bluuebunny/crossref_metadata_2025 huggingface dataset:
35 Wound Improvement Project: Improving Skill Sustainment and Confidence
Authors: Shingleton Sarah K , Helms Alexandra J , Cancio Leopoldo C , Abbott Monica L , Miner Corey A
Published: March 2020

Introduction

New burn intensive care unit (BICU) nurses in the Burn Center complete an evidence-based preceptorship to include standardized wound care education that is reinforced throughout preceptorship. A gap in skill sustainment was identified; factors include lack of a formal sustainment program, inconsistent reinforcement of wound care skills and a perceived decrease in pride in wound care. The purposes of this project are to 1) develop and implement a wound care skill sustainment program 2) re-establish confidence in wound care and 3) improve the quality of wound care delivered in the BICU.

Methods

A Wound Improvement Project (WIP) committee was formed FEB 2018 consisting 8 BICU nurses; the BICU Nurse Manager and Wound Clinical Nurse Specialist serve as consultants. WIP developed several learning modules and is now developing a wound skill sustainment program and evaluation tool based on the Burn Nurse Competency Initiative (BNCI) standards. BICU staff complete an anonymous survey about wound care confidence every 6 months. WIP mentors and evaluates competency through direct observation during 3 assigned shifts with each BICU nurse. Wound care documentation is audited monthly and a wound care quality audit tool is being developed. Descriptive statistics, student’s T-test, and ANOVA were used.

Results

The confidence survey was given in Spring 2018 (n=52), Winter 2019 (n=33) and Summer 2019 (n=64); each question showed significant improvement. Notably “how confident would you be doing a full body wound care by yourself with some help turning” improved from 4.12 (±1.17) to 4.64 (±0.65, p=.01). 24 BICU staff have been evaluated with 40 pending completion. No significant difference was found in skill competency between the 3 WIP assigned shifts; however self-evaluation for “how comfortable/confident do you feel advocating for a different type of wound care treatment for your patient” improved from 6.1 (±2.2) to 7.5 (±1.9, p< .0001). Average wound documentation scores improved from 85% in FEB 2018 to 99% in FEB 2019.

Conclusions

Wound care confidence and documentation have improved since initiation of WIP. Targeted education, bedside tools and workshops have all contributed. There is a positive trend (not significant) towards improved skill competency this is likely due to tool modifications and the small number of staff evaluated to date. Staff feedback has been positive with most staff finding WIP helpful. The long-term goal is to expand WIP to all areas of the Burn Center.

Applicability of Research to Practice

BNCI standards are a framework for skill sustainment and progression of staff from competent towards proficient and expert. Development and evaluation of nurse-led sustainment programs are needed across the burn community.
40 Implementation of a Nursing-driven Volume-based Enteral Feeding Protocol
Authors: Moore Kristin , Cooper Cheryl , Fagert Kayleigh , Cochran Amalia , Thomas Sheela S , Coffey Rebecca
Published: March 2020

Introduction

Nutrition in the burn patient is vital to proper wound healing and graft take, counteracting the hypermetabolic response, and improving patient outcomes. Studies support early, aggressive enteral nutrition for burn patients. Enteral nutrition is often interrupted during hospitalization, causing patients to fail to achieve their nutritional goals. To maximize nutritional support for burn patients, our institution implemented a nurse-driven, volume-based enteral infusion protocol (VBP). The goal of this quality improvement project was to compare clinical outcomes and volume of enteral nutrition received by the burn patient pre- and post-VBP.

Methods

A single-center retrospective analysis was conducted at one adult burn center comparing pre- and post-implementation of a VBP. Patients aged 18–89 years admitted to the SICU for initial management of burn injury between November 2014 – May 2015 (pre-VBP) and June 2015 – January 2016 (post-VBP) were included; for stepdown patients the time period ranged from June 2017 – December 2017 (pre-VBP) and February 2018 – September 2018 (post-VBP). Pertinent demographic and burn-related data were collected. Clinical outcomes included length of stay (LOS), complications as defined by National Burn Repository, duration of mechanical ventilation, percent weight gain or loss, and percent of enteral volume received.

Results

In the SICU, there were 10 patients pre-protocol and 12 patients post-protocol. When comparing pre-VBP to post-VBP demographics, mean TBSA was 19.6% (1–40.5) vs 24.83% (2–61.5%), with a mean age of 64.4 vs 60.7 years. For clinical outcomes, mean number of complications was 1.6 vs 2, with mean ventilator days of 16.2 vs 16.4, SICU mean length of stay/TBSA 1.99 vs 2.23 days, and hospital mean LOS/TBSA 3.83 vs 2.54 days. Overall prescribed amount of enteral nutrition received pre-VBP was 105% vs post-VBP amount received at 95% (p=0.09). For the step-down unit, there were 8 patients pre-protocol and 6 patients post-protocol. Overall prescribed amount of enteral nutrition received pre-VBP was 83% vs post-VBP amount received at 89% (p=0.3815).

Conclusions

While clinical outcomes remain unchanged during the evaluation period, our patients met their prescribed enteral nutrition volume requirements when a nurse-driven VBP was initiated. In addition, for non-ICU patients, a trend was seen towards increased tube feeds with VBP.

Applicability of Research to Practice

Nurse-driven VBPs allow for RNs to adjust the rate of enteral nutrition by “catching up” for interruptions in feeding to meet the patient’s nutritional goals for the day.
61 Tap Water: Still Burning After All These Years
Authors: Lee Christina , Bessey Palmer Q
Published: March 2020

Introduction

Hot tap water has long been recognized as a cause of burns, especially for children. Standards for appliance manufacture and building codes were established several decades ago to avoid excessively high hot water temperature at the tap in order to reduce the incidence of these injuries. The purpose of this study was to determine the prevalence and impact of tap water scalds (TWS) seen at burn centers in a recent time period.

Methods

We reviewed the National Burn Repository (NBR) for the years 2015–2017. We identified all scald burn injuries from the primary ICD10 code (former ECodes in ICD9, now External Cause Codes in ICD10). The codes for the cause of burns include X00 – X19. The X11 series identifies TWS. The data fields were analyzed using SAS 9.4 (Cary, NC). Data are expressed as Mean ± SEM or Mean (95% CI). Differences in continuous variable means were tested with TTest and categorical variables with Chi square and Fisher’s Exact Test. Logistic regression analysis was used to test differences between groups and identify risk factors for death.

Results

There were 16,318 patients included in the two-year data set. Of those, 5,014 (30.7 ± 0.4 %) had scald burns identified by the Primary ICD10 code, and 1,029 (20.5 ± 0.6 %) of those were due to hot tap water. The prevalence of TWS among children < 5 with scald injuries was 21.8% (15.9–23.8); among children 5–14, 19.4% (15.9–22.8); among young adults 15–44, 14.7% (12.8–16.5); those 45-64 24.1% (21.3–26.8); and those 65 and older 27.9% (23.7–32.2). Burn size for those 45–64 tended to be larger with TWS than other scald injuries (3.3 ± 0.7 % TBSA vs 2.0 ± 0.2, p=0.08), and was significantly larger in those 65 and older (3.8 ± 0.9 % vs 1.2 ± 0.3, p< 0.01). Case fatality for all TWS was greater than that for all other scalds (1.4 ± 0.4 % vs 0.3 ± 0.1, p< 0.01). No patient less than 45 died following TWS. Case fatality for those 45–64 tended to be greater for TWS than other scalds (0.9 ± 0.6 % vs 0, p=0.06.), and it was substantially higher for 65 and older (10.0 ± 2.8 % vs 2.3 ± 0.8, p< 0.01). Among patients 65 and older, those with TWS were slightly older than those with other scalds (76.3 ± 0.7 years vs 74.6 ± 0.4, p< 0.05).

Conclusions

TWS burns still account for a substantial proportion of scald burns across the country, despite the wide application of building codes and manufacturing standards designed to prevent these injuries. They are most prevalent among children and older adults. In older patients they are more extensive than other scalds and result in an appreciable case fatality. Hot tap water continues to be a clear and potentially deadly hazard, especially for the elderly. Additional strategies to prevent these injuries should be sought.

Applicability of Research to Practice

Directly Applicable.
63 Assessing the Quality and Reliability of Patient Information Regarding First-aid Burn Care on Youtube
Authors: Parizh David , Effendi Maleeh , Martin Thomas L
Published: March 2020

Introduction

Social media has increasingly become the first point of reference for patients regarding medical information. This study assesses the quality and reliability of patient information available on YouTube regarding First-Aid for Burn Care.

Methods

Using Google Trends, “burn treatment” was identified as the most common term to likely be used to seek out information regarding first-aid treatment of burns. The terms “burn treatment” was searched on YouTube within Internet Explorer on September 18, 2019. Results were filtered by view count and the first 6 pages of results, top 120 videos were reviewed, excluding duplicates, non-English language videos, and videos unrelated to first-aid burn care. Videos were analyzed by two independent reviewers and descriptive statistics. Videos were also rated for information reliability and quality using both the Modified DISCERN (MD) tool (1 = low, 5 = high) and the Global Quality Scale (GQS) (1 = poor, 5 = excellent).

Results

Overall 67% of the videos were classified as informative with 15% constituting personal experience, the remainder of which were misleading. The physicians had a lower number of mean views per video at 140k compared to 210k from non experts. Physician group constituted 20.6% of all speakers in the video, with NP/PA constituting 2.9%. The GQS mean was 2, with physicians scoring slightly higher at 2.3, NP/PA scoring 3, and the remainder of the speakers scoring lowest at 1.8. The Modified discern score mean was 2.0.

Conclusions

Overall the burn care professionals inclusion physician, nursing and physician assistants constituted a minority of the speakers present. 76% were by other professionals who don’t deliver care inside the hospital setting. The physicians had lower number of views when compared to non experts. However, burn care professionals scored higher on the modified discern and the GQS compared to non-experts. The overall quality of all videos was low across the board with a modified discern of 2 out of 5. There is an opportunity to improve resources available to our patients from the burn care professional stand point to increase online presence.

Applicability of Research to Practice

The quality of videos reviewed was poor, and demonstrated an opportunity for improvement of resources available to our patients online.
74 The Effectiveness of Serial Casting in Obtaining Maximum Range in Burn Scar Contracted Joints
Authors: Purushothaman Prabhu , Schetzsle Stephanie , Chiang Wei , Lin Weber , Tredget Edward , Kwan Peter
Published: March 2020

Introduction

Recovery from burn scar contracture demands significant time and resources from patients and healthcare providers. Few studies have explored how serial casting improves recovery. The aim is to present preliminary data illustrating the benefits of serial casting in burn scar contracture rehabilitation.

Methods

Six burn patients (8 joints) that did not respond to traditional conservative therapy were included. Joints were x-rayed to rule out heterotopic ossification/joint abnormality before casting. Patients were casted 5x, 3x or 1x/week. Initial session consisted of measuring baseline range of motion (ROM) prior to physiotherapy intervention (PTI) (heat, active ROM with end range overpressure, joint glides, and progressive resistive exercises) and plaster cast application by Occupational Therapy. Following sessions involved measuring ROM post cast removal, and before PTI and new cast application. Scar contractures were photographed weekly and assessed using the Modified Vancouver Scar Scale (MVSS).

Results

On average, casting started 93.67±20.31 days post burn injury and lasted 8.90±1.23 days. Mean time between cast changes was 2.30±0.25 days; on average, each joint was casted 4.30±0.65 times. MVSS score (pre/post serial casting:9.70±0.47 / 4.70±0.42, p< 0.0001) and ROM as a percentage of total (pre/post serial casting:56.30±5.12% / 96.40±0.90%, p< 0.0001) showed improvements from pre to post casting. Post casting, average ROM gained was 43.70±6.60 degrees and average percentage of ROM regained was 96.38±0.87%. Each joint consumed a mean of 6.56±1.22 therapy hours and $45.13±12.15 in materials.

Conclusions

Serial casting produced rapid gains in ROM to near full ROM in burn scar contracted joints. Correspondingly scar pliability, height, and pigmentation improved. Serial casting can be effective and initiated early in scar maturation.

Applicability of Research to Practice

Serial casting can be a standard technique in rehabilitation of burn scar contracture. It is easy to adopt due to low material cost, easy therapist training, and low time demands from patients and therapists. It can delay or prevent the need for contracture release surgery (in the case of 3 patients). Based on therapist observations, it can lead to increased treatment compliance due to rapid effectiveness.
78 Optimising Compression for the Management of Acute Hand Burn Edema
Authors: Edwick Dale O , Hince Dana A , Rawlins Jeremy M , Wood Fiona M , Edgar Dale W
Published: March 2020

Introduction

Compression, a common treatment of choice for the management of edema, is one intervention which is applied with little objective understanding of the optimal parameters of application or efficacy in a patient with an acute burn wound. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The hypothesis tested was: in alert acute hand burn injury patients, application of cohesive bandage will reduce edema faster than an off the shelf compression glove.

Methods

A randomized control study of 100 patients presenting with hand burn injury. Compression was randomized to one of three methods of application - 1) spiral application of cohesive bandage to fingers, figure of eight to hand and wrist; 2) pinch application or cohesive bandage to fingers, spiral application to hand and wrist; or 3) an off-the-shelf compression glove (control condition). Repeated volume measures of the hand were recorded using water displacement volumetry. The results were analysed using multi-level mixed effects regressions. Outcome measures were hand and wrist active range of movement, pain VAS and QuickDASH. ROM measures were collected with and without compression in situ. Patients were provided with a home exercise program including standardized exercises to optimize venous and lymphatic outflow, and exercises tailored depending on the location of the patients’ injury. Standard instruction to patients was to continue using their hand with the compression in situ, and to elevate at rest and overnight.

Results

One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods (10.0–14.5mL, p< 0.001). There was no evidence of difference between methods of compression for managing edema. All ROM measures improved, with significant improvement in hand composite finger flexion (p=0.001), hand span (p=0.022) and wrist flexion (p=0.022). QuickDASH decreased between sessions (p< 0.001) indicating reduced upper limb disability. There was no evidence of differences in ROM measures between compression methods.

Conclusions

There is no evidence of difference between these methods of compression for managing acute hand burn edema. ROM improves with reductions in hand burn edema.

Applicability of Research to Practice

For the management of acute edema following hand burn injury, this study demonstrates that compression can be applied by therapists of different experience, using methods they are familiar with, to positively influence edema following hand burn injury.
111 Predicting Restoration of Joint Function in the Contracted Burned Hand: The Benefit of the Soft Tissue to Skeletal Ratio
Authors: Simpson Roger L , Mulay Sagar , Nasser Ahmed , Ibrahim Ahmed
Published: March 2020

Introduction

Long-standing burn contractures of the hand produce marked soft tissue deficits across mobile joint surfaces. Optimum functional reconstruction requires attention to the ratio of soft tissue contracture to skeletal length. Maturation of burn scar and anticipated growth in children play a role in selecting procedures that maximize function and range.

Methods

Burn contractures of the hand show functional loss of motion by flexion/extension deformities of the fingers and wrist. Analysis of soft tissue shortening (contraction), measured against existing skeletal length was used to customize procedures to restore maximum function. Twenty six patients, aged 3 to 57 years underwent post burn reconstruction to maximize hand function. Each procedure selected was based on the ratio of existing soft tissue to skeletal length.

Results

Flexion/extension at all joints requires a balanced glide of soft tissue over existing bone length defining a 1:1 ratio between soft tissue and skeletal length. Burn contracture shortens soft tissue and restricts motion over joints. An objective ratio was applied to each joint contracture. A comparison of soft tissue quality to skeletal length (including growth in children) was used to determine the procedure for reconstruction associated with the best prognosis for maximum outcome with the least recurrence.

Abnormalities included post burn boutonniere deformities, webspace contractures, flexion and extension contracture deformities of the hand, and digits. Burn scar hypertrophy and induration worsened the ratio. Eight patients with a soft tissue to skeletal ratio of 0.4:1 or less required bone shortening in the form of either joint arthrodesis, trapeziectomy, or wrist fusion. Twelve patients with a ratio of 0.7:1 or better were managed with skin grafts and/or adjacent tissue rearrangement. In the remaining group, four patients required a combination of procedures including composite soft tissue and tendon expansion restoring length of all soft tissue relative to bony length precluding the need for flap reconstruction and tendon lengthening. Two patients underwent bone shortening with prosthetic joint replacement. All patients restored to a 0.8:1 ratio or better regained optimum position of joint position and function. No secondary procedures were required for deterioration of function at two years.

Conclusions

A balanced dynamic soft tissue to skeletal ratio is essential in restoring maximum function to the burned hand. Understanding soft tissue contraction compared to existing bone length will permit the objective design of a reconstructive hand/finger procedure that will predict outcome and maximize hand function.

Applicability of Research to Practice

Predicable outcomes of functional hand reconstruction are possible based on the relationship of burn scar contracture to measurable skeletal length.
120 Terahertz Spectral Imaging for Burn Depth Determination in an in Vivo Porcine Scald Model
Authors: Arbab M Hassan , Osman Omar , Zhou Juin , Khani Mahmoud E , Harris Zachery B , Singer Adam
Published: March 2020

Introduction

Clinical evaluation of burns results in about 50–70% accuracy in predicting the final burn progression and healing outcome in partial thickness burns. Early and accurate assessment of burn wounds is critical for determining the course of clinical management. Terahertz (THz) spectral imaging is a promising biomedical imaging modality that has been used to quantitatively determine burn severity in acute rodent models. Here, we hypothesized that the new THz modality can determine burn depth and predict the wound healing outcome of injuries using a standardized porcine model. We developed a handheld THz instrument to obtain diagnostic images from large animal burns with varying severities. The results showed that the THz imaging can differentiate between different burn groups defined by injury depth on days 1–5 post-burn, and predict their ultimate outcome defined by reepithelialization during a 28-day study period (1-way ANOVA, p< 0.05).

Methods

Multiple 1 inch diameter standardized cutaneous burns were created (n = 20–24 per pig) in 3 anesthetized female domestic pigs (~32kg) using a circulating heated water in replicates. The temperatures were controlled and kept constant at 95 C degrees using thermosensors, while the duration of exposure was varied between 5, 15, or 25 seconds. Burns were covered with a topical antibiotic ointment and frequent dressing changes were performed for 4 weeks. Daily THz scans were obtained from each burn during the first week, corresponding to the peak of the anti-inflammatory response of the burns. After the initial 5 days, weekly scans were obtained until the ultimate healing outcome was determined by an experienced surgeon and a blinded histopathologist. Periodic punch biopsies were taken to determine burn depth, percentage burns reepithelialized within 21 days, and depth of scar at 28 days.

Results

Attached figures show representative daily visual and THz images of burns with the associated ROI. Bar plots show mean and standard deviation of spectral amplitude (SA) and spectral slope (SS). Low severity burns showed decreasing SA and increasing SS over time, whereas SS from 25 second burns remained negative and SA increased by day 4. Variation in SS suggests changes in density of skin structure as a result of scattering and changes in SA suggests variations in water content. Detailed statistical analysis is in attached table.

Conclusions

Using the novel handheld THz scanner, analysis of the spectral slopes signal showed the ability of the new Terahertz imaging modality in differentiating between different burn severities (p < 0.05) and evaluating burn progression.

Applicability of Research to Practice

THz modality can result in improvement in the accuracy of burn triage, which in turn can lead to better wound healing outcomes, reduction in length of hospital stay and improvement in overall recovery of the patients.
122 Prevalence and Associated Predictors for Patients Developing Chronic, Neuropathic Pain Following Burns
Authors: Klifto Kevin M , Hultman C Scott
Published: March 2020

Introduction

Chronic pain, unrelated to the burn itself, can manifest as a long-term complication in patients sustaining burn injuries. The purpose of this study was to determine the prevalence and compare burn characteristics between burn patients who developed chronic neuropathic pain (CNP) and burn patients without CNP treated at a Burn Center.

Methods

A single-center, retrospective analysis of 1880 patients admitted to the adult Burn Center was performed from January 1, 2014 through January 1, 2019. Patients included were over the age of fifteen years, sustained a burn injury and were admitted to the Burn Unit. CNP was diagnosed clinically following burn injury. Patients were excluded from the definition of CNP if their pain was due to an underlying medical illness or medication. Comparisons between patients admitted to the Burn Unit with no pain and patients admitted to the Burn Unit who developed CNP were performed.

Results

One hundred thirteen (n=113) of the 1880 burn patients developed CNP as a direct result of burn injury over five years with a prevalence of 6%. Patients who developed CNP were a significantly older median age [54 vs. 46, p=0.002], abused alcohol [29% vs. 8.5%, p< 0.001], abused substances [31% vs. 9%, p< 0.001], were current everyday smokers [73% vs. 34%, p< 0.001], suffered more full-thickness burns [58% vs. 43%, p< 0.001], greater median %TBSA burns [6 vs. 3.5, p< 0.001], were more often intubated on mechanical ventilation [33% vs. 14%, p< 0.001], greater median number of surgeries [2 vs. 0, p< 0.001] and longer median hospital length of stay (LOS) [10 vs. 3 days, p< 0.001], compared to those who did not develop CNP, respectively. Median patient follow-up was 27 months.

Conclusions

The prevalence of CNP over five years was 6% in the Burn Center. Older ages, alcohol abuse, substance abuse, current everyday smoking, greater %TBSA burns, third degree burns, being intubated on mechanical ventilation, having more surgeries and longer hospital LOS were associated with developing CNP following burn injury.

Applicability of Research to Practice

The largest study to date assessing the prevalence of chronic nerve pain following burns. Identified new independent predictors for chronic neuropathic pain following burn injury, not previously assessed in the literature.
507 Outcomes After the Administration of Hydroxocobalamin
Authors: Pruskowski Kaitlin A , Cancio Leopoldo C
Published: March 2020

Introduction

Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting.

Methods

This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis.

Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality.

Results

Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay.

Conclusions

Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted.

Applicability of Research to Practice

The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.
525 Autologous Skin Cell Suspension May Enhance Healing of Burn Wounds and Skin Graft Donor Sites in Elderly Burn Patients
Authors: Chattopadhyay Arhana , Swan Courtney , Sheckter Clifford C , Gupta Deepak , Karanas Yvonne L
Published: March 2020

Introduction

An autologous skin cell suspension (ASCS) spray containing keratinocytes, fibroblasts, and melanocytes can be processed from a small split thickness skin sample for use at the point-of-care in the operating room. ASCS have been shown to facilitate epidermal regeneration in large TBSA partial thickness burns with minimal donor site morbidity. We hypothesized that ASCS in conjunction with a 3:1 split thickness skin graft applied to burn wounds and ASCS alone applied to the donor site would facilitate healing in a 95 year-old burn patient with 12% TBSA deep partial and full thickness scald burns to the abdomen and bilateral thighs. To our knowledge, she is the oldest patient to undergo epidermal autografting with ASCS.

Methods

All burn wounds were tangentially excised in the standard fashion to healthy tissue. Split thickness (12/1000 inch) skin graft was harvested from the right lateral thigh, meshed 3:1, and applied to all wound beds. ASCS were prepared and sprayed on grafted sites and the donor site. All areas were dressed with Telfa clear and Xeroform with bacitracin. Dressings were initially changed every 2 days, and wounds were photographed on day 2, 4, 6, 8, 10, and 20.

Results

All burn wounds were deep partial thickness or full thickness. The right thigh donor site was completely healed by POD 10. 90% of the burn wounds had healed by POD 10. The area of deepest burn, an approximately 20 cm2area on the left medial thigh, was healed by POD 20.

Conclusions

We believe that ASCS enhanced the rate of re-epithelialization of burn wounds in a 95 year-old patient compared to our experience with skin grafting alone in this population. ASCS also promoted complete healing of the donor site by POD 10. This technology may have a role in decreasing healing time in the geriatric burn population. These findings are important for this population as longer lengths of stay are associated with delirium, hospital acquired infections, and deconditioning. This patient’s improved donor site healing also has broader implications as split thickness skin grafts are used widely for wound coverage in plastic surgery.

Applicability of Research to Practice

Demonstrates efficacy of ASCS in very elderly patients with moderate-sized deep burns and with skin graft donor sites.
526 Antiseptic Wound Dressings Made of Bacterial Nanocellulose
Authors: Luze Hanna , Holzer Judith , de Mattos Ives Bernardelli , Tuca Alexandru-Cristian , Nischwitz Sebastian P , Funk Martin , Mautner Selma , Birngruber Thomas , Kamolz Lars-Peter
Published: March 2020

Introduction

Bacterial nanocellulose (BNC) is a novel wound dressing that consists of nearly 95% water. This hydrophilicity allows this matrix to absorb and release aqueous substances. We investigated how well BNC can absorb antiseptic substances in order to create on demand antimicrobial wound dressings.

Methods

Sheets of BNC-based wound dressings were placed in four different antiseptic substances. Punch biopsies were taken at different time points and the concentrations of the antiseptic agent was measured. Two PHMB-containing solutions, one octenidine-containing and one povidone-iodine-containing solution were tested. In addition, the release of the substances from the punch biopsies was examined. To test the efficacy of these novel wound dressing, the antimicrobial activity of the BNC sheets loaded with the antiseptic solutions were tested against Staphylococcus aureus.

Results

All antiseptic solutions showed excellent uptake into the BNC as well as release. Especially the PHMB- and octenidine-containing solutions already showed high values after only 30 minutes. The overall achieved concentrations were all highly effective against Staphylococcus aureus and were all higher than the minimal bactericidal concentration against MRSA.

Conclusions

Antiseptic, water-based solutions are excellently absorbed in a very short time and are released steadily over a period of time dependant on the size of the molecules. All tested antiseptic solutions reached effective antibacterial concentrations making them all suitable for the making of antiseptic BNC-based wound dressings. However, when using a commercially available solution and not a solution containing only the active ingredient, it must be taken into consideration that all ingredients have an effect on the uptake of the active substance and thus influence the maximum uptake and release concentration.

Applicability of Research to Practice

The findings of this experiment are ready to be used in practice.
527 Eschar Removal by Bromelain Based Enzymatic Debridement in Burns: European Consensus Guidelines Update
Authors: Hirche Christoph R , Ziegler Benjamin , Kneser Ulrich
Published: March 2020

Introduction

Bromelain based Enzymatic Debridement (ED) has been introduced as an additional concept to the burn surgeon’s armamentarium, and is best indicated for mid-to deep dermal burns with mixed patterns. Increasing evidence has been published on special regions and settings, adressing success and limitations of ED for improved patient care. To better guide ED in view of the increasing experience, there is a need to publish updated consensus guidelines with user-orientated recommendations.

Methods

A multiprofessional expert panel of plastic surgeons and burn care specialists from 10 European countries was convened, to assist in developing current recommendations for best practices with use of ED. Consensus statements were based on peer-reviewed publications and clinical relevance. For consensus agreement, the methodology employed was an agreement algorithm based on a modification of the Willy and Stellar method. For this study on ED, consensus was considered when there was at least 80 % agreement to each statement.

Results

The updated consensus guidelines from 2019 refer to a diversity of experience and practice patterns of 1232 summarized patient cases in Europe (2017: 500 cases), reflecting the impact of the published recommendations. Forty-three statements were formulated, addressing the following topics: indications, pain management and anesthesia, large surface indication, timing of application for various indications, preparation and application, post-interventional wound management, skin grafting, outcome, scar and revision management, cost-effectiveness, patient′s perspective, logistic aspects and training strategies. The degree of consensus was remarkably high, with consensus in 42 of 43 statements (97.7%), while no consensus was achieved on the role of outpatient treatment/ED as day cases in minor burns in experienced burn centers. A classifications with regard to timing of application for ED was introduced, with „immediate/ very early“(≤12h), early (12-72h) or delayed (>72h) treatment. All further recommendations are addressed in the presentation.

Conclusions

The updated guidelines in this paper represent further refinement of the recommended indication, application and post-interventional management for the use of ED. The published statements contain detailed, user-orientated recommendations aiming to align current and future users and prevent unnecessary pitfalls. The significance of this work is reflected by the magnitude of patient experience behind it, larger than the total number of patients treated in all published ED clinical trials.

Applicability of Research to Practice

These consensus guidelines may serve as refined user-orientated recommendations for implementation and successful application of ED in further countries (e.g. USA) based on the evidence and experience of 1232 summarized patient cases.
530 Osteomyelitis Increases the Rate of Amputation in Patients with Type 2 Diabetes and Lower Extremity Burns
Authors: Nizamani Rabia , Heisler Stephen , Chrisco Lori , Campbell Harold , Jones Samuel W , Cairns Bruce , Williams Felicia N
Published: March 2020

Introduction

In patients with type 2 diabetes (DM2), amputation rates exceed 30% when lower extremity osteomyelitis is present. We sought to determine the rate of osteomyelitis and any subsequent amputation in our patients with DM2 and lower extremity burns.

Methods

We performed a single site, retrospective review at our burn center using the institutional Burn Center registry with links to clinical and administrative data. Adults (≥18 years old) with DM2 admitted from January 1, 2014 to December 31, 2018 for isolated lower extremity burns were eligible for inclusion. We evaluated demographics, burn characteristics, comorbidities, admission laboratory values, presence of radiologically-confirmed osteomyelitis, length of stay (LOS), inpatient hospitalization costs, and amputation rate at 3 months and 12 months after injury. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results

For 103 patients identified with DM2 and isolated lower extremity burns, the average age was 54 years old. The majority of patients were male (78.6%) and white (55.3%). The average total body surface area (TBSA) of burn was 1.8% and 53.4% were scald burns. Thirty percent of patients had a history of heart disease and 22% were current smokers. The average hemoglobin A1c was 9.19 and average creatinine was 2.01. Overall rates of any amputation were 14.6% at 3 months and 18.4% at 12 months.

Fifteen patients (14.6%) had radiologically-confirmed osteomyelitis within 90 days of the burn injury. Compared to patients without osteomyelitis, this subset of patients had significantly increased LOS (average LOS 22.7 days vs 12.1 days, p=0.0041), inpatient hospitalization costs (average $135,345 vs $62,237, p=0.0008), amputation rate within 3 months (66.7% vs 5.70%, p< 0.00001), and amputation rate within 12 months (66.7% vs 10.2%, p< 0.0001). There were no significant differences in other characteristics between patients with osteomyelitis and those without.

Conclusions

Patients with DM2 and lower extremity burns incurred increased LOS, higher inpatient hospitalization costs, and increased amputation rates if radiologically-confirmed osteomyelitis was present.

Applicability of Research to Practice

Osteomyelitis in diabetic patients with lower extremity burns may predict need for amputation within one year of burn injury. Further study could aid in development of protocols for early identification and aggressive treatment of osteomyelitis in burn patients, which may improve LOS, cost, and amputation rates.
551 Mixed Methods Assessment of Pediatric Scald Burns
Authors: Lopez Christine , McDonald Eileen M , Ziegfield Susan
Published: March 2020

Introduction

CDC estimated more than 87,000 fire/burn injuries in 2017 among children 0–15 years old. Scald burns are the most common form of burn injury for children in the United States and are estimated to cost $44 million annually. Understanding the circumstances surrounding burn incidents and caretakers’ responses to them are needed to better guide prevention and education offerings.

Methods

We used a mixed methods approach to better understand pediatric scald burn mechanisms along with caregivers’ general knowledge, first aid responses and ability to accurately report characteristics of their child’s injury. Caregivers of children < 15 year old attending a burn follow up clinic with their child were recruited. Participants completed a 39-item, iPad-based survey that captured information about the circumstances, location and cause of the scald burn, whether first aid was provided, and caregiver/child demographics. With permission of the caregiver, the child’s medical record was accessed to collect burn descriptors (e.g., burn severity, total body surface area (TBSA), etc) to compare with parent self-report. Data collection occurred between May 2018 - May 2019. The study was approved by our institutional review board.

Results

Surveys were completed by 55 parents; 75% agreed to medical record review. The typical respondent was the female caregiver (80%) with more than a high school education (67%). The typical burn incident occurred in the kitchen (60%) of the family’s home (80%) and in the presence of the caregiver (71%). Seventy percent of respondents reported applying first aid; among those, 50% administered the proper first aid (using cool water on the burn) despite most (44%) reporting feeling “not confident” in the ability to do so. More than half (53%) didnot know their child’s TBSA; of those who did, self-reported TBSA ranged from 1 to 50%. Medical record review revealed that only 5 participants accurately reported their child’s TBSA.

Conclusions

Our data reveal that most scald burns occurred in the kitchen, of the child’s home, and in the presence of a caretaker. Half received incorrect first aid and few parents could accurately report their child’s TBSA. These results support the need to strengthen primary prevention offerings and improve parents’ understanding of their child’s burn injury.

Applicability of Research to Practice

The results of this research can help guide education efforts for primary prevention programs related to pediatric scald burn injuries. Furthermore, results can guide education practices for caregivers of children being treated for a scald burn injury.
558 Relationship Between Patient Characteristics and Number of Procedures as Well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository
Authors: Kowal Stacey , Kruger Eliza , Bilir S Pinar , Holmes James H , Foster Kevin N
Published: March 2020

Introduction

Published information on the relationship between patient characteristics such as total body surface area (TBSA) of burn on number of procedures and length of stay (LOS) is not widely available in the United States. Clinical expertise assumes a “rule of thumb” of 1 day stay per percentage TBSA, but deviations based on burn and patient characteristics is rarely explored. The American Burn Association NBR version 8.0 (2002–2011) was analyzed to understand the relationship between key patient and burn characteristics for surviving, severe (TBSA 10–60%) burn patients and number of procedures or LOS.

Methods

Outcomes include the number of procedures autograft, debridement, and excision procedures and LOS. Independent variables considered were TBSA, TBSA of partial-thickness and full-thickness (FT) burn, age (linear, squared and cubed to account for non-linearity), hospital-acquired infection (HAI), other infection, inhalation injury, female gender and diabetes status. Statistical regression models were developed to control for the independent variables and predict the number of procedures and LOS based on such characteristics.

Results

Among 21,175 surviving burn patients (TBSA 10–60%), the mean age was 33 years old, and the mean TBSA was 19.9%. Number of excision and autografting procedures increased with TBSA. All independent variables were retained in the LOS model. After adjusting for gender, age and comorbidities, predicted LOS for adults (18+) was 16.4, 29.5, 42.7 and 56.0 days for 10%, 20%, 30% and 40% TBSA respectively. Similarly, predicted LOS for pediatrics (age< 18) was 12.9, 26.0, 28.6 and 55.4 days for each TBSA group, respectively.

Conclusions

When considering all independent variables, the LOS per percent TBSA is estimated at approximately 1.12 days for adults and 1.01 for pediatrics. However, when considering patient (age, comorbidity status) and burn (burn depth, TBSA) characteristics, the observed LOS could vary by 66% more, as seen with detailed investigations into trends for patients with TBSA 20%. Using the predictive equations from this study, burn centers can generate tailored rule-of-thumb estimates for LOS/%TBSA that better reflect the influence of factors beyond burn center practice patterns.

Applicability of Research to Practice
587 DVT Screening in Lower Extremity Burns
Authors: Gibson Cameron J , Gupta Aakanksha , Houng Abraham
Published: March 2020

Introduction

Burn patients are at in increased risk for developing deep vein thromboses (DVT), with rates as high as 6%. Known risk factors include large burn size, use of central lines, increasing age, male, active smoker or alcoholic, increased blood transfusions and surgeries. No study to date has looked specifically at burn location as a possible risk factor. We hypothesized that lower extremity burns with delayed presentation to our burn center are at in increased risk for DVT formation.

Methods

A DVT screening protocol was developed and implemented for all burn patients admitted to our burn unit starting in May 2017. Patients who presented with lower extremity burns >48 hours from their injury time underwent screening ultrasounds at admission to evaluate for DVT in the affected extremity. Data was collected from May 2017 through December 2018 for all lower extremity patients. Screened patients were identified by reviewing the burn registry for patients admitted >2 days from their injury date and then reviewing the electronic medical record for screening US. DVT rates were compared between screened patients and the overall rate for all admissions during the study period.

Results

There were 1041 patients admitted to the burn unit during the study period, including 445 lower extremity burns with 118 admitted >48 hours after their burn injury. The overall compliance rate with the screening protocol was 41.5% (49/118). There were a total of 4 DVT’s diagnosed among all admitted patients during the study period (1 lower extremity, 3 upper extremity), giving an overall rate of 0.5% for our unit. No DVT’s were identified in the delayed presentation group (p=0.46).

Conclusions

Our overall DVT rate was much lower than quoted rates in the literature. Patients with lower extremity burns and delayed presentation to a burn center do not appear to be at increased risk for DVT. Compliance with our screening protocol was relatively poor, which may be due to short hospital stays and unavailability of ultrasound on weekends for non-urgent studies.

Applicability of Research to Practice

Patients with lower extremity burns should receive routine DVT prophylaxis (chemical and mechanical) similar to other burn patients.