bluuebunny/crossref_metadata_2025 huggingface dataset:
67 Patient Self-grading of Itch within Hypertrophic Scar Does Not Correlate to Mast Cell Concentration
Authors: Molina Esteban , Travis Taryn , McLawhorn Melissa , Shupp Jeffrey , Carney Bonnie
Published: May 2023

Introduction

Pruritus is a common and disturbing symptom among patients with hypertrophic scars (HTSs) that contributes to morbidity after burn injury. It can impact quality of life through sleep disturbance, limitation of daily activities, and psychosocial impairment. The pathophysiology and mechanisms behind HTS itch remain unclear but HTSs have previously been reported to have higher substance P (SP) nerve fiber density, greater SP levels, and an increased number of mast cells. Itch may be due to multiple contributing factors, and is commonly treated with various drugs with different targets including anti-histamines to target mast cells. We hypothesized that patients with self-reported high itch in HTS would have a higher concentration of mast cells compared to HTSs reported to have low itch. Here, we further investigate the involvement of mast cells in HTS itch.

Methods

Patients with post-burn HTS were enrolled into an observational clinical trial. Patient and observer scar assessment scales (POSAS) were used to assess itch, among other parameters. Punch biopsies were collected from regions of HTS and normal skin (NS). Biopsies were embedded in paraffin, sectioned, and stained with Giemsa stain to identify mast cells. Patients were stratified by POSAS-itch scores into high ( >5, n=6 patients) and low (< 5, n=5 patients) and mast cell numbers were compared between the two groups using a Student’s t-test.

Results

The high itch group was 83.3% female while the low itch group was 40.0% female. Other patient demographics did not significantly differ between the high itch group and the low itch group, including age (47±7.25 vs 48±7.07 years), Fitzpatrick skin type (5/6 type V vs 2/5 type V), and age of scar (8.4±2.16 vs 25.5±9.95 months). On histologic examination, the high itch group had an average of 16.25±24.1 mast cells per high powered field vs 5.70±3.6 mast cells in the low itch group (p=0.336). Regardless of itch score, HTS had an average of 11.45±18.1 mast cells vs 5.7±5.4 mast cells in normal skin (p=0.334).

Conclusions

HTSs self-graded as having high itch did not have a significantly different number of mast cells present in tissue punch biopsies compared to biopsies of HTSs self-graded as low itch. Mechanisms behind scar itch remain unclear, but are likely due to other factors that are more contributory than the presence of mast cells. Further investigation of scar itch is warranted due to the burden associated with this distressful symptom.

Applicability of Research to Practice

This research shows that mast cells may not be as contributory to itch symptomatology as previously thought, which may help explain why traditional antihistaminergics are often ineffective for HTS itch. Elucidating other pathways, such as those initiated by laser treatment which has been shown to decrease itch, may provide more opportunity to characterize potential targets to effectively treat HTS itch.
75 Tranexamic Acid Reduces Burn Wound Conversion and Lung Inflammation in a Murine Comb Burn Model
Authors: Carter Damien , Kacer Doreen , Turner Elizabeth , Prudovsky Igor
Published: May 2023

Introduction

Burn wound conversion is a process where superficial partial thickness burns convert into deep partial and even full thickness burn injuries. Unfortunately, the pathophysiology of this phenomenon is poorly understood. A therapeutic intervention that may prevent secondary progression and cell death in burn-injured tissue is desirable. Recent work by our group has established that tranexamic acid (TXA) has significant anti-inflammatory properties in addition to its well-known anti-fibrinolytic effects. This study investigates tranexamic acid as a novel therapeutic treatment to mitigate burn wound conversion and reduce systemic inflammation.

Methods

Sprague-Dawley rats were subjected to a hot comb burn contact injury using a 150-g brass comb preheated to 100°C, to create four rectangular burns, separated by three unburned interspaces. A subset of animals underwent the comb burn injury with an adjacent 30% TBSA contact injury using solid brass rods. The interspaces represent the ischemic zones simulating the zone of stasis. The treatment group received IP injection of TXA (100mg/kg) immediately after injury and once daily until sacrifice. Sham animals underwent an identical procedure, with application of a room temperature comb. Animals were sacrificed at 6hrs and 7-day time points post-injury. Photo images were obtained of the comb burn injury. Full-thickness biopsies from the ischemic zones and lung tissue were assessed with established histological and immunohistochemical (IHC) techniques.

Results

At 7-days post injury, the percentage of ischemic zones with necrosis was significantly reduced in the treatment group when compared with untreated burn controls by photographic image analysis. When compared with controls, the treatment groups had significantly less progression of ischemic zones to necrosis when assessed by standard microscopy. These findings were consistent in both the comb burn only and comb burn + 30%TBSA injury models. The TXA treatment group demonstrated significantly more expression of the regeneration marker (CTHRC-1) and a trend toward increased expression of the Ki-67 proliferation marker when compared to untreated burn group. At 6 hours post-injury, TXA significantly decreased infiltration of neutrophils in the lungs for the 30%TBSA burn injury model. Furthermore, systemic levels of mitochondrial DNA, IL-1α and TNFα were significantly lower in TXA treated animals when compared to untreated burn controls.

Conclusions

Animals treated with tranexamic acid demonstrated reduced burn wound conversion and decreased burn-induced SIRS response. Lung inflammation was also significantly reduced by administration of TXA after injury.

Applicability of Research to Practice

Tranexamic acid and agents with similar mechanisms of action may provide a treatment to reduce burn wound conversion. This therapy could be easily incorporated into standard acute burn care practices.
80 Examining the Relationship between Burn Injury Acuity and Risk for Developing PTSD and Depression Symptoms
Authors: Shoemaker Hannah , Gavrilova Yulia , Kahn Steven , Cerre Raleigh , Gaymon Shay , Ficalora Julia
Published: May 2023

Introduction

Individuals who experience traumatic events are at heightened risk for developing adverse mental health outcomes, specifically posttraumatic stress and depressive symptoms. Those hospitalized following a burn injury experience significant psychological and emotional burden during acute burn treatment. Symptoms of depression and posttraumatic stress are common following a traumatic burn injury; however, little is known about the impact of burn-related intensive care unit (ICU) admission on future risk of developing posttraumatic stress disorder (PTSD) and depression. Thus, the current study examined the associations between burn injury acuity (defined by admission to ICU vs. non-ICU) and risk for developing mental health problems (i.e., depression and PTSD) among burn center patients assessed within the initial 30 days following their injury.

Methods

Participants included 286 patients admitted to the burn center at a southeastern academic medical center (Mage = 46.79, SD = 17.47; 53% White; 66% Male; 94% Non-Hispanic; 25% admitted to ICU). Patients were assessed by the hospital’s burn behavioral health program. Risk of PTSD and depression was assessed via the Injured Trauma Survivor Screen (ITSS), a validated measure used to determine risk of PTSD and depression following an injury.

Results

Independent samples t-tests revealed that ICU admission was associated with an increased risk for developing posttraumatic stress (p = .022) and depressive symptoms (p = .016) as compared to non-ICU admitted patients when assessed within the initial 30 days following a burn injury.

Conclusions

Though preliminary, results highlight the importance of considering burn acuity when evaluating risk of developing psychopathology following a burn injury. Admission to ICU appears to play a key role in individuals’ risk for developing PTSD and depressive symptoms. Both physical and emotional healing are critical components of a patient’s recovery process following a burn injury.

Applicability of Research to Practice

Given these results, it is important to prioritize promoting psychological recovery following a potentially traumatic burn injury in those admitted to ICU through early screening and intervention. Early intervention should emphasize reducing avoidance of feared stimuli, gradual exposure, relaxation strategies, social support, and behavioral activation techniques particularly for patients admitted to the ICU to help mitigate negative effects of trauma exposure that may lead to increased psychopathology.
92 Effect of Blood Transfusion on Outcomes After Major Burns
Authors: Merchant Maryum , Hu Scott , Smith Malcolm , Cohen stella , Janga Geethika , Maddineni Saineha
Published: May 2023

Introduction

Severely burnt patients frequently receive blood transfusions to treat anemia, increase blood volume and improve wound healing. However, transfusion is not a safe prescription as it is associated with infections and immunosuppression.

Aim

Understand blood transfusion practices and assess patient transfusion-related outcomes.

Methods

A single-center retrospective review of 113 ICU patients with >20% TBSA burns from Jan 2014 to June 2022 was performed. Data collected: Age, type of burns, prior use of blood thinners, # of burn operations, hematocrit level pre and post-last transfusion, # of infections, AKI, ARDS during hospitalization, and hospital and ICU length of stay (LOS)

Statistical analysis

For univariate analysis comparing groups below to the above median of transfusions per hospital stay, a Fisher test was used to compare proportions, and either a t-test or a Wilcoxon test was used to compare continuous features. Cox proportional hazards model and logistic regression were used to analyze the survival and ARDS in multivariate analysis.

Results

Demographics

Out of 113 patients:

•94 survived admission

•54 had a concurrent inhalational injury

•21 developed ARDs

•38 developed AKI

•95 received at least 1 blood product

Median Data:

•Age: 43 years

•TBSA: 34%

•Hospital LOS: 37 days

•ICU LOS: 18 days

Mean Data:

PRBC transfusion/patient: 12

PRBC per 1% TBSA burnt: 0.36

Univariate analysis comparing the median # of transfusions per hospital LOS.

Patients who had more transfusions were mostly men, had higher TBSA burns, less inhalational injury, longer ICU and hospital stays, and more burn surgeries. They also had higher hemoglobin levels before their first transfusion and more infections. There was no difference in terms of mortality, AKI, or ARDS.

Having anemia (defined here as hemoglobin < 8g/dL) before burn injury did not affect survival. After controlling for the revised Baux score and hemoglobin before initial transfusion, more transfusions per hospital day were associated with decreased survival and increased infections.

There was no association between ARDS in multivariate analysis and increased transfusions.

Conclusions

The number of transfusions per hospital day was associated with decreased survival, although not meeting statistical significance (likely due to the small sample size). Hemoglobin < 8 g/dL before burns was not associated with decreased survival in multivariate analysis. On exploratory analysis, more transfusions per hospital day were significantly associated with increased infection, offering a possible reason for the negative survival association.

Applicability of Research to Practice

Understanding blood transfusion practices and outcomes improve the utilization of blood in severely burnt patients.
98 Care Discontinuity in Burn Patients: Does it Impact Long-Term Outcomes?
Authors: Castillo-Angeles Manuel , Shepler Lauren J , Orton Caitlin , Ryan Colleen , Schneider Jeffrey , Mehta Anupama
Published: May 2023

Introduction

Care discontinuity, or the care that is provided by disparate healthcare professionals when patients are readmitted to a hospital different than their original admission (non-index hospital), has been associated with worse outcomes among surgical patients. However, little is known about its effect on burn patients. Our aim was to determine the impact of care discontinuity on long-term outcomes in a national sample of burn patients.

Methods

The longitudinal Burn Model System National Database was queried from 1996 to 2021. All adult burn patients from participating sites were included. Care discontinuity was defined by having therapy or burn-related surgeries at non-index hospitals. The main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6 and 12 months after injury. Multivariable regression was used to examine the association between care discontinuity and long-term outcomes, adjusting for patient characteristics and burn injury severity.

Results

A total of 1,866 burn patients were included. Mean age was 43.36 (SD 15.85) years, 73% were male and 76% were white. Mean PCS scores were 43.56 (SD 10.95) and 45.17 (SD 11.18); and mean MCS scores were 48.00 (SD 12.60) and 48.25 (SD 12.55) at 6 and 12 months, respectively. Care discontinuity was reported in 423 (22.6%) burn patients, who reported having therapy or burn-related surgeries at a non-index hospital. In adjusted analyses, care discontinuity was associated with worse PCS at both 6 months (Coefficient -2.18, 95% Confidence Interval [CI] -3.44 – -0.91, p=0.001), and 12 months (Coefficient -2.16, 95% CI -3.50 – -0.82, p=0.002), compared to patients having therapy/surgery at index hospitals. Care discontinuity was not associated with MCS scores at 6 (Coefficient 0.54, 95% CI -0.04 – 2.03, p=0.473) and 12 months (Coefficient -0.90, 95% CI -2.49 – -0.67, p=0.262).

Conclusions

Care discontinuity was significantly associated with lower physical health component scores at long-term follow up, but not with mental health component scores. Future studies should focus on developing strategies to ensure continuity of care and/or identifying out of system patients to provide targeted resources.

Applicability of Research to Practice

Understanding the implications of care fragmentation on longitudinal outcomes may help clinicians develop strategies to ensure care continuity and consequently better outcomes.
115 The Association between Burn Characteristics and Body Image in School-Aged Children years 5 to 12
Authors: Patel Khushbu , Surette Kate , Ni Pengsheng , Warner Petra , Stoddard Frederick , Kazis Lewis , Schneider Jeffrey , Ryan Colleen , McGwin Madeleine , Branski Ludwik , Palmieri Tina
Published: May 2023

Introduction

Children ages 5 to 12 are in pivotal stages of psychological development as they become more self-aware. Body image can be a formation of both internal experiences and influences from the surrounding environment. This perceived image adapts during this age group and can be negatively impacted by the changes in physical appearance due to the burn injury. Previous research indicates older age and the presence of larger, visible burns can impact body image and self-esteem in the present and long-term. This study assessed the association between burn characteristics and the child’s ability to maintain positive body image in this age group using a new parent-reported instrument for assessment of child outcomes after burn injury.

Methods

Preliminary data was obtained from the School-Aged Life Impact Burn Recovery Evaluation (LIBRE)5-12 study, which is currently in stages of field-testing. Classic test theory methods were used to assess body image items (n = 13) from the Psychological domain. Each item was scored on a 5-point Likert scale ranging from 0 (never) to 4 (always). Data was recoded for selected items such that higher scores denote better functioning. Multivariate linear regression analyses measured the association between burn injury characteristics and body image (controlling for sex, race and ethnicity, burn injury to critical areas, total body surface area burned (TBSA), and age at survey completion). Mean body image score was calculated.

Results

Data was obtained from 356 surveys with completed body image items from parents of children with burns. The mean age at survey completion was 8.6 + 2.4 years and mean total body surface area burned (TBSA) was 9.2 + 13.9 with 55% male and 66% white. Items from body image subdomain were identified as a unidimensional scale (α = 0.91, item-total correlations >0.4, ratio of the 1st and 2nd eigenvalues = 4.98). The mean body image score was 3.5 + 0.6. The presence of a foot burn (p = 0.0099), genitalia burn (p = 0.0449) and TBSA >1% (p = 0.0013) resulted in a lower body image score (3.3 + 0.6, 3.1 + 0.8, and 3.4 + 0.7, respectively). In the regression model, age at survey completion was also associated with decreased body image score (β = 0.074, p < 0.0001).

Conclusions

Parents reported older school-aged burn survivors often had difficulty with body image. Presence of larger burn size and injury to critical areas also worsened body image.

Applicability of Research to Practice

Burn-care providers and family members can utilize body image score to understand the burn survivor’s current body image satisfaction and assist in fostering positive body image after burn injury through assessment and early intervention.
120 A Review of Certified Burn Therapist’s Involvement in JBCR
Authors: Warthman Renee , Murray Derek , O'Neil Audrey
Published: May 2023

Introduction

Burn therapist certification (BT-C) was introduced in 2018 to recognize therapists with specialized skill in burn rehabilitation and promote quality burn therapy. There are currently 32 BT-Cs, representing a small fraction of therapists who rehabilitate burn patients. Barriers to certification described in a Letter to the Editor by O’Neil in 2022 included an indifference to therapy research and program development. Despite efforts to call for additional support of therapy advancement and research, therapist publications continue to be sparse. This review analyzed BT-C therapists involved in publications as one indicator of a positive impact on the field.

Methods

A review of therapist-authored manuscripts and abstracts published in the Journal of Burn Care and Research from 2018-2022 was performed. Therapy authored publications included any manuscript or abstract with a therapist listed as a lead or contributing author. Publications with only SLP, PTA, or OTA credentials were excluded. Therapists were only considered to be certified if they had achieved BT-C at the time of publication.

Results

BT-C make up not more than 15% of therapists practicing in burns, yet the percentage of therapy-authored manuscripts published from 2018-2022 with a BT-C credited author is 50%. When examining supplemental editions, 31% of accepted therapy-authored submissions from 2018-2022 included a BT-C therapist. The table compares the percentage of therapy-authored manuscripts and therapy-authored submissions from BT-C versus the percentage of BT-C using the 215 identified PT and OT members from 2008 as a conservative estimate of the floor of the number of PT and OT providing routine burn care, with the current count of BT-C at 32.

Conclusions

Estimations of the number of PT and OT working in burn rehabilitation are difficult to determine. It is assured that therapists providing care to burn patients routinely are larger in number than those who are active members in the American Burn Association in any given year. One publication revealed 215 active PT and OT members in 2008. Despite BT-C therapists making up a small percentage of the therapy community working in burn rehabilitation, BT-C therapists contributed to half of therapy publications and almost a third of abstract submissions in each area respectively, indicating that certified burn therapists have a profound, and disproportionately large, impact on formal investigation and research.

Applicability of Research to Practice

Currently there is a lack of objective information that can be presented to administrators to validate support of the burn therapist certification. Supporting certification may promote quality care through involvement in research furthering best practice.
503 The Accuracy of the Revised Baux Score in Predicting Burn Mortality: A Systematic Review
Authors: Bond Stephanie , Edgar Michael , Jiang Sam , Scharf Isabel , Bejarano Geronimo , Vrouwe Sebastian
Published: May 2023

Introduction

Osler et al. revised the Baux score in 2010 to include inhalation injury, attempting to improve upon the original 1961 model given the significant advances in modern burn care. Other predictive models of burn mortality have similarly been developed using use an assortment of other variables, however there is no consensus on the preferred formula to use. This systematic review aims to investigate the accuracy of the revised Baux (rBaux) score in comparison to other models when determining mortality risk in patients with burn injuries.

Methods

A systematic review was performed by two independent reviewers using electronic databases (PubMed, EMBASE, Scopus) from March 1, 2010 to May 22, 2022. The majority of studies were classified as “high” quality and no studies were excluded due to risk of bias. Articles were included if they were published in English and assessed risk of mortality from burns using the rBaux model and an alternative model. The PRISMA statement was followed, and all the PROBAST quality appraisal checklist was used during data extraction.

Results

The search identified 79 non-duplicate citations, of which 33 underwent full-text review, and 21 met inclusion criteria. They assessed the predictive ability of the rBaux score in comparison to the original Baux score, Belgian Outcome for Burn Injury, Abbreviated Burn Severity Index, APACHE II, Sequential Organ Failure Assessment score, Boston Group/Ryan scores, the FLAMES model, the Prognostic Burn Index, and several other equations that have not been externally validated. The accuracy of mortality prediction (area under ROC curves) for the rBaux score ranged from 0.68 to 0.99 and 14 studies found a value greater than 0.90. These ROC values were found to be lowest in the two studies with subgroupings for age, demonstrating an ROC of 0.01 in children, and 0.68 and 0.92 in the elderly. Eleven studies described sensitivity, specificity, or both, with sensitivity ranging from 12% to 96%, and specificity ranging from 80% to 100%.

Conclusions

The rBaux score offers a relatively easy method to rapidly assess the mortality risk from burn injury in a broad range of patient populations based on age, percent total body surface area burned, and presence/absence of an inhalation injury. This tool remains valid despite the exclusion of patient comorbidities and other injury-related factors. However, this study also identified the rBaux’s ability to predict mortality risk was limited when applied to patients at the extremes of age, highlighting an important area for future research. At present, given its relative simplicity and generalizability, the rBaux score remains a useful clinical tool for predicting mortality.

Applicability of Research to Practice

The rBaux score remains a simple yet powerful predictor of mortality in burn patients, which can be applied at the bedside on initial presentation across diverse patient populations.
506 Review of Empiric Voriconazole Dosing in Large TBSA Burn Patients – A Case Series
Authors: Lautenslager Lauren , Boyd Allison , Hartman Brett , Spera Leigh
Published: May 2023

Introduction

Burn patients are significantly immunocompromised and susceptible to opportunistic fungal infections. Treatment includes aggressive surgical debridement with topical and systemic anti-fungal agents. Voriconazole (VCZ) is a systemic anti-fungal and an approved first line treatment of invasive Aspergillus and Fusarium species. Standard dosing is a 6 mg/kg loading dose twice followed by 200 mg enterally twice daily. Therapeutic drug monitoring is recommended to confirm a goal trough concentration of >1 mcg/mL, once steady state is reached, approximately 4-7 days after initiation. At our institution, VCZ levels are a send out lab, averaging 4-7 days for results. We reviewed a series of three patients with invasive fungal infections and their VCZ treatment dosing to assess impact of altered pharmacokinetics and time delays with drug monitoring.

Methods

Three patients with significant burn injury (TBSA >40%) and invasive fungal wound infections were reviewed. Two were treated with standard dosing of VCZ (200 mg BID). The %TBSA, weight, albumin at time of VCZ initiation, initial VCZ dosing, initial trough concentration, time from initiation to trough result and final VCZ dose was reviewed. Consideration of the subtherapeutic drug level of prior patients led to initiation of VCZ treatment at an increased initial empiric dose (300 mg BID) for a third patient, followed by assessment and review of the same variables.

Results

For the two patients treated with standard VCZ dosing, initial trough concentrations were subtherapeutic (0.4 mcg/mL and 0.9mcg/mL) and took 13 and 10 days from initiation to trough result, respectively. The albumin concentrations for these patients were 2.1 and 1.6 g/dL. Initial trough concentration for the third patient started on increased empiric dosing was therapeutic (4.9 mcg/mL), despite an albumin of < 1 g/dL. (Table 1).

Conclusions

Fungal infections significantly increase the morbidity and mortality of burn patients. The time lapse from initial dose to steady state plus turnaround time of send out labs may result in 1-2 weeks of subtherapeutic treatment. Results from our case series demonstrate that standard VCZ dosing could be inadequate for large TBSA burn patients ( >40%) and higher empiric doses should be considered.

Applicability of Research to Practice

Consider use of increased initial VCZ dosing for large burn patients to reach therapeutic serum levels more expeditiously.
528 Knowledge and Attitude of Health Care Staff in First Aid For Minor Burns
Authors: Doygaci Ayse Gul Atay , Abali Ayse Ebru , Unlu Elif , Santelis Santiago , Haberal Mehmet
Published: May 2023

Introduction

Health care professionals are supposed to be well-versed for correct and timely first aid interventions in burns. This research was conducted to evaluate their level of knowledge and attitude for first aid in minor burns.

Methods

Subjects were 402 volunteer health care staff in our university hospital. Study group involved nurses (n=163), medical technicians (n=94), technicians+patient-care support personnels (n=145). Data were collected by face-to-face interview technique using our "Introductory Characteristics of the Participants" and the "Evaluation Form of the First Aid Knowledge Levels of the Health Professionals Regarding Minor Burns" forms (p< 0.005).

Results

Mean age was 29.7 yrs (minimum:20, maximum:54). Female to male ratio was 1:0,7. Of all subjects, nurses were 40.5%, 29.4% were medical technicians, 30.1% were technicians+patient-care staff. The rate of participants who stated that they have received first aid training on burns was 41.5%; but only 38.3% of the subjects stated that they could confidently provide first aid. Participants who correctly answered the form of "First Aid Knowledge Levels of Health Professionals Evaluation Form for Minor Burns" involved 76.9% of all subjects. Washing with water was preferred by 85.6% of the participants, 13.2% used additional methods following water (topical agents, remedies, ice, yogurt, egg white, cucumber, etc.), only 1.2% preferred methods other than water. High education level, receiving first aid training, and seniority in the profession and in the institution were the effective factors in providing the right first aid method (p< 0.005). Female (58.5%), single (59.8%) and child-free (61.7%) subject, and the subjects who have attended first aid education programs more recently were prone to provide correct first aid than the others (p< 0.005). However, knowledge about the factors affecting the severity of the burn injury was significantly high only among the subjects who received first aid training (p< 0.005).

Conclusions

Many participants had basic knowledges on first aid for minor burns. However most did not have a comprehensive expertise and felt unconfident about providing first aid. Our results revealed that health care staff need education peculiar to them in addition to the basic awareness programs for burn injuries.

Applicability of Research to Practice

First aid is the initial step of an appropriate burn care. Health care staff are supposed to be well-versed for correct and timely first aid interventions. Present definitive study provides basic information about knowledge level and attitudes of health care staff and it demonstrates useful data for specifying the future educational strategies.
530 Utilization of Advanced Practice Provider for Quality Virtual Burn Care
Authors: Ayers Brittany , Bader Bryan
Published: May 2023

Introduction

From the plains of North Dakota to the lakes of Minnesota and beyond, for our patient population, telemedicine has grown to be an important burn care delivery method. Specialized burn care is essential to ensure successful patient outcomes from burn injury. Our institution utilizes an advanced practice provider (APP) either physician assistant or nurse practitioner to lead the telemedicine care instead of the burn surgeon. Given most of the burn care is non-operative management, an APP can deliver burn expertise and high-quality care to the burn patient.

Methods

A retrospective chart review performed via data extraction from the electronic medical record at a single ABA-verified Burn Center. Dates of review ranged from January 1, 2022, through June 30, 2022. Patient population was Regions Hospital Outpatient Burn Clinic and Telemedicine Clinic volumes. Data review included patient location, mode of visit (in-person or virtual), and time to >95% healed. Inclusion was acute burns of all ages and mechanisms of injury. Exclusion was non-burn wounds, scar management and frostbite patients.

Results

A total of 1300 (87%) of all outpatient visits performed by APPs with 328 (25%) of these visits conducted via telemedicine. Varying by month, 7-13% of patients were treated exclusively via telemedicine not requiring any in-person burn care. When comparing the patient distance from the burn center (1-50 miles and >50 miles) and time to >95% healed, there was no correlation. Patients who were treated exclusively via telemedicine, lived an average of 205 (5-580) miles from the burn center, had an average TBSA of 2.2 (0.25-55) % and had an average of 18.3 (7-62) days until 95% healed. Compared to patients treated in-person only or combination of in-person and telemedicine, lived an average of 91 (1-631) miles, had an average TBSA of 2.5 (0.25-67) % and had an average of 24.6 (5-80) days until 95% healed.

Conclusions

A burn telemedicine program led by APPs can facilitate remote expert burn care, all while maintaining standard of care. Limitations were a narrow review window, single center retrospective analysis, and the exact date for time to 95% healed is difficult to determine due to interval follow up windows. Our goal is to further review and analyze our telemedicine and clinic data to optimize burn care delivery with the utilization of APPs, investigate quality of care indicators within telemedicine and reduce transfers and travel for specialized burn care.

Applicability of Research to Practice

APP led telemedicine improves surgeon availability to do hands on treatment in the Burn Center and allows for outreach and specialized expertise to be delivered across remote distances. It allows for the ability to triage patients and optimize burn clinic resources. Telemedicine can be performed in any location and reduce travel. Telemedicine is reimbursable. Barriers include wound care supply access, technological limitations, state licensing and institutional credentialing.
531 Utilization of a Nurse Care Coordinator to Streamline the Outpatient Experience
Authors: Neal Joya , Hockenberry Tiffany , Richey Karen , Foster Kevin
Published: May 2023

Introduction

Often being discharged from the hospital can be a frightening experience for burn patients who have complex and multifaceted outpatient needs. Our center found that while clinical staff were able to manage the immediate needs of the patient, they were unable to provide the level of support needed for patients to reach their full rehabilitation potential. In response to these findings, burn leadership developed the outpatient Nurse Care Coordinator (NCC) role, to ease the transition to the outpatient setting and enhance support. The purpose of this project was to evaluate the utilization and efficacy of the new NCC role.

Methods

This was a retrospective 1.5-year review of activities performed by the NCC directly relating to patient services. Five domains were chosen for monthly tracking, individual number of patients assisted, external referrals, workman’s compensation patients, compression garment orders and PTSD screenings. Basic descriptive statistics were calculated.

Results

This position has been in place for 2 years. The mean number of patients followed by the NCC was 592/month (204-723), average external referrals 43/month (11-84), average workman’s compensation patients 43.4/month (30-59), total compression garments ordered 54.8/month (21-106) and average number of PTSD screening 47.4/month (1-129). External referrals encompassed home health services, outpatient therapies, and multiple providers resulting in 1-15 interactions/patient to establish ordered services. Workman’s compensation patients required coordination with insurance, care managers, employers and adjusters including required documentation. Compression garments were tracked for progress on fulfilment, arranging assistance for financial coverage, required documentation, and coordinating measurements and delivery with patients amongst multiple providers. For patients screening positive for PTSD, the NCC provided resources and multiple options for PTSD/trauma counselors for the patient’s mental wellbeing.

Conclusions

The dedicated outpatient Nurse Care Coordinator is uniquely positioned to facilitate and optimize the care of patients in the outpatient arena. While data is not available for direct comparison prior to institution of this role, anecdotally, vendors, patients, clinic staff and providers report improved continuity and compliance with recommendations. We continue to refine and enhance the responsibilities of the NCC to better serve our patient population.

Applicability of Research to Practice

The Nurse Care Coordinator is essential in helping the survivor with complex needs, successfully navigate the complex and multidimensional outpatient setting.
537 Epidemiology of Elderly Burn Injuries – A Five Decade Single Center Retrospective Review
Authors: Emanuelli Elisa , Li Angela , Korentager Richard , Bhavsar Dhaval
Published: May 2023

Introduction

Age has long been known to be an independent risk factor for worse outcomes in burn patients. In comparison to younger patients, geriatric patients have higher morbidity and mortality. As the median age of the US population has increased, we have seen a greater proportion of elderly burn patients at our burn unit over the last five decades.

Methods

Retrospective chart review was performed for all burn patients admitted to our burn unit between 2000 and 2019. Demographics and outcomes data was collected for geriatric patients (age 65 and older). This was compared to historic data available for our burn unit between 1972 to 2000.

Results

Between 2000 to 2019, our burn unit admitted a total of 5881 burn patients of all ages. There were 652 (11%) geriatric patients admitted. The proportion of geriatric patients admitted statistically significantly increased over that period. Meanwhile, length of stay and mortality statistically significantly decreased in the 2000-2019 time period compared to the previous period. The main mechanism of burn injury was flame exposure. Compared to data on geriatric burn patients from 1972 to 2000, mortality has decreased substantially. In the 1970s mortality was 77% compared to 21% in the past decade. The mortality rate increased significantly with age, TBSA and inhalation injury over both time periods.

Conclusions

Though lagging behind younger age groups, overall survival and outcomes are improving in elderly burn patient due to advances in critical care and surgical burn management. Acknowledging the unique characteristics of this group of patients, such as impaired healing and multiple comorbidities, allows for improved outcomes.

Applicability of Research to Practice

Burn centers should notice and prepare for an increasing trend in elderly burn patient admission.
538 Demographic and Injury Differences Between Children with Burn Injury from the United States and Mexico
Authors: Miles Victoria , Suman-Vejas oscar , Ryan Colleen , Stewart Barclay , Carrougher Gretchen , Orton Caitlin , Kowalske Karen , Thakur Bhaskar , Solis Kyra Jeanine , Dalal Sujata
Published: May 2023

Introduction

A large burn data set is being used to evaluate outcomes of pediatric burn survivors, but questions remain whether this data set is generalizable to the typical population of US burn centers as only 62% of enrollees are from the US. A better understanding of similarities and differences within this data set will help in the applicability of findings from it.

Methods

This is a retrospective cohort study using data from children enrolled in a burn database. Data from 2043 children admitted for burn injury from 1994 to 2020 were analyzed. Data were stratified into children who were US residents and Mexico residents at the time of injury, all treated in US hospitals, and grouped by age into “< 5 years”, “5-10 years” and “ >10 years”. Sex, race, ethnicity, injury etiology, total body surface area injured (TBSA), and circumstances of injury were compared. Fisher’s exact test and Kruskal–Wallis one-way analysis of variance were used to test for differences in categorical and continuous variables, respectively.

Results

Both US and Mexico populations showed increased incidence among males as they aged. In the US population, as expected the most frequent cause of burns in patients < 5 years was scald. In the Mexico population, fire/flame burns were more frequent in all ages and electric burns were more common among children > 5 years. In both populations, indoor injuries were more common among children < 5 years and outdoor injuries were more common as children aged. Children from Mexico had larger burns and longer lengths of hospital stay than US children across all ages.

Conclusions

Children from Mexico who were referred to the US for burn care were similar in demographic patterns to US children. While differences were seen in extent and mechanism, the difference is likely influenced by larger, more severe burns being transferred to the US for care, while low severity burns were treated locally. This suggests that children from Mexico in the database are not representative of the pediatric burn injury population of the US or Mexico more broadly. When studying datasets from US hospitals containing non-US residents, it is recommended that these populations be separately analyzed, otherwise, findings cannot be generalized to the US pediatric burn injury population.

Applicability of Research to Practice

In addition to identifying prevention needs, differences among US and Mexico resident children cared for in the US limit the utility of analyzing this population in the burn dataset.
545 Contrast and Similarities Between Self-Immolation and Self-Injury Burn Patients
Authors: Honea Ashley , Zhang Nathan , Islas Claudia , Richey Karen , Foster Kevin
Published: May 2023

Introduction

Self-immolation is an uncommon method of attempted suicide involving flammable substances. By contrast self-inflicted burn injuries utilize a chemical or heated object to cause injury, without suicidal intent. Both groups require psychological care post-hospitalization, but the successful rehabilitation of these populations may be compromised by availability of mental health services, patient resources and patient specific factors. The purpose of this study was to compare and contrast the two groups and evaluate post-discharge success.

Methods

This was a retrospective chart review of patients admitted over a 7-year period with either self-immolation (SIM) or self-inflicted (SIF) burn injury. Prospectively, patients were called to evaluate current status using the SF12 questionnaire. Basic descriptive statistics were calculated.

Results

A total of 90 patients met inclusion/exclusion criteria, 55 SIM and 35 SIF. Both groups were predominantly white males, and the average age was SIM=36.4 vs SIF=37.9 years (p=0.668). Flame was the most common mechanism of injury for both groups, 93% of SIM used an accelerant vs 26% of SIF (p< .00001). While overall, home was the most common location for the event to occur for both groups, n=19 SIM and n=17 SIF, 17 of SIM occurred in a public place vs 4 of SIF (p=.033). Both groups SIM vs SIF, while not significantly different, had high rates of substance use 75% vs 63%, serious mental illness 42% vs 46%, Title 19 support 29% vs 26% and prior suicide attempts 62% vs 51%. There were no significant differences between groups for psychiatric history or number of individual psychiatric diagnosis/patient (µ 1.53 vs 1.54). Significant differences were found between the SIM and SIF groups for TBSA 46.1% vs 10% (p< .00001), prior involvement of a psychiatric case manager 12 vs 0 (p=.003) and mortality 22 vs. 0 deaths (p< .00001). Contact was successful for 5 SIM with 3 agreeing to take survey, for the SIF group 1 was able to be reached and declined the survey. The average score for SF12 physical domain was 43.06 and 44.14 for the mental domain, both below the national average of 50 points.

Conclusions

The results of this study demonstrate the premorbid psychiatric conditions in this patient population. The major differences between groups were the degree of injury and mortality. Our inability to contact patients may be indicative of ongoing social instability. There remains a significant knowledge gap, indicating the need for prospective research to identify the most successful combination of therapies to both prevent and treat these injuries.

Applicability of Research to Practice

This study highlights the need for a risk assessment tool to identify high risk groups and an integrated approach in the outpatient burn arena with dedicated behavioral health clinicians.
552 Predictions Under Pressure: The Value of Intra-abdominal Hypertension in Forecasting Associated Complications During Fluid Resuscitation
Authors: Richerbach Stacey , Richey Karen , Foster Kevin
Published: May 2023

Introduction

The link between burn fluid resuscitation and intra-abdominal hypertension (IAH) is long-standing. Clinicians refer to measures of intra-abdominal pressure (IAP) to guide care of patients requiring resuscitation. In the non-burned critically ill patients mean IAP is 5-7 mmHg, yet more than half of patients with large burns have IAH with a pressure > 12mmHg. The purpose of this study was to determine the predictive value of IAH during resuscitation and to elucidate the prevalence of associated complications.

Methods

This was a retrospective chart review of patients requiring fluid resuscitation over a five-year period. Patient stratification was based upon IAP, < 12 mmHg (NIAH) vs > 12 mmHg (IAH). Basic descriptive statistics were calculated.

Results

Charts were reviewed for 138 patients with a total body surface area (TBSA) >20%. There were no significant differences for age, ethnicity, race, gender, nor mechanism of injury. Mean TBSA was greater for those with IAH 44.7% vs NIAH 29.6% (p < 0.0001). Diagnosis of inhalation injury was greater with IAH 37% vs NIAH 10% (p = 0.0009). Admission weight was greater in IAH 90.59 kg vs NIAH 80.34 kg (p=0.0169). Patients who arrive at our burn center sooner (IAH 105, NIAH 160 minutes; p = 0.033), were less likely to receive pre-hospital fluids (IAH 68%, NIAH 84%; p = 0.03850), and time from injury to the start of in-hospital resuscitation was lower (IAH 177 min, NIAH 245 min p = 0.02840). The average resuscitation duration was greater for IAH than for NIAH (34.4 h vs 28.04 h; p = 0.0008), as was total volume given (p < 0.0001), but resuscitation volume per kg/TBSA/hour was not statistically different (IAH 6.72 mL, NIAH 6.15 mL; p = 0.321). Mean urine output per hour between the groups was not significant (p 0.7699). Patients with IAH had more hours in the optimal range for urine output (6.6 h) than NIAH (4.95), (p = 0.041). No significant difference was revealed between the groups for eventual diagnosis of abdominal compartment syndrome (p = 0.06); compartment syndrome (p = 0.8346, ARDS (p = 0.242); laparotomy (p = 0.222), open abdomen (p = 0.060). Administration of vasopressors between the groups was insignificant (IAH 15%, NIAH 7%; p = 0.186), as was the use of CRRT (p = 0.787). Temperatures for hypothermic patients with IAH were significantly lower (34.5 c) than NIAH (35.1 c), (p = 0.0186) and patients with IAH were more likely to have an escharotomy than those in the NIAH group (IAH 43%, NIAH 16%; p = 0.0014).

Conclusions

Most associated complications of fluid resuscitation were not more likely to occur with IAH as compared to NIAH. However, patients with IAH were more likely to warrant an escharotomy involving an extremity and had a lower temperature when hypothermic than the NIAH group.

Applicability of Research to Practice

Further research is needed to evaluate the relationship between measures of IAP and associated complications.
Intel Inside: The Linguistic Properties of Effective Slogans
Authors: Hodges Brady T , Estes Zachary , Warren Caleb
Published: May 2023

How can marketers create slogans that consumers like and remember? We answer this question by analyzing how the lexical, semantic, and emotional properties of a slogan’s individual words combine to influence slogan liking and slogan memory. Through a large correlational study with over 800 brand slogans, laboratory experiments, a biometric eye-tracking experiment, and a field study, we unearth the word properties that make slogans effective. We predict and find that linguistic properties that make a slogan easier to process (i.e., more fluent) result in slogans that are more likable but less memorable, whereas linguistic properties that reduce processing fluency result in slogans that are less likable but more memorable. Across our multi-method investigation, participants indicated a more favorable attitude toward slogans that are shorter, omit the brand name, and use words that are linguistically frequent, perceptually distinct, and abstract. In contrast, participants were more likely to remember slogans that are longer, include the brand name, and use words that are linguistically infrequent, concrete, and less perceptually distinct. We conclude by offering marketers practical advice into optimal word-choice strategies and delivering actionable guidance for creating slogans that are either likable or memorable.