bluuebunny/crossref_metadata_2025 huggingface dataset:
Microbiological quality of irrigation water on highly diverse fresh produce smallholder farms: elucidating environmental routes of contamination
Authors: Viviers Sheldon A , Richter Loandi , du Plessis Erika M , Korsten Lise
Published: April 2024

Aim

To evaluate the microbiological safety, potential multidrug-resistant bacterial presence and genetic relatedness (DNA fingerprints) of Escherichia coli isolated from the water-soil-plant nexus on highly diverse fresh produce smallholder farms.

Methods and results

Irrigation water (n = 44), soil (n = 85), and fresh produce (n = 95) samples from six smallholder farms with different production systems were analysed for hygiene indicator bacterial counts and the presence of shigatoxigenic E. coli and Salmonella spp. using standard microbiological methods. Identities of isolates were confirmed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and the genetic relatedness of the E. coli isolates determined using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) analysis. Irrigation water E. coli levels ranged between 0 and 3.45 log MPN/100 ml−1 with five farms having acceptable levels according to the World Health Organization limit (3 log MPN/100 ml−1). Fresh produce samples on four farms (n = 65) harboured E. coli at low levels (<1 log CFU/g−1) except for one sample from kale, spring onion, green pepper, onion, and two tomato samples, which exceeded international acceptable limits (100 CFU/g−1). Only one baby carrot fresh produce sample tested positive for Salmonella spp. Of the 224 samples, E. coli isolates were identified in 40% (n = 90) of all water, soil, and fresh produce types after enrichment. Additionally, the DNA fingerprints of E. coli isolates from the water-soil-plant nexus of each respective farm clustered together at high similarity values (>90%), with all phenotypically characterized as multidrug-resistant.

Conclusions

The clustering of E. coli isolated throughout the water-soil-plant nexus, implicated irrigation water in fresh produce contamination. Highlighting the importance of complying with irrigation water microbiological quality guidelines to limit the spread of potential foodborne pathogens throughout the fresh produce supply chain.
7 Alcohol Use Acuity and Burn Mortality: A Ten-Year Retrospective Analysis
Authors: Hollowell Jamie L , Levine Ashley , Bodek Benjamin , Agala Chris B , Maxwell Eli , Chrisco Lori , Matthews Robert W , King Booker , Williams Felicia
Published: April 2024

Introduction

The high incidence of alcohol consumption nationally is linked to increased susceptibility for burn injuries in both cases of acute intoxication as well as chronic misuse. While detection of elevated blood ETOH levels on admission intuitively does not always reflect a patient’s history of use, it does introduce bias and can influence clinical decision-making. Understanding these inherent biases at play, our institution through a retrospective analysis, sought to investigate the differing effects a positive blood alcohol level and true chronic alcohol use disorder had on overall mortality within our burn center.

Methods

We conducted a retrospective analysis utilizing data from the Institutional Burn Center Registry, which was linked to clinical and administrative records. Our study included all adult patients admitted to the Burn Center between January 1, 2012, and December 31, 2022. We collected and analyzed various parameters, including patient demographics, length of hospital stay (LOS), comorbid conditions, and mortality outcomes. Using logistic regression modeling we evaluated the association between burn mortality and ETOH.

Results

Over the ten-year study period, a total of 9,955 adult patients were admitted to our burn center. 6,943 tested negative and 541 patients tested positive for blood ETOH on admission. The remaining 2,471 had no test. 567 were determined to have a diagnosis of alcohol use disorder. A positive for ETOH did not have significant impact on mortality (p=0.76) while history of chronic ETOH use had a nearly three-fold increase in odds of mortality (OR 2.58, CI 1.52-4.24, p=0.000) when accounting for factors present in traditional predictive models such as burn size, age, and inhalational injury.

Conclusions

Chronic alcoholism has a greater association with mortality than acute alcohol intoxication at our institution. Further, clinicians should exercise caution when presuming alcohol use disorder solely based on a positive test. This highlights the necessity of accurate medical history taking when estimating and counseling patients on mortality risk.

Applicability of Research to Practice

This emphasizes the pressing need for research into the effects of multiple comorbidities and social determinants on mortality among burn patients. The insights gained have practical implications for refining clinical approaches and optimizing care strategies for this vulnerable patient population.
17 Fluid Resuscitation Effects Endothelial Glycocalyx Shedding in a Swine Model of Severe Burn Injury
Authors: Ziedins Eriks , Kelly Edward J , Parajuli Babita , Carney Bonnie C , Shupp Jeffrey W , Moffatt Lauren T , Burmeister David M
Published: April 2024

Introduction

Severe burn injury is associated with altered hemodynamics and inflammation that can lead to reduced organ perfusion with subsequent organ dysfunction. While this may be mitigated with aggressive IV fluid administration, both over and under resuscitation can lead to poor outcomes. Confounding matters is endothelial glycocalyx (EGL) damage, which has also shown to be affected by crystalloid administration and is normally represented with syndecan-1 (SDC1) levels. The aim of this study was to examine EGL damage with respect to the amount of fluid administered in a swine model of burn resuscitation.

Methods

Yorkshire pigs were anesthetized and subjected to 40% total body surface area burn and 15% total blood volume-controlled hemorrhage to combat splenic autoresuscitation. Pigs were randomly selected to receive: decision support driven (adequate), fluid withholding (under), and high constant rates (over) of resuscitation. Pigs were monitored for 24 hours post-injury. Blood and urine samples were collected at pre-determined timepoints and analyzed for SDC-1 and sulfated glycosaminoglycans (sGAGs).

Results

A total of 27 pigs were analyzed. Total fluid requirements was significantly elevated in the over group compared to the under resuscitated group (11052 ± 235 mL vs. 794 ± 535 mL, p=0.003), with higher urine output as well (3145 ± 382 mL vs. 861 ± 176 mL, p=0.0008). Lower MAP and higher heart rates at hour 18 post-burn were seen in the under resuscitated group compared to subjects receiving fluids (p=0.003 and p=0.03 for MAP and heart rate, respectively). Kidney damage was also seen with higher blood creatine level at hour 18 post-burn in the under group compared to both the adequate and over resuscitated groups (2.6 ± 0.18, 1.9 ± 0.3, and 1.2 ± 0.15 mg/dL, p=0.02 and p< 0.0001 respectively). There were significantly elevated levels of plasma SDC1 for the under group compared to the over resuscitated group at hour 6 and 12 (p < 0.05 for both) (Figure 1). There were significantly elevated levels of sGAGs for the under group compared to the adequate and over resuscitated groups at hours 1, 2, 3, and 6 post-burn (p < 0.05 for all) (Figure 1).

Conclusions

This animal model showed significant differences in some markers of EGL damage based on varying levels of resuscitation.

Applicability of Research to Practice

Further elucidation of these parameters as they relate to resuscitation may help aid in more individualized care for burn patients.
31 Establishing Pressure Parameters and Viability of a 3D Printed Dynamic Microstomia Prevention Orthosis
Authors: Whitehead Christopher , Hall Courtney
Published: April 2024

Introduction

Microstomia prevention orthoses (MPOs) are a standard of care for perioral burns to prevent and correct contractures due to hypertrophic burn scar. A simple, cost effective 3D printed MPO was designed with a dynamic middle component and two mouthpieces. Our goal was to establish parameters for providing appropriate pressure and to examine the viability of the design before implementation. Although effective pressure standards for dynamic MPOs have not been established, our objective is 15-25 mmHg based on the current literature for effective pressure therapy of hypertrophic burn scars.

Methods

Multiple MPOs were fabricated with varying levels of elasticity. Two variables were modified: the length in 1 cm increments (9 cm to 13 cm) and the level of infill by 10% (80% to 100%), resulting in fifteen separate devices. A digital force gauge was used to measure peak force in four positions of compression to determine pressure for the MPOs along the varying levels of mouth opening. Starting with the mouth pieces 1 cm apart, the distance was increased by 1 cm increments (1 cm to 4 cm) and measured. Using the force divided by the surface area of the device, the pressure was calculated. Three of the MPOs that provided consistent pressure through the widest coverage of mouth opening were selected for further testing. Ten duplicates of each of the three MPOs were fabricated and re-tested in the same four positions to assess the precision of the design. Another ten duplicates of each size were measured for force at one-minute intervals for ten minutes with the mouthpieces 2.5 cm apart to assess a decline in elasticity over time.

Results

The lengths of 10 cm, 11 cm, and 12 cm with 80% infill were selected because they provide coverage from 27.3 mmHg at 1 cm to 21.2 mmHg at 4 cm apart. The mean, standard deviation, and coefficient of variation were calculated to assess precision for all sizes in all four positions. The standard deviation ranged from 0.21 to 0.49 mmHg and was 0.9 % to 2.2% of the mean. When assessing decline in elasticity, the MPOs dropped an average of 3.97 mmHg over a 10-minute period with 76.97% of the decrease occurring within the first three minutes.

Conclusions

The use of three MPOs of the same infill but different lengths provide sufficient pressure across the various degrees of mouth opening. They demonstrate consistent pressures between orthoses of the same length and infill. While there is an initial drop in pressure after application, the devices continue to provide therapeutic levels of pressure during use.

Applicability of Research to Practice

These orthoses have been shown to reliably provide pressure and are ready to be incorporated into clinical practice. A sizing chart can be used to select the correct size MPO based on horizontal mouth opening. This simple but effective design has the potential to provide a low cost solution for burn microstomia with worldwide availability.
58 Objective and Subjective Melanin Measurements Within Dyschromic Scars Do Not Correlate: A Treatment Evaluation Problem
Authors: Collins Monica , Huang Jennifer , Travis Taryn E , McLawhorn Melissa M , Shupp Jeffrey W , Carney Bonnie C
Published: April 2024

Introduction

Dyschromia, the presence of hyper- and/or hypopigmented epidermis, is a common result of burn injury and is associated with negative aesthetic outcomes. Three clinical scales, the Patient and Observer Scar Assessment Scale - Patient (POSAS-P), Patient and Observer Scar Assessment Scale - Observer (POSAS-O), and modified Vancouver Scar Scale (mVSS) are used to evaluate dyschromia when assessing treatment options and outcomes. However, these assessment tools have yet to be validated against objective scar tissue melanin measurements. We hypothesize that these scar scales do not adequately capture pigmentation changes, necessitating more accurate metrics for clinical assessment.

Methods

Patients (n=98) with dyschromic burn scars due to thermal, chemical, electrical, or friction burns were recruited from a local burn center. Scars were rated on the POSAS-P, POSAS-O, and mVSS and the melanin content of uninjured skin and hyper-pigmented scar tissue was assessed using a Skin Color Catch non-invasive probe. The “degree of hyperpigmentation” (DOH) was calculated by the change in melanin content from the normal skin (NS) to the hyper-pigmented scar tissue, which was tested for correlation with POSAS-P-color and POSAS-O-pigmentation scores. The DOH between scars in each of the four categories of the mVSS-pigment was compared. For POSAS-P and POSAS-O, a higher score indicates more dyschromia. For mVSS, dyschromia is categorized.

Results

Hyperpigmented scars were on average 96.08±6.08 Melanin Index points higher than NS. Observers rated hyperpigmented scars high at 7.14±0.28 while patients rated higher at 7.67±0.24 (both out of 10). The most common mVSS-pigment category observed was 2, mixed pigmentation. The correlations between POSAS-P-color and DOH and POSAS-O-pigmentation and DOH were not significant (r=-0.033, p=0.7455 and r=-0.12, p=0.2323). Additionally, there were no significant differences in melanin index means between scars in the four mVSS-pigment categories (p < 0.05).

Conclusions

The non-significant correlation between the scoring value from the POSAS-P, POSAS-O, and mVSS with DOH indicate that these tools do not adequately capture degree of dyschromia in patients with dyspigmentation following burn injury.

Applicability of Research to Practice

The data from these scales should not solely be used to evaluate treatment effect.
132 Detailed Characterization of a Novel Human Ex Vivo Model for Burn Injuries
Authors: Kotzbeck Petra , Hofmann Elisabeth , Foessl Ines , Fink Julia , Eberl Anita , Magnes Christoph , Kolb Dagmar , Birngruber Thomas , Funk Martin , Kamolz Lars-Peter
Published: April 2024

Introduction

Burn injuries belong to the most common soft tissue injuries and often result in extensive trauma but are also associated with cases of major emergency such as sepsis or systemic inflammatory response syndrome. The early phase after burn injury is critical and decides about later potential complications in wound healing. Burn injuries activate numerous processes, including heat shock, inflammation and tissue regeneration responses and thereby promote the release of cytokines and other signalling molecules such as miRNAs and metabolites. Despite extensive research, skin tissue reactions in the early phases after burn injuries still need to be investigated in more detail. Therefore, reliable burn models are needed to elucidate the exact sequence of events during the healing process and to monitor potential biomarkers that could give information about treatment success.

Methods

We induced contact burns on fresh human abdominal skin explants that were resected during abdominoplasty. Gene and miRNA expression patterns, cytokine production profiles of key mediators such as IL8 and IL6 and skin ultrastructure were analysed for 24 hours after the burn injury. Additionally, we used open flow microperfusion (OFM), a sampling technique that allows time and location dependent collection of dermal interstitial fluid (dISF), to also monitor the release of specific miRNAs, cytokines and metabolites.

Results

In burn injuries, we found significant changes in gene and miRNA expression as soon as one hour after burn injury. Inflammatory genes such as IL8 were significantly up-regulated whereas miRNAs were systematically down-regulated. miRNAs were actively released and mobilized into the dISF, while miR-497-5p could be identified stably downregulated in tissue and dISF in the early phase after a burn injury. Metabolome analysis of dISF showed a striking metabolic shift in burn injuries, linking burn injury to increased amino acid and glucose turnover in wounds.

Conclusions

By using this ex vivo human skin model for burn injuries we were able to study the immediate early responses to burns for up to 24 h. We found that miR-497-5p could serve as potential biomarker to assess burn severity since it is not only down-regulated in skin but also mobilized into the dISF after burn injury. Furthermore, we found distinct metabolite signatures after burn injury.

Applicability of Research to Practice

Identification and research on potential biomarkers to assess burn severity and treatment success.
512 Length of Stay Prediction Based on an Artificial Neural Network
Authors: Bandaru Vishal , Youssi Brandon , Morgan Ryan D D , Nguyen Kevin M , Liu Xiyu , Chaudhury Tristin , Griswold John A , Pang Alan
Published: April 2024

Introduction

Hospital length of stay (LOS) is difficult to predict in patients with burn injuries due to the complexity of the injuries and the wide variability in patient outcomes. Predicting hospital LOS in patients with burn injuries can have numerous benefits for patients, physicians, and insurance companies. Artificial neural networks may offer insight into more accurate LOS predictions.

Methods

We obtained electronic health records (EHR) for burn patients from July 01, 2011 - July 01, 2021. An artificial neural network was used to model the relationship between the input features and LOS. The input features were preprocessed by normalizing each feature to the range [0, 1] and transformed using log normal. The preprocessed data was split into training (70%), validation (15%), and testing (15%) sets. The neural network consisted of one hidden layer with 13 neurons and a linear output layer.

Results

The neural network achieved an R-squared (R2) value of 0.72 on the training data, indicating that 72% of the variance in the data (n=1347). The validation and testing R2 values were 0.66 and 0.68, respectively. The overall R2 value, computed by combining the predictions on the training, validation, and testing data, was 0.70. The best performance, validation performance, and testing performance achieved by the neural network during the training process were 0.28, 0.27, and 0.30, respectively. These values indicate the average squared difference between the predicted output and the true output for each set, with lower values indicating better performance.

Conclusions

The results suggest that the neural network can model the relationship between the input features and LOS with reasonable accuracy. The R2 values indicate that the model explains a substantial amount of the variability in the data. Further testing and validation may be needed to assess the robustness and reliability of the model.

Applicability of Research to Practice

Patient outcomes are largely variable and determining LOS to a closer degree helps planning more robust treatment plans. Additionally, these models have the potential to serve as a more accurate gauge of whether they are following closely to their expected treatment timeline. As survival rates continue to improve, the improvement focus has and will continue to shift towards patient outcomes.
524 Nutritional Risk in Frostbite
Authors: Graves Caran , LaChapelle Christopher R , Thompson Callie M , Fleming Irma D , Lewis Giavonni M
Published: April 2024

Introduction

People with frostbite are often unhoused and have a history of substance use which increases risk of malnutrition. In this retrospective study, we sought to evaluate malnutrition risk and incidence in those with frostbite admitted to an academic medical center.

Methods

Medical records of adults admitted with frostbite (ICD codes T33, T34) in 2019-2021 and with stays >4 days were reviewed. Data included anthropometrics, housing status, substance use and nutritional status. Patients were screened for nutritional risk using a modified malnutrition screening tool which focused on recent weight loss. High risk patients received an in-depth nutritional assessment. Nutritional interventions provided were also noted.

Results

A total of 109 patients were admitted with frostbite and 42 (93% male) met inclusion criteria. Most had stable housing (69% housed; 31% unhoused) and 90% had insurance (mainly Medicare/Medicaid). Patient-reported alcohol (33%) and drug use (29%) were common among both housed and unhoused. Housed patients reported higher use of alcohol than unhoused (43% vs 6%) with similar reported use of other drugs. Three patients were at high risk for malnutrition based on recent weight loss. The remainder did not meet high risk screening criteria as 31 denied weight loss and 8 did not know. Five patients (12%) received a focused malnutrition evaluation but only three (all with reported weight loss) met criteria for malnutrition. All patients tolerated oral diets and 6 (14%) received supplemental enteral nutrition; no one required parenteral nutrition.

Conclusions

This study population included a higher percentage of unhoused people than our usual thermal burn injured population. Frostbite patients also commonly used alcohol and drugs. Housing status and substance use are frequently cited risks for malnutrition, however, we did not identify malnutrition often in this population. Weight loss is a major risk factor for malnutrition and given the paucity of reported pre-admit weight loss this risk factor may have limited use for referral for a more focused nutritional evaluation.

Applicability of Research to Practice

Few patients had malnutrition identified on admission which is inconsistent with published reports. Relying on self-reported weight and intake may obscure risk in this population and presents opportunity for more focused screening in our patients.
549 Diabetic Foot Burns: A Single-Institution Retrospective Study Assessing Operative and Non-operative Outcomes
Authors: Cannata Brigette , Malkoff Nicolas , Choe Deborah , Manasyan Artur , Wang Sarah , Choi Katherine , Gillenwater Justin
Published: April 2024

Introduction

Foot burns in patients with diabetes mellitus (DM) tend to be more severe with delayed presentation due to comorbid peripheral neuropathy (PN) and peripheral vascular disease (PVD). Impaired wound healing in diabetes further complicates management. Currently, there is no consensus on best management of diabetic foot burns. Our regional burn center has adopted a treatment algorithm that prioritizes non-operative local wound care instead of early excision and grafting. Here we characterize the diabetic foot burn patients treated at our institution to compare the outcomes of patients treated operatively and non-operatively.

Methods

A retrospective review of all patients with DM admitted to a large urban burn center between 1/1/2015 and 6/30/2023 was conducted. Adult (age >18) patients with burns involving the foot were included for analysis. Patients with inaccessible charts and patients with burns greater than 20% total body surface area (TBSA) were excluded. In addition to descriptive statistics, linear and multinomial regression analyses were performed.

Results

A total of 3,035 DM patients were identified, of which 197 (6.5%) were adults with burns involving the foot. After additional screening, 172 patients were included for analysis. The mean patient age was 56.3 years (standard deviation 11.6), and 134 (77.9%) were male. Admission hemoglobin A1C was >7% in 66.9% (n = 115) of patients. Common comorbidities included PN (44.2%), PVD (8.1%), and obesity (37.2%). The majority of burns were partial thickness (72.1%, n = 124) and affected 2.5% TBSA or less (75.6%, n = 130). The plantar foot was involved in 50% (n = 86) of cases.

Only 12.8% (n = 22) of patients were managed operatively, including debridement (9.9%, n = 17), grafting (5.8%, n = 10), and amputation (4.1%, n = 7). While 5 patients (2.9%) were primarily amputated, 2 patients (9.1%) were secondarily amputated, defined as amputation after initial debridement and grafting. Surgical management was significantly associated with increased days to wound closure (standardized coefficient = 0.251, p = 0.002) and increased length of stay (standardized coefficient = 0.576, p < 0.001). Surgical management (OR 9.3, p = 0.02, CI = 1.34 - 64.39) and peripheral neuropathy (OR 6.9, p = 0.03, CI = 1.24 - 38.68) were independent predictors of wheelchair-dependency at discharge compared to normal ambulatory status.

Conclusions

Surgical management of foot burns in diabetic patients is associated with greater morbidity, including longer wound closure times, longer hospitalization, and decreased functional status at discharge. These findings suggest that local wound care of diabetic foot burns may yield better clinical outcomes than operative management.

Applicability of Research to Practice

This study can be considered when recommending treatment options for diabetic foot burn patients.
566 Burn Camp Volunteers Exhibit High Levels of Emotional Intelligence; Attributes to Consider for Volunteer Recruitment
Authors: Rimmer Ruth Brubaker , Bay Curt C , Kalil Emile T , Chacon Daniel W , Robaina Tess , Foster Kevin N
Published: April 2024

Introduction

Volunteers are the lifeblood of burn camp. However, there is a paucity of information regarding the individuals who donate significant time and resources to the camp process. This study sought to assess participant demographics and to measure their emotional intelligence. Higher emotional intelligence (EI) is associated with the ability to monitor and label one’s own and others' emotions and use these skills to pay better attention, be more engaged and more empathetic to others while developing positive relationships; all skills important for working successfully and effectively with burn-injured youth.

Methods

Burn camp volunteers from 3 U.S. burn camps completed the Assessing Emotions Scale (AES), a 33-item valid self-report screen measuring Emotional Intelligence (EI). Respondents rate themselves using a 5-point Likert scale ranging from 5 (strongly agree) to 1 (strongly disagree). A total score is calculated from the sum of all items. A higher score indicates a higher level of EI.

Results

Participants included 119 adult volunteers, female (n=64), and male (n=53). By ethnicity, counselors were Caucasian (75%), Hispanic (13%), African American (3%), and Asian (3%), with the majority in the 20-45-year age range (76%). Volunteers’ professions included firefighters (24%), medical professionals (16%), educators (5%), business (11%), and other (49%). Many (34%) reported being burn survivors, and 26% reporting visible scarring. Female and male participants scored significantly higher than normative means - females 130.05 vs. norm of 121.1. (p< 0.001) and males 129.4 vs. norm of 107.01 (p< 0.001). Burn survivors and Hispanics both reported notably high mean scores of 132. Educators had the highest mean at 137.

Conclusions

It appears that the participating burn camps are doing a good job of recruiting volunteers with high emotional intelligence. This is important because it indicates the participant characteristics include optimism, impulse control, and greater empathic perspective-taking. Of note, the majority of participating counselors were Caucasian, as compared to only 33% of campers.

Applicability of Research to Practice

A concerted effort for the continued recruitment of counselors exhibiting high EI attributes is advised. EI testing may be a beneficial screening tool for volunteer applicants as the competition for burn camp volunteer slots.
571 The Trauma Burden of Pediatric Burns in Low- and Middle-Income Countries: A Systematic Review
Authors: Park Flora , Ruiz Andres , Pang Jonathan , Young Kirsten , Roth Bradley , Smith Emily , Chin Theresa L
Published: April 2024

Introduction

Pediatric burns place a disproportionate burden of injury on low- and middle-income countries (LMICs). With this systematic review, we aimed to illustrate trends in pediatric burn epidemiology in LMICs and describe possible areas for international intervention.

Methods

We performed a systematic review of existing literature on pediatric burns in LMICs. PubMed and MEDLINE databases were searched for primary studies conducted in LMICs reporting pediatric burn incidence, male-to-female ratio, mortality, and mechanism of injury. A quality assessment analysis was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results

The search yielded 867 unique articles, of which 14 studies met MINORS criteria. The included studies covered pediatric burn data from 9 LMICs: Rwanda, Malawi, Uganda, Bangladesh, Sudan, Pakistan, Cameroon, Kenya, and Fiji. Upon qualitative analysis, burns were found to be the most common mechanism of injury and cause of death compared to other traumatic injuries in children under 5-years-old. The most common mechanism of burn was reported to be scald injury due to cooking accidents. Incidence of pediatric burn injury was difficult to calculate for LMICs as only three studies reported this information. The incidence of pediatric burns per 100,000 in Sudan, Kenya, and Fiji respectively were reported to be 1010, 4887, and 32.6. Lower socioeconomic status and access to surgery were cited as the most common barriers to adequate burn care in LMICs.

Conclusions

The burden of pediatric burn injury on LMICs is significant and can be characterized using a quality-controlled systematic review. Further standardized studies must be conducted in collaboration with LMICs on this topic.

Applicability of Research to Practice

Our study illuminates potential routes for improvement in pediatric burn management and prevention in LMICs, and we hope to encourage more conversation around this topic led by LMIC researchers and healthcare providers.
592 Pressure Garment Use by International Pediatric Patients During the COVID-19 Pandemic: A QI Study
Authors: Minter Debbie , Freeman Lauren , Greenhalgh David G , Palmieri Tina L , Romanowski Kathleen S , Sen Soman , Heard Jason
Published: April 2024

Introduction

Pressure therapy is a standard intervention for the treatment of hypertrophic scars. Due to the COVID-19 pandemic, our international burn outreach programs were canceled between March 2020 and June 2022 so the ability to monitor pressure garments was lost. During this time, patients were discharged from our burn unit with two sets of properly fitting pressure garments (PGs) but were unable to be provided with replacement sets in their home country. Our burn team used this unique opportunity to perform a QI study of how this lack of access to follow up care impacted our patients’ pressure therapy programs.

Methods

Surveys were given to pediatric patients in three of our reinstated international burn outreach clinics in 2023. Surveys were in the patient's native language with written instructions and were completed by the caregivers while waiting for their appointment. Patients with a date of injury occurring in 2019 or later who were discharged with PGs to their home country from our facility were included in the survey. Patients who were still using PGs were excluded.

Results

Fifty-four patients were included in the study with mean age at time of discharge of 6yr3mo and age range 10mo-17yr. The length of time that PGs were worn is summarized in Figure 1 with 46% of patients stopping PG use between 4-6 months and 39% stopping at one year or greater. The reasons for terminating PG use are summarized in Figure 2 with 68% of patients stopping due to outgrowing the garments. In terms of alternate solutions used, only 9% of patients tried to alter or repair the PGs or sought inexpensive off-the-shelf products as replacements. 17% used bandages when the PGs no longer fit.

Conclusions

A significant number of patients in our outreach clinics stopped using PGs between 4-6 months. This is considerably shorter than the one-year standard of care received by our local patients. A high number of patients also reported wearing them for a year, however, it is questionable how effective the initial sets of PGs would be after this length of time given that evidence suggests garments have significant pressure loss within the first two months. More studies are needed to determine the impact of reduced garment wear on these patients.

Applicability of Research to Practice

Compliance to pressure therapy programs is impacted by access to care. In order to follow best practice guidelines, solutions need to be explored to improve availability of serial sets of properly fitting pressure garments. Additionally, families may benefit from education that empowers them to make alterations and repairs as needed and to seek inexpensive off-the-shelf options when the custom PGs no longer fit.
597 Hypercalcemia in Burn Intensive Care: A Retrospective Analysis with Implications for Patient Outcome Prediction
Authors: Bandaru Vishal , Chaudhury Tristin , Chaudhury Hannah , Tran Vivie , Meltan Shakira , Keshvani Caezaan , Pang Alan
Published: April 2024

Introduction

Burn injuries account for significant acute hospitalizations in the US and are a global concern with approximately 180,000 deaths annually. These injuries elicit drastic changes in serum calcium levels due to physiological systems and factors such as imbalances in bone formation/resorption, Acute Renal Failure (ARF), burn severity (BSA) and patient immobilization. This study aims to explore the multifaceted causes of hypercalcemia in burn patients at our university hospital. We conducted a preliminary study of n= 200 burn patients and noted a strong positive correlation between peak calcium with acute renal failure, cardiac arrest, and TBSA (total body surface area).

We hypothesize that patients with higher burn severity, longer hospitalization, and renal complications will experience a more significant increase in serum calcium. Additionally, patients with hypercalcemia are expected to have higher morbidity and mortality rates than those with normal calcium levels.

Methods

This was a retrospective hypothesis-driven study of n= 832 burn patients that aims to analyze calcium levels by utilizing our hospital burn registry and Electronic Medical Record to gather pertinent data.

Results

After adjusting for age, comorbidities, and TBSA percentage, there was a strong negative correlation between nadir calcium and arrhythmia (r = -0.21), renal failure (r = -0.34), and morbidity (r = -0.34). There was no correlation between peak calcium and these three categories mentioned. Nadir calcium was negatively correlated with total length of stay (r = -0.47), mortality (r = -0.26), and total TBSA (r = -0.38). In addition, admission calcium levels had a strong positive correlation with nadir (r= 0.31) and peak calcium (r= 0.44) levels.

Conclusions

Compared to the preliminary study, a positive correlation was not observed between peak calcium and arrythmia, renal failure, and total TBSA. This data gathered emphasized nadir calcium as a potential marker for patient outcomes for admitted burn-related injuries. In addition, nadir calcium’s strong correlation with admission calcium suggests large fluctuations between these variables could help assess patient outcomes.

Applicability of Research to Practice

This study suggests potential connections between burn-related injuries and nadir calcium levels, underscoring the necessity for further research and rigorous statistical analysis. These findings could potentially prompt the adoption of nadir calcium as an admission marker for detecting potential adverse effects in clinical practice.
705 C. difficile Enterocolitis Diagnosis Elevated in Critically Ill Burn Patients Following Antibiotic Treatment
Authors: Nicot-Cartsonis Mathilda , Hallman Taylor , Song Juquan , Golovko Georgiy , Wolf Steven E
Published: April 2024

Introduction

C. difficile colitis (C diff colitis) is identified in up to 500k infections/year in the US, with up to 30,000 people per year dying with the diagnosis. Previous studies established risk factors for this condition including long-term antibiotic use. Burn patients are typically exposed to many antibiotics over long periods of time, and may have lengthy hospitalizations similar to other critically ill patients. Neither of these populations have been studied in terms of C diff colitis, risk and outcomes alike. Our aim is to compare C diff colitis rates among critically ill and non-critically ill burn populations, and to investigate the use of antibiotics prior to diagnosis.

Methods

All analyses were generated with TriNetX platform software (TriNetX, Cambridge, MA) in 2023. We compared incidence of C diff colitis in non-critically ill and critically ill burn populations, and non-burn injury control groups. Cohorts were propensity matched for age at diagnosis, sex, and race/ethnicity. The difference between groups was tested using the log-rank test and quantified with hazard ratios (95% CI), calculated with TriNetX Analytics features. We examined length of hospital stay of cohorts, antibiotic use prior to C diff colitis diagnosis, death within 1 year, and colectomy/toxic megacolon diagnosis.

Results

We found critically ill patients are diagnosed with C diff colitis at similar rates (OR = 1.065, 95% CI = 0.89, 1.276), but non-critically ill burn patients have a higher rate of C diff colitis compared to non-burn injury counterparts (OR = 1.713, 95% CI = 1.471, 1.995). Antibiotics use up to 2 weeks prior to C diff colitis diagnosis was higher in C diff colitis patients in all four cohorts. Specifically for critically ill burn C diff colitis patients, penicillin (p=0.0072), quinolones (p< 0.0001), tetracyclines (p=0.0037), trimethoprim (p=0.0011), vancomycin (p< 0.0001), clindamycin (p< 0.0357), metronidazole (p< 0.0001), and sulfonamides (p=0.0005) were all given more frequently as compared to counterparts without C diff colitis.

Conclusions

Critically ill burn patients are at an increased risk of C diff colitis compared to non-critically ill burn, as are critically ill non-burn patients. C diff colitis remains significantly associated with antibiotic use, and in the setting of critical illness and burn, is a notable risk factor.

Applicability of Research to Practice

C diff colitis remains a threat to hospitalized and burn patients, for the critically and non-critically ill, and antibiotics treatment could be more aware of the worse consequence.
716 Autologous Skin Cell Suspension for Dorsal Hand Burn Treatment
Authors: Maestas Joseph , Stanton Eloise , Cohen Kenzie , Johnson Maxwell B , Gillenwater Justin
Published: April 2024

Introduction

Intermediate and deep partial-thickness dorsal hand burn injuries require timely and appropriate care to preserve both form and function. Split-thickness autografting (STAG) remains the standard of care but requires postoperative immobilization and a large donor site. Autologous skin cell suspensions (ASCS) are prepared from a small piece of autograft and are an alternative to STAG for partial thickness burns. They have minimal donor site morbidity and do not require postoperative immobilization. This study aims to assess the utility of ASCS in the treatment of intermediate and deep partial thickness burns of the dorsal hand.

Methods

This IRB-approved retrospective case series identified patients at a regional burn center with intermediate and deep partial-thickness hand burn injuries who were treated with ASCS alone. Data on injury etiology, demographic information, complications, functional variables, and treatment outcomes were collected.

Results

Ten male right-hand dominant patients with intermediate to deep partial thickness dorsal hand burns were identified, with a mean total body surface area involvement of 12.0±9.3%. On average, patients received ASCS alone for their hand burns on post-burn day 7.3±2.5. All ten patients resumed occupational therapy on postoperative day one. Nine patients had full upper extremity range of motion on day of discharge, which occurred on average 9.1±7.0 days after surgery. Four patients developed hypertrophic scarring without range of motion limitation of the ASCS treated hand. One patient experienced ASCS failure and required autografting for wound closure.

Conclusions

This retrospective case series presents ASCS as an effective wound closure strategy for intermediate to deep partial thickness hand burn injuries. In select patients, ASCS minimizes donor site morbidity and permits immediate upper extremity rehabilitation with excellent functional outcomes..

Applicability of Research to Practice

This research highlights the potential benefits of using ASCS for the treatment of dorsal hand burn injuries and thus suggests a possible change in current burn would management.
733 Pediatric Burns: A Single Institution Retrospective Review of Incidence, Etiology, and Outcomes in 685 Patients
Authors: Chaudhry Bilal M , Lee Subin , Pineda Jonathan , Marano Michael A , Lee Robin A , Song Cherry , Lee Christina J
Published: April 2024

Introduction

Nearly 300 children die from burn injuries every year, and over 100,000 are admitted to a hospital or treated in an emergency department in the United States. Although largely preventable, burns remain a leading cause of morbidity in the pediatric population globally. This study assesses all pediatric burn admissions to a State Wide Certified Burn Treatment Center to evaluate trends in demographics, burn incidence, and cause across different age groups.

Methods

Demographic and clinical data were collected on all pediatric burn admissions during an 8 year period (2015-2022). These patients were stratified by age into "age 0 to 6," "age 7 to 12," and "age 13 to 18." Data were analyzed using standard statistical methodology. A state wide map was created allocating all patients into their respective zip codes to aid in targeting pediatric burn prevention programs.

Results

A total of 685 burn patients under age 18 were treated between 2015 and 2022. A total of 511 (74.6%) patients were ages 0 to 6, 89 (12.9%) were 7 to 12, and 85 (12.4%) were age 13 to 18. A total of 362 (52.8%) were male and 323 (47.2%) were female (male: female ratio of 1.12:1). Hispanics had the highest burn admissions across all age groups (35.8%), followed by African-Americans (23.6%). Caucasian teenagers formed the largest part (41%) of the teenage admissions. Mean TBSA burned was 8.9%, with torso being the most common site (68%). Scald burns constituted the majority of cases (83.4%, n = 571), with 70% attributable to hot liquids related to cooking, including coffee, tea or soup. In the 0-6 age group scald burns were the overwhelming cause (92.6%). In the teenage group, flame burns were the dominant cause (47.1%). Overall mean length of stay was 10.9 days for all patients. A total of 159 patients (23.2%) required an ICU admission. Seventeen patients (2.6 %) required a ventilator. Overall mortality was 0.4% (n = 3).

Conclusions

The majority of pediatric burn admissions were caused by scald burns, ages 0-6 were the most vulnerable in this regard. Flame burns predominated in the teenage population. Mean TBSA burned was 8.9% with the torso being the most likely to be involved. Mean length of stay was 11 days, 23% required ICU and 2.6% required a ventilator. Mortality was 0.4%.

Applicability of Research to Practice

The results of this study emphasize the need to target etiology specific burn prevention programs against scald burns in the very young (0-6yrs) and flame burns in the teenage population. Geographic depiction aids in highlighting the more vulnerable counties in our state.
759 Burn Injury Impacts Estrogen-treated Postmenopausal Women
Authors: Song Juquan , Golovko Georgiy , Botnar Kostiantyn , ayadi Amina E I , Vincent Kathleen L , Wolf Steven E
Published: April 2024

Introduction

Postmenopausal women are often treated with exogenous female hormones to alleviate mental and physical symptoms. Basic research studies showed the benefit of estrogen treatment on the improvement of cardiac function following burn injury. We posit that women treated with hormone replacement (HRP) fare better following severe burn.

Methods

De-identified patient data were obtained from a global healthcare Research network in March, 2023. Female patients greater than 18 years of age with the diagnoses of menopause were enrolled if they further encountered burn injury within 10 years. Patients with pre-existing gynecologic and chronic liver/heart diseases were excluded. The study population were grouped into those with or without estrogen treatment (ET) for complication examination in both short- and long-term periods . Cohort balancing was performed regarding age, race, and ethnicity using an exact match approach and controlled by the Chi-Square test. Subsequently, the odds ratio (ORs) was computed for these harmonized cohorts. All data manipulation was executed using a custom Python (version 3.10) program in conjunction with Scipy (version 1.11.1) and Pandas (version 2.0.3) libraries.

Results

In the 3-month observational period, women with ET had lower incidence of acute kidney injury and breast cancer [0.475/0.247-0.879, (ORs/95%CI) and 0.362/0.209-0.608]. Other complications were higher in patients with ET including osteoporosis [1.29/1.243-1.596], cerebral infarction [1.735/1.087-2.81], and acute myocardial infarction [3.0/1.776-5.292]. When observation extends to 3 years after injury, patients with ET had similar observations of decreased acute kidney failure [0.236/0.056-0.749], however, increased chronic kidney disease (CKD) [1.203/1.007-1.438], osteoporosis [1.338/11.083-1.654], breast cancer [1.513/1.217-1.885], and acute myocardial infarction (MI) [6.281/1.372-58.484]. All above data were significant with p values < 0.05.

Conclusions

ET in postmenopausal women was associated with decreased acute kidney injury after burn injury, however, also with increased CKD, osteoporosis and MI from 3 months to 3 years after injury. This is not consistent with the ET protective effect seen in rodent burn injury models, therefore, further study on the dose and duration of treatment is warranted as this study in postmenopausal women was primarily low dose, in the range of estrogen or hormone replacement therapy.

Applicability of Research to Practice

Current levels of estrogen provided with Estrogen or Hormone Replacement Therapy do not appear adequate to provide protection that has been seen in preclinical studies, therefore clinical studies to determine dose of estrogen at the time of burn injury should be instituted.