bluuebunny/crossref_metadata_2025 huggingface dataset:
124 Numerical Cut Points for Mild, Moderate and Severe Pain in Adult Burn Survivors
Authors: Carrougher Gretchen J , Bamer Alyssa M , Orton Caitlin M , Pacleb Maiya I , Slavin Mary D , Schneider Jeffrey C , Yenikomshian Haig A , Stewart Barclay T
Published: April 2024

Introduction

The optimal numerical cut points for mild, moderate, and severe burn pain have been established. Investigators at a single center determined that average burn pain can be categorized as mild (0-2), moderate (3-5), and severe (6-10). To address concerns about small sample size and limited diversity, we aimed to identify the most suitable average pain intensity rating scores for mild, moderate, and severe pain in a large, diverse cohort of adult burn survivors using a Patient Reported Outcome Measures Pain Interference (PROMIS-PI) short form.

Methods

Average 11-point pain intensity Visual Analog Scale (VAS) or Numerical Rating Scale (NRS) scores (0-10) and a customized PROMIS-PI 4-question short form were administered to adults with burn injury treated at 5 centers in the US at hospital discharge (baseline) and 6, 12, 24-months and 5-years post-injury. To identify pain intensity scores that best represent mild, moderate, and severe pain, F value statistics associated with multiple ANOVA comparisons for mean pain interference scores by various pain intensity cut points were computed. Based on previous research, 6 possible cut points (CP) were compared: CP 3,6; 3,7; 4,6; 4,7; 2,5; and 3,5. The optimal cut points were considered those with the highest ANOVA F statistic.

Results

Data from 1,190 participants (68% male, 80% white, 22% Hispanic, mean age 46 years) and 5 study centers with VAS/NRS pain intensity and PROMIS-PI scores at one or more study timepoints were analyzed. The optimal classification for mild, moderate, and severe pain was CP 2,5 at all timepoints (see table).

Conclusions

This study confirms that for a diverse cohort of burn-injured adults from multiple centers within the United States, burn intensity ratings of mild (0-2), moderate (3-5), and severe (6-10) is appropriate for up to 5 years post-injury. These findings support previous research findings and continue to advance our understanding of burn pain and pain intensity reporting while providing clinicians and researchers with an objective measure that can be used for screening, treatment, quality improvement, and research.

Applicability of Research to Practice

Use of this numerical classification for burn pain in the adult burn survivor can be used with greater confidence in diverse populations.
506 Methamphetamine Intoxication and Inpatient Outcomes for Burn Patients
Authors: Stanton Eloise , Karanas Yvonne L , Gillenwater Justin , Pham Tam N , Sheckter Clifford C
Published: April 2024

Introduction

Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, less is known about the associated inpatient complications and perioperative management in users. This analysis aims to identify these trends on a national level.

Methods

The US National Trauma Data Bank was queried to identify burn patients between 2017-2021. Methamphetamine intoxication was identified on admission and compared to those who screen negative. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure, timing of surgery, admission vitals, length of stay (LOS), and days in the intensive care unit (ICU). Multivariable regressions modeled the effects on outcomes adjusting for available covariates including demographics, total body surface area (TBSA) burned, and inhalation injury. Bonferroni adjustments were applied.

Results

326,614 burn encounters were identified, and 5,380 (1.7%) had positive methamphetamine drug screens upon admission. Users were significantly older (35.2 versus 31.9 years, p < .001), had a greater percentage of males (85.3 vs. 82.0, p < .001), were more likely to have inhalation injury and overall had larger %TBSA burns (16% vs. 13%, (p < .001). Users had significantly higher but clinically insignificant ED systolic blood pressures (132.1 vs. 129.9, p < .001). There was no significant difference between the two groups regarding pulse rate >120 (1.7% vs. 1.6%, p=.611). Users were not more likely to die, sustain an MI, or stroke during admission. In contrast, users were significantly more likely to have alcohol withdrawal (0.8% vs. 0.5%, p=.019), drug withdrawal (0.3% vs. 0.2%, p=.003), a pulmonary embolism (PE) (0.9% vs. 0.7%, p=.039), and delirium (1.2% vs. 0.4%, p=.003). Users had longer times to surgery adjusting for burn severity and demographics (1.6 vs. 1.4 days, p=.033). There were no significant differences in the average number of wound coverage procedures (1.50 vs. 1.45, p=.947). Users had significantly longer hospitalization (8.7 vs. 6.2 days, p < .001); however, there was no significant difference between days in the ICU (6.7 vs. 6.4 days, p=.072).

Conclusions

While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, drug withdrawal, and delirium. Methamphetamine use was associated with delays in surgery and hospitalization.

Applicability of Research to Practice

Recognize the increased risk of complications and the need for tailored perioperative care for methamphetamine users. Additionally, burn centers may consider how to avoid delaying care for users and support interventions for withdrawal.
513 Predictive Values of MRSA Nasal Swabs for Pneumonia in Burn ICU Patients
Authors: Carlson Zachary , Stoianovici Robyn N , Young Sierra R , Louie Erin L
Published: April 2024

Introduction

Sepsis in burn-injured patients remains a leading cause of mortality in those who survive initial resuscitation. Methicillin-resistant Staphylococcus aureus (MRSA) is a common causative pathogen for pneumonia in burn-injured patients. Studies evaluating the predictive value of MRSA nasal swabs for pneumonia have largely excluded the burn-injured population.

Methods

Patients 18 years or older admitted to the Burn ICU at a tertiary medical center from 2016 to 2021 were included if they had any burns, a pneumonia ICD-10 code, an MRSA nasal swab obtained during admission, and any respiratory cultures associated with at least five consecutive days of antibiotics.

Results

There were 267 instances of pneumonia across 136 patients included. MRSA nasal swabs had an overall sensitivity of 39%, specificity of 98.7%, positive predictive value (PPV) of 84.2%, and negative predictive value (NPV) of 89.9%. MRSA nasal swabs obtained less than seven days from antibiotic initiation had a specificity of 98.6% and NPV of 98.6%; meanwhile, swabs obtained at least seven days from antibiotic initiation had a specificity of 98.7% and NPV of 86.4%.

Conclusions

The high specificity and NPV indicate that negative MRSA nasal swabs obtained less than seven days from antibiotic initiation may be used to de-escalate anti-MRSA antibiotics in clinically stable burn-injured patients with suspicion of pneumonia. The decrease in NPV suggests that it may be beneficial to obtain a repeat swab periodically or upon suspicion of pneumonia.

Applicability of Research to Practice

This study is the first to measure the sensitivity, specificity, PPV, and NPV of the MRSA PCR nasal swab in a cohort comprised only of patients admitted to a burn intensive care unit. The findings support the use of the MRSA nasal swab as a tool to aid in the decision to initiate or de-escalate anti-MRSA antimicrobials for pneumonia.
522 Testosterone Supplementation in Patients with Burn Hypermetabolism
Authors: DeWitt Alexandra , Ivanko Anastasiya , Schoen Jonathan E , Keating Aimee , Phelan Herb A , Carter Jeffrey E
Published: April 2024

Introduction

After major burn injuries, patients experience a hypermetabolic response that leads to hyperdynamic circulatory, physiologic, catabolic, and immune system responses. Many transdisciplinary approaches have been tested to mitigate this postburn hypermetabolic syndrome such as comprehensive burn rehabilitation, nutritional support, monitoring, and pharmacological interventions. Oxandrolone, a synthetic analog of testosterone, has been shown to have higher anabolic properties and minimal androgenic effects and studied intensely in burn care. In 2023, the FDA asked all manufacturers of oxandrolone to cease production and subsequently removed the drug from market on June 28, 2023. Our study examines the cost and operationalization of an intramuscular (IM) testosterone protocol as an alternative in male burn patients with ≥20% total body surface area (TBSA).

Methods

A cost analysis was conducted using the National Drug Codes (NDC) and commercially available benchmarking data. The cost of oxandrolone and testosterone were included in our analysis. Following a thorough literature review, a protocol was developed for adult male patients with >20% TBSA burn injuries. Patients undergoing gender affirming hormone therapy, untreated obstructive sleep apnea, or hormonal blockers for cancer were excluded from the protocol.

Results

The protocol begins with total serum testosterone levels at the time of admission and weekly thereafter for male patients with ≥20% TBSA injury. Once a testosterone level < 150 ng/dL is detected, supplementation of testosterone with 200 mg IM once weekly for two weeks is started. Weekly evaluations include total body weight, metabolic panels, and nutritional panels. Cost comparison between oxandrolone and testosterone show an equivalent unit cost of $8.62 versus $8.38, respectively.

Conclusions

Drug shortages and supply chain challenges are becoming more common in burn care. We hypothesize testosterone to be both a clinically effective and cost-effective alternative to oxandrolone in the setting of burn hypermetabolism in male patients with major burns. Currently, burn experts are working with endocrinologists to assess pharmacologic alternatives for female patients and have obtained IRB-approval to evaluate both safety and efficacy of testosterone supplementation in the setting of burn hypermetabolism.

Applicability of Research to Practice

This study evaluates the safety and efficacy of testosterone supplementation as an alternative to oxandrolone in the setting of burn hypermetabolism. This study helps provide guidance to other burn centers in filling the gap in therapy that now exists in the pharmacologic management of hypermetabolic syndrome in patients with severe burns.
540 Increasing Discharges Prior to 11am in Patients with Burn Injuries
Authors: Leonard Clinton D , Slater Elizabeth L , Hargis Denise , Graham Richelle , Troche Maria , McGrew Sabrina , Sigel Matthew , Wagner Anne L
Published: April 2024

Introduction

This study describes a quality improvement project to increase the number of patient discharges prior to 11am in a high-volume Burn Center.

A limited supply of staffed inpatient beds creates capacity constraints and can adversely affect patient flow. Discharging patients earlier has been shown to promote throughput, improving length of stay (LOS), patient satisfaction, and decrease costs. Burn patients face unique barriers to discharge compared to other inpatient groups.

Methods

This initiative utilized the Four Disciplines of Execution (4DX) framework, which focuses on identifying key drivers to achieve a specific, time-delimited quality improvement goal. Our primary target was increasing the number of discharges prior to 11am to 30% over the span of 6 months. Lead measures included (a) designation of a “priority discharge” patient, (b) discharge order entry prior to 0930, and (c) discharge prescriptions filled by the pharmacy the night before discharge. Baseline data was gathered from June 1st until Dec 11th 2022 and compared to the intervention period December 12th, 2022 through May 31st, 2023.

Results

Discharges prior to 11am increased from 11.8% to 27.1% over the course of the study. Median discharge time improved by 72 minutes. Discharge order entry time improved by 121 minutes. Potential special-cause variation was identified in January 2023.

Conclusions

Discharges prior to 11am were significantly increased after implementing a multidisciplinary approach between nursing, providers, case management and social work.

Applicability of Research to Practice

The techniques we used to increase early discharges should be easily transferable to other Burn Centers, with positive impact on LOS and amount of time patients spend boarding in the ED.
547 ADHD and Burn Injuries: The Hidden Readmission Risk in Pediatric Patients
Authors: Halevi Alexandra , Anaya Melanie , Emigh Brent , Harrington David , Kheirbek Tareq
Published: April 2024

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with the hallmark characteristics of poor impulse control, inattention, hyperactivity, and other cognitive dysfunction; as a consequence, children with ADHD are at an increased risk of burn injury. We hypothesized that pediatric burn patients with ADHD have a higher rate of unplanned readmission compared to patients without a diagnosis of ADHD.

Methods

We analyzed the Nationwide Readmission Database (01/2018 - 10/2018) to compare 60-days readmission rates in children (< 18 yo) with and without a diagnosis of ADHD who were treated for burn injuries on their index admission. Weighted multiple logistic regression was performed to obtain population estimates of odds ratios (OR), adjusting for patients’ demographics, burn severity and location, comorbidities, socioeconomic status, other psychiatric illnesses, and burn treatment on index admission.

Results

Our cohort included 1,879 children with burn injury. Of these, 79 (4.2%) had a diagnosis of ADHD. ADHD patients were more likely to be male (86.1% vs 59.8%, p=0.0002 ) and older (11.6 ± 3.7 vs 5.4 ± 5.3 years, p=0.0001). Children with ADHD were more likely to have other psychiatric diagnoses (26.6% vs 3.8%), specifically obsessive compulsive disorder (2.5% vs 0%, p=0.004), and other developmental disorders (15.2% vs 1.6%, p=0.0002). Patients with ADHD were more likely to be readmitted within 60 days of their index admission (15.2% vs. 4.8%, p=0.002). On weighted multiple regression analysis, ADHD had a higher adjusted odds ratio of readmission (OR: 2.66, 95%CI: 1.13-6.29).

Conclusions

Children with ADHD have a higher adjusted risk of readmission following thermal injury. This is potentially due to higher barriers to compliance with wound care, physical therapy, and scar management. Targeted discharge planning for patients with ADHD, including scheduled short-term follow-up appointments, home nursing assistance, and post-discharge phone calls, may potentially lower readmission risks in this vulnerable population.

Applicability of Research to Practice

Pediatric patients with ADHD are at higher than average risk for unplanned readmission within 60 days of discharge. Pediatric burn centers have the opportunity to adjust their post-discharge practice with these high-risk patients to decrease this risk. Interventions could include: more frequent clinic follow-up, longer duration with outpatient therapy, and additional coaching for caretakers on how to improve patient compliance.
548 Diabetic Foot Burns and Amputation Rates: A Systematic Review and Meta-analysis
Authors: Cannata Brigette , Malkoff Nicolas , Choe Deborah , Gillenwater Justin
Published: April 2024

Introduction

Diabetes mellitus (DM) is one of the most common chronic metabolic diseases. Comorbid peripheral neuropathy (PN) and peripheral vascular disease (PVD) puts this population at risk for foot burns and poor wound healing outcomes. There is a lack of consensus in the literature regarding the optimal approach for management of these unique injuries. The aim of this study is to systematically identify studies reporting on diabetic foot burns and critically evaluate outcomes including amputation rates among patients managed operatively versus non operatively.

Methods

A comprehensive search of PubMed, Embase, and Web of Science was completed. Screening was performed by two independent reviewers. Primary research studies published between 1980 to 2023 that discussed outcomes of foot burns in adult patients with DM were included. Studies that included pediatric (< 18 years old) or animal subjects, had inaccessible full texts, or were written in a language other than English were excluded. All conflicts were resolved collaboratively. The included studies were critically appraised using Newcastle-Ottawa Scale (NOS), JBI critical appraisal tool for analytical cross-sectional studies, or a published methodological tool. Results are presented using descriptive statistics of aggregated data.

Results

The database search yielded 2,402 non-duplicate papers, which was narrowed to 105 full texts following initial screening. A total of 35 papers met inclusion criteria, 5 of which were removed for poor scores on critical appraisal. Nine papers were included for meta-analysis, including seven retrospective comparative analyses, one cross-sectional study, and one retrospective chart review. In sum, there were 1798 diabetic foot burn patients included for analysis. Mean age was 58.2 years (SD 4.12) and 73.1% (n = 1,314) were male. A total of 15.7% (n = 283) of patients were surgically managed, which included debridement (3.7%, n = 66), grafting (8.2%, n = 147), flap (0.2%, n = 3), and primary amputation (7.1%, n = 127). Secondary amputation rate, defined as amputation following initial surgery, was 4.9%, (n = 14). The overall amputation rate of the cohort was 7.8% (n = 141). Other complications included infection (4.0%, n = 72), osteomyelitis (1.9%, n = 34), and graft failure (8.2%, n = 12). Only 1 study reported functional status at last visit.

Conclusions

Diabetic foot burn patients that are managed operatively experience increased morbidity including graft failure, infection, and need for additional amputation. This can have damaging effects on functional outcomes after injury.

Applicability of Research to Practice

The global diabetic population is growing and vulnerable to poor health outcomes, driving the need for research on diabetic foot burns to help providers reach consensus on best management practices.
550 The Effect of COVID-19 in Hospital Length of Stay and Patient Population Following Burn Injury
Authors: Sheikh-Oleslami Sara , Papp Bettina , Papp Anthony
Published: April 2024

Introduction

Myriad medical services were complicated by the COVID-19 pandemic. Acute burn care is heavily resource dependent, and thus was greatly impacted by lack of specialized personnel, supplies, and other resources which grew scarce with the onset of COVID-19. The primary objective of this study was to examine the relationship between COVID-19 and the length of stay (LOS) in hospital following burn injury as prolonged hospital admission increases opportunity for hospital-related complications and has implications on both the individual and community level. Further, it has been shown that homeless patients are hospitalized longer than housed patients due to lack of respite care and resources post-discharge. As such, the secondary objective of this study was to see how COVID-19 affected the homeless burn population and its possible contribution to LOS.

Methods

Single-centre, retrospective cohort study using data from the Burn Registry and medical chart review with inclusion of all adult burn patients admitted to a quaternary provincial burn unit from April 1, 2016, to March 31, 2023. Patients admitted prior to April 1, 2020, were considered the pre-COVID cohort. Variables of interest included demographic characteristics as well as LOS. Homelessness was defined as lack of fixed address. We compared variables of interest by LOS.

Results

498 patients met inclusion criteria. Of these, 301 fell into the pre-COVID and 197 into the COVID cohorts. The mean age (years) and TBSA (%) (standard deviation, [SD]) were 48 (17) and 12 (13) in the pre-COVID cohort and 47 (15) and 14 (16) in the COVID cohort. Males comprised 75.4% and 75.6% of the pre-COVID and COVID cohorts, respectively. Only 9.3% and 14.2% of patients suffered inhalational injuries in the pre-COVID and COVID cohorts, respectively. Overall, there was no significant differences in LOS between cohorts, with COVID cohort patients staying in hospital for 22 (24) days compared to 20 (29) days in the pre-COVID cohort. However, a 169% increase in homeless patients was seen during COVID, with 16% (49/301) of admitted patients being homeless pre-COVID compared to 27% (53/197) during COVID.

Conclusions

COVID-19 pandemic did not affect the LOS in burn patients, but the results suggest that homeless patients were disproportionately affected by the pandemic.

Applicability of Research to Practice

This is important as prolonged hospital stays have serious implications for the patient and the healthcare systematic as a whole.
552 Pain in the Assessment: Improving Reassessment of Burn Patients in the Emergency Department
Authors: Richerbach Stacey , Granger Jenny , Hockenberry Tiffany , Richey Karen J , Foster Kevin N
Published: April 2024

Introduction

Treatment of burn patients in the emergency department (ED) is challenging and often complicated by excruciating pain sparked by the burn injury. Unmanaged burn pain causes undue stress to the patient, both mentally and physically, and may result in physiologic manifestations. The physiologic impact of extreme burn pain may convolute a provider’s assessment and priorities of care. To facilitate appropriate treatment, RNs in the ED must perform timely pain reassessments. Our institutional benchmark for pain reassessment following medication administration is 90%. In 2021, we observed a drop in compliance in the ED to 73% and instituted a multidisciplinary, quality improvement (QI) approach to improve pain reassessment. The purposes of this project were to pinpoint education needs of nursing staff, improve compliance of pain reassessment, and to evaluate the efficacy of our interventions.

Methods

A survey was disseminated to Burn ED nursing staff to identify barriers to pain reassessment. QI interventions included a collaboration between Nursing, Informatics, and Quality Assurance to overcome barriers related to education, optimization of documentation in the electronic health record (EHR), and timely performance feedback. Education was disseminated via pre-shift nursing huddle, weekly newsletters, and educational posters. Modifications were made to the EHR software to alert nurses to reassessment needs and accounted for medication ‘indication.’ Quality Assurance increased report frequency to furnish reports weekly instead of monthly, enabling nursing leadership to expedite individualized feedback and education. Feedback was well-received by staff. Reassessment metrics were added to the quality board and posted in staff lounges. Top performers were acknowledged monthly in the department newsletter’s ‘Benchmark Brief.’ Performance was analyzed from April 2021 through June 2023, and was grouped quarterly.

Results

Following initiation of the QI project, pain reassessment increased by 18.8% to a 93.6% rate of timely reassessment.

Conclusions

Our multidisciplinary quality improvement project was successful, increasing complete and timely pain reassessment in the ED by 18.8%. Further, we discovered the need to reinforce education related to medication administration route, as PO medications had a higher incidence of pain reassessment non-compliance. To reduce the limitations of staff education, we continue to work with Informatics and the EHR vendor to refine the use of technology and better facilitate reassessment.

Applicability of Research to Practice

Further research is needed to evaluate efficacy of education related to pain reassessment following PO medication administration.
564 Adults with Head and Neck Burns Have Worse Long-Term Psychosocial Outcomes
Authors: Choe Deborah , McMullen Kara , Stewart Barclay T , Kowalske Karen J , Schneider Jeffrey C , Ryan Colleen M , Kazis Lewis E , Orton Caitlin M , Yenikomshian Haig A
Published: April 2024

Introduction

People living with burns of the head and neck (H&N) often experience serious physical (e.g., microstomia, ectropion) and psychological sequelae (e.g., adjustment and mood disorders). We aimed to compare long-term outcomes in key psychosocial domains between adults with and without H&N burns.

Methods

Adults with burn injuries after 2014 enrolled in the Burn Model System national longitudinal, multicenter database were included. Survey responses using the PROMIS-29 (Anxiety, Depression, and Participation in Social Roles), Satisfaction with Life Scale (SWL), and Burn Specific Health Scale (BSHS) at 6-, 12-, and 24 months post-injury were analyzed. Differences between participants with and without H&N burns were examined with non-parametric tests.

Results

This study included 1,247 participants: 579 had H&N burns and 668 had non-H&N burns. Compared to those with non-H&N burns, participants with H&N burns had significantly larger burn size (22.3 ±18.2 vs. 8.6 ±11.0 % total body surface area (TBSA), p< 0.001) and longer hospital stays (32.6 ±38.3 vs. 16.9 ±16.5 days, p< 0.001). At 12 months, participants with H&N burns reported significantly worse anxiety (51.2 ±10.6 vs. 48.3 ±9.4, p=0.001), depression (50.4 ±10.6 vs. 47.8 ±9.4, p=0.0026), and SWL (17.9 ±7.6 vs. 19.6 ±6.5, p< 0.001). Participants with H&N burns also reported significantly worse body image at 6 months (2.5 ±1.3 vs. 3.0 ±1.2, p< 0.001), 12 months (2.5 ±1.3 vs. 3.2 ±1.1, p< 0.001), and 24 months (2.7 ±1.3 vs. 3.1 ±1.2, p< 0.001).

Conclusions

Participants with H&N burns reported significantly worse outcomes in several psychosocial domains, including anxiety, depression, life satisfaction, and body image. These findings and evidence from early psychological intervention suggest that the presence of H&N burns is a potentially useful screening tool to identify an adult population who might benefit from early evaluation and treatment for psychological stress, coping and adjustment (e.g., cognitive processing therapy).

Applicability of Research to Practice

In addition to future studies, this study may be used when considering recommendations for psychotherapy or counseling services available to people living with H&N burns.
572 Burn Epidemiology in Drug Users
Authors: Criscione Jaynie X , Randolph Ellie , Jupudi Rithvic , Moffitt Sarah , Koussayer Bilal , Le Nicole K , Whalen Kristen , Buller Kristina , Troy Jared , Laun Jake
Published: April 2024

Introduction

Our state has the second highest rate of drug overdose deaths in the country, with an epicenter located in our greater metropolitan area. Burn patients using drugs can fall victim to burns commonly related to drug use or risky behavior while intoxicated. As our institution is the safety net for this community, we aimed to analyze burn presentation and outcomes of burn patients with active drug use to help clinicians anticipate challenges related to drug usage and limited socioeconomic support.

Methods

Retrospective cohort analysis was performed of patients over the age of 18 years presenting to our institution from 2015 to 2020 with burn injuries. We considered drug use to include marijuana, intravenous drug use, cocaine, methamphetamines, opiates, and alcohol use disorder. We analyzed admission rate with logistic regression, controlling for differences in inhalation burns, related traumatic injury, and other confounding factors.

Results

We reviewed a total of 1339 burn patients with 30.19% reporting drug use. On presentation, burn patients using drugs had a greater percentage of full thickness burns (+0.56%, p< 0.02), TBSA (+1.84%, p< 0.03), burn related trauma (+8.53%, p< 0.01), and concomitant inhalation burns (+3.65%, p< 0.01). Flame burns were most common overall, with scald (-6.15%) and explosion burns (+2.61%) showing the greatest change in frequency for patients using drugs (p< 0.03).

During their hospital course, a larger proportion of burn patients using drugs were admitted (+16.75%, p< 0.01), and drug use was associated with a 2.4 increased log odds of admission (p< 0.01, 95% CI: 1.7-3.4). LOS, surgical intervention, ICU days, and infection showed no significant difference between cohorts. Patients using drugs were less likely to follow-up (-7.39%, p< 0.01) after discharge.

Conclusions

Burn victims who use drugs do not experience clinically significant increase in burn severity, such as TBSA and depth, compared with non-drug users, but were more likely to have inhalation burns and associated traumatic injury. A larger proportion of burn patients using drugs were uninsured or on Medicaid, suggesting the presence of unmanaged chronic conditions that could better explain higher rates of admission after controlling for their burns.

Drug use furthermore where more likely to be lost to follow-up, possibly attributed to decreased access to healthcare secondary to insurance status and limited financial resources. Therefore, we must carefully consider discharge disposition and barriers to care to minimize post burn complications.

Applicability of Research to Practice

We aim to help clinicians treat burn patients who use drugs by anticipating challenges related to their usage and limited socioeconomic support.
581 Ketamine Use for Initial Sedation: A Consensus Statement from the Pediatric Injury Quality Improvement Collaborative
Authors: Vitale Lisa C , Malaniak Mariah , Klein Justin D , Giles Sheila Sheila A , Horvath Kyle , Thakkar Rajan K , Surgeon Pediatric , Marx Daniel J , Skultety-Robinson Debra
Published: April 2024

Introduction

The importance of adequate pain management for children during burn debridement is well recognized. Safe and effective procedural sedation is a fundamental quality metric for patient care in pediatric emergency departments (ED). Current literature suggests that a relatively low percentage of pediatric patients receive adequate analgesia and sedation in ED settings. The Pediatric Injury Quality Improvement Collaborative (PIQIC), an established network of five pediatric trauma and burn centers, benchmarks burn data to improve patient care and evaluate outcomes.

Methods

Data was obtained across the five centers between March 2022 to August 2023 from the PIQIC database. A crosstab analysis was utilized to compare the total body surface area (TBSA) of burn injury to medication selection for sedation during initial burn debridement in the ED. A total of 698 patients (n=698) met the inclusion criteria of presenting to ED with subsequent need of admission to the burn center.

Results

Among the 698 patients, the most selected sedative used amongst the 5 centers for burn debridement was ketamine. Patients with 0-1% TBSA received ketamine 59.3% of the time, respectively 1.1-5% was used 76.4%, 5.1-10% was used 76.6%, 10.1-15% was used 75%, 15.1-20% was used 78.9%, and 20.1-99% was used 42.9% of the time.

Conclusions

The care of the pediatric burn patient is complex, and inadequate sedation for debridement can lead to acute and long-term psychological sequelae. Inappropriate initial sedation has also been shown to make subsequent dressing changes more difficult. Intravenous ketamine sedation provides safe and effective sedation that allows the health care team to complete adequate debridement, dressing application, and caregiver education. This data from 5 pediatric burn centers suggests that the use of intravenous ketamine sedation should be considered more broadly amongst other burn centers that care for pediatric patients.

Applicability of Research to Practice

Further evaluation with prospective case controlled studies are needed to standardize this further.
586 Show Me the Wound Closure! Burn Registry Data Compilation Project
Authors: Michelli Pamela , Martinez Sandra , Swain Jeana , Richards Sherrina , Bozoian Brooke
Published: April 2024

Introduction

The ABA requires that a verified burn center report wound closure percentage on discharge for patients with burns >10% TBSA. Multiple data elements are entered by the burn registry staff into the registry. One data point, wound closure percentage (WCP) was not being captured consistently in the registry, because the data point wasn’t being reported. The initial rates of wound closure capture for 2021 and 2022 were 7% and 43% respectively and the ABA BCQP platform requires 100% capture of this data element. The purpose of this project is to develop a reliable process for the burn registrars to capture this data element.

Methods

We performed a retrospective review for this quality improvement project using data collected from our burn registry. Inclusion criteria included: burn patients 18 years or older who were admitted to a single burn center that had a TBSA ≥ 10% from January 1, 2021 – August 31, 2023.

Data collected was presented in our multidisciplinary Burn Quality Meeting to optimize ways to capture this data point. Suggested implementations included: Discharge summary documentation in the Electronic Medical Record (EMR), reporting WCP at weekly burn multidisciplinary rounds (MDR). Education was developed and disseminated to physicians and registry staff.

Results

815 burn admissions from January 1,2021 to August 31,2023 were reviewed, 171 patients were admitted with a burn of TBSA ≥ 10%. Discharge summary documentation of WCP was implemented October 2021 and a yearly review demonstrated a 39% capture rate. MDR reporting was implemented November 2022, a seven-month review demonstrated a 58% capture rate.

Conclusions

The initial implementation, discharge summary documentation resulted in very little improvement in capture of WCP. The MDR improved our capture rate further but did not meet the 100% data compliance goal. A daily discharge EMR care plan note was developed to help social work with planning for discharge for our patients to decrease the length of stay rate. It was decided to include WCP in this note to increase the capture rate. Moving forward, we found this to be an opportunity for improvement and will utilize the care plan note in combination with MDR reporting for WCP capture. The combination of MDR reporting and review of the daily discharge EMR care plan note is proving to be the most efficient way to capture WCP for our registry staff. The Burn Clinical Coordinator (BCC) is present for MDR reporting and can enter WCP in the registry as needed.

Applicability of Research to Practice

Utilization of documentation of WCP in the discharge summary, MDR reporting of WCP, and the review of the daily discharge EMR care plan note will allow for 100% compliance of data capture of WCP.
722 Factors Affecting Split Thickness Skin Graft Loss in Elderly Burn Patients
Authors: Reiss Matthew J , Chang Naiwei Hsu
Published: April 2024

Introduction

Advanced age is one of the more established predictors of morbidity and mortality in patients with burn injuries. It is predicted that by 2030, the number of people 65 years or older may double. This demographic shift may lead to a concomitant increase in burn injuries. The elderly population is at higher risk for burn injuries due to physiological changes that includes impairment of cognition, coordination, vision, mobility and deterioration of reflexes which may lead to decreased responses in dangerous situations. Other factors that may impair the healing process can include increased co-morbidities, polypharmacy, malnutrition in the setting of hypermetabolism, and decreased physiological reserves. Due to this, there is an increased incidence of graft loss in the elderly burn population. Our study aims to identify other factors that may affect or contribute to graft loss in elderly burn patients.

Methods

A retrospective chart review was performed on patients aged 65 years old and above who were admitted at our Burn Center for Burn injuries from January 2020 to September 2022. Medical Records of 54 patients were examined with regards to patients’ demographics, co-morbidities, site of wound graft placement, and technique used in wound graft application. Graft loss, which was determined to be < 80% take, was examined at 1-week intervals in the post-operative period and patient outcomes at 1 to 2 weeks were included.

Results

It was noted that out of the 54 patient charts reviewed, 24 patients underwent Split Thickness Skin Graft with autologous skin donor. The population consisted of more male (70.8%) than female (29.2%) patients. The average graft take 1 week after surgery was 87.5% and 80.2% at 2 weeks after surgery. About 33.3% of this geriatric burn patients suffered graft loss. Half of these patients were noted to have Diabetes Mellitus, Hypertension and/or had a significant smoking history. The most frequently used surgical grafting technique was meshed skin grafts. It was observed that 50% of patients who sustained graft loss had 4:1 meshed graft placement and 37.5% had 2:1 meshed skin graft placement. 40% of the skin graft loss were on the upper extremities and 37.5% were on lower extremities.

Conclusions

Elderly burn patients in our population who have DM, HTN, smoking history have a higher incidence of graft loss. These patients have improved outcome with 2:1 meshed autograft and the location of the graft placement did not play a significant difference in graft take.

Applicability of Research to Practice

The aim of this retrospective study is to indicate and predict populations with increased risk factors to formulate a therapeutic plan of action to decrease possibility of graft failure. More effective methods may be implemented to avoid increased incidence of graft loss such as use of bolster dressing vs NPWT, orthopedic devices such as splints, and close monitoring of skin graft using bedside measurement tools.
732 An Evidenced Based Approach to Capturing Growth and Change Through the Burn Camp Experience
Authors: Jackson Brad , Mikolaj Kerry , Boulter Trudy J , Schiffer Nichole , Kierulf Genevieve
Published: April 2024

Introduction

The American Camping Association (ACA) explored “in what ways do children change because of camp experiences” (Thurber et al, 2007). Our burn camp approached this same question about the medical specialty camp experience assessing readiness and change in three key areas of growth: Independence / Leadership, Adventure / Exploration, and Social Skills.

Methods

The ACA supported the development of the Camper Growth Index (Henderson et al, 2006). For our medical specialty camp, a subset of items was selected for each area based on the strength of factor scores in the original study, relevance to our camp setting, and the growth being documented in counselor reports.

Campers ages 8 – 18 and caregivers rated items addressing these areas on a 4 point likert scale from disagree to agree. 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”.

Campers and caregivers received the questionnaires across a 3 year period.

Results

Pre-Camp ratings from campers and caregivers are consistent across the 3 years (Table 1). When campers were queried on the last day of camp, their adventure / exploration scores trended upwards, however that trend did not continue at 3 months, but independence / leadership trended upwards instead. Caregivers rated all three categories higher at the 3 month post camp assessment. Variation in the responses between individual items suggests discriminant validity and that certain items might be more sensitive to capturing the benefits of the burn camp experience.

Conclusions

Burn camps are a vital part of the burn rehab and aftercare experience for young burn survivors and their families. Documenting change through burn camp remains an important task. Change in these growth areas supports our targeted and intentional programming. The Camper Growth Index utilized by ACA allows us to assess the camper and caregiver experience of change, while linking the burn camp experience to the larger youth camp community of research.

Applicability of Research to Practice

We are evaluating the sensitivity of this abbreviated measure within a burn camp setting. Along with other measures of growth and change, we are hoping to document the magic of burn camp.
740 Injury Prevention Program Targeting Tap Water Scald Burns in Pediatric Patients
Authors: Vitale Lisa C , Zarr Renee , Malaniak Mariah
Published: April 2024

Introduction

Children in our urban ABA verified pediatric burn center have low socioeconomic status: 57.6% live in poverty, 67.9% receive food assistance and 65% are Medicaid-eligible. Research has consistently shown a correlation between childhood poverty and increased risk of unintentional injury and death. Using demographic and injury incidence data, our Injury Prevention Program developed education on scald burn prevention targeting expectant mothers and families with children ≤ 5 years.

Methods

A safety assessment was completed by caregivers and responses evaluated to customize the safety education. A tailored safety educational workshop was created based on burn registry data and pre assessment responses from caregivers. An immediate post workshop follow-up assessment was given to the caregivers about their educational workshop gauging their knowledge retention and comprehension. A one-month post assessment is then given to at least 25% of workshop attendees to assess knowledge retention.

Results

Caregiver pre and post comprehension assessments were evaluated to determine the program’s overall effectiveness. In 2022, the program pre-test assessment scores averaged 40%. Post-test assessment scores then improved to an average of 84%. P-Values were also calculated to determine that the injury prevention program was highly statistically significant with all correct assessment responses having a P-Value of < .0001. At one-month post course, caregivers are re-assessed for knowledge retention. Of those re-evaluated 94% of participants had retained critical knowledge and were noted to score ≥80% on one month post course evaluation.

Conclusions

It is well known that scald burns are the most common pediatric burn injury. From 2021-2022 there was a 10% decrease in patients presenting to our center with tap water scald injuries. This data suggests a targeted injury prevention program may help to increase caregiver knowledge and decrease common pediatric burn injuries.

Applicability of Research to Practice

Regular evaluation of prevention programs is critical in assessing for effectiveness. More research is needed to understand parental behavior pre and post course, along with knowledge retention to maximize efficiency of injury prevention programs.
742 Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community
Authors: Ross Erin E , Speiser Noah , Donohue Sean J , Gillenwater Justin , Yenikomshian Haig A
Published: April 2024

Introduction

Unhoused patients represent a unique and vulnerable population of burn survivors. Burn injuries in unhoused patients are more likely to be related to assault, drug use, and mental health issues compared to the general population. Here, we explore the more specific circumstances and activities contributing to burn admissions among unhoused patients to better inform injury prevention efforts.

Methods

After IRB approval, the burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019-2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics.

Results

There were 254 admissions to the burn unit for unhoused patients. Patients were mostly male (76.8%), Hispanic (49.6%), and middle aged (IQR 33-55 years). 58.1% of patients were positive for stimulants on admission. The most common burn etiologies were open flame (27.6%), burning clothing or bedding (17.7%), and accelerants (14.2%). Most burns were self-reported accidental (69.7%), 9.8% assault, and 7.1% self-inflicted (missing = 34). Among accidental injuries, 11.3% were related to cooking, 10.1% involved cooking or using methamphetamine, 9.6% involved smoking, 7.3% were due to bonfires, and 5.6% were caused by candles.

Conclusions

Most burn injuries among unhoused patients were accidental. Although methamphetamine use was directly related to only a small proportion of accidental injuries, more than half of unhoused patients were positive for stimulants upon admission. Most burn injuries among unhoused patients were preventable, with many accidental injuries related to cooking, smoking, and open flames for warmth or light.

Applicability of Research to Practice

Analysis of admission patterns and subjective history can reveal potential interventions for preventable causes of injury. Safe consumption sites, as well as outreach efforts to educate unhoused patients about situational awareness, accelerants, safe smoking practices, and safe cooking practices may be effective tools in reducing burn admissions in this vulnerable population.
752 Holding the Line: Decreasing CLABSI Rates in Burn Patients
Authors: Simpson Robertino , Dwars Brooke , Wellsandt Sara , Schneider Jolyn K , Slagel Matthew , Galet Colette , Wibbenmeyer Lucy
Published: April 2024

Introduction

Burn patients are at higher risk of hospital-associated infections (HAI) secondary to loss of the protective property of skin. Hospitals systematically track central line blood stream infections (CLABSI) with a goal of zero infections. We noted an uptick in our CLABSI rates from 2017 to 2019. A quality improvement project (QI) was implemented to improve CLABSI rates.

Methods

All burn patients 15 years and older admitted from 2017-2022 with a central line placed during their stay were included. The burn team instituted a multidisciplinary CLABSI intervention in three phases. The intervention began in 11/2019. It included education focused on occlusive dressings, protection from water during hydrotherapy, and daily discussion on the need for the central line. Prior to implementation, catheters were changed at the discretion of the team. Catheters were changed every 7 ± 2 days starting in 11/2019 (phase 1), every 7 days ± 1 day starting in 9/2020 (phase 2) and every 7 days in 3/2021 (phase 3). CLABSI rates were defined as number of infections per 1000 central line days. The pre-implementation period (1/2017 to 10/2019) served as the control. Demographics, burn injury, and central line data information were collected on patients who developed CLABSIs

Results

CLABSI rate was 3.6% during the control period. It went up to 7.5% and 6.7% after phase 1 and 2, respectively, and decreased to 1.3% after phase 3 with no CLABSIs in 2022. The median number of central line days were 8 [4-14] overall, 11 [8-14] pre-implementation, 7 [4-8] post-phase 1 and 2, and 7 after phase 3. Patients who developed CLABSI were mostly male (80%) with a median age of 45.5 y [19-78]; 40% presented with diabetes, 30% with hypertension, and 20% were smokers. Median %TBSA was 54.5% [11%-88%], and 20% had inhalation injury. The median length of stay was 104 [11-273] days. A week prior to CLABSI, their average blood glucose level was 203 ± 51.5mg/dl. Candida and Pseudomonas accounted for most of the infections (n= 4 (40%) for each). Four patients developed CLABSI in winter, 3 in summer, 2 in spring, and one in fall.

Conclusions

Increasing nurse education and strict 7-day central line replacement led to a decrease in the CLABSI rates in burn patients with zero infections in phase three. There was a spike in blood glucose levels the week prior to CLABSI documentation. The relationship between blood glucose control and infections requires more investigation

Applicability of Research to Practice

CLABSI rates can be reduced by nurse-led education and strict adherence to a 7-day central line replacement