bluuebunny/crossref_metadata_2025 huggingface dataset:
55 Initial Experience Using Artificial Intelligence for the Assessment of Pediatric Burn Depth
Authors: Holmes James H , Phelan Herb A , Shupp Jeffrey W , DiMaio J Michael , Carter Jeffrey E
Published: March 2022

Introduction

Estimation of burn depth, and hence severity, is critical for burn management. Burn depth estimates vary widely, and these inaccuracies can be compounded in pediatric burns. A reliable, objective, non-invasive device for the accurate assessment of burn depth is needed. A non-invasive imaging technology, using multispectral imaging (MSI) combined with a machine learning algorithm (MLA), is being developed as a tool for burn depth assessment. The results of the initial multi-center study using this artificial intelligence (AI) technology in pediatric burns are presented.

Methods

The MSI device was used to image subjects < 18y of age with thermal burns < 50% TBSA. It captured a set of images measuring the reflectance of visible and near-IR light, within a 23x23 cm field-of-view. Images were collected from up to 2 separate burned regions within 72 hours of injury that were then serially imaged for up to 7d post-injury. Burns that the investigator believed would heal spontaneously (superficial or superficial partial-thickness) were managed per institutional standard of care (SOC) and assessed at 21d post-injury for complete healing. Burns that the investigator felt would not heal by 21d post-injury (deep partial-thickness or full-thickness) were excised and grafted per institutional SOC, with multiple biopsies being taken prior to excision.

Regions of non-healing burn within every MSI image were identified by a panel of 3 burn surgeons. To accurately identify these non-healing regions, the panel of surgeons was given access to 1 of 2 clinical reference standards: a) the 21-day healing assessments for burns allowed to heal spontaneously; or b) pathology reports detailing histologic analyses from the biopsies.

This information was then used to develop a type of MLA called a convolutional neural network (CNN) that could automatically identify the regions of non-healing burn within an image. From these data, an ensemble of 8 separate CNN algorithms was used to automatically identify non-healing burn tissue. Training and test accuracies of the ensemble CNN were calculated using cross-validation at the level of the subject.

Results

Twenty-four (24) pediatric burn patients were enrolled, with 26 burned areas being serially imaged. The age range of the subjects was 7 months - 17y, with a mean age of 5.7y. Subjects had a mean burn size of 8.0 ± 4.2% TBSA, and 70% of the subjects were male. The AI performance results showed an accuracy of 88.2 ± 3.7%, sensitivity of 80.0 ± 14.6%, specificity of 88.0% ± 3.7%, and an area under the curve (AUC) of 0.92.

Conclusions

Our study demonstrates an improvement in the accuracy of burn depth assessment over the traditional exam, which could lead to improved burn care.
77 Impacts of Financial Assistance on Quality of Life Among People Living with Burn Injury
Authors: Martz Flora , McMullen Kara , Carrougher Gretchen J , Wolf Steven E , Schneider Jeffrey C , Stewart Barclay T , Sheckter Clifford C , Bunnell Aaron E
Published: March 2022

Introduction

Financial toxicity negatively impacts recovery after injury. Financial assistance (FA; e.g., disability income, food stamps, low-income housing voucher) may mitigate the impacts of financial toxicity. We aimed to describe FA after burn injury and its association with health-related quality of life (HRQL) and return to work.

Methods

Data from adult participants participating in a multicenter longitudinal database from 2015 to 2021 were used for complete-case analysis. Participants were separated into two groups: those who received any form of financial assistance due to their burn injury, and those who did not. The cohort and FA were described. Multi-level, mixed-effects, linear regression was performed to assess the associations of FA with VR-12 Physical and Mental Health Component Summary scores (PCS, MCS) and return to work. Lastly, a propensity score analysis matched 3:1 on age, gender, pre-injury PCS and MCS, burn size, length of hospital stay, and the number of operations as a result of burn injury was used to maximally reduce potential confounding.

Results

The analysis included 1,237 participants [725 who received FA, 512 who did not receive FA (NFA)]. Participants who received FA due to their burn injury were more likely to be younger (median 42 FA vs 48 NFA, p-value < 0.001), racially minoritized (19.2% FA vs 14.3% NFA, p-value < 0.001), have larger injuries (21% FA vs. 10% TBSA NFA, p-value < 0.001), longer hospital stays (median 29.5 days FA vs. 17 days NFA, p-value < 0.001), more days before returning to work (median 220 days FA vs 79 days NFA, p-value < 0.001), and have a workers compensation insurance payer (23.6% FA vs. 9.38% NFA, p-value < 0.001) compared to peers who did not receive FA. The number of participants who received new FA decreased after the 6-month time point: 11% at discharge, 33% at 6 months, and 15% at 12 months. Propensity score analysis demonstrated that receiving FA was associated with lower PCS and MCS scores at all time points and longer time to return to work (Table 1).

Conclusions

Given that financial toxicity is associated with unsatisfactory recovery after injury, efforts to reduce financial stressors are needed. FA seems somewhat matched to patients with greater recovery challenges (e.g., larger injuries, more complex hospitalizations). Additionally, most patients do not receive FA for a prolonged period (e.g., >6 months). While FA is associated with lower HRQL and longer return to work, these data may represent improvement compared to what people living with burn injury might have experienced without FA and represent unmeasured confounding.
78 Classification and Regression Tree Model for Predicting Satisfaction with Life Scale Scores After Burn Injury
Authors: Bissoon Zephorah , Gause Emma L , Carrougher Gretchen J , Baker Claudia , Wiechman Shelley A , Pham Tam N , Gibran Nicole S , Stewart Barclay T
Published: March 2022

Introduction

Current early burn care prognostication models predict in-hospital mortality (e.g., revised Baux Score). However, patients, families and clinicians need more holistic tools in the hours and days after injury to identify specific factors that might affect their quality of life and indicate a need for more intensive services. This project aims to predict Satisfaction with Life (SWL) in survivors of burn injury using patient, injury, and care factors available within 24 hours of admission.

Methods

Two hundred and fourteen participants were identified from a multicenter national longitudinal database and merged with clinical data from a single institution's trauma registry. Patients were randomized into a training dataset (80%) and a testing dataset (20%). A CART algorithm was used to examine the relative contributions of individual predictor variables in classifying low SWL at six-month follow up (SWL ≤ 20). Seventeen covariables obtained within 24 hours of index hospital admission were analyzed from five domains: demographics, comorbidities, injury, care, and host response to injury. Lab values were those closest to but not greater than 24 hours after index hospital admission.

Results

Multiple covariables contributed to the SWL score. CART analysis selected a pre-injury SWL score < 31 as the first node and strongest indicator of low SWL. CART then selected the following subgroups at risk for SWL ≤ 20 at 6 months: (1) hematocrit >55%; (2) lactate >4 mmol/L, age > 59; (3) total body surface area (TBSA) burned >30%, presence of a hand, neck, and/or face burn. The cross-validated predictive accuracy of the CART model was 69.4% with a cross-validated relative error of 0.379. In the validation data set, sensitivity and specificity were 62.5% and 72.0%, respectively.

Conclusions

The findings demonstrate the potential feasibility of creating a model that can predict a clinically meaningful quality of life outcome using covariables gathered within hours of hospital admission after burn injury. Predictive measures suggest that while some of the included covariables may be associated with SWL, they are not consistently and reliably predictive of low SWL alone. With more data and additional refined inputs, a similar model could be used to identify those in need of more intensive services earlier on in the hospitalization.
87 Comparing the Efficiency of Tumescent Infiltration Techniques in Burn Surgery
Authors: Fouché Tom , Bond Stephanie , Vrouwe Sebastian Q
Published: March 2022

Introduction

Tangential excision and grafting of burn wounds results in significant intra-operative blood loss. Infiltration of a dilute epinephrine solution is routinely performed to reduce bleeding from both the eschar and donor sites. Tumescence infiltration has been described using both a manual technique or a pump device. The purpose of this study is to compare the efficiency of these two methods in terms of time and economy of motion.

Methods

Consecutive adult burn patients who required excision and grafting were enrolled in the study. Manual infiltration consisted of an aspirating syringe (10 mL), spinal needle (18 gauge), and three-way stopcock connected to sterile tubing. Pump infiltration consisted of a blunt cannula and infiltration pump (300 mL/minute). Prior to each case, patients were randomized into either the manual or pump tumescent technique. Excisions of < 2% TBSA were excluded, along with specific anatomic regions (head and neck, genitalia, hands and forearms, feet, and legs below the knee). Infiltration with epinephrine-saline solution (1:500,000) was performed to the endpoint of tissue tumescence by a single surgeon for consistency. ImageJ software was used to calculate the surface area to be infiltrated. The infiltration was filmed and later coded for duration, number of maneuvers, and total volume of tumescence injected. Any complications related to the infiltration of tumescence were collected.

Results

A total of 14 patients were enrolled, and 16 cases were randomized to either manual (N=8) or pump infiltration (N=8). Participants were 71% male, with a mean age of 41.8 years, and mean burn size of 16.9% TBSA. The pump method required less time (2.0 cm2/s vs 1.1 cm2/s, p< 0.001) and fewer maneuvers (37.8 cm2/move vs 1.1 cm2/move, p< 0.001). Use of the infiltration pump also resulted in a reduced volume of fluid required to reach the endpoint of tumescence (1.7 mL/cm2 vs 2.4 mL/cm2, p=0.01). No complications were reported related to the process of tumescence in either group.

Conclusions

Compared to the manual technique, use an infiltration pump was significantly more efficacious in terms of both time and economy of motion. Additionally, less fluid volume was required to achieve the endpoint of tumescence.
90 Efficacy of Porcine Skin Xenotransplants Indistinguishable from Allograft in First-in-human Clinical Evaluation
Authors: Holzer Paul , Chang Elizabeth J , Lu Diana , Adkins Jon , Rogers Kaitlyn , Man Angela , Chang Kristina , Wicks Joan , Ko Dicken S C , Schulz John T , Kaiser Robert A , Swartz Harold M , Cetrulo Curtis L , Monroy Rod , Goverman Jeremy
Published: March 2022

Introduction

Human cadaver allograft (HCA) is the current standard of care for temporary wound closure of large burns, but a critical need for high-quality alternatives exists. Porcine skin shares many similarities with human skin, and hyperacute rejection is prevented via a single genetic modification. Like human skin, non-terminally sterilized porcine skin contains viable dermal and epidermal cells and intact vasculature that enables restoration of barrier function. These characteristics are distinct from those of traditional, terminally sterilized “xenografts” and may offer greater therapeutic capability. We report here key efficacy outcomes specific to severe burn care from a first-in-human clinical trial to assess the capability of genetically engineered porcine skin xenotransplants to provide temporary wound closure for severe and extensive deep-partial and full-thickness burn wounds, compared to HCA.

Methods

Split-thickness skin containing epidermal and dermal layers was harvested from Designated Pathogen Free, GalT-KO, porcine donors, cGMP processed to achieve USP< 71 > sterility and cryopreserved to retain >70% cell viability. These were transplanted side by side with HCA on debrided full-thickness burn wounds in six human subjects. Temporary wound closure, incidence of complete wound closure following autografting, and quality of healing, including scarring, contour, and feel of healed skin, normalization of skin markings or pigmentation, were independently assessed.

Results

Across all patients and assessment time points, adherence, vascularity, and overall appearance were indistinguishable between porcine skin xenotransplants and HCA control. After surgical removal, wound beds treated with each type of dressing were perfused and otherwise appeared equivalent and clinically suitable for autografting. Long-term outcomes were comparable between wound sites treated with porcine skin or HCA with no discernable differences in scarring or cosmesis.

Conclusions

Skin xenotransplants effectively provided temporary wound closure and restoration of barrier function via intact native vasculature, active cells, decreased antigenicity, and high-quality tissue architecture unimpacted by cryopreservation and thawing. These results show clinical promise as an interchangeable alternative to HCA in the treatment of severe burns. Expanded clinical evaluation is ongoing.
103 Differences in Estradiol Levels Following Burn Injury
Authors: Willis Micah L , Soliman Daniel S , Ngeve Sally-Irene , Mahung Cressida , Wallet Shannon , Maile Robert
Published: March 2022

Introduction

The American Burn Association estimates over one million people with burn injuries in the US need medical care, with around 4,500 cases ending in mortality each year. Mortality is due to bacterial infection as a consequence of severe cytokine dysregulation and impaired wound healing. Previous research has shown females have worse outcomes than males following burn injury, but the reasoning is unknown. Estradiol is involved in the regulation of local and systemic interleukin-6 (IL-6) levels, which has been demonstrated by others to positively correlates with poor outcomes following burn. We hypothesize that concentrations of Estrogen can create a pro-inflammatory effect in epithelial cells, which is controlled in a negative feedback loop.

Methods

We utilized plasma from 1) human burn patients and 2) our murine model of burn injury, in which C57BL/6 mice are exposed to a 20% total body surface area burn injury and 3) an in vitro cell model using human Oral Epithelial Cells (OECs) and human Airway Epithelial Cells (AECs).

Results

We measured human estradiol levels 1-3 days after burn injury and murine estradiol levels 3 and 7 days after injury by ELISA. In humans there were differences in levels at these timepoints (p< 0.05). In mice we observed a difference in the change in murine estradiol levels between males and females 7 days after injury (p < 0.01). We simulated a wound by removing the cell insert and treating cells with concentrations of estradiol (0.1 nM, 1.0 nM & 250 nM). Images were taken at 0, 6 & 24 H and analyzed using Fiji to observe wound closure. Supernatant was removed from cells at 24 H and analyzed for IL-6 levels (a key pro-inflammatory cytokine linked to poor wound healing after burn) via ELISA. mRNA was isolated from cells and analyzed for IL-6, TNFα & VEGF (important regulators of wound healing) via PCR. We observed an increase in percent wound closure in the AECs, and no difference in OECs. We observed an increase in IL-6 production following stimulation with Estradiol and LPS at different rates for each cell type and corresponding reduction in TNFα and VEGF expression. We also described different Estradiol Receptors in the two cell types.

Conclusions

Taken together, these data suggest burn injury upregulates estradiol in both humans and mice following burn injury whereby this is more robust in females at later stages of burn injury and thus contributing to female-associated poor clinical outcomes.
105 Nursing Theory and Burn Competency Training Practices to Address Gaps in Post-covid Trained Graduate Nurses
Authors: Dowling Lynn , Wilson Joan , Echols Jane D , Burke Susan , Hills Jocelyn
Published: March 2022

Introduction

Recruitment efforts just after the recent COVID crises brought in several new graduate nurses. They had limited clinical exposure during COVID-19 resulting in difficulty transitioning into practice providing safe patient care. As a result, these nurses lacked the fundamental knowledge needed to care for acutely ill burn and wound patients resulting in the new graduate registered nurses (NGRNs) feeling overwhelmed at the bedside. These findings coincide with assessments noted in Kavanagh and Sharpnack’s (2021), article identifying only 9% of NGRNs were practice ready, with 7% failing to recognize urgency or a change in a patient’s condition.

Methods

In order to achieve the designated American Burn Association (ABA) competencies, our center designed a program based on Patricia Benner’s Novice to Expert nursing theory. Additionally, we divided the competencies into achievable goals and domains using the Donna Wright's nursing competency model.

StaRN program: didactics/simulation/skills/unit orientation one on one with a preceptor

Competency based staged orientation program for new staff

Burn Specific Education includes:

1) Burn and complex wound care didactic

2) Burn specific High-fidelity simulation scenario utilizing critical care equipment promoting critical thinking and critical reasoning skills

3) Task trainers

4) On-going preceptor education

5) Nurse Extern program

Results

NGRNS arriving at our unit in early 2020 were found to be incapable of performing clinical tasks in the burn ICU (BICU) setting at the level of competency recommended by the ABA. We immediately placed this cohort into the revised training program incorporating Benners Novice to Expert Theory and Wright’s Competency Model. Of the 25, 17 were able to be placed in the BICU (68%), and 8 were able to transfer to a lower level of care (progressive care/med-surg). All 25 were given extended orientation (12 weeks instead of the normal 8, as recommended by our facility). We will follow this group to determine retention rates.

Conclusions

Current levels of competencies by the ABA creates gaps in care for graduate nurses entering the workforce with deficits. Applying Benner's Novice to Expert Theory and Wright’s Competency Model to modify approaches to training helps identify gaps in care, addresses areas that are weak for the nurse, and help guide the graduate nurse through stages of expertise to arrive more confidently at the level of competency expected by the ABA.
108 Development and Implementation of a Burn Nurse Educator
Authors: Snyder Emily , Rosenthal Jennifer
Published: March 2022

Introduction

Prior to the introduction of the Burn Nurse Educator (BNE), at a growing and newly established burn center, the education of the Burn Trauma ICU staff was completed by the Burn Director and Burn Supervisor. In this burn center, large amounts of education became difficult to create and distribute by the current Burn Director and Burn Supervisor due to the demand of their respective job roles. The role of the BNE was to create initial and ongoing education for the Burn Trauma ICU Staff, Ortho-Trauma staff, ED staff, local EMS agencies, and the community.

Methods

The Burn Nurse Educator reviewed previous education that was provided to the staff, compared it to the Burn Nurse Competencies established by the American Burn Association, and was able to formulate a new education plan. The Burn Nurse Educator created several burn-based courses. These classes included: Floating into Burn Care, Burn Boot Camp, and Burns in the Pediatric Population. There was also the introduction of mock codes focused on the pediatric burn population. In addition to the formulation of these educational opportunities, the Burn Nurse Educator worked directly with the Quality Improvement Committee to find gaps in care. These gaps were then turned into project improvement plans and additional education was provided to the bedside staff. The Burn Nurse Educator formed relationships with local EMS agencies and was able to provide burn lectures and continuing education.

Results

Each class offered had a pre and post test administered, all with improved scores. A sample size of 30 nurses who enrolled in Burns in the Pediatric Population had a score increase from 46% to 94%. A sample size of 14 nurses had a score increase of 55% to 80% after enrolling in Floating into Burn Care. A sample size of 30 nurses who enrolled in Burn Boot Camp had a score increase of 71% to 95%. More importantly, the staff expressed a higher level of confidence when caring for a burn patient after these classes. The outreach with local EMS agencies also increased our EMS admits to the hospital, improved knowledge for caring for burn victims, and created a relationship with our local cities EMS.

Conclusions

It is anticipated that as the program continues to expand, the role of the Burn Nurse Educator will continue to grow and encompass new responsibilities. To ensure each nurse remains competent in their skill set, additional knowledge testing will be completed one year after a nurse has completed a class.
109 The Impact of Distance to Treatment Center on Long-term Outcomes of Burn Patients
Authors: Galicia Kevin E , Kubasiak John , Mehta Anupama , Riviello Robert , Nitzschke Stephanie , McMullen Kara , Gibran Nicole S , Stewart Barclay T , Wolf Steven E , Ryan Colleen M , Schneider Jeffrey C
Published: March 2022

Introduction

Geospatial access to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. It is often necessary to transport patients hundreds of miles to provide definitive burn care and rehabilitation services. This study evaluates the impact of distance to treatment center on long-term outcomes of burn patients.

Methods

Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System (BMS) National Database, collected from 2015 to 2019, were analyzed to investigate the impact of distance to BMS center on long-term, patient-reported outcomes. Distance was calculated as driving distance between home zip code centroid and BMS center. Demographic and clinical data were compared between groups by distance from BMS center (< 20, 20-49.9, >50 miles). The following patient-reported outcome measures, collected 12 months after injury, were examined: Veterans Rand 12 Physical Component Summary Score (VR-12 PCS), Veterans Rand 12 Mental Component Summary Score (VR-12 MCS), Satisfaction with Life (SWL), employment status, and days to return to work. Mixed regression model analyses were used to examine the associations between distance to BMS center and each outcome measure, controlling for demographic and clinical variables.

Results

Of the 726 participants included in this study, 191 (26.3%) and 204 (28.1%) were < 20 and between 20-49.9 miles from a BMS center, respectively; 331 (46.6%) were >50 miles from a BMS center. Greater distance to BMS center was associated with white race/ethnicity (p< 0.001) and employment at time of injury (p=0.001). Greater distance to BMS center was also associated with flame injury (p< 0.001) and larger burn size (p< 0.001). There were no significant differences in length of stay or number of operations between groups. Regression analyses did not identify significant associations between distance to BMS center and VR-12 PCS, VR-12 MCS, SWL, employment at 12 months, or days to return to work.

Conclusions

After burn injury, patient-reported outcome measures of physical and psychosocial function, as well as employment, do not differ based on distance to BMS center.
118 Burn Injury Vandalizes Cancer Survival with Increased Risk of Complications
Authors: Keys Phillip H , Gotewal Sunny , Wermine Kendall , Efejuku Tsola A , Chokshi Shivan N , Huang Lyndon G , Corona Kassandra K , Villarreal Elvia L , Chaij Jasmine M , De La Tejera Giovanna , Bagby Shelby P , Haseem Maria , Joglar Alejandro A , Golovko George , Wolf Steven E , El Ayadi Amina , Song Juquan
Published: March 2022

Introduction

Burn injuries place patients in a compromised state, especially those with pre-existing comorbidities. The presence of cancer complicates care and worsens outcomes for patients suffering from illnesses unrelated to burns, such as sepsis. Therefore, we posit the incidence of burn injury on patients with preexisting cancer diagnoses results in an increased risk of complications.

Methods

Burned patients were identified using the TriNetX database, a global federated health research network. Fifty-one thousand patients with a diagnosis of cancer prior to experiencing a burn injury were identified. Control groups included 1) patients who had a previous cancer diagnosis and no incidence of burn, and 2) patients who experienced a burn with no history of cancer. Outcomes analyzed included sepsis, nutritional deficiency, eating disorder, immunodeficiency, and depression within 5 years. Cancer diagnoses were categorized into 5 of the 13 most common cancer reported in the US. Data was analyzed using a chi-square analysis with p< 0.05 considered significant, and presented odds ratio are with 95% confidence intervals.

Results

The majority of cancer survivors with burns were White (70%) and female (62%). Compared to cancer patients without burn injury, patients experiencing a burn after a diagnosis of cancer were more likely to develop sepsis (1.718, 1.612-1.83), nutritional deficiency (1.963, 1.593-2.418), immunodeficiency (1.265, 1.098-1.459), eating disorders (2.569, 2.077-3.177), and depression (1.538,1.468-1.611). When compared to burn patients with no history of cancer, burned patients with cancer diagnosis had increased odds of developing sepsis (3.806, 3.502-4.137), nutritional deficiency (3.529, 2.725-4.571), immunodeficiency (6.657, 5.126,8.645), eating disorder (2.184, 1.787-2.67), and depression (2.147, 2.041-2.259). Further, burned patients with a history of lung cancer experienced a uniquely high risk of sepsis. Additionally, burn patients with histories of either lung or breast cancers were also at increased risk ratios of experiencing depression (p< 0.05).

Conclusions

Burned patients with a history of a cancer demonstrated considerable increases in complications when compared to those with only a burn injury. Categorization of the broad “neoplasm” label uncovers patterns or trends for specific cancer types to inform the current healthcare system more accurately.
122 PTSD Symptom Clusters as Predictors of Pain Interference in Burn Survivors
Authors: Wiechman Shelley A , Bhalla Arjun , Bamer Alyssa M , Carrougher Gretchen J , Stewart Barclay T , Gibran Nicole S , Schneider Jeffrey C , Temes Christina , Stoddard Frederick J J , Roaten Kimberly
Published: March 2022

Introduction

Individuals who experience burns are at higher risk of developing post-traumatic stress disorder (PTSD) and chronic pain. There exists a synergistic relationship between PTSD and chronic pain in burn survivors. Theories exist about how aspects of each condition may perpetuate one another, or share underlying mechanisms. Both of these conditions are of relevance to pain-related disability. We sought to examine the role of individual PTSD symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two PTSD symptom clusters, pain intensity, and other covariates (burn size, hospital length of stay, age and gender).

Methods

Data were analyzed from the Burn Model System National Database. Inclusion criteria required participants to have a moderate to severe burn injury that required surgery for wound closure. Patient-reported outcome data: PTSD Checklist - Civilian, PROMIS-Pain Interference Short Form 4a, and a 0-10 average Pain Intensity item were analyzed at 6-months after injury. Hierarchical linear regression models were fit to examine the impact of PTSD symptom clusters on pain interference over and above that of pain intensity, and standardized betas were calculated (B).

Results

A total of 439 adult participants had complete responses on the measures of interest (e.g. PTSD symptoms, PROMIS-Pain Interference, and Pain Intensity) and were included in the analysis. Mean age, percent total body surface area burned, and hospital length of stay were 47 years, 18%, and 27 days, respectively. 69% were male and 82% were Caucasian. Results of a linear regression found that hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) PTSD symptom clusters were each significant predictors of pain-related disability, even when accounting for pain intensity (B = .64, p < .001). The covariates age, gender, days until discharge, and TBSA were all nonsignificant. The model accounted for 61% of the variance associated with pain-related disability.

Conclusions

Results highlight the importance of the emotional numbing and hyperarousal PTSD symptom clusters in explaining pain interference. Future evaluations parsing out the longitudinal relationships (i.e., beyond 6-months postburn) between PTSD symptom clusters, pain intensity, and pain interference, as well as evaluating other underlying mechanisms, are warranted.
126 Are Burn-injured Youth Anxiety Disorders Being Missed Because Parents Are Unaware of the Problem?
Authors: Brubaker Rimmer Ruth B , Bay R C C , Kalil Emile T , Chacon Daniel W , Foster Kevin N
Published: March 2022

Introduction

Anxiety disorders among pediatric burn survivors have been shown to be common in both the acute care and outpatient settings. However, there is a paucity of research regarding parental awareness of psychological issues affecting burn-injured Dallas & adolescents. This study examined the relationship between burn-injured youths’ self-reported anxiety levels, as compared to their parent’s perceptions.

Methods

Parents of burn injured Dallas were invited to complete the Parent Version of the 41-item survey, Screen for Child Anxiety Related Disorders (SCARED) which consists of five anxiety sub-scales as well as a Total Anxiety Score. Their Dallas also voluntarily complete the Child Version. A higher score indicates greater anxiety.

Results

Forty-five parent-child dyads, with girls (51%) and boys (49%), completed surveys Ethnicity was reported as Caucasian (36%) Hispanic (42%) African Am (18%). Mothers (78%) fathers (18%) grandmothers (2%) & guardian (2%) participated. Mean parent age was 39. Child mean age was 13. Burn scars were visible in 64% of Dallas. Matched-pairs t-tests were used to compare parent and child scores. Parents reported lower SCARED Total Anxiety scores (mean=10.52) than youth (21.06), p< 0.001. Parents also reported significantly lower scores on the Panic Disorder/ Somatic Symptoms (p< 0.001), Generalized Anxiety Disorder (p=.004), Separation Anxiety (p< 0.001), and School Avoidance subscale (p< 0.001). For the Separation Anxiety scale, 23 youth’s self-report exceeded the threshold for suspected disorder, while parent report classified only 3 with separation anxiety. Spearman correlations between parent and youth scale scores yielded no significant results (all less than rs =.20, p >0.25), indicating virtually no association between the two.

Conclusions

Results reveal a lack of parental awareness of their child’s anxiety disorder symptomology. This lack of recognition is of concern because Dallas are dependent on their parents/caregivers to identify psychopathologies and to help them seek services for mental health challenges.
128 Mental Health Outcomes in Burn Patients: A Single-site Experience
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia
Published: March 2022

Introduction

Burn injuries are a leading cause of morbidity and mortality among patients worldwide. Many survivors continue to suffer from psychiatric sequalae long after their physical injuries have healed. This may even be more pronounced in groups who have a history of mental health disorders prior to admission. Common pre-injury mental health problems may include substance abuse disorders, as well as affective, psychotic, and personality disorders. The aim of this study was to explore the outcomes of patients with previously diagnosed mental health disorders who were admitted to our Burn Center.

Methods

This was a single-site, retrospective review using our institutional Burn Center registry. All adult patients (18 years or older) admitted to our Burn Center between January 1, 2014 and June 30, 2021 who had a previous history of mental health disorders were included in this study. All adult patients who did not have any previous history of mental health disorders were also included for comparative purposes. Variables of interest included demographics, burn mechanism, length of stay (LOS), cost of hospitalization, and mortality. A p-value of < 0.05 was considered statistically significant for all analyses.

Results

There were 7,976 patients included in this study, with 32% of these patients having a previous diagnosis of mental health disorders. The mean age was 43.5 years, and the mean total body surface area (TBSA) involvement was 5.9%. Both the groups with a history of mental health disorders and those without were predominantly male (63.8% versus 68.0%). Most patients were flame-injured in both groups (44.5% versus 40.9%). The mean LOS for those with mental health disorder history was 14.5 days compared to 8.3 days for those without (p < 0.00001). The overall cost of hospitalization was $133,967 for those with mental health disorder history and $65,993 for those without (p < 0.00001). The overall hospital mortality for those with mental health disorder history was 2.3% and 3.4% for those without (p = 0.007).

Conclusions

Although there was no increase in mortality among patients with pre-existing mental health disorders, we did find that there was an increase in the hospital length of stay, as well as the overall cost of hospitalization. These findings do indicate that individuals with pre-existing mental health disorders do not necessarily have worse outcomes in terms of mortality; however, they may need access to care for longer periods of time, which may contribute to increased medical costs.
503 Social Media as a Platform for Burn Survivor Outreach at a Safety Net Hospital
Authors: Colbath Rachel A , Ross Erin E , Ebner Peggy J , Yu Jeremy , Gillenwater Justin , Yenikomshian Haig A
Published: March 2022

Introduction

Outpatient follow-up is a critical component of burn recovery. Sociodemographic variables that prevent patients from pursuing follow-up can lead vulnerable groups to have a lower quality of life after burn injury. Social media provides a platform for improvement of patient outreach and support. The purpose of this study is to investigate accessibility and interest in social media interventions among socioeconomically disadvantaged and minority burn patients.

Methods

Patients receiving treatment at a burn clinic in a large public hospital were asked to complete a survey about social media usage, difficulty attending follow-up appointments, and interest in engaging with the hospital through social media. Patient demographics and clinical data were obtained via chart review. The relationship between clinical or demographic factors, and interest in social media engagement, was assessed via exact logistic regression.

Results

Data were collected from 65 eligible patients. Social media use among participants (76.9%) was similar to the proportion in the U.S. general population (72%). 61.5% of participants used Facebook, 40% used Instagram, and 4.6% used Twitter. 81% of participants had consistent internet access. 58.3% of respondents expected to encounter challenges when planning follow-up appointments. Challenges included difficulty with transportation (26.2%), trouble taking time off work (9.8%), and forgetting to schedule (9.8%). Participants were asked if they were interested in receiving post-discharge education, care team outreach, and follow-up reminders via social media. 36.5% of patients were very or moderately interested, 27% were slightly interested, and 36.5% were unsure or not at all interested.

20% of patients both expected follow-up challenges and were moderately or very interested in social media engagement. While controlling for social media use, the odds of having moderate or greater interest in the post-discharge engagement program were estimated to be 2.6 times higher for patients older than 39 (OR 3.64; 95% CI 1.03-14.24; P=.044). There was a pattern of lower interest in social media engagement with higher %TBSA, while controlling for age or social media use, though P values were higher than .05.

Conclusions

Over half of the burn patients surveyed expected to face challenges when planning follow-up appointments, a third of whom were moderately or very interested in social media engagement. Social media may be an alternative form of outreach with older patients in particular. Observed overlap between follow-up difficulty and outreach program interest may suggest such a program could ameliorate follow-up challenges.
505 The Successful Development of a Digital Peer Supporter Training Program - How It is Done
Authors: Cramolini Sandra J , Irven Jessica , Peterson Pam
Published: March 2022

Introduction

The global pandemic of 2020 and 2021 has had an unforgettable impact on our lives and community well-being. Burn survivors are a particularly vulnerable population for social isolation and loneliness and, therefore, an amplified need for social connection. This abstract outlines the strategic structure, curriculum, and training required to move an in-person course to an innovative digital model.

Methods

A group of burn subject matter experts (SMEs), including burn survivors, peer supporters, and course instructors, virtually met to brainstorm program redesign, considering the needs of the burn survivors. Research of topics guided manual and course revisions. Experts recommended a website and digital resource review to streamline organizational data collection and participants’ experiences. A scheduled pilot course and evaluation would provide feedback for changes. SMEs created a short turnaround timeline.

Results

After research, the revised digital manual was condensed from 200 to 50 pages, allowing for hyperlinks, abbreviated resources, and replicated content removal. Five major content areas previously taught in-person were converted to recorded PowerPoint learning modules (April – June 2020). The asynchronous modules totaled 4 hours of self-paced learning assigned to the candidates before a set virtual course. A survey monkey assessment after each module evaluates the learner's base knowledge. SMEs developed a 4-hour virtual class incorporating the modules, manual, and group exercises. A designed pre-course worksheet prepares the candidates for group exercises. Based on their burn injury type or situation (parent to parent, survivors with amputations, death of loved one), candidates practice virtual peer support visits. After the first pilot course, a comprehensive evaluation tool assessed participant satisfaction and confidence, curriculum, instructor expertise, and comfort level navigating the virtual model (August 2020). A website landing page centralized course resources and content location, streamlining participant experience and organizational data collection (March 2021). A 2-hour instructor course (n=10) provided an update on the new structure. The instructors also observe a virtual peer supporter course, participate as an instructor in-training, then co-teach with another instructor before independent course instruction (June 2021).

Conclusions

The digital model has trained burn survivors (n=41) in 6 courses over eight months during a pandemic. Burn survivors have trained together from around the globe to one of the calendared courses improving efficiencies. There are monetary and resource cost savings for burn centers and the organization. The digital manual is easily updated, saving in resource allocation. Peer supporters navigate additional online resources for ongoing self-growth through the embedded website landing page.
509 Why do elderly burn patients die? Analysis of early versus delayed ICU deaths, from 2014-2021
Authors: Werthman Emily H , Ballou Jessica , Lagziel Tomer , Yoon Joshua S , Akhavan Arya A , Shamoun Feras , Caffrey Julie , Hultman Charles S
Published: March 2022

Introduction

Despite continued improvements in critical care, nutrition, and surgical technique, elderly patients with burn injury remain a vulnerable population, with increased mortality. The purpose of this study was to compare early versus late deaths in elderly burn patients admitted to the intensive care unit, to identify potential interventions that might improve survival.

Methods

We conducted a retrospective review of elderly patients (age >=60 years), who were admitted to an urban burn center ICU, with thermal and/or inhalation injury, over an 8-year period. Data were extracted from a prospectively maintained registry and verified through our electronic medical record. Patients who died less than 1 week after admission were compared with those who died after the first week. Univariate analysis was performed by 2-tailed Student’s T test and chi-square, with statistical significance assigned to p values < 0.05.

Results

From 2014-2021, we admitted 1322 patients to the burn ICU for thermal and/or inhalation injury. Mortality was 9.4% for patients >= 60 years of age, compared to 2.0% for patients < 60 (p< 0.001). The elderly patients who succumbed to their injury had a mean age of 75.3 years, TBSA 27.7%, modified Baux score of 111.3, and survival of 13.8 days. We observed a bimodal distribution of deaths, peaking on the first day after injury, and in the third week after admission, the most common cause of which, for both groups, was multisystem organ failure. Compared to the delayed deaths (n=21), patients who died within the first week (n=16) had an increased incidence of inhalation injury, a higher modified Baux score but similar age and TBSA, and lower baseline comorbidities and complications (TABLE).

Conclusions

Presence of inhalation injury and high modified Baux score, not necessarily age or %TBSA, was associated with early mortality in the elderly, after burn injury. Older patients who survive their initial resuscitation often succumb to complications related to baseline comorbidities. Improved management of these comorbidities, via the active involvement of geriatric medicine and palliative care, represents an opportunity to increase survival.
516 Phosphorus Requirements in Patients with Severe Thermal Injuries Requiring High-Volume Hemofiltration
Authors: Hill David M , Kail Daniel , Arif Faisal , Sultan-Ali Ibrahim , Velamuri Sai R
Published: March 2022

Introduction

Patients with thermal injuries have increased metabolic demands, requiring increased phosphate supplementation. Evidence is scant depicting incidence of hypophosphatemia and repletion requirements in patients with thermal injuries treated with high-volume hemofiltration (HVHF) and a high-flux membrane. The objective of this study was to determine the incidence of hypophosphatemia and characterize repletion requirements in this population.

Methods

This study was a case-control, retrospective chart review. Patients were included if sustained at least 20% total body surface area (TBSA) thermal injuries and required continuous HVHF (prescribed doses ≥ 35 mL/kg/hr). A randomly selected cohort (matched to age, TBSA, and inhalation injury) without acute kidney injury (AKI) was used to compare phosphorus requirements over an initial 14 day period. An a priori sample size was calculated (n = 26) to detect a minimum difference of 0.3 mmol/kg/day. Repeated measures ANOVA was used to compare requirements and concentrations. Demographics, diet, and variables affecting phosphorus concentrations were compared utilizing Fisher's exact, Student's t-test, or Mann-Whitney test depending on type and distribution.

Results

One thousand sixty-six patients were screened. Most were excluded from the HVHF group for TBSA < 20% (58%) or not a burn injury (29%). Sixteen patients were included in each group. The average age was 60.2 ± 15.1 vs 53.3 ± 16.4 (p = 0.22) with median TBSA (p = 0.73) of 30% (23.4, 56.3) vs 29% (26.4, 33.9). All patients in the study group were started on HVHF for AKI, utilizing a 1.6m2 polyethersulfone membrane (mean delivered prefilter dose of 54.7 ± 1.5 ml/kg/hr), and had statistically higher potassium and phosphorous laboratory values at baseline. Parenteral phosphorus replacements were 2 fold higher in the HVHF group (p = 0.02), but not statistically different after accounting for estimated enteral intake. Despite providing 0.75 mmol/kg/day of phosphorous supplementation (vs 0.66 mmol/kg/day in control, p = 0.45), the HVHF group experienced more days with hypophosphatemia (49.6 ± 12.4 % vs 29.3 ± 16.3 %, p = 0.012). By 72h, every HVHF patient experienced at least one episode of hypophosphatemia. Patients on longer durations of therapy had increasing risk of hypophosphatemia. There was a significant difference in days requiring mechanical ventilation (p < 0.001)

Conclusions

This study demonstrates thermally injured patients receiving HVHF for AKI are at increased risk for hypophosphatemia and require higher phosphate supplementation to maintain lower average serum concentrations, as compared to the controls with similar burns but without acute kidney injury.