bluuebunny/crossref_metadata_2025 huggingface dataset:
89 The Effect of Trauma Center Status and Burn Verification Process on Burn Patient Outcomes
Authors: Castillo-Angeles Manuel , Burns Christopher J , Kubasiak John C , Mehta Anupama , Riviello Robert , Salim Ali , Nitzschke Stephanie
Published: April 2021

Introduction

Burn center verification was implemented to ensure burn patients receive the best quality of care. As part of the of the organized burn care system, trauma centers that do not have a burn center within the hospital should refer burn patients to a designated burn center. However, more than 30% of burn patients are still being taken care of in non-verified burn centers. Our aim was to determine if trauma center status conferred a benefit in outcomes in a national sample of burn patients.

Methods

This is a retrospective study using State Inpatient Databases of 22 states in 2014. The inclusion criteria were all patients admitted for burn injury (ICD-9 codes 940–949). Hospitals were categorized as ABA verified centers (VBC) and non-verified burn centers (NVBC), as well as trauma centers (TC) and non-trauma centers (NTC) based on verification status at the time of admission. Main Outcomes were in-hospital mortality and length of hospitalization (LOS). Stratifying by burn center verification status, multivariable regression was used to identify the association between trauma center status and the outcomes.

Results

A total of 15,982 burn patients were identified. The overall in-hospital mortality rate was 2.45%. In our sample, we only had 26 hospitals that were both a TC and VBC (Table 1). The majority of patients (54%) were treated at a NVBC/TC. In unadjusted analysis, amongst verified centers, there was no difference in mortality between TC and NTCs (3.2% vs. 3.0%, p=0.877), but NTCs had longer LOS (14.7 vs. 10 d, p< 0.001). Amongst non-verified centers, TCs had higher mortality when compared with NTCs (2.4% vs. 1.1%, p< 0.001), but TCs had longer LOS (8.3 vs. 7.2 d, p=0.007). After adjusted analysis, within VBC, TC status was associated with shorter LOS (Coef -3.28, 95% CI -5.37 – -1.19, p=0.002), but not associated with mortality (OR 1.21, 95% CI 0.50 – 2.89, p=0.667). After adjusted analysis, within NVBC, TC status was associated with longer LOS (Coef 2.37, 95% CI 1.70 – 3.04, p< 0.001) and with mortality (OR 3.70, 95% CI 2.10 – 6.51).

Conclusions

Trauma center status does not confer any benefit for burn patient outcomes within the burn care verification system. Despite the regionalization of burn care through the development of verified burn centers, the majority of burn patients are receiving care at trauma centers with a non-verified burn center within the hospital.
90 Discrepancies in Mortality Metrics Between National Datasets
Authors: Ozhathil Deepak K , Gutierrez Garret , Mulay Sagar R , Ahmed Adil , Song Juquan , El Ayadi Amina , Golovko George , Wolf Steven E
Published: April 2021

Introduction

The National Burn Repository (NBR) is the recognized standard for data collection models within the academic burn community. Despite its robust capabilities, the NBR poses challenges to access and exploration that can be intimidating to some researchers. As a result, user-friendly alternative databases have grown in popularity. We compared the NBR to two commercially available large datasets using the well-recognized relationship between age and total body surface area (TBSA) on mortality as our metric to assess correlation.

Methods

We accessed the TriNetX Global Health Research Network and queried the Diamond network (medical clearinghouses) and Research network (41 healthcare organizations (HCO)) for all-cause mortality within 3 years following burn injuries that occurring between 2000 – 2020 using ICD-10 codes (T31-32). We explored the distribution of TBSA and age across these cohorts and compared the variance in the distribution to the 2008–2017 NBR report using one proportion z-tests for each age-TBSA matched sub-group. We also compared demographics and lethal area for 50% mortality (LA50).

Results

The Diamond network identified 336,965 entries with an all-cause mortality rate of 3.21% and an LA50 of < 10%. Demographics showed 50% male, 81% unknown race and a mean age of 39. In 2016 - 2017, 56,430 entries were reported. The Research network identified 114,778 entries with a mortality rate of 2.54% and an LA50 of < 10%. Demographics showed 61% male, 58% white, 24% unknown and 16% black with a mean age of 37. In 2016 - 2017, 14,164 entries were reported. In comparison, the NBR database reported 185,239 entries with a mortality rate of 2.96% and an LA50 of >70%. Demographics showed 67% male, 59% white and 3.6% unknown with a mean age between 20–29. In 2016 - 2017, 42,402 entries were reported. Comparison of mean mortality between age-TBSA matched subgroups in the Diamond and the Research networks relative to NBR showed correlation among pediatric populations but lacked significance.

Conclusions

The Diamond and Research networks are large datasets, which appear to be statistically different from the NBR dataset and are derived from different populations (insured patients, academic healthcare organization and accredited academic burn centers). The exact overlap between datasets is unknown, but demographics suggest that they are very different populations. The Figure depicts the relationship between age and TBSA on mortality for each database. Each database is large enough to achieve statistically significant conclusions, but caution should be used when contrasting conclusions between datasets due to the significant degree of divergence.
91 Current Practices and Beliefs Regarding Screening Burn Patients for Acute Stress Disorder and Post-Traumatic Stress Disorder: A Survey of the American Burn Association
Authors: Smith Mallory B , Wiechman Shelley A , Mandell Samuel P , Gibran Nicole S , Vavilala Monica , Rivara Frederick P
Published: April 2021

Introduction

The prevalence of Acute Stress Disorder (ASD) after burn injury may be up to 30% and the prevalence of Post-Traumatic Stress Disorder (PTSD) is as much as 40% at six months post-burn injury. The American Burn Association (ABA) published a consensus statement in 2013 recommending screening for ASD and PTSD in all patients with a burn injury. To our knowledge, the current practices of screening for ASD and PTSD in patients with burns is not known. This study aims to describe the current screening practices and provider beliefs regarding screening for stress disorders in burn patients in the US.

Methods

Interviews with psychologists and clinicians from our regional burn and injury center were utilized to generate a 31-question survey to assess burn center screening practices and provider beliefs regarding screening for ASD/PTSD. The Survey was approved by the ABA and distributed to its US membership in July 2020. Percentages of responses were generated, and chi-square tests were used to compare answers by profession type.

Results

There were 121 respondents out of 1500 recipients. The respondents were surgeons (27%), psychologists (6%), therapists or social workers (16%), nurses (31%), and advanced practice providers (13%). About half of the respondents (47%) worked at institutions that admit over 300 adult burn patients a year and had over 10 years of experience (52%). Seventy-five respondents (62%) indicated their institution formally screens for ASD and/or PTSD, 35 do not formally screen, and 11 respondents were unsure. Of the 35 centers that did not screen, the most common reason was a lack of mental healthcare providers (46%), lack of funding (26%) and lack of time (20%). The timing of screening, person administering the screening, and method of screening varied greatly across centers for pediatric and adult patients. Most respondents thought screening pediatric (83%) and adult (87%) patients with burns for ASD/PTSD was important, and 87% thought it should be standard of care. However, only 32% of respondents were comfortable screening pediatric patients and 62% were comfortable screening adults.

Conclusions

Whereas screening for ASD and PTSD is recommended for patients with burns, our study indicates that, despite general consensus that it should be, screening is not a current standard of care. Lack of mental health providers, funding, and time are contributing factors. Among those institutions that screen, a uniform screening protocol does not exist for pediatric or adult patients.
92 Is Virtual Burn Camp as Effective as In-Person Burn Camp?
Authors: Radics-Johnson Jennifer B , Zhang Li , Huang Anwen , Chacon Daniel W
Published: April 2021

Introduction

Burn camps provide a safe haven for child burn survivors to socialize and participate in recreational activities away from the unwanted stares from the public. But when a worldwide pandemic forced one of the world’s largest burn camps to forgo an in-person camp and pivot to a virtual camp, would the virtual burn camp prove as effective as an in-person burn camp?

Methods

In a 4-year retrospective review of camper evaluations within 2017–2020, we aimed to assess if the campers’ evaluation responses of virtual camp were consistent with their responses from past in-person camp evaluations. Camper self-evaluation forms were reviewed to record camper responses to questions regarding their opinions on camp. Camp rosters were reviewed to determine which campers attended virtual Burn Camp in 2020 as well as in-person Burn Camp among the years 2017–2019, and matched sample comparisons were reviewed (2020 vs. 2017; 2020 vs. 2018 and 2020 vs. 2019). Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To assess if the responses to each question were consistent between 2020 vs. 2017, 2018 and 2019, McNemar’s test was used. Statistical significance was declared based on a p value< 0.05.

Results

Within 2017–2020, there were 444 camper evaluations submitted. In 2020, there were 137 registered campers. Sample size of this study was small due to a low response rate to evaluation form requests from virtual Burn Camp participants. There were 31 individual completed evaluations forms (23% response rate). Among 31 campers, 20, 22 and 20 campers attended 2017, 2018, and 2019 in-person Burn Camp, respectively.

Participants’ demographic characteristics are summarized in Table 1. Comparisons between 2020 vs. 2017, 2018 and 2019, in general, the campers’ responses were consistent. However, for Question #8 (Did you learn anything new from the other burn survivors at this event?) in 2020, more people (n=8) answered Not/A little while they answered Yes/Mostly in 2019 (p=0.046). Participants’ responses to Question#8 are summarized in Tables 2 and 3.

Conclusions

Virtual Burn Camp was generally as effective as in-person Burn Camp in almost all areas of assessment, except for the ability for burn-injured children to learn from other burn-injured children. The virtual Burn Camp model provided some interaction between counselors and campers, but did not allow for much interaction between campers, resulting in a greater response of “A Little” or “Not at All” to the question “Did you learn anything new from the other burn survivors at this event?”
100 Use of the PHQ-2 as a Depression Screening Tool to Meet BQUIP Guidelines
Authors: Keatley Eva , Blayney Carolyn B , Wiechman Shelley A
Published: April 2021

Introduction

In 2015, the Burn Quality Improvement Program (BQUIP) guidelines were established with recommendations for systematic screening of Major Depressive Disorder at all verified burn centers. Our level one trauma center rolled out a program to screen all patients entering the burn service starting in June 2018. After a year of collecting data, we have been able to evaluate the program and make recommendations for other burn centers.

Methods

All patients admitted to the inpatient burn service who were over 12 years of age were screened by bedside nurses using the 2-item Patient Health Questionnaire (PHQ-2). Exclusion for screening included those who were intubated and sedated and/or not alert or oriented. A reminder automatically popped up in the nursing task list in the electronic medical record until it was given, or patient was coded as not appropriate for screening.

Results

A total of 509 patients were admitted to the Burn Service between June 2018 and May 2019. Of those, 40 were identified as not being appropriate for screening due to inability to regain consciousness, and 116 (24%) were not screened for unknown reasons. The remaining patients, 353 (77%) were screened with the PHQ-2 and 94% of these patients were screened on the same day of admit. Of the patients screened, 28 (8%) scored above the clinical cut-off for probable depression (PHQ-2 ³ 3) and 265 (75.1%) did not endorse any symptoms on the PHQ-2. Of the 28 that screened positive, 16 (57.1%) received psychological services. Of those that did not receive psychology services, the majority were admitted for less than 3 days (n=10, 76.9%).

Conclusions

In the first year of the program the vast majority of eligible patients were able to be screened by nursing staff with a 2-item measure. A 77% screening rate is high for a trauma setting. This success is likely due to the automation of the task in the electronic medical record, the ease of use of the PHQ-2 and the dedication of the nursing staff. The 8% rate of a positive screen is higher than the general population (4%) but a similar rate to what is reported in the literature of burn survivors who are 5- and 10-years post burn injury. Given that most patients were screened within 24 hours of admission, we are capturing depressive symptoms that predate the injury. We know that depression can impair burn recovery (e.g., affect participation in therapy, impede wound healing) and lead to poorer long-term outcomes. Systematic screening of depressive symptoms upon admission will allow us to intervene earlier and potentially reduce barriers to optimal recovery. We will be discussing utilization of resources for providing inpatient services to patients with a positive screen.
102 Early Palliative Care Consultation in the Burn Unit: Increasing Utilization and Areas for Improvement
Authors: Carmichael Heather , Mather Sarah E , Smith Tyler M , Duffy Patrick S , Wiktor Arek J , Lambert Wagner Anne L
Published: April 2021

Introduction

Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. While use of PCC is increasing, a prior study showed that less than 2% of patients with major burns had PCC during admission. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center.

Methods

This is a retrospective review of patient deaths over a four-year period (9/2016–8/2020). Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not resuscitate (DNR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended “triggers” for early (< 48 hrs of admission) PCC was instituted in 2019. Triggers included Baux score > 100 and/or complex decisions about treatment including need for cardiopulmonary resuscitation (CPR)/renal replacement therapy (RRT)/vasopressors, or at least two of the following: age > 70, major comorbidities, disagreement amongst family/patient/providers about best course of treatment, or no longer meeting expected milestones.

Results

A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42–72]. Median Baux score was 112 [IQR 81–133]. Eleven patients (33%) had major comorbidities. Many patients had life-sustaining interventions such as intubation, RRT, or CPR, often prior to admission. Amongst patients who survived >24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of patients having PCC before death (p=0.004). However, even during the later period, only half of patients had early PCC despite meeting criteria at admission.

Conclusions

Frequently, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended “triggers” for consultation, many patients who met criteria at admission did not receive early PCC.
103 A Retrospective Review of the Utilization of Burn Admission Criteria
Authors: Foster Kevin N , Krueger Larisa M , Richey Karen J
Published: April 2021

Introduction

Evidence-based criteria for burn patient admission are poorly defined. Attempts have been made by commercial entities to align payors and providers with evidence-based admission criteria to optimize resource use. However, these admission criteria have not be examined critically to see if they are appropriate and effective. We developed an admission criteria algorithm based on these existing standards and have utilized it for nearly 18 months. The purpose of this study is to retrospectively review this algorithm with respect to inpatient needs and outcome to assess its effectiveness.

Methods

A retrospective chart review of patients admitted the burn center over a 1-year period was performed. Incomplete datasets were excluded. Patients were grouped by TBSA, < 10%, 10–20% and > 20%. Appropriateness of admission was measured used length of stay (LOS) as surrogate marker, hospitalizations of < 3 days, unless deceased, were deemed inappropriate (IAP) and 3 days or more as appropriate (AP).

Results

There were complete datasets for 530 patients, < 10% (n=423), 10–20% (n= 72), >20% (n=35). There were no significant differences in age, gender, or payor sources between the groups. Patients with larger TBSA burns were more likely to have suffered a flame/flash injury. All patients in the two larger TBSA groups met admission criteria per algorithm. All IAP were in the < 10% group. When compared to AP, IAP were younger, 31.6 vs. 44.0 years (p< .0001), had smaller TBSA injuries 2.8% vs. 3.5% (p=.0045), had fewer clinical findings 1.4 vs 1.8 (p< .0001), fewer interventions 1.8 vs 2.6 (p< .0001) but were more likely to have suffered burns to the head 30% vs 13% (< .00001) and neck 9% vs 3% (=.0164). AP patients were more likely to have suffered contact burns 27% vs. 17% (p=.0323), full-thickness injuries 39% vs 14% (p< .0001), involvement of a major joint 42% vs 29% (p=.0085), combined burn and trauma 3% vs. 0% (p=.0444) and burns to the buttocks 7% vs 2% (p=.0357). AP patients were also more likely to require IV analgesia 82% vs 71% (p=.0107) and evaluated as likely needing surgery 82% vs 15% (p< .00001).

Conclusions

The admission criteria algorithm performed perfectly in patients with a ≥ 10% TBSA injury. For patients with burn < 10% TBSA the algorithm was not followed as closely leading to some inappropriate admissions. Patients with smaller burns admitted appropriately were more likely to have full thickness burns, contact burns, burns over joints and to require surgery. The algorithm was highly accurate in patients with large burns, however additional refinement is needed for those patients with smaller burn injuries.
104 A Quality Improvement Project to Reduce Orthoses Complications
Authors: Martinez Andria , Warthman Renee , Murray Derek , Hazak Kristin , Foster Kevin N
Published: April 2021

Introduction

Anatomical structures of the hand are complex and delicate making hand burns particularly challenging to manage. Orthoses are a cornerstone treatment modality and unsuccessful therapeutic interventions can result in hand contracture and deformities, which can result in up to 95% impairment in upper extremity function. Therapists at our burn center have varying degrees of education and credentials, and we had noticed increased incidence of orthotic induced complications in the hand. The purpose of this QI project was to implement a formal protocol that provided guidelines around fabricating and fitting hand orthoses.

Methods

The protocol mandated that custom fabricated resting hand orthoses should be fabricated by a single CHT or co-fabricated by two (non-CHT) therapists. Orthoses were fabricated as indicated. Orthosis modifications and orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) were documented. For the purposes of our study, breakdown was limited to the index finger. These modifications and complication totals were compared to pre-implementation data. Any patient with missing data points was excluded.

Results

Seventy-seven patient hands were examined from 2016–2019. Prior to implementation of the protocol, erythema occurred with 23.4% (n=18) of orthoses and orthosis induced partial thickness injury was found in 11.7% (n=9) of cases. Post protocol implementation involved examination of 51 hands. Erythema occurred in just 2.0% of cases (n=1) and partial thickness injury in 3.9% of cases (n=2) This represents a decrease of 94.4% and 77.7%, respectively. Number of modifications was reduced by 40.9%, from 22 to 13.

Conclusions

Orthosis fabrication is a specialized therapy skill, requiring hands-on training and advanced anatomical knowledge. While orthotic fabrication is part of general therapy education, the depth and breadth of this education is limited by the clinical opportunities presented to each therapist. CHT’s have undergone rigorous study and testing to make them experts in orthosis management and can bolster skills in a burn therapy department. For therapists without this specialty certification, co-fabrication can also lead to improved outcomes, through real time peer review. Data from this QI project showed a statistically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses.
107A Quality Improvement Process for Donning Custom Garments for the Burn Patients
Authors: Coffey Rebecca , Shepler Amanda , Cordova Alfredo
Published: April 2021

Introduction

Long term sequela of burn injuries include the development of scars leading to psychological, emotional, functional, and physical disabilities. There are multiple modalities for scar management including compression garments, topical silicone, orthotics, laser therapy, surgical releases, and medical treatment for symptom management. Multiple studies have found custom garments are a viable option to aid in improvement of range of motion, scar pliability, vascularity, color, height of scar, and improvement in appearance. Timing of garments is critical to the success of the treatment. The purpose of this quality improvement project is to develop an effective and efficient process to improve time to burn garment application.

Methods

At one verified ABA Burn Center, a retrospective chart review included adult burn patients, to compare the time for donning custom garments in the outpatient setting pre- and post-process improvement project. Pre-process improvement data was collected between October 1, 2018 and June 30, 2019. Post-process data collection carried from November 1, 2019 to August 31, 2020. A group including burn therapists, program manager, providers, and clinic staff met to identify the current practice and develop an improved workflow. An excel spreadsheet was developed to track key data points for continued improvement.

Results

A total of 33 patients were included in the initial pre-process improvement group (27 initial orders, 6 reorders) and 39 in the post-process group (24 initial orders, 15 reorders). The mean number of days for patients to receive their initial garment order was 98 days (range 19- 280) pre-process and 45.6 days (range 15 – 106) post-process (p = 0.0001). For reorders, mean days for receiving the garment was 37.3 days (range 19–70) preprocess and post process was 19.5 days (range 9–15) p = 0.039. Pre-process delays were related to packets not sent to vendor in a timely manner, necessary paperwork missing when sent to the vendor, lack of follow up for the status of the garment, insurance coverage, and staff being unaware of garment arrival. The major reason for delays with receiving garments in the post-process period was issues with insurance payments.

Conclusions

A defined, stepwise process may improve time to garment donning by patients. Support from insurance billing may further help improve this process.
109 Outpatient Nursing Care Charges: A Process Improvement Project
Authors: Caffey Carmen , Jeffries Anthony , Zelikoff Allison J , Chambers Mona , Stewart Barclay T , Pham Tam N
Published: April 2021

Introduction

High wound care complexity in a burn clinic mandates adequate nurse staffing and expertise to manage increasingly large wounds as outpatient. To achieve these service needs, appropriate charge capture is important for revenue generation. Our burn clinic performed a process improvement (PI) project using a Plan, Do, Study, Act (PDSA) cycle to improve the accuracy of charge capture for wound care episodes over the past 2 fiscal years (FY).

Methods

In the first phase (PLAN), we reviewed charges by 1-month sampling in FY20. We engaged stakeholders (medical and nursing providers, managers, revenue integrity and compliance teams) through iterative meetings. We performed a stakeholder analysis to identify their level of engagement, influence, and attitudes toward this PI. We next devised strategies for stakeholders to champion the project. The team developed and trialed the process by focusing on burn wound care Common Procedural Terminology (CPT) codes. In FY21, nurses began to enter CPT codes in accordance with burn wound care performed (DO). We then repeated a 1-month sampling of charges in FY21 (STUDY). We are now consolidating the new strategy, refreshing stakeholder engagement, and expanding it within our hospital (ACT).

Results

We identified multiple billing errors and opportunities to improve CPT code documentation for nursing wound care procedures in FY20. Stakeholder interviews revealed a gap between accurate billing and current practice. We proposed to alter the wound care billing workflow. Stakeholder engagement was high and well-represented among professional disciplines. In FY21 implementation, clinic nurses received the clinic coding in-service and were oriented to resource tools. We verified billing practice adherence via the institutional compliance department. FY21 sampling indicated a marked increase in accurate charges for burn wound care in the clinic (net+ $36,691). We have implemented real-time audits, identified and documented problems as they arise, and obtained feedback from nurses. The clinic is investigating non-burn wound care charge capture and has disseminated our findings through institutional shared governance.

Conclusions

The financial performance of outpatient burn nursing needs to be closely evaluated in today’s shifting healthcare environment. Using a PDSA process led by nurses, the accuracy of charge capture for complex wound care has substantially improved and led to increased revenue. This model is potentially translatable to other specialty clinics.
118 The Clinical and Demographic Predictors Associated with Physical Function in Pediatric Burn Survivors: A Burn Model System National Database Study
Authors: Ukoha Chiamaka J , Suman Oscar E , Schneider Jeffrey C , Ryan Colleen M , Kowalske Karen J , Roaten Kimberly , Diribe Chizorbam N , Gibran Nicole S , Stewart Barclay T
Published: April 2021

Introduction

Burns are a common pediatric injury, and severe burns can interfere with a child’s physical function. Rehabilitation for these patients continues to evolve; however, little is known about how clinical and demographic factors affect long-term physical function outcomes. This study will evaluate the association between Patient Reported Outcome Measurement Information System-29 (PROMIS) physical function-mobility subscale scores (PF) and various clinical and demographic factors among pediatric burn survivors.

Methods

Data were collected from the Burn Model System National Database (1994–2020) and was compiled from five ABA verified burn centers. The data requested included pediatric self-report PROMIS PF scores assessed at 6 months post-burn. A linear regression model was performed with PF total score at 6 months as the dependent variable and total body surface area (TBSA) burned, age, sex, etiology of the burn, length hospital of stay (LOS), and race/ethnicity as independent variables.

Results

A total of 82 patients between the ages of 8–17 were included in the regression analysis. The mean physical function scores for the participants was 46.2 (SD=11.9), 20.0–57.1 with 50 (SD=10) being the average for the general population. The mean % TBSA burned was 37 (SD=19), 2–90. The regression model revealed an association (n=82; F=7.85; p< 0.001; R2=0.2648) of PF to the predictors LOS (p < 0.001; regression coefficient= -0.18) and White ethnicity compared to Hispanic (p< 0.001; regression coefficient=8.89).

Conclusions

In this study, pediatric burn patients’ self-reported physical function was associated with ethnicity and hospital stay, with longer hospital stay and Hispanic ethnicity resulting in lower PF.
127 Plasma from Patients with Burn Injury Increases Endothelial Permeability In-Vitro
Authors: Keyloun John W , Carney Bonnie C , Nisar Saira , Moffatt Lauren T , Shupp Jeffrey W
Published: April 2021

Introduction

The contribution of endothelial injury to the pathogenesis of burn shock is not well characterized. Human umbilical endothelial cells (HUVECs) have been used to study endotheliopathy in myriad shock states. This work investigates the impact of burn patient plasma on the vascular endothelium and its barrier function.

Methods

HUVECs were seeded into the apical chambers of transwell plates and cultured over 5–7 days to a confluent monolayer which was confirmed by a transendothelial electrical resistance (TEER) of ≥30Ω. After IRB approval, plasma was collected from burn-injured patients 4 hours after admission. Demographic and injury characteristics were collected from the medical record. Plasma Syndecan-1 (SDC-1) was quantified by ELISA. HUVEC monolayers were exposed to 10% multi-donor pooled healthy human plasma (HHP) or burn patient plasma. Monolayers were subsequently incubated with FIT-C Dextran (40,000 kD). FIT-C diffusion through monolayers was measured in basal chamber supernatants. Monolayer permeability was measured with indices calculated by normalizing values to blank (transwell inserts) and HHP-treated monolayer FIT-C diffusion. HUVECs were also cultured on glass slides and exposed to HHP or burn patient plasma. Cells were fixed with 4% Paraformaldehyde and F-Actin was stained with Texas Red-Phalloidin. Intercellular gap area was calculated using imaging software. Differences between treatment conditions were analyzed with Welch’s t-test and one-way ANOVA, simple linear regression was used to characterize the relationship between plasma SDC-1 and permeability indices, significance was set at p < 0.05.

Results

Eight burn patient plasma samples were tested. Patients were mostly male (75%) with a mean age of 50±20 years and mean %TBSA burn of 37±34%. Five burn plasma samples significantly increased monolayer permeability. There were no significant differences between patient samples that increased permeability in age, TBSA, gender, or in-hospital mortality. Monolayer permeability indices increased between 7–15% (p< 0.05) among burn plasma treatment conditions (n=6) that increased permeability. There was a strong relationship between monolayer permeability index (%) and plasma SDC-1 (µg/mL) (p=0.03, R2=0.93). Morphological F-actin rearrangement was apparent on microscopy and intercellular gap area was increased in burn plasma treatment conditions (12% vs. 49%, p≤0.0007, n=6).

Conclusions

Plasma from burn patients induces endothelial damage that increases endothelial cell monolayer permeability. The endothelial biomarker SDC-1 is a reliable indicator of endothelial damage. F-actin rearrangement and an increase in intercellular gap area likely contributes to burn endotheliopathy.
130 Burn Injury Reduces Bone Marrow Mesenchymal Stem Cells and Sensitizes Their Adrenergic Receptor Subgroups in a Murine Model
Authors: Muthumalaiappan Kuzhali , Johnson Maria Camargo , Walczak Julia , Subramaniam Vimal , Baldea Anthony J , Liu Yuk Ming
Published: April 2021

Introduction

Previous burn and traumatic injury studies have established that adrenergic signaling is increased after burn injury and may lead to an impairment of hematopoietic cell development in the bone marrow (BM). Nonetheless, mesenchymal stem cells (MSCs), which have gained momentum in regenerative medicine also play a predominant role in the BM niche. Understanding the propensity of the adrenergic receptor (AR) response by MSCs can be utilized for devising targeted therapies. However, the traditional plastic adherence procedure using ex vivo culture of BM cells for several weeks may skew the actual characteristics of MSCs. Our current study focused on isolating MSCs from freshly obtained BM in a murine scald burn model with a goal to characterize the expression pattern of native AR subgroups present on BM MSCs as compared to sham mice.

Methods

Eight, two-month-old adult female mice were subjected to a 15% total body 3rd degree burn or sham burn. The mice were sacrificed 7 days later. Femurs were removed and total bone marrow cells were flushed out. Multi parametric flow cytometry was used to gate for cells negative for hematopoietic cell markers (CD45, CD11B) and positive for MSC markers (CD105, CD106, SSEA, Ly6A) and AR subgroups (α1, α2, β1, β2, β3). We measured the number of BM MSCs, quantified the subtypes of ARs present on MSCs, and compared the ratio of AR antibody binding per total MSC population.

Results

Overall the frequency of MSCs per million total BM cells decreased by 48% post-burn injury with165,300 ± 194 in sham versus 110,000 ± 30 in burn displayed as bar graph in Panel A. Over 90% of MSCs consistently express β2 AR and only 10% express α2 AR subgroup in both scald and sham burn. Presence of other subgroups ranged from 50% to 80% of MSCs as seen in histograms to the right of dotted line in Panel B. Our AR propensity score based on AR mean fluorescence intensity adjusted to total number of MSCs present was increased by 2.8-fold for α1, 2.5-fold for β1, 1.6-fold for β3, and 1.3-fold for β2 AR subgroups (Panel C). These findings indicate burn injury not only decreases the frequency of BM MSCs but also increases the affinity of certain AR subgroups present on MSCs. Since BM MSCs are the major source of cytokines, chemokines and growth factors; detailed studies on AR mediated signaling in BM MSCs is warranted.

Conclusions

Polarization of AR signaling in BM MSCs by burn-induced catecholamines may have broader implications for comorbidities such as bone resorption and muscle wasting observed in human patients post burn trauma.
140 Alpha-Mangostin Inhibits Proliferation, Promotes Apoptosis, and Modulates Fibrotic Gene Expression in Normal and Keloid Fibroblasts In Vitro
Authors: Supp Dorothy M , McFarland Kevin L , Hahn Jennifer M , Combs Kelly A
Published: April 2021

Introduction

Keloids are disfiguring lesions that result from an abnormal wound healing process. Despite the availability of numerous therapeutic options, keloids remain challenging to treat and often recur after therapy. α-Mangostin, a natural xanthone isolated from the fruit of the Mangosteen tree, has been used for centuries in many Southeast Asian nations for medicinal purposes, and has gained attention more recently due to its anti-inflammatory, antimicrobial, and antioxidant properties, with numerous studies suggesting possible anticarcinogenic activities. Hypothetically, α-mangostin may have therapeutic value for keloid suppression. To investigate this hypothesis, the effects of α-mangostin on fibroblast proliferation, apoptosis, and gene expression in vitro were analyzed.

Methods

Dermal fibroblasts were isolated and cultured from normal human skin and excised keloid lesions (3 donors each), and were treated with multiple doses (0–10 µm) of α-mangostin in vitro. Proliferation was measured using an MTT assay, gene expression was measured using quantitative real-time PCR (qPCR), and protein levels in culture media were measured by enzyme-linked immunosorbent assay (ELISA). Apoptosis was assessed by measuring expression of C/EBP homologous protein (CHOP), which mediates endoplasmic reticulum stress-induced apoptosis, by qPCR.

Results

Dose-dependent decreases in proliferation of keloid and normal fibroblasts were observed following treatment with α-mangostin. The α-mangostin treated fibroblasts displayed significantly increased expression of CHOP, indicating increased apoptosis. In addition, numerous changes in gene expression were observed in α-mangostin-treated keloid fibroblasts, including decreased expression of collagen type I alpha 1 chain (COL1A1) and increased expression of matrix metalloproteinase 1 (MMP1), MMP3, and MMP13. Secretion of pro-collagen I was decreased, and secretion of MMP1 and MMP3 proteins were increased, in α-mangostin-treated fibroblasts.

Conclusions

The results suggest that α-mangostin may exhibit antiproliferative, proapoptotic, and antifibrotic activities in keloid and normal fibroblasts.
144 Neck Splint Fabrication
Authors: Sher Malvina , Hunter Hope , Heffernan Jamie , Rabbitts Angela
Published: April 2021

Addressing the neck during burn rehabilitation is challenging, but critical as hypertrophy and contractures can result in adverse psychosocial, functional and cosmetic outcomes. Attention to the neck early in the rehabilitation process is crucial in minimizing scarring and preventing cervical contractures.

This video will demonstrate fabrication of a neck splint using silicon lined low-temperature thermoplastic material. The silicone-lined material is durable and has the capability of maintaining optimal pressure and position. It can be utilized alone or in a combination with compression garment to ensure 23 hours of pressure, which is crucial in preventing neck contractures, maintaining good cervical spine alignment and ROM, maximizing function and enhancing aesthetic appearance.

Based on our clinical experience, use of silicon lined low temperature thermoplastic splint allows for early and aggressive scar management. Furthermore, patients report improved compliance with wear and ease of care for this splint.
145 Positioning of Multiple Burned Joints- It Takes a Team
Authors: Dwertman Michelle N , Gallagher Catherine , Smith Michelle
Published: April 2021

Positioning of a burn patient with upper and lower extremity involvement is challenging and maintaining that position requires burn team support. This video displays positional strategies for the burn team to utilize to optimize recovery for the acute burn patient. Interventions strategies will include modifying the patient’s environment, management of orthotic devices and additional educational resources for successful execution of positional goals.
146 The Use of Biodegradable Temporizing Matrix
Authors: Gus Eduardo
Published: April 2021

Biodegradable temporizing matrix is a synthetic polyurethane dermal substitute that may have advantages over similar templates, which are mainly associated with its increased resistance to bacteria and infectious complications. It can be used to temporize large wounds in major burns, and to cover ungraftable beds, such as exposed bone or tendon. It has also been postulated to minimize the risk of scar contractures, which may warrant further studies. By means of a case report, this video illustrates its employment, showing the treatment stages of application, delamination, and grafting, as well as early postoperative results.
500 Burn Patient Recovery: Utilizing Virtual Connection During a Global Pandemic
Authors: Dines Margaret , Smith Tyler M , Dae Melanie K , Lambert Wagner Anne L
Published: April 2021

Introduction

Human connection is an essential element of healing for the burn survivor and their loved ones. The current global pandemic has created a barrier for in-person connection; hospitals nationwide have implemented visitor restrictions, which negatively impacts admitted patients. Our burn center integrated the use of video conferencing technology to increase connection amongst patients, loved ones, burn care team members, and burn survivors. We accomplished human interaction with our patients through virtual family meetings, peer support visits, and support groups.

Methods

Technology has been utilized in many different formats to help increase a patient’s connection with the outside world during the pandemic. Patient-centered family meetings were adapted to virtual formats and included the patient, the multidisciplinary burn care team, and the patient’s loved ones. We accomplished this by encouraging the patient’s family and the multidisciplinary team to join the meeting remotely, while the provider broadcasted from the patient room. In addition, the SOAR Peer Support group went entirely virtual, allowing survivors and peer supporters to attend and connect, despite in-person restrictions. Lastly, individual burn patient and SOAR visits were also adapted to the virtual platform.

Results

Video conferencing through a secured zoom platform was initiated in March 2020. From March 1, 2020 to September 24, 2020, 136 virtual family meetings were conducted, with an average of 4.5 family meetings per week. The quick adaptability to utilize technology allowed burn patients, loved ones, and burn care team members to continue to connect during times when those meetings would not have occurred. A virtual SOAR support group was held monthly, with an average of 3 attendees [2–6]. In this same time period, 14 SOAR Peer support individual meetings were conducted.

Conclusions

Despite the numerous challenges of a global pandemic, our Burn Center was able to proactively integrate technology to promote social connectedness. Utilization of technology allowed the burn multidisciplinary team to build trust with patients and their loved ones, offered invaluable patient-survivor relationships, and communicated the importance of social connection as an essential piece of burn recovery when our institution restricted visitors.
508 Cancel Burn Camp: No Way! Our Institutions Creation of a Virtual Burn Camp and What it Taught Us About Our Patients
Authors: Short Tracee
Published: April 2021

Introduction

Last year we planned and created our own burn camp. We saw a need not being served and jumped in a created a camp experience that was archived in a documentary and received stellar reviews by all who attended. The kids’ camp expectations was exceeded and everyone was looking forward to 2020. We planned for a great 2020 camp experience and then COVID struck. We debated about the safety to proceed with residential camp as we knew it. Other camps cancelled but our inner need to serve wouldn’t let us do this.

Methods

Our planning committee quickly shifted and began planning for how we can bring that experience to a virtual platform. We engaged our Facebook group and called every kid on our list to inform the parents of the change. We then created a daily schedule and purchased the items needed for all activities. We then sent or delivered these with a gift card to kids that couldn’t make the pickups. Pickups were scheduled in the cities where most of our kids reside. We conducted daily yoga and meditation, cooking classes, painting and campfire stories. We mixed daily online sessions with 3 tailgating meet ups. We invited guest lectures and left the virtual space open for the kids to hang out.

Results

At the final tailgate/virtual pizza party, we had an awards ceremony and received testimonials from kids and parents about how for the first-time siblings were able to participate. We delivered to 15 kids and had 20 attend the tailgate pickups. On average, we had 16 kids attend daily.

Conclusions

Parents could see how their child benefitted from this community and the intent of camp. This event revealed exactly where our patients reside from a socioeconomic standpoint. Deliveries to some homes left our volunteers in tears. This helped explain the discrepancy between interest expressed and the numbers that showed daily for events. It also made us recognize that camp means even more as it is an escape from their realities.
510 A Case-controlled Retrospective Review of Fluid Resuscitation in Patients with Concomitant Burn and Trauma Injuries
Authors: Foster Kevin N , Mellon Christopher , Islas Claudia , Smith Soraya , Davis Vanessa , Richey Karen J
Published: April 2021

Introduction

Aggressive fluid resuscitation with crystalloid has been a mainstay of therapy in burn injuries for over 50 years. However, in trauma populations there has been a shift away from crystalloid based resuscitation and the early administration of blood products has been recommended. The primary objective of this study was to evaluate if large-volume crystalloid resuscitation of patients presenting with both burn and trauma injuries is associated with higher mortality and complications.

Methods

This was a matched case-controlled retrospective chart review of patients treated over a 5-year period that suffered mixed burn and trauma injuries (MI). Patients that suffered burn only injuries (BO) were used as the control and were matched on TBSA, age, and gender. All patients were resuscitated using the standard burn center resuscitation protocol.

Results

A total of 4,416 patients were admitted to the burn center during the study period. Of those 18 had concomitant burn and trauma injuries requiring burn fluid resuscitation and were successfully matched to BO patients. There was no difference in age, gender, ethnicity, % TBSA burned, presence of inhalation injury, or Injury Severity Score (ISS). BO patients were more likely to have flame/flash as the etiology of burn injury (p=.0257). With fluid resuscitation, there was no difference in the total volume of fluid administered, or the amount of crystalloid or colloid administered. MI patients were more likely to have received blood products than BO patients (472 ml vs 19 ml, p=.0387). There was no difference in the following outcome measures: mortality, ICU days, ventilator days, number of surgeries, infections, or major complications. The only significant outcome difference was that the BO patients had a greater hospital length of stay (44 days) than the MI patients (24 days, p < 0.001).

Conclusions

Aggressive fluid resuscitation using existing burn resuscitation protocols did not result in greater complications in burn-trauma patients than in burn only patients. Crystalloid-based burn resuscitation is safe in patients with combined burn and trauma injuries.