by the National Institute of General Medical Sciences in team science has reduced postburn mortality.The journal of trauma and acute care surgery · 2017Article
- Local application of low-dose insulin in improving wound healing after deep burn surgery.Experimental and therapeutic medicine · 2016Article
- Satellite cell activation and apoptosis in skeletal muscle from severely burned children.The Journal of physiology · 2016Article
- Apyrase Elicits Host Antimicrobial Responses and Resolves Infection in Burns.Journal of burn care & research : official publication of the American Burn AssociationArticle
Corrections and comments
- Commented on byDiscussion.2014
Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundPost-burn hyperglycemia leads to graft failure, multiple organ failure, and death. A hyperinsulinemic-euglycemic clamp is used to keep serum glucose between 60 and 110 mg/dL. Because of frequent hypoglycemic episodes, a less-stringent sliding scale insulin protocol is used to maintain serum glucose levels between 80 and 160 mg/dL after elevations >180 mg/dL. STUDY
designWe randomized pediatric patients with massive burns into 2 groups, patients receiving sliding scale insulin to lower blood glucose levels (n = 145) and those receiving no insulin (n = 98), to determine the differences in morbidity and mortality. Patients 0 to 18 years old with burns covering ≥ 30% of the total body surface area and not randomized to receive anabolic agents were included in this study. End points included glucose levels, infections, resting energy expenditure, lean body mass, bone mineral content, fat mass, muscle strength, and serum inflammatory cytokines, hormones, and liver enzymes.
resultsMaximal glucose levels occurred within 6 days of burn injury. Blood glucose levels were age dependent, with older children requiring more insulin (p < 0.05). Daily maximum and daily minimum, but not 6 am, glucose levels were significantly different based on treatment group (p < 0.05). Insulin significantly increased resting energy expenditure and improved bone mineral content (p < 0.05). Each additional wound infection increased incidence of hyperglycemia (p = 0.004). There was no mortality in patients not receiving insulin, only in patients who received insulin (p < 0.004). Muscle strength was increased in patients receiving insulin (p < 0.05).
conclusionsBurn-induced hyperglycemia develops in a subset of severely burned children. Length of stay was reduced in the no insulin group, and there were no deaths in this group. Administration of insulin positively impacted bone mineral content and muscle strength, but increased resting energy expenditure, hypoglycemic episodes, and mortality. New glucose-lowering strategies might be needed.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.