bluuebunny/crossref_metadata_2025 huggingface dataset:
Is histological confirmation necessary to avoid futile resections? Comparative of 4 university hospitals
Authors: Aguinagalde Borja , Lizarbe Ion Ander , Rumbero Juan Carlos , Lorenzo Mónica , Sanchez Leire , Sanchez Laura , Fernández-Monge Arantza , Lopez Iker
Published: April 2024

OBJECTIVES

There is no consensus in the literature on preoperative histological analysis for lung cancer. The objective of this study was to assess 4 diagnostic models used in different hospitals with differing practices regarding preoperative histological diagnosis and the consequences in terms of unnecessary surgery and futile major resection.

METHODS

We carried out a retrospective observational study collected from 4 university hospitals in Spain over 3 years (January 2019 to December 2021). We included all patients with a confirmed diagnosis of primary lung cancer and any patients with suspected primary lung cancer who had undergone surgery. All patients underwent computed tomography and positron emission tomography/computed tomography scans. Each multidisciplinary committee was free to choose whether to perform flexible bronchoscopic or transthoracic lung biopsy. Decisions concerning whether to perform intraoperative sample analysis, the surgical approach and the type of resection were left to the surgical team.

RESULTS

We included a total of 1642 patients. The use of flexible endoscopy and its diagnostic performance varied substantially between hospitals (range: 23.8–79.3% and 25–60.7%, respectively); and the same was observed for transthoracic biopsy and its performance (range: 16.9–82.3% and 64.6–97%, respectively). Regarding major resection surgery (lobectomy or more extensive resection), the lowest rate was observed in hospital C (1%) and the highest in hospital B (2.8%), with between-hospital differences not reaching significance (P = 0.173).

CONCLUSIONS

The rate of histological sampling before lung cancer surgery still varies between hospitals. In spite of very diverse multidisciplinary management, the rate of futile lobectomy is not significantly higher in hospitals with lower rates of preoperative histological analysis.
Risk factors influencing postoperative pleural empyema in patients with pleural mesothelioma: a retrospective single-centre analysis
Authors: Henschke Peter , Guglielmetti Laura Chiara , Hillinger Sven , Monsch Gian-Marco , Schneiter Didier , Opitz Isabelle , Lauk Olivia
Published: April 2024

OBJECTIVES

Postoperative empyema is a severe, potentially lethal complication also present, but poorly studied in patients undergoing surgery for pleural mesothelioma. We aimed to analyse which perioperative characteristics might be associated with an increased risk for postoperative empyema.

METHODS

From September 1999 to February 2023 a retrospective analysis of consecutive patients undergoing surgery for pleural mesothelioma at the University Hospital of Zurich was performed. Uni- and multivariable logistic regression was used to identify associated risk factors of postoperative empyema after surgery.

RESULTS

A total of 400 PM patients were included in the analysis, of which n = 50 patients developed empyema after surgery (12.5%). Baseline demographics were comparable between patients with (Eyes) and without empyema (Eno). 39% (n = 156) patients underwent extrapleural pneumonectomy (EPP), of whom 22% (n = 35) developed postoperative pleural empyema; 6% (n = 15) of the remaining 244 patients undergoing pleurectomy and decortication (n = 46), extended pleurectomy and decortication (n = 114), partial pleurectomy (n = 54) or explorative thoracotomy (n = 30) resulted in postoperative empyema. In multivariable logistic regression analysis, EPP (odds ratio 2.8, 95% confidence interval 1.5–5.4, P = 0.002) emerged as the only risk factor associated with postoperative empyema when controlled for smoking status. Median overall survival was significantly worse for Eyes (16 months, interquartile range 5–27 months) than for Eno (18 months, interquartile range 8–35 months).

CONCLUSIONS

Patients undergoing EPP had a significantly higher risk of developing postoperative pleural empyema compared to patients undergoing other surgery types. Survival of patients with empyema was significantly shorter.
Identification and chemical structure elucidation of synthetic cannabinoids samples seized in Kuwait during 2019-2023 using GC-MS and NMR spectroscopy
Authors: Al-Matrouk Abdullah , Orabi Khaled Y
Published: April 2024

Cannabinoids, a class of chemical compounds, interact with cannabinoid receptors and are categorized into endocannabinoids, phytocannabinoids, and synthetic cannabinoids based on their origin. Among these, synthetic cannabinoids constitute the largest and most structurally diverse group of novel psychoactive substances, with around 280 compounds identified globally. They exhibit a high binding affinity to cannabinoid receptors CB1 and CB2, which are distributed throughout the central nervous and immune systems, leading to more potent psychoactive and toxic effects compared to their natural counterparts. Various adverse effects associated with synthetic cannabinoids include hypothermia, analgesia, catalepsy, psychosis, respiratory depression, cardiac arrest, nephrotoxicity, acute cerebral ischemia, seizures, and mortality. In a previous study, we reported the detection of several novel psychoactive substances in Kuwait using GC-MS and LC-MS/MS techniques. However, the identification was tentative, highlighting a limitation of these methods. To address this, the current study aimed to fully identify seventeen seized synthetic cannabinoid samples. Thin-layer chromatography was initially employed to assess the purity of the samples. Twelve pure samples (AKM-1 – AKM-12) underwent NMR analyses, including 1H, 13C, DEPT 45°, 90°, 135°, COSY, HSQC, and HMBC experiments. The identities of five samples (AKM-1, 5, 6, 8, 10) were confirmed as MDMB-4en-PINACA, one sample (AKM-2) as 4F-MDMB-BUTICA, one sample (AKM-3) as MPHP-2201, and three samples (AKM-4, 9, 11) as MMB-022. Additionally, two samples (AKM-7, 12) were identified as FUB-144. This comprehensive approach enhances the accuracy of synthetic cannabinoids identification compared to previous studies, emphasizing the importance of employing NMR alongside other spectral methods for a more robust analysis.
Allylboranes and boron enolates
Authors: Thomas Susan E.
Published: April 2024

This chapter considers allylboranes in organic synthesis. Focusing on the stability of allylboranes, the chapter displays how allyldialkylboranes can be used in further reactions if either they are prepared and used directly at low temperature, or the predominant isomer at equilibrium is the required isomer. The chapter also discusses the reaction of allylboranes with carbonyl compounds. It examines how triallylboranes react with aldehydes and ketones to give, on hydrolysis, homoallylic alcohols. The chapter then investigates the synthesis of homochiral homoallylic alcohols containing one chiral centre, and the synthesis of homoallylic alcohols containing two chiral centres. It ends with a discussion of boron enolates in organic synthesis.
12 Monitoring Monocyte Anisocytosis Changes as a Burn Injury Recovery Marker: Insights from a Clinical Study
Authors: Nazemidashtarjandi Saeed , Supple Matthew D , Boribong Brittany , Rosado Nikki , Karabacak Nezihi Murat , Yonker Lael , Yarmush Martin , Goverman Jeremy , Irimia Daniel
Published: April 2024

Introduction

Severe burn injuries trigger pathological immune responses. However, our ability to monitor these evolving responses is constrained by the intricate confluence of cellular, biochemical, and metabolic alterations that occur concurrently post-injury. Here, we focus on monocytes as integrators of the changes triggered by the burn injury and potential biomarkers for the immune responses after injury.

Methods

We enrolled patients with major burn injuries (15% or more) and collected blood samples twice a week for the duration of the hospital stay. We measured Monocyte Distribution Width (MDW) using a hematology analyzer. We assessed the association between MDW (an FDA-cleared biomarker for sepsis) and pro-inflammatory cytokines levels released in the serum of burn patients. As a reference, we measured the MDW changes in the presence of pro-inflammatory stimuli, e.g., lipopolysaccharide (LPS), as well as lipid mediators of inflammation resolution, e.g., prostaglandin E2 (PGE2), resolvin D1 (RvD1), and resolvin D2 (RvD2).

Results

We enrolled N = 10 patients with major burn injuries, from which we collected and analyzed N = 78 blood samples. We found that the MDW increases during the first week after a major burn injury (MDW = 24.1) above the threshold of healthy individuals of comparable age (MDW = 20.0) and decreases slowly at discharge. In non-surviving patients, MDW increased for ~10 days post-burn injury (MDW=28.7) and remained high until death. We found the strongest correlations between the MDW values and IL-18 cytokine levels in plasma (Two-tailed Student test, P=0.0095, positive Spearman r coefficient=0.9009).

In blood samples from healthy donors, we found that MDW increased upon LPS stimulation (104 EU/mL, MDW= 31.8), at the higher end of values measured in patients. The addition of RvD2 (5 µM) after LPS stimulation decreased MDW significantly (MDW = 20.1, One-way ANOVA, LPS vs. RvD2 +LPS, P = 0.0002), towards values measured in healthy donors.

Conclusions

In patients with major burns, changes in MDW could serve as a biomarker to track inflammation and its resolution throughout the hospitalization. The ability of RvD2 to decrease MDW is novel and deserves further investigation.

Applicability of Research to Practice

MDW values can be useful for monitoring hospitalized burn patients.
21 Untargeted Metabolomics Analysis: A Candidate Biomarker and Prognostic Tool in Burn Injury
Authors: Misganaw Burook , Pinto Desiree , Le Tuan D , Pusateri Anthony , Gautam Arti , Moffatt Lauren T , Shupp Jeffrey W , Hammamieh Rasha
Published: April 2024

Introduction

Untargeted metabolomics, an analysis of the molecular layer comprising many smaller molecular weight biomolecules, has emerged as a tool to diagnose and predict outcomes early in disease courses. Existing studies of metabolic changes following burn injury focus on select targeted metabolites using animal models. This study aims to identify metabolic signatures associated with burn severity and clinical outcomes using untargeted metabolomics analysis in patients.

Methods

Burn patients admitted to a regional center over the span of 4 years were prospectively enrolled in this study. Patient demographics, burn injury characteristics, and blood samples were collected at set timepoints from admission until 4 weeks. Mass spectrometry (MS)-based method was used to measure untargeted metabolomics. Comparison of the MS-based measurements of select metabolites with alternate standard clinical assaying was performed to ensure concordance and reliability. A linear regression model was then used to identify metabolites associated with bun severity (TBSA < 20% and ≥ 20%). Age, gender, BMI, presence of inhalation injury, administration of propofol and supplemental nutrition were added as covariates to control for confounding effects.

Results

Complete metabolome datasets were collected for 58 patients from a total of 115 patients reviewed. The sample had a median TBSA of 18.3%, median age of 38.5 and 27.6% had concomitant inhalation injury. A total of 925 metabolites, including 335 lipids, 183 amino acids, 146 xenobiotics, 24 carbohydrates, and 23 peptides were analyzed. MS-based measurements compared with alternate standard clinical assaying resulted in a high level of concordance (R ~ 0.8). The first two principal components (account for 22% of total variance) show the main drivers of global metabolomics variation are time since admission and severity of injury. At admission, a significant elevation of xenobiotics, amino acids, nucleotide, and lipids related metabolites was observed among severely burned patients (TBSA ≥ 20%). Longitudinal analysis reveal that xenobiotic related metabolites are significantly elevated at admission but are depleted overtime. An abundance of select metabolites at admission showed an excellent ability to predict 30-day mortality (AUROC ~ 90%).

Conclusions

Patterns of metabolic alterations were associated with severe burn injury (TBSA ≥ 20%). Distinct classes of metabolic profiles change in a time dependent manner. Therefore, metabolic profiling has the potential to be used as early indicators of disease severity and progression.

Applicability of Research to Practice

Identifying and utilizing early indicators of disease severity and outcomes before the onset of clinical signs is crucial for burn patients. Metabolomic changes is a prime candidate for the development of these prognostic and biomarker panels.
35 The Impact of Hand Burns on Strength; An Analysis of the ACT Database
Authors: Warthman Renée , Bay Curt C , Pirsig Whitney , Murray Derek , Richey Karen J , Foster Kevin N
Published: April 2024

Introduction

Although hand burns comprise a small TBSA percentage, they can have significant functional implications. Multiple studies show grip strength as a predictor of health and quality of life. A decrease in grip strength has been reported in multiple populations with hospital admission; however, there is limited evidence concerning how burns affect hand strength. The purpose of this study was to examine the impact of burns on grip strength, measured at hospital discharge.

Methods

This study is a retrospective review of data from the prospective Burn Patient Acuity Demographics, Scar Contracture and Rehabilitation Treatment Related to Patient Outcome Study (ACT). Patients had grip strength measured of both hands 3 times consecutively at discharge. Data related to grip strength of patients with burn injuries were compared to age- and sex-matched normative values. Burn characteristics, including presence of hand burns, skin grafting, and length of stay were evaluated.

Results

There were 307 participants in ACT; 195 (63.5%) had hand burns and met inclusion for analyses. Among those with hand burns, the majority were male (72.8%), right-hand dominant (84.1%), mean ±SD age was 42.9±17.0; LOS, 23.3±22.8 days; and TBSA, 14.5%±13.3. Among patients with hand burns, 112 (57.4%) received skin grafts to at least one hand. Expressed as the percentage of grip strength loss relative to normative data, those with a burn injury to the hand averaged -55.8±33.4%, while those with no burns to the hand averaged -25.7%±36.3%, p < .001. Patients with a skin graft to the hand averaged -65.8±27.2% grip strength, while those with hand burns, but no grafts averaged -36.1%±35.5%, p < .001. Decreased grip strength is associated with increased length of stay, r= .21, p < .001.

Conclusions

This study of hand strength in burn survivors at the time of hospital discharge corroborates previous reports regarding nosocomial strength loss but specific to the hand. Overall, patients hospitalized with burn injuries lose hand grip strength but more-so if a hand is burned and furthermore if a hand is skin grafted.

Applicability of Research to Practice

Understanding of the impact of burns on grip strength may help guide clinical decision making, allowing therapists treating those with burn injuries to anticipate deficits and subsequent functional impact. Expectation of a loss of grip strength in patients without burns to the hands should inform treatment planning during acute hospitalization to promote improved function and quality of life.
73 Examining Health-Related Quality of Life in Hispanic Adults with Burn Injuries
Authors: Dominguez Tamara Alcala , McMullen Kara , Orton Caitlin M , Yenikomshian Haig A , Flores Elizabeth , Schneider Jeffrey C , Ryan Colleen M , Stewart Barclay T
Published: April 2024

Introduction

The intersectionality of an individual’s social and political position shapes their lived experience and can be associated with inequities. Thus, historically ethnicity has been used as a contextual indicator of inequity and often as a proxy of economic disadvantage. A resulting presumption is that the interplay of ethnic identity and socioeconomic (SES) factors can compound the burden faced by individuals during recovery and affect overall health related quality of life (HRQOL). In this analysis, we hypothesize that Hispanic adults with burn injuries and who had low SES status prior to injury reported decreased HRQOL post-injury compared to those with average-SES.

Methods

Data from adult participants in a national multicenter longitudinal database was analyzed. Ethnicity was provided by self-report or medical record. SES was classified as low ( < $49,000 annual income or no high school diploma/GED), average ($50,000-$99,999 annual income or completion of high school/GED), and high (>$99,999 annual income or at least some college or trade school). VR-12 and PROMIS Global-10 measure HRQOL in both physical and mental health domains, through validated physical component scores (PCS) and mental component scores (MCS). Kruskal Wallis tests were used to test differences of PCS and MCS between subsets of Hispanics and non-Hispanics with low, average, and high SES.

Results

Out of 952 participants, 19.5% were Hispanic. The average age was 40.6 years. Nearly half reported less than a high school education (47.3%), 40.3% were high school graduates, and 12.4% had either a vocational degree or some form of higher education. Non-Hispanic participants averaged 47 years of age, with 14.6% reporting less than a high school education. Nearly a third of Hispanic participants experienced low SES (34.4%), 38.7% experienced average SES, and 26.9% experienced high SES. Conversely, non-Hispanic participants experienced low and average SES less commonly (8.1 and 30.9%, respectively) and 61% experienced high SES (all differences p< 0.001). Burn surface area, sex, and PCS were not statistically different between groups. Notably, the low SES Hispanic group consistently reported statistically significantly higher MCS, compared to all other cohorts, at 6-months (59.6, p=0.0008), 12-months (59.7, p=0.001), and 24-months (60.6, p=0.003) post-injury follow-up (Figure 1).

Conclusions

Hispanic adults with low SES reported higher mental health scores, signifying better HRQOL in this domain, than their average SES Hispanic and non-Hispanic counterparts over a 24-month follow-up period.

Applicability of Research to Practice

These results underscore the complexity of burn recovery experiences and could be suggestive of underlying protective factors that should be explored for possible utilization in culturally nuanced approaches to rehabilitation.
76 Social Reintegration After Burn Injury Is Negatively Impacted by Sensory Impairments
Authors: Pacleb Maiya I , deGrauw Xinyao , Orton Caitlin M , Schneider Jeffrey C , Yenikomshian Haig A , Stewart Barclay T
Published: April 2024

Introduction

Social reintegration is an important goal of recovery for people living with a burn injury. Sensory impairments are common after major burn injury and can compound challenges related to burn recovery more generally. Therefore, we aimed to describe social integration outcomes of people living with burn injury who have hearing, vision, or dual sensory impairment (DSI, hearing and vision impairments) when compared to those with no sensory impairment (NSI). We hypothesized that those with sensory impairments would have lower social integration when compared to those without.

Methods

Adult participants in a multicenter national longitudinal database who provided responses for the abbreviated Community Integration Questionnaire (CIQ) were included. CIQ evaluates social integration on a scale of 0 (no community integration) to 12 (excellent community integration). Participants self-reported (yes/no) sensory impairment at discharge (pre-injury recall) and 6, 12, and 24 months after injury and were then grouped into cohorts with hearing impairments, vision impairments, DSI, and NSI. Mixed effect regression models evaluated the impact of sensory impairments on CIQ compared to pre-injury scores and the differences between cohorts at each timepoint.

Results

852 participants were analyzed, with older participants (≥55 years) more likely to have sensory impairment (p < 0.001). There were 11% (n=95) with hearing impairment, 9% (n=72) with vision impairment, 3% (n=30) with DSI, and 77% (n=655) with NSI. Those with vision impairment reported a significantly lower CIQ score pre-injury compared to those with NSI (p < 0.01). Compared to pre-injury, participants with DSI had significantly lower CIQ at 6, 12, and 24 months (p < 0.01), and participants with NSI had lower CIQ at 6 and 12 months (Figure 1, p< 0.01). Compared to those with NSI, participants with DSI had more CIQ score loss at all follow-up timepoints (0.97 at 6 months, p< 0.05; 1.07 at 12 months, p< 0.05; 1.43 at 24 months, p< 0.01). The CIQ for those with DSI continued to decrease 24 months post-injury, whereas those with hearing impairment, vision impairment, and NSI improved.

Conclusions

While all groups’ social integration decreased after burn injury, significantly lower CIQ scores were reported by those with DSI. Importantly, those with hearing impairment, vision impairment, or NSI had CIQ scores that gradually improved over time. Future studies should evaluate the effect of systematic screening and delivery of key resources for those with sensory impairments after burn injury to aid their community reintegration.

Applicability of Research to Practice

Those who experience sensory impairments after burn injury may need focused rehabilitation efforts and adapted recovery resources that address their unique health and social needs to achieve a successful reintegration.
115 Examination of Voice Changes up to Five Years After Burn Injury
Authors: Chacon Kaitlyn , Santos Edward , McMullen Kara , Shepler Lauren , Clark Audra , Akarichi Chiaka O , Yenikomshian Haig A , Orton Caitlin M , Tierney-Hendricks Carla , Ryan Colleen M , Schneider Jeffrey C
Published: April 2024

Introduction

Voice plays a prominent role in verbal communication and social interactions. Acute burn care often includes intubation, mechanical ventilation and tracheostomy, which may impact voice quality. However, the issue of long-term dysphonia remains underexplored. Thus, this study aims to examine the frequency of and associated factors with voice changes long term in the burn population.

Methods

Adult data from a multicenter longitudinal database from 2015-2023 were analyzed. The frequency of self-reported vocal changes (yes/no) was examined at discharge and 6, 12, 24, and 60 months after injury. Demographic and clinical data were compared between those with and without vocal changes at 12 months after injury. An omnibus chi-square test examined the incidence of voice changes among burn survivors based on ventilator days. Additionally, the percentage of tracheostomies by ventilator days was observed and compared amongst those with and without a voice change. Logistic regression analysis examined the associations between demographic and clinical factors and self-reported voice change at 12 months.

Results

A total of 582 individuals with burn injuries were included (65 with and 517 without voice change at 12 months). Voice changes were most commonly reported at discharge (16.4%) and persisted over the 60-month follow up period (11.6-12.7%). Those with voice changes were more likely to have had a flame burn, inhalation injury, tracheostomy, outpatient speech-language pathology, head/neck burn, larger burn size, mechanical ventilation, more ventilator days, and multiple trips to the operating room than those who reported no voice changes (p < 0.001). Increasing frequency of voice changes is associated with greater ventilator days (p < 0.001). For those on a ventilator more than 21 days, 48.7% experience voice changes at 12 months and 83.3% had received a tracheostomy. The regression analysis demonstrates that individuals that were placed on a ventilator and received a tracheostomy were more likely to report a voice change at 12 months (284%, p=0.027 and 431%, p< 0.001, respectively).

Conclusions

Voice changes were frequently observed in people living with a burn injury, showing that symptoms can persist for up to five years after injury. Mechanical ventilation and tracheostomy were the primary factors associated with persistent voice changes after injury. Future studies could explore the impact of speech-language pathology and other interventions on individuals experiencing long-term dysphonia following burns.

Applicability of Research to Practice

This study emphasizes the need to understand the long-term voice effects of intubation and tracheostomy in burn care.
117 QuickDASH Quantifies Perceived Upper Extremity Function in Acute Burn Rehabilitation: A Quality Improvement Project
Authors: Coakley Katie , Berry AnnMarie , Serrano Jaime
Published: April 2024

Introduction

A patients’ perception of their abilities to complete daily tasks post-burn injury can be difficult to measure and warrants more research. To ensure patients with an upper extremity (UE) burn injury are gaining the functional outcomes they desire, one burn center developed a quality improvement (QI) project focused on burn patients’ perceived ability to complete daily tasks.

Methods

Occupational Therapists (OTs) assessed burn patients’ perceived UE function at evaluation and discharge with the QuickDASH, a self-reported outcome measure. Scores range from 0-100, higher scores indicate greater perceived deficits. The minimal clinically importance difference (MCID) is 15.9. Inclusion criteria was at least 18 years old, UE burn injury, hospitalized for > 48 hours, and cognitively able to participate. Data was collected & analyzed using Microsoft Excel. Normative data including means and standard deviations were reported. An analysis of variance (ANOVA) was performed to identify if changes in QuickDASH scores were significantly different for operative and non-operative patients.

Results

115 patients met inclusion criteria from Sept. 2022 - Sept. 2023. 70.1% patients were male, 29.9% were female. The average total body surface area burned was 9.8%. The ANOVA did not find a significant difference in changes in QuickDASH scores between operative and non-operative patients (p=.79). The number of patients from initial data collection period to most recent who met the inclusion criteria increased, of those, the amount that completed a QuickDASH upon evaluation and discharged increased. See Table 1 below for the three data collection periods.

Conclusions

The QuickDASH is a helpful tool for OTs working in the acute phases of burn rehabilitation. Tracking QuickDASH scores for patients with an UE burn injury contributes to continuous efforts of improving the quality of care and promoting patients’ achievement of desired outcomes. The QuickDASH can identify therapy needs beyond an acute care setting and promotes patient engagement.

Applicability of Research to Practice

This QI project promotes continued growth for the burn center and adds to the body of knowledge about acute phases of burn rehabilitation. An area of opportunity for a future QI project includes implementing the QuickDASH in an outpatient setting, which would allow comparison to the patient’s acute care discharge score to promote continued progression towards desired outcomes. The presenters will continue to collect and analyze data prior to presentation if accepted.
123 National Study of the Increased Incidence of Complex Regional Pain Syndrome Following Severe Burn Injury
Authors: Krishna Sunskruthi , Shah Suhaib , Segura Carolina , Ramgopal Yash , Durand Jean pierre , Richter Christopher G , Wolf Steven E , ayadi Amina E I , Song Juquan
Published: April 2024

Introduction

Complex Regional Pain Syndrome (CRPS) is a clinical condition that presents after an operation, trauma, or burn injury with allodynia, hyperalgesia, and myasthenia. The etiology of CRPS remains poorly understood and there is a notable gap in literature linking the severity of burns to the risk of developing CRPS. Our study aims to address this by investigating retrospective patient data to determine the relationship between the degree and total body surface area (TBSA) of burn injury and the incidence of CRPS.

Methods

Patient records were accessed through a national database of de-identified electronic patient medical records from 2010 to 2019. Specific ICD-10 codes were used to define cohorts and outcomes. Three cohorts were established among patients with a history of burns- those with first-, second-, and third-degree burns. Two additional cohorts of TBSA of burns of ≤20% and >20% were established. These cohorts were analyzed for the risk of developing CRPS (type 1 and 2) within 6 months of first instance of burn injury. A z-test was performed after propensity score matching with age, sex, race, and ethnicity with significant p-value < 0.05.

Results

0.274% of third-degree burn patients (n= 2,682), 0.213% of second-degree burn patients (n= 2,009), and 0.221% of first-degree burn patients (n= 2,686) were diagnosed with CRPS within 6 months of the first instance of burn injury. Patients with third-degree burns were at a significantly higher risk for developing CRPS compared to patients with first-degree burns (p= 0.0270), second-degree burns (p=0.0102), and first- and second-degree burns combined (p < 0.001) within 6 months post-burn injury. Patients with more severe burns of TBSA>20% (n= 6,628) were more likely to develop CRPS with a risk of 0. 422% (p= 0.0305). Additionally, burn patients with CRPS were more likely to be female than without CRPS for first- (74%), second- (67%), and third- degree burns (53%), and TBSA>20% (62%).

Conclusions

Patients who undergo third-degree burns or burns of TBSA>20% have a significantly greater risk for developing CRPS post-injury. Based on hypothesized mechanisms, the extensive tissue damage of more severe burns will result in a higher incidence of CRPS.

Applicability of Research to Practice

These results indicate a need for a proactive risk assessment and more comprehensive post-hospital care to limit and manage the risk of CRPS in burn patients. Future research can inquire about other predisposing factors and complications of CRPS in the burn population and explore incidence of CRPS for other time periods post-injury.
507 Decrease in Total Leukocyte Count Is Associated with Acute Kidney Injury After Severe Burn
Authors: Aden James K , Rizzo Julie A , Schauer Steven G , Pham Tam N , Salinas Jose , Johnson Laura S , Harris Rachel
Published: April 2024

Introduction

Whereas leukocytosis is common immediately after major burn injury, total leukocyte count (TLC) often decreases 72-96 hours post-injury. It is reported that up to 50% of patients may experience leukopenia during this timeframe, which is typically self-limiting. The incidence of early (< 72 hours) leukopenia and its implications have not been well-described. This analysis sought to determine if early and extreme decreases in TLC after burn injury was associated with increased fluid requirements or resuscitation-related complications in patients after burn injury.

Methods

The Burn Navigator (BN) database is composed of patients with > 20% TBSA, > 40kg that were resuscitated utilizing the BN. Patients were split into study arms based on decreases in TLC relative to admission value within the first 24 hours after injury. Demographics were collected on the two study arms as well as resuscitation volumes, resuscitation-related complications and 7-day survival.

Results

A total of 295 patients were included in the analysis. Demographics were similar between the two groups. Patients with a larger decrease in TLC from admission had more full-thickness burns (14.2 [2,36]) and greater overall TBSA (41 [30.2, 57.4]) than those with a smaller decrease (7.7 [0.3, 14.8], 7.5 [23, 36], both p < 0.001). Patients with a decrease in TLC from admission greater than 15 points had a higher incidence of admission myoglobinuria (55.6%) than those with a TLC decrease less than 15 (44.4 %, p = 0.01). Patients with a greater TLC drop had an increased incidence of developing acute kidney injury (AKI) in the first 48 hours of resuscitation (62.9% vs. 37.1%, p = 0.003) despite receiving more fluid. After controlling for TBSA, patients with a greater TLC drop still had a higher incidence of AKI. Patients with a TLC drop greater than 15 had significantly decreased 7-day survival (66.7% lived) compared to those with a TLC drop of less than 15 (83.7% lived, p< 0.001).

Conclusions

Acute leukopenia alone was not associated with mortality after thermal injury. An early, severe decrease in TLC was found to be associated with early AKI and this may be readily identified by admission myoglobinuria. Future studies need to investigate the mechanism behind this association and possible early therapeutic interventions to prevent AKI and decrease mortality after severe burn injury.

Applicability of Research to Practice

Variability in leukocyte response to thermal injury may help guide both clinician optimization of organ function, and allow for realistic goals of care to be discussed with patient advocates.
523 Weight Loss in Patients with Large Burns
Authors: Graves Caran , Thompson Callie M , LaChapelle Christopher R , Fleming Irma D , Lewis Giavonni M
Published: April 2024

Introduction

The deleterious effect of weight loss in those with burns is well known. However, guidelines for monitoring loss are limited. This descriptive study evaluated weight loss incidence in patients with large burns admitted to a regional burn center.

Methods

Medical records for adult patients admitted to a regional burn center (2019-2021) with burns ≥20% total body surface area burned (TBSA) were reviewed. Patients with amputations were excluded. Data collection included burn size/depth, resuscitation fluids (pre- and post-admission), initial and final weight (last week of admission) and nutritional interventions. Patients were divided into three groups based on %TBSA: 20-29%, 30-39% and ≥40%.

Results

From 2019-2021, 722 patients with new burn injuries were admitted of whom 542 were over 18 years of age. Fifty-two (94% male) met inclusion criteria. Those with smaller burns had fewer surgeries and shorter stays. (Table 1).

Most patients (85%) received resuscitation fluids prior to admission (PTA) with an average of 2782 mL PTA and a total of 21,079 mL after admission. Larger burns received high resuscitation volumes both pre- and post- admission.

Over half of patients lost weight though 23 had a net weight gain. Most patients (56%) lost some weight but nearly half (48%) discharged within 5% of admission weight. The average loss across all groups was only 2.6% of admission weight (Table 2). Patients with larger burns were more likely to lose weight and also had more weight loss.

Almost all (94%) patients required enteral nutrition and all transitioned to full oral intake prior to discharge; no one required parenteral nutrition. Again, patients with larger burns required more enteral intake.

Conclusions

Most patients lost weight though some had net weight gain. Those with larger burns lost more weight than those with smaller burns. Weight loss is a risk factor for malnutrition even with nutritional support. Weight loss in burn patients should be monitored—particularly in those with burns >30% TBSA--and be considered as an outcome measure in burn care.

Applicability of Research to Practice

Weight loss in burn patients should be monitored and considered as an outcome measure in burn care.
538 Lessons Learned: Helping Non-Burn Facilities Prepare for Burn Mass Casualty Disasters
Authors: Steinert Amy , Mendelson Julia K
Published: April 2024

Introduction

At the request of the state, our burn center updated and rewrote the State Mass Burn Casualty Plan (MBCP) with a specific emphasis on helping local hospitals prepare to care for burn patients longer than the normal 96 hours. Grants funded outreach events to educate the various entities in the health regions on the new MBCP and practice implementing it in tabletop exercises (TTE). The goal of the TTE is to test the new state MBCP and identify barriers to successful implementation of the plan in a mock region-specific Burn Mass Casualty Disaster (BMCD).

Methods

Two outreach events for three regions were performed. On 4/7/23 at 0820, an event for region 6 & 9 occurred on Teams with 20 participants. The second event, for region 2, took place on 4/14/2023 at 0800 at a county fairground with 16 participants.

Each event began by explaining the new MBCP, focusing on education, triaging, and caring for burn patients for >96 hrs. until transfers became available. Next was the TTE in which participants responded to a mock region-specific BMCD. The phases of the TTE included: Phase 1 (first 30 minutes), Phase 2 (30 minutes-2 hours), Phase 3 (up to 96 hours) and Phase 4 (96+hrs). The participants decided who and how the different entities would respond during each phase. All actions and communication were informed by real-time data acquired from the hospitals’ nursing supervisors and the state’s database capacity system.

Results

The results are broken down by region. Region 2 is urban. The TTE lasted 4 hours. The scenario involved an explosion at a chemical plant during the day shift. The chemical plant and local EMS are immediately overwhelmed and call for help. 7 hospitals, on average 29 miles from the accident can offer support.

Region 6&9 are rural or frontier. The TTE lasted 193 minutes. A small plane crashes into a parade. Multiple burns and traumas are caused from the crash, leaking fuel, and burning parade wagons. Local EMS are immediately overwhelmed. 9 hospitals, on average 102 miles from the accident can offer support.

All regions experienced similar problems: difficulty establishing control at the scene and the initial responding hospital, insufficient decontamination supplies, traffic and delays in transporting patients necessitating the holding of burn patients longer than 96 hrs., and lack of staffing.

Conclusions

Since both regions, despite their differences, share the same issues, this suggests that hospitals must update their internal and external disaster plans to address the problems listed above.

Applicability of Research to Practice

When updating BMCP, consider adding a section where all regions incorporate mitigation plans for the expected issues: establishing scene control, decontamination, transportation of patients and delays, and staffing.
563 Self-management Interventions and Outcome Measures for Individuals with Chronic Traumatic Injury: A Scoping Review
Authors: Coates Caitlin P , Shepler Lauren , Velasquez-Cano Mariana , Ryan Colleen M , Schneider Jeffrey C , Kazis Lewis E
Published: April 2024

Introduction

Self-management education programs have demonstrated efficacy in various chronic conditions to empower and educate patients to manage their treatment intervention options, work through disease related challenges, gain confidence about their treatment related decisions and ultimately improve their quality of life. Burns are increasingly recognized as a chronic condition, however there is limited data on self-management interventions in this population. Therefore, the purpose of this study is to perform a scoping review of self-management education programs for chronic traumatic injury populations to identify self-management interventions and gaps in knowledge in this population.

Methods

Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines were used to conduct a comprehensive search of peer-reviewed literature for articles from 2013-2023 using keywords relating to ‘self-management’ and ‘chronic traumatic injury’ in the following databases: PubMed (MEDLINE), Embase, Scopus, and ScienceDirect. Article inclusion criteria included: papers written in English, participants over the age of 18 years, studies focusing on physical traumatic injury populations. This scoping review is inclusive of studies focusing on participants of all races, genders, educational status, and employment status.

Results

A total of 810 studies resulted from the initial database searches, resulting in 6 studies that met the inclusion criteria for the scoping review. Of the resulting literature 3 studies focused on individuals with Traumatic Brain Injury and 3 with Spinal Cord Injury. There were no studies in the burn population. Total sample size ranged from 7 to 84 participants in the included studies. Interventions were applied for varying study durations with a minimum of 21 days up to 586 days across the studies reviewed. There were 5 studies that utilized telephone calls to apply their intervention, making this the most common intervention modality. Notably of the studies reviewed, 5 studies showed a benefit to the self-management intervention applied meaning that they described an increase in either self-efficacy scores or overall participant satisfaction with the intervention.

Conclusions

There are limited research studies examining self management interventions in the chronic traumatic injury population, thus identifying a gap in the knowledge surrounding self-management interventions in these populations. Of the six included studies, most demonstrated benefits with self-management interventions.

Applicability of Research to Practice

This review establishes the need for scientific testing of a self-management intervention in the chronic traumatic injury population, inclusive of individuals living with a burn injury.
570 Adult Self-Inflicted Burn Demographics in West Texas
Authors: Bandaru Vishal , Tran Vivie , Youssi Brandon , Wagnon Coltyn , Fakhreddine Aya Bou , Conkin Lauren , Pendse Rohan , Meers Kaylen J , Griswold John A , Pang Alan
Published: April 2024

Introduction

Self-inflicted burns (SIB) are a subset of burns defined based on self-injury, sometimes also referred to as self-immolation. The United States generally reports SIB in the context of psychiatric ailment. However, due to the difference in geographic locations, the West Texas burn coverage has never been checked for SIB patients. We hypothesize that patients with SIB have higher rates of psychiatric disorders and are generally older men.

Methods

We obtained a list of all patients admitted to the burn intensive care unit (BICU) with a Second/Third-degree burn. After, we verified the inclusion of patients meeting the study criteria from July 01, 2011, to July 01, 2021, ages between 18 and 89, and a completed Lund-Browder Chart. Data was collected from a mix of manual chart review from electronic health records and electronic data retrieval. Patients were split into two groups, SIB and non-intentional burns (NIB). Bivariate analysis was conducted using Mann Whitney U test and either Fisher’s exact test or Chi-square test when independent variables were categorical.

Results

The initial data set (n=2,875) decreased due to missing burn documentation, burn intensive care unit admission, and incomplete records and was split into two groups: SIB (n=49) and NIB (n=1,243). The average age and percentage of male patients compared between NIB and SIB were not significant (p=0.32, p=0.39). However, TBSA, frequency of inhalation injury, burn symmetry, suicidal ideation, history of drug abuse, history of self-harm, history of mental illness, past mental health hospitalization, and mortality were all significantly higher in the SIB group (p< 0.001). There was also a statistically significant higher frequency of psychological disorders in the SIB group for depression, acute schizophrenia, borderline personality disorder, bipolar disorder (p>0.001), anxiety disorders (p=0.02), post-traumatic stress disorder (p=0.006), atypical psychosis, drug-induced psychosis, and delirium (p=0.04).

Conclusions

The demographics of the West Texas SIB population are comparable to that of the United States, predominantly older male patients. Similarly, many psychiatric disorders occur at a higher frequency in SIB patients than NIB: depression, acute schizophrenia, borderline personality disorder, anxiety disorder, post—traumatic stress disorder, bipolar disorder, atypical psychosis, drug-induced psychosis, and delirium.

Applicability of Research to Practice

While SIB patients make a small portion of the total burn population, there burns are often associated with worse outcomes – mortality, larger burns, and length of stay. The severity of their injuries begs the need for further analysis and hopefully prevention of SIB. Addressing psychiatric facilities and preventing these incidents from occurring may offer preventative methods.
582 Predictors of Care Discontinuity in a National Sample of Burn Patients
Authors: Castillo-Angeles Manuel , Shepler Lauren , Orton Caitlin M , Ryan Colleen M , Schneider Jeffrey C , Mehta Anupama
Published: April 2024

Introduction

Continuity of care has become a widely accepted metric of quality of care. It has been shown that care discontinuity is associated with worse outcomes in the surgical and burn populations. However, there is a scarcity of data on factors leading to this discontinuity. The aim of this study was to determine predictors of care discontinuity in a national sample of burn patients.

Methods

This was a retrospective study using a multicenter longitudinal database from 1996 to 2021. All adult burn patients from participating sites were included. The main outcome was care discontinuity. This was defined by having therapy or burn-related surgeries at non-index (different hospital than the one for the original admission). Multivariable logistic regression was used to examine the association between multiple demographic and clinical factors and care discontinuity.

Results

A total of 4,167 burn patients were included. Mean age was 43.36 (SD 15.85) years, 73% were male and 70% were white. 505 (12.1%) burn patients reported having therapy or burn-related surgeries at a non-index hospital. After adjusted analysis, we identified several predictors of care discontinuity in the burn population. Older age (Odds Ratio [OR] 1.02, 95% Confidence Interval [CI] 1.01 – 1.03), female sex (OR 1.28, 95% CI 1.01 – 1.62), Total Body Surface Area burned (OR 1.01, 95% CI 1.01 – 1.02) and number of trips to the operating room (OR 1.26, 95% CI 1.19 – 1.32) were associated with higher odds of being readmitted to a non-index hospital. However, racial minority (OR 0.65, 95% CI 0.49 – 0.88) and a longer hospital stay (OR 0.99, 95% CI 0.98 – 0.99) were associated with a lower risk of care discontinuity.

Conclusions

Care discontinuity was not that common in the burn population, and it is mainly driven by patient demographic and burn-specific clinical characteristics. Further research should focus on developing strategies targeted to address these disparities in order to improve continuity of care in the burn population.

Applicability of Research to Practice

Understanding the predictors of care discontinuity in the burn population may help clinicians develop strategies to address these disparities, decrease care fragmentation and subsequently have better outcomes.