bluuebunny/crossref_metadata_2025 huggingface dataset:
616 Quantification of Nutritional Intakes in Burn Outpatients
Authors: Rousseau Anne-Françoise , Lengelé Laetitia , Fadeur Marjorie , Martin François , Hans Nadine , Bruyère Olivier , Misset Benoit
Published: March 2020

Introduction

Adequate nutrition is essential for wound healing, especially burns. Data on nutritional intakes of burn outpatients (BO) are rare, as well as dedicated guidelines. Objectives of this observational study were to quantify actual nutritional intakes in BO and to search for risk factors of inadequate intakes.

Methods

The study was conducted during 35 weeks in a university burn outpatient clinic. Adults treated exclusively on an outpatient basis were enrolled. Their average daily food intakes were evaluated by a dietician using a ten-point visual assessment of consumed portions during the last meal (SEFI tool) and a food anamnesis. Intakes (calories (Cal), proteins (P), omega-3 and-6 fatty acids (FA), selenium, copper (Cu), zinc (Zn), calcium (Ca), magnesium (Mg), iron, vitamins (vit) A, C, D and E) were compared to national recommended dietary allowances (RDA) for healthy subjects. Actual, ideal or adjusted weight was used as required according to body mass index (BMI). Micronutrients intakes were also calculated in a simulated situation where patients would have received a daily commercial tablet containing multiple vitamins and minerals. Data are expressed as median (P25-P75).

Results

Forty two patients (57% male, age 45 (34–56)y, BMI 25.9 (23.5–28.9)kg/m2, burn surface area (BSA) 2 (1–3)%) were included. Daily Cal and P intakes were 23.6 (19.6 – 29.9) kcal/kg and 1.08 (0.76 – 1.45) g/kg respectively. Inadequate intakes (defined as < 66% RDA) of Cal and P were observed in 36% and 14% of BO, respectively. More than half of BO had inadequate intakes of omega-3 and -6 FA, Ca, Mg, Cu, and vit A, C, D and E. A SEFI < 7 was associated with insufficient intakes in both Cal and P. Probability for patients to have insufficient intakes in both Cal and P was about 6 times more per 1% BSA. No risk factors were detected for insufficient micronutrients intakes. Inadequate intakes were not associated with prolonged healing. Seven BO already took vit C or D, or multiple micronutrients. With daily micronutrients supplements, the others (35/42) would have reached micronutrients RDA, excepting for Ca, Mg, Cu and vit D. Inadequate Ca and vit D intakes would have persisted in 57% and 37% of the supplemented patients, respectively.

Conclusions

Adequacy of Cal and P intakes should be assessed in BO patients with SEFI < 7 or with substantial BSA. Micronutrients intakes, particularly vitamins, were frequently lower than RDA but could be efficiently increased through oral multiple supplementation. With regards to its pleiotropic effects, vit D should probably be supplemented separately in all BO.

Applicability of Research to Practice

Raising awareness about insufficient micronutrients intakes in a number of BO.
620 Impacting Teen Parents with Early Education for Burn and Fire Prevention
Authors: Henry Shana M , Kopari Nicole M
Published: March 2020

Introduction

Unintentional fire or burn injuries are the 5th leading cause of injury deaths in the United States for children age 1–4 and the 3rd for those age 5–9. 24% of all burn injuries occur in children under the age of 15. Preparation and education are key elements in preventing fire tragedies in children. We recognized a trend in children of teen pregnancies presenting to our outpatient burn clinic with burn injuries and identified an opportunity to incorporate burn and fire prevention education into a pre-existing teen parenting program within local schools.

Methods

We utilized an established relationship with the local school district, which offers an elective course focusing on teen parenting in high schools with credit granted toward high school graduation. This course offers parenting classes and life skills training on a variety of topics including car seat safety, water safety, bike and pedestrian safely, and poison and first aid education. The Burn Prevention Coordinator partnered with the Fire Department Injury Prevention Specialist to teach a one hour lecture on burn and fire safety. Upon completion, the teen parents were provided with water testers to prevent scald burns, outlet protectors to prevent electrical injuries, temperature sensitive spoons for safe feeding, travel mugs, smoke alarms, and “First Aid for Burns” refrigerator magnets.

Results

We have taught 16 classes over the past 2 years and reached 600–800 teen parents per year. Teen parents received education regarding scald and contact burn prevention, home escape planning, smoke alarm education including contact information to have smoke alarms installed into their homes, and education regarding first aid and when to seek medical attention in regard to burn injuries. Post-lecture feedback forms have shown positive results. On average, each teen parent learned two new fire and burn prevention techniques for their child.

Conclusions

We identified a high risk population and partnered with a well-established teen parenting course to educate teen parents on burn and fire prevention. We provided teen parents with tools to assist them in creating a safer environment for their children.

Applicability of Research to Practice

Partnering with established community programs we were able to immediately make an impact focusing on burn and fire prevention.
622 Seasonal Impact on Burn Admissions in a Desert Burn Unit
Authors: Saquib Syed F , Chestovich Paul J , Carroll Joseph T
Published: March 2020

Introduction

In much of the US and the world, burn injuries are more common in the winter season. However, to our knowledge there has not been any study reviewing the seasonal variation of burn injuries in a desert climate. This study examines the seasonal impact of admissions, acuity, mortality and resource utilization at an accredited burn center located in a desert climate.

Methods

This is a retrospective analysis of all patients admitted from March 1, 2014 to February 28, 2019 for acute burns at our specialized burn center located in a desert climate. Patients were categorized in four groups according to each season based on their date of admission. The seasonal breakdown was the following: Spring (March/April/May), Summer (June/July/August), Fall (September/October/November), and Winter (December/January/February). Demographics include age, gender, etiology, and TBSA. Outcome measures included are total admissions for each season, average daily inpatient census, mortality, ICU-free and hospital-free days (30 days). Statistical analysis was completed with STATA.

Results

A total of 1519 patients were included in this study. 1016 were male (66.9%) with an average age 39.6 years (IQR 20–59). Most admissions came during the Summer (35%), followed by Winter (23%), Spring (21%) and Fall (21%). Figure 1 displays the burn admissions per month throughout the year separated by etiology. Most common mechanisms are flame/flash (677, 44.6%), scald (414, 27.3%) and pavement (194, 12.8%). 169 (87.1%) of 194 pavement burn admissions occurred during the Summer. Average TBSA was 12.8%, and was highest for flash/flame (16.8%), electrical (10.6%) and pavement (9.5%). Average hospital free days was 19.9, lowest for pavement (16.2 days), flash/flame (18.0 days) and contact (21.8 days). Average ICU free days were lowest for flash/flame (24.4 days), followed by pavement (26.4 days) and electrical (27.9 days). Overall 1437 patients (94.6%) survived to hospital discharge. Average daily inpatient census was highest in Summer (14.1), followed by Winter (9.8), Spring (8.7) and Fall (7.1).

Conclusions

In a desert climate, the summer months are the peak season for burn admissions and average daily inpatient census in large part due to pavement burns. As these burns have a longer length of stay, it leads to increase in resource utilization compared to the other mechanisms.

Applicability of Research to Practice

The results of this study justify the need for continued community education focused on prevention of pavement burns. It highlights the need to increase hospital resources such as nursing staff, residents, fellows and mid-level providers during the Summer season.
624 Car Seat Heater Burns: A Case Report Intended to Raise Awareness
Authors: Richman Evan H , Brown Parker , Richman Owen , Reilly Debra A
Published: March 2020

Introduction

Today it is estimated that approximately 30–40% of the cars in U.S have seat warmers, with the demand increasing. Unfortunately, these seat warmers do not have any established guideline of safety, leading some warmers to stay on for extended periods of time and reach temperatures that far exceed the human skin tolerance levels. Magunia et al. first described a patient with full-thickness burns in 2003, however in the time since this publishing, minimal factory standards have been instituted. We report a unique case of a neurologically impaired patient who suffered posterior thigh full-thickness burns secondary to a car seat heater. A delay in her treatment led to the need for surgical intervention. We also tested car models 2014 and newer to establish whether modern cars still present a danger to vulnerable populations.

Methods

Testing of 10 cars, models 2014 or newer, with a contact surface temperature thermometer independently calibrated. Testing in 21°C ambient air. Four tests, average and highest temperature both recorded.

Results

Maximum seat temperatures range from 35°C - 53°C. Average seat temperatures range from 34°C - 49°C.

Conclusions

This case illustrates the dangers and risks presented with car seat heaters. Cases such as this, still happening after the voluntary NHTSA mandate, emphasize the need for heightened physician awareness and mandatory factory standards. In agreement with the National Highway Traffic Safety Administration (NHTSA) statement, under no circumstances should a seat heater top 43°C. We tested 10 cars and found 7 of these cars exceeded the 43°C. In addition, all seat heaters should include self-timers. In our unique case, the patient had no awareness the seat heater was on, suggesting the need for a clearer alert on the dashboard. Health-care providers should also help educate patients about the potential dangers of seat warmers, especially in vulnerable populations.

Applicability of Research to Practice

This research highlights the potential dangers car seat heaters present to consumers. Mounting evidence, including lawsuit and case reports, show car seat heaters far exceed voluntary standards set by NHTSA. These temperatures put patrons at increased risk of life-altering burns. Furthermore, these are not “faulty” heaters, these heaters are functioning as the manufacturers fabricated them. We also report seat heaters have not followed suggestions outlined by Manguina et al in 2003, such as dash alerts, automatic turn off timer, and other safety features. The first step is raising awareness to healthcare workers so proper warnings can be made to patients, especially those who are neurologically impaired.
630 Fear Avoidance Beliefs and Behaviours of Burn Survivors: A Mixed Methods Approach
Authors: Shashoua Danielle , Vincent-Toskin Sacha , Langlois Jade , de Vilhena Bernardo S , Duchesne Philippe , Calva Valerie , Oliveira Ana de , Nedelec Bernadette
Published: March 2020

Introduction

The Fear-Avoidance (FA) Model describes a cascade of events after pain that is perceived as threatening, which may lead to avoidance of valued and meaningful life activities and greater disability. Literature examining burn survivors (BS) suggests they may experience FA, however, the evaluation tool that has been used is four items extracted from the Tampa Scale of Kinesiophobia that were modified for BS, but never formally validated with this population. Therefore, the aim of this study was to explore the lived-experience of BS with respect to FA and determine whether the questionnaire reflects and accurately measures their lived-experience.

Methods

A mixed methods approach was used with quantitative data collected using the modified questionnaire followed by individual interviews to gather qualitative data about the participants’ opinion and perceived relevance of the questionnaire using cognitive debriefing as well as their lived-experience of FA. Participants were recruited using purposeful sampling so that a range of FA beliefs and behaviors were explored. The inclusion criteria were adults BS who required hospitalization and skin grafting whose burn injury occurred within the past 3 years.

Results

17 participants (9 ♂, 8 ♀, mean age = 51, mean TBSA burned = 22%, mean days post-burn = 458). The overall mean score of the questionnaire was 1.63 where >1 is considered FA. Five major themes emerged from the thematic analysis of the interviews: perceived vulnerability to re-injury; others as fear influencers; difficulties & hardships during recovery; engagement in activity, and active thoughts. The questionnaire results identified 12 FA participants vs 9 based on the interviews. Only one of the questions was able to discriminate FA participants from non FA participants and none of the current questions clearly resonated with BS.

Conclusions

This study demonstrated that the modified questionnaire did not demonstrate the ability to quantify or reflect the BS lived-experience of FA. However, this remains an important issue since more than half of the participants reported avoiding engagement in valued life activities due to fear of pain or injury even months or years after their injury. Further research should focus on protective factors that may aid patients in reducing or preventing FA.

Applicability of Research to Practice

FA should be evaluated and addressed with BS using an assessment tool that has been specifically validated with this population.
633 ‘Living Well’ After Burn Injury: Using Case Report Mapping to Illustrate Life Changing Contributions from the Burn Model System Research Program
Authors: Carrougher Gretchen J , Bamer Alyssa M , Amtmann Dagmar , Wolfe Audrey E , Schneider Jeffrey C , Holavanahalli Radha K , Kowalske Karen J , Gibran Nicole S
Published: March 2020

Introduction

The Burn Model System (BMS) program of research has been funded since 1994. The overarching aim of this program is to improve outcomes and quality of life for people with disabilities in the areas of: 1) health and function, 2) employment, and 3) community living and participation. This review reports BMS contributions that have positively impacted lives of individuals with a significant burn injury using case report mapping to relate contributions to the recovery of a burn survivor.

Methods

Peer-reviewed publications derived from BMS data were reviewed in July 2019 for significant contributions as identified by current grantees.

Results

With 25 years of funding, many unique contributions (see Table) with direct benefit to patient recovery were identified and categorized into one of the following areas: Treatment, Assessment measures, Sequelae, Peer support, Employment, and Long-term functional outcomes. A second review for significant results of BMS research that add to the understanding of burn injury, pathophysiology and recovery research were identified and categorized as Injury and recovery research.

Conclusions

The knowledge generation and clinical innovation that this program has contributed to our collective understanding of recovery after burn injury is considerable. Using a case study story board, impact of these findings will be illustrated.

Applicability of Research to Practice

Past contributions help inform future research, particularly in the arena of rehabilitation research.
634 Use and Benefits of Using Acrylic Splints Inside the Pressotherapy Glove in Pediatric Burned Hands, Six Years Retrospective Review
Authors: Montanez Ginna A Parra , Adema Sarlos Siri , Gutiérrez Hannia Pacheco
Published: March 2020

Introduction

Burns children’s hands in special care areas. This report describes 1. how to handle using acrylic splints burned hands in pressotherapy gloves and 2. how to make splints using cuts and remaining parts of the face acrylic splints. The hand splints offer comfort, long-lasting, and full fit and produce full passive stretching of the scar During the maturation period. This splints are easy to be handled by parents.

Methods

We developed splints were to be placed inside gloves. For this process and given the selected material, it was agreed with the seamstress that the glove as appropriate, We have developed an alternative method of using the material. The splints are constructed as follows: 1. It′s purchase in sheets, although the cuts or parts that are face masks with acrylic reused.2.To copy the mold wax pencil is required. 3. To mold hot air gun is required. 4. It is easy to wash and sand to the finish.

Results

A pilot trial of 40 splints was undertaken and once it was deemed safe to use it became our practice. Over the last 6 years, 486 acrylic splints have been fabricated and utilized in over 210 surgical cases to address splint needs for the hand. This technique with acrylic is used as a material available for making face masks which minimizes costs. The use of splints inside the glove allows full adjustment over the scar counteracting the forces of retraction of these scars and also at a palmar and digital level. With the use of splints parents said there is a best period of adaptation of children and they do not remove them.

Conclusions

Acrylic with silicone is lightweight and flexible, being comfortable for children to use inside the glove. It is used especially in evening hours, but can also be used in the day, in any case accompany the use of the splint with a strengthening program, tactile desensitization and manual stretching to prevent muscle atrophy and deconditioning. For molding the acrylic, gloves and hot air gun are needed to cut more easily and thus give the required angulation required in each case. Care should be taken strictly using acrylic splints to prevent compressive neuropathies. It should be checked rigorously usage time of the splints during the first week review possible areas of pressure on edges, inside the glove, to prevent secondary complications.

Applicability of Research to Practice
656 Inter- and Intra-user Reliability of Skin Graft Thickness as a Function of Instrument
Authors: Powell Heather M , Baumann Molly E , Bailey John Kevin
Published: March 2020

Introduction

The most popular powered dermatomes (both electric and pneumatic) have a linear blade which oscillates at high speeds. Though the thickness of skin graft being elevated can be controlled by the depth-adjustment dial on the side of the instrument, factors, such as applied pressure, angle between the instrument and the surface, and curvature of the harvest site, can cause deviations from the target depth. As a result, the same depth setting can result in significantly different thicknesses of excised tissue among operators. A newer, powered dermatome has been developed which pneumatically rotates a circular blade at a fixed angle to the surface of the skin and does not require additional downward pressure. The goal of this study was to assess inter- and intra-user uniformity of graft thickness using conventional and newly designed dermatomes and assess the accuracy of the excised thickness.

Methods

Split thickness skin grafts were collected from the dorsum of Yorkshire pigs using a conventional dermatome and a newly designed test dermatome. Three different users collected three 2-inch wide by 4-inch long strips of skin using both instruments. Skin thickness at the center and edges of each strip were measured using a digital micrometer. Additionally, grafts were laser scanned to create a map of thickness for the entire piece of tissue. Reliability of the harvest was assessed using inter- and intra-class correlation coefficient.

Results

Both instruments were set to collect grafts 0.012” thick. Grafts harvested using the conventional dermatome ranged from 0.020–0.038” thick while grafts harvested with the test instrument ranged from 0.008–0.016” thick. On average, the conventional dermatome harvested grafts that were 2.16-fold thicker than the instrument setting while the test instrument collected grafts 0.91-fold the target thickness. Intra-user reliability was similar between instruments with greater reliability observed when users has substantial prior experience. Additionally, inter-user reliability was significantly increased with the test instrument.

Conclusions

Many factors control the uniformity and overall thickness of a skin graft including applied pressure and angle of attack, and how much tension is applied to the elevated graft. Using a conventional dermatome, variability in thickness was observed with greater average measured thickness versus depth setting. Grafts harvested using the newly designed instrument were on average closer to the desired thickness and more reproducible among users.

Applicability of Research to Practice

New instruments for skin harvesting may enhance uniformity of skin grafts.
665 Reliability of Resting Energy Expenditure in Major Burns: Comparison Between Measured and Predictive Equations
Authors: Hur Jun , Kym Dohern
Published: March 2020

Introduction

Poor outcomes can result from inadequate energy intake. We aimed to investigate the reliability of resting energy expenditure (REE) measured by indirect calorimetry (IC) with REE calculated using predictive equations for nutritional support in patients with major burns.

Methods

REE was measured using IC and compared with predictive equations in 215 adult severe burns patients from Jan 2011 to Jun 2015. Agreement between IC and predictive equations was assessed using Bland-Altman methods.

Results

All predictive equations were compared with REE measured using IC. The mean measured REE was 1712 kcal/d. Bland-Altman analysis showed that 1.2 times HBE, Thumb 25, and Ireton-Jones equations had higher accuracy and reliability. The concordance correlation coefficient was higher (0.49) in the Ireton-Jones equation, and root mean square error (RMSE) was lowest (471.5) in the Thumb 25 equation. The proportion of patients with predicted REE within ±10% of measured REE was highest with Thumb 25 (52.5%). Other equations for burns patients had higher mean bias and overestimated REE when compared with IC results.

Conclusions

This study suggests that Thumb 25 can be used as an alternative method for estimating energy requirements of patients with major burns when IC is not available or applicable.

Applicability of Research to Practice

Harrison-Benedict known as standard equation failed to show superiority to others in burns. Burn-specific equations are tend to overestimate ebergy requirements.
705 Evaluation of Burn Resuscitation Practices at a Large Burn Center
Authors: Gayed Rita , Tran Tu-Trinh , Tidwell Ansley , Hodge Juvonda , Ingram Walter L
Published: March 2020

Introduction

Large burns cause a systemic inflammatory response in the entire body leading to profound capillary leak, tissue edema and hemodynamic instability, a condition known as burn shock. If not managed appropriately, the patient can go into cardiac collapse and multi-organ failure. Adequate and timely burn resuscitation is a cornerstone in burn care. Different formulas have been studied to estimate fluid needs during the first 24hrs.

The purpose of this study was to retrospectively evaluate burn resuscitation practices of large burns (20% TBSA and greater) and their associated outcomes at a large urban burn center.

Methods

This was a retrospective chart review of adult patients admitted to the burn center with burns of 20% TBSA or greater who survived the first 48hrs of admission. Primary outcome was evaluating the percentage of patients who received resuscitation according to predetermined volume ranges (< or equal to 4ml/kg/% TBSA vs >4ml/kg/%TBSA). Secondary outcomes included the use of adjuncts (colloids and ascorbic acid), markers of over- and under-resuscitation, the use of perfusion markers to guide resuscitation, and ICU and hospital length of stay.

Results

One hundred and fifty one adults with burns of 30–50% TBSA were included. Fifty nine per cent of them received a median of 2.9ml/kg/%TBSA (low volume- LV group) compared to 41% that received 5.1ml/kg/%TBSA (high volume-HV group). The HV group received more adjuncts in form of colloids (73% vs 61%) and ascorbic acid infusion (55% vs 37% of patients). Majority of patients in both groups had an adequate urine output and showed an improved base deficit at 24hrs from admission which were used as resuscitation markers; lactate levels were trended infrequently. The most common over-resuscitation complication was pulmonary edema, found in both groups in ~ 30% of patients. Only 6% of patients in both groups required renal replacement therapy initiation at 96hrs from admission. Patients in the LV group had a shorter ICU and hospital length of stay (16 vs 36 days, and 27 vs 39 days, respectively, p value < 0.05).

Conclusions

Patients who received median resuscitation volumes of ~ 3ml/kg/%TBSA had better outcomes compared to patients who received higher volumes. Protocolized monitoring of resuscitation markers is key to tailoring resuscitation efforts to patient’s individual response. The effect of the different adjunct therapies (colloids, ascorbic acid) should be further investigated.

Applicability of Research to Practice

Burn resuscitation is a cornerstone of specialized critical burn care. Additional data regarding the amount and type of resuscitation volume used and its associated outcomes can advance practice to guide successful resuscitation and decrease early set backs that may further complicate the patient’s clinical course.
722 An Experience with a Biodegradable Temporizing Matrix in a Metropolitan Burn Center
Authors: Lodescar Rachelle J , Gibson Cameron J , Gallagher James
Published: March 2020

Introduction

In a large adult and pediatric metropolitan burn center, we are faced with a variety of challenging burn and complex wound cases that require surgical intervention. With the introduction of a new biodegradable temporizing matrix (BTM) in the US in 2017, we have introduced into our surgical routine a new option for wound coverage in these complex cases. This new biodegradable temporizing matrix has allowed us to provide dermal support and temporary wound closure in critical patients undergoing life-saving clinical support while awaiting skin graft closure. We share our experience using BTM in managing complex wounds in a series of patients over the past year.

Methods

A retrospective chart review of six patients who were admitted to our burn center, underwent BTM placement and subsequent skin grafting from February 2018 – August 2019 was performed. We analyzed mechanism and type of injury, indication for BTM placement, post burn day (PBD) placement of BTM and PBD to skin grafting and objective patient outcome.

Results

Conclusions: The availability of a biodegradable temporizing, polyurethane-based material in our burn center has positively added to our repertoire as surgeons an additional method for temporary wound closure as a dermal template. What we have learned is that we can improve wound bed preparation for ultimate skin grafting, particularly in critically ill patients with complex wounds and comorbidities.

Applicability of Research to Practice

Directly applicable to research.
725 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome
Authors: Lifferth Gregory , Roth Bryan , Lardizabal Marisse , Kowal-Vern Areta , Foster Kevin N , Matthews Marc
Published: March 2020

Introduction

Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations.

Methods

This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019.

Results

The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p < .0002. Dorsal/Lateral incisions had the highest number of amputations.

Conclusions

Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases.

Applicability of Research to Practice

This research was a critical appraisal of the safest escharotomy foot incisions for compartment syndrome to avoid possible amputations in burn injury.
726 The Use of Xeroform Dressings for Partial Thickness Scald Burn Injuries in a Verified Pediatric Burn Center
Authors: Vitale Lisa C , Livingston Jennifer , Curtis Erica , Oag Katherine , Shanti Christina M , Klein Justin D
Published: March 2020

Introduction

For children who have suffered a burn injury one of the greatest challenges is managing pain with an adequate yet practical burn wound dressing that will ultimately be managed at home. Medical product companies have created a variety of wound care products available on the market. These products are advertised to be more superior over one another in categories such as decrease in wound infections, minimization of pain, ease of dressing application, increased dressing wear time, and better wound healing. With all the options for burn wound care there are many factors to consider when choosing a burn dressing such as cost, ease of dressing for families at home, comfort, and efficacy. At our ten year verified pediatric burn center we have tried many different burn wound care products, however we have found Xeroform and bacitracin to be the most practical and easy to use for our patient population.

Methods

A retrospective chart review was performed from 2016–2018 of all cascading scald injuries to children 0–5 years of age treated at our verified pediatric burn center. 179 patients were included in this review. Of those patients a total of 52 patients were excluded, 28 patients had no follow up, 21 patients received alternate dressings, and 3 patients had full thickness injuries requiring a split thickness skin graft (STSG). Charts were reviewed for total body surface area (TBSA), length of stay (LOS), discharge dressing type, complications, and time to healing. All patients included routinely received consistent application of the Xeroform and bacitracin.

Results

127 patients discharged with Xeroform dressings were included in this study with an average age of 1.4 years old (range 0–5 years) and average TBSA of 2.5% (range 0.25–13%). The average LOS was 1.6 days (range 1–10 days). In this sample 32 (25%) patients were healed within 7 days. 77 (61%) patients were healed within 7–14 days. 11 (9%) patients were healed within 14–21 days. 7 (5%) patients were healed in greater than 21 days. There were no wound complications identified within this study group.

Conclusions

Using Xeroform as our standard of practice has streamlined the care provided to our patients. We have demonstrated consistent effective re-epithelization, protection from infection, and ease of dressings for families and burn providers. In our experience Xeroform has provided a versatile way to care for partial thickness burn injuries.

Applicability of Research to Practice

We suggest Xeroform and bacitracin dressings be used for partial thickness burn injuries in patients under 5 years of age. This dressing may be superior to other products because it allows for bathing while providing good wound epithelization and is easy to use.
741 Trends in Offending Medications in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis in a Large Academic Burn Center
Authors: Duplisea Michael , Chrisco Lori , Williams Felicia N , Nizamani Rabia , Laughon Sarah L , Cairns Bruce , Jones Samuel W , Ziemer Carolyn
Published: March 2020

Introduction

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a rare, severe mucocutaneous eruption caused by medications and resulting in diffuse epidermal detachment. Patients are often referred to burn units for specialized care. This study assesses trends in precipitating medications over 10 years at our Burn Center.

Methods

We performed a single-site, retrospective review at our burn center using the institutional burn registry and patient charts. Patients admitted from January 1, 2009 to December 31, 2018 identified as having SJS/TEN were eligible for inclusion. Demographics, comorbidities, diagnosis, treatment, inciting agents, and severity-of-illness score for TEN (SCORTEN) were evaluated. Statistical analysis was performed using the Mann Whitney U test using SAS version 9.4 (SAS Inc., Cary, NC).

Results

Biopsy-proven SJS, SJS/TEN overlap, or TEN was confirmed in 168 patients. Of these, 103 had a single identified offending drug. Of these patients, 36% had been exposed to sulfamethoxazole-trimethoprim (SMX-TMP), 11% to allopurinol, and 10% to lamotrigine. Trends in culprit drug by year are shown in Figure 1. The majority of SMX-TMP and penicillin cases occurred early in the period of study; lamotrigine and pembrolizumab cases occurred more recently. Patients exposed to allopurinol presented with higher SCORTENs than patients exposed to SMX-TMP, 2.9 vs 1.9, respectively (p< 0.035).

Conclusions

SMX-TMP once accounted for a large portion of SJS and TEN cases at our center. In recent years, lamotrigine has become a more common offending drug, prescribed in our cohort for psychiatric indications. Also notable, in the past year we have treated three patients with TEN due to immunotherapy (pembrolizumab) for metastatic or unresectable cancer. Paralleling the increasing use of immunotherapy has been a rise of immune-related adverse events, including severe skin toxicities. Further study is warranted to determine what can be done to prevent SJS/TEN from occurring in patients treated with these drugs.

Applicability of Research to Practice

Understanding emerging trends in causative agents of SJS/TEN will allow the burn community to focus education efforts for providers who prescribe these medications frequently. The psychiatric and oncology communities may benefit from increased awareness of the risk of SJS/TEN in patients receiving lamotrigine and immunotherapy, respectively.
742 Marijuana and Drugs of Abuse: Impact on Clinical Outcomes in Burn Injury
Authors: Wagner Anne L Lambert , Smith Tyler M , Dyamenahalli Kiran U , Duffy Patrick , Kovacs Elizabeth J , Wiktor Arek J
Published: March 2020

Introduction

Alcohol has been shown to increase hospital length of stay, complications and mortality in burn patients in studies examining its effects over the past 25 years. In contrast, there is a scarcity of published data on the effects of marijuana and other drugs of abuse in the burn population. The primary aim of this study is to evaluate the clinical outcomes of marijuana use on burn patients in comparison to other drugs of abuse including alcohol.

Methods

A retrospective cohort study was conducted on 875 burn patients admitted to a verified burn center from July 2015 to July 2019. Patients were identified from our burn registry and additional data was obtained from chart reviews. The primary comparison was between patients with and without a positive toxicology (tox) screens on admission. Contingency analysis for categorical variables was performed using Fisher’s exact test, while the Mann-Whitney U test was used to compare continuous variables, reporting two-tailed p values.

Results

Results of admission tox screens on all burn admissions were positive in 48% (423) of patients for drugs of abuse including: marijuana 41% (358), alcohol 16% (141), and stimulants 15% (134). Tox screens positive for alcohol were significant for increased: hospital length of stay (LOS) (p=0.0121), ICU LOS (p=0.0166), ventilator days (p=0.0324), number of operations (p=0.0341), and complication rates (p=0.0005). Patients with positive drug, but negative alcohol screens showed significant increases in: hospital LOS (p=0.029), hospital complications (p=0.0251), and wound infections (p=0.04). Patients testing positive for marijuana approached significance for an increased hospital LOS (p=0.0756) and was significant for increased wound infections (p=0.0476). Looking at median ages: tox positive patients (35) were significantly younger (p=< 0.0001) than negative (49). The median age for patients testing positive for marijuana (35) was significantly younger (p=< 0.0001) than those that testing negative (47). Median age regarding alcohol tox screens was insignificant. Looking at significance in median TBSA, significance was found between tox positive (4.3%) and tox negative (3.5%) patients (p=0.004). TBSA was insignificant in the other groups.

Conclusions

Almost half of all admitted burn patients tested positive for alcohol and other drugs of abuse. As in previous studies, patients testing positive for alcohol continue to have a more complicated hospital course and longer hospital and ICU LOS. Marijuana, positive in 41% of all burn admissions, showed significance in increased wound infections and a slight trend towards an increased hospital stay.

Applicability of Research to Practice

The association between burns and drugs of abuse including alcohol indicates the need for increased preventative and educational efforts especially in patients suffering from alcohol abuse/dependence and younger patients.
747 Developing a Burn Mass Casualty Incident (BMCI) Plan for a State (first Steps)
Authors: Kearns Randy D , Mai Kathryn , Hargrove Paige B , Short Tracee , Hector Chris W , Carter Jeffrey E
Published: March 2020

Introduction

A burn mass casualty incident (BMCI) occurs when a disaster involves many injured patients who have specific burn injuries. For this particular state, there are four burn centers. They range in size from 4–20 beds. The area hazards include:

Methods

A meeting was arranged for the burn center directors. Burn surgeons, along with burn center nursing staff, evaluated a series of “predefined patients” distributed over a compressed timeline during the hourlong exercise. The participants had not previously seen the “patients” nor were they aware of their injuries until the exercise controller released the information. The exercise controller was provided by a state emergency response coordination agency. The exercise followed a meeting that discussed efforts to standardize emergency medical services (EMS) care in the state, and route burn patients through the state call center to the most appropriate burn center. The final hour of the morning focused on the tabletop exercise, followed by a “hot-wash” (debriefing).

Results

The scenario included 20 patients staggered over the morning with each surgeon considering capacity and capability to manage the theoretical patients who ranged in age from 1 month to 81 years old (Median 24, Mean 28.2) with a TBSA range of 0 to 73 (Median 6, Mean 12.85). There were 4/20 patients intubated on arrival, and an additional 7/16 had “soot tinged sputum.” 16/20 arrived by EMS.

Assuming this was a Type III Burn Disaster (meaning burn event only), all four burn center directors reported under ideal circumstances; they could absorb these patients into their respective hospital systems. However, it was also clear that while all could admit, sustaining all of these patients over an extended period may be problematic and potentially require a transfer. It was also discussed that had the severity of burn injury changed for two or more patients, it could have led to exceeding the capability/capacity for most of the burn centers.

Conclusions

The key to this event was to identify a trigger point for each facility. Every disaster plan requires a trigger or triggers meaning an activation point to begin treating an event based on their BMCI (or burn surge) plan. The next logical step in this process is to analyze further the capabilities and capacities that will inform the planning process as it evolves.

Applicability of Research to Practice

A working BMCI plan could improve resource utilization during disasters.
752 Single-center Experience with 4th of July Fireworks Injuries
Authors: Thomas Mini , Sneller Cindy R , Joe Victor C , Chin Theresa L , Inocando Jocel
Published: March 2020

Introduction

Despite existing restrictions and laws related to sale and use of fireworks, prevention of firework injuries has not reached its goal line. The purpose of this project is to identify impact of firework injuries and to seek for any trends or patterns.

Methods

We conducted a retrospective chart review of 2019 firework related injuries treated at our burn center and obtained 2017–2019 firework data from the County Firework Authority. All patients treated in the month of July 2019 at emergency department, clinic, and inpatient service were included. Data extracted include patient demographics, nature of injury, type of firework involved, location, treatment, and length of stay.

Results

A total of 24 cases were reported to the county and 14 patients received care for firework related injuries in our center. Additionally, four out of the fourteen patients reported or screened to be positive for alcohol, THC and or toxic drug. Further, three of the incidents happened in cities not permitted for firework. Even though total burn surface area was less than 5% for all patients, 50% of patients required surgical treatment, including amputation of fingers for one patient. Hand burn was observed to be the most (78%) common body part affected.

Conclusions

Preventable injuries of 14 cases related to fireworks in a single burn center around a holiday could be considered a large group. However, our center is in a county with less than national average firework injuries and had reported fourteen less cases in 2019 than 2018. Further, only 10 out of 34 cities in the county have firework permits. “Safe and sane” fireworks, allowed in the 10 permitted cities, were named only in a single incident. The majority of incidents involved fireworks illegal in all cities of the county, including M-80’s, firecrackers, mortars, roman candles and bottle rockets. Cities were probably safer in 2019 due to significantly larger (5965lbs) confiscated fireworks. While 2019 injuries is relatively lesser in volume compared to previous years and other locations, significant injuries leading to surgery and loss of body part requires further preventive work.

Applicability of Research to Practice

There is a need for increased education and prevention efforts regarding fireworks and potential for burn injury. This education needs to include both the device user and associated bystanders. Advocacy should involve the development of safety features for these devices and additional stringent policies and law enforcement.
753 Burn Specialty Specific Advocacy, What Can You Do for Injury Prevention
Authors: Sanford Arthur , Petersen Paula , Liberio Julie N , Sanford Susan , Liu Yuk Ming , Baldea Anthony J
Published: March 2020

Introduction

Scald injuries affect many vulnerable populations. We know that there is a relationship between time and temperature as to severity of injury. When one of the authors had their residential hot water heater replaced, it was set to an uncomfortable temperature, 134oF, until adjusted to a safe level. This highlighted the possibility of catastrophic injury from a simple household function like washing hands or taking a bath. As a result, we have undertaken efforts to assess locations where burn team members and their families are potentially exposed to excessively hot water and educate them as to methods to measure their water temperature and maintain it at safe levels. Temperature differences between 120oF and 130oF mean the difference between injury in minutes to seconds.

Methods

Using a Taylor Market Digital Candy Thermometer, the tap is run at maximum hot water for 2 minutes. With water still running, a volume of approximately one liter is collected and the thermometer is immediately immersed in the water with the temperature recorded once stable. Data was recorded at a variety of locations, including residential (of care team), hotels, and around a variety of taps through the hospital.

Results

Twenty sites were measured for water temperature. The average temperature recorded was 114.1oF, with a median temperature recorded 110.9oF. There were three recordings of water temperature greater than 120oF, with the highest recorded at 132.9oF. All of these sites were immediately informed of the risks and appropriate measures taken to adjust water sources to an appropriate temperature.

Conclusions

We as burn care professionals know what acceptable water temperatures are for taps in our personal spaces. Despite that it is possible that hazardous conditions can exist. Many areas of society are looking for the guidance of health care providers, and we need to start in our own homes to make that environment safe, and then take that message to our relatives and community.

Applicability of Research to Practice

This is a real world demonstration of the need to verify safety in our own homes and then take that message of prevention to vulnerable populations.