bluuebunny/crossref_metadata_2025 huggingface dataset:
56 The Impact of a Nurse Morbidity and Mortality Meeting
Authors: Figel Ginny
Published: April 2021

Introduction

Physicians have long held Morbidity and Mortality (M&M) conferences to discuss complications and deaths. The format for these conferences lays out the case, discusses care performed, and generates discussion on areas of opportunity. Physician M&M usually focuses on teaching and the presenter may not be the caregiver. There is not much literature on the use of this teaching methodology in nursing. Due to the strong culture of safety on the unit, it was determined that using a similar format for nursing on the Burn Unit could prove beneficial for discussion of complications, deaths, errors, and good catches.

Methods

Nurse M&M is held monthly for one hour. The nurses are given the opportunity to present the individual case or give personal testimony as to the situation from their point of view. The cases are all presented in the same format. The initial slides cover background, history of present illness, and where the report came from. Next is all of the pertinent review from the electronic charting system and any discussions had with those involved in the case. The presenter then opens up the floor for discussion. If there was a variation in practice, the policy or procedure that relates to the error is reviewed. Topics for Nurse M&M are gathered through many different venues. The hospital uses an online reporting system for electronic submission of adverse events, variations in care, and good catches. The entire multidisciplinary team have all individually reported something they wanted discussed at Nurse M&M. If clarification is needed on a case, the question is punted back to the appropriate decision maker and followed up to the staff.

Results

Nurse M&M is the most highly attended, non-mandatory, meeting held on the unit. The nursing staff was surveyed to determine their perceptions on how the addition of Nurse M&M had effected them. The results were overwhelmingly positive. All nurses surveyed rated the statement, “I feel that Nurse M&M has had a positive outcome on the unit’s collective practice”, as agree or strongly agree. Over time, the notes taken have evolved into a basic table of what was discussed and if there were action items created off of a case. The staff have come to the point where they will self-report events before they are entered into the online system.

Conclusions

In conclusion, the Burn Unit nursing staff are highly engaged Nurse M&M. The staff are open to discussing errors in a way that fosters educational growth and critical thinking development. Even if the case being discussed is because of a personal error, more often than not, the person responsible will discuss why they made the decision they did and facilitate the discussion with their peers as to what could have been done differently. The bedside nurses’ commitment to being present, engaged, and open minded are strong signs of the healthy work environment present on the unit.
60 A Retrospective Review of Factors Influencing Post-Hospital Discharge Follow-up in Patients with Burn Injuries
Authors: Taylor Ryan C , Islas Claudia , Richey Karen J , Foster Kevin N
Published: April 2021

Introduction

Approximately 486,000 burn injuries, requiring hospitalization and/or outpatient care occur annually. Physical and psychosocial problems may develop at any time during recovery and it is important that care continue after discharge to maximize outcomes. Often, patients discharge themselves from clinic for unknown reasons. The purpose of this study was to identify factors related to self-discharge.

Methods

A retrospective chart review of patients admitted to the burn center and outpatient follow up visits in 2018 was performed. Patients were grouped by lost to follow up (LTF) versus completed patients (COM). The LTF were further stratified by distance from clinic (≤ 50 miles vs. > 50 miles). COM were categorized as those who were discharged from clinic as PRN follow up visits.

Results

A total of 211 patients were scheduled for outpatient visits, mean age was 36.4 years and 74% were male. Most were Caucasian (41%) and Hispanic (31%). The most frequent payor sources were Medicaid (58%)/ Medicare (17%). Mean TBSA was 5.8 %, the most common mechanisms were Flame/Flash and Scald (30% each). Mean length of stay was 10.3 days, mean number of surgeries was 1.5. The majority of patients were discharged Home (71%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. LTF patients had a smaller TBSA (4.69%) compared to COM (9.62%). Comparison between LTF and COM, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=< 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p< 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group. When LTF were stratified by distance, Native Americans were significantly more likely to live > 50 miles from the clinic (p < .00001).

Conclusions

A large percentage of patients discharged themselves from clinic. Factors associated with self-discharge include healed wounds, no scarring issues, smoking, substance abuse and mental illness. Given the geographic distribution of races and ethnicities in our state, it is unsurprising that Native Americans live distant to our clinic. This provides an opportunity to expand our outreach efforts and incorporate the use of technology to improve access to care for this population.
62 The Essential Need of Having Dedicated Clinical Social Workers in Both the Burn Outpatient and Inpatient Setting
Authors: Dines Margaret , Smith Tyler M , Lambert Wagner Anne L
Published: April 2021

Introduction

By providing holistic support to the entire patient, a licensed clinical social worker (LCSW) plays an essential role on a Burn Center multidisciplinary team. A majority of our burn population exhibit difficulties in navigating the complex array of psychosocial issues in regard to basic needs such as employment, food, housing, and transportation. While these needs can be addressed with inpatients, our patients who follow-up in Burn Clinic face additional challenges. A need was identified to have a dedicated LCSW in the outpatient setting.

Methods

As with the continued growth of inpatient admissions in our burn center, our burn clinic encountered an even higher number of new patients. With limited bandwidth, our burn LCSW was seeing both inpatient and clinic patients. Recognizing the need for additional support, the hospital’s care management department approved a full-time outpatient Burn Clinic LCSW position. Their role will include trauma screens, mental health, and psychosocial support to patients in clinic rather than providing reactive support to the most acute patients.

Results

In FY2019, our Burn Center admitted 501 patients across a seven-state region. Our Burn Clinic saw 1132 patients with 1932 clinic visit encounters. In addition to seeing all admitted patients, our inpatient LCSW also saw 13.7% (n=155) of the clinic patients and had 175 documented encounters. Furthermore, 16.6% (n=188) of these clinic patients had a form of Medicaid Health Insurance.

Conclusions

The capacity to provide access and resources to our patients has been limited to the time of one LCSW. By hiring a dedicated Burn Clinic LCSW, we will be able to increase our patients’ abilities to navigate barriers, while limiting unnecessary hospital resources with Emergency Department visits and readmissions. The clinic LCSW will assist by finding primary care physicians, transportation and housing needs, applying for disability, and accessing community resources such as our SOAR support group.
83 Burn Injuries in Sub-Saharan Africa: A Global Burden of Disease Study
Authors: Collier Zachary J , Naidu Priyanka , Choi Katherine J , Pham Christopher H , Potokar Tom , Gillenwater Justin
Published: April 2021

Introduction

Over 1 million burns occur in Sub-Saharan Africa (SSA) each year leading to significant morbidity and mortality. Financial constraints, social stigma, political strife, inaccessible healthcare facilities, limited perioperative resources, and low workforce capacity results in steep barriers to obtaining timely and effective burn care. This study set out to better define the burn burden as well as the age and gender-related disparities within SSA, to identify specific sub-regions and countries that would benefit most from targeted interventions to enhance burn care.

Methods

Data for all 46 SSA countries were acquired from the 2017 Global Burden of Disease (GBD17) database of the Global Health Data Exchange. Information regarding fire, heat, and hot substance-related injuries was derived from 17,792 data sources to estimate burn-related incidence, deaths, and Disability Adjusted Life Years (DALYs) by year, sex, age, and location from 1990 to 2017. Summative statistics were created for burn incidence, deaths, DALYs, and mortality ratio (deaths: incidence; %). Spatial mapping was performed to identify burn burden for specific regions and countries.

Results

An estimated 28,127,199 burns occurred in SSA from 1990–2017. On average, SSA accounted for 16% of worldwide burns, 21% of burn deaths, and 25% of DALYs. Furthermore, the mortality rate was 2.2 times the global average and remained nearly double the entire 27-year period. While all SSA regions had higher incidence, deaths, and DALYs compared to the global cohort, the Southern SSA region consistently had the highest incidence (211 cases per 100,000), deaths (7 per 100,000), and DALYs (355 years per 100,000) throughout the time period, with Lesotho, Swaziland, and Zimbabwe having the highest rates. In contrast to gender similarities globally for burn indicators, all regions within SSA showed higher incidence rates (144 vs 136 cases per 100,000), deaths (5.4 vs 4.7 deaths per 100,000), and DALYs (289 vs 272 years per 100,000) for men than women when age standardized.

Conclusions

With an estimated 1.4 million burn injuries in 2017, SSA accounted for over 15% of all worldwide burns and 20% of global burn deaths. Although all trended rates improved over the years for each country, they were consistently worse and slower to improve in all regions of SSA compared to the rest of the world. While both Central and Southern SSA regions had the greatest burn burden, burns in Central SSA more significantly impacted those under 5 years whereas Southern SSA saw the greatest burden on the 15–49-year age group.
94 Agreement Between Proxy- and Self-Report PROMIS Scores in Pediatric Burn Survivors
Authors: Amtmann Dagmar , Bamer Alyssa M , McMullen Kara , Stewart Barclay T , Kazis Lewis E , Rencken Camerin A
Published: April 2021

Introduction

Reporting by proxy is necessary when patients are not able to report their own experience, such as young children or those too sick to respond. PROMIS pediatric proxy-report item banks are a set of generic measures that facilitate comparisons across populations and studies. Our objectives were to (1) examine agreement in pediatric burn survivors between child self- and caregiver proxy-report on multiple PROMIS domains and (2) examine factors associated with differences between self- and proxy-reports.

Methods

Data were collected from children 8–17 years with moderate to severe burn injury and their respective caregivers between 6 months and 15 years after injury. The PROMIS-25 and Anger v1.0 short form were completed by pediatric burn participants. Caregivers completed either custom (depression, pain interference) or standard (Physical Function (PF) 8a, Peer 7a, Anger 5a) PROMIS proxy short forms. Self- and proxy-report scores were compared using Wilcoxon sign rank test, Cohen’s effect size, and intraclass correlation coefficients (ICC(2,1)) and by agreement across severity of symptoms based on recommended cutoffs. Regression analyses examined child- (self-report score, age, gender, and ethnicity) and proxy-related (relationship to child) factors associated with score differences.

Results

A total of 274 child-caregiver pairs completed the PROMIS measures. Mean child age was 13.0 (SD:3) years. Caregivers reported significantly worse scores than the child on PF, pain, and anger (all p≤0.01). Cohen’s d ranged from 0.05 (depression) to 0.25 (PF), with all domains except PF in the small effect size range (< 0.2). Similarly, ICCs were all of moderate agreement and ranged from 0.51 (pain) to 0.69 (depression). The percentage of dyads in agreement by severity groups was high with only 5% (pain), 8% (PF, peer relationships), and 9% (depression, anger) of pairs discordant. Regression models indicated only higher self-report score was associated (all p< 0.05) with greater differences across all domains, though female gender was also associated with greater differences on depression only.

Conclusions

This study provides support for the use of pediatric proxy PROMIS depression, PF, peer relationships, pain interference, and anger scales in pediatric burn patients. Although agreement was moderate to good, proxy report should only be considered when self-report is not possible or practical. Caregivers typically report slightly worse severity of symptoms than children across all domains.
99 Barriers of Follow Up within the Burn and Wound Population.
Authors: Tay Erika , Ochtli Ché R , Kirby Katharine A , Carmean Melissa , Bernal Nicole O , Joe Victor C , Chin Theresa L
Published: April 2021

Introduction

Access to quality health care services is important for acute burn care, but comprehensive burn care goes beyond acute hospitalization. Follow up is an essential part of recovery, where providers can assess late effects of burn and help the patients with community re-integration, injury rehabilitation, and mental health. However, not all patients return for follow up after burn injury due to barriers in care and patient characteristics. We hypothesized that patients with neuropsychiatric comorbidities and 0–10% of total body surface (TBSA%) are more likely to be lost at follow up compared to patients with no neuropsychiatric comorbidities and higher TBSA.

Methods

A retrospective analysis was completed on patients that were admitted to a verified Burn Center from January 2016 to June 2019. Patients that were under 18 years of age and patients that died prior to discharge were excluded. Patient characteristics included were age, gender, TBSA, discharge location, payer, and comorbidities. Univariate analysis was completed using Tableau and multiple logistic regression analysis using Stata. Neuropsychiatric comorbidities were defined as dementia, alcoholism, major psychiatric disease, and drug dependence. Lost to follow up was defined as no follow up in clinic after inpatient discharge date within 1 month.

Results

Of 562 patients, 35.94% (n=202) were female and 65.12% (n=366) were Caucasian followed by Asian 13.7% (n=77) and Other Race 13.7% (n=77). Of the 562 patients, 157 (27.95%) were lost to follow up. After adjusting for insurance type, race, and medical comorbidities, patients with neuropsychiatric comorbidities had double the risk (OR 2.052; 1.377 - 3.057 p< 0.001) to be lost at follow up compared with those that did not have neuropsychiatric disorders. Homelessness was collinear with neuropsychiatric comorbidities suggesting an association.

Patients with a TBSA >20% (n=37) were 3 times more likely to be lost at follow up in comparison with patients with 0–10% TBSA. (OR 2.921; 1.455–5.861 p< 0.003).

Race, medical comorbidities, and insurance status had no significant impact on follow up.

Conclusions

Patients with dementia, alcoholism, major psychiatric disease, and drug dependence were more likely to be lost at follow up. Contrary to intuition, patients with burns >20% TBSA were also less likely to follow-up. Additional research is needed to better identify how psychosocial factors affect follow up in our burn patients and how to address those barriers. By focusing on our population and their needs, we can adjust our practices to make sure that we are providing holistic burn care.
106 Frailty Assessment in the Burn Population: A Single Center Retrospective Review
Authors: Horrell Erin Wolf , Mubang Ronnie , Folliard Sarah A , Beyene Robel , Gondek Stephen , Thompson Callie M
Published: April 2021

Introduction

Burn morbidity and mortality increases with advancing age. Frailty is characterized by reduced homeostatic reserves and is associated with an increased biological age compared to chronological age. Our primary aim was to determine whether frailty as assessed on admission would be predictive of outcomes in the burn population.

Methods

We conducted a single institution 7-month retrospective chart review of all admitted acute burn patients ages 45 and older. Patient and injury characteristics were collected and compared using standard statistical analysis. Frailty scores were assessed upon admission using the FRAIL Scale.

Results

Eighty-five patients met inclusion criteria and were able to complete the FRAIL assessment. Patient and injury characteristics are listed in Table 1. Mean burn size was 6.7%TBSA (95%CI 4.9–8.4%). 34 patients (40%) were classified as robust (FRAIL score 0), 26(30.6%) as pre-frail (FRAIL score 1-Patients in the pre-frail/frail cohort received more palliative care consultations (p=.096) and had a longer length of stay (3.3d vs 7.55d p = .002), while prefrail patients had a similar LOS to frail patients (7.46 vs 7.64d p =.938). Patients in the pre-frail/frail cohort were also more likely to be discharged to a higher level of care than they were admitted from(p=.032) with prefrail patients experience an escalation in level of care more frequently than frail patients. The distribution by age by half-decade ranges is in Figure 1. By age 55–59, the majority of patients were prefrail or frail.

Conclusions

We demonstrated that frailty as assessed by the FRAIL score was predictive of increased length of stay and an escalation in post discharge care. In addition, patients characterized as pre-frail experience outcomes similar to frail patients and should be managed as such. Given the prevalence of frailty and prefrailty in the younger group of patients, we advocate for routine frailty screening beginning at age 55.
108 Length of Stay per Total Body Surface Area Relative to Burn Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study
Authors: Patterson Kelli N , Horvath Kyle , Onwuka Amanda , Fabia Renata , Giles Sheila , Marx Daniel J , Aguayo Pablo , Ziegfeld Susan , Garcia Alejandro , Stewart Dylan F , Fritzeen Jennifer , Burd Randall S , Vitale Lisa C , Klein Justin D , Thakkar Rajan K
Published: April 2021

Introduction

Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients have been performed at single institutions and based on ranges of TBSA burn. A LOS to TBSA burn ratio of 1:1 has also been widely accepted but not confirmed over time across numerous institutions. The objective of this study was to use multi-institutional pediatric burn data to describe benchmarks associated with LOS per TBSA burn.

Methods

Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for 1004 patients (n=1004) treated at five pediatric burn centers from July 2018-March 2020. LOS/TBSA burn ratios were calculated for each site. LOS/TBSA burn by institution and mechanism were analyzed. Generalized linear regression models were used to model the effect of hospital and burn mechanism on the LOS/TBSA ratio.

Results

Among the 1004 injuries, the most common burn mechanism was by scald (64%), followed by contact (16%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.3 days (SD 2.2). Flame burns had a higher LOS/TBSA burn ratio than scald burns with a mean LOS/TBSA burn of 1.63 compared to 0.84. In adjusted models, scald burns, and chemical burns had the lowest LOS/TBSA burn ratio and electrical and friction burns had the highest LOS/TBSA burn ratio. The LOS/TBSA burn ratio was comparable across hospitals after adjustment for mechanism, with just Hospital 4 having a lower average LOS/TBSA burn of 0.49 days.

Conclusions

These data establish a multi-institutional ratio for the overall performance in LOS for pediatric burn patients. A LOS per TBSA ratio of about 1 was observed across PIQIC centers, except for a lower ratio at one center. Additionally, it provides evidence on the variance in LOS per TBSA burn relative to the sustained burn mechanism. Further collaborative data analysis will allow us to recognize specific patterns and outcomes in pediatric burn care, which is essential for the implementation of quality improvement standards.
114 The Patient’s Perspective: Burn Reconstructive Surgery During the Pandemic
Authors: Won Paul , Celie Karel-Bart , Gillenwater Justin , Yenikomshian Haig A
Published: April 2021

Introduction

The novel Coronavirus disease 2019 (COVID-19) has created profound challenges in healthcare delivery. Hospital systems have delayed or shut down elective surgeries and outpatient care. These measures resulted in profound disruptions to burn treatment regarding reconstructive care from surgery to therapy. This study aims to characterize burn patients’ perspectives on elective reconstructive surgery during COVID-19.

Methods

As part of a quality improvement initiative, a 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center during COVID-19 was conducted. Responses regarding willingness to undergo reconstruction during COVID-19, perceived medical and personal impacts of COVID-19, and perspectives on telehealth were gathered. Surveys were administered over the phone in English and Spanish to burn patients or to primary caregivers in the case of pediatric patients.

Results

We surveyed 23 participants who met our inclusion criteria. Average age was 23 and 43% were male. We found 22 (96%) patients were willing to undergo reconstruction during the COVID-19 pandemic. Table 1 outlines the responses to questions regarding telehealth and being a burn patient during COVID-19. Examples of stressors experienced by patients and their families due to COVID-19 included: inability to communicate with healthcare providers in person, increased anxiety in public places, delayed surgical care, and interruption of physical or occupational therapy. Family members in 5 out of the 8 Spanish speaking households lost their job due to COVID-19, resulting in financial stress for the burn patient.

Conclusions

The majority of patients expressed strong desires to return to surgical and therapy care delayed by COVID-19. Patients reported feeling especially vulnerable as burn patients and cited receiving healthcare and financial stressors as a result of the COVID-19 pandemic as the main causes.
115 The Impact of Burn Injury on Upper Extremity Prosthesis Users
Authors: Cancio Jill M , Borgia Matthew , Cancio Leopoldo C , Resnik Linda
Published: April 2021

Introduction

Burns with upper extremity (UE) amputation present a unique rehabilitation challenge. The purpose of this study of UE amputees who are active prosthesis users was to compare outcomes for those with and without burns.

Methods

This is part of a larger nationwide study of U.S. military members and veterans with UE amputations. In-person data were collected at 5 sites. An therapist measured passive and active range of motion (PROM, AROM); administered the Quick Disability of the Arm, Shoulder, and Hand; Community Reintegration of Injured Service Members-Computer Adaptive-Test; Trinity Amputation and Prosthetic Experience Scale; health-related quality of life (VR-12); Activities Measure for Upper Extremity Amputees; Southampton Assessment Procedure; 9-Hole Peg Test; and Jebsen-Taylor Hand Function Test (JTHF); and recorded residual and phantom pain; timing of prosthesis receipt; and current prosthesis use. The IRB approved this study.

Results

Data were collected on 126 individuals with UE amputation, of whom 105 had data on etiology and were included. Of these, 13 (12.4%) had burns (B) vs non-burn (NB). The majority were unilateral amputees (69% B, 90% NB). Most were transradial (TR) amputees (B 84.6%, NB 66.3%) as opposed to transhumeral (TH). A minority received their prosthetics within the first 3 months post-amputation (11.1% B, 28.8% NB) (p=0.15). Average age was 57.6 (SD 15.6) years for NB and 53.0 (20.6) years for B. Mean time since amputation was 22.5 (18.0) years for NB and 25.2 (17.3) years for B. The following non-significant differences in outcomes between B and NB were observed. Thirty-nine percent of B were employed full-time vs 18.9% of NB (p=0.15). The primary prosthesis was, for NB, a body-powered prosthesis (66.7%); for B, myoelectric (50%) or body-powered (50%). For unilateral UE amputees, there were no differences between B and NB on performance testing for dexterity and functional tasks or in self-reported disability, quality of life or prevalence or intensity of pain. B trended towards more moderate to severe PROM deficits with shoulder forward flexion (TH B 50%, TH NB 23.1% [p=0.444]; TR B 20%, TR NB 5.6% [p=0.197]) and shoulder abduction (TH B 50%, TH NB 26.9% [p=0.497]; TR B 30%, TR NB 16.4% [p=0.376]). Also, TR amputees with burns trended towards more PROM deficits with elbow flexion (B 20%, NB 6.9% [p=0.212]) and elbow extension (B 20%, NB 8.6% [p=0.272]). AROM deficits also trended greater in B.

Conclusions

We did not observe differences in physical function, pain levels, or quality of life between those with and without burns. Further studies with larger samples are needed, to include analysis of burn location, burn size, hospital length of stay, and rehabilitation care.
124 Autologous Skin Cell Suspension Achieves Closure of Donor Site Wounds Facilitating Early Re-harvesting for Large TBSA burn Injuries
Authors: Foster Kevin N , Molnar Joseph , Hickerson William L , Lee Jeanne , Hartman Brett C , Carter Jeffrey E , Kahn Steven , Sood Rajiv , Coffman Beretta C , Holmes James H
Published: April 2021

Introduction

Management of extensive burn injuries is complicated often resulting in significant morbidity and mortality. Current standard of care includes use of split-thickness skin grafts (STSG) to obtain definitive closure; however, this treatment is often limited by donor site availability, which requires repeated re-harvesting of donor sites to obtain definitive closure in large total body surface area injuries. Additionally, this limitation often leads to increased risk of infection, hypertrophic scarring, and extended hospital length of stay.

Autologous skin cell suspension (ASCS) prepared using the autologous cell harvesting device is an FDA approved point-of-care regenerative medicine technology that significantly reduces donor skin requirements to achieve definitive closure in acute thermal burn injuries across small and large burns. A prospective uncontrolled observational study (IDE 15945—NCT02992249) was conducted in which patients with life-threatening burn injuries were treated with ASCS. In this study, clinical outcomes were evaluated when ASCS was used in combination with wide meshed autografts for burn site treatment. Within the study, a subset of donor sites was also treated with ASCS and the purpose of the current work was to evaluate the clinical outcomes obtained to better understand impact on healing times and effect of re-harvesting in this compromised patient population.

Methods

ASCS was applied to the donor site after harvesting of split-thickness skin grafts. Clinical outcomes out to one year were evaluated, including the percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events.

Results

Subjects (n=96) from 22 burn centers received ASCS as part of their donor site treatment regimen (n=528). Mean subject baseline demographics were: 30.2 years of age, 54.0 ± 17.4% TBSA injury, and 89.4 ± 32.9 Baux score with 37% of subjects having a score greater than 100.

Percentage of donor sites healed, defined as >95% re-epithelialization, was 37.1% and 82.7% after week 1 and week 2, respectively. Approximately 20% of the donor sites treated with ASCS were re-harvested multiple times following initial healing (up to four times). Of these donor sites 39.3% (n=84), 81.0% (n=79), and 85.7% (n=77) were healed by week 1, week 2, and week 4, respectively.

Scar assessments conducted on 427 donor sites after one year showed the majority had matched or mildly mismatched color, pigment, and texture. Safety analyses of adverse events (AEs) following ASCS treatment were unlikely or unrelated to the device.

Conclusions

This study demonstrates successful use of ASCS to achieve closure of donor site wounds in patients with extensive burn injuries.
131 Burn-Induced Coagulopathy: Burn Patient Plasma Causes Platelet Dysfunction
Authors: Gibson Breanne H , Duvernay Matthew T , Gondek Stephen , Schoenecker Jonathan G
Published: April 2021

Introduction

Burn-induced coagulopathy (BIC) greatly increases the risk of thrombosis, leading to organ dysfunction and death. Although BIC is attributed to a multitude of factors including hemodilution, SIRS, and excess coagulation, the exact molecular mechanisms are elusive. Determination of these mechanisms is essential to develop new strategies aimed at reducing the morbidity and mortality of BIC as commonly used anticoagulants are ineffective at preventing the consequences of BIC. Platelet dysfunction, which has been associated with bleeding, thrombosis, poor wound repair, and susceptibility to infection, occurs in BIC, but the etiology of this phenomenon is unknown. Burn injuries provoke a dramatic increase in plasma levels of inflammatory, coagulation, and fibrinolytic factors, potentially altering the physiology of blood cells and platelets. Therefore, we hypothesized that burn patient plasma pathologically alters normal platelet function.

Methods

In this prospective study, plasma samples were collected from 32 adult patients with burns >10% TBSA at a regional burn center. To assess the effects of burn plasma on platelet function, platelets isolated from healthy individuals were incubated with heparinized plasma from burn patients or control plasmas (N=15) for 2 hours. Following incubation, platelets were stimulated with various agonists, and markers of platelet activation (GPIIb/IIIa activation and P-selectin expression) were measured using flow cytometry.

Results

Platelets incubated with burn plasmas exhibited a reduction in response to stimulation compared with those incubated with control plasma. Both GPIIb/IIIa activation and P-selectin expression were affected, suggesting a defect in platelet signaling. This dysfunction did not strongly correlate with TBSA affected or modified Baux score but was significant when compared to healthy controls (P< 0.05). However, measurement of markers of inflammation, coagulation, and fibrinolysis in burn plasmas revealed a significant correlation of both plasma D-dimer (P< 0.02) and soluble P-selectin (P< 0.05) with induced platelet dysfunction. This suggests circulating factors indicative of coagulation, fibrinolysis, and endothelial dysfunction may play a role in platelet dysfunction observed in BIC.

Conclusions

This study demonstrates an in vitro effect of burn patient plasma on platelet function, suggesting a possible benefit for resuscitation with FFP. BIC is a principal source of morbidity and mortality in burn patients, and current thromboprophylaxis for burn patients may not address critical elements of BIC. Future studies are required to optimize resuscitation and minimize the consequences of BIC.
132 A Novel Murine Model of Burn-Induced Platelet Dysfunction
Authors: Gibson Breanne H , Duvernay Matthew T , Gondek Stephen , Schoenecker Jonathan G
Published: April 2021

Introduction

Platelet dysfunction has been demonstrated as a part of burn induced coagulopathy (BIC), however, the etiology and clinical significance are unknown. Determining the etiology and clinical significance of BIC platelet dysfunction is difficult in humans due to heterogeneity of injuries and treatment. The goal of this study was to develop a murine model of BIC burn-induced platelet dysfunction to allow for high-throughput investigation of the mechanisms and the possible effects platelet dysfunction has on burn outcomes.

Methods

Using an established murine model of burn injury, we investigated plasma and cellular markers of BIC. Under adequate anesthesia and analgesia six-week-old C57BL6/J mice were administered a ~30% TBSA dorsal burn by scalding. Sham animals received identical preparation and resuscitation without the burn injury. Blood was collected at 6-, 24-, and 48-hours post-burn for measurement of platelet function, and plasma was isolated for protein measurements of coagulopathy (N=5 per group per time point).

Results

Like findings in humans, mice exhibited systemic markers of BIC (excess coagulation, fibrinolysis, and inflammation) within the first 6–24 hours post-burn. Platelets in whole blood were treated with platelet agonists ADP and PAR4-activating peptide (PAR4AP), and markers of platelet signaling and function (P-selectin expression and GpIIb/IIIa activation) were measured by flow cytometry. At 6 hours post-procedure, platelets from burn mice exhibited a slight, insignificant increase in markers of activation and response to stimulation compared with platelets from sham mice. At 24 hours post-burn, burn mice exhibited a significant decrease in platelet count (P< 0.02) and platelet function indicated by reduced GpIIb/IIIa activation (P< 0.01) and P-selectin expression (P< 0.05)in response to ADP and PAR4-AP compared with sham mice. Platelet function began to return at 48 hours post-burn with no significant difference between groups.

Conclusions

Platelet loss and dysfunction occur after burn injury, but the consequence of these effects is not well understood. The findings in this study are consistent across multiple experiments and resembled platelet dysfunction observed in different human traumatic injuries, validating the murine model as an inexpensive and efficient model of human injury in which to study platelet defects and the molecular mechanisms driving them.
136 Use of 816 Consecutive Burn Wound Biopsies to Inform a Histologic Algorithm for Burn Depth Diagnosis
Authors: Phelan Herb A , Holmes James H , COCKERELL Clay J , Hickerson William L , Shupp Jeffrey W , Carter Jeffrey E
Published: April 2021

Introduction

Burn experts are only 77% accurate when subjectively assessing burn depth, leaving almost a quarter of patients to undergo unnecessary surgery or conversely suffer a delay in treatment. To aid clinicians in burn depth assessment (BDA), new technologies are being studied with machine learning algorithms calibrated to histologic standards. Our group has iteratively created a theoretical burn biopsy algorithm (BBA) based on histologic analysis, and subsequently informed it with the largest burn wound biopsy repository in the literature. Here, we sought to report that process.

Methods

This was an IRB-approved, prospective, multicenter study. A BBA was created a priori and refined in an iterative manner, resulting in the current state of the algorithm seen in Figure 1. Patients with burn wounds assessed by burn experts as requiring excision and autograft underwent 4mm biopsies procured every 25cm2. Serial still photos were obtained at enrollment and at excision intraoperatively. Burn biopsies were histologically assessed for presence/absence of epidermis, papillary dermis, reticular dermis, and proportion of necrotic adnexal structures by a dermatopathologist using H&E with whole slide scanning. First degree and superficial 2nd degree were considered to be burn wounds likely to have healed without surgery, while deep 2nd and 3rd degree burns were considered unlikely to heal by 21 days. Biopsy histopathology results were correlated with still photos by 3 burn experts for consensus of final burn depth diagnosis.

Results

Sixty-six subjects were enrolled with 117 wounds and 816 biopsies. The BBA was used to categorize 100% of subjects into 4 categories: 7% of burns were categorized as 1st degree, 13% as superficial 2nd degree, 43% as deep 2nd degree, and 37% as 3rd degree. Therefore 20% of burn wounds were incorrectly judged as needing excision and grafting by the clinical team. As H&E is unable to assess the viability of papillary and reticular dermis, with time our team came to appreciate the greater importance of adnexal structure necrosis over dermal appearance in assessing healing potential.

Conclusions

Our study demonstrates that a BBA with objective histologic criteria can be used to categorize BDA with clinical misclassification rates consistent with past literature. This study serves as the largest analysis of burn biopsies by modern day burn experts and the first to define histologic parameters for BDA.
502 Adapting to COVID19: Can Virtual Burn Camp be as Impactful as Last Year’s In-person Camp?
Authors: Banks Jessica , Ferdock Matt , Nagle Jennifer
Published: April 2021

Introduction

Skin is not the only casualty following a burn accident. Many children suffer long term, debilitating emotional effects from their burn injury (Abdullah et al. 1994; Kornhaber et al. 2018). Armstrong-James et al. (2018) and Maslow and Lobato (2010) found that summer camps explicitly designed for burn survivor children can positively impact children’s adaptability to stares and comments and improve their sense of self-esteem. Camp Susquehanna has been a summer camp for burn survivors for the past 25+ years. When the COVID19 pandemic closed many businesses, we decided to transition our in-person camp to 100% online. Researchers demonstrated the positive effects of summer camp for burn survivors (Maslow & Lobato, 2010; Bakker et al. 2011). However, the effects of a 100% online camp are not known. Our concern was, are we able to transition and be as impactful as it is face to face at camp? What will the schedule and activities look like in this new format? How will we ensure all children participating will have access to online and the supplies necessary?

Methods

We opted to select a three-week format with two sessions a day divided into two age groups. We ensured every child had internet access then mailed out a “camp in the box.” It contained all the things needed for each planned activity. The critical question remained, however, will we be as impactful? The current research looks at quantitative and qualitative measures of self-esteem, happiness, and satisfaction following participation in a three-week summer program held in July 2020. We make comparisons to previous years’ results. The authors expected that self-esteem, happiness, and satisfaction levels matched or exceeded last years’ levels.

Results

We collected data from 42 campers and 22 volunteer camp counselors. Results show that campers were able to receive the support they needed, not only from the staff but also from their peers.

Conclusions

The delivery method was indeed different this year, but the positive effect on our campers remained the same.
504 Creative Aftercare Program Amidst Coronavirus Pandemic
Authors: Henry Shana M , Kopari Nicole M
Published: April 2021

Introduction

Coronavirus disease presented itself early in 2019 inducing a considerable degree of fear, worry, and unknown throughout the United States. National and State governed laws imposed social distancing measures, quarantining citizens, and isolating infected persons. Apart from its physical impact, COVID-19 pandemic has brought numerous changes to people’s lives affecting people both physically and psychologically. A key component of quality of life of burn survivors consist of maintaining a long-term burn center connection through support groups. Our burn center developed a virtual format for aftercare to provide psychological support during the pandemic.

Methods

Regular attendees and new burn survivors were contacted by the aftercare specialist from an American Burn Associated verified burn center. Participants were surveyed on the best mode of contact and current addresses were obtained. “Happy Mail” was mailed to support group participants 3 times/month. Items included in these packages ranged from motivational sayings, gift cards, essential oils, candies, art projects, and reminders to log onto the virtual support groups. The gift packages also included a mental health check-in icebreaker. These gift packages took the place of our in-person support groups and contained all materials needed to engage and guide participation in the virtual monthly support group. Participants were then invited to join a social media support group for our local burn center.

Results

Burn survivors continued to receive quality psychosocial support to cope with and process feelings as well as validate emotions. Attendees regularly expressed gratitude in receiving “Happy Mail” as it brought a feeling of connectiveness to a group of burn survivors who rely on each other for peer support. The gift packages also served as a reminder of the upcoming virtual aftercare support groups as our attendance did not see a decline at monthly meetings.

Conclusions

Our experience suggests that a method of offering “Happy Mail” as part of a curriculum to augment virtual aftercare can be a model to adapt to the emotional support burn survivors and their family members need during the pandemic.
505 Support Group Lives on Virtually Despite Pandemic
Authors: Deeter Lyndsay , Garber Rebecca
Published: April 2021

Introduction

Support group for burn survivors is immensely beneficial for reintegration and normalization of the burn recovery. The corona virus pandemic, however, limited in-person interactions significantly and decreased the travel capabilities. Our regional burn center serves an 8-state region, and as such, our every other month in-person support group consisted of survivors and family members from a large geographic area.

Methods

Support group volunteers and staff members recognized the need for continued support of survivors during the pandemic. Limitations of large, in-person meetings were implemented by our host organization to comply with pandemic safety guidelines. Evaluation of resources available led to development of a virtually supported meeting space. Email addresses were gathered to schedule. This allowed for interaction of survivors from an unlimited geographic area.

Results

Support group survivor volunteers and staff met to develop parameters, topics, IT support and logistics. Every other month support group was converted to a monthly gathering virtually due to easier access by survivors. Attendees completed a survey to evaluate and make recommendations for opportunities for improvement. The same number of survivors were present for in person and virtual meetings.

Conclusions

During this pandemic, limitations were placed that further isolate survivors. A virtually based support group has allowed for more frequent interactions between volunteers and new survivors. Various topics were discussed including survivor preparedness for public reintegration, worker’s compensation and care giver burnout. Speakers from multiple disciplines have been able to address issues requested by survivors. In this format, we have been able to continue the support of our survivors as they continue to recover. Social distancing has isolated many people during the pandemic; virtual support group has been paramount in continuing to connect our survivor family.
511 A Retrospective Review of the Timing of Tracheostomy in Mechanically Ventilated Patients
Authors: Foster Kevin N , Munaim Juzer R , Engineering Biomedical , Islas Claudia , Osborn Suzanne C , Spadafore Philomene , Richey Karen J
Published: April 2021

Introduction

Tracheostomy is indicated for prolonged mechanical ventilation. Tracheostomy provides various benefits over prolonged endotracheal intubation including improved airway care, diminished need for sedation, reduced airway resistance, and increased patient comfort. However, the timing and effectiveness of tracheostomies has been controversial. Several studies, have indicated that early tracheostomy reduces the length of ICU and hospital stay, decrease the time on mechanical ventilation, and reduces the incidence of nosocomial pneumonia. In contrast other studies have shown that early tracheostomy shows no benefit, or even extends the length of mechanical ventilation in some patients. The purpose of this study was to evaluate the timing and the appropriateness of timing of tracheostomy.

Methods

This was a retrospective study of burn patients requiring mechanical ventilation over a 5-year period. The main comparison groups were endotracheal tube only (ETT) vs tracheostomy (Trach) and early tracheostomy (ETrach) vs. late tracheostomy (LTrach). Tracheostomies that were performed within the first 7 days were considered to be ETrach.

Results

Age, gender, ethnicity, % TBSA burned, presence of inhalation injury did not differ between any of the groups. The Trach group demonstrated increased hospital length of stay (LOS) (22 vs. 39 days, p< .0001), greater number of ICU days (11 vs. 31 days, p< .0001), greater number of surgeries (3.7 vs. 6.6, p< .0001) and patients in this group were more likely to be discharged to a post-acute care facility rather than home, when compared to the ETT group (p< .0001). The Trach group also was more likely to develop ventilator-associated pneumonia (VAP) (23% vs. 48%, p< .0001), and more likely to develop swallowing abnormalities. Similarly, the LTrach group demonstrated greater number of ICU days (25 vs. 32 days, p=.04), greater number of ventilator days (23 vs. 29 days, p=.03), greater number of surgeries (4.5 vs 7.2, p=.02), but fewer days to liberate from the ventilator (19.4 vs 13.6 days, p=.04). This group also was more likely to develop VAP than the ETrach group (28% vs 53%, p=.03).

Conclusions

This study demonstrates a number of improved outcomes of tracheostomy over continued endotracheal intubation, and a number of improved outcomes of early tracheostomy over later tracheostomy. The most significant improved outcomes were decreased incidence of VAP and decreased swallowing difficulties following extubation/decannulation.
512 Bedside Transthoracic echography volume Assessment in the BICU
Authors: Chambers Michael G , Garrett Britton , Cancio Leopoldo C
Published: April 2021

Introduction

Point-of-Care Ultrasound (POCUS) has been shown to be a useful adjunct in assessment of various shock states and utilized to guide resuscitative and post-resuscitation de-escalation efforts. POCUS use for guiding resuscitation in burn injured patient has not be described.

Objectives

characterize the use of bedside ultrasound examinations performed by advance practice providers and treating physicians in a regional burn intensive care unit

Methods

Daily beside ultrasound examinations were performed utilizing a bedside ultrasound device by an advanced practice provider prior to rounds POCUS examinations consist of:

Ultrasound images were archived to a centralized image repository and reviewed daily during multi-disciplinary rounds. Ultrasonographic volume assessment compared to clinical volume assessment made during daily multidisciplinary rounds.

Results

100 examinations were performed of those 32 were within the initial 72 hour window:

Conclusions

Our results demonstrate that bedside ultrasound aides in guidance of both resuscitative and post-resuscitative efforts. We identified a cohort of patients who appeared hypervolemic clinically but US findings supported hypovolemia, we refer to as pseudohypervolemia US volume assessment provides information that changes management. We believe point of care ultrasound is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.