bluuebunny/crossref_metadata_2025 huggingface dataset:
31 Regional Anesthesia for Reducing Postoperative Opioid Use in Split Thickness Skin Grafting
Authors: Duggan Robert P , Mefford Austin T , Palackic Alen , Owolabi Adebukola , Branski Ludwik K
Published: March 2022

Introduction

Split thickness skin grafting is ubiquitous in the management of acute burns and burn reconstruction. Patients describe the resulting partial-thickness donor site wound as one of the most painful aspects of burn care. Managing donor site pain is challenging and frequently involves potent opioid regimens. Rapid reepithelization of the donor site makes long-acting local and regional anesthesia an attractive option for reducing opioid use. This study aims to determine the efficacy of graft donor site regional anesthesia at reducing postoperative opioid consumption in burn patients.

Methods

A retrospective review of burn patients undergoing split-thickness skin grafting at our institution was performed. Patient demographics, burn mechanism, and percent burned total body surface area were collected. The type of regional anesthesia, when it was performed, and the anesthetic agents used were also determined. Milligram morphine equivalents (MME) were calculated for three 24-hour periods postoperatively to quantify opioid usage. The total MME in 72h postoperatively was also determined and used to calculate per day MME requirements. Mean, and peak pain scores in the first 24h postoperatively were collected. Univariate and multivariate analyses were performed to determine the efficacy of regional anesthesia.

Results

Twenty-five patients were identified, 14 who received donor site regional anesthesia and 11 who did not. The two groups did not differ significantly in age, gender, race, BMI, or burn mechanism. The regional anesthesia group had a significantly lower percent burned TBSA (5.3 vs. 21.6, p < 0.001). Still, donor site dimensions did not differ significantly between groups (363 cm2 vs. 411 cm2, p = 0.247). The use of regional anesthesia was associated with significantly lower MME requirements in the first 24h postoperatively (22.5 vs. 84.9, p = 0.023), lower total requirements after 72h (47.3 vs. 147.8, p = 0.016), and lower per day requirements (17.6 vs., 51, p = 0.014). The regional anesthesia group was discharged on average one week sooner (5.1 days vs. 12.4 days, p = 0.031). Multivariate analysis demonstrated the use of regional anesthesia independently predicted decreasing MME requirements in the first 24h after surgery, decreasing MME requirements in total, and decreasing per day MME requirements. No patients experienced anesthesia-related complications.

Conclusions

In a cohort of burn patients undergoing split-thickness skin grafting, the use of regional anesthesia was highly effective at reducing opioid requirements in the immediate postoperative period. We believe regional anesthetic blockades should be considered to provide long-lasting donor site analgesia. More investigation is warranted into ideal anesthetic agents, the maximum donor site dimensions, and the extent of cost savings.
32 Effect of Oral Ketamine on Analgesia During Burn Wound Care
Authors: Rozynski Jill , Larger Charlotte , Patton Alicia , Kohler Amber , Wiktor Arek J
Published: March 2022

Introduction

Pain and anxiety can be difficult to control in the burn patient. Ketamine, a NMDA receptor antagonist can be utilized, however intravenous (IV) dosing requires increased monitoring. In contrast, oral ketamine (O.K.) is reported to have fewer side effects, and can be administered without a higher level of care. Little is known about dosing and efficacy of O.K. in the treatment of burn patients. We sought to examine the use of O.K. in our burn population.

Methods

This was a cross-sectional comparative quality improvement study conducted at our ABA verified burn center from January 2021through September 2021. Inclusion criteria were in patients experiencing refractory pain and anxiety after receiving fentanyl and midazolam during wound therapy one day prior to first O.K. administration, along with completion of pre-post patient assessment surveys. Patients were administered 50mg-150mg of ketamine in an oral suspension mixed with 30mL-120mL juice. Effectiveness of the O.K. was measured using pre-post patient surveys, pre-post IV pain medication usage, and subjective staff evaluation of pre-post tolerance of debridement. Baseline demographics were recorded, along with adverse events. O.K. was deemed effective by improved survey scores, improved tolerance to debridement, and reduction in IV medication requirements. Students T-test was performed to determine significance.

Results

A total of 71 patients were given O.K, and 32 met inclusion criteria. Baseline demographics included: 19 male (59%), median age 36 years (range14-66), median TBSA 9.9% (range 1.6%-33.2%). O.K. reduced mean fentanyl use by 33% (pre 199.2mcg- post 123.5mcg, p< 0.01) and mean midazolam use by 39% (pre 1.4mg - post 0.7mg, p< 0.01). On a scale of 1-10 (1 best, 10 worst) mean pain scores improved 38.8% (pre 8 – post 4.6, p< 0.01), anxiety by 36.6% (pre 6.5 – post 3.5, p< 0.01), and overall experience by 37.5% (pre 5.9 – post 3, p< 0.01). Mean O.K. effective dose was 50mg. Staff noted O.K. improved the patient’s ability to tolerate debridement; uncooperative and inconsolable patients participated in their own wound care, and reported to prefer tub time with O.K. One patient experienced psychotomimetic effects, while one patient requested discontinuation due to increased anxiety 4 hours after O.K. administration.

Conclusions

O.K. appears to be efficacious in improving pain and anxiety during wound care while being well tolerated by patients. It also subjectively improved the wound care therapy experience.
34 Using a National Burn Registry to Develop a Model for Risk-adjusted Length of Stay Benchmarking
Authors: Thompson Callie M , Bessey Palmer Q , Higginson Sara , Hoarle Kimberly , Hsu Naiwei , Pardon Darryl A , Phillips Bart D , Phillips Matthew H , Weber Joan M , Mandell Samuel P
Published: March 2022

Introduction

Length of stay (LOS) is a frequently reported outcome after a burn injury. Previous literature estimates LOS at 1 day per % total burn surface area (TBSA) but this varies considerably across patients & centers. LOS benchmarking will benefit individual burn centers as a way to measure their performance & set expectations for patients. We sought to create a nationwide, risk-adjusted model to allow for LOS benchmarking based on data from a national burn registry.

Methods

Using data from a national burn registry, we queried admissions from 7/2015-6/2020 & identified 126,129 records with LOS data reported by 103 centers. We selected 23 predictor variables on the basis of completeness (min. 75% required) & clinical significance. Missing data were multiply imputed with a Bayesian Ridge Regression estimator. All statistics were calculated in Python using Numpy & Scikit-Learn libraries. Comparisons of unpenalized linear regression & Gradient boosted (CatBoost) regressor models were performed by measuring the R2 & concordance correlation coefficient (CCC) on the application of the model to the test dataset. The CatBoost model applied to bootstrapped versions of the entire dataset was then used to calculate O/E ratios for individual burn centers. Confidence intervals (CI) for O/E ratios were calculated using a normal distribution parametric model. Analyses were run on 3 cohorts: all patients, 10-20% TBSA, >20% TBSA.

Results

The CatBoost model outperformed the linear regression model with a test R2 of 0.68 & CCC of 0.81 compared to the regression model with R2=0.52, CCC=0.70. The CatBoost was also less biased for higher & lower LOS durations. Due to the CatBoost model’s superiority in predicting the outcome, this model alone was used for O/E ratio calculations. The O/E ratio data from the model for all 3 cohorts are shown in Figure 1.

Conclusions

Gradient boosted regression models provided greater model performance than traditional regression analysis. Using national burn data, we can predict LOS across contributing burn centers while accounting for patient & center characteristics, producing more meaningful O/E ratios. These models provide a risk-adjusted LOS benchmarking using a robust data source, the first of its kind, for burn centers.
53 Use of Polylactic-acid-membrane in Split-thickness Skin Graft Donor Sites: A Prospective, Comparative, Randomized Study
Authors: Möllhoff Nicholas , Ehrl Denis
Published: March 2022

Introduction

Polyurethane film (PU) dressings are commonly applied for coverage of split-thickness skin graft (SSG) donor sites, while previous studies have suggested reduced morbidity using a polylactic acid membrane (PLM). To further investigate the optimal treatment approach, the presented study compared outcome of donor sites in patients receiving either PLM or PU.

Methods

This randomized clinical trial allocated patients requiring SSG to receive either PLM or PU at the donor-site. Primary endpoint was difference in donor site scar appearance between groups 3 months postoperatively (Vancouver Scar Scale – VSS). Secondary endpoints included pain, the number of and time required for wound dressing changes, and costs related to the wound dressing.

Results

30 patients were allocated to each group. The median VSS scored lower for patients receiving PLM (PU: 3 (Q1: 2; Q3: 4) vs. PLM: 2 (Q1: 1; Q3: 3); p=0.049). Pain during change of wound dressing (PU: 2.0 ± 0.2 vs. PLM: 0.5 ± 0.2; p< 0.001) and mobilization (PU: 0.8 ± 0.2 vs. PLM: 0.3 ± 0.1; p=0.032) was reduced in the PLM group. Patients with PLM required less dressing changes per day of hospital stay (PU: 0.44 ± 0.06 vs. PLM: 0.28 ± 0.02; p=0.015). Mean time for wound dressing changes per patient was higher in the PU group (PU: 74.50 ± 5.72 vs. PLM: 21.43 ± 2.61 min; p< 0.001). Costs were higher in the PLM group (PU: 67.83 ± 5.56 vs. PLM: 162.79 ± 21.76 €; p< 0.001).

Conclusions

PLM improves outcome of SSG donor sites, however, higher treatment costs must be taken into consideration.
59 Burns in Low- and Middle-income Countries: A Scientometric Analysis of Peer-reviewed Research
Authors: Collier Zachary J , Kanmounye Ulrick S , Naidu Priyanka , Tapia Maria Fernanda , Bustamante Atenas , Bradley Daniel , Msokera Chifundo , Dutton John , Magee William P , Gillenwater Justin
Published: March 2022

Introduction

Low- and middle-income countries (LMICs) account for 70% of all global burns. Due to this significantly disproportionate burden, it’s critical we identify barriers to burn care and prevention in LMICs. As a result, this study aimed to elucidate trends in LMIC-related burn research to create focused strategies for burn care training, research, and innovation. Accomplishing meaningful change from the study’s findings will be guided by the first 4 steps of Dr. John Kotter’s “8-Step Process for Leading Change” – 1) create urgency for change, 2) build a guiding team, 3) develop a vision and plan, 4) communicate with key stakeholders to obtain buy-in.

Methods

Web of Science’s 7 citation databases were searched through March 2, 2021 using synonyms of “burns” and “low- and middle-income countries.” After screening articles, metadata were uploaded to VOSviewer (Leiden, Netherlands) where citation and network metrics were generated. The Kruskal-Wallis test and linear regression were used for bivariable and multivariable analysis of factors influencing publications, citations, and total link strength (TLS) – the strength of association between a given research article, other articles, and additional institutions.

Results

Bibliometric analysis identified 2,027 articles by 8,602 authors in 692 journals. Two-thirds of journals published a single article (n=453, 65.5%) whereas only 3.6% published ≥10 articles. One-quarter of LMIC burn research was published in ISBI’s Burns (n=417 articles, 20.6%) and ABA’s Journal of Burn Care & Research (n=89 articles, 4.4%). Most authors published < 5 articles (n=8521, 99.1%) but 19 (0.2%) had published ≥10. Authors were affiliated with 2,519 organizations in 132 countries. There was a strong positive correlation between total publications and citations (R=0.87, P< 0.001). In addition, there was a significant difference in the number of publications (P=0.003, 0.07), citations (P=0.005, 0.03), and TLS (P=0.009, 0.008) by geographic and economic categories - North America had the highest while Latin American and the Caribbean had the lowest. The USA (n = 563), India (n = 161), and China (n = 154) published the most articles.

Conclusions

Given the disproportionate representation of high-income countries and authors in the current LMIC burn research landscape, there must be a sense of urgency to develop pathways for facilitating change. Local and regional candidates for mentors and leaders were identified using bibliometric findings. Assembling teams with these individuals and prolific authors using a well-defined vision for change will facilitate sustainable communication and collaboration within LMIC research.
60 Running Water While Bathing Is a Risk Factor for Pediatric Scald Burns
Authors: Moser William J , Bilka Kristen R , Vrouwe Sebastian Q , Glick Jill , Ramaiah Veena
Published: March 2022

Introduction

Scalds are the most common mechanism of burn in children, and a significant proportion of these injuries are associated with bathing. Burns sustained while bathing present a unique opportunity for injury prevention; previous studies have examined lowering water heater temperatures, however reputable infant bathing educational resources do not explicitly recommend avoiding running water and the risks that it could pose. In an effort to inform prevention programs, this study seeks to determine the incidence and circumstances of running water in bathing scald burns at our institution.

Methods

A retrospective review was performed of records from an American Burn Association verified center over a ten year period (1/1/2010 to 12/31/2019). This center treats both children and adults and is affiliated with an academic hospital in a major urban center. The burn database was queried for scald injuries in children less than three years involving bathing. The Child Advocacy and Protective Services team provides inpatient consultation for all children less than three years old with burn injuries allowing us to analyze the specific events surrounding the bathing scald burns in this cohort.

Results

A total of 123 patients met inclusion criteria. Three bathing safety risk factors were specifically noted in the chart review: (1) running water, (2) lack of caregiver presence for duration of bathing, and (3) failure of caregiver to check water temperature before bathing. Of the cases identified, 107 (87%) had clear documentation of running water as part of the history of injury, 66 (54%) cases involved failure of caregiver to check the water temperature before bathing and 53 (43%) cases did not have a caretaker present for the duration of the bath. In cases with only one risk factor, running water was identified in 34 (94%) out of 36 cases, and in cases with one or two risk factors, running water remained the primary risk factor with 38 (90%) out of 42 cases. When looking at the combination of risk factors, only three (2%) cases had no risk factors while 77 (63%) involved two or more risk factors.

Conclusions

The vast majority of bathing burn injuries in this series involved running water. In addition, a significant number of scald burns occurred from running water alone, even without the other identified risk factors. Conversely, only 2% of scald burns associated with bathing featured none of these three risk factors, suggesting that these injuries could be greatly impacted by safe bathing education.
73 Associations Between Pre-burn Occupation Type and Employment Outcomes at One Year
Authors: Shepler Lauren J , Carrougher Gretchen J , Gibran Nicole S , Kowalske Karen J , Stewart Barclay T , Ryan Colleen M , Schneider Jeffrey C
Published: March 2022

Introduction

Reintegration into the workforce after burn injury is an important issue for survivors. In a 2012 systematic review, 28% of burn survivors never returned to any form of employment. Although pre-burn employment status is strongly associated with post-burn employment, there are little data on the role of pre-injury occupation type on workplace reintegration. The aim of this project was to assess the impact of occupation type on employment outcomes after burn injury.

Methods

Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Longitudinal Database from 2015 to 2021 were used to investigate the association between occupation type and employment outcomes. Occupation type was classified into two groups, Labor and Non-labor, using the U.S. Bureau of Labor Statistics Standard Occupational Classification System. Demographic and clinical data were compared between groups. Mixed regression analyses examined associations between pre-burn occupation type and post-burn employment outcomes (employment at 1 year, days to return to work), controlling for age, gender, race, ethnicity, pre-injury employment, and burn size.

Results

Of the 600 patients who were employed pre-injury, 247 (41%) identified with a non-labor occupation and 353 (59%) with labor occupations. The Labor group was more male (82% vs. 61%) and Hispanic (23% vs. 6%), younger (mean age 42.1 vs. 48.3 years), less educated (high school or less, 25% vs. 11%) and more likely to have been injured at work (28% vs. 14%) compared to the Non-labor group (p< 0.001 for all comparisons). Changes in occupation were seen from pre-injury to post-injury; 16% of working survivors changed from Non-labor to Labor and 13% from Labor to Non-labor occupation types. For those who did return to work after injury, the average time to return to work was greater for Labor compared to the Non-labor group (150 vs 100 days; p=0.003). Additionally, those in the pre-injury Labor group were less likely to be employed at 12 months compared to the Non-labor group (odds ratio = 0.41; p=0.009).

Conclusions

Pre-injury occupation type is associated with employment outcomes after injury. Therefore, occupation type can be used to inform vocational reintegration resources, such as vocational rehabilitation programs, to optimize survivor outcomes.
75 Patient Reported Outcome Measures Associated with Burn Severity
Authors: Saldana Golddy M , Greenhalgh David , Sen Soman , Palmieri Tina L , Skipton Romanowski Kathleen S
Published: March 2022

Introduction

Burns continue to be a leading cause of unintentional injury sustained by children. The lasting effects of burn treatment on pediatric patients’ quality of life are still poorly understood. Patient-Reported Outcomes Measurement Information System (PROMIS) is a reliable tool that evaluates a patient’s physical, mental, and social health. To measure the impact of burn injuries on quality of life, we integrated the use of PROMIS into our outpatient clinic. Our aim for this study is to determine the effects of patient demographics, burn treatment, and burn characteristics on PROMIS scores.

Methods

A retrospective review of patient and PROMIS data collected at our institution from June 2016 to August 2019 was conducted. Patient demographics, burn injury characteristics, PROMIS Pediatric Mobility, Upper Extremity, Pain Interference, and Peer Relationships scores were collected. Statistical analysis was conducted using Wilcoxon Two-Sample Test, Chi-Square, and Pearson’s Correlation Coefficient.

Results

163 pediatric burn patients completed PROMIS questionnaires. The median injury age was 5.94 years (interquartile range (IQR)= 6.9) and had a median total body surface area of 15% (IQR = 25.5). Individual burn characteristics did not impact Peer Relationships scores; however, they did have a significant effect on Upper Extremity, Mobility, and to a lesser extent, Pain Interference scores. Older injury age (-0.24, p = 0.02), longer length of stay (-0.25, p = 0.02), larger total body surface area (-0.27, p = 0.009), and more operating room visits (-0.28, p = 0.006), were associated with worse Upper Extremity scores. Similarly, older injury age (-0.2, p = 0.04), longer length of stay (-0.25, p = 0.01), more days in the intensive care unit (-0.24, p = 0.01), and more operating room visits (-0.26, p = 0.01) impacted Mobility scores. Worse Pain Interference scores were correlated with longer length of stay (0.24, p=0.01), and larger total body surface area (0.19, p=0.05). Upper Extremity scores correlated with Mobility scores (0.60, p < 0.0001); Pain Interference (-0.23, p < 0.02) and Upper Extremity (0.3, p < 0.003) scores correlated with Peer Relationships scores; and Upper Extremity (-0.48, p < 0.0001) and Mobility (-0.42, p < 0.0001) scores correlated with Pain Interference scores.

Conclusions

Peer Relationships scores are not influenced by patient demographics or burn characteristics. This is in contrast with Upper Extremity, Mobility, and Pain Interference scores which are all directly affected by burn characteristics. The patients’ impression of their upper extremity function has the greatest impact on their perceived pain, peer relationships, and mobility.
82 Early Skin Excision Decreased the Risk of Skin Infection, Sepsis and Mortality Among Burn Patients
Authors: De La Tejera Giovanna , Song Juquan , Corona Kassandra K , Gotewal Sunny , Wermine Kendall , Efejuku Tsola A , Keys Phillip H , Joglar Alejandro A , Villarreal Elvia L , Huang Lyndon G , Chokshi Shivan N , Chaij Jasmine M , Bagby Shelby P , Haseem Maria , Golovko George , El Ayadi Amina , Wolf Steven E
Published: March 2022

Introduction

In lieu of outdated and limited patient studies on excision for severe burns, a more comprehensive analysis is indicated to determine the effects of early skin excision following burn. This study aims to address the outcomes of early excision.

Methods

Data collection and analysis was performed using TriNetX, a national research database. The study population included patients ranging from 0 to 90 years old who underwent excision for burns. Groups were stratified by the number of days after injury in which they received a skin excision treatment. Five outcomes were analyzed: death, cardiac stress, wound infection, blood transfusion, and sepsis. Risk and incidence of various health outcomes were compared between groups after matching for age, gender and race, using a z-test with p< 0.05 considered significant.

Results

We identified 2,522 patients who underwent excision between 0-3 days, 825 between 4-7 days, and 419 between 8-14 days following burn. We found a significant decrease in risk of skin infection and sepsis for skin excision 0-3 days after burn compared to 4-7 days (p< 0.05). Additionally, the frequency of blood transfusion significantly increased for those with excision 0-3 days after burn when compared to 4-7 days (p< 0.05). There was a significant increase in the risk of mortality for patients who received skin excision 8-14 days after injury as compared to both 0-3 days (p< 0.05) and 4-7 days (p< 0.05). However, we found no statistical difference in cardiac stress, skin infection, blood transfusion or sepsis between 0-3 and 8-14 days nor 4-7 and 8-14 days.

Conclusions

Skin excision 0-3 days after burn injury results in a significantly lowered risk of skin infection and sepsis as compared to skin excision 4-7 days and 8-14 days after burn. Skin excision within the first 7 days after burn decreased the risk of mortality as compared to excision 8-14 days after burn. The risk of blood transfusion increased with early excision, which may be explained by the severity of the injury.
91 Comparison of a Polylactic Acid Skin Substitute to Porcine Xenograft for Pediatric Partial Thickness Burns
Authors: Pogson Kaylyn B , Chrisco Lori , Nizamani Rabia , Williams Felicia , King Booker
Published: March 2022

Introduction

In August of 2020, our institution transitioned from porcine xenograft to a polylactic acid skin substitute for the management of pediatric partial thickness burns. This change in treatment was due to the discontinuation of porcine xenograft by the primary supplier to the United States. We sought to make a length of stay (LOS), postoperative pain score, postoperative dressing change, and cost analysis of the polylactic acid skin substitute as compared to porcine xenograft for the treatment of pediatric burns.

Methods

Patients were identified using an institutional Burn Center registry and linked to clinical and administrative data. All pediatric patients admitted between January 1st, 2019 and March 31st, 2021 who sustained partial thickness burns were eligible for inclusion. LOS, burn etiology, total burn surface area (TBSA), postoperative pain scores, postoperative dressing changes, complications, infections, and hospital cost were evaluated.

Results

A total of 259 patients were identified, 47 of whom received the polylactic acid skin substitute and 212 of whom received xenograft. Average age for polylactic acid skin substitute patients was 5.4 years with 51.1% male, average age for xenograft patients was 4.6 years with 58.5% male. Average LOS for polylactic acid skin substitute patients was 3.4 days and 3.2 days for xenograft patients (p = 0.45). Etiology of burns was 83.0% scald and 10.6% flame for polylactic acid skin substitute patients and 80.2% scald and 9.40% flame for xenograft patients (p = 0.66 and p = 0.71, respectively). Polylactic acid skin substitute patients had an average TBSA of 5.3% and xenograft patients an average TBSA of 4.3% (p = 0.11). Postoperative pain scores on postoperative day (POD) 1 were 1.1 for polylactic acid skin substitute and 1.2 for xenograft (p = 0.13). Average number of inpatient postoperative dressing changes was equivalent between the polylactic acid skin substitute and xenograft (p = 0.62), while average day of first postoperative dressing change was POD 10.9 for the polylactic acid skin substitute and POD 9.9 for xenograft (p = 0.15). Neither group had postoperative infections, though xenograft had a complication rate of 1% with 2 patients while the polylactic acid skin substitute had 0%. Polylactic acid skin substitute patients had an average hospital cost of $28,415 and xenograft patients an average of $27,935 (p = 0.80).

Conclusions

A polylactic acid skin substitute is equivalent to porcine xenograft in LOS, postoperative pain, postoperative dressing changes, and cost in the setting of similar age, burn etiology, and %TBSA. More analysis with wound healing indices and safety profiles could determine the clinically superior choice.
110 Does Discharge to a Post-acute Facility Predispose Burn Patients to a Deterioration of Their Wounds?
Authors: Osborn Suzanne C , Addison David , Islas Claudia , Richey Karen , Foster Kevin N
Published: March 2022

Introduction

The care of burn injuries requiring hospitalization is complex and highly specialized. In-hospital treatment results in discharging patients with stabilized, but unhealed wounds with the need for ongoing care. The expectation is that wounds continue to heal without complication. For patient who are unable to be discharged home, disposition is frequently dictated by finance and payor source. Post-acute facilities such as Skilled Nursing facilities (SNF), Acute Rehabilitation Centers (ARC) and Long-term Acute Care facilities (LTAC) are utilized. The purpose of this study was to evaluate the wound healing in patients being sent to SNF and ARC.

Methods

A retrospective chart review of patients discharged to a SNF or ARC over a one-year period was performed. Photographic review was done comparing photos from the first clinic visit to those from hospital discharge. Wounds were designated as “Improved” (IM) or “Worsened/No Change” (W/NC) by a single burn surgeon.

Results

Of the 963 charts reviewed, 719 patients suffered burn injuries, and of these 127 were discharged to post-acute facilities, 54 were either discharged to a LTAC or did not have photos available for review at their first clinic visit. Thus 73 were evaluable. The majority, 51% (n=37) worsened or showed no change (W/NC) and 49% (n=36) improved (IM). All patients returned to clinic within the first 2 weeks of discharge. There were no significance differences for age, gender, BMI, comorbidities, substance abuse, living situation, ICU days, ventilator days, length of stay, number of surgeries, payor source or facility type (SNF vs ARC). Mean TBSA was greater in IM 13.99% vs W/NC 8.31% (p=0.018). There were no significant differences between groups for mechanism, although IM was more likely to have suffered a flame/flash injury (n=20) and W/NC contact burns (n=21). A total of 30 different facilities were utilized for discharge.

Conclusions

Despite having smaller burn injuries, the majority of patients worsened if discharged to a post-acute facility. No patient factors were identified that were associated with worsening/no change in wound status at the first clinic visit post discharge. Given the number of discharge facilities utilized, we were unable to analyze the relationship between specific facilities and outcomes. The magnitude of the problem warrants further investigation. A Quality Improvement project is being developed to further identify areas for intervention.
115 Analyzing Temporal Trends and Outcomes Associated with High Prevalence Bacterial Infections in Burn Patients
Authors: Chokshi Shivan N , Golovko George , Song Juquan , Wolf Steven E , El Ayadi Amina , Joglar Alejandro A , Efejuku Tsola A , Corona Kassandra K , Haseem Maria , Gotewal Sunny , De La Tejera Giovanna , Keys Phillip H , Huang Lyndon G , Villarreal Elvia L , Bagby Shelby P
Published: March 2022

Introduction

Bacterial infections are a leading cause of complications in burn patients. However, ambiguity remains around the most common infectious etiologies and their resulting complications. Our study identifies which bacterial infections will lead to specific complications and tracks infection rates of these bacteria over time.

Methods

Burn patients diagnosed with a bacterial infection within 6 months of burn were identified in the TriNetX database using ICD-10 codes; those with bacterial infections prior to injury were excluded. Occurrence of the following outcomes within 12 months of injury were compared for those with bacterial infections and those without, including acute kidney injury (AKI), congestive heart failure (CHF), hypertrophic scarring, sepsis, and death. The top 4 bacterial infections, by incidence, were then identified and analyzed for the outcomes. Lastly, infection rates were stratified by year from 2010-2020. Data was analyzed using chi-square with p < .05 considered significant, and regressions.

Results

We identified 457,383 burn patients, of whom 4,688 (1.0%) were diagnosed with a bacterial infection within 6 months of injury. The bacteria that constituted the highest proportion of infected patients were Staph aureus (51.1%), E. Coli (20.2%), Pseudomonas (17.6%), and Enterococcus (9.6%). When outcomes were stratified by bacteria, Enterococcus infection was associated with the highest incidence of AKI (23.1%), sepsis (25.2%), and mortality (16.03%). E. Coli was associated with the highest incidence of CHF (17.7%) and Pseudomonas was associated with the highest incidence of hypertrophic scarring (13.3%). All data was found to be statistically significant (p< .05). Time trend data from 2010 to 2020 stratified by bacterial infection is displayed in Figure 1. Of note, Pseudomonas infection rates increased by 90% (r2 = 0.6717) while E. Coli infection rates increased by 33%. (r2 = 0.7223). In contrast, Staph Aureus infection rates have decreased since 2013. Lastly, Enterococcus infection rates displayed a fluctuating pattern with an increasing trend since 2017.

Conclusions

Species identification of a post-burn bacterial infection is an important step in outcome management. Despite its low incidence, Enterococcus infection was associated with the highest incidence of AKI, sepsis, and mortality, and has displayed recent increases in infection rates. Pseudomonas has shown a similar increasing trend and is notable for hypertrophic scar formation.
117 Evaluating Predicted vs. Actual Vancomycin Pharmacokinetic Target Attainment Using AUC Dosing
Authors: Boyd Allison N , Walroth Todd A , Bollinger Christopher , Candidate M B A , Hartman Brett C
Published: March 2022

Introduction

Vancomycin is a broad-spectrum antibiotic commonly used in burn patients. Traditionally, vancomycin has been managed with a trough level dosing strategy. However, recent literature and practice changes have encouraged utilizing an area under the curve (AUC) dosing strategy. The objective of this study was to evaluate the likelihood of attaining therapeutic targets using population kinetics in burn patients utilizing AUC.

Methods

This retrospective cohort included adult burn patients who received vancomycin dosed with an AUC strategy. Data collection covered 20 months following an institutional shift to AUC monitoring. Patients were excluded if they did not have pharmacokinetic (PK) data documented, received renal replacement therapy, or had a nonburn injury. The primary outcome was the difference between predicted and actual vancomycin AUC. Secondary outcomes included differences between additional PK parameters.

Results

The AUC analysis included 14 patients. Mean (SD) age was 47 (12) years, 57% were male, and mean (SD) TBSA was 30 (21). The mean (SD) AUC in the predicted and actual groups was 522 (42) and 455 (122) mg*h/L, respectively (p=0.05). A total of 6 patients were evaluated for additional PK analysis, summarized in Table 1.

Conclusions

Actual patient-specific AUC was significantly lower than predicted AUC. This corroborates previous trough-based data indicating burn patients dosed using standard population estimates are at risk of being subtherapeutic, likely due to their hypermetabolic state. Our findings suggest AUC monitoring is an appropriate dosing strategy for burn patients and potentially more accurate than a traditional trough-based approach.
127 Anxiety Disorder Symptomology Found to Be Prevalent in Burn-injured Youth
Authors: Brubaker Rimmer Ruth B , Bay R C C , Kalil Emile T , Chacon Daniel W , Foster Kevin N
Published: March 2022

Introduction

Anxiety Disorder (AD) is common in inpatient pediatric burn patients and likely related to pain/stress associated with acute care. This study ascertained if burn survivors reported higher anxiety levels based on sex, visibility of scars, or TBSA ≥ 50%.

Methods

Burn-injured youth completed the Screen for Child Anxiety Related Disorders (SCARED) with parental consent. This 41 item self-report measures DSM-IV pediatric anxiety disorder symptoms: panic disorder (PD), separation anxiety (SA), generalized anxiety disorder (GAD), social phobia (SP) school phobia (SCP) and total anxiety (TA). The percentage of respondents above threshold for each disorder was calculated.

Results

112 survivors, mean age of 13, included boys (51%) & girls (49%). 83 reported visible scars. Females had higher percentages for TA (53%) vs. males (21%) (p < 0.001), PD (47%) vs. (7%) (p< 0.001), GAD (40%) vs. (16%) (p < 0.005), & SA (51%) vs. (21%) (p < 0.001). Youth with TBSA ≥ 50% (n=22) had higher precents for GAD (46%) vs. < 50% (24%) (p < 0.01). The visibly scarred had higher percent for GAD (38%) vs. hidden (7%) (p< .01).

Conclusions

Female, visibly scarred, and patients with burns > 50% revealed increased AD symptoms. AD may be chronic, interfere with a child’s home & school function and lead to chronic distress, substance abuse, and isolation. Screening for anxiety in burn-injured youth is recommended.
504 Starting a Pediatric Burn Center: Challenges Faced in an Underserved Patient Population
Authors: Kopari Nicole M , Zagory Jessica A , Lindsey Kristen , Phelan Herb A , Carter Jeffrey E
Published: March 2022

Introduction

Burn injury is the third most common cause of childhood injury resulting in death. The CDC recognizing the South as having the highest rate of pediatric burn deaths in the U.S. Unfortunately, 10% of all child abuse cases involve burn injuries and 20% of all pediatric burn admissions are due to nonaccidental trauma. Our study demonstrated that aftercare was a major challenge in starting a pediatric burn center. We analyzed the rate of lost to follow-up in burn-injured children following surgery and our steps to address this need in our community through key partnerships within our state.

Methods

Our study is a single center review of pediatric burn-injured children undergoing surgery from 01/01/2021 through 09/30/2021. Lost to follow-up was defined as three or more consecutive months without clinic or telemedicine visits despite three of more documented communication attempts by attending surgeons and/or clinic staff. Children requiring child protective services (CPS) for suspected nonaccidental trauma were compared to those where nonaccidental trauma was not suspected. All children sustained burn injuries of sufficient severity to require excision and autograft with follow-up in the outpatient clinic. Families were provided with an after-visit summary reviewing the clinic appointment, transportation and meal assistance, and they received a call prior to clinic to remind them of the scheduled appointment.

Results

A total of 35 children required surgery with outpatient follow-up per protocol. 23% of the patients required CPS investigations. We reviewed 151 subsequent clinic visits and the associated cancellations, rescheduled appointments, and no-show visits. Children under the care of CPS had a higher rate of being lost to follow-up (50%) compared to other children (17%). Parents undergoing CPS investigation were 4x less likely to provide cancellation notice. Children placed in foster care had no cancellations, reschedules appointments, or missed visits despite a higher number of clinic visits overall.

Conclusions

Children suffering nonaccidental injuries represent an exceptionally vulnerable portion of our population. Burn injuries often are a public and personal reminder of severe trauma. CPS works to find a balance in securing a safe home while attempting to maintain a family unit. Our work demonstrated an unacceptably high rate of loss to follow-up for children requiring surgical intervention after injury especially in those with concerns for nonaccidental etiologies. As a result, our burn surgeons led an initiative with statewide burn directors and our state’s emergency response network to engage the state’s CPS department. Our goal was to raise awareness and increase education for CPS social workers and foster families on burn injury and aftercare needs.
506 Hidradenitis Suppurativa Reddit Support Group: Finding New Meaning in Social Media during the COVID-19 Pandemic
Authors: Yesantharao Lekha , Suresh Rachana , Cox Carrie A , Lerman Sheera F , Caffrey Julie
Published: March 2022

Introduction

Hidradenitis suppurativa (HS) is a chronic inflammation of sweat glands that can result in abscesses and scarring, significantly impacting quality of life. Online support groups provide a platform to connect with other HS patients – increasingly important with pandemic-related social isolation. The popular social media site Reddit allows users with common interests, like HS, to form a community and share information. This study characterizes HS patients’ use of Reddit and social media more broadly before and during the COVID-19 pandemic.

Methods

This study consisted of a cross-sectional survey of HS patients treated at our institution between May 2021 and July 2021, collecting data on patient demographics, HS status, and social media support group usage/interest. A longitudinal analysis of use of a popular HS support page on Reddit from January 2019 to August 2021 was also conducted, analyzing the number of subscribers over time.

Results

The number of subscribers to the subreddit r/Hidradenitis increased exponentially from January 2019 to August 2021 (R2= 0.9978 for exponential model fit to data); this suggests that the onset of the COVID-19 pandemic was associated with a greater increase in the number of subreddit subscribers. Further, 20 patients (90% female, mean age of 32.4 years) completed the survey that was administered. Participants were stratified into two groups: online support group users (n=8) and non-users (n=12). There were no significant differences in sex, age, education level, HS activity, antidepressant usage, and overall social media usage between these groups. However, there was a significant difference in Hurley staging between the two groups; 75% (n=6) of online support group users reported a Hurley III staging, while only 16.7% (n=2) of non-users self-reported as Hurley III (p=0.003). In terms of features patients desired to see in online support groups, non-users ranked the following categories of advice/information as important more frequently than current users: bandaging/dressing boils, living with HS, medical advice from professionals, causes of HS, and diet (p=0.047, p=0.043, p=0.043, p=0.047, and p=0.013, respectively).

Conclusions

This study demonstrates that online support group use is associated with patients with HS of higher clinical severity. Since virtual support groups have an unprecedented importance due to increased social isolation and limited access to in-person support groups and health resources, healthcare providers may encourage non-users to partake in these online support communities during these trying times. Based on the needs and expectations of these patients as identified in this study, recommendations can be made to moderators of online communities to help fill any existing lacunae.
507 Capturing Growth and Change Through the Burn Camp Experience
Authors: Mikolaj Kerry , Jackson Brad , Boulter Trudy , Schiffer Nichole M
Published: March 2022

Introduction

The American Camping Association (ACA) has asked in their study titled, Youth Development Outcomes of the Camp Experience: Evidence for Multidimensional Growth, “In what ways do children change because of camp experiences?” Our burn camp program wanted to answer this same question about the medical specialty camp experience. Camp counselors and staff have been addressing this question in their camp summary reports for years, focusing on independence, social relationships, and adventure/risk taking. This project asked campers and caregivers/parents to rate their experiences of change in these key areas of growth and development.

Methods

The ACA supported the development of the Camper Growth Index instrument. We selected items from this larger scale to address three areas of change in our burn camp population: Independence/Leadership, Adventure/Exploration, and Social Skills. Three to four items were selected for each area based on the strength of their factor scores in the original study, relevance to our medical specialty camp setting, and the growth we were already documenting in our counselor reports.

Campers ages 8–18 and their caregivers/parents rate items addressing these areas on a 4-point Likert scale (disagree a lot, disagree a little, agree a little, agree a lot). Sample questions are “I am good at doing things on my own”, “I like to talk to kids I don’t know yet”, and “My child likes to try new activities”. Items are phrased in positive and negative directions (reversed scored).

All 60 campers and caregivers received these questions prior to camp. The same questions will be sent 3 months post camp to assess change in these areas.

Results

Preliminary findings from the pre-camp responses indicate positive evaluations in these three areas. We will be gathering post-camp responses from youth and caregivers / parents to assess change over the camp experience and return to home and school.

Conclusions

Burn camps are a vital part of the burn rehabilitation and aftercare experience for young burn survivors and their families. Documenting the change we all believe happens at burn camp (and hear about anecdotally from our campers and families) remains an important task. The Camper Growth Index utilized by the broader ACA study allows us to assess the camper and caregiver/parent experience of this change.
510 5-Year Retrospective Analysis of a Vented Early Mobility Algorithm in the Burn ICU
Authors: ONeil Audrey M , Rush Cassandra , Griffard Laura , Roggy David , Hartman Brett C , Boyd Allison N
Published: March 2022

Introduction

The practice of early mobilization on mechanically ventilated patients in ICU settings has received significant attention within recent literature, however limited research to date has focused specifically on the burn population. The purpose of this single center retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine the safety and feasibility of early mobility programs in the burn population, expose limitations preventing mobility progression at our facility, and discuss unique challenges to early mobility with burn patients.

Methods

A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for all intubated patients from initial evaluation until each patient was either extubated or underwent a tracheostomy. Data was collected using the stages of the mobility algorithm.

Results

In the 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average TBSA of 22.8%. Of these patients, 25 were transitioned to comfort care measures due to the extent of their burn injuries but were included in the review. The average intubated days were 8.05 days and the average length of stay was 26 days. No adverse events occurred during treatment with the algorithm. Stage 1: PROM/AROM was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with only 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) including: unstable medical status, agitation, sedation, cultured epithelial autograft placement, and orthopedic restrictions. Line placement, including femoral and pedal catheters , was also found to be a barrier to the use of our algorithm in 21% of held patient treatments.

Conclusions

Retrospective analysis demonstrates that early mobilization during mechanical ventilation is safe and feasible with in the burn population despite challenges including airway stability, sedation, and line limitations. Dedicated burn therapy staff and team coordination is required to optimize management during the critical care stage of recovery and improve outcomes for survivors.