bluuebunny/crossref_metadata_2025 huggingface dataset:
Genomic prediction of morphometric and colorimetric traits in Solanaceous fruits
Authors: Tong Hao , Nankar Amol N , Liu Jintao , Todorova Velichka , Ganeva Daniela , Grozeva Stanislava , Tringovska Ivanka , Pasev Gancho , Radeva-Ivanova Vesela , Gechev Tsanko , Kostova Dimitrina , Nikoloski Zoran
Published: March 2022

Selection of high-performance lines with respect to traits of interest is a key step in plant breeding. Genomic prediction allows to determine the genomic estimated breeding values of unseen lines for trait of interest using genetic markers, e.g. single-nucleotide polymorphisms (SNPs), and machine learning approaches, which can therefore shorten breeding cycles, referring to genomic selection (GS). Here, we applied GS approaches in two populations of Solanaceous crops, i.e. tomato and pepper, to predict morphometric and colorimetric traits. The traits were measured by using scoring-based conventional descriptors (CDs) as well as by Tomato Analyzer (TA) tool using the longitudinally and latitudinally cut fruit images. The GS performance was assessed in cross-validations of classification-based and regression-based machine learning models for CD and TA traits, respectively. The results showed the usage of TA traits and tag SNPs provide a powerful combination to predict morphology and color-related traits of Solanaceous fruits. The highest predictability of 0.89 was achieved for fruit width in pepper, with an average predictability of 0.69 over all traits. The multi-trait GS models are of slightly better predictability than single-trait models for some colorimetric traits in pepper. While model validation performs poorly on wild tomato accessions, the usage as many as one accession per wild species in the training set can increase the transferability of models to unseen populations for some traits (e.g. fruit shape for which predictability in unseen scenario increased from zero to 0.6). Overall, GS approaches can assist the selection of high-performance Solanaceous fruits in crop breeding.
Tooth count, untreated caries and mortality in US adults: a population-based cohort study
Authors: Liu Jie , Zong Xiaoyu , Vogtmann Emily , Cao Chao , James Aimee S , Chan Andrew T , Rimm Eric B , Hayes Richard B , Colditz Graham A , Michaud Dominique S , Joshipura Kaumudi J , Abnet Christian C , Cao Yin
Published: March 2022

Background

The link between oral diseases and mortality remains under-explored. We aimed to evaluate the associations between tooth count, untreated caries and risk of all-cause and cause-specific mortality.

Methods

Data on 24 029 adults from the National Health and Nutrition Examination Survey 1988–94/1999–2010, with mortality linkage to the National Death Index to 31 December 2015, were analysed. Baseline total number of permanent teeth and any untreated caries were assessed by trained dental professionals.

Results

During up to 27 years of follow-up, 5270 deaths occurred. Fewer permanent teeth were associated with higher all-cause mortality, including heart disease and cancer mortality (all P <0.05 for trend) but not cerebrovascular disease mortality. For every 10 teeth missing, the multivariable-adjusted hazard ratios (HRs) were 1.13 (95% CI: 1.08 to 1.18) for all-cause, 1.16 (95% CI: 1.05, 1.29) for heart disease and 1.19 (95% CI: 1.09, 1.29) for cancer mortality. Untreated caries was associated with increased all-cause (HR: 1.26, 95% CI: 1.15, 1.39) and heart disease mortality (HR: 1.48, 95% CI: 1.17, 1.88) but not cerebrovascular disease/cancer mortality, after adjusting for tooth count, periodontitis and sociodemographic/lifestyle factors. Compared with those without untreated caries and with 25–28 teeth, individuals with untreated caries and 1–16 teeth had a 53% increased risk of all-cause mortality (HR: 1.53, 95% CI: 1.27, 1.85) and 96 % increased risk of heart disease mortality (HR: 1.96, 95% CI: 1.28, 3.01).

Conclusions

In nationally representative cohorts, fewer permanent teeth and untreated caries were associated with all-cause and heart disease mortality. Fewer teeth were also associated with higher cancer mortality.
Investigating the transparency of reporting in two-sample summary data Mendelian randomization studies using the MR-Base platform
Authors: Woolf Benjamin , Di Cara Nina , Moreno-Stokoe Christopher , Skrivankova Veronika , Drax Katie , Higgins Julian P T , Hemani Gibran , Munafò Marcus R , Davey Smith George , Yarmolinsky James , Richmond Rebecca C
Published: March 2022

Background

Two-sample Mendelian randomization (2SMR) is an increasingly popular epidemiological method that uses genetic variants as instruments for making causal inferences. Clear reporting of methods employed in such studies is important for evaluating their underlying quality. However, the quality of methodological reporting of 2SMR studies is currently unclear. We aimed to assess the reporting quality of studies that used MR-Base, one of the most popular platforms for implementing 2SMR analysis.

Methods

We created a bespoke reporting checklist to evaluate reporting quality of 2SMR studies. We then searched Web of Science Core Collection, PsycInfo, MEDLINE, EMBASE and Google Scholar citations of the MR-Base descriptor paper to identify published MR studies that used MR-Base for any component of the MR analysis. Study screening and data extraction were performed by at least two independent reviewers.

Results

In the primary analysis, 87 studies were included. Reporting quality was generally poor across studies, with a mean of 53% (SD = 14%) of items reported in each study. Many items required for evaluating the validity of key assumptions made in MR were poorly reported: only 44% of studies provided sufficient details for assessing if the genetic variant associates with the exposure (‘relevance’ assumption), 31% for assessing if there are any variant-outcome confounders (‘independence’ assumption), 89% for the assessing if the variant causes the outcome independently of the exposure (‘exclusion restriction’ assumption) and 32% for assumptions of falsification tests. We did not find evidence of a change in reporting quality over time or a difference in reporting quality between studies that used MR-Base and a random sample of MR studies that did not use this platform.

Conclusions

The quality of reporting of two-sample Mendelian randomization studies in our sample was generally poor. Journals and researchers should consider using the STROBE-MR guidelines to improve reporting quality.
Why Does the Omicron Variant Largely Spare Olfactory Function? Implications for the Pathogenesis of Anosmia in Coronavirus Disease 2019
Authors: Butowt Rafal , Bilińska Katarzyna , von Bartheld Christopher
Published: March 2022

The omicron variant of severe acute respiratory syndrome coronavirus 2 causes much less olfactory dysfunction than the previous variants. There are several potential mechanisms for how omicron may change tissue tropism and spare olfactory function. The new mutations make omicron more hydrophobic and alkaline than previous variants, which may reduce penetration of the mucus layer. Overall, the new mutations minimally change receptor binding affinity, but entry efficiency into host cells is reduced in cells expressing transmembrane serine protease 2 (TMPRSS2). Because the support cells in the olfactory epithelium abundantly express TMPRSS2, these main target cells in the olfactory epithelium may become infected less by the new omicron variant.
3 Continuous Renal Replacement Therapy for the Treatment of Burn Shock: A Post Hoc Analysis
Authors: Basel Anthony P , Britton Garrett W , Evans Jordan , Dado David , Scott Laura L , Grantham Lonnie E , Cancio Leopoldo C , Chung Kevin K
Published: March 2022

Introduction

Burn shock is a consequence of burns that cover ≥20% TBSA and may be complicated by acute kidney injury, which is commonly treated with continuous renal replacement therapy (CRRT). However, early initiation of CRRT has not been clinically evaluated for the treatment of burn shock.

Methods

Data were obtained from the Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study. In that study, baseline (t0) measurements were taken at the time of CRRT initiation and ~24 (t1) and ~48 (t2) hours thereafter. Patients were included in this analysis if they had ≥20% TBSA and began CRRT within 2 days of injury. Patients were categorized as Group A (began CRRT on same day as injury), Group B (began CRRT on day 1 postburn), and Group C (began CRRT on day 2 postburn). Outcomes measured at t0, t1, and t2 and hospital and ICU length of stay (LOS) were analyzed using generalized linear mixed models. Cox proportional hazards models were used to assess survival to hospital discharge (HD). All models were adjusted, e.g. for age, % full thickness, etc. Burn center was included as a random effect.

Results

More than half of the 48 patients included were treated at just 2 burn centers. Timing of CRRT initiation varied by center, with all patients at one center starting CRRT on either the day of injury or the day after injury. Nearly 96% of patients had AKI at CRRT start and, of those, 22 were at stage 1 or 2. Patients generally had severe burns; Group A had more inhalation injuries and higher %TBSA, % full thickness, and Baux scores than Groups B and C. Shock index (SI) was persistently elevated across all 3 time points and did not vary by timing of CRRT initiation (p=0.37). Vasopressor dependency index (VDI) was also not associated with timing of CRRT initiation (p >0.99), although mean VDI for Groups B and C declined over time. For all 3 groups, fluid balance decreased from t0, but there were no differences among the groups (all p >0.30). Survival to HD was better for patients with lower TBSA (i.e. 20-49%) compared to those with TBSA ≥50% (hazard ratio=0.37; 95% CI=0.15-0.91). In contrast, timing of CRRT initiation was not associated with survival (p=0.73). Among patients that survived to HD, the mean hospital LOS was shorter for Groups A (13 days; p=0.01) and B (39 days; p=0.03) compared to Group C (131 days). Mean ICU LOS was also shorter for Groups A (13 days; p=0.01) and B (52 days; p=0.03) than for Group C (168 days).

Conclusions

In this analysis, earlier initiation of CRRT did not improve survival to hospital discharge. Nonetheless, starting patients on CRRT early may be advantageous for reducing ICU and hospital LOS for those patients that do survive.
8 Less Is More: Reconsidering Hourly Urine Output Goals in Burn Resuscitation
Authors: Nosanov Lauren B , Harris Kathryn E , Libraro Kaitlyn M , Lorico Jeremiah P , Heffernan Jamie M , Chang Philip H , Houng Abraham , Gallagher Jim
Published: March 2022

Introduction

Significant morbidity and mortality is seen with high volume burn resuscitations. Surpassing the Ivy Index, defined as 250 milliliters/kilogram (ml/kg), has been correlated with increased incidence of complications such as abdominal compartment syndrome. Cognizance of factors contributing to over-resuscitation can help optimize fluid administration strategies to minimize associated morbidity.

Methods

A single-center Quality Improvement review was performed of all adult (age ≧ 18 years) burn-injured patients presenting to a major metropolitan burn center with burns ≧ 20% total body surface area (TBSA) between 12/2020-8/2021. Those not surviving the first 24 hours were excluded. Patient demographics and injury characteristics were collected, and resuscitation volumes and timing were recorded prospectively. Patients were categorized by whether their initial 24-hour intake exceeded their Ivy Index, and groups were compared to assess factors associated with over-resuscitation.

Results

During the study period 11 patients met inclusion criteria, and one early mortality was excluded. Patients were predominantly male (70.0%), with mean age 49.9±17.4 years. Burns were primarily due to flame injury, with mean TBSA 41.4±18.6%. Patients required resuscitation volumes of 5.9±1.7 ml/kg/TBSA%, with half surpassing their Ivy Index in the first 24 hours. These patients had larger burns (55.1±17.0% v. 27.7±5.1%) with a significantly higher third degree component (41.4±15.8% v. 15.4±15.2%, p = 0.029). None had diagnosed inhalation injury, and none required abdominal decompression for resuscitation-related compartment syndrome. Observed mortality rate was 30.0%. Patients resuscitating beyond their Ivy Index had significantly higher hourly urine output rates (0.96 v. 0.52 ml/kg, p = 0.024), and hourly urine output was significantly higher among non-survivors as compared to survivors (1.10 v. 0.60 ml/kg, p = 0.033).

Conclusions

Patients with severe burn injury are at high risk for over-resuscitation and associated complications. While traditional teaching instructs a goal of hourly urine output of 0.5-1.0 ml/kg, our study shows that patients resuscitated on the higher end of this range were significantly more likely to surpass their Ivy Index and less likely to survive.
10 The Impact of Insurance Disparities on Long-term Burn Outcomes: A Burn Model System Investigation
Authors: Castillo-Angeles Manuel , Shepler Lauren J , Carrougher Gretchen J , Gibran Nicole S , Stewart Barclay T , Wolf Steven E , Kowalske Karen J , Ryan Colleen M , Schneider Jeffrey C , Mehta Anupama
Published: March 2022

Introduction

Access to healthcare and insurance coverage are associated with quality of life, morbidity, and mortality outcomes. However, most studies have only focused on same-admission and short-term outcomes due to the lack of national longitudinal data and there is limited data on this topic in the burn literature. Our aim was to determine the effect of insurance status on long-term outcomes in a national sample of burn patients.

Methods

This is a retrospective study using the longitudinal Burn Model System National Database from January 2015 to April 2021. The inclusion criteria were all adult patients admitted for burn injury from participating sites. Main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6, 12, and 24 months after injury. Multivariable regression was used to examine the association between insurance status and the outcomes, adjusting for demographics (i.e., age, gender, race/ethnicity) and burn injury severity.

Results

A total of 3,698 burn patients were included. Mean age was 43.39 (SD 15.84) years, 72% were male and 76% were white. Most patients had private/commercial insurance (56.37%), followed by Medicare (14.42%) and Medicaid (13.18%). The remaining 16% were uninsured patients (self-pay or philanthropy). Mean PCS scores were 43.64 (SD 10.87), 45.31 (SD 11.04) and 46.45 (SD 10.65) and Mean MCS scores were 47.80 (SD 12.35), 48.18 (SD 12.30) and 48.44 (SD 12.18) at 6, 12 and 24 months, respectively. In adjusted analyses, Medicaid insurance was associated with worse MCS at 6 months (Coefficient -3.90, p=0.001), and worse PCS at 12 and 24 months (Coefficient -3.09, p=0.004 and Coefficient -4.18, p< 0.001, respectively), compared to uninsured status. Medicare insurance was associated with worse PCS scores at 24 months (Coefficient -3.07, p=0.013).

Conclusions

Having Medicaid and Medicare insurance was significantly associated with a lower health-related quality of life at long-term follow up, even after adjusting for demographics and burn injury severity. Further studies need to focus on analyzing the reasons for these disparities and developing strategies to improve the quality of life of this subpopulation.
13 Statewide Prehospital Routing of Burn Injuries Reduces Patient Length of Stay
Authors: Kearns Randy D , Short Tracee , Barrios Joseph , Sittig Kevin , Hargrove Paige B , Hector Chris W , Carter Jeffrey E
Published: March 2022

Introduction

In the U.S., traumatic injuries are the leading cause of death before age 45 and have a significantly lower mortality if routed to a verified trauma center. Burn injuries are included in trauma statistics and represent 1.1 million injured people annually seeking medical assistance. Routing of burn injuries to ABA-recognized burn centers has yet to be assessed as it has in trauma injury. Our goal was to examine the impact of prehospital routing of burn injuries on hospital length of stay, mortality, and potential costs of care through a statewide care coordination center, the Louisiana Emergency Response Network.

Methods

Our study is a retrospective statewide analysis of burn injuries from 01/01/2017 thru 12/31/2019 using the Louisiana Hospital Inpatient Discharge Database. Routing of burn patients was implemented in 2018 using the ABA burn referral criteria. Data included: total admissions with primary burn diagnosis, region, discharge status, length of stay, and raw mortality by region and state. Descriptive and comparative statistics were performed to assess the impact of routing of burn injured patients. Cost analysis was performed using Louisiana Medicaid per diem rates from 2021 at $1,907.92/day.

Results

1,288 patients were treated in Louisiana during the study period with 855 post-routing and 433 pre-routing. The mean length of stay was reduced from 11.84 days in 2017 to 8.82 days in 2018 (p value=0.0988) with a potential savings of 761 inpatient care days or $2.17 million. Overall mortality across the state was unchanged except in the highest volume region where it dropped from 7.9% in 2017 to 3.6% in 2019 (54%).

Conclusions

Burn injuries meeting ABA referral criteria are a form of time-sensitive trauma. This study marks the first analysis pre and post implementation of routing for burn injuries by a statewide care coordination center. Our study demonstrates improvement in length of stay and mortality but a continued need to examine other contributing factors such as severity of injury and concomitant trauma.
18 Comparison of Topical Agents for Eschar Removal in Porcine Model: Bromelain-enriched vs. Traditional Collagenase Agents
Authors: Singer Adam , Grandfield Samuel , Goradia Eshani , Shah Kunal , Zhang Nigel , McClain Steve
Published: March 2022

Introduction

Surgical excision and grafting of deep partial thickness (DPT) and full thickness (FT) burns is a cornerstone of modern burn wound care. Use of commercially available topical enzymatic agents has been limited due to slower and less complete eschar removal than surgical excision. Using a porcine model of DPT and FT burns, we compared the eschar removal efficacy of a bromelain-enriched enzymatic agent derived from the stems of pineapple plants and a commercially available collagenase.

Methods

Under an approved animal welfare committee protocol, we created 10 DPT and 10 FT burns measuring 2.5 by 2.5 cm on each of four anesthetized Yorkshire pigs weighing 30 kg using a preheated aluminum bar applied to the dorsum and flanks of the animals. For DPT burns, the bar was preheated to 80ºC and applied for 20 seconds with a pressure of 2 kg. For FT burns, the bar was preheated to 100ºC and applied for 30 seconds. Eschar removal was initiated 24-hours later. Two pigs each were randomly assigned to collagenase or the bromelain-enriched agent. The bromelain-enriched agent was applied topically once on day 1 for a period of 4 hours followed by a 2-hour soaking period with normal saline. The collagenase was applied topically daily as per manufacturer instructions until complete removal of the eschar or for up to 14 days. The primary outcome was the percentage of burns with complete eschar removal assessed by a masked observer at 1, 10 and 14 days after application.

Results

A total of 40 FT and 40 DPT burns were created on the four pigs. Regarding FT burns, all bromelain treated burns experienced complete removal of eschar on day 1 after the single 4-hour application. In contrast, none of the collagenase treated FT burns experienced complete removal of eschar after 14 days of treatment. At 10 days, 30% of collagenase treated burns had < 50% removed eschar; by day 14, 40% had >50% removed eschar and 15% had < 50% eschar removed. Regarding DPT burns, all bromelain treated burns had complete eschar removal after the single 4 hour application. In contrast, none of the collagenase treated burns experienced complete removal of eschar after 10 days; by day 14, 35% had complete eschar removal. At day 10, 10% of collagenase treated burns had >50% eschar removed and 75% had < 50% eschar removed; by day 14, 30% had > 50% eschar removed and 35% had < 50% eschar removed. There were no wound infections or any other adverse events noted.

Conclusions

Topical treatment of DPT and FT porcine burns with a single 4-hour application of a bromelain-enriched enzyme resulted in complete eschar removal of all burns. In contrast, after 14 daily topical applications of the collagenase, none of the FT burns experienced complete removal of the eschar and in 35% of the DPT burns, eschar removal was complete.
21 Decreasing Preparation Time of Full-thickness Engineered Constructs: Seeding Dermal Allografts with Non-cultured Keratinocytes
Authors: Gallentine Summer , Powell Heather
Published: March 2022

Introduction

Early wound closure reduces risk of infection and fluid loss, which can reduce mortality and decrease length of hospital stay. The most common challenge associated with rapid wound closure in patients with large, full-thickness (FT) burns is lack of available donor skin. Tissue engineering can generate significant amounts of tissue for grafting but requires specialized facilities and up to three weeks of culture, substantially increasing time to closure.

Off-the-shelf technologies that do not require ex vivo culture of cells represent a major advance in wound care. Point-of-care cell spray technology isolated using an autologous cell harvesting device (ACHD) allows for immediate application of a cell suspension to the wound bed, eliminating specialized laboratory equipment and culture of skin cells. The goal of this project was to assess the ability of freshly isolated skin cells harvested using ACHD or traditional laboratory techniques to regenerate epithelium on engineered dermal tissue, in an effort to decrease time required for preparation of FT engineered skin.

Methods

Dermal allografts were made by seeding collagen scaffolds with human dermal fibroblasts. Human surgical discard tissue was collected with IRB approval. Split-thickness skin (0.008”) was harvested from the discard tissue and cells were isolated using ACHD or via standard laboratory procedures following epidermal separation. Cell suspensions were seeded on the dermal allografts and cell populations were assessed histologically using H&E and Fontana-Masson’s, and via immunohistochemistry for Ki67, ColIV, ColVII, keratin 15, and involucrin. Advanced phenotyping of the cell suspension isolated using ACHD was assessed using flow cytometry.

Results

Isolation of cells using ACHD required 8-fold less preparation time and resulted in a different ratio of cell constituents. ACHD yielded suspensions comprised predominantly of keratinocytes (60-75%), fibroblasts (25-40%), and melanocytes (1-3%). Advanced phenotyping indicates subpopulations of keratinocytes including epidermal stem cells, activated keratinocytes, and proliferating keratinocytes. The standard laboratory protocol resulted in a keratinocyte suspension (96-99%) with melanocytes (1-3%) and no fibroblasts. Both cell suspensions were capable of epidermal regeneration with greater pigment and slightly higher numbers of proliferative cells and epidermal stem cells with the ACHD.

Conclusions

The results suggest non-cultured cell sprays have the potential to regenerate bioengineered dermal allografts in the absence of a split-thickness skin graft. Additionally, ACHD offers a significant time advantage to laboratory-based procedures in the preparation of cell-spray.
27 Pain Medication Use at Follow up Is Associated with Long-term Outcomes
Authors: Kelter Brian M , Shepler Lauren J , Stewart Barclay T , Wolf Steven E , Mandell Samuel P , Kazis Lewis E , Ryan Colleen M , Schneider Jeffrey C
Published: March 2022

Introduction

Use of prescription pain medication after burn injury is commonly required. However, little is known about long-term pain medication use and its association with outcomes. Therefore, the purpose of this study is to assess patterns of prescription pain medication use after discharge and the association between these medications and quality of life outcomes.

Methods

Data from the Burn Model System National Longitudinal Database (2015-2021) were analyzed. Pain medication use was assessed at pre-injury (recall at discharge), discharge (medical record) and follow-up (self-report at 6, 12, and 24 months after injury). Outcome measures included: VR-12 Physical and Mental Component Summary scores (PCS and MCS), Community Integration Questionnaire (CIQ), Posttraumatic Stress Disorder Checklist (PCL), Satisfaction with Life Scale (SWLS), and NeuroQOL Stigma. The population was divided into two groups, those taking and not taking prescription pain medications at one year. Regression analyses examined associations between prescription pain medication use and outcomes at 12 months, controlling for age, gender, race, ethnicity and burn size.

Results

Of the 645 participants, 15% reported prescription pain medication use prior to their burn. At discharge, 81% reported use of an opioid and 46% reported use of a neuropathic pain medication. At 12 months, 32% of individuals indicated prescription pain medication use. The pain medication group exhibited larger burn size (24.0% vs 15.2%) and longer hospital stays (40.4 vs 25.0 days) than the non-pain medication group (p< 0.0001 for all). Additionally, 25% of individuals who reported pre-injury pain medication use also reported use at 12 months. Regression analyses demonstrated that pain medication use was associated with worse physical health (PCS: coefficient 8.69, p< 0.0001) mental health (MCS: 6.31, p< 0.0001), stigma (NeuroQOL Stigma: 3.91, p< 0.0001), and satisfaction with life (SWLS: -3.66, p< 0.0001) at one year. Additionally, pain medication use was associated with 45% decreased odds of being employed (coefficient 0.55, p=0.029) and approximately 3 times greater odds of having post-traumatic stress disorder at 12 months (coefficient 3.25, p< 0.0001).

Conclusions

There are significant associations between prescription pain medication use and worse physical, mental and employment outcomes at twelve months. This information may be used to trigger screening and manage long-term recovery outcomes.
28 Risk Factors and Outcomes of Opioid Dependence After Burn Injury: A Single Center Study
Authors: Walters Elliot , Wolf Steven E
Published: March 2022

Introduction

Patients with severe burns often have a prolonged recovery course and frequently opioid pain medications. Several studies showed patients who receive frequent and high doses of opioid medications are at elevated risk of developing opioid dependence. Risk factors for opioid dependence have been established in several fields, including in trauma patients, however opioid dependence within the burn population has not been well studied. In this study we identify risk factors and outcomes for burned patients with opioid dependence.

Methods

We performed a review of a deidentified database that covers our institution comprising over 1.9 million patients. ICD-10 codes were used to identify those with burns. We identified 9150 patients who received treatment for a burn injury between January 1, 2010 and December 31, 2020. From this cohort 130 patients (1.4%) developed documented opioid dependence. Patients from each cohort were balanced by propensity score matching. The database was then examined to determine treatment type and concomitant diagnoses.

Results

Prior to matching we found a significant increase in mortality, chronic pain, non-opioid substance abuse, depression, and use of opioid and non-opioid medication (p< 0.05) for those with opioid dependence. After propensity score matching, we found no significant increase in mortality or depression (p >0.05). Chronic pain and non-opioid substance abuse remained elevated (OR 2.7, CI 1.6, 4.4; OR 2.4, CI 1.3, 4.5, p< 0.05, respectively). Those who developed opioid dependence were more likely to receive opioid and non-opioid pain medication (p< 0.05), but these were not more likely to receive IV opioid pain medication (p >0.05). However, they were more likely to receive IV opioid pain medication more frequently (p< 0.05). Interestingly, patients who developed opioid dependence were more likely to follow up post-operatively and to receive anti-depressant and anti-epileptic (gabapentin and pregabalin) medications (p< 0.05).

Conclusions

Here we presented data on patients who developed opioid dependence following burn injury. These patients appear to receive more pain medication and receive it more frequently. We did not find a correlation of opioid dependence to depression or patient compliance. Characterizing the patient who develops opioid dependence will better help clinicians to identify patients at risk and direct their care accordingly. Further investigation is indicated to determine the impact these factors have and how these might be mitigated.
30 A Retrospective Review of Outpatient Pain Management in the Burn Injured Population
Authors: Foster Kevin N , Spadafore Philomene , Mongelluzzo Anthony , Richey Karen
Published: March 2022

Introduction

Burn injuries and their associated treatments are exquisitely painful and often require hospitalization to achieve adequate pain control. Hospitalized patients have their pain managed aggressively, with rigorous monitoring. However, once patients are discharged from the hospital, the assessment of ongoing pain management becomes more difficult. The purpose of this study was to examine our current practices in the outpatient setting regarding pain management.

Methods

This was a retrospective review of patients treated in the outpatient burn clinic following discharge home from the burn center over a one-year period. Patients with a significant history of premorbid pain and those discharged initially to a post-acute facility were excluded. Patients were stratified into those requiring opioids ≤ 4 weeks/ > 4 weeks, autografting/no autografting, opioids required following 95% wound closure/not required and those with and without a history of significant substance abuse.

Results

There were 206 evaluable patients in this study. The mean number of days to healing was 19.5 days. The mean percent total body surface area injured was 5% yielding a mean number of days to healing per percent total body surface area burn of 4. Overall, narcotic pain medications were discontinued 8 days prior to wound closure. The majority of patients, 83% (n=170) had their narcotic pain medications discontinued before 95% wound closure was achieved; 17% (n=36) number of patients had their narcotic pain medications continued beyond wound healing. Subgroup analysis revealed the following findings. Patients who were on narcotic pain medication > four weeks following the time of injury (n=37) had a mean duration of narcotic pain therapy of 57 days compared to 11 days in patients who received ≤ four weeks (n=169, p < .00001). Likewise, patients who were grafted had a longer narcotic pain duration, 28 days vs 12 days in patients who were not grafted (p < .00001). Finally, the presence of previous or current substance abuse appeared to have no impact on the duration of narcotic therapy 19. 8 days vs 19.3 days.

Conclusions

Most patients followed in the burn outpatient clinic demonstrated cessation of narcotic analgesic use around the same time as burn wound closure. Factors tending to extend the duration of narcotic use included longer inpatient narcotic use, and the necessity of skin grafting for burn wound management. Interestingly, previous substance abuse history did not influence length of post-hospital narcotic use.
33 Setting the Standard: Using a National Burn Registry to Benchmark Risk Adjusted Mortality
Authors: Mandell Samuel P , Higginson Sara , Hoarle Kimberly , Hsu Naiwei , Pardon Darryl A , Phillips Bart D , Phillips Matthew H , Thompson Callie M , Weber Joan M , Bessey Palmer Q
Published: March 2022

Introduction

Reports of single center experience and studies of larger databases have identified several predictors of burn center mortality, including age, burn size, and inhalation injury. None of these analyses has been broad enough to allow benchmarking across burn centers. The purpose of this study was to derive a reliable risk-adjusted, statistical model of mortality based on real-life experience at many of the burn centers in the United States.

Methods

We used a national burn registry to identify 128,252 initial admissions from July 2015 through June 2020 across 103 unique burn centers. We selected 23 predictor variables, from over 50 recorded in the dataset based on completeness (at least 75% complete required) and clinical significance. Missing data were multiply imputed with a Bayesian Ridge Regression estimator. All data analysis was performed in Python using Numpy and Scikit-Learn libraries. We used Gradient boosted regression (CatBoost), a form of machine learning, to predict mortality and compared this to traditional logistic regression. Model performance was evaluated with AUC and PR curves. Using the CatBoost predictions, observe to expected mortality was calculated for each center. Confidence intervals for O/E analysis in the case of mortality prediction were calculated using a custom implementation of the Clopper-Pearson method. Analyses were run on three cohorts: All patients; Patients with 10-20% TBSA; and >20% TBSA.

Results

The CatBoost model achieved a test AUC of 0.982 with an average precision of 0.801. The logistic regression, by comparison, produced an AUC of 0.974 with an average precision of 0.726. While accuracy, the measure most reported in the literature, is near ceiling for both models, the CatBoost model is markedly more sensitive, leading to a substantial improvement in average precision. Because of the superiority of the CatBoost model with respect to outcome prediction, we only used CatBoost models for calculation of O/E ratio (Fig. 1).

Conclusions

Gradient boosted regression models provided greater model performance than traditional, multivariate, logistic regression. Using data from a national burn registry, we can predict burn mortality across contributing centers allowing for meaningful O/E ratios. Further, this allows for comparison of mortality across centers contributing data to the registry.
36 Common Data Elements (CDE) in Burn Care Documentation: A Single-center Retrospective Review
Authors: Dang Justin , Bernabe Rendell , Lin Joshua , Kuromaru Yuki , Pham Christopher H , Huang Samantha , Sheth Megha , Yenikomshian Haig A , Gillenwater Justin
Published: March 2022

Introduction

Thorough documentation is an important component of delivering quality patient care. Documentation of common data elements (CDE), defined as a precise question with a specified set of responses used across multiple databases or studies, can also assist in improving data collection. Currently, burn care does not have an existing set of CDEs despite their potential to be a reproducible and reliable system for data collection which leads to improved burn care. Our institution performed a retrospective review of patient charts to identify the consistency of our burn care documentation and highlight deficits that could be remedied by the implementation of CDEs.

Methods

This was a single-center retrospective review of patient charts from 2014-2019. Thirty-three CDEs were investigated. Two hundred four patient charts were randomly selected for review. We presented extracted CDEs as frequencies and percentages. Information was obtained from the history and physical notes, progress notes, and discharge summaries.

Results

Our review yielded 204 patient records. The note/record of some data points could not be identified and were excluded from the qualitative calculation. Of the data points that included more than 200 records, 86% percent specified the date of injury, 88% recorded the admission date, 99% reported burn etiology, 94% included total body surface area (TBSA) burned, 94% included burn thickness, 99% specified anatomic injury location, 97% included information about wound care agents/dressings, and 24% recorded the patient’s pain scores. Thirty percent (49/164) reported the presence or absence of inhalation injury. Twenty-six percent (38/148) listed reported presence or absence of non-burn related injuries. Sixty-four percent (127/200) reported presence or absence of comorbid conditions. Other data points were found with varying frequencies (Table 1).

Conclusions

Consistent documentation of burn care remains challenging and many variables are collected inconsistently. Our results highlight the need for CDEs in burn care to standardize documentation.
45 Endothelial Damage Occurs Early After Inhalation Injury as Measured by Increased syndecan-1 Levels
Authors: Kelly Edward J , Keyloun John W , Carney Bonnie C , Moffatt Lauren T , Shupp Jeffrey W
Published: March 2022

Introduction

Inhalation injury is a significant cause of morbidity and mortality in the burn patient population. However, the pathogenesis of inhalation injury and its potential involvement in burn shock is not well understood. Pre-clinical studies have shown endothelial injury, as measured by syndecan-1 levels, to be involved in the increased vascular permeability seen in shock states. Furthermore, the lung has been identified as a site of significant syndecan-1 shedding. Here we aim to characterize the contribution of endotheliopathy caused by inhalation alone in a swine model.

Methods

Eight female Yorkshire pigs were used in this experiment. A custom-made smoke box was employed to deliver smoke via endotracheal tube directly into the swine lungs. Carboxyhemoglobin levels were then titrated to a level of 50-75%. Blood was collected at induction of anesthesia, pre-injury, 30 minutes, and at hours 1, 2, 4, 6, and 12 post-injury and was stored in EDTA tubes from which plasma was separated and stored for future analysis. Pigs were necropsied immediately after completion of the experiment and lung samples were placed in all-protect and flash frozen. Histology was performed on lung sections and a validated, published scoring system composed of 5 parameters (neutrophils in the alveolar space, neutrophils in the interstitial space, hyaline membrane formation, protein detritus in the alveolar space and septum thickening) was used to assess lung injury severity (between 0 and 1).Plasma Syndecan-1 (SDC-1) was quantified by ELISA. All data was compared to Syndecan-1 levels measured at induction. Conditions were analyzed with one-way ANOVA with multiple comparisons and Dunnett’s correction for multiple comparisons.

Results

Syndecan-1 levels at induction were 13.74 ± 2.03 ng/ml. Pre-injury and 30 minutes post-injury levels remained similar. Syndecan-1 levels at hour 2 post-injury increased 37% from induction (18.36 ± 1.28 ng/ml, p=0.0057). This trend continued with a 47% percent increase from induction at hour 4 post-injury (19.62 ± 2.15 ng/ml, p=0.0033) and a 49% increase from induction at hour 6 post-injury (20.42 ± 2.43 ng/ml, p=0.0011). Histological sections showed higher lung injury severity compared to control pigs (0.1-0.3 vs. 0.5-0.74, p< .05).

Conclusions

Significant increases in syndecan-1 levels in this animal model provide evidence for a connection between smoke inhalation injury and endothelial injury. Furthermore, the endotheliopathy that leads to burn shock could be exacerbated by inhalation injury, leading to the poor clinical outcomes that are often seen in patients with combined burn and inhalation injuries. Future research should focus on the mechanisms underlying inhalation injury and its contribution to shock physiology.
51 Wireless Electroceutical Dressing for the Treatment of Biofilm Infected Burn Wounds
Authors: Nuutila Kristo , Diaz Victoria , Anselmo Kristin , Steiner Shomita , Sen Chandan K , Carlsson Anders H , Chan Rodney K , Roy Sashwati
Published: March 2022

Introduction

Burn injuries are common to all military conflicts. In combat, eradication and prevention of burn wound infection is complicated by high rates of soft tissue contamination and prolonged delays to definitive stateside care. Furthermore, in the battlefield setting the salvage rate for infected burned extremities is low. Therefore, a simple, easy, non-invasive and rapid method to protect the wound, while also inhibiting infection, would represent a significant advance in the treatment of combat burn wounds. The purpose of this clinical trial was to investigate the efficacy of an FDA approved disposable and easily portable, wireless electroceutical dressing (WED) in the treatment of burn wounds. The hypothesis was that a low electric field generated by the moisture-activated WED will reduce infection load, improve graft survival and take, enhance wound healing and restore skin barrier function of biofilm infected wounds.

Methods

A phase I, prospective, randomized, controlled clinical trial was performed to evaluate the efficacy of the WED dressing as compared to the standard of care (SoC) dressing to prevent and disrupt biofilms. Subjects were screened from inpatient admissions for traumatic burns >300cm2 in size. In total 38 subjects were enrolled to the study. Subject burn wounds were divided into two parts and randomized to receive either the SoC dressing or the WED dressing. Dressings were changed on day 4, removed on day 7 and the burns were followed for 30 days. Small biopsies were collected on days 4 and 7 for histology, SEM examination of biofilm and for quantitative bacteriological analysis. In addition, non-invasive wound imaging techniques were utilized to study wound healing. Furthermore, Vancouver scar scale and patient observer scar assessment were used to evaluate quality of healing.

Results

The results showed that at the time of dressing removal, non-grafted burns that were treated with the WED dressing presented statistically significantly less biofilm in comparison to the SoC treated burns (p < 0.05). The results also demonstrated that the WED dressing was more efficient at eradicating biofilm than the SoC dressing. At the time of the dressing removal, biofilm score [0-3] had decreased in 48% of the WED dressing treated burns in comparison to 28% in the SoC treated burns. In terms of wound healing and quality of healing no significant differences were observed between the WED and the SoC dressings.

Conclusions

This trial demonstrated that the WED dressing was more efficient against biofilm infection than the SoC dressing. In addition, the study concluded that the WED dressing performed equally well as the SoC in terms of burn wound healing.
52 Refinement of a Histologic Algorithm for Burn Depth Categorization Using 1142 Consecutive Burn Wound Biopsies
Authors: Phelan Herb A , Holmes James H , Hickerson William L , Cockerell Clay J , Shupp Jeffrey W , DiMaio J Michael , Carter Jeffrey E
Published: March 2022

Introduction

Our group previously reported a theoretical burn biopsy algorithm (BBA-V1) for the categorization of burn wound depth based on histologic analysis, and informed it with the largest series of burn wound biopsies in the literature. That iteration of the BBA resulted in clinical misclassification rates consistent with past literature. Since our last report of that process, we have refined the algorithm with new criteria and a larger repository of burn wound biopsies. Here, we sought to promulgate this newer, simpler version of the BBA (BBA-V2).

Methods

This was an IRB-approved, prospective, multicenter study. Patients with burn wounds assessed by burn experts as requiring excision and autograft underwent 4mm biopsies procured every 25cm2. Serial still photos were obtained at enrollment and at excision intraoperatively.

Using H&E with whole slide scanning, a board-certified dermatopathologist assessed each burn biopsy. The criteria used for categorization of burn wound depth in BBA-V1 were: 1) proportion of necrotic adnexal structures, and 2) presence/absence of each of epidermis, papillary dermis, and reticular dermis. The criteria used for BBA-V2 were: 1) magnitude of reticular dermal degeneration, 2) proportion of necrotic adnexal structures, and 3) magnitude of vessel thrombosis.

Biopsy pathology results were correlated with still photos by 3 burn experts for consensus of final burn depth diagnosis. Superficial partial thickness (SPT) wounds were considered to be burn wounds likely to have healed without surgery, while deep partial thickness (DPT) and full thickness (FT) were considered unlikely to heal by 21 days.

Results

The development of BBA V-1 was previously informed by 66 subjects with 117 wounds and 816 biopsies, and resulted in wound categorizations as follows: SPT (20%), DPT (43%), and FT (37%). Therefore, according to BBA-V1, 20% of burn wounds were incorrectly judged as needing excision and grafting by the clinical team. The overall cohort was enlarged to 162 subjects with 294 wounds and 1142 biopsies. The most recent 838 burn wound biopsies were then re-reviewed and re-categorized according to the new BBA-V2 criteria and algorithm. Under BBA-V2, 3% of all burn wound biopsies were categorized as superficial partial thickness, 69% were categorized as deep partial thickness, and 29% were categorized as full thickness.

Conclusions

Our study demonstrates that by adding dermal degeneration severity and vessel thrombosis to our previous criterion of adnexal structure necrosis, BBA-V2 had a much higher rate of concordance with visual clinical assessment for burn wounds clinically judged as needing surgical excision. This study serves as the largest analysis of burn biopsies by modern day burn experts.