bluuebunny/crossref_metadata_2025 huggingface dataset:
703 Evaluation of a Stress Ulcer Prophylaxis Protocol in an Burn Intensive Care Unit
Authors: Drabick Zachary , Driscoll Ian , Nguyen Duong
Published: March 2022

Introduction

Patients suffering from large burn injuries have an increased risk of gastrointestinal mucosal damage from stress ulcers. Proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs) are routinely used for stress ulcer prophylaxis in burn patients, however there are few comparative trials evaluating the efficacy of these therapies in the burn population. Our burn center uses a stress ulcer prophylaxis protocol that incorporates both classes in a step-wise manner. The objective of this study was to evaluate the protocol by comparing the incidence of uncontrolled gastric pH, positive gastric occult blood, and gastrointestinal bleed (GIB) while on famotidine or pantoprazole prophylaxis.

Methods

This was a single-center retrospective observational study conducted at an academic medical center and was approved by the hospital’s Institutional Review Board. Patients were included if they were at least 18 years of age, admitted to the burn intensive care unit (BICU) from June 2017 to August 2020 with burns involving at least 1% TBSA, and had at least one documented gastric pH and/or occult blood test while receiving famotidine or pantoprazole. The primary endpoint was a composite of gastric pH less than 5, a positive occult blood test, or occurrence of GIB.

Results

In total, 107 patients with a mean age of 55 yo were included in the study. The median TBSA burn was 16% and length of stay was 23 days. Seventy seven (72%) patients received famotidine and 93 (87%) of patients received pantoprazole. The incidence of the primary endpoint in all patients receiving famotidine and pantoprazole were 69 (90%) and 86 (92%), respectively (p = 0.513). During famotidine prophylaxis, 256 (43%) gastric pH tests were less than 5 and 397 (47%) gastric occult blood tests were positive, with no reports of GI bleeding. During pantoprazole prophylaxis, 751 (33%) gastric pH tests were less than 5 and 1220 (47%) gastric occult blood tests were positive, and 4 (4%) were diagnosed with a GI bleed. A total of 91 (85%) patients had deviations from the protocol, which included 42 (46%) patients who did not receive the recommended dose or agent, 27 (30%) patients who were not initiated on the recommended initial agent, and 22 (24%) patients who did not receive a recommended increase in dose or switch agents when recommended.

Conclusions

In the setting of burn injuries of at least 1% TBSA, no difference was detected in uncontrolled gastric pH, positive occult blood tests, or GIB when using famotidine or pantoprazole in our stress ulcer prophylaxis protocol. The overall incidence of gastric pH less than 5 and positive gastric occult blood was high for both agents, while the incidence of GIB was low in both groups.
705 Reduction in Central Line Associated Blood Stream Infection Rate with a Central Line Change-Over Protocol
Authors: Hollowell Jamie L , Williams Felicia , Blandon-Hendrix Daniel , King Booker , Nizamani Rabia , Chrisco Lori , Gebe Patricia , Hoke Emily
Published: March 2022

Introduction

Burn Intensive Care Units (BICU)s traditionally have changed central lines over a wire (COWs) as a method to reduce infection. To date, there is not a standard timeline for this process and every center has their own timeline for this process. We aimed to create a standardized process for this practice to then have a baseline for future study.

Methods

The Change-Over-Wire (COW) process was evaluated with the BICU Infection Control Nurse and Performance Improvement Manager. A protocol was developed that includes step-by-step detail that was modified until it was deemed practical and acceptable to all involved parties as the best practice for maintaining the most sterility as possible. The protocol was provided to the Central Line team, the ICU Advisory Board, and the UNC CLABSI committee for review

Results

While the hospital as a whole does not standardly endorse routine COWs, the protocol was reviewed and accepted as best practice by both the ICU Advisory Board and the UNC CLABSI committee. Additionally, the BICU had an 80% reduction in CLABSI’s from FY 2017 to 2020 with implementation of this protocol (p value = 0091).

Conclusions

Having a standardized method for COWs both allows for best practice and a starting point for study. Endorsement by both hospital committees allows this practice to be the published standard by which future studies can be measured.
715 The incidence of refeeding syndrome in burn patients receiving enteral nutrition
Authors: Hendren-Santiago Bryce K , Vrouwe Sebastian Q , Pakvasa Mikhail , Reynolds Valerie , Micic Dejan , Gottlieb Lawrence J
Published: March 2022

Introduction

A major burn injury result in a hypermetabolic response which leads to increased nutritional requirements. Previous studies have shown that burn patients experience severe electrolyte abnormalities that are likely the result of multiple factors, but share similarities to refeeding syndrome (RS). Recently, the American Society for Parenteral and Enteral Nutrition (ASPEN) published consensus recommendations on RS, including clinical definitions and a grading system. Our aim was to evaluate this definition in a cohort of burn patients.

Methods

A retrospective analysis was performed of adults admitted to an American Burn Association-verified center from 2015-2020 with a burn injury who received enteral feeding for at least 72 hours. Patients with a length of stay < 7 days were excluded. Patients were categorized as having mild, moderate, or severe RS based on the newly established ASPEN criteria, defined by a decrease in any one, two, or three of serum phosphorus, potassium, and/or magnesium levels from baseline by 10%–20% (mild RS), 20%–30% (moderate RS), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe RS).

Results

A total of 350 patients were reviewed, from which 72 met the inclusion criteria. The mean patient age was 52 ± 18 years, and the average BMI was 28.3 ± 7.4. The average burn size was 21.7 ±17.0% TBSA and the average length of stay was 36 ± 32 days. A total of 57 (89%) patients had severe RS while five (8%) exhibited moderate and two (3%) developed mild refeeding syndrome. Of the 57 patients with severe RS, hypophosphatemia was the most prevalent (89%) followed by hypokalemia (19%) and hypomagnesemia (13%). Regression analysis comparing those with severe RS to those with mild or moderate RS revealed that number of surgeries performed was positively associated with the development of severe RS (p=0.0006). %TBSA trended but was not statistically significant (p=0.063). All other variables evaluated were not significant on univariate analysis.

Conclusions

The presence of severe electrolyte abnormalities as a result of burn injuries is significantly more common than originally anticipated. Further investigations are needed to determine if these abnormalities truly reflect RS or are primarily a result of the hypermetabolic response characteristic of burn patients.
716 Safety and benefits of intraoperative enteral nutrition in critically ill pediatric burn patients
Authors: Morzycki Alexander , Hudson Alexandra , Wong Joshua N
Published: March 2022

Introduction

Burn injuries significantly increase a patient’s metabolic demand. Adequate nutrition is essential to aid in recovery and reduce morbidity and mortality. This is important for pediatric patients, who have limited reserves and are in a period of growth, in contrast to adults. Burn patients often need multiple surgeries, with standard perioperative fasting periods leading to multiple nutritional interruptions. Continuous intraoperative feeding has been a proposed solution, but there is no current consensus on its role and safety, particularly in the pediatric population. The goal of our study was therefore to examine the safety and benefits of intraoperative nutrition in critically ill pediatric burn injury patients.

Methods

A systematic review of MEDLINE, PubMed, Scopus, and Google Scholar was conducted using the following terms: Feeding or enteral or nutrition or fasting and adolescent or youth or pediatric or child or teen and burn or thermal injury or fire. The primary outcome was incidence of aspiration. Secondary outcomes included patient nutritional status (caloric deficit, weight), wound healing, days spent in the intensive care unit, ventilator days, pneumonia, number of surgeries, length of hospital stay, and mortality. Pooled analyses of binary outcomes were computed.

Results

Four studies consisting of 496 patients, met inclusion criteria. All studies were level IV evidence, but had high methodological quality. The median burn total body surface area (TBSA) was 43.8% (IQR 33.4-58.8%), with a median of one-third of patients having an inhalational injury. Patients underwent a median of 4.2 surgeries (IQR 1.8-7.4). Intraoperative feeding was conducted through nasoduodenal tubes. There were no aspiration events. Pooled analysis demonstrated that there were no differences in rates of aspiration, pneumonia, or wound infection (p >0.05) between patients who were intraoperatively fed and those who were not. Those fed intraoperatively had significantly more surgeries, ventilator days, longer hospital stays, but lower mortality (p< 0.05). There was large heterogeneity in nutritional assessment methods. Intraoperatively fed patients had an average gain of 144.4 kcal/kg and 1.7 days of exclusive enteral nutrition (vs. loss of -119.1 kcal/kg and -1.4 days) and cumulative positive caloric balance of +2673kcal ±2147 (vs. loss of -7899kcal ±3123), compared to those with interrupted feeding.

Conclusions

Continuous intraoperative duodenal feeding during burn surgery appears to be safe in the Pediatric burn population, with no reported episodes of aspiration. Uninterrupted feeding was also associated with weight maintenance and reduced caloric deficit. It may also have survival benefit, as continuously fed patients needed more surgeries and intensive/hospital care, but had decreased mortality.
725 Case Series: New Porcine Placental ECM for Burn Injuries
Authors: G'sell David , Carter Jeffrey E , Kopari Nicole M , Hickerson William L
Published: March 2022

Introduction

Human amniotic membrane (HAM) has been used as a biologic dressing for burn wounds since 1955 but limited due to availability, size, and processing costs. In 2021 a new porcine placental product was FDA-approved overcoming challenges with human-sourced products. Our study is the first case series to report outcomes using porcine placental extracellular matrix (PPECM) in the use of adult burn patients.

Methods

Adults with thermal burns resulting in partial-thickness burn wounds (PTBW) were consented and included in the study from 03/2021 to 09/2021. Patients with full-thickness injures, concomitant trauma, or adverse beliefs to porcine products were not included in the study. Serial still images and initial wound measurements were obtained intraoperatively and post-operatively. PPECM trial product processed with a proprietary decellularization method to produce single sheets up to 15x20cm was approved by the facility value assessment committee. Adverse events were defined a priori as infection, increased pain or itching relative to adjacent autografts, or failure to heal. Infection was defined as a PPECM treatment site requiring any change from standard of care or initiation of local or systemic antibiotics. Pain was assessed using a visual analogue scale. Itching was assessed at discharge and follow-up. Healing was assessed using the FDA guidance for wound closure with 2 consecutive visits 2 weeks apart demonstrating 100% epithelialization without drainage or dressing requirements.

Results

Four patients were treated during the study period with wounds involving the torso and major joints such as the hands/wrists and knees. None of the PPECM wounds demonstrated failure to heal or required revision excision, or autograft. None of the PPECM wounds had evidence of infection. PPECM wounds had decreased pain/itching relative to adjacent burn wounds which were treated with split-thickness autograft, autologous skin cell suspension, or allogeneic cultured skin substitute (VAS mean 1 vs 3.1). Healing was noted in all wounds at 1-week primary dressing removal with confirmation at 2-week interval follow-up.

Conclusions

PPECM treatment of PTBW was not associated with adverse events and resulted in favorable outcomes clinically. The large size, ease of use, and lower costs relative to HAM is an intriguing alternative for PTBW. Comparative studies are needed in the field to determine best practices and overall value.
740 Cyclosporine in Stevens Johnson Syndrome & Toxic Epidermal Necrolysis: Experience from a Tertiary Care Center
Authors: Hassan Manal , Ho Bao Vincent , Bhavsar Dhaval , Korentager Richard
Published: March 2022

Introduction

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare severe cutaneous adverse reactions associated with high morbidity and mortality, however, there lacks an established treatment protocol. Treatment with intravenous immunoglobulin (IVIg) has demonstrated mixed success rates in improving mortality. More recently, cyclosporine (CsA) has been found to have a promising role in management of SJS/TEN owing to its potent anti-apoptotic activity. We present 3 patients with SJS/TEN treated in our burn unit with CsA; all of them demonstrated clinical improvement.

Methods

We conducted a retrospective analysis of patients who were hospitalized with the diagnosis of SJS/TEN in a specialized burn center in the year 2020. Data regarding clinical factors, causative agent(s), disease severity, treatment received, and outcome were collected on chart review. SCORTEN and ABCD-10 prognostic scores were calculated for each patient at the time of admission. All patients were evaluated by a dermatologist and started on CsA at a dosage of 5 mg/kg daily given in 2 divided doses. Predicted mortality rate was compared with observed mortality rate to assess treatment outcomes.

Results

A total of 3 patients were identified with a mean age of 48.33 ± 16.50. All patients had TEN with an average initial BSA involvement of 56.67 ± 20.21 and peak BSA involvement of 63.33 ± 25.17. Lamotrigine was the presumptive causative drug in each case with an average duration of time from starting the medication to symptom onset of 19.3 days. Patients received CsA on average 7 days after symptom onset. Most of our patients had oral (100%), ocular (100%), genital (100%), and esophageal (33.3%) involvement during hospitalization. The observed mortality rate of 0% was lower than that predicted by SCORTEN (12.2% to 32.4%) and ABCD-10 (5.4% to 12.3%). No patients developed complications during admission. All patients had minimal wound care needs on discharge as most of the involved areas were healed by then.

Conclusions

Our study sheds light on a possible beneficial role of cyclosporine for the treatment of SJS/TEN and reinforces the necessity of further prospective studies to solidify treatment guidelines.
756 Self-Inflicted Frostbite with Dry Ice: A Case Report
Authors: Shingleton Sarah K , Chambers Michael G , Rowland Michael R , Britton Garrett W , Basel Anthony P
Published: March 2022

Introduction

Frostbite (FB) is a severe form of cold injury that may result in significant morbidity. Freezing causes formation of ice crystals and protein denaturation leading to cellular damage and tissue necrosis. Although commonly affecting populations who live and work or become stranded in cold environments, the true prevalence is unknown due to lack of standardized reporting. Dry ice is a solid form of carbon dioxide commonly found in the food industry, that can reach temperatures as cold as -110 degrees Fahrenheit and can be purchased at local department stores. Exposure to dry ice is an unusual cause of FB injury that could occur anywhere, especially in warmer climates. Healthcare professionals practicing in warmer climates may be unprepared to assess and treat patients with such injuries.

Methods

We describe a case of self-inflicted FB injury to the bilateral lower extremities (BLE) following intentional submersion in dry ice who presented to a Southern U.S. Burn Unit.

Results

A 20-year-old man with self-diagnosed Body Integrity Identity Disorder (BIID) sustained a 12% TBSA FB injury to his BLE following intentional submersion in dry ice for an estimated 4 hours (Figure 1). He presented to the Burn Center from an outside facility approximately 12 hours post injury with initial rewarming having already occurred. He immediately underwent catheter directed intra-arterial thrombolysis with tissue plasminogen activator (TPA) for leg length preservation. TPA infusion was initiated at 16 hours post-injury for a total infusion time of 24 hours. Wound care consisted of gentle twice daily cleansing with silver sulfadiazine and mafenide acetate creams. The patient ultimately required bilateral below the knee amputations which successfully healed with minimal autografting to the distal limbs. He was formally diagnosed with schizophrenia by our behavioral health team and initiated on risperidone. He underwent aggressive physical therapy and was discharged home with his parents after 21 days. He underwent weekly mental health follow up appointments and has been seen regularly in our burn and rehabilitation clinic.

Conclusions

This unusual case is one of few to describe Grade 4 FB after exposure to dry ice and highlights that severe FB may occur in any climate and can cause severe morbidity. Severe cold injury management is important for burn care professionals to maximize tissue and limb preservation.
757 A Patient Inclusion Criteria Algorithm for New Burn Centers Seeking to Implement a Burn Registry
Authors: Guilford Amanda , Garland Jeneva , Wyse Ransom , Harbour Lori , Smith Rebecca , Bregman Monica , Jones Samuel W
Published: March 2022

Introduction

Data submissions to the NBR are based upon the standardized medical definitions and generalized guidance on patient inclusion criteria found in the ABA Burn Care Quality Data Dictionary. The guidance is complex, often leading to confusion in determining proper patient identification. This is most problematic for new burn centers seeking to implement a burn registry. Therefore, at our burn center, we designed and implemented an algorithm based on a thorough literature review and ABA guidance to improve the accuracy and efficiency of patient identification.

Methods

A review of the literature was conducted using the PubMed database. In addition, utilizing the ABA’s multitude of resources including, the Burn Care & Quality Platform (BCQP) Data Dictionary 2020 version 1.1 patient inclusion criteria statements, a BCQP Q&A session on admission information, and Quality & Registry Community discussion boards, the following algorithm was developed by the compilation and simplification of the definitions provided for burn and non-burn injury patient inclusion criteria.

Results

A thorough literature review produced no articles that address NBR inclusion criteria. According to these documents, all patients admitted to the hospital for treatment of an acute burn or soft tissue wound should be included in the burn registry; however, a BCQP Q&A session expressed the Burn Service must provide medical care in order for a patient to be included in the registry. Furthermore, the BCQP Data Dictionary outlines patient inclusion based on a hospital length of stay >24 hours, a surgical operation, or expire at a hospital facility for registry inclusion. Observation patients and non-burn patient consults are excluded from the NBR. The ABA community discussion board revealed many centers only count and track non-burn injury admissions to the burn center service line. The compilation of information resulted in the development of a standardized algorithm defining a patient for registry inclusion.

Conclusions

A comprehensive review of the ABA resource documents was compiled to clarify the patient inclusion criteria for data submission to the NBR. The BCQP Data Dictionary 2020 version 1.1 patient inclusion criteria statements, the collaborative Ameriburn communities, and the BCQP Q&A session influenced the design of the clarification algorithm for patient identification to assist burn centers seeking to accurately and most efficiently implement a burn registry. Further research should be conducted on the utilization of the algorithm in comparison to other burn centers.
758 Constant evolution: Early experiences treating COVID-19 in a burn center
Authors: Basel Anthony P , Britton Garrett W , Yugawa Craig , Cancio Leopoldo C
Published: March 2022

Introduction

The COVID-19 pandemic came as an unexpected challenge to many healthcare systems around the world. Many centers struggled to provide COVID-19 ICU-level care while also maintaining adequate care for non-COVID-19-related conditions, especially in critical care specialty units like trauma and burn. We present a case series of our early experiences treating COVID-19 in a burn center.

Methods

We present a case.

Results

See Table 1. Though one case was admitted prior to initiation of universal testing, routine infection-control protocols limited exposure to personnel and prevented transmission to staff. In May 2020, we implemented the use of N95 mask and eye protection during all aerosolizing procedures, N95 mask use in all ORs, and universal surgical mask use in all rooms regardless of COVID-19 status. An in-house risk-stratification system was used to screen patients based on symptoms and exposure. Burn-center admissions were screened at a lower threshold than throughout the institution given the unique nature of burn injury. Eventually, because of increasing community spread, all admissions to the hospital were universally screened with RT-PCR prior to admission. To minimize exposure to non-COVID patients and Burn Center staff, COVID-19 positive burn admissions were assessed on a case-by-case basis. High acuity patients were admitted to the Burn Center and followed by the COVID consult team. Lower acuity patients were admitted to the Burn Center but were treated on the medical COVID unit and followed by the burn consult service.

Conclusions

The COVID 19 pandemic has strained healthcare systems worldwide. Development and implementation of universal screening, testing, infection-control precautions, and triage strategies are critical elements of burn care during the COVID-19 pandemic. As we prepare for future surges due to more transmissible variants, implementation of standard protocols enables continued provision of quality care, preservation of the healthcare workforce, and efficient use of resources.
761 Burn first aid in Australian pre-hospital environments
Authors: Griffin Bronwyn R , Kimble Roy M , Holbert Maleea
Published: March 2022

Introduction

Best-practice burns first aid is well defined as 20 minutes of cool running water (CRW) within three hours of injury and an expectation of burn care in Australia. This study aims to identify barriers to applying this intervention and assess burn first aid knowledge amongst Australian paramedics.

Methods

Using multiple methods we assessed; 1) burn first aid adequacy in a cross-sectional study of health care professionals, utilizing a prospectively collected registry of patients managed at an Australian tertiary children’s hospital. Logistic regression models were used to evaluate the relationship between first aid adequacy between health services (eg. Paramedics and emergency departments). Then 2) paramedics completed a questionnaire containing demographic and clinical expertise and environment as well as recording immediate first aid management across five multiple choice burn case scenarios

Results

Overall, 31.3% of children received adequate CRW from caregivers. Factors associated with caregiver inadequacy of CRW were very young age and early adolescence (p< 0.001) rural location ( P = 0.045), low socioeconomic status ( P = 0.030) amongst others. Paramedics and general practitioners provided adequate cooling to 184/735 (25.0%) and 52/215 (24.2%) of their patients, respectively. Local general hospitals provided adequate CRW to 1019/1809 (56.3%) patients. Paramedic questionnaire responses (n=326) identified 56% of paramedics answered all burn case scenarios correctly. Respondents who treated a burn within six months scored higher on burn first aid scenarios compared to paramedics who had not recently treated a burn (p=0.004).

Conclusions

: deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. First aid delivery was significantly worse in children aged 0-2, adolescents aged 15-16, those living rurally, and the socioeconomically disadvantaged.
770 Increasing SOAR Participation in a Burn Center through a Social Work Team Approach
Authors: Dines Margaret M , Spotts Margaret , Madsen Laura , Wiktor Arek J
Published: March 2022

Introduction

Peer support has long been used in Burn Centers through organized support groups and programs like Phoenix Society for Burn Survivor’s SOAR (Survivors Offering Assistance in Recovery) individual peer support, often led by Social Workers (SW). The addition of an ambulatory SW in partnership with an inpatient SW allowed our Burn Center to continue participation in the group and individual peer support offerings despite the simultaneous COVID-19 pandemic. We sought to examine participation in support services using our dual SW model.

Methods

Prior to 2020, our ABA verified Burn Center only had an inpatient SW who was able to engage our admitted patient population to support services. With the addition of an ambulatory SW, we have been able to target support group participation in the larger ambulatory population. Our dual SW model allows for continued recruitment to our support services; meeting the patient’s needs at each stage of recovery. This tag team approach, coupled with increased use of technology driven by the pandemic, has shown to increase the average number of participants. We reviewed our support group participation and attendance over the past 2 years.

Results

In calendar year 2020 with one SW facilitator, only 14 virtual support groups were held with an attendance average of 4-5 participants and 22 individual peer support visits. In only the first 9 months of calendar year 2021 with the addition of a second SOAR trained SW, 18 support groups were completed virtually with new inpatient, in-person participation. The participation rate of now bi-monthly support groups has increased to 9 participants per support group average. At this continued rate, we expect to serve 216 attendees per year through support group. In this same 9-month span 51 SOAR individual peer support visits (12 in-person and 39 virtual), were conducted. Which is an increase from the 22 total peer support visits facilitated in 2020.

Conclusions

An additional SOAR trained SW to our Burn Center has increased participation and availability of support groups and individual peer support visits. Peer support promotes socialization and can provide healing for the burn patients and their families in a meaningful and profound way. Burn centers must continue to prioritize the role of the clinical SW to ensure programs such as SOAR support group and individual peer support can be facilitated to ensure an environment that fosters psychological and emotional healing.
774 Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review
Authors: Deng Huan , Shepler Lauren J , Abouzeid Callie , Hamner Jason W , Mercier Hannah W , Andrew Taylor J , Kazis Lewis E , Slavin Mary D , Ryan Colleen M , Schneider Jeffrey C
Published: March 2022

Introduction

Burn survivors experience significant social participation challenges in their recovery. However, enrolment and compliance with face-to-face interventions for such issues are often limited by time, location, and financial resources. Digital technologies are increasingly utilized in healthcare and provide a flexible, accessible, and low-cost treatment option. Given the sparse literature on this topic in the burn field, this review evaluated digital interventions for social participation in adults with long-term physical conditions to inform future use in the burn population.

Methods

MEDLINE, EMBASE, CINAHL and PsycINFO databases were searched using keywords and Medical Subject Headings (MeSH) terms related to ‘digital intervention’ and ‘social participation’ for studies published in English between January 2010 and May 2021. Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Study quality was evaluated using Oxford Levels of Evidence. Data on study methodology, digital intervention and findings related to social participation were summarized.

Results

The search yielded a total of 4646 articles, of which 158 were full-text screened and 14 met inclusion and exclusion criteria. There were five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Twenty-five different measurement tools were utilized to assess social participation and two of them were used twice. Three types of digital interventions were implemented to improve social participation: group support, individual skill training or counselling, and education and support. The group support intervention developed a social network among affected people through videoconference, app, or virtual reality platform (3 of 4 studies with positive results). Individual skill training or counselling utilized phone calls or videoconference to help participants with activity participation and interpersonal relationships (2 of 6 studies with positive results). The education and support intervention used messages and website information to increase participants’ knowledge and provide support (3 of 3 studies with positive results).

Conclusions

This review presents evidence of different digital interventions’ effect on improving social participation in adults with long-term physical conditions. However, the existing literature is limited by the heterogeneity of outcome measures and varied methodology quality that preclude larger generalizations.
793 "Minimally Invasive" Skin Grafting with Enzymatic Debridement and Autologous Skin Cell Suspension
Authors: Kahn Steven A , Gaweda Gabriel G , Halicki Elizabeth , Hirsch Jason , Hink Ashley , Hickerson William L , Holmes James H , Carter Jeffrey E
Published: March 2022

Introduction

Minimally invasive surgery has become standard of care across numerous subspecialties. However, burn surgery has lagged behind; as the mainstay of treatment still involves excision with a knife and a split thickness skin graft (STSG) with a painful donor site. Enzymatic debridement with bromelain and autologous skin cell spray (ASCS) have independently been STSG use and decrease the donor site size. Due to constraints with the time course of these products only being available via studies before one was FDA approved, these technologies have not been utilized together in the United States until recently. Little literature exists regarding their use in combination. The current study characterizes a series of patients who received “minimally invasive” skin grafts with enzymatic debridement and ASCS as proof of concept.

Methods

This was a retrospective study of a single academic burn center’s experience using bromelain and ASCS together. Data collection included demographics, injury characteristics, length of stay, complications, and measurements of donor sites, STSGs, and ASCS treatment. Donor site size:total area treated with ASCS and/or STSG was calculated. Length of stay (LOS) was qualitatively compared to expected using a factor of 1.1days:%TBSA, and O/E LOS ratio was calculated. Data was reported in medians with interquartile ranges. Patients with 1-30%TBSA qualified for the bromelain study and were treated according to protocol. Those deemed to have enough residual dermis were treated with ASCS, while 3rd degree areas received meshed split thickness skin patch grafts with ASCS overspray.

Results

Eleven patients were included in the study. Four patients received ASCS alone, while 7 patients received a meshed STSG on portions of their burn. Median burn size was 13% TBSA (IQR:5,20), while DPT+FT size was 9% TBSA (IQR:5,16). Patients had a median of 1067 sq cm (IQR:772,2183) of burn operatively treated with ASCS, and 351 sq cm (IQR:0,457) treated with meshed autograft. Donor site size (ASCS and STSG) was 225 sq cm (IQR:72,315), and ratio of donor site are to total treatment area was 0.0125 (IQR:0.01,0.32), suggesting an expansion of 80:1. Median LOS was 11 days (IQR:7,21), 0.84 days per %TBSA (IQR:0.5,1.16). Expected LOS was 14.3 days, with an O/E ratio of 0.77. Two patients developed infection; one required reoperation with STSG on half of his burned areas (5% TBSA).

Conclusions

Enzymatic debridement and ASCS can be used to treat burn injury with a “minimally invasive” approach. Donor sites were much smaller than expected had they been treated with a conventional meshed STSG on deep 2nd degree and 3rd degree areas. The data also suggests that length of stay was lower than expected. Further study is needed to determine which subsets of patients and burn wounds are optimal for this combination of technologies.
796 Predictive Factors/Outcomes for Lower Extremity Amputations in Burn-Injured Adult Patients: 10 Year Review
Authors: Smith Susan L , Curry Dominick M , Rainey Andrew , Smith Howard G , Seoane Jacqueline
Published: March 2022

Introduction

Lower extremity amputations (LEAs) in the burn population may occur urgently due to critical loss of tissue and perfusion or may proceed more slowly if viability remains uncertain. The existing literature describes amputations following electrical injuries; however, little is published discussing burn-injured patients who underwent delayed lower extremity amputations due to other burn mechanisms. Co-morbid illness and infections, patient/family resistance and provider delay in hopes of salvage may prolong time to amputation. Examining outcomes for burn patients’ suffering LEAs will delineate relationships among demographics, burn size, surgical timing, morbidity, mortality and length of stay (LOS) supporting the importance of early amputation.

Methods

Single verified burn center conducted an IRB exempted retrospective medical records review of adult burn – injured patients, 18 years of age and older, admitted as inpatients from January 1, 2010 to December 31, 2020. Patients were identified using International Classification of Disease 9 & 10 and Current Procedural Terminology codes. Patients with non-burn related amputations or toe / partial foot amputations resulting from diabetes were excluded. The association between multiple variables and both day of first amputation and burn size was measured through linear regression, one sample t-test, and one-way analysis of variance (ANOVA).

Results

The study population was 12 with 11 males, mean age 44, and one mortality. The majority (83%) suffered flame burns and 58% with mechanism of motor vehicle collision. Hospital day of first amputation ranged from 1-30, with a mean 11. Seven patients required vasopressors ranging from 30 minutes to 500 hours. For every 24 total pressor hours, day of first amputation increased by 1 day. Three patients (25%) had positive blood cultures and two (16%) had positive sputum cultures. Five patients (42%) had positive tissue cultures from the affected extremity. The diagnosis and treatment of infections were detailed and analyzed. Patients with positive tissue cultures were found to have waited an average 10.17 days longer for amputation than those without. Hospital LOS ranged from 31-126 days with mean of 54 days.

Conclusions

Day of first amputation was the most impactful parameter, with longer time to first amputation associated with positive tissue cultures, mortality, vasopressor therapy and hospital length of stay. Limitations include retrospective nature, small sample size and reliance on electronic medical record and registry data. This study provided data to support earlier amputation for non-viable extremities, though additional research is clearly needed to better describe these relationships.
803 Biodegradable Temporizing Matrix as a Dermal Template in the Reconstruction of Pediatric Full-Thickness Foot Injuries
Authors: Renkert Miriam , Svoboda Daniel , Wessel Lucas M
Published: March 2022

Introduction

Extensive thermal or traumatic full-thickness injuries to the foot, though rare in children, can lead to severe complications. They are often associated with significant skin loss and underlying tendon or bone exposure. Timely wound closure is essential to minimize the risk of deep infection and to avoid subsequent loss of function.

Tried and tested animal- or human-derived biological dermal templates have always come with a risk of infection and subsequent scar contraction. A biodegradable temporizing matrix (BTM) consisting of a polyurethane scaffold is a synthetic alternative to cover deep defects and promote the development of neodermis.

We report on our first experience with this dermal matrix in the reconstruction of complex foot injuries in children.

Methods

From August 2020 to June 2021, we treated four patients with severe full-thickness injuries of the foot and need for necrectomy with BTM, as the prevalence of exposed bone or tendon prohibited primary wound closure via skin grafting. All cases were caused by contact burns or mechanical trauma. In three of these cases, we utilized a temporary negative pressure wound therapy. Wound closure was achieved by application of full-thickness (3/4) or split-thickness (1/4) skin grafts after delamination of the fully integrated BTM.

Results

Wound monitoring through regular outer dressing changes showed that BTM remained in place and was fully integrated after 3-6 weeks. We saw excellent dermal regeneration in all patients. Swab cultures at first patient contact detected pre-existing wound contamination with Pseudomonas aeruginosa in two children and MRSA in one case. Wound healing before and after skin grafting was unimpaired, though, under topical antimicrobial treatment with polyhexanide. There were no signs of systemic infection.

The take rate of skin grafts was excellent with no graft failure, resulting in pliable, smooth scars. Long-term outcome showed minimal to no scar shrinkage without any functional impairment.

Conclusions

BTM is a good alternative to established dermal templates for complex foot injuries in children. In our experience, even in cases of bacterial wound contamination the synthetic material integrates well and promotes unimpaired tissue regeneration. Contraction and hypertrophic scarring is minimal with very good quality of the developing neodermis.
809 An Allogenic Fat-First Approach to Burn Reconstruction Mitigates Adhesion and Soft Tissue Deficit
Authors: Loder Shawn J , Lee Phoebe , Cannon Matthew , Leftwich Patricia , Kokai Lauren , Marra Kacey , Rubin J
Published: March 2022

Introduction

Adipose and adipose-derived stem cell therapies have met success as adjunctive treatment during burn reconstruction with well described benefit in the delayed-treatment of soft-tissue deficits. While the use of allogeneic skin is well-described, adipose tissues have typically remained autologous. Allogenic fat is not commonly used in burn care, however, in large, complex burns where autologous tissue is limited adipose may not be readily available for harvest or use. Understanding the efficacy of allogeneic tissues in this setting is critical to expand our reconstructive options. Here we describe a protocol utilizing allogeneic fat as well as examine the efficacy of this approach on burn-wound contractures, adhesions, and soft-tissue deficits.

Methods

Female, Yorkshire swine received 16, 4x4 cm full-thickness burns. After 48 hours, eschar was removed to fascia. Wounds were stratified to receive either A) No Reconstruction, B) Skin-Only, C) Fat-Only, D) Immediate-Skin, Delayed-Fat, or E) Immediate-Fat, Delayed-Skin. All fat utilized was allogeneic sourced from vendor-matched swine. At 8-weeks post-engraftment animals were sacrificed and all wounds were collected for photography, ultrasound, histology and serum studies.

Results

Use of allogeneic fat significantly improved terminal soft-tissue thickness under both immediate and delayed administration (p< 0.05). Immediate use of allogeneic fat significantly improved tissue mobility vs. untreated and skin graft controls (p< 0.05). Contracture was most significantly affected by timing of skin graft placement, however, could be further mitigated under standard delayed-fat approached with allogeneic tissue.

Conclusions

Here we demonstrate use of allogeneic fat in both traditional-delayed and a fat-first approach with significant mitigation of adhesion when applied as an initial basal layer. Both immediate and delayed allogeneic fat were sufficient to improve on soft tissue deficits.
810 Synthetic Platelet-Mimetics with Gentamicin: Outcomes in Deep Partial-Thickness Burns
Authors: Valdera Franklin , Nuutila Kristo , Cooper Laura E , Varon David E , Cooley Jennifer , Chapa Javier , Chan Rodney K , Carlsson Anders H
Published: March 2022

Introduction

Infection and prolonged inflammation in deep partial-thickness burns can lead to inadequate healing. In addition to their role in hemostasis, activated platelets also contain granules with anti-inflammatory properties which may impact wound healing. However, portability and storage of platelets remain a challenge. Synthetic platelet-mimetics (SPM) avoid these difficulties, but like natural platelets, SPM have vesicles that can transport bioactive agents, such as antibiotics. We sought to evaluate wound healing outcomes in deep partial-thickness burns treated topically with SPM.

Methods

A total of 30 circular, deep partial-thickness burns were created on the dorsum of 2 porcine models. Each wound measured 5cm in diameter and was standardized using a thermocoupled burn device. Sets of six wounds were randomized into five groups: SPM, gentamicin alone, SPM with gentamicin, a vehicle control (saline), or dry gauze (the standard of care, SOC). Additionally, two separate 5cm diameter circular areas were demarcated to serve as normal skin controls. Wounds were assessed at post-burn days 3, 7, 14, 21, 28, 60 and 90 with a variety of non-invasive imaging and punch biopsies. Treatments were re-applied at each assessment. The primary outcome was the amount of wound re-epithelialization, measured histologically, at post-burn day 28. Secondary outcomes consisted of the percentage of wound contraction, amount of superficial blood flow, and mean bacterial load.

Results

The amount of wound re-epithelialization in wounds treated with SPM was 96% whereas those treated with the SOC measured only slightly less at 92% (p = 0.56). The percentage of wound contraction was 39% in the SPM with gentamicin group, while in the SOC group contraction was higher at 45% (p = 0.20). Moreover, superficial blood flow in the SPM group was measured to be 168% of normal skin controls, while wounds in the SPM with gentamicin group were slightly lower at 160%, and in wounds treated with the SOC blood flow was 110% of normal skin controls (p = 0.27). The mean bacterial load in each group was measured at post-burn day 3 and notably consisted of bacterial load being the lowest in wounds treated with gentamicin alone at 17/100, meanwhile in wounds treated with the SOC or those in the SPM with gentamicin group, mean bacterial loads were significantly higher at 43/100 and 47/100, respectively (p = 0.02).

Conclusions

SPM applied to deep partial-thickness burns did not significantly improve measured outcomes over the SOC. Although numerical improvements were shown in all measured outcomes, no significant differences were noted. The theoretical and observed potential for SPM to improve wound healing deserves additional evaluation in larger preclinical studies.
814 Devices measuring transepidermal water loss of the skin: a systematic review of measurement properties
Authors: Klotz Tanja , Ibrahim Abdullah , Maddern Guy , Caplash Yugesh , Wagstaff Marcus
Published: March 2022

Introduction

TEWL is a physiological property of skin which increases when the epidermis is damaged. It is, therefore, a commonly utilised measure of skin barrier integrity. Devices measuring TEWL are available as open, semi-open or closed chamber. Studies of reliability examine the consistency of measurement, and/or responsive whereas measurement error scores in absolute terms the amount of error due to sources of variation.

Methods

The search strategy aimed to locate published and unpublished studies. Databases searched included PubMed, Embase, CINAHL and Web of Science, utilising identified keywords and limited to studies in English. Grey literature sources were searched to identify any unpublished documents. Study selection using the inclusion criteria was then assessed by two reviewers for methodological quality utilising the COSMIN risk of bias tool to assess the reliability and measurement error of outcome measurement instruments.

Studies examining the reliability and/or measurement error of TEWL measurement devices were included. Studies that only report on measurement of TEWL outcomes without examination of reliability and/or measurement error were excluded.

Results

A total of 22 devices were examined in the 38 included studies. The quality of study design was on average rated as ‘Adequate’ however reliability and measurement error statistical methods were on average rated as ‘Doubtful’.

Conclusions

TEWL measurement devices were found to demonstrate good reliability and often correlated with other devices. However, measurement error was highly variable but improves under in-vitro conditions.