bluuebunny/crossref_metadata_2025 huggingface dataset:
25 Baseline Copper Levels are Associated with Worse Outcome in Burn Patients with Overweight and Obesity
Authors: Dhanasekara Chathurika S , Schrader Kaylee , Chandrahas Sheila , Aickareth Genesy , Dissanaike Sharmila D , Griswold John A
Published: April 2021

Introduction

While copper (Cu) has been shown to be beneficial in wound healing, high levels of circulating Cu are also associated with increased oxidative stress. Interestingly, elevated baseline Cu levels have been seen in obese patients, and theoretically, this is associated with higher baseline oxidative stress. Overweight (OW) and Obesity (OB) are common conditions in the US; therefore, a significant proportion of burn patients will be potentially affected. We examined the interactive effects of Cu and obesity on outcomes of burn patients; specifically, we hypothesized that higher baseline Cu levels in OW and OB burn patients are associated with worse clinical outcomes.

Methods

A retrospective review of patients with burns ≥20% TBSA between 2015–2019. Patients were grouped according to body mass index (BMI) (i.e., NW:18–24.9; OW:25–29.9; and OB: ≥ 30 kg/m2). Baseline characteristics were compared using ANOVA and χ 2 tests. The interactions between baseline Cu and BMI groups on 1) lengths of ICU stay (ICUS), 2) overall hospital stay (LOS), and 3) the number of operative procedures, were examined in a series of multiple regression models in R.

Results

Data of 160 patients met eligibility (NW: OW: OB = 53: 38: 69). BMI groups did not differ significantly on demographics, TBSA, degree of burn, inhalational injury, or mortality. Regression models revealed that NW patients with high baseline Cu levels had shorter ICUS (p< 0.001) and LOS (p=0.003) and also had fewer operations (p = 0.001). While OW and OB were protective at low Cu levels, patients with OW or OB who had high baseline Cu levels had longer ICUS (p< 0.001 and p=0.033), LOS (p=0.001 and p=0.063), and a greater number of operations (p< 0.001 and p=0.066) (Table 1).

Conclusions

High baseline Cu seems to be beneficial for NW burn patients, yet associated with adverse outcomes in burn patients with OW and OB. While further evidence is needed to confirm this notion, caution is advised when supplementing Cu for burn patients with OW and OB.
43 COVID Crisis: A Burn Approach
Authors: Heffernan Jamie , Gallagher James
Published: April 2021

Introduction

The net effect of the COVID-19 pandemic on this northeastern, urban healthcare system during March, April and May 2020 was the redirection of virtually all resources to the care of the affected population. Conversion of the majority of the hospital’s assets, including staff and infrastructure, to COVID care created a large reduction in resources for other clinical problems. The burn service was among those few essential disciplines that continued to receive acutely affected individuals during the crisis. The preservation of the burn center’s ability to continue its mission within the walls of a COVID hospital is the subject of this review.

Methods

All of the hospital’s ICU rooms, including all those on the burn unit, post anesthesia care units, some step-down units, and over 90% of the operating rooms (ORs) converted to COVID care ICUs. These vital actions by hospital administration enabled an increase in ICU beds from 114 to 270. Staff were redeployed to cover the massive influx of critical COVID patients.

Burn inpatients during the transition were categorized by severity and age for disposition consideration. Of the 17 inpatients, 4 pediatric patients discharged home and 1 transferred to our associated children’s hospital; 7 adults discharged home, 2 transferred to our associated inpatient psychiatric hospital, 1 to inpatient rehab, and 2 transferred to a neighboring orthopedic hospital converted into an adult acute care hospital.

The commitment to keep the burn center operational for both children and adults was facilitated by protecting the burn ICU hydrotherapy room, a large patient care space in the center of the burn ICU. Children, initially admitted and cared for in the hydrotherapy room until stable, transferred to our network Children’s hospital for continued care. Critical adult burns were admitted to the inpatient ICU with the COVID patients, acute burns were housed on the few remaining medical surgical units. Burn care was performed in the patients’ rooms to keep the hydrotherapy room “clean”.

Results

During the 3-month period described the burn service admitted and cared for 92 adult and 25 pediatric patients while maintaining a full ICU census. Although 3 admitted burn patients were COVID +, no burn patients housed in the ICU became COVID + during their stay.

Conclusions

The commitment to protect the burn hydrotherapy space for burn triage and care from the top level of administration was critical and notable given the widespread conversion of the subspecialty ICUs and most other patient care areas to COVID care units. Strict adherence to infection prevention guidelines and protection of the hydrotherapy room allowed burn patients to receive timely and appropriate care during a pandemic.
51 We Test Everyone… Really? Bias in Drug Screening in an Academic Burn Center
Authors: Sloan Keturah , Greenhalgh David G , Sen Soman , Palmieri Tina L , Romanowski Kathleen S
Published: April 2021

Introduction

Previous studies have found that burn-injured patients who use illicit substances, such as methamphetamines, have worse outcomes and longer hospital lengths of stay when compared to those who do not use illicit drugs. It is our units’ stated practice to perform a urine drug screen on all patients admitted with a burn injury. We hypothesize that, while we intend to test all patients, we fall short of this goal. The purpose of this study is to examine our urine drug screening practices.

Methods

Following IRB approval, a retrospective chart review was conducted using electronic medical records of all adult patients admitted to the burn center from 2016–2018. Data collected included information on the burn injury, drug screening, and demographics. Due to the fact that many patients receive opioids and benzodiazepines for pain and anxiety related to their burn injury, these were not considered positive if present on drug screen without gas chromatography to confirm use. Data analysis was conducted using chi-square, t-test, and logistic regression models.

Results

A total of 1134 patients (mean age 45.9 ± 17.3 years, 855 males (75.4%), mean burn size (TBSA) 12.1±15.5%) were analyzed. Of the 1134 patients admitted, 65% had a urine drug screen performed. Of those who were not screened, 12.1% had a test ordered but not performed while 87.8% had no test ordered. Globally, amphetamines/methamphetamines were the most commonly detected substances in 262 patients (23.1%) followed by cocaine with 14 patients (0.2%) Those with larger burns were more likely to be tested with the mean burn size of those tested being 15.0% while the mean size of those not tested was 6.6%, p< 0.0001. When looking at the effect of age on drug screening, those at the extremes of age (< 20 years (37.5%), 61–70 years (38.9%), 71–80 years (51.5%) and >80 years (76.9%)) were more likely to not be tested (p< 0.0001). All other age groups had a rate of not testing between 30.3% and 33.3%. Additionally, overall men were more likely to be tested than women (68.3% vs. 54.8%, p< 0.0001). On multivariate logistic regression, age (OR 0.99 (0.98–0.99), p< 0.0001), burn size (OR 1.07 (1.05–1.08), p< 0.0001), and female gender (OR 0.61 (0.45–0.81), p=0.0008) were independently associated with a patient receiving a urine drug screen.

Conclusions

Although our intention is to perform a urine drug screen on all patients admitted with burn injury, we fall short of this goal. A significant number of patients do not get tested and these tend to be older patients, those with smaller burns, and women. Given that drugs of abuse can alter patient outcomes we need to be more rigorous in our efforts to obtain tests on all patients.
65 Pain Management Practices in the Elderly Patient with Burn Injury
Authors: Hutchison Ciara , Gayed Rita , Mittal Rohit
Published: April 2021

Introduction

Opioids are key to pain management in burns but have increased side effects like falls and delirium in the elderly. However, comorbidities prevalent in this population (e.g., chronic kidney disease) limit use of non-opioid adjuncts, making pain control for these patients a difficult balance. Little data exists regarding pain control practices in elderly burn patients. We aim to retrospectively characterize pain management strategies (including opioids and non-opioid adjuncts) in this patient population.

Methods

This is a retrospective cohort of patients age >65 with burns < 20% total body surface area (TBSA) admitted to the burn stepdown unit from 2014 to 2019. The primary outcome was to quantify opioid use inpatient and at discharge in morphine milligram equivalents (MME). Secondary outcomes included percent of patients receiving opioids and adjunct analgesics at these timepoints. Mean MME inpatient vs. at discharge were compared using paired t-test. Percent of patients receiving opioids and non-opioid adjuncts were compared using McNemar’s test.

Results

One hundred elderly patients (mean age 73.9, SD 6.7) with mean TBSA of 5.6% (SD 4.5) were included. Fifty-two percent required autografting; the remainder received porcine or non-operative therapy. Mean daily inpatient MME was 18.0 (SD 20.8) and mean discharge MME was 28.0 (SD 20.5) (p=.001), equivalent to 12mg and 18.5mg of oral oxycodone. Inpatient, 72% of patients received opioids vs. 83% at discharge (p=.041). Acetaminophen was the most commonly prescribed non-opioid adjunct inpatient and at discharge; other adjuncts like non-steroidal anti-inflammatories (NSAIDs) and gabanoids were infrequently used.

Conclusions

Elderly burn patients are discharged with more opioids than utilized while inpatient. Aside from acetaminophen, non-opioid adjuncts used commonly in younger patients such as NSAIDs and gabanoid medications are under-utilized, presumably due to concern for comorbidities.
67 Identifying Risk Factors that Increase Analgesic Requirements at Discharge Among Patients with Burn Injuries
Authors: Yeung Celine , Kiss Alex , Rehou Sarah , Shahrohki Shahriar
Published: April 2021

Introduction

Opioids and neuropathic pain agents (NPAs) like gabapentin and pregabalin are commonly prescribed in large doses to achieve adequate pain control among patients with burn injuries. This patient population is therefore at greater risk of becoming dependent and misusing analgesics following their injuries. Factors that increase the risk of chronic use of opioids or NPAs among this patient population has not yet been characterized. The purpose of this study was to identify factors that increase the amount of analgesics required by patients with acute burn injuries at the time of discharge.

Methods

Patient charts from July 1, 2015 - 2018 were reviewed retrospectively to determine opioid and neuropathic pain agent (NPAs) requirements 24 hours before discharge (n = 199). Regression models were performed to determine whether the following risk factors increased analgesic requirements at discharge: surgical intervention; age; gender; TBSA; history of psychiatric disorder; and history of substance misuse.

Results

Patients with a history of substance misuse or who were managed surgically required higher doses of opioids at discharge compared to those without a history of misuse or those who were managed conservatively (p = 0.01 and 0.02, respectively). Similarly, patients who had undergone surgery required more NPAs compared to those who did not have surgical debridement of their injuries (p < 0.001). For every percent increase in TBSA, patients required 14 mg more NPAs (p = 0.01). In contrast, older patients and those with a longer hospital stay required fewer amounts of NPAs before they were discharged from hospital. For every increase in years of age, patients required on average 7 mg less NPAs (p = 0.006), and for each additional day in a patient’s length of stay, patients required 6 mg less NPAs (p = 0.009).

Conclusions

Predictors of high analgesic requirements at discharge include patients with a history of substance misuse, those who underwent surgical debridement of their burn injuries, and patients with higher TBSA. Characterizing patient risk factors that increase analgesic requirements may help burn care providers tailor how much narcotics and NPAs to prescribe each patient at discharge.
74 Epidemiology and Outcomes of Cooking and Cookstove-related Burn Injuries: A World Health Organization (WHO) Global Burn Registry (GBR) Report
Authors: Mehta Kajal , Thrikutam Nikitha , Nakarmi Kiran K , Hoyte-Williams Paa Ekow , Peck Michael , Stewart Barclay T
Published: April 2021

Introduction

Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally. A cookstove is any apparatus that provides heat and is used for cooking (e.g., three-stone fire, traditional or improved cookstove). There are limited data on patterns of cooking behaviors and CSBs to inform prevention initiatives and advocacy. We aimed to describe the epidemiology, risk factors and outcomes of cooking-related burns and CSBs, specifically.

Methods

Patients with cooking and non-cooking related burns from 2018 to 2020 were identified in the World Health Organization (WHO) Global Burn Registry (GBR). Patient demographics, cooking arrangement, injury characteristics [mechanism, total body surface area (TBSA), revised Baux score] and outcomes were described. Differences in proportions and medians were compared. Bivariate regression was performed to identify risk factors associated with occurrence of CSB.

Results

GBR contained data of 6,965 burn-injured patients from 17 countries; 88% were from middle-income countries. One quarter of burn injuries (1,723 burns) were cooking-related. More than half of cooking-related burns (55%) occurred in females. Median age for cooking-related burns was 11 years (IQR 2–35). Of cooking-related burns, 22% were cookstove-related burns (CSBs; 311 burns). The most common mechanism in CSB was flame (87%), whereas the most common mechanism in other cooking burns was scald (62%). Patients with CSBs were more often female (65% vs 53%; p< 0.001) and much older than patients with other cooking burns (32 years, IQR 22–47 vs 5 years, IQR 2–30). CSBs were significantly larger in TBSA size (30%, IQR 15–45% vs 15%, IQR 10–25%; p< 0.001), had higher revised Baux scores (70, IQR 46–95 vs 28, IQR 10–25; p< 0.001) and more often resulted in death (41 vs 11%; p< 0.001) than other cooking burns (Table1). Patients with CSBs were more likely to be burned by fires (OR 4.74; 95% CI 2.99–7.54) and explosions (OR 2.91, 95% CI 2.03–4.18) than other cooking injuries. Kerosene had the highest odds of CSB than all other cooking fuels (OR 2.37, 95% CI 1.52–3.69).

Conclusions

Cooking-related burns are common and have different epidemiology than CSBs, specifically (e.g., more often female, older, larger burn size, higher mortality). CSBs were more likely caused by structural factors (e.g., explosion, fire) than behavioral factors (e.g., accidental movements) when compared to other cooking burns.
76 Survival Outcomes from Burn Injury in Rural Africa
Authors: Hunter Mary A , Sylvester Kimutai , Vivier Patrick M , Harrington David T , White Russell , Parker Robert K
Published: April 2021

Introduction

Burn injuries contribute a considerable burden of disease in variable-resource settings, often resulting in mortality. Despite contributing a substantial burden, outcomes from burn injuries in rural Africa are rarely described. The objective of this study was to examine factors associated with mortality from burn injury in rural Africa.

Methods

A retrospective chart review was conducted for all patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in eastern Africa. Bivariate analysis was used to compare patients who survived the hospital stay with those who did not. Using total body surface area (TBSA), the LD50 (Lethal Dose 50, burn size with a lethality of 50% of patients), and the modified-Baux score were calculated. Due to small sample size, lasso inference techniques for logistic regression were utilized to avoid overfitting a model and to determine relevant risk factors for mortality, by evaluating burn severity, age, sex, location of residence, payer status, time from injury to arrival, distance from hospital, presence of full thickness burns, inhalational injury, and referral status.

Results

A total 171 burn injury patients were reviewed for this study; two were excluded due to missing data. Among 169 patients, 14.8% (n=25) experienced mortality prior to hospital discharge. Fifty patients suffered an adverse event (29.6%) including: 17 wound infections, 10 urinary tract infections, 10 with sepsis, and 25 with respiratory complications. The LD50 for TBSA was 42%. The LD50 for the modified-Baux score was 81. Non-survivors had higher average TBSA (31.0±5.0% vs 11.5±0.8%; p< 0.01), more inhalational injury (44% vs 2.8%, p< 0.01), full-thickness burns (56.5% vs 23.9%, p< 0.01), and complications (88% vs 19.4%, p< 0.01). Odds of mortality increased 1.06 times for every percent increase in TBSA burn (95%CI: 1.02, 1.11; p< 0.01) and 13.9 times with inhalational injury (95%CI: 3.4, 56.4; p < 0.01).

Conclusions

Mortality from burn injury represents a substantial portion of patients at a hospital in rural Africa. Factors of larger TBSA and inhalational injury represent the greatest risk.
96 Relation of Coping Strategies to Social Functioning and Self-Concept in Pediatric Burn Survivors
Authors: Snider Mira , Young Sarah , Enlow Paul , Ahrabi-Nejad Corrine , Leonard Linda , Aballay Ariel , Duncan Christina
Published: April 2021

Introduction

Burn survivors can experience challenges in social functioning (e.g., bullying, stigmatization) and self-concept (e.g., body image concerns). Use of coping strategies is associated with engagement in social supports and positive self-concept in pediatric oncology and physical injury populations; however, their relation has not been examined in pediatric burn survivors. This study aims to explore coping as it relates to social functioning and self-concept in these youth.

Methods

Fifty-one pediatric burn survivors aged 7–17 years (M=12.53; SD=2.68), and their primary caregiver participated. Youth and caregivers completed questionnaires, including the Child Coping Strategies Checklist (CCSC; youth report); the Burn Injury Social Questionnaire (BISQ; parent & youth report; higher scores = more social problems); and the Piers-Harris Children’s Self-Concept Scale-2 (PH-2; youth report). Associations between the BISQ, coping strategies (Active, Avoidance, Distraction, Support), self-concept, yearly family income, and burn injury characteristics (e.g., total body surface area; TBSA, participant grafting) were examined via bivariate correlations. Hierarchical linear regression was used to examine whether coping strategies (with significant bivariate correlations) predicted BISQ and PH-2 scores above and beyond burn injury and demographic variables. Three hierarchical regression models were run, one each for parent- and youth-report BISQ and youth-report PH-2 scores.

Results

Our sample is predominantly male (62.7%) and Caucasian (82.4%) with average TBSA of 8.74% (SD=11.02). Parent- and youth-reports on the BISQ were positively correlated with TBSA (r=.61 and .37, respectively) and negatively correlated with family income (r=-.37 and -.36, respectively). Parents of youth who had a skin graft reported higher BISQ scores (rho=.34). Distraction coping was significantly associated with youth-reported BISQ scores (r=-.31); no coping strategies were correlated with parent-report BISQ scores. In regression models, TBSA significantly predicted of parent-report BISQ (B=.27, p< .001). Higher family income (B=-.40, p=.04) and greater distraction coping (B=-3.41, p=.004) significantly predicted better youth-report BISQ scores. Greater active coping significantly predicted better self-concept (B=6.21, p=.01).

Conclusions

Results suggest that use of positive coping strategies relates to better youth-reported social functioning and youth-reported self-concept after burn injury in addition to injury characteristics and socioeconomic variables.
126 Early Transcriptomic Response to Burn injury: Prolonged Inflammatory Response is Associated with Mortality
Authors: Keyloun John W , Campbell Ross , Detwiler Leanne , Miller Stacy-Ann , Guatam Aarti , Moffatt Lauren T , Carney Bonnie C , Hammamieh Rasha , Jett Marti , Shupp Jeffrey W
Published: April 2021

Introduction

Burn injuries are associated with high morbidity and mortality. Burn care has improved significantly in the last few decades with emphasis on early surgical management, improvements in local wound care, and specialized critical care. While survival rates are improving, mortality remains high in certain patient populations, including those with larger burns. Burn injury induces a systemic hyperinflammatory response with detrimental side effects. Prior studies have offered early insights into the biochemical changes that occur after severe burn injury. The underlying cellular response is still largely unknown. The goal of this work is to characterize the blood transcriptome of severe burn injury and compare this response between patients who live or subsequently die of their injuries.

Methods

Burn patients presenting to a regional center between 2012–2017 were prospectively enrolled. Blood was collected on admission and at predetermined timepoints (Hours 2, 4, 8, 12, 24) over the first 24 hours. mRNA was isolated and a transcriptomic microarray was used to measure global transcript levels over time. To identify differentially regulated genes (FDR≤0.1) by injury severity, patients were grouped by burn size (TBSA >20%) and mortality. Microarray data was analyzed using bioinformatics software and pathway analysis. Descriptive statistics were generated with Mann-Whitney, Chi-Square, and Fisher’s exact test as appropriate.

Results

Sixty-eight patients were included in this analysis, most patients were male with a median age of 41 (IQR, 30.5–58.5) years, and TBSA of 20% (IQR, 11–34%). Thirty-five patients suffered %TBSA injury >20%, and this group experienced greater mortality (26% vs. 3%, p=0.008). There were no significant differences in age, race, or gender. Comparative analysis of genes from patients with < />20% TBSA revealed 1250, 444, 209, 20, 865, and 557 differentially regulated genes at hours 0, 2, 4, 8, 12 and 24 respectively. Pathway analysis reveals an initial upregulation in several immune/inflammatory pathways within the >20% TBSA groups between hours 0–2 followed by shutdown between hours 12–24. Immune pathways include Th17 activation pathway and natural killer cell signaling, inflammatory pathways include EIF2 signaling. These pathways remain upregulated in the group of patients with >20% TBSA who died.

Conclusions

Severe burn injury is associated with an early proinflammatory immune response followed by shutdown of these pathways. Burn patients who die show continued upregulation in the first 24 hours after injury in several proinflammatory pathways compared to those who live.
137 Maximal Harvest Density of Full-Thickness Skin Columns in Skin Replacement Therapy
Authors: Cooper Laura E , Chapa Javier A , Christy Sean E , Chan Rodney K , Carlsson Anders H
Published: April 2021

Introduction

Split-thickness skin grafts (STSGs) are the mainstay of skin replacement therapy but fail to adequately reproduce basic skin functions and subject patients to new, open wounds that can cause significant pain and scarring. Full-thickness skin grafts (FTSGs) have improved cosmetic outcomes and better recapitulate skin functions, but few sites can serve as donors and requirement for “take” is greater. Prior research has shown that full-thickness skin column (FTSC) harvest results in improved healing of the injured site and decreased morbidity of the donor site at 10% harvest density. This study aims to determine the maximal harvest density of FTSC donor sites.

Methods

Ten donor sites were created on the dorsum of anesthetized swine (Sus scrofa domestica). STSG donor sites were harvested with a dermatome (12/1000 inch) and compared to FTSC donor sites with the highest possible harvest ratio of sixteen 1.5mm-diameter skin columns/1cm2 (28% harvest density). Donor site morbidity was assessed via re-epithelialization, contraction, pigmentation, number of hair follicles, and scar thickness on post-burn day (PBD) 7, 14, 21, 28, 60, and 90.

Results

There were no significant differences in re-epithelialization or contraction between FTSC and STSG donor sites. STSG donor site pigmentation was significantly decreased as compared to control on all assessment days (p=0.0161, 0.0003, 0.0031, 0.0095, 0.0244, respectively), and remained significantly hypopigmented as compared to FTSC starting at PBD 14 (p< 0.0001). Pigmentation was decreased for FTSC donor sites at PBD 14 (p=0.0204) but significance was lost by PBD 21. Both FTSC and STSG donor sites showed significantly fewer hair follicles as compared to control at PBD 7 (p=0.0011, 0.0003, respectively). On PBD 21, STSG had significantly less hair follicles as compared to FTSC donor sites (p=0.0010). This resolved by PBD 28. FTSC scars were significantly thicker than both control and STSG at PBD 28 (p=0.0348, 0.0038, respectively) and PBD 60 (p=0.0174, 0.0329, respectively). This significance was lost by PBD 90.

Conclusions

No statistically significant differences were seen in re-epithelialization and contraction between FTSC and STSG donor sites. STSG were hypopigmented as compared to FTSC donor sites and had significantly less hair follicles at day 21. FTSC donor site scars were significantly thicker than STSG. Although decreased donor site morbidity has been observed at lower harvest densities (10%), these results were not seen at 28%, which likely exceeds the optimal harvest density.
142 Transcriptome Analysis Captures Radiation Exposure in a Dose-sensitive Manner and Predicts Short-term Survival in a Mouse Model
Authors: Alkhalil Abdulnaser , Clifford John L , Miller Stacy-Ann , Guatam Aarti , Jett Marti , Hammamieh Rasha , Moffatt Lauren T , Shupp Jeffrey W
Published: April 2021

Introduction

A mass exposure to irradiation would be a challenge to health care systems. A simple tool or test that indicates the intensity of the absorbed radiation or the chances of survivability would be invaluable in this scenario. To identify biomarkers that potentially could provide novel biodosimetry tools, we have conducted a radiation dose-response and time-course experiment in mice that includes an assessment of the transcriptome of the skin.

Methods

Groups of mice (n=5) received whole-body X-ray exposures (0, 1, 3, 6, or 20Gy) and skin biopsies were obtained from each animal at times post-irradiation (h2, Days 4, 7, 21, 28). Biopsies were collected from the 20Gy cohort for only days 0, 4, and 7. Total RNA was isolated and microarrays were performed and analyzed using custom R scripts to obtain lists of probe sets differentially expressed. Changes in gene expression at Benjamini-Hochberg FDR adjusted P < 0.05 and FC >2 were deemed significant. Analyses were performed comparing the different doses of X-ray exposure over all time points.

Results

Mice in the 20Gy group were euthanized by d7 and the dose was considered lethal. Animals in 1, 3, and 6Gy groups completed the full experiment to d28. Sammon plot analysis of transcriptomes showed clear separation of samples based on the irradiation levels and time after exposure. The clearest separation was between samples of lethal and sublethal doses. Samples from animals exposed to sublethal doses separated more based on timepoints rather than the IR dose suggesting a level of similarity in the progression of the response to sublethal doses. Downregulation was the dominant modulation in the significantly differentially transcribed genes (SDTGs) in the 20Gy group. Temporal changes in ratios of upregulated/downregulated SDTGs (P < 0.05 and FC > 2) revealed further the difference between of transcriptome responses after exposure to lethal and sublethal doses and indicated a delayed peaks response with increasing IR doses within the sublethal range. About 59% of the SDTGs in 20gy were common to all timepoints while no more than 11% were common at the same duration in the other groups. Ratios of the number of SDTGs at h2 to those common to all TPs decreased in a dose-dependent manner with potential radiation dosimetric applications.

Conclusions

These results demonstrate a solid ability in detecting IR exposure, differentiating lethal and sublethal exposures, and differentiating among the exposure to sublethal doses.
506 Creating Strategic Structure, Curriculum, and Training to Provide an Effective Virtual Burn Camp During a Pandemic.
Authors: Mayer Nichole F , Mikolaj Kerry , Schuetz Tim , Boulter Trudy
Published: April 2021

Introduction

When forming our virtual burn camp, burn camp leadership generated themes for each day to formulate a strategic camp curriculum, providing building blocks over the week to create camp community and connection. Each of the themes were well defined with defining concepts. The goal of the program was to provide consistency and guidance for our staff who were located all over the country and beyond to structure our virtual programming for our campers.

Methods

Burn camp leadership created a theme for each of the 5 days of virtual burn camp to create fluidity across the camp. Supporting these daily themes, we defined 5 core words to further outline the overall theme for the day. Our opening day theme was Creating Community. Accompanying our theme of Creating Community, we provided counselors with the following driving concepts: acceptance, belonging, inclusion, bonded, and connection.

Our theme for the second day was Growth. We provided the following driving concepts to support Growth: develop, flourish, thrive, stretch, and progressing. The third day’s theme was Inspire with the following driving concepts: encourage, motivate, energize, enthuse, and lead. Dream was the theme for the fourth day with the following driving concepts: aspire, consider, visualize, imagine, and ambition. Our last day of camp our theme was Hope to inspire kids to look into the future beyond virtual burn camp. The driving concepts included: optimism, plan, promise, confidence, and wish.

These themes and driving concepts with definitions were provided to our cabin counselors prior to camp and were sent out each morning. Counselors were required to complete a Google Survey at the end of each day to assess effectiveness and ability to execute the theme for the day.

Results

The themes and driving concepts allowed for intentionality for each day that provided fluidity for our virtual burn camp. Each daily theme built on the previous theme(s) to provide a connected community and intentional camp experience. Results of our Google Surveys showed the counselors were able to create community, facilitate growth, inspire campers, encourage campers to dream and instill hope.

Conclusions

Despite a challenging circumstance and an unprecedented situation facing our burn camp, our burn camp leadership team was able to create a structured and strategic framework with which to guide our virtual burn camp. This structure allowed our counselors to feel empowered to facilitate programming each day to connect our campers and move them forward despite difficult times.
513 Continuous Heparin Infusion in Burn Patients on Continuous Renal Replacement Therapy
Authors: Sullivan Louisa , Quan Asia N , Richey Karen J , Foster Kevin N
Published: April 2021

Introduction

Hyper-coagulopathy has been widely described in patients following burn injury. In burn patients with renal dysfunction requiring continuous renal replacement therapy (CRRT), citrate is commonly used to anticoagulate the circuit. However, if venous thromboembolism develops, or if the patient requires treatment-dose anticoagulation for acute coronary syndrome or atrial fibrillation, an unfractionated heparin (UFH) infusion can be used for anticoagulation. This study reviewed the use of heparin infusion in burned patients on concomitant continuous renal replacement therapy.

Methods

This study was a retrospective review of patients in a single burn center over six years. Patients were included if they were 18 years or older and receiving UFH as a continuous infusion for VTE, acute coronary syndrome (ACS), or new onset atrial fibrillation while on concomitant CRRT.

Results

Eight patients were included. Seven of eight patients reached a therapeutic aPTT level. The maximum rate of heparin infusion which was required to produce a therapeutic aPTT was 34 units/kg/hr while the minimum was 9 units/kg/hr. The patient requiring the highest heparin infusion rate met criteria for heparin resistance. Four of eight patients developed clinically significant bleeding while on heparin infusion. All four patients had some duration of concomitant citrate infusion during heparin infusion and all four were receiving heparin for VTE. Each of these patients required a heparin infusion rate of 24 units/kg/hr or greater to obtain therapeutic aPTT levels. Patients who did not have clinically significant bleeding had a maximum therapeutic heparin infusion rate of 22 units/kg/hr or less.

Conclusions

Heparin infusion can be used successfully in burn patients who are receiving concomitant CRRT, with the majority (7 of 8) of the patients in this study able to achieve a therapeutic aPTT level. Clinically significant bleeding occurred in 50% of patients and was associated with higher rates of heparin infusion (> 24 units/kg/hr) and the use of concomitant citrate infusion to anticoagulate the CRRT circuit. Heparin resistance appeared to be present in at least one patient in the study, with high doses of heparin required to achieve a therapeutic aPTT level.
520 Weight-based vs. BSA-based Fluid Resuscitation Predictions in Pediatric Burn Patients
Authors: Stevens Jan V , Prieto Nina , Ridelman Elika , Klein Justin D , Shanti Christina M
Published: April 2021

Introduction

Current practice for major pediatric burns includes fluid resuscitation using formulas that estimate fluid requirements based on weight and/or body surface area (BSA) along with percent total burn surface area (TBSA). Adult studies have shown that these formulas can cause fluid overload in obese patients and increase risk of complications. These findings have not been validated in pediatric patients. This study aims to evaluate whether a weight-based resuscitation formula increases the risk of complications in obese children following burn injuries and compares fluid estimates to those that incorporate BSA.

Methods

A retrospective review was conducted on 110 children (≤ 18 years old) admitted to an ABA-verified urban pediatric burn center from October 2008 to May 2020. Patients had ≥15% TBSA, were resuscitated with the weight-based Parkland formula, and had fluids titrated to urine output every two hours (1 ml/kg/hr if ≤ 30kg; 0.5 ml/kg/hr if > 30kg). Demographics, burn type, and TBSA were collected on admission. BSA-based Galveston and BSA-incorporated Cincinnati formula resuscitation predictions were also calculated. Output and input volumes were collected at 8h and 24h post-injury. Complications were collected throughout the hospital stay. Patients were classified into CDC-defined weight groups based on percentile ranges. Statistical analysis was conducted using SPSS Statistics version 10.0.

Results

This study included 11 underweight, 60 normal weight, 18 overweight, and 21 obese children. Our patients had a mean age-based weight CDC percentile of 62.2%, and mean TBSA of 25.4%. Predicted resuscitation volumes increased as CDC percentile increased for all three formulas (p=0.033, 0.092, 0.038), however there were no significant differences between overweight and obese children. Total fluid administered was higher as CDC percentile increased (p=0.023). However, overweight children received more total fluid than obese children. The difference between total fluids given and Galveston predicted resuscitation volumes were significant across all groups (p=0.042); however, the difference using the Parkland and Cincinnati formulas were not statistically significant. There were more children in the normal weight group who developed complications compared to other groups, but these findings were not significant.

Conclusions

The Parkland formula tended to underpredict fluid needs in the underweight, normal weight, and overweight children, and it overpredicted fluid needs for the obese. Further research is needed to determine the value of weight-based vs BSA-based or incorporated formulas in terms of their risk of complications.
537 Autologous Skin Cell Suspension for the Treatment of Small (≤10% TBSA) Mixed-Depth Burns
Authors: Carter Jeffrey E , Holmes James H , Foster Kevin N , Smith David J , Shupp Jeffrey W
Published: April 2021

Introduction

Split-thickness skin grafts (STSGs) have been the standard of care for many decades. Despite their widespread use, STSGs frequently fail. Autologous skin cell suspension (ASCS) is an FDA approved point of care regenerative medicine technology that reduces donor skin requirements without compromising clinical outcomes. ASCS allows for early treatment and less donor skin harvested that may be useful for hard-to-treat anatomical locations, in compromised patients that have risks for impaired wound healing, or elderly patients with thinner skin. We examined ASCS treatment as an adjunct to meshed autografts in adults with small mixed-depth/full-thickness burns.

Methods

We obtained IRB-approval for a prospective, multi-center, uncontrolled observational study that allowed continued access to ASCS before FDA approval (ClinicalTrials.gov Identifiers: NCT03333941). Subjects with mixed-depth/full-thickness injuries that required skin grafting with a minimum treatment area of 320 cm2 and burns ranging from 5–50% TBSA were eligible for study enrollment. Our analyses included only patients >18 years of age and ≤10% TBSA mixed-depth/full-thickness injuries that had completed the trial. All subjects had ≥1 burn wounds treated with meshed autografts (2:1–4:1) in combination with ASCS. Healing outcomes were accessed following ASCS treatment by direct visualization of each individual wound and included healing, scar outcomes, and safety data.

Results

Analyses included 20 subjects older than 18 years of age with ≤10% TBSA mixed-depth/full-thickness injuries. Of these, compromised wound healing was seen in 50.0% of subjects. Burn wounds with ≥90% re-epithelialization increased over time, with 62%, 80%, and 100% of wounds achieving closure at Weeks 1, 2, and 8, respectively. Similar results were seen in subjects with comorbidities known to affect wound healing and in elderly subjects despite their risks for impaired healing. Total POSAS patient (37.8 and 35.4) and observer scores were comparable (23.3 and 18.4) at Weeks 12 and 24. Safety events were typical for this patient population, and no serious adverse events occurred for any of the wounds.

Conclusions

This analysis provides additional information supporting the use of ASCS for the treatment of small, mixed-depth/full-thickness acute thermal burn injuries in adults, notably those with risk factors for impaired wound healing.
540 Treatment of Severe Burns with Autologous Skin Cell Suspension and Meshed Autograft with Allograft Overlay
Authors: Houng Abraham , O’Sullivan Geoffrey , Lodescar Rachelle
Published: April 2021

Introduction

Autologous skin cell suspension (ASCS) is gaining in popularity in the treatment of severe burns. Prior to the approval of ASCS, widely meshed autograft with allograft overlay is the standard of care in the treatment of severe burns. We are reporting a novel technique of using ASCS and widely meshed autograft with allograft overlay on a series of patients with full thickness flame and scald burns.

Methods

The study is a retrospective chart review of patients from May 2019 to February of 2020. Inclusion criteria: full thickness injury, had multiple staged excisions, with or without allografting, grafted widely meshed 4:1 autograft and ASCS with allograft overlay. Demographic data, grafting information, and time to re-epithelization with photographic evidence were collected.

Results

Six patients were studied from the inclusion criteria: age 24–70, TBSA% 16–77. All surgeries were performed by a single surgeon. All patients had excision/wound bed preparation via tangential excision, autografted with 4:1 mesh. ASCS was applied, and 2:1 allograft was secured onto the wound. Size of the grafts range from 235 cm2 to 3880 cm2. Average time to ≥95% re-epithelialization was 23 days (range 15 days to 35 days).

Conclusions

By using this novel technique, average time to fully epithelized was 23 days. This compares favorably to the previously presented outcome of ≥95% re-epithelialization in 96% of ASCS-treated wounds after 8 weeks. More studies are needed to validate this finding.
548 Heterotopic Ossification or Dystrophic Calcinosis Cutis in Burn Scars - A Case Series
Authors: Blome-Eberwein Sigrid A , Pinataro Cassandra
Published: April 2021

Introduction

Heterotopic ossification of large joints is a commonly seen and described entity in Burn survivors. We have observed a rather uncommon phenomenon in a series of 4 Burn survivors who presented to our Burn center for scar treatment and open wounds many years after their injuries. A chronic, small, splinter-like subcutaneous irritation led to open wounds and infections in their burn scars. A similar condition is known as dystrophic calcinosis cutis in the dermatologic literature, but caused by calcium metabolism changes in otherwise healthy skin.

Methods

The demographics and history of illness was documented in all 4 patients. A literature review was performed. The calcified bone-like irritant was removed surgically in all patients, sometimes in more than one location. Pathologic evaluation was performed on the removed specimen. Strategies leading to healing of the wounds were evaluated.

Results

Four publications were found addressing this phenomenon in Burn scars, all case reports. All of our patients had undergone curettage of the lesions by a dermatologist in the past without resolution. All lesions were excised surgically and proved to extend subcutaneously far more extensively than the visible skin lesion. X rays proved not helpful in preoperative assessment of the extent. All wounds healed after the irritant was removed.

Conclusions

All lesions appeared to have formed along tendon or fascia remnants underneath the burn scars, exerting pressure on the overlying epithelium which eventually led to breakdown and necrosis. This finding prompted the term “heterotopic cutaneous ossification”. Chronic tension and inflammation were assumed in the etiology, rather than calcium metabolism abnormalities or systemic connective tissue disease, which were not present in these patients. Research is needed to establish the prevalence, cause, and prevention of this condition in Burn survivors.
552 Limb Salvage: Amputations Prevented with Dehydrated Human Amnion/Chorion Membrane Allografts (dHACM) Used in Combination with Decellularized Human Collagen Matrix (dHCM)
Authors: Matthews Marc R , Helmick Emily , Mellon Christopher , Thornburg Danielle , Kowal-Vern Areta , Tettelbach William H , Foster Kevin N
Published: April 2021

Introduction

Burn and traumatic limb injuries with exposed bone/tendon typically require surgical flaps or amputations for healing. Some burn patients are not candidates for these invasive techniques. Placental amniotic membrane has been used as a wound dressing for more than 100 years and may offer an alternative to flaps and/or amputations. Processed dehydrated human amnion/chorion membrane (dHACM), from human placental tissue, contains type 1 human collagen as well as non-viable cells and 285 identified regulatory proteins including growth factors, chemokines, cytokines, metalloproteinases, and other tissue growth and inflammatory mediators. dHACM has been successfully used as a dressing for wound ulcers, burns, donor sites, & surgical debridement. This study reports the use of dHCAM as a limb salvage tool in four patients with severe injuries.

Methods

This is a retrospective case series of patients suffering severe lower extremity injury with bone/tendon exposure that had applied dHACM/dHCM over or packed (depending on wound depth), then covered with 3% bismuth tribromophenate petrolatum dressing & glycerol/ hydroxyethylcellulose lubricant. Negative pressure wound therapy (NPWT) was initiated; wound re-evaluation occurred in seven days. dHACM/dHCM was reapplied if required (bone still exposed).

Results

There were 3 males and 1 female with three burns and one NSTI. The mean±sd (median) age was 58±23 (61) years; % total burn surface area 3±3 (2); length of hospital stay 48±30 (40) days; number of tangential excisions & debridements 6.5±1 (6.5); days from admission to product application 49±47 (34) and discharge 24±19 (19) days; negative pressure wound therapy (NPWT) 53±6 (56) days. All four patients continued treatment upon discharge with clinic visits and home NPWT. All recovered with good results and no complications. Treatment may be continued with NPWT therapy at home or in a skilled nursing facility. Patients healed after two to three dHACM/dHCM applications and did not require leg or foot amputations.

Conclusions

In select limb salvage cases, dHACM/HCM may be a promising alternative to extremity amputations, tissue transfer flaps or other techniques for secondary intention healing of wounds with bone/tendon exposure.