bluuebunny/crossref_metadata_2025 huggingface dataset:
531 Sex-based Differences in the Skin: Is It Just a Female Problem?
Authors: Duplisea Michael , Williams Felicia N , Ziemer Carolyn , Chrisco Lori , Laughon Sarah L , Nizamani Rabia , Cairns Bruce , Jones Samuel W
Published: March 2020

Introduction

Female gender is associated with poorer outcomes in burns, not necessarily related to co-morbid conditions. Our objective was to analyze the effect of gender in biopsy proven Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) spectrum disorders at our institution.

Methods

Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted with biopsy proven SJS, SJS/TEN overlap, and TEN between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay, and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results

One hundred and sixty-eight patients had biopsy proven SJS, SJS/TEN overlap, or TEN. Sixty-one percent of patients were female. The average age of female patients was 51 years while the average age of male patients was 44 years, p< 0.05. Fifty-sex percent of female patients were black. All American Indian patients were female. Female patients had significantly longer lengths of stay, 34 days versus 22 days, p< 0.05. Female patients had an average SCORTEN (a severity of illness score of TEN) compared to male patients. Thirty-three percent of female patients died compared to 18% of male patients, p< 0.05. Two out of three American Indian patients in this cohort died.

Conclusions

Female gender is associated with increased mortality in burn patients, as well as in our cohort of patients with SJS/TEN. Females represent 51% of our state’s population, but 61% of patients with biopsy proven SJS, SJS/TEN overlap, and TEN at our institution. Compared to male patients, female patients presented with more severe disease (higher SCORTEN at presentation). Genomic, and proteomic studies looking at sex-based differences may be helpful in elucidating the origin of these differences.

Applicability of Research to Practice

This study demonstrates sex-based differences related to skin desquamating disorders, and these outcomes, coupled with known disparities in burns, may indicate a need for hypervigilance in inpatient management for women, and a re-evaluation of prognostic scoring tools to include a variable for gender.
552 Ten Year Mortality Trends in Stevens Johnsons Syndrome and Toxic Epidermal Necrolysis Trends in a Single Burn Center
Authors: Duplisea Michael , Williams Felicia N , Ziemer Carolyn , Chrisco Lori , Nizamani Rabia , Laughon Sarah L , Cairns Bruce , Jones Samuel W
Published: March 2020

Introduction

Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are a spectrum of rare, life-threatening drug reactions characterized by diffuse skin detachment and mucositis. Our objective was to describe and analyze mortality trends at our institution for patients with biopsy-proven SJS and TEN over the last decade.

Methods

Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted with biopsy proven SJS, SJS/TEN overlap, and TEN between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results

One hundred sixty-eight patients had biopsy-proven SJS, SJS/TEN overlap, or TEN. The average age was 48 years. Sixty-one percent of patients were female. The average length of stay was 30 days. Fifty-six percent of patients were Black. Twenty-seven percent of patients died. Increased mortality risk was significantly associated with female gender, age, underrepresented minorities, Human Immunodeficiency Virus, and chronic obstructive pulmonary disease. The presence or absence of malignancy or chronic kidney disease was not evaluated.

Conclusions

Biopsy proven SJS, SJS/TEN overlap, and TEN are associated with increased mortality for females, underrepresented minority populations, and patients with comorbidities. Black patients represent 28% of our state’s population, but 56% of patients with biopsy proven SJS, SJS/TEN overlap, and TEN at our institution. Further study is warranted to investigate and mitigate these outcome disparities in these patient populations.

Applicability of Research to Practice

This study highlights the importance of acknowledging that these at-risk patient populations must be protected with higher vigilance during evaluation, assessment of the offending agent, and resuscitation.
604 Comparing Disinfection of Different Dosages of Vaporized Hydrogen Peroxide in Burn Ward
Authors: Zhang Yin
Published: March 2020

Introduction

The objective of this study is to compare the disinfection effects using the vaporized hydrogen peroxide disinfection method in critical burn ward.

Methods

A 110m3 empty ward of the burn center was selected as the experimental site. The Bacillus subtilis var. niger spores were opened and placed in 15 unprepared positions (with 0 m, 1 m, 2 m, 3 m, and 4 m from the disinfection machine, each of which was divided into upper, middle, and The lower 3 planes), as well as the 15 points of the cloth (the same position as before), are fixed with hydrogen peroxide indicating tape. The amount of hydrogen peroxide was calculated according to the size of the ward (8 g/m3, 12 g/m3, respectively), and disinfected at a rate of 10 g/min of hydrogen peroxide release flow. After 5 hours of disinfection, the chemical indicator tape and the bacteria pieces were taken out. Observe the discoloration of the chemical indicating tape. The bacteria pieces were placed in a test tube containing the broth culture medium, and the results were observed after incubation in a 37 ° C incubator for 7*24 hours.

Results

(1) Under the condition of no cover, the two disinfecting dose chemical indicating tapes are all discolored, and in the case of obstruction, they cannot be completely discolored; (2) When the amount of hydrogen peroxide disinfection is 8g/m3 and 12g/m3 respectively, The positive rates of unobstructed specimens were 6.67% and 2.67%, respectively, no significant difference (P= >0.05), and there was no difference in disinfection effect between the positions (P >0.05); (3) 8g/m3 disinfection dose The peak concentration is 255.9g, the peak concentration is 1h48min; the peak concentration is 337.6g at 12g/m3 disinfection, and the peak concentration is 2h26min. When the two disinfection doses were disinfected for 8 hours, the peak concentrations of the chambers were basically the same(1) Under the condition of no cover, the two disinfecting dose chemical indicating tapes are all discolored, and in the case of obstruction, they cannot be completely discolored; (2) When the amount of hydrogen peroxide disinfection is 8g/m3 and 12g/m3 respectively, The positive rates of unobstructed specimens were 6.67% and 2.67%, respectively, no significant difference (P= >0.05), and there was no difference in disinfection effect between the positions (P >0.05); (3) 8g/m3 disinfection dose The peak concentration is 255.9g, the peak concentration is 1h48min; the peak concentration is 337.6g at 12g/m3 disinfection, and the peak concentration is 2h26min. When the two disinfection doses were disinfected for 8 hours, the peak concentrations of the chambers were basically the same.

Conclusions

The use of vaporized hydrogen peroxide for terminal disinfection should be as full as possible to expose the items to be disinfected.

Applicability of Research to Practice

Disinfection.
651 NLRP3 Activation Induced by Neutrophil Extracellular Traps Sustains Inflammatory Response in the Diabetic Wound
Authors: Liu Dan
Published: March 2020

Introduction

Persistent inﬂammatory response in the diabetic wound impairs the healing process, resulting in significant morbidity and mortality. Mounting evidence indicates that the activation of NLRP3 inflammasome in macrophages (MF) contributes to the sustained inﬂammatory response and impaired wound healing associated with diabetes. However, the main trigger of NLRP3 inflammasome in the wounds is not known. Neutrophils, as sentinels of the innate immune system and key stimulators of MF, are immune cells that play the main role in the early phase of healing. Neutrophils release extracellular traps (NETs) as defense against pathogens. On the other hand, NETs induce tissue damage. NETs have been detected in the diabetic wound and implicated in the impaired healing process, but the mechanism of NETs suspend wound healing are elusive.

Methods

WB, immunofluorescence and immunocoprecipitation were used to detect the expression of NETs, NLRP3 inflammasome and IL-1b in diabetic foot ulcer wounds and the expression and activation of NLRP3 inflammsome after lowering the level of NETs. The role of NETs in activating macrophage inflammsome was verified and its mechanism was explored. Induced type I diabetic rats by STZ injection to detect the expression of NETs in the wound and observe the effects of exogenous DNase I on the expression of inflammasome and IL-1b in the wound, inflammatory cell infiltration and wound healing.

Results

NLRP3 and NETs are elevated in human and rat diabetic wounds. NETs overproduced in the diabetic wounds triggered NLRP3 inflammasome activation and IL-1b release. NETs up-regulated NLRP3 and pro-IL-1b levels via the TLR-4/TLR-9/NF-kB signalling pathway. NETs elicited ROS, which facilitated the association between NLRP3 and TXNIP, and activated the NLRP3 inflammasome. DNase I alleviated the activation of NLRP3 inflammasome, regulated the immune cell infiltration, and accelerated wound healing.

Conclusions

NETs contribute to the activation of NLRP3 inflammasome and sustained inflammatory response in the diabetic wound. NET digestion by DNase I alleviated the activation of NLRP3 inflammasome and accelerated wound healing.

Applicability of Research to Practice
707 Factors Associated with Early vs. Late AKI in Burn Patients
Authors: Respicio Jessicah A , Duffy Patrick , Smith Tyler M , Dyamenahalli Kiran U , Wiktor Arek J , Wagner Anne L Lambert
Published: March 2020

Introduction

Acute kidney injury (AKI) in burn patients is known to increase morbidity and mortality, with significant improvement after the initiation of renal replacement therapy (RRT). Our primary objective is to characterize the sub-population of burn patients with early (≤48 hours post-injury) versus late (>48 hours post injury) onset of AKI. We hypothesize that patients with early onset AKI versus late onset AKI have different causalities, risk factors, and outcomes. A secondary aim is to investigate the timing and use of RRT in the setting of early and late AKI with the goal of improving morbidity and mortality.

Methods

A retrospective cohort study was conducted on all patients admitted to a verified burn center requiring RRT for AKI from 2015 – 2019. Patients were stratified by age, gender, percent total body surface area (TBSA), race, time of onset of AKI, timing of RRT initiation, hospital LOS, pre-admission co-morbidities, admission toxicology, and mortality.

Results

In total, 1537 burn patients were reviewed and 1.3% (n=20) required RRT for AKI. Out of this cohort, 70% developed early AKI and 30% developed late AKI. Early versus late AKI patients had the same median age (57). Patients with larger TBSA developed early AKI (median TBSA 51%) versus late AKI (median TBSA 21%). Half of the patients who developed late AKI presented with positive alcohol toxicology screens, while 86% of patients with early AKI tested negative. The patient mortality rate in early AKI was 57%, and the mortality rate in late AKI was 17%. Only 14% of early AKI patients required dialysis at discharge, while 33% of late AKI patients required dialysis at discharge. The majority of patients started on early RRT (< 48 hours post injury) did not develop sepsis (43% developed sepsis), while the majority of patients started on late RRT (>48 hours post injury) did develop sepsis (85%).

Conclusions

Positivity for alcohol on admission may be a predictor for development of late AKI, while larger TBSA may predict early AKI. Mortality is higher for patients with early AKI; however, the need for dialysis at discharge is higher in patients with late AKI. Our data further suggests that early initiation of RRT is negatively correlated with the development of sepsis.

Applicability of Research to Practice

A deeper understanding of associations and causality of early vs late onset AKI in burn patients will help guide further management and improve outcomes.
728 The Faces of Autologous Skin Cell Suspension as Epidermal Grafts
Authors: Van Hoorebeke Justin , Pang Alan , Kopari Nicole M
Published: March 2020

Introduction

Facial burns are frequently severe and are difficult to skin graft, which may lead to increased morbidity including chronic pain, scarring, and psychosocial stigma. The aim of this study was to describe outcomes of patients with facial burns who received autologous skin cell suspension as an epidermal graft.

Methods

A retrospective chart review of patients with facial burns admitted to an ABA verified Burn Center from January 2019 to August 2019 was performed. Each patient underwent tangential excision of superficial and deep partial-thickness burn wounds followed by autologous skin cell suspension applied as an epidermal autograft. The wounds were covered with a non-adherent dressing along with bismuth-impregnated, petroleum-based gauze. The dressings were secured in place with sutures to prevent disruption. On post-operative day 6 the dressings were removed with transition to an antimicrobial ointment applied to any remaining open wounds or a moisturizing lotion.

Results

Five patients, aged 41–89 years, were included. Total body surface ranged from 7–50%. Etiology of the burns included: flame from metal fabricating, assault followed by dousing the patient in gasoline and lighting on fire, flash flame from a water heater explosion, hot oil contact, and involvement in a house fire. 3 of the 5 patients had complete healing noted by post-operative day 6 with excellent results. Two patients required a second excision and application of autologous skin to small portions of the lateral face after healing the majority of the face. One patient developed mild microstomia requiring oral splinting. One of the two patients that required a second application developed ectropian to one of her eyes which was treated with temporary tarsorrhaphy. The second patient that required a second application, died during her hospitalization secondary to complications from her burns and underlying medical co-morbidities. Surviving patients reported satisfaction with the cosmetic outcomes.

Conclusions

Autologous skin cell suspension as an epidermal graft is a viable option for cosmetically important areas such as the face. This case series provides evidence for its validity when treating partial-thickness burns utilizing the above described protocol in conjunction with a multidisciplinary care team within a burn center.

Applicability of Research to Practice

By sharing our institutions experience with this relatively new technique we hope to share our positive outcomes as an alternative to stand excision and grafting to areas of significant cosmetic outcomes.
764 What Do You Think? The Ethics of Treating the Medically and Socially Complicated Patient
Authors: Gerrek Monica L , Lambrix Marcie A , Schirokauer Oliver , Coffee Tammy , Yowler Charles
Published: March 2020

Introduction

Medically complicated burn patients also often present with complex social situations which raise difficult ethical questions for the providers caring for them. While the four principles of biomedical ethics, respect for autonomy, nonmaleficence, beneficence, and justice help guide medical decision making, providers are often faced with making recommendations that are ethically uncomfortable for them.

Methods

At the ABA Annual Meeting in 2019, we presented a poster of a case of a medically, socially, and ethically complicated patient who was treated at our verified burn unit about a decade ago. Embedded in the poster was a QR code and weblink that people could scan to get to a 10-item online survey containing questions regarding decision making in the case. For our regional burn conference in September 2019, we asked the organizers to send an email containing a summary of the case and a link to the survey via email to all of those who had registered two weeks before the conference. A summary of the case follows:

47-year-old male with an 81% TBSA burn from a car accident, currently intubated and sedated and unable to participate in medical decision making. He needs four limb amputations, though his chance of long-term survival is ultimately thought to be less than 10–20%; best case scenario is a vent-dependent life with tetraplegia, likely without prosthetics due to skin graft issues. He has a very complicated family situation.

Survey questions included those about whether it was medically appropriate to do or not do the amputations, how that appropriateness should be assessed, the extent to which the patient’s previous expressed wishes matter, who the appropriate surrogate is, and whether and to what extent the medical team’s feelings about the situation matter.

Results

Twelve people at the ABA annual meeting and 17 people from the regional meeting responded to the survey. Every respondent answered every question. While there were some similar responses, there were also those with significant variation. Of note, at the ABA, 50% of respondents felt the evidence needed to withdraw treatment was the same as that needed to continue treatment; 70% of participants at the regional meeting thought this. 25% of respondents at the ABA thought it was extremely important that a decision be made that allows team members to sleep at night; 17.65% of participants at the regional meeting thought this.

Conclusions

Burn care providers do not agree on important aspects of decision making for patients who are medically, socially, and ethically complicated.

Applicability of Research to Practice

Further discussion of decision making in burn care is needed to help increase provider comfort in making recommendations for patients who are medically, socially, and ethically complicated.
766 Clinical Outcome Assessment of a Psychosocial Intensive Retreat for Girls with Severe Burns
Authors: Stoycos Sarah A , Sammons Ashley J , Cartelli Lesia S , Price Leigh Ann
Published: March 2020

Introduction

Burn camps and peer support groups are widely utilized for the psychosocial care of pediatric burn survivors, providing community and recreation. However, camps and support groups often do not involve psychological therapy to assist with potential distress. This abstract presents program development outcome assessments for an alternative approach to psychosocial care: a psychosocial intensive retreat for adolescent survivors of pediatric burns, led by trained mental health professionals, with group therapy interspersed with recreation.

Methods

A 6-day, residential psychosocial intensive was open to adolescent girls with disfiguring burns. Psychological assessments were administered for clinical utility at the start (T0) and end (T1) of the program and were used to guide programming. Assessments included: Posttraumatic Stress Checklist for DSM-5 (PCL), Satisfaction with Appearance Scale (SWAP), Rosenberg Self-Esteem Scale (RSES) and the Acceptance and Action Questionnaire (AAQ) measuring psychological inflexibility. Bivariate correlations and univariate t-tests were used to assess program outcomes.

Results

Fifteen girls (Mage = 16, SD = 2.04; Mageofburn = 6.64, SD = 5.40) attended. At T0, girls reported subclinical scores (PCL (M = 23.53, SD = 20.20, range 1–65); SWAP (M = 44.93, SD = 11.88); RSES (M = 27.28, SD = 5.76); AAQ (M = 20.71, SD = 9.64) with a subset of 5 reporting clinical distress on PCL. Therapeutic programming was adjusted to primarily focus on typically developing adolescent issues such as communication, boundaries, identity formation, and healthy relationships, with some burns-specific groups (grief and loss, social exposures). Those with clinically significant distress participated in trauma and affect regulation training.

AAQ at T0 was negatively associated with RSES (r = -.78, p = .003) and positively associated with PCL scores (r = .82, p < .001). RSES was negatively associated with PCL (r = -.87, p < .001). SWAP was not associated with any measures. From T0 (M = 26.70, SD = 6.07) to T1 (M = 30.18, SD = 5.74) girls reported a significant increase in RSES, t(10) = -3.15, p = .01. As expected given low symptoms reported at T0, no other pre to post changes occurred. TBSA, time since burn and age were not associated with outcome variables.

Conclusions

Overall, girls suffered burn injury before the age of 7 and current symptom profiles replicated prior literature supporting subthreshold, long-term psychological morbidity for pediatric burns. A brief, 6 day psychosocial intensive may facilitate growth in self-esteem. Use of clinical assessments to inform programming is emphasized.

Applicability of Research to Practice

Psychosocial intensives that intersperse empirically-supported, assessment-driven therapeutic programming with social connection may be useful in increasing adolescent self-esteem for girls with a history of disfiguring burns.
792 A Retrospective Review of the Utilization of Burn Admission Criteria
Authors: Foster Kevin N , Krueger Larisa M , Richey Karen J
Published: March 2020

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.

Applicability of Research to Practice

This study helps to define appropriateness of inpatient care following burn injury.
814 Do Patients Receive Reliable Outpatient Occupational Therapy After Hand Burns
Authors: Choi Katherine J , Pham Christopher H , Collier Zachary J , Carney John , Kurakazu Dawn , Yenikomshian Haig A , Gillenwater Justin
Published: March 2020

Introduction

Hands are the most commonly burned body part, and are prone to developing limited range of motion and scar contractures, which benefit from aggressive occupational therapy (OT). Many burn survivors are vulnerable with limited resources and poor follow up. The purpose of this study is to determine outpatient OT referral and compliance rates in our patient population.

Methods

All patients with hand burns admitted to a single ABA verified burn center from January 2015 to May 2016 were reviewed. Demographics (living situation, substance use, psychiatric illness), TBSA, interventions (type/number of surgeries), outcomes (length of stay [LOS]), and OT outcomes (inpatient and outpatient treatment, reason for discontinuation) were evaluated.

Results

Sixty-one patients met inclusion criteria. Mean age was 33±18 years. In terms of living situation, 17% (n=10) were homeless, and 3% (n=2) were incarcerated. A documented history of alcohol abuse was present in 13% (n=8), 23% (n=14) had positive urine toxicology screens, and 15% (n=9) had diagnosed psychiatric illness. Mean TBSA was 10%±6. Half (N=30, 51%) were managed non-operatively.

At discharge, 30% (n=18) had normal hand function and did not meet criteria for outpatient hand therapy. Over 70% (n=43) received outpatient referrals, but only 44% (n=19) of those referred reliably returned for outpatient OT.

Despite having outpatient OT referrals, 33% (n=14) did not present to outpatient therapy after repeats attempts of contact, and 67% (n=29) of those with referrals only came to one visit. Of those that did not complete therapy, most (n=14, 58%) were lost to follow up and unable to be contacted. Other reasons for not completing therapy within our system were out-of-network insurances requiring follow-up outside our hospital (36%) and incarceration (6%).

Conclusions

At our center, nearly 1 in 3 patients with hand burns had excellent function upon discharge and did not require outpatient therapy. However, when patients are referred for outpatient therapy, many do not show up or maintain reliable compliance. Many patients are simply lost to follow up.

Applicability of Research to Practice

While occupational therapy remains an effective and viable option for hand rehabilitation, further efforts must be aimed at providing patients mechanisms and education for achieving reliable outpatient follow up.
822 Smoking on Home Oxygen and Burn Related Injuries. a Single Center Experience
Authors: Mubang Ronnie , Horrell Erin Wolf , Folliard Sarah A , Beyene Robel , Gondek Stephen , Thompson Callie M
Published: March 2020

Introduction

Oxygen therapy is a mainstream treatment for many cardiopulmonary disease processes in the United States with COPD being most common. Despite various warnings against smoking on oxygen therapy, some patients continue to smoke on oxygen and sustain burn-related injuries. These patients are frequently intubated due to concern for inhalation injury. We aim to characterize the injury patterns, morbidities, and mortalities associated with burns sustained while on oxygen therapy at home. We hypothesize that the prevalence of these injuries is underrecognized.

Methods

We performed a retrospective review of all patients ≥45 years of age admitted to our regional burn center from 10/2018-4/2019. Injuries related to smoking on home oxygen were isolated and patient and injury characteristics are described.

Results

A total of 143 patients were included in this review, 20 patients (15%) had injuries related to smoking on home oxygen. Patient and injury characteristics are described in Table 1. Notably, 25% of patients were intubated and none of those patients had an inhalation injury documented on bronchoscopy. Four patients were extubated within a day of admission & one patient was extubated on hospital day 2. No patient died in-hospital. Nine patients (45%) required an escalation of care in the post-acute care period.

Conclusions

Smoking on home oxygen is an underrated problem and better education is needed for both patients receiving the therapy and providers prescribing the therapy. Due to the mechanism, inhalation injury is rare though a significant percentage of patients continue to receive prophylactic intubation.

Applicability of Research to Practice

This study describes the prevalence of thermal injuries associated with smoking while on oxygen therapy. This study provides additional data for patients and prescribers to underscore this risk.

External Funding

None.
832 Trends for Treatment of Complex Hand Burns in the Acute Setting
Authors: Sher Malvina , Freudenberger Stephanie , Auriemmo Stephanie , Tufaro Patricia , Hunter Hope , Marren Maureen , Chang Philip
Published: March 2020

Introduction

Complex hand burns require special consideration of therapy practices within the acute setting. Deep hand burns, their associated injuries, and the sequelae of healing can cause significant dysfunction. The purpose of this study was to examine current practices in the inpatient treatment of complex hand burns in order to identify potential trends that may guide clinical practice for edema management, anti-deformity positioning, and range of motion (ROM).

Methods

A confidential internet survey was sent to burn therapists in this country from the American Burn Association (ABA) Occupational and Physical Therapy (OT/PT) Special Interest Group list. One therapist from each burn center was asked to complete the survey.

Results

There were 41 respondents representing 33% of burn centers. The majority of respondents were occupational therapists (78%) from burn centers with 500 or less annual admissions (76%) and more than 16 years of experience treating burn patients (68%). Burn therapists most commonly measure composite (57%) and isolated (51%) joint passive/active ROM, followed by measuring distance from fingertip to distal palmar crease (43%). With questionable or confirmed tendon involvement, the majority (68%) of OT/PTs performed isolated joint techniques, with active ROM the most common at 38%. Therapists initiate edema management, other than elevation, within 24 hours (44%) from the patient’s admission. The most prevalent edema management practice is active exercise (94%) compared to other more aggressive practices such as self-adherent wrap (50%). Anti-deformity orthotics are initiated within 24 hours (44%) and are the most common means of post-graft immobilization (41%). For hand stiffness, 53% of therapists utilize casting. For stiff proximal interphalangeal (PIP) joints, joint mobilization (45%) and thermal modality with ROM exercises (32%) were viewed as the most effective interventions, surpassing orthotics and casting. While 88% of centers utilize an interdisciplinary approach to care for the hand, 59% view the hand as a surgical priority. Percutaneous pins are utilized for joint stability, most frequently in PIP joints (62%) and remained 2–3 weeks on average (45%).

Conclusions

The survey highlights trends directed towards a more conservative management of complex hand burns related to edema management, anti-deformity positioning, and ROM. There is less of a clear consensus among burn therapists on how to approach complicated hand injuries that involve exposed/injured tendons or stiff joints. Interdisciplinary rounds can be utilized to promote communication regarding more aggressive means of therapy intervention in order to improve patient outcomes related to the hand.

Applicability of Research to Practice

Present current trends in the inpatient treatment of complex hand burns.
857 Reconstruction of the Pediatric Upper Extremity Following High Voltage Electrical Burn Injury
Authors: Depamphilis Matthew A , Cauley Ryan , Sadeq Farzin , Sheridan Robert , Driscoll Daniel N
Published: March 2020

Introduction

High voltage electrical burns are often associated with significant morbidity, posing great acute and delayed reconstructive challenges for plastic surgeons. As survival from these injuries increases, attention has been focused on improving quality of life post burn injury through restoration of sensory and motor function. However, due to the complexity of the upper extremity and its small surface area in pediatric patients, its reconstruction can be a very complex endeavor. Especially in pediatric patients that are still growing, ensuing great risk for upper extremity contracture and deformity.

Methods

A retrospective chart review was conducted on patients aged 0–18 years admitted to our institution with a high voltage electrical burn involving the upper extremity. The timeframe under study was 13 years from January 1st 2005 to December 1st 2018. This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board.

Results

Out of the 68 electrical burns treated at our pediatric burn center, 58 involved the upper extremity. This further divides into 37 patients with high voltage and 31 patients with low voltage upper extremity electric burns. Of the 37 high voltage upper extremity patients, 35 underwent acute surgical management and 18 had delayed surgical reconstruction for the upper extremity.

Conclusions

The reconstructive techniques employed at our institution following severe electrical injuries typically follow a reconstructive ladder. The majority of chronic contractures in our series were successfully treated with either minimally invasive techniques such as laser and steroid infiltration, local tissue flaps, or release and skin grafting. Applicability of Research to Practice Multidisciplinary treatment of severe electrical injuries to the upper extremity is vital to optimizing a patient’s long-term function. Given the significant depth of injury in cases of electrical burns to the upper extremity the risk of developing contractures is relatively high. The expeditious treatment of secondary contractures is important to maximize a patient’s long-term function. The general treatment of contractures of the upper extremity should be based on the location and severity of the contracture, with considerations made for the patient’s reconstructive goals.
868 Guideline for Discharge Opioid Prescription Management in Adult and Pediatric Burn Patients
Authors: Bui An , Williams Felicia N , Chrisco Lori , Sljivic Sanja , Nizamani Rabia , Cairns Bruce , Jones Samuel W
Published: March 2020

Introduction

Pediatric and adult burn survivors are at risk for chronic opioid dependency. Conversely, undertreatment of pain can negatively affect mental health and patient compliance. Overtreatment has arguably led to the current opioid legislation. Despite an opioid-limiting mandate, there has been little direction for streamlining prescribing practices and there has been no guideline established to facilitate prescribing practices for burn patients. We evaluated the efficacy of a standard opioid prescribing schedule (SOPS) for surgical patients admitted greater than four days, based on pain scores, in our adult and pediatric burn patients.

Methods

This was a retrospective review conducted between June 2018 to June 2019 of our prescribing practices compared to a newly established standardized prescribing schedule. All patients admitted to the burn center were included if they had a length of stay longer than 4 days, and were prescribed oxycodone doses between 0-60mg within the last 24 hours of their stay. The primary outcome was amount of oxycodone prescribed upon discharge compared to the doses they received within their last 24hrs before and after the SOPS was established.

Results

The year before the SOPS was developed, we prescribed an average of 140mg of oxycodone to our pediatric patients upon discharge, even when they used 0mg within 24 hours of discharge. We prescribed an average of 165mg of oxycodone to adult patients who required 0mg 24hrs prior to discharge. We prescribed an average of 200mg to adult patients who required 15mg. We prescribed an average of 235mg to adult patients who required 35mg. We prescribed 310mg to adult patients that required the maximum of 60mg within their last 24 hours. This represented 0% compliance. After adopting the surgical standard opioid prescribing schedule to determine doses, we became 87.5% complaint with all patients and saw no increased in readmissions for pain.

Conclusions

An institutional guideline for discharge opioid prescribing practices has reduced the number of opioid pills patients take home, and the risk for overtreatment. A Standardized Opioid Prescribing schedule for burn patients is feasible and merits further investigation.

Applicability of Research to Practice

This study demonstrates the benefits of a standardized prescribing schedule and its applicability to burn patients.
The pandemic of social media panic travels faster than the COVID-19 outbreak
Authors: Depoux Anneliese , Martin Sam , Karafillakis Emilie , Preet Raman , Wilder-Smith Annelies , Larson Heidi
Published: March 2020

We need to rapidly detect and respond to public rumours, perceptions, attitudes and behaviours around COVID-19 and control measures. The creation of an interactive platform and dashboard to provide real-time alerts of rumours and concerns about coronavirus spreading globally would enable public health officials and relevant stakeholders to respond rapidly with a proactive and engaging narrative that can mitigate misinformation.
Concussion Symptom Characteristics and Resolution in 20 United States High School Sports, 2013/14-2017/18 Academic Years
Authors: Chandran Avinash , Kerr Zachary Y , Roby Patricia R , Nedimyer Aliza K , Arakkal Alan , Pierpoint Lauren A , Zuckerman Scott L
Published: March 2020

BACKGROUND

High school (HS) sport-related concussions (SRCs) remain a public health concern in the United States.

OBJECTIVE

To describe patterns in symptom prevalence, symptom resolution time (SRT), and return-to-play time (RTP) for SRCs sustained in 20 HS sports during the 2013/14-2017/18 academic years.

METHODS

A convenience sample of athletic trainers reported concussion information to the HS RIOTMsurveillance system. Symptom prevalence, average number of symptoms, and SRT and RTP distributions were examined and compared by event type (practice, competition), injury mechanism (person contact, nonperson contact), sex, and contact level (collision, high contact, and low contact) with chi-square tests and Wilcoxon rank-sum tests.

RESULTS

Among all SRCs (n = 9542), headache (94.5%), dizziness (73.8%), and difficulty concentrating (56.0%) were commonly reported symptoms. On average, 4.7 ± 2.4 symptoms were reported per SRC. Overall, 51.3% had symptoms resolve in <7 d, yet only 7.9% had RTP < 7 d. Differential prevalence of amnesia was seen between practice and competition-related SRCs (8.8% vs 13.0%;P < .001); nonperson-contact and person-contact SRCs (9.3% vs 12.7%;P < .001); and female and male SRCs in low-contact sports (5.8% vs 17.5%;P < .001). Differential prevalence of loss of consciousness was seen between practice and game-related SRCs (1.3% vs 3.2%;P < .001); and female and male SRCs in high contact sports (1.2% vs 4.0%;P < .001). Differential longer SRT (>21 d) was seen between new and recurrent SRCs (9.4% vs 15.9%;P < .001).

CONCLUSION

Headache was the most commonly reported symptom. Notable group differences in the prevalence of amnesia, loss of consciousness, and SRT may be associated with more severe SRCs, warranting further attention.
Treatment of Acutely Ruptured Cerebral Aneurysms With the Woven EndoBridge Device: Experience Post-FDA Approval
Authors: Al Saiegh Fadi , Hasan David , Mouchtouris Nikolaos , Zanaty Mario , Sweid Ahmad , Khanna Omaditya , Chalouhi Nohra , Ghosh Ritam , Tjoumakaris Stavropoula , Gooch M Reid , Rosenwasser Robert , Jabbour Pascal
Published: March 2020

BACKGROUND

Coil embolization of ruptured bifurcation aneurysms is challenging and often necessitates adjunctive stenting, which requires antiplatelet therapy in the setting of subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB; Terumo) device is an alternative self-expanding 3D mesh that does not require antiplatelet agents. However, its use has been mostly reserved for unruptured aneurysms.

OBJECTIVE

To assess the safety and feasibility of ruptured aneurysm treatment with the WEB.

METHODS

Retrospective analysis of 9 SAH patients with 11 aneurysms that were treated with the WEB device at 2 institutions after FDA approval.

RESULTS

Hunt and Hess grades were III and IV in 4 (44%) each and V in 1 (11%). All patients were treated within 24 h of hospitalization, and a single WEB was used in all but one aneurysm. Aneurysms treated were 3 basilar tip, 2 anterior communicating artery, 2 posterior inferior cerebellarartery, 1 middle cerebral artery, 1 carotid-ophthalmic artery, 1 posterior communicating artery, and 1 vertebrobasilar junction. Mean aneurysm height and width were 6.2 ± 2.2 mm (range: 3-10) and 5.6 ± 3.0 mm (range: 3.3-14), respectively. Mean dome-to-neck ratio was 1.7 ± 0.8 (range: 1.0-3.8). There was one intraoperative rupture that occurred because of device dislodgement and was managed with embolization. There were no treatment-related mortalities and no re-rupture after securement of the aneurysms with the WEB.

CONCLUSION

Our preliminary experience indicates that the WEB device can be used safely for ruptured aneurysms of various sizes in the anterior and posterior circulation. Larger series with long-term follow-up are necessary to confirm our findings.
Operative Treatment of a Superior Cerebellar Artery Perforator Dissecting Aneurysm
Authors: Lee Jonathan J , Huang Meng , Guerrero Jaime , Desai Virendra R , Jenson Amanda , Austerman Ryan , Diaz Orlando , Britz Gavin W
Published: March 2020

BACKGROUND AND IMPORTANCE

Superior cerebellar artery (SCA) perforator aneurysms are extremely rare, with only one other case published in the literature. There is no conclusive management strategy for these aneurysms, although endovascular treatment, open surgical treatment with clipping, and antifibrinolytic administration with spontaneous thrombosis have all been discussed.

CLINICAL PRESENTATION

A 61-yr-old male presented with intraventricular hemorrhage (IVH) primarily in the posterior fossa. He was found to have a dissecting left SCA perforator aneurysm lying on the floor of the fourth ventricle. The aneurysm was not amenable to endovascular treatment, and antifibrinolytic therapy failed to spontaneously thrombose the aneurysm. We performed a suboccipital craniotomy and used a supracerebellar transvermian approach to resect the aneurysm. There was total obliteration of the aneurysm on postoperative cerebral angiogram.

CONCLUSION

SCA perforator aneurysms represent an extremely uncommon subset of intracranial aneurysms. The best therapeutic strategy has yet to be definitively proven. When pursuing surgical treatment, the supracerebellar transvermian navigated approach can be a useful and safe option, as described and illustrated in this video.
A Unified Welfare Analysis of Government Policies*
Authors: Hendren Nathaniel , Sprung-Keyser Ben
Published: March 2020

We conduct a comparative welfare analysis of 133 historical policy changes over the past half-century in the United States, focusing on policies in social insurance, education and job training, taxes and cash transfers, and in-kind transfers. For each policy, we use existing causal estimates to calculate the benefit that each policy provides its recipients (measured as their willingness to pay) and the policy’s net cost, inclusive of long-term effects on the government’s budget. We divide the willingness to pay by the net cost to the government to form each policy’s Marginal Value of Public Funds, or its ``MVPF''. Comparing MVPFs across policies provides a unified method of assessing their effect on social welfare. Our results suggest that direct investments in low-income children’s health and education have historically had the highest MVPFs, on average exceeding 5. Many such policies have paid for themselves as the government recouped the cost of their initial expenditures through additional taxes collected and reduced transfers. We find large MVPFs for education and health policies among children of all ages, rather than observing diminishing marginal returns throughout childhood. We find smaller MVPFs for policies targeting adults, generally between 0.5 and 2. Expenditures on adults have exceeded this MVPF range in particular if they induced large spillovers on children. We relate our estimates to existing theories of optimal government policy, and we discuss how the MVPF provides lessons for the design of future research.
Higher Serum C-Reactive Protein Levels in Catatonic Patients: A Comparison to Non-catatonic Patients and Healthy Controls
Authors: Zhou Fu-Chun , Lee Joseph W Y , Zhang Qi-Hang , Sun Zuo-Li , Bo Qijing , He Xiao-Xiao , Han Tian , Xiong Min , Li Chaohui , Wang Chuan-Yue
Published: March 2020

Catatonia is a psychomotor syndrome defined by a constellation of predominantly motor symptoms. The aim of the present study was to determine whether recently admitted psychiatric patients with catatonia exhibited higher serum C-reactive protein (hs-CRP) levels compared to non-catatonic psychiatric patients and healthy controls (HCs). Recently admitted psychiatric patients were screened and evaluated for the catatonia syndrome using the Bush-Francis Catatonia Rating Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The study sample was formed by 150 individuals (39 male and 111 female), including 51 catatonic patients, 55 non-catatonic patients, and 44 HCs. Serum hs-CRP levels were processed with the enzyme-linked immunosorbent assay. Serum levels of creatine kinase (CK), adrenocorticotropic hormone (ACTH), immunoglobulin G (IgG), complement component 3 (C3), and complement component 4 (C4) were also determined. There was a significantly higher percentage of patients with high inflammatory levels (hs-CRP > 3000ng/ml) in the catatonic (43.1%) than in the non-catatonic (14.5%) or HCs group (9.1%) (χ 2 =18.9, P < .001). Logistic regression showed that catatonic patients had significantly higher hs-CRP levels compared to non-catatonic patients even after controlling for other clinical and laboratory variables (OR = 3.52, P = .015, 95% CI 1.28–9.79). Multiple linear regression analysis revealed that log-transformed hs-CRP was independently predicted by body mass index and log-transformed C4, ACTH, and Cortisol in catatonic patients. Findings of the present study suggest that catatonia is specifically linked to a higher level of systemic inflammation, not merely attributable to the overall psychopathology, or alterations in the stress level and complement system.