Burn wounds in children result in significant and long lasting physical and emotional impacts which require repeated surgeries and rehabilitation efforts well into adulthood. Burn wound treatment involves ‘de-roofing’ of blisters, however, little attention has been paid to the composition of the blister fluid and if the constituents have diagnostic or prognostic potential. Blister fluid analysis provides an opportunity to non-invasively investigate the biology of the initial response to burn injury and potentially uncover novel diagnostics or prognostics to assist in early clinical decision making that might assist healing and reduce scarring.
We performed a proteomic analysis of 87 paediatric burn blister fluid samples using liquid chromatography - tandem mass spectrometry with SWATH (data independent) acquisition. The blister fluid proteomes of all samples were compared to the key clinical features of burn depth classification (superficial-partial thickness; deep-partial thickness; and full-thickness) and time-to-reepithelialisation (time to healing). Both of these clinical parameters are critical for enabling accurate clinical decisions regarding early burn treatment options such as whether or not to graft.
More than 600 proteins were quantitatively compared between samples using partial least squares-discriminant analysis which revealed significant differences in the biochemistry associated with both burn depth and time-to-reepithelialisation. Interestingly, the protein profiles provided evidence of potential clinical misclassification of some burn wounds examined in this study.
While full-thickness burns are often grafted and superficial-partial thickness burns are often not grafted, it is more difficult to determine if deep-partial thickness burns should be grafted or not. Thus, with further validation, utilisation of the results of this study could translate to aid in clinical decision making. Overall, this study provides new insights into the early stages of burn wound biology in children and may help with the development of diagnostic or prognostic tools to assist with clinical decisions regarding burn treatment options.