bluuebunny/crossref_metadata_2025 huggingface dataset:
81 Effectiveness of Simultaneous Intense Pulsed Light and Fractional CO2 Laser Therapy in Hypertrophic Burn Scars
Authors: Elkady Djoni , Larson Brandon M , Sharma Steffi , Lou Richard B , Khandelwal Anjay
Published: April 2024

Introduction

Hypertrophic burn scars present challenges for patients and clinicians. Intense Pulsed Light (IPL) and Ablative Fractional CO2 Lasers (AFCL) have shown promise in scar treatment by targeting vascular structures and promoting collagen production. While IPL-AFCL has been used in managing hypertrophic scarring in various dermatological conditions, limited data exist for burn scar treatment. In addition, scar vascularity can frequently limit the depth of penetration and density of AFCL yielding delayed results. The author's conducted a study assessing the efficacy of simultaneous IPL-AFCL therapy on hypertrophic burn scars using the Modified Vancouver Scar Scale (MVSS). To the author's knowledge, this is the first reported case series of simultaneous laser treatment in the treatment of hypertrophic burn scars.

Methods

In this retrospective study (April 2021 to July 2023), data from patients (pediatric and adult) receiving at least two IPL-AFCL treatments were analyzed. Demographics, burn details, and complications were collected. Linear regression assessed the impact of time from burn to first treatment on MVSS scores. Unpaired t-tests compared pre/post-MVSS scores for partial-thickness (PT) and full-thickness (FT) burns, and paired t-tests evaluated pre/post-treatment MVSS score differences after IPL-AFCL treatment.

Results

The study involving 33 patients (11 PT burns, 22 FT burns), the mean pre-MVSS score was 12.09 ± 2.77, and post-MVSS score was 6.24 ± 2.96. IPL-AFCL significantly reduced MVSS scores by a mean of 5.85 ± 0.43 (p < 0.0001) with an average of 3.70 ± 1.69 IPL-AFCL treatments per patient. Significant reductions were also observed in pigmentation (p=0.001), vascularity, pliability, height, pain, and pruritus (p < 0.0001). Linear regression analysis showed that the duration from burn injury to the first laser treatment significantly influenced pre-MVSS scores (p=0.008) but not post-MVSS (p=0.062). No significant differences were found in pre-MVSS (p=0.186) and post-MVSS (p=0.233) scores between PT and FT burns. As for complications, 4/33 patients experienced blistering following treatment which did not result in any long-term consequences.

Conclusions

Our study demonstrated that IPL-AFCL treatment effectively improved hypertrophic burn scars. MVSS scores did not significantly differ between PT and FT burns, but the time from the initial burn to the first treatment significantly influenced pre-MVSS scores.

Applicability of Research to Practice

Simultaneous use of different light/laser modalities is safe and effective and may offer advantages with symptomatic, functional and cosmetic benefits.
82 Free Flap Failure and Contracture Recurrence in Delayed Burn Reconstruction: A Systematic Review and Meta-analysis
Authors: Arellano Jose Antonio , Liu Hilary , Alessandri-Bonetti Mario , Kasmirski Julia , Stofman Guy M , Egro Francesco
Published: April 2024

Introduction

Free tissue transfer is often considered a last resort in burn reconstruction due to its complexity and associated risks. Free flap and contracture recurrence outcomes in delayed burn reconstruction remain unclear as reported in the literature, and a comprehensive review on free flap outcomes in delayed burn reconstruction is currently lacking. The study aims to evaluate the available evidence on the failure and contracture recurrence rates in free flap delayed burn reconstruction.

Methods

A systematic review and meta-analysis was conducted and reported according to PRISMA guidelines. The protocol was registered on PROSPERO (CRD42023404478). PubMed, Embase, Web of Science, and Cochrane Library databases were queried. The results were limited to English-language literature with extractable data relating to microsurgical delayed burn reconstruction only. The measured outcomes were free flap loss and contracture recurrence rate.

Results

Of the 1262 retrieved articles, 40 qualified for inclusion, reporting on 1026 free flaps performed in 928 patients (50.3% male, 49.7% female). The mean age was 29.25 years [95% CI: 24.63, 33.88]. Delayed burn reconstruction was performed at an average of 94.68 months [95% CI: -9.34, 198.70] after initial injury, with a follow-up period of 23.02 months [95% CI: 4.46, 41.58]. Total flap loss (TFL) rate was 3.80% [95% CI: 2.79, 5.16] (Figure 1) and partial flap loss (PFL) rate was 5.95% [95% CI: 4.65, 7.57]. Interestingly, burn contracture recurrence rate was 0.62% [95% CI: 0.20, 1.90] (Figure 2).

Conclusions

This systematic review provides a comprehensive evaluation of the free flap outcomes in delayed burn reconstruction. The flap loss rate was relatively low, given the complexity of the procedure and potential risks. Furthermore, burn contracture rate was found to be extremely low. This study demonstrates that free flaps are a safe and effective option for delayed burn reconstruction.

Applicability of Research to Practice

The findings of this systematic review suggest that free flap procedures are a viable and relatively safe option for delayed burn reconstruction, with low rates of flap loss and burn contracture recurrence, providing valuable insights for researchers exploring reconstructive options in burn injury cases.
96 The Influence of Consulting Child Protective Care Services on Patients’ Length of Stay in Burns
Authors: Mikhael Marian , Koussayer Bilal , Nehila Timothy , West, III William , Morris Julia A , Le Nicole K , Whalen Kristen , Buller Kristina , Parikh Jeegan , Ayzenshtat Luba , Troy Jared , Laun Jake
Published: April 2024

Introduction

Child endangerment commonly involves abuse, including burns. Healthcare professionals may feel that consulting Child Protective Services (CPS) unnecessarily prolongs a patient’s length of stay (LOS), as most cases are determined to be not significant for abuse. This study was conducted to determine the relationship between CPS consultations and patients’ LOS.

Methods

We conducted a retrospective cohort study of pediatric patients under the age of 18 years that were admitted at our tertiary healthcare institution between 2020-2021 for burns. We examined the LOS for patients in which CPS was not consulted (Control), CPS was consulted without evidence of child endangerment (-CPS), and CPS was consulted with evidence of child endangerment (+CPS). A secondary analysis was conducted only on patients who required inpatient burn care by removing patients that did not undergo surgical intervention.

Results

Of the 158 patients admitted, 33 patients had CPS involved. There was no significant difference between LOS in the control and CPS consultation (- for abuse) patients (p=0.086). There was also no significant difference between LOS in the control and CPS consultation (+ for abuse) patients (p=0.150). These findings persisted controlling for age, total burned surface area (TBSA), and number of surgeries for burns.

In the secondary analysis, 104 patients did not undergo surgical intervention and were removed. The effect of consulting CPS on LOS in the remaining 54 patients did not change (p>0.05).

Conclusions

This study demonstrates that CPS should be consulted when there is any suspicion of child endangerment without concern for unnecessarily increasing the patient’s LOS.

Applicability of Research to Practice

CPS plays a vital role in burn consultations for pediatric patients by identifying risk factors for endangerment, ensuring the welfare of children, and providing legal protection. No previous studies have explicitly examined the relationship between CPS consultation and LOS in pediatric burn patients or in any other child abuse victims due to other etiology. In some instances, there may be a hesitancy to contact CPS when there is doubt about non-accidental trauma and concern for unnecessary hospital admission, however our study results suggest that CPS involvement does not affect the LOS of patients. Early identification and intervention can help protect these patients, and establishing standardized protocols for reporting suspected child abuse cases is crucial to ensure that at-risk patients receive the proper consultations in a timely manner.
97 Animals Are People Too: Comparing Human and Animal Burns in a Large Wildfire
Authors: Epstein Larissa , Peyton Jamie L , Coward Alexandra , Heard Jason , Sen Soman , Romanowski Kathleen S , Palmieri Tina L
Published: April 2024

Introduction

Although human burns have been studied in depth, there are few studies involving animal burns, and even fewer studies that compare the two. However, recent wildfires across the globe, like the 2019 Australian bushfire, have drawn attention to the plight of animals. Our study aims to compare effects of wildfire burns between humans and animals. Animals have adaptations that may protect them from burns: fur/feathers, agility, innate fight or flight response, and burrowing/swimming/flying abilities. We hypothesize that humans would have deeper burns and a higher mortality rate than their animal counterparts.

Methods

After IRB approval, a retrospective chart review was conducted using electronic medical records for humans with burns in 2018 wildfires at a university hospital and burned animals treated at the veterinary hospital. Animals were split into 2 groups: companion animals (CA) and non-companion animals (NCA). Data collected included demographics, burn and hospitalization characteristics, treatment, discharge, and outcomes. Analysis was conducted with SAS statistical software, version 9.4 (SAS Institute, Cary, NC, USA) using Chi-squared and Kruskal-Wallis tests.

Results

In all, 123 animals and 10 humans were analyzed. Ninety-four animals were identified as CA (dogs, cats) and 29 NCA (turtles, cattle, llamas, etc). All groups had mean total body surface area (TBSA) below the 20% TBSA resuscitation guidelines (70% human vs. 98.9% CA vs.72.5% NCA). There was no difference between location or burn severity, between groups. The most common location of burns in humans was the head (80%) and hands and feet (80%). Similarly, animals most commonly burned their paws (97.9% CA vs. 62.1% NCA). The median time to presentation was significantly different between humans, CAs, and NCAs (Day 0, 5, 8; p< 0.001). Humans and CAs sustained mainly 2nd degree burns (90% vs. 76.6%) while NCAs suffered mostly from 3rd degree burns (65.5%). Median number of hospital days (HD) between humans, CAs, and NCAs differed significantly between groups (16.5, 27, 8; p=0.025). Survival to discharge was highest in humans (90.0% human vs. 92.4% CA vs. 72.4% NCA, p=0.039). Humans were treated with surgery (100%). Fewer animals underwent surgical excision at initial presentation (16% CA vs.40.7% NCA p< 0.001).

Conclusions

Humans and animals burned by wildfires had different injury extent, survival, and burn distribution. CAs had the most HDs, yet had the fewest surgeries. There are major differences in treatment between human and animal burn treatment and outcomes. Current animal burn care does not follow human medical standards.

Applicability of Research to Practice

Most burn outcomes and research are focused on humans. More attention is being brought towards burned animals, which can be used to further research into animal care.
102 The Consequences of a Career in Burn Surgery: An Economic Analysis to Aid Prospective Clinicians
Authors: Carter Jeffrey E , Ivanko Anastasiya , Schoen Jonathan E , Phelan Herb A , Hickerson William L , Kearns Randy D
Published: April 2024

Introduction

Many factors are assessed by prospective resident physicians and medical students when considering a career in healthcare. A rising awareness of educational costs, physician burnout, and well-being have many considering the economics of their decisions. Coupled with the projected physician shortage, burn surgeons are a vulnerable population consisting of less than 0.4% of all surgeons in the U.S. Our study examines the economic consequences of a career in burn surgery as compared to other surgical specialties.

Methods

Using AAMC benchmark salary data, we calculated a net present value (NPV) for 12 surgical specialties. NPV was selected as it incorporates revenue and liabilities over the career period with the time value of money. Conservative assumptions from established references were used to determine resident salary, medical school debt, interest, opportunity costs, federal income taxes, and career duration (retirement at age 65). The model also assumes no delays in education or training, practice at an academic institution, and evaluated 2-year vs 1-year burn fellowship pathway against 11 other surgical careers: general, neurosurgery, orthopedic, pediatric, plastic and reconstructive, surgical oncology, cardiothoracic, transplant, trauma, urology, and vascular surgery.

Results

Without loan forgiveness programs for medical school, physicians attending public institutions should expect to pay $509,173 over the life of the loan. Each year of fellowship after general surgery residency results in $257,641 of lost income after taxes. Neurosurgery, orthopedic, and cardiovascular performed >30% above the average NPV for all surgical specialties while surgical oncology and 2-year burn performed the worst at 28% and 23% below the average NPV, respectively. Selecting a 1-year burn fellowship improved performance to 11% below the average, while still outperforming trauma.

Conclusions

The consequences of a career in healthcare are immense with few students or residents understanding the economic liabilities they assume because of historical perspectives that are unquestionably inaccurate in today’s climate. A career in burn surgery is rewarding but the economic considerations must be accounted for especially in a climate with limited resources. Our model takes many assumptions into consideration but does not take into account the productivity of burn surgeons relative to other surgical specialties making the inequity even more concerning. Additional research is needed to discern the complexity and intensity of burn care to aid future advocacy efforts.

Applicability of Research to Practice

This study aids prospective burn docs to consider fellowship costs.
104 Wildland Firefighters Suffer Increasing Risk of Job-Related Death
Authors: Glover Kelsey G , Kahn Steven A , Mittal Rohit
Published: April 2024

Introduction

Wildland firefighting is a niche specialization in the fire service - inherently dangerous with unique risks. Over the past decade, fatalities amongst all firefighters have decreased; however, wildland firefighter fatalities have increased. This subject has only been described in the grey literature, and a paucity of medical literature exists. With the recent wave of large-scale fire disasters across the US and Canada, the aim of this novel study is to analyze and better understand the trend of fatalities to eventually improve safety measures.

Methods

The United States Fire Administration’s online fatality database was queried for on duty mortality between 1990 and 2022. The year 2001 was excluded due to the 340 deaths that occurred on September 11th. Data collected included demographics, incident characteristics, and nature of fatality. The data was then compared between the decades using a Fisher’s exact test.

Results

From 1990-2000, there were 25 wildland fatalities out of 1,119 total firefighter fatalities, which increased to 75 wildland fatalities out of 1,190 total from 2002-2012. Between 2013-2022, there were 96 wildland fatalities out of 968, an increase from 2% to 10% of the total fatalities (p < 0.00001) from the first to last decade - a 500% relative increase. Despite the recent wave of 2023 wildfires across North America, the average annual number of wildfires has actually decreased 23% (from 79,829 to 61,377) between 1990-2000 and 2013-2022. Burn related fatalities have increased over time, from 9% of fatalities to 27% (p < 0.01), while trauma and motor vehicle crash fatalities have decreased significantly. MI accounted for 16% of total fatalities, with no significant change over time - however, number of years on the job was an independent risk factor for death from stress/exertion and MI, while age was not.

Conclusions

Although wildfires have become less common over the past decade, there was a 5-fold increase in wildland firefighter fatalities. Burn related fatalities have also increased over time. Total number of years on the job increases the risk of death, while age does not, suggesting the job itself creates the risk of death - either from catastrophic incident or from cumulative inflammation from stress or byproducts of combustion. Further investigation, including analysis of 2023 data, is required to augment development of health and safety measures for these heroes. Multidisciplinary collaboration is necessary to mitigate the inherent job-related risk in this unique population.

Applicability of Research to Practice

Burn centers are involved in caring for firefighters, thus must understand the relevant epidemiology and aid in risk mitigation for this population.
110 Seven-Year Analysis of National Rehabilitation Trends and Outcomes Among Burn Patients
Authors: Little Darby , Mason Stephanie A
Published: April 2024

Introduction

The recovery journey for individuals with major burns is often protracted, necessitating extended stays at rehabilitation facilities before they can return home. We aimed to describe national resource utilization and outcomes related to inpatient rehabilitation following burn injury.

Methods

In this retrospective population-based study, we examined all admissions to inpatient rehabilitation facilities from April 1, 2016-March 31, 2023, available from a national repository of health administrative data. This database aggregates information from participating adult inpatient rehabilitation facilities (including 104 programs by May 2022) in 9 provinces.

Results

During the 7-year study period, we identified 513 burn patients who were admitted to inpatient rehabilitation in the database. Burn patients were overall younger, with a greater proportion of burn survivors under 45 years of age (25.9%-54.2%) compared to the general rehabilitation population (5.5%-6.1%). Throughout the study period, burn patients consistently experienced a longer median length of stay, which generally increased from 26.5 days in 2017 to 30.5 days in 2023. In contrast, the median length of stay for the general rehabilitation population remained stable between 22.0-23.0 days. Throughout the study period, 66.1% of burn patients reported improved pain levels upon discharge from the rehabilitation facility. Moreover, burn patients demonstrated enhancements in their motor functional scores, with an average increase score of 20.3-29.8 per year, as determined by the 18-item Functional Independence Measure instrument.

Conclusions

Burn patients experience extended rehabilitation admissions when compared to the general rehabilitation population. Their improvements in pain and functional scores emphasize the importance of rehabilitation in facilitating their recovery and improving their quality of life.

Applicability of Research to Practice

This national population-based study underscores the importance of rehabilitation services in the recovery of burn patients.
113 A Study in Precision and Ergonomics: A Cadaveric Study
Authors: Aickareth Genesy , Brown Elizabeth , Pang Alan , Griswold John A , Kurtz Debra J
Published: April 2024

Introduction

Split-thickness skin grafts have remained the mainstay treatment for 2nd and 3rd-degree burns. Traditional dermatome (TD) and dermatome with a rotating circular blade (DRO) are devices that have been used for skin grafting since the 1900s and 2013, respectively. Few studies have been conducted analyzing graft harvesting with the DRO. Our study analyzed skin depth consistency when harvesting with the DRO versus the TD. We conducted this study using varying levels of skin grafting expertise, gathered with both devices, and compared depth consistency across the graft.

Methods

The study was conducted on a deidentified cadaver. There were 4 levels of harvesters: pre-clinical medical students, residents, a burn fellow, and a surgical technician with 10+ years of skin harvesting experience. All harvesters underwent basic training using each product’s instructional videos/training curriculum. The depth gauge of each device was set to 0.009 inches. Each subject harvested a 5-in length graft using each tool from the back and leg. The TD and DRO harvest occurred side-by-side at each location to minimize confounding. Each harvested 5-in section was punched in three locations diagonally with a 6 mm punch biopsy blade. Each punch was analyzed by dermatopathology for depth and sufficient graft harvest. The punches from each graft were analyzed for variance in depth against the gauge setting, and grafts from both devices were compared for depth consistency.

Results

A total of 118 grafts were analyzed (Table 1). Grafts taken by the TD were significantly thicker than the DRO (p-value of <=.046). When compared to the depth gauge setting of 0.009 inches, the TD averaged 33% thicker and the DRO averaged 11% thinner. There were no significant differences between the levels of the harvesters nor the body location of the grafts.

Conclusions

There are only a few studies that have been conducted comparing the DRO to the TD. In this study, the DRO was closer to the desired depth value than the TD regardless of skill level. This is significant because the participants had drastically varying familiarity with the tools themselves. This study was the medical student’s first time using the instruments, while the surgical technician used them for years. Additionally, the depth of the grafts taken by DRO was similar throughout all skill levels ranging from .0071-.0083. When using the DRO, all skill levels had decreased variability of thickness across the specimen. DRO is easier to use correctly as evidenced by the medical student and the resident who had similar depths of .0082 and .0081 respectively.

Applicability of Research to Practice

This preliminary study shows that DRO offers skin grafts that are more consistent with the desired thickness and are uniform throughout the graft. A more constant graft thickness could possibly lead to better graft take and improved healing of the donor site.
510 Antibiotic Serum Concentrations in Burn Patients with Augmented Renal Clearance and Adjusted Regimens
Authors: Mueller Scott W , Gibson Cameron , Wiktor Arek J
Published: April 2024

Introduction

Burn patients have altered pharmacokinetics, in part, due to a high incidence of augmented renal clearance (ARC). Augmented renal clearance is associated with subtherapeutic antibiotic concentrations necessitating dosing regimens that are greater than FDA approved doses. The objective of this cohort analysis was to assess antibiotic concentrations in patients with ARC specifically when real-time therapeutic drug monitoring was not available for the antibiotic.

Methods

This retrospective descriptive cohort was performed at an ABA verified burn center. All patients with an antibiotic serum concentration measured between 2/2022 and 7/2023 and confirmed ARC were included. Patients were excluded if the only antibiotic concentration available was an aminoglycoside or vancomycin.

Results

In all, 10 patients (90% male) had 15 non-real time antibiotic concentration assessments. The median (range) age, weight, TBSA, day since injury, serum creatinine and urine collection creatinine clearance corresponding to the drug concentration were 38 years (18-53), 85 kg (51-190), 24% (3-68.25), 13 days (6-32), 0.77 mg/dL (< 0.2-1.53), and 200 mL/min (96-336), respectively. The most common antibiotic concentration assessed was piperacillin (PIP, n=9), followed by meropenem (MER, n=3), cefepime (n=2), and linezolid (n=1). Piperacillin/tazobactam was administered as 22.5g/day continuous infusion and resulted in a median (range) PIP concentration of 43.7 mg/L (25-117). A single outlier of 117 mg/L occurred in a patient who was no longer in ARC, but reexhibited ARC days later and had a follow-up PIP concentration of 32 mg/L. Two MER concentrations representing a 2g every 8 hours using a 6 hour infusion were 13.9 mg/L at the end of infusion and 7.3 mg/L one hour after infusion. MER 1g every 8 hours with a 3 hour extended infusion resulted in a trough concentration of 1.2 mg/L. Cefepime 2g every 6 hours with a 3 hour extended infusion resulted in a peak and trough of 43.8 and 29.6 mg/L. Linezolid 600mg orally every 8 hours resulted in a trough of 4.21 mg/L. No adverse events were identified.

Conclusions

Burn patients with ARC may require more aggressive dosing regimens to reach adequate antibiotic concentrations. A large prospective study is required to identify appropriate antibiotic dosing strategies to overcome pharmacokinetic alterations in this population, especially in the setting of pathogens with high minimum inhibitory concentrations.

Applicability of Research to Practice

Although antibiotic target concentrations have not been established in the burn population, this cohort suggests antimicrobial regimens should be adjusted in burn patients with ARC. The lack of timely therapeutic drug monitoring for most antimicrobials may hamper patient specific dosing regimens to adequately treat infectious pathogens with elevated minimum inhibitory concentrations.
516 Fluid Resuscitation and Acute Kidney Injury in the Electric Burn Patient. Reconsidering Initial Resuscitation Goals
Authors: Bernal Sandra J , Nasiff Laura S , Navarrete Norberto
Published: April 2024

Introduction

In burn patients, multiple studies have confirmed the risks of acute kidney injury (AKI) and mortality attributed to both under or over-volume resuscitation. Nonetheless, electrical burns patients are systematically excluded from these studies due to their unique pathophysiology, high incidence of rhabdomyolysis, and poor correlation between TBSA and injury severity. Recommendations regarding volume management vary and remain controversial as the literature is limited. The objective of this study is to describe fluid resuscitation while concurrently evaluating its association between sub-optimal or excessive fluid administration and the incidence of early AKI (eAKI).

Methods

Retrospective cohort study. Registry data for adult patients admitted to Burn ICU during the first 48 hours after electrical injury, between 2007 to 2013 was analyzed. Descriptive statistics were calculated. The primary outcome was eAKI, according to the AKI network criteria. eAKI was modeled using multivariable logistic regression, including age, sex, TBSA, time to treat (between injury to start of treatment), and creatine phosphokinase maximum (CPKmax). CPK, fluid requirements, and urine output (UO) were recorded in the first week (Day 0-6 of admission). The protocol targets were UO >1.5 ml/kg/h in rhabdomyolysis or >2 ml/kg/h if macroscopic myoglobinuria were present.

Results

A total of 456 patients were included. The median TBSA was 5% (2%-12%). 27 patients (5,9%) developed eAKI. None of the patients underwent renal replacement therapy. There were no significant differences in age, sex, CPK, or CPKmax value between eAKI and Non-eAKI patients, except for CPK3 (p=0.0483). Although volume infused in 0-2 days were lower in the eAKI group, there were no significant differences regarding under or over-resuscitation frequency and the hourly fluid resuscitation volume. The UO0 and UO1 (ml/hr) were significantly lower in the eAKI group (37.9 v. 139.1 ml/hr, p< 0.001 and 162.0 v. 187.6 ml/hr, p=0.005 respectively). The UO0 was the only variable independently associated with the development of eAKI (OR: 0.984, 95% CI: 0.976 - 0.992).

Conclusions

Neither the time to treat nor the fluid volume resuscitation are associated with the development of eAKI in electrical injuries. However, reduced diuresis during the day of admission is associated with the development of eAKI.

Applicability of Research to Practice

Estimating fluid volume according to TBSA is insufficient in electrical injuries, mainly when TBSA is less than 12%. Crystalloid infusion guided by urinary output may result in a lower incidence of eAKI.
554 Implementation of the Abbreviated Burn Specific Pain and Anxiety Scale
Authors: Harms Jonny , Treftz Morgan , Dispalatro Paige , Bode Courtney , Worthington Hailey
Published: April 2024

Introduction

This project targeted the use of the Abbreviated Burn Specific Pain and Anxiety Scale (BSPAS) in patients 18 or greater with 10-50% TBSA burns undergoing dressing change and/or therapy. The BSPAS is recognized by the ABA and was implemented to improve both patient care and nursing practice. Currently, in our standard of care there are no tools available to specifically assess anxiety related to pain. This can drastically impact the overall care of burn patients in various stages of care including treatment, recovery, and rehabilitation.

Methods

Pre-data surveys were used to assess nursing staff’s perceptions of incorporating the BSPAS into practice. Per the survey, nurses felt they did not have a consistent scale to measure the burn patient’s pain and anxiety. Our implementation of the BSPAS consisted of 5 questions asked by the nurse to better understand the patient’s pain and anxiety prior to treatment.

Results

A post-implementation survey revealed that nurses felt the BSPAS was a consistent and effective way to better understand and communicate a patient’s pain and anxiety related to the anticipation of burn care.

Conclusions

Our sample size was small due to limited burn patient admissions during the pilot phase of this project. The current nurse residency group has continued to implement and evaluate the use of the BSPAS to improve the quality and overall standard of care within our unit.

Applicability of Research to Practice

Our project can help burn units better understand patient’s anxiety and pain related to burn dressing changes and therapy.
562 Caregivers and Clinic Providers View Soft Casts for Pediatric Hand Burns as Acceptable and Feasible
Authors: Schuh Jennifer M , Linzell Leanna L , Abebrese Emmanuel L , Flynn-O'Brien Katherine T
Published: April 2024

Introduction

Soft casts have been introduced as a strategy to manage hand burns that is associated with less wound care burden for families. We hypothesized that the use of soft casts in pediatric hand burns would be viewed as acceptable by patient caregivers and providers, perceived as logistically feasible, and result in satisfactory clinical outcomes.

Methods

A retrospective chart reviewed was perform for pediatric patients with hand burns who were managed with soft casts in clinic since implementation in 2022. A survey was sent to patient caregivers (n=33), and a separate survey sent to burn clinic staff and providers (n=20). The primary outcome was perception of acceptability of soft casts as a management strategy (questions targeted care burden, overall satisfaction, ease of use, healing concerns, efficacy, and comfortability). The secondary outcome was provider perception of feasibility of this new strategy (effect on clinic workflow, efficiency). Survey questions were both Likert scale and open ended. Findings were summarized and qualitatively assessed.

Results

Since implementation of soft casting in 2022, 33 English-speaking patients with hand burns were managed with soft casts and 38 soft casts applied. Total body surface area burned ranged from < 0.5% to 2.5%, with both superficial and deep burns treated. There was a mean of 1.8 reapplications (mode 1, range 1-22) and a median time to healing of 13 days. There were no infections attributed to the use of soft casting, and only one patient initially in a soft cast required grafting. Survey responses were collected from 70% of caregivers (23/33) and 90% of providers (18/20). Caregivers overwhelmingly agreed with statements favoring soft cast acceptability and disagreed with negative statements regarding soft casts (Figure 1). Among clinic providers, 78% strongly agreed (9 or 10 on Likert) with the statement “The soft casting method has streamlined our clinic’s operational efficiency for managing hand burns” and 94% would recommend soft casts (range 7-10, mode 10 on Likert). Qualitative thematic analysis of open-ended questions was conducted (Table 1).

Conclusions

Overall, the introduction of soft casts as a management strategy for pediatric hand burns was well received by patient caregivers and clinic team, and felt to be acceptable (satisfactory, comfortable, practical, and efficacious) and feasible, with little disruption to clinic flow. The clinical outcomes assessed suggest soft casts are associated with good wound healing with minimal wound care for patient and family.

Applicability of Research to Practice

The perceived acceptability of soft casts for pediatric hand burn treatment and feasibility of integrating this as a new management strategy into a busy clinic speak to the pragmatism of logistically integrating soft casts into practice and support the strategy as satisfactory to parents and providers.
576 Head and Neck Burn Injuries: A Nationwide Analysis in Pediatric and Adult Populations
Authors: Najafali Daniel , Pozin Michael , Camacho Justin M , Tran Quincy K
Published: April 2024

Introduction

Burns to the head and neck impact a patient’s aesthetics in the most direct way and in severe cases impair function and quality of life. The purpose of this study is to compare outcomes between adult and pediatric patients sustaining burns to the head and neck region.

Methods

Head and neck burn encounters were isolated from the ABA Burn Care Quality Platform between January 2008 and December 2018. Cohorts were separated into two based on patient's age (≤14 years and 15+ years). Descriptive statistics summarized patient demographics and clinical characteristics. Multivariable regression analysis determined predictors associated with any complications, increased lengths of stay, and mortality.

Results

The analysis identified 52,272 individuals (mean age=34 years) sustaining a burn to the head and neck, of which 12,663 (24%) were pediatric cases (mean age=4 years) and 71% were male. The majority of adult and pediatric patients were White, 64% and 38% respectively. The top 3 etiologies for adults were: 1) flame, 2) scald, and 3) flash burns. For pediatric cases they were: 1) scald, 2) flame, and 3) contact burns. Burn severity as indicated by TBSA had a median [IQR] of 7% [3-17%] for adults and 6% [3-12%] for pediatric patients (p< 0.001). The mean (SD) percent of the burn concentrated on the head and neck was 42% (34%). Any complication was significantly associated with pediatric cases (OR 1.60, 95%CI 1.48-1.75), identifying as Hispanic or Latino (OR 3.80, 95%CI 1.63-8.44), and increased burn surface area to the head and neck (OR 1.01, 95%CI 1.00-1.01). Black patients (OR 1.90, 95%CI 1.60-2.20), patients with inhalation injury (OR 3.10, 95%CI 1.50-6.20), and greater TBSA (OR 1.10, 95%CI 1.10-1.10) had higher odds of mortality.

Conclusions

Pediatric patients recovered faster and were more likely to survive their burn injuries to the head and neck. Adverse outcomes were observed to affect marginalized racial/ethnic communities. The existing disparities require increased attention and efforts should be made to determine any potential environmental or cultural factors that may predispose groups to more severe head and neck burn.

Applicability of Research to Practice

These findings can help guide and educate clinicians in regard to head and neck burns as well as the existing disparities and epidemiological trends implicated.
602 Too Few Burn Papers and Images, Lowering Publication Barriers for Low- and Middle-Income Country Authors
Authors: Kneib Cameron J , Shor Ryann E , Nakarmi Kiran K , Yadav Manish K , Shrestha Raslina , Miranda Ariel , Pham Tam N , Stewart Barclay T
Published: April 2024

Introduction

Whereas the burden of burn injury is greatest in low- and middle-income countries (LMIC), publications from these regions represent a disproportionately small volume of the published burn literature in English. This important gap in our cumulative knowledge contributes to the slow progress in global burn injury control. In addition to manuscripts, clinical photographs are important representations of injury and outcomes. We aimed to compare the current volume of burn publications and photographs to the global burn injury burden and sought to identify potential journal-level barriers to publication.

Methods

A bibliometric analysis was performed by sampling three leading burn surgery journals published in the English language (Journal of Burn Care and Research, Burns, European Burn Journal) between 2021-2023. Country of corresponding author and number of photos were tabulated and categorized by region. Volume was compared to Global Burden of Disease (GBD) 2019 estimates for incidence of thermal injury by region. Journal submission instructions were reviewed for potential barriers to publication.

Results

A total of 916 articles were reviewed from 59 countries. Analysis showed 147 articles with 1117 human photos. GBD incidence of burn, publications, and photographs by region are shown in Figure 1. North America, Europe, the Middle East, and Oceania had a higher proportion of published images to burn injury incidence than Latin America, Africa, and Asia (X2 (6, N = 915) =3585, p < 0.001). Barriers to journal publication included charges for published images (up to 600 USD/image), open access costs (900-3500 USD with 1 of 3 publishers offering tiered discounts specific to LMIC), English language review (0.06-0.07 USD/word), and society affiliation discounts. Table 1 summarizes identified barriers and potential solutions.

Conclusions

There is a relative paucity of LMIC contributions to publications and clinical photos in English language burn journals. Identified publication barriers and added costs from journals likely contribute to this disparity.

Applicability of Research to Practice

Publication-level strategies to increase authorship and clinical photographs from underrepresented regions are urgently needed.
707 Is Central Venous Catheter the Main Culprit for Clinically Significant Venous Thromboembolism in Burn Patients
Authors: Caesar-Peterson Shannon , Libraro Kaitlyn M , Houng Abraham
Published: April 2024

Introduction

Venous thromboembolism (VTE) is a significant clinical problem for burn patients. The incidence of VTE has been reported as 0.25% to 47.1%. Known risk factors include large burn size, increasing age, male gender, active smoker or alcohol use, blood transfusion and surgeries. Central venous line (CVL) use is also a known risk factor for VTE. With all the known factors, we retrospectively analyzed our patients with VTE.

Methods

Retrospective chart review was performed on a single institution burn center in the calendar year of 2022. Pediatric patients were excluded. Following data were collected: age, burn size, mechanism, length of hospital stays, VTE diagnosis, VTE chemoprophylaxis, and central venous line days. VTE diagnosis was made using CT venogram or ultrasound. This project was a quality improvement initiative

Results

There were 420 patients in the study period. Of all the admitted patients, there were 6 patients diagnosed with 7 VTE. One patient had 2 separate diagnoses of VTE at 2 distinct period and anatomical site. The incidence of VTE is 1.7%. Upon further chart review, all the VTE were at the site of central venous catheters. All the patients were on VTE chemoprophylaxis. The correlation between burn size, age, length of hospital stay and VTE was not significant.

Conclusions

Risk of VTE is high in burn patients due to the correlation with the Virchow’s Triad. All the patients admitted to the burn unit are placed on chemoprophylaxis unless contraindicated. The 7 patients diagnosed with VTE were on chemoprophylaxis. All the VTE were at the site of central venous catheter insertion sites, which is a known complication of catheters. The incident of 1.7% is on par with VTE incidents of burn patients, but much less than VTE caused by central venous catheters in non-burn patients. Large multicenter data collection is needed to validate this finding.

Applicability of Research to Practice

Understanding the Importance of Chemoprophylaxis in Burn patients in comparison to Non-Burn Patients in Relation to Central Venous Catheter Associated VTE
708 Chemokine Signature Pattern in Toxic Epidermal Necrolysis: Diagnostic and Therapeutic Relevance
Authors: Anklowitz Andrew , Quinn Michael , Hale Justin , Poloni Dana , Kumar Sanjiv , Aranda Marcus , Prasad Balakrishna
Published: April 2024

Introduction

Toxic Epidermal Necrolysis (TEN) is a delayed hypersensitivity reaction to some pharmacological agents. Common drugs involved include antibiotics, anticonvulsants, and allopurinol. The pathophysiology of TEN is not well understood. The mortality of TEN is upwards of 50%, and more research is needed to help understand this disease to develop diagnostic assays and potential targeted treatments. This study aimed to identify the signature pattern of cytokine/chemokine response to TEN.

Methods

To distinguish the immune response to skin injury from pathogenic immune activation leading to TEN, we studied the cytokine profile in burn and TENS patients during the first week of hospitalization. We analyzed daily plasma samples from 25 burn and 9 TEN patients using the Luminex Multiplex assay platform.

Results

Several pro-inflammatory cytokines were increased in both burns and TENS patients. However, three chemokines were significantly elevated in almost all TENS patients analyzed compared to the burn cohort: CXCL9, CXCL10, and CXCL11. This response was sustained for the one week of hospital stay.

Conclusions

The chemokine/cytokine signature response appears to be involved in the pathophysiology of TEN. This signature response could be used to develop in-vitro diagnostic assays to identify causative agents and to develop therapeutic drugs targeting the pathologic response in TENS.

Applicability of Research to Practice

Identifying and determining the significance of specific chemokines that remain significantly elevated helps serve as preliminary data to justify a larger, clinical study that may help in understanding this disease process better, to help develop diagnostic assays and to help develop potential targeted treatments.
714 Our Experience with Enzymatic Debriding Agent, Anacaulase, for Burn Injuries: A 14 Patient Case Series
Authors: Bird Cole L , Reynolds Jessica , Bhavsar Dhaval
Published: April 2024

Introduction

Background: Enzymatic debridement of burn wounds facilitates early removal of eschar. It has shown to improve healing time and decrease need for surgical intervention. We wanted to review our results of use of an enzymatic debriding agent (EDA - Anacaulase) in deep partial and full thickness burns.

Methods: Methods

We undertook a retrospective review of consecutive 14 adult patients treated with EDA at our Burn Center. These patients received therapy with Anacaulase, a novel enzymatic debriding agent, spanning from the year 2020 to the present day. Burn characteristics, EDA applications details, surgical interventions if any, time of heal, scar assessments were noted. We used Microsoft Excel for a descriptive analysis of the data. We examined continuous variables within specific ranges and provided summaries including median, minimum, maximum values, and percentages.

Results: Results

Patients demographics and burn injury characteristics are included in table 1. We were able to achieve >95% eschar removal with single application in all 14 patients. 57% patients required subsequent skin grafts. The time to achieve 95% wound closure averaged 35.5 days. Scars improved substantially over the study period, as indicated by mean Vancouver Scar Scale scores of 3.8 to 0.5 at 3 and 12 months, respectively. Only 2 patients required scar release surgery due to contracture.

Conclusions

Conclusion: Our review highlights potential benefits of early eschar removal with EDA. 47% patients were able to avoid autologous skin graft closure of deep partial and full thickness burn wounds. EDA (Anacaulase) may add value in care of select patients with deep partial and full thickness burn wounds.

Applicability of Research to Practice

Our review highlights potential benefits of early eschar removal with EDA. EDA (Anacaulase) may add value in care of select patients with deep partial and full thickness burn wounds.
734 Use of the Burn Care Quality Platform (BCQP) for Modern Burn Care Benchmarking
Authors: Lechtenberg Madeline G , Carter Jeffrey E , Danos Denise , Phillips Bart D , Murata Erica , Schoen Jonathan E , Phelan Herb A
Published: April 2024

Introduction

In 2019, the American Burn Association (ABA) launched the Burn Care Quality Platform (BCQP), a registry tailored to create consistency across other national trauma registries. With the release of BCQP version 2 (BCQPv2) in 2021, this registry now includes data from 103 participating burn centers and 375,000 total patients as of 2021. This robust registry therefore represents a unique opportunity to measure up-to-date benchmarks for outcomes among U.S. burn centers.

Methods

BCQPv2 was queried for clinically relevant burn outcomes for all data-submitting centers between the years 2018 to 2022. An additional query was run to measure outcomes for our verified, urban burn unit. Results were reported as descriptive statistics.

Results

Nationally, mortality rates for all burn center admissions was 3.3%. Mean length of stay (LOS) was 3.0 days/% Total body surface area (TBSA) burned, and severe injury (defined as burn >20% TBSA) constituted 6.4% of all burn injuries nationally. Seven point nine percent of burn injuries included concomitant nonthermal traumatic injury. Payor mixes for all burn patients were 29.1% Medicaid, 15.9% Medicare, 25.6% private insurance, and 6.3% workman’s comp. National discharge dispositions followed an expected stair-step distribution when grouped by TBSA deciles. Locally, we found our mortality to be 5.1% with a mean LOS of 1.8 days/%TBSA. We saw higher proportions of severe injury (12.0%), Medicaid (41.4%), workman’s comp (10.4%), and burns with concomitant trauma (32.0%) as compared to the national findings. Additionally, higher rates of discharge home were seen on a burn-by-burn basis.

Conclusions

These results represent the current state of burn care in the U.S. Locally, our burn center’s results differ in important ways, some of them potentially modifiable. Further work is being done to determine the etiologies of these differences and whether they are potentially exportable.

Applicability of Research to Practice

This robust registry enables us to better evaluate the outcomes of current standards of care. This raises the possibility of improved modern burn care benchmarking and eventually better patient outcomes.