bluuebunny/crossref_metadata_2025 huggingface dataset:
617 Indocyanine Green: Harnessing Novel Methods to Identify Burn Wound Healing Potential
Authors: Zajac Jocelyn C , Gibson Angela , Liu Aiping , Hassan Sameeha E
Published: March 2022

Introduction

Objective determination of burn wound healing potential remains elusive and significantly impacts decision making for surgery, the extent of tissue excised intraoperatively and the use of donor site-sparing alternative tissue therapies. Indocyanine green angiography (ICGA) has promise as an adjunct to evaluate healing potential, but feasibility has limited adoption in clinical practice. Delayed fluorescence imaging of indocyanine green (ICG), in a method called second-window ICG (SWIG), is a new technique used intraoperatively to guide tumor resection via increased peritumoral endothelial permeability. The objective of this study is to examine ICGA and SWIG fluorescence in burns requiring excision and grafting, and to correlate SWIG fluorescence to microscopic localization of inflamed and necrotic tissue.

Methods

Deep partial thickness, indeterminate depth or full thickness burns were identified in adult patients scheduled for excision and grafting. 24 hours prior to surgery, baseline bright light and fluorescence images were obtained before the administration of up to 5 mg/kg ICG intravenously. ICGA was performed within 5 minutes of infusion initiation. On the day of surgery, bright light and SWIG fluorescence images were obtained before and after burn excision. The excised tissue was imaged ex-vivo to determine the presence of fluorescence in the tissue compared to that remaining within the wound bed. Excised tissue was processed for histologic analysis of cellular architecture, viability, inflammation and necrosis. Macroscopic ICGA and SWIG fluorescence images were compared to the associated microscopic tissue sections to determine the presence of inflammatory infiltrate, localization of non-viable tissue, and co-localization of ICG fluorescence.

Results

ICGA imaging performed preoperatively demonstrated variable fluorescence throughout the burns without a clear cutoff value to delineate deep partial versus full thickness burns. SWIG imaging revealed a speckled fluorescence pattern prior to burn excision that became diffuse after excision suggesting a potential utility of SWIG to intraoperatively identify excision completion. ICGA and SWIG fluorescence demonstrated an inverse relationship, and SWIG fluorescence was associated with non-viable tissue.

Conclusions

ICGA imaging alone was unreliable to delineate the need for surgical intervention. SWIG imaging of burn injuries may represent a valuable tool to guide the extent of excision intraoperatively and reduce unnecessary excision of viable tissue. Further studies are needed to understand SWIG fluorescence at the inflammation-necrosis border and how ICGA fluorescence along with SWIG can synergistically improve detection of healing potential in burn patients.
702 Outcomes of COPD Patients with Burn Injuries at a Single Institution
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Matthews R O B E R T W , Williams Felicia
Published: March 2022

Introduction

Chronic obstructive pulmonary disease (COPD) is a condition with significant morbidity and mortality. In 2018, about 16 million adults in the United States reported a diagnosis of COPD based on data from the American Lung Association. Home oxygen is often used in more severe cases of COPD, and despite warnings against smoking while using home oxygen, many patients continue to sustain burn injuries. An existing diagnosis of COPD can further complicate management of a burn patient, especially if there is concomitant inhalation injury present. The objective of this study was to explore the outcomes of COPD patients admitted to our Burn Center.

Methods

This was a single-site, retrospective review using our institutional Burn Center registry. All adult patients with flame burns (18 years or older) admitted to our Burn Center between July 1, 2011 and June 30, 2020 who had a history of COPD with and without home oxygen use were included in this study. All adult patients with flame burns, who did not have a history of COPD, were included for comparative purposes. Variables of interest included demographics, burn mechanism, length of stay (LOS), ICU and ventilator days, and mortality.

Results

There were a total of 4,397 patients with flame burns included in this study, and 515 of those patients were identified to have an existing diagnosis of COPD. The mean age of the COPD group was 45.1 years +/- 13.0 years, and the patient population was predominantly male (60.4%). The mean total body surface area (TBSA) involvement was 5.12% +/- 10.38%. Inhalation injury was present in 10.1% of patients with COPD and in 7.8% of those without COPD. The mean LOS for the COPD group was 11.9 days +/- 19.4 days and 13.4 days +/- 31.0 days for the non-COPD group. The mean ICU LOS for the COPD group was 11.2 days +/- 19.9 days and 18.0 days +/- 37.0 days for the non-COPD group. The mean number of ventilator days was 16.5 days +/- 35.4 days for the COPD group and 26.3 days +/- 42.0 days for the non-COPD group. The overall hospital mortality was 10.3% for the COPD group and 4.3% for the non-COPD group.

Conclusions

This study demonstrates that the overall hospital mortality was highest in the COPD group. Although hospital and ICU length of stay, as well as the number of ventilator days were higher in the non-COPD group, it remains clear that an existing diagnosis of COPD can negatively impact the outcomes of burn patients.
710 Specific Patterns of Vital Sign Fluctuations Predict Bloodstream Infection in Pediatric Burn Patients
Authors: Sadeq Farzin , Poster Jonah , Weber Joan M , Begis Maggie D , Sheridan Robert L , Uygun Korkut
Published: March 2022

Introduction

Early recognition of the clinical signs of bloodstream infection in pediatric burn patients is key to improving survival rates in the burn unit. The objective of this study was to propose a simple scoring criteria that used readily available temperature, heart rate (HR) and mean arterial pressure (MAP) data to accurately predict bloodstream infection in pediatric burn patients.

Methods

A retrospective chart review included 100 patients admitted to the pediatric burn unit for >20% total body surface area (TBSA) burn injuries. Each patient had multiple blood culture tests, and each test was treated as a separate and independent “infection event” for analysis. The time at each blood culture draw was time 0 for that event, and temperature, HR and MAP data was collected for 24 hours after the blood culture was drawn. “Infection events” included in this study had at least six complete sets of temperature, HR and MAP data entries. Median temperature, HR and MAP, as well as mean fever spikes, HR spikes and MAP dips, were compared between infection group (positive blood cultures) and control group (negative blood cultures). These vital sign fluctuations were evaluated individually and as a combination of all three as timely predictors of bloodstream infection. In addition, we tested the prediction of Gram-negative bacteria versus Gram-positive or fungi present in blood cultures.

Results

Patients in the infection group had significantly higher median temperatures (p< 0.001), mean fever spikes (p< 0.001) and mean HR spikes (p< 0.001), compared to the control group. Using the combination scoring criteria to predict bloodstream infection, the strongest predictive values in the 24-hour timeframe had high sensitivity (93%) and specificity (81%). The predictive test metric based on vital sign spikes predicted Gram-negative bacteria, but with limited sensitivity (57%) and specificity (44%).

Conclusions

This study found that using a combination scoring criteria of fever spikes, HR spikes and MAP dips predicted bloodstream infection in pediatric patients with burn injuries with 87% accuracy, which may justify its use in resource-poor environments, or in cases where practical supporting evidence is needed for preemptive antibiotic treatment before culture results are available.
718 Indirect Calorimetry is Necessary to Optimize Nutrition in Large Burns
Authors: Srinivas Shruthi , Thomas Sheela S , Cordova Alfredo C , Bernal Nicole O
Published: March 2022

Introduction

Assessing nutritional requirements in large total body surface area (TBSA) burns is a challenge due to frequent metabolic variation. Studies have compared indirect calorimetry (IC) with predictive equations and identified formulas that are frequently used in the absence of IC. Large TBSA burns remain poorly understood, as does the role of changing metabolic rate and multiple surgical procedures over the course of recovery. We sought to understand whether these equations remain reliable in these situations.

Methods

The patient is a 31 year old, 92% full-thickness TBSA burn who was studied over the first 75 days of hospitalization at various points per institutional IC guidelines. Using total energy expenditure (TEE) by IC as the standard, we assessed variation of each predictive equation for accuracy. Only the Milner and Toronto formulas are dynamic, and we analyzed variation by post-burn day (PBD) compared to dates of major surgical procedures in these studies. The patient was excised on PBD 1, 2, 5, 7, 9, 21, and 25; he was grafted on POD 5, 11, 20, 41, and 56. Weekly monitoring of prealbumin and CRP indicated adequate nutrition.

Results

On post-burn day (PBD) 5, when all major burns were excised, all predictive equations inappropriately estimated the patient’s energy expenditure. On longitudinal analysis of 16 IC studies (Table 2), the Milner equation was most accurate, estimating within 5% variance of TEE at 5 time points (31%). The Toronto formula did not estimate within 5% variance at any time point. No energy equation consistently and accurately estimated energy expenditure over all calculated time points.

Conclusions

Although predictive equations are frequently used, in high TBSA burns with many operations and changing nutritional needs, equations are not as accurate as IC. Given that over- or under-estimating needs result in many complications avoided with IC, we propose frequent IC for intubated, high TBSA patients.
721 Defining Bleeding Characteristics in Frostbite Patients Managed with tPA
Authors: Murphy Jenna E , Winters M Kenett , Rogers Charlotte , Walter Ellen , Neumann Nichole , Weber Lynn , Lacey Alexandra M , Punjabi Gopal , Endorf Frederick W , Nygaard Rachel M
Published: March 2022

Introduction

Frostbite is caused by exposure to cold temperatures and can be a severe injury leading to hospital admissions, surgeries, or amputations. Disease progression involves endothelial injury, thrombosis, and tissue necrosis; therefore, management of patients involves a process of rewarming and restoration of blood flow to the affected area. Tissue plasminogen activator (tPA) is a thrombolytic agent that has demonstrated efficacy at restoring tissue perfusion in patients with frostbite. The goal of frostbite management with tPA is to salvage tissue without causing clinically significant bleeding, a documented adverse effect of tPA administration. The purpose of this study was to characterize specific bleeding complications associated with tPA administration. The secondary objective was to compare the rate of bleeding complications in frostbite patients treated with intravenous (IV) tPA to frostbite patients that did not receive tPA.

Methods

This single center retrospective study included all adult patients with severe frostbite who presented between October 2013 and March 2020. tPA was given to patients per institutional protocol. To assess for bleeding events, patient charts were reviewed and any instance of bleeding was categorized based on severity. Bleeding was categorized as: 1) none, 2) mild: not clinically significant (bandage or moved IV site), 3) moderate: change of management (tPA stopped, enoxaparin held, or specialty consult), and 4) severe: included a change and intervention (transfusion, fasciotomy for compartment syndrome). Any change in management or any additional therapies used to control bleeding were documented, as well as the timing of bleeding in relation to tPA administration.

Results

Over a 7-year period 209 patients were analyzed and 202 patients were included. For patients with bleeding events requiring intervention, the mean time to bleed was 105.5 hours (range 4 to 576 hours). Of these, 4 (3 transfusions and 1 fasciotomy for compartment syndrome) were temporally associated with tPA administration (within 24 hours). Two of the 4 patients had minor to moderate traumatic injury prior to admission, the 3rd patient had incomplete work-up at referring center that initiated tPA prior to transport, and the 4th patient was in restraints. Of the patients who did not receive tPA, 3.39% had a severe bleeding event requiring intervention compared to 6.99% of patients treated with tPA (P=0.516).

Conclusions

Though there was a higher incidence of bleeding in tPA-treated patients, for the majority of patients studied, tPA was safe for the treatment of severe frostbite. Bleeding events occur in frostbite patients treated with or without tPA and warrant close follow-up for these infrequent complications.
722 Collagen-elastin matrix for defect coverage in exposed bradytrophic tissue after severe burn and degloving injuries
Authors: Oehlbauer Markus
Published: March 2022

Introduction

Despite successful defect coverage by means of complex skin or muscle flaps, particularly large and deep problematic wounds with exposed bradytrophic tissues after soft tissue loss are very susceptible to surgical revision.

A dermal matrix, consisting of native collagen (collagen type I, III and V) supplemented by an elastin hydolyzate was first used for the treatment of burns, predominantly those that were full-thickness. Subsequently, its use was extended to defect coverage especially after soft tissue loss caused by degloving injuries.

Methods

52 patients with exposed bradytrophic tissues caused by severe burn or degloving injuries were treated the same way.

In all patients operative debridement showed soft tissue loss with free bone or free periostal structures, exposed tendons or joint capsules.

In all patients after accurate wound bed preparation defect coverage was performed with collagen-elastin matrix and unmeshed split skin grafts in combination with negative pressure wound therapy for fixation of dermal matrix and split skin grafts.

Results

Two-years follow up of these collagen-elastin matrix procedures in defect coverage showed an excellent functional outcome:

Up until now, no areas with unstable scars have occurred, no surgical scar revisions were required. The patients were still able to wear normal footwear, clinical gait analysis showed perfect functional outcome.

Conclusions

The application of collagen-elastin matrix in patients with exposed bradytrophic tissues after severe burn or degloving injury treated so far represents an excellent reconstruction method, from initial coverage to scar development.
724 Role of synthetic dermal matrix for reconstruction of complex non-graftable wound defects
Authors: Concannon Elizabeth , Wagstaff Marcus
Published: March 2022

Introduction

The aim of this study was to investigate the role of a synthetic dermal matrix, Biodegradable Temporising Matrix (BTM), for coverage of complex wounds. The authors defined complex wounds as wounds not amenable to reconstruction with skin grafting alone due to an inherent avascularity of the wound bed, such as the presence of exposed bone, tendinous or neural structures.

Methods

A retrospective review of a prospectively maintained database of complex wounds as defined above was carried out. Clinical and operative notes were reviewed along with review of an extensive photographic database demonstrating wound healing progress using staged dermal matrix (BTM) and autologous skin graft reconstruction.

Results

55 patients were identified who underwent staged dermal matrix and autologous skin graft reconstruction for complex wounds affecting a wide variety of patient demographics, treatment indications and body sites. Wound aetiology varied between burn injury, non-burn related trauma including degloving injury and infective complications. We discuss caveats relating to successful application of a dermal matrix, technique tips, prevention and management of complications.

Dermal substitutes play an integral role in providing biological wound cover for avascular wound beds which may otherwise require complex distant flap or microsurgical free flap reconstruction. BTM is a completely synthetic dermal matrix comprised of a 2-mm-thick sheet of biodegradable polyurethane foam bonded to a non-biodegradable polyurethane sealing membrane. Our department has developed significant expertise in the use of BTM throughout its development from initial animal studies through to recent human clinical trials. The synthetic composition of BTM does not require rapid neo-vascularisation for its integrity or survival. As such, two-stage BTM reconstruction has proven robustness in the face of unfavourable wounds compared with other popular dermal matrices, physiologically covering avascular structures, allowing for early graft take, expediting rehabilitation and mobilisation with excellent scar cosmesis and limited contracture formation.

Conclusions

Dermal matrices such as BTM play an important role in complex wound healing, frequently achieving excellent results with a low complication profile. BTM has been used successfully in cases where biological matrices would not routinely be considered as demonstrated by this clinical series. It has provided a valuable alternative to free-tissue transfer in patients with significant co-morbidities, vascular insufficiency and/or those for whom long operations are undesirable.
727 Novel silver based â€œsuitâ€#157; dressing technique for Steven Johnson Syndrome and other cutaneous exfoliative conditions
Authors: Laun Jake , Maynell Kimberly Brown , Taylor Loryn , Simmons Lancia , Krenitsky Amanda , Smith David J
Published: March 2022

Introduction

Exfoliative skin conditions such as Steven Johnson Syndrome (SJS)/toxic epidermal necrolysis (TEN) and other significant drug related reactions are complex medical conditions that provide a challenge to the burn surgeon, especially with regards to local wound care. Various modalities of wound care require frequent dressing changes; however, these changes put the patient through significant pain and potentially harmful experiences that could lead to worse skin exfoliation, scarring and pigmentation changes. As part of our burn unit, we have created a dressing utilizing silver impregnated nylon sheets that limits the amount of wound care performed and therefore the amount of potential exfoliative damage.

Methods

We have employed this means of dressing in all our Steven Johnson patients with significant open or blistered areas. We performed a retrospective analysis looking at our patients who were admitted with Steven Johnson Syndrome/toxic epidermal necrolysis or other exfoliative skin disorder over the last 7 years. We had 52 patients who ranged from having 2-100% of skin involved with significant blistering or exposed areas. The suit is made specific to the patient as each area is measured and the silver sheets are formed to the patient and secured in place. The silver sheets are saturated with sterile water and rewet with saline every four hours and changed every three days.

Results

By utilizing these silver-based dressings, we have limited the amount of dressing changes and concomitant pain for patients while also limiting skin infections to only 1 out of our 52 patients. For blisters on the face, a local antibiotic ointment was used; and once the skin lesions had healed, a moisturizing lotion was used.

Conclusions

Steven Johnson Syndrome and other exfoliative skin conditions require significant wound care. By minimizing dressing changes, one can lessen the pain to patients and by utilizing dressings that are infused with silver, one can also potentially decrease the risk for infection as was seen in our patient population.
731 Utilizing call for burn admissions to guide clinical staffing decisions for Advanced Practice Providers (APP)
Authors: Alam Atique , Coffman Beretta C , Presberry Yusuf , Wilson Joan
Published: March 2022

Introduction

Over the past decade, the Advanced Practice Provider (APP) role has expanded into various care settings. The literature confirms that APPs contribute positively to the ICU setting, where better patient outcomes are noted, and they are seen as a safe adjunct to the ICU team. The VA recognizes the need for a more significant presence, and practice-based variations are considered crucial as restructuring goals are established. In 2014, Edkins et al. recognized the need for APPs in the burn setting as the number of residents declined. They stressed appropriate utilization and ongoing educational opportunities to develop the role in burns further.

Methods

This project was conducted by establishing a protocol within our burn referral call system to adequately and efficiently ensure accurate data is accumulated and leveraged to make staffing decisions. Implementation of the protocol began in January of 2018 and is well established. The primary purpose of the protocol is to efficiently store and transfer patient data to make informed decisions across both clinical and administrative departments. The Customer Relationship Management (CRM) System, Salesforce, was the primary software to implement and maintain this process.

Results

For three years, a total of 42,460 referral calls came through our burn call system. The number of patient calls that required admission to a regional burn center totaled 15,293. 70% of total patient referral calls came during the hours of Noon-Midnight; similarly, 72% of admission patient calls came during Noon-Midnight. Hourly trends were similar for both total patient call volume and admission patient referral call volume as they both had the highest number of referral calls between the hours of Noon-Midnight. The majority (32%) of total patient referral calls came in during earlier days of the week (Monday and Tuesday), while the majority (30%) of admission patient referral calls came in during the later days of the week (Friday or Saturday).

Conclusions

Our study demonstrates the benefits of implementing a collaborative protocol that allows sharing data and information across all facets of a burn center. Opportunities for additional studies include implementing similar protocols for administrative staffing and analysis of patient outcomes to see how staffing utilization has affected patient care.
732 Examining Staff Views and Perceptions After Implementation of a Laser Doppler Imaging Device Into Practice
Authors: Tejiram Shawn , Washburn Thomas , Shupp Jeffrey W
Published: March 2022

Introduction

Laser doppler imaging (LDI) has been established as an accurate diagnostic tool to assess burn depth and measure healing potential. Despite this, its use in burn centers remain limited. While studies have examined challenges to LDI use, there is a paucity of literature factoring staff views and attitudes as a barrier to implementation into burn practice. The aim of this work was to assess and examine attitudes and perspectives following implementation of an LDI protocol into acute burn injury assessment.

Methods

Following institutional approval, a 22-question survey was disseminated among staff involved with implementation of an LDI device as a point of care tool to assess acute burn injury at a single ABA verified burn center. The survey focused on questions examining device ease of use, understanding of the underlying LDI technology, interpretation of imaging generation from wounds, and perceptions of patients’ experience. Questions were answered on a standard 5-point Likert scale. All survey data was collected anonymously into an electronic database for assessment.

Results

Overall, there were 15 respondents to the survey questions. Five respondents found the LDI device difficult to use (33%). Barriers to device ease of use included difficulty with device movement (60%), incorporation of scanning into wound care and dressing placement (60%), and management of hardware or software issues that arise during use (60%). Challenges noted by respondents external to device use was mainly high patient census (80%). Despite this, 60% of respondents found the device easier to use after performing several scans in one or more patients and 60% found that scans generated matched their assessment of burn depth. Among respondents, 66% found patients amenable to the scanning process and 80% did not feel that that the scanning process worsened patients’ pain.

Conclusions

Challenges in LDI device use, implementation with wound care and dressing placement, and high patient census were identified as barriers to LDI use. Despite this, ease of device use improved with more frequent use. Identification of views and perceptions such as these can lead to protocol changes and additional training that facilitate ease of LDI use. Further examination will be required to better elucidate this information.
735 Early Treatment with NSAIDs Improves Blood Clotting Function in Severely Burned Patients
Authors: Huang Lyndon G , Song Juquan , Corona Kassandra K , Wermine Kendall , Villarreal Elvia L , Keys Phillip H , De La Tejera Giovanna , Gotewal Sunny , Joglar Alejandro A , Efejuku Tsola A , Chokshi Shivan N , Bagby Shelby P , Chaij Jasmine M , Haseem Maria , El Ayadi Amina , Golovko George , Wolf Steven E
Published: March 2022

Introduction

The risk of coagulopathy is increased in severe burns. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in burn patients to relieve pain and reduce inflammation. This study investigates the impact of NSAIDs on burn induced coagulopathy in severely burned patients.

Methods

Severe burn patients (total body surface area [TBSA] >20%) were identified with TriNetX, a North American federated health research network from 51 health-care organizations (HCOs) and categorized for those receiving NSAIDs during the first week following injury; those with NSAID use prior to injury were excluded. NSAIDs included in this study were ibuprofen, oxaprozin, indomethacin, aspirin, diclofenac, celecoxib, and naproxen. Burn induced coagulopathy was defined as international normalized ratio (INR) levels ≥1.5. Statistical significance of the rate of burn-induced coagulopathy in the week following injury among the two groups was analyzed with measures of association using chi-squared tests.

Results

We identified 709 severely burned patients receiving NSAIDS during the week after burn and 1,032 severely burned patients without NSAID use. Among those receiving NSAIDs, ibuprofen and aspirin were the most prescribed at rates of 80% and 36%, respectively. After cohort matching, the risk of burn induced coagulopathy was significantly decreased in patients taking NSAIDs (17.7%) compared to patients not receiving NSAIDs (32.3%) (p< 0.0001). The protective nature of NSAIDs was greatest on the same day (p=0.0002) and first day following burn injury (p=0.0026). On average, those not taking NSAIDs had an elevated risk of developing coagulopathy compared to those who did as %TBSA increased in 10% intervals. This observation was confirmed in a linear regression analysis with slopes of 0.0453 and 0.0293, respectively. Furthermore, patients taking NSAIDs were less likely to develop sepsis (p=0.0046) and thrombocytopenia (p=0.0003) and die the first week following injury (p< 0.0001).

Conclusions

The early protective effects of NSAIDs at reducing the risk of coagulopathy occurs during the acute phase of burns, though selection bias cannot be excluded. The potential risk of burn induced coagulopathy increased more with %TBSA in patients without NASIDs.
742 Is There a Mortality Benefit of Being Well-Insured in Burns?
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia
Published: March 2022

Introduction

The purpose of the Affordable Care Act was to make affordable health insurance available to more people, to cover adults with fewer resources, and to facilitate delivering health care in a cost-effective way. Burn care is both financially and medically intense, expensive, and prolonged. We aimed to compare outcomes of patients treated at a tertiary care center with no insurance, those considered under-insured (Medicare/Medicaid), and those with private/commercial insurance.

Methods

Patients were identified using our institutional Burn Center registry and linked to the clinical and administrative data. All adult patients admitted to the Burn Center between January 1, 2011 and December 31, 2020 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions and mortality were evaluated. Statistical analysis was performed with Students’ t-test and chi-squared.

Results

A total of 9,306 patients were admitted during the study period. Forty-one percent of patients had private/commercial insurance. Thirty-four percent were under-insured, while 25% of patients had no insurance. Total body surface area (TBSA) of the burn was significantly higher for the under-insured, p< 0.05. Mortality was significantly higher for the under-insured, p< 0.05. The average LOS for the under-insured was 14.7 days, which was significantly longer than that for the insured (9.2 days) and for those without insurance (7.4 days), p< 0.05.

Conclusions

There are outcome disparities secondary to insurance coverage in burns. Under-insured patients had poorer outcomes than those with private/commercial insurance and those without insurance.
747 Standardization of Upper Extremity Elevation
Authors: Miller Hannah
Published: March 2022

Introduction

Elevation of burn-injured extremities is crucial to preserve function, prevent contracture and scar formation. Limited data leading to various techniques utilized across burn centers has resulted in no local, national, or international standard of practice. The absence of standardized documentation of these interventions prevents data tracking and outcome analysis.

Methods

A literature review was conducted to assess the various methods of upper extremity elevation in burn patients. A request was sent to ABA verified burn centers to collect feedback on elevation practices. The interdisciplinary team was consulted for their professional expertise and opinion. The unit practice council reviewed all data to establish a standard of practice for upper extremity elevation. A procedure was written explaining the purpose, proper implementation, and potential complications. Documentation in the electronic medical record (EMR) was updated to reflect the practice change. Education will be disseminated to bedside staff. Return demonstration will be required, completed with a trained validator to ensure staff competency. Data will be collected and analyzed through EMR audits.

Results

Information gathered via literature review proves there is inconsistent practice of upper extremity elevation post-burn injury. ABA verified burn center survey results support the current literature findings, and the importance elevation plays in preserving function and quality of life in burn survivors.

Conclusions

Upper extremities are frequently impacted by burn injury, potentially resulting in significant disability. A common physical complication of burn injury is contracture of major joints, leading to further surgical intervention and/or permanent disability. Standardizing the practice of upper extremity elevation has the potential to preserve joint function and range-of-motion. A procedure has been written and published hospital-wide. Staff compliance and documentation audits will assist in evaluating the efficacy of the upper extremity elevation. Barriers to optimal outcomes include staff compliance, documentation inconsistencies, and limited sample size.
765 Treatment of burns due to application of hair extensions and braiding in younger female patients
Authors: Coffman Beretta C , Wilson Joan , Hardy Kade , Parker Farrah , Addison Shana
Published: March 2022

Introduction

Burn injury due to hair styling processes have been reported in the literature, but most of those have been reported to involve flat irons or chemical processing during hair coloring. Moreover, these injuries have predominantly involved adult patients. In the past, our center has seen similar injuries intermittently, with the addition of hot comb burns to the scalp as well.

More recently, a number of younger female patients have been treated for a more uncommon injury related to application of hair extensions. The hair extensions are curled with hot boiling water which is usually taken from the microwave. The ends of the extensions are dipped in the hot water and when they are applied to the hair, the hot water burns the back, shoulders, and scalp.

The purpose of this project is to describe the mechanism of injury from this type of hair styling process and to identify the population at risk. This will serve to raise awareness in the community so that preventive measures might be considered.

Methods

This is a case series describing an unusual mechanism of burn injury reviewing admissions from January 2016 through June 30, 2021.

Results

A total of 35 patients were admitted for this type of burn during this time. 32 were children and 3 were adults. Though this type of injury occurs more commonly in children, it can occur in adults as well. For purposes of this study, the focus will be injuries occurring in children.

Conclusions

This case series serves as a public service announcement to alert parents of young girls obtaining hair extensions and parents braiding the hair of young children of the potential danger of burn injury from the process. Burn clinicians are obligated to provide education that serves to help prevent such injuries. This presentation serves that purpose as well.
772 Impact of Clinical Course on Psychosocial Outcomes in Adult Burn Survivors
Authors: Ross Erin E , Colbath Rachel A , Yu Jeremy , Munabi Naikhoba , Gillenwater Justin , Yenikomshian Haig A
Published: March 2022

Introduction

There has been conflicting data on the relationship between burn severity and psychological outcome. The present study aims to characterize the baseline psychosocial disposition of adults attending outpatient burn clinic at a large county hospital, as well as the impact of clinical course on self-reported psychosocial well-being.

Methods

Adult patients attending outpatient burn clinic completed survey questions from National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Managing Emotions (ME) and Managing Social Interactions (MSI). Sociodemographic variables collected from surveys and retrospective chart review included age, ethnicity, zip code, employment, and marital status. Clinical variables included total body surface area burned (TBSA), initial hospital length of stay (LOS), surgical history, and number of days since injury. US census data based on patient’s home zip code was used to estimate percent of community living below US poverty level. Scores on ME and MSI were compared to the population mean by one-sample T-test. TBSA, hospital LOS, surgery, and days since burn were separately evaluated for associations with ME and MSI scores by Tobit regression while adjusting for sociodemographic variables.

Results

71 patients completed surveys. Compared to the general US population mean score of 50.0, had lower scores in MSI (mean=48.0, p=.041) but not significantly different ME scores (mean=50.9, p=.394). While controlling for age, ethnicity, marital status, employment status, and neighborhood poverty, increased LOS was associated with lower scores on both ME and MSI scores (Table 1); the associations of TBSA, surgical

Conclusions

Burn patients may experience difficulty in getting support after burn injury. This challenge may be increased in patients with more extensive debilitation after injury, as increased duration of hospitalization worsened self-efficacy for managing emotions and social interactions. Additionally, prolonged hospitalization may remove patients from their normal support systems.
773 Insurance Coverage Does Not Increase Risk of Depression and Anxiety in Burn Patients
Authors: Pezzopane Laura , Gray Anthea , Cordova Alfredo C , Bergus Katherine , Bernal Nicole O
Published: March 2022

Introduction

A burn injury can have long-term mental and physical effects on individual patients. When burn injuries occur at work, there is an additional unfamiliar stress of income loss and dependence on a third-party payer. Patients with claims through the Bureau of Worker’s Compensation (BWC) report frustration and overall dissatisfaction in working with the BWC to achieve claim coverage. Of workers who are off of work more than 5 days due to a work-related injury, 10% are diagnosed with depression in the 12 months following the injury (Carnide, 2016).

In our clinic, screening for depression and anxiety is done through the Patient Health Questionnaire (PHQ-4), a valid four-item assessment tool that utilizes a Likert style measurement to assess symptoms of depression and anxiety (Kroenke et al., 2009). This is a health questionnaire that determines a patient’s risk for depression and anxiety as mild, moderate, or severe.

Objective

To determine if there is a correlation between insurance type and PHQ-4 scores in burn patients. We hypothesized that risk of depression and anxiety could differ based on payer, which can affect a patient’s access to care, referral approval, and financial burden of treatment. Additional focus was placed on BWC patients due to their reported frustrations and dissatisfaction in working with BWC and the established correlation between depression and missed work.

Methods

A quality improvement project was initiated based on increased rates of referrals for psychological evaluation and treatment in BWC patients. A retrospective review was conducted of outpatient burn clinic visits where a PHQ-4 questionnaire was completed in the past 3 fiscal years: 7/1/2019-6/30/2021.

Results

Total of 1932 visits with PHQ-4 collection were reviewed within the above specified time frame. The rates of moderate and high-risk scores for anxiety and depression were highest with BWC and Medicaid patients. Patients with private insurance showed a lower risk of moderate and severe depression. However, there was no significant difference when comparing BWC verses all other insurance. Table 1

Conclusions

Overall there was no significant difference in risk of anxiety and depression with BWC versus other insurance coverage based on PHQ-4 scores. Limitations of the study include no distinction of extent of burn injury/burn depth, burn care/treatments, length of hospital stay if any; no distinction was made amongst BWC patients and their length of time off of work. A portion of the timeframe reviewed was during the COVID-19 pandemic.
776 Quality Improvement in Prehospital Burn Care
Authors: Phillips Frank , Sturges Mariah
Published: March 2022

Introduction

Burn center implemented a new quality improvement program with emergency medical services (EMS) that examined patient care prior to arrival. Inconsistencies were noted with key interventions that would improve patient’s overall health. These included oxygen administration, fluid resuscitation, pain management, and the application of sterile dressings. There was also improvement in the transfer of care from EMS to receiving hospital.

Methods

Patient care reports were examined to see the quality of care that was being given in the prehospital setting. Based on these results, education in the form of a lecture and prior cases are presented routinely to different emergency medical services. To improve transfer of care at bed side from EMS, “burn page” was created. This is a page sent directly to charge nurse of burn unit, emergency department, attending physicians of burn unit, outreach coordinator, and prehospital care coordinator. This allows for improved preparation to receive burn patient from EMS. After the patient is received from EMS, a patient follow up is provided by the prehospital care coordinator to EMS within 24 hours. The patient care report from EMS is reviewed along with the care currently being provided by the burn unit. A case review is scheduled with EMS to examine the care provided and see where improvement can be made with both EMS care and the transition of care at the bed side. This case review also allows the EMS crew to see how the patient is doing a few weeks later.

Results

The burn center has noticed drastic improvement of care in the prehospital setting. This includes hitting critical bench marks as described in the introduction. This improvement is seen at the transition of care at bedside and in patient care reports done by EMS. These EMS providers also express the improvement of how patients are transferred to the burn center and a sense of trust that the patient will have excellent burn care. They also express that creating the patient follow ups and case reviews helps close the loop in patient care resulting in better burn care being provided in the prehospital setting.

Conclusions

With noticing what critical bench marks that were not being met regarding burn care in the prehospital setting, corrective actions can be created that will establish a closed loop that drastically improves care. From the point of injury to the end of stay in the burn unit, patient care has been drastically improved.
781 Multimodal Virtual Reality Encouragement
Authors: Thomas Mini , Blacker Hayley
Published: March 2022

Introduction

Burn units’ nurses develop creative methods to mitigate unpleasant experiences. Peer reviewed research has affirmed that non-pharmacological stimuli can distract patients from noxious procedures. Therefore, novel virtual reality was introduced as a nurse-driven modality to improve patient care. Multiple approaches encouraged staff utilization of this exciting, yet unfamiliar, technology.

Methods

A needs assessment concluded that patients experience moderate pain and some anxiety during wound care - indicating an opportunity to explore virtual reality. The virtual reality headset was introduced to nurses via in-services to encourage hands-on experience. The following month, an interactive “VR Superstars” poster was developed as a visual cue to motivate nurses to attempt the new product. Whenever a nurse used the device with a patient, a star sticker was applied next to his/her name. Next, a resource binder was created: This binder included the device protocol, patient inclusion criteria, educational handouts to assist staff with introduction to patients, and surveys. Biweekly emails encouraged virtual reality use and acknowledged staff members who proactively utilized it. The multidisciplinary team also discussed virtual reality at daily rounds.

Results

To assess virtual reality’s effectiveness, patients completed surveys after each use. At the end of the first month, staff implemented virtual reality only three times - as identified by the number of surveys. Upon completion of the multi-modal staff encouragement, virtual reality use doubled. By the third month, nurses implemented the technology on six occasions within the month.

Conclusions

The multi-modal approach ultimately familiarized nurses. These techniques contributed to increasing staff experience, thereby improving staff confidence to utilize a new product. As exposure increased, nurses reported more excitement to introduce the product to patients. Due to the implementation of multiple motivators, nurses are more readily implementing an intervention to benefit a patient’s experience.
787 Two Year Follow Up of Microblading in Patients with a Facial Burn Injury
Authors: Brown Melissa , Turgeon Lori , Bojovic Branko
Published: March 2022

Introduction

Recovery from a facial burn injury can be challenging. Excessive reconstructive interventions and the emotional devastation can be taxing. Microblading, semi-permanent eyebrow tattooing, is a potential non-invasive alternative treatment. Little research exists on microblading’s longevity and durability over burn scar or its impact on self-esteem. A single case study showed positive impact on patient perceived body image and maintenance of shape and color. Two years post microblading new data supports its efficacy as a potential treatment for patients with a facial burn.

Methods

Single case study two years post microblading of a 22-year-old female who sustained a 30% total body surface area burn injury to bilateral upper extremities, hands and face at age one. Based on referral from her plastic surgeon, she underwent first microblading treatment March 2019 with a standard touch up session May 2019. Patient has not undergone any additional sessions since. Photos obtained two years post treatment were compared to before/after photos immediately following microblading to assess longevity and durability on scar tissue. Self-reported patient outcomes obtained two years after microblading assessed impact on self-esteem and body image.

Results

Photos were taken pre/post microblading, at nine months, and 2.5 years post. Comparison of photos over time showed some expected fading but maintenance of overall shape. Patient self-reports using an eyebrow pencil to darken when she desires brows that are more vibrant and trims hair as needed to maintain shape. Patient reports positive impact to her self-esteem post-microblading. “I most definitely did notice some changes in my self-esteem.” She notes feeling happier and more confident, especially in social situations with peers. Comparison of responses immediately post-microblading with 2.5 years later show focus on improved self-esteem versus satisfaction with appearance of the eyebrow.

Conclusions

Comparison of follow up photos obtained 2.5 years after initial microblading shows maintenance of eyebrow shape with some fading of color. Further research is needed to determine if color fading is as expected or more pronounced in patients with scarred skin. Also important is the impact of characteristic dryness of scars on fading rate. To maintain adequate color, additional treatments would be recommended. Better understanding of factors affecting fading would help determine frequency and timing of maintenance sessions. Patient report indicates increasingly improved self-esteem over time as evidenced by focus on confidence versus appearance. Despite some fading, data supports microblading as an effective non-surgical treatment in establishing eyebrow appearance and function over burn scar.