bluuebunny/crossref_metadata_2025 huggingface dataset:
111 Predictors of Social Participation Outcomes at Two Years after Burn Injury
Authors: Deng Huan , Shepler Lauren J , Tenney Diana , Slavin Mary D , Kazis Lewis , Ryan Colleen , Schneider Jeffrey , Stewart Barclay , Carrougher Gretchen , Kowalske Karen , Wolf Steven , Chacon Kaitlyn Linette
Published: May 2023

Introduction

People with burn injury often experience long-term social participation challenges. A previous study explored demographic and injury variables predicting social participation outcomes after burn injury. This study aims to further examine post-traumatic growth, and physical and psychological symptoms as predictors of social participation.

Methods

This is a multi-center Burn Model System (BMS) study with a prospective cohort design. Adult BMS Database participants from July 2018 to April 2022 were included. Predictors were measured at 12- and 24-month after injury including Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Fatigue, Sleep Disturbance, Pain Interference and Heat Intolerance. Social participation outcomes were measured with Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities at 24-month after injury. Multivariable regression analyses were conducted to assess the association between predictors and outcomes.

Results

A total of 158 burn survivors were included with an average age of 47 years and a mean burn size of 19.5% total body surface area. Significant predictors included PCL-C and PROMIS-29 Depression for LIBRE Social Interactions, and Heat Intolerance, PROMIS-29 Pain Interference and Depression, and PCL-C for LIBRE Social Activities. See Table 1 for details of regression results.

Conclusions

Overall, self-reported post-traumatic stress and depression are associated with limited social interactions while heat intolerance, pain interference, depression, and post-traumatic stress are related to fewer social activities.

Applicability of Research to Practice

This study improves our understanding of the multiple and modifiable factors which influence social participation after burn injury.
113 Impact of State Labor and Industry Benefits on Quality-Adjusted Life-Years Among Working Burn-Injured Adults
Authors: Orton Caitlin , deGrauw Xinyao , Stewart Barclay , Patel Kushang , Carrougher Gretchen , Kowalske Karen , Bamer Alyssa , Hamilton April , Schneider Jeffrey , Ellyson Alice
Published: May 2023

Introduction

State labor and industry benefits (L&I) include workers’ compensation, wage replacement, vocational rehabilitation (VcR), workplace accommodations, job retraining, and labor protections. These vital services are not available to working adults injured outside their workplaces. We aimed to examine the impact of L&I on quality-adjusted life-years (QALY) lost among working adults with burn injury.

Methods

Burn Model System National Database was queried for adult participants who self-identified as worker, volunteer, or caretaker and who answered the Veterans RAND 12-Item Health Survey (VR-12) at discharge (pre-injury recall) and 6-, 12- and 24-month post-injury. Participants were stratified into those with and without L&I and compared using independent samples t-test and Chi-squared test. Primary outcome, QALYs lost, was calculated by transforming VR-12 responses to SF-6D (SF-12) utility values. Mixed effects linear regression modeling was used to assess the impact of L&I on utility values over a 2-year period post-injury. Models were adjusted for age, sex, race, substance use, chronic medical conditions, burn size, hand injury, inhalation injury, and number of surgeries.

Results

495 participants were analyzed (90 with L&I, 405 without L&I). Males accounted for 87% of L&I beneficiaries and 72% of those without L&I (p=0.001). No significant difference was seen in the other covariates. Mean utility values were 0.73 for L&I beneficiaries and 0.73 for those without L&I (p=0.99) pre-injury and were significantly lower for both groups at each timepoint post-injury (Figure 1). Greater utility value loss was seen in those with L&I compared to those without L&I at 6-month (p< =0.07), 12-month (p=0.02), and 24-month (p=0.03). During the 2 years post-injury, L&I beneficiaries lost 0.26 QALY and those without L&I lost 0.18 QALY (p=0.03).

Conclusions

All working adults experienced a drop in utility values post-injury. Those who received L&I benefits lost more QALYs than their non-L&I peers. These findings are consistent with investigations among working adults with non-burn upper extremity and back injuries, suggesting there is opportunity to improve the delivery of L&I benefits and VcR for all injured workers.

Applicability of Research to Practice

Current L&I benefits and VcR services for working adults with burn injury may not meet their needs. To actualize the benefits of VcR service delivery, the intensity of interventions should be more tailored to person-specific needs, risks of complicated return-to-work and recovery journeys.
117 Allocation of Therapist Time: Mobilization of CFU’s in Hand w/Burn Injury
Authors: Fletchall Sandra , Hartl Grace
Published: May 2023

Introduction

Movement of the hands and digits are used to perform communication and activities for IADL’s and competitive employment. Following a second or third degree to the hand(s), there is a potential for the development of burn scar contracture(s) (BSC), which decreases hand skills creating the potential for decreased quality of life.

The ABA data base identifies that 70% of burns are sustained to the upper torso, UE, hands. One ABA verified burn center created a study to identify the time required for the burn therapist to elongate hand CFU’s to pre-burn movement.

Methods

The one-year retrospective study included unilateral and bilateral hand burns with LOS of 2 days or greater or had an outpatient OT session within one week of the burn.

Co-author created the Passive Motion Scoring Grid (PMSG), using a number score with higher number indicating greater passive movement. Education was provided to the OT’s to complete the PMSG at the beginning and end of each hand CFU elongation session. Otherwise, there was no change in the OT burn hand therapy treatment. The study included (5) OT’s with mean of 6 years of experience (3-46).

Results

There were 50 patients, average age was 48.91 years with majority male and African American. All burns were secondary to thermal with burns of 2nd and 3rd degree.

There were 33 unilateral hand burns with an average TBSA of 7.02% and 17 patients sustained bilateral hand burns with an average TBSA of 21.3%.

Unilateral hand burns had an average number of CFU’s of 39.4 (11-68) and hand CFU’s accounted for 87.1% of the CFU’s. Average number of CFU’s in bilateral hand burns was 90.3 (8-196) with hand CFU’s accounting of 83.4% of the CFU’s.

A total of 539 OT sessions were provided to those with unilateral hand burns with an average of 18 OT sessions (3-36). Bilateral hand burns received a total of 487 OT sessions with average of 24.4 OT sessions (4-67)

Therapist time for hand CFU elongation to pre-burn status: unilateral hand burns, 43.5 minutes (SD=24.7) and bilateral hand burns was 53.5 minutes (SD=32.2). The minutes only reflect CFU elongation not the entire therapy time.

Conclusions

Hand burns result in a small number for TBSA, however it results in a greater number of CFU’s than other body locati8ons. The greater number of CFU’s involved, indicates greater potential for development of BSC. At the completion of the burn OT therapy, no patient exhibited BSC.

Providing education and information to funding sources regarding CFU’s in hand burns, equating that to potential BSC development and time required for therapist direct hands-on techniques to obtain pre-burn movement can positively influence authorization for therapy.

Applicability of Research to Practice

Can assist with allocating therapist time with hand burns. Can positively influence funding authorization for therapy.
121 An Examination of Function at Follow-Up in Historically Marginalized Persons with Burn Injury
Authors: Ferreira Betsey , Benavides Lynne , Yelvington Miranda , Lundquist Kathryn , Shepler Lauren J , Schneider Jeffrey , Solis Kyra Jeanine , Mandell Samuel , Gibran Nicole , McMullen Kara
Published: May 2023

Introduction

Previous studies demonstrate that historically marginalized individuals living with burn injury received comparable physical and occupational therapy services to non-marginalized groups. However, other outcomes are not well studied in these groups. This study aims to examine functional outcomes of historically marginalized burn population.

Methods

Data was obtained from the Burn Model System National Database between 1993 and 2015 for adults alive at discharge. The marginalized group was defined as: age >65; non-White; Hispanic; Medicaid or public support/indigent; homeless; drug or alcohol misuse prior to injury. Demographic and clinical characteristics were examined. Function was compared between groups (marginalized vs. non-marginalized) using the SF-12/VR-12 Physical (PCS) and Mental Component Summary (MCS) Scores at 6 and 12 months after injury.

Results

The sample included 583 participants (69.3%, n=404 marginalized group), was 83.9% white, and mean burn size was 16.7% (SD 17.6) total body surface area. Follow-up status was not significantly different between groups at 12 (p=0.115) and 24 (p=0.250) months. The non-marginalized group had higher PCS and MCS scores at 6 months than the marginalized group (Table). There were no significant differences in outcomes between groups at other time points.

Conclusions

The marginalized group exhibited worse physical and mental function scores than the non-marginalized group. This suggests that despite similar follow-up rates marginalized populations have worse outcomes.

Applicability of Research to Practice

Differences in functional scores between groups suggest that patients from historically marginalized groups may require more resources to achieve similar outcomes to their non-marginalized counterparts. Further research is necessary to delineate the unique needs of historically marginalized groups and design interventions to achieve equitable outcomes.
509 Relationship of Full Thickness Burn And Volume of Initial Fluid Resuscitation After Major Burn Injury
Authors: Jain Arpana , Islas Claudia , Kabir Samin , Le Dora , Guntu Rachna , Richey Karen , Foster Kevin
Published: May 2023

Introduction

Full thickness burn injury affects the host response to burn injury differently that partial thickness burn injury. Current guidelines for initial resuscitation calculate fluid infusion based on Total Body Surface Area (TBSA) affected and patient’s weight. The widely used formula does not offer guidance based on the depth of the injury. We present an investigation into relationship of full thickness burn injury on fluid resuscitation. This study was approved by our Institutional Review Board.

Methods

We performed a retrospective review of patients’ charts who were admitted after major burn injury of greater than 20% TBSA to a busy regional burn center. We included patients over age of 14 years admitted from year 2014-2019. We excluded patients who did not have complete resuscitation data, allowing 99 patients for analysis. We performed t test to uncover relationship of age, gender, body weight, TBSA and percent of full thickness burn with fluid received during initial resuscitation with significance set at p < 0.05.

Results

The volume of fluids given during initial resuscitation was significantly affected by gender and full thickness burn injury. Fluids requirement for females was 4.6ml/kg/TBSA vs males was 3.3ml/kg/TBSA (p value 0.04). Fluid requirement for full thickness burn was 8.4ml/kg/TBSA vs 3.7ml/kg/TBSA for all patients (p=0.0004). Initial fluid resuscitation fluids did not have significant relationship with age, body weight or overall TBSA.

Conclusions

This study demonstrates that full thickness burn injury has a significant impact on initial fluid resuscitation. Further research is needed to elicit the mechanism to explain the higher fluid requirement for full thickness burn injury.

Applicability of Research to Practice

Our study brings attention to the effect of depth of burn injury on the actual volume of fluids needed during initial resuscitation of burn injury. This study will alert the clinician to take into account both the surface area as well as depth of the burn injury while embarking on fluid resuscitation after a major burn injury.
510 Outcomes for Patients with SJS/TENS with Diabetes Compared to other Comorbid Conditions
Authors: Chandran Keshav , Hink Ashley , Kahn Steven , Ozhathil Deepak
Published: May 2023

Introduction

Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN Overlap Syndrome are on the same spectrum of severe blistering skin diseases that affect the skin and mucosal surfaces of the body. They have an immunological etiology and are caused by toxins, drugs, or infectious agents. The mortality rate for patients with these conditions is high, but there is limited research on the outcomes for those patients with additional comorbidities. This study investigates the association of inflammatory conditions such as diabetes mellitus, obesity, and tobacco usage have on the outcomes of patients with SJS or related disease. It was predicted that each of these comorbidities would be associated with higher rates of mortality and disease complications.

Methods

This study is a retrospective observational cohort study using a commercially available large database, which provides deidentified electronic medical data from health care organizations all over the world. Our database was used to perform a search and analysis for patients with SJS, SJS-TEN Overlap Syndrome, and TEN as well diabetes mellitus (DM), tobacco usage (TU), or overweight/obesity status. A fourth, control cohort of patients without any comorbidities was also included. In total, 8,962 patients were included in the study: 6,348 patients in the control group; 426 patients in the TU group; 1,186 patients in the DM group, and 1,002 patients in the Obesity group. Outcome variables measured were rate and incidence of pneumonia, sepsis, and endotracheal intubation. Outcome variables from each of the four cohorts were analyzed with a total of six unique comparisons.

Results

Compared to the control group, the DM group had a mortality rate 14.3% higher (CI 95%, 11.8% -16.9%), pneumonia rate 7.6% higher (CI 95%, 5.4%-9.9%), sepsis rate 4.7% higher (CI 95%, 6.9%-11.4%), and endotracheal intubation rate of 1.9% higher (CI 95%, 0.8%-3.0%). Furthermore, compared to the Obesity group, the DM group had a mortality rate 11.6% higher (CI 95%, 8.5%- 14.8%) and sepsis rate 4.7% higher (CI 95%, 1.7%-7.6%). Compared to the TU group, the DM group had a mortality rate 12.4% higher (CI 95%, 8.5%- 16.3%) and sepsis rate 8.1% higher (CI 95% 4.7%-11.6%). Besides this data on the DM group, the Obesity group showed statistically significant worse outcomes as well. Compared to the control group, the Obesity group showed a mortality rate 2.7% higher (CI 95%, 0.5%-4.9%), pneumonia rate 5% higher (CI 95%, 2.7%-7.3%), sepsis rate 4.5% higher (CI 95%, 2.3%-6.6%), and intubation rate of 2.1% higher (CI 95%, 0.8%-3.4%).

Conclusions

Using a large multi-institutional database, Diabetes mellitus is associated with worse outcomes for patients with SJS, SJS-TEN overlaps, or TEN compared to obesity and tobacco usage.

Applicability of Research to Practice

This data argues the importance of examining a patient’s past medical history when evaluating their prognosis for SJS, SJS-TEN overlaps or TEN.
512 Mean Arterial Pressure, Morbidity, and Mortality Associated with Necrotizing Soft Tissue Infection
Authors: Grossman Holly , Marschke Brianna , Pang Alan , Griswold John , Bharadia Deepak
Published: May 2023

Introduction

Adequate mean arterial pressure (MAP), or the average pressure in arteries during one cardiac cycle, plays an important role in ensuring adequate blood flow and perfusion in critically ill patients. MAP values of 65 mmHg or greater have been widely regarded as the ideal value for hospitalized patients in the past, especially those suffering from septic shock. Necrotizing soft tissue infections (NSTIs) present a unique challenge due to their rapid progression and high mortality, which creates the need for specific diagnostic and treatment guidelines that differ from those directed toward the care of sepsis secondary to other causes. Further research is still required to better understand the complex interactions between mean arterial pressure and morbidity and mortality among those with necrotizing soft tissue infections.

Methods

Data was collected from a retrospective cohort study of 50 adult patients hospitalized with an NSTI from 2015-2021. MAP ranges in the first 48 hours of admission were sorted into four categories: under 60 mmHg, 60-69 mmHg, 70-79 mmHg, and above 79 mmHg. We investigated outcomes relating to increased morbidity, including need for repeat debridement, need for dialysis, or development of acute kidney injury. Statistical logistic regressions were fitted to model the outcome as a function of the available pool of predictors: demographic variables, co-morbidities, and hemodynamic variables, such as MAP and use of vasopressors.

Results

In this small study, we found no significant association between time spent in different MAP groups or vasopressor volumes on the need for repeat debridement for NSTI patients or overall patient morbidity and mortality (p=0.1742). Patients who were significantly more likely to need a repeat debridement included those with previously diagnosed diabetes and hypertension (p=0.0485 and 0.0252, respectively).

Conclusions

NSTI patients can tolerate mild fluctuations in MAP without these pressures significantly impacting their need for repeat debridement or other sources of morbidity. However, patients who are hypertensive at baseline or diabetic are significantly more likely to require a second surgery, necessitating a more extensive primary debridement.

Applicability of Research to Practice

Patients hospitalized for NSTI can fluctuate at pressures below the established MAP goal of 65 mmHg without a significant need for pressors. Those with a history of hypertension or diabetes should be followed closely for possible spread of infection after primary surgery.
513 Lovenox Titration in Burn Patients: Does a One Size Fits All Model Work?
Authors: Wamakima Anita , Anderson Jeffrey , Rae Lisa , Hyman Jessica , Romano Devon , Zhao Huaqing , Lu Xiaoning
Published: May 2023

Introduction

Venous thromboembolism (VTE) presents a significant morbidity to burn injured patients. The Western Trauma Association (WTA) and American Association of Trauma Surgeons (AAST) have recently developed guidelines for VTE prophylaxis dosing in trauma patients in which doses are adjusted based on anti-Xa levels. We sought to determine whether adopting these guidelines would lead to improved VTE prophylaxis in patients admitted to our burn service.

Methods

We initiated a protocol at our American Burn Association verified burn center of titrating VTE prophylaxis for our patients based on anti-Xa levels consistent with the WTA and AAST guidelines. We performed a retrospective chart review of all patients in which anti-Xa levels were measured between May and October 2022. Chi square, Fisher's exact, and ANOVA were used to analyze the data.

Results

A total of thirty six patients met our inclusion criteria. Age (49 [35.0, 61.0]), BMI (26.7 [6.8]), gender (67% male), and percent total body surface area (4.5 [2.0, 10.5]) were not statistically significant. Patients with a final lovenox dose of 30mg twice daily required a significantly lower dose adjustment than patients with a final lovenox dose of greater than 30mg (5.1 vs 7.9, p=0.0003). While not statistically significant, there was a trend for patients with a final lovenox dose of greater than 30mg twice daily to have larger percent TBSA affected (6.0 vs 13.6, p = 0.079). When comparing patients whose final dose of lovenox was less than, equal to, or greater than their initial dose, there was a significant difference in dose adjustment between patients whose lovenox had to be decreased as opposed to those who had to be increased (10.0 vs 15.8, p< 0.0001). None of our patients suffered a VTE event over the study period.

Conclusions

A “one size fits all” approach to VTE prophylaxis in burn patients may lead to inappropriate prophylaxis. Our study demonstrates that titration of VTE prophylaxis with lovenox using anti-Xa levels in the burn population is feasible and that patients with burns may require individualized dosing for appropriate prophylaxis.

Applicability of Research to Practice

Our research demonstrates that titration of VTE prophylaxis in a burn population may be more appropriate than the traditional “one size fits all” approach.
516 Negative Pressure Wound Therapy in Burns: A Prospective, Randomized-Controlled Trial
Authors: Tapking Christian , Endlein Jonathan , Warszawski Jan , Kotsougiani-Fischer Dimitra , Gazyakan Emre , Hundeshagen Gabriel , Fischer Sebastian , Hirche Christoph , Kneser Ulrich
Published: May 2023

Introduction

Negative pressure wound therapy (NPWT) is a widely used tool for the treatment of complex wounds, including burns. However, there is only little data comparing NPWT to other wound dressings. This study aimed to evaluate the effectiveness of NPWT in small, acute burns of upper and lower extremities and to compare to the standard of care (SOC) at our institution.

Methods

Patients that were admitted to our institution with burns on extremities between 0.5 and 10% of the total body surface area (%TBSA) burned were included and randomized to either NPWT or SOC (polyhexanide gel, fatty gauze, and cotton wool). Treatment was performed until complete wound healing. Patients that required skin grafts, received NPWT independent on the group. Patients pain level, time to wound healing, number of dressing changes and functional outcomes were assessed.

Results

Sixty-two patients with burns, admitted between May 2019 and November 2021, were randomized into treatment with NPWT (n=32) or SOC (n=30). Both groups were similar regarding age (38.6±12.2 vs. 45.1±16.0 years, p=0.080), total burn size (2.95±2.42 vs. 3.31±2.93 %TBSA, p=0.595) and treated wound size (1.84±1.41 vs. 1.38±0.93 %TBSA, p=0.137). There were significant differences regarding healing time (11.19±4.92 vs. 8.70±3.58, p=0.027) and number of dressing changes throughout the study (2.19±1.49 vs. 3.97±1.69, p< 0.001). There were no differences in necessity of surgery (12.5% vs. 13.3%, p=0.329) pain assessments or functional outcomes.

Conclusions

Healing time was longer in the NPWT, whereas NPWT group needed less dressing changes. This may be a psychological and logistical advantage. No differences were found regarding necessity of surgery pain and scarring.

Applicability of Research to Practice

NPWT is safe in small burns and can lead to fewer dressing changes and pain.
518 Autologous Skin Cell Suspensions for Reconstruction of Nonthermal Soft Tissue Wounds: A Case Series
Authors: Deville Paige , Lovick Elle , Carter Jeffrey , Phelan Herbert
Published: May 2023

Introduction

Based on studies showing the use of autologous skin cell suspensions (ASCS) leads to burn wound closure with significantly smaller amounts of harvested donor skin, the Food and Drug Administration approved the first ASCS for the reconstruction of thermal injuries in September, 2018. The benefit of needing less donor skin to heal a given soft tissue wound has led to off-label usage of ASCS in a variety of clinical situations, such as necrotizing soft tissue infections (NSTI), toxic epidermal necrolysis (TEN), and traumatic injuries with soft tissue loss among others. Here, we report on a single-institution case series of ASCS usage for closure of soft tissue wounds caused by nonthermal mechanisms.

Methods

We performed a retrospective chart review of all patients treated with ASCS for an indication of non-thermal soft tissue wounds at our American Burn Association-verified academic burn center between April 1, 2018 to June 1, 2022. Descriptive demographic data were collected.

Results

Eight patients (6 male/2 female, mean age 57 + 17 yrs, mean length of stay 46 + 30 days) were found to have undergone closure of their wounds using ASCS during the time period of the chart review. Indications were NSTI (n=2), frostbite (n=2), antiphospholipid syndrome (n=2), and TEN (n=2). ASCS was used as a sole therapy for the TEN patients while ASCS was used in combination with meshed autografting for all other patients. The mean size of wounds treated with ASCS was 2835 + 2670 cm2, and the mean ASCS take rate was 86 + 7%. No ASCS-related complications were found.

Conclusions

These results bolster the off-label use of ASCS solutions for closure of nonthermal wounds while the surgical world awaits the results of an ongoing Phase III trial on this question

Applicability of Research to Practice

This study seeks to contribute to the literature supporting off-label uses of ASCS in non-thermal injuries & diseases.
521 Silk A Biological Dressing for Superficial Burns Treatment: Randomized Controlled Trial Versus Silver Sulfadiazine
Authors: Dantzer Eric J
Published: May 2023

Introduction

Silver Sulfadiazine is currently the standard treatment for superficial second-degree burns. These burns are common and should not necessarily require hospital treatment. However, caretaking may become an issue: dressing technique is not always mastered by home health care nurses, their practical realization may be more difficult considering the surface to be treated; duration of care can also be too long and painful. We have evaluated the interest of a dressing based on natural silk with this indication.

Methods

In a preliminary study, we have compared SSD to silk dressing (S) in the treatment of 2nd degree burns. Following diagnosis, the topical to be used was determined by drawing of lots. The SSD associated with fatty gauze was applied and then covered with dry gauzes and bandages. Silk was applied directly on the lesion and then covered with dry gauzes and bandages. Dressings were changed every 48 hours. The SSD was changed with each dressing after cleansing the lesion with saline; the silk one was left in place until healing, only the dry gauzes and bandages were changed. Pain, duration of care and healing time were assessed.

Results

80 patients were included 25 men, 15 women (7 to 83years) were treated with SSD; 22 men, 18 women (17 to 84 years) with silk. The average surface area treated was 5% in both groups (1% to 20% SSD) and (1% to 23% S). Pain (EVA) was evaluated between 3 and 4/10 for the SSD group and 0 to 2 for the S group. Dressing duration was 20-30 minutes for the SSD group and 10-15 minutes for the S group. The average healing time was 13 days for both groups. 2 complications, as infections , were observed in each group.

Conclusions

The flexibility of silk facilitates smooth application on all surfaces and localisations like SSD. Silk treatment has the same healing time as that obtained with SSD, i.e. the physiological healing time of 2nd degree superficial burns. Silk has allowed shorter treatments, because it is technically simple, and less painful as the lesion was never exposed to air. This allowed reduction of analgesics. A larger study should confirm that 2nd degree burns can be managed with silk dressing as outpatients, by home health care nurses, inexperienced in burns and even for larger surfaces and reduce the cost effective of the treatment and the need for painkillers.

Applicability of Research to Practice

immediate
532 The Impact of a Clinical Pharmacist on Medication Management in an Adult Burn Clinic
Authors: Boyd Allison , Walroth Todd , Meadows Katherine , Spera Leigh , Hartman Brett
Published: May 2023

Introduction

Pharmacists in our burn center have historically assisted with discharges and transitions of care for patients sent home or to a facility. Despite these efforts, pharmacists were not formally involved in managing burn clinic patients. Collaborative Drug Therapy Management (CDTM) protocols allow pharmacists working within a defined context to independently assume responsibility for direct patient care activities. The goal of implementing this model in our clinic was to improve access to care and streamline management of pharmacologic issues. The objective of our study was to assess the impact of a clinical pharmacist on medication management in an adult burn clinic via a CDTM protocol.

Methods

The CDTM protocol allows pharmacists to independently manage the following disease states via in-person or telephone visits: pain, agitation, delirium, insomnia, venous thromboembolism, skin/soft tissue infections, and hypermetabolic complications. All treatment decisions, interventions, and education are documented in the electronic record. “Incident-to” billing is completed at Level 99211. All pharmacist visits between 1/1/22-9/21/22 were included for review in the study. Demographics were reported for unique patients, and interventions were included from each visit for patients with multiple pharmacist visits.

Results

A total of 19 patients were seen at 39 visits with a clinical pharmacist during the study. Patients were mostly males (84%) with a mean (SD) age of 45 (18) years. Majority of patients were in-state (95%), with 11 (58%) being from an outside county. Patients were seen for a median (IQR) of 2 (1,2) visits each. Additional interventions were made in 12 patients (63%) at 19 visits (49%), including medication reconciliation [16 (41%)], medications ordered [14 (36%)], labs ordered [2 (5%)], referrals placed [1 (3%)], and allergies addressed [1 (3%)]. At applicable visits, patients had a median (IQR) of 2 (1,2) interventions made or 2 (1, 3) medications ordered.

Conclusions

Historically, pharmacists were only involved with clinic patients when issues arose, serving in an “as-needed” capacity. Pharmacists are now able to proactively help with medication reconciliation, medication prescribing, ordering labs, and placing referrals. Implementing a CDTM protocol has allowed our pharmacists to become more formally involved in post-discharge follow-up and managing ambulatory burn patients.

Applicability of Research to Practice

To our knowledge, ours is the first burn center to implement a Clinical Pharmacist CDTM Protocol, which may serve as a framework for others. Future directions include continuing to track data for adherence, medication access, billing/reimbursement, and clinical outcomes.
535 Influence of Covid-19 Pandemic Conditions on the Features of Pediatric Minor Burn Injuries
Authors: Abali Ayse Ebru , Aydogan Cem , Kamilova Semra , Turkmen Nigar , Santelis Santiago , Haberal Mehmet
Published: May 2023

Introduction

Majority of pediatric burns are minor injuries. Social life changes due to Covid-19 pandemic may have influenced their characteristics. We compared the features of pediatric burn cases which were treated as outpatients at our center before and during Covid-19 pandemic.

Methods

The records of 658 patients were reviewed. The study group was evaluated in two groups; Group I: patients-treated between March 2018 and February 2020 (pre-pandemic) (n=350), Group II: patients-treated between March 2020 and February 2022(Pandemic) (n=308). Data collected for each case were age; sex; insurance status, place of residence; burn-causes, extent of burns; body-site affected; time and environment where the injury occurred, time-interval between occurrence of injury and admissions to the burn-center; (mean± SE, p<.05).

Results

Mean age (years) was 4,32±0,24 for Group I, it was 4,32±0,18 for Group II; male:female ratio was 0,87:1 in Group I, it was 1,1: 1 in Group II; mean total surface area burned was 1,94±0,14 % (min:0,5, max:16) in Group I, and it was 1,98±0,26% (min:0,1 max: 16,1) in Group II (p>.05). Most of the patients were from urban areas and were covered by social security system in both groups (p>.05). Injuries occurred between 06:00 and 18:00 in 63,7% of Group I and in 62,6% of Group II (p>.05). The most common scenario was the domestic environment for both groups with a rise in rates of outdoor-burns Group II (p<.05) and this rise was observed during the ‘new normal’ period, but not during the ‘lock-down’(p< .05). The most common burn-cause was the scalds for both groups (p >.05). Hands, trunk, head and neck regions were less frequently involved in group II (p<.05). Rates of direct admission were similar for both, but children in Group II were more frequently brought to our burn center on the day of injury (p<.05).

Conclusions

The decrease in injuries to hands, trunk, head and neck, and the increase in admissions on the day of injury were remarkable during pandemic period. These results may be clues for enhanced care-giver precautions against injuries during ‘stay home’ days. Increased frequency of outdoor burns during ‘new normal’ may indicate the negative effects of this new unfamiliar social life on care-giver watchfulness. However, increased admissions on the day of the injury may be influenced both by the changing social conditions of care-givers and the uninterrupted service of our burn center while others were serving for covid-19 patients rather than burn victims.

Applicability of Research to Practice

This study helped to make recommendations for evidence-based interventions to decrease factors associated with pediatric minor burn injuries before, during and after pandemic
539 Contact Burns Associated with Concomitant use of Methamphetamines and Heat Stroke, Resulting in Neurological Sequela
Authors: Glennon Colleen , Richey Karen , Foster Kevin
Published: May 2023

Introduction

On a summer day in the desert southwest, ground surfaces can soar to 180 degrees Fahrenheit, posing significant risk to individuals who sustain contact with such surfaces, particularly if unable to get up. These individuals are also at risk for heat stroke. This summer, an increased number of patients admitted with contact burns were positive for methamphetamine and concomitant heat stroke. The purpose of this case series is to describe the hospital course and outcomes of this subset of patients.

Methods

A retrospective chart review of patients admitted between June and September 2022 was completed. Criteria for inclusion included contact burn, initial core body temperature > 38.8°C, and a methamphetamine positive drug screen. Outcome measures included length of stay, discharge disposition, number of operations, admission Glasgow Coma Score, neurology work-up and sequela.

Results

A total of 23 patients were admitted who suffered contact burns and tested positive for methamphetamine. Ten of those patients had core body temperatures greater than 38.8°C upon initial evaluation. The mean age was 36.6 years (24-62), with an average temperature of 42.3°C (40.5-43.1°. All 10 were found down in the community with altered mental status, the average Glasgow Coma Scale was 5.9 (3- 12). CT scans were done on 9, all were negative for acute intracranial abnormalities. Neurology was consulted for 3 patients with 2 having EEGs performed, both displayed slowing and attenuation secondary to hyperthermia. Ten of these patients were concurrently positive for fentanyl. The mean total burn surface area burned was 9.6% (4-17.5%), The average number of operations was 4.1/patient (1-11). Of the 8 patients discharged the average LOS was 30 days (10-61), 2 patients remain hospitalized in the ICU with a current LOS of 61-71 days. Of the 8 patients discharged, all required post-acute care with only 1 meeting rehabilitation criteria.

Conclusions

Elevated temperatures in the Southwestern United States have been known to cause an increase in surface-related contact burns during the summer months. Historically, the at-risk patient population has been elderly individuals prone to falls with limited physical ability to get up. This summer highlighted a new phenomenon of younger individuals suffering both contact burns and heat stroke secondary to the combination of methamphetamine use and elevated summer temperatures. This patient population suffered significant morbidity, and none were able to be discharged home. This case series highlights the dangers posed by ambiently heated surfaces during the summer months, particularly in combination with illicit drug use.

Applicability of Research to Practice

This case series, demonstrates the increased risk of sequela associated with burn patients who have comorbid substance abuse disorder.
540 Psychiatric Illness and Substance Abuse: Unaddressed Factors in Burn Injury
Authors: Won Paul , Johnson Maxwell , Stoycos Sarah , Gillenwater Justin , Yenikomshian Haig
Published: May 2023

Introduction

Patients with psychiatric illness and substance use disorder have high rates of burn injuries. These patients require multidisciplinary care and experience prolonged admissions. Less is known about these patients after discharge due to challenges such as poor healthcare literacy and inequities to healthcare access. This study characterizes this marginalized population’s inpatient burn care and post-discharge outcomes compared to the general burn population.

Methods

Patients who were admitted to a single burn center from January 1st, 2018 to June 1st, 2022 were included. Patient demographics, history of psychiatric disorders, burn and psychiatric treatment data, and post-discharge outcomes were collected.

Results

A total of 1,660 patients were included in this study, of which 91 (6%) patients had psychiatric comorbidity and/or substance use disorder. These 91 patients had an average age of 36 years (standard deviation (SD): 12 years). In this cohort, the majority of patients were undomiciled (66%) and male (67%). On admission, 66 (72%) patients reported recent illicit substance use or had positive urine toxicology results. At the time of burn injury, 25 (28%) patients had a pre-existing psychiatric disorder. Patients were treated most for self-inflicted burns, with 36 (40%) patients presenting with burns secondary to self-immolation. In this population, 67 (74%) patients required inpatient psychiatric intervention, of which 31 (46%) were placed on a psychiatric hold. After discharge, 39 (43%) patients returned to the hospital for outpatient follow-up. The readmission rate for patients with psychiatric or substance use comorbidity was greater than 4 times higher than that of the general burn population (31% vs 7%). The most common cause of readmission were subsequent mental health crisis (40%) and inability to perform burn care (32%).

Conclusions

Burn patients with psychiatric disorders and substance abuse are most often young men who exhibit self-harm. These patients have limited outpatient follow up and access to support outside of the hospital. High readmission rates for subsequent mental health crises and inability to perform basic wound care exemplifies inadequate short-term care for this marginalized population.

Applicability of Research to Practice

In the short term, patients with psychiatric and substance use disorders may benefit from additional professional support and treatment to address burn care and comorbidities after burn injury.
541 Needs Assessment among Adult Burn Survivors’ Caregivers in Korea
Authors: Hwang Se-Hee , Park So-Young
Published: May 2023

Introduction

Burn injuries have negative impact on both burn survivors and their loved ones. As family members usually care for burn survivors, it is very critical to understand the concerns of family caregivers and their needs for social services during the process of recovery. The purpose of this study is to assess 1) a broad range of difficulties among family caregivers of adult burn survivors, 2) the frequency of use of social service programs and satisfaction with these services, and 3) the needs of caregivers of burn survivors on the service provision.

Methods

We used a cross-sectional survey design with purpose sampling. We conducted both online and face-to-face surveys from November 2021 to February 2022. A total of 92 family caregivers aged 20 years or older participated in the survey. We measured 1) physical (e.g. chronic diseases such as pain and hypertension), psychological (e.g., family conflicts, communication issues with a burn survivor), financial (e.g., medical expenses, living costs), and social & environmental problems (e.g., living environment, education, discrimination or prejudice due to burn scars and disabilities), 2) the use of social service programs and the level of service satisfaction, and 3) the needs of social service programs (e.g., counseling services for PTSD treatment, financial support, and discharge planning). We used SPSS 24.0 for all data analyses.

Results

The most challenging problems were financial matters followed by psychological, and social & environmental ones among study participants. Study respondents used social service programs to resolve their psychological, financial, and discharge related difficulties. Those who used social service programs showed higher satisfaction with an average of 3 out of 5 points. More than 50% of study participants reported that it was necessary to receive social services on psychosocial, financial, and discharge related problems and they were willing to receive these services in future.

Conclusions

These findings imply that it is necessary to develop and provide needs-based social services for caregivers of burn survivors and that the provision of social services should be expanded further.

Applicability of Research to Practice

Findings of this study demonstrate that social service programs can relieve the burden of caregivers and improve the quality of life of both burn survivors and their caregivers.
543 Diversity in Burn Surgery Programs
Authors: Delapena Samantha , Chen Andy , Houng Abraham , Lodescar Rachelle
Published: May 2023

Introduction

Racial and gender disparities have been longstanding in the fields of medicine and surgery. In the literature, underrepresentation has been highlighted in plastic surgery and general surgery programs, however few studies examine this within burn surgery. Two studies describe the gender and racial disparities that exist in burn surgery leadership. This study seeks to compare and highlight the representation of minority and female surgeons in burn surgery training at a major metropolitan burn center to other surgical programs.

Methods

Applicant data were reviewed for acceptance to the clinical burn surgery fellowship program from 2008 to 2022. Self-identification was used to categorize gender as male or female and race as Asian, African American, White, and other. The gender and race of each applicant was recorded. The data was analyzed and compared to data trends in female and minority representation among physicians in other training programs. Demographic data were also obtained from newly hired staff of the same metropolitan burn center.

Results

From 2008-2022, there have been 30 physicians enrolled in this institution’s burn surgery fellowship program. Fourteen (46.7%) were female. Twelve (40%) were White, ten (33.3%) were African American, six (20%) were Asian, and two (6.7%) were of unknown racial background. From 2018-2022, there have been 277 newly hired staff members for the burn center. There were 238 females (85.9%). There were 142 (51.2%) who were White, 82 (29.6%) who were African American, 30 (10.8%) who were Asian, and 23 (8.3%) who were Hispanic or Latino.

Conclusions

In 2022, the US graduating medical class was 52% female – a proportion that has slightly increased over the last four years. Furthermore, the US graduating medical school class was 58.8% White, 25.5% Asian, 10.6% Hispanic or Latino, 8.3% Black; these proportions of minority groups have also demonstrated a slow, but steady, increase over the last four years. Previous studies have demonstrated a lack of diversity among burn surgery leadership, but do not address diversity among burn surgery fellows or among newly recruited medical staff within burn centers. This institution’s burn surgical program has aimed to maintain a diverse minority representation to serve a community that is also diverse in race, gender, and socioeconomic status.

Applicability of Research to Practice

Increasing gender and racial representation in burn surgery programs is beneficial for supporting the burn patient population, which is frequently diverse in race, gender, and socioeconomic status.
544 Creating Communities for Burn Survivors Using Metaverse Platform
Authors: Hwang Se-Hee
Published: May 2023

Introduction

In the post-COVID-19 era, as face-to-face activities become difficult, the psychosocial difficulties of burn survivors are increasing, and their social isolation is also intensifying. At this time, studies on the effectiveness of online intervention have been reported, and demand for the use of metaverse platforms that can supplement face-to-face activities is also increasing. Accordingly, the metaverse platform was intended to be used to prevent social isolation of burn survivors and to prepare a social support system, and their experiences were analyzed and its impact was investigated.

Methods

Among the various metaverse platforms, Burn Hospital was established on Gather Town platform, which can present or communicate on an online map and has the function of producing or sharing videos, writings, and paintings. Main plaza, auditorium, education room, exhibition room, counseling room, and play room were built on the platform, and burn survivors could access the treatment process and various information, and at the same time, they could easily access the content with their families through programs by treatment stage, age, and group. In particular, various education, workshops, and support groups were held to share burn experiences with each other and provide opportunities to benchmark each other's overcoming strategies. In addition, using Ifland, a mobile phone app-based platform, education on safety and burn awareness improvement campaigns were conducted to citizens.

Results

A total of 700 people participated in a total of 20 education and lectures held at Burn Hospital on Gather Town platform, which opened on December 18, 2021. In addition, art therapy programs for children burn survivors are underway every week. Most of the participants evaluated their experiences on the metaverse platform as new and fun, and it was positively evaluated that geographical limitations could be overcome and community support group meetings were possible.

Conclusions

It was evaluated that the establishment of communities using metaverse has a positive effect on helping the psychosocial recovery of burn survivors and their families and establishing a social support system. In particular, compared to face-to-face services, it was time-wise and economically efficient and had the advantage of being able to experience interesting factors. On the other hand, it is somewhat difficult for burn survivors who have difficulty using PC to access the platform, so digital literacy education should be preceded, and support for improving digital accessibility is needed.

Applicability of Research to Practice

Along with face-to-face services, it is expected that the community activities of burn survivors using the metaverse platform will continue to expand, and it is expected to lead to the development of digital treatments in the future by developing various digital-based clinical programs to help burn survivors to recover physically and socially.