bluuebunny/crossref_metadata_2025_split huggingface dataset:
663 Effect of Admission Vitamin D Levels on Outcomes in Pediatric Burn Patients
Authors: Pape Kate , Galet Colette 
Published: March 2020

Abstract

Introduction
The effect of vitamin D levels on clinical outcomes has been studied in critically ill non-burn patients and adult burn patients. Low vitamin D levels predicted sepsis and were associated with in-hospital mortality in critically ill non-burn patients. Vitamin D deficiency and insufficiency in adult burn patients correlated with higher rates of complications and longer ICU and hospital length of stay (LOS). Vitamin D levels in pediatric patients have been studied during the post-burn period, showing that low vitamin D levels post-burn may play a role in post-burn osteopenia. However, the effects of admission vitamin D levels on outcomes have not been evaluated in the pediatric burn population.

Methods
This is a retrospective study of pediatric burn patients admitted to an American Burn Association verified burn center over a 3-year period. Patients were included if they were under the age of 18 years and had a vitamin D level measured within 7 days of admission. Vitamin D deficiency was defined as vitamin D level less than 12 ng/mL; insufficiency as vitamin D level 12–20 ng/mL; sufficiency greater than 20 ng/mL. Basic demographics were collected. Outcome data collected included infection, graft loss, renal failure requiring renal replacement therapy, LOS, number of days requiring the ventilator, and need for vasopressors. Univariate and multivariate analyses were performed using SPSS 25.0. P &lt; 0.05 was considered significant.

Results
A total of 249 pediatric patients were admitted during the study period. Of those, 38 patients had vitamin D levels measured within the first 7 days of admission and were included in the study. No patients were vitamin D deficient, and 7 (18%) patients were vitamin D insufficient. No significant differences were observed between patients who were vitamin D sufficient or insufficient with regards to sex, race, or mechanism of burn injury. Patients who were vitamin D insufficient had a longer LOS (15 days vs. 3.34 days; p = 0.023), a larger total body surface area burn size (16.75% vs. 7.23%; p = 0.027), and required more surgeries (1.14 vs. 0.06; p = 0.037). After adjustment for age and gender, higher vitamin D levels were associated with an increased chance of not having surgery (OR = 1.29, 95%CI[1.06–1.58]; p = 0.013).

Conclusions
Despite its retrospective nature and small sample size, our study suggests that pediatric patients who present with vitamin D insufficiency may be at risk for increased LOS and need for surgery.

Applicability of Research to Practice
Larger studies are warranted to identify outcomes affected by low vitamin D levels on admission as well as socioeconomic factors, such poverty level and food insecurity, that may affect vitamin D levels on admission.
704 Lessons Learned from a Mass Disaster: Successful Institutional Planning and Preparedness
Authors: Singhal Maneesh 
Published: March 2020

Abstract

Introduction
This abstract discusses the experience of a Burn disaster at the largest thermal power plant of the country, which was successfully managed at our center. The experience gained will hopefully help in the planning and management of similar disaster scenes in resource-constrained developing countries.

Methods
In a National thermal power plant, there was an explosion in the 500-megawatt unit. Hot fuel gases and steam escaped affecting close to 100 people working around the area. Twenty-six people succumbed to death and six victims who sustained burn injuries were referred to our trauma center where they were received about twenty-six hours after the injury. Despite having no infrastructure supporting the treatment of acute burns, proper planning and coordinated effort by all sectors and persons concerned were immediately initiated and ultimately all patients were discharged in a healthy state with no incidence of mortality or significant morbidity from the burns.

Results
All the six patients were males ranging from 25 to 45 years age and sustained 20% to 45% deep thermal burns over their bodies. All patients were initially evaluated in the emergency where triage was conducted, and four patients out of six were found to have symptoms of respiratory burns and carbon monoxide poisoning. One high dependency unit (HDU) was immediately converted to a burn ICU(Intensive care unit), and all these patients were nursed in isolation. Two patients had severe airway burns and had to be intubated and ventilated. These patients also required hyperbaric oxygen therapy to revert the carbon monoxide poisoning. Out of the six patients, two patients underwent tangential burn wound excision of both upper limbs and skin allograft placement procured from Skin bank. The other four patients underwent debridement, and allograft application subsequently.
all the patients recovered from the burn injuries and were discharged with advice to continue rehabilitation at the regional center. This was one of a kind effort where a trauma center was converted to a full-fledged burn ICU to provide the best possible burn care to the victims. A team of 20 people consisting of Plastic Surgeons, Intensivists, Physiotherapists, Nutritionists, Infection Control Nurses, Wound Care Nurses, Hyperbaric oxygen therapist, and other support staff contributed immensely for management of these patients.

Conclusions
planned cooperation and prepared coordination between the team of doctors and other support staff are the key in the successful management of a disaster.

Applicability of Research to Practice
In the event of a mass disaster a level 1 trauma center was immediately converted to a facility equipped to handle burns. This experience gained may be useful in the future in the planning and management of similar disaster scenes in developing countries with limited resources.
713 Delayed Spinal Cord Injury from Electrical Burns: Case Reports
Authors: AlQasas Taeq , Wibbenmeyer Lucy , Galet Colette , Bertellotti Robert , Granchi Thomas , Mashruwala Neil 
Published: March 2020

Abstract

Introduction
Spinal cord injury has been described in only 2–5% of electrical injuries. Its presentation is often delayed for several days to weeks after the initial injury. Recovery is also variable. Prompted by two recent patients, we sought to review our center’s electrical injury experience.

Methods
Data from all electrical injury patients admitted to our burn center from 12/2002 to 7/2019 were retrieved from the burn registry. Abstracted variables included demographics; admission, injury and treatment data; hospital length of stay (LOS); complications, including infection, graft loss and neurologic injury information if any; and mortality. The medical records of the two spinal cord injury patients were reviewed for hospital course and follow up. Pertinent imaging and neurology consultation were noted. Descriptive statistics were obtained using SPSS.

Results
A total of 168 patients with electrical injuries were identified. The cohort were Caucasians (89.3%) and males (92.3%) with a mean age of 35.6 ± 15.5 years. Almost 90% sustained cutaneous burns with an average burn size of 6.1 ± 11.4%. The mean LOS was 6.3 ± 10.7 days. Less than 20% required mechanical ventilation for 5.6 ± 9.5 days. Seventeen patients were found to have new neurological findings on or after admission; 11 had intracerebral injuries, 3 had peripheral nerve injuries, and 1 had new onset seizures, while 2 developed spinal cord injuries. Complete resolution occurred in 6 of the 14 surviving patients. The two spinal cord injury cases are presented.

Case 1
A 60-year-old male presented with a 40% TBSA after contacting a power line. His burns involved his chest wall and paraspinal muscles of the lower back. On hospital day 6, we noted weakness in his lower extremities which progressed to flaccid paralysis. He had an abnormal magnetic resonance imaging (MRI) and was diagnosed with thoracic myelopathy. He elected to have comfort measures only and died.

Case 2
A 58-year-old male sustained a high voltage injury from an electrical source arcing to a pole he was carrying. He underwent CPR for 2 minutes. On day 2, he started to have progressive weakness of his lower extremities that progressed to flaccid paralysis of his lower extremities. He underwent bilateral below knee amputation. Electromyography and imaging were normal. He is walking with assistance.

Conclusions
Neurological complications after electrical injuries are rare and vary in presentation and outcomes. Complete flaccid paralysis of the lower extremities late after electrical injury is rare and associated with variable degrees of recovery. Of the 17 patients with neurologic problems after electrical injury, nearly half resolved on follow up.

Applicability of Research to Practice
This suggests that electrical injury patients with neurologic signs and symptoms should be closely evaluated and followed.
734 A Comparison of Burn Depth Assessment Between Clinical Diagnosis and Laser Doppler Imaging
Authors: Mitchell Suzanne , Bhavsar Dhaval , Reynolds Jessica , Jones Jessica , Pena Julia M 
Published: March 2020

Abstract

Introduction
Accurate burn assessment is crucial to prescribing appropriate treatment and is dependent upon the experience of the provider and the timing of diagnosis relative to the burn injury evaluation. Differentiating between a deep partial thickness and full thickness burn may not be easily discernible. To augment the clinical diagnosis of burn depth, a laser doppler image measures the microvascular blood flow of injured tissue to predict burn wound healing. The aim of this study is to evaluate the clinical assessment of burn wounds by experienced burn providers compared to the laser doppler image assessment in predicting which burn wounds should heal spontaneously in 3 weeks.

Methods
A retrospective chart review from 2012–2016, included 54 subjects. The clinical assessment included a description of burn variables relevant to the determination of spontaneous burn wound healing (burn depth, total body surface area, mechanism of injury, anatomical location, clinical burn depth diagnosis, and laser doppler image). A chi-square analysis compared the clinical diagnosis and the laser doppler assessment of burn wound depth, as well as the correlation between clinical diagnosis versus laser doppler image in predicting spontaneous burn wound healing.

Results
Comparing partial thickness burn injuries, there were 38 clinically diagnosed partial thickness injuries (by experienced burn providers) and 38 partial thickness burn injures diagnosed via LDI. Deep partial thickness burn injuries were diagnosed clinically in 9 subjects, compared to 10 via LDI. Full thickness burn injuries were diagnosed clinically in 7 subjects and 6 via LDI. A chi-square test was performed to examine the relationship between clinical diagnosis of burn depth and laser doppler image. The relation between these variables was significant,X2= 26.884, p&lt; .000. Comparing clinically diagnosed burn depth to LDI, each approach (clinical or LDI) diagnosed 42 subjects with partial thickness or deep partial thickness burn injuries and all healed spontaneously. Two of the clinically diagnosed full thickness burn injuries required skin grafting. Six patients were lost to follow-up (X2= 17.745, p &lt; .001).

Conclusions
This study confirms there is no difference between an experienced burn provider’s clinical diagnosis of burn wound depth and prognosis for spontaneous healing compared to a laser doppler image prognosis of burn wound healing.

Applicability of Research to Practice
In an era of advanced technologies, expert clinical bedside assessment is the standard of care.
737 Treadmill Friction Hand Injuries in the Pediatric Patient
Authors: Abbas Paulette , Choe Mia , Ridelman Elika , Angst Beth A , Klein Justin D , Shanti Christina M 
Published: March 2020

Abstract

Introduction
Pediatric friction hand injuries are prevalent, likely due to the increasing presence of home exercise equipment. While friction injuries often appear deeper on initial assessment, not all are treated surgically during the acute phase. We sought to characterize our experience with outcomes based on acute (&lt; 30 days) surgical intervention compared to delayed intervention.

Methods
Patients were queried from a single institution, verified pediatric burn center database. A retrospective chart review of pediatric patients (&lt; 18 years) over a 5 year period was performed. Data collected included demographics, treatment methods (acute vs. delayed), dressing type, scar management, and follow-up. Outcomes included additional surgical and non-surgical adjuncts to treat the sequela of injury.

Results
Our institution treated 23 treadmill hand injuries over the 5-year period. There was a slight predominance of female (n=13, 57%) vs. male (n=10, 43%) patients. Median age at injury was 2 years (IQR 1–3). Thirteen patients (57%) sustained an injury equivalent to a second degree burn and ten (43%) to third degree. Injuries were initially treated with silvadene (n=14) and/or xeroform (n=21). Involvement of left and right hands were equally divided and all injuries involved the digits. The median number of digits involved was 2 (range 1–4). The most commonly injured digits were the middle and ring fingers (19 each). Average length of stay was 14 hours. All but one patient followed-up with a median number of 4 clinic visits. All of these patients were reported as healed at time of last follow-up. Median time to healing was 31.5 days (IQR 29 – 58).
Overall, 4 patients (17%) underwent acute surgical intervention with a median of 7 days from injury (IQR 1.75–13.5). Of these 4 patients, 2 (50%) required additional operations for scar management and 2 (50%) required non-surgical management. Of the 19 (83%) who did not undergo early surgical management, only 1 patient (6%) required a Z-plasty, 12 (63%) were managed with non-surgical intervention and 6 (31%) needed no further treatment after healing.

Conclusions
Pediatric friction hand injuries often affect multiple digits and lead to a median of 4 clinic visits. Our data suggest that early surgical intervention in this cohort did not minimize future surgical procedures or non-surgical management. Rather, delayed intervention appears to allow for fewer surgical procedures and similar non-surgical management. Larger studies are required to validate this finding; however, this data suggests that continued initial management with a combination of silvadene and xeroform may be a safe option.

Applicability of Research to Practice
Our study provides guidance in the evaluation and treatment of pediatric treadmill friction injury. This data supports delaying surgical interventions on these seemingly deep hand injuries.
761 Comparisons of Peer Supporters and Burn Patient’s Satisfaction with Peer Support Encounters
Authors: Henderson Tammy L , Joe Victor C 
Published: March 2020

Abstract

Introduction
Offering peer support to burn patients throughout the recovery process provides a sense of belonging and shared experiences that foster hope. Peer support connects survivors and their families and has been shown to have a positive impact for patients in inpatient and outpatient settings. Data is limited on the effects of providing support from both supporter and patient viewpoints, which setting is preferred, and if multiple visits are more beneficial than a single visit.

Methods
Satisfaction surveys were offered to all supporters and patients after each visit over an 11-year period (2007–17). Survey participation was voluntary and anonymous. Both supporter and patient surveys were scored on a 7-point Likert scale with five and six questions, respectively. Scores were compiled and reported as means with standard deviations. Comparisons were made between inpatient vs outpatient visits and single vs multiple visits. Data were analyzed by student’s t-test with significance defined as p &lt; 0.5.

Results
There were 132 surveys collected from peer supporters (109 inpatient, 23 outpatient) and from 67 patients. Satisfaction for supporters and patients were consistently high in both settings (Table 1). Supporters’ desire to visit again were higher for the outpatient setting (p=0.03). There were no significant differences for supporters in single vs multiple inpatient visits. For patients, the lowest mean satisfaction score occurred in the single outpatient visit (5.77 ± 1.83). Comparing patients who had single vs multiple inpatient visits, mean scores for all questions except “questions answered” were higher for the latter though statistical significance was found only for “visit again” (p=0.01) and “good listener” (p=0.03).

Conclusions
Satisfaction overall is very high for peer support visits. However, burn patients preferred multiple visits in the inpatient setting while peer supporters preferred the outpatient setting.

Applicability of Research to Practice
More qualitative research is needed to explore why peer supporters may feel more comfortable in the outpatient setting and why patients appear to prefer multiple inpatient visits. Overall, patients are satisfied even with single visits from peer supporters.
770 Increasing Attendance in Parent Support Groups Through Creative Engagement
Authors: Stefan Julie , Magnuson Erica , Joe Victor C 
Published: March 2020

Abstract

Introduction
Engaging parents of pediatric burn survivors in support programs enhances children’s coping and self-esteem. A parent support group for pediatric burn survivors was created to address these issues, but participation was consistently low, with an average attendance of two. To increase attendance, the format of the program was modified to target the survivor as well as parental needs.

Methods
The program was created for burn survivors age 3 to 17 years and their parents. The pediatric module incorporated developmentally appropriate activities to engage pediatric burn survivors and siblings in therapeutic techniques to normalize their experience and provide expressive opportunities. Parents attended a parent support group, where facilitators encouraged expression of feelings connected to their child’s burn injury and developing strategies for supporting their child through daily life. The parent portion also fostered an opportunity for them to develop their own coping skills. A trained peer support volunteer attended the program to foster peer support. A survey gauging parental perception of their child’s coping and their own coping was developed and distributed to all parents at the end of the session.

Results
There were 29 attendees (11 adults and 18 children). Ten surveys were completed, but one was eliminated due to user error. The results were overwhelmingly positive and validated a need for parent support (see table). Most parent participants (78%) had never attended a burn survivor support program though all had previously attended survivor-related social events. All respondents indicated they wound attend this event again.

Conclusions
Engaging survivors and their families in recreational-based events appears to lead to higher attendance, as all participants had previously attended social events provided by the burn program. Parents may be more inclined to attend an event that focuses on their child’s needs rather than, or in addition to, their own. Additional programs are planned with a goal of quarterly meetings. Attendance and feedback will need to be tracked to corroborate the findings of this initial experience and foster the growth of a robust parental support program.

Applicability of Research to Practice
Providers of parent support groups need to be creative in developing formats that increase participation. Recreational activities alone do not foster coping skills and emotional support. Activities need to be created that support the psychosocial needs of pediatric burn survivors and their parents.
773 Do Physician Apparel, Posture and Familiarity Impact Adolescent Girls’ Engagement in Post-burn Medical Care?
Authors: Cartelli Lesia S , Sammons Ashley J , Stoycos Sarah A , Price Leigh Ann 
Published: March 2020

Abstract

Introduction
Pediatric burns require ongoing developmental adjustment to lifelong medical care. One well documented phenomenon, “white coat syndrome”, highlights the influence of physician status and medical settings on physiology, while data assessing patient perception of physician care highlights the importance of disarming power attributions by sitting at patient eye-level. The current qualitative report aimed to understand how adolescent patients engage with doctors and whether physician’s clothing, posture and white-coat influence willingness to engage.

Methods
As part of a 6-day therapeutic residential retreat for girls with burns, girls participated in three question-and-answer sessions with the retreat Medical Director, a burn reconstructive surgeon. In the first two sessions, the surgeon wore casual clothing and sat down in a circle with the girls. Session three, the surgeon wore a white coat and stood amongst the seated girls. Engagement with care was assessed via girls’ willingness to ask the surgeon medical care questions. Clinical quality assurance measures assessing nervousness and comfort with doctors were administered at baseline (T0) and post-second (T1) and third sessions (T2). Univariate t-tests were used to assess for mean differences across timepoints.

Results
Fifteen girls (range = 12–20 years old) attended and completed quality assurance questionnaires. Girls reported a significant reduction in nervousness from T1 (M = 2.70) to T2 (M = 1.60), t (9) = 2.54, p = .03, but no change from T0 to T1. Topics discussed included women’s health, scar revision for function vs aesthetic options and communication skills for conversing with medical professionals. Girls exhibited behavior consistent with increased comfort with the surgeon during the final session, as evidenced by spontaneous questions and candid discussion as the girls leapt from their chairs rolling up sleeves, pulling up pant legs and shifting their hair covering scars for a hands-on assessment.

Conclusions
Subtle shifts in physician apparel, posture and interaction may impact adolescent patient’s willingness to engage in their care via asking questions. Future research applying “white coat syndrome” theory to behavioral presentations and engagement with care may be warranted.

Applicability of Research to Practice
Future prospective quantitative research with a larger sample size may be warranted. Physicians treating adolescents who were burned as children may want to consider the formality of their clothes, white coat, stance and posture during initial encounters with patients in an attempt to increase patient comfort and engagement with care.