bluuebunny/crossref_metadata_2025_split huggingface dataset:
561 Impact of Support Group for Teen Burn Survivors
Authors: Castro Alexis , Muro Marissa , Dominic William , Kopari Nicole M 
Published: March 2020

Abstract

Introduction
The recovery of a burn survivor continues long after the physical wounds are healed. Peer support groups offer survivors an opportunity for psychosocial recovery, particularly in the areas of self-acceptance, changes in perspective, and identity. Multiple published studies have found group support to be beneficial. We identified a need to provide a separate teen burn survivor support group to optimize engagement and to address specific age appropriate discussions.

Methods
The support group included female burn survivors 14–17 years of age. The group sessions were facilitated by a child life specialist and a burn nurse. Meetings were held on the same evenings as adult support groups to allow parents of the teen survivors to attend the adult meeting. During the first meeting, participants were given the opportunity to share topics they would like to discuss, and these were incorporated into the curriculum. Topics specific to teens included identity issues, body image, peer relationships, and what it means to be a burn survivor advocate. Additional outings have been incorporated such as family dinners and movie nights. After 15 months, participants were surveyed on their overall experience.

Results
The group was established in February 2018 and has had a steady participation of teen burn survivors. All teen burn survivors completed the participation survey. All teens strongly agreed their experience was positive, felt more connected to the other participants through the group activities, felt accepted by the other group members, and would recommend the teen support group to other teen burn survivors. Teens rated positive results for learning about themselves as a burn survivor, changing their perspective on their recovery, and the importance of participating in a support group.

Conclusions
Teen burn survivor support group has been shown to be a sustainable method to support these burn survivors and provide them with an opportunity for psychosocial recovery.

Applicability of Research to Practice
By sharing our experience with a teen burn survivor support group, we hope to inspire other burn centers in developing ways that their facility can meet the needs of burn survivors.
706 Frostbite and Drugs of Abuse: Friend or Foe?
Authors: Wagner Anne L Lambert , Dyamenahalli Kiran U , Smith Tyler M , Duffy Patrick , Kovacs Elizabeth J , Wiktor Arek J 
Published: March 2020

Abstract

Introduction
In the literature, the incidence of alcohol and/or drug use among burn patients ranges from 16.4%-69%. Burn patients with positive toxicology (tox) screens on admission are known to have increased rates of morbidity and mortality. To date little has been published on the effects of positive alcohol and/or drug screens on outcomes in the frostbite population. The objective of this study was to investigate the incidence of drugs and alcohol use in admitted patients with severe frostbite and their association with clinical outcomes.

Methods
A retrospective cohort study was conducted on 141 frostbite patients admitted to a verified burn center from November 2015 to March 2019. Patients were identified using our burn registry and relevant data was obtained through chart reviews. The primary comparison was between patients with and without a positive tox screen on admission, assessing administration of thrombolytics (tPA) and rates of amputation. Contingency analysis for categorical variables was performed using Fisher’s exact test, while the Mann-Whitney U test was used for continuous variables, reporting, two-tailed p values.

Results
Tox screens were positive in 77.3% (109) of frostbite patients: 52.5% (74) for marijuana and 56.7% (80) for alcohol. Homelessness accounted for 50.4% (71) and 63.1% (89) were tobacco users. Compared to patients with negative tox screens, significantly higher rates of amputation were found in those using marijuana (p=0.016), other drugs of abuse (p=0.008) and tobacco (p=0.0093). Significantly higher limb salvage rates were found in patients presenting with a negative tox screen (p=0.0077). Only tobacco users had a significantly greater length of stay (p=0.02). 36.2% (51) of the patients received tPA with no difference in administration rates between positive and negative tox screened patients. Patients receiving tPA had significantly lower rates of amputation (p=0.02). 51.8% (73) of admitted patients were homeless, with 83.6% (61) testing tox positive. Both increased hospital length of stay (p=&lt; 0.001) and amputation rates (p=0.0004) were observed in the homeless frostbite population.

Conclusions
Drugs, alcohol and homelessness significantly impact clinical outcomes in frostbite patients. Homelessness, marijuana, tobacco and other drugs of abuse are associated with significantly higher rates of amputation despite receiving tPA at the same rate. Administration of tPA is significant in lowering amputation rates.

Applicability of Research to Practice
The association between drugs of abuse, homelessness and frostbite highlight the need for increased preventative efforts especially in the homeless population.
714 IL-6 and Soluble IL-6 Receptor – Two Sides of the Same Coin
Authors: Rehou Sarah , Abdullahi Abdikarim , Jeschke Marc G 
Published: March 2020

Abstract

Introduction
Interleukin (IL)-6 is a multifunctional cytokine that has both a pro- and anti-inflammatory role. In many studies, IL-6 has been shown to increase rapidly after burn injury and is associated with poor outcomes. IL-6 can signal via its soluble IL-6 Receptor (sIL-6R) and is referred to as trans-signaling, which is regarded as the pro-inflammatory pathway. The role of sIL-6R post-burn injury has not yet been explored. We hypothesized that patients with a lower ratio of IL-6 to sIL-6R would have worse outcomes.

Methods
Patients admitted to our burn centre within 7 days of injury were included in this study. Patients were divided into two groups based on IL-6 and sIL-6R levels measured within the first 30 days post-burn injury. Patients were in the high ratio group if their IL-6:sIL-6R ratio was ≥ 0.185. Clinical outcomes included organ biomarkers, morbidities, and hospital length of stay. Groups were compared using Student’s t-test, Mann-Whitney U, and Fisher’s exact test as appropriate; a P value of &lt; 0.05 was considered statistically significant.

Results
We studied 104 patients, mean age 51 ± 18 years and 24 ± 17% total body surface area (TBSA) burn. There were 49 patients categorized with a low IL-6:sIL-6R ratio and 55 patients with a high IL-6:sIL-6R ratio. Patients in the high IL-6:sIL-6R ratio group had a significantly greater TBSA burn and a significantly greater proportion of patients with inhalation injury (p&lt; 0.05). Levels of sIL-6R were not significantly different among the low and high group (770 ± 264 pg/mL vs. 798 ± 268 pg/mL respectively; p=0.601). However, levels of IL-6 were significantly higher in patients with a high IL-6:sIL-6R ratio (37 IQR 19–97 pg/mL vs. 567 IQR 273–916 pg/mL; p&lt; 0.0001). Mortality was significantly greater in the high IL-6:sIL-6R ratio group (2% vs. 27%; p&lt; 0.001).

Conclusions
Interestingly, patients with a higher ratio of IL-6:sIL-6R had significantly greater mortality. Using sIL-6R as a marker for the proinflammatory immune response, we expected patients with a lower IL-6:sIL-6R ratio to have poor outcomes which are typically associated with a hyperinflammatory or exaggerated immune response. However, the absolute value of sIL-6R did not differ. This suggests that classic signaling of IL-6 via its membrane bound receptor, with an anti-inflammatory function, is an important factor.

Applicability of Research to Practice
The opposing pro- and anti-inflammatory function of IL-6 through trans- and classic signaling is contingent on the ratios expressed. The demonstrated increase in classic signaling highlights the importance of measuring both IL-6 and sIL-6R in future studies. Additionally, it lays the foundation for potential precision medicine approaches to selectively block specific signaling pathways.
760 Patients with Pre-existing Mental Illness Who Developed Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Lessons Learned at a Large Tertiary Burn Center and the Importance of Accurately Diagnosing Psychiatric Disorders
Authors: Laughon Sarah L , Duplisea Michael , Ziemer Carolyn , Chrisco Lori , Williams Felicia N , Jones Samuel W , Cairns Bruce , Nizamani Rabia , Gala Gary J 
Published: March 2020

Abstract

Introduction
In recent years, burn centers are managing more patients with exfoliative skin disorders including Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and SJS/TEN overlap. While it is well known that burn patients have higher rates of co-morbid psychiatric disorders than the general population, the incidence of pre-existing psychiatric disorders among patients who develop SJS, SJS/TEN overlap, and TEN is unknown. This study aimed to characterize a cohort of patients with pre-existing psychiatric disorders admitted to a tertiary burn center for treatment of SJS, SJS/TEN overlap, and TEN with specific focus on those who received the offending agent for a psychiatric indication.

Methods
A retrospective descriptive case series using an institutional burn center registry was performed. All patients admitted to a single verified burn center between January 1, 2009 and December 31, 2018 with biopsy-proven SJS, SJS/TEN overlap, or TEN and the presence of a co-morbid psychiatric disorder were identified. Demographic, hospital, and clinical information were extracted from the burn registry and verified through review of the electronic medical record.

Results
Among 168 patients with biopsy-proven SJS, SJS/TEN overlap, or TEN, 18% (30/168) had a pre-existing psychiatric disorder, with the offending agent being prescribed for a psychiatric indication in 30% (10/30) of patients. Lamotrigine was the offending agent in 80% of cases and prescribed 100% of the time for a psychiatric indication. Of those who received lamotrigine, patients were 100% female, 63% black, and had an average age of 38 years. The mean length of stay was 24 days and 88% received a psychiatric consultation. While 75% of patients were started on lamotrigine for a diagnosis of bipolar disorder, none of these patients met criteria for bipolar disorder.

Conclusions
Pre-existing psychiatric comorbidity is less common among patients that develop SJS, SJS/TEN overlap, and TEN than in burn-injured patients. For patients with pre-existing psychiatric disorders who develop these potentially fatal skin diseases from an offending agent that was prescribed for a psychiatric indication, early involvement of psychiatry colleagues is recommended to ensure proper psychiatric diagnosis and management moving forward.

Applicability of Research to Practice
This study highlights the importance of accurate assessment for and diagnosis of bipolar disorder prior to determining treatment approach. For the burn surgeon treating these patients, early involvement of psychiatric consultants is recommended and extremely important.
778 Association of Demographic and Burn-related Factors to PTSD Pre-screen Survey Results Among Burn Patients
Authors: Spadafore Sophia , Meyer Paul , Spadafore Philomene , Bhattarai Bikash , Foster Kevin N 
Published: March 2020

Abstract

Introduction
A burn injury can be a traumatic experience and many patients suffer physical, social, and psychological consequences. Stress disorders, including posttraumatic stress disorder (PTSD), have been reported to occur after burn injury in 18%-33% of cases, but knowledge about the predictors of PTSD in burn patients is still lacking. The objective of our study is to evaluate the demographic and burn-related factors in these patients associated with screening positive or negative to be at high risk for PTSD.

Methods
All patients who met the inclusion/exclusion criteria were administered the 4-item Primary Care Post-Traumatic Stress Disorder screen (PC-PTSD) survey, and subsequently their charts were reviewed. High risk of PTSD was defined as a “yes” answer to three or more survey questions. Variables collected on each subject included gender, date of birth, age at time of burn, date of burn, race, ethnicity, insurance category, TBSA, burn location, and whether surgery was required for the burn. Wilcoxon rank sum test with continuity correction was used to compare patients with a positive screen to those without one. Fisher’s Exact Test for Count Data was used to analyze the associations of gender and need for surgery to the positive or negative screening test results.

Results
Among the 121 patients who met inclusion criteria and had burn mechanism documented, 15 were excluded due to missing information or unclear burn mechanism. Among the 121 patients, 55 (45.5%) screened positive and 66 screened negative. The mean (median) TBSA percentage for the patients screening negative was 4.79 (3.0) and 11.35 (4.5) for the patients who screened positive (P=0.02). 51.8% of females had a positive screening test compared to 40% males (Fisher’s exact P=0.206). Of the patients requiring surgery, 49% of the patients had a positive screening test, compared to only 40% who did not require surgery (Fisher’s exact P = 0.365).

Conclusions
In analyzing these survey results it was clear that burn patients with a higher TBSA are significantly more likely to develop PTSD than those will a smaller TBSA, with the mean TBSA for patients developing PTSD being 11.35%. Probable association was found between developing PTSD and female gender. The need for surgery was also correlated with a slight increase in PTSD, though this was not statistically significant. More research is necessary to determine other factors in burn patients that may be associated with PTSD.

Applicability of Research to Practice
All patients with burns should be screened for PTSD, but particularly those with greater than 11% TBSA. Resources should be given to burn patients at discharge to follow up on the results of their PTSD screening.
785 Beyond the Burn Center: Creating Nursing Clinical Guidelines for Pediatric Burn Patients That Present to Community Emergency Departments
Authors: Nickerson Jillian , Decerbo Paul C 
Published: March 2020

Abstract

Introduction
The goal of this project was to improve the initial care of pediatric burn patients that present to community hospital emergency departments before transfer to a burn center. The pediatric burn center received a transfer of a burn patient from a community emergency department that showed there was room for improvement on the initial care before transfer to the burn center.

Methods
This was a quality improvement project between the pediatric emergency department in conjunction with an outside community hospital emergency department to develop clinical guidelines using the burn centers handbook as well as the most recent ABA and ABLS guidelines to develop standards of care for a pediatric burn patient. These clinical guidelines would serve as recommendations in regards of calculating the total body surface area (TBSA) effected, the calculations of required fluid resuscitation including the addition of maintenance fluids, pain control recommendations, as well as when to transfer to a burn center.

Results
This project resulted in a multi-site collaborative effort which produced a thorough and easy to follow algorithm which takes the care provider through each step of the initial resuscitation of a pediatric burn patient. The algorithm initiates with the primary survey and moves through to the secondary survey with individual color coded categories for each thickness of burn. These categories run through the treatment recommendations while adhering to burn center’s treatment recommendations. This all terminates into a disposition determination for both minor and major burns. The major burn category runs through the transport criteria set forth by The American Burn Association.

Conclusions
Phase one of this project concluded with a collaborative effort between a Community Hospital ED and a Level 1 Burn Center ED. This coordination established an evidence based practice guideline allowing two completely separate departments within the state to provide synergistic and coordinated care to one of the most vulnerable populations.

Applicability of Research to Practice
The algorithm produced by this project while detailed, is a universal approach and can be implemented and adapted by any first line or receiving facility. Moving forward there will be collaborative efforts to conduct exercises involving identification, stabilization, and initial resuscitation of a simulated pediatric burn case at the community hospital for which this diagram was developed for. It is our goal to keep this momentum going and conduct these simulations regularly in order to test the system and make improvements to the algorithm.
786 Guardian Refusal for Pediatric Burn Surgery, What Providers Need to Understand
Authors: Libraro Kaitlyn , Heffernan Jamie , Lorico Jeremiah , Lodescar Rachelle J , Rabbitts Angela 
Published: March 2020

Abstract

Introduction
Pediatric patients, between the age of newborn and 18 years, require legal guardian consent for any surgical procedure. In some cases, despite medical advisement, guardians refuse excision and skin graft for a minor in their care. In these cases, extended healing times, re-admission, scaring, contracture and physical disability may ensue. Our study aims to review contributing factors of guardian refusal and explore the outcomes of such refusals.

Methods
Retrospective chart review of all pediatric patients admitted to a large verified burn center between January 2018 through May 2019 were reviewed for total body surface area (TBSA) burned, age, depth of wound, mechanism, MD recommendation for surgical procedure, operative procedures conducted and length of hospital stay (LOS).

Results
Of the 265 pediatric patients admitted to the Burn Service, 32 (12%) were recommended surgical intervention during their hospitalization. Of these, 25 (78%) guardians consented for surgical skin grafting procedures following recommendation; 3 (9%) guardians delayed treatment consent by an average of 5 days; and 4 (13%) refused surgical consent for skin grafting procedures entirely. The average TBSA for patients recommended for surgical intervention was 8.7, those who accepted surgical intervention had an average TBSA of 8.35, compared to the 11.25 TBSA who refused surgical intervention. Average inpatient length of stay for patients whose guardians consented to surgical intervention promptly was 15.8 days. Despite an average 5 day delay in consent, guardians who deferred consent for surgical intervention doubled their length of stay (31.1 inpatient days). The four guardians who refused recommended surgical intervention had an average inpatient stay of 8.25 days. This finding is consistent with multi-day dressing use and outpatient clinic management. Of note, the four patients that did not receive surgical intervention for burn wound management were linked by common cultural background.

Conclusions
Pediatric burn injury is both acute and chronic, and the shock of initial injury is often overwhelming for both the patient and the guardian. Furthermore, guardians are then asked to make surgical decisions for a minor in their care. The burn team needs to have a heightened awareness of the cultural norms in the communities they serve to ensure quality care deliverance and patient safety.

Applicability of Research to Practice
Directly Applicable.
791 Institutional Experience Using a Treatment Algorithm for Electrical Injury
Authors: Nisar Saira , Keyloun John W , McLawhorn Melissa M , Moffatt Lauren T , Travis Taryn E , Shupp Jeffrey W , Johnson Laura S 
Published: March 2020

Abstract

Introduction
Electrical injury has a low incidence, however is often associated with significant morbidity and mortality. There is some variability in the initial diagnosis and management of patients injured by electricity among institutions. This is particularly evident when non-burn specialists are managing care. This may result in unnecessary testing, monitoring, or admissions. The goal of this study was to examine the effectiveness of an electrical injury treatment algorithm (Figure), aimed to identify patients at risk for complications and reduce unnecessary investigations.

Methods
After IRB approval, demographics, laboratory tests, length of stay, telemetry monitoring, and disposition were collected for patients arriving to a regional burn center with the diagnosis of electrical injury from December 2012 to September 2018. Patients with arc injury were treated based on thermal injury algorithm and thus were excluded. Results were compared for patients who were admitted with electrical injury before and after implementation of the algorithm in July 2015.

Results
Fifty-eight patients were included in the pre-algorithm cohort and 38 in the post-algorithm cohort. Mean age in both groups was 36±12. There were no significant differences between groups in age, cutaneous burn area or gender. Incidence of creatine kinase, troponin, and urinary myoglobin testing in pre-algorithm cohort was significantly higher compared to post-algorithm cohort (81% vs. 47%, p&lt; 0.05, 77% vs. 34%, p&lt; 0.05 and 79% vs. 45%, p&lt; 0.05 respectively). There was a trend towards higher number of days on telemetry prior to the protocol implementation but this was not found to be significant (3.6±6 vs. 1.1±0.3, p=0.054). One patient in each cohort had a pre-hospital cardiac arrest and attended the hospital with ACLS in progress and was subsequently pronounced dead. There were no significant differences in length of stay (6±11 vs. 3±3.6, p=0.11) or intensive care unit admission (33% vs. 27%, p=0.5).

Conclusions
An electrical injury treatment algorithm provides a way to triage patients appropriately for admission to the hospital and reducing the number of laboratory tests. Continued data collection and targeted quality improvement will guide further protocolization for the management of these patients. This will ultimately reduce unnecessary admissions to the hospital and the amount of clinical testing without affecting outcomes.

Applicability of Research to Practice
Electrical injury treatment algorithm provides a way to triage patients appropriately for admission to the burn center and reduces unnecessary investigation.