bluuebunny/crossref_metadata_2025_split huggingface dataset:
722 An Experience with a Biodegradable Temporizing Matrix in a Metropolitan Burn Center
Authors: Lodescar Rachelle J , Gibson Cameron J , Gallagher James 
Published: March 2020

Abstract

Introduction
In a large adult and pediatric metropolitan burn center, we are faced with a variety of challenging burn and complex wound cases that require surgical intervention. With the introduction of a new biodegradable temporizing matrix (BTM) in the US in 2017, we have introduced into our surgical routine a new option for wound coverage in these complex cases. This new biodegradable temporizing matrix has allowed us to provide dermal support and temporary wound closure in critical patients undergoing life-saving clinical support while awaiting skin graft closure. We share our experience using BTM in managing complex wounds in a series of patients over the past year.

Methods
A retrospective chart review of six patients who were admitted to our burn center, underwent BTM placement and subsequent skin grafting from February 2018 – August 2019 was performed. We analyzed mechanism and type of injury, indication for BTM placement, post burn day (PBD) placement of BTM and PBD to skin grafting and objective patient outcome.

Results
Conclusions: The availability of a biodegradable temporizing, polyurethane-based material in our burn center has positively added to our repertoire as surgeons an additional method for temporary wound closure as a dermal template. What we have learned is that we can improve wound bed preparation for ultimate skin grafting, particularly in critically ill patients with complex wounds and comorbidities.

Applicability of Research to Practice
Directly applicable to research.
725 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome
Authors: Lifferth Gregory , Roth Bryan , Lardizabal Marisse , Kowal-Vern Areta , Foster Kevin N , Matthews Marc 
Published: March 2020

Abstract

Introduction
Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations.

Methods
This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019.

Results
The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p &lt; .0002. Dorsal/Lateral incisions had the highest number of amputations.

Conclusions
Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases.

Applicability of Research to Practice
This research was a critical appraisal of the safest escharotomy foot incisions for compartment syndrome to avoid possible amputations in burn injury.
726 The Use of Xeroform Dressings for Partial Thickness Scald Burn Injuries in a Verified Pediatric Burn Center
Authors: Vitale Lisa C , Livingston Jennifer , Curtis Erica , Oag Katherine , Shanti Christina M , Klein Justin D 
Published: March 2020

Abstract

Introduction
For children who have suffered a burn injury one of the greatest challenges is managing pain with an adequate yet practical burn wound dressing that will ultimately be managed at home. Medical product companies have created a variety of wound care products available on the market. These products are advertised to be more superior over one another in categories such as decrease in wound infections, minimization of pain, ease of dressing application, increased dressing wear time, and better wound healing. With all the options for burn wound care there are many factors to consider when choosing a burn dressing such as cost, ease of dressing for families at home, comfort, and efficacy. At our ten year verified pediatric burn center we have tried many different burn wound care products, however we have found Xeroform and bacitracin to be the most practical and easy to use for our patient population.

Methods
A retrospective chart review was performed from 2016–2018 of all cascading scald injuries to children 0–5 years of age treated at our verified pediatric burn center. 179 patients were included in this review. Of those patients a total of 52 patients were excluded, 28 patients had no follow up, 21 patients received alternate dressings, and 3 patients had full thickness injuries requiring a split thickness skin graft (STSG). Charts were reviewed for total body surface area (TBSA), length of stay (LOS), discharge dressing type, complications, and time to healing. All patients included routinely received consistent application of the Xeroform and bacitracin.

Results
127 patients discharged with Xeroform dressings were included in this study with an average age of 1.4 years old (range 0–5 years) and average TBSA of 2.5% (range 0.25–13%). The average LOS was 1.6 days (range 1–10 days). In this sample 32 (25%) patients were healed within 7 days. 77 (61%) patients were healed within 7–14 days. 11 (9%) patients were healed within 14–21 days. 7 (5%) patients were healed in greater than 21 days. There were no wound complications identified within this study group.

Conclusions
Using Xeroform as our standard of practice has streamlined the care provided to our patients. We have demonstrated consistent effective re-epithelization, protection from infection, and ease of dressings for families and burn providers. In our experience Xeroform has provided a versatile way to care for partial thickness burn injuries.

Applicability of Research to Practice
We suggest Xeroform and bacitracin dressings be used for partial thickness burn injuries in patients under 5 years of age. This dressing may be superior to other products because it allows for bathing while providing good wound epithelization and is easy to use.
741 Trends in Offending Medications in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis in a Large Academic Burn Center
Authors: Duplisea Michael , Chrisco Lori , Williams Felicia N , Nizamani Rabia , Laughon Sarah L , Cairns Bruce , Jones Samuel W , Ziemer Carolyn 
Published: March 2020

Abstract

Introduction
Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a rare, severe mucocutaneous eruption caused by medications and resulting in diffuse epidermal detachment. Patients are often referred to burn units for specialized care. This study assesses trends in precipitating medications over 10 years at our Burn Center.

Methods
We performed a single-site, retrospective review at our burn center using the institutional burn registry and patient charts. Patients admitted from January 1, 2009 to December 31, 2018 identified as having SJS/TEN were eligible for inclusion. Demographics, comorbidities, diagnosis, treatment, inciting agents, and severity-of-illness score for TEN (SCORTEN) were evaluated. Statistical analysis was performed using the Mann Whitney U test using SAS version 9.4 (SAS Inc., Cary, NC).

Results
Biopsy-proven SJS, SJS/TEN overlap, or TEN was confirmed in 168 patients. Of these, 103 had a single identified offending drug. Of these patients, 36% had been exposed to sulfamethoxazole-trimethoprim (SMX-TMP), 11% to allopurinol, and 10% to lamotrigine. Trends in culprit drug by year are shown in Figure 1. The majority of SMX-TMP and penicillin cases occurred early in the period of study; lamotrigine and pembrolizumab cases occurred more recently. Patients exposed to allopurinol presented with higher SCORTENs than patients exposed to SMX-TMP, 2.9 vs 1.9, respectively (p&lt; 0.035).

Conclusions
SMX-TMP once accounted for a large portion of SJS and TEN cases at our center. In recent years, lamotrigine has become a more common offending drug, prescribed in our cohort for psychiatric indications. Also notable, in the past year we have treated three patients with TEN due to immunotherapy (pembrolizumab) for metastatic or unresectable cancer. Paralleling the increasing use of immunotherapy has been a rise of immune-related adverse events, including severe skin toxicities. Further study is warranted to determine what can be done to prevent SJS/TEN from occurring in patients treated with these drugs.

Applicability of Research to Practice
Understanding emerging trends in causative agents of SJS/TEN will allow the burn community to focus education efforts for providers who prescribe these medications frequently. The psychiatric and oncology communities may benefit from increased awareness of the risk of SJS/TEN in patients receiving lamotrigine and immunotherapy, respectively.
742 Marijuana and Drugs of Abuse: Impact on Clinical Outcomes in Burn Injury
Authors: Wagner Anne L Lambert , Smith Tyler M , Dyamenahalli Kiran U , Duffy Patrick , Kovacs Elizabeth J , Wiktor Arek J 
Published: March 2020

Abstract

Introduction
Alcohol has been shown to increase hospital length of stay, complications and mortality in burn patients in studies examining its effects over the past 25 years. In contrast, there is a scarcity of published data on the effects of marijuana and other drugs of abuse in the burn population. The primary aim of this study is to evaluate the clinical outcomes of marijuana use on burn patients in comparison to other drugs of abuse including alcohol.

Methods
A retrospective cohort study was conducted on 875 burn patients admitted to a verified burn center from July 2015 to July 2019. Patients were identified from our burn registry and additional data was obtained from chart reviews. The primary comparison was between patients with and without a positive toxicology (tox) screens on admission. Contingency analysis for categorical variables was performed using Fisher’s exact test, while the Mann-Whitney U test was used to compare continuous variables, reporting two-tailed p values.

Results
Results of admission tox screens on all burn admissions were positive in 48% (423) of patients for drugs of abuse including: marijuana 41% (358), alcohol 16% (141), and stimulants 15% (134). Tox screens positive for alcohol were significant for increased: hospital length of stay (LOS) (p=0.0121), ICU LOS (p=0.0166), ventilator days (p=0.0324), number of operations (p=0.0341), and complication rates (p=0.0005). Patients with positive drug, but negative alcohol screens showed significant increases in: hospital LOS (p=0.029), hospital complications (p=0.0251), and wound infections (p=0.04). Patients testing positive for marijuana approached significance for an increased hospital LOS (p=0.0756) and was significant for increased wound infections (p=0.0476). Looking at median ages: tox positive patients (35) were significantly younger (p=&lt; 0.0001) than negative (49). The median age for patients testing positive for marijuana (35) was significantly younger (p=&lt; 0.0001) than those that testing negative (47). Median age regarding alcohol tox screens was insignificant. Looking at significance in median TBSA, significance was found between tox positive (4.3%) and tox negative (3.5%) patients (p=0.004). TBSA was insignificant in the other groups.

Conclusions
Almost half of all admitted burn patients tested positive for alcohol and other drugs of abuse. As in previous studies, patients testing positive for alcohol continue to have a more complicated hospital course and longer hospital and ICU LOS. Marijuana, positive in 41% of all burn admissions, showed significance in increased wound infections and a slight trend towards an increased hospital stay.

Applicability of Research to Practice
The association between burns and drugs of abuse including alcohol indicates the need for increased preventative and educational efforts especially in patients suffering from alcohol abuse/dependence and younger patients.
747 Developing a Burn Mass Casualty Incident (BMCI) Plan for a State (first Steps)
Authors: Kearns Randy D , Mai Kathryn , Hargrove Paige B , Short Tracee , Hector Chris W , Carter Jeffrey E 
Published: March 2020

Abstract

Introduction
A burn mass casualty incident (BMCI) occurs when a disaster involves many injured patients who have specific burn injuries. For this particular state, there are four burn centers. They range in size from 4–20 beds. The area hazards include:

Methods
A meeting was arranged for the burn center directors. Burn surgeons, along with burn center nursing staff, evaluated a series of “predefined patients” distributed over a compressed timeline during the hourlong exercise. The participants had not previously seen the “patients” nor were they aware of their injuries until the exercise controller released the information. The exercise controller was provided by a state emergency response coordination agency. The exercise followed a meeting that discussed efforts to standardize emergency medical services (EMS) care in the state, and route burn patients through the state call center to the most appropriate burn center. The final hour of the morning focused on the tabletop exercise, followed by a “hot-wash” (debriefing).

Results
The scenario included 20 patients staggered over the morning with each surgeon considering capacity and capability to manage the theoretical patients who ranged in age from 1 month to 81 years old (Median 24, Mean 28.2) with a TBSA range of 0 to 73 (Median 6, Mean 12.85). There were 4/20 patients intubated on arrival, and an additional 7/16 had “soot tinged sputum.” 16/20 arrived by EMS.
Assuming this was a Type III Burn Disaster (meaning burn event only), all four burn center directors reported under ideal circumstances; they could absorb these patients into their respective hospital systems. However, it was also clear that while all could admit, sustaining all of these patients over an extended period may be problematic and potentially require a transfer. It was also discussed that had the severity of burn injury changed for two or more patients, it could have led to exceeding the capability/capacity for most of the burn centers.

Conclusions
The key to this event was to identify a trigger point for each facility. Every disaster plan requires a trigger or triggers meaning an activation point to begin treating an event based on their BMCI (or burn surge) plan. The next logical step in this process is to analyze further the capabilities and capacities that will inform the planning process as it evolves.

Applicability of Research to Practice
A working BMCI plan could improve resource utilization during disasters.
752 Single-center Experience with 4th of July Fireworks Injuries
Authors: Thomas Mini , Sneller Cindy R , Joe Victor C , Chin Theresa L , Inocando Jocel 
Published: March 2020

Abstract

Introduction
Despite existing restrictions and laws related to sale and use of fireworks, prevention of firework injuries has not reached its goal line. The purpose of this project is to identify impact of firework injuries and to seek for any trends or patterns.

Methods
We conducted a retrospective chart review of 2019 firework related injuries treated at our burn center and obtained 2017–2019 firework data from the County Firework Authority. All patients treated in the month of July 2019 at emergency department, clinic, and inpatient service were included. Data extracted include patient demographics, nature of injury, type of firework involved, location, treatment, and length of stay.

Results
A total of 24 cases were reported to the county and 14 patients received care for firework related injuries in our center. Additionally, four out of the fourteen patients reported or screened to be positive for alcohol, THC and or toxic drug. Further, three of the incidents happened in cities not permitted for firework. Even though total burn surface area was less than 5% for all patients, 50% of patients required surgical treatment, including amputation of fingers for one patient. Hand burn was observed to be the most (78%) common body part affected.

Conclusions
Preventable injuries of 14 cases related to fireworks in a single burn center around a holiday could be considered a large group. However, our center is in a county with less than national average firework injuries and had reported fourteen less cases in 2019 than 2018. Further, only 10 out of 34 cities in the county have firework permits. “Safe and sane” fireworks, allowed in the 10 permitted cities, were named only in a single incident. The majority of incidents involved fireworks illegal in all cities of the county, including M-80’s, firecrackers, mortars, roman candles and bottle rockets. Cities were probably safer in 2019 due to significantly larger (5965lbs) confiscated fireworks. While 2019 injuries is relatively lesser in volume compared to previous years and other locations, significant injuries leading to surgery and loss of body part requires further preventive work.

Applicability of Research to Practice
There is a need for increased education and prevention efforts regarding fireworks and potential for burn injury. This education needs to include both the device user and associated bystanders. Advocacy should involve the development of safety features for these devices and additional stringent policies and law enforcement.
753 Burn Specialty Specific Advocacy, What Can You Do for Injury Prevention
Authors: Sanford Arthur , Petersen Paula , Liberio Julie N , Sanford Susan , Liu Yuk Ming , Baldea Anthony J 
Published: March 2020

Abstract

Introduction
Scald injuries affect many vulnerable populations. We know that there is a relationship between time and temperature as to severity of injury. When one of the authors had their residential hot water heater replaced, it was set to an uncomfortable temperature, 134oF, until adjusted to a safe level. This highlighted the possibility of catastrophic injury from a simple household function like washing hands or taking a bath. As a result, we have undertaken efforts to assess locations where burn team members and their families are potentially exposed to excessively hot water and educate them as to methods to measure their water temperature and maintain it at safe levels. Temperature differences between 120oF and 130oF mean the difference between injury in minutes to seconds.

Methods
Using a Taylor Market Digital Candy Thermometer, the tap is run at maximum hot water for 2 minutes. With water still running, a volume of approximately one liter is collected and the thermometer is immediately immersed in the water with the temperature recorded once stable. Data was recorded at a variety of locations, including residential (of care team), hotels, and around a variety of taps through the hospital.

Results
Twenty sites were measured for water temperature. The average temperature recorded was 114.1oF, with a median temperature recorded 110.9oF. There were three recordings of water temperature greater than 120oF, with the highest recorded at 132.9oF. All of these sites were immediately informed of the risks and appropriate measures taken to adjust water sources to an appropriate temperature.

Conclusions
We as burn care professionals know what acceptable water temperatures are for taps in our personal spaces. Despite that it is possible that hazardous conditions can exist. Many areas of society are looking for the guidance of health care providers, and we need to start in our own homes to make that environment safe, and then take that message to our relatives and community.

Applicability of Research to Practice
This is a real world demonstration of the need to verify safety in our own homes and then take that message of prevention to vulnerable populations.
772 Psychosocial Impact of a New Peer-support Program at a Burn Center
Authors: Lam Loc H , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
In March 2019, this Burn Center became the 76th active Survivors Offering Assistance in Recovery (SOAR) hospital in the U.S. and Canada. Burn survivors are directly affected by their burn injuries, but so is the survivor’s family, their healthcare staff, and their community. The purpose of this project is to describe our efforts to improve psychosocial care after discharge.

Methods
The Burn Center’s SOAR peer-support program consists of: 1) group care, 2) individual care, 3) staff care, and 4) community care. Group care consists of weekly peer-support sessions for burn survivors, led by certified SOAR peer supporters/burn survivors, with support from certified SOAR program coordinators. We also host monthly social outings. Individual care occurs when a SOAR peer supporter provides one-on-one support to another survivor. Our burn survivors have historically visited patients in their support of each other’s recovery. We expanded this by teaching survivors an evidence-based approach. Care has been conducted in-person, via phone, social media, and/or through the SOAR webpage. It seems most effective for people who live at a distance from the burn center and who cannot attend weekly sessions. Staff care aims to increase morale and mitigate burnout. Burn survivors, who are deemed psychiatrically stable, are invited to speak to the same staff who took care of them. The intent is to remind staff of the life-saving effect of their daily work, and to instill a sense of meaningfulness. Staff are also invited to attend burn community activities. Community care consists of survivors speaking at various community events to raise awareness and promote prevention.

Results
At 24 weeks, there have been 931 SOAR encounters: group care (24 group sessions and n=216), individual care (n=55), staff care (4 events and n=212), and community care (7 events and n=448). The weekly groups currently have an average of 10 participants. There are 55 documented individual-care encounters. A common staff theme revolves around regaining a sense of meaningfulness. Qualitative reports show improved mood, community reintegration, anxiety, pain, and rehabilitation. Recent survivors and their families report feeling better connected to the community than those injured years ago.

Conclusions
There is a desire for the continuation of the Burn Center’s peer-support program. There continue to be new and recurring attendees at our weekly group sessions. Our peer supporters are semi-autonomous and eager to provide individual support. The program coordinators and peer supporters continue to support Burn Center staff.

Applicability of Research to Practice
Programs such as this are a powerful venue for sharing one’s experiences and for inspiring others on the path of burn recovery.