bluuebunny/crossref_metadata_2025 huggingface dataset:
53 The Role of Body Mass Index in Hospitalized Burn Patients
Authors: Saquib Syed , Chestovich Paul , Flores Carmen , Carroll Joseph , Fraser Douglas , Tullington Jessica , Batra Kavita
Published: May 2023

Introduction

Body mass index (BMI) has been identified as an independent risk factor for morbidity and mortality in hospitalized patients. The objective of this study was to investigate what role BMI played in hospitalized burn patients.

Methods

Registry data for all burn patients over the age of 18 admitted to our ABA verified burn center between July 1, 2015 to December 31, 2020 was analyzed. Patients were categorized based on the World Health Organization’s definition of BMI. Age, gender, co-morbidities, race, ethnicity, total body surface area (TBSA) and mechanism of injury were included. Total length of stay, ICU length of stay, the need for a ventilator, and hospital disposition were also analyzed.

Categorical variables were compared using chi-square, and continuous using one-way ANOVA with post-hoc analysis. A multivariate logistic regression model was fit to generate adjusted odds ratios for the likelihood in-patient mortality with a p-value of < 0.05 was considered significant

Results

A total of 1106 patients were included for analysis. Mean age was 48.8 years. Mean BMI was 27.7. 785 (71%) were male. The most common burn mechanism was flame (551, 49.8 %). The following was the distribution based on BMI: underweight 50 (4.5%), normal weight 381 (34.4%), overweight 337 (30.5%), Class 1 obesity 198 (17.9%), Class 2 obesity 81 (7.3%), and Class 3 obesity 59 (5.3%).

All classes of obese patients were more likely to have hypertension (P < 0.001). Class 2 and 3 obese patients were more likely to have diabetes mellitus (P < 0.001). Underweight patients were more likely to have pre-existing cardiovascular disease (P< 0.001) and respiratory disease (P = 0.003).

Age (P < 0.001) and TBSA (P< 0.001) were the only independent variables that demonstrated a statistically significant higher likelihood of death. Being underweight conferred an odds ratio of 2.569 with respect to mortality but it did not rise to statistical significance. Obesity was not an independent risk factor for increased mortality. Underweight patients were more likely be discharged to a rehabilitation or skilled nursing facility and less likely to be sent home (P=0.002). There was no difference in TBSA, total length of stay, ICU or ventilator days amongst the six groups.

Conclusions

Having a low or high BMI does not increase the mortality rate of hospitalized burn patients. However, being underweight is a risk factor for a hospital disposition other than home.

Applicability of Research to Practice

Abnormal BMI alone does not confer an increased mortality risk in burn patients. More studies need to be performed to investigate other adverse events related to BMI.
54 Prophylactic Antibiotics are Unnecessary for Routine CO2 Laser Burn Scar Treatment
Authors: Kevin Records , Munnerlyn Brittany , Kahn Steven
Published: May 2023

Introduction

Many providers utilize prophylactic cephalexin prior to Co2 ablation laser for hypertrophic scarring. Many providers use this as standard of treatment despite a paucity of high-quality literature supporting the practice. The purpose of this study is to report a single-center experience in performing laser-assisted delivery of triamcinolone and destruction of burn scars without the use of antibiotics.

Methods

This was a retrospective descriptive study from a single center with a new laser scar program. The first 14 patients received cephalexin 500mg by mouth every 6 hours starting the day of the procedure for 5 days and valaciclovir 1000mg by mouth daily for 5 days for their first two procedures- as per manufacturer recommendations. After that, cephalexin was no longer utilized nor were any antibiotics given at the start time of procedure. Valacyclovir is given on a case-by-case basis for patients with a history of cold sores, known herpes simplex, or extensive facial procedures. Burn team staff members followed up with the patients within 48 -72 hours by phone call. Burn staff called patients after each laser treatment to assess for any adverse reactions. Adverse reactions include open areas, rashes, or blisters to laser site. The two groups were compared with a Fisher’s exact test for number of infections.

Results

Patients who received cephalexin accounted for the first 28 cases and none developed an infection. In 201 cases without antibiotics, only one patient developed cellulitis (0.5%), p=1. This patient was noncompliant with restrictions on hand hygiene and used a cheap lotion with parabens, dyes, and perfumes on post operative day 2. Another patient experienced a self-limiting dermatitis on their back of uncertain etiology. In 36 cases, valacyclovir was given. None of the patients in either group developed vesicular lesions consistent with HSV.

Conclusions

There were no significant differences in number of infections whether patients treated with or without prophylactic antibiotics before laser treatment of hypertrophic burn scars. The authors continue to treat patients without administering prophylactic antibiotics.

Applicability of Research to Practice

laser programs are common in burn centers
56 The Impact of Inhalation Injury Grade on Bacterial Isolates from Diagnostic Bronchoscopy with Bronchoalveolar Lavage
Authors: Coston Taylor , Stewart Barclay , Gaskins Devin , Arbabi Saman , West T Eoin , McClellan John , Bailey Austin
Published: May 2023

Introduction

Inhalation injury is associated with increased incidence of pneumonia. Bacteria are commonly isolated from bronchoalveolar lavage (BAL) within 12-48 hours of injury with unclear clinical significance. We aimed to determine if grade of inhalation injury is associated with different bacterial species isolated from initial BAL, and if higher inhalation injury grade is associated with increased risk of pneumonia.

Methods

Abbreviated injury scores (AIS) and clinical microbiology isolates from diagnostic bronchoscopy with BAL performed within 48 hours of injury among adults with inhalation injuries from 2009-2022 were extracted from medical records at an ABA-verified burn center. CDC PNU1 criteria was used to identify pneumonia >48 hours after admission. Modified Poisson regression with robust standard errors was used to assess the association of inhalation injury grade and subsequent pneumonia.

Results

Two hundred forty-six patients with inhalation injury who underwent diagnostic bronchoscopy for airway inspection and surveillance BAL within 48 hours of injury were included in this analysis. Fourteen (5.7%) were grade 0, 106 (43.1%) grade 1, 75 (30.5%) grade 2, 51 (20.7%) grade 3-4. The most common bacterial isolate was Streptococcus spp irrespective of AIS grade. Higher AIS grade was associated with increased incidence of pneumonia (IRR 1.3; 95% CI 1.09-1.61; p = 0.01) after adjustment for age, sex, and total body surface area of burn involvement.

Conclusions

Bacterial species isolated did not differ by inhalation injury grade. Higher inhalation injury grade was associated with increased risk of pneumonia.

Applicability of Research to Practice

Providers should be vigilant that patients with higher grade of inhalation injury are at increased risk of pneumonia. Further research is urgently needed to assess the clinical significance of organisms isolated on initial BAL and their role – if any – on the development of pneumonia.
70 Burn Injury is Not a Risk Factor for Long-term Opioid Use
Authors: Keeven David , Vacek Jonathan , Bozeman Matthew , Miller Keith , Nash Nicholas , Benns Matthew , Pera Samuel , Coleman Jamie , Risinger William , Franklin Glen
Published: May 2023

Introduction

The United States continues to suffer from a serious epidemic of opioid use. Exposure to opioids is a known risk factor for long-term use and dependence. This is of particular importance to burn care, as opioids are frequently essential to manage the pain associated with burn injuries. The purpose of this study was to characterize opioid use among burn patients after hospitalization and to identify any risk factors for long-term dependence.

Methods

All patients admitted to a burn center during a single year period (2/1/2020-2/1/21) were examined. Patients who died were excluded. A controlled substance reporting system was utilized to determine opioid use over a time period from 6 months prior to injury and up to 12 months post-hospital discharge. Reporting to this database is mandated by law and therefore includes all prescriptions regardless of prescriber, insurance, location, etc. Duration of opioid use was recorded for all patients in the study. Long-term use was defined as having an active opioid prescription at 12 months post-hospital discharge. Patient demographic information, burn injury characteristics, operative interventions, and hospital course were examined to determine risk factors for long-term opioid use following burn injury.

Results

A total of 185 patients were included in the study. Patients were predominantly male (76.2%) and had an average age of 47.5 years old. Patients had an average TBSA burn of 9.5% and a length of stay of 6.7 days. A total of 54.7% of patients received an opioid prescription at discharge. Only 17 patients (9.7%) had persistent opioid use at 1 year. The only independent risk factor identified for long term opioid use was pre-injury use (p< 0.001). Among the 17 patients still on opioids at 1 year, 16 had filled 3 or more opioid prescriptions in the 6 months prior to injury. The solitary patient without a pre-existing opioid history had multiple readmissions and delayed operative interventions after their initial hospital course.

Conclusions

A majority of burn patients received opioids for pain control following hospital discharge. However, the duration of therapy was generally short among opioid naïve patients. Burn injury was not associated with long term opioid use among patients in the study.

Applicability of Research to Practice

When used judiciously and with caution, opioids can be safely prescribed to burn patients without fear of long-term opioid dependence.
84 The Association between Family Relations and School Outcomes in School-Aged Children 5-12 years old
Authors: McGwin Madeleine , Patel Khushbu , Ni Pengsheng , Stoddard Frederick , Branski Ludwik , Warner Petra , Schneider Jeffrey , Kazis Lewis , Ryan Colleen , Palmieri Tina , Surette Kate
Published: May 2023

Introduction

School-aged children between the ages of 5 and 12 years face new environments and experiences as they transition through grade school. They are still developing and learning as they engage within their home and carry these experiences into their school environment. This study is an assessment of the association between family relations and school outcomes in children 5 to 12 years of age as measured by the field-tested SA-LIBRE5-12 (School-Aged Life Impact Burn Recovery Evaluation), a new parent-reported outcome measure.

Methods

Within the social and family functioning domain of the SA-LIBRE5-12, 10 family relations and 13 school items were scored on a scale from 0 (Never) to 4 (Always). Scores were re-coded so that higher scores denote better functioning. An exploratory factor analysis (EFA) was conducted to confirm model fit. A regression model assessed the relationship between the school and family factors, controlling for demographic and clinical characteristics (child sex, race, ethnicity, age at survey completion, burn size, burns to critical areas, and pain severity).

Results

A total of 356 parents completed these items from the SA-LIBRE5-12. EFA resulted in four sub domains of family engagement, family stress impact, school success, and school difficulties. A univariate analysis of the demographic characteristics showed that the child being female (p=0.008) and non-white (p=0.0216) had a better mean score in school success (3.33 vs. 3.19 + 0.78 (SD) and 3.38 vs. 3.21 + 0.75 (SD), respectively). In addition, children with a burn size < 1% had better school difficulties score (3.76 vs 3.61 + 0.38, p=0.0018). Regression analysis showed positive correlations between family engagement and school difficulties (r=0.26, p< .0001), family engagement and school success (r = 0.56, p< .0001), family stress impact and school success (r=0.21, p< .0001) and family stress impact and school difficulties (r=0.49, p< .0001).

Conclusions

This study indicates that a cohesive family relationship and home life may promote productive school outcomes in children between the ages of 5 and 12 based on parent reported outcomes.

Applicability of Research to Practice

This research will provide burn care providers, parents, and teachers with greater insight into the relationship between a child’s current family relations and their success in school. Results will guide caregivers in fostering a productive and healthy family environment.
89 Second-Degree versus Third-Degree Burn Differences in Length of Stay
Authors: Bandaru Vishal , Youssi Brandon , Morgan Ryan , Nguyen Kevin , Liu Xiyu , Chaudhury Tristin , Gani Zarif , Shaw Chip , Pang Alan , Griswold John
Published: May 2023

Introduction

Length of stay (LOS) is a crucial element to patient care plans, hospital profit, and a patient’s well-being. However, predicting LOS is difficult as burn injuries often have complications. The expectation for LOS in the burn ward is generally one day per percent total body surface area (TBSA) burned. This prediction approximates the average but rarely represents true patient LOS. Healing times for second and third-degree burns differ, yet most studies only evaluate TBSA rather than 2nd and 3rd degree burns separately. We hypothesized that third-degree burns would have a longer LOS than same sized second-degree burns.

Methods

We obtained a list of all patients diagnosed with Second/Third-degree and verified the inclusion of patients meeting the study criteria from July 01, 2011, to July 01, 2021. Afterward, data was manually extracted from electronic health records and separated from patients with inhalation injury. We placed the aggregate findings in a 3D scatter plot to develop a predictive LOS formula.

Results

The initial data set (n=678) decreased due to missing burn documentation and exclusion of the inhalation injury group yielding the final data set (n=388). For every one percent second-degree burn increase, the LOS (in days) increases by 0.587 + 0.057 (p= 3.07E-22). For every third-degree burn percent increase, LOS increases by 1.328 + 0.086 (p=1.4E-42). The intercept for the 3D scatter plot was set to 0 as a patient without burns or inhalation injury should have a LOS of 0. The r-squared value is 0.58 which shows a medium level of correlation. Our current equation – LOS = 0.587(2nd degree-burn) +1.328(3rd degree-burn).

Conclusions

The one day per percent TBSA rule does not accurately predict LOS. Third-degree burn percentage may double the length of stay when compared to second-degree burns. More closely following 2nd v. 3rd degree burn and other comorbidities will give patients a more accurate estimate of their LOS.

Applicability of Research to Practice

Insurance, physicians, and patients are all affected by LOS. Insurance companies require accurate depictions of LOS to ensure sufficient funding for their patients’ hospital stay. Physicians use LOS to assess course of healing and if other problems are hindering recovery. Furthermore, hospital stay changes a patient’s daily life, work, education, and family. Better predictions for LOS may allow patients to fully grasp what to expect with their recovery.
107 Meta-Analysis of Clinical and Preclinical Microbiome Data from Studies of Burn Injury
Authors: Horseman Timothy , Frank Andrew , Shupp Jeffrey , Burmeister David
Published: May 2023

Introduction

Following burn injury, the ecology of the host microbiota is disrupted to varying degrees and may leave the patient susceptible to opportunistic pathogens or disrupt the endogenous flora needed to potentiate recovery and homeostasis. Studies examining the microbiome post-burn injury usually have a limited sample size which, coupled with experimental and analysis variation, impacts overall interpretation of data.

Methods

We performed a meta-analysis of publicly available sequencing data from burn patients and burn animals to determine if there were consistent alterations in the microbiome across various anatomical sites and species. A MEDLINE search was used to identify applicable publications. Corresponding authors of papers without available data were contacted, and data were used if a response occurred. Ten human and animal 16S rRNA sequencing studies spanning respiratory, urinary, cutaneous, and gastrointestinal microbiomes were included. Raw sequencing data were systematically analyzed with taxonomic classification and α and β diversity metrics generated.

Results

Alpha diversity was consistently lower post-burn, except for human skin (Figure 1) due to perianal skin sampling of burn patients resulting in higher species richness than controls. Weighted UniFrac distance analysis showed that rodent specimens clustered less closely to humans than pig samples (P < 0.0001) for both rectal and skin samples. Host species (R2 = 0.21, P = 0.001), and institute (R2 = 0.35, P = 0.001) had a significant impact on the β diversity. In rectal samples, bacterial composition in pig and human burn samples included Bacteroidetes, Firmicutes, and Proteobacteria, while rodent samples were dominated by over 90% Firmicutes. Burns induced an increase of Proteobacteria and a decrease in Bacteroidetes and Firmicutes in pig rectal samples. Proteobacteria and Firmicutes increased on burned skin in each host species. Longitudinal studies revealed a decrease in α diversity upon burn injury with β diversity and taxa shifts.

Conclusions

Overall, our results suggest that host species and the sequencing site strongly influence microbiome structure. Burn-induced alterations in microbiome diversity and taxa exist across hosts, with certain metrics more influenced by host.

Applicability of Research to Practice

Coordinated, multi-center studies, both clinical and pre-clinical, are needed to truly realize the diagnostic and therapeutic potential of the microbiome for improving outcomes post-burn.
108 Effects of Prior Hyperthyroidism Diagnosis on Burn Patient Outcomes
Authors: Soudah Chris , Karam Kathleen , Amador Dalton , Obias Isabel , Arceneaux Amy , Wolf Steven , Song Juquan , El Ayadi Amina , Golovko Georgiy
Published: May 2023

Introduction

The metabolic response to severe burns is described by an initial hypometabolic ‘ebb’ phase and followed by a hypermetabolic ‘flow’ phase. The hypermetabolic phase is mediated by hormonal and cellular dysregulation with elevated catecholamine levels. The role of thyroid hormone, however, is not described well. This study investigates relative risks of various outcomes in those with a previous diagnosis of hyperthyroidism following severe burn compared to those without.

Methods

This study obtained data from the TriNetX Research Network, a national database of de-identified electronic medical data from a secure network. The population was stratified to compare patients with and without a prior diagnosis of hyperthyroidism who sustained burns. Outcomes were measured within three years of injury in order to assess long-term effects occurring alongside the hypermetabolic phase. Outcomes observed for both groups included systemic inflammation and infection, sepsis, mortality, and infections of the skin and subcutaneous tissue.

Results

This study identified 5,250 patients with a prior diagnosis of hyperthyroidism who sustained burn injuries and 648,336 patients without hyperthyroidism prior to matching for demographics and diagnoses. Propensity score matching then yielded 5,077 patients with and without a prior diagnosis of hyperthyroidism. Both cohorts were balanced using propensity score matching for age, sex, race, ethnicity, and TBSA burned.

After assessing the outcomes for a three-year span since burn injury, patients with a prior diagnosis of hyperthyroidism had a higher risk of systemic inflammation and infection (risk ratio [RR], 1.599, p < 0.0003), sepsis ([RR], 1.572, p < 0.0001), mortality ([RR], 1.488, p < 0.0001), and developing infections of the skin and subcutaneous tissue ([RR], 1.332, p < 0.0001) compared to patients without prior diagnosis history.

Conclusions

Burned patients with a prior history of hyperthyroidism have increased risk of systemic inflammation and infection, sepsis, mortality, and infections of the skin and subcutaneous tissue. Thus, history of this condition or concomitant diagnosis with the injury is warranted.

Applicability of Research to Practice

This study encourages further insight into the relationship between the metabolic effects of burn injuries and concurrent metabolic conditions to modify patient treatment plans and customize practices.
119 Exercise in the ICU and its Effects on Physical and Mental Health in Pediatric Burn
Authors: Rego Andrea , Parry Ingrid , Sen Soman , Spratt Heidi , Lee Jong , Herndon David , Wolf Steven , Branski Ludwik , Suman-Vejas Oscar
Published: May 2023

Introduction

Suffering a severe burn is an event that can have lifelong physical and mental ramifications. Exercise after discharge from the hospital, has been shown to improve quality of life with better physical and mental status in children with severe burns. However, the effect of exercise, implemented in the acute care setting, on quality of life in the specific population of adolescent patients with burns needs more research. The purpose of this study was to determine the effects of aerobic exercising in the burn intensive care unit (BICU) on patient self-reported physical and mental health outcomes in severely burned children. We hypothesized that aerobic exercise would improve self-reported physical and mental outcomes.

Methods

This was a multi-center, prospective, randomized controlled trial. 48 children between the ages of seven and seventeen with ≥ 30% total body surface area (TBSA) burn were randomized in a 1:2 study design to standard of care (SOC) or standard of care plus receiving additional exercise with a cycle ergometer (SOC+Ex). Self-reported physical and mental health outcomes were obtained via surveys at admission and at discharge from the BICU.

Results

Pain, weakness, and tiredness scores were significantly decreased from admission to the discharge time point in both groups (p< 0.05). Linear regression modeling revealed that there were no differences in pain, weakness, and tiredness levels due to treatment at any timepoint between groups. When controlling for age, gender, length of stay, number of exercise sessions, and %TBSA, time point makes a difference in pain, weakness, and tiredness levels (p < 0.0001). Sleep, sadness and misery scores were significantly decreased from admission to the discharge time point in both groups (p< 0.05). When controlling for age, gender, length of stay, number of exercise sessions, and %TBSA, time made a difference in sleep, sadness and miserable levels (p < 0.0001). There was a significant interaction (p = 0.0285) between time and treatment for the misery score.

Conclusions

The findings of this study suggest that aerobic exercise in the BICU does not reduce self-reported physical and mental outcomes for severely burned children. Our recommendation is for all pediatric patients in the BICU to continue with the SOC and consult with their physician over the benefits of additional aerobic exercise. This study suggests that perhaps there is potential for increasing the amount of exercise that can be administered to pediatric burn survivors beyond SOC as we did not find aerobic exercise to result in any adverse events or to be of any harm to the patients if it is performed properly and under supervision.

Applicability of Research to Practice

Additional aerobic exercise in the acute care setting is beneficial for severely burned children in terms of self-reported physical and mental health outcomes.
122 Assessment of Frailty on Discharge Disposition and Long Term Functional Outcomes Following Burn Injury
Authors: Dellheim Vanessa , Cuerdon Elizabeth
Published: May 2023

Introduction

There is an increasing aging population. The goal of our study was to look at how frailty impacts discharge from acute hospitalization as well as long term function at 1 year following their burn.

Methods

After IRB approval, all patients over age 50 who were admitted September 2019-2021 were considered for enrollment. Exclusion criteria included, a non-survival burn and underlying co-morbidities that would affect long term outcomes independent of a burn. Data collected included: age, gender, TBSA, surgical intervention, Canadian Health and Aging Frailty Score (CFS), discharge disposition, Barthel index, and a functional questionnaire. Follow-up phone calls were completed 6 month-1.5 post.

Results

Follow up data obtained via phone call for 30 subjects; the average age was 71 (10.8) years old with 8.6 % (16.5) TBSA, with a CFS average of 2.89 (1.5). 20 (40%) were lost to follow-up. 90 % of patients returned to their baseline and prior living environment. Of the patients who did not return to their prior functional status all had impaired Bartel index prior to their burn injury as well as higher CFS >5, as well as longer LOS (26 day), and were older. Discharge was assessed based on enrollment sample size (n=50), average age 71 yo (10.4), burn size of 7.4% TBSA (13.2), CFS of 3.4 (1.64), and length of stay 20 (25.09) days. 13 patients (26%) were discharge to an IRF, 10 patients (20%) to a SNF, and 27 patients (54%) to home. Patients who discharge home had Lower CFS 2.2, lower age, 69 y.o., and lower TBSA 5.6% compared to patients who were discharged to SNF and IRF. Patients who were discharge to an IRF were older (77yo), had larger TBSA (13.5) and a lower CFS (3) compared to patients who were discharged to a SNF. 80% of patients who discharge to a IRF returned to their prior level of function compared to 40 % who discharged to a SNF

Conclusions

This work helps structure discussions with the geriatric population about expectations to return to their prior level of function. Frailty appears to be associated with outcomes and discharge as lower CFS, older age and larger TBSA were more likely to discharge to IRF and recover to their baseline compared to patients with higher frailty score who were more likely to discharge to a SNF despite younger age and smaller TBSA. This shows that even relatively small burns (8% TBSA) in the elderly can affect ability to care for oneself and ability to go into the community 1 year after their injury.

Applicability of Research to Practice

This can be used by physicians and therapists to aide in discussions about discharge from the hospital as well as long term outcomes expected following their burn injury.
508 Retrospective Review of Early Pulmonary Mechanics After Inhalation Injury
Authors: Lam Eric , Frerk Rita , Chin Theresa , Burton Kimberly , Joe Victor , Jeng James
Published: May 2023

Introduction

Management of inhalation injury is largely supportive and consists primarily of mechanical ventilation, bronchodilators, muscarinic receptor antagonists, and inhaled mucolytics and anticoagulants. The purpose of this study is to examine the early changes in pulmonary mechanics after inhalation injury and see if the use of NT affects lung function.

Methods

Retrospective study was done on Inhalation injury patients over a 12 years period from 01/2009 to 01/2021. Patients’ data collected from their medical records, included patient demographics and outcomes, percentage Total Body Surface Area (TBSA), Carboxyhemoglobin level upon admission, Respiratory Treatments (bronchodilator, Mucolytic and Heparin), Tobramycin treatment, Oxygen requirement, Lung compliance (peak airway pressure & Mean airway Pressure), Mode of Ventilation, total Ventilator Day, and number of Hospital Days. Patients with inhalation injury from 2009-2019 were retrospectively reviewed for treatment of inhalation injury. Univariate analysis and multiple logistic regression were performed using Excel and Stata.

Results

Of 90 patients with inhalation injury, median age was 53.5 (IQR:31-65) with 30% (n=28) women and median TBSA of 15%(IQR:2-38%). The median length of stay was 21 days (IQR:6-47). Median ventilator days was (8.5, IQR:3-21) and median ICU days was 12 (IQR:3-28). After adjusting for grade of inhalation injury, patients who did not receive NT were 2.7 times as likely to get pneumonia compared to patients who received NT (p=0.037). Initial median carboxyhemoglobin was 3.9 (IQR: 2-9.1). Overall mortality was 21%, but the incidence of death increased with grade of injury

The Median Mean Airway Pressures were Day 1: 9.5mmHg, Day 2: 11mmHg, Day 3: 13mmHg, Day 4: 12mmHg

The median peak pressures were Day 1; 20mmHg, Day 2: 21mmHg; Day 3: 22.5mmHg; Day 4: 21mmHg

Conclusions

Patients with inhalation injury are susceptible to Acute Respiratory Distress Syndrome, indicated by a decrease in lung compliance and increase in the patient’s oxygenation support. The lung compliance of these patients being to change resulting in an increase in their Peak Airway Pressure and Mean Airway Pressure within the first 72 hours. Moderate hypoxemia is present in these patients with the progress of the smoke inhalation injury. The usage of NT did not have a direct benefit to the pulmonary mechanics for inhalation injury when used as a prophylactic strategy. Additional research and clinical trials are needed to better understand the effect of inhalation injury on pulmonary mechanics.

Applicability of Research to Practice

Analysis of pulmonary mechanics in patients with inhalation injury can allow clinicians to better tailor ventilator settings to improve clinical outcomes.
520 Use of Phenobarbital for Alcohol Withdrawal in Small Burn Patients: Evaluation of a Pilot Protocol
Authors: Drabick Zachary , Cochran Amalia , Driscoll Ian
Published: May 2023

Introduction

Phenobarbital is a long-acting barbiturate that has primarily been used an antiepileptic in clinical practice. However its use as a sedative has seen a resurgence recently especially for the prevention and/or treatment of alcohol withdrawal. It has several characteristics that make it appealing for this indication, including its long half-life and its distinct binding to GABAA receptors that, unlike benzodiazepines, does not depend on endogenous GABA to produce its effects. Several recent studies have evaluated its use for the treatment of alcohol withdrawal both inside and outside of the ICU setting, however reports of its use in patients with burn injury are sparse. A pilot treatment protocol utilizing phenobarbital for patients with less than 20% TBSA burns at high risk of alcohol withdrawal was formulated and put into practice at our center in January of 2022. We sought to evaluate the safety and efficacy of this protocol for quality improvement.

Methods

This was a retrospective chart review of patients admitted from January to August 2022 with less than 20% TBSA burns who received treatment with phenobarbital for alcohol withdrawal at a major burn center in North Central Florida. There were no exclusion criteria. This project was registered as a Quality Improvement Project with the institution.

Results

Ten patients were included in the evaluation. Median age was 63 yo, 90% were male, and 70% were Caucasian. Median % TBSA burn was 6.5% (range 0.5-12%) and median length of stay was 16 days (range 9-50 days). Most patients were injured by Fire/Flame (80%). Most patients had a history of binge drinking (70%), and most reported drinking at least 3-4 alcoholic drinks 4 or more times per week (70%). Of those that had a detectable blood alcohol concentration on admission, the median was 163 mg/dL (range 44-325 mcg/dL). Over half of the patients (60%) received an IV bolus (either 5 or 10 mg/kg based on ideal body weight) of phenobarbital followed by an oral taper, with the remaining 40% having received an oral taper without a bolus dose. Median RASS prior to initiation of the protocol was +1, and the majority of patients remained RASS +1 or less throughout the duration of the protocol (70%). No rescue benzodiazepines were needed, no seizures were identified, and no intubations occurred while patients were on the protocol.

Conclusions

The phenobarbital protocol was well tolerated and controlled agitation in the majority of the patients who received it. No obvious safety concerns were identified during this review. Although this was a small sample size, these results are encouraging and support continued use of phenobarbital in preventing and controlling symptoms of alcohol withdrawal in patients with less than 20% TBSA burns.

Applicability of Research to Practice

Phenobarbital may be a safe and effective benzodiazepine-free option for preventing and/or treating alcohol withdrawal in small burn patients.
542 Identifying Psychosocial Factors Impacting Burn Survivors
Authors: Kilmer Debra , Cottrill Paula , Rose Amanda
Published: May 2023

Introduction

Burn survivors often suffer from profound psychosocial stress. Following a traumatic burn, new stressors and mental health symptoms can arise, and previously existing factors can be amplified. Alleviation of these stressors can facilitate healing, treatment compliance, and favorable outcomes.

We sought to better identify psychosocial factors that impact the lives of adult burn survivors. Our primary aim was to develop a psychosocial screening battery and brief screener to identify stressors common among such patients at our hospital-based outpatient burn center.

Methods

A survey was administered to adult burn survivors at a monthly support group. Participants were instructed to endorse items from a list of 39 possible stressors and symptoms that impacted them after their burn injury. The most frequently endorsed items were considered for inclusion in the screening tool.

Results

A total of 17 surveys were completed, nine (53%) of whom were men and eight (47%) of whom were women. Ages ranged from 18 to 79 years. The earliest burn injury occurred in 1990, and the most recent occurred in 2022. There were 17 survey items endorsed by 29% or more of the respondents (Table 1).

Conclusions

Numerous symptoms and stressors endorsed by participants align with mental health conditions like acute stress disorder, post-traumatic stress disorder (PTSD), anxiety, and depression. We decided to implement the Primary Care PTSD Screen and the Generalized Anxiety Disorder 7-Item within our outpatient clinic in addition to the depression screen already in use. Items not addressed by questions on these mental health screens were included in our brief burn survivor stress screening measure.

Applicability of Research to Practice

Implementation of this screening battery will enable identification of psychosocial factors impacting adult burn patients previously hospitalized as a result of their injuries. This will allow us to address patient concerns, offer recommendations for support and resources, and guide treatment planning to improve compliance and outcomes. In the future, this information will facilitate the development of additional programs to assist burn survivors.
556 Minimally Invasive Contracture Release Improves Function in Patients with Burn Contractures
Authors: Blome-Eberwein Sigrid , Schwartz Adam
Published: May 2023

Introduction

Scar contracture bands after burns are a persistent problem that cause discomfort and physical and aesthetic limitation. Standard treatment for contracture bands in burn scars involves physical therapy, stretching, splinting and laser treatment, as well as surgical releases with local/distant flaps and grafting. A minimally invasive transcutaneous approach for the release of scar bands was initiated in our institution 6 years ago. The method was derived from techniques pioneered by Jose Daher and Raul Gonzalez to interrupt platysma bands in neck rejuvenation.

With IRB approval we evaluated this new approach regarding long term outcomes.

Methods

A retrospective review of 45 patient charts was conducted for those with burn scars who received subcutaneous contracture release from May 1, 2016, through March 31, 2022. The procedure involves introducing a braided suture to loop the contracture band and moving it in a sawing motion until it cuts through the band in multiple sites along the contracture. Demographic data, total burn surface area (TBSA), location, amount of contracture release increments, scar size, and duration of treatment was recorded. Concurrent scar treatments and whether performed under anesthesia was also noted. In follow up visits 3-12 months post release patients were surveyed on satisfaction with the treatment and whether they noticed increased mobility after the procedure. The Vancouver Scar Scale was administered pre- and post-treatment. Patient range of motion was measured pre-and post treatment to assess for change in mobility at treated sites.

Results

Male to female ratio was 51%:49%, average age was 38.8(6 to 68), 58% were white . TBSA ranged from 0.5% to 85%, with an average of 36.1 ± 22.3. The release was applied to 11 different sites spanning the entire body, 39% on the neck . The procedure involved an average of 19.0 ± 8.8 incremental releases, and the average scar size for treatment was 174.4 ± 140.0 cm2. 93% of the procedures involved laser treatment, 76% were done under anesthesia because of the laser, and 84% involved a site that was skin grafted. Only one of the 45 patients reported bleeding post-discharge, and none had an infection at a puncture site. Out of 20 responses, 13 patients reported being “satisfied” and 3 “very satisfied”; none reported being “dissatisfied”. 19 noted an increase in mobility at the contracture site and one did not. On average, patient range of motion increased by 13.6 degrees.

Conclusions

The minimally invasive contracture release described is a versatile, safe, and well-tolerated procedure that can help patients regain form and function after a burn injury. It was successfully applied to a large range of age groups, burn sizes, and scar contracture sites. Encouraging data regarding patient recovery and gain in mobility supports the use of this contracture release technique. Further studies should include prospective multicenter trials.

Applicability of Research to Practice

Immediate
557 Adverse Events Associated with Fractional CO2 Laser Therapy for Hypertrophic Burn Scars
Authors: Won Paul , Cooper Michael , Gillenwater Justin , Yenikomshian Haig
Published: May 2023

Introduction

Laser therapy is a growing intervention in hypertrophic scar treatment. This therapy is associated with minimal risks, however these are poorly studied in the burn population. Anecdotal reports of adverse effects such as pain and dyspigmentation exist. As patients, stakeholders, and insurance companies decide on reimbursement for this therapy, a better studied safety profile is necessary. This study is a retrospective review of all laser therapies for adverse events.

Methods

A retrospective review of patients who underwent laser therapy at two centers between May 2019 and June 2022. Patient demographics, details of laser treatments, adverse events, and scar characteristics before and after laser therapy were collected.

Results

A total of 167 patients underwent 533 laser treatments. There were 75 (44.9%) males and 92 (55.1%) females, with an average age of 26 (SD: 20.6) years. In total, 94 patients (56.3%) were Hispanic or Latino, 24 (14.4%) Caucasian, and 49 (29.3%) identified as "Other". All patients were treated for hypertrophic scars after burn injuries. For all patients, average number of laser treatments was 3 (SD: 2.2), with a range of 1 to 17 sessions. There were 9 (1.68%) instances of adverse events out of the total laser encounters. There were 5 (0.93%) reports of increased pain, 1 (0.18%) of an open wound, 2 (0.37%) of increased scar discoloration, and 1 (0.18%) of decreased scar pliability. Of the 5 (2.98%) total patients who encountered adverse events, 3 continued with laser therapy. There was no correlation between number of laser treatments and adverse events.

Conclusions

Patients undergoing laser treatment for burn scar management rarely face adverse events, of which the most common were increased scar pain and dyspigmentation. Even so, most patients experiencing adverse events chose to continue treatments. Laser therapy remains effective in burn scar treatment with minimal risks regarding safety profile.

Applicability of Research to Practice

This review will assist patients in making more informed decisions when considering laser therapy for burn scar management.
558 Wound Care Program Development to Advance Physical Therapy Practice in a Specialized Burn Unit
Authors: Gerlich Nicole , Tepe Melinda
Published: May 2023

Introduction

There is a nation-wide shortage of nurses which is true at our institution as well. As a result, there is a lack of consistent, qualified staff to perform wound care in our burn center. Wound care is within a physical therapist’s (PT) scope of practice and we felt this was an area for opportunity and expansion for PT practice at our institution as we had not previously been involved in wound care services for any patient population.

Methods

We posted on the ABA PT/OT SIG page asking other burn centers about PT involvement in daily wound care. Respondents then participated in an online question/answer session. Based on this information, additional education resources, and our own institution’s practice model for nursing, we developed a PT checklist for demonstrating competency with theory and practice for burn wound care. The 2 primary burn PTs completed a 4 week training under the direction of the nurse clinical coordinators and advanced practice providers (APPs) and were deemed competent. The attending MDs have signed off on our process. We have now developed a training program to ensure more PTs are competent with wound care for the burn patient.

Results

Of 186 members of the OT/PT SIG who had access to the original post, we received only 8 responses. Five of eight had PTs partially involved in wound care in the inpatient setting with burn patients. PTs are the primary wound care providers in 2 of 8 responding burn centers. In the remainder, PTs were primarily involved in wound care only in the outpatient setting. Four centers participated in the online video question and answer sessions. Despite all of them following ABA guidelines, there was no standardization of developing a wound care program. Our program includes 1:1 orientation to the burn unit for 3-4 weeks, direct supervision of wound care and dressing changes by the primary burn PTs, completion of knowledge-based quiz, and demonstration of skills checklist.

Conclusions

It was feasible to create a new wound care program including PTs in a burn center. We found variation in practice due to regional preferences, physician preferences, availability of different dressings, and staff training. We feel confident in our competency process as it includes both a written knowledge assessment as well as requiring demonstration of techniques. Developing this program has increased the trust between the PTs, physicians, and APPs thereby allowing us to advance our PT practice. We can now perform high quality wound care and complete more aggressive functional mobility without fear of disrupting dressings. Based on actual visualization of the wounds, we can provide more thorough patient education and perform more specific range of motion stretching.

Applicability of Research to Practice

Utilizing PTs knowledge of all soft tissue healing may be of benefit. We encourage other PT departments to advocate to participate in wound care of the burn patient.
572 Trace Element Supplementation in Burn Patients: A Quality Improvement Project
Authors: Kurjatko Alexander , Weigel Isaac , Galet Colette , Suarez Justin , Cavanaugh Kelly , Wibbenmeyer Lucy
Published: May 2023

Introduction

Patients with major burns suffer deficiencies in trace elements (TE), which can affect their clinical course. We established a quality improvement (QI) project to supplement TE (multivitamins with TE, vitamin C, and zinc). Herein, we assessed the impact of QI implementation on outcomes.

Methods

We queried the burn registry for burn patients admitted from 8/1/2019-5/31/2022 who weighed > 40 Kg and stayed >14 days. Demographics; comorbidities; injury, and hospital course information were collected. Post-implementation, TE levels (zinc, copper, and selenium) as well as C reactive protein levels were measured at 2 weeks. Analyses were performed to assess differences between the pre- and post-groups and post-group patients with major burns (≥20%TBSA) and smaller burns (< 20%TBSA). P < 0.05 was considered significant.

Results

We included 111 patients, 45 in the pre- and 66 in the post-group. Overall, the population was male (79.3%) with a median age of 53 years. Age and sex were not significantly different between the pre- and post-groups. The post-group had higher TBSA (p = 0.005). They were more likely to smoke (p =0.018) and have an alcohol use disorder (p = 0.035). There was no significant difference observed in mortality, complications, or LOS/TBSA (2.1 days [1.2-5.5] vs. 1.7 days [1.2-3.1], p = 0.300) between the groups. Focusing on the post-group, 37 presented with smaller burns and 29 with major burns. Patients with major burns were younger (p =0.003) and healthier than patients with smaller burns. At 14 days, 81.5% and 33.3% of patients with major burns were deficient in zinc and copper, respectively. Zinc (47.6 µg/dL vs.79.2 µg/dL p < 0.001), copper (80.2 µg/dL vs.121.9 µg/dL p < 0.001), and selenium (98.7 µg/L vs.135.5 µg/L, p = 0.003) levels were significantly lower in patients with major burns. C-reactive protein levels were high in both groups but significantly higher in patients with major burns (p < 0.001). Patients with major burns were more likely to have infectious complications (p = 0.004); however their LOS/TBSA was significantly lower than that of patients with smaller burns (1.21 days vs. 2.43 days, p < 0.001). Zinc levels of patients with major burns significantly increased overtime from 47.6 µg/dL at 14 days post-admission to 73.5 µg/dL at 53 ± 16 days (p < 0.01).

Conclusions

Our data show that TE supplementation was efficient in bringing zinc levels close to the normal range in patients with burns ≥20%TBSA who stayed up to 50 days in hospital. Controlled for TBSA burned, supplementation of TE significantly decreased LOS of patients with major burns compared to patients with smaller burns.

Applicability of Research to Practice

Further studies are needed to evaluate the correlation between supplementation of TE and improvement of patient LOS.