bluuebunny/crossref_metadata_2025 huggingface dataset:
511 Characteristics of Inhalation Injury Management at a Referral Burn Center: A Ten-year Experience
Authors: Drake Mack , Leichtle Stefan , Todd Borchers C , Ali Naushin S , Labban Nayla , Feldman Michael J
Published: March 2022

Introduction

Variability exists in the diagnosis and treatment of upper airway and inhalation injury (UAII). Institutional algorithm at our ABA-verified burn center in part necessitates fiberoptic diagnostic laryngoscopy (DL) in patients at risk for UAII. We sought to determine patterns and characteristics of UAII management and complications over a ten-year period.

Methods

A retrospective review of burn admissions between January, 2011 and December, 2020 was performed. 253 patients with concern for UAII underwent DL upon presentation. Patients under age 18 were excluded. 66 patients were excluded for inability to tolerate/refusal/unreported results. Univariate and multivariate analyses were used to determine independent predictors of a positive DL.

Results

169 patients were analyzed. The population was frequently middle-aged, male, and overweight. 81 patients used tobacco and 34 patients had history of COPD. Examination of injury characteristics yielded median ISS of 6. 116 patients (69%) had no or < 1% cutaneous thermal burns. 75 patients had facial soot or singed nasal hairs concerning for UAII. Of 169 patients who underwent DL, DL was positive in 106 (63%). Tracked complications in patients with positive DL yielded few unplanned intubations (n=2, 1%), unplanned ICU admission (n=2, 1%), unplanned extubation (n=4, 2%), VAP (n=1, 1%). Median ICU LOS was 2 days and average hospital LOS was 3 days. Mortality overall was 5% (n=8). Subgroup analysis was used to compare patients with positive versus negative DL. Patients with positive DL were older (54 vs 49 years, p=0.09), primarily male (63% vs 60%, p=0.7), had lower BMI (29 vs 30, p=0.94), were tobacco users (52% vs 41%, p=0.18), and often carried diagnosis of COPD (24% vs 14%, p=0.15). Median ISS was higher in the positive DL group (10 vs 4, p< 0.0001). Cutaneous burns were absent or < 1% (85 vs 58, p=0.05). Presence of facial burns and soot was significantly associated with positive DL (56 vs 19, p< 0.0001, OR 15.9, 95% CI). With positive DL, median ICU LOS, hospital LOS, and mortality were significantly higher (p< 0.0001, p< 0.0001, and p=0.03, respectively).

Conclusions

These findings lend credit to an approach of aggressive diagnosis and subsequent management. Multivariate analysis of factors associated with positive DL highlighted obvious facial burns or soot and ISS (OR 1.1, 95% CI, p=0.01) as most predictive. Though rates of tracked complications were too low for subgroup analysis, no patient with negative DL on admission required unplanned intubation. Patients with positive DL at our institution are placed on an algorithm of ICU admission, 24-hour period of NPO, mucolytic therapy, enhanced pulmonary hygiene, and lung protective ventilatory strategies. Patients with positive DL exhibited longer ICU and hospital LOS and increased mortality.
512 Systemic Norepinephrine Impact on Tangential Split Thickness Skin Graft Outcomes in Burn Shock Patients
Authors: Terziyski Ilina , John Albin A , Snitman Annie , Sorensen Grant , Adams Callie M , Novello Matteo , Griswold John A
Published: March 2022

Introduction

Blood pressure supporting agents like vasopressors are often used to treat patients with burn shock. Norepinephrine is part of the algorithms used by regional burn centers for fluid resuscitation in burn shock. In our population of burn shock patients, we have noticed an association of poor graft take when norepinephrine is used. We undertook this study to assess the relationship between systemic norepinephrine use and split-thickness skin graft (STSG) healing.

Methods

We retrospectively identified burn patients who presented to our burn center from January 2014 –June 2020, who were treated with systemic vasopressors within the first 48 hours of admission, and received at least one tangential excision and STSG procedure as part of their treatment. We compared these patients to a matched control group of burn patients who did not receive vasopressors for resuscitative purposes. The primary outcome investigated was graft take percentage at time of graft takedown.

Results

During the time frame, we found 19 patients and 19 matched controls within the same time period who did not receive norepinephrine. The mean percent graft take for patients treated with systemic norepinephrine was 77.9% (SE = 3.00), which was significantly lower than that of the control group, 92.8% (SE = 3.56) (P= < 0.001). Furthermore, patients who received norepinephrine had a statistically significant increase in both hospital (P= 0.038) and intensive care unit (ICU) length of stay (P= 0.009). The two populations were equivalent in all other characteristics such as TBSA, number of comorbidities, age, and resuscitation volumes.

Conclusions

In this retrospective assessment, the use of norepinephrine seems to have a significant association with worse graft take and longer length of stay. Since graft loss begets more graft reoperations and a longer stay, our findings would lead one to incorporate norepinephrine as a last resort in the treatment algorithm for burn shock.
518 Prescribing practices of atypical antipsychotics in the burn ICU
Authors: Gayed Rita , Robinson Kristen , Labatut Annalise , Mittal Rohit
Published: March 2022

Introduction

Atypical antipsychotics are commonly used in the management of agitation and delirium in the intensive care unit (ICU). Patients admitted to the burn intensive care unit (BICU) with burns with large total body surface involvement ( >20%) require prolonged mechanical ventilation and prolonged ICU stay, putting them at risk of ICU delirium. Furthermore, patients with burn injuries often have underlying psychiatric conditions, and some can develop new psychiatric disorders secondary to the trauma associated with their burn. Due to these factors many burn patients receive scheduled oral atypical antipsychotics during their ICU stay. The purpose of this study was to retrospectively characterize the prescribing practices of atypical antipsychotics in the BICU.

Methods

This was a single-center, retrospective chart review of adults admitted to the BICU with a burn injury who received scheduled oral atypical antipsychotics. Prescribing patterns in the ICU and on all transitions of care were analyzed. Additionally, the appropriateness of AAP prescribing at discharge was evaluated. AAPs were considered to be appropriately prescribed at discharge if a patient was continuing a home medication, or if psychiatric consult services recommended continuing at discharge.

Results

During the five year study period, 440 adults were admitted to the BICU with a burn injury, 18.2% of which were prescribed an AAP during their ICU course. Of those prescribed an AAP, 28.8% had a documented underlying psychiatric condition. Most patients were male (70%) with an average age of 41 years, and a mean total body surface area burn of 32%. The average ICU length of stay was 32 days. AAPs were primarily used to treat agitation/delirium (72.5% of patients). Quetiapine was the most commonly prescribed AAP. On transfer to stepdown, AAPs were continued in 78.4% of patients. Additionally, 67.7% were discharged on an AAP. Of these patients, continuation was considered appropriate in 54% of patients.

Conclusions

Despite overall lower AAP prescribing in the burn ICU compared to other ICUs, over two thirds of patients initiated on AAPs in the BICU were prescribed AAPs at discharge. AAPs should be evaluated for appropriateness at each transition of care.
519 Congruence of clinical suspicion of invasive fungal wound infection and biopsy positivity in burn patients
Authors: Pruskowski Kaitlin A , Britton Garrett W , Mitchell Thomas A , Cancio Leopoldo C
Published: March 2022

Introduction

Invasive fungal wound infection (FWI) in burn patients is a high-mortality complication; early diagnosis and treatment may improve outcomes. Management of suspected FWI includes initiating broad-spectrum antifungals, obtaining a biopsy for histopathology and culture, and performing urgent surgical excision. However, the relationship between clinical suspicion (manifested by initiation of antifungals) and histopathological diagnosis is unknown.

Methods

Patients admitted between 2004 and 2019 to our burn center, and initiated on any systemic antifungal, were identified. The electronic medical record (EMR) was reviewed to determine the indication for such therapy. Patients were included if antifungals were initiated out of concern for FWI. If the indication was not clear, patients were included if the systemic antifungal agent(s) initiated were triazoles (not fluconazole), echinocandins, or amphotericin B.

Results

Two hundred one patients who received 251 courses of broad-spectrum antifungal therapy were included. Thirty six patients (17.9%) received more than one course of antifungal therapy. One hundred sixty five (82%) patients were male, with an average age of 41.1 ± 17.7 years. The average burn size was 49.7 ± 22.8% total body surface area (TBSA) and 60 (29.8%) patients had inhalation injury. The median time from injury to antifungal initiation was 17.5 days (IQR 10.7, 38.6 days).

One hundred sixty eight biopsies were obtained within 3 days of antifungal initiation. Seventy five biopsies showed FWC (44.6% of biopsies), 37 had FWI (i.e. fungi were identified either in viable tissue or angioinvasion) (22% of biopsies), and 56 had negative biopsies (33.3% of biopsies). Despite presence of fungi on histopathology, there were only 112 positive fungal wound cultures (44.6% of 251 antifungal courses) within 3 days initiation of antifungal therapy. Aspergillus was the most commonly isolated genus (n=47) followed by Candida (n=46), Fusarium (n=26), Mucor (n=10), and other (n=20). There were 35 instances where multiple fungal organisms were recovered in tissue culture. One hundred five patients (52.2%) died during their hospital stay; 38 of these patients had FWC, 25 had FWI, 20 had negative biopsies, and 22 did not have biopsies taken.

Conclusions

Of 251 systemic antifungal courses initiated out of concern for FWI, FWI was biopsy-proven 14.7% of the time. Antifungal stewardship is needed to better identify appropriate high-risk patients for FWI. The development of a novel criteria or scoring system may be warranted to assist in deciding when to initiate systemic antifungal therapy for FWI in burn patients.
521 Maintaining Central Line Patency in Burned Children
Authors: Arredondo Olivia , Palmieri Tina L , Sen Soman , Greenhalgh David G , Romanowski Kathleen S
Published: March 2022

Introduction

Children with major burn injury frequently require prolonged central venous access to assure appropriate fluid management and pain control. Central venous catheters in children frequently develop clots that prevent drug administration, requiring administration of tissue plasminogen activator (TPA). The purpose of this study was to identify the frequency and efficacy of TPA use in burned children with central venous catheters (CVC).

Methods

This retrospective chart review evaluated all children requiring CVC admitted to our tertiary pediatric burn center from 2018-2019. Data collected included patient demographics (age, burn size, hospital length of stay (LOS)), catheter-related data (number of central lines, lines replaced due to clotting), TPA administration (number of times administered, successful TPA administrations, how often repeated), and line clotting data (time from insertion to clot, interval between TPA order and administration).

Results

In 2018, 116 lines were place in 49 children with mean age of 8.4 years and mean burn size of 29%, intensive care unit LOS was 24 days. TPA was infused in 20% of lines to relieve obstruction and was successful in relieving the clot in 21% (5/23). The interval between identification of the obstructed line to TPA order was 191 minutes, with the administration of TPA 83 minutes after order placement. The average time from identification of obstruction to TPA administration was 257 minutes. In 2019, 150 lines were place in 65 children with mean age of 5.2 years and mean burn size of 25%, LOS was 13 days in the PICU. TPA was infused in 5% of lines to relieve obstruction and was successful in relieving the clot in 0 % (0/8). The interval between identification of the obstructed line to TPA order was 117 minutes, with the administration of TPA 49 minutes after order placement. The average time from identification of obstruction to TPA administration was 158 minutes.

Conclusions

The incidence of obstruction in pediatric central venous catheters in our unit decreased from 26% in 2018 to 3% in 2019. TPA was successful in clot resolution in only 5% (2018), and 0% (2019) . Based on our results, we targeted areas for improvement including: Standing order for TPA; staff education on TPA use; decreasing our average time to identify, order, and administer TPA; and standardizing the frequency of flushing unused central venous catheter lumens with heparinized saline flush.
522 Food Deserts and Burn Wound Healing - Does Geography in an Urban Environment Matter?
Authors: Donovan Brienne , Anderson Jeffrey , Akpunonu Chinaemelum , Rae Lisa , Zhao Huaqing
Published: March 2022

Introduction

Many burn injury victims in the United States live in regions designated as food deserts. The United States Department of Agriculture (USDA) defines food deserts as low-income areas where a substantial number of residents do not have access to a supermarket. Nutrition is known to be critical to wound healing. The purpose of this investigation was to determine if there is a relationship between residence in a USDA designated food desert, burn patient cormorbidities, and wound healing at an urban academic medical center.

Methods

We performed a retrospective review of burn injured patients at an ABA verified urban academic burn center between September 2018 and April 2021. Inclusion criteria were burn injury of less than 20% total body surface area (TBSA), age ≥ 18, and single operation for split thickness skin grafting. Zip codes were used in conjunction with the USDA Food Access Research Atlas to classify residence in food deserts. The primary outcome was donor site time to healing. A multivariable logistical regression analysis was performed to evaluate risk factors for poor wound healing at an urban academic burn center and to determine if residence in a USDA delegated food desert was one of those risk factors.

Results

A total of 150 patients were identified for inclusion from September 2018 through April 2021. There were 73 women (48.7%) and 77 men (51.3%). The median age was 48.5 (IQR 34.0, 58.0). The average body mass index (BMI) was 28.2 (6.6). Age (p=0.60), sex (p=0.35), hypertension (p=0.74), chronic obstructive pulmonary disease (p=0.076), hyperlipidemia (p=0.77), congestive heart failure (p=0.47), and BMI (p=0.37), and time to donor site healing (p=0.55) were not significantly different between patients who lived in food deserts and those who did not. Patients who lived in food deserts, however, had a higher incidence of diabetes (p=0.05). The multivariable model also shows that time to healing is not different between patients who live in food deserts and those who did not. However, the multivariable model shows that patients with diabetes have an increased time to healing (p=0.002).

Conclusions

Residence in a USDA delegated food desert does not significantly influence time to healing of donor sites in burn injured patients. However, diabetes is significantly higher in patients who live in USDA delegated food deserts, and diabetes demonstrates a significant delay in wound healing. This is the first study comparing residence in a USDA food desert, burn patient comorbidities, and time to wound healing in an urban burn population.
523 Reduced Incidence of Fractures After Treatment with Oxandrolone in Burn Patients
Authors: Walters Elliot , Whitley Kayleen , Wolf Steven E
Published: March 2022

Introduction

Bone density loss is a significant and well documented complication after major burns. Oxandrolone and bisphosphonates have both been used successfully to mitigate this outcome. Studies show these agents reduce both short-term and long-term bone loss, but no studies have examined the long-term clinical outcomes of these agents. This study investigates long-term outcomes of treatment with oxandrolone and bisphosphonates in burn patients.

Methods

We examined a deidentified database of electronic medical records across 55 healthcare organizations including over 75 million patients. ICD 10 codes were used to identify patients with thermal or chemical burns from January 1, 2010 to December 31, 2020. We included patients who received their first dose of oxandrolone or bisphosphonate within one month of injury. Propensity score matching was used to balance patient cohorts. ICD 10 and CPT codes were used to evaluate outcomes.

Results

We identified 280,367 patients with burn injuries during the study time period. Of these, 903 (0.32%) received at least one dose of oxandrolone and 307 (0.11%) received at least one dose of a bisphosphonate medication within 1 month of injury. Mortality was higher among matched patients receiving oxandrolone (OR: 3.146, CI: 2.224, 4.449) or a bisphosphonate (OR 3.027, CI: 1.8, 5.092). Fracture at any site and fracture of long bones were significantly lower among matched patients who received oxandrolone (OR: 0.704 CI: 0.542, 0.914, OR: 0.689, CI: 0.51, 0.931; respectively) compared to those who did not. No reduction of fractures was seen among patients who received bisphosphonates (p >0.05). Among patients receiving oxandrolone acute kidney failure was increased (OR: 1.941, CI: 1.454, 2.592) compared to those not receiving the medication but chronic kidney failure was reduced (OR: 0.513, CI: 0.351, 0.749). There was no increase in acute or chronic kidney failure among patients receiving a bisphosphonate (p >0.05). Liver injury was not increased among patients receiving either medication (p >0.05).

Conclusions

Oxandrolone and bisphosphonate medications have been well studied and shown to decrease bone density loss after burn injury. Fractures of all bones and specifically long bones were reduced in patients receiving oxandrolone, suggesting that decreased bone catabolism during the acute recovery period may provide long-term injury protection. While we do see an increase in mortality with both of these medications, there is no we do not see any increase in liver failure or chronic kidney failure suggesting that factors unrelated to the administration of these medications are driving the increased mortality and may be related to selection bias. This is the first study to show that oxandrolone decreases the incidence of fractures after burn injury.
528 Evaluation of phosphate replacement practices in burn patients
Authors: Derisse Giae Surine S , Panter Elizabeth , Helder Angela M , Kiehle Nicole D
Published: March 2022

Introduction

Burn injury causes acute shifts in phosphorus leading to hypophosphatemia and negative sequelae, such as motor neuropathy, muscle weakness, cardiac failure, and respiratory failure. These patients require frequent phosphorus level monitoring and repletion beyond the needs of a general critical care patient. Data suggests patients with normal phosphorus levels have lower incidence of ventilator wean failure and positive clinical outcomes. There is limited data evaluating phosphate replacement practices in burn patients for their intensive care unit (ICU) length of stay while also evaluating those who concomitantly receive continuous renal replacement therapy (CRRT) as it is the primary mode of renal replacement therapy in this population and further depletes phosphorus levels.

Methods

This was a single-center, retrospective, observational study of patients with a burn injury admitted and discharged from a burn intensive care unit (BICU) from January 1, 2016 to June 30, 2020 who received phosphate. Patients less than 18 years of age and those admitted to the BICU for non-burn injuries were excluded. Burn injury type, number of phosphorus doses per day, and phosphorus levels were collected. Normal phosphorus was defined as 2.5-4.9 mg/dL and hypophosphatemia as < 2.5mg/dL. Patient data was evaluated in 24-hour time intervals as defined as midnight to midnight. Phosphorus lab values were included in data analysis if there was corresponding phosphate administration in that 24-hour interval. The primary objective was to assess the temporal dose-response to phosphate replacement in burn patients.

Results

There were 291 patients who met criteria, 116 were selected in chronological order by admission date and were included in data analysis. The mean age was 51.51 years and the mean total body surface area burned was 21.48%. Flame burn accounted for 83.6 % (n=97) of patients and 37.06% (n=43) of patients had concomitant inhalation injury. The mean amount of phosphate given to a patient per day was 28.38 mmol and patients on CRRT received a mean amount of phosphate of 33.34 mmol per day. In response to phosphate administration, the mean change in phosphorus was 0.334 ± 1.08 mg/dL. In patients on CRRT, the mean change in phosphorus was 1.4 ± 1.89 mg/dL. Patients experienced hypophosphatemia 69.63% of the days that they received phosphate repletion and patients on CRRT had hypophosphatemia 87.39% of the days they received phosphate repletion.

Conclusions

Hypophosphatemia is common in the burn injury population and current phosphate replacement practices are insufficient to replete phosphorus in burn injury patients.
538 Partial Thickness Pediatric Burn Injuries Treated with Autologous Skin Cell Suspension
Authors: Kopari Nicole M , Gray Fabienne , Phelan Herb A , Carter Jeffrey E
Published: March 2022

Introduction

Management of pediatric burn injuries resulting in optimal aesthetic remains a significant challenge in burn care. Wound care and acute surgical intervention coupled with reconstructive interventions is an essential component of burn care. Incorporation of new technologies in burn care has challenged historic paradigms. Our goal was to evaluate the use of autologous skin cell suspension (ASCS) for the treatment of partial-thickness pediatric burn injuries.

Methods

A retrospective chart review from a single pediatric institution over a 10-month period was performed on patients undergoing treatment with ASCS. Patients with full-thickness injuries treated with autografting were excluded. Demographics and data collection included total burn surface area (TBSA), location of burn, mechanism of burn, time to ASCS application, time to >90% re-epithelization, hospital length of stay, ASCS failure requiring repeat operation, and reconstructive procedures or laser interventions.

Results

26 pediatric patients ≤13 years of age charts were reviewed. 14 patients received ASCS and met inclusion criteria. 8 faces were included in our study along with 11 upper extremity burns, 5 lower extremity burns, and 8 torso burns or some combination of the above. The most common etiology was scald injury from hot water followed by noodle soup burns and grease burns. Other etiologies included road rash, flame burn, and a steam burn. ASCS was applied 2 days (range 1-4) after injuries and patients only required 1 operation. The average length of hospital stay was 4 days (range 1-10) and the average TBSA was 10% (range 4-17). The average time to >90% re-epithelization was 7 days with one outlier with healing at day 24. This is the only patient in the ASCS group that required laser interventions. No patients required repeat procedures, subsequent autografting, or reconstructive procedures.

Conclusions

Pediatric patients with partial-thickness burns benefitted from the ASCS by having limited donor sites, short hospitalizations compared to %TBSA, improved time to >90% re-epithelization, and no repeat surgical interventions. The fast-healing time and good cosmetic outcome decreases the need for compression garments and subsequent laser interventions. Key factors include patient selection and appropriate wound preparation.
541 Designing a web-based technology system to support burn disaster response
Authors: Conlon Kathe M , Marano Michael A , Lee Robin A , Montgomery Kevin
Published: March 2022

Introduction

Accurately transmitting information in a burn mass casualty incident (BMCI) is critical. Modern technology, including “apps” and web-based systems coordinated through a central command center addresses this need. The system should 1.) Function as a real-time link between on-scene personnel, local hospitals or trauma centers and regional burn centers; 2.) Organize triage in accordance with accepted burn mass casualty national standards; and 3.) Match acuity of age and percent burn to immediate open beds, either direct from the scene or from secondary hospitals, without overwhelming any one particular facility.

Methods

Extensive literature review was conducted to do a comparative study of similar/existing commercial data management tools; investigate technology designs of mobile apps and web browsers accessible to cloud-based systems, and identify what data and processes needed to be tracked and coordinated across diverse stakeholders to deliver real-time situational awareness for definitive medical planning capabilities.

Results

Development of a Burn Patient Transfer System (BPTS) web-based application with mobile access resulted. The BPTS is series of dashboards designed for specific patient management for both referring (RF) and receiving facilities (RC), coordinated through a central command center. Focus for RFs includes an ability to list number of patients by acuity, addition of new patients, transfer status confirmation and situational awareness throughout the BMCI. RCs report or modify open bed availability of both immediate and eventual beds, for adult or pediatric patients. With this information, appropriate receiving facilities are identified by command personnel to coordinate approval of patient transfer, mode of transport and maintain situational awareness between medical personnel at referring and receiving facilities without exceeding facility surge capability. Clinical experts are responsible for final decisions on a case-by-case basis at both RF and RCs, as defined by a patient transfer algorithm matching patients by age and acuity.

Conclusions

The BPTS is an accessible communications system designed to serve three critical functions; A). Provide a mechanism and platform to report both immediate and surge burn bed capacity; B). Match patient acuity with available open beds at registered medical facilities and burn centers in accordance with ABA Disaster Triage recommendations and C). Track patient movement in real-time. Its core functionality is patient transfer management to and from locations where appropriate care can be delivered based upon clinical needs. This may include initial transfer to a local hospital or trauma center for primary stabilization, or direct to a burn center if and when weather, security and infrastructure permit.
549 Length of Stay per Total Body Surface Area Burn: Validation Using the National Burn Repository
Authors: Patterson Kelli N , Onwuka Amanda , Thakkar Rajan K
Published: March 2022

Introduction

A length of stay (LOS) of one day per percent total body surface area (TBSA) burn has been widely accepted in clinical practice but not validated in current pediatric burn studies. Additionally, TBSA burn data is often presented in ranges, which lacks granular details. The primary objective of this study is to validate our previous Pediatric Injury Quality Improvement Collaboration (PIQIC) findings by using a national burn registry to evaluate LOS per TBSA burn relative to burn mechanism, sociodemographic characteristics, and clinical factors which influence this ratio.

Methods

We evaluated patients 0-18 years old who sustained a burn injury and whose demographics were submitted to the National Burn Repository (NBR) dataset from July 2008 through June 2018. Patients sustaining inhalation injury and electrical burns were excluded due to LOS being significantly increased unrelated to cutaneous injury. Mixed effects generalized additive regression models were then performed to identify characteristics associated with the LOS per TBSA ratio, a nonparametric variable.

Results

Among 51,561 pediatric burn patients, 45% were Non-Hispanic White, 58% were male, and the median age was 3 years old (IQR: 1, 9). The most common burn mechanism was scald (55.9%), followed by flame (19.4%), and contact (16.4%), with most burns occurring at home (82.2%). The median LOS per TBSA burn ratio across all cases was 0.9 (IQR: 0.4, 1.8). In adjusted models, scald burns and radiation burns had similar LOS per TBSA burn ratios (mean predicted values: 1.22 vs 1.77), while all other burn mechanisms had a significantly higher LOS per TBSA burn ratio (p< 0.0001). Chemical burns had the highest ratio (predicted mean: 4.8), followed by contact burns (mean predicted value: 2.8; Table 1, Figure 1). Non-Hispanic White patients had lower LOS per TBSA ratios than all other races and ethnicities (p< 0.05) with mean predicted values of 1.6. Native Americans and Hispanics had the highest ratios (2.0 and 1.8 respectively, (Table 1).

Conclusions

These data substantiate evidence on variance in LOS per TBSA burn relative to burn mechanism, previously demonstrated by PIQIC centers. It also validates differences in LOS per TBSA burn ratios among race/ethnicity.
552 DFB: Tiny burn, big problem - the implications of a diabetic foot burn
Authors: Uche Stanley , Gayed Rita , Mittal Rohit , Ingram Walter L
Published: March 2022

Introduction

In the United States, >30 million people (10.5% of the population) have diabetes, both diagnosed and undiagnosed. Many of these patients go on to develop diabetes related complications, such as peripheral neuropathy. Patients with diabetes are also prone to foot injury. The purpose of this study is to determine clinical outcomes associated with foot burns in patients with diabetes.

Methods

A retrospective chart review of adult patients (≥18yo) admitted to a major metropolitan burn center at a safety-net hospital from 2008-2021 with an isolated burn to the lower extremity and a diagnosis of diabetes mellitus. Patients were categorized based on admission hemoglobin A1C. The primary outcome was hospital length of stay and secondary outcomes were time to presentation, infection, amputations, and mortality.

Results

A total of 136 patients were included in the study, 79% of which were male.84% of the patients were < 65yo and the mean age was 54.1yo and an average HbA1C of 9%. Scald injury was most common mechanism of injury (54%) followed by radiant (24.3%) and contact burns (16.2%). The average burn size was 2.3% TBSA. The median length of stay was 7 days (3 days per percent TBSA). Patients presented on average 5.2 days following injury with 44.8% patients presenting with an infection. More than half (54%) of the patients had peripheral neuropathy at baseline. A majority (74%) of the patients underwent surgical excision. About 18% of the patients underwent an amputation and 3.7% were admitted to the intensive care unit with an average ICU length of stay of 7 Additionally, there was 1 inpatient mortality.

Conclusions

Our study found that lower extremity burns in patients with diabetes were associated with a prolonged hospital stay, high infection rate, need for surgical intervention and high morbidity/disability rate as evident by the number of patients requiring amputations despite the small size of the burn. Peripheral neuropathy may be one of the reasons leading to delayed presentation to a burn center following injury. Hence, burn prevention in this patient population through intense education on proper foot care and inspection along with adequate glycemic control are key to improving outcomes for patients with diabetes.
553 Does COVID-19 Lead to Worse Outcomes in A Burn Center?
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia
Published: March 2022

Introduction

The global pandemic caused by severe acute respiratory syndrome coronavirus-2 (COVID-19) has exhausted resources and devastated at-risk populations. Our objective was to determine if COVID-positive patients have worse outcomes compared to COVID-negative patients after burn injury or desquamating skin disorders.

Methods

Patients were identified using our institutional Burn Center registry and linked to the clinical and administrative data. All patients admitted between March 1, 2020 and August 31, 2021 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions, and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results

A total of 1,994 patients were admitted during this period, and of those patients, 1,467 were adults. Twenty-three adults were COVID-positive. There were no significant differences in age, LOS, total body surface area (TBSA) involvement, hospital costs, sex, race or ethnicities of patients. There were no significant differences in percentage of patients presenting for burn or desquamating skin disorders. COVID-positive adult patients had a significantly higher mortality after injury than COVID-negative adults, p=0.003. There were no differences in COVID-positive pediatric patients admitted to our burn center.

Conclusions

A positive COVID test is associated with worse outcomes in patients admitted for burn injury or skin-sloughing disorders. Further study is warranted to investigate and mitigate what aspect of their care could be adjusted to improve outcomes.
560 A National Analysis of Discharge Disposition in Older Adults with Burns Estimating Independence at Discharge
Authors: Cobert Jason , Sheckter Clifford C , Pham Tam N
Published: March 2022

Introduction

Whereas older age strongly predicts higher burn mortality, the impact of age on discharge disposition is less well defined. Both providers and patients need a better understanding of the likelihood of discharge to non-independent living, as this factor may matter most to older patients. This investigation assesses the relationship between older age and discharge disposition after burns, in a nationally representative sample.

Methods

We queried the 2007-2015 National Trauma Data Bank (NTDB) for burn hospitalizations in older adults. Pre-defined age categories were 55-64 years (working age group), 65-74 years (young-old), 75-84 years (middle-old), and 85+ years (old-old). Covariables included inhalation injury, comorbidities, burn total body surface area (TBSA), injury mechanism, and race. Discharge to non-independent living (nursing home, rehabilitation, and other facilities) was the primary outcome. Logistic regression was used to assess the association between older age and discharge to non-independent living, adjusting for covariables.

Results

There were 25,840 burn hospitalizations in older adults with complete data during the study period. Working-age patients comprised 13,563 (53%) of admissions. Young-old accounted for 7,342 (28%), while middle-old comprised 3,876 (15%), and 1,059 (4%) were classified as old-old. Discharge to non-independent living steadily increased with burn TBSA and older age in survivors (Table). Beginning in the 65-74 age group (young-old), most patients with burns ≥20% TBSA were discharged to non-independent living. After adjusting for patient and injury factors, odd ratios for discharge to non-independent living were 2.1 for young-old, 3.5 for middle-old and 7.6 for old-old patients, when compared to working-age patients (all p< 0.001).

Conclusions

Older age is a strong predictor of discharge to non-independent living after burns. These findings provide a realistic discharge framework for providers and older adults with acute burns.
566 Burn Disparities: Do Race, Gender and Insurance Status Affect Mortality?
Authors: Satahoo Shevonne , Hodge Juvonda , Joe Victor C
Published: March 2022

Introduction

The National Inpatient Sample (NIS) provides ideas of trends across the country. A recent study in trauma patients found that there were no differences in race or insurance status in regard to mortality. As such, we sought to examine these effects in burn patients and hypothesized that these trends would be similar.

Methods

The NIS was queried for all patients age ≥18 years with ICD-9 codes for total body surface area (TBSA) burn ≥ 20% and non-elective admissions. Years included were 2013 to the third quarter of 2015. Age, race, insurance status, TBSA, median household income for patient's zip code quartile and mortality were recorded. Cases with missing data for race, insurance status and mortality were excluded. Statistical analysis was done with student’s t-test and Chi-Square testing, as appropriate. Mortality was then used to run a binary logistic regression using these variables. A p-valve ≤0.05 was considered significant.

Results

There were 5685 weighted cases. Females encompassed 28.3%. The mortality rate was 21.1%. The patients that died were older (58.6 ± 19.1 years versus 44.7 ± 17.1 years for survivors, p< 0.001).

On multi-variate analysis of mortality using these variables, older age (p< 0.001), female gender (odds ratio (OR) 1.26 [1.05-1.50], p=0.011), lower median household income zip code quartile (highest quartile compared to lowest OR 0.69 [0.51-0.80], p< 0.001) and insurance status (compared to government insurance, private insurance OR 0.59 [0.47-0.72]; self pay OR 1.51 [1.18-1.93], p< 0.001) were associated with mortality. Increasing TBSA was also associated with mortality. Race was not a significant contributor (p=0.432).

Conclusions

While there was a trend towards a higher rate of mortality in the black population, race was not associated with mortality in a statistically significant manner. Socioeconomic factors were associated with higher mortality. The dynamics between race and

other social determinants of health, and the potential impact of structural racism and bias should be the focus of future research rather than on race itself, especially considering that access and resources vary by state.
568 Virtualization of In-school, Teacher-Directed Prevention Programs for Children
Authors: Banks Jessica L
Published: March 2022

Introduction

While remote/virtual teaching has been used for many years, Covid-19 increased the need for quality educational programs in virtual format. BPN has two in-school, school-based programs, Flicks Fire and Burn Safety for grades 1-5 and The Great Escape for grades 6-8. These teacher-directed programs cover essential topics such as home fire safety, stop drop and roll, youth fire misuse, and home fire escape. They have, historically, been deployed as hard copy curriculum, student workbooks, and associated educational videos, which were physically mailed directly to classrooms within the BPN’s 24-county service area. When Covid-19 became the new reality, the need to pivot to a different type of program delivery became apparent.

Methods

BPN recruited professional educators from targeted grade levels, representing varying geographic locations and socioeconomic backgrounds to recreate these programs in a format that will work in a remote learning environment. This team researched various e-learning platforms to determine what would work best for our content and is commonly used across all school districts. We determined that Google Classroom combined with Bitmoji would best serve our needs. We recreated a set of age-appropriate lessons for each grade level from 1-8. Each grade has information that ties each lesson to the appropriate academic standard for education. We employed multiple content formats based on best practices, including videos, audio tracks, text-based articles, and more. Lastly, we virtualized activities by turning them into on-screen interactive games, puzzles, quizzes, worksheets, etc.

Results

Our result is a virtual program for grades 1-8 conducive to both classroom and remote learning environments. It is linked directly to academic standards for education for each grade level and includes engaging, interactive content in various forms. This format not only gives us the ability to update and add new content quickly it also gives us the ability to expand geographic distribution seamlessly.

Conclusions

By utilizing platforms preferred by professional educators and integrating fire safety and burn prevention lessons into existing mandated educational standards, we can more effectively and cost-efficiently expand quality educational programming to children ages 6 – 14.
574 Want some s’more? The hidden risks of marshmallows
Authors: Ghini Francesca , Thakkar Mehul , Schrire Timothy , Bednarz Bartlomiej
Published: March 2022

Introduction

Marshmallows are a spongy confectionery commonly made with gum Arabic or gelatine, corn syrup, sugar, and flavouring. It is common, in many Anglophone countries, to toast marshmallows as an outdoor childhood pastime. Being an aerated aqueous mixture, marshmallows have unique properties when exposed to high temperatures, resulting in a Maillard reaction between the sugars and proteins. They therefore present a distinctive and significant method of burn injury.

Methods

We reviewed our regional online burns database for marshmallow related burns in the last six years to collate data on patient demographics, burn size and depth, method of injury, and outcome.

Results

Between 2015-2020, our Regional Burns Centre treated 35 patients with an average age of 8.3 years (range 4-14). The most commonly injured area was the face in 44% of the cases (lips specifically in 25%), followed by hands in 36%. The burn depth extended from deep dermal to full thickness in 6% of cases and the total body surface area affected was 0.3% on average. No admission or surgical intervention was required. A significant proportion of burns were associated with camping, open fires or barbecues (63%), however the recorded mechanisms of injury were not limited to these activities alone. 77% of injuries occurred between Friday and Sunday.

Conclusions

Marshmallow burns are hazardous due to their composition and response to heat. The adhesive nature of a toasted marshmallow leads to a deeper pattern of burn injury, even though, the majority can usually be managed conservatively due to the limited area affected.
575 Are There Racial Disparities in Burn Center Care?
Authors: Bessey Palmer Q , Heffernan Jamie M , Gallagher Jim
Published: March 2022

Introduction

Events in the past two years highlighted disparities in outcomes based on race for several disease conditions. There have been reports suggesting racial disparities may exist for burn care. This burn center has long been committed to serving all groups within the city. The purpose of this study was to determine if race might influence the outcome of burn care at this center.

Methods

We reviewed inpatient admissions for eight years, 2012 through 2019. Racial identity was reported by patients and their families and categorized as Asian, Black, Latino, or White. Place of residence was categorized by Zip code. Other variables were recorded. The revised Baux Score (RBS) was calculated according to Osler and Hosmer (2010). Several logistic regression models were tested for each racial group. They related death to RBS as well to age, burn size, and inhalation injury. An additional predictor variable for race was then added to each regression model. Statistical calculations were performed using SAS 9.4 (SAS Institute Inc., Cary, NC).

Results

5,440 patients were admitted as inpatients. Of these 4,626 (85%) resided in a zip code within this city, and patients lived in essentially every zip code. The racial distribution of the patients reflected the racial distribution of the city and of the several neighborhoods within the city. Death was strongly related to RBS or to age, burns size, and inhalation injury for all groups. In all cases, an additional predictor for race was not significant.

Conclusions

This burn center serves all areas and populations of the city. Outcome of burn center care was related to burn extent, age, inhalation injury. There were no detectable differences in the outcome of burn center care associated with race. Burn Center care should be equally effective for all races.
578 A Multi-pronged Approach to Improving Communication, Collaboration and Outcomes in the Burn ICU
Authors: Hockenberry Tiffany , Richerbach Stacey , Richey Karen , Foster Kevin N
Published: March 2022

Introduction

Effective communication between members of the burn healthcare team is vital as it impacts both patient outcomes and staff satisfaction. Discontinuity is a consistent barrier to communication. Fragmented communication may occur for a variety of reasons, including delineated shifts for staff, a decreased presence of physicians and allied health professionals at night, and variable levels of collaboration between nursing, therapy, allied health professionals and physicians. The purpose of this quality improvement project (QI) was to evaluate 3 interventions aimed at improving communication, collaboration, and ultimately patient outcomes.

Methods

The 3 interventions included the use of daily goal cards, increased frequency of interdisciplinary bedside rounds from once daily to twice daily and expanded in-house burn team coverage to include a burn-specific Physician Assistant/Nurse Practitioner (PA/NP) staffed in the center from 3:00pm to 11:00 pm. A 12-item survey consisting of a 5-point Likert scale and open-ended questions was distributed to team members to evaluate effectiveness of the interventions. Incidence of code events were evaluated as an indicator of patient outcomes.

Results

There were a total of 29 respondents, including physicians, allied healthcare professionals, therapists, and nurses. Sixty-nine percent of participants felt that the daily goal cards were an effective means of communication however only 45 % strongly agreed/agreed that achievement of daily goals had increased. The expanded coverage by a burn PA/NP was viewed as an improvement to patient care by 90 % of respondents, with 79 % strongly agreeing/agreeing that the expanded coverage prevented errors. When evaluating afternoon rounds 69 % of respondents either strongly agreed/agreed that it improved patient care and 52% found it to prevent errors. Nocturnal code events decreased by 56% over the one-year period following the institution of expanded coverage. There was no added expense associated with any of the three interventions.

Conclusions

While the results of this QI project were overwhelmingly positive, the expanded coverage by a dedicated burn PA or NP was viewed to be the most beneficial change. Temporally, the expanded coverage was also associated with a marked decrease in nocturnal code events. The addition of afternoon rounds was the next most beneficial change noted with positive findings in both effectiveness and improvement of patient care. There was a dichotomy between the effectiveness of the daily goal cards and the accomplishment of the goals that were set forth that needs further exploration.