bluuebunny/crossref_metadata_2025 huggingface dataset:
515 Evaluation of growth hormone use in patients with large burns and complex wounds
Authors: Gayed Rita , Lindsey Lindsey , Mittal Rohit , Hodge Juvonda , Ingram Walter L
Published: April 2021

Introduction

Large burn injuries lead to an extensive and prolonged catabolic state that results in loss of body mass and impaired wound healing. To combat this hypermetabolic response, different strategies have been employed including early excision and grafting, infection control, early nutrition and anabolic therapies such as oxandrolone. Human growth hormone is of interest for burn patients because of its anabolic properties.

While its use has been associated with worse outcomes in the critically ill adult with sepsis, it has shown improved outcomes when used in pediatric burn patients. The purpose of this study was to retrospectively evaluate the appropriateness of human growth hormone use, its adverse events and cost in patients with large burns or complex wounds and poor wound healing.

Methods

This was an IRB approved, retrospective, single center chart review from 2011 to 2019 assessing human growth hormone prescribing patterns in the burn unit. The primary objective was appropriateness of use, defined as documentation of poor wound healing prior to initiation despite adequate nutrition delivery and use of standard anabolic therapies (i.e., oxandrolone). Secondary objectives included perceived benefit, adverse events and median therapy cost per patient of human growth hormone.

Results

Thirty-eight patients were included in the study, 79% of which were adults, with a median total body surface area involvement of 50% (IQR 40 to 71). Only forty-one per cent of patients receiving human growth hormone met our predefined criteria for appropriateness; this was primarily driven by poor documentation of wound healing. However, 80% of patients were receiving adequate nutrition and oxandrolone, indicating appropriate clinical use. Most adult patients received a dose of 20mg daily, while pediatrics received the weight based 0.2mg/kg daily dose. The median duration of treatment was 24 days (IQR 13–35) and median time from admission to growth hormone initiation was 27 days (IQR 12–34). Overall clinical improvement was noted in 53% of patients, as evident by increased weight, prealbumin and/or documentation of improved wound healing. The most common adverse effect noted was hyperglycemia, followed by new sepsis onset. The median therapy cost per patient was $42,000.

Conclusions

Human growth hormone may serve as a salvage therapy for large burns with poorly healing wounds. Prior to initiating therapy, nutrition must be optimized and standard, more researched anabolic therapies should be started. While receiving therapy, patients should be monitored for both hyperglycemia and the development of new sepsis.
517 Hyperbaric Oxygen and Mortality in Burns with Inhalation Injury: a Study of the National Burn Repository
Authors: Nygaard Rachel M , Endorf Frederick W
Published: April 2021

Introduction

Mortality in burn injury is primarily influenced by three factors: age, percent burn (%TBSA), and presence of inhalation injury. Numerous modalities have been tried in an attempt to treat those patients with burns and inhalation injury, including the use of hyperbaric oxygen (HBO). The aim of our study was to find the national prevalence of HBO for burns with inhalation injury, and whether HBO influenced mortality in these often severely injured patients.

Methods

This retrospective study used the National Burn Repository (NBR) to identify hospital admissions of patients with both cutaneous burns and inhalation injuries. After applying exclusion criteria, a total of 13,044 patients were identified. Variables included in the multivariate regression analysis included: age, sex, race, payer, mechanism of burn injury, TBSA group, total procedure number, mechanical ventilator days, and treatment with HBO. The main outcome variable was mortality.

Results

Of the 13,044 patients, 67 had HBO therapy. The HBO patients were older (mean age 51.7 years vs. 42.8 years, p< 0.001) but had smaller burns and thus a similar Baux score (66.6 vs. 65.2, p=0.661). The HBO patients had a higher mortality (29.9% vs. 17.5%, p= 0.01). On multivariate regression analysis, HBO was an independent predictor of mortality (OR= 2.484, p= 0.004). Other significant predictors of mortality included age, Black race, Medicaid or uninsured patients, and %TBSA.

Conclusions

The use of HBO for patients with burns and inhalation injury is uncommon in this database. It is unclear whether that reflects low prevalence or if individual centers do not all impute HBO into the NBR. For those patients in this database, HBO is an independent predictor of mortality. It can be difficult to determine the severity of inhalation injury in the NBR, so those patients receiving HBO could theoretically have more severe inhalation injury.
518 Massive Burn Injury Outcomes in Children
Authors: Martens Sally A , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G , Sen Soman
Published: April 2021

Introduction

Advances in the care of burn injured pediatric patients has improved mortality over the last 20 years. However, massive burn injuries in pediatric patients, while overall rare, have a significant morbidity and mortality. The primary aim for this study is to analyze outcomes in massive pediatric burn injuries.

Methods

After institutional review board approval, a retrospective study of children with burn injuries 50% TBSA or greater who were admitted to our pediatric burn center from 2009 to 2019 was conducted. Data collected include age, gender, ethnicity, race, country of residence, % TBSA, degree of burn, presence of inhalation injury, hospital duration, intensive care duration, presence of tracheostomy, number and types of surgeries performed and discharge outcomes. All mean values are mean±standard deviation, all median values are median (interquartile range), and p-value < 0.05 were considered significant.

Results

This study included 84 patients (60.7% male) with a mean age of 8±6 years old. The median time from injury to admission was 2(1–4) days. 56% of patients were from Mexico, 43% were from the United States and 1 patient was from American Samoa. 21% of the patients died. There was no difference in the extent of burn injury between patients who died (68±14% TBSA) versus those who lived (66±12% TBSA). The median length of stay was significantly shorter in the patients who died (19(5–44) vs. 74(35–138) days p=0.0001). Patients who died also suffered more inhalation injury (61% vs. 21%, p=0.01). After adjusting for age and TBSA, inhalation was a significant independent predictor of death (OR- 4.3, (1.4-13 95% CI), p=0.01).

Conclusions

Over the past decade, nearly 80% of children with massive burn injuries survived. The children who died as a result of their massive burn injury, died within the first month of admission. Inhalation injury significantly and independently increases the risk of dying in pediatric patients with a massive burn injury.
519 The Routine Addition of Maintenance IV Fluid is Not Warranted during all Pediatric Burn Resuscitation: A Retrospective Study
Authors: Senthil-Kumar Prabhu , Zieger Madeline , Hartman Brett C
Published: April 2021

Introduction

Pediatric burn resuscitation has improved dramatically over the years with improved survival and outcomes. Recent studies have shown the amount of fluid given (ml/kg/%TBSA) has direct correlation to the outcomes. Over resuscitation (fluid creep) results in multiple systemic and wound complications. We hypothesize the addition of maintenance IV fluid with Parkland resuscitation fluid in younger pediatric burns (< 30kg) may not be needed to achieve adequate end points of resuscitation.

Methods

We performed a retrospective chart analysis of our pediatric burn patients at our institution by categorizing younger patients (< 30kg) into two groups: The maintenance IV fluid (MF) group and the resuscitation fluid (RF) only group. We identified 18 patients that met the criteria with 9 patients in each group. All of the patients in both groups were under 30kg, age range 2-8yrs, and TBSA: 16–50 %. We included 3 patients under 20% TBSA that were resuscitated due to full thickness burns and smoke inhalation injury. We analyzed their hourly and 24-hour fluid administration including all oral intake and tube feeds as well as their hourly vitals, urine output, and laboratory values during the resuscitation.

Results

We found that the RF group received 1.311+/- 1.295 cc/kg cc less fluid compared to the MF group without any hypoglycemic events or deleterious hemodynamic effects. The patients who had good oral intake or received tube feeds during resuscitation resulted in significantly less resuscitation volume than the estimated resuscitation volume in both groups.

Conclusions

We conclude that resuscitation can be safely done in pediatric burn patients under 30 kg without adding routine maintenance IV fluid. Early oral and enteral feeding is very critical in all burn patients. The volume that was administered enterally should also be considered in hourly fluid titration rates to reduce the resuscitation fluids given thereby preventing fluid creep and ensuing deleterious complications.
526 Outcomes of Burn Patients with Pre-Existing Human Immunodeficiency Virus: A Systematic-Review and Meta-Analysis
Authors: Mafla Laura M , Quiroga Luis H , Cemaj Sophie L , Khalil Nora , Hultman Charles S
Published: April 2021

Introduction

Burn injuries are well known to cause a state of immunosuppression in patients. This can result in wound infections, a common complication in burn injuries, that can lead to sepsis and increased mortality. Human immunodeficiency virus (HIV) is also known to cause immunosuppression in patients. The outcomes of burn patients with pre-existing HIV infections, however, are not yet completely understood. We conducted a systematic review and meta-analysis to compare the outcomes of burn patients with pre-existing HIV against those without this chronic infection.

Methods

We searched MEDLINE (Pubmed), Google Scholar, Scopus, and Embase for studies that compared outcomes and complications between burn patients with and without HIV. From this search, we screened 445 articles. Through our selection criteria, five articles focusing on HIV patients were selected for systematic review and meta-analysis. Data were analyzed using the Cochrane Review Manager (RevMan) Data Analysis package to produce pooled odds ratios and mean differences from the random effect model.

Results

Five studies observing a total of 24,419 burn patients, published between 2000 and 2017, were included. Of these, two are prospective studies and three are retrospective chart reviews. The primary outcome of mortality for HIV+ patients compared to HIV- patients had an odds ratio of 2.04 (CI= 0.46–9.14) in the random effects model. Secondary outcomes of sepsis and wound infection odds ratios were 1.47 (CI= 0.44–4.99) and 1.10 (CI= 0.28–4.25), respectively. The length of stay (LOS) between studies showed an overall mean difference of 0.95 (CI=-8.08–9.99). Most studies had a greater proportion of male patients. TBSA between studies ranged from 13.1% and 35%.

Conclusions

From our results, we concluded that HIV+ had a tendency toward greater mortality (OR=2.04) and sepsis (OR=1.47). However, mortality and sepsis had confidence intervals of [0.46–9.14] and [0.44–4.99], respectively. Therefore, we cannot definitively state that HIV infection is responsible for greater mortality or sepsis in burn patients. Additionally, LOS analysis also showed a wide confidence interval [-8.08–9.99], preventing us from making reliable deductions about this outcome. We believe further research is needed before universal conclusion or recommendations are appropriate.
531 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State
Authors: Matthews Marc R , Calder Sara , Kowal-Vern Areta , Spadafore Philomene , Richey Karen J , Foster Kevin N
Published: April 2021

Introduction

Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations.

Methods

This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed.

Results

The mean ±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5.

Conclusions

Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.
533 Evaluation of growth hormone use in patients with large burns and complex wounds
Authors: Gayed Rita , Lindsey Lindsey , Mittal Rohit , Hodge Juvonda , Ingram Walter L
Published: April 2021

Introduction

Large burn injuries lead to an extensive and prolonged catabolic state that results in loss of body mass and impaired wound healing. To combat this hypermetabolic response, different strategies have been employed including early excision and grafting, infection control, early nutrition and anabolic therapies such as oxandrolone. Human growth hormone is of interest for burn patients because of its anabolic properties. While its use has been associated with worse outcomes in the critically ill adult with sepsis, it has shown improved outcomes when used in pediatric burn patients.

The purpose of this study was to retrospectively evaluate the appropriateness of human growth hormone use, its adverse events and cost in patients with large burns or complex wounds and poor wound healing.

Methods

This was an IRB approved, retrospective, single center chart review from 2011 to 2019 assessing human growth hormone prescribing patterns in the burn unit. The primary objective was appropriateness of use, defined as documentation of poor wound healing prior to initiation despite adequate nutrition delivery and use of standard anabolic therapies (i.e. oxandrolone). Secondary objectives included perceived benefit, adverse events and median therapy cost per patient of human growth hormone.

Results

Thirty-eight patients were included in the study, 79% of which were adults, with a median total body surface area involvement of 50% (IQR 40 to 71). Only forty-one per cent of patients receiving human growth hormone met our predefined criteria for appropriateness; this was primarily driven by poor documentation of wound healing. However, 80% of patients were receiving adequate nutrition and oxandrolone, indicating appropriate clinical use. Most adult patients received a dose of 20mg daily, while pediatrics received the weight based 0.2mg/kg daily dose. The median duration of treatment was 24 days (IQR 13–35) and median time from admission to growth hormone initiation was 27 days (IQR 12–34). Overall clinical improvement was noted in 53% of patients, as evident by increased weight, prealbumin and/or documentation of improved wound healing. The most common adverse effect noted was hyperglycemia, followed by new sepsis onset. The median therapy cost per patient was $42,000.

Conclusions

Human growth hormone may serve as a salvage therapy for large burns with poorly healing wounds. Prior to initiating therapy, nutrition must be optimized and standard, more researched anabolic therapies should be started. While receiving therapy, patients should be monitored for both hyperglycemia and the development of new sepsis.
534 Persistent Copper and Zinc Deficiency in Excess of 30 Days Post Burn Injury
Authors: Sullivan Louisa , Quan Asia N , Richey Karen J , Foster Kevin N
Published: April 2021

Introduction

Copper and zinc deficiencies are common after burn injury, with the lowest levels usually occurring within seven days. Both trace elements are important for wound healing, but due to competition for absorption in the small intestine, oral replacement of zinc and copper may not be sufficient. Nutritional guidelines recommend copper and zinc replacement for up to 30 days, but little data is available to guide long-term trace element replacement.

Methods

This case series includes four patients with 15% or larger total body surface area burns who had hypocupremia at least 30 days after admission despite receiving at least the recommended daily allowance of copper via tube feeds.

Results

In two patients, copper levels increased following discontinuation of oral zinc tablets. However, one patient had continued hypocupremia and increasing zinc levels while receiving zinc only from tube feeds, suggesting this amount of zinc may decrease dietary copper absorption. For one patient with 95% TBSA burns, hypocupremia was associated with polyneuropathy and osteopenia. Another patient experienced an acute drop in zinc levels associated with bacteremia and sepsis.

Conclusions

In this case series, hypocupremia was associated with anemia and zinc deficiency with poor wound healing. Additional multicenter practice reviews of copper and zinc supplementation in burn centers would be beneficial.
541 72 Facial Burns Treated with Autologous Skin Cell Suspension- A Real World Data Analysis Across 5 U.S. Burn Centers
Authors: Carter Jeffrey E , Phelan Herbert , Kopari Nicole M , Kahn Steven , Molnar Joseph , Bailey John K , Saraswat Anju , Holmes James H
Published: April 2021

Introduction

Optimal management of facial burn injuries remains a significant challenge in burn care. Acute surgical intervention is often coupled with delayed reconstructive procedures as an essential option for burn care. Experience with new surgical technologies could challenge historic reconstructive ladders. Our goal was to pragmatically assess the rate of successful intervention with autologous skin cell suspension (ASCS) for the treatment of facial burn injuries from real-world data.

Methods

A retrospective review from five burn centers over a three-year period was performed from deidentified registry data for facial burn injuries initially treated with ASCS. Cases of non-acute thermal burn and burns not involving the face were excluded. Data collection included: date of surgery, last follow-up date, need for grafting (split or full thickness skin graft, STSG or FTSG, respectively) or reapplication of ASCS within the same hospitalization, and reconstruction not including laser procedures due to scarring during the follow-up period. Descriptive statistics were calculated and data are reported as median with interquartile ranges where appropriate.

Results

A total of 72 burn injuries were treated with ASCS for facial burn injuries. Two burn centers treated 4 patients each, one treated 18, and the remaining two treated 22 and 24 patients. The median follow-up was 199 days (range 9 -1,150 days). Acute failure requiring a second treatment with ASCS or application of a full-thickness or split-thickness autograft occurred in 12 (16%) of the patients with 5 undergoing re-application of ASCS and 7 undergoing FTSG or STSG. reconstruction secondary to scarring during the follow-up period occurred in 10 (14%) of patients. Reconstruction was required in 1 of 5 patients that underwent a second treatment with ASCS as opposed to 4 of 5 patients treated with FTSG or STSG.

Conclusions

This study represents the largest experience with the use of ASCS for the management of facial burn injury in the reported literature. Use of ASCS from real-world data indicated that ASCS successfully resulted in definitive wound closure in 90% of the patients treated with facial burn injuries, with 10% requiring secondary intervention. This failure rate is below the previously published rate of 33%, indicating the disruptive potential of this technology for the management of facial burn injuries.
542 A Prospective Observational Trial of Clinical Burn Wound Imaging with Spatial Frequency Domain Imaging
Authors: Rowland Rebecca , Ponticorvo Adrien , Kennedy Gordon T , Bernal Nicole O , Burmeister David M , Chin Theresa L , Christy Robert J , Durkin Anthony , Joe Victor C
Published: April 2021

Introduction

While visual assessment is the standard for burn severity evaluation, new technologies are attempting to increase objectivity. Burn depth assessment accuracy improves over time as the appearance changes, but earlier diagnosis potentially leads to prompt treatment and shorter recovery. Laser Speckle Imaging (LSI), FDA approved for grading burns, is typically done 72hrs after injury. Spatial Frequency Domain Imaging (SFDI), a novel technology only tested in animal burn models, uses multiple wavelengths of patterned light to quantify tissue absorption (hemodynamics) and scattering (structure). SFDI has shown the potential to differentiate burns as early as 24hrs postburn by measuring scattering (µs’) changes due to collagen damage. Here, we examine SFDI burn severity assessment in clinical patients, and compare against LSI and clinical assessment.

Methods

5 burn cases were imaged with LSI and SFDI approximately 24 and 72hrs postburn. The clinician was blinded to imaging results and made diagnoses on their standard of care.

Results

One patient received no surgical intervention, one received excision and xenograft, and two received excision and autograft. An autograft was recommended for one patient, but not performed due to preexisting conditions. SFDI measurements at 24hrs showed low µs’ values in regions that eventually required autografts, and high µs’ in burns that did not. While clinical decisions were made no earlier than 72hrs postburn, µs’ maps at 24hrs postburn were able to illustrate severity in these regions. In 2 of 3 autograft cases, LSI was unable to determine the severity until 72hrs postburn.

Conclusions

Here, we compared SFDI to LSI in a clinical setting to quantify burn wound severity. Similar to animal models, SFDI was demonstrated to accurately characterize severity earlier than the perfusion-based LSI. This is likely due to sensitivity of µs’ measured by SFDI to the structural changes in damaged collagen (i.e., zone of coagulation) that occur immediately postburn.
551 Fish Skin Compared to Cadaver Skin as a Temporary Coverage and Wound Bed Preparation for Full Thickness Burns: An Early Feasibility Trial.
Authors: Shupp Jeffrey W , McLawhorn Melissa M , Moffatt Lauren T
Published: April 2021

Introduction

Full-thickness thermal burns may require staged procedures with temporary coverage to ensure the wound bed is optimized for autografting. A potential dermal substitute for thermal injury is fish skin grafts. These are made in Iceland from freeze dried, sterilized, decellularized skin of North Atlantic cod (Gadus morhua). The gentle processing of the fish skin removes the risk of viral disease transmission to humans and retains its naturally occurring Omega3 fatty acids which are known for their pain and inflammation modulating effects. Fish skin graft has a shelf life of 3 years at room temperature, whereas cadaver skin, the current standard of care at many institutions, has to be cryopreserved, is donor derived, and contains only trace amounts of Omega3. While fish skin graft has been cleared by the FDA as a medical device for use in acute, surgical, chronic wounds, and partial thickness burns, it has not yet been indicated for use in full-thickness burns. The purpose of this clinical trial is to assess the safety and efficacy of decellularized, freeze dried fish skin as an alternative to cadaveric skin (standard of care) for temporary coverage in the setting of a full-thickness burn requiring staged grafting.

Methods

Patients with full thickness burns to their extremities and/or chest were randomized to have two adjacent areas (70–140 cm2 each) covered with either fish skin or cadaver skin for one week following excision. Patients then received a split thickness skin graft (STSG). Healing was observed by blinded assessors for each area weekly for three weeks, with a scarring assessment completed at 3 months post STSG. Background pain was measured by a visual analogue scale (VAS) for pain and wounds were photographed at each time point.

Results

Five patients are included in this initial analysis and all completed the 3-month post STSG follow up. TBSA ranged from 8–37%.

The fish skin treated area was assessed to be 90% healed at the same timeframe or earlier than cadaver treated areas in all subjects. There was a trend towards a reduction in pain in the fish skin covered areas. One patient was unable to give a pain score due to heavy sedation.

Adverse events were reported in all five patients, but none were associated with the use of the investigational product. Graft failures were observed in two cadaver skin covered areas and one partial failure in a fish skin covered area.

Conclusions

Results from this trial so far indicate that the fish skin is safe and non-inferior to cadaver skin as an early coverage for full thickness burns. Enrollment in this study is still ongoing, and patients will be followed up for 12 months.
555 Early Application of a Water-soluble Surfactant Dressing for Partial-thickness Burn Wounds to Reduce Wound Conversion
Authors: Hill David M , Mahmood Ammar O , Mitchell Matthew B , Allen Jakob H , Hickerson William L , Velamuri Sai R R , Director Medical
Published: April 2021

Introduction

Surfactant-based wound dressings have been utilized in chronic, non-healing wounds and small burn wounds to soften and aid removal of wound debris. In vitro data suggest enhanced healing properties are due to the ability to stabilize and potentially reseal plasma membranes, thereby, retaining cellular integrity and enhance wound healing. Further, surfactant-based wound dressings are non-ionic and may facilitate removal, sensitize, or prevent bacterial biofilms. Biofilms are an evolved, protective mechanism bacteria utilize to reduce antimicrobial efficacy. Removal or penetration of biofilms is essential for bacterial eradication. This case series presents outcomes from use of a water-soluble surfactant dressing (WSD) is used at hospital admission for treating partial thickness (PT) burn wounds.

Methods

This retrospective, single-center, electronic health record review, included patients, if they were admitted between August 1, 2019 - January 31, 2020, at least 18 years old, and sustained a PT burn wound treated with WSD on admission. Pregnant or incarcerated patients were excluded. The WSD was applied following initial wound debridement, and then twice daily until either discharge or it was deemed burn wound excision would be required. PT tissue salvage was calculated from body mass index (BMI), PT total body surface area (TBSA) burned, and cm2 requiring autografting. SigmaPlot 11.0 was utilized for statistical analysis.

Results

Thirty-two patients were included. All but one patient had a TBSA burned less than 20% with median (IQR) of 6% (3.5,9). Fifteen also had some full thickness injuries. Seventy-eight percent had flame injuries; 19% contact. Two had inhalation injuries. All but four had a significant past medical and/or social history. Fifty-nine percent had a history of substance abuse and 22% had diabetes. Nine patients had a delayed admission. The median BMI was 26 (24.3,34.2). There were no deaths. Seven patients were discharged within 48 hours to complete outpatient treatment. Median length of stay was 7 days (4.8,12.8). There was lack of any full thickness conversion to the applied areas in 69% of patients; 91% demonstrated either complete or some tissue salvage. Median % PT tissue salvage was 100 (75.3,100). The WSD was well tolerated and no patients developed a wound infection to the applied area.

Conclusions

Understanding inherent design limitations, this case series demonstrates feasibility of early application, and potential efficacy preventing wound conversion in a complex population with comorbidities and polysubstance abuse.
556 The Use of a Concentrated Surfactant Based Gel to Promote Burn Wound Healing
Authors: Coffey Rebecca , Penny Rachel
Published: April 2021

Introduction

Strategies to remove necrotic tissue from burn wounds include excisional and non-excisional debridement. Alternative treatments could promote burn wound healing while minimizing patient discomfort and the need for surgery. We evaluated the usage of a concentrated surfactant gel (CSG) to promote burn wound healing in those with indeterminate depth and full thickness burn injuries.

Methods

An IRB approved retrospective study was conducted during a 10-patient new product trial period with enrollment between September and October 2019. Patients included in this study had indeterminate or full thickness burn wounds and were treated with a concentrated surfactant-based gel. Patients with non-burn diagnoses were excluded. Data collected included demographic information, injury descriptors, and additional burn wound characteristics.

Results

A total of 10 patients were included in this study as part of a new product trial. The subjects were 80% male with an average TBSA of 7.5%. 40% had indeterminate and 60% had full thickness burn wounds. Prior to initiation of the CSG, the burn wounds had been open for an average of 41 days. There were no infections or complications with usage of the CSG. 90% of patients reported less pain than the standard of care topical agents for burns. Average duration of treatment with the CSG until healing was 28 days. After usage of the CSG, no patients required surgery.

Conclusions

Our findings support the usage of a concentrated surfactant-based gel in patients with burn wounds. Patients reported decreased pain during dressing changes and ease of use compared to the standard topical agent in burn care. It also prevented surgical debridement in those with indeterminate and full thickness burn injuries.
560 Vacuum Assisted Dressing can be Used as an Effective Dressing Over Non-cultured, Autologous Skin Cell Suspension (ASCS) Combined with Wide Meshed Split Thickness Autografts (mSTSG)
Authors: Olivi Joe A , Rodgers Megan D
Published: April 2021

Introduction

There are accounts of various dressings being applied over epidermal spray cell suspension graft(s) (SCSG) with varying success and no one perfect dressing. We present 3 patients with ASCS grafts used in combination with mSTSG that were treated with vacuum assisted dressing with excellent outcomes.

Methods

All 3 of our patients received surgical debridement, down to healthy viable tissue with exposed tendon. BTM Dermal matrix was used in 2 of the 3 patients with exposed tendon. All three patients had mSTSG with ACSS autografts. All grafts were covered with telfa ™ clear, followed by tacky macroporous silver dressing, then a vacuum assisted closure device. These were left undisturbed until post operative day (POD) 5.

Results

All patients had their dressings taken down on POD #5 with excellent results. The interstices were closed quickly with no negative outcome noted from the vacuum dressings. All patients had excellent wound closure and good function postoperatively.

Conclusions

Vacuum assisted closure devices can be used to cover ASCS and wide meshed grafts with good outcomes. They provide patients with a stable dressing that does not need to be changed and leads to excellent graft take and wound closure.
562 Burn Bed Availability in the Northeast Region During the COVID-19 Pandemic
Authors: Lee Christina , Conlon Kathe M , Marano Michael A , Dimler Margaret A , Lee Robin , Houng Abraham
Published: April 2021

Introduction

The coronavirus disease pandemic has placed enormous strain on all medical services with ICU capabilities throughout the Northeast region. The surge in ICU beds might severely limit burn centers to accept burn patients in a regional mass casualty incident.

Methods

Burn bed data was collected by a regional burn disaster consortium. Open burn bed census was collected via telephone from each burn center in the consortium on April 15th, May 7th, May 21st, June 4th and June 18th of 2020. This data was compared to published data from 2009 to 2016.

Results

The results are listed in Table 1. Lowest available burn bed was 35 beds on April 15th, 2020.

Conclusions

Although a disaster may impact surrounding local and state hospitals, it does not always impact a burn center’s ability to transfer patients from a local trauma center or nearby burn center. A pandemic however affects a larger region and impacts all hospitals within that region.

Peak ICU utilization in the Northeast was between the second and third week of April. During the peak utilization time, burn bed census was about 50% of the historical average. Burn bed census did not return to historical average until May 7, 2020. If a mass casualty event occurred in the pandemic region, the Northeast region would have to reach out to other ABA designated regions for assistance.

Historically, burn mass casualty plans are based on the capacity to move burn patients to other burn centers in order to relieve surge capacity at the affected center. This data illustrates that, in a pandemic, burn beds are being utilized for non-burn patients. The ability to follow these plans will be greatly impacted.
566 Single-Center Experience with Mass Paraquat Exposure
Authors: Williams Felicia N , McKinzie Brian , Powell Brandon , Hollowell Jamie , Maxwell Eli , Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker
Published: April 2021

Introduction

Paraquat dichloride is a widely used, highly toxic chemical herbicide and a leading cause of fatal poisonings. Toxicity is thought to be related to lipid peroxidation. Hours after exposure, patients may experience signs and symptoms ranging from nausea to multi-system organ failure. To prevent pulmonary complications and death, it is recommended to give patients repeated pulse therapy with cyclophosphamide and methylprednisolone administered over a 72-hour period. Our objective is to report our center’s experience treating patients who had been exposed to paraquat over a two-day period.

Methods

Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. Demographics, length of stay, costs and mortality were evaluated.

Results

There were nine patients admitted from the exposure. All were male. All survived. Eight were undocumented migrant farmer workers. The average age was 36 years (range 25–59 years). The average length of stay was 3.3 days (range 2–5 days). Fifty-six percent had cutaneous injury, but only one required debridement and placement of a skin substitute. Thirty-three percent complained of continued shortness of breath after discharge. Average total hospital cost was $28,131 ($9,500–51,000).

Conclusions

Paraquat is a highly toxic herbicide and exposure can be fatal if not treated promptly. Immediate decontamination and repeated pulse therapy with cyclophosphamide and methylprednisolone may be lifesaving.
569 Surrogate Decision Making: Who Has the Ultimate Say in Patient Care?
Authors: Huzar Todd F , Gerrek Monica L , Freet Daniel J
Published: April 2021

Introduction

Burn patients may present with an inability to communicate. In these cases, we need to rely on surrogates such as the Medical Power of Attorney (MPoA) or next of kin. A MPoA gives the agent the authority to participate in medical decision and in accordance with their wishes. The agent may consent to, refuse, withdraw, or withhold treatment, including life-sustaining interventions. At times, they may feel unable to participate in decision making without assistance (i.e. family members). The process can become more complicated and decision making can become “muddied” due to others influencing decisions. In our state, the MPoA is the proxy if the patient is unable to participate in decision making; however, there are cases when the patient doesn’t have an MPoA and the next of kin is the surrogate. In these cases, the next of kin would be consulted in the following order: spouse, adult children, parents, and nearest relatives. Some next of kin may not know the patient’s wishes complicating their care.

Methods

Two cases involving surrogates: #1: 60-year-old man with a history of HIV involved in a MVC and sustained 30% TBSA third and fourth degree burns to the face, torso, and extremities. The severity of his injuries and outcomes were discussed with his wife. She was not certain what her would want and she consulted her family because she did not know what to do; however, she knew that he would not want to live like this. After talking to the family, the kids “over-ruled” her. They wanted aggressive care despite the risks of complications and inability to perform ADLs because of his severe facial and hand burns.

Case#2: 40 something year-old man with a history of schizophrenia that sustained 65% TBSA third and fourth degree burns to his face, neck, torso, and extremities due to self-immolation. The patient’s mother was identified, and it was explained to the patient’s mother that if he did survive his injury, he will not be able to perform any of his ADLs due his hand and facial burns. The patient’s mother wanted everything done for her son.

Results

Both patients were unable to perform ADLs due to their injuries. One patient was discharged for further inpatient care and the other was discharged home because his mother refused further care. The first patient was unable to communicate about his thoughts on his outcome. The other patient was discharged home. He was upset about what he looked like. He also told the staff that he will do his best to finish what he started.

Conclusions

Complex issues can arise when the patient cannot communicate their wishes and the next of kin plays the role of surrogate. The family may disagree and alter the decision-making process. After seeing this scenario play out and patients not being happy about their outcomes, the policies regarding surrogate decision making should be re-evaluated.
570 A 10-year Retrospective Review of Pediatric Burn Care in a High-volume, Verified Burn Center
Authors: Fagan Shawn P , Cartie Richard , Ponte Raul , Hassan Zaheed , Homsombath Bounthavy , Jones Samuel W
Published: April 2021

Introduction

Historically, our pediatric admission population has comprised approximately one-third of all admissions. Periodically, it is beneficial to review demographics and outcomes. This type of review aids in planning, determining needed areas of improvement, efficiency in delivery of care, and it helps develop protocols which could be applicable to our other centers within the burn network. Moreover, it also establishes safety and adequacy of care for this specialized patient population in the face of potential life-threatening injuries. The purpose of this study is to create a demographic and clinical outcome profile of pediatric patients admitted to this burn center over the past ten years.

Methods

This retrospective chart review study was granted exemption from IntegReview IRB. Basic demographics and clinical outcomes were reviewed from data received from the Trauma Registry of the American College of Surgeons (TRACS) data base. The data reports for the 10-yr period were obtained in two 5-yr intervals. (01 Jan 2009 – June 2015 and July 2015 – December 31, 2019). As a result, the initial 5-yr period was not as detailed compared to the second 5-yr period. The authors summarized and accounted for as many differences in this documentation as possible, as the results will demonstrate.

Results

The study data was collected from data related to all pediatric burn admissions from January 1, 2009 – December 31, 2019. There was a total of 6354 admissions during this time.

***See attached diagram for further results data***

Conclusions

This review of data has demonstrated a safe and effective model of care in a large, growing burn center. As growth and change continue, it is imperative that we maintain regular self-assessments of this type to ensure continuity of this quality of care and to identify and address any gaps that exist to safeguard the health and outcomes of future patients.
575 A Retrospective Review Evaluating the Institution of Nurse Clinic Visits for the Treatment of Burn Patients Being Managed at Home
Authors: Solis-Gonzalez Stacy , Osborn Suzanne C , Richey Karen J , Foster Kevin N
Published: April 2021

Introduction

Most burn injuries can be managed at home; however appropriate follow up care is vital to prevent complications. Our center developed an outpatient dressing and care algorithm aimed at improving patient outcomes and optimizing the use of healthcare providers. The algorithm consisted of scheduling patients discharged home from the burn emergency department with a nurse visit (NV) within 3 days of discharge and a provider visit (PV) 1 week later. All NV could be converted to PV prn. The purpose of this study was to evaluate the effectiveness and safety of our nurse clinic visits.

Methods

This was a retrospective study of outpatients managed using the new care algorithm over a 1-year period. Patients whose NV was converted (CV) to a PV were compared to those who were not converted (NCV). Basic descriptive statistics were calculated.

Results

The charts of 259 patients scheduled for NVs were reviewed, mean age was 24.3 years and 51% were male. The population consisted primarily of Caucasians (47%) and Hispanics (35%). Most patients had a payor source with private insurance (40%) and Medicaid (31%) being the most common. Initial presentation to the burn ED was 1.56 days post injury, mean TBSA was 1.58% and most injuries involved the hands (36%) and arms (28%). The most common mechanism was scald (56%) followed by contact (28%). The most common dressing was petroleum gauze (41%) followed by silver impregnated foam (39%). NVs were converted to PV for 16% of the population. The most common reason for conversion was discharge from clinic (33%), followed by worsening (24%), therapy needs (24%) and change in dressing (19%). When CV patients were compared to NCV there were no significant difference in age, gender, past medical history, burn history (time to presentation, TBSA, mechanism, area of injury) or dressing type with the exception of enzymatic debriders (p=.0226). Native Americans (p=0.0257) and patients with Workman’s Compensation (p=0.026) were more likely to be converted to a PV. Hispanic patients were less likely to be converted to PV (p=.0357). The charges for NV ranged from $120-$185/visit with an average reimbursement of $60.88.

Conclusions

Overall compliance with the scheduling of nurse visits was poor. However, when scheduled per the algorithm, nurse visits were safe and effective, decreasing provider workload while still allowing for patients to be seen in a timely manner.
577 The Collaboration of Burn Outreach and Wound Care Nurses
Authors: Vohra Ekta
Published: April 2021

Introduction

Certified wound care nurses perform a vital role in skin health and management in the hospital setting. During the certification process, minimal time is spent on burn wound education, despite the fact that wound care nurses are consulted for various wound etiologies; one of those being burns. This construct created a need for collaboration between the burn team and wound care nurses. Although all burns are essentially wounds, the reality is that all wounds are not burns. The management of the burn wound is often different from the management of pressure injuries or surgical wounds. In speaking with the wound care nurses at this large urban academic medical center, a knowledge gap was identified in burn wound care education as well as appropriate and timely consultation of the burn team.

Methods

This knowledge improvement project focused on educating the wound care nurses in assessment and treatment of burns, and the process for burn service consultation. Burn education was provided through in-person didactic presentations. The lecture included burn wound photos with opportunities to classify the potential depth of burn wounds as well as typical complications. Additionally, it discussed when a burn consult is needed. A basic knowledge retrospective pre-posttest method was utilized.

Results

An educational plan was tailored to meet the learning needs of the wound care nurses to address the knowledge gap. Post test data results were tracked. Post scores were increased, indicating a successful educational intervention.

Also, while providing the education, the burn outreach coordinator identified an opportunity to expand the burn center’s presence among colleagues through collaboration with the wound care nurses. The wound nurses made excellent ambassadors for the mission of the burn service.

Conclusions

Provision of burn education across disciplines may improve recognition of burn wounds and facilitate definitive treatment.