bluuebunny/crossref_metadata_2025 huggingface dataset:
129 Stimulating the Cholinergic Anti-inflammatory Pathway Alters Inflammatory Cell Mobilization after Burn Injury
Authors: Costantini Todd , Weaver Jessica , Eliceiri Brian
Published: April 2021

Introduction

Severe burn injury causes a systemic inflammatory response (SIRS) that is characterized by mobilization of inflammatory cells into the circulation and is associated with distant organ injury that can lead to significant morbidity and mortality. The cholinergic anti-inflammatory pathway, mediated by the vagus nerve, regulates the anti-inflammatory response to injury and infection. We have previously shown in models of burn injury that stimulating the vagus nerve may be a potential therapy aimed at limiting SIRS. Here, we hypothesized that stimulating the vagus nerve (VNS) would limit the SIRS response by altering the mobilization and trafficking of inflammatory cells after burn injury.

Methods

Wild type 10–12-week-old C57BL/6 mice were injured with a 30% total body surface area steam burn. A separate cohort of animals was treated with electrical stimulation of the cervical vagus nerve for 10 minutes immediately post-burn. Bone marrow, blood and lung tissue were collected 24 hours after burn injury. Flow cytometry of bone marrow was performed to measure Lineage- c-kit± Sca-1+ (LSK) hematopoietic stem cells (HSC), then further analyzed to quantify changes in Long-term (LT) HSC, short-term (ST) HSC, and Multipotential Progenitor (MPP) compartments. Bone marrow, blood and perfused lung tissue were analyzed by flow cytometry using a panel of myeloid cell markers.

Results

Severe burn injury decreased bone marrow LSK expression by 50% compared to sham, with LT-HSC and MPP expression decreasing to a greater degree than ST-HSCs. VNS did not alter burn-induced changes in any bone marrow HSC cell type. Burn injury was associated with increased mobilization of CD45+CD11b+ monocytes and CD11b+Ly6Chi inflammatory monocytes into the peripheral blood and lung, while increased CD11b+Ly6Clo patrolling monocytes and Gr1+Ly6C- neutrophils was seen in the lung only. VNS significantly prevented the burn-induced increase in CD45+ inflammatory cells, CD11b+Ly6Clo patrolling monocytes and Gr1+Ly6C- neutrophils in the lung (see Figure), reducing their expression to sham levels, despite only modest changes to myeloid cell expression in the blood.

Conclusions

VNS attenuates myeloid cell cell trafficking to the lung after severe burn injury despite having no effect on emergency myelopoiesis in the bone marrow. Further studies are needed to define the mechanism by which the cholinergic anti-inflammatory pathway attenuates the SIRS response to burn.
138 Evaluation of Healing Outcomes Combining Negative Pressure Wound Therapy with Autologous Skin Cell Suspension and Meshed Autografts: Pre-Clinical and Clinical Evidence
Authors: Carney Bonnie C , Moffatt Lauren T , Travis Taryn E , Nisar Saira , Keyloun John W , Prindeze Nicholas , Oliver Mary , Kirkpatrick Liam , Johnson Laura S , Shupp Jeffrey W
Published: April 2021

Introduction

Negative pressure wound therapy (NPWT) is an option for securing meshed split thickness skin grafts (mSTSGs) after burn excision to optimize skin graft adherence, working by minimizing disruption by shear forces and promoting the continual removal of wound bed drainage. Recently, the use of autologous skin cell suspension (ASCS) has been approved for use in treating full-thickness burn injuries in conjunction with mSTSGs. Limited data exists regarding the impact of NPWT on healing outcomes when the cellular suspension is utilized. It was hypothesized that NPWT in conjunction with ASCS+mSTSGs would aid in skin graft adherence without compromise to healing outcomes.

Methods

In this study, a Duroc pig model of burn, excision, mSTSG, ASCS + NPWT was used (n=2), where each animal had 2 sets of paired burns. Four wounds received mSTSG+ASCS+NPWT through post-operative day 3, and 4 wounds received mSTSG+ACSC+ traditional ASCS dressings. Percent re-epithelialization was measured using digital planimetry and Image J. Graft-adherence was evaluated using a scale with blinded reviewers (0=no graft loss, 4= >50% graft loss). Histological architecture, pigmentation, elasticity, and blood perfusion and blood vessel density were assessed at multiple time points through 2 weeks. After the evaluation of its effectiveness in animal models, the same surgical technique, including NPWT, was used in patients with full-thickness burns (n=9), and wound healing trajectories were described.

Results

In the Duroc pig study, all wounds healed within 14 days with minimal scar pathology and no significant differences in percent re-epithelialization between NPWT and non-NPWT wounds were observed (61.09 ± 9.01 and 61.15 ± 0.82% at Day 7). Additionally, no differences were detected for pigmentation, perfusion, or blood vessel density. Overall, the non-NPWT group had higher amounts of graft loss (1.0 ± 1.41 vs. 0 ± 0). NPWT-treated wounds had significantly improved elasticity (NPWT=109.5 ± 21.23 vs. non-NPWT=177.5 ± 35.4, p< 0.05). There were no differences in histological architecture between treatment groups. Patients had a median age of 53 (37–69), and median TBSA of 12.5 (8–18) resulting primarily from scald burns (67%). There were no reported morbidities, and all wounds were re-epithelialized within an expected time period. The use of NPWT promoted graft adherence, and was useful as a bolster dressing in wounds that crossed joints.

Conclusions

These data suggest the positive attributes of the cellular suspension delivered are retained following the application of NPWT. Re-epithelialization, revascularization, and repigmentation are not adversely impacted.
507 Burn Survivor Perspectives On a “Virtual” Survivor Retreat
Authors: Yelvington Miranda L , Wilkinson Gretta E
Published: April 2021

Introduction

The social distancing restrictions mandated by the COVID-19 pandemic have directly impacted burn survivor support groups. Around the country, Pediatric Camps and Adult Support groups have been canceled or moved to an alternate format. While these alternative methods provide much-needed support and interaction for burn survivor groups, it is unknown how they compare to traditional, in-person support programs. In November 2020, our facility will replace our traditional Adult Burn Survivor Retreat with an entirely virtual, synchronous retreat. The retreat will feature many of the sessions and experiences from the in-person retreat but will be lacking the face-to-face contact that is so valued by our Adult Survivor Group. Educational sessions will be provided by adult psychologists and social workers, burn therapists and nurses. An adult burn survivor will provide the keynote address. Adult burn survivors, who have participated in prior year’s retreats, will be invited to participate in a comparison feedback survey.

Methods

Participants in the Virtual Adult Survivor Retreat will complete a post-retreat survey, comparing the virtual retreat experience to the traditional in-person retreat format. Likert scale questions will address participation level, benefit of retreat, specific feedback for sessions and ease of ability for survivors to interact with peers. In addition, the survey will seek to identify barriers of the virtual format as a means of providing needed survivor support.

Results

Survey results will be analyzed, and trends will be reported. Statistically significant results can be further explored to guide future virtual events.

Conclusions

Virtual events utilizing video platforms have become commonplace in the era of COVID-19, however, this format is still new, and the benefits have not been fully explored. Evidence has shown a direct benefit to survivors participating in support services. In an attempt to fill the gap left by the cancelation of in-person events, our facility is hosting a synchronous virtual retreat for adult burn survivors. Retreat evaluation and data comparing the virtual event to prior in-person events will be analyzed and reported.
509 Use of a burn sepsis screening protocol results in lower antibiotic usage rates
Authors: Jastram Charles W , Carter Jeffrey E , Bilbe Sarah , Vu Catherine , Phelan Herb A
Published: April 2021

Introduction

Antibiotic stewardship is widely recognized as being a necessary component of modern hospital care but remains difficult to put into practice particularly on burn services where the risk of infection is known to be higher than the general hospital population. Our burn service instituted a protocol for sepsis screening triggers and antibiotic usage, becoming the only unit in our hospital to do so. In-house quality metrics have shown this protocol to be successful in reducing utilization.

Methods

With the opening of our burn unit in April 2018, a burn sepsis screening protocol was put in place (see accompanying image). Briefly, the first level of screening consists of threshold hemodynamic and physiologic parameters. If these are met the pathway leads to drawing of basic laboratory tests plus lactate and procalcitonin. Group A findings consist of either Serum Lactic Acid >2.2mmol/Lor Procalcitonin >0.69ng/ml, and Group B findings consist of: Platelets < 100,000/mmorGlucose >150 mg/dL or New Insulin Requirement. If one finding from each of groups A and B are present, antibiotics are started, and a source work up is initiated. De-identified aggregate data on antibiotic usage are routinely tracked as a quality metric by our hospital’s Infection Control Committee. The results from calendar year 2019 are presented here for all antibiotics, vancomycin usage, and beta-lactam usage. One-way Analysis of Variance with Tukey’s post-hoc testing was used to analyze the differences in intravenous antibiotic usage rates between the Burn Intensive Care Unit (BICU), the Trauma ICU (TICU), and the remainder of the hospital.

Results

The BICU used significantly fewer IV antibiotics than the TICU across all examined parameters and fewer than the remainder of the hospital for all antibiotics and vancomycin usage. Data is presented as antibiotic days/1000 patient days.

Conclusions

Initiation of a formal protocol for sepsis screening and IV antibiotic initiation significantly lowers antibiotic utilization. Future work will focus on this protocol’s impact on clinical outcomes.
514 Duration of Nebulized Heparin for Inhalation Injury
Authors: Zavala Sarah , Chowdhury Ibrahim , Moomey Kyle , Liu Yuk Ming
Published: April 2021

Introduction

Inhalation injuries (IHI) are a major source of morbidity and mortality in burn patients. The purpose of this study is to evaluate short versus long duration of nebulized heparin in IHI and its effect on ventilator-free days.

Methods

This was a single-center retrospective analysis of adult patients with bronchoscopy-confirmed IHI admitted to a large academic medical center with an American Burn Association-verified Burn Unit between March 2013 and March 2018, who received nebulized heparin 10,000 units every four hours for three days or until the patient no longer had carbonaceous sputum, whichever is longer. Patients were excluded if they expired within 24 hours, had less than 48 hours of mechanical ventilation, or were made comfort care. The primary outcome was ventilator-free days of the first 28 days. Secondary outcomes include in-hospital mortality, length of hospitalization, baseline and day 3 lung inhalation score, reintubation, discharge disposition, and major and minor bleeding events. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test, as appropriate. A sample size of 24 patients to be appropriately powered (β = 0.2; α = 0.05) was required to show a mean difference of 8 days on the ventilator.

Results

A total of 40 patients were included in the study. Eleven patients received nebulized heparin for three days or less, and 29 patients received nebulized heparin for more than three days. Patients were primarily white, middle-aged males. More patients in the short duration group had a history of never smoking (4 vs 1, p = 0.04), and patients in the long duration group had a higher grade of inhalation injury (grade 3 vs grade 2, p = 0.01). Median ventilator free days of the first 28 was 4 days for the short duration group and 6 days for the long duration group (p = 0.88). There was no significant difference in length of hospital stay (12 days vs 20 days, p = 0.12), lung injury score, incidence of ventilator associated pneumonia, or bleeding events. No major bleeding events occurred.

Conclusions

This study introduces the potential use of carbonaceous sputum as a clinical marker for directing therapy and using a shorter duration of therapy as compared to previous studies. There was no difference found in ventilator free days between groups, and this study affirmed the safety of using nebulized heparin for IHI.
528 Smoking on Home Oxygen and Burn Related Injuries. A Single Center Experience
Authors: Mubang Ronnie , Horrell Erin Wolf , Folliard Sarah A , Beyene Robel , Gondek Stephen , Thompson Callie M
Published: April 2021

Introduction

Oxygen therapy is a mainstream treatment for many cardiopulmonary disease processes in the United States with COPD being most common. Despite various warnings against smoking on oxygen therapy, some patients continue to smoke on oxygen and sustain burn-related injuries. These patients are frequently intubated due to concern for inhalation injury. We aim to characterize the injury patterns, morbidities, and mortalities associated with burns sustained while on oxygen therapy at home. We hypothesize that the prevalence of these injuries is underrecognized.

Methods

We performed a retrospective review of all patients ≥45 years of age admitted to our regional burn center from 10/2018-4/2019. Injuries related to smoking on home oxygen were isolated and patient and injury characteristics are described.

Results

A total of 143 patients were included in this review, 20 patients (15%) had injuries related to smoking on home oxygen. Patient and injury characteristics are described in Table 1. Notably, 25% of patients were intubated and none of those patients had an inhalation injury documented on bronchoscopy. Four patients were extubated within a day of admission & one patient was extubated on hospital day 2. No patient died in the hospital. Nine patients (45%) required an escalation of care in the post-acute care period.

Conclusions

Smoking on home oxygen is an underrated problem and better education is needed for both patients receiving the therapy and providers prescribing the therapy. Due to the mechanism, inhalation injury is rare though a significant percentage of patients continue to receive prophylactic intubation.
538 Antishear Therapy for Toxic Epidermal Necrolysis: A Follow-up Study
Authors: Haravu Pranav N , Gottlieb Lawrence J , Vrouwe Sebastian Q
Published: April 2021

Introduction

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are life-threatening dermatologic conditions, which are best approached by a multidisciplinary team practicing burn-equivalent care. There is a lack of consensus on wound management in these patients, in particular whether to debride detached epidermis. Our center instituted “antishear” wound therapy thirty-five years ago, where detached skin is left in situ as a biologic dressing. A standardized protocol aims to avoid shear forces to prevent further desquamation of involved areas. In this study, we follow-up on our outcomes with antishear therapy during the latter half of our center’s experience.

Methods

A retrospective chart review was conducted for all patients admitted between July 2004 – May 2020 with a Dermatologist-confirmed diagnosis of SJS/TEN. Patients admitted with non-SJS/TEN dermatologic diagnoses and those treated outside of the burn center were excluded. All patients were treated with burn-equivalent critical care and antishear wound therapy. Data was characterized by demographics, inciting agent, total body surface area (%TBSA) affected, hospital course, and any administered systemic therapy. Univariate regression was performed to identify factors that increased mortality. Standardized mortality ratios were calculated at each SCORTEN level and in aggregate.

Results

Of the 51 patients that met inclusion criteria, 10 (20%), 22 (43%), and 19 (37%) developed SJS (< 10% TBSA), SJS/TEN overlap (10%-30% TBSA), and TEN (>30% TBSA) respectively. Mean SCORTEN (day 3) and %TBSA were 2.6 and 28%, respectively. Overall mortality was 22%; SCORTEN (p< 0.001), %TBSA involvement (p< 0.02), and development of multi-system organ failure (p< 0.001) correlated with increased mortality. No mortality was observed for patients with a SCORTEN ≤2. Patients with SCORTEN scores of ≤3 and >3 had standardized mortality ratios of 0.63 (p=0.21) and 0.78 (p=0.17), respectively, representing 37% and 22% reductions in mortality. The standardized mortality ratio across the entire cohort was 0.73 (p=0.14), representing a 23% reduction in mortality.

Conclusions

Incorporating the antishear approach as part of burn-equivalent care in SJS/TENS patients is an effective alternative with equivalent mortality outcomes compared to SCORTEN predictions. Standardized mortality ratios were lower for patients with SCORTEN ≤3 and SCORTEN >3, but limited sample size reduced ability to show statistical significance.
545 Pharmacologic and Comorbid Factors Associated with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome
Authors: Africa Robert , Mobli Keyan , Hallman Taylor , Schober Marc , Torres Mark Jason , Wermine Kendall , Gotewal Sunny , Cuartas-Olarte Andres , Ozhathil Deepak K , Song Juquan , El Ayadi Amina , Golovko George , Wolf Steven E
Published: April 2021

Introduction

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis syndrome (TENS) share immune-mediated etiology for epidermal detachment and pharmacologic triggers. Both conditions are on a spectrum of diseases of varying severity, with TENS representing the graver end of the continuum. The demographics and comorbidities of this population remain relatively unknown due to their rare incidence. Comorbidities determine the causative drugs used, but also afford triggers for the autoimmune cascade resulting in SJS or TENS. We analyzed the trends of comorbid and pharmacologic risk factors associated with these diseases in over 3,000 patients.

Methods

We used the TriNetX Global Health Research Network from 2009–2020 to identify 3,515 patients diagnosed with SJS or TENS (ICD-10 codes L51.1–51.3). We then obtained annual demographic and comorbidity data. We indexed patients into cohorts that were prescribed a high-risk drug as previously reported in the literature to be associated with SJS and TENS development. Our control cohort consisted of patients that did not take these high-risk drugs. These cohorts were analyzed to identify the relative risk of developing SJS or TENS 4 to 56 days after taking a high-risk drug. Similarly, we excluded co-medication of the other high-risk drugs and compared these patients to our control group.

Results

The mean age was 46 with a female predominance (59.8%). The most common comorbidities were hypertension (20.2–21.3%), mood affective disorders (12.4–15.8%), or kidney disease (11.6–12.8%), and the prevalence of these have remained constant. Phenobarbital had the highest risk for these diseases (RR: 20.2, CI: 13.58–29.93), with carbamazepine second (RR: 14.1, CI: 8.68–22.85). After excluding other high-risk medication, phenobarbital continued to be associated with the highest risk (RR: 30.3, CI: 16.12–56.73), followed by phenytoin (RR: 25.3, CI: 13.51–47.53) and carbamazepine (RR: 24.7, CI: 13.74–46.34). Well reported triggers like sulfamethoxazole, allopurinol, and sertraline only represented moderate risk (RR: 7.7, CI: 6.11–9.83; RR: 5.2, CI: 2.77–9.73; RR: 1.7, CI: 0.90–3.16) even after excluding co-founding factors.

Conclusions

This study suggests that seizure disorder medications such as phenobarbital, carbamazepine, and phenytoin demonstrate the highest risk for developing SJS and TENS.
550 A retrospective Study of a Zinc-oxide/dimethicone for Pediatric Perineal Burn Treatment
Authors: Diab Waseem , Ridelman Elika , Cloutier Dawn , Vitale Lisa C , Klein Justin D , Shanti Christina M
Published: April 2021

Introduction

Silver-based treatments have seen widespread use for the management of burns. Recent literature, however, has demonstrated silver nanoparticles may negatively impact healing time due to its toxic effect on keratinocytes and fibroblasts at higher concentrations. At our institution, an ABA-verified pediatric burn center, the use of a silver sulfadiazine cream for management of post-discharge perineal and genital burn wounds has been replaced by a zinc-oxide/dimethicone spray-on solution initiated for its comparative ease of use. The dimethicone allows the spray to be occlusive without interfering with clothing, yet easily removed. We believed this would improve compliance with at-home treatments. Zinc-oxide’s antimicrobial activity has been demonstrated in vitro and the results from animal studies are promising for burn management. This is the first study of zinc-oxide’s efficacy as a burn management agent in humans. Our burn center’s experience with both silver sulfadiazine and zinc-oxide/dimethicone creates an opportunity to compare these products for the treatment of burn wounds. We sought to analyze the time to healing of burns treated by silver sulfadiazine against zinc-oxide/dimethicone in order to determine if zinc-oxide/dimethicone, in its easy-to-use form, is a viable alternative to silver sulfadiazine.

Methods

A retrospective review of medical records was conducted at a large pediatric verified burn center. Data on 98 patients was collected from the burn registry and electronic medical records. 58 patients received silver sulfadiazine while 40 received zinc-oxide/dimethicone. Four patients were removed from the silver sulfadiazine group due to incomplete data. All patients were initially treated by the burn team with follow up in burn clinic on a weekly basis until healing was achieved.

Results

Time to healing was significantly lower in the zinc-oxide/dimethicone intervention group (10.61 +/- .918 days) than the silver sulfadiazine control group (16.88 +/- 2.134 days). The silver sulfadiazine group contained patients with total body surface area burns significantly greater than the zinc-oxide/dimethicone group (mean: 11.57% versus 6.64%); likely due to selective treatment when zinc-oxide/dimethicone was first introduced at our facility. Differences in depth and size of burn wounds may have confound our results and negatively impacted healing time in the control group. No infection, allergic reaction, or other adverse events were noted in any patient.

Conclusions

Zinc-oxide/dimethicone had a significantly lower healing time than silver sulfadiazine in the treatment of at-home, post-discharge 2nd degree pediatric burns to the perineum, genitalia, suprapubis, and buttocks. Further study is needed to quantify its efficacy.
572 Integrating Shared Governance Principles with Real-time Technology to Improve Infection Rates in a Large Burn Center with Patients of Varying Acuity Levels
Authors: Echols Jane , Gamble Ashley , Berry Lisa , Dowling Lynn , Wheeler Michael
Published: April 2021

Introduction

Increased job satisfaction, and nursing retention are outcomes that have been related to nursing empowerment.1 Probably one of the most beneficial results of nursing empowerment is improved patient outcomes.1 Empowering nurses is not always an easy task, but the nursing best practice of shared governance through unit-based councils gives nurses the ability to mobilize resources within their own groups to get things done. Couple this mobilization of resources with real-time technology that provides a true clinical picture of outcomes, and this creates a template for success.

Methods

This is a nursing Quality Improvement project. Shared governance in the form of unit-based councils created within all of our patient care units has proven to be part of the equation for improved infection rates in all units. Our number of CAUTI AND CLABIS from 2018–2019 were reduced, we significantly reduced the number of device days (hospital-wide) for both foleys and central lines, which was also a goal. Through extensive nursing education, utilizing nurse driven protocol for foley removal, increased use of bladder scanning (each unit now has their own bladder scanner) and teaching about de-escalation of central lines/PICC lines as soon as possible, we have been able to reduce our device days overall.

Alongside this nursing best practice, a new nursing data portal that allows for real time data collection to identify breaks in protocol with regards to central line and foley maintenance leading to CAUTIs and CLABSIs was also implemented, which allowed nursing to have direct impact on achieving success.

Results

Percent Change

2018 – 2019

CAUTI

BU = 83% decrease, 3E burn = 100% decrease, 4W burn = 100% decrease

Overall decrease = 90%

CLABSI

BU = 85%, 3E burn = 67% increase, 4W burn = no change

Overall decrease = 78%

Conclusions

Implementation of nursing best practice efforts such as shared governance and unit-based councils, coupled with cutting edge technological resources directly contribute to improved infection rate outcomes. Another result of these efforts is the overall positivity fostered among nursing staff, boosting their sense of empowerment and creating better retention rates in all our units.
573 A Novel Nursing Approach in Reducing Catheter-Associated Urinary Tract Infections in a Regional Burn Center
Authors: Smith Lisa C , Phillips Alexis T , Cox Carrie A , Orosco Rowena , Flores Carolina , Caffrey Julie
Published: April 2021

Introduction

Catheter-associated urinary tract infections (CAUTI) adversely affect more than 30% of patients in critical care hospital settings. Considered one of the most prevalent of nosocomial infections, CAUTI are linked to extended hospital stays, rising health care costs, and increased morbidity and mortality. CAUTI are attributed to prolonged catheter use, contaminated catheter insertion, and improper care and maintenance. Adhering to infection control guidelines is essential in preventing CAUTI in healthcare institutions. To illustrate, nearly 380,000 CAUTIs could be prevented and 9,000 lives saved, annually, with the prevention of CAUTI (Centers for Disease Control and Prevention, 2019).

Methods

Over the last nine months, our burn team has been working to reduce the CAUTI Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the Burn Center. Efforts to facilitate this reduction include the education of nurses and providers on the indications for placement, replacement, and removal of indwelling urinary catheters. We also developed and assigned a PowerPoint presentation and post-assessment to staff members to educate and measure their understanding of the proper care for patients with urinary catheters in place. The hospital facility’s protocol was revised to reflect the specific needs and alternatives for urinary catheters in our burn patient population. The new burn specific protocol now serves as a guideline for the multidisciplinary team during daily rounds to reduce the risk of CAUTI in the Burn Center. Charge Nurses continue regular audits.

Results

The SIR benchmark for 2019 was 0.774. The SIR for the Burn Center in the third quarter of 2019 was incalculable because the predicted number was less than one. The SIR for the fourth quarter of 2019 was 0.913. The SUR benchmark for 2019 was 1. The SUR for the Burn Center in the third and fourth quarters of 2019 were 1.035 and 1.150, respectively. This data indicated the need for a comprehensive plan for improvement.

Following the implementation of our team’s comprehensive improvement plan, the SIR and number of infections for the first quarter of 2020 was zero, which is below the SIR benchmark 0.727 for 2020. The improvement plan we instituted also reduced the SUR to 0.897 for the first quarter of 2020, compared to the benchmark of one for 2020. The SUR rate for the second quarter was 1.118.

Conclusions

Instituting this simple nurse-driven protocol has resulted in a noteworthy improvement in patient outcomes. Achieving benchmark goals remains a significant priority to our burn center team as we continue to see the progress and health benefits of fostering the safest care environment for our patients, while remaining financially responsible to our institution.
579 Benefits of Licensed Clinical Social Worker Utilization in an Adult Burn Clinic: More Than Just Checking the Box
Authors: Broers Michelle , Wojcik Jodi , Journey Lindsey k
Published: April 2021

Introduction

Our burn institution cares for critically ill burn patients and provides post-acute care for a large referral base. The clinic is staffed by a wound certified physical therapist, an advanced practice registered nurse and a licensed clinical social worker (LCSW), with consult access to Trauma/Burn Surgeons. The incidence of acute stress symptoms after burn injury is noted in up to 35% to 40% of patients. Therefore, it is important to identify symptoms of anxiety and depression early and begin symptom management. Burn patients have access to a multi-disciplinary team, and a licensed therapist, that can identify symptoms of acute stress and make recommendations for appropriate treatment in concert with the medical staff. This project seeks to determine the prevalence of acute stress in post-acute burn patients seen in an adult burn clinic and the benefits of utilizing a Licensed Clinical Social Worker to perform screening.

Methods

For a one-year period all burn patients in the burn clinic were screened by the LCSW. The subjects underwent initial screenings for depression, anxiety, and suicide risk at their first clinic visit. The PHQ-2 and PHQ-9 were utilized to assess depression, the GAD-7 for anxiety and the Columbia Suicide scale to assess suicide risk. Patients were initiated into multi-modal therapies based on specific scoring. These intervention strategies were based on the Depression Screening Protocol which included education on depression, and/or anxiety, with or without participation in a Trauma/Burn Peer Support Group. Patients were prescribed medication per provider discretion, and/or connected to community resources such as, counseling, and psychiatric mental health services.

Results

During the one-year assessment period screening compliance was >90%. During this period, >50% of patient’s scores were clinically significant for acute stress. Over half of those that screened positive were connected to community resources of counseling services or psychiatric care. 100% of those that screened positive were given education and connection to peer support services. An incidental correlation was noted between increased total body surface area involvement and work-related accidents with increased symptomology.

Conclusions

The inclusion of an LCSW in the burn clinic has improved the overall care of the burn injured patient. The assessment of depression and anxiety related to the burn injury has led to an increase in peer support participation and an increase in referrals to counseling and/or psychiatric services.
582 A Survey of Burn Care Providers Regarding the Utility of Telehealth to Provide Outpatient Burn Care
Authors: Foster Kevin N , Jacobsen Sarah J , Jain Arpana , Peck Michael , Richey Karen J
Published: April 2021

Introduction

Telehealth is purported to be the wave of the future, offering improved access to care by overcoming geographical and other logistical challenges while simultaneously improving efficiencies within the healthcare system. As the global COVID-19 pandemic swept through our state, we were abruptly forced to take our burn clinic to a telehealth platform for most patients. The purpose of this study was to evaluate our experience with telehealth in managing burn wounds and other complex skin defects.

Methods

A 16-item survey was developed using the framework outlined by the National Quality Forum for the development of telehealth measures. The survey was distributed to direct care providers and focused on the domains of experience and effectiveness and the subdomains of efficiency and satisfaction.

Results

There were a total of 14 respondents, including physicians, allied healthcare professionals, therapists and nurses. Seventy-seven percent of participants felt that overall, the system was efficient in the 4 categories of time required for scheduling, check-in, visit conduct and care coordination. Telehealth was deemed moderately to very effective by 80% in providing the patient access to care and the provider’s ability to educate the patient. However, providers, therapists and nurses uniformly found telehealth to be either not at all effective or slightly effective in assessing wounds, musculoskeletal function and developing a plan of care. When rating satisfaction with connectivity and overall quality of the clinic visit 70% of respondents were either dissatisfied/neither satisfied nor dissatisfied with the platform.

Conclusions

The operational aspects of our burn clinic telehealth program implemented during the COVID-19 pandemic were found to be largely satisfactory, with the exception of connectivity issues. However, the clinical aspects of the program were found to be largely unsatisfactory and, notably, were judged to be inferior to in-person visits.
590 Nonpharmacologic Pain Management in Pediatric Burn Patients: A Systematic Review
Authors: Gillum Matthew , Huang Samantha , Kuromaru Yuki , Dang Justin , Yenikomshian Haig A , Gillenwater Justin
Published: April 2021

Introduction

Pain is a universal feature of pediatric burns that is associated with long-term mental health consequences in this population. While pharmacologic therapy can alleviate pain, it does not always provide complete control and carries its own risks. Current literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct in pediatric burn patients. The aim of this systematic review is to summarize the literature of nonpharmacologic pain management in pediatric burn patients.

Methods

A systematic review was conducted using PubMed, Ovid MEDLINE, Scopus, and Web of Science. Keywords included: analgesia, pain, children, pediatric, paediatric, child, young, adolescent, burn, and scald. Papers were included if they were randomized, controlled, had original data, collected pain scores as a function of nonpharmacologic treatment, and were conducted on pediatric burn patients. Reviews, case reports, and opinion papers were excluded. Data were extracted on pain scale, pain score during and after treatment, and significance of results. Pain reduction was calculated as the percent difference between experimental and control pain scores, and treatments with significant pain reduction were considered effective.

Results

Sixteen studies were included, with nonpharmacologic treatments categorized as interactive (n=12) or passive (n=4). Interactive treatments required patient activity throughout treatment and included virtual reality (n=6), distraction devices (n=3), child life therapy (n=1), directed play (n=1) and digital tablet games (n=1). Passive treatments included cartoons (n=1), hypnosis (n=1), massage therapy (n=1) and music (n=1). Mean age was 8.39 years and percent total body surface area (%TBSA) burned was 5.95%. Treatment was effective in 9 out of 16 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 24.3% (n=12) and post-procedure pain by 33.6% (n=5). Of the studies reporting mid procedure pain, pain reduction was greater in interactive treatments (32.3% n=10) than in passive treatments (-15.6% n=2) (p=.016).

Conclusions

Nonpharmacologic therapy can be an effective adjunct in pediatric burn pain management. Significantly greater pain reduction in interactive treatments suggests distraction may lead to greater analgesia; however, the number of passive treatments for comparison was low. This study shows promise in the application of nonpharmacologic therapy, and further research will allow standardized algorithms to integrate nonpharmacologic therapy with medications.
593 Mortality of Burn patients over two decades: Improving outcomes in the elderly
Authors: Grigsby Melissa J , Romanowski Kathleen S , Sen Soman , Palmieri Tina L , Ponzini Matthew D , Taylor Sandra , Greenhalgh David G
Published: April 2021

Introduction

Shifting paradigms in the care of burn patients over the past two decades have led to the improved survival of adult and pediatric patients, but the same trend has not been manifested in the elderly population. We aimed to review our patient population, particularly the elderly, for the last twenty years and examine the relationship of age to the TBSA (total burn surface area) LD50 (lethal dose, 50%).

Methods

This IRB approved study retrospectively analyzed acute burn patients admitted at two academic regional burn centers from January 1, 1999 to August 1, 2019. Data collected included age, gender, TBSA, mortality, mechanism of burn, inhalation injury, and presence of full-thickness burn. The relationship between mortality and TBSA and age was assessed using logistic regression. The TBSA LD50 was calculated conditional on age and confidence intervals were constructed based on 1000 bootstrap samples.

Results

A total of 9,721 patients were admitted for treatment of acute burn injury between the two institutions. In our population, flame was the most common cause of burn injury (51%), full-thickness burns were present 47% of the time, and mean TBSA was 13%. The average patient age was 28, although there were 789 patients over the age of 65. The TBSA LD50 relationship to age best fit a cubic regression model with a peak of 81% TBSA LD50 at 17 years of age, rapid decrease early in the 5th decade and a general leveling out at the nadir of 27% TBSA (Figure). The LD50 did not reach 30% until 78 years of age.

Conclusions

Over the past two decades, elderly patients treated at our hospitals appear to have improved survival in comparison to the outcomes reported nationally. Due the ongoing rapid aging of the population, it is important that we continue to focus on both improving survival and delivering the best care to this vulnerable part of the population. Moreover, this continuous model could be used to track improvements in care within our institution and serve as a template for a national model.
597 Non-Survival Distributions in Paediatric Burn Patients; A Comparative Study of Two National Databases
Authors: Wermine Kendall , Gotewal Sunny , Schober Marc , Africa Robert , Hallman Taylor , Cuartas-Olarte Andres , Torres Mark Jason , Peterson Joshua M , Golovko George , Song Juquan , El Ayadi Amina , Wolf Steven E
Published: April 2021

Introduction

A contemporary, age-specific model for the distribution of burn mortality in children has not been developed for over a decade. Using data from both TriNetX, a global federated health research network, and the American Burn Association’s Nation Burn Repository (NBR), we investigated non-survival distributions for paediatric burns in the United States.

Methods

Paediatric burn patients ages 0–20 between 2010–2020 were identified in TriNetX from 41 Health Care Organisations (HCOs) using ICD-10 codes (T.20-T.30) and identified as lived/died. These were compared to the non-survival data from 90 certified burn centers in NBR database between 2016–2018. The patient population was stratified by age into subgroups of 0–4, 5–9, 10–14, 15–20 years. Descriptive statistics were generated and statistical analysed by chi-square; p < .05 was considered significant.

Results

81,507 and 21,442 unique paediatric burn patients were identified in the TriNetX and NBR databases, respectively. Overall non-survival rates were 0.62% and 0.52%, respectively. Boys had a higher incidence of mortality than girls in both databases (0.34% vs. 0.28% NBR, p = 0.13 and 0.31% vs. 0.21% TriNetX, p = < 0.001). When comparing age subgroups in TriNetX, burned children ages 5–9 had significantly increased frequency of non-survival, constituting 65% of all deaths (p = < 0.001). However, NBR data suggested that children 0–4 experience the highest frequency of mortality (p = < 0.001). Comparison of ethnic cohorts between 2010–2015 and 2016–2020 subgroups showed that non-survival rates of African-American children increased relative to white children (TriNetX, p = < 0.001), however evidence was insufficient to conclude that African-American children die more frequently than other ethnicities (NBR, p = 0.054).

Conclusions

Large sample size databases such as TriNetX and NBR afford sufficient statistical power to reflect relative non-survival rates in burned children. TriNetX also captures a unique demographic of burn patients not treated at ABA certified centers reporting to NBR, informing inferences on results. However, differences in reporting time periods must also be considered. Furthermore, potential ethnic disparities in paediatric non-survival outcomes were identified, meriting further investigation.
606 Is Social Media Contributing to a New Trend of Burns in Youth?
Authors: Ramos Margarita , Yerokun Oluwatobi , Lerman Sheera F , Caffrey Julie , Hultman Charles S
Published: April 2021

Introduction

Burn injuries in adolescents in the United States continue to occur at significant rates despite the many different programs focused on burn education and prevention. With the introduction of social media earlier in life and more social media targeting younger populations, our burn center has experienced a new class of burn injury: risky behavior promoted or encouraged as part of gaining social media popularity. Adolescents are likely the most vulnerable population in this type of risky behavior because of their access to social media and their willingness and ability to attempt the challenges, but younger children can also be burnt as bystanders or recruited participants by older minors. This study seeks to understand the content in social media which may lead to this risky behavior in minors.

Methods

We performed a term search in a popular social media application (TikTok) which included “burn”, “fire”, and “fire challenge””. We screened the top 50 most popular videos for each word search. Only videos which included footage of a person or body part being set on fire whether real or through a hologram or filters. We excluded videos showing professionals use fire (i.e. cooks, entertainers, welders, artisans), video game characters, videos with no body parts on fire. Metrics included in the social media were number of likes and number of views, as well as date posted.

Results

Six hundred and twelve videos were screened (153 videos in each search term category). A total of 20 (3.2%) of videos contained a demonstration of a risky behavior with fire. The most common content was four videos (20%) were the subject was setting one hand on fire. Two videos were pranks involving burning the pranked. Sixteen videos (80%) involved real fire and 4 (20%) involved a hologram of fire. The “likes” on the videos ranged from 1.9 million to 189. The comments ranged from 0 to 11,200. All of the authors were young adolescents or young adults. The videos had been there from 6 weeks to 21 months.

Conclusions

TikTok is a fast way to disseminate videos a large number of viewers. The majority of videos with content of risky behavior around fire are of individuals which are playing with fire or simulating playing with fire and often have no other overt agenda but to want attention and popularity. A minority of these videos are purposefully spreading risky behavior around fire as a “challenge” or “trend” to be copied by other TikTok viewers.
622 Enhanced Recovery After Surgery for Fractional CO2 Laser Treatment of Burn Scars
Authors: Virgadamo Lacy , G’Sell David , Smith Sydney , Mai Kathryn , Lavis Amy K , Jastram Charles W , Salinas Orlando , Phelan Herbert , Carter Jeffrey E
Published: April 2021

Introduction

Healthcare systems have adopted enhanced recovery after surgery (ERAS) programs as evidence-based, multimodal, and multidisciplinary perioperative approaches to mitigate complications and improve early recovery. ERAS programs modify psychological and physiological response to surgery with standardized care pathways that range from preoperative assessment and education through pharmacologic and surgical interventions. Our study demonstrates a burn scar specific ERAS protocol with pre- and post- intervention outcomes.

Methods

As part of a quality and performance improvement initiative, a multidisciplinary panel at an ABA-verified burn center consisting of burn nurses, burn surgeons, burn physician assistants, burn therapist, clinical pharmacist, certified medical laser safety officer, and anesthesiologist reviewed the available literature regarding pain, laser treatments, and medication histories of prior fractional CO2 laser treatments. The ERAS program was designed with preoperative, perioperative, and postoperative interventions to reduce pain and complications defined as unscheduled visits/admission to the ER or burn center, narcotic administration >1 hour post procedure, or wound complications secondary to laser treatment requiring dressing changes >1 week post-procedure. Quality and performance metrics were collected as a component of the burn registry program and reviewed twice monthly. The ERAS protocol preoperative phase included standardization of outpatient screening, assessment, and electronic medical record documentation. The perioperative phase included standardization of preprocedural medications including multimodal analgesia. The intraoperative phase included standardization of medications and dressing application. Post procedural phase included standardized instructions for wound care and follow-up.

Results

Pre-implementation complications over a three-month period included one patient requiring wound care >1 week post laser treatment and 4 patients requiring narcotic administration >1 hour post procedure (16% of laser cases). Post-implementation of the ERAS program no complications were identified in 62 cases over a three-month period.

Conclusions

At our institution a burn scar specific ERAS protocol reduced perioperative complications following fractional CO2 laser procedures. While many opportunities exist to improve scarring and pain, the multidisciplinary approach in burn care is as essential for outpatients as it is for inpatients at reducing avoidable complications.