bluuebunny/crossref_metadata_2025_split huggingface dataset:
98 A 10-year Retrospective Review of Older Adult Admissions at a Regional Burn Center
Authors: Campbell Stephanie , Andres Trina 
Published: March 2020

Abstract

Introduction
A verified regional burn center conducted a 10-year retrospective review of older adult patients admitted to the burn service. The primary goal of the review was to examine trends in mechanisms of injury, demographics, and outcomes to inform burn prevention programming.

Methods
Admission data from 2009–2018 was retrieved from burn center databases and combined into a Microsoft Excel spreadsheet. Older adults were defined as age 65 years and older. Patients admitted to the burn service for skin disorders or soft tissue infections were excluded. Patients with cutaneous burn injuries or inhalation only injuries were included.

Results
The total number of patients included was 697. Nearly a third of the patients were 65 to 69 years old, with incidence declining with each subsequent 5-year age group. Males accounted for 61.3% of admissions. Two thirds of the patients were White (67.6%). The other third consisted of Black (18.4%) and Hispanic (9.8%), Asian (1.9%) and Native American (0.14%) patients. Overall mortality was 14%. Mortality generally increased per 5-year age group: 65–69 (7.8%), 70–74 (10.6%), 75–79 (13.7%), 80–84 (20.6%), 85–89 (29.8%), 90–94 (24.2%), and 95–99 (42.9%). Baux scores ranged from 65 to 180. The highest Baux score that lived to discharge was 119. The average Baux score of the mortality group was 114 and the average of the lived group was 82. No patients with a Total Body Surface Area (TBSA) above 43% lived. Fire/flame burns accounted for 72.7%. Scald burns made up 19.9%, contact burns 3%, chemical burns 2.3% and electrical burns &lt; 1%. Nearly a quarter (24.6%) of fire/flame burns were related to smoking on home oxygen therapy (HOT), which was also the overall most common mechanism at 17.8%. Other fire/flame mechanisms included housefires (21.2%), clothing catching on fire (16.9%), and gasoline-related injuries (11.7%). More than 70% of scald burns came from the three mechanisms: hot tap water, boiling water, and hot grease. For the mortality group, a third of patients had been injured in housefires (32.7%), followed by clothing catching on fire (17.4%) and HOT burns (12.2%).

Conclusions
Incidence rates decline with increasing age but mortality rates climb. Burn injuries with a TBSA greater than 40% are generally fatal in the older adult. Flame burns account for the majority of injuries with HOT and house fire injuries as the leading mechanisms. Scald burns were most often caused by hot tap water or boiling water. White older adults accounted for more than double the number of patients identified in all other races combined.

Applicability of Research to Practice
The demographics and mechanism of injury insight gained from this review can be utilized to inform prevention programming design in this region. Trends in mortality can help emphasize the seriousness of preventing older adult burn injuries and anticipate the mortality risk for older adults admitted to the burn center.
102 Wildfire Burns: Implications for Burn Care
Authors: Palmieri Tina L , Romanowski Kathleen S , Sen Soman , Greenhalgh David G 
Published: March 2020

Abstract

Introduction
Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries.

Methods
Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups.

Results
A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group).

Conclusions
Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries.

Applicability of Research to Practice
All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.
107 Esterified Hyaluronic Acid Matrix in Lower Extremity Wound Reconstruction
Authors: Velamuri Sai R , Kozusko Steven D , Mahmood Ammar , Hill David M , Dadireddy Kalyan C 
Published: March 2020

Abstract

Introduction
Esterified hyaluronic acid matrix (eHAM) skin substitutes have been applied to burn wounds, chronic wounds, and even congenital syndactyly release. eHAM consists of a controlled release form of hyaluronic acid (HA) in a matrix covered with a silicone layer. HA draws water into the wound bed, allowing for capillary ingrowth and cellular invasion. Angiogenesis and dermal regeneration with endothelial cells and fibroblasts promotes tissue regeneration.

Methods
We performed a retrospective review of patients treated with an eHAM at the regional burn center in the past year. A total of fifteen patients were identified. Their charts were reviewed to assess demographics, time to graft, follow-up duration, mechanism, comorbidities, outcomes, and complications. Additionally, photographic images were obtained from the burn center camera for each patient to assess clinical progression of healing.

Results
The mean patient age was 45.8 years. Mean time to split-thickness skin graft was 22.9 days, with a range of 14 to 36 days. The medium follow-up for this study was 12 weeks. Six patients sustained an injury due to either a thermal or electrical burn, and seven patients had diabetes mellitus. Nine patients were active smokers. Eight patients had hypertension and four had kidney disease. Coverage included tibia, calcaneus, Achilles tendon, and dorsal foot extensor tendons. One patient received bedside application of HM. One patient received a second OR application of HM. This series consisted of fifteen patients with multiple medical comorbidities and exposed critical structures, thirteen of which were successfully treated with eHAM.

Conclusions
When critical structures such as bone and tendon are exposed, dermal coverage is often needed prior to skin-grafting. Dermal coverage is necessary to prevent infection, desiccation, and osteomyelitis. eHAM is a modality that create a granulation bed that covers critical structures, allowing for subsequent skin-grafting in a properly selected and challenging population.
eHAM can be used as a dermal substitute in complex wound cases as a bridge to definitive coverage with autologous skin-grafting. This study has demonstrated successful coverage of tendons, bones, and chronic wounds in mean time of three to four weeks in a population with multiple medical comorbidities, complex lower extremity wounds, and contraindications to local and free flap coverage.

Applicability of Research to Practice
This research is based on clinical practice. We have salvaged thirteen of fifteen wounds that were at risk for amputation or further delayed healing, desiccation, and infection.
110 Self-reported Health Measures in Burn Survivors Undergoing Burn Surgery Following Acute Hospitalization
Authors: Luna Daniel E , Sheckter Clifford C , Carrougher Gretchen J , Stewart Barclay T , Schneider Jeffrey C , Ryan Colleen M , Holavanahalli Radha K , Amtmann Dagmar , Gibran Nicole S 
Published: March 2020

Abstract

Introduction
Perception of mental and physical function in adult burn survivors is decreased following injury. Individuals who undergo post-hospitalization reconstructive surgery may have lower Health Related Quality of Life (HRQoL) that is influenced by the severity of their burns. We sought to characterize self-reported health perceptions in burn survivors undergoing surgery post-hospitalization within 24 months of injury.

Methods
Patient Reported Outcomes Measurement Information System (PROMIS)-29 Profile v2.0 data were collected from participants from a multi-center longitudinal study at 6, 12, and 24 months post-injury. Surgical operations performed within the 24-month follow-up period were classified as: open wound, contracture release or scar revision. PROMIS-29 domain scores were compared for those undergoing surgery (surgical participants) to those who did not (non-surgical participants) using separate linear regression analysis for open wound versus scar revision/contracture release at each of the 3 follow-up time points. Linear regression was adjusted for age, burn size, range of motion limitation, number of operations during acute treatment, and insurance/payer.

Results
727 participants provided complete PROMIS-29 data, of which 227 (31.2%) underwent &gt; 1 operative procedure within 24 months post-injury. PROMIS-29 anxiety and depression scores were worse at 6 months post-injury for participants who underwent contracture release and scar revision compared to non-surgical peers (p&lt; 0.05). At 12 months after injury, individuals who underwent open wound surgery post-initial hospitalization reported worse anxiety, depression, and pain interference (p&lt; 0.05). Participants in the contracture release and scar revision categories reported lower PROMIS-29 scores in all domains 24 months after injury (p&lt; 0.05), even after adjusting for confounders.

Conclusions
Burn-related reconstructive surgery has the potential to improve the lives of patients including promoting functional recovery and improving cosmetic appearance. Our data suggest that participants who undergo reconstruction surgery after hospital discharge report worse self-reported indicators of health compared to participants who do not undergo surgery after adjusting for known confounders.

Applicability of Research to Practice
Better understanding of determinants of HRQoL following a burn injury provides a potential opportunity to improve burn survivor outcomes and clinical care.
118 Comparison of Contact and Scald Burns in a Porcine Model
Authors: Singer Adam , Zhou Juin , Osman Omar , Harris Zachery B , Khani Mahmoud E , Baer Evyatar , Zhang Nigel , McClain Steve , Arbab M Hassan 
Published: March 2020

Abstract

Introduction
Whether the depth and healing of scalds and contact burns are similar is controversial. Prior studies have not compared scalds and contact burns using identical temperatures and durations of exposure limiting direct comparison. We hypothesized that when exposed to similar temepratures and durations of exposure, burns caused by hot water and contact with hot metal would be similar.

Methods
Multiple 2.5 or 5 cm diameter standardized cutaneous burns were created in two anesthetized female domestic pigs (~45kg) using a brass bar or circulating heated water in replicates. The temperatures were controlled and kept constant using thermosensors. In one pig, the temperature was kept constant (95 degrees C) while the duration of exposure varied (5, 10, 15 sec.) In the second pig, the exposure time was kept constant (10 sec.) while the temperature of exposure varied (70, 80, 98 degrees C). Burns were covered with a topical antibiotic ointment and frequent dressing changes were performed for 4 weeks. Periodic punch biospies were taken to determine burn depth immediately after injury, percentage burns reepithelialized within 21 days, and depth of scar at 28 days. Analysis was performed using analysis of variance.

Results
When temperature was held constant, duration of exposure (5, 10, and 15 sec.) was associated with scar depth (2.1 vs 3.8 vs 5.0 mm respectively, P=0.001) and there was a trend for an association with burn depth (2.0 vs 2.2 vs 2.3 mm respectively, P=0.10). When exposure duration was held constant, temperature (70, 80, 98 degrees C) was associated with scar depth (0.6 vs 1.7 vs 3.6, P&lt; 0.001) but not significantly associated with burn depth (1.2 vs 1.5 vs 1.7 mm respectively, P=0.21). For each pig a comparison of burn and scar depth by device generally showed that depths were greater for scald than contact burns although not significantly greater. Only scar depth in the first pig showed a difference with a significance of less than 0.10 (2.9 for contact vs 4.1 mm for scalds, P=0.08). After controlling for temperature the difference between scalds and contact burns was statistically significant (marginal means 3.0 for contact burns, 4.3 for scalds, P=0.008). When combining data from both pigs and controlling for temperatures and duration, scar depths for scalds (2.7 mm) vs contacts (1.9 mm) showed a significant difference (P=0.02) while burn depth was not quite significant (1.7 vs 1.5 mm, P=0.07). Almost all burns were reepithelialized by day 21.

Conclusions
Burns created in swine with circulating hot water tend to be deeper and result in deeper scars than those created by contact with a brass bar when controlling for temperature and duration of exposure.

Applicability of Research to Practice
Scalds of similar temperature and exposure times result in deeper scars than contact burns.
501 Burn Center Referral of Patients with Suspected Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)
Authors: Rizzo Julie A , Lidwell David S , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but potentially life-threatening, as such referral of these patients to a burn center is appropriate. However, patients with suspected SJS/TEN are often referred to the Burn Center and are found to not actually be suffering from the disease process in question. This inefficient referral process warrants further examination to identify pre-arrival those patients who are appropriate for transfer.

Methods
As an approved PI project we examined the records of all patients referred to our Burn Center for suspicion of SJS/TEN for the time period 2016–2018. We analyzed the corresponding data to in an attempt to more effectively identify patients with SJS/TEN and prevent unnecessary Burn Center transfers.

Results
Of 84 patients referred for suspected SJS/TEN 32 received confirmatory diagnosis with skin biopsy after transfer (38%). The average length of stay was 8 ICU days and 14 hospital days versus 3.6 and 9.6 days, respectively, for patients with a negative diagnosis. The mortality rate of SJS/TEN patients was 12.5% (4/32).
In addition to SJS/TEN, a wide range of skin conditions were identified among referred patients, many of whom also required hospitalization, including BICU care. The various diagnoses included:
Drug eruptions (14%), psoriasis (6%), dermatitis (6%), erythema multiforme (2%), lupus erythematosus (2%) and generalized exanthematous pustulosis (2%). The remainder of patients had miscellaneous or nonspecific conditions (28%).

Conclusions
SJS/TEN is a potentially life threatening disease often requiring hospitalization in a Burn Intensive Care Unit (BICU). However, many other disease processes have similar presentations and may also be appropriate for Burn Unit care. Without a confirmatory skin biopsy prior to referral a large number of patients are transferred to the BICU unnecessarily.

Applicability of Research to Practice
In the absence of skin biopsy capabilities at the referring facility an algorithm using common characteristics of actual SJS/TEN patients may improve the accuracy of pre-referral diagnosis. Additionally, this data underscores the importance of dermatology support to the Burn Unit in diagnosing and treating desquamating skin disorders.
502 Use of Hydrocortisone, Vitamin C, and Thiamine to Treat Burn Sepsis: A Case Series
Authors: Resch Thomas R , Fischer Sarah 
Published: March 2020

Abstract

Introduction
Sepsis remains a leading cause of morbidity and mortality in burn patients. Therefore, novel treatment adjuncts are of constant interest. Early studies by Marik et al. have suggested that bundled use of intravenous hydrocortisone, vitamin C, and thiamine may improve outcomes in intensive care patients diagnosed with systemic sepsis. However, to our knowledge, evaluation of this treatment modality has not been applied to burn patients.

Methods
Chart review of seven patients with major cutaneous injuries admitted to our burn center and treated with the adjunct therapy as per Marik et al. occurred. Baseline characteristics, treatment, and outcome variables were identified. Variables abstracted include demographics, injury characteristics, comorbidities, discharge disposition, length of stay, mechanical ventilation, use of vasopressors, acute kidney injury, blood cultures, white blood cell count, lactate, creatinine, predicted mortality (modified BAUX, APACHE II, APACHE IV, and SOFA scores), procalcitonin, quantitative culture and histology results, time to first excision, and time to final surgery and/or healing.

Results
Five patients sustained flame burns ranging from 24% to 46% total body surface area. One patient was admitted for road rash causing full thickness injury and one with toxic epidermal necrolysis encompassing 90% total body surface area. Ages ranged from 19 to 74 years. Modified BAUX with APACHE II and IV scores were used to predict baseline mortality risk. Four of the seven patients succumbed to their injuries, two within the first week of admission. Of the remaining cases, all required fewer vasopressors after beginning adjunct therapy. Among survivors, SOFA scores suggested greater than 95.2% predicted mortality at start of adjunct therapy and within four days, predicted mortality ranged from less than 33.3% to 50%.

Conclusions
The aim of this case series is to review our early experience with this novel treatment in burn patients. No conclusions can be drawn at this time. It is understood that continued research must be conducted to support correlation between intervention and outcomes. Optimism is present based upon early non-burn studies and our regional burn center experience. A prospective study is currently being developed at our burn center.

Applicability of Research to Practice
This case series explores a potential treatment adjunct to decrease morbidity and mortality from burn sepsis.
504 Venous Thromboembolism Chemoprophylaxis in Burn Patients: A Literature Review and Single-institution Experience
Authors: Liu Alice , Minasian Raquel , Maniago Ellen , Gillenwater Justin , Garner Warren L , Yenikomshian Haig A 
Published: March 2020

Abstract

Introduction
Hospitalized burn patients meet the criteria for Virchow’s triad (endothelial damage, hypercoagulability, and stasis), predisposing them to venous thromboembolism (VTE). While the cost, morbidity, and mortality of VTE suggest a need for prevention in this population, unreliable reported VTE rates, variable and complicated prophylaxis regimens, and risks associated with chemoprophylaxis have prevented the establishment of a universal protocol. This paper reviews the thromboprophylaxis practices both in the literature and at our own institution.

Methods
A systematic review was conducted according to Preferred Reported Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines identifying studies pertaining to VTE chemoprophylaxis in burn patients. Additionally, medical records of patients admitted to an American Burn Association-verified burn center between June 2015 and June 2019 were retrospectively reviewed for patient demographics, chemoprophylaxis, and presence of VTE defined as either deep vein thrombosis (DVT) or pulmonary embolism (PE).

Results
35 studies met inclusion criteria. In the 11 studies that reported VTE incidence, rates ranged widely from 0.27 to 23.3%. The two largest retrospective studies (n = 33,637 and 36,638) reported a VTE incidence of 0.61% and a DVT incidence of 0.8% in populations with unknown or inconsistently recorded chemoprophylaxis. Throughout the literature, prevention protocols were mixed, though a trend toward using dose-adjusted subcutaneous low molecular weight heparin based on serum anti-factor Xa level was noted.
At our institution, 1440 patients were admitted over four years. At-risk patients received a simple chemoprophylaxis regimen of 5000U of subcutaneous unfractionated heparin every eight hours. No routine monitoring tests were performed to limit cost. Ten cases of DVT and two cases of PE were identified with an incidence of 0.69% and 0.14%, respectively, and a total VTE incidence of 0.83%. One patient developed heparin-induced thrombocytopenia (0.07%). There were no other heparin-associated complications.

Conclusions
VTE incidence rates reported in the literature are wide-ranging and poorly capture the effect of any one chemoprophylaxis regimen in the burn population. Our center uses a single, safe, and cost-effective protocol with a VTE rate comparable to that of large national retrospective studies.

Applicability of Research to Practice
VTE continues to represent a threat to the burn population. While simple and safe chemoprophylaxis regimens exist, the optimal prevention protocol remains elusive.