bluuebunny/crossref_metadata_2025 huggingface dataset:
143 Galunisertib Exerts Targeted Anti-Fibrotic Effects in In Vitro Models of Burn Wound Healing
Authors: Peterson Joshua M , Prasai Anesh , Jay Jayson W , Wolf Steven E , El Ayadi Amina
Published: April 2021

Introduction

Inhibition of TGF-β has shown promising in vitro and in vivo results for reduction of hypertrophic scarring after burn injury. However, TGF-β regulates diverse cellular pathways apart from fibrosis, including physiologic wound healing, cell cycle control, and homeostasis. Galunisertib, a novel small molecular tyrosine kinase inhibitor of TGF-beta receptor type 1, specifically targets downstream pro-fibrotic pathways of TGF-β signaling, has an excellent adverse effect profile, and minimal off-target effects. We hypothesized that galunisertib diminishes fibrotic phenotypes in a targeted fashion, making it a promising candidate drug for prevention of hypertrophic burn scar and contracture.

Methods

Commercially available fibroblasts were treated with TGF-β at concentrations typical of burn wounds to induce fibrotic phenotype fibroblasts (FPF). FPF cells were treated with galunisertib for 0, 1, 2, 3, and 7 days at concentrations ranging from 0.01 μM to 100 μM. FPF viability and proliferation were assessed with MTT assay. Modulation of FPF cell fibrotic gene and was analyzed using quantitative real-time PCR (qRT-PCR) of COL1A1, COL3A1, FN1, αSMA, CTGF, DCN, MMP1, and MMP13. Analysis of phenotype modulation was performed by western blotting of P-Smad2/3, collagen-1, fibronectin, and αSMA. Statistical analysis performed with students t-test and ANOVA.

Results

TGF-β treated FPF cells had significantly increased proliferation relative to commercially available fibroblasts, which was attenuated by treatment with 2.5–10 μM galunisertib at 2 or 3 days after treatment in a concentration dependent manner (p < 0.05) while also not causing a relative decrease in proliferation. Expression of FPF downstream pro-fibrotic genes underwent significant fold changes (FN1, αSMA, CTGF: p < 0.05). Protein expression showed decrease in both SMAD2/3 phosphorylation and fibrotic protein expression. Scratch assay analysis is ongoing.

Conclusions

Galunisertib exerts targeted dose-dependent inhibition of fibrotic gene expression and phenotypes in vitro without hindering cellular proliferation.
524 Use of Broad-Spectrum Antibiotics and Sepsis-3 Criteria in Burns
Authors: Meza Luis E , Rehou Sarah , Shahrohki Shahriar
Published: April 2021

Introduction

Sepsis is a diagnostic challenge in critically ill patients; especially so in the burn population because the signs and symptoms of sepsis are pervasive after injury. The Sepsis-3 criteria identify organ dysfunction as an acute change in SOFA score ≥ 2 points consequent to infection. The objective of this study was to evaluate if Sepsis-3 criteria were fulfilled when broad-spectrum antimicrobial therapy was started in a burn cohort.

Methods

We included all adult (≥ 18 years) patients with an acute burn admitted to our burn centre within 2 days of injury between 2016 and 2019. Only patients that received meropenem or piperacillin/tazobactam during their acute hospitalization period were included. Patients were stratified based on the Sepsis-3 definition using evidence of infection and evaluation of organ failure in the 48-hour period prior to the administration of antibiotics.

Results

We studied 70 patients, with 24 patients in the control group and 46 patients in the Sepsis-3 group. Demographics were similar among the control and Sepsis-3 groups: mean age was 44 ± 18 versus 48 ± 18 years (p=0.372); but injury severity was significantly different: median percent TBSA burn 18% vs. 32% (p=0.003) and proportion of inhalation injury 13% vs. 50% (p=0.002). Length of stay (LOS) was significantly longer in the Sepsis-3 group, control group median 23 days vs. median 43 days (p< 0.001). However, LOS/TBSA was not significantly different in the control group compared to the Sepsis-3 group: median 1.6 vs. 1.4 days per percent TBSA burn (p=0.777). Mortality was similar among the groups: 13% vs. 20% (p=0.526). The proportion of patients diagnosed by a physician with sepsis was also similar with 21% in the control group vs. 33% in the Sepsis-3 group (p=0.406).

Conclusions

Though the Sepsis-3 group had greater injury severity, mortality, and LOS in-hospital, when normalized to TBSA, was similar. Patients were diagnosed by a physician with sepsis in less than a third of cases. This raises the question of why broad-spectrum antibiotics were started. Potentially, patients were treated based on clinical suspicion of sepsis instead of delaying treatment until diagnosis was confirmed. Benefits of early antibiotic administration must be considered in conjunction with antimicrobial stewardship.
525 Biomarkers for the Early Diagnosis of Sepsis in Burns: Systematic Review and Meta-analysis
Authors: Li Andrew , Moussa Anthony , Gus Eduardo , Paul Eldho , Yii Erwin , Romero Lorena , Lo Cheng H , Cleland Heather j
Published: April 2021

Introduction

Early clinical diagnosis of sepsis in burns patients is notoriously difficult, and many biomarkers have been proposed as adjuncts to clinical assessment. We aimed to evaluate the diagnostic performance of all previously studied biomarkers for the early diagnosis of sepsis in hospitalized patients with burns.

Methods

We conducted a systematic literature search to February 2020 of Medline, Embase, Cochrane Central, Biosis Previews, Web of Science, and Medline In-Process. Only diagnostic studies utilising a sepsis definition of positive blood cultures or a combination of infection, systemic inflammation, and organ dysfunction were included. Where possible, contingency tables were used as reported or constructed from original data using a cut-off based on Youden’s index. Pooled sensitivity and specificity estimates were derived for each biomarker using random effects meta-analysis.

Results

We included 27 studies evaluating 56 different biomarkers. Procalcitonin was moderately sensitive and specific for sepsis in patients with burns (sensitivity 72%, specificity 74%). CRP was also moderately sensitive and specific (74% and 64% respectively). White cell count had poor sensitivity and specificity (46% and 59% respectively). All other biomarkers had insufficient studies to include in a meta-analysis, however cell free DNA, nuclear DNA, BDG, BNP, and SVI showed the most promise in single studies. There was considerable heterogeneity between studies reflecting different definitions and cut-offs.

Conclusions

The most widely studied biomarkers are poorly predictive for sepsis in burn patients. Several promising candidates have been reported which should be evaluated in further studies. A standardized approach to the evaluation of diagnostic markers (including time of sampling, approach to cut-offs and outcome) would be useful.
527 Use of Bioelectrical Impedance Analysis for Assessing Phase Angle, Hydration Status, and Predicting Outcomes in Critically Ill Patients: A Systematic Review and Meta-Analysis
Authors: Dang Justin , Lin Matthew E , Huang Samantha , Hulsebos Ian F , Yenikomshian Haig A , Gillenwater Justin
Published: April 2021

Introduction

Bioelectrical impedance analysis (BIA) is a simple, noninvasive method of assessing body composition. BIA operates by sending a low-voltage electric current through the body and measuring the impedance to that current. Parameters obtained from BIA have been used to investigate a range of variables such as nutrition and hydration status in a variety of patient populations. Phase angle is also a unique parameter that is thought to reflect cellular health. BIA parameters can undergo further analysis by bioelectrical impedance vector analysis (BIVA) which can provide information about hydration status. Burn and critical care patients pose a unique challenge because they are particularly sensitive to fluid shifts and metabolic derangements which are associated with poorer outcomes. The utility of BIA and BIVA in this patient population has not been well studied. Thus, we have conducted a systematic review and meta-analysis of the ability of BIVA and BIA parameters to assess cellular health and hydration status in critically ill adults and whether they can be correlated with outcomes.

Methods

A search was performed on PubMed and Google Scholar in accordance with PRISMA guidelines between June 2020-August 2020 utilizing the keywords: bioelectrical impedance analysis, critical care, critical, body composition, phase angle, water, fluid. Inclusion criteria were articles investigating the relationship between BIA, BIVA and outcomes with regards to phase angle, hydration, and fluid status in critically ill adults. Reviews, non-English articles, and studies involving pediatric patients were excluded. A meta-analysis was conducted on the correlation between mean phase angle and mortality.

Results

The final analysis included 21 articles; 4 articles were included in the meta-analysis. Statistically significant correlations were found between phase angle and mortality in 9/13 articles, hospital length of stay in 4/7 articles, ICU length of stay in 5/7 articles, and mechanical ventilation duration in 1/4 articles. For meta-analysis, mean phase angle in survivors and non-survivors was 4.5 and 3.9 respectively, and this difference was statistically significant (Figure 1, p< 0.01). Significant correlations were found between ECW/TBW and mortality in 4/7 articles, and BIVA derived hydration status and mortality in 6/7 articles.

Conclusions

BIA and BIVA may be used as a prognostic indicator for outcomes in critical care patients. Further investigations are needed to explore this relationship in the burn patient population.
535 Vitamin C in the Management of Burn Patients: A Review of Benefits and Risks
Authors: Siddiqi Mahwash , Bryan Francesca , Bokhari Faran
Published: April 2021

Introduction

Burns are global public health problem. Micronutrients play an essential role in defense mechanisms and immunity. Vitamin C has fostered a growing interest. We reviewed current evidence regarding the effects of Vitamin C on management of burn patients and aims to understand its benefits and risks.

Methods

A narrative review was performed from January 2000 through September 2020 via PubMed by searching the terms “vitamin C”, “ascorbic acid” and “burns”. The search yielded a total of 170 journal articles. The following were excluded: commentaries, experimental research and studies on non-human subjects. Ultimately, 20 articles qualified for review.

Results

A total of 924 patients were studied. The literature collectively endorsed a difference in patient outcomes when vitamin C is administered on the first day of admission. The average age across the studies was 15–45 years old. Only 10% of studies included vulnerable age groups (2–15 years old). The Mean Total Body Surface Area (TBSA) of patients was 31%. Most of the studies excluded patients with co-morbidities.

The benefits of vitamin C in various aspects of burn management were documented in 70% of studies. Patients who were given vitamin C exhibited a decrease in fluid requirement in 42% of the studies when compared to controls. Additionally, a decrease in wound healing time was reported in 35% of studies, a decreased rate of post-burn infections was reported in 28%, and 14% of studies state that patients given vitamin C had reduced edema.

The effect of vitamin C dosing methods on outcomes was also examined. It was reported by 14% of Studies that low-dose Vitamin C infusion does not improve outcomes, while 50% of studies that used high-dose infusion revealed improved results. Additionally, when comparing oral route of administration 20 % of studies used high-dose with favorable results.

In regards to risk, oxalate nephropathy, acute kidney injury, and renal failure was documented by six studies.

Conclusions

Our review concludes that there is decreased fluid requirement, improvement in edema, healing time and post burn infections when high-dose vitamin C (66mg/kg/hr) is given to adults on first day of admission and continuously infused for 24 hours in 1st and 2nd degree burn involving 10 to 40% TBSA. However, there is an associated risk of acute kidney injury and renal failure.
536 Use of Bioelectrical Impedance Analysis for Assessment of Nutritional Status: A Systematic Review
Authors: Dang Justin , Lin Matthew E , Huang Samantha , Hulsebos Ian F , Yenikomshian Haig A , Gillenwater Justin
Published: April 2021

Introduction

Nutritional support is an essential component of caring for burn patients. Burns can induce a hypermetabolic state greater than twice the normal metabolic rate which can lead to higher rates of lean tissue mass breakdown. Despite its importance, there is no clear gold standard for monitoring nutritional status in the burn and critical care population. Many current methods of assessing body composition can be costly, labor-intensive, and inaccurate. Bioelectrical impedance analysis (BIA) is a promising new technology for assessing body composition that functions by sending a low-voltage current through the body and measuring the impedance to that current. Parameters derived from BIA have been demonstrated to reflect cellular health and correlate with nutritional status. The use of BIA to assess nutritional status in the critical care and burn population has not been well investigated. Thus, we have conducted a systematic review of the use of BIA to assess nutritional status in critically ill adults.

Methods

A search was conducted on Pubmed and Google Scholar in accordance with PRISMA guidelines between June 2020-August 2020 utilizing the keywords: bioelectrical impedance analysis, critical care, critical, nutrition, body composition, lean body mass, phase angle, water, fluid. Inclusion criteria were articles investigating the relationship between BIA and nutritional status in critically ill adults. Reviews, non-English articles, and studies involving pediatric patients were excluded.

Results

Our final study included 14 articles. BIA measured muscle mass was compared to a CT scan in two studies, with both reporting a statistically significant correlation. One article compared the ability of BIA and ultrasound to assess muscle mass, and this relationship was statistically significant. BIA derived phase angle was compared to NUTRIC and Subjective Global Assessment scores in four articles with all four reporting significant correlations. BIA was also compared to biochemical markers of nutrition such as albumin and two of three articles found significant correlations. One article compared BIA with gas exchange measured by indirect calorimetry and found that BIA could accurately assess body cell mass. No articles were found comparing BIA with other common nutritional markers such as prealbumin or nitrogen balance.

Conclusions

BIA shows promise as a method of assessing body composition and nutritional status in the critically ill patient population.
546 Management of Pediatric Pavement Burns
Authors: Saquib Syed F , Chestovich Paul J , Carroll Joseph T , Flores Carmen E
Published: April 2021

Introduction

Pavement burns are common in a dry high heat climate. This study reviews the etiology, management and outcome of pavement burns in children.

Methods

All patients age < 18 who suffered contact burns from hot pavement from Jan 1, 2014 to Dec 31, 2019 were reviewed. A total of 45 patient charts met inclusion criteria. High ambient temperature on each date, and zip code of each injury was extracted from Weather Underground (www.wunderground.com)

Results

In this study, 45 patients met criteria and were reviewed, of whom 27 patients (60%) were male. Average age was 3.29 years (SD 0.69), made up two discrete age groups: age under 3 (n= 40, 89%) and 14+ (n=5, 11%). 38 patients (84%) had no known medical history. All had 2nd degree burns and one patient (2%) had third degree burns. Mean total body surface area (TBSA) was 2.5% (SD 1.4%, range 0.75% to 5.5%). Burn etiology included 31 patients (69%) walking barefoot on pavement, 6 (13%) falling onto pavement, and other/unknown etiology for the remaining 8 patients (18%). 30 patients (67%) had injuries on the plantar aspect of bilateral feet, 2 (4%) to bilateral palms of hands, 4 (9%) to other parts of upper extremities and 10 (22%) to other parts of lower extremities.

Thirty-four (34) patients (76%) were managed without any hospitalization. Those that were hospitalized had an average length of stay (LOS) of 2.72 days (range 1–9 days). All burns were managed non-operatively with topical therapy alone. 35 patients (78%) were managed initially with Silvadene, and 6 (13%) with bacitracin. Aquacel was utilized in 10 patients at a follow-up visit (22%). Three patients (6.7%) were treated with collagenase enzyme therapy. One patient developed a superficial infection requiring oral antibiotic therapy. There were no mortalities in this group. The high ambient temperature on date and location of each injury was 101 F (SD 1.10 F, range 73F-111F). Of the thirty that continued to follow up in clinic, the average time to the burn being 95% healed was 10.50 days (SD 8.97 days, range 2–40 days).

Conclusions

Pavement burns in children are partial thickness and are safely managed with topical therapy alone, with good outcomes. Patients age 3 and under are a vulnerable population and therefore at particular risk of injury.
553 Treatment of Scalp Pressure Ulcers with an Aerosol Formula with Silver Sulfadiazine, Lidocaine and Vitamin A: Early Clinical Experience
Authors: Aguilar Hernan , Basso Robertino , Dolino Florencia , Diaz Ana , Tessore Nadia M , sanroman eduardo , Mayer Horacio F
Published: April 2021

Introduction

Management of scalp pressure ulcers (SPU) in patients admitted to intensive care units (ICU) remains a challenge. The impossibility of freely moving the head due to different factors such as the intubation, enteral nutrition, dialysis and use of extracorporeal membrane oxygenation among others, makes the management of these wounds problematic. Herein, we present our early clinical experience in the treatment of SPU with a novel aerosol formulation of silver sulfadiazine.

Methods

A prospective study including all patients with SPU who were treated with an aerosol formula that includes silver sulfadiazine, lidocaine and vitamin A was carried out. Wound dressings were changed every 12h and consisted in wound cleansing, aerosol application and occlusion with sterile gauze.

Evolution of each SPU was controlled with pictures and measures on the affected area every 48 hours. In order to determine the total wound area, pictures were analyzed using the Informatics Image System from the U.S National Institute of Health.

Results

Six patients were prospectively followed and were included in this study. There were 2 females and 4 males. Average age was 70.8 years (range 41–99), while average hospital stay in the ICU was 14 days (range 5–22).

None of these patients experienced wound progression to a more critical stage. One patient had a favorable evolution from stage IV to stage II. Also, none of them showed clinical signs of a local infection of the SPU.

The average quantity of aerosol used per dressing was 1.3 ml which represents 2,6 mm/day and a cost of A$106,16 (U$S 1,45). As the cost of hydrocolloid dressings, at our institution, is A$602 per dressing (U$S 8,24), this represented an important saving in costs.

Conclusions

In this case series, the use of this novel aerosol formulation of silver sulfadiazine has shown promising results in the treatment of SPU in patients admitted to ICU, facilitating the application and saving costs. Further and larger studies to confirm our encouraging preliminary results are warranted.
554 A Comparison of Intact Piscine Skin, Split-thickness Skin Graft, and Lactic Acid Membrane in Treating Superficial and Deep Burn Wounds Following Enzymatic Debridement
Authors: Wallner Christoph , Holtermann Jana , Drysch Marius , Wagner Johannes Maximilian , Dadras Mehran , Sogorski Alexander , Sacher Maxi , Becerikli Mustafa , Lehnhardt Marcus , Behr Björn
Published: April 2021

Introduction

The optimal therapy for deep burn wounds is based on the principle of rapid necrectomy and coverage in order to achieve healing that is as scar-free as possible. The available infrastructure and the patient’s condition represent limitations. With enzymatic debridement, selective bedside debridement can now be performed, however the optimal cover after enzymatic debridement has not been elucidated to date. In this study we compare superficial dermal and deep dermal wounds, which are either covered with lactic acid membrane, piscine skin, or split-thickness skin graft. To validate our approach the healed burn wounds were examined for objective (elasticity, water content, sebum, wound healing) and subjective skin quality as part of our standard follow-up care.

Methods

In this study, 12 patients who had received piscine skin, lactic acid membrane, or split-thickness skin graft after enzymatic debridement were retrospectively examined objectively and subjectively for scar quality as part of follow-up care 12 months after the accident. The wound healing process was also documented.

Results

Acceleration of wound healing was observed with the application of piscine skin vs split-thickness skin graft or lactic acid membrane. Skin elasticity was comparable to that of split-thickness skin graft but significantly better than lactic acid membrane. The sebum production in wounds treated with piscine skin was higher compared to lactic acid membrane covered wounds. The water storage capacity in the piscine skin treated wounds was also significantly higher than in lactic acid membrane or split-thickness skin graft treated wounds. Using the POSAS score, an improvement in elasticity, thickness, pigmentation, and relief was shown in piscine skin treated wounds, as well as a reduction in pain and itching, compared to split-thickness skin graft or lactic acid membrane.

Conclusions

The use of intact piscine skin immediately following enzymatic debridement in burn wounds results in faster wound healing and better patient outcomes compared to split-thickness skin graft or lactic acid membrane.
563 “After the Fire”; The Legacy of a College Dormitory Fire Twenty Years Later
Authors: Conlon Kathe M , Dimler Margaret A , Petrone Sylvia J , Marano Michael A
Published: April 2021

Introduction

In January 2000 fire erupted at a local college. Panicked students, many who failed to attend school-sponsored fire drills or ignored the alarms that night, found themselves scrambling to escape. Seven students were admitted for severe burns to a near-by burn center (BC), with 54 initially staged in the Emergency Department. While this dormitory fire took place more than twenty years ago, its legacy is still being felt today.

Methods

History shows that, with any tragedy, there are lessons to learn that lessen the impact of property destruction, injury or death. Literature review of several major fires looked at their impact promoting burn care and fire safety to correlate those lessons with this fire. Four key areas of improvement emerged: disaster preparedness, media relations, legislation, and fire prevention.

Results

Changes to BC disaster preparedness included formation of a more comprehensive plan, revisions to triage and transfer protocols, new guidelines for unit staffing, creation of a mid-Atlantic group of BCs that eventually morphed into the Eastern Regional Burn Disaster Consortium, and installation of a medical command center for regional disaster response. Media relations saw a collaboration with law enforcement, due to criminal investigation, and a partnership with a syndicated newspaper to document the journey of two survivors. A series of articles eventually resulted in a Pulitzer Prize-finalist book, with award winning photographs displayed at a national museum. Redesigned fire safety programs targeted high school and college students emphasizing escape plans, and clinical education included disaster drills. Two survivors became motivational speakers, sharing their personal story on campuses across the United States. New legislation mandated sprinkler installation in dormitories nationwide, and a non-profit foundation was formed to improve burn care. The anniversary of this fire is still commemorated each year with a ceremony and wreath-laying on campus.

Conclusions

Despite this dormitory fire being ranked as the deadliest in state history, all these years later the legacy of this landmark event remains one of triumph and resilience as its lessons still to resonate today
578 Failure to Follow-Up: Implementation of a Program to Reduce Risk and Engage Patients
Authors: G’Sell David , Phelan Herbert , Smith Sydney , Virgadamo Lacy , Rivera-Barbosa Mario , Mai Kathryn , Carter Jeffrey E
Published: April 2021

Introduction

Establishing a patient-physician relationship creates a duty to meet the standard of care for inpatients and outpatients. Growth in burn ambulatory care, workforce changes, and the digital age of healthcare communications have broadened the definition of the patient-physician relationship and increased ambulatory medical liability especially when patients fail to follow-up (FTF). To mitigate this risk, many professional liability insurers have advised physician practices to implement processes to ensure appropriate follow-up and communication. Our study reviewed a multidisciplinary quality and performance improvement initiative to reduce risk from FTF with a goal to improve patient engagement.

Methods

In response to notification by our medical professional liability insurer, a multidisciplinary team of burn specialists reviewed, designed, and implemented a FTF risk reduction program at an ABA-verified burn center. Burn surgeons, physician assistants (PA), nurses, schedulers, and administrative assistants contributed to the development of the FTF protocol. Patients were discharged with follow-up date and time from inpatients stays or at the conclusion of outpatient encounters. If a patient had a FTF event, three attempts were made to contact the patient starting with the scheduler, followed by the nurse, and finally the PA or MD. Each attempt was documented in the EMR. Compliance with the FTF protocol was monitored twice monthly as a component of the burn quality and performance improvement program. Outpatient encounters were abstracted from the EMR into three categories: completions, cancellations, and FTF over a 4-month period prior to implementation and 4-month period post implementation.

Results

Our analysis included over 2,678 outpatient physician/PA encounters. Prior to implementation patients were intermittently contacted with no consistent processes or documentation in the EMR. Staff compliance with the FTF protocol improved from 83% the first month after implementation to 100% by the fourth month. Interestingly, the failure to cancellation rate remained stable while the failure to follow-up rate declined from 15% prior to implementation to 13% post implementation. Patients failing to follow-up commonly stated that they forgot or had transportation challenges.

Conclusions

FTF protocols are essential to engage patients and reduce ambulatory professional liability. Patients will continue to face FTF challenges with language barriers, transportation issues, natural disasters, and even the pandemic. This study was not designed to reduce cancellations or FTF as it is reactionary. Additional work is needed to reduce all causes of FTF and to improve outpatient engagement.
585 Burn Wound Care for Patients and Families through Video Education
Authors: Beaucock Beverly
Published: April 2021

Introduction

The treatment and care of a burn injury is specialized and can be very intimidating to the patient and family. It is the obligation of the burn team to educate the patient and caregiver at a level where they clearly understand and are comfortable. It is important to be mindful of how others comprehend whether it is visual, auditory, reading/writing, or kinesthetic. When attempting to learn something new, especially when compounded by a burn injury, can be quite challenging.

Methods

Videos of burn injury cleansing techniques and various applications of dressings were produced to enhance patient and family education.

Results

Our analysis of feedback from the patient and family indicates an appreciation for other learning platforms and is a complement to written instructions.

Conclusions

We concluded that by offering video education along with other educational tools, it has enhanced the patient and family experience in the burn center.
589 Methadone in Procedural Care for Burn Injuries of 20–30% Total Burn Surface Area: A Retrospective Chart Review
Authors: Taylor Loryn , Maynell Kimberly , Tran Thanh , Smith David J
Published: April 2021

Introduction

Prolonged opioid usage remains a concern in pain management in procedural care. Recent evidence also suggests that a considerable number of patients who were prescribed opioids struggle with transitioning to non-opioid pain medications. As a continuous effort to reduce opioid consumption following burn surgical procedures, our institution recently evaluated methadone administration for burn procedural care in patients with 20–30% total burn surface area (TBSA) requiring excision and grafting.

Methods

After IRB approval, we performed a retrospective chart review of patients who underwent excision and grafting procedure for 20–30% TBSA burn injuries between January 1, 2019 and June 30, 2020. The following data was evaluated: postoperative opioid consumption, postoperative pain intensity (rated as “No Pain” [NRS=0], “Minor Pain” [NRS 1 to 3], “Moderate Pain” [NRS 4 to 6], “Severe Pain” [NRS 7 to 10]), time to physical therapy and time to hospital discharge. Data was analyzed using chi square/Fisher exact test for categorical variables and t-test/Wilcoxon rank sum test for continuous variables.

Results

Our preliminary data included 12 patients who met inclusion criteria, of which two patients received methadone administration. Our patient sample consisted of average age of 43 years, 75% male, and 24% TBSA (92% were flame burns). Patients in both methadone and non-methadone groups had no significant differences in medical histories and TBSA (23% TBSA in methadone, 25% TBSA in non-methadone). There was no significant difference in reported preoperative pain intensity between the two groups, rating moderate to severe. Postoperative pain intensity remained the same, rating moderate to severe and controlled with fentanyl, oxycodone, morphine and non-opioid analgesics. While there was no difference in postoperative fentanyl, opioid and non-opioid analgesic consumptions between the two groups, morphine consumption was significantly lower in the methadone group compared to non-methadone group (2±2 mg vs 51±54 mg, respectively, p=0.02). There was no significant difference between average time from surgery to first physical therapy session and time to hospital discharge (about 21 days after surgery) between the two groups.

Conclusions

This evaluation shows a potential trend in reduction of inpatient postoperative opioid consumption with the conjunctive administration of methadone, although a bigger sample size is needed for further assessment.
603 Evaluating real-world national and regional trends in definitive closure in US burn care: A survey of US Burn Centers
Authors: Carter Jeffrey E , Amani H , Carter Damien W , Foster Kevin N , Griswold John A , Hickerson William L , Holmes James H , Jones Samuel W , Surgery General , Khandelwal Anjay , Kopari Nicole M , Litt Jeffrey S , Savetamal Alisa , Shupp Jeffrey W , Sood Rajiv , Ferrufino Cheryl P , Vadagam Pratyusha , Kowal Stacey , Walsh Tom , Sparks Jeremiah
Published: April 2021

Introduction

Real-world data is observational data gathered outside of the experimental setting from diverse sources which is analyzed to produce real-world evidence. To better understand the impact of burn center treatment patterns, a national sample survey for real-world data sought to benchmark key burn center practice patterns, resource utilization, and clinical outcomes with national data contained within NBR version 8.0 (NBR).

Methods

A survey was developed by healthcare economists and burn specialists and administered to a representative sample of US burn centers. The survey collected information across several domains, including: burn center characteristics; patient characteristics including number of patients, and burn size and depth; aggregate number of types of procedures; and resource use such as autograft procedure time, length of stay (LOS), and dressing changes; and costs. Nuanced information was collected on care practices and patient outcomes for TBSA burns under 20%. Survey findings were aggregated by key outcomes (LOS, number of procedures, costs) nationally and regionally. Aggregated burn center data were also compared to the NBR to identify trends relative to current treatment patterns.

Results

Benchmarking survey results demonstrated shifts in burn center patient mix, with more severe cases being seen in the inpatient setting and less severe burns moving to the outpatient setting. Additionally, an overall reduction in the number of autograft procedures was observed compared to NBR, and time efficiencies improved as the intervention time per TBSA decreases with TBSA increases. Both nationally and regionally, an increase in costs were observed.

Conclusions

The results suggest resource use estimates from NBR version 8.0 may be higher than current practices, thus highlighting the importance of improved NBR reporting and further research on burn center standard of care practices. This study demonstrates significant variations in burn center characteristics, practice patterns, and resource utilization thus increasing our understanding of burn center operations and behavior.
613Pediatric Burn Bibliotherapy - An Initial Assessment of Novels About Young Burn Survivors and Their Collective Experiences
Authors: Chang Philip H , Barrios Antonella , Heffernan Jamie , Rabbitts Angela , Jedlicka Caroline
Published: April 2021

Introduction

Bibliotherapy is the use of books as a therapeutic intervention for structuring interaction between facilitator and participant based on the mutual sharing of literature. Bibliotherapy has been utilized to address childhood teasing, healthy lifestyles in children, and eating disorders. With the dramatic improvements in survival of burn patients over the past decades, biographies and novels featuring pediatric burn survivors have emerged. These patients often face significant barriers in accessing psychosocial support. Our team hypothesized that bibliotherapy could benefit pediatric burn patients. In order to test this hypothesis, as a first step, our team conducted an assessment of the available burn survivor literature.

Methods

WorldCat book database was queried using the terms “Burn Patient Fiction” (45 results) and “Burn Patient Biography” (53 results). The authors identified 12 books out of these 98 results likely to be appropriate for adolescent and teenage burn patients based on the brief summaries. The 12 books were then read by the research team and analyzed for burn patient demographics and relevant clinical data when available. Simple descriptive statistics were utilized for numerical data

Results

Out of 12 books read, 5 were biographies & 7 fictional novels. Protagonists mean age at time of injury was 8.7±5.1 years (range 2–16), with 5 males and 7 females. Average injury size was 57±21% TBSA (range: 14–85). 10 of 12 protagonists suffered facial burns; 7 of 12 suffered hand burns. Oral health/dental issues were described in 4 of 12 books. Geographically, these English language novels spanned Australia (1), Canada 92), and the U.S. (9). Average page length was 237±88 pages (range: 64–372).

In 11 of 12 books, mechanism of injury involved flame from car accidents (2), house fires (4), and campfires (2).

With regards to sources of positive support during the recovery phase, family was the most commonly cited source (11 novels) followed by friends (10), spiritual/religious support (5), sports (3), burn survivor groups (3), hospital psychiatrists (3), and performing arts (2).

Appropriate audience group for most books were teenagers (11) with 5 books deemed also appropriate for adults (only 1 book judged appropriate only for adults), and 2 books appropriate for adolescents.

Conclusions

Several novels and biographies with pediatric burn survivor protagonists have been written over the past 20 years. Commonalities across these books include flame burn etiology, relatively large TBSA, and burn injuries to visible body areas (face and hand). Family and friends were the most common emotional support for these protagonists. Most books were appropriate for teenagers.
636 Subcutaneous Contracture Band Release in Burn Scars
Authors: Blome-Eberwein Sigrid A , Lepage Lisa , Starner Sophia
Published: April 2021

Introduction

Contracture scars post-burn injury often develop in areas near joints and can restrict movement as well as cause cosmetic deformities.1,2 The goal of subcutaneous scar release is to maximize mobility and minimize the need for invasive procedures which can require more recovery time and cause less aesthetically pleasing outcomes, although this new minimally invasive technique may also be used in conjunction with invasive procedures or after more invasive reconstructions to yield the best functional and cosmetic outcome.

Methods

Retrospective data from May 2016 to July 2019 were collected and analyzed for 28 patients ranging from ages 6 to 68 years old that were diagnosed with a subcutaneous contracture in one or more areas of their body. The data recorded included demographics, procedure specifics and outcomes, patients’ assessments, and areas of which the procedure was most frequently done on.

Results

Of the data available, range of motion per site improved by 19.1 degrees. Average pain scores reported directly after the procedure were relatively low at 1.5 on a 10-point scale. Vancouver Scar Scale scores decreased by 0.6 from pre-operatively (10.7) to post-operatively (10.1). The most frequently occurring areas that subcutaneous scar release was done on was the neck (15), axilla (7), and shoulder (7). Overall, 83% of patients reported being very satisfied or satisfied with the outcome of their procedure.

Conclusions

Subcutaneous scar release improves burn patients’ range of mobility with less residual scarring and less recovery time than standard of care treatments for scar contractures.
639 Maximizing Safe Positioning of Upper Extremities after Axillary Burn Injuries to Prevent Contractures and Maintain Function
Authors: Greiser Connie , Lorello David , Lyons Dan , Richey Karen J , Murray Derek , Foster Kevin N
Published: April 2021

Introduction

Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction.

Methods

The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions.

Results

A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%).

Conclusions

The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours.
644 Use of Plantar Foot Plate Splints and High-Profile Leg Net Devices for Prevention of Plantarflexion Contracture following Placement of Cultured Epidermal Autograft to Lower Extremities
Authors: Dean Brooke , Andre Gregory , Vocke Scott F
Published: April 2021

Introduction

Burn Therapists strive to prevent burn scar contracture through positioning strategies beginning in the acute phase of burn injury. This task is even more challenging when paired with posterior offloading and joint immobilization required for the viability of cultured epidermal autograft (CEA). High profile leg net devices are the standard for posterior offloading after application of CEA circumferentially to lower extremities but can result in poor positioning of the ankle. Custom foot plate splints were designed and fabricated to preserve ankle dorsiflexion during the initial stages of CEA healing.

Methods

The high-profile leg net devices were assembled using 3/4 inch PVC piping and PVC fittings (45 degrees, 90 degrees, and tees) with double layered elastic tubular netting to allow proper wound ventilation while supporting the lower extremity with the patient in supine. The plantar foot plates were custom molded to the patient’s foot using thermoplastic material and lined with medium density temper foam for pressure relief. The foot plate was attached to the frame using Velcro and straps. Instructions with photographs were posted in the patient’s room for nursing staff to reference. Netting was exchanged daily and frames were disinfected using standard techniques.

Results

Goniometric measures were taken for ankle dorsiflexion were taken on day of CEA application with lower extremities positioned on high profile nets (in alignment with cutaneous functional unit modified position): -6 degrees right ankle, -2 degrees left ankle. Repeat measures were taken after one week period of bilateral lower extremity immobilization per CEA protocol: -1 degree right ankle, 2 degrees left ankle. One month follow-up at the discontinuance of leg net devices showed bilateral ankle dorsiflexion preserved with 3-degree right ankle dorsiflexion and 5 degrees on the left.

Conclusions

The use of custom foot plates on high profile leg net devices appears to improve ankle dorsiflexion range of motion while maintaining adequate posterior offloading required for CEA precautions for a burn survivor with extensive lower extremity burn wounds.
530 Case Report of Curling’s Ulcer in Convalescing Burn Patient
Authors: Hunter Lucas , Williams Jeffrey W , Craig Christopher K , McEathron Rachel , Saraswat Anju , Holmes James H , Bailey John K
Published: April 2021

Introduction

Although stress ulcer disease related to burn injury was noted previously, it was the report of a series of 10 cases by Curling which lent the name to the finding. Occurrence of the disease has been attributed to the stress factors of hemodynamic instability with resultant decrease in defense factors of the gastroduodenal epithelium noted as patients began to survive massive burns. At one time, the incidence was reported as high as 23% of hospitalized burn patients. However, with advances in supportive care and antacid therapy, some have wondered if Curlings ulcers may have become extinct.

Methods

We report the case of a 21-year-old male admitted after MVC with 53% TBSA burn (32% full-thickness) and multiple blunt trauma injuries. Early in his course he underwent splenectomy, small bowel resection, right hemicolectomy, and ORIF of an unstable lumbar fracture, and below-knee amputation. He underwent staged excision and grafting of burn wounds and had been autografted with exception of about 11%TBSA of the left lower extremity (wound controlled with allograft). On hospital day 38, the patient was noted to have melanotic colostomy output with a concomitant drop in hemoglobin level from 7.6 g/dl to 3.5 g/dl.

Results

The gastroenterology service was consulted, and they performed upper endoscopy on hospital day 39. A large amount of clotted blood was seen in the stomach, but the source of bleeding was not visualized. Subsequent endoscopy the following day showed an erosion of gastric mucosa in the gastric fundus consistent with ulcer, on which two clips were placed. The patient’s stool was tested for H. pylori antigen and the test was negative. The patient continued on a proton pump inhibitor, non-steroidal anti-inflammatory drugs were held, and his hemoglobin stabilized and melanotic ostomy output resolved.

Conclusions

Antacid therapy, H2-blockers, and proton pump inhibitors have historically been used in cases of large burns. However, in the care of other critically ill patients the association of this therapy with ventilator associated pneumonias has lead to new scrutiny. In addition, a renewed emphasis on multimodal pain management may be introducing a bias towards an increase in so-called aggressive factors, namely NSAIDS administered over longer periods. Advances in critical care of burn patients have made Curling’s ulcers rare, but not extinct.
Providing Effective Mental Health Support for Oncology Health-Care Workers in the COVID-19 Era: Responding Quickly but Carefully
Authors: Major Ajay , Recklitis Christopher J , Bober Sharon
Published: April 2021

Oncology health-care workers (HCWs) are facing substantial stressors during the current coronavirus disease 2019 pandemic, resulting in a wide range of acute stress responses. To appropriately meet the growing mental health needs of HCWs, it is imperative to differentiate expectable stress responses from posttraumatic stress disorder and mental illness, because traditional mental health interventions may pathologize healthy stress reactions and risk retraumatizing HCWs under acute duress. Further, HCWs are experiencing protracted forms of acute stress as the pandemic continues, including moral injury, and require mental health interventions that are flexible and can adapt as the acuity of stressors changes. Previously developed frameworks to support people experiencing acute stress, such as Psychological First Aid, are particularly relevant for HCWs in the ongoing pandemic. Acute stress interventions like Psychological First Aid are guided by the Stress Continuum Model, which conceptualizes stress reactions on a continuum, from a zone of normal readiness and expectable consequences to a zone of more persistent and extreme reactions such as posttraumatic stress disorder and major depression. Key principles of the Stress Continuum Model include the expectation that emotional reactivity does not lead to psychiatric problems, that interventions need to be appropriately targeted to symptoms along the stress continuum, and that people will return to normal recovery. Various core actions to reduce acute stress include delivering practical assistance, reducing arousal, mobilizing support, and providing targeted collaborative services. This nonpathologizing approach offers a valuable framework for delivering both individual and organizational-level interventions during the coronavirus disease 2019 pandemic.