bluuebunny/crossref_metadata_2025_split huggingface dataset:
508 Fungal Infections in Burn Patients from 2014–2019: A 5-year Retrospective Review
Authors: Pruskowski Kaitlin A , Rizzo Julie A , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
Topical and systemic antibiotic agents used to treat burn wounds allow for fungal growth. Fungal infections often occur later in the hospital course and carry a higher mortality rate than bacterial infections in critically ill burn patients. The primary objective of this study was to describe the incidence and characteristics of fungal infections in our burn center.

Methods
This was a retrospective chart review. Subjects who were admitted between January 2014 and February 2019 after sustaining a burn injury and received a systemic antifungal agent were included. All cultures and histopathology results that were positive for fungus were recorded.

Results
Ninety one subjects were included in this analysis. The average age was 42.3±16.9 years and 74 (81.3%) subjects were male. Seventy four (81.3%) subjects were admitted after flame burn. The average burn size was 40.1±24.2% TBSA. The average hospital length of stay was 57.2±44.8 days. Thirty eight (41.7%) subjects died during their hospital stay.
The 91 subjects had 220 cultures positive for fungi: 29 blood cultures, 19 BAL cultures, 23 sputum cultures, 118 tissue cultures, and 31 urine cultures. The most common fungal genera isolated were: Candida (n=146), Aspergillus (n=55), and Fusarium (n=44).
Twenty six (28.6%) subjects had histopathology results that showed fungus in non-viable tissue, with an average time from injury to fungus of 20.4±11.8 days. Twenty six (28.6%) subjects had histopathology results that showed fungus in viable tissue, with an average time from injury to fungus of 22.7±16.7 days. Of note, these were not the group that had fungus in non-viable tissue. Twelve (13.2%) subjects had angioinvasion, with an average time to angioinvasion of 26.6±22 days.
The 91 subjects received 133 courses of antifungals. The average course of antifungal therapy was 7.8±8.9 days. The most common antifungals used were: micafungin (n=54), fluconazole (n=53), and liposomal amphotericin B (n=44).

Conclusions
Patients who were started on a systemic antifungal had a high mortality rate. Common fungi isolated included Candida and Aspergillus, which is consistent with previous literature. Further research is needed on the early recognition, accurate diagnosis, and timely management of fungal infections in this patient population.

Applicability of Research to Practice
Fungal infections after burn injury carry a high mortality rate. Early recognition and timely management of these infections is paramount.
511 Point-of-care 3-dimensional Body Mapping for Determining Total Body Surface Area in Severely Burned Patients
Authors: Loegering Julia , Webb Kevin , Ahlquist Jesse , Krause Kevin , Xu Karen , Greenhalgh David G , Palmieri Tina L , Tran Nam K 
Published: March 2020

Abstract

Introduction
With severe burn injury, there is systemic fluid loss due to inflammatory responses in damaged tissue, leading to disruption of cellular processes. Patient fluid levels are restored with the calculation of total body surface area (TBSA). Clinically used TBSA equations are often outdated and inaccurate with error up to 20%, resulting in misinformed treatment and subsequent sequelae including prolonged hospital length of stay and increased mortality. Our objective, therefore, was to create a point-of-care (POC) system employing 3D imaging technology to accurately calculate TBSA for all patient population varieties.

Methods
Our team employed an iPad attachable, infrared scanner to create 3D models of the human body. From these models, TBSA can be extrapolated using scan processing software. Subject scans were collected on our device and on a gold standard scanner for comparison of TBSA output. Clinical testing on burn patients is occurring at present to establish scanning precision of TBSA in the burn care environment.

Results
Non-clinical verification tests of the 3D scanned TBSA revealed a 4.05% error when compared to the gold standard, and precision error of 3.8%. Additionally, we introduced the device into the burn unit for preliminary testing with a physician user and non-patient subjects. The subjects were scanned in a prone position to mimic burn care workflow. Clinician scanning error was 1.41% when compared to the gold standard scan of the same subject. Clinical precision study results are on-going in collection.

Conclusions
Our device introduces an improved method of TBSA estimation to assist clinicians in making accurate burn care decisions and further precision medicine with greater anthropomteric data, notably for children. This device is one of the first POC-3D scanning technologies to be used in a burn setting and may also be employed at outlying medical facilities. Destructive wildfires and combat burn injuries highlight the need for such a device to standardize the triage of burn victims with and away from experienced medical staff.

Applicability of Research to Practice
3D body mapping points to an enhanced method of TBSA calculation and minimally disruptive to the burn workflow. Future developments of 3D scanning include deep learning algorithms to identify and better assess burned surface area. Additionally, further automation of TBSA scan processing to reduce user error in calculation and improve burn injury outcomes.
512 Single Center Experience with Venous Thromboembolism Prophylaxis for Obese Burn Patients
Authors: McKinzie Brian , Nizamani Rabia , Jones Samuel W , Williams Felicia N 
Published: March 2020

Abstract

Introduction
Burn injured patients are at high risk of thromboembolic complications. Morbid obesity further increases risk for thromboembolic complications. Recent evidence supports the use of anti-Xa guided enoxaparin dosing for the prevention of venous thromboembolism (VTE) in high risk populations. Our objective was to evaluate the efficacy of enoxaparin 40mg twice daily in achieving prophylactic plasma anti-Xa levels in obese burn patients.

Methods
A retrospective chart review of an ABA-verified burn center from November 2018 until September 2019 identified patients who were either ≥100 kilograms (kg) or had a body mass index (BMI) ≥ 30 kg/m2 and were initiated on enoxaparin 40 mg twice daily for VTE prophylaxis. Patients were included if they were at least 18 years of age and received at least three sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy. Patient demographics were analyzed, as well as body weight, BMI, and total body surface area (TBSA) burn. Statistical analysis was performed with student’s t-test for continuous data and Fischer’s exact test for categorical data.

Results
During the study period, 148 patients were screened with 44 patients included for analysis. Forty-one percent of the patients evaluated did not reach target peak plasma anti-Xa levels (0.2–0.5 IU/mL) on enoxaparin 40 mg twice daily. Patients who did not meet prophylactic target levels were more likely to be male (p&lt; 0.05) and have an increased body weight (129 +/- 24 kg versus 112 +/- 17 kg, p&lt; 0.05). Eleven out of 18 patients received dosage adjustments with subsequent anti-Xa levels available for follow-up assessment, of which an additional four patients required further dosage adjustment to meet goal peak plasma levels.

Conclusions
Current utilization of a fixed 40 mg twice daily regimen of enoxaparin for VTE prophylaxis is inadequate to meet target prophylactic peak plasma anti-Xa levels in the obese burn patient population. Dose adjusting enoxaparin to target peak plasma anti-Xa levels to reduce VTE rates in obese burn patients should be further evaluated.

Applicability of Research to Practice
This study demonstrates the need for more accurate dosing and evaluation of our dosing practices for VTE prevention. It also demonstrates the importance of having a Burn dedicated pharmacist in facilitating appropriate care.
517 ALDEN Based Determination of Culprit Drugs in Stevens-Johnson Syndrome: A 15-year Single Center Review
Authors: de Bustros Paul M , Baldea Anthony J , Sanford Arthur , Bouchard Charles , Joyce Cara 
Published: March 2020

Abstract

Introduction
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are severe and potentially lethal adverse drug reactions characterized by acute inflammation and subsequent necrosis of the skin, mucous membranes, and ocular surface. SJS/TENS is defined on a spectrum based on the percent of total body surface area (%TBSA) with epidermal detachment: SJS (&lt; 10% TBSA), Overlap Syndrome (10–30%), and TENS (&gt;30%).
The purpose of our study was to perform a systemic retrospective trend analysis of SJS spectrum diagnoses and culprit drugs in 147 patients admitted to the burn center over the past 15 years with the final diagnosis of SJS/TENS. The burn center serves as a regional referral center for patients with suspected or confirmed SJS/TENS. These referrals came from the five other academic medical centers as well as private hospitals in the area.

Methods
The electronic medical records of patients with a confirmed diagnosis of SJS/TENS admitted to the burn center from 2002 to 2017 were reviewed. Clinical data and the algorithm of drug causality for epidermal necrolysis (ALDEN) were used to identify the single most probable culprit drug. The following data were reviewed: date of admission, %TBSA with detachment, biopsy confirmation, and possible inciting agents. Chi-square tests were used to assess statistical significance for group comparisons.

Results
Over 15 years, 147 patients had a biopsy-confirmed diagnosis of SJS/TENS, of which 67% (n =98) had a culprit drug identified. The most common spectrum classification was TENS (n=73), followed by SJS (n=46) and Overlap Syndrome (n=27). Anticonvulsants (n=24), fluoroquinolones (n=14), allopurinol (n=11), sulfa drugs (n=9), and NSAIDs (n=9) were the most common inciting agents. Between 2006–2017, the proportion of patients presenting with SJS increased as compared to TENS and Overlap syndrome (10% in 2002–2009 vs. 42% in 2010–2017, p&lt; 0.01). Sulfa drug reactions were more prevalent in recent years (0% in 2002–2009 vs. 18% in 2010–2017, p=0.065) and fluoroquinolone-induced reactions in earlier years (21% in 2002–2009 vs. 6% in 2010–2017, p=0.068).

Conclusions
This is one of the largest single center series of SJS/TENS/Overlap cases in the US. Our data supports trends presented in the EuroSCAR (1997–2001) and RegiSCAR (2003–2012) studies.

Applicability of Research to Practice
The ALDEN algorithm provides an important and validated method for determining the probable culprit drug in SJS/TENS spectrum reactions. Trends in culprit drugs can shift over time based on changes in prescribing practices. Therefore, these trends need to be monitored in order to advise providers on which agents present the greatest risk to patients.
518 Relationship of Microbiome, Antimicrobial Resistance, and Wound Closure in &gt;90% Burn Patients
Authors: Monahan Alison M , Dyamenahalli Kiran U , Barron Michelle , Duffy Patrick , Wagner Anne L Lambert , Wiktor Arek J 
Published: March 2020

Abstract

Introduction
Patients with 90% or greater total body surface area (TBSA) burns of face many unique challenges, including prolonged open wounds and antibiotic use. Furthermore, increased antibiotic use can be associated with increased antibiotic resistance. Despite the commonality, the relationship between prolonged wound closure (months) combined with prolonged duration of antibiotic use (months) has not been fully explored. The specific aim of this study was to examine the evolution of burned patients’ microbiome over time in association with wound healing and antibiotic use.

Methods
We conducted a retrospective review of all patients admitted to our ABA-verified burn center from 2010-present with 90% TBSA or greater burns who survived to discharge. Demographic data, length of stay, percentage monthly wound closure (including donor sites), microbial culture data of bacteria, yeast, fungus, and mold (YFM), antibiotic susceptibilities, and systemic antimicrobial agents administered were recorded. Statistical analysis was performed using Pearson correlation coefficient.

Results
Two patients met inclusion criteria. Patient A (PtA), a 36 year old (yo) female with 95% TBSA burns and Patient B (PtB), a 45 yo male with 90% TBSA burns. Patients spent a combined 766 days (PtA 425, PtB 341) as inpatients. 347 separate positive cultures were analyzed, 180 of which were bacterial. 15 distinct species of bacteria were cultured (8 PtA, 9 PtB), along with 4 subtypes of Pseudomonas aeruginosa, and 9 distinct YFM (6 PtA, 6 PtB). Increasing antibiotic resistance was found in 57% (PtA) and 71% (PtB) of bacterial species. Pseudomonas was the most commonly isolated organism in 65% (n=118) of cultures. The relationships between percent wound closure, daily antibiotic use, and Pseudomonas antibiotic resistance are shown in the Graph below. There was a strong correlation between wound closure of &gt;50% with decreased amount of antibiotics used per day (PtA 0.83, PtB 0.86) and decreasing % of Pseudomonas antibiotic resistance (PtA 0.66, PtB 0.8).

Conclusions
Antibiotic resistance increases over time and efforts should be taken to decrease number of antibiotics administered. As wound closure passes a certain threshold, the number of antibiotics needed decreases, and Pseudomonas antibiotic resistance appears to decrease as well.

Applicability of Research to Practice
Recognition of different environmental pressures for bacteria may point to changes in microbial resistance patterns and thus clinical management.
529 Collagen Plus Alginate Wound Dressing for the Treatment of Split-thickness Skin Graft Donor Sites: A Cost-effectiveness Study
Authors: Sanches-Pinto Debora C , Mota Wellington M , Gomez David S , Gemperli Rolf 
Published: March 2020

Abstract

Introduction
The collagen plus alginate dressings for donor sites have been used in our country since 2003. Before that, the use of rayon was the main and only preference of use. We were looking for something new at that time that could be less painful and maybe presented a good relation cost-benefit. This alternative dressing seemed to offer collagen to the wound so that the imbalance of metalloproteases would be reduced. We started a study to evaluate the use of collagen calcium-alginate dressing for donor sites.

Methods
A prospective clinical study was conducted for 2010 to 2017, when this material was donated (high cost in our service). Patients were selected consecutively and randomly allocated into three groups according to the treatment used on the donor site: rayon soaked in 0.9% saline; rayon covered with sterile cotton gauze and bandage; 90% bovine collagen with 10% calcium-alginate dressing covered with transparent polyurethane film. Following parameters was comparatively analyzed: pain, time to epithelialization, length of stay and costs.

Results
We studied 30 patients, ranging from 12 to 60 years of age. Fifteen of these patients had their donor sites covered with collagen calcium-alginate dressing, which showed pain reduction of 79.5% (p&lt; 0.01) shorter hospital stay and epithelialization, average of 5.8 days (p&lt; 0.01) and reduction in hospital costs about 47% (p&lt; 0.01) in comparison with rayon dressing. None presented infection in the donor site.

Conclusions
Collagen calcium-alginate dressing showed better cost-benefit than rayon to cover donor sites, with significant reduction of pain, epithelialization time, length of stay and costs.

Applicability of Research to Practice
cost-effective dressings and painless dressings, Burn care units, Ambulatory care.
545 The Association of Plastic Surgery Facility Volume with Inpatient Burn Outcomes
Authors: Sheckter Clifford C , Perrault David , Rochlin Danielle H , Chattopadhyay Arhana , Karanas Yvonne L 
Published: March 2020

Abstract

Introduction
Acute burn care involves a spectrum of physicians, nurses, and allied health professionals. Similarly, burn surgeons have variable training backgrounds that originate from different specialties. Plastic surgery was founded on the core principles of reconstruction and offers the full spectrum of acute burn care and reconstructive surgery. Previous work has shown that variations in practice within burn surgery are partially driven by training background. We hypothesize that plastic surgery involvement and access to the full reconstructive paradigm will improve inpatient outcomes in the treatment of burn injuries.

Methods
Acute burn patients with known percent total body surface area (%TBSA) were extracted from the National Inpatient Sample (NIS) from 2012–2014 based on International Classification of Disease 9th Edition codes. Plastic surgery volume per facility for the entire NIS was determined based on ICD-9 codes for flap procedures, breast reconstruction, and complex hand reconstruction. Outcomes included odds of receiving a flap, patient safety indicators (venous thromboembolic event, sepsis, surgical bleeding, pneumonia, wound complications) and mortality. Regression models included the following variables: age, %TBSA, gender, inhalation injury, comorbidities, hospital size, and urban/teaching status.

Results
The weighted sample included 99,510 burn admissions with a mean age of 37.2 years (standard deviation [SD] 24.3) and mean %TBSA of 12.4% (SD 12.4%). The weighted median plastic surgery volume by facility was 245 cases per year (Interquartile range 115, 495). Compared to the lowest quartile, the upper three quartiles of plastic surgery volume were associated with an increased likelihood of undergoing a flap procedure during admission (p&lt; 0.05). Plastic surgery volume was also associated with decreased likelihood of patient safety indicator events, whereby the highest quartile showed an OR of 0.71 (95% confidence interval 0.59–0.85, p&lt; 0.001). Plastic surgery facility volume was not significantly associated with a difference in the likelihood of inpatient death.

Conclusions
Burn patients treated at high volume plastic surgery facilities were more likely to undergo flap procedures during their admission compared to low volume centers. High volume plastic surgery facilities were associated with lower likelihood of inpatient complications, although there were no differences in mortality.

Applicability of Research to Practice
Inform health systems design in the delivery of burn care to provide the best outcomes for burn survivors.
559 Seasonal Variation in Hospitalizations for Burn Injuries
Authors: Shmelev Artem , Robinson Emmanuel , Quiroga Luis H , Hultman C Scott , Asif Mohammed 
Published: March 2020

Abstract

Introduction
Seasonal variation in traumatic injuries is a known phenomenon, but published data from large scale studies on burn hospitalization rates is sparse. We aimed to describe trends and seasonality in burns admissions using largest available administrative U.S. database with respect to percentage of total body surface area (TBSA) involved.

Methods
Study population was obtained from National Inpatient Sample 2000–2015 and included all primary admissions for burn injuries (n=490,247). Monthly hospitalization rates were calculated and seasonal trend decomposition was performed, including subgroup analysis by TBSA.

Results
The highest hospitalization rate was observed during summer months, with a peak in July. Seasonal differences were significant for burns with TBSA 10–39%. Seasonal amplitude accounts for 28% of total burns hospitalization rates. Increase of annual trends (2000–2015) reached significance for burns with TBSA &lt; 10% and ≥40%, while admission rate for burns with TBSA 10–39% remained stable. Patients, admitted during summer months were more frequently younger males, had burns with TBSA &gt;10%, shorter length of hospitalization and lower in-hospital mortality, compared to other seasons (all p&lt; 0.001).

Conclusions
Observed seasonal variation in burns incidence could be related to summer peak in outdoors grilling and fire activities, although the mechanism of injury can not be captured by administrative databases.

Applicability of Research to Practice
Anticipation of summer peak can help burn units to allocate resources and bring attention of society to preventive measures while working with open fire.
560 So Much More Than Just a Good Time: A Qualitative Look at a Burn Camp Experience
Authors: Barr Michele , Marrale Kelley , Fields Anita , Chrisco Lori 
Published: March 2020

Abstract

Introduction
Parents do not send their children to burn camp only to have fun. Since inception over three decades ago, burn specific camps have reported many benefits. A qualitative review of a well-established camp confirms that parents primarily send their kids to camp for the peer related social benefits that extend beyond the recreational aspects of a camp experience.

Methods
A nine-question survey was sent electronically to households of 58 burn survivors between the ages of 7–15 during the week after their child’s burn camp experience. Open-ended questions allowed for unrestricted disclosure of thoughts, feelings, praise or criticism. Responses were evaluated for similarities or differences to determine frequency and relative importance. The data was coded and analyzed for correlations into emergent categories with agreement between reviewers.

Results
The overall survey response rate was 63%. Categorical analysis of parent responses indicated their primary motivation for having a child attend camp was for the “Shared Experiences” with other burn survivors. Results indicated the enjoyment or fun aspect of camp was the least important motivational factor behind a parent’s decision. Analysis of the perceived benefits were social in nature, with “Connection” listed as the primary perceived benefit of the camp experience.

Conclusions
Fun is a byproduct of coming to camp, but not the primary reason parents send their kids to burn camp. The robust survey response rate suggests that parents are eager to share their thoughts about the impact of camp. The detailed responses demonstrate an understanding of and appreciation for the specific social and emotional benefits of this unique shared experience. Finding congruence between the rationale for camp attendance, and the perceived benefits is conducive to optimal program planning.

Applicability of Research to Practice
Although it is not possible to undo any traumatic events suffered by a child, research on burn camps has elucidated the benefits primarily through a qualitative lens. The burn community continues to be challenged in validating the benefits of camps quantitatively. Motivating people to engage in specific behaviors, like attending an event, is a crucial step for delivering aftercare programs designed to help their recovery. Burn camps can offer a safe environment, connection with others who understand, and the possibility for long term positive relationships with trusted adults to potentially mitigate the impact of a medical trauma. Further research about the impact of such programs on trauma healing is warranted.