bluuebunny/crossref_metadata_2025 huggingface dataset:
107 Esterified Hyaluronic Acid Matrix in Lower Extremity Wound Reconstruction
Authors: Velamuri Sai R , Kozusko Steven D , Mahmood Ammar , Hill David M , Dadireddy Kalyan C
Published: March 2020

Introduction

Esterified hyaluronic acid matrix (eHAM) skin substitutes have been applied to burn wounds, chronic wounds, and even congenital syndactyly release. eHAM consists of a controlled release form of hyaluronic acid (HA) in a matrix covered with a silicone layer. HA draws water into the wound bed, allowing for capillary ingrowth and cellular invasion. Angiogenesis and dermal regeneration with endothelial cells and fibroblasts promotes tissue regeneration.

Methods

We performed a retrospective review of patients treated with an eHAM at the regional burn center in the past year. A total of fifteen patients were identified. Their charts were reviewed to assess demographics, time to graft, follow-up duration, mechanism, comorbidities, outcomes, and complications. Additionally, photographic images were obtained from the burn center camera for each patient to assess clinical progression of healing.

Results

The mean patient age was 45.8 years. Mean time to split-thickness skin graft was 22.9 days, with a range of 14 to 36 days. The medium follow-up for this study was 12 weeks. Six patients sustained an injury due to either a thermal or electrical burn, and seven patients had diabetes mellitus. Nine patients were active smokers. Eight patients had hypertension and four had kidney disease. Coverage included tibia, calcaneus, Achilles tendon, and dorsal foot extensor tendons. One patient received bedside application of HM. One patient received a second OR application of HM. This series consisted of fifteen patients with multiple medical comorbidities and exposed critical structures, thirteen of which were successfully treated with eHAM.

Conclusions

When critical structures such as bone and tendon are exposed, dermal coverage is often needed prior to skin-grafting. Dermal coverage is necessary to prevent infection, desiccation, and osteomyelitis. eHAM is a modality that create a granulation bed that covers critical structures, allowing for subsequent skin-grafting in a properly selected and challenging population.

eHAM can be used as a dermal substitute in complex wound cases as a bridge to definitive coverage with autologous skin-grafting. This study has demonstrated successful coverage of tendons, bones, and chronic wounds in mean time of three to four weeks in a population with multiple medical comorbidities, complex lower extremity wounds, and contraindications to local and free flap coverage.

Applicability of Research to Practice

This research is based on clinical practice. We have salvaged thirteen of fifteen wounds that were at risk for amputation or further delayed healing, desiccation, and infection.
110 Self-reported Health Measures in Burn Survivors Undergoing Burn Surgery Following Acute Hospitalization
Authors: Luna Daniel E , Sheckter Clifford C , Carrougher Gretchen J , Stewart Barclay T , Schneider Jeffrey C , Ryan Colleen M , Holavanahalli Radha K , Amtmann Dagmar , Gibran Nicole S
Published: March 2020

Introduction

Perception of mental and physical function in adult burn survivors is decreased following injury. Individuals who undergo post-hospitalization reconstructive surgery may have lower Health Related Quality of Life (HRQoL) that is influenced by the severity of their burns. We sought to characterize self-reported health perceptions in burn survivors undergoing surgery post-hospitalization within 24 months of injury.

Methods

Patient Reported Outcomes Measurement Information System (PROMIS)-29 Profile v2.0 data were collected from participants from a multi-center longitudinal study at 6, 12, and 24 months post-injury. Surgical operations performed within the 24-month follow-up period were classified as: open wound, contracture release or scar revision. PROMIS-29 domain scores were compared for those undergoing surgery (surgical participants) to those who did not (non-surgical participants) using separate linear regression analysis for open wound versus scar revision/contracture release at each of the 3 follow-up time points. Linear regression was adjusted for age, burn size, range of motion limitation, number of operations during acute treatment, and insurance/payer.

Results

727 participants provided complete PROMIS-29 data, of which 227 (31.2%) underwent > 1 operative procedure within 24 months post-injury. PROMIS-29 anxiety and depression scores were worse at 6 months post-injury for participants who underwent contracture release and scar revision compared to non-surgical peers (p< 0.05). At 12 months after injury, individuals who underwent open wound surgery post-initial hospitalization reported worse anxiety, depression, and pain interference (p< 0.05). Participants in the contracture release and scar revision categories reported lower PROMIS-29 scores in all domains 24 months after injury (p< 0.05), even after adjusting for confounders.

Conclusions

Burn-related reconstructive surgery has the potential to improve the lives of patients including promoting functional recovery and improving cosmetic appearance. Our data suggest that participants who undergo reconstruction surgery after hospital discharge report worse self-reported indicators of health compared to participants who do not undergo surgery after adjusting for known confounders.

Applicability of Research to Practice

Better understanding of determinants of HRQoL following a burn injury provides a potential opportunity to improve burn survivor outcomes and clinical care.
118 Comparison of Contact and Scald Burns in a Porcine Model
Authors: Singer Adam , Zhou Juin , Osman Omar , Harris Zachery B , Khani Mahmoud E , Baer Evyatar , Zhang Nigel , McClain Steve , Arbab M Hassan
Published: March 2020

Introduction

Whether the depth and healing of scalds and contact burns are similar is controversial. Prior studies have not compared scalds and contact burns using identical temperatures and durations of exposure limiting direct comparison. We hypothesized that when exposed to similar temepratures and durations of exposure, burns caused by hot water and contact with hot metal would be similar.

Methods

Multiple 2.5 or 5 cm diameter standardized cutaneous burns were created in two anesthetized female domestic pigs (~45kg) using a brass bar or circulating heated water in replicates. The temperatures were controlled and kept constant using thermosensors. In one pig, the temperature was kept constant (95 degrees C) while the duration of exposure varied (5, 10, 15 sec.) In the second pig, the exposure time was kept constant (10 sec.) while the temperature of exposure varied (70, 80, 98 degrees C). Burns were covered with a topical antibiotic ointment and frequent dressing changes were performed for 4 weeks. Periodic punch biospies were taken to determine burn depth immediately after injury, percentage burns reepithelialized within 21 days, and depth of scar at 28 days. Analysis was performed using analysis of variance.

Results

When temperature was held constant, duration of exposure (5, 10, and 15 sec.) was associated with scar depth (2.1 vs 3.8 vs 5.0 mm respectively, P=0.001) and there was a trend for an association with burn depth (2.0 vs 2.2 vs 2.3 mm respectively, P=0.10). When exposure duration was held constant, temperature (70, 80, 98 degrees C) was associated with scar depth (0.6 vs 1.7 vs 3.6, P< 0.001) but not significantly associated with burn depth (1.2 vs 1.5 vs 1.7 mm respectively, P=0.21). For each pig a comparison of burn and scar depth by device generally showed that depths were greater for scald than contact burns although not significantly greater. Only scar depth in the first pig showed a difference with a significance of less than 0.10 (2.9 for contact vs 4.1 mm for scalds, P=0.08). After controlling for temperature the difference between scalds and contact burns was statistically significant (marginal means 3.0 for contact burns, 4.3 for scalds, P=0.008). When combining data from both pigs and controlling for temperatures and duration, scar depths for scalds (2.7 mm) vs contacts (1.9 mm) showed a significant difference (P=0.02) while burn depth was not quite significant (1.7 vs 1.5 mm, P=0.07). Almost all burns were reepithelialized by day 21.

Conclusions

Burns created in swine with circulating hot water tend to be deeper and result in deeper scars than those created by contact with a brass bar when controlling for temperature and duration of exposure.

Applicability of Research to Practice

Scalds of similar temperature and exposure times result in deeper scars than contact burns.
501 Burn Center Referral of Patients with Suspected Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)
Authors: Rizzo Julie A , Lidwell David S , Cancio Leopoldo C
Published: March 2020

Introduction

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but potentially life-threatening, as such referral of these patients to a burn center is appropriate. However, patients with suspected SJS/TEN are often referred to the Burn Center and are found to not actually be suffering from the disease process in question. This inefficient referral process warrants further examination to identify pre-arrival those patients who are appropriate for transfer.

Methods

As an approved PI project we examined the records of all patients referred to our Burn Center for suspicion of SJS/TEN for the time period 2016–2018. We analyzed the corresponding data to in an attempt to more effectively identify patients with SJS/TEN and prevent unnecessary Burn Center transfers.

Results

Of 84 patients referred for suspected SJS/TEN 32 received confirmatory diagnosis with skin biopsy after transfer (38%). The average length of stay was 8 ICU days and 14 hospital days versus 3.6 and 9.6 days, respectively, for patients with a negative diagnosis. The mortality rate of SJS/TEN patients was 12.5% (4/32).

In addition to SJS/TEN, a wide range of skin conditions were identified among referred patients, many of whom also required hospitalization, including BICU care. The various diagnoses included:

Drug eruptions (14%), psoriasis (6%), dermatitis (6%), erythema multiforme (2%), lupus erythematosus (2%) and generalized exanthematous pustulosis (2%). The remainder of patients had miscellaneous or nonspecific conditions (28%).

Conclusions

SJS/TEN is a potentially life threatening disease often requiring hospitalization in a Burn Intensive Care Unit (BICU). However, many other disease processes have similar presentations and may also be appropriate for Burn Unit care. Without a confirmatory skin biopsy prior to referral a large number of patients are transferred to the BICU unnecessarily.

Applicability of Research to Practice

In the absence of skin biopsy capabilities at the referring facility an algorithm using common characteristics of actual SJS/TEN patients may improve the accuracy of pre-referral diagnosis. Additionally, this data underscores the importance of dermatology support to the Burn Unit in diagnosing and treating desquamating skin disorders.
502 Use of Hydrocortisone, Vitamin C, and Thiamine to Treat Burn Sepsis: A Case Series
Authors: Resch Thomas R , Fischer Sarah
Published: March 2020

Introduction

Sepsis remains a leading cause of morbidity and mortality in burn patients. Therefore, novel treatment adjuncts are of constant interest. Early studies by Marik et al. have suggested that bundled use of intravenous hydrocortisone, vitamin C, and thiamine may improve outcomes in intensive care patients diagnosed with systemic sepsis. However, to our knowledge, evaluation of this treatment modality has not been applied to burn patients.

Methods

Chart review of seven patients with major cutaneous injuries admitted to our burn center and treated with the adjunct therapy as per Marik et al. occurred. Baseline characteristics, treatment, and outcome variables were identified. Variables abstracted include demographics, injury characteristics, comorbidities, discharge disposition, length of stay, mechanical ventilation, use of vasopressors, acute kidney injury, blood cultures, white blood cell count, lactate, creatinine, predicted mortality (modified BAUX, APACHE II, APACHE IV, and SOFA scores), procalcitonin, quantitative culture and histology results, time to first excision, and time to final surgery and/or healing.

Results

Five patients sustained flame burns ranging from 24% to 46% total body surface area. One patient was admitted for road rash causing full thickness injury and one with toxic epidermal necrolysis encompassing 90% total body surface area. Ages ranged from 19 to 74 years. Modified BAUX with APACHE II and IV scores were used to predict baseline mortality risk. Four of the seven patients succumbed to their injuries, two within the first week of admission. Of the remaining cases, all required fewer vasopressors after beginning adjunct therapy. Among survivors, SOFA scores suggested greater than 95.2% predicted mortality at start of adjunct therapy and within four days, predicted mortality ranged from less than 33.3% to 50%.

Conclusions

The aim of this case series is to review our early experience with this novel treatment in burn patients. No conclusions can be drawn at this time. It is understood that continued research must be conducted to support correlation between intervention and outcomes. Optimism is present based upon early non-burn studies and our regional burn center experience. A prospective study is currently being developed at our burn center.

Applicability of Research to Practice

This case series explores a potential treatment adjunct to decrease morbidity and mortality from burn sepsis.
504 Venous Thromboembolism Chemoprophylaxis in Burn Patients: A Literature Review and Single-institution Experience
Authors: Liu Alice , Minasian Raquel , Maniago Ellen , Gillenwater Justin , Garner Warren L , Yenikomshian Haig A
Published: March 2020

Introduction

Hospitalized burn patients meet the criteria for Virchow’s triad (endothelial damage, hypercoagulability, and stasis), predisposing them to venous thromboembolism (VTE). While the cost, morbidity, and mortality of VTE suggest a need for prevention in this population, unreliable reported VTE rates, variable and complicated prophylaxis regimens, and risks associated with chemoprophylaxis have prevented the establishment of a universal protocol. This paper reviews the thromboprophylaxis practices both in the literature and at our own institution.

Methods

A systematic review was conducted according to Preferred Reported Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines identifying studies pertaining to VTE chemoprophylaxis in burn patients. Additionally, medical records of patients admitted to an American Burn Association-verified burn center between June 2015 and June 2019 were retrospectively reviewed for patient demographics, chemoprophylaxis, and presence of VTE defined as either deep vein thrombosis (DVT) or pulmonary embolism (PE).

Results

35 studies met inclusion criteria. In the 11 studies that reported VTE incidence, rates ranged widely from 0.27 to 23.3%. The two largest retrospective studies (n = 33,637 and 36,638) reported a VTE incidence of 0.61% and a DVT incidence of 0.8% in populations with unknown or inconsistently recorded chemoprophylaxis. Throughout the literature, prevention protocols were mixed, though a trend toward using dose-adjusted subcutaneous low molecular weight heparin based on serum anti-factor Xa level was noted.

At our institution, 1440 patients were admitted over four years. At-risk patients received a simple chemoprophylaxis regimen of 5000U of subcutaneous unfractionated heparin every eight hours. No routine monitoring tests were performed to limit cost. Ten cases of DVT and two cases of PE were identified with an incidence of 0.69% and 0.14%, respectively, and a total VTE incidence of 0.83%. One patient developed heparin-induced thrombocytopenia (0.07%). There were no other heparin-associated complications.

Conclusions

VTE incidence rates reported in the literature are wide-ranging and poorly capture the effect of any one chemoprophylaxis regimen in the burn population. Our center uses a single, safe, and cost-effective protocol with a VTE rate comparable to that of large national retrospective studies.

Applicability of Research to Practice

VTE continues to represent a threat to the burn population. While simple and safe chemoprophylaxis regimens exist, the optimal prevention protocol remains elusive.
519 Retrospective Pilot Study to Examine Potential Predictors of a Standardized Scoring System for Smoke Inhalation Injury
Authors: Frost Joshua , Sorensen Grant , Van Spronsen Nicole , Howell Jordan , Ayala Donna , Kesey Jennifer , Keesari Rohali , Almekdash Mhd Hasan , Griswold John
Published: March 2020

Introduction

Smoke inhalation injury is strongly associated with increased morbidity/mortality. Bronchoscopy is used to diagnosis smoke inhalation injury, but its interpretation is subjective. This study sought to assess diagnostic significance of physical exam, history, location, and adjunct studies characteristically performed on patients suspected of smoke inhalation by comparing these findings to outcomes. The primary goal was to examine variables that could be used to create an accurate smoke inhalation injury scoring system in order to develop an objective method that considers the severity of inhalation injury.

Methods

This retrospective study evaluated demographics, clinical presentation, carboxyhemoglobin level, intubation on arrival, bronchoscopy, comorbidities, hospital course, and outcomes associated with smoke inhalation. Bronchoscopy findings included: red mucosa, carbon particles at carina, and numerical score (1–4). The primary outcome was resuscitation fluid required in the first 24 hours of treatment compared to that predicted by the modified Brooke formula (2cc*weight in kg* Total Burn Surface Area). If the patient received more fluid than predicted, this was considered positive for smoke inhalation. Differences between predictor/outcome variables were determined using Wilcoxon rank sum test for continuous variables and Chi-squared test for categorical.

Results

A positive bronchoscopy score was defined on the condition of having positive physical exam finding and/or bronchoscopy score 1–4. Physical exam findings consisted of soot or carbon sputum present on the patient along with hoarseness, wheezing, or a red oropharynx on physical exam. If the patient met one of these conditions, we considered this a positive result. Inclusion criteria: age 18–89, admission from 1/1/2004 and 5/31/18, and diagnosis of smoke inhalation injury/burn injury. There was a significant difference in positive bronchoscopy between those positive for our condition of inhalation injury and no injury (p< 0.001; Table 1). Patients with a positive bronchoscopy score were 9 times more likely (OR=9.91, 95% CI = 2.8–35.01) to be diagnosed with inhalation injury as compared to those without a positive bronchoscopy score.

Conclusions

These results display the importance of bronchoscopy in suspected smoke inhalation injury and reinforce the need for an objective bronchoscopy assessment. Future studies can build upon these results by creating an objective scoring system to guide providers performing bronchoscopy.

Applicability of Research to Practice

Due to the 9-fold benefit of performing bronchoscopy, it should be the primary tool used to assess potential smoke inhalation injury; other tests may be secondary in nature.
537 Transplantation of Fresh Scalp Allograft in Repairing Extensive Deep Burn Wounds in Children
Authors: Shen Chuanan , Sun Tianjun , Deng Huping , Niu Yuezeng
Published: March 2020

Introduction

It is difficult to treat pediatric extensive burns, which contribute to high mortality rates, partly because of the lack of large allogeneic skin to close wound in China. Therefore, we innovatively used fresh scalp as thin split thickness skin allografts to cover the burn wounds of pediatric patients.

Methods

Fresh scalp allografts were harvested from voluntary donors who were patients’ relatives. The median total burn area in the major burns was of 40% TBSA, in depth of deep second to third degree. The fresh scalp allografts were transplanted on the wounds post tangential excision or escharectomy in the way of mere fresh scalp allografts coverage or mixed coverage with autografts and fresh scalp allografts.

Results

All the patients survived without serious complications during the treatment period. The median healing time was 47 days; the average healing time of the donors’ scalps was (7.6±1.08) days with no scar formation, alopecia areata or folliculitis post operation.

Conclusions

The use of fresh scalp allografts in the treatment of pediatric major burns is an effective and feasible method in protecting wounds and promoting wound healing as well as in reducing scar formation in the donor sites of burned children. The high ratio of fresh scalp areas to pediatric burn wound areas ensures high efficiency of wound coverage; and healthy relative skin donors have more initiatives and favorable healing results.

Applicability of Research to Practice

This is a clinical research which is highly applicable in practice.
541 Gender Disparities Among Burn Surgery Leadership
Authors: Egro Francesco M , Konanur Anisha , Kettering Caroline E , Corcos Alain C , Stofman Guy M , Ziembicki Jenny A
Published: March 2020

Introduction

Gender disparities have been described in the plastic surgery and general surgery literature, but no data has been reported in burn surgery. The aim of this study is to determine gender disparities among burn surgery leadership.

Methods

A cross-sectional study was performed. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers, past presidents of the ABA and International Society for Burn Injuries (ISBI), and editors of the Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma. Training, age, H-index, and academic level and leadership position were compared among surgeons identified.

Results

Among the 69 ABA and ISBI past presidents, 203 burn journals’ editorial board members, and 71 burn unit directors, females represented only2.9 percent, 10.5 percent, and 17 percent, respectively. Among burn unit directors, females completed fellowship training more recently than males (female = 2006, male = 1999, p < 0.02), have lower H-indexes (female = 8.6, male = 17.3, p = 0.03), and are less represented asfull professors (female = 8.3 percent, male = 42.4 percent, p = 0.026). There were no differences in age, residency, research fellowship, or number of fellowships.

Conclusions

Gender disparities exist in burn surgery and are highlighted at the leadership level, even though female surgeons have a similar age, residency training and other background factors. However, gender diversity in burn surgery may improve as females in junior faculty positions advance in their careers.

Applicability of Research to Practice

Gender disparities are a significant issue in burn leadership, which needs further discussion at national level and should be addressed more proactively through programs that emphasize leadership opportunities and mentorship for women.
543 Acute Carpal Tunnel Syndrome from a Solar Panel Electrical Injury: A Case Report and Literature Review
Authors: Qumsiyeh Yazen , Van Hoorebeke Justin , Kopari Nicole M
Published: March 2020

Introduction

The utilization of solar panels for residential and industrial purposes is increasing. Electrical injury from solar panels has not been well defined. Most of the literature on electrical burns is predominately from alternating current (AC) injuries instead of direct current (DC) as seen in solar panels. The implication of solar panel electrical injury in the pathogenesis of acute carpal tunnel syndrome has yet to be reported.

Methods

A retrospective chart review of a patient presenting to our burn unit following a solar panel electrical injury was performed.

Results

The patient was a 46 year old otherwise healthy male who presented after 5–10 seconds of high voltage (~7500V) direct current injury to his right forearm. The patient had deep partial thickness burns to his right hypothenar eminence and a full thickness defect with exposed muscle on his right volar forearm. On admission he had complete function, but within hours developed an inability to move his hand. He was taken for exploration on hospital day 2 because of mildly elevated compartment pressures, pain, and paresthesia. The hypothenar injury was noted to have converted to full thickness injury and a distal right volar forearm fasciotomy and carpal tunnel release was performed. On hospital day 3, the patient’s pain and neurologic examination improved. At 3 month follow-up, the patient had some restored function of his hand, but reduced grip strength, and mild persistent pain and paresthesia in the volar wrist and hand.

Conclusions

Solar panel injuries are expected to rise. The use of high voltage direct current energy has the potential to cause serious harm and appropriate awareness can lead to thorough management and better outcomes of burn victims. With electrical injuries to the hand, providers should have a low threshold for carpal tunnel syndrome, whose symptoms may be complicated by concomitant compartment syndrome of the hand and/or forearm. Lastly, as with most burn injuries a multidisciplinary approach should be established with focus on long term care.

Applicability of Research to Practice

We suspect that this new etiology of electrical burn is on the rise as we see more solar panels being utilized. Physician should be familiar with potential complications in this complex patient population.
549 Differences in Treatment of Stevens-johnson Syndrome and Toxic Epidermal Necrolysis at Burn Centers and Non-burn Centers
Authors: Nygaard Rachel , Endorf Frederick W
Published: March 2020

Introduction

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at non-burn centers and then transferred to burn centers. We wanted to explore whether patients had any differences in care or outcomes when they received definitive treatment at burn centers and non-burn centers.

Methods

We queried the National Inpatient Sample (NIS) database from 2016 for patients with SJS, SJS/TEN, and TEN diagnosis. We considered burn centers as those with greater than 10 burn transfers to their center and fewer than 5 burn transfers out of their center in a year. Multivariable logistic regression assessed factors associated with treatment at a burn center and mortality.

Results

Using the NIS, a total of 1164 patients were identified. These were divided into two groups, non-burn centers vs. burn centers, and those groups were compared for demographic characteristics as well as variables in their hospital course and outcome. Patients treated at non-burn centers were more likely to have SJS and patients treated at burn centers were more likely to have both SJS/TEN and TEN. Demographics were similar between treatment locations, though African-Americans were more likely to be treated at a burn center. Burn centers had higher rates of patients with extreme severity and mortality risks, and a longer length of stay. However, burn centers had similar actual mortality compared to non-burn centers. Patients treated at burn centers had higher charges and were more likely to be transferred to long-term care after their hospital stay.

Conclusions

The majority of patients with exfoliative skin disorders are still treated at non-burn centers. Patients with SJS/TEN and TEN were more likely to be treated at a burn center. Patients treated at burn centers appear to have more severe disease but similar mortality to those treated at non-burn centers. Our data suggest that more patients with these disorders could benefit from transfer to a burn center.

Applicability of Research to Practice

These data may aid in outreach efforts to improve appropriate transfers of patients with severe exfoliative skin disorders to burn centers for definitive care.
555 The Prevalence of Patients with Homelessness or Housing Instability in Patients Admitted to an Urban Burn Intensive Care Unit
Authors: Shetty Pragna N , Mafla Laura M , Slavin Benjamin R , Yesantharao Pooja S , Javia Vidhi , Cox Carrie A , Hultman C Scott
Published: March 2020

Introduction

Patients with homelessness in the setting of burns experience more complications and longer lengths of stay (LOS), resulting in higher costs of care and recidivism rates, making appropriate screening and documentation critical to improving outcomes. However, the prevalence of housing instability and its effect on outcomes has not yet been studied. This study sought to describe the prevalence of housing insecurity, or homelessness and housing instability, in patients admitted to an urban burn intensive care unit (BICU) and compare their outcomes to their housed counterparts.

Methods

This is a retrospective cohort study of all adult patients admitted to our BICU over 3 years. The degree of burn injury and LOS were collected. We used the World Health Organization definitions of housing insecurity to identify patients. Physician and case management notes were used to evaluate housing status.

Results

There were 881 patients observed. The prevalence of patients with homelessness was 2.9 per 100 patients. The prevalence of patients with housing instability was 10.3 per 100 patients. The median length of stay was 8 (IQR 4 – 11) days for patients with homelessness and 4.5 (IQR 2 – 12) days for patients with housing instability compared to 4 (IQR 1 – 8) days for housed patients (P < 0.001). Patients with housing insecurity had similar injuries to housed patients (P = 0.06). Physicians incorrectly documented housing status in 42.9% of patients with housing insecurity compared to case management, which correctly screened all patients (P < 0.01). The electronic medical record correctly screened less than 1% of the patients with housing insecurity (P < 0.01).

Conclusions

Housing insecurity is more prevalent than previously thought, with 13.2 per 100 patients experiencing either homelessness or housing instability. These patients have similar injuries to their housed counterparts, with longer stays and higher health care costs. Identifying and implementing appropriate screening tools can help provider teams connect patients with resources, reducing costs and improving outcomes.

Applicability of Research to Practice

Identifying patients at high risk earlier in their care can ensure that they are provided with the appropriate resources to avoid complications and worse outcomes.
567 A Qualitative Exploration of Social Workers as Members of Burn Care Teams
Authors: Abrams Thereasa E , Held Mary L , Lloyd Alison , Skeesick Jessica
Published: March 2020

Introduction

Social workers as members of interprofessional teams are important in treating the psychosocial sequela of trauma and burn injuries. However, the specific skills needed and roles of social workers on treatment teams can be confusing and poorly articulated not only by medical providers, but even among social workers themselves. This qualitative study was designed to increase both the breadth and depth of knowledge related to social work practice on interprofessional burn care teams.

Methods

Primarily qualitative methods were used to explore the roles of social workers employed on burn care teams. In addition to conducting individual interviews, brief surveys were collected from each of the social work participants (N = 11) focused on participant work environments and demographics. All qualitative interviews were transcribed verbatim to capture the perceptions of participants in their own words. Each interview was analyzed and coded by at least two research team members using NVivo 12 (QSR International, 2018). Analysis applied grounded theory strategies for inductive thematic approaches.

Results

Ten females and one male participated. All participants held some level of professional license and had a mean of 4.69 years of experience working in a burn center (range = 1–13 years). Themes and sub-themes derived between and across participant interviews were: “Skills” (building trust/rapport, thorough assessment of needs, support, communication, case management, trauma-informed therapy, and knowledge of medical terminology and burn treatment); “Challenges/Barriers to Treatment” (patient finances, lack of community providers knowledgeable in management of burn injuries, knowledge of available community resources throughout their catchment area, unstable social support systems, premorbid patient mental illness and substance abuse, inadequate insurance coverage, transportation insecurity, and the long-term nature of burn recovery); and “Resources” (Phoenix Society, SOAR, World Burn Congress, burn foundations, hospital programs, stable support systems, and resilience of burn survivors).

Conclusions

By gaining insight into the skills, barriers, and resources of social workers working in U.S. burn centers, treatment team members can better and more consistently understand, utilize, and support their current and/or incoming social workers. In addition, Master’s level academic programs can better prepare new social workers in how to best assist burn survivors and their families at both the inpatient and community level. Content related to the needed competencies can be incorporated into required social work courses and medical social work electives.

Applicability of Research to Practice

By establishing the requisite skills of burn center social workers, there will be opportunity for consistency through certification in burn care much like allied health providers.
572 Examination of Gender Differences in Return to School and PROMIS-25® Outcomes for Pediatric Burn Survivors
Authors: Stockly Olivia , Wolfe Audrey E , Gibran Nicole S , Ryan Colleen M , Schneider Jeffrey C
Published: March 2020

Introduction

Gender differences in pediatric burn outcomes are not well-known. Long-term physical and mental health outcomes, in addition to school status, serve as important markers in recovery for school-aged burn survivors. This study aimed to assess the impact of gender on school status and health outcomes in pediatric burn survivors.

Methods

Data from pediatric burn survivors, age 8–17 years at time of injury that are participating in the Burn Model System National Database (2015–2019) were analyzed. Descriptive statistics were generated for demographic and clinical characteristics. Scores on the seven subscales of the PROMIS-25 (physical function, anxiety, depression, fatigue, peer support, pain interference, and pain intensity) and school status at 12 months post-injury were examined. All demographic, clinical, and outcome data were compared by gender using Chi-square tests of association and two-sample t-tests for categorical and continuous variables, respectively.

Results

A total of 104 individuals (76 male, 28 female) were included in the demographic analysis. Additionally, 60 individuals had complete PROMIS-25® data at 12 months post-injury and were included in analysis. Demographic and clinical characteristics including age at time of burn injury, race/ethnicity, burn etiology, burn location and burn size did not differ by gender. No differences were found in PROMIS-25® subscales (p=0.22–0.87; Table 1) or school status by gender. Nearly 80% of male and female burn survivors were in school at 12-months post-injury (76.6% male vs. 88.2% female; p=0.307).

Conclusions

In this study, burn survivors between the ages of 8 and 17 years old did not experience any differences in long-term PROMIS-25® outcomes or school status at 12 months post-injury based on gender.

Applicability of Research to Practice

Preliminary data suggest similar physical, mental, and school outcomes for school aged children based on gender. A more robust examination of long-term pediatric outcomes and school status are needed in the future.
573 Frequency of Burn Injuries in Children with Autism Spectrum Disorders and Attention Deficit/hyperactivity Disorder and Implications on Treatment Compliance
Authors: Sadeq Farzin , Riobueno-Naylor Alexa , Ceranoglu Atilla , Sheridan Robert
Published: March 2020

Introduction

Children with autism spectrum disorders (ASD) and attention deficit/hyperactivity disorder (ADHD) are at a higher risk of burn injuries, compared to children with neurotypical development, but little is known about the epidemiology of burn injuries in children diagnosed with ASD and ADHD. Research within the pediatric burn population using the Burn Outcomes Questionnaire (BOQ) has been successful in capturing levels of risk on burn-recovery specific domains such as compliance to treatment, pain, and parental concerns.

Methods

The current study retrospectively assessed a subsample of BOQ data in children with burn injuries who also had a diagnosis of ASD or ADHD. This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board.

Results

Of the 593 patients who completed a BOQ, 186 patients were identified with a diagnosis of ASD or ADHD. 127 patients had multiple parent-reported symptoms which align with diagnoses of ASD and ADHD, including 116 (63.4%) with attention or behavioral problems, 42 (23.3%) with a developmental delay, 7 (3.9%) with an intellectual disability and 90 (49.7%) had learning problems. 66 (37.3%) patients had pre-existing comorbid psychiatric diagnoses of depression.

Conclusions

Results indicated that a large portion of patients have a diagnosis of ASD/ADHD with significantly higher levels of parental concern regarding compliance compared to youth without an ASD/ADHD diagnosis. Results suggest that modified curriculum may be necessary to assure effective prevention education for children with ASD and ADHD.

Applicability of Research to Practice

While it is important to educate all children in burn prevention efforts, special attention may be necessary to assure training with children at greater risk for burn injury. Specific parent training would be imperative to understand the critical burn care needs of children with developmental disabilities.
582 Bridging the Gap Between Inpatient and Outpatient Burn Care Compliance: Incentive Programs for Pediatric Burn Patients
Authors: Crandon Stephanie , Fleming Lenore
Published: March 2020

Introduction

As healthcare advances, treatment options are expanding to allow patients to be cared for in outpatient settings. To ensure quality of treatment is maintained, efforts must be made to translate resources offered during inpatient stays to the outpatient population. This is especially important for pediatric burn patients and their families whose treatment plan is contingent on maintaining critical aspects of care provided during the course of an admission. Optimal outcomes are dependent on patients complying with physical/occupational therapy activities, meeting increased nutritional standards, and performing daily dressing changes.

Methods

Incentive programs have traditionally been effective during hospital stays by rewarding children upon completion of difficult tasks, which encourages participation and provides a sense of control. In order to meet the needs of our patient population, a burn specific incentive program named “Burn Bucks” was developed with the intent to establish early patient engagement and goal setting. This program allows for a successful transition from inpatient to the home setting. Patients identify their most difficult healthcare goals and a dollar amount is assigned to that goal. Throughout their stay, staff give “bucks” for the completion of goals. As patients progress, goals are updated. Patients may use Burn Bucks earned to shop in the “Burn Bucks Store.” In preparation for discharge, home care goals are set for patients. Upon return to clinic, patients may shop in the Burn Bucks Store at the end of each appointment.

Results

Patients who participated in the Burn Bucks program returned as outpatients less fearful of the treatment room and more motivated to take an active role in their therapies. Preliminary data shows those who use burn bucks in the home setting are more likely to meet or surpass treatment goals. Additionally, parents and staff report increased participation as well as an improved overall demeanor by children who participate in the Burn Bucks program.

Conclusions

The Burn Bucks program has proven to be a successful tool to engage patients and families in their treatment plan. Early introduction during inpatient stays encourages participants to continue using Burn Bucks in the home setting. We continue to find ways to adapt the structure of the program to support various age groups and abilities, enhance coping, and individualize incentives to achieve optimal outcomes.

Applicability of Research to Practice

The success this program has brought to our patient population has prompted other teams within our hospital to adopt the Burn Bucks program to accommodate a variety of treatment plans. The ability for this particular incentive program to adapt to various treatment goals contributes to its consistent success. The principles of this program can be easily implemented in burn centers of any size.
626 Causes and Injury Patterns of Elderly Burn Patients
Authors: Miotke Sam , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G , Sen Soman
Published: March 2020

Introduction

Older patients are a particularly vulnerable population with respect to burn injuries. The American Burn Association has invested resources in improving burn care and burn prevention within this age group, recognizing the difficulties in both the identification and subsequent modification of risk factors. The National Electronic Injury Surveillance System (NEISS) is maintained by the Consumer Product Safety Commission to surveil for injury trends and is populated with data from a representative group of approximately 100 emergency departments in the United States. This database could serve as a useful tool to evaluate burn injury patterns in elderly patients with an eye toward targeted prevention measures.

Methods

The NEISS was queried for patients aged 55 years and older with a diagnosis of scald, thermal, chemical, electrical, or unspecified burn injuries for the years 2008 - 2017. Each injury was classified by body part(s) burned, causative product, gender, and age group of patient (55–64, 65–74, 75–84, 85 and older). The ten most commonly burned sites as well as the ten most common causative products were determined for each gender and age group and in aggregate. Weighted estimates from the NEISS data were utilized to calculate injury numbers across the population.

Results

The most common etiology of burn injuries for all patients aged 55 and older was hot water. Men were most commonly injured by gasoline, a product which did not rank in the top ten for women in any age group. Additionally, within each age group, gasoline was among the top 4 products that was associated with burn injuries in men. Cookware was the second most common cause of burn injury among women aged 55 and older and was the sixth most common cause among men. For women, the combination of cookware and ranges/ovens was among the top 2 products associated with burn injury within each age group. The most commonly injured body part for all patients was the face. This held across most age and gender groupings except for women aged 75 to 84 (upper trunk), and women 85 and older (foot). Men were more likely to injure their hands than women.

Conclusions

The most common cause of burn injuries in older adults is hot water, and the most common body part affected is the face. Women are more likely to be injured by cookware and ranges/ovens. Men are more likely to be injured secondary to gasoline and are more likely to injure their hands.

Applicability of Research to Practice

NEISS data could be useful in the development of targeted prevention campaigns, such as focused education about the dangers of hot liquids, cooking, and accelerants.
647 Development of a Cerium (III) Nitrate-containing Electrospun Dressing for Mitigating Delayed Eschar Removal
Authors: Jockheck-Clark Angela R , Williams Cortes , Kowalczewski Christine , Roy Jahnabi , Thompson Marc A , Martinez Luis A , Christy Robert J
Published: March 2020

Introduction

During periods of delayed burn treatment, cells within the eschar leach toxic and immunomodulatory metabolites that can profoundly impact neighboring tissue. Therefore, to reduce the burn-related morbidities and mortalities that are the result of delayed surgical interventions, electrospinning was utilized to generate a novel cerium (III) nitrate (Ce(III)N) dressing. Previously published work has demonstrated that topical Ce(III)N application changes the eschar morphology, and that tissue beneath the treated eschar was generally healthy and had a high rate of graft acceptance.

Methods

Ce(III)N was dissolved with polyethylene oxide and spun onto a grounded rotating mandrel. The uni-axially spun mesh was compared to a co-axially electrospun dressing that contained a Ce(III)N core. Dressings were evaluated for topography/morphology, porosity and oxygen permeation using scanning electron microscopy, helium pycnometry, and a gas exchange chamber, respectively. Ce(III)N release rates were evaluated, as well as 60-day storage stability.

Results

All electrospun dressings contained functional Ce(III)N, with the co-axially spun dressing containing three times the amount of Ce(III)N as the traditionally spun dressing. Uni-axially and co-axially spun nanofibers had diameters of 1487±560 nm and 1071±147 nm, and porosities of 83.9% and 74.1%, respectively. Scaffolds released the majority of Ce(III)N within the first hour of wetting.

Conclusions

All dressings were capable of a burst of Ce(III)N release and maintained stability when stored at room temperature for 60 days.

Applicability of Research to Practice

Despite advancement in protective equipment worn by military personnel, the incidence of thermal injury is expected to rise in future conflicts. There are no burn wound dressings that can mitigate the pathophysiological processes associated with delayed burn wound treatment.