bluuebunny/crossref_metadata_2025 huggingface dataset:
501 A Change to Virtual Peer Supporter Training and its Effect on Participant Readiness and Satisfaction
Authors: Cramolini Sandra J , Irven Jessica , Peterson Pam
Published: March 2022

Introduction

Peer support gives burn survivors and their loved ones hope for a brighter future helping speed and strengthen recovery for burn survivors and their loved ones. A strategic plan to explore a digital program change from in-person increasing access for burn survivors and burn programs was scheduled for the third quarter of 2021, but the global pandemic expedited the implementation. A 2-week asynchronous and a 4-hour virtual course was designed. This study sought to evaluate the effectiveness and participants' perceptions of asynchronous and virtual training and their post-course readiness in the role of peer supporter.

Methods

A 5-point Likert scale was used to evaluate the opinions, perceptions, and satisfaction of the participants. The scale, ranging from strongly agree to disagree strongly, evaluated the modular education (length, relationship to manual, preparation for the virtual course) and the usefulness of a condensed online manual. A 5-point Likert scale (ranging from extremely helpful to not at all helpful) was used to evaluate each component of the course group exercises and the participants' perception of skill development to become peer supporters. Open ended questions collected additional feedback to analyze potential changes to the new platform. The metric Net Promoter Score, or NPS, was used to measure the recommendation of the new program to others.

Results

Burn survivors (n=41) and medical professionals (n=3) participated in 6 courses over eight months. Participants reported the manual helped prepare for the course (86% strongly agree and 14% agree). Respondents felt the asynchronous modular education prepared them for the virtual component of the class (75% strongly agree and 25% agree). Additionally, respondents felt the 2-week timeline for module completion met their expectations (98% yes and 2% no). The participants felt the overall length of the course was just right (89%) to 9% too short and 2% too long. Participants rated their readiness (confidence level) to utilize their learned skills to support another burn survivor (52% extremely confident, 39% very confident, and 9% confident) after the virtual class. The combined courses rated an 82 NPS, equating to a positive participant experience and a course recommendation to others.

Conclusions

This study concluded the asynchronous and virtual education course provided an effective method to train burn survivors to become peer supporters. Overall, burn survivors expressed confidence in utilizing the skills learned from the new training program. Participants also experienced the use of virtual tools to meet the needs of burn survivors for peer support.
502 Estimation of Return to Work After Burn Injury
Authors: Ifland Aidan , Hsu Naiwei , Reiss Matthew J
Published: March 2022

Introduction

A major milestone of recovery from a burn injury is returning to work (RTW). A systematic review by Mason et al. suggested that perhaps 28% of burn survivors do not return to work, while other studies have identified complex factors that affect RTW, including patient age, pre-existing mental health issues, injury locations such as hands, and type of work they do. Due to the large number of complex interactions involved, predicting a timeline for RTW is challenging.

We anticipate that underestimations of RTW may result in frustration, and perhaps contribute to negative psychological outcomes. Therefore, we wished to exam the accuracy of our surgeons estimates of RTW.

Methods

A retrospective chart review of inpatients treated at our center with burn injury, with Worker's Compensation as insurance, with follow up at our outpatient clinic, and admitted during the calendar years 2018 to 2019, produced 23 records with sufficient documentation. Hospital admission was taken as the starting point, and number of days until the (first) estimated RTW date was compared to the number of days until the actual date of RTW if documented, or else the final documented surgeons estimate.

Results

Limited demographic information and results are found in table 1. in 6 cases (23%), patients had not returned to work by one-year post hospitalization. Reasons for non-return to work in all cases included chronic pain requiring a pain management specialist, or psychologic sequelae requiring psychological treatment, or both.

We found that our surgeons estimated an average RTW date 65 days post admission date, whereas the average actual RTW was 177 days after admission. Expressed as a ratio, the actual time was 2.9x the estimated time, and expressed as a difference, the surgeons underestimated by 112 days.

Conclusions

The actual time needed for RTW was much longer that the surgeons initial assessment. These findings suggest that despite a wealth of experience in burn care, surgeons are prone to underestimate recovery time and especially time to RTW.
508 A Case Report of Trichosporon asahii Burn Infection: A Not-So-Fungi
Authors: Boyd Allison N , Walroth Todd A , Blunier Abbie , Harris William H , Hartman Brett C
Published: March 2022

Introduction

Trichosporon asahii is a yeast-like basidiomycete that can cause infections in immunocompromised hosts including superficial infections, pneumonia, meningitis, fungemia, and disseminated trichosporonosis. These infections have become more common over the last 30 years in patients with burns or other immunosuppressive conditions. Disseminated T. asahii is intrinsically difficult to treat and carries a mortality rate as high as 70% despite the availability of effective medications.

Methods

A 61-year-old male was admitted after falling into a vat of pig manure which was 160 degrees F, resulting in approximately 75% total body surface area injury to his anterior and posterior trunk, and bilateral upper and lower extremities. Throughout his hospital course, he underwent surgical debridement on multiple occasions with placement of homograft, autograft, and spray keratinocytes. The earliest cultures to demonstrate T. asahii growth were obtained on post-burn day (PBD) 23 and growth continued until PBD 32. Quantitative colony counts ranged from 600-365000000 CFU/g from left lower and upper extremities and chest. Cultures were obtained in preparation for cultured epithelial autograft placement which occurred on PBD 36. Susceptibility testing was sent and the minimum inhibitory concentration (MIC) results are reported in Table 1. Clinical and Laboratory Standards Institute (CLSI) guidelines for interpretation of susceptibility are not available for T. asahii, but suggested breakpoints are summarized in Table 1.

Results

On PBD 23, topical amphotericin B irrigation and voriconazole oral suspension were initiated. A voriconazole level was obtained on PBD 31, which was subtherapeutic, and dosing was subsequently adjusted. In total, the patient received 13 days of topical amphotericin B and 21 days of voriconazole for treatment. Subsequent cultures demonstrated microbiologic cure of T. asahii.

Conclusions

This immunocompromised burn patient was successfully treated for Trichosporon asahii using a combination of topical and systemic antifungal agents.
513 Fluid Over-Resuscitation in Burn Patients After Initial 24-Hours of Care is Associated with Increased Mortality
Authors: Kishawi Sami K , Badrinathan Avanti , Kohler Casey L , Dvorak Justin E
Published: March 2022

Introduction

Fluid resuscitation is a cornerstone of modern burn care. Despite the use of well-established formulae to determine the appropriate amount of fluid resuscitation for the first 24 hours of care, there is increasing recognition that patients receive fluids in excess of predicted volumes, a phenomenon termed fluid creep. Underscoring the significance of this phenomenon is the association between large volumes of fluid resuscitation and adverse outcomes. Although research in non-burn ICU patients reveals a clear association between overall fluid intake and increased morbidity, minimal burn-related literature exists regarding fluid patterns after the initial 24-hour period and their impact on outcomes. We hypothesized that increased fluid administration after the standard initial resuscitation period is associated with increased morbidity and mortality.

Methods

A retrospective chart review was performed for 113 patients with ≥20% TBSA burns admitted to an American Burn Association-verified burn center between 2010 and 2020. Patients admitted with Stevens-Johnson Syndrome and/or Toxic Epidermal Necrolysis, with length of stay ≤ 72 hours, who required renal replacement therapy (RRT) within 72 hours of admission, and those with withdrawal of care ≤ 7 days of admission were excluded. Univariate and multivariate logistic regression was used to determine the association between the primary outcome of in-hospital mortality and secondary outcomes of increased ventilator days, acute kidney injury, need for RRT, and hospital length of stay, with increasing total and net fluid volumes from days 2 through 7 of treatment. Additionally, the association between first OR day and total fluid volumes in the first week were assessed.

Results

Median age was 41 years (IQR 23-55) and TBSA was 31% (IQR 24-43). 21 patients (18.6%) died during hospitalization. Increase in net fluid balance from days 2-7 were associated with increased mortality (OR 1.016, 95% CI 1.00 – 1.03, p = 0.013). Increasing total fluid volumes were significantly associated with increased ventilator days (OR 1.027, 95% CI 1.008-1.047, p = 0.006) and acute kidney injury (OR 1.003, 95% CI 1.000-1.006, p = 0.017). Early first OR day was associated with decreased net fluid balance between hospital days 2-7 (OR 0.993, 95% CI 0.989-0.997, p = 0.001).

Conclusions

Similar to studies on other ICU populations, increasing total fluid volumes and net fluid balance is associated with adverse outcomes in critically ill burn patients. Additionally, earlier initial OR is associated with less total fluid volumes and lower net fluid balance in the first week of hospitalization. Further investigation is needed to elucidate optimal markers of resuscitation in burn patients in an effort to decrease adverse fluid administration.
514 The Outcomes of Tracheostomy on Burn Inhalation injuries
Authors: Ruiz Samuel G , Puyana Salomon , Hai Shaikh A , Mckenney Mark G , Mir Haaris
Published: March 2022

Introduction

Tracheostomy has been proposed for patients with expected prolonged intubation and it has been shown to be beneficial for trauma patients with severe brain injury; however, the benefit of performing tracheostomy on burn inhalation injuries has not been extensively investigated. Our study aims to determine the outcomes of performing tracheostomy on patients with burn inhalation injuries requiring mechanical ventilation.

Methods

Retrospective review of our institutional burn registry from 2011 to 2019. We compared the outcomes of all burn patients that met our inclusion criteria which included: adequate data recording of inhalation injury within the registry, ventilator support for at least 24 hours, and a TBSA burn injury of < 15%. We stratified the patients into two groups: tracheostomy (group 1) versus no tracheostomy (group 2). Outcome measures included: in-hospital mortality rate, hospital length of stay, ICU length of stay, ventilator days, and ventilator associated pneumonia (VAP). Chi-squared and t-test analyses were used with significance defined as p< 0.05.

Results

A total of 33 burn patients met our inclusion criteria. Group 1 consisted of 10 patients and group 2 consisted of 23 patients. There was no statistically significant difference between the two groups in terms of %TBSA (p =0.24, t-test). There was a significantly higher ICU length of stay at 23.8 days in group 1 compared to 3.16 days in group 2 (p=0.0001, χ2). There was a significantly higher hospital length of stay at 28.4 days in group 1 compared to 5.26 days in group 2 (p=0.0001, χ2). Ventilator days was also significantly higher in group 1 with 20.8 days compared to 2.5 days in group 2. There was no statistically significant difference between the two groups in terms of mortality, however, the incidence of VAP was significantly higher in group 1 than in group 2, with six cases compared to zero cases, respectively(p=0.0001, χ2).

Conclusions

The ideal timing and implementation of tracheostomy with inhalational injury has yet to be determined. In our study, tracheostomy was associated with much longer lengths of stay and pneumonia. The impact of the underlying lung injury, versus the tracheostomy itself on these observations, is unclear. The challenge of characterizing the severity of an inhalation injury based on early visual inspection remains.
532 Cross-Reactivity Between Topical and Systemic Sulfa Antibiotics
Authors: Powelson Ian A , Ketheeswaran Suvethavarshini , Hultman Charles S
Published: March 2022

Introduction

Silver sulfadiazine cream 1% is a sulfa derivative topical antimicrobial commonly used in burn care, in part due to its wide spectrum of activity, particularly against Pseudomonas aeruginosa. Contact dermatitis due to sulfadiazine component is a known but rare complication of silver sulfadiazine. In contrast, systemic sulfonamide antimicrobials are a commonly reported allergy and have been implicated in multiple hypersensitivity reactions. Some authors recommend avoidance of all sulfonamide antimicrobials regardless of route of administration for a patient with a known allergy to a sulfonamide antimicrobial due to structural similarities between all drugs in the class, resulting in a high risk of cross-reactivity. Clinical reports are lacking, however, and the few reports that do exist implicate silver as the culprit rather than the sulfadiazine component. Therefore, while the theoretical risk of reactivity to a topical application of sulfadiazine exists, there is no data to support this in practice.

Methods

A retrospective review of 42 patients with a sulfa allergy who were admitted to the burn unit of an academic medical center between June 2016 and June 2021 were reviewed. Inclusion criteria were age > 18, burn requiring admission, sulfa allergy, and receiving topical sulfa antimicrobial therapy. Data on the reported allergen, reaction, and any adverse reaction from the use of topical sulfa agents were recorded.

Results

Forty-two patients were identified. Of these, 32 (76%) reported a non-specific “sulfa” allergy, while 10 (24%) reported a specific allergy to trimethoprim-sulfamethoxazole. The reactions were reported as unknown (20, 48%), rash (9, 21%), hives (6, 14%), gastrointestinal (4, 9%), or other (3, 7%). One patient had a history of respiratory distress with trimethoprim-sulfamethoxazole administration. All 42 patients received treatment with topical silver sulfadiazine and 10 also were treated with topical mafenide acetate solution. There were no reported adverse events and no patients discontinued therapy. Two patients were identified with no previous sulfa allergy but who discontinued topical silver sulfadiazine due to burning sensation, a rare but previously reported side effect of this medication.

Conclusions

Silver sulfadiazine remains one of the most commonly used topical antimicrobials in burn care due to its broad spectrum of activity, low cost, and ease of use. Adverse reactions to topical silver sulfadiazine and mafenide acetate are rare, even in those with reported sulfa allergies. Topical sulfa anti-microbials can likely be used safely in most patients with allergies to systemic sulfa antibiotics, and the rate of cross-reactivity appears to be low. A test patch is recommended prior to application over a large area.
533 Human Case Characterizations of Skin Burn Using Novel Multi-Spectral Short Wave Infrared Imaging
Authors: Nunez Johanna H , Park Caroline , Clark Audra , Akarichi Chiaka , Arnoldo Brett , Mandell Samuel P , Carlson Deborah L , Huebinger Ryan M , Chan Rodney K , Goverman Jeremy , Mironov Sergey , Levi Benjamin , Berenfeld Omer
Published: March 2022

Introduction

Determining the depth of skin burns in patients is critical for surgical decision making, but currently lacks accuracy in clinical practice. Short-wave infrared (SWIR) light penetrates tissue more than visual or near-infrared light and is very sensitive to water content. We have shown in animal models that imaging of skin burns in the SWIR range distinguishes between superficial and deep tissue necrosis. Here we present the first 2 cases of multi-spectral SWIR imaging of human burn injury as a first step toward a non-invasive, label-free, technique for burn depth determination.

Methods

Two subjects admitted for mixed depth, thermal, 6% and 7% total body surface area (TBSA), burns were studied. Prior to burn excision, a novel system, based on a specialized camera, imaged the burn areas and normal skin at 4 different SWIR bands. Standard photographs from imaged areas were collected and presented for 5 independent, blinded, surgeons’ assessments. In SWIR images, 3-5 regions of interest (ROIs) were selected in burned and adjacent normal skin and the reflected light intensity in each ROI was averaged.

Results

Visual and SWIR images were collected for 9 burn areas in the hands, arms, and shoulder of 2 patients (Panel A). Fifty ROIs from the burn areas were assessed by the surgeons and 30 (60%) ROIs were agreed as being superficial or superficial partial thickness (n=5), deep partial thickness (n=11), or full thickness (n=14) burns by a majority (60% or above consensus together with a possible disagreement only between deep partial and full thickness burn). In Panel B the cumulative SWIR reflectance intensity at the 4 SWIR bands for the 3 burn groups, determined by expert surgeon evaluation, and normal skin are compared. The reflectance from superficial and superficial partial thickness burns (yellow) were 102.7±1.2%, 102.3±0.7% and 103.4±1.4% of the normal skin reflectance for 1200, 1650 and 1940 nm, respectively. On the other hand, the reflectance from deep partial thickness burns (grey) were 96.7±0.1% and 94.7±0.1%, and for full thickness burn (red) were 96.1±1.4% and 93.7±1.6% of normal skin reflectance for 1650 and 1940 nm, respectively.

Conclusions

We present the first human SWIR study demonstrating a distinct reflectance intensity of SWIR wavelengths for different burn depths based on surgeon assessments. The results motivate further studies of SWIR imaging of burns in the hope to non-invasively and accurately identify operative versus non-operative burns.
544 Southern US Burn Centers, Surge Capacity and 15 Months of the COVID19 Pandemic
Authors: Kearns Randy D , Flores Carl A , Hickerson William L , Carter Jeffrey E
Published: March 2022

Introduction

Burn mass casualty incident (BMCI) planning efforts have been in practice and publication for 40+ years. Through these ongoing efforts, we know there are measurable limits to burn center capacity and capability through modeling and real-world events relying on conventional and contingency standards of care, even when the only focus is those patients with burn injuries. The southern region of the American Burn Association (ABA) includes 37 burn centers and continues to play a critical role in the BMCI preparedness process.

COVID-19 has emerged as the greatest pandemic in terms of morbidity and mortality since the 1918 influenza pandemic. While COVID-19 has no direct connection to burn injuries, the impact of COVID-19 on the American Healthcare System to include burn care was and remains significant.

Methods

We conducted a retrospective analysis of (southern) regional data voluntarily submitted to the ABA from March 2020 to June 2021 and generally coincides with the first three waves of the pandemic. We focused on the self-reported data specific to the three critical components in managing a surge of patients: staffing, space, and supplies (to include pharmaceuticals and equipment).

Results

Staff: These data were collected over a period that coincided with the first three waves seen in the region. Staffing shortages were noted during each of the surges but were most excessive when a regional surge paralleled surges in other parts of the country (November-December 2020).

Space

Late November and early December 2020, space was in short supply with the surge of patients for more of the region than at any other time during the 28 weeks of reporting. While single facilities reported other episodes of limited space or supplemented with temporary structures, the peak was early December.

Supplies

As the first surge began to subside, the supply shortages were abated. However, as additional surges occurred, the supply chain had not recovered. Supply shortages were reported in greater numbers than either space or staffing needs through the multiple waves of the pandemic.

Conclusions

The surge of patients that had to be managed by the greater healthcare community placed a substantial strain on the burn centers to keep beds dedicated for patients with burn injuries. The pandemic directly led to a diminished available capacity for burn care in such a way that it could have compromised our ability to confront a surge of burn-injured patients. Future BMCI planning efforts must consider this aspect of the process. Crisis Standards of Care may come into play during such an event.
551 Age Does Not Predict Admission Culture Positivity
Authors: Ivanko Anastasiya , Skipton Romanowski Kathleen S , Man Angela , Wall Joyce E , Allabadi Najib M , Jeschke Marc G , Savetamal Alisa , Schulz John T
Published: March 2022

Introduction

Burn patients are susceptible to wound infections, urinary tract infections, pneumonia, and bloodstream infections. With rising rates of community colonization with multidrug-resistant organisms (MDRO), the colonization of wounds with commensal organisms is more concerning than ever, which is particularly true in patients with recent hospital admissions, advanced age, or institutional living situations. The purpose of this study was to examine if age was a factor in obtaining admission cultures and if older patients were more likely to have positive cultures.

Methods

A retrospective chart review was conducted involving burn patients admitted at three ABA verified burn centers from January 2016 - December 2017. Data collected included demographics, burn injury, and cultures obtained within 24 hours of admission. Patients were divided into 10-year age increments from 20 to ≥ 80 years old. Data analysis was conducted using Chi-square, Fisher Exact, and Kruskal-Wallis tests.

Results

A total of 1615 patients (mean age 45.9± 17.7 years, 1145 males (70.9%), mean burn size (TBSA) 9.6± 14.2%) were analyzed. Admission cultures obtained were: 656 (40.6%) wound cultures, 196 (12.1%) urine cultures, 139 (8.6%) blood cultures, and 1445 (89.5%) Methicillin-Resistant Staphylococcus Aureus (MRSA) screen. In all age groups, there were no significant differences between patients who had wound cultures (p = 0.97), blood cultures (p = 0.39), or MRSA screening (p = 0.9). As patients aged, they were more likely to have urine cultures obtained (p=0.01); - 23% of patients >80 years old had urine cultures ordered at admission compared to 8.6-16.9% of younger patients. Positive results by age group: wound cultures (p= 0.09), urine cultures (p= 0.16), blood cultures (0.10), MRSA screen (p=0.98). In looking at increased exposure to MDROs prior to admission by age groups, patients in the 61–70year (8.33%), 71–80-year (5.68%), and >80-year (6.67%) age groups were more likely to have a recent (within 30 days) hospitalization (p = 0.02), but there was no significant difference in pre-hospital institutionalization (i.e., prison, skilled nursing facility) by age group (p = 0.06). With a recent hospitalization, MRSA screening was more likely to be positive (11.3% vs. 4.9%, p = 0.05).

Conclusions

All burn patients are susceptible to infections. Urine cultures were more likely to be obtained in older burn injured patients who are 80 years of age or older. There was no significant difference in culture positivity by age. Apart from MRSA screen positivity, there was no increased risk of urine, wound, or blood culture positivity with recent hospitalization or institutionalization. The utility of screening all patients for MDROs on admission should be considered for patients 20 years of age and older.
556 Entering Into a Helping Relationship: A Novel Approach to Burn Center Staff Education/Orientation
Authors: Quinn Kristen C , Schnebly Drew , Gravis P J , Lewis Giavonni M , Thompson Callie M
Published: March 2022

Introduction

In the past, our regional burn center’s staff orientation was a robust overview of the interdisciplinary team’s dynamic approach to patient care. 2020 illuminated gaps in our staff orientation and education process, along with seeing increased levels of staff turnover. The need to truly prepare staff to do the work of caring for burn injured patients while also caring for themselves was identified.

A novel approach to orientation was developed; this included the development of a four hour workshop designed to increase awareness of vicarious trauma, the neurobiology of trauma and its impacts on the care we deliver, our home life and our emotional wellbeing. Social taboos surrounding self-care were addressed. A deep dive into trauma informed care formed the foundation of the workshop. Participants were given tools they can use at work, home, for patients and themselves to increase self-awareness regarding vicarious trauma and implement change in their daily lives.

Methods

Registration was prioritized for new burn staff and open to veteran members of the team. Material was presented via a variety of modalities: art, team build exercise, didactic lecture and discussion. This course will be offered bi-annually. A post course survey was completed; see attached evaluation and graphed likert scale.

Results

The 17 participants included nurses, CNS’s and paramedics;15 from the burn center and 2 from the emergency department. Evaluations were overwhelming positive (see graph). Comments included “it really helped me understand more of the psychological part of my own care”, “it taught me to look at my family and my patient’s family through their world view”, “this was the most important class I’ve ever been given as a nurse”.

Conclusions

Given the success of this novel approach to nursing education/orientation, we are looking for additional pathways to offer this workshop. Follow up discussions with participants have indicated sustained benefits from this program. We are exploring options to measure these outcomes and impacts on longevity and retention.
561 Ethnicity Influences Outcomes of Adult Burn Patients
Authors: DiPaolo Nicola , Hulsebos Ian F , Yu Jeremy , Gillenwater Justin , Yenikomshian Haig A
Published: March 2022

Introduction

Outcomes of burn survivors is a well-studied field of research for burn providers; however, there has been little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any disparities in burn outcomes of broad ethnic groups. Adjustment was made for demographic, social and pre-hospital clinical factors to help isolate ethnic disparities that might not be explainable by other factors.

Methods

A retrospective chart review of an American Burn Association verified burn center identified adult inpatient admissions from 2015 to 2019 with documented insurance status. A total of 1142 patients were categorized by recorded primary ethnicity: 142 Black (or African American), 72 Asian, 479 Hispanic (or Latinx), 90 white, 215 other, and 144 patients whose race or ethnicity was not indicated. Firth logistic regression was used to study the relationship between ethnicity and each of several binary outcomes. Zero-truncated negative binomial regression was used to examine hospital length of stay (LOS) and intensive care unit LOS. Adjustment was made for several confounders (age, gender, homelessness, primary insurance type, diabetes, inhalation injury, primary burn depth, percentage of total body surface area injured) to clarify the statistical effect of ethnicity. The specific adjustment set used depended on the outcome type or frequency.

Results

Relative to white patients, surviving Black patients had an estimated 29% higher average hospital LOS (ratio 1.29; 95% CI 1.01-1.64; unadjusted P=.04). Had the average surviving patient in this sample been Black, their hospital stay would be 2.7 days longer (95% CI 0.1-5.4). Relative to white patients, the odds of being discharged home with or without services, or to hospice care, were an estimated 123% higher for Hispanic patients (OR 2.23; 95% CI 1.28-3.88; unadjusted P=.005). Compared with non-Hispanic ethnicity, Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (OR 0.56; 95% CI 0.34-0.92; unadjusted P=.022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P=.041, P=0.011 respectively).

Conclusions

Even when controlling for burn severity, age, and other factors, Black patients had longer hospital stays. Hispanic patients were more likely to be discharged to home or to hospice care. The causes of these disparities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery or insurance coverage.
576 Comparison of Survival Benefit Between Direct Emergency Department Admissions and Inter-hospital Transfers in Burn Victims
Authors: Hulsebos Ian F , Collier Zachary J , Yenikomshian Haig A , Gillenwater Justin
Published: March 2022

Introduction

Severe burn injuries create systemic insults that are life threatening and require immediate stabilization, resuscitation, and, potentially, emergent surgery. Non-burn emergencies, such as stroke, have shown improved survival benefit and outcomes when patients are immediately transferred to specialized facilities. Our objective was to compare the outcomes between burn patients who were transferred to the burn unit from outside hospitals (HT) to controls who were directly admitted from our own emergency department (ED). We hypothesized that HT patients were at increased risk for mortality, wound healing complications, and infectious sequelae relative to the ED cohort.

Methods

A matched retrospective cohort study from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. HT patients were identified and matched with ED patients by age and percent total body surface area burned (TBSA). HT and ED cohorts were compared as a whole and then stratified into groups according to % TBSA burned (< 10%, 11-20%, 21-40%, and > 40%). Patient and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes included total length of stay (LOS), ICU requirement and complications.

Results

A total of 410 HT and 377 ED patients were identified. There were no significant differences in age (P=0.17), burn severity (TBSA: P=0.27; full thickness burns: P=0.13), and inhalation injury (P=0.29). There were no demographic differences when comparing cohorts according to TBSA. For the primary outcome, there were no significant differences in mortality in the cohorts at large (P=0.48) nor between the groups when stratifying for TBSA (< 10% : P=0.35; 11-20% : P=0.44; 21-40% : P=0.30; >40% : P=0.26). For the secondary outcomes at large, there was no significant difference in LOS (P=0.35), ICU requirement (P=0.17), or wound and infectious complications (P=0.14). HT patients at large, however, spent less time in the ICU (P=0.03).

Conclusions

There was no significant difference in overall mortality rates between the HT and ED groups regardless of TBSA. Additionally, there was no difference in hospital course between the cohorts except for longer ICU stays in those admitted directly from the ED. Once the transfer process is initiated, our unit maintains close physician-to-physician communication with the transferring facility throughout the transfer process, including guiding initial resuscitation efforts. This may play a role in the parity of outcomes between groups.
594 Dermal Matrix versus Autologous Grafting for Full-Thickness Burns of Head and Neck: Trends, Outcomes, Cost
Authors: Di Chiaro Bianca A , Galicia Kevin E , Anstadt Michael J , Patel Purvi P , Portalatin Manuel E , Ton-That Hieu H , Gonzalez Richard , Carson Joshua S , Kubasiak John
Published: March 2022

Introduction

Burns of the head and neck are particularly devastating, commonly occurring due to accidental flame or scald injury. Autologous grafting has traditionally been used for reconstruction in this area. Recently the use of dermal matrices as a reconstructive alternative has increased. This study compares annual trends, outcomes, and hospital costs between head and neck burn patients who underwent reconstruction with dermal matrix or autologous grafting.

Methods

The U.S Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was queried from 2012 to 2016. Patients with head and neck burns treated with dermal matrix or autologous graft were identified using International Classification of Disease Ninth and Tenth Revision diagnosis and procedure codes. Demographic, clinical characteristics, and outcome measures were reported. χ 2 and Student’s t-tests were used for univariate survey-adjusted comparisons between groups. Multivariate survey-adjusted linear regressions were used to identify associations between surgical intervention, length of stay and cost of hospitalization. Analyses were conducted with RStudio (1.4.1717).

Results

A total of 6,730 patients met inclusion criteria; 2,855 underwent reconstruction dermal matrix and 3,875 with autologous graft. There was an increasing number of patients undergoing dermal matrix reconstruction each year, peak in 2016 (1,450, 50.8%). The dermal matrix group was younger (33.7 vs 39.9, p< 0.001) had fewer females (27.3% vs 38.2%, p=0.003) and fewer inhalation injury (4.0% vs 11.0%, p< 0.001). The dermal matrix group had a shorter length of stay (11.2 vs 27.8, p< 0.001) and more home discharges (80.4% vs 53.4%, p< 0.001); they had lower Elixhauser Comorbidity Index score for readmission (6.57 vs 11.92, p< 0.001) and in hospital mortality (4.76 vs 9.69, p< 0.001). Median cost of care was lower for the dermal matrix group ($17,858 vs $59,860, p< 0.001). Multivariable regression demonstrated that reconstruction with dermal matrix was independently associated with decreased length of stay (11.01 [7.95 - 14.07], p< 0.001) and decreased cost ($38,297 [23,813], p< 0.001).

Conclusions

Operative management of head and neck burns with dermal matrix is associated with a shorter hospital stay, greater likelihood of home discharge, and decreased hospital costs. Patients with autologous grafting had higher rates of inhalation injury, which may account for longer hospital stays and increased discharges to nursing facilities. A limit of this study is the inability to differentiate patients undergoing staged procedures. Further study is needed to evaluate factors contributing to faster discharges home in the head and neck burn population.
595 Hypochlorous Acid for Skin Preparation in Fractional Ablative CO2 Laser Treatment of Burn Scars
Authors: Bekeny Jenna C , Shupp Jeffrey W , Travis Taryn E
Published: March 2022

Introduction

While complications from fractional ablative CO2 laser treatment for burn hypertrophic scar (HTS) are relatively rare, the risk of surgical site infection (SSI) after laser treatment exists. When infection occurs, it has been linked to further morbidity, such as scar development in previously unaffected skin. Hypochlorous acid is a non-flammable and colorless antiseptic solution that has been used to treat wounds and is believed to be a less cytotoxic alternative to other agents such as betadine and chlorhexidine. This study aims to investigate the use of hypochlorous acid solution as a skin prep for patients undergoing laser scar revision for HTS and determine its efficacy in preventing SSI.

Methods

All patients undergoing fractional ablative CO2 laser revision of HTS at a single center from September 2016 through September 2021 were retrospectively reviewed. Data pertaining to patient demographics, skin characteristics, treatment sessions, and post-treatment complications were recorded. All patients underwent topical skin preparation with hypochlorous acid-soaked laparotomy pads for 10 minutes before laser treatment. No perioperative oral or topical antibiotics were given to any included patient. Patients were excluded from analysis if they were not treated with a fractional ablative CO2 laser, were treated for a scar etiology outside of burn injury, or if insufficient follow-up was documented.

Results

A total of 208 patients undergoing a total of 758 laser treatments were identified. Average patient age was 45 years (SD 16), with 112 (53.8%) patients being female and 96 (46.2%) being male. Median number of laser treatments was 3 (IQR: 1-5). Patients from all Fitzpatrick skin types were treated, with the most common type being type 5 (n=54, 26.0%). None (n=0, 0.0%) of the 208 patients experienced a surgical site infection after any of the laser treatments received.

Conclusions

Hypochlorous acid is a safe and effective skin preparation for patients undergoing laser burn-scar revision to prevent SSI. Moreover it is non-flammable, colorless and does not need to dry prior to procedure.
603 Timing of autologous spray cell suspension: better early than late
Authors: Komak Spogmai
Published: March 2022

Introduction

Autologous spray cell suspension is associated with multiple beneficial outcomes, however, the optimal timing of use has not been determined. We examined the timing of spay cell application, and hypothesize that early (< 72 hr) use is associated with faster definitive wound coverage, impacting multiple clinical outcomes compared to late ( >72 hr) use of spray cells.

Methods

A retrospective review of 28 patients with spray cell application from March 2020 -- May 2021 was conducted. Pediatric patients < 16 yrs (n=1) as well as deaths (n=2--including 1 withdrawal) were excluded, leaving 25 patients. Those that received spray cells early (< 72 hrs, n=14) were compared to late ( >72 hrs, n=11). Time to index operation, time to spray cell application, rate of complete wound coverage, number of OR trips required for wound closure, wound infection rates, LOS / %TBSA, and overall hospital LOS were examined.

Results

There was no difference in demographics or % TBSA burn (21.4% vs. 23/5%), between early and late spray cell groups. The early group had a significantly faster time to index operation (1.2 dys vs. 2.5 dys P= .05), and faster time to spray cell application (1.6 dys vs. 18.1 dys P=.036) (Table 1). The early group had a greater wound coverage rate at index operation —64.2% complete coverage vs. 18.1% in the late group (p< .03). The total number of OR trips needed for wound coverage was less in the early group (1.5 trips / pt) vs. the late (7.0 trips / pt) P=0.03. The early group had less wound infections, a shorter LOS / % TBSA burn ( 0.83 dys vs. 1.85 dys P=0.005), and shorter overall LOS (16.5 dys vs. 46.9 dys P=0.03).

Conclusions

Autologous spray cell use has multiple beneficial outcomes, however, the optimal timing of application has not been determined. We report that early (< 72 hr) application of spray cells is associated with greater rate of complete wound coverage at index operation, decreased total number of operations needed for wound coverage, less wound infections, shorter LOS / %TBSA, and shorter overall LOS. This is likely related to earlier definitive wound coverage and closure, which is afforded by the large expansion ratio of spray cells.
609 Available non-invasive skin probes distinguish between normal skin and hypertrophic scar but not laser-treated scar
Authors: Carney Bonnie C , Jimenez Lesle M , Oliver Mary A , Keyloun John W , Moffatt Lauren T , Shupp Jeffrey W , Travis Taryn E
Published: March 2022

Introduction

Skin fibrosis is the most under-studied fibrotic condition, and as such, there are limited treatment options for hypertrophic scar (HTS). HTS is difficult to study because scars improve over time, thus making the distinction between natural improvements and interventions difficult. In addition, clinical, histologic, cellular, and molecular outcome metrics are not agreed upon among providers/researchers. It was hypothesized that a set of non-invasive skin probes would be able to distinguish between HTS and normal skin (NS), but not between HTS before and after treatment with fractional ablative laser, despite histologic-level evidence showing improvement with treatment.

Methods

Wounds were created and HTS were allowed to form (n=8 scars). At Day 77, HTS and NS (n=4) were assessed with non-invasive skin probes measuring elasticity and trans-epidermal water loss (TEWL). HTS were then treated with CO2 fractional ablative laser (FLSR) at 70 mJ, 250Hz, and 1% density. The same data, sample collection, and FLSR treatment was carried out at weeks 1, 2, 3 and 4. Formalin-fixed biopsies were processed and stained with H&E, Herovici, Masson’s Trichrome, and Picrosirius red stains. Collagen type and architecture were qualitatively evaluated. Rete ridge ratio (RRR) was calculated from H&E stains.

Results

All stains distinguished between HTS and NS with ease. Herovici stain showed differences in collagen architecture and collagen type after treatment with FLSR. Pre laser treatment, elasticity was different between HTS and NS (290.50±32.90 N/m vs. 90.92±5.61 N/m, p< 0.001). However, elasticity did not change after FLSR at 1, 2, 3, or 4 weeks (248.17±48.54, 215.54±44.68, 295.29±37.5, 290.79±30.17, p >0.05). RRR was different between HTS and NS (1.22±0.11 vs. 1.51±0.03, p=0.08). FLSR induced a significant increase in RRR in HTSs (pre=1.3±0.1 vs. week 4=1.9±0.1, p< 0.05). Pre-treatment, TEWL was different between HTS and NS (12.96±1.99 g/m2h vs. 8.72±1.11 g/m2h, p=0.09). However, TEWL did not change after FLSR at 1, 2, 3, or 4 weeks (15.95±1.99, 20.35± 3.15, 15.9±1.96, 14.01±2.22, p >0.05).

Conclusions

Outcome metrics that non-invasively measure the qualities of scar are critical for HTS research to evaluate treatment effectiveness. Currently available technologies distinguish between NS and HTS well. However, they are inadequate to distinguish scars pre- and post-treatment despite evidence at the histologic level that changes occur. New technologies should be developed that are able to more effectively demonstrate changes to HTS after treatment.
616 Application of Antibacterial Thermosensitive Collagen-Based Hydrogel in Wound Healing
Authors: Amiri Nafise , Ghaffari Sahand , Hassanpour Ida , Chae Taesik , Jalili Reza B , Kilani Ruhangiz Taghi , Ko Frank , Lange Dirk
Published: March 2022

Introduction

Burn wound infections are a serious complication of thermal injury. Among the many factors that may limit effective wound healing in patients with burn, bacterial infection and poor cell recruitment appear as the leading causes for prolonged healing. Thus, a novel strategy that aims to prevent bacterial infection within the wound, while at the same time providing structural scaffolding that promotes endogenous tissue repair, would be of great interest. As a nutritional protective barrier for the wound, we developed a thermosensitive collagen-based matrix called MeshFill (MF) that contains all nutrition required for cell growth with the ability to fill up all the cavities and void areas in wounds regardless of their geometry. In a previous study, MF was successfully combined with partial-thickness mesh grafted skin in a porcine model and improved healing and aesthetic outcomes. In the present work, we report on the development, and in vitro and in vivo testing of a new formulation of MF containing silver nanoparticles (AgNPs), which simultaneously prevent bacterial infection and promote skin regeneration.

Methods

We fabricated MF/Ag formulation by loading different concentrations of AgNPs in MF hydrogel. The antibacterial activity of MF/Ag formulation against Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) was examined in vitro. The wound healing efficacy of the formulation was evaluated in a silicon ring splinted delayed wound healing model in rats. The splinted full-thickness wounds were generated on the back of rats and treated with either MF or MF/Ag with different concentrations of AgNPs or were bandaged with no treatment (NT) as a control. The healing process was monitored for 18 days. Clinical wound measurements and histological assessments were performed to compare different treatment regimens

Results

The results of in vitro antibacterial study showed MF/Ag released a sufficient concentration of silver which caused a marked reduction in colony forming units (CFU) of MRSA and PA as compared to MF alone. MF/Ag did not show any cytotoxicity to human fibroblast. Moreover, the result of the animal study confirmed the safety and efficacy of applying different concentrations of AgNPs loaded in MF without compromising the healing outcome in our rat model.

Conclusions

These findings suggest that AgNPs loaded MF would be a safe, nutritional, flowable hydrogel that provides an ideal moisture environment for healing while protecting the wound from bacteria and can potentially be used as a functional scaffold in partial-thickness mesh grafted skin in burn patients.
620 The Effectiveness of Aromatherapy in an Urban-Based, Safety-Net Hospital on Pain and anxiety
Authors: Coffey Rebecca , Buchert Justin , Ruiz Alina , Alcorn Jillian , Van Hoose June
Published: March 2022

Introduction

Essential oils have been used for centuries for their calming properties. This alternative medicine therapy is gaining popularity in the inpatient setting for symptom management including pain, anxiety, nausea, and insomnia. The purpose of this project is to evaluate the effectiveness of aromatherapy complement as an alternative and/or treatment for pain and anxiety ion the acute care setting at on Health and Hospital System, The target population for this study was patient who were receiving care in the Surgical Services inpatient units including burn patients.

Methods

This study included all surgical patients admitted to one hospital and this is an analysis of the burn cohort enrolled thus far in this study. All adult burn patients that met inclusion criteria were included to evaluate the impact of aromatherapy on the administration of pain and anxiety medications (PANX). After introducing the patient to the study and obtaining informed consent a Lavender-Sandalwood scented aromatherapy sticker was placed on the patients' gown. The aroma last from the sticker last for twelve hours and could be replaced upon patient request. The stickers were used for a total of three days. Survey data was collected to describe the experience with the sticker as well as PANX medication administration and demographic information. Pain scores were recorded for each patient before PANX administration within the 72 hour time period after surgery or burn wound care procedures.

Results

To date a total of fourteen patients were enrolled in the study mean age was 44 years old, 71% of the patients were male and the mean TBSA was 5%.Two patients withdrew one because the scent gave them a headache and one because there were no study logs completed. Each of the twelve patients used a total of 6 stickers over the 3 days of the intervention. Prior to the start of the study the average pain score was 8.6 (range 7-10). On day one of the intervention the mean pain score was 4.75 (range 3-8), day two 4.25 (range 2-8), and on day three 4.3 (range 0 - 9). Post intervention pain scores were 5.75 (range 0-9). Comparison of the pain scores pre and post intervention were statistically significant t= -2.904(95% CI = -4.85 to -0.81) p = 0.0082. Of note patients reported that sleep was improved while using the aromatherapy sticker.

Conclusions

Aromatherapy may provide a natural alternative to reduce opioid pain medications and improve sleep in the burn patient thereby improving long term outcomes.