bluuebunny/crossref_metadata_2025 huggingface dataset:
89 Pooled Safety Analysis Evaluating Bioengineered Allogeneic Cellularized Construct in Patients with Deep Partial-thickness Thermal Burns
Authors: Holmes James H , Cancio Leopoldo C , Faucher Lee D , Foster Kevin N , Gibson Angela
Published: March 2022

Introduction

Autograft (AG) is the standard of care treatment for deep burns but requires creation of a donor site wound prone to pain and scarring. Treatment with a bioengineered allogeneic cellularized construct (BACC) is an alternative approach that can reduce or eliminate the need for autografting. The BACC is a bilayer construct that was recently approved in the US for the treatment of adult deep partial-thickness (DPT) burns. Here, we report the analysis of pooled safety data from two open-label, randomized, controlled trials (STRATA2011 [NCT01437852] and STRATA2016 [NCT03005106]) that evaluated efficacy and safety of BACC versus autografting in patients with DPT burns.

Methods

The trials enrolled 101 patients aged ≥18 years with 3–49% total body surface area (TBSA) thermal burns. In each patient, two DPT areas on the torso or extremities were randomized to receive BACC or AG, where the mean total BACC dosage was 234.8 cm2 (range: 12.0–960.0 cm2). The safety endpoints assessed at each visit included: 1) treatment-emergent adverse events (TEAEs), treatment-related AEs (TRAEs), and serious AEs (SAEs); 2) changes in immunologic responses (panel reactive antibodies [PRA], anti-bovine serum albumin [BSA] antibody response [STRATA2016 only]); 3) persistence of allogeneic DNA; and 4) laboratory exam and vital signs.

Results

Eighty-seven patients (86.1%) experienced TEAEs, 30 patients (29.7%) experienced TRAEs, and 16 patients (15.8%) experienced SAEs. The most frequent TEAEs reported by ≥10% of patients in the pooled analysis were pruritus (n=31, 30.7%) and blister, hypertension, and hypertrophic scar (n=11, 10.9% each). The most frequent TRAEs (≥5% of patients) were pruritus (n=13, 12.9%) and blister (n=5, 5%). The most common SAEs were transplant (BACC or AG) failure, pneumonia, and deep vein thrombosis (n=2, 2% each), where only one SAE (impaired healing of moderate severity) was possibly related to BACC. One patient (1%) discontinued the trial due to a TEAE (traumatic brain injury). Two patients (2%) experienced SAEs that led to death, neither related to BACC. The number of patients with positive PRA values that were negative at baseline were 36 (38.7%) at Day 28 and 20 (22%) at Month 3. The number of patients with reactivity to HLA I class alleles found in the BACC increased from 4 (4%) at baseline to 39 (40.9%) at Day 28, then decreased to 22 (24.2%) at Month 3. No persistence of allogeneic DNA from the BACC was detected.

Conclusions

BACC is well tolerated and is not associated with any unexpected SAEs or TEAEs. The safety profile at BACC treatment sites is similar to that at AG treatment sites. Thus, BACC may offer a safe alternative to autografting for the treatment of DPT burns.
96.5 Using Computer Vision-Based Algorithms Trained on Mobile-Device Camera Images for Monitoring Burn Wound Healing
Authors: Chan Hannah O , Joshi Rakesh , Morzycki Alexander , Pun Andrew C , Wong Joshua N , Hong Collins
Published: March 2022

Introduction

The appropriate characterization of burn depth and healing is paramount. Unfortunately, the accuracy of approximating thermal injury depth among all physicians is poor. While tools to improve detection accuracy, including laser doppler imaging and laser speckle imaging exist, these technologies are expensive and limited to specialized burn referral centres. They also do not provide an easy means for quantitative, interval tracking of burn healing. Considering these limitations, the application of artificial intelligence has garnered significant interest. We herein present the use of three novel machine learning and computer vision-based algorithms to track burn wound healing.

Methods

Convolutional neural network (CNN) models, were trained on 1800 2D color burn images, to classify them into four burn severities. These CNNs were used to develop saliency algorithms that identify the highest “attention” pixels used to recognize burns. Image-based algorithms that count these attention pixels of the CNN, count pixels representing red granulation of burns, and measure burns, were also developed. As proof-of-concept, we tracked the healing of a localized burn on a 25-year-old female patient. The patient suffered a scald on the dorsum of the foot, resulting in a deep partial-thickness burn. Opting out of surgical intervention, the patient visited the hospital over a 6-week period for treatment with non-adhesive dressings and silver nitrate. High-resolution images of the burn, with and without a fiducial marker, were captured with a smartphone camera every 7-days. Images were taken under institutional lighting and used as algorithmic inputs.

Results

Data analyses indicate that the healing of the open-wound area was accurately measured in millimetres (+/- 1.7 mm error) using a fiducial marker (18.3 mm diameter). The open-wound area shrank consistently from week 1 to week 6 seen in (Figure 1. a-b). The normalized, 2D colour images, where the “red” pixel value was counted (Figure 1. a-b), confirms the reduction of the red granulation in the wound. The saliency algorithm also measured a percentage reduction in the machine learning model’s total attention pixels over the 6-week period (Figure 1. c-d). This suggests that the model was less discerning of the healing burn wound over time, suggesting burn healing, which was also clinically validated.
107 Nursing Interventions in the Temperature Management of Acute Burn Patients in the Burn Operating Room
Authors: Polsgrove Nicole , Zieger Madeline , Roggy David , Hartman Brett C
Published: March 2022

Introduction

The development of hypothermia in the operating room is a known risk that has been well documented in the literature. The typical surgical patient undergoing general anesthesia experiences a temperature loss of approximately 4°F without warming interventions. Burn patients are at a higher risk for hypothermia due to the greater body surface area exposure and evaporative losses related to their burn injury and length of their operative interventions. The purpose of this review is to determine the average loss of body temperature of the burn surgical patient as it pertains to total body surface area (TBSA) injury and the use of warming interventions.

Methods

A two year retrospective review was performed on acute burn surgical cases in our two dedicated burn operating rooms within our burn center. Data obtained included TBSA of each case, pre and post-procedure patient temperatures, maximum OR room temperature, and use of adjunctive warming interventions. The surgical procedures were categorized by percent TBSA burn of < 10%, 10-20%, 21-40%, and >40%.

Results

We identified 415 cases that were included in this review from 2019 and 2020. As expected, patients with larger TBSA involvement led to a greater temperature decline. As seen in Table 1, forced warm air devices were utilized in 67.2% of cases. In our large Burn OR suite, we utilize a heat panel that is integrated in the ceiling above the OR table. Utilization of these devices is determined by the Burn OR nurse. They are either initiated prior to the start of the case or intra-operatively if the patient’s temperature is declining and intervention is required. Mean operating room temperatures were 80.1°F in all cases with cooler room temperatures in the smallest TBSA group. Our average patient temperature decline was 1.25°F in all cases. However, in the largest TBSA group, the mean temperature loss was 2.68°F which is significantly less than the 4°F loss in general anesthesia procedures without warming interventions.

Conclusions

The use of elevated ambient operative room temperatures along with other warming interventions aid in the maintenance of core body temperature in the burn surgical patient. Having dedicated burn operative nurses with investment in the outcome of the burn surgical patient contributes to the overall safety and the maintenance of temperature homeostatic state.
517 Outcomes of Patients with Burns Associated with Home Oxygen Therapy: An Institutional Retrospective Review
Authors: Yoon Joshua S , Khoo Kimberly H , Puthumana Joseph S , Keller Patrick R , Lagziel Tomer , Cox Carrie A , Werthman Emily H , Galiatsatos Panagis , Hultman Charles S
Published: March 2022

Introduction

Home oxygen therapy (HOT) is frequently prescribed for patients with pulmonary dysfunction, which predisposes them to a unique health hazard at home. Prior studies show that HOT burns carry high morbidity and mortality, in large part due to inhalational injury. A significant portion of HOT patients are active smokers, which is the most frequent cause of HOT ignition. We conducted a retrospective review of patients with HOT related burns at our institution to characterize demographics and outcomes in this patient population.

Methods

An IRB-approved single-institution retrospective review was conducted by querying our institutional burn registry for patients diagnosed with head and neck burns between July 2016 and January 2021. Patients with burns due to HOT ignition were included. Patients were separated into three groups: i) discharged from the emergency department (ED), ii) observed for less than 24 hours, and iii) admitted to the hospital. Demographic and clinical outcome data were compared between groups.

Results

We identified 100 patients with HOT burns, who were evaluated from 2016-2021, during which time we treated 3606 patients with burn injuries. Mean age was 66.6 ± 9.3 years with a male to female ratio of 1.3:1 and median TBSA of 1%. In these patients, 97% were on HOT for COPD and smoking caused 87.3% of burns. Thirteen were discharged from the ED, 35 observed for less than 24 hours, and 52 admitted. For admitted patients, 69.2% were admitted to the ICU with a median ICU stay of 1.5 days, 37% required intubation for a median duration of 1 day, and 11.5% required debridement and grafting with an average of 2.6 ± 1.6 procedures. Inhalational injury was found in 26.9% of patients, 3.9% underwent tracheostomy, and 17.3% experienced hospital complications. In-hospital mortality was 9.6% and 7.7% discharged to hospice. Among those admitted, median length of stay was 4 days and 67.3% discharged home. After discharge, 13.5% required readmission within 30 days. Patients admitted to the hospital had significantly higher rates of admission to the ICU, intubation, and inhalational injury compared to those that were not admitted (p < .01).

Conclusions

Most HOT-related burns are caused by smoking and these injuries can result in significant morbidity and mortality. Efforts to educate and encourage smoking cessation with more judicious HOT allocation would assist in preventing these unnecessary highly morbid injuries.
526 Keep it up! Inpatient Weight Changes in Burn Patients with >20%TBSA
Authors: Lagziel Tomer , Yoon Joshua S , Martinez Stephanie L , Cox Carrie A , Duraes Eliana F , Hultman Charles S , Caffrey Julie
Published: March 2022

Introduction

Burn patients with >20%TBSA suffer from a hypermetabolic state causing loss of muscle mass as well as a compromised immune system and delayed wound healing. Weight loss is most severe in patients with >20%TBSA with an initial gain of weight due to fluid resuscitation. These findings led the American Burn Association to propose new quality measures for burn-injury admissions, including weight loss from admission to discharge. We aim to assess how our institution’s outcomes adhere to the proposed measures and if our findings correlate with previously described results.

Methods

A retrospective review was conducted for adult patients admitted to our institution with burn injuries of >20%TBSA since 2016. Three groups were established based on %TBSA: 20-29% (Group 1), 30-39% (Group 2), and >40% (Group 3). We assessed weight changes from admission to discharge and performed a multivariate analysis to account for age, sex, number of surgical procedures, and hospital length-of-stay (LOS).

Results

Data from 40 patients suffering burn injuries of >20%TBSA showed 11 patients with %TBSA of 20-29%, 10 patients with %TBSA of 30-39%, and 19 patients with %TBSA of >40%. When comparing groups 1 and 2, we saw significantly more weight loss in group 2 over the course of admission without a significant change in total hospital LOS. The average %weight loss for group 1 was 1.46%, 8.36% for group 2, and 10.56% for group 3. No patients in group 1 had a weight loss >15%. For group 2, patients with weight loss >15% had a significantly longer LOS and underwent significantly more surgical procedures during their admission. For group 3, most patients that experienced weight loss >20% did not have a longer LOS but did require more surgical procedures during their course of admission.

Conclusions

Analysis of the data demonstrates that patients with >20%TBSA do suffer significant weight changes, likely due to extreme metabolic disturbances. Our data suggests that an increased length of stay is not a significant driver for weight loss changes between patients with %TBSA of 20-29 and 30-39, suggesting other pathophysiologic mechanisms in play. Our data supports the idea that patients with %TBSA>40 are a unique subset of patients, requiring specialized nutritional protocols and metabolic analysis.
531 Comparison of Clinical Estimation and Stereophotogrammic Instrumented Imaging of Burn Scar Height and Volume
Authors: Bharadia Shyla K , Gabriel Vincent
Published: March 2022

Introduction

Descriptive clinical tools for the characterization of burn scar features are limited by variability between users and unknown sensitivity to change over time. We have previously described pre-clinical assessment of stereophotogrammetry as a valid measure of burn related scar and in this study compare the estimated vs. instrumented measurement of maximum height and total positive volume of burn scars in a tertiary care adult outpatient burn clinic.

Methods

This study was approved by our university’s research ethics board. All participants provided written informed consent. Persons 18 years or older presenting to an outpatient burn clinic with closed burn scar that may be captured in a single image were enrolled in the study. Patients with scars from other injuries or who were unable to provide consent were excluded. Photographs of burn scars were taken with a commercially available 3D camera. Three experienced wound care therapists estimated the maximum height and total positive volume of the collected images. The images were assessed with stereophotogrammic software with results exported to a spreadsheet for further analysis. Two factor analysis without replication was performed to calculate intra-class correlation coefficients (ICC) between the assessors estimated scar height and volume and the measured height and volume. Two sided Wilcoxon tests were performed comparing mean estimated height and volume between estimated and measured output.

Results

Fifteen participants with a mean age of 42.6 (21-68) were enrolled. Twenty-six scar images were taken from wounds that were managed by non operative treatment (20), excision and grafting (5), and 1 image was collected from a skin graft donor site. Scar images were taken of the trunk and extremities, but none of the head nor neck. The estimated maximum scar height ICC was 0.595 and volume 0.531. The measured scar height ICC was 0.933 and volume 0.890. Wilcoxon tests of estimated and measured volume were significantly different (z = -2.87, p = 0.041). Comparison of estimated and measured height were not significant (z = -1.39, p 0.161).

Conclusions

Stereophotogrammic measurement of maximum scar height and total scar volume is more reliable than clinical photograph assessment. Clinical estimation of scar volume is significantly less than instrumented measurement, although maximum estimated vs. measured scar height was not significant in this study. There are limitations in measuring scar properties for image capture that exceeds the visual field.
535 Pre-operative Expectations, Post-operative Satisfaction and Patient Directed Priorities for Clinical Burn Research
Authors: Bharadia Shyla K , Horch Jenny , Burnett Lindsay , Yu Zheng , Shen Hua , Gabriel Vincent
Published: March 2022

Introduction

Patients receiving split thickness skin grafting due to deep burns are left with scarring and chronically dysfunctional skin at the graft site. Given evidence that patients’ pre-operative expectations mediate post-operative outcomes and satisfaction, we sought to describe burn patients’ experience, expectations, and satisfaction with their skin graft, and their views towards a future cell-based clinical trial to improve their graft, over time. We also aimed to identify graft outcome measures for use in future studies.

Methods

This study was approved by our university's research ethics board. All participants provided written and informed consent. Data were collected via patient questionnaires pre-operatively, one, and three months post-operatively.

Results

Most patients had small burns. Expectations of graft function were consistent pre- and post-operatively. Expectations of graft appearance showed significant decrease over time (β 1 = -0.290, p = 0.008). Significant improvements in skin function (β 1 = 0.579, p = 0.000) and appearance (β 1 = 0.247, p = 0.025) at the wound site during recovery were observed, although patients noted great difference between grafted and normal skin. Patient satisfaction with their graft did not change significantly over time. Patients were willing to participate in a cell-based clinical trial that may improve graft symptomology. They prioritized diminished scarring, redness, and improved sensation and elasticity as the most salient aspects of grafts to be enhanced by cell-based therapy.

Conclusions

Patient graft concerns changed over time; outcome measures in trials advancing skin grafting should reflect chronic, patient prioritized limitations.
554 Preventing accidental central line removal: Early success through a novel securement device
Authors: Ha Aemilio W , Thomas Mini
Published: March 2022

Introduction

Central Venous Catheter (CVC) placement and maintenance can be difficult due to non-intact skin and possible surrounding weeping wounds. In addition, routinely used products require intact skin for the adherence of the central line dressing along with sutures or securement devices. With the increased number of line dislodgements, the Burn Intensive Care Unit (BICU) searched for alternative means of line securement. A subcutaneously anchored sutureless system (SASS) was found that could secure the line and allow for improved cleaning around the insertion site. The SASS is a device made of metal which resides in subcutaneous portion of the skin and anchors the CVC while allowing lifting of the catheter to clean underneath.

Methods

After identification of the SASS product, a trial was implemented. Nurses (RN) and providers were trained virtually by the product representative. Nursing champions were selected to be a liaison between the product representative and the staff. Patients included burn patients or Steven Johnsons (SJS) patients, with large open total body surface area, who had a CVC placed peripherally or centrally between September 2020 to June 2021. A survey was conducted upon insertion of the device, with dressing changes, and upon removal.

Results

In 2018, there were a total of 14 CVC dislodgements and 12 in the year 2019. For the year 2020, there were 4 dislodgements and 2 in 2021. Both adult and pediatric patients utilized approximately 12 SASS. From the nurses who cared for the patients, 19 responses were obtained regarding the SASS. Overall, 94% of staff recommended this product for use. No accidental removal of the CVC was reported with use of the SASS. With cleaning around the catheter insertion site, 53% believed that they were able to clean better while 47% felt that it was the same with the previous practice. In terms of duration of changing the dressing and maintaining the catheter, 53% felt that it was the same while 47% thought it was faster. During maintenance, the most discomfort reported by patients was 4/10.

Conclusions

The SASS can be implemented as another viable method to prevent accidental dislodgement of the CVC while securing CVC without sutures. In addition, RNs believed it allows for faster cleaning around the insertion site and faster dressing changes with minimal discomfort to the patient. More data can be collected over longer periods of time and to look at its efficacy in non-burn patients.
557 Introduction of a Pediatric Burn Education Program in an Adult Hospital
Authors: Snyder Emily
Published: March 2022

Introduction

At a newly developed burn unit, the program decided to expand further and start admitting pediatric patients. While there are many working parts to this endeavor, we will primarily address staff preparedness. Prior to the introduction of a burn education course entitled Burns in the Pediatric Population, only a handful of nurses had received any hospital-based education for caring for pediatric patients. A previous pediatric course had been taught, however, this course focused primarily on illnesses of childhood. Staff had voiced on many occasions that they felt the education they received was not adequate and felt uncomfortable taking care of pediatric burn patients.

Methods

All Burn Intensive Care (BICU) nurses, regardless of having received the prior pediatric education, were required to take Burns in the Pediatric Population (n=42). The course content was based on the Burn Nurse Competencies. The course consisted of didactic lectures and hands-on sessions. Each participant was required to take a pre-test before the class and a post-test at the conclusion. The test included knowledge-based questions and self-rated confidence level questions. In addition, each participant was sent a survey three months after the completion of the class to evaluate their knowledge and confidence level.

Results

At the conclusion of the class, the average test score went from 49.3% to 92.7%. Both the pre-test and post-test had each nurse evaluate their own confidence level for caring for a pediatric patient. Initially, 19.5% of the nurses stated that they had no confidence in caring for a pediatric patient. At the conclusion of the class, all nurses expressed some confidence with caring for a pediatric patient, with the majority, 72.7%, stating they had moderate or high confidence.

The return rate of the three-month evaluation was 81% (n=34). The knowledge-based test had an average score of 71%. 30.3% of the staff stated that their confidence in caring for a pediatric patient increased, 54.5% stated their confidence level remained the same, and 15.1% of those returning the survey stated that their confidence level decreased in the three month time period.

Conclusions

The results from the three-month survey have been utilized to edit and make our pediatric mock codes and course more specific to the needs of the bedside nurses. In addition, we are planning to increase the frequency and the level of participation in our pediatric mock codes. All Burn ICU nurses will need to participate in a pediatric mock code on a semi-annual basis. In addition, there will be a section that is added to each Burn ICU nurse’s annual competency specifically covering pediatric burns.
567 Features of Burn Injuries in Youth: A Single Center Experience
Authors: Ozkan Burak , Abali Ayse Ebru , Erkent Murathan , Aydogan Cem , Moray Gokhan , Haberal Mehmet
Published: March 2022

Introduction

Youth is categorized as combination of adolescence and young adulthood. Young people are prone to injuries, because this period involves essential changes in many aspects of life within a complicated physiological and mental developmental age. Our aim was to investigate the features of burn injuries in youth.

Methods

Subjects were 622 adolescents (10-18yrs, n=313) and young adults (19-24yrs, n=309) who were treated at our burn-center from 2010 to 2021. Data collected for each case were age, sex, social-security status, occupation, marital status, scene of injury, burn extent, burn cause, history of injury, affected major body sites, and need for inpatient-care (median±SD,mean±SD)(p<.05).

Results

Median age was 18yrs±4,76. Male to female ratio was 0,66:1 with female predominance especially among young adults (0,48:1)(p˂.05). Most subjects were in civil social-security-system (n=612, 98,4%); most were students (n=475, 76,4%); a total of 103 subjects were in labour-force(16,5%); 44 were unemployed(7,1%). Most young people were single (n=600, 96,4%); 4 subjects in adolescent group and 18 subjects in young adult group were married(0,64% and %2,9 respectively); 15 of married cases were female(68,2%)(p< .05). Injuries occurred mostly at home (n=411, 66,1%). Mean total body surface area (TBSA) burned was 3,21 % ± 7,5(min:0,2 max:75). The most commonly affected body site was the hand (n=165, 26,5%). Leading burn cause was scalds (n=433, 69,6%). Female subjects mostly suffered from scalds with mean TBSA burned of 2,0%±2,21 (min:0,2 max:18)(n=297, 79,2%). However, vast majority of flame burn victims were male (n=41, 82,0%) (mean TBSA burned: 12,8%±21,35, min:0,2 max: 75) and almost all severe electrical injuries happened to male subjects (n=13, 86,7%)(mean TBSA burned:14,2±14,81, min:0,2 max:40)(p˂.05). All cases were preventable accidents; the unique instance for ‘substance-abuse related burns’ was butane-lighter-liquid burns in 9 cases(1,4%). Inpatient-care was needed for 52(8,2%) victims. Mean TBSA burned for inpatients was 13,5%±19,6(min:1, max:75). All subjects survived.

Conclusions

Our results suggest that young female subjects are prone to burn injuries, but severe injuries happen to male and there are many other aspects that should be considered. Combined evaluation of adolescents and young adults may provide purposive data for burn repositories.
569 Burn Registries State of Affairs: A Scoping Review
Authors: Gus Eduardo I , Brooks Stephanie , Multani Iqbal , Zhu Jane , Zuccaro Jennifer , Singer Yvonne
Published: March 2022

Introduction

Registry science applies observational study designs to interpret large secondary databases. It can be utilized to understand disease and injury, answer research questions, inform regulatory decision making, and engender benchmarking of quality-of-care indicators. Numerous burn registries exist globally, however their contributions to the science of burn epidemiology, care and treatment have not been summarized. The objective of this study is to characterize the available literature on burn registries.

Methods

We conducted a scoping review, having registered the protocol a priori. A comprehensive literature search across several databases, including the grey literature, was carried out. Studies of all methodological designs were included provided they utilized, analyzed, and/or critiqued burn registry data. Pilot projects from registries in development were included as well. Studies involving non-burn specific registries or registries from a single burn centre were excluded.

Results

Two hundred and sixty-eight studies were included, encompassing 16 existing burn registries. Although registry science has been used to investigate burn care since 1970, the majority of studies were published after 2007. Most studies utilized the American Burn Association Burn Registry or one of its previous versions (75.7%) and the Burns Registry of Australia and New Zealand (10.4%). Main limitations of existing registries are the inclusion of patients admitted to burn centres only, deficient capture of outpatient and long-term outcome data, and lack of data standardization across registries.

Conclusions

Registries are an invaluable source of data for research, delivery of care planning, and benchmarking of processes and outcomes. Efforts should be made to stimulate other jurisdictions to build and maintain burn registries, to incorporate data linkage from administrative and other secondary databases, and to standardize data collection, in order to maximize the potential of registry science in burn care.
570 Burn-Related Injuries Treated at Two Gulf Coast Hospitals During Following a Category 4 Hurricane
Authors: Kopari Nicole M , Rivera Mario , Phelan Herb A , Kearns Randy D , Carter Jeffrey E
Published: March 2022

Introduction

Natural disasters are commonly associated with mass destruction and severe injuries. On August 29th, 2021 a category 4 hurricane made landfall before mandatory evacuations were ordered in a major metropolitan community. The powerful storm challenged disaster management teams and first responders as communities struggled to recover. Our study analyzes the demographics of those injured and the injury patterns treated at our state’s only verified burn/trauma center and the adjacent children’s hospital in the aftermath of the hurricane.

Methods

A retrospective chart review was performed on patients seeking emergent care following the hurricane. Demographic data was abstracted from the medical records along with injury pattern including age, gender, mechanism of injury, total body surface area (TBSA), surgical interventions, and length of stay. In addition, brief surveys of fire chiefs from the two most impacted regions were performed to assess prehospital challenges.

Results

41 patients (76% male) presented to our ER with a median age of 44 (7 patients < 12 years of age). 85% of injuries occurred at home while 15% occurred at work. Of the 78% requiring admission, 66% underwent excision and autograft with a mean TBSA of 17% (range 1-80%). Power outages resulted in increased gas generator usage across the region. Most of the burn injuries following the storm were due to generator and cooking accidents (56%). Each fire chief reported up to 91 calls/day due to suspected carbon monoxide poisoning for the two weeks following the storm. A single event resulted in 8 inhalation injuries treated in our ER with one burn ICU admission. The mean hospital length of stay was 1.11 days/%TBSA for those undergoing surgery.

Conclusions

Hurricanes are more common today with many coastal cities as risk for similar natural disasters. Despite our generator safety media outreach efforts prior to the storm, this remains an opportunity for improved injury prevention. Many patients suffered delays in discharge as their homes/nursing facilities suffered structural damages and were without power and water. Disaster planning should account for limited disposition options during severe storms. Our study is the first to describe burn-related injuries from a category 4 storm and our communities’ response.
582 Expanding Burn Expertise Through Telemedicine for the Frontliners during the COVID-19 Pandemic
Authors: Firaza Myra Alexandra P , Abella Maria Redencion B
Published: March 2022

Introduction

Inexperience of frontliners and referring physicians from non-specialty centers in burn wound assessment results to the incorrect triage of patients, thereby aggravating the current hospital situations and causing unnecessary exposures. Emergency care in burn centers in developing countries must strike a balance between doctor and patient safety, and uncompromised care of burn patients. Telemedicine is deemed a valid and sound option to maintain social distancing and promote safety, yet provide proper burn care. It is a valuable and indispensable tool for all doctors of all branches of medicine and surgery. Although many of its limitations in developing countries are still being unraveled, the benefits of this technology are being realized worldwide. This study determined the accuracy and timeliness in diagnosing and classifying burn patients assessed by a frontliner non-burn specialist in-person (NBSP), a Burn Specialist online (BSO), and a Burn Specialist in-person (BSP).

Methods

All burn patients (January to March 2021) with signed consent for participation were photographed in a standardized manner by the NBSP and referred to a BSO via an online messaging application. These patients were also assessed independently by the BSP. The % total body surface area (TBSA), burn depth classification, and the time the patients were seen by the NBSP, the time the online referrals were sent to the BSO through the messaging application, the time the BSO sent the diagnoses, and the time of assessment by the BSP, were recorded. One-Way Repeated Measures Analysis of Variance (ANOVA) with and without blocking were done.Post-hoc Tukey-Test was used to analyze the pair-wise differences for any ANOVA that showed significant statistical differences.

Results

Data gathered from 82 patients throughout the 3-month study duration demonstrated that burn size (% TBSA) among the three different physicians (NBSP, BSO, BSP) was not statistically significant (p=0.8794). Our analysis also showed no statistical difference for the 19 different body parts per patient and burn depth classification (p=0.9718). One-way ANOVA tests on timeliness were statistically significant with a p-value of p< 0.0001. A post-hoc comparison using Tukey test revealed no statistical significance between the BSO and BSP (p=0.892).

Conclusions

Smartphone telemedicine platform through photographic transfer and analysis is an accurate method in estimating burn size and depth classification. Timeliness can be improved with a dedicated 24/7 online available burn specialists and a reliable network access. Hence, frontliners can refer to burn specialists in a developing country using this telemedicine platform for optimum burn care with an accurate diagnosis and overcome the challenges during and even after this pandemic.
589 Video-Enhanced Telepresence for Burn Care may Improve Patient and Staff Satisfaction
Authors: Cordova Alfredo C , Kane Chelsea , Miller Samuel M , Heller Margaret , Bernal Nicole O
Published: March 2022

Introduction

Telemedicine and telepresence technology successfully contributes to the care of patients in different medical disciplines. Burn care is a highly specialized field that requires a multidisciplinary team and frequent visual evaluation of a patient’s injuries. Wound care can be extensive and demanding. Physician availability at the “Wound Care Room” is often limited by other responsibilities in the operating room, emergency department, surgical clinic, or academic conferences. We hypothesized that the incorporation of a telemedicine platform would provide greater access to surgical providers (SP- burn surgeons, general and plastic surgery residents) and allow for more efficient evaluation and prompt decision making. We also predicted that it would improve communication among SP, nursing staff (NS- nurses and nurse aides), and burn patients (BP) in real time without compromising BP privacy and comfort.

Methods

A dual-way video and voice telemedicine platform was incorporated into burn care at a Level-1 Trauma Center and ABA-verified Burn Center. The video module was positioned so that SP were able to remotely assess the progression of burn injuries during wound care. Patients included were hospitalized and undergoing wound care by NS. Adult BP were included regardless of age, burn thickness, and burn surface area. BP, SP, and NS were asked the following questions after wound care had been provided:

1. Did you feel comfortable using this technology?

2. Was the patient’s sense of privacy compromised?

3. Did use of the video module enhance the provision of care?

4. Did use of the video module improve team communication?

5. Overall, were you satisfied with the use of the platform?

Results

BP with ages ranging from 18-74 years old and with injuries involving 8-44% TBSA were included. Interviews from 38 patient encounters were conducted, and included input from 4 SP, 6 NS, and 24 BP.

The BP, SP, and NS surveyed all reported comfort using this technology. There were no reports of concern for patient’s privacy. SP felt they could make a final management plan in 74% of the cases, with difficulty arising in 26% of cases due to image resolution. BP reported that use of the video modules contributed positively to their care in 87% of cases, with issues related to communication and lack of understanding arising in the other 13%.

Conclusions

Telemedicine was well accepted by all the BP, SP, and NS. The perception from NS and SP was that it enhanced prompt communication contributing to better patient care. Final management decisions were achieved in most cases, with picture resolution being identified as an area for improvement. With improved picture quality, this technology can likely be used as a reliable decision-making tool to improve care.
589 Burn Center Trainees: Not Just for Surgery or Plastic Surgery Residents
Authors: Nosanov Lauren B , Houng Abraham
Published: March 2022

Introduction

The Burn unit offers a unique training environment for residents. The Accreditation Council for Graduate Medical Education (ACGME) requires all General Surgery trainees to have knowledge of burn physiology and experience with initial burn management. However, there are no burn requirements for other ACGME-sponsored training programs except for Plastic Surgery. Since care of the burned patient spans multiple settings – the intensive care unit, operating room, wards, outpatient clinic, and the emergency department – having residents from varied specialties might benefit not only the trainee, but also the Burn Center.

Methods

A retrospective review of all residents rotated to the burn center of an American Burn Association verified unit was performed. Data from the 7/2018-6/2018 academic year were collected by analyzing resident rotational and call schedules of both intra institutional and inter-institutional residents. The specific time period was chosen to account for COVID affecting the number of residents more recently.

Results

A total of 48 residents rotated at the burn center during the studied academic year. Within the institution, there were 34 residents (71%): 12 general surgery interns (8 categorical, 4 preliminary), 2 plastic surgery interns, 10 emergency medicine (EM) residents, and 10 anesthesia residents. There were 14 residents (29%) from 3 outside institutions: 3 plastic surgery residents, 8 surgery interns from one program, and 3 surgery interns from another program. All surgical specialty trainees were interns, whereas other specialties, EM and anesthesia, were PGY2 trainees.

Conclusions

While most residents were from general surgery and plastic surgery programs (58%) due to ACGME requirement, a significant portion of the resident complement (42%) was from non-surgical specialties. EM residents gain competency in wound reading as well as burn critical care. Anesthesia residents learn surgical management of the burn patient and critical care procedures. Since the burn center is a tertiary referral center, having outside residents rotating in the burn unit might facilitate transfers and increase knowledge of proper resuscitation.
593 Development of a Burn Center Multi-Disciplinary Debriefing Process
Authors: Wyatt Shannon
Published: March 2022

Introduction

The purpose of debriefings are to help facilitate a healthier work environment for team members, improve processes, and improve patient outcomes. Debriefing staff members after specific events provides a time to support team member’s emotional needs, improve communication among the team members, and improve patient outcomes (Schulman, Jhanwar, and Shara, 2015; Wolfe et al., 2014). Multi-disciplinary team members working in Burn Units are repeatedly exposed to stressful patient events such as end of life, escalation of care, major burn admissions, or mass casualty events. These traumatic exposures can all increase the risk of staff burnout, which is negatively associated with resilience (Colville et al., 2017).

In 2019, our Burn Unit had 7 events that met criteria for a formal debrief but had no process for conducting these debriefs. Without a formal team debrief there is no loop closure of an event for staff and no platform to discuss potential ways to improve practice. The purpose of this project was to develop a formal debrief process and institute the process on the Burn Unit.

Methods

Criteria for debriefing were identified as adults and pediatrics requiring CPR, end-of-life care, and emergent escalation of care. Six registered nurses volunteered to be Debrief Facilitators (DFs) and underwent training utilizing real-time simulation scenarios conducted by the Simulation Education Center. DFs were provided a Process Map along with debrief tools and resources needed to conduct a formal debrief. Facilitators were responsible for initiating, organizing, facilitating, and documenting a debrief after an event that met criteria.

Results

The formal debrief process was initiated in September of 2020. Since the initiation, 12 events have met criteria for debrief. 12 formal debriefs were conducted during the following 10 months.

Conclusions

After a formal debrief process was identified and education provided by the Simulation Education Center the Burn Unit conducted 100% of events that met criteria for debriefing through June of 2021. In conclusion, giving team members formal processes, tools, and educational opportunities has proven successful for formal debriefs in the Burn Unit.
599 Eyelash Reconstruction Utilizing a Strip Graft for Burn-related Madarosis: A Case Report and Operative Technique
Authors: Driscoll Daniel N , Dabek Robert J
Published: March 2022

Introduction

Facial burns are a common occurrence with a small percentage causing injury to the periocular region. Although the eye itself is often spared, madarosis may occur from deep burn injury to the eyelid. Reconstruction of the eyelid margin is technically difficult due to the challenging aesthetic region, as well as specific characteristics of eyelashes. Although there are several options for eyelash grafting there is no established gold standard, and there is little to no-literature related to procedures involving burn madarosis.

Methods

Here we describe a case of unilateral eyelash grafting utilizing a composite strip graft in a 20-year-old female who sustained a 70% flame injury at the age of two.

Results

The presented results show the efficacy of this technique at restoring function and providing a good aesthetic result which is maintained at 1 year follow up.

Conclusions

Utilization of a composite strip graft to recreate the eyelid margin is a viable choice for reconstruction of burned upper eyelids in the appropriate patient. Further exploration regarding procedure timing and choice of donor site are warranted.
611 Progressing necrosis, how to make it stop? Clostridial collagenase debridement salvages the zone of stasis
Authors: Sood Rajiv , Bearden Robert N , Frederick Rosie
Published: March 2022

Introduction

In burns, conversion of partial thickness to deeper, full-thickness burns is largely attributed accumulation of chemical and mechanical mediators altering physiologic processes of tissue viability. Studies suggest that c. collagenase debridement digest denatured collagen without degrading otherwise intact collagen in granulation and healthy tissue. Moreover, modulating cellular responses to foster an anti-inflammatory milieu. To better understand c. collagenase effects in treatment of burns and salvaging the zone of stasis, we evaluated its ability to effectively debride while minimizing secondary necrosis for translative understanding associated with our clinical algorithm

Methods

In this prospective, controlled animal study, deep-partial thickness burns were created on the caudal dorsa. Following burn injuries, wounds were immediately cleaned and treated with either c. collagenase or a hydrogel. Daily treatment was provided. At selected time points, punch biopsies were obtained from unburned interspaces, fixed and prepared for evaluation. In tandem with pathological and histological assessment, samples were examined for cellular and analyte constituents

Results

Gross images and histology revealed, c. collagenase treatment reduced necrosis and apoptosis. In control burns, papillary and reticular dermal collagen was shown to be disorganized and advancing in necrosis as exhibited by significant (p< 0.001) staining of HMGB1. In contrast, the interstices of c. collagenase treated burns demonstrated earlier sloughing of the epidermal layer with a clearly defined basement membrane and significantly (p< 0.001) reduced HMGB1 staining. Moreover, activated caspase 3a staining was significantly (p< 0.05) reduced in c. collagenase treated burn wounds. In assessing the inflammatory response, c. collagenase-treated wounds exhibited significantly (p< 0.05) greater neutrophil influx at day 1, with macrophage recruitment throughout days 1, 2, and 4. In further evaluation, macrophage polarization to MHC II and vascular network maintenance was significantly (p< 0.05) increased in c. collagenase treated wounds

Conclusions

These data corroborate our clinical treatment algorithm, supported by presented case studies. Providing further evidence to potential cellular mechanisms to complement the clinical scenario. Thus, warranting inclusion of early treatment of c. collagenase debridement to preserve tissue from progressive necrosis
623 Multi-Modal Analgesia for > 10% TBSA Pediatric Burns
Authors: Wratney Angela , Beitz Erin , Roberts Tamara , Anderson Margaret
Published: March 2022

Introduction

A review of literature revealed no analgesia or opioid sparing treatment guidelines for > 10% TBSA pediatric burns. Clinicians may benefit from an analgesia support guidance tool for the management of critically ill PICU and non-PICU inpatient pediatric burn patients with > 10% TBSA.

Methods

A multi-disciplinary team of experts created a pediatric analgesia support guidance tool for clinicians managing non-procedural pain in critically ill pediatric burn patients in the PICU and non-PICU inpatient setting. Agent selection was at the discretion of the clinician based on FLACC scoring. We performed a retrospective chart review, Jan 2019 to Jun 2021, of pediatric patients age 1 month to 14 years of age admitted to the Pediatric Burn Trauma service with > 10%TBSA. Analgesia was categorized as Yes/No for acetaminophen, ibuprofen, opioids (morphine, fentanyl, oxycodone, hydromorphone), gabapentin, alpha 2-agonists (dexmedetomidine, clonidine).

Results

16 pediatric burn patients age 2 months to 14 years. 75% male, 4 (25%) PICU, 3 (19%) mechanically ventilated. Average LOS 7.19 days, range 1 to 25 days. 9 (56%) received standing acetaminophen, 1(6%) ibuprofen, 12 (75%) opioids, 4 (25%) gabapentin, 3 (19%) alpha-2 agonists.

Legend

Y, years; M, months; TBSA Total Body Surface Area; MOI mechanism of injury; LOS length of stay; vent ventilator; PICU pediatric intensive care unit;

Conclusions

We found 75% of our pediatric patients received opioids, and only 56% received standing acetaminophen. 7 patients (43.8%) received either gabapentin and/or alpha-2 agonists. Our pediatric analgesia support guidance tool influenced clinician pain management practice for the pediatric burn patient. With continued use, we will determine if this multimodal approach can reduce an over reliance on opioid analgesia regimens.