bluuebunny/crossref_metadata_2025 huggingface dataset:
37 The Impact of the Intersectionality of Sex and Race on Body Image in Burn Survivors
Authors: Humbert Andrew , McMullen Kara , Bamer Alyssa M , Orton Caitlin M , Roaten Kimberly , Schneider Jeffrey C , Solis-Beach Kyra , Trinh Nhi-Ha , Yenikomshian Haig A , Amtmann Dagmar
Published: April 2024

Introduction

Health disparities associated with racial and ethnic minoritized status as well as sex are well documented in burn survivors. Specifically, previous work has found that people from racial and ethnic minority backgrounds as well as females tend to have lower satisfaction with appearance after injury1,2. However, the impact of the intersection between race/ethnicity and sex outside their individual effects has not been well studied. This study aims to assess: 1) the independent association between race/ethnicity and sex with body image, as measured using the Burn Specific Health Scale body image subscale (BSHS-BI), with higher scores corresponding to a better outcome; and 2) test if the association between sex and BSHS-BI differs by survivors’ race/ethnicity.

Methods

Adult participants enrolled in a large longitudinal study who had at least one BSHS-BI score and complete race/ethnicity, sex, age, and total burn surface area (TBSA) data were included. Race/ethnicity and sex were obtained through a combination of self-report and electronic health records. Due to sample size restrictions, race/ethnicity was categorized as White, non-Hispanic; Hispanic; or other, non-Hispanic. A linear mixed effects model was used to analyze the effects of race/ethnicity and sex after adjusting for age, TBSA, and follow-up time. A second linear mixed effects model was used to analyze the interaction between race/ethnicity and sex to determine if race modifies the association between sex and BSHS-BI.

Results

Data from 1,191 participants with injuries from 1996 to 2021 were included in the final analysis. The study sample was796 (66.8%) male, 398 (33.2%) female, 869 (73.0%) White, non-Hispanic, 145 (12.2%) Hispanic, and 177 (14.9%) other, non-Hispanic. The mean age was 43 (standard deviation (SD) = 17) and mean TBSA was 21 (SD = 44). After adjusting for age, TBSA, and follow-up time, mean BSHS-BI score for females was significantly lower than males (0.62 points lower; p < 0.001) and those identifying as Hispanic had mean scores 0.32 (p=.002) higher than White, non-Hispanic and 0.41 (p=0.02) higher than other, non-Hispanic. No significant differences in BSHS-BI were found between White, non-Hispanic and other, non-Hispanic groups. There was no evidence that the association between sex and BSHS-BI differed by race/ethnicity.

Conclusions

Those who self-identified as male and Hispanic had significantly better BSHS-BI scores; however, there was no evidence that the intersection between sex and race/ethnicity was associated with BSHS-BI after accounting for individual sex and race/ethnicity effects.

Applicability of Research to Practice

Consistent with previous research, the results suggest that sex and race/ethnicity are important characteristics to consider when addressing body image changes after burn injury.
69 The Burn Is Just the Symptom: Analyzing Psychosocial Determinants of Health in the Burn Population
Authors: Harris Kathryn E , Kalnberg Patty , Gallagher James , Heffernan Jamie M , An Anjile , Lorico Jeremiah P , Hsu Chun Yun
Published: April 2024

Introduction

There is an understanding in the burn community that burns occur as a result of something, whether it be medical conditions, psychiatric illness, poverty, living conditions, etc. Social determinants of health (SDOH) are defined as non-medical factors that can affect one’s health. These factors, along with psychiatric illness, can impact inpatient care and discharge planning. Our objective was to determine the prevalence of psychosocial factors in our burn population and analyze their impact on length of stay (LOS) and discharge disposition.

Methods

A retrospective chart review from January 1, 2022 to December 31, 2022 was performed at a large, urban, American Burn Association (ABA)-verified burn center using data from the ABA Burn Care Quality Platform (BCQP). All admitted patients ≥18 years old who sustained a burn injury were included. The two SDOH captured by BCQP, insurance status and living situation, were collected, in addition to psychiatric diagnosis, substance use disorder and alcohol use disorder. Primary outcome was LOS and secondary outcome was discharge disposition. Continuous variables were represented as median (interquartile range) and categorical variables as n (%). The Wilcoxon rank-sum test and Fisher’s exact test were used to compare LOS and discharge disposition between psychosocial variables of interest.

Results

Out of 302 patients, 129 (43%) had at least one negative SDOH. Of these 129 patients, 97% of them were uninsured/underinsured and 14% were undomiciled. Of the total population, 16% had a psychiatric diagnosis, 4.6% had alcohol use disorder and 8.6% had substance use disorder with a higher prevalence in the uninsured/underinsured and undomiciled population. There were 18 patients (6%) who were undomiciled prior to admission. The median LOS for all 302 patients was 8 days (IQR: 2, 17) and was not significantly different by insurance. Patients with a psychiatric diagnosis had significantly longer median LOS (15 days) when compared to those without (7 days, p=0.009). Undomiciled patients also had significantly longer median LOS (12 days vs 7 days, p = 0.034). Comparing by insurance, patients were discharged home with self-care at a similar rate (68% for insured, 62% for uninsured/underinsured). Patients in the uninsured/underinsured group were less likely to go to subacute rehab (4.3%) compared to the well-insured (11%). Only 28% of undomiciled patients were discharged back to a shelter or street.

Conclusions

The care of our burn patients is not defined by insurance status. However, the burn community needs a better, systematic process of collecting additional SDOH to further understand the impact they have on our patients. The longer LOS for those with psychiatric illness and homelessness highlights the need for specialized care both in the inpatient and post-discharge setting.

Applicability of Research to Practice

Directly applicable
70 Anxiety and Depression Increase Sleep Disturbances for Burn Survivors: A Burn Model System Study
Authors: Kim Anika , McMullen Kara , Stewart Barclay T , Schneider Jeffrey C , Ryan Colleen M , Won Paul , Yenikomshian Haig A
Published: April 2024

Introduction

In aftercare, burn survivors have many challenges arising from their injuries. Sleep disturbance, despite its significant impact on quality of life, remains a poorly understood and studied consequence. This study investigates the interplay between sleep quality, mental health, and recovery in adult burn survivors.

Methods

This retrospective study used the Burn Model System National Longitudinal Database (2015 to 2023) to examine sleep disturbance (SD) in adult burn patients. Subjects were divided into two groups based on their PROMIS-29 SD scores at 6, 12, 24 months, and 5 years follow-up: no to mild and moderate to severe SD. Mixed-effects modeling was used to compare the clinical characteristics of the two groups at 6 months. Person-level and site-level random effects were included to account for variations among subjects and treatment sites.

Results

The study included 558 adult burn survivors with a mean age of 47.7 years and a mean Total Body Surface Area (TBSA) burn size of 16.0%. Mean SD scores were highest at 6 months (51.1) and decreased by 24 months (49.1) (higher scores = more SD). The study identified a positive association between SD and depression and anxiety scores (higher scores = more anxiety and depression). A one-unit increase in SD corresponded to a 0.184 increase in depression scores and a 0.343 increase in anxiety scores at 6 months (p-value < 0.001) (see Table 1). The association remained significant when controlling for person and burn injury site differences. No other significant differences were found between demographic or clinical characteristics at 6 months.

Conclusions

This study highlights the complex interaction between SD, mental health, and recovery after burn injuries. Our data reveal that while subjects with depression and anxiety are more likely to experience SD after burn injury, there's a promising trend of improvement over time. These findings lay the foundation for improving targeted interventions and education in the clinical care of adult burn survivors.

Applicability of Research to Practice

Insights from the study identify a subgroup of burn survivors who might benefit from personalized interventions addressing sleep, anxiety, and depression. Furthermore, integrating the expected sleep patterns after burn injuries into patient and caregiver education at discharge and providing patient-specific coping strategies will further enhance the recovery outlook and personalize the aftercare experience.
74 Patient’s Perception of Likelihood to Attend Follow-Up in Burn Surgery Clinic
Authors: Coward Alexandra , Gilbert Megan , Ivanko Anastasiya , Heard Jason , Sen Soman , Palmieri Tina L , Greenhalgh David G , Romanowski Kathleen S
Published: April 2024

Introduction

Previous work has demonstrated that follow-up rates in burn patients are concerningly low. The ability to predict which patients will follow up in the clinic could improve short and long-term patient outcomes; through providing alternative means to obtain care. This study aims to evaluate if patients are aware of their likelihood of attending follow-up appointments.

Methods

Following the determination by the IRB that this was an exempt project and did not require informed consent, a survey assessing patient’s confidence that they would attend follow-up, was obtained for all admitted Burn Surgery patients at the time of discharge from September 2021 to June 2022 (N=251). Chart review then determined if patients presented for follow-up within thirty days of discharge. Univariate statistical analysis was performed. For all statistically significant variables, multivariate logistic regression with backward elimination was performed.

Results

Of the 251 included patients, 65% (N=165) presented for follow-up. These patients were able to accurately predict if they would present to follow-up (p < 0.0001). Of patients who were either very or somewhat confident that they would follow up (217 patients), 151 (69.6%) did attend a follow-up. Of patients who were either very or somewhat unconfident (8 patients), 5 patients (62.5%) did not attend a follow-up. A history of substance use disorder (p=0.004), tobacco use (p=0.0004), housing insecurity (p < 0.0001), disposition to a location other than their prior residence (p=0.02), and MediCal or Medicare insurance (p=0.003) were associated with lack of follow up care. Factors independently associated with follow-up include confidence in presenting on survey Odds Ratio (OR)=1.36 (95% Confidence Interval (CI) 0.18-9.8), no housing insecurity OR=4.17 (95% CI 1.53-11.32), and no history of substance use disorder OR=3.09 (95% CI 1.47-6.49).

Conclusions

Patients can accurately predict if they will follow up after discharge, while housing insecurity and history of substance use disorder are independently associated with a lack of follow-up care. Further research on alternatives to traditional follow-up is warranted to improve patient outcomes.

Applicability of Research to Practice

Alternative methods of follow-up should be considered for patients who do not think they will be able to follow up in burn clinic.
51 The Association Between Neighborhood Disadvantage and Patient-Reported Outcomes in Burn Survivors
Authors: Biswas Arushi , Zamore Zachary H , Aslami Zohra V , Tiongco Rafael Felix P , Ali Ayman , Cooney Carisa M M , Fisher Mark , Caffrey Julie A , Lerman Sheera F
Published: April 2024

Introduction

Burns are a leading cause of morbidity and mortality, with long-term complications including pain and poor physical function. While neighborhood disadvantage has been shown to be associated with burn severity, its relationship with long-term burn complications has not yet been investigated. Therefore, we hypothesized that higher area of deprivation index (ADI), an aggregate marker of neighborhood disadvantage, will be associated with increased likelihood of pain and poor physical function post-burn.

Methods

We obtained data from the Burn Model System (BMS) database. We linked patient data with ADI state decile 1-10 (1=least and 10=most disadvantaged) using year of injury and Census Block Group based on residence at time of injury. We used bivariate analyses to identify associations between ADI and patient and burn characteristics. We used multivariate regression to determine whether ADI was associated with self-reported pain and physical function (PROMIS-29 subscales) 6 and 24 months post-burn. Significance was p < 0.05.

Results

We included 780 patients who were admitted to one of three BMS centers between 2014 and 2021 of whom 538 (69%) were male. Most identified as White (83%), Black (9.8%), or Asian (2.5%). Mean age at time of burn was 46.2 years, mean ADI state decile was 5.75, and mean TBSA was 15.2%. Bivariate analysis demonstrated significant associations between ADI and age at injury, ethnicity, race, pre-injury household income, pre-injury education, increased pain intensity at 6- and 24-month follow-ups, and worse physical function at 24-month follow-up. Multivariate regressions controlling for TBSA, race, age, sex, anxiety, depression, and pain interference demonstrated that ADI was a significant predictor of higher pain intensity at 6- (p=0.008) and 24- (p=0.020) month follow up and worse physical function at 24-month follow up (p=0.011).

Conclusions

Burn patients living in areas of higher neighborhood disadvantage are more likely to report increased long-term pain and reduced physical function, even after controlling for other known risk factors. Further investigation into the relationship between neighborhood disadvantage and post-burn outcomes in larger, nationally representative samples is warranted.

Applicability of Research to Practice

Along with existing literature, our findings suggest that policy targeting neighborhood disadvantage may help improve short- and long-term post-burn outcomes and assist in identifying patients who are at increased risk for negative health-related outcomes.
98 Assessment of Burn Center Providers’ Professional Quality of Life
Authors: Grauer Christine M , Yelvington Miranda L
Published: April 2024

Introduction

Professional Quality of Life encompasses concepts related to compassion satisfaction and compassion fatigue. Healthcare professionals experience compassion satisfaction as they enjoy caring for others and achieve success in their work. Compassion Fatigue has been associated with physical symptoms and illness among affected individuals, increased staff turnover, and decreased patient safety and satisfaction. The purpose of this study was to assess the professional quality of life of staff at one Burn Center.

Methods

Multidisciplinary healthcare providers who care for adult and pediatric patients at a single Burn Center completed a demographic and Professional Quality of Life Health Measure (ProQOL Health) survey. The ProQOL Health consists of five subscales: Compassion Satisfaction (CS), Perceived Support (PS), Burnout (BO), Secondary Traumatic Stress (STS), and Moral Distress (MD). For each subscale, scores are defined as low ≤ 12, moderate 13-23, and high ≥ 24.

Results

Forty-four participants completed this pilot survey of staff who care for people who sustained burn injuries. Twelve participants identified as non-burn team (NBT) members, and 32 identified as members of the burn team (BT). ProQOL Health subscale scores were calculated and analyzed. Mean, standard deviation, and range are reported for all participants and by subgroup (Table 1).

This cross-sectional study demonstrated moderate levels of CS, PS, BO, STS, and MD among healthcare providers who work directly with adult and pediatric burn survivors. An independent samples t-test was used to evaluate differences in subscale scores of the ProQOL Health based on burn team (n = 32) or non-burn team (n = 12) self-selection. There was a statistically significant difference in STS mean score between burn team and non-burn team members, t(40.63) = 2.81, p = .004. Mean BT STS scores (15.53 ± 4.54) were higher than mean NBT STS scores (12.75 ± 2.01). The BT mean STS score was 2.78 (95% CI, 0.78 to 4.78) higher than the NBT STS score. Groups were not significantly different for other subscales.

Conclusions

Higher STS subscale scores among BT members may be due to repeated exposure to patients who have experienced traumatic and stressful events related to their burn injuries or the care they require.

Applicability of Research to Practice

Interventions designed to address professional quality of life should be considered for all healthcare providers who care for burn survivors and not exclusively those who consider themselves members of the BT.
100 Negotiated Commercial Rates for Burn Care in the Era of Price Transparency—Does Verification Signal Quality?
Authors: Stanton Eloise , Swaminathan Akshay , Rizk Nada , Pedreira Rachel , Sheckter Clifford C
Published: April 2024

Introduction

The Price Transparency Rule was enacted in 2021 to facilitate disclosure of negotiated rates between payors and hospitals with the goal of reducing the cost of healthcare. Burn care is intensive and costly; to date there have been no national analyses of price variation. In particular, we aimed to investigate the relationship between prices, market competition and American Burn Association (ABA) verification status.

Methods

All available commercial rates for 2021-2022 for Diagnosis Related Group (DRG) codes 927 (extensive burn with grafting, mechanical ventilation >96 hours), 928 (extensive burn with grafting or inhalation injury with complication/comorbidity), 929 (extensive burn with grafting or inhalation injury without complication/comorbidity), 933 (extensive burn without grafting, mechanical ventilation >96 hours), 934 (extensive burn without grafting, no mechanical ventilation), and 935 (non-extensive burn without grafting) were merged with hospital level variables, burn center verification status, and Herfindahl-Hirschman Index (HHI, marker of healthcare market competition). For each DRG code, a linear random effects model was fit with cost as the outcome and the following variables as covariates: HHI (categorical), plan type (categorical), safety net status (binary), nonprofit status (binary), verified burn center status (binary), rural status (binary), teaching hospital status (binary). A random effect was included for each unique facility to respect endogenous variation with hospitals.

Results

There were 170,738 rates published from 1541 unique hospitals. Rates for the same DRG varied by a factor of 3 within hospitals. Similarly, rates across hospitals varied by a factor of 3 for all DRGs, with DRG 927 having the most variation. ABA verification status was independently associated with higher reimbursement rates adjusting for facility level factors for all DRGs except for 935. Notably HHI was the greatest predictor of commercial rates, suggesting that market competition is the dominant force in determining burn center payments.

Conclusions

Regional market competition was the dominant factor in determining burn care remuneration. ABA verification status for burn centers was independently associated with increased payments, suggesting a signal for leverage/quality.

Applicability of Research to Practice

For the first time we have national benchmarks for inpatient burn commercial rates which vary substantially within and between hospitals. Burn centers may leverage this information when negotiating rates. In particular, verification status garners greater payments.
103 The Long-Term Economic Burden of Burn Injury
Authors: Dougherty Jacob M , Maqsood Hannan A , Fan Zhaohui , Wang Stewart C , Hemmila Mark R , Sangji Naveen F
Published: April 2024

Introduction

The long-term economic burden of burn injury on patients and payors for outpatient burn care has not been previously described. For small burns deemed appropriate for outpatient treatment alone, costs can still be significant. While initial hospitalization and intensive care is not required, outpatient burn care may require regular wound care, debridement, skin graft operations, eventual hospital admission, laser treatments, and follow-up appointments placing a large burden on payors and patients. We investigated index and post-acute payor and out-of-pocket (OOP) costs related to burn injury for outpatient care at 30 days, 12 months, 24 months, and 36 months following initial injury to better understand the long-term economic burdens for patients treated for burns without inpatient admission at the time of initial injury.

Methods

An observational cohort study was conducted using a commercial claims database from IBM Watson Health® Marketscan. Patients age ≤ 65 years with an ICD9/10 diagnosis code of burn injury that did not initially require inpatient treatment between 2010 and 2016 were identified and tracked for a three-year period following injury. This cohort was used to determine the payor and OOP costs for burn care during the initial treatment and three-year period following their index encounter through 2019.

Results

We identified 63,540 patients who were treated in an outpatient capacity following their index visitation between 2010 and 2016 (Table 1). Of this cohort, 95.8% received only outpatient treatment while 4.2% received inpatient care within 30 days of their initial visit. The mean inflation-adjusted index out-patient evaluation or emergency room costs were $186 during the study period (Table 1). The mean incremental payor costs for burn care were $2,896 at 30 days, $237 at 12-months, $31 at 24-months, and $15 at 36 months (Table 2). The mean incremental OOP costs for burn care were $588 at 30 days, $27 at 12-months, $4 at 24-months, and $2 at 36 months post-injury for each year from 2010 to 2016 (Table 2).

Conclusions

Burn injury creates significant financial burdens even when the initial injury does not require admission at presentation. This economic burden is highly impactful to both patient and providers, and further investigation of the economic considerations regarding burn injury is an area of interest in burn care.

Applicability of Research to Practice

Allows for a burn team to be cognizant of patient costs associated with ongoing treatment and to provide social work and other resources to patients.
105 Burn Injury Severity: Proposed Definitions Based on the National Burn Research Dataset
Authors: Heard Jason , Ren Yunyi , Sen Soman , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G
Published: April 2024

Introduction

Overall care of the burn injured patient has improved substantially leading to improved survival and outcomes. However, despite these improvements, how burn severity is classified based on total body surface area burned (TBSA) and depth has not changed. No recent work has employed data-driven methods to distinguish burns as minor, moderate, severe, or massive. Our aim was to leverage the National Burn Repository to develop data driven definitions of burn severity.

Methods

We used the American Burn Association (ABA) Burn Research Dataset encompassing all burn admissions from contributing burn centers from 2008-2018. Exclusion criteria were aged < 18 years, death, or hospice care within 7 days of admission, or burn etiology of cold injury, trauma, electrical burns, or no cutaneous injury. Latent class analysis (LCA) was performed using the following categorized patient variables: length of stay, ICU length of stay, number of complications, bedside procedures (central line, arterial line, feeding tube placement, and bronchoscopy), amputation, tracheostomy, excisions, grafting, and transfusions. Hierarchical clustering was then applied to the most severe burn group identified through LCA to further stratify severe from massive burn injuries.

Results

There were 112,297 unique records included in analysis. The LCA identified three clusters termed minor (N=63,637), moderate (N=37,320) and severe (N=11,340). The severe group was further split into two groups: severe (N=9,975) and massive (N=1365) using HCA. The mean (SD) total TBSA burned in the groups were 4.2(4.9) in mild, 7.8(7.9) in moderate, 23.4(18) in severe and 39.8(22.4) in massive group. The mean rBaux score in the mild group was 48.2(18.2), 55.0(19.5) in moderate, 80.3(22.8) in severe and 94.5(24.7) in the massive group.

Conclusions

While burn injuries exist on a continuum of severity there are advantages to grouping burn injury severity based on size. Objective and modern categorization can not only help triage patients with burn injuries, but also will be helpful in burn research. There are variable definitions for severe and massive burn injuries in the literature which leads to ambiguity when comparing studies on this unique patient population. This analysis supports a definition of < 10% TBSA for minor burns, 10-20% TBSA for moderate burns, 20-40% TBSA for severe burns and >40% TBSA for massive burns.

Applicability of Research to Practice

This research can help burn and non-burn centers triage patients based on expected resource utilization. However, this research will be most applicable to research that aims to study patients based on burn severity now that more homogenous groups have been defined.
106 Concordance of ChatGPT with American Burn Association Guidelines on Acute Burns
Authors: Arellano Jose Antonio , Pandya Sumaarg , Alessandri-Bonetti Mario , Liu Hilary , Jeong Tiffany , Ziembicki Jenny A , Egro Francesco
Published: April 2024

Introduction

Burn injuries often require immediate assistance and specialized care for optimal management and outcomes. The emergence of accessible artificial intelligence technology has just recently started being applied to healthcare decision-making and patient education. However, its role in clinical recommendations is still under scrutiny. This study aims to evaluate whether ChatGPT general expertise on domestic burn management and appropriate responses to commonly asked questions regarding acute burn injuries compared to the American Burn Association guidelines.

Methods

Twelve commonly asked questions were formulated by a fellowship-trained burn surgeon to address the American Burn Association’s recommendations on burn injuries, management, and patient referral. These questions were prompted into ChatGPT, and each response was compared with the aforementioned guidelines, the gold standard for accurate and evidence-based burn care recommendations. Three burn surgeons independently evaluated the appropriateness and comprehensiveness of each ChatGPT response based on the guidelines according to the modified Global Quality Score scale.

Results

The average score for ChatGPT-generated responses was 4.56 ± 0.65, indicating the responses were exceptional quality with the most important topics covered and in high concordance with the guidelines. Overall, 58% of the questions were focused on first aid and management of acute burns, while 42% focused on patient referral criteria. Of the twelve questions asked, two (16.7%) ChatGPT-generated responses scored a perfect 5.00 ± 0.00, demonstrating perfect concordance with the ABA guidelines. Nine (75.0%) ChatGPT answers between good and excellent quality, with average GQS scores ranging from 4.33 to 4.67. One (8.3%) response describing chemical burn referral recommendations scored a 3.33 ± 0.58, indicating somewhat concordance with the ABA guidelines.

Conclusions

This initial comparison of ChatGPT-generated responses and the American Burn Association guidelines demonstrates that ChatGPT can accurately and comprehensibly describe appropriate treatment and management plans for acute burn injuries. We foresee that ChatGPT may play a role as a complementary tool in medical decision-making and patient education, having a profound impact on clinical practice, research, and education.

Applicability of Research to Practice

This research enhances burn injury care and education by using ChatGPT as a complementary tool to provide accurate guidance to help aid healthcare decisions, patient education, and medical training.
107 Genital Burn Injuries: A Nationwide Analysis of Patient Outcomes
Authors: Najafali Daniel , Pozin Michael , Gangidi Suma , Govande Mukul , Camacho Justin M , Tran Quincy K
Published: April 2024

Introduction

Burn injuries to the genitals can lead to devastating injury with lifelong sequela that can impair function, aesthetics, and hygiene, directly impacting a patient’s quality of life. There is limited research investigating burn injuries to the genitalia. This study aims to characterize the outcomes of patients with burn injuries to their genitals.

Methods

Burn encounters to the genitals were isolated from ABA Burn Care Quality Platform between January 2008 to December 2018. Cohorts were separated based on age: adult and pediatric. Descriptive statistics summarized patients’ demographics, injury characteristics, treatment course, and ultimate dispositions. Multivariable logistics regressions evaluated any complications, length of stay, and mortality.

Results

A total of 7,096 patients had burn injuries to the genital region, of which 4,478 (63%) were adults. The majority of patients were male (66%), Caucasian (49%), and had a mean (SD) age of 31 (26) years. The most common cause of injury for adults was flame-based (34%), whereas scald injuries were responsible for 80% of the genital injuries for the pediatric population (p < 0.001). Median (IQR) TBSA burned was 18% [5-54%] for adults and 6% [3-15%] for pediatric cases (p < 0.001). When isolating the percent of body surface area that was directly impacting the genital region the median was 6% [2-17%]. Most patients had no complications (75%) and survived their burn injury (84%). Factors significantly associated with complications during treatment were pediatric patients (OR 2.0, 95%CI 1.68-2.30) and having a higher proportion of the burn concentrated to the genital region (OR 1.02, 95%CI 1.01-1.02). Longer lengths of stay were observed in black patients (OR 1.22, 95%CI 1.04-1.44) and patients with rash or skin infections (OR 18.9, 95%CI 12.4-29.8), whereas shorter lengths of stay were associated when burns were concentrated on the genitals (OR 0.97, 95%CI 0.97-0.98). Mortality was significantly associated with race, etiology of injury, TBSA, and a greater proportion of burn concentrated on the genitals.

Conclusions

This study highlighted outcomes for burn injuries to the genital region and found that most patients are discharged. We observed that a greater burn concentration to the genital area significantly correlated with increased complications. Paradoxically, these cases were associated with shorter hospital stays. To better support patients with genital burns, we recommend the development of specialized post-discharge care protocols to mitigate potential complication and ensure optimal long-term outcomes.

Applicability of Research to Practice

There is a gap in the literature regarding burn injuries sustained to the genitals and their management. Focusing on identifying populations at increased risk of poor outcomes will inform managing providers.
111 The Association of Burn Center Profit Status and Trauma Designation with Racial/Ethnic Diversity and Transfers
Authors: Steeman Samantha , Lakhlani Devi , Stanton Eloise , Sheckter Clifford C
Published: April 2024

Introduction

Health equity has become a prominent focus in conversations on improving healthcare delivery. Concerns have arisen that for-profit burn centers without trauma status may engage in patient selection practices that favor commercially insured patients, potentially resulting in underrepresentation of minority patients. This study investigates the relationship between profit status and trauma center designation in burn centers in relation to diversity of patients treated.

Methods

Using the California Department of Health Care Access and Information (HCAI), 2009-2019, all inpatient encounters at verified and non-verified burn centers were identified using ICD-9/10 and diagnosis related group codes. Primary outcomes of interest included proportion of burn transfers accepted with Medi-Cal or uninsured and the proportion of minority patients treated. Key covariates included burn center safety net status, profit status, American Burn Association (ABA) verification status, and American College Surgeons (ACS) Level 1 trauma center designation. Adjusted covariates were burn size, gender, age, and payer type. Linear regression modeling was performed and analyses were conducted at the level of individual burn centers, annually. Bonferroni adjustments were applied for multiple testing.

Results

There were 12 burn centers over 11 years. The median proportion of Black and Hispanic patients treated per burn center per year was 44.7%, (IQR 37.4%, 53.2%). On multivariable analysis, for profit burn centers were negatively associated with proportion of Black and Hispanic patients treated (coef -9.2%, p=0.008), and burn centers with trauma center designation were positively associated with higher proportion (coef 8.1%, p=0.011). Safety-net status and verification did not have a significant relationship, though safety-net burn centers care for significantly more MediCal (Medicaid) patients (coef 9.9%, p=0.001). There was not a single ED to burn center transfer for an uninsured patient at for-profit burn center, compared to 9 uninsured transfers to non-profit burn centers. There were only 2 ED to burn center transfers for MediCal (Medicaid) patients at for-profit centers compared to 239 for non-profit burn centers.

Conclusions

For-profit burn centers care for disproportionately few Black and Hispanic patients, while burn centers with trauma center designation care for more. For-profit burn centers have disproportionately fewer transfers with Medi-Cal (Medicaid) payer or uninsured compared to other burn centers.

Applicability of Research to Practice

In the pursuit of delivering high equity burn care across the US, this study identifies disparities related to profit status and trauma center designation in burn centers, underscoring the need for targeted, equity-based interventions and policy development.
129 Are There Differences in Scar Assessments as a Function of Fitzpatrick Skin Type
Authors: Carney Bonnie C , Lee Davon T , Travis Taryn E , Allely Rebekah R , Tejiram Shawn , Shupp Jeffrey W
Published: April 2024

Introduction

Skin type, as organized within the Fitzpatrick scale, may be an important variable in scar severity. Fitzpatrick skin type II (FST-II) and Fitzpatrick skin type V (FST-V) were chosen, to compare scar outcomes of lighter and darker skin patients with burn injuries. It was hypothesized that patients with FST-V skin have worse scar outcomes than patients with FST-II skin.

Methods

Demographic variables were obtained from the EMR including patient age, age of scar at time of assessment, gender, etiology of burn injury, and location of injury for this retrospective chart review. A variety of scar assessment scales and non-invasive measurements of scar qualities were administered during visits with the rehabilitation team around 4 months post-burn. These included The Patient and Observer Scar Assessment Scale (POSAS) which was broken up into: POSAS-Observer (O) avg, POSAS-Patient (P) Itch, POSAS-P Pain, and POSAS-P avg. This evaluation also included the Vancouver Scar Scales (VSS), and pliability, erythema, and melanin objective measurements.

Results

Thirty patients were included in the analysis, 15 in each group. In FST-II, 53% of subjects were female, 47% were male. In FST-V, 33% of patients were male, while 67% were female (p>0.05). There are no significant differences in categorical patient age ( 42.2±4.6 vs 45.6±4). Approximately 67% of FST-II patients had flame burns, 33% scald injuries. Similarly 62% of FST-V subjects had flame burns, and 38% had scald injuries. The location of injuries was variable in both groups, but not different among groups. Scars were evaluated at 3.7±0.3 months with a range from 1-8 months post-burn and this evaluation time was not different between groups. For observer driven scar assessment (POSAS-O avg and VSS), there were no differences in scores between the groups (6.2±0.4 vs. 6.1±0.4 and 6.1±0.4 vs. 5.8±0.5). POSAS-P Itch scores and Melanin levels were higher in FST-V (7.3±0.6 vs. 5.3±0.7, p< 0.05, 896.4±9.5 vs. 727.2±9.8, p< 0.0001). Erythema was higher in FST-II (463.7±6.4 vs. 398.7±11.4, p< 0.0001). There was no statistical difference in POSAS-P Pain or pliability scores between FST-II and FST-V groups.

Conclusions

These findings suggest that patients rate their scars as being equally morbid regardless of skin type. There may be a correlation between higher melanin levels and pruritis in burn scars. Although scars in darker patients is thought to result in worse outcomes, the data shows that observers rate them equally. These findings bring into question the validity of current scar assessment scales and whether they adequately measure scars within different FST groups.

Applicability of Research to Practice

Performance of current scar scales in different skin types could affect treatment decisions. New metrics may need to be added to current scar assessment tools.
503 Should Co-morbid Conditions Be Factored in Mortality Prediction Models for Burn Injury: Single Center Evaluation
Authors: Hollowell Jamie L , Levine Ashley , Bodek Benjamin , Agala Chris B , Maxwell Eli , Chrisco Lori , Matthews Robert W , King booker , Williams Felicia
Published: April 2024

Introduction

Comprehensive conversations about prognosis in burns currently neglect the impact of co-morbid conditions on outcomes. Currently, the most often quoted burn mortality predictors focus on age, burn size and depth, and inhalation injury. We suspect comorbidities increase the risk of mortality from a large burn. Our aim is to identify and quantify the magnitude of impact pre-existing comorbidities may have on the outcomes of our burn patients.

Methods

Patients were identified using Institutional Burn Center registry and linked to the clinical and administrative data. Adult patients admitted from Jan 1, 2012, to June 30, 2023, were included. Demographics, length of stay (LOS), and mortality were evaluated using logistic regression to create a predictive model. LASSO regularization was used for variable selection; model was fit with a training dataset (n=7948) and evaluated on a validation dataset (n=1975).

Results

We evaluated 23 variables to identify variables with independent predictive power. Fourteen variables had increased predicted risk of mortality: female sex (0.07), increasing age (0.065), etiology other than burn(0.36), burn size (0.8), public insurance (0.27), inhalation injury (1.92), positive alcohol status upon admission (0.07), COPD (0.85), congestive heart failure (0.56), stroke (0.36), diabetes (0.08), renal failure (0.97), alcoholism (0.64), and substance abuse (0.51). Conversely, 5 variables led to a decreased predicted risk of mortality: other/unknown insurance status (-0.23), unknown alcohol history (-0.24), positive cocaine status upon admission (-0.22), asthma (-0.18), and hypertension (0.24). The model’s AUC on the validation dataset was 0.926.

Conclusions

Not all co-morbid conditions effect outcomes negatively. Additionally, the lack of association of some variables may be attributed to the presence of other comorbidities accounting for their impact. Next steps are to determine if any of these factors are modifiable with changes in treatment strategies regardless of the chronicity of the co-morbid condition.

Applicability of Research to Practice

Current burn mortality predictors lack many comorbid factors, so further work needs to be done to determine if additional comorbid conditions should be considered in formal mortality predictions.
504 Revised Baux Score Identifies a New Risk Factor for Mortality: History of Diabetes
Authors: Nehila Timothy , Mikhael Marian , Arora Shreya , Jupudi Rithvic , Criscione Jaynie X , Le Nicole K , Whalen Kristen , Buller Kristina , Troy Jared , Laun Jake
Published: April 2024

Introduction

Mortality following burn injury is influenced by many objective factors. Over the past several decades, numerous predictive formulas have been developed to estimate the probability of death from burn injury. Despite the preponderance of models, there are relatively few widely accepted objective measures found to impact mortality in burn patients. These factors include sex, age, burn depth, TBSA, and presence of inhalation injury. In this study, we retrospectively analyzed mortality in the burn patients at our level one trauma center to identify prognostic factors.

Methods

A retrospective chart review was performed on all patients between 2015-2020 over the age of 18 that presented to our trauma center for burns. Significant risk factors for the prediction of mortality based on a set of objective variables were identified using a stepwise forward logistic-regression analysis.

Results

Of the 963 patients (mean [±SD] age, 47±17; mean TBSA, 9±13), 96% lived to discharge. The identified risk factors for death were increased age (OR 1.08, 95% CI 1.04-1.11, p< 0.001), increased TBSA (OR 1.10, 95% CI 1.06-1.13, p< 0.001), the presence of inhalation injury (OR 4.72, 95% CI 1.49-14.94, p=0.008), third degree burn depth (OR 6.09, 95% CI 1.15-32.00, p=0.033), and having diabetes (OR 3.61, 95% CI 1.17-11.08, p=0.025 (Table 1). The probability of death from patients who experience burns is described by the equation:

probability=1/(1+e^(-log f ()it))

With logit equal too:

logit = -9.584 + 0.072*(Age) + 0.090*(TBSA) + 1.804 (Presence Third Degree Burns) -2.231 (Presence Second & Third-Degree Burns) + 1.282 (Presence Diabetes) + 1.551 (Presence Inhalation Burns)

Categorical values should be treated as 1 if they are present and 0 if they are absent.

Conclusions

Between 1990 and 2010 the number of people living with diabetes tripled, and the annual incidence doubled. Diabetic wound healing is characterized by excessive inflammation and reduced angiogenesis, resulting in increased risk for complications. Diabetes is an established comorbidity in burn patients, but has never been identified as a significant risk factor for mortality.

Applicability of Research to Practice

Analysis of burn patients at our level 1 trauma center identified history of diabetes as a significant risk factor for mortality and suggests that the inclusion of diabetic status in future mortality models would increase their prognostic value in comparable populations.
517 Continuous Post-Pyloric Tube Feeds During Prone Operations Do Not Significantly Increase Rates of Pneumonia
Authors: Sather Kristiana , Lacey Alexandra M
Published: April 2024

Introduction

It is well established that nutrition is critical for burn patients due to their catabolic, hypermetabolic, and inflammatory states, and enteral nutrition is the preferred route. For patients with significant burns and those who are unable to meet caloric demands, tube feeds are the preferred method of nutrition. It is important to minimize interruptions in nutrition and in collaboration with the anesthesia colleagues at our institution patients continue to receive continuous post-pyloric tube feeds intraoperatively regardless of positioning. We hypothesized that the rates of post-operative pneumonia would not increase despite receiving post-pyloric tube feeds while in prone positioning.

Methods

This retrospective cohort study includes all pediatric and adult burn patients admitted to our institution between January 2022 through July 2023. The primary outcome was the rate of post-operative pneumonia in patients receiving continuous tube feeds during prone positioning in the operating room compared to the rates of pneumonia in all admitted burn patients. Pneumonia is defined as pneumonia discussed at our Morbidity and Mortality conference and in the continuous tube feeds during prone positioning group, this was further defined as being documented within 48 hours post-operatively. The secondary outcome is the rate of post-operative pneumonia following all prone operative cases in which patients received continuous post-pyloric tube feeds. A p value < 0.05 is considered statistically significant.

Results

Of 855 burn admissions during this time frame, 46 patients received continuous post-pyloric tube feeds while in prone positioning during at least one trip to the operating room. Of these 46 patients, 4.3% developed post-operative pneumonia compared to a 2.2% rate of pneumonia in all admitted burn patients (p = 0.178). Considering some patients required multiple operations, there were a total of 94 operative cases involving patients that received continuous post-pyloric tube feeds while prone and the rate of post-operative pneumonia when these cases were analyzed as individual events was 2.1%.

Conclusions

Although continuous post-pyloric tube feeds during prone cases in the operating room was associated with an increase in pneumonia compared to all burn patients, this was not statistically significant. Furthermore, when the rate of post-operative pneumonia was stratified by total number of prone cases rather than by number of patients, the rate of pneumonia decreased to the same rate of pneumonia in the general burn population.

Applicability of Research to Practice

The purpose of this project is to promote uninterrupted nutrition in burn patients and encourage other institutions to consider continuing post-pyloric tube feeds during prone operating room positioning.