bluuebunny/crossref_metadata_2025 huggingface dataset:
61 Real-time Burn Outpatient Virtual Visits in the Home During the Era of COVID-19
Authors: Head William T , Garcia Denise I , Kahn Steven , Lesher Aaron
Published: April 2021

Introduction

The majority of burn injured patients travel long distances to receive burn care from regional burn centers, creating a burden on families and impairing outcomes. Recent federal policies in response to the COVID-19 pandemic have relaxed some of the barriers to virtual visits in the non-health care setting. We sought to review the experience of a comprehensive burn program in managing burn patients with a virtual platform.

Methods

A clinical quality database was maintained to evaluate virtual videoconference and in-person clinic visits for a comprehensive adult and pediatric burn program during the COVID-19 pandemic (March 2020 to August 2020). Virtual visits utilized a telemedicine platform that employs real-time audio and video communication. Demographic, burn severity, and visit quality data were recorded. Zip code data was also collected and then used to calculate the following estimated savings for the patient and their family: total miles, travel hours, driving costs, and wages.

Results

A total of 145 patients were included in this study with 96 (66.2%) male and 49 (33.7%) female. 91 (62.8%) were pediatric patients with a mean age of 6.2 ± 0.5 years and 54 (37.2%) were adult patients with a mean age of 40.4 ± 2.5 years. There were 320 total burn outpatient follow-up visits with 199 pediatric visits (40 virtual and 159 in-person) and 121 adult visits (24 virtual and 97 in-person). The majority of patients (73.1%) were treated as in-person visits while 6.9% had purely virtual visits, and 20.0% of patients had both virtual and in-person visits. The following savings were associated with virtual visits: 8562.6 total miles (average 133.8 ± 42.4), $6789.29 total driving cost (average $106.08 ± 33.61), 161.5 total travel hours (average 2.5 ± 0.7), and $4758.42 total wages lost to travel (average $74.35 ± 21.43). Technical issues were only reported in 14% of total visits (2.5% of pediatric virtual visits and 33.3% of adult virtual visits).

Conclusions

Outpatient virtual visits for burn care are a new frontier, driven by improvements in technology and reduced barriers to reimbursement. This study demonstrates that virtual visits are associated with major financial and temporal benefits for patients and their families. Technical issues remain an important barrier, particularly in the adult population. A clear understanding of this and other barriers may improve implementation of this new healthcare delivery paradigm.
66 Prescribing Patterns of Opioids and Adjunctive Analgesics for Patients with Burn Injuries
Authors: Yeung Celine , Kiss Alex , Rehou Sarah , Shahrohki Shahriar
Published: April 2021

Introduction

Large quantities of analgesics are prescribed to control pain among patients with burn injuries and may lead to chronic use and dependency. This study aimed to determine whether patients are overprescribed analgesics at discharge and to identify factors that influence prescribing patterns.

Methods

A retrospective review of patient charts (n = 199) between July 1, 2015 - 2018 were reviewed from a registry at a single burn center. Opioid, neuropathic pain agent (NPAs), acetaminophen, and ibuprofen quantities given before and at discharge were compared. Linear mixed regression models were used to identify factors that increased the amount of analgesics prescribed among burn care providers.

Results

On average, patients were prescribed significantly more analgesics at discharge compared to what was consumed pre-discharge (p < 0.0001). Specifically, on average, providers did not overprescribe the daily dose of analgesics, but overprescribed the duration of pain medications required. For every increase in percent TBSA, 14 MEQ more opioids, 203 mg more NPAs, 843 mg more acetaminophen, and 126 mg more ibuprofen were prescribed (p < 0.05). Surgery was a predictor for higher opioid and NPA prescriptions (p = 0.03), while length of stay was associated with fewer NPAs prescribed (p = 0.04). Fewer ibuprofen were given to patients with a history of substance misuse (p = 0.01).

Conclusions

The quantity of analgesics prescribed at discharge varied widely and often prescribed for long durations of time. Standardized prescribing guidelines should be developed to optimize how analgesics are prescribed at discharge.
71 Treatment for Chronic-Burn Induced Neuropathy: A Systematic Review and Meta-Analysis
Authors: Bekheet Faraah N , El Eter Leen , Klifto Kevin M , Abeles Elisabeth B , Church Taylor R , Mafla Laura M , Hultman Charles S
Published: April 2021

Introduction

Effective management of chronic burn-induced neuropathy manifesting as pain and/or pruritus presents an ongoing challenge for clinicians. Standards of care are based on limited evidence and vary widely, especially for non-surgical neuropathies that are not associated with a specific nerve distribution. This study aims to quantify and qualify evidence for non-surgical treatments of chronic burn-induced neuropathy to define their efficacy.

Methods

PRISMA and Cochrane guidelines were implemented for review structure. PubMed, Science Direct, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies. Inclusion criteria were patients age 18 years and older, with neuropathy lasting >6 months following burn injury. Studies for inclusion were comparative intervention studies for treatments of chronic burn-induced neuropathies. Mean differences (MD) between interventions eligible for meta-analysis were analyzed for neuropathy outcomes.

Results

Seventeen randomized controlled trials (RCTs) were identified for inclusion with a mean post-burn follow-up of 20.8±39.3 months. Nine studies reported pain and sixteen reported pruritus using patient reported visual analogue scales for 601 and 975 patients, respectively. Pain interventions included transcranial direct current stimulation (tDCS), extracorporeal shockwave therapy (EWST), massage therapy, carbon dioxide (CO2) laser, silicone gel, and pressure therapy. Pruritus interventions included tDCS, ESWT, massage, herbal cream, doxepin cream, enzymatic moisturizer, CO2 laser, silicone gel, and pressure therapy. CO2 laser showed no improvement over standard care for the treatment of pain or pruritus associated with hypertrophic scarring (pain: MD 0.26, 95%CI -0.04, 0.57; p=0.09; pruritus: MD -0.07, 95%CI -0.44, 0.30; p=0.72). ESWT showed no statistically significant improvement over standard care for the treatment of pruritus (MD -2.69, 95%CI -5.42, 0.04; p=0.05). Massage therapy was associated with significantly greater improvements in pruritus than standard care (MD -1.64, 95%CI -2.10, -1.09; p< 0.00001). Doxepin cream was not associated with greater improvements in pruritus than placebo or antihistamines (MD -0.84, 95%CI -3.61, 1.94; p=0.56).

Conclusions

Creative efforts have revealed massage therapy as a potential non-surgical intervention for treating chronic burn-induced neuropathy. Additional RCTs with innovative non-surgical interventions will provide further insights for this challenging condition.
86 Impact of Community-Level Socioeconomic Disparities on Quality of Life After Burn Injury: A Burn Model Systems Database Study
Authors: Mason Stephanie A , Gause Emma L , Archer Helena , Sibbett Stephen H , Holavanahalli Radha K , Schneider Jeffrey C , Gibran Nicole S , Kazis Lewis E , Stewart Barclay T
Published: April 2021

Introduction

Individual- and community-level socioeconomic disparities impact overall health and injury incidence, severity, and outcomes. However, the impact of community-level socioeconomic disparities on recovery after burn injury is unknown. We aimed to characterize the association between community-level socioeconomic disparities and health-related quality of life (HRQL) after burn injury. These findings might inform rehabilitation service delivery and policy making at administrative levels.

Methods

Participants with the NIDILRR Burn Model System who were ≥14 years with a zip code were included. Sociodemographic and injury characteristics and 12-item Short Form Health Survey (SF-12) and Veterans RAND (VR-12) physical (PCS) and mental (MCS) component summary scores 6 months after injury were extracted. Data were deterministically linked by zip code to the Distressed Communities Index (DCI), which combines seven census-derived metrics into a single indicator of economic well-being that ranges from 0 (lowest distress) to 100 (highest distress). Multilevel linear regression models estimated the association between DCI and HRQL.

Results

The 342 participants were mostly male (239, 69%) had a median age of 48 years (IQR 33–57) and sustained a median burn size of 10% TBSA (IQR 3–28%). More than one-third of participants (117, 34%) lived in a neighborhood within the two most distressed quintiles. After adjusting for age, race/ethnicity, and pre-injury HRQL, increasing neighborhood distress was negatively associated with PCS (ß-0.05, SE 0.02, p=0.01). Age and pre-injury PCS were also significantly associated with 6-month PCS. There was no association between neighborhood distress and 6-month MCS. However, pre-injury MCS was significantly associated with 6-month MCS (0.56, SE 0.07, p< 0.001).

Conclusions

Neighborhood distress is associated with lower PCS after burn injury but is not associated with MCS. Regardless of neighborhood distress, pre-injury HRQL is significantly associated with both PCS and MCS during recovery.
113 Long-term Reconstructive Surgery of the Burned Hand: 16-year Experience at a Major Burn Center
Authors: Buta Martin , Abouzeid Callie , Patel Khushbu F , Stockly Olivia , Cauley Ryan , Chen Liang , Wolfe Audrey E , Bojovic Branko , Friedstat Jonathan S , Goverman Jeremy , Schneider Jeffrey C , Ryan Colleen M
Published: April 2021

Introduction

Early excision and grafting for deeper hand burns is important for preservation of long-term hand function. Little information exists on long-term reconstructive and revision operations after acute grafting. Limited quantitative data is available on early predictors of this outcome. This study retrospectively examines a cohort of patients who underwent excision and grafting of acute hand burns and details their reconstructive course in the years after injury. Predictors of future reconstructive hand surgery are examined.

Methods

A retrospective review was conducted using medical records of patients admitted with acute burn injury to a major regional burn center from February 1999 to October 2015 and who subsequently underwent excision and grafting for closure of the acute wound. Information collected included demographics, burn size and etiology, anatomical involvement, grafting, contracture release, local tissue rearrangement, and regional and distant flaps. Regression analysis assessed for demographic and clinical predictors for future contracture release with grafts and/or local tissue rearrangement surgery.

Results

A total of 704 hands in 532 adults (71% male, median age 40 years, average burn size 14.9% TBSA) met study criteria (Table 1). Ninety-eight patients underwent at least one reconstructive surgery (122 burned hands). Mean length of follow-up was 1000 days. Multivariable logistic regression analysis showed that male gender was negatively associated (p< 0.001; OR 0.369; 90% CI, 0.233–0.584) with contracture release with graft whereas white race (p=0.030; OR 2.060; 90% CI, 1.192–3.560) and burn size ≥21% TBSA (p< 0.001; OR 3.962; 90% CI, 2.224–7.057) were positively associated. Males had a negative association (p=0.023; OR 0.527; 90% CI, 0.332–0.837) and burn size a positive association with local tissue rearrangement (5–10% TBSA - p=0.041; OR 2.149; 90% CI, 1.161–3.975 and >21% TBSA - p< 0.001; OR 4.230; 90% CI, 7.927).

Conclusions

Approximately 1 in 6 acutely grafted hands underwent at least one reconstructive surgery of clinically significant contractures, primarily in digits and web spaces. Female gender and burn size were positive predictors of both categories of reconstructive surgery while white race was a positive predictor of release and graft.
116 Cross-cultural Translation, Adaptation and Validation of the Burnt Hand Outcome Tool (BHOT) from English to French Canadian
Authors: Gane Claire , Robillard Anne-Sophie , Royea Claudia , Lacasse Laurence , Calva Valerie , de Oliveira Ana , Nedelec Bernadette
Published: April 2021

Introduction

The Burnt Hand Outcome Tool (BHOT) is a comprehensive patient-reported outcome measure to assess the multiple impacts of hand burn injuries. However, this tool is currently only available in English. The aim of this study was to create a French Canadian, cross-cultural translation and adaptation of the BHOT and to investigate its reliability and validity.

Methods

The BHOT was translated and culturally adapted following published good practice principles for patient-reported outcome measures. The steps included translation to French, backward translation, expert committee review, and cognitive debriefing with 5 adults having burn injuries excluding their hands. Then, 39 adults with hand burn injuries tested the pre-final French version of the questionnaire (BHOT-F) in order to determine its clinimetric properties. Reliability was investigated by determining the Cronbach’s alpha internal consistency coefficient. Construct convergent validity was assessed by comparing the BHOT-F to the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Content validity was evaluated based on comments extracted from interviews with the participants and a committee of burn care experts.

Results

The BHOT-F was modified during the adaption process to ensure its clarity. Cronbach’s alpha was 0.94 indicating excellent internal consistency and was > 0.75 for all sub-domains. The BHOT-F and the QuickDASH were strongly correlated (rs = .86; p < 0.01). Content validity was deemed satisfying.

Conclusions

The French-Canadian version of the BHOT is a reliable and valid tool that can confidently be used in clinical practice for adults with hand burn injuries and compared to data generated with Anglophone populations.
119 Satisfaction with Life and Community Integration Outcomes up to 20 Years after Burn Injury
Authors: Abouzeid Callie , Wolfe Audrey E , Carrougher Gretchen J , Gibran Nicole S , Holavanahalli Radha K , Ni Pengsheng , Roaten Kimberly , Ryan Colleen M , Suman Oscar E , Kazis Lewis E , Schneider Jeffrey C
Published: April 2021

Introduction

Among the many challenges burn survivors face, community integration is often difficult and might affect overall satisfaction with life long-term. The purpose of this study is to examine quality of life, based on life satisfaction and community integration, at long-term follow-ups in the burn population.

Methods

Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and at 5, 10, 15, and 20 years after injury. The Satisfaction with Life Scale (SWLS) was used to measure participants’ satisfaction with life and the Community Integration Questionnaire (CIQ) measured level of community integration. A random intercept model was used to fit the data and generate a score trajectory with 95% confidence intervals to demonstrate the changes in scores over time and the impact of the demographic and clinical covariates on the model. SWLS trajectory is depicted in the Figure.

Results

The study population included 214 adult burn survivors with a mean age of 45.2 years. The population was mainly male (65.9%) and white (77.1%) with a mean burn size of 22.5% and average length of hospital stay of 34.7 days. This study found that SWLS scores decrease over time, but CIQ scores were relatively stable. The CIQ model with additional covariates were not statistically significant and did not improve the fit of the model.

Conclusions

Satisfaction with life was significantly worse over time. Community integration showed little or no change over the long term.
121 25 years later: Has the Practice of Splinting Burned Joints Changed?
Authors: Khor Desmond , Liao Junlin , Kowalske Karen J , Parry Ingrid , Schneider Jeffrey C , Richard Reg , Wibbenmeyer Lucy
Published: April 2021

Introduction

Burn scar contracture (BSC) across joints is a common pathological outcome following burn injuries, leading to limitations in range of motion (ROM) of affected joints and impairment in activities of daily living (ADLs). Despite a paucity of research addressing it efficacy, static splinting of burned joints is a common preventative practice. A survey of burn centers performed 25 years ago showed a widely divergent practice of splinting. We undertook this study to determine the current practice of splinting in acute burn injuries.

Methods

This is a retrospective observational study of 246 patients who were included in the Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) database from 2010–2013. The most commonly splinted joints (elbow, wrist, knee and ankle) and their 8 motions were included. Variables included patients’ demographics, burn variables, rehabilitation treatment and hospital course details. Univariate and multivariate analysis of factors related to splinting was performed. P< 0.05 was significant.

Results

Thirty percent of the study population (75 patients) underwent splinting during their hospitalization. On average splinting was initiated about a third of the way into the hospital length of stay (LOS, 35 ± 21% of LOS) and splints were worn for 50% (50±26%) of the LOS. Joints were splinted for an average 15.1 ± 4.8 hours a day. Joints with higher amounts of burn involvement and need for grafting to their associated cutaneous functional units (CFU) were more likely to be splinted (p< 0.001). The wrist was most frequently splinted (30.7%) while the knee was the least frequently splinted joint (8.2%). The knee was splinted the longest (17.6 ± 4.8 hours) and the ankle the least (14.4 ± 4.6 hours). One third had splinting continued to discharge (20, 27%). The requirement for skin grafting in the associated CFU was the only factor that was independently related to splinting, increasing the odds of splinting 2% for every 1% of CFU grafted (adj OR =1.02, 95% CI=1.01–1.03, p< 0.001).

Conclusions

The current practice, especially the timing, hours of wear and duration of splinting following burns remains diverse among burn centers. Splinting is more common in joints that have more burn and deeper burns require grafting in the associated CFU; otherwise there appears to be little consensus in the practice of splinting. Future study looking at splinting application and its outcomes is warranted.
501 Creating a Virtual Burn Camp Experience: Growth, Hope, Dream, Inspire
Authors: Boulter Trudy , Mayer Nichole F , Mikolaj Kerry , Schuetz Tim
Published: April 2021

Introduction

Our Burn Camps program has a suite of well-established residential programs. In 2020 we were forced to pivot to a virtual platform. Our goal was to uphold our mission; “to provide children who have sustained a burn injury and their families healing opportunities by offering inspiration, rehabilitation and shared experiences in a safe, nurturing and supportive environment.” Our theme “Always Together” utilized the following program pillars: creating community, growth, inspire, dream and hope.

Methods

Recruitment Campers/Counselors: The 2018–2020 campers were contacted providing virtual camp logistics and application information. Our best counselors returned as our 2020 staff. We built the same cabin groups as 2019.

Staffing

Camp leadership team and 2 Psychologists

Platform

The conference center provided ZOOM access for planning meetings and staff training. Four Zoom accounts were used to manage 8 cabin groups.

Application

A new online application was developed including the following questions: Coping with the pandemic, current social justice issues and access to technology.

Schedule

The schedule included 4 live meetings per day for 5 days. We included the anchors of camp: morning exercise, crafts, talent show, banquet, and play day.

“Camp in a Box”: 125 boxes were designed and sent to campers, staff and donors. Boxes included envelopes for each day of the week, with content specific for each cabin.

Results

We had 62 campers registered for camp and 35 staff from across the country. Our “Camp in a Box” was successfully sent to 62 campers, 35 staff and 25 donors. We had four Zoom accounts. Each account was managed by a member of the leadership team. There was one primary Zoom account that hosted the large group activities for consistency. Each live activity that was offered was attended by 40–70 participants. Our Zoom calls were a mix of live and prerecorded videos. Counselors filled out a staff survey at the end of each evening allowing the leadership team feedback about the day’s activities and any camper concerns.

Conclusions

During a time when connection is so important, our community rose to the challenge and supported our campers. We were able to show that burn camp lives inside each of us no matter the location. Our campers and their families were engaged throughout the week and grateful for the opportunity. We learned a lot about running a virtual program and hope to use these concepts even when the pandemic is over.
503 Burn Camp Volunteer Engagement
Authors: Yelvington Miranda L , Wilkinson Gretta E
Published: April 2021

Introduction

Much has been published in burn literature regarding the positive impact of camp participation on burn survivors. Less has been said about the positive benefits reaped by the volunteers who freely give their time to support burn camp initiatives. Often these volunteers are fire fighters, members of the hospital’s burn team, family members or burn survivors or adult burn survivors. Occasionally, volunteers have no prior ties to the burn injury community. These individuals donate their time to attending burn camp as a counselor or camp volunteer and many serve through the year on planning and organization committees. Prior studies have reported a positive professional benefit from camp participation including improved job effectiveness and motivation. Counselors also reported personal benefits including personal growth and socialization. The same benefits may be present for non-counselor volunteers.

Methods

This survey-based project explored the attitudes of burn camp volunteers. Surveys were sent to current and past volunteers of one facility’s Pediatric Burn Camp. These include but are not limited to community members, firefighters, medical staff and Burn Team members. Surveys were sent via mail with a follow-up email sent one month later to encourage survey completion.

Results

Surveys were sent to 40 pediatric burn camp volunteers. 28 respondents reported between 1 and 27 years of camp participation. 75% report no regular contact with burn survivors related to their occupation. 29% of respondents were firefighters, 18% were burn team members and 32% were burn survivors. Respondents answered write in questions related to what they love about camp and how their camp experience could be made better. Nine topics related to attitudes were addressed in a Likert scale format. Statistical analysis will be performed to evaluate trends in volunteer attitudes and to compare attitudes to longevity of camp participation, volunteer age and occupation. Trends in recommended camp improvements will be addressed.

Conclusions

Longevity of camp participation is directly related to volunteer believes and attitudes. Whether because of other responsibilities, changing vocations or a loss of interest in the cause, often volunteers fail to return year to year. Volunteer engagement is an essential part of keeping burn camp a viable resource for pediatric burn survivors. By assessing volunteer perceptions, camp directors can discover areas for improvement and camp attributes that draw volunteers to burn camp. Volunteer recruit strategies developed with these trends in mind may be more successful in attainment and retention of dedicated volunteers.
516 Higher Risk of Acute Kidney Injury in Burn Patients with Rhabdomyolysis
Authors: Ko Andrew , Song Juquan , El Ayadi Amina , Golovko George , Wolf Steven E
Published: April 2021

Introduction

Rhabdomyolysis, a rapid breakdown of damaged skeletal muscle, is a serious complication known to occur in approximately 1% of burn patients. Muscle breakdown products can accumulate in the renal tubules leading to acute kidney injury (AKI) and increased deaths. Burn-associated factors such as under-resuscitation, infection, and nephrotoxic drugs likely increase incidence of AKI in those with rhabdomyolysis after burn. Other variables such as age, sex, and pre-existing conditions may also be implicated in this relationship. We investigated whether burn patients with rhabdomyolysis are at greater risk of developing AKI than others with rhabdomyolysis.

Methods

TriNetX, a global health research network, was accessed in September 2020 to create three patient cohorts with a combination of rhabdomyolysis and burns. Data from years 2000 to 2020 from 38 health care organizations was used. Cohort 1 included burned patients who developed rhabdomyolysis within 14 days after injury. Cohort 2 were those with rhabdomyolysis who did not suffer a burn within 14 days prior to diagnosis. Cohort 3 included burned patients who did not develop rhabdomyolysis within 14 days of the burn. Burn diagnosis was identified by ICD-10 codes T20-25, T26-28, or T30-32; rhabdomyolysis was identified with M62.82. We identified 699 patients in Cohort 1. Propensity score matching was done to Cohorts 2 and 3 to balance similar demographics and pre-existing conditions to Cohort 1. Cohorts were then compared to assess the risk of developing AKI (N17) within 14 days of the initial event.

Results

Cohort 1 had a mean age at incidence of 48.4±19.8; 552 patients were male and 146 were female. 154 patients with hypertensive diseases, 66 with diabetes mellitus, 41 with chronic kidney disease, and 51 overweight or obese patients were identified. Matched Cohorts 2 and 3 had the same number of patients and similar demographics and pre-existing conditions as Cohort 1. 391 of 699 burn patients with rhabdomyolysis (56%), 293 of 699 non-burn patients with rhabdomyolysis (42%), and 23 of 699 burn patients without rhabdomyolysis (3%) developed AKI within 14 days. The risk ratio difference for developing AKI between burn patients and non-burn patients with rhabdomyolysis was 14.02% with a 95% CI of 8.831–19.209% (< 0.0001 p-value) and between burn patients with and without rhabdomyolysis was 52.647% with a 95% CI of 48.736–56.557% (< 0.0001 p-value). The odds ratios for developing AKI were 1.759 and 37.312, respectively.

Conclusions

We found the risk of developing AKI in burn patients with rhabdomyolysis to be significantly augmented compared to non-burn patients with rhabdomyolysis or burn patients without rhabdomyolysis.
522 Perioperative Echocardiographic Assessment of Malnutrition-Related Cardiomyopathy: A Case Series
Authors: McQuitty Alexis L , Brown Frances , Ozhathil Deepak K , Sreshta Erin , Talon Mark D
Published: April 2021

Introduction

It is known that systolic dysfunction (dilated cardiomyopathy) may occur in a high percentage of patients with large TBSA burns. The reversible myocardial depression may be due to many factors: thermal injury, sepsis, severe malnutrition. Monitoring nutritional status is an integral part of improving post-burn cardiomyopathy. Perioperative echocardiography can be used to assess the degree of cardiac dysfunction and alter treatment in these patients.

Methods

Serial echocardiographic parameters were measured (ejection fraction, fractional shortening, pericardial fluid) in 4 patients with evidence of malnutrition (low BMI, low albumin and prealbumin, muscle wasting), delayed wound healing, and a late presentation to the hospital. Initial echocardiography was performed post-injury day 30 -142; follow-up exams were performed in some patients up to 2 years post-injury. Acutely injured or septic patients were excluded.

Results

Echocardiographic measurements were obtained in 4 patients, ages 7–21. The TBSA ranged from 33–95% and included flame injury and electrical burns. The initial ejection fraction ranged from 12–38% in patients with a BMI range of 10–16. The mean initial albumin was 1.65g/dL; the mean prealbumin was 10.8mg/dL. Selenium deficiency was noted in 1 patient. Dobutamine was required intraoperatively in several patients.

Conclusions

Patients presenting with malnutrition and impaired wound healing all had evidence of cardiomyopathy of varying degrees. However, the degree of systolic dysfunction varied significantly. Chronic surgical grafting was used to manage burn wounds, while slow nutritional rehabilitation normalized the patient’s BMI with careful avoidance of refeeding syndrome. As exemplified by serial echocardiography, one patient’s EF improved over 1 year from 12% to 50–55% as the nutritional status also improved, demonstrated by the normalization of his BMI. Despite the lower ejection fractions, many patients maintained an adequate cardiac index and required only short-term inotropic agents. Intraoperative and serial echocardiography allowed for continued monitoring and alteration of the heart failure medication regimens if required. With time and adequate nutrition, cardiac function improved, although many remained with mild dysfunction in the first year.
523 Retrospective Outcomes Analysis of Tracheostomy in Paediatric Burn Population
Authors: Iglesias Nicholas , Prasai Anesh , Golovko George , Ozhathil Deepak K , Wolf Steven E
Published: April 2021

Introduction

For decades, controversy has raged regarding the placement of tracheostomy in severe paediatric burns. Numerous variables including extent of smoke inhalation injury, % TBSA burned, age of the patient, and co-morbidities among others complicate reaching consensus. Furthermore, paediatric patients are particularly susceptible to complications including inadvertent loss of airway and long-term swallowing and other anatomic issues. Additionally, previous analysis of the efficacy of tracheostomy in paediatric burn patients appears to be hindered by a lack of nationwide analysis. The aim of this study was to explore the efficacy of tracheostomy in the general paediatric burn patient population.

Methods

De-identified patient data was obtained from the TriNetX Research Network database. Two cohorts were identified: paediatric burn patients with tracheostomy (cohort A) and paediatric burn patients without tracheostomy (cohort B). Burn patients were identified using the ICD-10 codes T20-T25 & T30-T32. Tracheostomy was identified using the ICD-10 codes 1005887, 1014613, 31600, 31601, 31603, 31604, 31610, and Z93.0. A total of 132 patients were identified in cohort A in 23 HCOs and 83,117 patients were identified in cohort B in 38 HCOs. Infection, hypovolemia, pulmonary injury, laryngeal injury, pneumonia, and death were compared between the cohorts.

Results

Cohort A had a mean age of 11 (SD=5) and Cohort B had a mean age of 9 (SD=5). Paediatric burn patients with tracheostomy had a higher risk for death, infection, hypovolemia, pulmonary injury, laryngeal injury, and pneumonia when compared to their non-tracheostomy counterparts. The risk ratios for these outcomes were 62.452, 4.713, 9.267, 26.483, 116.163, and 18.154, respectively.

Conclusions

The analysis of the longitudinal outcomes of pediatric burn patients with tracheostomy as compared to those without tracheostomy demonstrated the tracheostomy cohort suffered much worse mortality and morbidity across several metrics. The potential benefits of tracheostomy placement in pediatric burn patients should be weighed against these outcomes.
529 Acute Colonic Pseudo-Obstruction: A Critical Complication in Burn Patients
Authors: John Albin A , Anand Rohan , Frost Joshua , Griswold John A
Published: April 2021

Introduction

Acute Colonic Pseudo-Obstruction (ACPO) is a rare clinical condition characterized by gross dilation of the large bowel in the absence of an obstruction. It presents a particularly complex challenge in diagnosis and management in the context of burn trauma. We followed five burn patients who developed ACPO that did not respond to conservative treatments. These patients ultimately required surgical intervention to resolve their ACPO. Through our study, we propose that traditional management may not be successful in fully treating ACPO in burn patients without recurrence and that complete resolution necessitates a more aggressive management course, often in the form of surgical intervention.

Methods

We studied the clinical course of all burn patients who developed ACPO in the past 2 years at our burn center. Using Electronic Health Records, we collected patient demographic data, percent total burn surface area (%TBSA), hospital length of stay, cecal diameter, bowel regimen for catharsis, and vital sign measurements. Abdominal CT scans and X-rays were used to monitor the progression of cecal diameter.

Results

We have noted that burn patients who are at a high risk of developing ACPO tend to either be obese, have large TBSA burns (>20%), or have a combination of both. Furthermore, patients who had a greater percentage of 3rd degree burns had worse outcomes. All patients received acetylcholinesterase inhibitors (AChEi’s), but ultimately underwent some manner of further intervention for complete resolution of ACPO. Two patients were treated solely with decompression: one via NGT suction, the other via colonoscope. Three patients received surgical intervention through hemicolectomy, subtotal colectomy, and cecostomy. The former two subsequently expired, one due to direct ACPO complications; the latter three survived and remain well today.

Conclusions

ACPO is a rare but serious complication in burn patients that may easily be missed by the diagnosing clinician. In the treatment of ACPO in burn patients, one should consider a more aggressive approach, as traditional medical therapy may not be enough to resolve the original distention or prevent a recurrence. In our review of five burn patients that subsequently developed ACPO, surgical intervention was universally the mechanism by which definitive resolution of the condition was achieved.
544 Temporizing Matrix in the Complex Wound: A Retrospective Three-year Review
Authors: Blome-Eberwein Sigrid A , Bothwell Lydia
Published: April 2021

Introduction

A complex wound is a wound that will not heal spontaneously or with simple or standard closure techniques. Often functional structures (bone, tendon, fascia, joint capsule etc.) are exposed and a matrix can be used for bridging of these structures. The Temporizing Matrix is an entirely synthetic matrix made from polyurethane open-cell foam. This matrix was used in the burn center for three years for the indication “complex wound” with good success. The study objective was to evaluate success rate (leading to wound closure after STSG, duration of treatment) and complications (infection, failure, scarring) on this patient cohort. IRB approval was obtained.

Methods

All charts of patients receiving the Matrix between June 2017 through May 2020 were reviewed. Data collected were demographics, surgery dates, wound descriptions, healing, infection, failure, reapplication, time from application to STSG, time to healing, post discharge complications and scar quality.

Results

33 patients with 37 complex wounds were identified to meet inclusion criteria, 61% male, 39% female, age ranging from 3 months to 72 years. The wounds were caused by Burns, necrotizing infections, trauma or amputation post burn. The Matrix was placed for widely exposed structures (70%), failed STSG(3%), thin subcutaneous tissue coverage over amputation stumps (15%) and other reasons (12%). Primary graft success was 97%. Infection rate was 15% with 8% reapplication. Most infections were treated locally. The average Vancouver scar scale rating after discharge was 9/15.

Conclusions

This temporizing Matrix in preparation to STSG led to successful wound closure in 97% of these complex wounds with low complication rates and an acceptable long-term scar.
559 Benzocaine-Lidocaine-Tetracaine (BLT) Cream Adverse Effects in Burn Patients: A Case Report and Literature Review
Authors: Walroth Todd A , Brown Michelle E , Gordon Katelyn , Martinez Moises , Grooms Cortni , Hartman Brett C
Published: April 2021

Introduction

Historically, BLT cream has been used at our burn center in laser procedures and tattoo removal with 6–8% lidocaine to improve tolerance of outpatient procedures. Recently, the laser BLT formulation (8%) has been trialed as an opioid-sparing alternative for managing pain during inpatient microneedling procedures. When utilizing this formulation for microneedling, the high percentage of lidocaine absorption may correlate with adverse central nervous system (CNS) effects.

Methods

A literature evaluation and retrospective chart review of burn patients receiving BLT cream for inpatient microneedling was performed.

Results

From January to June 2020, two elderly females (77 and 78 years old) received several doses of BLT cream during inpatient microneedling procedures with no documented adverse events attributed to the medication. A 68 year old male with a total body surface area (TBSA) of 8% reported dizziness shortly after he received BLT cream. Vitals were normal, but the patient was unable to focus his eyes or communicate clearly. Neurological exam revealed sluggish, pinpoint pupils. Patient remained disoriented with gargling and tongue thrusting though vitals remained stable. At this time, the remainder of the BLT cream was removed from the wound and his mentation returned to baseline within 90 minutes. No residual neurologic deficits occurred. No other potential causes were identified. Literature review revealed topical lidocaine can be absorbed systemically and cause CNS depression, confusion, and disorientation. Based on limited published data in healthy patients, it is recommended to use no more than 5% of topical lidocaine in large quantities, especially over raw surfaces or blistered areas. The amount of lidocaine systemically absorbed is linked to both the duration of application and the surface area over which it is applied. Using study data from lidocaine/prilocaine 2.5% cream and lidocaine patches, we explored a safer BLT formulation for burn patients as published data do not exist for this group.

Conclusions

Based on our review, we determined 2% to be the maximum lidocaine concentration to apply to a burn wound, 5% TBSA as the maximum surface area involved, and total exposure time limited to 30 minutes or less to reduce incidence of adverse effects. Specifically, formulations with a higher lidocaine concentration applied to a burn wound have the potential to result in untoward neurological deficits.
561 Bilateral Upper Extremity Amputation After High Voltage Electrical Injury: A Case Report
Authors: Khalifa Andrew , Sarfraz Anzar , Avraham Jacob B , Archie Ronnie , Kaminsky Matthew , Poulakidas Stathis , Bokhari Faran , Bajani Francesco
Published: April 2021

Introduction

Electrical injuries represent 0.4–3.2% of admissions to burn units and are responsible for >500 deaths per year in the United States. Approximately half occur in the workplace and are the fourth leading cause of work-related-traumatic death. The extent of injury can be drastically underestimated by total body surface area percentage (TBSA). Along with cutaneous burns, high voltage electrical injuries can lead to necrosis of muscle, bone, nervous tissue, and blood vessels. Aggressive management allows for patient survival, but at significant cost. Newer technologic advances help improve functional outcomes.

Methods

This case-report was conducted via retrospective chart review of the case presented.

Results

A 43-year-old male sustained a HVEI (>10, 000 V) after contacting an active wire while working as a linesman for an electric company. He presented after less than 15-minute transport from an outside hospital with full thickness burns and auto-amputation to all fingers on both hands and the distal third of the left hand (Images 1 and 2). There were full thickness circumferential burns to the entire left and right upper extremities with contractures, with the burns extending into the axilla, and chest wall musculature. The patient had 4th degree burns and a large wound to the left shoulder with posterior extension to the scapula, flank and back with approximately 25% TBSA (Image 3). Compartments were tense in both upper extremities. Patient was sedated and intubated to protect the airway and placed on mechanical ventilation. A femoral central line was then placed, and the patient was given pain control, continued fluid resuscitation, and blood products. Dark red colored urine from a foley catheter that was immediately identified as rhabdomyolysis induced myoglobinuria. Labs drawn demonstrated elevated troponin I, CK >40,000. BUN 18, creatinine 1.0, K+ 5.2 and phosphate 5.6. Decision was made immediately for operative intervention with emergent amputation of both upper extremities in the light of rhabdomyolysis secondary to tissue necrosis and oliguria. During the patient’s hospital course, he underwent multiple operations for further debridement with vacuum-assisted closure therapy and skin grafting of sites, as well as targeted muscle reinnervation (TMR) 6 months later at an outside hospital.

Conclusions

Although HVEI only account for a small percentage of burn admissions, they are associated with greater morbidity than low-voltage injuries. Patients with HVEI often incur multiple injuries, more surgical procedures, have higher rates of complications, and more long term psychological and rehabilitative difficulties. Despite the need for amputation in some of these critically ill patients, options exist that allow for them to obtain long term functional success.
565 Pandemia Experience in Pediatric Minor to Moderate Burns and the Role of Telemedicine in Treatment
Authors: Abali Ayse Ebru , Aydogan Cem , Turkmen Nigar , Haberal Mehmet
Published: April 2021

Introduction

A huge number of pediatric burn injuries are minor to moderate burns. During covid-19 pandemia, these cases have continued to require medical attention. Aim of the present study was to share our burn center’s pandemia experience in minor to moderate burns in children.

Methods

Records of 117 victims (age:0 to 17yrs) were documented {study period: 3/11/2020(pandemia decleration by WHO)-9/11/2020}. Data were classified according to treatment modalities (outpatient/inpatient/telemedicine). Age; sex; extent of burns; burn cause; environment in which injury occured; referral history (time interval between injury and referral; other hospitals before arriving at our center) were noted for each case. Thereafter, subjects were divided into two subgroups according to pandemia calender: GroupIconsisted of referrals in march+april+may (national ‘lock-down’ period for children n=60) and GroupIIconsisted of referrals in june+july+august+september (‘new normal’ period with limited social life n=57) (mean±SE,p˂.05).

Results:

Outpatients comprised 82,1% of all referrals(n=96) with 361 in-person visits. Mean age was 4,2yrs±0,4(min:0 max:17); male/female ratio was 1,04/1. Mean total body surface area(TBSA) burned was 2,6%±0,6(min:0,2 max:20). The most common burn causes were scalds(n=79; 82,3%) and contact burns (n=11;11,5%). Number of referrals on the same day with injury was 41 (42,7%) and 65 referrals were unmediated(67,7%).

Inpatients comprised of 11,1% of all referrals (n=13). Mean age was 3,9yrs ± 1,7 (min:1 max: 16). Male/female ratio was 0,9/1. Mean TBSA burned was 9,3%±1,8 (min:1 max:18). The most common burn cause was scalds(92,3%;n=12). Nine patients were hospitalized on the same day with injury (69,2%). Ten patients were referred from other hospitals (76,9%). Mean lenght of hospital stay was 6,77days±1,4 (min:1 max:14).

Telemedicine visits (n=33) which were carried out for 23 children via e-mail and phone/video calls included photographic follow up visits for scars, treatment of contact dermatitis and controls of wound-dressings. Comparison of ‘lock-down’ period (groupI) with ‘new normal’ period (groupII) revealed that almost whole telemedicine service was carried out in groupI except two interurban visits in groupII. Findings were similar in both groups except the significant increase of outdoor burns and remarkable presence of sun burns in groupII(p< .05).

Conclusions

Covid pandemia has created extraordinary conditions; however present data suggests that minor to moderate burns in childhood continue to occur anyway. Telemedicine is an advantageous method under pandemia conditions. Therefore, attempts for basic burn-care guidelines including telemedicine facilities should be supported.
567 Results from a Survey About the Ethical Challenges of Treating a Medically and Socially Complicated Patient
Authors: Gerrek Monica L , Lambrix Marcie A , Schirokauer Oliver , Coffee Tammy , Yowler Charles J
Published: April 2021

Introduction

Medically complicated burn patients can present with complex social situations that lead to difficult ethical decision. While the four principles of biomedical ethics, viz., respect for autonomy, nonmaleficence, beneficence, and justice, offer guidance, they may not lead to a clear resolution. Instead, providers may be faced with making a recommendation that is ethically uncomfortable.

Methods

At the 2109 ABA Annual Meeting, we presented a poster of the following real-life case:

Patient is a 47-year-old male who has an 81% TBSA burn, is intubated, and is unable to participate in medical decision making. He needs four limb amputations. His chance of long-term survival with amputation is less than 20%, and the best case scenario is a vent-dependent life with tetraplegia. His complicated family, which include his wife, ex-wife, children, and siblings, is unable to agree on what interventions should be provided.

The poster included a QR code and a link, both of which took respondents to a 10-item survey. Later in 2019, we asked the organizers of our regional burn conference to email a case summary and a link to the same survey to registered participants.

The survey addressed medical appropriateness and various factors that might affect decision making.

Results

We received responses from 12 attendees at the ABA Annual Meeting and 18 regional conference registrants.

On the 8 questions for which only a single response was permitted, 64% of respondents on average chose the same answer. This number goes up to 72% if we restrict to the 5 questions with only two options. Though these numbers indicate a degree of consensus, they also reflect a notable lack of agreement. In fact, less than 77% of respondents agreed about the medical appropriateness of not amputating, the roles that quality of life and justice (resource allocation) should play in decision making, whether the level of evidence needed to withdraw treatment is the same as is needed to continue, how to handle the conflicting claims of family members, and the level of importance that should be attached to the team’s comfort. In the case of the last two issues, none of the 5 available responses for each question received more than a third of the votes. The only position unanimously endorsed on the survey was that comfort care should be an option for the patient/family.

Conclusions

Our data suggest that there is substantial disagreement among those involved in burn care regarding important aspects of decision making for a patient who is medically, socially, and ethically complicated.