bluuebunny/crossref_metadata_2025_split huggingface dataset:
507 Outcomes After the Administration of Hydroxocobalamin
Authors: Pruskowski Kaitlin A , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting.

Methods
This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis.
Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality.

Results
Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay.

Conclusions
Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted.

Applicability of Research to Practice
The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.
525 Autologous Skin Cell Suspension May Enhance Healing of Burn Wounds and Skin Graft Donor Sites in Elderly Burn Patients
Authors: Chattopadhyay Arhana , Swan Courtney , Sheckter Clifford C , Gupta Deepak , Karanas Yvonne L 
Published: March 2020

Abstract

Introduction
An autologous skin cell suspension (ASCS) spray containing keratinocytes, fibroblasts, and melanocytes can be processed from a small split thickness skin sample for use at the point-of-care in the operating room. ASCS have been shown to facilitate epidermal regeneration in large TBSA partial thickness burns with minimal donor site morbidity. We hypothesized that ASCS in conjunction with a 3:1 split thickness skin graft applied to burn wounds and ASCS alone applied to the donor site would facilitate healing in a 95 year-old burn patient with 12% TBSA deep partial and full thickness scald burns to the abdomen and bilateral thighs. To our knowledge, she is the oldest patient to undergo epidermal autografting with ASCS.

Methods
All burn wounds were tangentially excised in the standard fashion to healthy tissue. Split thickness (12/1000 inch) skin graft was harvested from the right lateral thigh, meshed 3:1, and applied to all wound beds. ASCS were prepared and sprayed on grafted sites and the donor site. All areas were dressed with Telfa clear and Xeroform with bacitracin. Dressings were initially changed every 2 days, and wounds were photographed on day 2, 4, 6, 8, 10, and 20.

Results
All burn wounds were deep partial thickness or full thickness. The right thigh donor site was completely healed by POD 10. 90% of the burn wounds had healed by POD 10. The area of deepest burn, an approximately 20 cm2area on the left medial thigh, was healed by POD 20.

Conclusions
We believe that ASCS enhanced the rate of re-epithelialization of burn wounds in a 95 year-old patient compared to our experience with skin grafting alone in this population. ASCS also promoted complete healing of the donor site by POD 10. This technology may have a role in decreasing healing time in the geriatric burn population. These findings are important for this population as longer lengths of stay are associated with delirium, hospital acquired infections, and deconditioning. This patient’s improved donor site healing also has broader implications as split thickness skin grafts are used widely for wound coverage in plastic surgery.

Applicability of Research to Practice
Demonstrates efficacy of ASCS in very elderly patients with moderate-sized deep burns and with skin graft donor sites.
526 Antiseptic Wound Dressings Made of Bacterial Nanocellulose
Authors: Luze Hanna , Holzer Judith , de Mattos Ives Bernardelli , Tuca Alexandru-Cristian , Nischwitz Sebastian P , Funk Martin , Mautner Selma , Birngruber Thomas , Kamolz Lars-Peter 
Published: March 2020

Abstract

Introduction
Bacterial nanocellulose (BNC) is a novel wound dressing that consists of nearly 95% water. This hydrophilicity allows this matrix to absorb and release aqueous substances. We investigated how well BNC can absorb antiseptic substances in order to create on demand antimicrobial wound dressings.

Methods
Sheets of BNC-based wound dressings were placed in four different antiseptic substances. Punch biopsies were taken at different time points and the concentrations of the antiseptic agent was measured. Two PHMB-containing solutions, one octenidine-containing and one povidone-iodine-containing solution were tested. In addition, the release of the substances from the punch biopsies was examined. To test the efficacy of these novel wound dressing, the antimicrobial activity of the BNC sheets loaded with the antiseptic solutions were tested against Staphylococcus aureus.

Results
All antiseptic solutions showed excellent uptake into the BNC as well as release. Especially the PHMB- and octenidine-containing solutions already showed high values after only 30 minutes. The overall achieved concentrations were all highly effective against Staphylococcus aureus and were all higher than the minimal bactericidal concentration against MRSA.

Conclusions
Antiseptic, water-based solutions are excellently absorbed in a very short time and are released steadily over a period of time dependant on the size of the molecules. All tested antiseptic solutions reached effective antibacterial concentrations making them all suitable for the making of antiseptic BNC-based wound dressings. However, when using a commercially available solution and not a solution containing only the active ingredient, it must be taken into consideration that all ingredients have an effect on the uptake of the active substance and thus influence the maximum uptake and release concentration.

Applicability of Research to Practice
The findings of this experiment are ready to be used in practice.
527 Eschar Removal by Bromelain Based Enzymatic Debridement in Burns: European Consensus Guidelines Update
Authors: Hirche Christoph R , Ziegler Benjamin , Kneser Ulrich 
Published: March 2020

Abstract

Introduction
Bromelain based Enzymatic Debridement (ED) has been introduced as an additional concept to the burn surgeon’s armamentarium, and is best indicated for mid-to deep dermal burns with mixed patterns. Increasing evidence has been published on special regions and settings, adressing success and limitations of ED for improved patient care. To better guide ED in view of the increasing experience, there is a need to publish updated consensus guidelines with user-orientated recommendations.

Methods
A multiprofessional expert panel of plastic surgeons and burn care specialists from 10 European countries was convened, to assist in developing current recommendations for best practices with use of ED. Consensus statements were based on peer-reviewed publications and clinical relevance. For consensus agreement, the methodology employed was an agreement algorithm based on a modification of the Willy and Stellar method. For this study on ED, consensus was considered when there was at least 80 % agreement to each statement.

Results
The updated consensus guidelines from 2019 refer to a diversity of experience and practice patterns of 1232 summarized patient cases in Europe (2017: 500 cases), reflecting the impact of the published recommendations. Forty-three statements were formulated, addressing the following topics: indications, pain management and anesthesia, large surface indication, timing of application for various indications, preparation and application, post-interventional wound management, skin grafting, outcome, scar and revision management, cost-effectiveness, patient′s perspective, logistic aspects and training strategies. The degree of consensus was remarkably high, with consensus in 42 of 43 statements (97.7%), while no consensus was achieved on the role of outpatient treatment/ED as day cases in minor burns in experienced burn centers. A classifications with regard to timing of application for ED was introduced, with „immediate/ very early“(≤12h), early (12-72h) or delayed (&gt;72h) treatment. All further recommendations are addressed in the presentation.

Conclusions
The updated guidelines in this paper represent further refinement of the recommended indication, application and post-interventional management for the use of ED. The published statements contain detailed, user-orientated recommendations aiming to align current and future users and prevent unnecessary pitfalls. The significance of this work is reflected by the magnitude of patient experience behind it, larger than the total number of patients treated in all published ED clinical trials.

Applicability of Research to Practice
These consensus guidelines may serve as refined user-orientated recommendations for implementation and successful application of ED in further countries (e.g. USA) based on the evidence and experience of 1232 summarized patient cases.
530 Osteomyelitis Increases the Rate of Amputation in Patients with Type 2 Diabetes and Lower Extremity Burns
Authors: Nizamani Rabia , Heisler Stephen , Chrisco Lori , Campbell Harold , Jones Samuel W , Cairns Bruce , Williams Felicia N 
Published: March 2020

Abstract

Introduction
In patients with type 2 diabetes (DM2), amputation rates exceed 30% when lower extremity osteomyelitis is present. We sought to determine the rate of osteomyelitis and any subsequent amputation in our patients with DM2 and lower extremity burns.

Methods
We performed a single site, retrospective review at our burn center using the institutional Burn Center registry with links to clinical and administrative data. Adults (≥18 years old) with DM2 admitted from January 1, 2014 to December 31, 2018 for isolated lower extremity burns were eligible for inclusion. We evaluated demographics, burn characteristics, comorbidities, admission laboratory values, presence of radiologically-confirmed osteomyelitis, length of stay (LOS), inpatient hospitalization costs, and amputation rate at 3 months and 12 months after injury. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results
For 103 patients identified with DM2 and isolated lower extremity burns, the average age was 54 years old. The majority of patients were male (78.6%) and white (55.3%). The average total body surface area (TBSA) of burn was 1.8% and 53.4% were scald burns. Thirty percent of patients had a history of heart disease and 22% were current smokers. The average hemoglobin A1c was 9.19 and average creatinine was 2.01. Overall rates of any amputation were 14.6% at 3 months and 18.4% at 12 months.
Fifteen patients (14.6%) had radiologically-confirmed osteomyelitis within 90 days of the burn injury. Compared to patients without osteomyelitis, this subset of patients had significantly increased LOS (average LOS 22.7 days vs 12.1 days, p=0.0041), inpatient hospitalization costs (average $135,345 vs $62,237, p=0.0008), amputation rate within 3 months (66.7% vs 5.70%, p&lt; 0.00001), and amputation rate within 12 months (66.7% vs 10.2%, p&lt; 0.0001). There were no significant differences in other characteristics between patients with osteomyelitis and those without.

Conclusions
Patients with DM2 and lower extremity burns incurred increased LOS, higher inpatient hospitalization costs, and increased amputation rates if radiologically-confirmed osteomyelitis was present.

Applicability of Research to Practice
Osteomyelitis in diabetic patients with lower extremity burns may predict need for amputation within one year of burn injury. Further study could aid in development of protocols for early identification and aggressive treatment of osteomyelitis in burn patients, which may improve LOS, cost, and amputation rates.
551 Mixed Methods Assessment of Pediatric Scald Burns
Authors: Lopez Christine , McDonald Eileen M , Ziegfield Susan 
Published: March 2020

Abstract

Introduction
CDC estimated more than 87,000 fire/burn injuries in 2017 among children 0–15 years old. Scald burns are the most common form of burn injury for children in the United States and are estimated to cost $44 million annually. Understanding the circumstances surrounding burn incidents and caretakers’ responses to them are needed to better guide prevention and education offerings.

Methods
We used a mixed methods approach to better understand pediatric scald burn mechanisms along with caregivers’ general knowledge, first aid responses and ability to accurately report characteristics of their child’s injury. Caregivers of children &lt; 15 year old attending a burn follow up clinic with their child were recruited. Participants completed a 39-item, iPad-based survey that captured information about the circumstances, location and cause of the scald burn, whether first aid was provided, and caregiver/child demographics. With permission of the caregiver, the child’s medical record was accessed to collect burn descriptors (e.g., burn severity, total body surface area (TBSA), etc) to compare with parent self-report. Data collection occurred between May 2018 - May 2019. The study was approved by our institutional review board.

Results
Surveys were completed by 55 parents; 75% agreed to medical record review. The typical respondent was the female caregiver (80%) with more than a high school education (67%). The typical burn incident occurred in the kitchen (60%) of the family’s home (80%) and in the presence of the caregiver (71%). Seventy percent of respondents reported applying first aid; among those, 50% administered the proper first aid (using cool water on the burn) despite most (44%) reporting feeling “not confident” in the ability to do so. More than half (53%) didnot know their child’s TBSA; of those who did, self-reported TBSA ranged from 1 to 50%. Medical record review revealed that only 5 participants accurately reported their child’s TBSA.

Conclusions
Our data reveal that most scald burns occurred in the kitchen, of the child’s home, and in the presence of a caretaker. Half received incorrect first aid and few parents could accurately report their child’s TBSA. These results support the need to strengthen primary prevention offerings and improve parents’ understanding of their child’s burn injury.

Applicability of Research to Practice
The results of this research can help guide education efforts for primary prevention programs related to pediatric scald burn injuries. Furthermore, results can guide education practices for caregivers of children being treated for a scald burn injury.
558 Relationship Between Patient Characteristics and Number of Procedures as Well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository
Authors: Kowal Stacey , Kruger Eliza , Bilir S Pinar , Holmes James H , Foster Kevin N 
Published: March 2020

Abstract

Introduction
Published information on the relationship between patient characteristics such as total body surface area (TBSA) of burn on number of procedures and length of stay (LOS) is not widely available in the United States. Clinical expertise assumes a “rule of thumb” of 1 day stay per percentage TBSA, but deviations based on burn and patient characteristics is rarely explored. The American Burn Association NBR version 8.0 (2002–2011) was analyzed to understand the relationship between key patient and burn characteristics for surviving, severe (TBSA 10–60%) burn patients and number of procedures or LOS.

Methods
Outcomes include the number of procedures autograft, debridement, and excision procedures and LOS. Independent variables considered were TBSA, TBSA of partial-thickness and full-thickness (FT) burn, age (linear, squared and cubed to account for non-linearity), hospital-acquired infection (HAI), other infection, inhalation injury, female gender and diabetes status. Statistical regression models were developed to control for the independent variables and predict the number of procedures and LOS based on such characteristics.

Results
Among 21,175 surviving burn patients (TBSA 10–60%), the mean age was 33 years old, and the mean TBSA was 19.9%. Number of excision and autografting procedures increased with TBSA. All independent variables were retained in the LOS model. After adjusting for gender, age and comorbidities, predicted LOS for adults (18+) was 16.4, 29.5, 42.7 and 56.0 days for 10%, 20%, 30% and 40% TBSA respectively. Similarly, predicted LOS for pediatrics (age&lt; 18) was 12.9, 26.0, 28.6 and 55.4 days for each TBSA group, respectively.

Conclusions
When considering all independent variables, the LOS per percent TBSA is estimated at approximately 1.12 days for adults and 1.01 for pediatrics. However, when considering patient (age, comorbidity status) and burn (burn depth, TBSA) characteristics, the observed LOS could vary by 66% more, as seen with detailed investigations into trends for patients with TBSA 20%. Using the predictive equations from this study, burn centers can generate tailored rule-of-thumb estimates for LOS/%TBSA that better reflect the influence of factors beyond burn center practice patterns.

Applicability of Research to Practice
587 DVT Screening in Lower Extremity Burns
Authors: Gibson Cameron J , Gupta Aakanksha , Houng Abraham 
Published: March 2020

Abstract

Introduction
Burn patients are at in increased risk for developing deep vein thromboses (DVT), with rates as high as 6%. Known risk factors include large burn size, use of central lines, increasing age, male, active smoker or alcoholic, increased blood transfusions and surgeries. No study to date has looked specifically at burn location as a possible risk factor. We hypothesized that lower extremity burns with delayed presentation to our burn center are at in increased risk for DVT formation.

Methods
A DVT screening protocol was developed and implemented for all burn patients admitted to our burn unit starting in May 2017. Patients who presented with lower extremity burns &gt;48 hours from their injury time underwent screening ultrasounds at admission to evaluate for DVT in the affected extremity. Data was collected from May 2017 through December 2018 for all lower extremity patients. Screened patients were identified by reviewing the burn registry for patients admitted &gt;2 days from their injury date and then reviewing the electronic medical record for screening US. DVT rates were compared between screened patients and the overall rate for all admissions during the study period.

Results
There were 1041 patients admitted to the burn unit during the study period, including 445 lower extremity burns with 118 admitted &gt;48 hours after their burn injury. The overall compliance rate with the screening protocol was 41.5% (49/118). There were a total of 4 DVT’s diagnosed among all admitted patients during the study period (1 lower extremity, 3 upper extremity), giving an overall rate of 0.5% for our unit. No DVT’s were identified in the delayed presentation group (p=0.46).

Conclusions
Our overall DVT rate was much lower than quoted rates in the literature. Patients with lower extremity burns and delayed presentation to a burn center do not appear to be at increased risk for DVT. Compliance with our screening protocol was relatively poor, which may be due to short hospital stays and unavailability of ultrasound on weekends for non-urgent studies.

Applicability of Research to Practice
Patients with lower extremity burns should receive routine DVT prophylaxis (chemical and mechanical) similar to other burn patients.
594 Improving the Accuracy of Discharge Wound Care Instructions in a Teaching Facility
Authors: Robinson Kara , McMahon Melanie , Campbell Stephanie 
Published: March 2020

Abstract

Introduction
Clinic staff at a regional verified burn center reported a trend of patients coming in for follow up appointments confused about home wound care due to written discharge instructions that did not match what they were taught in their last inpatient wound care session. Examples of inaccurate instructions included referring to topicals the patient was not currently using or failing to address the care of all wound types present. The reported cases were reviewed by nursing and physician leadership through the burn center quality improvement process.

Methods
A retrospective chart review of all patients discharged with open wounds was completed for the previous 5-month period to establish a baseline rate of inaccurate instructions. Discharge instructions were counted as inconsistent if they did not match the wound types, dressings, and topicals charted in the patient’s last inpatient wound care. Contributing factors identified included that the instructions were most often free texted by rotating surgical residents. It was decided that pre-written choices might improve the accuracy of the instructions. A wound care discharge template was developed through a collaboration with the hospital clinical informatics department. The design included drop down choices for dressings, topicals, and body parts. Standard phrases within each selection were written by an experienced burn service provider. Discharge education was added to the monthly in-service for resident physicians. A large sign with instructions for the template was placed in the physician workroom along with cards posted to the top of each computer. Audits comparing the discharge instructions to the last wound care note then continued for a 4-month period.

Results
The retrospective chart review revealed an average of 28% of discharge instructions were incorrect or incomplete each month, with a range of 25–32.7%. In the 4-month period after the template was released, the monthly average dropped to 12.85%, with a range of 7.7–17.9%. It was also noted that inaccurate instructions in the post-template audits typically only had a small error compared to the more complicated errors noted prior to the template implementation.

Conclusions
The incidence of incorrect wound care discharge instructions written by burn team providers decreased with the introduction of a discharge wound care template. More analysis is needed to identify additional opportunities to further decrease the rate of inconsistencies.

Applicability of Research to Practice
Thorough and accurate wound care instructions with standardized language may improve the patient’s confidence with performing wound care at home and improve their post-discharge experience. Consistent wound care instructions also help to ensure that the wounds are cleaned and dressed with the appropriate topicals and dressings, potentially decreasing the risk of infection and graft loss.