bluuebunny/crossref_metadata_2025 huggingface dataset:
45 Application of Machine Learning Models to Thermal Burn Patient Outcome Predictions in the Aftermath of a Nuclear Event
Authors: Taylor Morgan A , Kearns Randy D , Carter Jeffrey E , Ebell Mark H , Harris Curt A
Published: April 2021

Introduction

A nuclear disaster would generate an unprecedented volume of thermal burn patients from the explosion and subsequent mass fires (Figure 1). Prediction models characterizing outcomes for these patients may better equip healthcare providers and other responders to manage large scale nuclear events. Logistic regression models have traditionally been employed to develop prediction scores for mortality of all burn patients. However, other healthcare disciplines have increasingly transitioned to machine learning (ML) models, which are automatically generated and continually improved, potentially increasing predictive accuracy. Preliminary research suggests ML models can predict burn patient mortality more accurately than commonly used prediction scores. The purpose of this study is to examine the efficacy of various ML methods in assessing thermal burn patient mortality and length of stay in burn centers.

Methods

This retrospective study identified patients with fire/flame burn etiologies in the National Burn Repository between the years 2009 – 2018. Patients were randomly partitioned into a 67%/33% split for training and validation. A random forest model (RF) and an artificial neural network (ANN) were then constructed for each outcome, mortality and length of stay. These models were then compared to logistic regression models and previously developed prediction tools with similar outcomes using a combination of classification and regression metrics.

Results

During the study period, 82,404 burn patients with a thermal etiology were identified in the analysis. The ANN models will likely tend to overfit the data, which can be resolved by ending the model training early or adding additional regularization parameters. Further exploration of the advantages and limitations of these models is forthcoming as metric analyses become available.

Conclusions

In this proof-of-concept study, we anticipate that at least one ML model will predict the targeted outcomes of thermal burn patient mortality and length of stay as judged by the fidelity with which it matches the logistic regression analysis. These advancements can then help disaster preparedness programs consider resource limitations during catastrophic incidents resulting in burn injuries.
46 Increased Concomitant Burn and Trauma Injuries Follows an Increase in Overall Trauma Volume: A Descriptive Analysis
Authors: Komak Spogmai , Jiang Chuantao , Crocker Rebecca , Khan Saleem , Freet Daniel J , Wainwright David J , Huzar Todd F , Wandling Michael W , Adams Sasha D , Kao Lillian S , Harvin John A , Wade Charles E
Published: April 2021

Introduction

Concomitant traumatic injury in the burn patient complicates care coordination and increases morbidity and mortality. The incidence of concomitant injury, however, is uncommon and reported to range from 5–7%. In May 2020, our level 1 trauma center began seeing 40% more patients per month that the 12 months prior. We sought to determine the incidence of concomitant injury in burn patients during this time of increased trauma volume and to examine the associated traumatic injuries in this group.

Methods

The burn registry at a single ABA-verified burn center was examined from 5/20–9/20. Patients with concomitant burn and traumatic injury were examined with respect to: %TBSA burn, mechanism of injury, operative interventions, associated traumatic injuries, and length of hospital stay. Continuous data was presented as mean (standard deviation).

Results

Eighty-nine burn patients were admitted during this period, of whom 24 (26.9%) had concomitant traumatic injuries. The cohort was young and mostly male; the mean TBSA was 16% () (Table 1). The most common mechanism of injury was motor vehicle collision (12 or 50%), followed by fall after high voltage electrical injury (6 or 25%) and motorcycle collisions (5 or 21%).

The most common associated injuries were: pulmonary contusions 29.1% (7/24); long bone fractures 25% (6/24); pelvic/acetabular fractures 20.8% (5/24); femur fractures 16.6% (4/24); and solid organ injury: 16.6% (4/24).

Twenty patients (83.3%) required burn or trauma operative intervention during hospital stay. Of the 20 patients who required operative intervention, 85% underwent burn surgery and 55% underwent trauma surgery (solid organ or orthopedic). Forty percent of these patients required operation for both burn and traumatic injury. In looking specifically at the electric injury group, all six patients required operative intervention for burn injuries, and four required extremity fasciotomy. Patients with electrical injury had a significantly longer hospital stay relative to their TBSA (p< 0.04).

Conclusions

Concomitant trauma and burn injuries are infrequent yet present a major clinical challenge. Our recent increase in overall trauma volume was paralleled by an increase in patients with concomitant burn injuries. The associated traumatic injuries require a multi-disciplinary approach to minimize morbidity and restore function.
52 Impact of National Marijuana Legalization on Delirium Rates and Opioid Use in Acute Burns
Authors: Ziolkowski Natalia , D’Abbondanza Josephine , Rehou Sarah , Shahrohki Shahriar
Published: April 2021

Introduction

Cannabis use has been associated with larger total burn size areas, longer hospital stays, and an increased number of operations. Legalization of marijuana in Colorado has led to marked increases in burn injuries. Tetahydrocannabinol (‘THC’) use has been shown to increase psychosis, anxiety, and depression, however, it is unknown how this has impacted rates of ICU related delirium in the burn context. Further, observational studies have shown that marijuana use has decreased opioid-related overdoses, but it is unknown how chronic marijuana use affects opioid consumption in the ICU. Thus, it is unknown how national marijuana legalization has impacted ICU rates of delirium and opioid use. As such, the objectives of this study are to describe trends of marijuana legalization on burns and determine if the amount of delirium and opioid use while in hospital has increased after national marijuana legalization.

Methods

We conducted a retrospective cohort study of 514 patients admitted to an ABA-verified centre one year prior to national marijuana legalization and one-year afterwards. Inclusion criteria consisted of an acute burn injury admission. Data included demographics, toxicology screening information, hospital rates of delirium, and pain medication use. Statistical analysis consisted of student’s t-test, one-way ANOVA, Kruskal-Wallis, Mann-Whitney U, Fisher’s exact, and χ2 test. P value of < 0.05 was considered statistically significant.

Results

Out of 514 patients, 422 were included; 203 prior to legalization (‘PL’) and 219 afterwards (‘AL’). Cohorts were similar regarding age, gender, inhalation injury, and smoking history. TBSA, length of stay, police custody, major psychiatric illness, alcoholism, and drug dependence were significantly higher in the AL cohort. Positive cannabinoid screens were similar in each cohort (13.3 versus 13.7%), however in both cohorts a large proportion of admissions did not have a toxicology screen completed (58.4–63.5%). Delirium rates (PL=0.5%, AL=4.1%; p=0.02) and opioid use (PL=48%; AL=52%;X2(1, N=422)=5.7, p=0.02) were significantly higher in the AL cohort.

Conclusions

National legalization of marijuana is associated with increased in-hospital delirium rates and opioid consumption in the acute burn context. Every effort should be made to ensure toxicology screens are completed on admission with the appropriate use of both opioid and adjunct pain medication regimens. In addition, for those not eligible for a toxicology screen due to delayed arrival time to the burn centre, an in-depth discussion should be completed to elicit drug history.
58 Rate and Predictors of Outpatient Follow-Up Compliance of Pediatric Burn Patients During the COVID-19 Pandemic
Authors: Chara Alejandro O , Hodgman Erica , Ziegfeld Susan , Parrish Carisa , Rhee Daniel , Garcia Alejandro
Published: April 2021

Introduction

The effect of the COVID-19 pandemic has led to increased isolation of families at home and potentially decreased access to the healthcare system. We therefore evaluated the effect of COVID-19 on rates of compliance with recommended post-injury follow-up. We hypothesized that this isolation may lead to detrimental effects on adherence to proper follow-up for children with burn injuries.

Methods

We queried the registry at an ABA-verified Level 1 pediatric burn center for patients aged 0–14 years who were treated and released from March 30 to July 31, 2020, which represents the height of the pandemic. As a control, we searched the registry for patients treated during the same time frame from 2016 to 2019. Patient and clinical factors were compared between the COVID and pre-COVID cohorts. Predictors of follow-up were compared using chi-squared and Kruskal-Wallis tests. Multivariable logistic regression was used to evaluate for predictors of compliance with follow-up.

Results

A total of 401 patients were seen and discharged from the pediatric ED for burn injuries. The COVID cohort consisted of 58 (14.5%) of these patients. Burn characteristics and demographic patterns did not differ between the COVID and pre-COVID cohorts. Demographics, including age, gender, race, and ethnicity did not differ between patients with 2-week follow-up and those without. The rate of compliance with 2-week follow-up was also not affected (62.4% prior to COVID vs. 55.2% during, p=0.29). As expected, burn size, burn depth, and mechanism of injury all significantly predicted compliance with 2-week follow up (table 1). After adjusting for these variables, there was still no difference in the odds of appropriate follow up (OR 0.6, 95% CI 0.3 – 1.1; p=0.12).

Conclusions

Despite concerns about decreased access to healthcare during the pandemic, the experience at our Level 1 pediatric burn center, including rates of follow-up for those managed as outpatients, appears unchanged.
68 Opioid Tolerance and Pharmacogenetics in Pediatric Burn Patients
Authors: Stokes Sarah C , Palmieri Tina L , Romanowski Kathleen S , Sen Soman , Greenhalgh David G , Grimsrud Kristin N
Published: April 2021

Introduction

Opioids are the predominant analgesic for pediatric burn patients. Burned children are frequently critically ill and require prolonged hospitalization with multiple surgical interventions. Pain associated with burns is severe, and failure to appropriately manage burn pain acutely can lead to long term negative consequences for these children. Prolonged opioid use, however, can lead to tolerance. While tolerance is anecdotally observed to develop at different rates in individual patients, the impact of genetic variability on the rate of development of tolerance is not known. This prospective study assesses the impact of genetic variability on opiate requirement in burned children.

Methods

A pilot study of pediatric burn patients was performed. Whole exome sequencing was used to evaluate genes involved in the metabolism and response to opioids. Oral morphine equivalents by weight (OME/kg) were calculated by day. Tolerance was determined by evaluating the rate of decline of OME/kg following the final major surgical procedure. Patients in the lowest third for rate of decline of opioid use were compared to other patients.

Results

Nine pediatric burn patients with median total body surface area of burn of 22% (IQR 12–36) and median age 7 years (IQR 5–13) were analyzed. Significant variability in the rate of decline of OME was observed, ranging from a decline 0.0971 OMEs/kg/day to an incline of 0.0057 OME/kg/day. Patients with a rate of decline in the lower third had a high frequency of missense mutations with predicted functional impact in the mu opioid receptor: 67% had a variant predicted to have functional impact, compared to 50% of patients in the upper two thirds. Two patients overall had missense mutations with predicted functional impact in the delta opioid receptor, with one having more rapidly developed tolerance.

Conclusions

The rate at which pediatric burn patients develop tolerance is variable. Variants in the mu opioid receptor may contribute to the rate at which patients develop tolerance. The function of many variants identified in this study is unknown, and their contribution to the development of tolerance requires further studies. Large scale studies to evaluate the rate of variants in the population and their relationship to tolerance development are critical to formulate personalized pain management for burned children.
73 High Cost and Resource Utilization of Frostbite Readmissions
Authors: Endorf Frederick W , Nygaard Rachel M
Published: April 2021

Introduction

Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people.

Methods

Index hospitalizations and readmissions were identified in the 2016 and 2017 Nationwide Readmission Database. Weighted incidence and characteristics of readmissions associated with frostbite injury were calculated and adjusted for by using survey weight, sampling clusters, and stratum. Multivariable logistic regression was clustered by hospital and additionally adjusted for severe frostbite injury, gender, year, payor group, severity, and comorbidity index.

Results

The unplanned readmission rate following frostbite injury was 35.4% (95% CI 32.2 – 38.6%). In the two-year cohort, 1,065 index hospitalizations resulted in 1,907 total hospitalizations following frostbite injury. Most patients were male (80.3%), lived in metropolitan/urban areas (82.3%), and nearly half were insured with Medicaid (46.4%). Of the 842 readmissions, 53.7% were associated with complications typically associated with frostbite injury. Overall, 29% of frostbite injuries resulted in at least one amputation. The average total cost and total LOS of readmissions was $236,872 and 34.7 days. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission. Factors associated with multiple readmissions include discharge AMA and Medicare Insurance, but not drug or alcohol abuse or homelessness.

Conclusions

This is the first study examining readmissions following frostbite injury on a national level. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission, while only AMA discharge and Medicare insurance were associated with multiple readmissions.
78 A Retrospective Review of Contact Burns Occurring over the Past Five Years and the Impact of Daily High Temperatures
Authors: Foster Kevin N , Hockenberry Tiffany , Murray Derek , Richey Karen J
Published: April 2021

Introduction

Thermal burns as a result of contact with a hot surface are a frequent cause of injury. A unique subset of contact burns are those sustained as a result of exposure to a hot surface during summer days in geographic areas with excessive ambient temperatures. Under these conditions, external surface temperatures can reach 180 degrees Fahrenheit, and deep cutaneous burns can happen with only a brief contact. Often exposure occurs in patients with impairments that prevent them from removing themselves from such contact in an expeditious fashion leading to severe injury. The purpose of this study was to review and analyze patients admitted to a southwest burn center with burns caused by contact with a hot external surface during the summertime months.

Methods

This was a retrospective chart review of patients admitted to our regional burn center over a 6-year period, whose burns were sustained from contact with the ground during the months of June, July, and August. Patients were stratified into two groups those whose injuries occurred from 2015 – 2019 and those that occurred in 2020. Climate data was collected from the National Oceanic and Atmospheric Administration website.

Results

The mean high daily temperature for June, July, and August 2020 was 108.5oF compared to 106.3oF for June, July and August of the preceding five years 2015 to 2019 (p < 0.0001) The number of days during this 3-month period with high temperatures exceeding 110oF was 48 for 2020 compared to a mean of 24 for years 2015 to 2019 (p < 0.0001). Correspondingly, there were 104 inpatient admissions for contact burns during this 3-month period in 2020 compared to a mean of 70 patients each year for 2015 to 2019, a 49% increase. There was no difference in age, gender, % TBSA burned, length of stay, or comorbidities in the two groups of patients. There were differences noted in the ethnicity compositions between the two groups. While alcohol use was not different between the two groups, the admission blood alcohol level was significantly greater in the 2020 group versus the 2015–2019 group (p=.0477). Additionally, the 2020 group demonstrated significantly greater illicit drug use than the 2015 to 2019 group (p.0098).

Conclusions

This study shows that increasing summertime temperatures in the southwest USA results in a corresponding increase in the number of patients with hot surface contact burns, and this increase is also associated with significantly great drug and alcohol abuse.
79 Electronic Cigarette-Related Injuries Presenting to Five Large Burn Centers, 2015–2019
Authors: Flores Carmen E , Chestovich Paul J , Saquib Syed F , Carroll Joseph T , Daubs Mariam Al-Hamad , Foster Kevin N , Delapena Samantha , Richey Karen J , Lallemand Michael , Dennis Bradley M , Palmieri Tina L , Romanowski Kathleen S , Godat Laura N , Lee Jeanne
Published: April 2021

Introduction

Electronic cigarettes are advertised as safer alternatives to smoking cigarettes yet can cause serious injury. As consumer use of electronic cigarettes has increased, burn centers have witnessed a rise in both inpatient and outpatient visits to treat thermal and blast injuries related to their use.

Methods

A multicenter retrospective chart review of ABA burn registry data from 5 large burn centers was performed from January 2015 to July 2019 to identify patients who sustained Electronic Nicotine Delivery Systems (ENDS)-related injuries.

Results

A total of 127 patients with electronic cigarette-related injuries were identified, of which 113 were male (89%) and 14 were female (11%). Mean age was 34.0 years (SD 13.5%, range 1–75 years). The majority of patients (n=92, 72%) were treated on an inpatient basis, and average length of stay was 6.7 days. Most patients sustained less than 10% total body surface area burns (mean 3.8%, SD 2.6%, range 0.1% to 16.5%). 66% (n=85) sustained 2nd degree burns, and 36% (n=46) sustained 3rd degree burns. Most patients were injured while using the ENDS (n=100, 78%), while 18% (n=24) of patients reported spontaneous combustion. 2 patients (1.5%) were injured while changing their device battery, and 2 patients (1.5%) were injured while modifying the device. 3% (n=4) were injured by second-hand mechanism.

Burn injury was the most common injury pattern (100%), followed by blast injury (n=81, 63%). Flame burns were the most common (n=89, 70%) type of thermal injury, followed by contact burns (n= 70, 55%), flash burns (n=47, 37%), chemical burns (n=2, 1.5%), and electrical burns (n=1, 0.7%). The most commonly injured body region was the extremities. There were no ENDS-related deaths.

Silvadene was the most common topical agent used in the initial management of thermal injuries, followed by Bacitracin and Xeroform. 63% (n=80) of patients did not require surgery, while 36% (n=46) required surgical excision, and 15% (n=20) required split-thickness skin grafting. Multiple surgeries were uncommon. 22% of patients required one operation, 12% required two operations, and 2% required 3 operations.

Conclusions

Our data recognizes use of ENDS as a growing public health problem with potential to cause thermal injury and secondary trauma. Most injuries occur during use, however many result from spontaneous combustion while the device is not being used. Treatment of ENDS-related injuries is institution-dependent. Most patients are treated on an inpatient basis however the majority of patients treated on outpatient basis have good outcomes.
80 Minor Burns in Infants: What has Changed During the Last 15 Years?
Authors: Abali Ayse Ebru , Aydogan Cem , Turkmen Nigar , Haberal Mehmet
Published: April 2021

Introduction

Infants are prone to unintentional minor burns. Caregivers play a key role in prevention and first aid. So, updating communal burn-prevention education programs according to time-related social changes is of importance. Aim of the present study was to analyze features of minor burns in infants who were referred to our burn center in the last 15 years.

Methods

Subjects were 973 infants(1-24months) with minor burns who were treated at our burn center between 2005 and 2019. Subjects were divided into two subgroups; groupI: referrals between 2005 and 2014(n=465) and groupII: referrals between 2015 and 2019(n=508). Data collected for each case were age; sex; burn-cause; extent of burns; affected major body-sites; environment in which injury occurred; first-aid method used by the caregiver; referral history (time interval between injury and referral (TIIR) and other hospitals before arriving at our center). Socioeconomic status was investigated with social-security status; home-types and methods of home-heating.

Results

Median age was 1±0,2 both in groupI and in groupII; male/female ratio was 0,96/1 in groupI and it was 1,07/1 in groupII. Mean TBSA burned was 2,74±0,12%(min:0,1,max:18) in groupI and it was 2,22±0,11(min:0,1,max:18) in groupII. Most common burn-cause was scalds in both groups (groupI: n=351;75,5%, groupII: n=405;79,8%) (p˃,05). Chemical burns slightly increased, flame burns decreased in groupII (p˂,05). Hands continued to be the most common affected major body-site (n=334;34,5%)(p˃,05).Home was the most common environment in which injury occurred (groupI: n=428;92%, groupII: n=487;95,9%) (p˃,05). Tap water was the favorite first-aid method (groupI: n=366;78,9%; groupII: n=411;80,9%) (p˃,05). But tendency to herbal and/or unreasoning first-aid methods increased in groupII (groupI: n=10;2,2%, groupII: n=47;9,3%)(p˂,05). TIIR was under 3 days for 820 cases (84,3%)(p˃,05). Rates of unmediated referral to our burn-center were higher in groupII (groupI:n=221;47,5%,groupII:n=303;59,7%)(p<,05). Most infants were in civil social-security-system, with an increased number of private-insurance in groupII (groupI: n=12;25,7%,groupII: n=29;74,3%)(p<,05). Most lived at centrally heated homes(n=926; 95,2%), and number of infants who lived at stove-heated homes decreased in group II (groupI:n=31; 6,7%,groupII:n=16; 3,1%)(p˂,05).

Conclusions

Our results revealed that socioeconomic status has improved, direct referrals to burn center increased in the last 5 years. Unfortunately usage of herbal and unreasoning first aid methods also increased in the same period. Future communal education programs for caregivers should emphatically continue to focus on precautions against threats at homes and correct first-aid methods should be urged.
81 The Impact of COVID-19 on a Major Metropolitan Burn Center
Authors: Codner Jesse A , Mittal Rohit , De Ayala Rafael
Published: April 2021

Introduction

The current and long-term impact of the coronavirus disease 2019 (COVID-19) global pandemic on our healthcare system is still unknown. When healthcare resources were being diverted to only the most critical of needs, emergent surgical and burn care remained essential. Currently, no data exist on the impact of a global pandemic on a burn center. Our aim for this study was to understand how the COVID-19 pandemic affected admissions, hospital course, and discharges at a major metropolitan burn center.

Methods

This was a retrospective cohort study of admissions to our burn center. Our institution’s medical record was reviewed from 1/1–8/31 for years 2020, 2019, & 2018. We included all thermal, chemical, and electrical burn inpatient admissions over these time periods. Non-burn wound admissions and vulnerable patient populations were excluded. Our population included 1,358 patients. These patients were grouped by year 2020 (n=425), 2019 (n=470), and 2018 (n=463). The medical record was queried for admission, hospital course, and discharge variables. SAS 9.4 statistical software was used to compare the pre-pandemic 2018/2019 groups against the 2020 group. Group means were compared using two-sample two-tailed t-tests, and categorical variables were compared using Chi-Square analysis.

Results

In 2020 the burn center had 425 admissions compared to 470 and 463 in 2019 and 2018 respectively. On admission, there were no differences in age, gender, pediatric admissions, burn etiology, total body surface area (TBSA), TBSA >20%, work-related injuries, or suspected abuse related injuries. Of note, the mean days from injury to admission for the groups were (2020 2.5±4.9 vs 2019 1.4±4.3, p=0.001, vs 2018 1.5±4.3, p=0.0017). Groups were similar in respect to burns requiring surgery and mean OR visits. 2019 and 2018 had increased ICU admissions compared to the 2020 cohort (ICU: 2020 60-(14%) vs 2019 91-(19.4%), p=0.041, vs 2018 108-(23.3%), p=0.033). Inpatient mortality was lower in the 2020 cohort compared to the pre-pandemic cohorts (2020 2 (0.6%) vs 2019 9 (2.5%), p=0.04, vs 2018 14 (4.2%) p=0.0017).

Conclusions

Volume at our burn center remains high during the pandemic. There is an increased lag time from burn injury to hospital admission in the 2020 cohort. We hypothesize this is due to patients’ avoiding the hospital due to fear of contracting COVID-19. TBSA is similar across groups, but ICU admissions are down in the 2020 cohort. Further work is needed to understand whether the increased lag time has affected outcomes and whether the decreased ICU admissions are due to yearly variation or the pandemic.
87 Identification of Critical Burn Knowledge Gaps within the USA Population: A Survey and Education on Burn Prevention and Preparedness
Authors: Xun Helen , Mafla Laura M , Cox Carrie A , Cooney Carisa , Duraes Eliana , Javia Vidhi , Caffrey Julie , Hultman Charles S
Published: April 2021

Introduction

Associations, institutions, and providers have made enormous efforts to educate the United States public on burn injury in the hopes of preventing burns. However, there are no reports to-date describing the level of public burn knowledge in the U.S. This study characterized the public knowledge of burn prevention and preparedness in the US. It also aimed to assess if our interactive quiz is an appropriate educational tool.

Methods

QualtricsTM surveys designed to test knowledge and educate about burns were crowdsourced to laypersons via Amazon MTurk. Demographics were self-reported. In section 1, respondents were presented six questions asking about causes and care for burns, in a quiz style with explanations provided immediately. In section 2, respondents self-reported personal experiences with burns, burn education, and knowledge of verified burn centers. In section 3, they reported attitudes towards burn care. Survey responses were analyzed using two-tailed Student’s t tests and chi square analyses.

Results

We received 402 completed survey responses, and 331 total were included for analysis; studies were excluded if they were completed in < 5 minutes or had incorrect attention check questions. The mean age was 39.4 ± 12.08, and 51% male.

1. Knowledge: The average quiz score was 51% ± 8; while 65% of respondents knew to run scald burns under cool water, only 41% knew the optimal time of more than 20 minutes. The majority of respondents (92%) reported the quiz improved their burn knowledge. Also, while majority (63%) of respondents had heard of verified burn centers, only 44% knew where the closest one was.

2. Experiences: 72% of respondents had personally experienced a burn, of which 62% were treated in the emergency room. 57% of respondents had witnessed a burn injury occur, of which 92% applied first aid using cool running water (26%), ice (18%), burn gel (17%), and gauze (11%). Only 61% of respondents have participated in burn precautions at home. 56% of respondents have received formal burn training, such as from CPR class (21.4%) and recent first aid training (32.9%). Informal sources include from friends and family (66%), personal burn experience (63%), or social media (47.4%).

3. Attitudes: The majority of respondents agreed there should be more public education on risks/prevention (85%) and treatment of burns (78.6%). Only 63% believe acute burn care should be covered by insurance.

Conclusions

Our study demonstrates that despite personal experiences with burns and formalized courses, there remain gaps in public burn knowledge in the US. Further studies are required to characterize more detailed knowledge gaps and intervention strategies.
88 Substance Use Testing Upon Burn Admission: Insights from the National Burn Repository
Authors: Abrams Thereasa E , Nugent William R
Published: April 2021

Introduction

Knowledge of substance use history is important for treating patients with burn injuries due to increased risk of mortality, complications, and poor outcomes. Yet, there has been little research on how admitting medical providers make the determination of who to test for alcohol or drug use. Burn severity, etiology, and circumstances surrounding the burns are important factors that should be considered when determining who should be tested. The race of the victim should not. This study analyzed data from the National Burn Repository for years 2008–2017 to ascertain if there were associations between race and decisions to do alcohol and drug testing upon burn center admission, controlling for other demographics, burn severity, and circumstances surrounding burn injuries.

Methods

This study was a secondary analysis of 37,355 cases from the National Burn Data Repository (American Burn Association). The dependent variables were whether a burn victim was tested for alcohol or drug use. These were dichotomous dependent variables, so a binary logit regression analysis was used. Missing data were handled with full information maximum likelihood. The independent variables were age, gender, whether physical abuse was reported, mental health comorbidity, marital status, severity of burns, whether the injury was work related, injury circumstances, and etiology of injury. Race was the independent variable of focus. The hypothesis was that race was associated with whether a burn victim was tested for drug or alcohol use.

Results

Controlling for independent variables, race was associated with whether a victim was tested for alcohol use, X2(5) = 71.3, p < .0001; race was also associated with whether a burn victim was tested for drug use, X2(5) = 66.5, p < .0001. Odds ratios for comparing the likelihoods of victims of different racial categories being tested ranged from .69 to 2.3 for alcohol testing, and from .79 to 2.4 for drug testing. These results were consistent with racial bias in decisions to test burn victims for alcohol and/or drug use.

Conclusions

Because there is little written about criteria for alcohol or drug testing on admission for critical burn injuries, it is unclear what prompts admitting health care providers to test. Our study found several racial groups had differential likelihoods of being tested upon admission to a burn center. Using Critical Race theory as a framework, these findings suggest racial bias may have influenced decisions to test for substance use in reported burn admissions. There is a need to establish a protocol for alcohol and drug use testing upon burn center admission that is equitable across all populations.
93 Virtual Burn Camp 2020 vs. In-Person Burn Camp - Did It Hit the Mark
Authors: Brubaker Ruth B , Bay Curt , Chacon Daniel W , Carson Madeleine , Cahill Jade A , Foster Kevin N
Published: April 2021

Introduction

Burn camps have served burn-injured youth in the U.S. for over 35 years. Camp is a rehabilitation program that has been recognized as an important part of young survivors’ recovery. The 2020 global pandemic made an in-person camp impossible, so volunteers rallied to provide a virtual experience. Registered campers received a “Camp in a Box” filled with activities, art supplies, a camp tee-shirt, and snacks to enjoy at Virtual Burn Camp (VBC). Participants connected with campers and counselors online. This study sought to determine how youth viewed VBC compared to in-person camp, how the pandemic was affecting their emotional status and whether VBC helped them.

Methods

The study asked participants to rate survey items regarding levels of comfort, connection, and support at VBC vs. in-person camp on a 4-point scale from 1. NO! 2. no 3. yes 4. YES! Multiple choice questions such as My favorite thing about virtual camp, and “Things I missed most about regular burn camp” - choose 2. General stress & anxiety levels related to Covid-19 were assessed, as well as if VBC helped to reduce their anxiety/stress levels.

Results

Pediatric burn survivors (n=77) participating in 2 virtual camps, demographic’s included mean age 13.8 years, male (n=39%), female (n=61%), visible scars (74%) vs. (10%) hidden scars with the majority representing racial/ethnic minorities (65%) vs. white (35%). Campers reported feeling more connected at in-person camp (84%) vs. VBC (38%). Feeling supported was higher at regular burn camp (84%), but the majority (76%) also claimed feeling supported at VBC. Camper’s favorite things about VBC were Camp in a Box (66%), Being Part of the Burn Community (51%), and Seeing Counselors (47%). Things missed most about regular burn camp were seeing Friends (83%) and Counselors (61%). Respondents reported high Covid-19 related stress/anxiety levels (66%) and (88%) said that VBC reduced their anxiety/stress. Top benefits included feeling Happy (48%) and Thankful (32%).

Conclusions

Pediatric burn survivors place a high value on their burn community involvement. Though not the preferred camp method, the VBC earned high marks for camper’s improved emotional status and for reducing their Covid-19 stress and anxiety levels. The program succeeded in helping Virtual Campers feel supported and provided an important venue for connecting them with their burn-injured peers and camp counselors.
110 Pain Medication Prescription Patterns and the American Burn Association 2020 Guidelines on the Management of Acute Pain in the Adult Burn Patient
Authors: Ziolkowski Natalia , D’Abbondanza Josephine , Rehou Sarah , Shahrohki Shahriar
Published: April 2021

Introduction

In September 2020, the American Burn Association released new pain guidelines following a rigorous literature review and input from experts. These guidelines were last updated 14 years ago and represent a multitude of changes including increased importance for non-opioid pain medication use and non-pharmacologic adjuncts given the current opioid crisis. Specifically, the main recommendations were to use opioid medication sparingly and always with adjuncts; acetaminophen utilized in all patients; NSAID use depending on baseline comorbidities and kidney function; neuropathic pain therapy for those with such pain/refractory to standard therapy; and ketamine for procedural sedation/adjunct for opioid consumption. Further, nonpharmacologic treatments include cognitive-behavioural therapy (‘CBT’), hypnosis, and virtual reality should be considered. The objective of this study is to describe current pain medication prescription habits at one ABA-verified centre and how well they are in compliance with these new guidelines.

Methods

We conducted phase one of a quality improvement retrospective study of 514 patients admitted to an ABA-verified centre over a two-year period. Data included demographics and pain medication use which was compared against the new ABA American Burn Association 2020 Guidelines on the Management of Acute Pain in the Adult Burn Patient. Pain medication contraindications were defined using UpToDate Drug Information. Statistical analysis was descriptive in nature.

Results

422 patients were admitted for acute burns. 65.9% were male with an average age of 46.4 (st dev 17.6,range 15–96). Flame burns were most common(n=209,49.5%) with average TBSA of 11.9%(st dev 16.5,range 0–98%) and 54 inhalation injuries(12.8%) covering an average length of stay of 15.6 days in the burn centre (st dev 16.8,range 1–146 days). A total of 3549 pain medications were prescribed: 1792 opioid(50.5%) and 1757 non-opioid(49.5%). Of those admitted, 93.8% were prescribed opioids, 72.5% NSAIDs, 87.2% acetaminophen, 74.4% nerve pain medications, and 25.3% ketamine. Opioids were not prescribed in 26 patients(6.2%) and only prescribed in 29 patients(6.9%). Regarding adjuncts, 4(0.94%) had documented contraindications to NSAIDs and 3(0.71%) to acetaminophen. No referrals were completed for CBT. Virtual reality and hypnosis are not available at this centre.

Conclusions

This work represents the first known study examining compliance to the new pain guidelines in an ABA-verified burn centre. There is significant room for improvement for the use of adjuncts specifically NSAIDs and acetaminophen as both were under prescribed. In addition, nonpharmacologic treatments are largely not available or not used and may be an untapped resource for better pain control.
111 Burn Sepsis Screening Tool to Facilitate Diagnosis of Burn Sepsis
Authors: Libraro Kaitlyn , Bessey Palmer , Heffernan Jamie , Gallagher James
Published: April 2021

Introduction

Sepsis following critical burn injury is an ominous development that can lead to death. Most patients will manifest a systemic inflammatory response syndrome (SIRS), even without being septic. This may obscure the clinical recognition of developing sepsis and delay the initiation of effective treatment. We developed a burn sepsis screening tool (BSST) to facilitate the recognition of developing burn sepsis. The purpose of this study was to review the utility of that tool.

Methods

The BSST was based on several clinical signs, laboratory values, and changes in physiologic support modalities associated with sepsis. It consisted of nine parameters that could be scored as indicating or not indicating sepsis or not applicable. If three were positive, the patient was identified as septic, and a search for a septic source was undertaken and treatment initiated. The BSST was completed on patients judged to be critically ill during morning rounds over a period of nine months. The values were transcribed into a secure web database and analyzed using SAS 9.4.

Results

There were 593 individual encounters on 31 critically ill patients with burns and/or inhalation injury for which the BSST was completed. The mean age of the patients was 57 ± 4 years (Mean ± SEM), and the burn size was 24 ± 15 % TBSA. Eleven patients were women (36%) and 7 patients had inhalation injury (23%). The expected case fatality was 21 - 30% depending on the statistical model used. Six patients (19%) died. The length of stay was 64 ± 10 days and ranged from 3 to 267 days. A patient was judged to be septic in only 45 of the daily encounters (8.0 % ± 1.1). There were 21 instances of a new septic event made in 12 patients. Episode of sepsis separated by at least 5 days of no sepsis, were considered to be a new septic event. There was a substantial amount of data that was missing or not applicable. There were no significant differences in the septic parameters on days with new sepsis diagnosis when compared to the day prior, or compared to all encounters in patients that were never septic. Patients deteriorated acutely between BSST completions on only two occasions and both were stabilized.

Conclusions

The BSST was used consistently to help evaluate the daily status of critically ill burn injured patients. The expected case fatality of the group was moderately high, based on statistical models derived from the ABA Burn Registry. The observed outcome was as good as or better than predicted. Acute decompensation was rare. The BSST added daily administrative work to rounds, and the data recorded were often incomplete. Although the BSST did not demonstrate any single clinical feature that identified the transition from SIRS to sepsis, it did add structure and rigor to daily rounds. That contributed to the effectiveness of rounds, and it may have been responsible, in part, for the favorable outcomes.
120 A Survey of Burn Care Professionals to Characterize Patterns of Early Mobility in ICU Burn Patients
Authors: Higgins Lauren , Hines Danika , Murray Derek , Richey Karen J , Foster Kevin N
Published: April 2021

Introduction

Early mobility in intensive care unit (ICU) patients has been demonstrated effective in improving functional status, range of motion, preventing complications, and decreasing length of stay. There is limited data regarding the early mobilization of burn ICU patients. The purpose of this study was to survey burn care providers to better understand their experience with early mobilization and explore perceived barriers and contraindications.

Methods

An internet-based 21-item survey was distributed to burn professionals at North American burn centers and units. Descriptive statistics were performed.

Results

There were a total of 63 respondents. Most respondents were physical therapists (33%), occupational therapists (33%), or nurses (25%), with >5 years of burn care experience (71%). Early mobility was characterized as both in bed and out of bed activities within 24 hours of ICU admission, up to any time during the course of mechanical ventilation or ICU stay. The majority of respondents (54%) indicated they mobilize patients on ventilators in bed and out of bed, while there was an even split on whether or not patients on vasopressor support were mobilized. Of those respondents (46%) who use the Richmond Agitation-Sedation Scale (RASS) to guide mobility, 14% mobilize patients with a RASS of -4 or -5 and 41% mobilize patients with a RASS of -3 to -2. The highest appropriate score for mobilization was +1 to +2 (76%). Hgb/Hct, line presence, ventilator mode, mental status, and vital signs were viewed as precautions to discuss with the medical team, rather than a contraindication to mobility. Respiratory rate < 6 and presence of ECMO were the areas of most concern, with the majority respondents indicating they would likely hold mobility. Most respondents indicated that they would mobilize any burn ICU patients after discussion with the medical team if necessary. The majority of respondents (72%) indicated that they did not have an early mobilization protocol for burn ICU patients.

Conclusions

There is a paucity of evidence available for early mobility in burn ICU patients. This survey demonstrates a lack of consensus regarding what constitutes early mobility and when patients should be mobilized. A multi-center observational trial is needed to inform the development of an evidence-based mobility protocol.
128 Nonlinear Dynamic Analysis of Heart Rate Variability Can Detect Sepsis in Severe Burns
Authors: Zhu Min , Cummins Claire B , Radhakrishnan Ravi S
Published: April 2021

Introduction

Sepsis after burn injury affects 50–84% of adult patients and ~55% of pediatric patients. The diagnosis of sepsis in patients with severe burns is complicated by the overlap of clinical signs of post-burn hypermetabolic response with those of sepsis. Earlier detection of sepsis could lead to improved outcomes and decreased morbidity and mortality. Nonlinear dynamic (ND) analysis of heart rate variability (HRV) can identify non-random relationships between different HRV parameters by using a complex oscillogram. ND can be obtained even when heart rate recordings are weak or poor in quality, which is common in the setting of burns. We hypothesized that ND could detect differences in HRV after severe burns.

Methods

All patients enrolled during the study period at our institution with >20% total body surface area (TBSA) burn were eligible for this study. High-definition heart rate monitoring was collected three times for each patient in five-minute intervals. The first collection occurred after patient ICU admission, and the third collection occurred 16–24 hours. Matlab was used to analyze heart rate using the following common ND methods: Correlation dimension (CD), detrended fluctuation (DF), largest Lyapunov exponent (LLE), approximate entropy (AE), fractal dimension (FD), Hurst exponent (HE), and recurrence quantification analysis (RQA). Additionally, several linear time-domain parameters were analyzed, including heart rate (R), RR interval (RR), SD1, and SD2.

Results

A total of six non-septic (NS) and four septic (S) patients were enrolled in the study. There were no significant differences between the two groups in age, sex, percent TBSA, or percent TBSA of third-degree burns. Two nonlinear parameters were significantly different between NS and S patients: AE and the density of recurrence points in RQA. AE was significantly lower in NS than S patients at all time points [(0.931±0.011 vs. 0.960±0.024, p=0.001); (0.923±0.019 vs. 0.959±0.025, p=0.008); (0.933±0.011 vs. 0.964±0.025, p=0.013)]. The density of recurrence points in RQA were significantly higher than in NS than S patients at all time points. [(90.4±40.2 vs. 41.4± 27.8, p=0.029), (102.2±39.4 vs. 40.1±22.9, p=0.008), (92.5±34.4 vs. 45.5±33.9, p=0.043)].

Conclusions

The two ND parameters AE and RQA, can be used to distinguish between patients with and without sepsis in the setting of severe burns.