bluuebunny/crossref_metadata_2025_split huggingface dataset:
59 Annual Incidence of Childhood Burn Injuries and Prevalence of Household Risk Factors in Rural Ghana: A Population-based Cluster-randomized Survey
Authors: Mehta Kajal , Gyedu Adam , Mock Charles , Stewart Barclay T 
Published: March 2020

Abstract

Introduction
Childhood burns are a leading cause of injury in low- and middle-income countries. Many childhood burns can be prevented by modifications in the household environment and targeted education. Therefore, we aimed to determine the incidence of childhood burn injuries and describe the prevalence of potentially modifiable household risk factors.

Methods
We performed a population-based, cluster-randomized, household survey of 358 households in a rural district in Ghana. From the district, 6 of 11 community clusters were randomly selected. Within these clusters, a census of all households with a caregiver of at least one child &lt; 5 years of age was conducted. Caregivers were interviewed regarding childhood burn injury (CBI) within the past 6 months and potentially modifiable household risk factors.

Results
Of the 358 households sampled, most households lived in completed structures they owned (67%, 95% CI 61.9–71.6%). The adjusted annual incidence of childhood burn injury was 7.9%. The median age of burn injury was 3 years. The most common etiology of CBI was flame burn (53%, 95% CI 36.8–67.7%). Increasing year of age (AOR 0.92, 95% CI 0.84–1.01) and households with an older sibling ³12 years (AOR 0.53, 95% CI 0.24–1.17) were weakly associated with lower odds of CBI. The majority of households (84%, 95% CI 80.5–88%) used an open fire with firewood as fuel arrangement for cooking. In most households there was not a separate room used as a kitchen (90%, 95% CI 86–92.4%) and the stove/cooking arrangement height was within reach of children under five (&lt; 1 meter; 96%, 95% CI 94.6–97%). Female gender (AOR 1.37, 95% CI 0.71–2.64), outdoor cooking arrangement (AOR 1.05, 95% CI 0.42–2.62) and an increased number of children under caregiver supervision (≥5 children; AOR 1.32, 95%CI 0.42–2.62) were not predictive of CBI.

Conclusions
Burns are a common cause of childhood injury in rural Ghana. There may be opportunities to reduce the risk of burn injuries in rural settings by supporting the transition to safer cooking arrangements, child barrier apparatuses (e.g. playpens that separate children from cooking arrangements), and/or health promotion initiatives. Given the high incidence of childhood burn injuries, strategic burn-related healthcare capacity development is also required to limit preventable death and disability.

Applicability of Research to Practice
These findings, which differ somewhat from similar studies in other LMIC communities, suggest that there is not a one-size-fits-all solution for the prevention of childhood burn injuries. Community-specific and contextually relevant interventions that aim to prevent childhood burn injuries can be identified by results from population-based surveys of injury epidemiology and potentially modifiable risk factors.
79 Maximizing Safe Positioning of Upper Extremities After Axillary Burn Injuries to Prevent Contractures and Maintain Function
Authors: Greiser Connie , Lorello David , Barto Eric , Gartner S V , Lyons Dan , Stutesman Derek , Richey Karen J , Murray Derek O , Foster Kevin N 
Published: March 2020

Abstract

Introduction
Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction.

Methods
The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions.

Results
A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%).

Conclusions
The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours.

Applicability of Research to Practice
Additional research is needed to determine optimal positioning for the shoulder joint.
80 Burn Rehabilitation: How Do You Minimize Delays?
Authors: Barba Michael G 
Published: March 2020

Abstract

Introduction
Timely rehabilitation is vital to the functional outcomes of burn patients. The rehabilitation department at our ABA certified Burn Center determined there was a need for a more effective method to coordinate daily care in the Burn Progressive Care Unit (BPCU). The purpose of this performance improvement project was to evaluate whether our Burn Center had a problem with delays in rehabilitation and if so, develop a plan to reduce disruptions.

Methods
Lean Six Sigma Process Improvement Methodology guided the team in this project. A 5-question needs assessment Pre-Rehabilitation Worksheet (Pre-RW) was used to evaluate the problem. The Pre-RW asked if there was a delay; reason for delay; length of delay; communication between services; body region, and the number of cutaneous functional units (CFUs) involved. The team then analyzed data from the Pre-RWs using descriptive statistics and a Pareto chart. Results from the Pre-RWs were used to prioritize changes that would mitigate delays. Rehabilitation staff then completed Post-RWs. Pre- and Post-RW results were compared to determine if the changes decreased delays in rehabilitative care.

Results
From April 24 to August 5, 2018, 140 Pre-RWs were completed in the BPCU; 24 were incomplete/omitted. Rehabilitation encounters that were delayed or canceled were 37.9% (n=53). Of these, 64% were delayed but eventually completed. The top 3 reasons for delay were: dressings down for morning rounds (DFR, 26%); wound care in progress (19%); patient refusal (16%). In 47% of the encounter delays the patients had over 15 CFUs involved. Improvements were made as follows: DFR assessment became part of the bedside rounds process; wound care orders were placed prior to 9 a.m.; patients were offered evening wound care. Communication improved through the use of a whiteboard, hands-free voice-call badges, and a time frame for coordinating the plan of the day. Following the improvements, Post-RWs (n=131) were collected from May 1 to July 30, 2019. 23.8% of all encounters were delayed or canceled. Of these, 51% were delayed but performed. The 3 chief reasons for delay were patient refusal, 38%; untimely dressing changes, 19%; and medical issues, 13%. In 84% of the deficit encounters 0–15 CFUs were involved.

Conclusions
Our burn center was able to define a problem with delays in rehabilitation and mitigate delays. This project demonstrates that deliberate changes decrease delays in rehabilitation.

Applicability of Research to Practice
Care of the burn patient requires a structured interdisciplinary, systems approach. Burn centers can improve outcomes by adopting a plan to improve coordination of services.
554 Severity of Gasoline Burns: A Retrospective Review
Authors: Smith Hannah , Echternacht Scott R , Bell Derek 
Published: March 2020

Abstract

Introduction
Gasoline burns represent a significant source of preventable morbidity each year. Often used inappropriately as an accelerant, gasoline is substantially more volatile than other commonly used accelerants due to its low flash point and vapor pressure. We sought to review the clinical outcomes for patients presenting with burns caused by gasoline accelerated flame.

Methods
An IRB exempt retrospective study of consecutive patients presenting from 2010–2017 to a single ABA verified institution was performed. Exclusion criteria included ultraviolet burns, allergic reactions and Stevens-Johnson Syndrome. Collected patient demographics included age and gender. The primary clinical endpoint was percent total body surface area (%TBSA) burned, delineated into second or third degree burn. Secondary endpoints included length of stay (LOS), days admitted to the intensive care unit (ICU), and mortality. Kruskal-Wallis Test and Wilcoxon Rank Sum Test were used for statistical comparison between the etiologies of burns. Fisher’s Exact test was used for comparison of mortality rates using a Bonferroni correction accounting for nine pairwise comparisons.

Results
A total of 5,994 patients were included; 256 with burns from gasoline fueled flame and 5,738 from other etiologies including flame with other accelerants, flame, scald, contact, electrical, chemical, friction, radiation, and frostbite. Gasoline burns resulted in a higher %TBSA of second degree burns (x̅=4.37%: 95% CI 3.62–5.12; p &lt; 0.001; Table 1) and higher overall %TBSA (x̅=4.94%: 95% CI 3.99–5.88; p &lt; 0.001; Table 2) than burns of all other etiologies except radiation burns where no statistically significant difference was found. Gasoline burns had a lower percent mortality (0.39%) than flame burns (4.98%; p&lt; 0.05) and showed no statistically significant difference in mortality rate compared to other etiologies of burns. Comparison of second degree measures of LOS and number of ICU days yielded mixed results and lacked statistical significance.

Conclusions
Patients with burns caused by gasoline accelerated flame sustain a higher %TBSA of second degree burns and overall %TBSA than all other etiologies of burns except radiation burns.

Applicability of Research to Practice
Our results highlight the extent of burns caused by gasoline accelerated flame and underscore the importance of public education to reduce the inappropriate use of gasoline as an accelerant with the ultimate goal of reducing the significant morbidity associated with these burns.
578 Childhood Burn Injuries: The Parent Perspective
Authors: Dillard Dana R , Kolomer Stacey R 
Published: March 2020

Abstract

Introduction
Interventions for burn-injured children (BIC) largely focus on the child with the physical injury while consideration for family systems appears incidental. This study aimed to gain insight into the perspectives and needs of parents/caregivers of pediatric burn patients (PPBP). When considering BIC within the context of a family system, it is reasonable to expect the injury to engulf everyone. The literature emphasizes the acute and lasting physical and emotional impact of burns. Moreover, research suggests PPBP experience an emotional response to the incident that is often complicated by physical absence from their other uninjured children. Thus, this exploratory study fills a gap by engaging the unique perspective of the PPBP and posits direct implications for essential program enhancement/development.

Methods
PPBP attending a family program participated in semi-structured interviews (N=11) guided by the research question: What are the experiences of PPBP? Participants’ self-identified as African American (n=4), Caucasian (n=5), and Latino (n=2). Age ranged from 29 to 48 (M=38.36, SD=6.14). Interviews involved queries regarding the burn incident, from injury to present (M=7.12 years, SD=4.61), including support received, what they wish people understood about the experience, and ideas for programming. Interviews were recorded and transcribed. Data were analyzed using van Manen’s hermeneutic phenomenological approach.

Results
Findings supported PPBP’s unique experience coalescing into one theme—the never-ending trip from hell—conceptualized as, “I didn’t mean to get here—none of this is familiar and I can’t find anyone I know. What’s going on and when will it be over?” Mutual painful insights were parental guilt, sensory experiences related to the acute incident and aftercare, unknown prognosis and medical treatment expectations, physical/emotional health problems, family members insensitivity, managing the cruelty of others, isolation, marital strains, and sibling tensions. Families also reported positive outcomes: strength of informal support networks, empowerment through educating others, and creating new allies. PPBP emphasized the benefits associated with meeting other families who also endured a burn injury and the importance of mutual support.

Conclusions
Programs should address the needs of all family members, not just BIC. In order to mitigate the impact of burn trauma, the family system impact remains a critical primary consideration for research and interventions.

Applicability of Research to Practice
Findings can contribute to program planning with increased consideration of the family system. As a result of findings from this study, siblings are now included in a summer camp program historically serving only BIC.
733 From the Trenches of War to the Bedside of Civilians: Joseph E. Murray MD FACS and the Contributions of Military Surgeons to Advances in Burn Care
Authors: Paletta Christian 
Published: March 2020

Abstract

Introduction
Significant advances in medical and surgical care have often originated from our experience caring for those wounded on the battlefield. The year of the ABA’s 52nd annual meeting marks the 30th anniversary of the selection of Joseph E. Murray MD FACS as recipient of the 1990 Nobel Prize in Medicine.

Methods
In his autobiography Surgery of the Soul: Reflections on a Curious Career, Dr. Murray credits a 22 year old US Army aviator named Charles Woods with guiding him into an emerging field of transplantation surgery. On December 23, 1944, Woods sustained burns over 70% of his body in an accident during takeoff while teaching another pilot at his Army Air Corps base in India. Woods survived and eventually was transferred back to the US where came under of the care of a young 25 year old surgeon named Joseph Murray.

Results
Like many young surgeons of his era, Dr. Murray joined the military service during WWII. Dr. Murray had just completed his internship at Peter Bent Brigham in Boston in September 1944 when he was assigned to Valley Forge General Hospital in Phoenixville, PA. Valley Forge was one of eight regional US Army hospitals created during WWII dedicated to plastic surgery and burn care. It was during his care for soldiers wounded in battle at this time in his early formative years that Dr. Murray developed his curiosity regarding tissue transplantation. Following military service, he completed his surgical training in Boston and New York City, and returned to the Brigham in July 1951. His military service caring for burn victims instilled a passion and curiosity regarding transplantation of human tissue. This culminated in his leading a team to perform the first human kidney transplantation on December 23, 1954...exactly 10 years to the day after the airplane crash that injured Charlie Woods.

Conclusions
Recognizing his dedication and accomplishments in the field of transplantation surgery, the Nobel selection committee awarded Dr. Murray thirty-six years later it’s Prize in Medicine.

Applicability of Research to Practice
Dr. Murray’s legacy which began during his care of soldiers during WWII offers an inspiration to all those caring for patients who have sustained burn injuries.
736 Autologous Skin Cell Suspension in Combination with Meshed Autograft: A Case Report Demonstrating the Efficacy in NSTI
Authors: Kopari Nicole M 
Published: March 2020

Abstract

Introduction
Necrotizing soft tissue infections (NSTIs) are some of the more difficult disease processes encountered by physicians. Most patients require multiple surgical debridements, and survivors often have complex wounds requiring soft tissue coverage and prolonged hospitalizations. The goal of this report is to describe the use of autologous skin cell suspension over widely meshed skin graft in a patient with large wound secondary to a NSTI.

Methods
A retrospective chart review was performed of a patient with NSTI of the abdomen.The patient received autologous skin cell suspension as an epidermal graft in combination with widely meshed skin grafting.

Results
A 41 year-old female had an abdominal wound infection resulting in a NSTI. The patients had poorly controlled diabetes, congestive heart failure, and coronary heart disease with a drug eluting stent on dual antiplatelet therapy. She presented septic to an outside facility where she underwent multiple abdominal wound debridements. She was transferred to our institution with concerns for ongoing infection. Upon arrival, the wounds appeared stable with granulation tissue present over the wound bed with small areas of necrotic fat. She underwent debridement and autologous skin cell suspension in combination with a widely (3:1) meshed skin graft. The donor site also received treatment with the cell suspension. The wounds were covered with a non-adherent dressing along with bismuth-impregnated, petroleum-based gauze. Additional padding was secured with sutures to prevent post-operative shearing. On post-operative day (POD) 2 the outer dressings were changed with excellent adherence of the graft. On POD 4 her dressings were taken down completely, staples were removed, and she was transitioned to daily topical antimicrobial ointment and a non-adherent dress to her torso. She had &gt;95% closure on POD 7 on both her graft and donor site.

Conclusions
Similar to severe burn injuries, the magnitude and scope of NSTI necessitates radical debridement often creating challenges in wound care, preservation of function, and cosmesis. Autologous skin cell suspension in combination with widely meshed skin grafts appear to be well-suited for treatment of large wounds resulting from NSTI. Treatment of this patient demonstrated decreased healing times, decreased donor sites, and an acceptable cosmetic outcome.

Applicability of Research to Practice
Autologous skin cell suspension has been approved for the use in partial and full thickness burn either as an epidermal graft alone or in combination with widely meshed grafts. This case report represents an example of its use in large complex wounds secondary to NSTI with acceptable outcomes.
738 Post-operative Wound Care Using Silver-based Dressing with Autologous Skin Cell Suspension
Authors: Carter Jeffrey E , Mai Kathryn , Lennard Shana , Landry Jeremy , G’sell David , Tuggle Charles T 
Published: March 2020

Abstract

Introduction
Postoperative dressing and wound care are essential to optimize graft survival through imbibition, inosculation, and neovascularization. Autologous skin cell suspension (ASCS) using extended-wear dressings (EWD) as a primary or secondary has not been previously described in the literature. The goal of our study was to assess the feasibility of new dressing protocol for ASCS at reducing dressing changes without increasing reoperation rates for failure to close or mortality.

Methods
The study was an IRB approved, single-center, retrospective review of admissions between April 2018 to August 2019. Patients included in the study were &gt;14 years of age with &gt;3%TBSA partial-thickness and full-thickness burns undergoing excision and ASCS. EWD included a controlled-release silver antimicrobial dressing with active fluid management. Standard of Care (SoC) primary dressing with fine-pore, non-adherent polyethylene film followed by petroleum gauze, layered gauze, and compressive dressings. Data included age, gender, %TBSA, mortality, primary and secondary dressing, dressings changes prior to primary dressing change (DC), and failure to close (FTC) requiring reoperation. Fisher’s exact test was used to compare the two populations.

Results
A total of 53 ASCS cases were performed with 33 receiving standard of care (SOC) and 20 EWD post-operatively. The median age was 48 (range 14–85) with 26% of the patients being female. The median TBSA was 17% (range 3–72%). Median age for SoC was 57 and for EWD was 33 (p-value= 0.0289). Median %TBSA for SoC was 20% and for EWD was 15% (p-value= 0.0182). 1 SoC patient required reoperation from both groups (p-value= 0.5210). No EWD patients required reoperation. 1 patient expired (SoC) in the study secondary to decompensated cirrhosis. EWD required median 1 DC versus 3 in the SoC group (p-value= 0.0164).

Conclusions
EWD with ASCS reduced the total number of dressing changes and did not result in increased mortality or reoperation for FTC in our feasibility trial with partial-thickness and full-thickness burn injuries. Optimizing postoperative care with EWD in ASCS may serve to reduce dressing change costs and patient discomfort as well as to shorten hospital length of stay.

Applicability of Research to Practice
Reduced wound care following autologous skin cell suspension.