bluuebunny/crossref_metadata_2025 huggingface dataset:
580 Assessing Opioid Use After Discharge in Pediatric Burn Patients
Authors: Owens Victoria , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G , Sen Soman
Published: April 2021

Introduction

Opioids are frequently prescribed after burn injury. Prolonged use of opioids can increase dependence and potential for life threatening complications. For burn-injured children, optimizing opioid prescriptions in the outpatient setting can reduce these risks. Our aim for this study was to assess and analyze the outpatient opioid prescription use in children with burn injuries.

Methods

After approval from the institutional review board, pediatric patients admitted to our institution with £20% total body surface area (TBSA) burn were included. Data collected included age, gender, % TBSA burn, mechanism of injury, length of stay, surgical procedures, total morphine milligram equivalent (MME) given in last 24 hours prior to discharge and discharge pain prescriptions. 7 days after discharge, families tracked and provided daily usage of prescription opioids, acetaminophen, and ibuprofen, as well as daily pain scores. Families were given a follow up questionnaire about whether a prescription opioid was prescribed and filled, daily medication needs, pain scores, storage of opioids, quantity of medications remaining, and disposal of any remaining opioids. All mean values are mean±standard deviation, all median values are median(interquartile range).

Results

Twenty-nine patients were enrolled with a mean age of 7±5.8 years and mean TBSA of 10±6%. Daily outpatient pain scores ranged from 0–2. 18 patients underwent skin graft surgery (SUR) and 11 did not (NOSUR). The mean % of opioids that were not used was 50%±38% and 52% of families kept the left-over opioids for future use. For the SUR group, a median % of opioids that were not used was 64(14–90)% and for the NOSUR the median was 35(17.5–56)% and 56% of SUR families and 45% of NOSUR families kept the left-over opioids for future use.

Conclusions

For pediatric burn patients, opioids prescribed at discharge may be overestimating pain needs. In our study, half of the opioids were not used, and this was even more pronounced in patients who underwent surgery. More concerning is that the majority of families did not dispose the opioids and instead kept the medication for future use. We recommend optimizing opioid prescribing practices to reduce over-prescribing opioids to burn injured children and educating families on the need for proper disposal of left-over opioids.
583 Burn Care During Six Months Covid-19 Pandemic; Report of A Single Center
Authors: Aydogan Cem , Ayvazoglu Soy Ebru H , Turk Emin , Yabanoglu Hakan , Avci Tevfik , Gedik Ender , Haberal Mehmet
Published: April 2021

Introduction

The novel coronavirus (SARS-CoV-2) responsible for COVID-19 pandemic caused an unprecedented health care crisis. During pandemic burn centers had to preserve the ongoing burn care in a safe and ethical way. It is crucial to manage inpatients, outpatients, wards and staff carefully to prevent epidemia in burn units. Here, we aimed to report our burn care experience during the six months COVID-19 pandemic.

Methods

We retrospectively evaluated our ambulatory and hospitalized burn patients during the six months COVID-19 pandemic (from March to September 2020) with respect to the demographic data, wound care, surgery, intensive care management. Based on the model of our infection control team, we formed first to third degree prevention methods while contacting with burn patients in our outpatient clinic, semi-sterile ward (with beds) and intensive care unit (with 4 beds) which were sterilized and ventilated regularly. During hospitalization, we restricted the degree of interaction during multidisciplinary rounds. To screen for nosocomial infections, patients were routinely tested with PCR test.

Results

402 burn patients (158 paediatric, 244 adults) were managed as outpatients (n=332;82%) and in patients (n=70; 18%) in our burn centre. Total body surface area percentage of burn in hospitalized patients were 9, 95±2, 76 % in paediatric and 25, 34±3, 49 in adult group. Majority of the burns were scald (86.7% paediatric, 60.5% adults) burns. We successfully performed 66 surgical debridement and grafting procedures. Three adult patients had mechanical ventilation support during follow up and one of them died due to multi organ failure with negative PCR. We detected COVID-19 in 2 patients and both of them were discharged successfully.

Conclusions

According to our results, when precautions are taken, burn care can be managed successfully without posing any risk to patients during the pandemic period.
586 Patient Satisfaction for the Use of DVPRS in the Assessment of Pain in the Burn and Surgical ICU
Authors: Banks Michael C , Yesantharao Pooja S , Smith Lisa C , Werthman Emily h , Cox Carrie A , Javia Vidhi , Caffrey Julie
Published: April 2021

Introduction

The assessment and treatment of pain has become increasingly important in light of the opioid epidemic. Inadequately managed pain can lead to increased risk of psychiatric illness. The numeric rating scale (NRS) is used in most ICUs and only assesses pain intensity. Although it is reliable, valid, and user-friendly, other publications have criticized this one-dimensional pain assessment tools as offering little information about the impact of the pain on the patient’s life.

The defense and veterans pain rating scale (DVPRS) is a multi-dimensional tool designed to assess the patient’s pain intensity as well as how the pain interferes with the patient’s general activity, sleep, mood and stress. Studies have shown that it has good validity and reliability in the inpatient and outpatient military population with neuropathic and non-neuropathic pain. The DVPRS has not been evaluated in critical care patients. Thus, this study comparatively investigated ICU patients’ satisfaction with the DVPRS versus the NRS.

Methods

This was a prospective pilot study performed from September 2018 to July 2019 in a 10 bed burn intensive care unit (BICU) and 10 bed surgical intensive care unit (SICU) at a university teaching hospital. This was an IRB approved study. All enrolled patients were older than 18 years of age and were CAM-ICU negative. The participating staff members were educated on the use of the scales prior to the start of the study. Routine treatment of pain was not altered by the study. Pain was assessed by staff nurses randomly assigned to use the NRS or DVPRS tool. The selected tool was used on admission, during wound care and every 4 hours or upon patient need. The patients completed satisfaction surveys on the day of discharge.

Results

42 patients participated and 32 completed the study. 18 patients were in the DVPRS arm and 14 were in the NRS arm. Our primary outcome was patient satisfaction, ranked on a scale from 0–10, where 0 was the lowest score and 10 was the highest. Overall, patients in the DVPRS cohort had higher median satisfaction scores (median score: 10, interquartile range: 8–10) than the NRS cohort (median score: 8, interquartile range 7–9), though this difference did not reach statistical significance (p=0.16). However, DVPRS patients were significantly more likely to be “completely satisfied” than NRS patients (55.6% in DVPRS patients versus 21.4% in NRS patients; p=0.04). Furthermore, upon multivariate logistic analysis adjusting for age, gender, and ICU using the NRS pain scale conferred lower odds of complete satisfaction with pain management (odds ratio: 0.19, p=0.04).

Conclusions

Our study showed that ICU patients preferred the DVPRS over the NRS. The DVPRS appeared to be as effective as the NRS in pain relief and gave providers more information about patients’ pain.
588 Peripheral Nerve Blocks in Procedural Care for Burn Injuries Less Than 10% Total Burn Surface Area: A Retrospective Chart Review.
Authors: Maynell Kimberly , Chharath Khattiya , Tran Thanh , Taylor Loryn , Smith David J
Published: April 2021

Introduction

Pain control remains one of the major challenges in management of burn patients. Pain associated with procedural and post-procedural burn care such as excision and grafting, postoperative dressing changes, and postoperative physical therapies often requires patients to be on intravenous and oral analgesics leading to potential long-term dependence after hospital discharge. Peripheral nerve blocks (PNB) use for perioperative pain management in burn patients may present an alternative pain management modality to help decrease analgesic consumption and shorten length of stay following procedural care. Our hypothesis was tested by evaluating the outcomes from implementation of PNB with ultrasound guided catheter placement for burn procedural care in patients with ≤ 10% total burn surface area (TBSA) requiring excision and grafting.

Methods

After IRB approval, we retrospectively collected demographics, medical history, 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]), postoperative analgesic consumption and time to hospital discharge of patients who underwent autografting procedures for burn injuries ≤ 10% TBSA from October 1, 2019 to December 31, 2019 (the start of our implementation of PNB for procedural burn care). Data was analyzed using chi square/Fisher exact test for categorical variables and t-test for continuous variables.

Results

Our preliminary data included 20 patients (10 patients had PNB) with average age of 53 years, 60% males and average TBSA of 4.8%. Patients in both PNB and non-PNB groups had unremarkable medical histories and scald and flame as mechanism of burns. There was no significant difference in TBSA (5.3% TBSA in PNB and 4.8% TBSA in non-PNB). Pain intensity before autografting procedure for both groups were reported as moderate to severe and managed with fentanyl, morphine, oxycodone, along with ibuprofen and acetaminophen. There was no significant difference in postoperative pain intensity and opioid consumptions; however, postoperative acetaminophen consumption was less in PNB group compared to non-PNB group (2762±3646 mg vs 3932±7511 mg, respectively), although not statistically significant. There was no significant difference between time from surgery to first physical therapy session; however, time to hospital discharge was shorter in PNB group compared to non-PNB group (5.7±1 days vs 10.5±9 days, respectively), although not statistically significant.

Conclusions

This evaluation shows a trend in reduction of inpatient postoperative analgesic consumption as well as time to hospital discharge with the use of PNB, although a bigger sample size is needed for further assessment.
598 Temperature profiles of sunlight-exposed surfaces in a desert climate: Determining the risks for pavement burns.
Authors: Chestovich Paul J , Saroukhanoff Richard Z , Saquib Syed F , Carroll Joseph T , Flores Carmen E , Moujaes Samir F
Published: April 2021

Introduction

In the desert climates of the United States, plentiful sunlight and high summer temperatures cause significant burn injuries from hot pavement and other surfaces. Although it is well known that surfaces reach temperatures sufficient to cause full-thickness burns, the peak temperature, time of day, and highest risk materials is not well described. This work measured continuous temperature measurements of six materials in a desert climate over a five-month period.

Methods

Six different solid materials common in an urban environment were utilized for measurement. Asphalt, brick, concrete, sand, porous rock, and galvanized metal were equipped with thermocouples attached to a data acquisition module. All solid materials except metal were placed in a 2’x2’x3.5” form, and identical samples were placed in both shade and direct sunlight. Ambient temperature was recorded, and sunlight intensity was measured using a pyranometer. Measurement time interval was set at three minutes. A computational fluid dynamics (CFD) model was created using Star CCM+ to validate the data. Contour plots of temperature, solar irradiance, and time of day were created using MiniTab for all surfaces tested.

Results

75,000 temperature measurements were obtained from March through August 2020. Maximum recorded temperatures for sunlight-exposed samples of porous rock was 170 F, asphalt 166 F, brick 152 F, concrete 144 F, metal 144 F, and sand 143 F. Peak temperatures were recorded on August 6, 2020 at 2:10 pm, when ambient temperature was 120 F and sunlight intensity 940 W/m2 (Table). Temperatures ranged from 36 F - 56 F higher than identical materials in the shade at the same time. The highest daily temperatures were achieved between 2:00 pm to 4:00 pm due to maximum solar irradiance. Contour plots of surface temperature as function of solar irradiation and time of day were created for all surfaces tested. Nearly identical results obtained from the CFD models to the experimentally collected data, which validated the experimental data.

Conclusions

Surfaces exposed to direct, continuous sunlight in a desert climate achieve temperatures from 143 F to 170 F in the early afternoon and are high enough to cause significant injury with sufficient exposure. Porous rock reached the highest temperature, followed closely by asphalt. This information is useful to inform the public of the dangers of exposed surfaces in a desert climate.
599 A Retrospective Outcome Analysis of the Involvement of Department of Child Services in Suspected Cases at a Major Regional Pediatric Burn Center
Authors: Senthil-Kumar Prabhu , Zieger Madeline , Shostrand Lisa M , Hartman Brett C
Published: April 2021

Introduction

Cases of child abuse are an important manifestation of pediatric burns owing to their nature and all too common occurrence. In our institution, the Department of Child Services (DCS) is often frequently involved in minimally suspicious cases in conjunction with or even before the internal child protective team involvement. To our knowledge, there is no recent literature evaluating the outcome of DCS involvement in suspected cases in pediatric burn populations.

Methods

We performed a retrospective chart analysis of the pediatric burn patient database at our institution from 2017–2020. We identified 116 out of 565 patients who matched our criteria for the involvement of DCS. We collected the following information: age, race, address at time of injury, payer source, where DCS involvement was initiated, and the outcome of the investigation.

Results

We found that 20.5 % of all the pediatric burn patients admitted from 2017–2020 had DCS involvement. Of the total admitted patients only 3.8% were removed from the previous caregivers. The factors that were found to be statistically significant were male sex, age under 3 years, Caucasian child with single parent and living in an urban setting. A higher incidence was noted in the capital city area compared to the rest of the state. There was no statistical difference noted among races, location of DCS notification, and payer source.

Conclusions

We conclude that vigilance and early reporting is essential in detecting child abuse. Involvement of the multidisciplinary child protection team at our institution may reduce the burden on DCS. Screening out high risk factors such as age less than 3 years old, male sex, and single parent of Caucasian race may assist in detecting the non-accidental burn victims. We will target prevention educational outreach programs to the community to decrease the occurrence of child abuse in the future.
600 Social Determinants and Their Impact on Burn Surgery Outcomes
Authors: Quiroga Luis H , Lagziel Tomer , Asif Mohammed , Fang Raymond , Rozycki Grace F , Hultman Charles S
Published: April 2021

Introduction

To our knowledge, no studies have been conducted assessing the social determinants of health and the impact on the outcomes for burn patients. Such studies are needed considering burn injuries are associated with high costs, severe psychological impact, and a high burden placed on the healthcare systems. The burden is hypothesized to be aggravated by the increasing amount of diabetes and obesity seen in the general population which put patients at increased risk for developing chronic wounds. Studies have shown that several socioeconomic status (SES) factors are associated with increased risk of burns, but none have documented the outcomes of burn patients based on their social determinants of health. In our study, we will be comparing patients in the burn ICU (BICU) to patients in the surgical ICU (SICU). The purpose of this comparison is to evaluate whether the same social determinants of health have similar influences in both groups.

Methods

We performed a retrospective analysis of population group data from patients admitted to the BICU and SICU from January 1, 2016, to November 18, 2019. The primary outcomes were length-of-stay (LOS), mortality, 30-day-readmission, and hospital charges. Pearson’s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups.

Results

We analyzed a total of 487 burn and 510 surgical patients. When comparing BICU and SICU patients, we observed significantly higher mean hospital charges and LOS in burn patients with a history of mental health (mean difference: $42,756.04, p=0.013 and 7.12 days, p=0.0085), ESRD ($57,8124.7, p=0.0047 and 78.62 days, p=0.0104), sepsis ($168,825.19, p=< 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=< 0.001 and 72.9 days, p=0.002). Also, higher mortality was observed in burn patients with ESRD, STEMI, sepsis, VTE, and diabetes mellitus. Burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus also had greater 30-day-readmissions rates.

Conclusions

This study sheds new knowledge on the considerable variability that exists between the different population health groups in terms of outcomes for each cohort of critically ill patients. It demonstrates the impacts of population health group on outcomes. These population groups and social determinants have different effects on BICU versus SICU patients and this study provides supporting evidence for the need to identify and develop new strategies to decrease overspending in healthcare. Further research to develop relevant and timely interventions that can improve these outcomes.
604 Epidemiology and Microbiologic Profile of Pediatric Burn Patients: Eight-years’ Experience in a Tertiary Hospital
Authors: Santos Stephen Matthew B , Jumao-as Jed-Waylon L
Published: April 2021

Introduction

Burn injury is major morbidity and is the third most common cause of mortality among the pediatric population.

Methods

This study retrospectively analyzed pediatric burn admissions from a tertiary hospital in an 8-year period from 2009–2016. A total of 218 pediatric patients were reviewed for demographics, burn incidence, characteristics, cause of burn and microbiologic profile.

Results

There were 107(49.08%) Infants, 47 (21.56%)Toddlers, 32 (14.68%) Preschoolers, 17 (7.79%) belonged to school age and 15 (6.88%) were adolescent. Most of the admitted patients were within the city 122 (56%) while 96 (44%) were from other localities outside the city. Scald burn was the most common cause of burn with 160 (73.39%) cases and was highest in the infant age group (49.8%). The mean total body surface area was 10%, the highest being caused by flame burn at 13% TBSA among toddlers and preschoolers having the highest total body surface area involved (12%). The most commonly involved body area is the chest (13.6%). The mean transfer time from injury to the admission of patients coming from within and outside the city was 8.8 and 28 hours respectively. The mean length of hospital stay was 9.08 days. There was also a decrease in mean transfer time and hospital stay from 2009 to 2016. Flame burn accounted for the longest hospital stay at 20.27 days. Microbiologic profile of burn wound cultures showed a predominance of gram-negative rods (90%) with Enterobacter cloacae and Klebsiella pneumonia as common isolates. Culture studies also showed amoxicillin-clavulanic, ampicillin-sulbactam, and cefuroxime have the highest resistance, while most isolates are still susceptible to Amikacin, Ertapenem, Meropenem, and Ciprofloxacin.

Conclusions

Patients belonging to the school-age group has the highest mean number of hospital days (27.3 days). On review of culture study results from wound tissue samples, Gram-negative rods were the most common and Enterobacter cloacae were the most common isolate. Antibiotics such as Amoxicillin clavulanic, ampicillin-sulbactam, cefuroxime, and ceftazidime had high resistance rates and therefore should not be initially used for patients suspecting of the infected burn wound.
607 Characteristics of Pediatric Burn Patients with Child Protective Services Involvement at an Academic Children’s Hospital
Authors: Sundesha Aashna , Seivert Nicholas , Ziegfeld Susan , Green Katerina , Garcia Alejandro , Thompson B Simone , Parrish Carisa
Published: April 2021

Introduction

Pediatric burns are typically accidental, but burns caused by caregiver abuse/neglect represent a significant proportion of patients. Literature on risk factors most associated with these injuries include younger age, male, African American, and larger burns. This study examined child and burn injury factors that were associated with Child Protective Services (CPS) involvement at an urban, academic children’s hospital.

Methods

At this institution, decision to report a burn patient to CPS is determined by a multi-disciplinary medical team. Criteria for referral is multifactorial and may include burn patterns consistent with forced immersion, a reported mechanism that does not match the burn pattern or the patient’s developmental capabilities, concern for lack of supervision, or a delay in seeking medical care. Data from inpatient admissions over a 3-year period (July 2016 – June 2019) were extracted from hospital charts, and analyses (chi-square, t-tests) examined age, sex, total body surface area (TBSA), burn severity, length of stay, insurance type, race/ethnicity, and whether a CPS report was made (i.e., yes/no). Records for the outcome and disposition of the CPS case, such as whether the CPS investigation confirmed the abuse/neglect allegations, were not readily available as the law requires confidentiality.

Results

389 children were admitted for burn treatment. 80% had partial-thickness burns; 33% White, 43% Black, 62% male; 10% had CPS involvement. 72% had Medicaid/other government insurance, 23% had private/commercial, 4% were uncovered, and 1% insurance status unknown. Medicaid/government insurance was overrepresented among burns compared to other inpatients at the hospital (72% vs 51%). Consistent with previous findings, CPS reports involved children who were younger (2.8 vs 4.8 years), had greater TBSA (8.4% vs 4.9%), and had longer admissions (7.5 vs 3.0 days). Children with Medicaid/governmental or no insurance were more likely to have CPS reports than commercial/private insurance (97% vs 3%). Importantly, contrary to prior findings, child sex, child ethnicity, and burn thickness were not significantly different between children with and without CPS reports.

Conclusions

Younger children with bigger burns and longer admissions were most associated with CPS involvement. Historical findings on risk factors of male sex, African American ethnicity, and greater burn thickness were not replicated. Prior literature may not be generalizable to many settings; the current study provides an important update. Further research is needed to examine outcomes of CPS involvement and long-term patient health outcomes. Findings are limited to only urban, inpatient pediatric burns.
612 Non-burn Injuries in the Emergency Department as Indicators for Future Burn Abuse
Authors: Rodriguez Guillermo , Ridelman Elika , Klein Justin D , Shanti Christina M
Published: April 2021

Introduction

Thermal burns are a common form of child abuse. They account for up to 20% of all abuse cases reported and are a significant cause of morbidity and mortality. It is imperative that healthcare professionals maintain a high degree of vigilance recognizing signs of abuse, however subtle they may be. This is necessary to protect these vulnerable patients and prevent further injury. Our study seeks to identify predictors of future abuse in patients presenting to the emergency department. This might allow us to identify at risk patients and employ earlier interventions to prevent future harm.

Methods

A retrospective data review was conducted on all pediatric patients admitted to our burn center between 2008–2018 who were also suspected victims of abuse. Data collected included patient demographics, length of stay, size of the burn, type, degree and location of burn, number of previous emergency room visits, and patterns of injury during previous emergency room visits. Abuse was suspected and investigated if the history was inconsistent with the injury or if it changed, if there was an unreasonable delay in seeking medical care. or if the patient was discharged to an alternative caregiver. Data was analyzed with SPSS Statistics version 10.

Results

Out of the 5915 total burn admissions between 2008–2018, abuse was suspected and investigated in 297 cases and confirmed in 131 of those suspected. Patients admitted for suspicious burn injuries had an average of 1.82 (SD=3.15, Min=0, Max=25) previous ED visits. Of these patients, 93.6% had medical insurance, 80.5% had a primary care physician, and 72.7% were up to date with their immunizations. The majority presented with 2nd degree burns (86.5%) and the most common mechanism of injury was scald (60.1%). Pediatric patients with confirmed abusive burn injuries had longer hospital length of stay (9.23 days vs. 3.90 days, p< 0.001), and had greater total body surfaced area burned (9.24% vs 4.71%, p=0.001). Significant indicators of abuse included burn injuries to the bilateral lower extremities (thigh and legs) (p< 0.001), bilateral feet (p=0.030), buttocks (p=0.047), and genitalia (p=0.018), as well as signs of abusive non-burn injuries during previous emergency room visits (p=0.005).

Conclusions

Non-accidental burns should be highly suspected in children presenting with injuries to the bilateral lower extremities, bilateral feet, buttocks, or genitalia, or those with a history of previous non-burn injuries suspicious of abuse. Furthermore, patients with non-accidental burn injuries had more extensive burns and longer lengths of stay in the hospital.
617 Who Benefits the Most from Burn Camps?
Authors: Radics-Johnson Jennifer B , Chacon Daniel W , Zhang Li
Published: April 2021

Introduction

Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child.

Methods

A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value< 0.5.

Results

Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32).

There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?”

Conclusions

In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.
618 Clinical and Humanistic Burdens of Pediatric Burns: A Systematic Literature Review
Authors: Hahn Helen , Yu Tzy-Chyi , Rutan Randi L , Salyer David L
Published: April 2021

Introduction

Children face long-term clinical and psychological sequelae from burn injuries. This review summarizes the scientific literature on the clinical and humanistic burdens of pediatric burns.

Methods

A systematic review of literature published between Jan 2015 and Jun 2020 was conducted based on PRISMA guidelines in Embase, Biosis, and MEDLINE to identify publications examining the clinical, humanistic, economic, and/or epidemiologic burdens of illness associated with pediatric burns in the US.

Results

Of 2,286 unique articles identified, 28 met eligibility criteria. This analysis focused on studies relating to the clinical (n=8) and humanistic (n=9) burdens of pediatric burns. Across all studies, flame and scald were the most common burn etiologies. Among the 8 clinical studies, several evaluated outcomes (n=2) or treatments (n=3) in predominantly graft recipients. One study found that 64% of pediatric split-thickness autograft recipients exhibited hypertrophic scarring (HTS) at the donor site. Other variables (time to re-epithelialization, donor-site harvest depth, harvest in an acute burn care setting, thigh donor-site location) were associated with increased risk of HTS. An increase in percentage total body surface area (%TBSA) burned corresponded to increased number of autograft procedures, risk for HTS, and viral infection risk. Other reported outcomes included infections (eg, healthcare-associated, wound, viral), pain, inhalation injury, and sepsis. One study found that while the frequency and intensity of pruritis decreased over time, 63% of children continued to report symptoms at 2 years after injury. Among the 9 humanistic studies, 4 reported larger %TBSA corresponded to worse health-related quality of life assessed by various instruments. In a study of patients under age 5 with burns, Burns Outcomes Questionnaire (0–4) scores improved over time in multiple domains. In youth with a history of burn injuries, patient-reported pain interference with daily living was significantly associated with decreased physical functioning, depression, and impaired peer relationships. Two studies assessed caregiver burden, with one study finding that 19% of caregivers self-reported clinical or at-risk levels of distress following the child’s burn injury.

Conclusions

Pediatric burns place a substantial clinical and humanistic burden on patients and their caregivers. While outcomes appeared to improve over time, clinical and humanistic consequences of pediatric burns endured. More research on novel treatment products and procedures is needed to reduce the burden of burns for this population.
619 The Impact of Global / National Phenomena on Young Burn Survivors and their Families
Authors: Jackson Brad , Mikolaj Kerry , Boulter Trudy , Mayer Nichole F
Published: April 2021

Introduction

2020 brought numerous challenges for burn survivors and their families. This project assessed the impact of two major global / national phenomena, specifically the impact of a) COVID-19 and b) local / community / national actions around racism and policing on child and youth burn survivors and their families.

Methods

Our burn camp program moved to a virtual format for 2020. Campers (ages 8 – 18) and their caregivers / parents completed questionnaires about their year, rating and specifying the personal impacts of these phenomena. They rated how their year has been overall and selected “what has helped you get through tough times”. 47 campers and 47 caregivers / parents participated.

Results:

Impact of COVID-19

The majority of youth rated the impact of COVID-19 as “somewhat” to “highly” (78%), while the majority of caregivers rated “somewhat” (64%). Campers and caregivers identified the following impacts most often and to similar degrees: Online school/virtual learning, Friends/Social, Sports/Activities, Quarantine, Isolation, Worries, Quality time with family. Caregivers also highlighted: Getting creative at home and Uncertainties.

Impact of local / community / national actions around racism and policing on you and your family

The majority of campers and caregivers rated the impact as “Somewhat”, “Very Little” or “Not Impacted” (86%), although participants rating higher impact also provided moving personal experiences.

What has helped you get through tough times this year

Over 85% of campers and caregivers / parents rated their year overall as “OK” or “Pretty Good”.

Campers and caregivers endorsed Family, Friends, Faith, and What I learned recovering from my burn injury as factors helping them get through tough times.

Conclusions

Children, youth, and families who have experienced a burn injury report both negative and positive impacts from the global and national phenomena of COVID-19 and local / community / national actions around racism and policing. Not all youth and families are equally impacted. Family and friends were the greatest sources of support during tough times. One burn survivor family indicated that what they learned recovering from burn injury has helped them through this challenging year – “I have learned to just adapt and change because anything can happen at any point.” Most burn survivors and their families indicate the year has been “OK” or “pretty good”. Connection through burn camp provided the opportunity to share the impacts, but also the strengths and resiliencies in our burn community.
621 Discharge Survey of Burn Patients Reveals Concerns About Attending Follow up Appointments
Authors: Solomon Eve A , Phelan Elizabeth , Tumbaga Lilia G , Karashchuk Irina P , Greenhalgh David G , Sen Soman , Palmieri Tina L , Romanowski Kathleen S
Published: April 2021

Introduction

Follow-up appointments are important after a burn injury to minimize adverse sequelae. A retrospective study at our institution revealed that over 25% of patients never attend a follow-up appointment. Failure to follow-up was associated with homelessness, drug use, and distance to the clinic. The purpose of this study was to design and administer a survey prior to discharge that seeks to identify patient-perceived barriers to follow-up.

Methods

A multidisciplinary team consisting of a burn surgeon, medical student, discharge planner, and social worker developed an 18-question survey that examined areas that might influence following up in burn clinic. There were questions regarding transportation, living situation, motivation to return for follow-up, homelessness, drug use, and social determinants of health. As a quality improvement project the surveys were administered to patients discharged following a burn injury by either the discharge planner or social worker from September 2019 to July 2020. Statistical analysis included descriptive statistics of survey responses.

Results

There were 473 patients discharged during the study period. A total of 342 patients completed surveys (72.3% response rate). Most patients (208, 60.8%) were very confident that they would come to a follow-up appointment and stated they had no obstacles to keeping their appointment. The most common obstacles stated were: transportation (143, 41.8%), cost (100, 29.2%), and time off work/school (70, 20.5%). The planned mode of transportation to appointments was being driven by someone else in a personal car (234, 68.4%), the second most common response was that they were unsure of their transportation (29, 8.5%). Patients traveled a great distance to come to the clinic with 188 patients (55%) traveling more than one hour. The most frequent discharge location was the patient’s home (169, 49.4%), with the second most frequent being the home of a friend or family member (95, 27.8%). Sixty-two patients (18.1%) were homeless at the time of admission. When asked about their motivation for following up in clinic the most common response was concern about their injuries/healing (269, 78.7%). The most common levels of educational attainment were high school (149, 43.6%) and College (114, 33.3%). The most common employment status was unemployed (131, 38.3%) and 141 patients (41.2%) made less than $25,000 per year. With respect to substance use, 171 (50%) patients used alcohol, 151 (44.2%) patients smoked, and 82 (24%) patients used illicit drugs.

Conclusions

Many patients are motivated to come to their follow-up appointments but face significant difficulties in coming to appointments due to distance to the clinic, transportation, and cost issues.
625 The Impact of COVID-19 on Burn Care at a Regional Burn Center
Authors: Rogers Alan D , Surg Plast
Published: April 2021

Introduction

The COVID-19 pandemic has had a profound global impact, not least on hospital functioning. Institutions have all had to prepare and adapt to a large number of admissions, and the influence on elective and emergency surgical services, including burn care, has been significant; it may be some time before we know the full extent of this. While many centers were able to commence more normal activities for a while, we are now seeing an exponential rise in cases again, with potentially catastrophic consequences for the provision of burn care.

Methods

A review of all admissions, operative cases and clinic visits between 1 April and 31 August 2020 was undertaken at an American Burn Association verified burn center. These data were compared with the same five-month period in the preceding two years.

Results

Selected data highlights are tabulated (Table 1). During the five months in question, fewer patients were admitted than the previous two years (N=81 versus 121). The mean total body surface area was slightly higher this year (13.7%), and the mean length of hospital stay longer (18 days). The male-to-female ratio of admitted patients was greater during the five months of 2020, at 2.9:1, compared to 1.7:1. No significant differences in terms of etiology were detected, however. As expected, clinic visits reduced dramatically from a mean of 160 patient visits per month to just 81 per month, with the majority conducted virtually. During 2020 the operative cases were similar in number to previous years (N=176), but the mean duration was significantly longer (190 minutes). The total time utilised for burn surgery was similar to previous years (572 hours).

Table 1. Selected burn center data comparing 2020 with 2019 and 2018.

Conclusions

This study demonstrates that although total admissions were slightly reduced, the demands on Burn ICU bed resources and burn operating time were similar. The data supports the notion that removing scheduled operating time for our service resulted in less efficient execution of acute burn surgeries and longer hospital stays. Although formal clinic visits were significantly reduced and were mainly conducted virtually, several patients were satisfied by a novel and user-friendly email service conducted by our clinic nurse specialist.
627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients
Authors: Shostrand Lisa M , Hartman Brett C , Frazee Belinda , Daniels Dawn , Zieger Madeline
Published: April 2021

Introduction

Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day.

Methods

Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED.

Results

Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions.

Conclusions

Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.
628 Venous Thromboembolism Prophylaxis in Burn Patients: Analyzing the Effectiveness of a Standardized Protocol
Authors: Folliard Sarah A , Gabbert Jared L , Rumbaugh Kelli , Thompson Callie M , Oleis Cathy
Published: April 2021

Introduction

Burn patients have a high risk of developing venous thromboembolism (VTE) due to extensive immobilization, surgical interventions, endothelial injury, and the presence of polytrauma. Studies have shown VTE rates ranging from 0.25% to 23.3% in this patient population. Although burn patients have a greater risk for VTE compared to other hospitalized patients, there are no standardized guidelines on how to approach VTE prophylaxis in the burn population. In March 2018, the Burn Intensive Care Unit (BICU) implemented a new VTE prophylaxis protocol that stratified patients based on risk factors for VTE. Patients were started on enoxaparin 30mg every 12 hours or 40mg every 12 hours depending on body mass index (BMI). The purpose of this study was to examine compliance with the new protocol and overall rates of VTE in the burn population.

Methods

A single-center, retrospective analysis was conducted from March 1, 2018 to July 31, 2018. Patients included were admitted to the BICU with a documented burn injury for at least 48 hours and were ≥ 18 years of age. The primary outcome was compliance with the VTE prophylaxis protocol. Secondary outcomes included reasons for non-compliance and incidence of VTE events.

Results

Out of 105 patients that met inclusion criteria (median age, 53 years [36 to 63]; BMI 27.1 kg/m2 [25.7 to 33.2]; total body surface area 6% [3% to 18%]), the protocol was correctly utilized in 81 patients (77%). The most common reason for non-compliance to the protocol was incorrect dosing (60.9% [14/105]). Of 105 patients, 1 (0.9%) developed a VTE.

Conclusions

Overall, the compliance to the Burn Intensive Care Unit VTE pharmacologic prophylaxis protocol has room for improvement. Despite following the protocol, one VTE event occurred during the five-month study period. To improve compliance, additional education and training regarding the dosing of and monitoring anti-coagulants was provided to nursing and medical staff.
634 Utilizing Simulation Based Training to Teach Wound Management Strategies When Caring for Burns Treated with Autologous Skin Cell Suspension
Authors: Bell Cameron C , Johnson James E
Published: April 2021

Introduction

Simulation based training (SBT) is an experience meant to replace real-life events with guided simulated clinical scenarios. The goal is fully interactive training that closely replicates the real world. SBT is well known in military and aviation and has been well integrated into the education of new nurses and physicians however, it has not been fully integrated into the ongoing development of skills for clinicians practicing in hospitals that are learning new technologies. Following FDA approval of a regenerative medicine platform that prepares autologous skin cell suspension (ASCS), an opportunity was identified to augment conventional training with a SBT educational program giving clinicians the opportunity to practice wound care in a simulated learning environment.

Methods

A prototype was developed alongside experts from a university-based experiential learning center. It included an anatomical silicone mold of a thigh (model) with silicone cartridges of ASCS treatment areas (excised deep partial-thickness burn with dermis and excised full-thickness burn with wide meshed split thickness skin graft). The cartridges fit in a depressed area of the thigh and can be exchanged between case scenarios. The cartridge allows for moulage to be applied, enhancing the life-like appearance of the model. The initial prototype was tested during a pilot with burn center staff. A total of 4 case scenarios related to ASCS aftercare were evaluated. Following the pilot, the program was demonstrated to our internal clinical team to gain additional insight. The feedback was incorporated into a final design.

Results

There were 17 participants in the pilot training (6 hands-on/11 observers). All hands-on participants either agreed or strongly agreed that SBT was useful to their clinical practice. Comments included: “Very realistic”, “really liked the hands-on”, “confidence booster”, “these are the most common scenarios we see”. One participant commented that even though she had never participated in an ASCS dressing change, she has the confidence to do so now. Soliciting feedback from our internal team on the design and portability of the model was an important step to ensure barriers to use were removed. To date, 11 training systems including models, cartridges, case scenarios, debrief tools and dressing kits have been distributed with a total of 30 systems expected by the end of 2020.

Conclusions

During development of the SBT program, input from clinicians and educators helped gain insight to the program and ensured the scenarios were relative to real-world experiences. Early findings suggest SBT is a value add for clinicians caring for patients post ASCS application.