bluuebunny/crossref_metadata_2025_split huggingface dataset:
519 Retrospective Pilot Study to Examine Potential Predictors of a Standardized Scoring System for Smoke Inhalation Injury
Authors: Frost Joshua , Sorensen Grant , Van Spronsen Nicole , Howell Jordan , Ayala Donna , Kesey Jennifer , Keesari Rohali , Almekdash Mhd Hasan , Griswold John 
Published: March 2020

Abstract

Introduction
Smoke inhalation injury is strongly associated with increased morbidity/mortality. Bronchoscopy is used to diagnosis smoke inhalation injury, but its interpretation is subjective. This study sought to assess diagnostic significance of physical exam, history, location, and adjunct studies characteristically performed on patients suspected of smoke inhalation by comparing these findings to outcomes. The primary goal was to examine variables that could be used to create an accurate smoke inhalation injury scoring system in order to develop an objective method that considers the severity of inhalation injury.

Methods
This retrospective study evaluated demographics, clinical presentation, carboxyhemoglobin level, intubation on arrival, bronchoscopy, comorbidities, hospital course, and outcomes associated with smoke inhalation. Bronchoscopy findings included: red mucosa, carbon particles at carina, and numerical score (1–4). The primary outcome was resuscitation fluid required in the first 24 hours of treatment compared to that predicted by the modified Brooke formula (2cc*weight in kg* Total Burn Surface Area). If the patient received more fluid than predicted, this was considered positive for smoke inhalation. Differences between predictor/outcome variables were determined using Wilcoxon rank sum test for continuous variables and Chi-squared test for categorical.

Results
A positive bronchoscopy score was defined on the condition of having positive physical exam finding and/or bronchoscopy score 1–4. Physical exam findings consisted of soot or carbon sputum present on the patient along with hoarseness, wheezing, or a red oropharynx on physical exam. If the patient met one of these conditions, we considered this a positive result. Inclusion criteria: age 18–89, admission from 1/1/2004 and 5/31/18, and diagnosis of smoke inhalation injury/burn injury. There was a significant difference in positive bronchoscopy between those positive for our condition of inhalation injury and no injury (p&lt; 0.001; Table 1). Patients with a positive bronchoscopy score were 9 times more likely (OR=9.91, 95% CI = 2.8–35.01) to be diagnosed with inhalation injury as compared to those without a positive bronchoscopy score.

Conclusions
These results display the importance of bronchoscopy in suspected smoke inhalation injury and reinforce the need for an objective bronchoscopy assessment. Future studies can build upon these results by creating an objective scoring system to guide providers performing bronchoscopy.

Applicability of Research to Practice
Due to the 9-fold benefit of performing bronchoscopy, it should be the primary tool used to assess potential smoke inhalation injury; other tests may be secondary in nature.
537 Transplantation of Fresh Scalp Allograft in Repairing Extensive Deep Burn Wounds in Children
Authors: Shen Chuanan , Sun Tianjun , Deng Huping , Niu Yuezeng 
Published: March 2020

Abstract

Introduction
It is difficult to treat pediatric extensive burns, which contribute to high mortality rates, partly because of the lack of large allogeneic skin to close wound in China. Therefore, we innovatively used fresh scalp as thin split thickness skin allografts to cover the burn wounds of pediatric patients.

Methods
Fresh scalp allografts were harvested from voluntary donors who were patients’ relatives. The median total burn area in the major burns was of 40% TBSA, in depth of deep second to third degree. The fresh scalp allografts were transplanted on the wounds post tangential excision or escharectomy in the way of mere fresh scalp allografts coverage or mixed coverage with autografts and fresh scalp allografts.

Results
All the patients survived without serious complications during the treatment period. The median healing time was 47 days; the average healing time of the donors’ scalps was (7.6±1.08) days with no scar formation, alopecia areata or folliculitis post operation.

Conclusions
The use of fresh scalp allografts in the treatment of pediatric major burns is an effective and feasible method in protecting wounds and promoting wound healing as well as in reducing scar formation in the donor sites of burned children. The high ratio of fresh scalp areas to pediatric burn wound areas ensures high efficiency of wound coverage; and healthy relative skin donors have more initiatives and favorable healing results.

Applicability of Research to Practice
This is a clinical research which is highly applicable in practice.
541 Gender Disparities Among Burn Surgery Leadership
Authors: Egro Francesco M , Konanur Anisha , Kettering Caroline E , Corcos Alain C , Stofman Guy M , Ziembicki Jenny A 
Published: March 2020

Abstract

Introduction
Gender disparities have been described in the plastic surgery and general surgery literature, but no data has been reported in burn surgery. The aim of this study is to determine gender disparities among burn surgery leadership.

Methods
A cross-sectional study was performed. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers, past presidents of the ABA and International Society for Burn Injuries (ISBI), and editors of the Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma. Training, age, H-index, and academic level and leadership position were compared among surgeons identified.

Results
Among the 69 ABA and ISBI past presidents, 203 burn journals’ editorial board members, and 71 burn unit directors, females represented only2.9 percent, 10.5 percent, and 17 percent, respectively. Among burn unit directors, females completed fellowship training more recently than males (female = 2006, male = 1999, p &lt; 0.02), have lower H-indexes (female = 8.6, male = 17.3, p = 0.03), and are less represented asfull professors (female = 8.3 percent, male = 42.4 percent, p = 0.026). There were no differences in age, residency, research fellowship, or number of fellowships.

Conclusions
Gender disparities exist in burn surgery and are highlighted at the leadership level, even though female surgeons have a similar age, residency training and other background factors. However, gender diversity in burn surgery may improve as females in junior faculty positions advance in their careers.

Applicability of Research to Practice
Gender disparities are a significant issue in burn leadership, which needs further discussion at national level and should be addressed more proactively through programs that emphasize leadership opportunities and mentorship for women.
543 Acute Carpal Tunnel Syndrome from a Solar Panel Electrical Injury: A Case Report and Literature Review
Authors: Qumsiyeh Yazen , Van Hoorebeke Justin , Kopari Nicole M 
Published: March 2020

Abstract

Introduction
The utilization of solar panels for residential and industrial purposes is increasing. Electrical injury from solar panels has not been well defined. Most of the literature on electrical burns is predominately from alternating current (AC) injuries instead of direct current (DC) as seen in solar panels. The implication of solar panel electrical injury in the pathogenesis of acute carpal tunnel syndrome has yet to be reported.

Methods
A retrospective chart review of a patient presenting to our burn unit following a solar panel electrical injury was performed.

Results
The patient was a 46 year old otherwise healthy male who presented after 5–10 seconds of high voltage (~7500V) direct current injury to his right forearm. The patient had deep partial thickness burns to his right hypothenar eminence and a full thickness defect with exposed muscle on his right volar forearm. On admission he had complete function, but within hours developed an inability to move his hand. He was taken for exploration on hospital day 2 because of mildly elevated compartment pressures, pain, and paresthesia. The hypothenar injury was noted to have converted to full thickness injury and a distal right volar forearm fasciotomy and carpal tunnel release was performed. On hospital day 3, the patient’s pain and neurologic examination improved. At 3 month follow-up, the patient had some restored function of his hand, but reduced grip strength, and mild persistent pain and paresthesia in the volar wrist and hand.

Conclusions
Solar panel injuries are expected to rise. The use of high voltage direct current energy has the potential to cause serious harm and appropriate awareness can lead to thorough management and better outcomes of burn victims. With electrical injuries to the hand, providers should have a low threshold for carpal tunnel syndrome, whose symptoms may be complicated by concomitant compartment syndrome of the hand and/or forearm. Lastly, as with most burn injuries a multidisciplinary approach should be established with focus on long term care.

Applicability of Research to Practice
We suspect that this new etiology of electrical burn is on the rise as we see more solar panels being utilized. Physician should be familiar with potential complications in this complex patient population.
549 Differences in Treatment of Stevens-johnson Syndrome and Toxic Epidermal Necrolysis at Burn Centers and Non-burn Centers
Authors: Nygaard Rachel , Endorf Frederick W 
Published: March 2020

Abstract

Introduction
Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at non-burn centers and then transferred to burn centers. We wanted to explore whether patients had any differences in care or outcomes when they received definitive treatment at burn centers and non-burn centers.

Methods
We queried the National Inpatient Sample (NIS) database from 2016 for patients with SJS, SJS/TEN, and TEN diagnosis. We considered burn centers as those with greater than 10 burn transfers to their center and fewer than 5 burn transfers out of their center in a year. Multivariable logistic regression assessed factors associated with treatment at a burn center and mortality.

Results
Using the NIS, a total of 1164 patients were identified. These were divided into two groups, non-burn centers vs. burn centers, and those groups were compared for demographic characteristics as well as variables in their hospital course and outcome. Patients treated at non-burn centers were more likely to have SJS and patients treated at burn centers were more likely to have both SJS/TEN and TEN. Demographics were similar between treatment locations, though African-Americans were more likely to be treated at a burn center. Burn centers had higher rates of patients with extreme severity and mortality risks, and a longer length of stay. However, burn centers had similar actual mortality compared to non-burn centers. Patients treated at burn centers had higher charges and were more likely to be transferred to long-term care after their hospital stay.

Conclusions
The majority of patients with exfoliative skin disorders are still treated at non-burn centers. Patients with SJS/TEN and TEN were more likely to be treated at a burn center. Patients treated at burn centers appear to have more severe disease but similar mortality to those treated at non-burn centers. Our data suggest that more patients with these disorders could benefit from transfer to a burn center.

Applicability of Research to Practice
These data may aid in outreach efforts to improve appropriate transfers of patients with severe exfoliative skin disorders to burn centers for definitive care.
555 The Prevalence of Patients with Homelessness or Housing Instability in Patients Admitted to an Urban Burn Intensive Care Unit
Authors: Shetty Pragna N , Mafla Laura M , Slavin Benjamin R , Yesantharao Pooja S , Javia Vidhi , Cox Carrie A , Hultman C Scott 
Published: March 2020

Abstract

Introduction
Patients with homelessness in the setting of burns experience more complications and longer lengths of stay (LOS), resulting in higher costs of care and recidivism rates, making appropriate screening and documentation critical to improving outcomes. However, the prevalence of housing instability and its effect on outcomes has not yet been studied. This study sought to describe the prevalence of housing insecurity, or homelessness and housing instability, in patients admitted to an urban burn intensive care unit (BICU) and compare their outcomes to their housed counterparts.

Methods
This is a retrospective cohort study of all adult patients admitted to our BICU over 3 years. The degree of burn injury and LOS were collected. We used the World Health Organization definitions of housing insecurity to identify patients. Physician and case management notes were used to evaluate housing status.

Results
There were 881 patients observed. The prevalence of patients with homelessness was 2.9 per 100 patients. The prevalence of patients with housing instability was 10.3 per 100 patients. The median length of stay was 8 (IQR 4 – 11) days for patients with homelessness and 4.5 (IQR 2 – 12) days for patients with housing instability compared to 4 (IQR 1 – 8) days for housed patients (P &lt; 0.001). Patients with housing insecurity had similar injuries to housed patients (P = 0.06). Physicians incorrectly documented housing status in 42.9% of patients with housing insecurity compared to case management, which correctly screened all patients (P &lt; 0.01). The electronic medical record correctly screened less than 1% of the patients with housing insecurity (P &lt; 0.01).

Conclusions
Housing insecurity is more prevalent than previously thought, with 13.2 per 100 patients experiencing either homelessness or housing instability. These patients have similar injuries to their housed counterparts, with longer stays and higher health care costs. Identifying and implementing appropriate screening tools can help provider teams connect patients with resources, reducing costs and improving outcomes.

Applicability of Research to Practice
Identifying patients at high risk earlier in their care can ensure that they are provided with the appropriate resources to avoid complications and worse outcomes.
567 A Qualitative Exploration of Social Workers as Members of Burn Care Teams
Authors: Abrams Thereasa E , Held Mary L , Lloyd Alison , Skeesick Jessica 
Published: March 2020

Abstract

Introduction
Social workers as members of interprofessional teams are important in treating the psychosocial sequela of trauma and burn injuries. However, the specific skills needed and roles of social workers on treatment teams can be confusing and poorly articulated not only by medical providers, but even among social workers themselves. This qualitative study was designed to increase both the breadth and depth of knowledge related to social work practice on interprofessional burn care teams.

Methods
Primarily qualitative methods were used to explore the roles of social workers employed on burn care teams. In addition to conducting individual interviews, brief surveys were collected from each of the social work participants (N = 11) focused on participant work environments and demographics. All qualitative interviews were transcribed verbatim to capture the perceptions of participants in their own words. Each interview was analyzed and coded by at least two research team members using NVivo 12 (QSR International, 2018). Analysis applied grounded theory strategies for inductive thematic approaches.

Results
Ten females and one male participated. All participants held some level of professional license and had a mean of 4.69 years of experience working in a burn center (range = 1–13 years). Themes and sub-themes derived between and across participant interviews were: “Skills” (building trust/rapport, thorough assessment of needs, support, communication, case management, trauma-informed therapy, and knowledge of medical terminology and burn treatment); “Challenges/Barriers to Treatment” (patient finances, lack of community providers knowledgeable in management of burn injuries, knowledge of available community resources throughout their catchment area, unstable social support systems, premorbid patient mental illness and substance abuse, inadequate insurance coverage, transportation insecurity, and the long-term nature of burn recovery); and “Resources” (Phoenix Society, SOAR, World Burn Congress, burn foundations, hospital programs, stable support systems, and resilience of burn survivors).

Conclusions
By gaining insight into the skills, barriers, and resources of social workers working in U.S. burn centers, treatment team members can better and more consistently understand, utilize, and support their current and/or incoming social workers. In addition, Master’s level academic programs can better prepare new social workers in how to best assist burn survivors and their families at both the inpatient and community level. Content related to the needed competencies can be incorporated into required social work courses and medical social work electives.

Applicability of Research to Practice
By establishing the requisite skills of burn center social workers, there will be opportunity for consistency through certification in burn care much like allied health providers.
572 Examination of Gender Differences in Return to School and PROMIS-25® Outcomes for Pediatric Burn Survivors
Authors: Stockly Olivia , Wolfe Audrey E , Gibran Nicole S , Ryan Colleen M , Schneider Jeffrey C 
Published: March 2020

Abstract

Introduction
Gender differences in pediatric burn outcomes are not well-known. Long-term physical and mental health outcomes, in addition to school status, serve as important markers in recovery for school-aged burn survivors. This study aimed to assess the impact of gender on school status and health outcomes in pediatric burn survivors.

Methods
Data from pediatric burn survivors, age 8–17 years at time of injury that are participating in the Burn Model System National Database (2015–2019) were analyzed. Descriptive statistics were generated for demographic and clinical characteristics. Scores on the seven subscales of the PROMIS-25 (physical function, anxiety, depression, fatigue, peer support, pain interference, and pain intensity) and school status at 12 months post-injury were examined. All demographic, clinical, and outcome data were compared by gender using Chi-square tests of association and two-sample t-tests for categorical and continuous variables, respectively.

Results
A total of 104 individuals (76 male, 28 female) were included in the demographic analysis. Additionally, 60 individuals had complete PROMIS-25® data at 12 months post-injury and were included in analysis. Demographic and clinical characteristics including age at time of burn injury, race/ethnicity, burn etiology, burn location and burn size did not differ by gender. No differences were found in PROMIS-25® subscales (p=0.22–0.87; Table 1) or school status by gender. Nearly 80% of male and female burn survivors were in school at 12-months post-injury (76.6% male vs. 88.2% female; p=0.307).

Conclusions
In this study, burn survivors between the ages of 8 and 17 years old did not experience any differences in long-term PROMIS-25® outcomes or school status at 12 months post-injury based on gender.

Applicability of Research to Practice
Preliminary data suggest similar physical, mental, and school outcomes for school aged children based on gender. A more robust examination of long-term pediatric outcomes and school status are needed in the future.
573 Frequency of Burn Injuries in Children with Autism Spectrum Disorders and Attention Deficit/hyperactivity Disorder and Implications on Treatment Compliance
Authors: Sadeq Farzin , Riobueno-Naylor Alexa , Ceranoglu Atilla , Sheridan Robert 
Published: March 2020

Abstract

Introduction
Children with autism spectrum disorders (ASD) and attention deficit/hyperactivity disorder (ADHD) are at a higher risk of burn injuries, compared to children with neurotypical development, but little is known about the epidemiology of burn injuries in children diagnosed with ASD and ADHD. Research within the pediatric burn population using the Burn Outcomes Questionnaire (BOQ) has been successful in capturing levels of risk on burn-recovery specific domains such as compliance to treatment, pain, and parental concerns.

Methods
The current study retrospectively assessed a subsample of BOQ data in children with burn injuries who also had a diagnosis of ASD or ADHD. This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board.

Results
Of the 593 patients who completed a BOQ, 186 patients were identified with a diagnosis of ASD or ADHD. 127 patients had multiple parent-reported symptoms which align with diagnoses of ASD and ADHD, including 116 (63.4%) with attention or behavioral problems, 42 (23.3%) with a developmental delay, 7 (3.9%) with an intellectual disability and 90 (49.7%) had learning problems. 66 (37.3%) patients had pre-existing comorbid psychiatric diagnoses of depression.

Conclusions
Results indicated that a large portion of patients have a diagnosis of ASD/ADHD with significantly higher levels of parental concern regarding compliance compared to youth without an ASD/ADHD diagnosis. Results suggest that modified curriculum may be necessary to assure effective prevention education for children with ASD and ADHD.

Applicability of Research to Practice
While it is important to educate all children in burn prevention efforts, special attention may be necessary to assure training with children at greater risk for burn injury. Specific parent training would be imperative to understand the critical burn care needs of children with developmental disabilities.