bluuebunny/crossref_metadata_2025_split huggingface dataset:
81 Inhalation Injury Is Associated with Long-term Physical, Satisfaction with Life, and Employment Outcomes: A Longitudinal National Database Study
Authors: Stockly Olivia , Wolfe Audrey E , Carrougher Gretchen J , Stewart Barclay T , Gibran Nicole S , Kowalske Karen J , Schneider Jeffrey C , Ryan Colleen M , Wolf Steven E 
Published: March 2020

Abstract

Introduction
The effects of inhalation injury on mortality are well established. However, little is known about the long-term impacts of inhalation injuries on survivors. This study aims to describe the inhalation injury population and examine differences in long-term physical, mental, employment, and satisfaction with life outcomes between adult burn survivors with and without inhalation injury.

Methods
Data from the Burn Model System National Database (1993–2019) were analyzed. Demographic and clinical characteristics of those with and without inhalation injury were assessed. The Physical Health Composite Scale (PCS) and Mental Health Composite Scale (MCS) of the Short Form-12 Health Survey, Employment Status, and Satisfaction with Life Scale (SWLS) were analyzed at 24 months post-injury. Regression analyses assessed whether inhalation injury was associated with each outcome, which were adjusted for age, gender, race, ethnicity, and burn size.

Results
The analysis included 4,045 individuals (452 with inhalation injury, 3,593 without inhalation injury). Those with inhalation injury had larger burn size, longer hospital lengths of stay, and more operations; they were less likely to be employed at injury and injured at work, and took longer to gain employment after injury (Table 1). Two years after injury, individuals with inhalation injury were half as likely to be working (OR = 0.49, p&lt; 0.001), and had worse PCS (β=-2.51, p=0.021) and SWL scores (β=-2.35, p=0.006) compared to those without inhalation injury. MCS scores did not differ between groups.

Conclusions
Burn survivors with inhalation injuries experience lower rates of employment, worse physical functioning, and worse satisfaction with life outcomes at 24 months post-injury compared to those without inhalation injuries.

Applicability of Research to Practice
Burn survivors with an inhalation injury may require supplementary resources and treatment as well as monitoring of sequelae long-term.
89 Antimicrobial Resistance Pattern and Prevalence of Extended Spectrum Beta-lactamase in Non-fermenting Gram Negative Bacteria, Isolated from Burn Wounds: A Prospective Study from a Tertiary Burn Center
Authors: Naderi Niyousha , Safdarpour Armin , Hakemi-Vala Mojdeh , Masoomi Hossein 
Published: March 2020

Abstract

Introduction
Burn wound infections are one of the major causes for long-term hospitalization and mortality among patients with thermal injuries. Identifying the bacterial cause of infection and determining the appropriate antibiotic to treat these infections is an important stage in treatment. The aim of this study was to investigate antimicrobial drug resistance in non-fermenting gram-negative bacteria isolated from burn wounds in patients who were admitted to a tertiary burn center.

Methods
In this prospective study during a six-month period in 2018,100 isolates of non-fermenting gram-negative bacteria were collected from 100 patients with thermal injuries. Antibiotic susceptibility test was performed using the Kirby-Bauer method based on the clinical and laboratory standards institute guidelines. Double-disc synergy test, a phenotypic method, was used to identify strains producing extended-spectrum beta-lactamase (ESBL). Data analyses were performed using SPSS.

Results
A total of 100 wound samples were examined from 100 patients, 76% were male and 24% were female with a mean age of 33 years (range 1–89 years old). Mean total body surface area burned was 35% (range 1–95%) and mean length of hospital stay was 24 days (range 3–69 days). Eighty five percent of cases were under 50 years old. Overall mortality rate in this study was 17%. The major causes of burn were liquefied natural gas tank explosion (35%) and scalds (19%). Acinetobacter baumannii (A.baumannii) was the most common pathogen followed by Pseudomonas aeruginosa (P.aeruginosa) (60% and 40%, respectively). ESBL producing rate was significantly higher in P.aeruginosa isolates (27.5%) than A.baumannii isolates (3.3%) (P-value &lt; 0.001). Antibiotic resistance pattern of P.aeruginosa showed the highest resistance to ciprofloxacin, amikacin and imipenem (95%), followed by gentamicin (92.9%),ceftazidime(87.50) and piperacillin-tazobactam(85%). Antibiotic resistance pattern of A.baumannii showed the highest resistance to ceftazidime(100%) followed by ciprofloxacin, amikacin, imipenem(98.3%), gentamicin and piperacillin-tazobactam (93.3%). Multiple drug resistance (MDR) rate among A.baumannii and P.aeruginosa was 98.3% and 92.5% respectively, which is higher than previous reports.

Conclusions
A.baumannii and P.aeruginosa were the most common pathogens identified in this cohort with a significant MDR rate (over 95%). New strategies to control expansion of antimicrobial resistance in burn centers are necessary.

Applicability of Research to Practice
This study shows the antimicrobial resistance pattern and prevalence of ESBL in burn wounds indicating that further studies requires to identify new strategies to control emerging antimicrobial resistance in burn centers.
97 Burns in the Military Setting- analyzing 12,799 Routine & Combat Cases
Authors: Yaacobi Dafna (Shilo) , Lvovsky Alex , Ad-El Nitay , Levi Diana , Glick Yuval , Furer Ariel , Ad-El Dean D 
Published: March 2020

Abstract

Introduction
Burns are an important part of military trauma injuries. Studying the epidemiology, due to large morbidity related issues, is important for decision makers.
The aim of the study is to review and characterize the burn injuries that occurred in the Israel Defense Forces (IDF) during the years 2008–2016 in training, routine and war. The burn area, degree, setting, unit, etc. will help us characterize the etiology, severity and consequences which is crucial in developing and directing resources to prevention and treatment programs.

Methods
All burn injuries in 2008–2016 were retrieved (ICD-Z 940–949). Data was collected from the IDF military medical records and included 3 months of follow-up. We retrieved 65,536 medical records, which included follow up of 12,799 soldiers. Special algorithms were specifically designed to retrieve and analyze variables included.
Distribution analysis was performed, Parametric Kruskal–Wallis test was used and Chi Square test was used for comparing categorical variables.

Results
During the years 2008–2016, 65,536 burn related visits were retrieved and 12,799 burn injuries were identified. Gender distribution in figure 1.
Gradual decrease in burn injuries was identified (figure 2). Distribution by Setting (figure 3), Commands (figure 4), Etiologies (figure 5), and etiologies within commands (figure 6).
Average Total Body Surface Area (TBSA) was 7.524% (figure 7) and also declined over the years (7.7% in 2008 to 7.1% in 2016).

Conclusions
The decrease in burn rate could be attributed to the increased awareness of soldiers due to the emphasis given to health education and preventive medicine, as well as to improved protection.
Scald and flame replaced by chemicals as the leading etiology, It is hypothesized that a small part of chemical burns is a result of self-infliction, which is more prevalent at non-combat units.
Average Total Body Surface Area (TBSA) was similar but lower than other studies.
The nature and operation mode of the IDF must be kept in mind- a relatively small army composed mainly with obligatory servicemen, there are no dedicated military hospitals, major trauma can be transported directly to the civilian medical system and not appear in the military medical charts.

Applicability of Research to Practice
This extensive report shows the trends and characteristics of burn injuries in the IDF, allowing for better understanding of these important injuries, and concluding for target health education based on common etiologies and at-risk populations and commands.
IDF Commanders should preserve the current burn prevention educational programs, and protection instruments such as uniforms, special gloves and eye protection appliances, since they seem to work, and improvement was observed.
Education should also focus on proper handling of various chemicals, and if self-inflicted suspected- psychological intervention should be considered.
99 Hand Burns: An Independent Risk Factor for Worse Hospital Outcomes
Authors: Pham Christopher H , Collier Zachary J , Sheckter Clifford C , Yenikomshian Haig A , Gillenwater Justin 
Published: March 2020

Abstract

Introduction
Hand burns cause disability, loss of productivity, and psychological distress. While rarely life-threatening, hand burns are life-altering. There are limited large-scale investigations on the prevalence of hand burns and the impact on hospital outcomes. We present the first National Burn Repository (NBR) study on the prevalence of hand burns and associated outcomes.

Methods
We used NBR Version 8.0 to identify patients who sustained isolated and non-isolated hand burns. These patients were then sub-stratified into operative vs. non-operative hand burns and compared with non-hand burns as controls. Patient demographics and hospital outcomes (mortality, length of stay [LOS], intensive care unit LOS [ICU LOS], hospital charges) were collected. Multivariable logistic and multiple linear regressions determined the effect of hand burns on outcomes adjusting for age, %TBSA, full-thickness involvement, and inhalation injury.

Results
Of 172,640 NBR patients, 47,424 patients had hand burns and 5,870 (12%) were operative. Patients with hand burns had significantly larger %TBSA burns (12±18% vs. 7±8%, P&lt; 10–4), more full-thickness involvement (6±16% vs. 2±6%, p&lt; 10–4), a higher prevalence of inhalation injury (7% vs. 5%, p&lt; 10–4), were more often male (73% vs. 66%, p&lt; 10–4), higher mortality (5% vs. 2%, p&lt; 10–4), longer LOS (12±22 vs. 8±21 days, p&lt; 10–4) and ICU LOS (7±18 vs. 3±10 days, p&lt; 10–4). Similarly, operative hand burns had longer LOS (25±30 vs. 10±20, p&lt; 10–4) and ICU LOS (25±29 vs. 12±22, p&lt; 10–4) but lower mortality (3% vs. 6%, p&lt; 10–4) than non-operative hands. When controlling for age, sex, TBSA, full-thickness involvement, and inhalation injury, the presence of hand burns significantly predicted higher mortality (OR=1.6, 95% CI 1.5–1.8, p&lt; 10–4) and prolonged ICU stays by 0.79 days (p=0.003), but was not associated with prolonged LOS (p &gt;0.05). Billing data revealed significantly higher hospital charges ($114,608±294,289 vs. $58,314±158,758, p&lt; 10–4) in patients with hand burns (N=17,140) compared to those without (N=12,530).

Conclusions
Patients with hand burns had worse inpatient outcomes and were also more costly to the healthcare system. Practitioners must pay close attention to hand burns as the cost to the system and society warrants improved management. In a society increasingly focused on value and quality, additional investigations are needed to understand how we can better treat hand burns to decrease inpatient morbidity.

Applicability of Research to Practice
Granular data for the hospital course of patients with hand burns may better elucidate why they require more healthcare resources than others.
112 Improvements in Burn Hypertrophic Scar After Fractional Ablative Laser Scar Revision
Authors: Travis Taryn E , Allely Rebekah R , Johnson Laura S , Shupp Jeffrey W 
Published: March 2020

Abstract

Introduction
Fractional ablative laser therapy use is increasing for treating burn hypertrophic scar (HTS). However, standard components of a routine HTS evaluation prior to starting laser scar revision (LSR) and after each intervention have yet to be determined, and metrics for effective treatment have not been established.

Methods
Patients who entered a LSR program between September 2018 and September 2019, underwent at least two LSR treatments, and completed post-LSR scar evaluations for each of these treatments were included in the studied sample. Patients were treated with a fractional ablative CO2 laser. A single burn rehabilitation therapist conducted all pre- and post-procedure scar evaluations, which included the Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale (VSS), Institutional Scar Comparison Scale (SCS), durometry, and active range of motion (AROM) measurements.

Results
From 9/2018 to 9/2019, 25 patients began the LSR program and underwent at least two treatments with post-laser scar assessments for each intervention. Patients underwent an average of 3±1 LSR sessions during the time period for a total of 84 sessions amongst the group. Patients averaged 51±14 years old (range 26–80), with all Fitzpatrick skin types represented (mode type 5). Average HTS age was 14±19 months post-injury (range 3–98 months post injury).
After one session of LSR, 91% of patients improved in at least one scar assessment metric (average 3±1.4 areas). After two sessions, all patients showed improvement in at least one metric (average 3.6±1.2 areas). One LSR session was associated with a 10.8±31.9% improvement in AROM of a HTS-affected joint, and this increased to 38.1±41.4% after five LSR treatments (p=0.0002). Durometry readings demonstrated decreasing scar hardness compared to adjacent uninjured skin in 90% of patients, and 96% of patients experienced improvements in POSAS, VSS, and SCS scores during a treatment course.

Conclusions
Improvements in burn HTS can be achieved with fractional ablative laser therapy in a wide range of scar ages and skin types, as early as the first LSR session. These continue to increase as additional sessions are performed.

Applicability of Research to Practice
This work suggests necessary baseline evaluation components for patients undergoing LSR, as well as a timeline for expected clinical improvements. This data may inform conversations with burn survivors and providers when considering laser therapy for symptomatic HTS.
115 Predicting Graft Failure in a Porcine Burn Model of Various Debridement Depths via Laser Speckle Imaging and Deep Learning
Authors: Liu Nehemiah T , Stone Randolph , Salinas José , Christy Robert J 
Published: March 2020

Abstract

Introduction
Early excision and grafting (E&G) remains a mainstay in the treatment of burns. Procedures to remove necrotic tissue from severe burn wounds continue to be challenging and may affect rates of successful grafting. The use of laser speckle imaging (LSI) may help detect necrotic tissue remaining but requires human interpretation. Additional decision-making support is needed, especially in prolonged field care settings. The purpose of this study was to evaluate whether graft success or failure can be predicted from LSI using machine learning (ML) and deep learning (DL) techniques in a porcine burn model of various burn depths.

Methods
Anesthetized Yorkshire pigs (n=12) were burned with a 5x5 cm square brass block (0.4 kg/cm2) @ 100°C to produce partial, deep partial, or full thickness burns (PT, DPT, FT) at 10 square sections on the back of each pig. Debridement was randomized from 1 (0.030”) to 4 (0.120”) passes performed using a dermatome, and then meshed split thickness skin grafts taken from 4 caudal donor sites were applied to wounds. Post-debridement was denoted as Day 0. Graft success/failure (&gt;70% graft take) was determined at Day 7. Laser speckle images were captured at Days 0, 3, 7, 10, and 14. ML and DL were used to develop models in order to predict graft failure and burn/debridement depth. Model performance was measured using loss, accuracy, and confusion matrices.

Results
Of 120 sections corresponding to 12 pigs, 7.5% (9/120) were not burned, 41.7% (50/120) were PT, 25.8% (31/120) were DPT, and 25.0% (30/120) were FT burns. Graft failure was 19.2% (23/120), with a 50.0% (10/20) rate for DPT burns involving 1- or 2-pass debridement. Both ML and DL used 600 images for algorithm development; 540 images, for training; and 60 images, for testing. DL was superior over ML in test accuracy (93.3% vs 75.0%, p&lt; 0.05). A three-stage architecture plus image resizing was employed in DL to predict graft failure and burn/debridement depth. A best convolutional neural network for graft failure prediction was obtained, yielding a minimum cross entropy loss of 11.7% and accuracies of 96.5% (training), 93.3% (testing 1), 100.0% (testing 2), and 96.2% (overall). Promising results were also obtained for predicting burn/debridement depth: 97.6% (training), 93.3% (testing).

Conclusions
This study showed that graft success or failure can be predicted from LSI and DL in a porcine burn model of various debridement depths. Use of this technology may provide a potential approach for accurately assessing early E&G in severely burned patients and may aid providers during prolonged field care scenarios.

Applicability of Research to Practice
Use of LSI in conjunction with DL may provide a potential approach for accurately assessing early E&G in severely burned patients and may aid providers during prolonged field care scenarios.
500 Intracranial Injuries and the Effect of Fluid Resuscitation in Burn Patients
Authors: Williams Alicia M , Stephens Brian , Rizzo Julie A , Frattalone Anthony R , Chung Kevin K , Ainsworth Craig , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
Few studies exist that describe the neurologic injuries seen in patients admitted to the burn ICU. Patients who have sustained a severe thermal injury undergo complex metabolic, hemodynamic, and inflammatory changes and require aggressive fluid resuscitation. The neurologic consequences of burn-associated resuscitation may have clinical implications. The purpose of this study was to evaluate the intracranial neurologic injuries and how they relate to volume of burn-related resuscitation fluids administered.

Methods
We performed a retrospective analysis of all patients admitted to the Burn ICU at a single facility between January 2003 and June 2017. Patients were included if they were admitted within 24 hours of their burn injury and obtained head computed tomography (CT) for any indication in the first 96 hours of hospitalization.

Results
Of a total 5176 patients admitted, 439 met the inclusion criteria. An acute intracranial process was identified in 41 cases. 27 patients received 0–150 cc/kg of IV fluids, while 11 received &gt;200 cc/kg during the first 24 hours. The most common injuries in the former were hemorrhage (subarachnoid, intraparenchymal) and edema (7/27 for each), while ischemia/infarction (4/11) was the most frequent in those receiving &gt;200 cc/kg. Follow up imaging was more likely to be worse in the &gt;200 cc/kg group (5/11) than in the &lt; 150 cc/kg group (2/27).

Conclusions
Of patients admitted to the Burn ICU within 24 hours of injury and who received a head CT within the first 96 hours, an acute intracranial abnormality was found in 8% of patients. The most common diagnosis was hemorrhage in those receiving &lt; 150 cc/kg of IV resuscitation, while ischemic/infarction was more common in those receiving &gt;200 cc/kg. Follow up imaging in those receiving more IV fluids was more likely to demonstrate worsening, which could suggest that increased resuscitation leads to worsening intracerebral outcomes.

Applicability of Research to Practice
Having a high index of suspicion for intracranial complications related to resuscitation improves the multi-disciplinary team’s ability to prevent, identify early and treat appropriately in order to improve patient outcomes.
506 Anticoagulation After Thrombolytic Treatment for Frostbite: A Case Series
Authors: Garza Amanda M , Zavala Sarah , Sanford Arthur , Baldea Anthony J , Liu Yuk Ming 
Published: March 2020

Abstract

Introduction
Historically, management of frostbite followed the adage “freeze in January and amputate in July.” While rapid rewarming primarily addresses the ice crystal formation phase of damage, vascular injury and resulting thrombosis result in the overall tissue damage. Over the last two decades, limb salvage for frostbite has been widely employed. The use of tissue plasminogen activator (tPA) to prevent vascular thrombosis has been found to reduce the number of digit amputations and benefit of systemic thrombolytic therapy has been demonstrated. Post-thrombolysis anticoagulation has changed as well. Our institution has changed its protocol from using warfarin after tPA therapy to aspirin (ASA) for ease of adherence. This study evaluates the use of warfarin or aspirin for management after tPA therapy.

Methods
This was a retrospective review of patients who received tPA for frostbite between January 2008 and April 2019. Data collected included age, height, weight, sex, past medical history, contributing factors to development of frostbite, toxicology screen on admission, cold exposure time, rewarming time, number of digits/limbs affected, and highest grade of injury. Outcomes data included medications received, number of digits/limbs amputated, length of stay, and number of follow up visits.

Results
Ten patients were included in the statistical analysis, 7 patients in the ASA group and 3 patients in the warfarin group. Baseline demographics were similar between groups, except the ASA group was significantly younger (31.9 vs 64.7 years, p &lt; 0.001) and weighed less (70.3 vs 86.8 kg, p = 0.02) than the warfarin group. Statistical analysis demonstrated no significant difference in outcomes when comparing patients managed with ASA 325 milligrams (mg) versus warfarin after tPA therapy. The average number of limbs amputated for patients taking ASA was 0 + 0.0 and was 0.7 + 1.2 for those taking warfarin (p=0.42). Average number of digits amputated for patients taking ASA and warfarin was 0.1 + 0.4 and 3.7 + 5.5, respectively (p=0.38). For patients who took ASA, length of hospital stay averaged at 8.0 + 4 days, while those who took warfarin stayed for 9.4 + 7.2 days (p= 0.64). Finally, the average number of follow up visits for patients who took ASA and warfarin was 3.9 + 4.7 and 8.0 + 9.6, respectively (p=0.37).

Conclusions
These findings indicate that there may not be a significant difference in clinical outcomes when comparing patients who took ASA to warfarin after tPA therapy. It is common for patients to have a delayed presentation and prolonged rewarming time, resulting in ineligibility to receive tPA. Single center frostbite studies are limited due to sample size and multi-centered studies are necessary for future studies.

Applicability of Research to Practice
ASA 325 mg daily may be a suitable alternative to warfarin therapy after tPA administration following a frostbite injury.