bluuebunny/crossref_metadata_2025_split huggingface dataset:
709 24 Hour Patterns of Vital Signs as Predictors of Blood Infection in Pediatric Burn Patients
Authors: Munoz Elena Maria S , Weber Joan , Lydon Martha , Uygun Korkut , Sheridan Robert 
Published: March 2020

Abstract

Introduction
Blood infection diagnosis requires a positive blood culture, which may take 3 days, thus hindering early treatment and negatively impacting clinical outcomes.

Methods
In a retrospective review, 100 patients were screened, 34 remained after exclusions for incomplete data, leaving 89 blood cultures. Subjects were separated by infection (positive blood culture), or control (negative blood culture) groups.

Results
A combination of vital signs to aid in early and accurate prediction of blood infection.
Within 24 hours of blood draws and antipyretic administration, the vital sign combination of 1 or more MAP Dips (MAP below 60 mmHg) and 2 or more Fever Spikes (temperature above 39°C) or 2 or more Heartrate Spikes (heartrate above 2 SD age-specific norms), show: True Positive Rate (Sensitivity), 95%, True Negative Rate (Specificity), 94%, Positive Predictive Value (Precision), 92%, Negative Predictive Value, 96%, False Positive Rate, 6%, False Negative Rate, 5%, False Discovery Rate, 8%, Accuracy, 94%, F1 Score, 94%, Informedness, 0.89, Markedness, 0.88, Matthews Correlation Coefficient, 0.89. We evaluated different combinations of vital signs associated with blood infection including temperature below 36.5°C and various numbers of MAP dips, fever spikes, and heartrate spikes, with weaker predictive metric values.

Conclusions
Blood infection can be predicted with patterns in vital signs within 24 hours.

Applicability of Research to Practice
Vital signs and readily available data may be beneficial for use in clinical care of pediatric burn patients in relation to blood infection. We are currently analyzing dynamic trends in vital signs and infectious organism to not only predict infection, but anticipate appropriate treatments.
717 Using the VDR to Safely Transport Critically Ill Burn Patients to the OR
Authors: Mehta Anupama , Marano Michael , Englert William , Zanni Elyse 
Published: March 2020

Abstract

Introduction
Critically ill burn patients’ inability to tolerate conventional mechanical ventilation often results in delays, postponements and cancellations of surgical interventions. Early intervention with surgical excision and debridement can help prevent infection, multi-system organ failure and mortality. Severe burn victims often sustain lung injury due to inhalation of toxic smoke and heated gases. Severe respiratory distress due to smoke inhalation has been associated with a mortality of up to 80%. The application of conventional mechanical ventilation can rupture healthy alveoli and may intensify lung injury due to the constant opening and closing of lung units. Volumetric diffusive respiration allows for the diffusion of oxygen via intrapulmonary percussion with convective removal of carbon dioxide. This mode of ventilation in burn patients aids in the clearance of small airway debris. Diffusive oxygenation provides alveolar protection by eliminating repetitive opening and closing while convective forces provide CO2 and debris clearance. At our facility, with the assistance of the Volumetric Diffusive Respirator (VDR), we have been able to successfully stabilize the respiratory status of compromised patients by improving their oxygenation and ventilation. This technology has allowed us to safely transport patients to the operating room sooner to undergo surgical procedures.

Methods
A retrospective review was conducted of all VDR transports for surgery from January 2017 to May 2019. A total of eight patients were transported on the VDR to and from the OR on twenty-eight separate occasions. Patients presented with 19% to 73% TBSA burns with or without smoke inhalation. The population consisted of four males and four females, ranging in age from 21 – 61 years. Patients with severe burns and hypoxemia that failed conventional ventilation were placed on VDR. The VDR was initiated a minimum of 24 hours prior to surgery. Settings were optimized to achieve a PaO₂ of 60 mmHg or greater and a pH within 7.35–7.45 range. Patients were transported to the OR on VDR with a BICU Nurse, VDR technology trained Respiratory Therapist and a Burn Surgeon. Patients remained on the VDR throughout the entire operative case and were transported directly back to the BICU on the VDR.

Results

No difference was noted in EtCO2 or SpO2 with use of the VDR. A difference is PaO2 was noted with use of the VDR.

Conclusions
This study demonstrates that patients requiring VDR support can be safely transported to the OR. Critically ill burn patients who have refractory hypoxemia can undergo early surgical excisions and debridement. These timely surgical interventions can reduce the delay to surgery which could potentially lead to a negative impact on the patient’s outcome.

Applicability of Research to Practice
The use of VDR can lead to more timely surgical intervention and thus, the rate of infections and pulmonary injury can be studied.
723 Should Allograft / Homograft Still Be Used for Small and Medium Size Burns?
Authors: Gasteratos Konstantinos , Goverman Jeremy 
Published: March 2020

Abstract

Introduction
There is no doubt that human cadaveric allograft has been invaluable for the temporary coverage of large and extensive burns. In such cases, allograft has important systemic effects with respect to fluid and heat loss, inflammation, and metabolism. The incidence of large burns, however, has decreased over time. Small and medium-sized burns remain constant and are often treated with allograft as a means to test and/or prepare a wound bed after excision. This allows for a conservative, staged approach to burn wound closure but it remains unclear if the use of allograft in this way is advantageous. Knowing the deleterious immunomodulatory effects of allogeneic transplantation and given current applications of negative pressure wound therapy (NPWT), is allografting still a valid option for temporary coverage of small and medium-size burns.

Methods
A patient with a 20% TBSA full-thickness flame burn underwent tangential excision of the left thigh down to the level of the subcutaneous tissue. A 3x3 cm square of freshly thawed, commercially available, human cadaveric allograft was applied to a portion of the wound and the entire would be placed into an NPWT dressing for 3 days. The dressing was removed in the OR and photos of the underlying wound bed were obtained.

Results
Macroscopically, the wound bed beneath the allograft appeared markedly less vascular (figure 1-2-3-A and B) than that of the control. Additionally, the wound bed beneath the allograft appeared to have more necrotic, or unhealthy appearing, adipose tissue. The wound bed beneath the allograft appeared desiccated while the control appeared healthy and vascular.

Conclusions
Allograft may not prevent desiccation, may not prepare a wound bed as well as NPWT, and may not be the best option for the staged treatment of small and medium-sized burns. Controlled trials are needed, as is an open and honest discussion regarding the potentially negative implications this may have on reimbursement.

Applicability of Research to Practice
Challenging the status quo in the surgical management of severe deep burns and the current reconstruction methods can be useful in order to make a change and improve patient safety and outcomes.
732 Evaluating the Cost-effectiveness, Efficacy, Safety, and Tolerance of Silver Sulfadiazine Dressings Once Daily versus Twice Daily in the Treatment of Burn Wounds
Authors: Lagziel Tomer , Born Louis , Quiroga Luis H , Duraes Eliana F , Slavin Benjamin R , Shetty Pragna N , Javia Vidhi , Cox Carrie A , Caffrey Julie , Hultman C Scott , Asif Mohammed 
Published: March 2020

Abstract

Introduction
Topical antibacterial agents are an essential component of burn wound management. The aim is to prevent wound infection effectively and promote healing. A poorly treated wound can result in scarring or even sepsis and multi-organ dysfunction in severe cases. Topical Silver Sulfadiazine cream (SSD 1%) has been the gold standard for burn care since 1960s. Due to the immediate burst release of the drug into the exposed areas, application is relatively frequent, usually twice daily. However, it remains unknown whether twice-daily SSD dressings are superior to once-daily.

Methods
Our institution maintained a twice-daily dressing change standard of care until 01/01/2019. Patients admitted after that date had their dressing changed once daily. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after the change. Our main outcomes recorded are wound infection, average pain scores, average daily narcotic requirements and length-of-stay.

Results
Preliminary results of 20 pre-change-of-practice and 20 post-change-of-practice patients showed no difference in the outcomes between the two groups. The infection rates were the same for both groups (15%), average pain scores (Graph 1) for the post-change group were slightly higher (pre=5.5, post=5.8; p=0.7), average length-of-stay (Graph 2) was longer in the pre-change group (pre=9.2, post=5.7; p=0.04), and no other surgical complications were reported for patients in either group.

Conclusions
Preliminary results show that a once-daily dressing change of SSD, has no negative impact on burn wound outcomes. In addition, it is associated with a decreased length-of-stay. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. Changing the standard-of-care to once-daily could prove beneficial. Further patient review will shed more light on the significance of these results, however so far there is no inferiority in wound healing.

Applicability of Research to Practice
The frequency of dressing changes directly affects staff workload who are required to spend a lot of time carefully changing dressings. In addition, patient discomfort associated with frequent dressing changes including interference with sleep hygiene and increased pain medications could also be avoided. Finally, fewer dressing changes are associated with less medical supplies and hospital utilization without putting the patient at any further risk of infection.
740 Mechanisms, Outcomes and Management of Pavement Burns
Authors: Eisenberg Matthew T , Chestovich Paul J , Saquib Syed F 
Published: March 2020

Abstract

Introduction
Burns from contact with hot pavement are commonly seen at burn centers located in desert climates. Previous work has shown increased risk of pavement burns as ambient temperatures rise above 95 degrees. In direct sunlight pavement absorbs radiant energy causing it to rise to temperatures high enough to cause second degree burns in under 35 seconds. This study aims to review the experience of treating pavement burns in a desert climate.

Methods
A retrospective chart review was performed on pavement burns at an ABA-verified Burn Center for 5 years from 2014–2018. The data collected included %TBSA, surface area per body region, cause, operative management, comorbidities, complications, incident location and cause of death. Patients were separated by cause into groups which included found down, walked on pavement, heat/dehydration, mechanical fall, syncope, seizure, trauma, substance/psych and unknown.

Results
A total of 185 patients admitted for pavement burns were identified in the study period. The average length of stay for survivors was 16.7 days. Of the survivors, 23% spent time in the ICU with an average stay of 11.4 days. The average TBSA was 5.5% (IQR 2–7.5%) with a maximum of 25%. TBSA breakdown by body region is shown in figure 1. It was found that 50.5% of admitted pavement burn patients required burn excision and 35.9% required split thickness skin grafting. The leading causes of pavement burn admissions were being found down by EMS and walking on pavement at 21.6% each, followed by mechanical falls at 15.1% (See figure 2). Of the 185 patients admitted 17.8% were under the influence of alcohol or drugs. Comorbidities were common; 32.4% had hypertension, 21.6% had diabetes, 13.5% had neuropathy, 2.2% had coronary artery disease, 5.4% had chronic kidney disease. Of the patients that walked on pavement to receive their burns, 50% also had peripheral neuropathy. Rhabdomyolysis developed in 5.4%, and hospital 30-day mortality was 4.9%.

Conclusions
Pavement burns are a common burn mechanism in hot and sunny climates, but may be seen in other locations during periods of high heat. Patients at risk are those with medical comorbidities and who come in contact with hot pavement for long time periods.

Applicability of Research to Practice
Data provided from this study can be used for a public health initiative to help patients who may be at risk of acquiring pavement burns. The data may also be helpful for clinicians gaining information about the management, cause and outcomes of pavement burn patients.
777 Use of the PHQ-2 as a Depression Screening Tool
Authors: Wiechman Shelley A , Keatley Eva , Blayney Carolyn B 
Published: March 2020

Abstract

Introduction
In 2015, the Burn Quality Improvement Program (BQUIP) guidelines recommended systematic screening of Major Depressive Disorder at all verified burn centers. Our level one trauma center rolled out a program to screen all patients entering the burn service starting in June 2018. This project evaluates the program after the first year of implementation.

Methods
All patients over age 12 admitted to the burn service were screened by bedside nurses using the 2-item Patient Health Questionnaire (PHQ-2). Exclusion for screening included those who were intubated and sedated and/or not alert or oriented. A reminder for the PHQ-2 screener automatically popped up in the nursing task list in the electronic medical record until it was given or patient was coded as not appropriate for screening.

Results
A total of 509 patients were admitted to the Burn Service between June 2018 and May 2019. Of those, 40 were identified as not being appropriate for screening due to prolonged mental impairment (e.g. not able to regain consciousness), and 116 (24%) were not screened for unknown reasons. The remaining patients (n=353, 77%) were screened with the PHQ-2 and 94% of these patients were screened on the same day of admit. Of the patients screened, 28 (8%) scored above the clinical cut-off for probable depression (PHQ-2 ³ 3) and 265 (75.1%) did not endorse any symptoms on the PHQ-2 (PHQ-2 = 0). Of the 28 that screened positive on the PHQ-2, 16 (57.1%) received psychological services. Of those that did not receive psychology services, the majority were admitted for less than 3 days (n=10, 76.9%).

Conclusions
In the first year of the program the vast majority of eligible patients were able to be screened by nursing staff with a 2-item measure within one day of admit to the burn service. This success is likely due to the automation of the task in the electronic medical record, the ease of use of the PHQ-2 and the dedication of the nursing staff. The 8% rate of a positive screen is higher than the general population. Given that most patients were screened within 24 hours of admission, we are capturing depressive symptoms that predate the injury. We know that depression can impair burn recovery (e.g. affect participation in therapy, impede wound healing) and lead to poorer long term outcomes. Systematic screening of depressive symptoms upon admission will allow us to intervene earlier and potentially reduce barriers to optimal recovery. Despite high screening rates, about 40% of patients did not receive psychological intervention. We will be discussing utilization of resources for providing inpatient services to patients with a positive screen.

Applicability of Research to Practice
The PHQ-2 is an effective screening tool for depressive symptoms for patients on an inpatient burn unit. These findings are important for hospital systems looking to screen for and treat the mental health needs of burn patients. Depression screening will be required for BQUIP starting in 2020.
783 Scar Revisions: Are We Asking the Right Questions?
Authors: Ziolkowski Natalia , Zuccaro Jennifer , Fish Joel 
Published: March 2020

Abstract

Introduction
Scars have wide-ranging effects on the individual and as such, many seek to have their scars. Currently, there is no gold standard for conducting scar revision consults. Scar-specific patient-reported outcome measures (PROM) are questionnaires created by individuals with scars and encompass all concepts of interest (COI) important to them. PROMs can be used for quality improvement (QI) initiatives to determine if all COI are being asked of patients. SCAR-Q, a new, internationally validated, scar-PROM measuring COI related to scar appearance, symptoms and function, and psychosocial impact was used. The purpose of this QI study was to determine if COI important to patients with scars are routinely asked during scar revision consults.

Methods
All scar revisions consults from July 1, 2017 to June 30, 2019 were reviewed at a single pediatric hospital using an electronic database. This study represents Phase 1 of the QI study approved by the institution and follows Model for Improvement methodology. Inclusion criteria were: patient aged ≥8 years, had a cutaneous scar, and speak English. Demographic information included: gender, age; and items related to the patient’s scar including etiology, time since injury, location, interventions; COI encompassed by SCAR-Q.

Results
162 electronic patient charts were reviewed with 88 meeting inclusion criteria. 45 were females (51.1%) with an average age of 12.6(SD 3.1, 8–20 years) with time since injury scar of 4.0 years (SD4.6,1 month-17 years). Burns, specifically scalds (18,45.0%) were the most common etiology (40,45%). Scars were located predominantly on the face/scalp (34,39.5%), chest (16,18.6%), and arm (15,17.4%). Most patients had no previous scar intervention at the time of the consultation (43, 51.2%). No scar revision consults encompassed all COI as defined by the SCAR-Q with appearance and Symptom/Function questions being more common than Psychosocial (Table 1). Specifically, scar color, hardness/thickness, disliking the scar were the most frequently asked questions (Table 2).

Conclusions
There is currently no established gold standard for conducting scar revision consults. SCAR-Q, a newly validated scar-specific PROM was used to determine if all questions that are important to individuals with scars were asked during routine scar revision consults. The most common questions asked of individuals with scars were related to appearance followed closely by symptoms/functional implications. Questions related to psychosocial impact are not routinely asked and represent a large area of improvement. Next steps include implementing a scar-specific PROM to ensure that all COI are implemented in routine clinical care.

Applicability of Research to Practice
This research is applicable to practice as it shows that PROM can be utilized for QI studies including identifying areas that are lacking in scar revision consults.
789 Split-thickness Skin Graft Meshing: The True Mesh Ratio
Authors: Egro Francesco M , Roy Eva , Konanur Anisha , Murphy Carolyn , Corcos Alain C , Ziembicki Jenny A 
Published: March 2020

Abstract

Introduction
Skin graft meshing is frequently used to allow coverage of extensive wound areas, reduction of donor site size, and prevention of fluid accumulation underneath the skin graft. Meshers allow for various ratios to be used but no studies have confirmed the accuracy of the mesh ratio provided by the manufacturers. The objective of this study was to measure the true mesh ratio achieved using some of the most commonly used skin meshers.

Methods
A prospective cohort study was performed in 2019. The true expansion ratio was calculated for standardized human split-thickness skin grafts (4x4cm harvested 0.0012in depth using an air dermatome) of the most commonly used meshing ratios (1:1, 1:5:1, 2:1, 3:1, 4:1, and 6:1).

Results
We had a total of 18 patients resulting in 86 measurements. The study population consisted of 12 males and 6 females; 89% white, 11% non-white; average age of 43 years (SD 21.2). The true mesh ratios of 1:1, 1.5:1, 2:1, 3:1, 4:1, and 6:1 meshers were found to be 1.20 (SD 0.14), 1.55 (SD 0.32), 1.68 (SD 0.32), 2.62 (SD 0.51), 2.87 (SD 0.92), 4.94 (SD 1.35), respectively. The percent errors were 20.2%, 3.3%, -15.8%, -12.5%, -28.3%, -17.7% respectively.

Conclusions
Mesh ratios of 2:1 meshers and above established by manufacturers are inaccurate. Therefore, overestimation of 2:1 meshers and above is recommended. We recommend an overestimation of 10% or more for meshers 2:1 and above.

Applicability of Research to Practice
This has significant applicability to practice as it can affect surgical decisions related to estimating the extent of donor area needed to cover skin and soft tissue defects.
790 Venous Thromboembolism Prophylaxis in Burn Patients: Analyzing the Effectiveness of a Standardized Protocol
Authors: Folliard Sarah A , Gabbert Jared L , Thompson Callie M 
Published: March 2020

Abstract

Introduction
Burn patients have a high risk of developing venous thromboembolism (VTE) due to extensive immobilization, surgical interventions, endothelial injury, and the presence of polytrauma. Studies have shown VTE rates ranging from 0.25% to 23.3% in this patient population. Although burn patients have a greater risk for VTE compared to other hospitalized patients, there are no standardized guidelines on how to approach VTE prophylaxis in the burn population. In March 2018, the Burn Intensive Care Unit (BICU) implemented a new VTE prophylaxis protocol that stratified patients based on risk factors for VTE. Patients were started on enoxaparin 30mg every 12 hours or 40mg every 12 hours depending on body mass index (BMI). The purpose of this study was to examine compliance with the new protocol and overall rates of VTE in the burn population.
In March 2018, the Burn Intensive Care Unit (BICU) implemented a new VTE prophylaxis protocol that stratified patients based on risk factors for VTE. Patients were started on enoxaparin 30mg every 12 hours or 40mg every 12 hours depending on body mass index (BMI). Patients with impaired renal function or a contraindication to enoxaparin were given LDUH 5,000 units every 8 hours. The purpose of this study was to examine compliance with the new protocol and overall rates of VTE.

Methods
A single-center, retrospective analysis was conducted from March 1, 2018 to July 31, 2018. Patients included were admitted to the BICU with a documented burn injury for at least 48 hours and were ≥ 18 years of age. The primary outcome was compliance with the VTE prophylaxis protocol. Secondary outcomes included reasons for non-compliance and incidence of VTE events.

Results
Out of 105 patients that met inclusion criteria (median age, 53 years [36 to 63]; BMI 27.1 kg/m2 [25.7 to 33.2]; total body surface area 6% [3% to 18%]), the protocol was correctly utilized in 81 patients (77%). The most common reason for non-compliance to the protocol was incorrect dosing (60.9% [14/105]). Of 105 patients, 1 (0.9%) developed a VTE.

Conclusions
Overall, the compliance to the Burn Intensive Care Unit VTE pharmacologic prophylaxis protocol has room for improvement. Despite following the protocol, one VTE event occurred during the five-month study period. To improve compliance, additional education and training regarding the dosing of and monitoring anti-coagulants was provided to nursing and medical staff.

Applicability of Research to Practice
Although protocols can improve consistency of health care, reduce costs and improve health outcomes, they must be properly utilized in order to see the benefits. Successful implementation of protocols requires a multistep approach that includes a strong quality improvement process, multidisciplinary buy-in, ongoing education efforts, and assessment to review adherence to and efficacy of the protocols themselves.