bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolomics and bioinformatic analyses to determine the effects of oxygen exposure within longissimus lumborum steak on beef discoloration
Authors: Denzer Morgan L , Pfeiffer Morgan , Mafi Gretchen G , Ramanathan Ranjith
Published: May 2023

Meat discoloration starts from the interior and spreads to oxymyoglobin layer on the surface. The effects of oxygen exposure within a steak on the metabolome have not been evaluated. Therefore, the objective of this study was to evaluate the impact of oxygen exposure on the metabolome of the longissimus lumborum muscle. Six United States Department of Agriculture (USDA) Low Choice beef strip loins were sliced into steaks (1.91-cm) and packaged in polyvinyl chloride overwrap trays for 3 or 6 d of retail display. The oxygen exposed (OE) surface was the display surface during retail, and the non-oxygen exposed (NOE) surface was the intact interior muscle. The instrumental color was evaluated using a HunterLab MiniScan spectrophotometer. To analyze the NOE surface on days 3 and 6, steaks were sliced parallel to the OE surface to expose the NOE surface. Metmyoglobin reducing ability (MRA) was determined by nitrite-induced metmyoglobin reduction. A gas chromatography–mass spectrometry was used to identify metabolites. The a* values of steaks decreased (P < 0.05) with display time. MRA was greater (P < 0.05) in the NOE surface compared with the OE surface on days 3 and 6. The KEGG pathway analysis indicated the tricarboxylic acid (TCA) cycle, pentose and glucuronate interconversions, phenylalanine, tyrosine, and tryptophan metabolism were influenced by the oxygen exposure. The decrease in abundance of succinate from days 0 to 6 during retail display aligned with a decline in redness during display. Furthermore, citric acid and gluconic acid were indicated as important metabolites affected by oxygen exposure and retail display based on the variable importance in the projection in the PLS-DA plot. Citric acid was lower in the NOE surface than the OE surface on day 6 of retail display, which could relate to the formation of succinate for extended oxidative stability. Greater alpha-tocopherol (P < 0.05) in the NOE surface supported less oxidative changes compared to the OE surface during retail display. These results indicate the presence of oxygen can influence metabolite profile and promote migration of the metmyoglobin layer from interior to surface.
T2 New York City Structural Fires are Linked to Inequities in Safe Heating for Immigrant Communities
Authors: Stanton Eloise , Sheckter Clifford C , Biedry Julia , Rochlin Danielle
Published: May 2023

Introduction

The US was rattled January 9th, 2022 when a structural fire claimed the lives of eight children and nine adults in New York City’s (NYC) Bronx borough. Existing reports suggest that in low-income historically Black/Latinx communities, heating complaints are often ignored. While this pattern implies housing inequities, landlord negligence, and greater risk of residential fires in the Bronx and other low socioeconomic neighborhoods, this postulation has not been scientifically evaluated. We investigated the relationship between structural fires and heating complaints in NYC, leveraging municipal data from 59 community districts.

Methods

Data from the NYC Open Data Portal Fire Incident Dispatch data and Heat/Hot Water Complaints were merged to identify the number of heating complaints and structural fires per month in each NYC community district from 2017-2022. Population and demographic comparisons were made using US Census–NYC Demographics 2020 data. The primary outcome was number of structural fires per month which was modeled with mixed effects multivariable regression. Community districts were treated as random intercepts given demographic and architectural variation between districts. Statistical analyses were performed using Stata/IC Version 17.0 (StataCorp LLC).

Results

Within NYC’s 59 community districts, 3,877 heating complaints were filed against 3,989 structural fires during the study period (Figure 1). The mixed effects model demonstrated a significant association between heat complaints and frequency of structural fires (coefficient 0.013, 95% CI .012-.014 p< .001,). Further, the model demonstrated significant variance among community districts in predicting structural fires (σ2=215, p < .001). The Likelihood ratio test comparing the mixed effects linear model to a simple linear regression yield a p-value of < 0.001 in favor of the mixed effects model.

Conclusions

The frequency of heating complaints was significantly associated with the frequency of structural fires in NYC. Importantly, this association varied across community districts with more fires occurring in districts with greater proportions of Black/Latinx residents. Our results highlight a pattern adversely affecting marginalized racial/ethnic communities in which ongoing ignored heating complaints and landlord negligence may lead residents to use unsafe heating practices, inadvertently creating structure fires, morbidity, and death.

Applicability of Research to Practice

Our findings can help guide and educate both clinicians and policymakers in regard to socioeconomic disparities and epidemiological trends implicated in burn care.
33 Targeting Vulnerability in the Homeless–A National Analysis of Burn Injuries Presenting to the Emergency Department.
Authors: Shah Jennifer , Liu Farrah , Cevallos Priscila , Amakiri Uchechukwu , Johnstone Thomas , Sheckter Clifford , Nazerali Rahim
Published: May 2023

Introduction

Burn management is complex and outcomes depend on injury severity, timing of presentation, and specialized multidisciplinary care. Burn injuries among the homeless are an increasing problem in the United States (US) as record numbers of people are unsheltered and using unsafe heating practices. This study aims to characterize mechanism, demographic, and social factors related to burn injuries in homeless persons.

Methods

Burn encounters were extracted from the 2019 Nationwide Emergency Department Sample (NEDS) database. Two cohorts were created comparing homeless and non-homeless encounters. Burn characteristics (size, depth, location and mechanism), comorbidities, demographics, and ED treatments were compared with univariate testing. Multivariable regression evaluated the likelihood of admission. Discharge weights were used to yield national estimates.

Results

Of 316,334 ED visits meeting criteria for burn injuries in 2019, 1,919 (0.6%) had a diagnosis code for homelessness. Homelessness burn encounters were significantly older (mean age 32.4 vs. 44.8), were more often male (71% vs. 52%), were more often White (59% vs. 54%) or Black (24% vs. 21%), were more often presenting to EDs in the Western region of the US (43% vs. 19%), and more often had Medicaid as primary payer (51% vs 33%). Burns in homeless encounters more commonly resulted from flame injury and more commonly involved the lower extremity (p< 0.001). Among homeless encounters, burn injuries were more often due to self-harm (12% vs. 2%) or assault (5% vs. 1%)(p< 0.001). In addition, homeless encounters had significantly greater mental illness related to substance abuse (69% vs 16%, p< 0.001) and had greater comorbidity burden (38% vs. 6% had Elixhauser index scores of 3 or higher; p< 0.001). Homeless encounters experienced higher rates of third degree burns and concomitant injuries (p≤0.003). 49% vs 7% of homeless and non-homeless encounters, respectively, required admission, and homelessness was associated with higher odds of admission (adjusted OR 4.58; 95% CI 3.066–6.828; p< 0.001).

Conclusions

Burn injuries in the homeless affect a vulnerable population who is older, has more comorbidities, and has deeper burns. Mental illness is over 4 times more likely in this population who is also at increased risk of getting burned through assault.

Applicability of Research to Practice

Burn injuries presenting to the ED should be screened for homelessness given the associated risk factors. Legal, medical, and mental health resources can then be appropriately targeted.
34 Evaluation of Socioeconomic Status and Burn Injuries: A Retrospective Review From a Desert Burn Center
Authors: Cohler Samuel , Chestovich Paul , Saquib Syed , Batra Kavita
Published: May 2023

Introduction

Incidence of burn injury rate appears to be affected by socioeconomic status (SES). Previous studies have indicated that patients with low SES have an increased risk of unintentional burn injuries. However, this association has not been explored robustly in the Southwest United States. This study aims to investigate the relationship between SES and burn injuries amongst patients in the Southwest United States.

Methods

A retrospective registry review was performed on all burn injury admissions to our ABA verified burn center from January 1, 2017 to December 31, 2021. Their zip code was then inputted into the Distressed Communities Index (DCI). This is a national database that stratifies communities by zip code into quintiles, indicating overall distress. The DCI was used as a measure of SES as it reflects employment status, education level, poverty rate, median income, business growth, and housing vacancies. Patients who did not report an accurate residential zip code or reported a zip code not included in the DCI were excluded. Many clinical variables were reviewed within each quintile including age, gender, total body surface area (TBSA), ICU days, hospital length of stay (LOS), ventilator days, surgical interventions, and discharge disposition. Student’s t-test and Chi-squared tests were used to compare groups, and statistical significance was defined at p < 0.05.

Results

A total of 1,323 patients were identified in the study period. The most distressed quintile accounted for 481 (36.4%) admissions. Flame and contact burns were the most common etiology overall (46.5%), as well as within each quintile (Figure 1). The distribution of burn injury etiology was statistically significant by age, %TBSA, gender, race, and ethnicity (p < 0.001, Table 1); however, it was not significant by SES (p = 0.202). Burn severity, categorized as less than or equal to second degree burns, or greater than or equal to third degree burns, showed significance when compared to age, LOS, ICU days, ventilator days, and total surgical interventions performed (p < 0.001). However, the association between SES and burn severity was not found to be significant (p = 0.886).

Conclusions

The two most distressed quintiles represented over half of the burn admissions. A lower SES did not contribute to increased burn severity or utilization of healthcare resources. This study highlighted differences in burn injuries between age, gender, race, and ethnicity.

Applicability of Research to Practice

Identifying communities at increased risk for burn injuries can help with public health initiatives, focused on awareness and prevention of these injuries.
39 Certified Burn Center Access in the United States: The Geospatial and Transport Cost of Transfer
Authors: Edwards Shelly , Brown Madyson , Humphries Laura , Hoppe Ian
Published: May 2023

Introduction

Specialized burn centers are critical in minimizing burn-associated morbidity and mortality. However, American Burn Association (ABA)-verified burn centers are unequally distributed across the US, and fewer verified centers are available for pediatric patients relative to adults. The economic burden of transport to verified centers represents a significant proportion of the already high cost of burn-associated care. The present study aims to quantify inequitable burn care access in the contiguous US due to age group and locality as a function of physical proximity and transportation cost.

Methods

County-level distances (n=3,106) to the nearest ABA-verified adult or pediatric burn center were determined and mapped. Distances were then analyzed separately for rural (n = 1440) and urban (n = 1666) counties for both adult and pediatric burn centers. Distance calculations for each population were combined with transport cost data (2022 CMS Ambulance fee Schedules) to determine the average cost of transport for each patient population (adult vs. pediatric, urban vs. rural).

Results

59 Adult and 43 Pediatric ABA-verified centers were identified from the ABA burn center directory. Pediatric patients reside 30.57 miles (p < 0.001) further than adults from the nearest center, accounting for a 10.5% - 15.9% transport cost increase. Transport costs increased dramatically between urban and rural counties, with rural patients facing a cost increase of 32.7% and 80.88% for ground and air transportation, respectively.

Conclusions

Physical proximity to burn care may appear to differ only modestly across age and region. However, the seemingly marginal increase in distance significantly impacts the cost of patient transport. The present study highlights both physical and economic barriers to burn care access faced by rural and pediatric patients. Increasing ABA burn center certification in targeted areas across the US may decrease the disparities in access to burn care faced by these groups.

Applicability of Research to Practice

Identify areas that may benefit from expansion of certified burn-care access and additional provider education.
42 Utilizing FAB Scores to Determine Next Level of Care for Patients with Burn Injury
Authors: Geib Teresa , Hill David , Mincey Meghan , Velamuri Sai , Fletchall Sandra
Published: May 2023

Introduction

Determining next level of care for burn patients is a difficult task for the entire medical team. Secondary to the nature of the injury, patients often do not have the social or economic support required to return to their prior level of function. The Functional Assessment for Burns (FAB) score has been shown an objective measure to determine functional independence and a predictor of discharge outcomes in adults. However, it is undetermined whether this assessment can be utilized to guide next level of care and time which it takes to return to prior level of function. We hypothesized the number of therapy sessions to be positively associated with patients’ return to baseline FAB.

Methods

This single center, retrospective study of patients admitted to a single ABA-verified burn center was completed by collecting FAB assessment scores within 48 hours of admission and within 48 hours of discharge over the last year. Demographics, injury characteristics, surgical procedures, and number of treatment sessions were collected. Shapiro-wilk test was utilized to test for normality. Regression analysis was utilized to analyze variable associations with changes in FAB scores. A paired t test was used to compare paired FAB scores between admission and discharge.

Results

One-hundred patients were included with a median age of 53 (38.5, 64) years and 7 (3.5, 14) percent total body surface area burned (TBSA). The median FAB for preadmission (preadm.), admission (adm.), and discharge (DC) were 35 (35, 35), 17 (14, 24), and 24 (19, 32), respectively. The paired difference between adm. and DC scores (< 0.001) indicated significant improvement. TBSA and age, together, were significant predictors of change in preadm. to adm. FAB (r2=0.202, p< 0.001). Adm. FAB and TBSA were both associated with number of therapy sessions. Only 16% of patients returned to preadm. level of functional independence by discharge with only 20% qualifying for / entering a post-acute inpatient rehabilitation facility. Number of combined therapy sessions was not associated with return to preadm. FAB. Of note, only 28% returned within 90% of preadmission FAB by discharge. In fact, 13% actually saw their FAB regress from adm. to DC. None of the collected variables were associated with the negative change in FAB scores through admission.

Conclusions

In this sample, number of sessions was not predictive of return to preadmission FAB; however, this may be due to the low numbers that achieved the milestone at all. Despite this fact, there was an alarmingly small number admitted to a subsequent inpatient rehabilitation facility. There was a significant improvement in paired scores from admission to discharge. Taken together, there may be value in reassessing inpatient rehabilitation facility adm. criteria.

Applicability of Research to Practice

FAB scores may be a useful indicator of further rehabilitation needs.
55 Risk of Sepsis and Mortality in SJS and TENS Patients Treated with Corticosteroids
Authors: Everett Catherine , Hink Ashley , Kahn Steven , Ozhathil Deepak
Published: May 2023

Introduction

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are a rare adverse cutaneous drug reaction that historically has a high risk of mortality. The use of corticosteroids (CS) to treat SJS/TENS remains controversial as the literature is limited to small cohort trials by the rarity of the condition. Some conflicting studies suggested that CS may increase mortality due to augmented infection risk. This study evaluated the incidence of sepsis and mortality following CS use in patients with SJS/TENS.

Methods

We performed a retrospective study utilizing a commercially available multi-institutional database derived from deidentified inpatient coding data to assess the incidence of sepsis and mortality within 30 days after diagnosis of SJS/TENS in patients >18 years old treated with CS within one week of their initial diagnosis. Data was analyzed from years 2000-2022. Patients treated with CS within 1 week of diagnosis (n=3930) and those treated without CS (n=6557) were propensity matched for age, race, gender, severe sepsis and SIRS (n=3723) and were assessed for relative risk of mortality and sepsis occurrence.

Results

Of the patients who received CS 171 of 3723 died vs 98 of 3723 of those that did not receive CS. They incurred a 1.961% relative risk (RR: 1.745, 1.367, 2.227 95% CI, p=< 0.0001) for mortality. Similarly, of the patients that received CS 245 of 3723 suffered sepsis vs 173 of 3723 that did not receive CS. This was a 1.934% relative risk (RR: 1.416, 1.172, 1.711 95% CI, p=0.0003) of developing sepsis. The number of instances and median days till instance were not statistically different between cohorts.

Conclusions

This study indicated that amongst adult patients diagnosed with SJS/TENS, the utilization of CS within the first week of diagnosis is affiliated with a statistically significant increased risk of sepsis and death within 30 days of diagnosis.

Applicability of Research to Practice

The application of CS therapy may enable the development of infections in patients such as sepsis, which may ultimately worsen prognosis, but the rarity of this condition prohibits effective single-institution assessment of this impact. Care should be taken to assess the risks and benefits of prescribing CS therapy in SJS/TENS patients.
69 Methamphetamine Positivity Prior to Burn Surgery Does not Adversely Affect Intraoperative or Inpatient Outcomes
Authors: Sheckter Clifford , Rizk Nada , Crawford David , Karanas Yvonne , Barnes Christopher , Pham Tam
Published: May 2023

Introduction

The treatment of burn patients using amphetamines is challenging for hemodynamic and behavioral reasons. In addition, recent amphetamine use may also pose intraoperative risks. Due to insufficient literature to guide the safety and timing of operative care, wide practice variation exists in the operative timing for this patient population. We hypothesize that burn excision without negative amphetamine toxicology is safe.

Methods

We queried the operative and electronic health records of amphetamine-positive patients treated from 2017-2022 at two ABA verified burn centers. The practice guideline at Center A obtains admission toxicology only and proceeds with surgery based on hemodynamic status and operative urgency, whereas Center B sends daily toxicology until a negative test results. The primary safety outcome was the use of vasoactive agents during the index operation. This risk was modeled via logistic regression and adjusted for injury severity and hospital day for index operation. Secondary outcomes included death and inpatient complications.

Results

A total of 270 patients were identified during the study period. Mean age was 45.5 years (SD 12.9 years), median TBSA was 9.2% and the majority were male (76.7%). There were no significant differences in injury size, age, or male/female proportion between the two sites. Whereas Center A only tested once on admission, Center B obtained a median of 4 toxicology screens prior to surgery. There were no difference in mean induction systolic blood pressure between the 2 sites, although Center A had more patients who had SBP< 95 or >160mmHg on induction (one-way ANOVA p=0.596). The adjusted OR of requiring vasoactive support during surgery was not associated with negative toxicology status (p=0.821). A larger injury size (%TBSA >20) conferred a significant higher risk of vasoactive support (adj. OR 13.42 [3.90 – 46.23], p< 0.001). Clinical outcomes at the 2 sites were similar in the terms of mortality, number of operations, stroke, and hospital length of stay.

Conclusions

Comparison between 2 ABA verified burn centers identifies a significant variation in practice with regards to serial amphetamine screenings prior to burn surgery. This study indicates that negative toxicology does not impact intraoperative anesthesia management nor subsequent burn clinical outcomes.

Applicability of Research to Practice

Serial toxicology tests are unnecessary to guide operative timing of burn patients with amphetamine use.
85 The Severity of Burns and Associated Psychiatric Risk Factors in Self-Immolation
Authors: Mannekote Thippaiah Srinagesh , Ramos Gilbert , Richey Karen , Foster Kevin , Ayub Ibraheim , Challita Youssef
Published: May 2023

Introduction

Self-Immolation is the act of setting oneself on fire to inflict death or self-injury. It is most commonly seen in developing nations and is associated with high mortality. In developed countries, self-immolation is uncommon and occurs mostly in middle-aged males with a history of mental illness, substance abuse, and unemployment. In the United States, it is an extreme act of suicide or self-injurious behavior with a mortality rate of 11.4% and exhibits a significant burden on healthcare systems. In this study authors aimed to characterize and explore psychiatric risk factors for self-immolation; broader understanding helps to optimize patient care and reduce the future recurrence of self-immolation act.

Methods

This was a retrospective review of all inpatient admissions from July 2015 to August 2022 with a history of self-immolation were included in the study. Data collection included demographics, total body surface area burned (TBSA), Suicide attempt or Self injurious behavior, urine drug screen, length of stay and psychiatric history. Twelve patients without incomplete data were excluded. Patients were divided into mild (< 20%), moderate (20-40%), and severe ( >40%) burns based on percent of TBSA. Data analysis was conducted using Chi-Squared, and Fisher's Exact tests in SPSS v28.

Results

We identified 103 patients who attempted self-immolation. Mean TBSA was 27 ± 33 with 66 (64%) experiencing mild, 11 (10%) with moderate, and 27 (26%) with severe burns. Mortality in this population was 21%. The majority were male (70.9%), Caucasian (63.1%), and single (79.6%) with a mean age of 38 ± 14 years old. Urine drug screen was positive in 44% upon admission, and 63% reported chronic drug use. Methamphetamine (37%), and alcohol (30%) were in the highest prevalence upon admission. Additionally, 83% of patients had underlying psychiatric illnesses including major depressive disorder (36%) and Schizophrenia spectrum disorders (27%). The presence of suicidal intent (n=68) was a predicted risk factor for severe burns (p < 0.001).

Conclusions

Our study found that patients undergoing self-immolation were more likely to have suicidal intent and that suicidal intent strongly predicted burn severity. Although no specific psychiatric disorder predicted burn severity, the overwhelming majority of self-immolation patients suffered from underlying psychiatric illnesses.

Applicability of Research to Practice

There is limited data on the triggers and risk factors for self-immolation. Due to the large prevalence of drug use and underlying psychiatric disorders, providers should obtain an early psychiatric assessment for self-immolation patients to minimize recurrence and optimize inpatient care. Similarly, home safety education for patients with suicidal intent and their families may help reduce the frequency and severity of self-immolation in the outpatient setting.
93 Inhalation Injury: Which Providers Can Assess the Need for Intubation?
Authors: Adams Laura , Perkins Louis , Santorelli Jarrett , Lee Jeanne , Smith Alan , Doucet Jay
Published: May 2023

Introduction

Previous studies have suggested many burn patients undergo unnecessary intubation due to concern for inhalation injury. There is a lack of clear consensus guidelines for intubation and thus there is significant variation in practice pattern. In this study we hypothesized intubation rates would differ between Acute Care Surgeons with specialized burn training and those without.

Methods

A retrospective analysis of 388 patients admitted to an ABA verified level 1 burn center who presented emergently following burn injury from 7/2015 to 12/2021 was performed. Patients excluded include polytrauma patients, isolated friction burns, and patients intubated prior to hospital arrival. All providers performing initial evaluation are Acute Care Surgeons, with a subset having additional specialized fellowship training and/or extensive burn experience. Our primary outcome was intubation rates between burn and non-burn trained providers. The Chi-Square and Mann-Whitney U statistical tests were used to compare categorical and continuous variables, respectively.

Results

There were 465 major burn patients admitted through the trauma bay and screened during the study period with 388 patients meeting inclusion criteria. The population was 72% male, with mean age of 44 years +- 21, TBSA of 12%, and COHgb level of 2.9%. In total, 73 (19%) of patients underwent intubation. The patients in the two provider groups did not differ in terms of age, gender, race, TBSA, COHgb level, or airway exam findings. 240 (62%) patients were evaluated by a burn provider and 148 (38%) were evaluated by a non-burn provider. There was no significant difference in the rate of emergent intubation of patients treated by burn vs non-burn trained providers (RR 0.71, CI 0.47 - 1.07). Of the patients who were intubated, there was no significant difference between burn and non-burn providers in the diagnosis of inhalation injury on bronchoscopy (RR 1.3, CI 0.91-1.85). In both groups, objective evidence of inhalation injury was found in only 68% of patients undergoing routine bronchoscopy following emergent intubation.

Conclusions

There was no significant difference in intubation rates between burn and non-burn trained acute care surgeons. This demonstrates that following standard ATLS and ABLS principles provides appropriate training in the evaluation, diagnosis, and treatment of inhalation injury. Interestingly, 32% of all patients intubated did not have evidence of inhalational injury on bronchoscopy following intubation. This study suggests that further research is needed to determine objective criteria for intubation guidelines when inhalation injury is suspected in the acute burn patient population.

Applicability of Research to Practice

Applicable
100 Long Term Outcomes for Inpatient Visits in Bcqp - Feasibility to Bridge the Gap
Authors: Weber Joan , Malic Claudia ,   QBR Outpatient Work Group, Lynch Brian
Published: May 2023

Introduction

The ABA burn registry is designed to improve the quality and cost of burn care by collecting and exchanging information on burn injuries and outcomes. The BCQP has data related to inpatients visits only. Data on long term outcomes from outpatient settings are not yet available in the ABA’s Quality Burn Registry, but there is agreement that such data should be collected. With any expansion of the registry, attention should be given to the type of data that are collected and the efforts needed to gather accurate data. A pilot phase (alpha pilot) is required before embarking on a larger scale of data gathering.

Aim

This alpha pilot aims to determine what outcomes should be selected to continue data collection for patients who were discharged from a burn center and are followed up within outpatient settings.

Methods

The QBR Outpatient Work Group identified 9 items (5 clinical and 4 psychosocial outcomes) that could define the long term outcomes after discharge from the initial admission related to the thermal injuries. A five questions survey was developed to evaluate the length of time spent by registrars to gather the data, and around data quality assurance. Seven verified burn centres were enrolled on voluntary basis on the alpha pilot. Each centre had to enter a patient in each of the predefined categories (age and burn extent related) for the 12 months post discharge divided in 3 monthly periods. The data gathering finished in April 2022.

Results

A total of 29 patients were entered in the alpha pilot, with 5 patients < 18 yrs of age and 6 over the age 65. The most frequent cause of burn injury was flame (18/29). Fourteen patients sustained burn injuries >20% TBSA. The 95% wound closure was documented in 79.3% and follow up was complete or ongoing for 89.7%. Details about any surgical procedures after discharge was well documented (100%). The burn scar appearance was present in the chart in 69.2% of the cases and only in 3 patients pressure garments was not documented. Presence of depression or PTSD was not documented in 50% of the cases, whereas the presence of pain and itch was documented between 79% to 83%. Registrars found that it took up to 20 minutes to retrieve the data from the charts.

Conclusions

The findings were presented to the Quality and Burn Registry Committee. As alpha pilot was the first PDSA cycle for this project, further amendments were made to the definitions and layout of the data. A beta pilot (14 hospitals) is ongoing currently as second PDSA cycle in order to identify further barriers for large scale implementation of long term outcomes in the burn registry.

Applicability of Research to Practice

implementation of long term outcomes in the ABA Burn Registry
103 Analysis of Arterial Blood Pressure Waveform Features in a Porcine Model of Burn and Resuscitation
Authors: Arabidarrehdor Ghazal , Kao Yi-Ming , Hahn Jin-Oh , Burmeister David , Parajuli Babita , Carney Bonnie , Keyloun John , Moffatt Lauren , Shupp Jeffrey , Reese Adam , Oliver Mary
Published: May 2023

Introduction

Functional arterial blood pressure waveform (ABW) features are incompletely understood in the context of burn injury and resuscitation. In this work, we analyzed the variability of pulse pressure (PPV), systolic pressure (SPV), stroke volume (SVV), and five measures of heart rate variability (HRV) in time and frequency domains as potential indicators of burn resuscitation adequacy in a large total body surface area (TBSA) porcine model with varying degrees of intravenous fluids.

Methods

Data were collected from 21 anesthetized and mechanically-ventilated pigs (32±4 kg weight, 40% TBSA), which were instrumented for continuous hemodynamic monitoring for 24 hours. Urinary output (UO), hematocrit (HCT) and cardiac output (CO) were also measured at various time points. The animals were divided into Paradigm 1 (P1): no resuscitation (N=7); Paradigm 2 (P2): fluid titration to UO (N=8); and Paradigm 3 (P3): deliberate over-resuscitation with consistent high fluid rates (N=6). We calculated PPV, SPV, SVV, and five widely used HRV measures: normalized low-frequency power (NLF), high-frequency power (NHF), very-low-frequency power (VLF), low-frequency-high-frequency (LFHF) ratio, and the root-mean-squared of the duration difference in consecutive beats (RR-RMS). All features were averaged on an hourly basis and their potential in tracking reference CO and SV was investigated via linear regression and correlation analysis after calibrating the data to SV and CO on an individual basis.

Results

PPV, SPV, SVV, and RR-RMSE showed statistically distinguishable trends for different paradigms, as depicted in Figure 1, along with averaged trends for lab measurement. PPV, SPV, and SVV tracked the CO the best and were comparable to UO, however, SVV was far superior in tracking SV. A regression analysis between these four features and UO showed a very low level of agreement despite comparable tracking of SV and CO. HRV measures did not distinguish resuscitation paradigms and were inferior in tracking CO and similar in tracking SV to aforesaid features.

Conclusions

PPV, SPV, SVV, and RR-RMSE may potentially complement UO in the hemodynamic assessment of the burn patients and outperform other HRV measures in general. Future work will optimize the extraction of strategic informative features of ABW analysis in the various fluid status states post-burn injury.

Applicability of Research to Practice

Titrating burn resuscitation rates to have protocols including PPV, SPV, SVV, and RR-RMSE alongside other standard metrics may offer precision medicine strategies to fine-tune IV fluid rates.
116 Relationship between Smartphone-tracked Physical Activities and Psychosocial Outcomes for Burn Survivors Living in the Community
Authors: Deng Huan , Abouzeid Cailin A , Shepler Lauren J , Slavin Mary D , Herrera-Escobar Juan P , Kazis Lewis , Ryan Colleen , Schneider Jeffrey
Published: May 2023

Introduction

Following burn survivors in the community is critical to understand their problems and needs. Physical activities automatically recorded by smartphones have shown to be a convenient and burdenless method for post-discharge assessment. However, it is unclear if physical activities are associated with burn survivors’ physical and psychosocial outcomes. This study aims to examine the relationship between smartphone-tracked physical activities and scale-based outcomes.

Methods

Adult burn survivors living in the community were included in this study. A mobile application was downloaded to participants’ smartphones and automatically recorded daily number of steps, travel miles and activity minutes. Participants received weekly surveys assessing pain (Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Interference), depression (Patient Health Questionnaire (PHQ-8)), anxiety (PROMIS Anxiety) and social participation (Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities). Correlation coefficients between physical activities and survey results were examined and interpreted as “very weak” (|r|≤0.19), “weak” (0.20≤|r|≤0.39), “moderate” (0.40≤|r|≤0.59), “strong” (0.60≤|r|≤0.79), and “very strong” (0.80≤|r|≤1.00).

Results

There were 24 burn survivors with an average of 24 years after injury included in this study. The 180-week data collected between November 2021 and August 2022 was analyzed. Daily number of steps, travel miles and activity minutes separately showed relationships with PROMIS Pain Intensity (r=-0.312, p< 0.001; r=-0.247, p=0.001; r=-0.239, p=0.001), PROMIS Pain Interference (r=-0.375, p< 0.001; r=-0.318, p< 0.001; r=-0.291, p< 0.001), PHQ-8 (r=-0.403, p< 0.001; r=-0.357, p< 0.001; r=-0.311, p< 0.001), PROMIS Anxiety (r=-0.310, p< 0.001; r=-0.209, p=0.007; r=-0.150, p=0.054), LIBRE Social Interactions (r=0.272, p< 0.001; r=0.291, p< 0.001; r=0.328, p< 0.001) and LIBRE Social Activities (r=0.381, p< 0.001; r=0.414, p< 0.001; r=0.404, p< 0.001).

Conclusions

Daily number of steps demonstrated a moderate correlation with depression while both daily travel miles and activity minutes showed moderate correlations with social participation. The results support that smartphone-tracked physical activities are related to burn survivors’ psychosocial outcomes.

Applicability of Research to Practice

This study may inform future use of smartphone-tracked physical activities to understand and track burn recovery and ultimately improve care.
118 Outcomes of Amputation Following Electrical Burn Injuries: A Five-Year Follow-Up
Authors: Kim Eunyeop , Kowalske Karen , Solis Kyra Jeanine , Wan Bingchun
Published: May 2023

Introduction

Studies have acknowledged the prevalence of amputation in patients with electrical burns; however, the exact probability of amputation as a result of electrical injuries and the effect of amputation on the long-term health remain unclear. The purpose of this study was to analyze electrical burn survivors with amputation using a large multi-center database and assess their corresponding long-term physical and mental health, compared with a non-electrical burn population with amputation.

Methods

Retrospective reviews of burn patients from 1993 to 2021 were performed using the Burn Model System National Database, that yielded 408 patients with electrical etiology and 6341 with non-electrical etiology. The variables for analysis included the Veterans RAND 12-Item Health Survey and the Patient-Reported Outcomes Measurement Information System 29, collected at discharge, six months, 12 months, 24 months, and five years post-burn.

Results

Electrical burn patients showed a higher amputation rate (30.3%) than non-electrical burn patients (6.6%) (p < 0.0001). Electrical burn patients with amputation showed significantly lower physical component scores (PCS=34.1) and physical function scores (PFS=37.1) at discharge than electrical burn patients without amputation (p < 0.05). No significant differences were found in mental component scores, anxiety, depression, sleep, or fatigue between patients regardless of burn type or amputation. Electrical burn patients experienced similar post-injury trends compared with non-electrical burn patients. Non-electrical burn survivors with amputation had the worst outcomes of all patient groups. The Hispanic population comprised the largest percentage of the electrical burn group (80%).

Conclusions

This study shows that patients with amputation need extra attention to their physical impairment at discharge. Early rehabilitation in electrical burn patients with amputation should be emphasized. Non-electrical burn survivors with amputation need the most support from both physical and psychological perspectives. This study like many others supports that regardless of burn etiology, all burn survivors require psychological support at discharge. The study also accentuates the need for better electrical injury prevention and rehabilitation program for those who speak Spanish.

Applicability of Research to Practice

More intensive and comprehensive interventions for electrical burn survivors with amputation in the earlier stages of rehabilitation can help ensure better long-term physical, psychological, and social outcomes. In contrast, rehabilitation plans for patients with non-electrical burns with amputation should concentrate more on the long-term management for up to a minimum of two years post injury, as these patients face significantly longer and severe difficulties than electrical burns patients with and without amputation.
123 Flexion Glove Modification to Isolate Proximal and Distal Interphalangeal Joint Range of Motion
Authors: Rodriguez Joshua , Vocke Scott , Andre Gregory , Dean Brooke
Published: May 2023

Introduction

Flexion gloves are a quick and easy way to provide a dynamic stretch to the digits for patients with limited composite flexion range of motion (ROM) or who are at risk for digit extension burn scar contractures. However, the flexion glove has been observed clinically to bias metacarpal phalangeal (MCP) joint flexion ROM when compared to the proximal and distal phalangeal (PIP and DIP) joints. The purpose of this case study is to demonstrate the use of a custom thermoplastic hand-based splint to block MCP joint motion in order to better isolate PIP and DIP joint ROM for a patient with primary PIP and DIP flexion ROM limitations.

Methods

A custom, thermoplastic, palmer hand-based splint was fabricated with an opening for the thumb and the splint extending to the proximal phalanxes stopping below the PIP joints in order to block MCP joint flexion ROM as seen in Figure 1b. Composite flexion passive ROM (PROM) measurements were taken for all MCP, PIP, and DIP joints of digits 2-4 with only the flexion glove donned and with the hand-based splint applied over the flexion glove as seen in Figure 1a and 1c.

Results

An increase in combined PIP and DIP joint PROM was found for all digits when the hand-based splint was donned over the flexion glove compared to the flexion glove only (see Table 1). These increases in combined PIP and DIP PROM included 35° for the index finger, 10° for the middle finger, 20° for the ring finger and 30° for the small finger, with an overall mean increase of 23.75°

Conclusions

This easy splinting technique combined with a flexion glove was effectively used to bias stretch of the PIP and DIP joints into flexion for a patient with adequate MCP flexion ROM and impaired PIP and DIP flexion ROM caused by burn scar contracture.

Applicability of Research to Practice

Using an off the shelf flexion glove and a basic hand-based splint, therapists can use this technique to easily adjust the angle of pull to maximize the benefit from a flexion glove to address specific joint limitations of the finger caused by burn scar contracture.
500 Wound Coverage for Massive Burn Injuries ≥50% TBSA – A Systematic Review and Meta-Analysis
Authors: Hundeshagen Gabriel , Kneser Ulrich , Tapking Christian , Abdulrazzak Obada , Palmer Jack , Veeramani Anamika , Tchiloemba Bianief , Stögner Viola , Haug Valentin
Published: May 2023

Introduction

Early wound coverage remains one of the most essential variables influencing survival of extensively burned patients, especially with a total burned surface area (TBSA) of more than 50%. In patients with limited donor sites, techniques such as e.g. the Meek micrograft procedure or cultured epidermal allografts have proven to be viable methods. In this systematic review (SR) and meta-analysis (MA) we studied the outcomes of different techniques for wound coverage in patients with massive burn injuries ≥50% TBSA within the last 17 years.

Methods

According to PRISMA guideline the medical databases PubMed, Cochrane, Embase, Web of Science Medical records were screened in 5 languages from 01/2005 until 01/2022 by three reviewers, independently. Inclusion criteria were prospective or retrospective studies on patients with massive burns of ≥50% TBSA.

Results

After a two-stage review process, 33 studies were identified for the SR and MA. Regions of publication were Asia (n=15), North America (n=8), Europe (n=7), Australia (n=3). In total, 1678 patients with a mean age of 31.4 ± 14.2 years were included. The male to female ratio was 2.25 : 1. Mean TBSA was 66,5 ± 12.2%. Methods of wound coverage consisted of Meek micrografts, cultured epithelial autografts and/or allografts. The mean length of stay was 76.5 ± 32.4 days. Initial graft-take was 78,0 ± 15.8%. Grafting techniques did neither substantially differ in the length of stay nor the healing rate.

Conclusions

In patients with massive burn injuries of ≥50% TBSA the length of stay and the healing rates were comparable between Meek micrograft procedure, cultured epithelial allografts and combined techniques.

Applicability of Research to Practice

Wound coverage by Meek micrograft procedure with expansion of up to 1:10 and a potential combination with cultured epithelial allografts should be considered early in patients with massive burn injury.
505 Risk Stratification by TBSA for Acute Kidney Injury in Burn Patients Following Combination Antibiotic Therapy
Authors: Brondeel Kimberley , Palackic Alen , El Ayadi Amina , Wolf Steven , Lee Jong , Song Juquan , Golovko Georgiy
Published: May 2023

Introduction

Burn patients are susceptible to infections and are often treated with broad-spectrum antibiotics. Vancomycin is a common antibiotic administered alone, or in combination with piperacillin-tazobactam (Pip/Tazo). This combination therapy was associated with increased rates of acute kidney injury (AKI) in burn patients when compared to Vancomycin alone or in combination with other antibiotics. However, recent studies failed to demonstrate these findings. We sought to determine the degree of nephrotoxicity of Vancomycin, Pip/Tazo, and their combination, with burn severity.

Methods

A retrospective, multi-institutional study was performed utilizing TriNetX Global Health Research Network that encompasses de-identified patient records from 55 health care organization across the US. We identified the population of burn patients between 2000-2020 and stratified them into 3 groups by TBSA < 10%, 10-39%, or 40%+. Patients were further stratified into cohorts by administration of broad-spectrum antibiotics within 3 months of their burn: Vancomycin, Pip/Tazo alone, in combination (Combo), or neither. Cohorts were propensity score matched for age at index, gender, race, ethnicity, and pre-existing conditions that predispose to AKI. We explored patient distribution and conducted a comparative outcome analysis to determine the risk of developing AKI in 7- and 90-day outcome windows.

Results

Vancomycin and Pip/Tazo were compared to control groups and showed increased risk of AKI in all TBSA groups and time outcomes(p< 0.0001). Before stratifying by TBSA, all burn patients administered combination antibiotics showed increased risk of AKI when compared to control, Vancomycin alone, and Pip/Tazo. In patients under < 10% TBSA, combo antibiotics increased AKI incidence in both 7- and 90-days when compared to all other groups. In the 10-39% TBSA group, combination therapy increased the risk of AKI when compared to Pip/Tazo at 7-days. Increased risk of AKI occurred in the combo group when compared to both Vancomycin and Pip/Tazo in 90-days. In the 40%+ TBSA cohort, combination antibiotics did not increase the incidence of AKI in either time period or when compared to Vancomycin and Pip/Tazo. The results of the comparative analysis are included in Table 1.

Conclusions

Broad-spectrum antibiotics use in burn patients is associated with increased risk of AKI, this risk is higher with Vancomycin and Piperacillin/Tazobactam combination. Combo therapy increased AKI in < 10% and 10-39% but not 40%+ TBSA. These findings can be used to monitor for early manifestations of AKI when using broad-spectrum antibiotics.

Applicability of Research to Practice

The decision to initiate antimicrobial therapy is crucial in burn patients as they are already at risk for AKI. TBSA can be a useful tool for guiding risk stratification.