bluuebunny/crossref_metadata_2025_split huggingface dataset:
516 Mortality from Inhalation Injury in Oxygen Dependent Patients Exceeds Prediction from Prognostic Models
Authors: Singer Kathleen , Harvey Jalen , Dale Elizabeth 
Published: March 2020

Abstract

Introduction
The Boston Criteria and the Abbreviated Burn Severity Index (ABSI) are two widely accepted models for predicting mortality in burn patients. We aimed to elucidate whether these models are able to accurately predict risk of mortality in patients who sustain burns while smoking on home oxygen given their overall clinical fragility.

Methods
We conducted a retrospective chart review of 48 patients admitted to our burn center from November 2013 to September 2017 who sustained a burn while smoking on home oxygen. Yearlong mortality was the primary outcome of the investigation; secondary outcomes included discharge to facility, length of stay, and need for tracheostomy. We then calculated the expected mortality rate for each patient based on Boston Criteria and ABSI, respectively, and compared the mortality rate observed in our cohort.

Results
Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p &lt; 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p &lt; 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy.

Conclusions
Patients whose burns are attributable to smoking on home oxygen may have an increased risk of mortality than prognostication models, such as the Boston Criteria and ABSI, may suggest. This bears significant clinical impact, particularly regarding family and provider decision-making in pursuing aggressive management.

Applicability of Research to Practice
This data indicates that these injuries are direr than expected, which may have significant impact on family and provider decision-making.
535 Intermediate Skin Substitutes Are Unnecessary in Small (&lt; 10% TBSA) Burns
Authors: Lacey Alexandra M , Gillenwater Justin , Maniago Ellen , Yenikomshian Haig A , Garner Warren L 
Published: March 2020

Abstract

Introduction
The use of intermediate skin substitutes between debridement and final autografting is routine for many practitioners. Materials such as xenografts and allografts have been promoted to help with wound coverage before autografting. However there is limited data for their use in relatively small burn wounds (&lt; 10% total body surface area, TBSA). In this study, we analyzed the outcomes of one hundred consecutive patients who underwent autografting for burns &lt; 10% TBSA at our ABA verified burn unit in the absence of intermediate skin substitute use.

Methods
We retrospectively analyzed one hundred patients who underwent split thickness skin graft autografting for burns &lt; 10% TBSA between November 2017 and June 2019. No patients were treated with intermediate skin substitutes. Analysis included basic demographics, comorbidities, TBSA burned, mechanism of burn, time to grafting, if grafting was performed in a single procedure or staged, graft loss (&gt;50% graft failure), and time to complete healing (no further wound care required).

Results
Twelve patients (12%) had unpredictable graft beds and their procedure was staged. These patients underwent surgical debridement and were dressed in antimicrobial dressing for an average of 5 days before autografting. No patients had intermediate skin substitutes between procedures. Eighty-eight patients (88%) were debrided and grafted in a single stage. In the staged group, there was a 0% rate of graft failure compared to 9.1% rate of graft failure in the primarily grafted group (p=0.004). There was a similar length of stay and time to complete healing in the staged group and primarily grafted group (p=0.496 and p=0.571). There was a significantly shorter time from injury to first procedure between the staged group and the primarily grafted group (8.7 days and 13.5 days, p=0.014). Many of the patients with these small burns were first managed outpatient and then brought in for autografting leading to a longer time from injury to surgery; while the staged group often presented with wounds that appeared infected and required urgent debridement. In the eight instances of graft failure, infection or inadequate debridement was the cause. Seven of these eight cases required further surgical intervention.

Conclusions
Intermediate skin substitutes are an unnecessary step in grafting small burns. These add only complexity and cost to patient care. Many patients can be debrided and grafted in a single stage. Debridement alone with delayed grafting is a highly effective surgical method when the wound bed is not suitable for immediate grafting.

Applicability of Research to Practice
The use of intermediate skin substitutes in small burns requires further investigation as this study finds low benefit for this product.
538 Successful Wound Closure in Patients with Large Total Body Surface Area (TBSA) Calciphylaxis with Aggressive Medical and Surgical Therapy
Authors: Curfman Eric , Khandelwal Anjay 
Published: March 2020

Abstract

Introduction
Calcific Uremic Arteriolopathy (CUA), commonly known as Calciphylaxis, is a rare disorder characterized by ischemic necrosis of the skin and histologically by arteriolar calcification. CUA is most commonly seen in patients with end-stage renal disease (ESRD), but can be seen in other patients as well. CUA is an extremely morbid condition and carries a high mortality rate, up to 80% in some studies, even in patients with limited disease. In light of this, many surgeons have adopted a “do-not-touch” approach. Over the past five years, our institution has seen an increase in the referrals of patients with large total-body-surface-area (TBSA) CUA.

Methods
Retrospective review of all patients with biopsy-proven (by dermatopathology) large, &gt;5% TBSA CUA admitted to a Verified Adult and Pediatric Burn Center from 2015 to present. Demographics, laboratory data, treatment modalities, infectious complications and outcomes, including mortality and wound closure were recorded. Secondary observations included exposure to anticoagulants and recent significant weight loss.

Results
A total of eight patients with large TBSA CUA were admitted after being transferred from outside hospitals. Average TBSA affected was 13.76% (range 5–27%). Six of these patients (75%) were noted to have non-uremic calciphylaxis. One patient (12.5%) had elevated parathyroid hormone (PTH) levels and hyperphosphatemia while one patient each had isolated hypercalcemia and hyperphosphatemia. All patients had positive wound cultures on admission, and one patient (12.5%) developed a bacteremia in hospital. There were no central line associated bloodstream infections, catheter associated urinary tract infections or ventilator associated infections. All patients underwent surgical debridement (average 4.125, range 2–5), and 5 patients (62.5%) underwent grafting, (average 1.6, range 2–5) and subsequently proceeded to wound closure. In-hospital mortality was 25% and another patient was referred to a hospice facility after being readmitted with medical complications related to her calciphylaxis. Secondary findings included 50% of the patients recently experienced significant weight loss (&gt;100 lbs) and 25% of the patients were taking warfarin within 6 months of presentation. Percent TBSA involvement did not correlate with mortality.

Conclusions
Utilizing a multi-modal management strategy that includes surgical debridement and skin grafting, patients with large total body surface area calciphylaxis can progress to wound closure.

Applicability of Research to Practice
Findings may influence surgeons to be aggressive surgically with patients with calciphylaxis leading to improved morbidity and mortality. Improved medical multi-modal therapy has been shown to influence outcomes as well.
542 Lessons Learned from Implementation and Management of Skin Allograft Banking Programs in Low- and Middle-income Countries: A Systematic Review
Authors: Roberson Jeffrey L , Pham Julie , Shen Jolie , Stewart Kelly , Adu Emmanuel , Mehta Kajal , Pedraza Morales , Allorto Nikki L , Pham Tam N , Stewart Barclay T 
Published: March 2020

Abstract

Introduction
Wound excision and temporary coverage with a biologic dressing can improve survival for patients with large burns. Allograft skin possesses many of the ideal properties of biologic dressings and can play a major role in the management of large burns when autologous tissue is not available or the patient’s condition does not allow safe autografting. Healthcare systems in low- and middle-income countries (LMICs) rarely have access to allografts, which may contribute to limited survival in large burns. Therefore, we aimed to describe the lessons learned from the implementation and maintenance of tissue banks in LMICs to guide system planning.

Methods
PubMed, MEDLINE, CINAHL, and World Health Organization (WHO) Catalog were systematically searched with database-specific headings and language to represent a priori terms (e.g., skin, allograft, tissue bank) and all LMICs as defined by The World Bank. Data regarding tissue banking programs (e.g., date of creation, location, lead agency, functions, products), governance, capital investments, safety, maintenance and operations, costs per donation, ethics and sociocultural issues were extracted and described in a narrative synthesis.

Results
The search returned 3,346 records. After eliminating duplicates and non-relevant records, 33 reports were analyzed. The synthesis represented tissue banks from 17 countries. Commonly reported barriers to ideal or planned implementation included high capital costs and operational costs per graft, opt-in donation schemes, and sociocultural stigma around donation and grafting. Reports repeatedly recommended: i) developing a legal framework for oversight, accreditation and ethical practice; ii) engaging diverse stakeholders (e.g., government and non-governmental agencies, community and religious stakeholders, health officials) to improve donation and transplantation rates, iii) creating regional training hubs, and iv) facilitating international cooperation across tissue banking programs to improve transplantation efficiency.

Conclusions
Many lessons were learned from the development and management of tissue banks around the world. The availability of skin allografts can be improved through strategic investments in international governance and regulatory structures, regional cooperation and training initiatives, standardized protocols, and inclusive public awareness campaigns. Capacity-building efforts that involve key stakeholders may increase rates of transplantations.

Applicability of Research to Practice
Ubiquitous challenges in implementing and maintaining tissue banks represent important lessons in program planning to improve allograft availability for patients in countries of all national income levels.
546 Impact of the Affordable Care Act on Burn Outcomes
Authors: Oh Jamie , Fernando Amali , Sibbett Stephen , Carrougher Gretchen J , Stewart Barclay T , Pham Tam N , Mandell Samuel P , Gibran Nicole S 
Published: March 2020

Abstract

Introduction
With changes in insurance coverage after the implementation of the Affordable Care Act (ACA) in 2014, we aim to analyze the impact of Medicaid expansion on clinical outcomes and patient disposition after burn injury. We hypothesize that with increased insurance coverage, more patients are discharged to a skilled nursing facility (SNF) or rehabilitation center.

Methods
Under IRB approval, we reviewed trauma registry data for patients with burn injuries admitted to a regional burn center from 2011 to 2018. Patients were grouped into two categories: before (2011–2014) and after (2015–2018) ACA; we excluded data from 2014 to serve as a washout period. Outcomes of interest were length of hospital stay controlled for burn size (LOS/TBSA), number of complications, patient disposition (Home, SNF, or Rehab), and mortality. Chi square analysis and student t-tests were performed to determine differences between the two groups. Multivariate logistic regression including age, sex, race, distance from medical center, burn size, and etiology of the burn as covariates were used to determine the impact of ACA implementation on patient disposition.

Results
Inpatient mortality rates did not change following ACA implementation. Average LOS/TBSA and number of complications increased, which may be due to increased average age, burn size, and distance from the burn center after ACA. Fewer patients were discharged home and more patients were sent to rehabilitation centers and SNF, which may relate to more patients being insured. Even after adjusting for covariates, discharge to inpatient rehabilitation was significantly increased and discharge to a SNF approached significance.

Conclusions
Since ACA implementation, there has been no change in mortality after a burn injury, but an increase in average LOS and complication rates, consistent with increased injury severity. Rates of discharge to rehab centers and SNF improved with the increase in overall insurance coverage in the burn population.

Applicability of Research to Practice
This work highlights changes in patient outcomes with ACA implementation and can help to guide understanding of health disparity and resource utilization in this population.
547 Long-term Outcomes of Chemical Burn Injuries: A Burn Model System National Database Study
Authors: Grant Gabrielle G , Stockly Olivia , Wolfe Audrey E , Wolf Steven E , Schneider Jeffrey C , Ryan Colleen M 
Published: March 2020

Abstract

Introduction
Information on long-term outcomes following chemical burn injury is sparse. This study aims to examine whether or not there are differences in long-term outcomes for individuals with chemical burn injuries compared to those with fire/flame injuries.

Methods
Data from the Burn Model System (BMS) National Database (1997–2019) were used for analysis. Demographic and clinical characteristics of adult burn survivors with chemical injuries and fire/flame injuries were compared. Regression analyses for the Mental Health Composite Scale (MCS) and the Physical Health Composite Scale (PCS) of the Short Form Health Survey-12, employment status, and Satisfaction with Life Scale (SWLS) were conducted at 12 and 24 months post-burn, adjusting for age, gender, race, and burn size.

Results
A total of 2,522 database participants (96 with chemical burns; 2,426 with fire/flame injuries) were included in the analyses. Those with chemical injuries had smaller burn sizes, shorter hospital stays, and fewer ventilator days (p&lt; 0.0001, p=0.0034, and p=0.0005, respectively). Chemical burn survivors were more likely to be employed at the time of the burn (p&lt; 0.0001), to have sustained an employment-related injury (p&lt; 0.0001), and to have been discharged to their own home following their acute stay (p&lt; 0.0001). No significant differences in the MCS, PCS, employment status or SWLS were found at either 12 or 24 months post-burn between groups in the regression analyses.

Conclusions
Chemical burn injuries were not found to have a significant difference on mental health, physical health, employment status, and satisfaction with life outcomes compared to fire/flame injuries. However, the effects of chemical burn injury on long-term outcomes may be difficult to detect due to the relatively small sample size of this population.

Applicability of Research to Practice
Further investigation is needed to better understand long-term outcomes following chemical injuries. Individuals with chemical burn injuries may require more specific assessment tools to improve how these types of injuries are studied.
557 Use of Online Clinical Guidelines for Burn Care in the Deployed Environment: A Model for Care in Rural or Remote Locations
Authors: Gurney Jennifer M , Cancio Leopoldo C , Remley Michael , Shackelford Stacy , Rhodes Rachel 
Published: March 2020

Abstract

Introduction
During the last decade, our national Joint Trauma System (JTS) has served as the reference body for trauma care throughout our military. The JTS has published 63 Clinical Practice Guidelines (CPGs) on its website to set standards and to provide guidance for deployed providers in the management of challenging clinical scenarios. Given that there is limited burn expertise in the military, the JTS CPGs are a major source of information for most providers. It has been possible to track CPG download activity for over a year. We hypothesized that assessment of download activity would reflect the relative value of JTS CPGs. In particular, we aimed to document the value of burn-related CPGs.

Methods
Download activity was determined from data pulled for jts.amedd.army.mil, utilizing Google’s Digital Analytics Program (DAP), for 27 Feb 2018 to 3 Sep 2019. After refining results from all of the military down to jts.amedd.army.mil, a search was then launched to determine the top activities on the JTS webpage. An additional refinement was conducted to establish search-date parameters. Data were exported into an Excel spreadsheet for further analysis. The data were analyzed for specific titles and numbers of downloads; those downloads consistently appearing at the top of the download activity were split out and detailed.

Results
Downloading was consistently the top “event” or tangible action on the site. In 17 months, total CPG downloads from the JTS website were 75,901. Burn-related CPGs and supporting documents (e.g. Lund-Browder chart; resuscitation flowsheet) were downloaded 6,177 times. The next most frequently downloaded CPG was the traumatic brain injury (TBI) CPG, which was downloaded 6,041 times. If each guideline had equal distribution of downloads, they would each be downloaded 1,205 times; burn-related CPGs were download 5 times more frequently than the mean.

Conclusions
This study emphasizes the importance of burn-related CPGs to providers throughout the global continuum of care. These providers frequently work in expeditionary, remote and austere environments without rapid access to specialty surgical expertise. The use of detailed CPGs can help bridge this gap.

Applicability of Research to Practice
This model can be used for remote rural areas nationally and internationally. Computer-based tracking of CPG and educational material downloads can, furthermore, be used to identify ongoing educational needs.
575 Determining Risk Factors Associated with Development of Depression Following Burn Injury
Authors: Stockly Olivia , Wolfe Audrey E , Wiechman Shelley A , Roaten Kimberly , Ryan Colleen M , Schneider Jeffrey C 
Published: March 2020

Abstract

Introduction
Depression symptoms following burn injury are common, however a tool to risk stratify the likelihood of development of these symptoms does not exist. This study aims to examine the demographic and clinical factors associated with depression symptoms at 12 months post-injury. This data will be used to develop a depression risk scoring system.

Methods
Data from the Burn Model System National Database (2015–2019) were analyzed. Depression subscale scores of the PROMIS-29 were examined at 12 months and those with scores greater than 60 were considered to have depression symptoms. Demographic and clinical characteristics of the study population were compared between those with and without depression symptoms. Predictors of depression symptoms at 12 months post-injury were determined using multivariate logistic regression.

Results
The analysis included 298 individuals (52 with and 246 without depression symptoms). Those with depression symptoms at 12 months post-injury were more likely to be female, have had psychological treatment in the year prior to injury, and have sustained a suspected self-inflicted burn injury. Those with depression symptoms were less likely to be married or working at the time of injury compared to those without depression symptoms. No differences in age, burn size, race/ethnicity, etiology of injury, or education level were observed between groups (Table 1). Psychological therapy or counseling in the year prior to injury was the only significant predictor of depression symptoms at 12 months post-injury (p= 0.016). Age and female gender approached significance (p=0.092 and p= 0.086, respectively).

Conclusions
A history of recent pre-injury psychological treatment was the only significant predictor of depressive symptoms found one-year post-injury.

Applicability of Research to Practice
This data will be used to create a depression risk scoring system to be used at time of acute care admission to identify burn survivors who are at high risk of developing depression. Identifying those at high risk of depression will facilitate appropriate utilization of resources and potential treatment prophylaxis.
576 Firefighter Post-injury Return to Work: A Balance of Dedication and Obligation
Authors: Nosanov Lauren B , Romanowski Kathleen S 
Published: March 2020

Abstract

Introduction
Over the duration of firefighters’ careers there exists a high probability of sustaining burn injuries necessitating medical evaluation and treatment. While many are minor and do not significantly affect the ability to work in full capacity, there exists risk for both short and long-term incapacitation. It is not uncommon for firefighters to push for earlier return to work than is medically advisable. However, there are additional external factors which drive premature return to duty.

Methods
An online cross-sectional survey was sent to firefighters who were members of a statewide Professional Firefighters’ Union. A multiple-choice format was used to assess demographics, injury details, medical care received and return to work. Free text format allowed for elaboration regarding factors influencing decisions to return to work.

Results
The survey was sent to 30,000 firefighters, with 413 (1.4%) responses received. Excluding those with incomplete data, 354 remained for analysis. Of these, 132 (37.3%) reported a burn injury which required medical evaluation. The majority were sustained during active duty, with 90.7% using protective gear at the time. Most burns were small and affected the head (50.8%) and upper extremities (48.3%). The majority were not treated at a Burn Center. While 12 (16.2%) reported returning to work prematurely themselves, nearly half indicated that they knew a colleague whom they felt had returned to work too soon. Factors cited include firefighter culture, finances, limitations of workman’s compensation, pressure from peers and employers, dislike of light duty and a driving desire to get back to work.

Conclusions
While many cite love of the job and a culture of pride and camaraderie that is “in our DNA”, firefighters’ decisions to return to work after burn injury are equally driven external pressures and obligations. Additional education is needed at both the individual and organizational level, which may best be facilitated by evaluation and treatment at a Burn Center.

Applicability of Research to Practice
Improved understanding of factors driving firefighters’ views on returning to duty after injury may help establish support systems and improve education regarding risks of premature return to work, particularly with regard to reinjury.