bluuebunny/crossref_metadata_2025_split huggingface dataset:
105 The Impact of Flap Timing and Mechanism of Injury on Flap Complications in Acute Burn Patients
Authors: Sheckter Clifford C , Perrault David , Rochlin Danielle H , Pham Christopher H , Karanas Yvonne L 
Published: March 2020

Abstract

Introduction
Burn wounds are often amenable to excision and grafting, but pedicled and free flaps are sometimes necessary to achieve closure of complex wounds. Flap coverage of exposed bone, tendons and cartilage has classicaly been delayed in acute burn patients due to concern of progressive tissue necrosis, microvascular thrombosis and percieved high failure rates. More recently, a number of reports have demonstrated that the use of flaps is safe earlier in acute burn care. We aim to elucidate the role of flaps in primary burn woud coverage leveraging national US data.

Methods
Acute burn patients with known % total body surface area were extracted from the Nationwide/National Inpatient Sample from 2002–2014 based on International Classification of Disease (ICD) Codes 9th edition. Flap procedures were identified based on ICD-9 procedure codes. Flap and non-flapped patients were compared using multivariable analysis. Variables included age, gender, race, Elixhauser comorbidity index, %TBSA, burn mechanism, inhalation injury, and location of burn. Flap complication was defined by ICD-9 procedure code 8675, return to OR for revision of flap. Multivariable analysis evaluated predictors of flap compromise based on stepwise logistic regression with backwards elimination.

Results
The weighted sample included 306,924 encounters of which 526 received a flap (0.17%). The mean age of encounters receiving a flap was 45.0 (SD 21.2) years versus 35.5 (SD 24.2) years in the non flap group (p=0.023). 7.8% of patients who received a flap suffered electric injury compared to 2.7% of non-free flap encounters (OR 3.76, 95% CI 1.95–7.24, p&lt; 0.001). Patients who underwent flap wound coverage were more likely to have a lower extremity burn; 55.3% of encounters versus 43.1% in non- flap patients (OR 2.26, 95% CI 1.05–2.15, p=0.024). There were no significant differences in gender, race, Elixhauser comorbidity index, %TBSA, or inhalation injury. The mean hospital day of the flap procedure was 10.1 (SD 10.7) days. Flap complications occurred in 6.4% of flap encounters. The only independent predictor of flap complication was electrical injury (OR 40.49, 95% OR 2.98–550.64, p=0.005). The time to flap coverage and location were not associated with complications.

Conclusions
Electrical injury was an independent predictor of flap complications compared to other mechanisms. Flap timing was not associated with return to surgery for complications. This suggests that the use of flaps is safe in acute burn care to achieve burn wound closure with an understanding that electrical injuries may deserve particular consideration to avoid failure.

Applicability of Research to Practice
Inform surgeon decision making when deciding candidacy for flap surgery in acute burn patients.
114 Galectin-1 Is Overexpressed in Post-Burn Hypertrophic Scar
Authors: Kirkpatrick Liam D , Carney Bonnie C , Smith Robert D , Moffatt Lauren T , Shupp Jeffrey W 
Published: March 2020

Abstract

Introduction
Upon healing, burn wounds often leave hypertrophic scars (HTS), a significant morbidity for patients that can have lasting psychosocial impacts. HTS is marked by excess collagen deposition, dermal and epidermal thickening, and an increased concentration of fibroblasts. The Galectins, a family of lectins with a conserved carbohydrate-recognition-domain, function intracellularly and extracellularly as mediators of a multitude of biological processes including inflammatory responses, cell migration and differentiation, and cell-ECM adhesion. Galectin-1 (Gal-1) has been associated with several fibrotic diseases and can induce keratinocyte and fibroblast proliferation and migration as well as differentiation into fibroproliferative myofibroblasts. Gal-1 transcription is driven by the PI3K/AKT pathway, and AKT activation is increased in HTS compared to normal skin (NS). In this study, Gal-1 expression was assessed in human and porcine HTS and NS tissues.

Methods
mRNA was isolated from biopsies of human or porcine HTS and NS tissue. Total transcriptome microarray analysis was performed in porcine HTS vs. NS. Transcription of the Galectin-1 gene (LGALS1) was assessed by qRT-PCR using primers specific to human or porcine LGALS1 and GAPDH genes. A Gal-1 antibody was used for immunofluorescent (IF) staining to corroborate gene expression data.

Results
LGALS1, 4, 8, and 12 were differentially regulated genes in pig HTS vs. NS by microarray analysis (fold change= 3.58, 6.11, 1.89, and 3.03, p&lt; 0.01). Confirmatory qRT-PCR results showed significant upregulation of LGALS1 transcription in HTS compared to NS of both human and porcine tissues (Fold change= 6.11 and 7.70, n=15 and n=3 scars respectively, p&lt; .001). In pig HTS, this upregulation was maintained throughout scar development and remodeling (days 49, 56, 77, 99, and 112 post-wounding). IF Gal-1 in human HTS showed significantly increased fluorescence (503±58 vs 346±23, p&lt; .001, n=5 scars) compared to NS, and Gal-1 was visualized in both intracellular and extracellular areas of the dermis.

Conclusions
Galectin-1 is overexpressed in HTS at the mRNA and protein levels and may have a role in the development of scar phenotypes due to fibroblast over-proliferation, collagen secretion, and dermal thickening. The role of galectins shows promise for future study and may lead to development of new pharmacotherapies.

Applicability of Research to Practice
A better understanding of galectin signaling and its effects on the ECM and cell growth may lead to new treatments aimed at reducing scar formation. Changes in galectin expression could be induced as possible downstream effects of anti-scarring gene therapies aimed at AKT-inactivation.
121 The Opioid Dependence Paradox in Among Patients with Burn Injury
Authors: Peluso Heather , Georgi Marc S , Caffrey Julie 
Published: March 2020

Abstract

Introduction
The opioid epidemic has contributed significantly to the healthcare economic burden nationwide.

Methods
Using the 2016 National Readmission Database, patients were included if they had a principal diagnosis of burn injury. Opioid dependence was identified using appropriate ICD-10 CM codes. The primary outcome was 30-day all-cause readmission. Secondary outcomes were in-hospital and calendar-year mortality, resource utilization, and most common reasons for admission and readmission. Confounders were adjusted for using multivariate regression analysis.

Results
22,348 patients were included, 597 of whom were opioid dependent. Opioid dependent patients were more likely to be older (43 years, range: 38.6–47.2 years) and male (70.8%) compared with patients without opioid dependence. Opioid dependence was associated with higher 30-day readmission rates (adjusted odds ratio (aOR): 1.93, 95% confidence interval (CI):1.39–2.68, p-value: &lt; 0.01), longer mean length of stay (adjusted mean difference (aMD): 5.46 days, CI:2.63–8.29, p-value: &lt; 0.01). and higher total hospitalization charges (aMD: $50,050, CI:$5,941-$94,960, p-value: 0.03) and costs (aMD: $14,889, CI:$3,658-$26,119, p-value: 0.01). However, opioid dependence was associated with lower in-hospital (aOR: 0.23, CI:0.06–0.85, p-value: 0.03) and calendar-year (aOR: 0.47, CI:0.22–0.99, p-value: 0.04) mortality. The most common reasons for both initial admission and readmission are presented in Table 1.

Conclusions
Opioid dependence is associated with lower in-hospital and calendar-year mortality, but higher rates of readmission, longer mean length of stay and higher hospital charges among patients with burn injuries.

Applicability of Research to Practice
Despite increased resource utilization for patients with opioid dependence, mortality was decreased in this population. Further research is needed to elucidate this paradox.
125 Management of Acute Pain in the Burn Patient: Reaching a New Guideline
Authors: Romanowski Kathleen S , Carson Joshua S , Pape Kate , Bernal Eileen , Wiechman Shelley A , Carter Damien W , Nitzschke Stephanie , Bhalla Paul I , Litt Jeffrey , Friedman Bruce , Jeng James C , Sharar Sam , Liu Yuk , Ryan Colleen M , Joe Victor C 
Published: March 2020

Abstract

Introduction
The most recent ABA pain guidelines were developed over 13 years ago and have not been revised despite the changing practice of burn care. Coupled with the nationwide opioid epidemic there is a need to examine the available literature and revise the ABA practice guidelines for pain management.

Methods
A committee of a professional association was created to revise the previously published pain guidelines and consisted of a wide range of burn care providers including burn surgeons, burn nurses, anesthesiologists, a pharmacist, and a psychologist. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords “burn pain,” “treatment,” and “assessment”. Selected other references were also used based on our evaluation of the greater pain literature. Studies were graded by 2 members of the committee using Oxford Centre for Evidence-based Medicine – Levels of Evidence (level 1 being the highest and level 5 the lowest). When there was a disagreement, a third member of the committee was used to resolve the disagreement. Our next step was to meet as a group and determine what our expert consensus was on a variety of topics related to treating pain in burn-injured patients. Finally, we assessed gaps in the knowledge that was available and determined research questions that would aid us in providing better recommendations for the care of the burn-injured patient.

Results
The literature search produced 189 papers, of which 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature, 115 references were included so a total of 210 papers were analyzed. The greatest number of papers were level 5 evidence (62, 29.5%) while only 30 (14.3%) were level 1. Following the review of the literature and meeting to establish consensus, 18 guidelines were established in the areas of pain assessment, opioid pain medications, non-opioid pain medications, regional anesthesia, and non-pharmacologic treatments.

Conclusions
While there is increasing research on various pain management modalities, the available studies are inadequate to create a true standard of care. Despite this, our committee reached a consensus using available literature from burn or other areas, expert experience and knowledge of pain physiology. Moving forward we call for more burn specific research into all modalities for burn pain control as well as research on multimodal pain control.

Applicability of Research to Practice
Burn pain is particularly difficult to manage and further study is needed to develop a standard of care for burn pain management.
515 Compliance with a Restrictive Blood Transfusion Strategy: Do We Actually Follow Scientific Evidence?
Authors: Wallace David L , Rogers Alan D , Cartotto Robert 
Published: March 2020

Abstract

Introduction
Many burn centers use a restrictive blood transfusion strategy based on randomized controlled trials in burn patients (e.g. Transfusion Requirements in Burn Care Evaluation -TRIBE) and non-burn populations (e.g. Transfusion Requirements in Critical Care – TRICC), which have demonstrated no increased morbidity or mortality between restrictive and liberal transfusion approaches. The purpose of this study was to evaluate the adherence to a restrictive hemoglobin transfusion trigger strategy of 7 g/dL.

Methods
Retrospective study of all patients admitted to an adult regional ABA-verified burn centre between 15/11/ 2015 and 15/6/2018 who received at least one unit of blood (RBC). We use a restrictive transfusion strategy that administers RBC for a hemoglobin (HGb) &lt; 7 gm/dL, one unit at a time, with a pre and post HGb level for each RBC transfusion, unless the patient is actively bleeding and/or hemodynamically unstable. RBC transfusions in the operating room do not follow this policy and were not studied. Values are presented as mean ± SD or median (IQR) as appropriate.

Results
We studied 66 patients (30% female) with age 53.2 ± 18.3 years, % TBSA burn 22 (11–41), % TBSA full thickness burn 6.5 (0.5 -21.8), and with 41% having inhalation injury. Overall, there were 691 RBC transfusions (TXns). A pre-TXn HGb was obtained 95% of the time and was 6.8 (6.5–7) gm/dL. TXn for a HGb &gt; 7 gm/dL occurred in 35%. A post TXn HGb was obtained for 92% of these TXns with a HGb of 7.6 (7.2–8) gm/dL. RBC TXns during nighttime (1700 to 0800, n=449) were given for a HGb trigger of 6.8 (6.4–6.9) and were not compliant with our restrictive strategy 22% of the time. Daytime transfusions (0800 to 1700, n=207) were given for a significantly higher HGb [7 (6.7–7.1), p&lt; 0.001] with significantly more non-compliance with the restrictive strategy (50%, p&lt; 0.001). We also compared TXns before and after the TRIBE publication. Pre-TRIBE TXns (n=484) were given for significantly lower HGb than 172 post TRIBE TXns [6.8 (6.4–7) vs 6.9 (6.6–7.1) gm/dL respectively, p=0.001] and at significantly lower rate of non-compliance with the 7 gm/dL threshold than post TRIBE transfusions (28.1% vs 37.8%, respectively, p=0.02).

Conclusions
While a pre-TXn HGb level was available for 95% of blood transfusions, approximately one-third were given for a HGb &gt; 7 gm/dL. Transfusion during nighttime (being predominantly ordered by housestaff physicians) were administered at a significantly lower HGb trigger and with significantly better compliance with the restrictive strategy than daytime transfusions. Paradoxically, compliance with the restrictive strategy was worse following the TRIBE publication.

Applicability of Research to Practice
These results identify important areas for improvement in adherence to our restrictive transfusion strategy.
553 Work-related Burn Injuries Among Burn Patients in a Tertiary Care Burn Facility, 2013 – 2018
Authors: Williams Felicia N , Nurczyk Kamil , Sljivic Sanja , Chrisco Lori , Calvert Catherine , Nizamani Rabia , Jones Samuel W , Cairns Bruce 
Published: March 2020

Abstract

Introduction
The characteristics of work-related (WR) burn injuries compared to non-work-related (non-WR) burns are not well defined in the literature. In an effort to determine the potential impact of commonly accepted prevention efforts, we compared WR and non-WR burn injuries in our facility for the last five years.

Methods
All patients admitted to the burn center between January 1st, 2013 and December 31st, 2018, of working age were included. Demographics, burn characteristics, and patient outcomes were evaluated using Student’s t-test and chi-squared test where appropriate, significance was accepted at p&lt; 0.05.

Results
3,545 patients were included in this study. WR patients were 22% of all patients in this cohort. The majority of patients in both cohorts were white males in their twenties. Compared to non-WR patients, WR patients had fewer comorbidities with 30% smaller total body surface area burns, and shorter lengths of stay (see table). WR patients were more likely to suffer chemical (14.5% vs 2.3%) and electrical burns (11.9% vs 1.2%) compared to non-WR patients, respectively. 67% percent of WR burn fatalities were from electrical injuries, while flame was the leading cause of death in non-WR patients.

Conclusions
WR burn injured patients are young males with fewer co-morbid conditions. Etiologies of injuries are vastly different between non-lethal and lethal WR and non-WR injuries. Classic burn prevention strategies that target flame burn injuries and fatalities will have little impact on WR burn injuries.

Applicability of Research to Practice
This study highlights the importance of focusing prevention campaigns to industry as well as schools and homes.
577 The Intersection Between Burns and Psychiatric Disorders
Authors: Gasteratos Konstantinos , Voitsidis Pantelis , Vlahopoulos Nikolaos , Shen Abra H 
Published: March 2020

Abstract

Introduction
Burns constitute a major health problem accounting together with fires for more than 300.000 deaths per year worldwide and for a great rate of disability-adjusted life years (DALYs). Identifying the relationship between mental disorders and burns is crucial since the former seems to constitute an important risk factor for the latter. At the same time, clinical experience and scientific evidence suggest that survivors of burns often develop psychiatric sequelae, causing poorer outcomes and lower quality of life.

Methods
We conducted a systematic review in order to study the relationship between burns and psychopathology as well as the quality of life. We used the search engine “PubMed” with the term “((psychiatric[Title/Abstract]) OR psychological[Title/Abstract]) AND burns[Title/Abstract]” without limits regarding the time of publication, resulting in 761 studies. Using the Covidence online platform that enables screening of the articles by two reviewers, we screened the articles, first by title and abstract and then by full text. Non-English papers or papers with no full texts will be excluded from the study. We aim to register the review in the official international prospective register of the National Institute for Health Research (PROSPERO).

Results
Preliminary results suggest that a history of mental disorder is common among burn patients, whether self-inflicted or not. Research tends to focus on self-inflicted burns which are expected to show such an association. Indeed, psychotic disorders, drug dependence and depression constitute significant risk factors for self-immolation. At the same time, the presence of a mental disorder may be associated with a worse prognosis (burn complications, patient morbidity, and mortality, multiple hospitalizations, increased cost for treatment). Burn survivors are also at risk for developing psychiatric complications, such as Post Traumatic Stress Disorder (PTSD), depression and anxiety disorders, as well as experiencing a lower quality of life. It appears that the disfigurement, loss of function and change in body image perception caused by the burns lead to the emergence or recurrence of a psychiatric condition. Last but not least, the relationship between delirium in the Burns Intensive Care Unit patients is well established.

Conclusions
There seems to exist a significant ambidirectional connection between burns and mental disorders. Higher rates of mental disorders among burn patients in the pre- and post-burn period complicate the situation and lead to poorer results if left untreated.

Applicability of Research to Practice
Identifying risk factors for burns associated with the medical history, early recognition and appropriate treatment of mental disorders after the burn incident, improving rehabilitation and psychosocial re-integration of this patient population.
590 Is There a Burn Center Community Standard on How to Best Manage Pediatric Burn Patients?
Authors: Helmold Emily , Eshraghi Niknam 
Published: March 2020

Abstract

Introduction
A burn center is defined by the American College of Surgeons as a program that facilitates the provision of specialized multidisciplinary care in a designated setting. The Children’s Hospital Association states that pediatric patients need age specific health care delivered by specialty trained clinicians in an environment designed just for kids. When these two different specialty areas within one organization cross paths, how does the organization determine all the factors that go into determining the standard of care? One burn center found itself at the heart of this question when asked to determine the best location and how to care for pediatric burn patients.

Methods
An email survey was sent to burn centers verified with the American Burn Association (ABA) to care for both adult and pediatric patients and located within their region or with a similar volume. The questions included:

Results
Thirteen burn centers responded. Nine of the thirteen were located within the western region, two in the mid-west, one each in the south and northeast regions. Eight burn centers were categorized as academic and the other five as teaching hospitals. Bed size ranged from 8–44 with an average of 18 beds. Eighty-five percent of the respondents stated they admitted most if not all pediatric burn patients to the burn unit with two of those centers being the only location within their hospital for pediatric patients. Over seventy-five percent provided 24/7 provider coverage. There was more variability in answers regarding rate of pediatrician consultation, code blue team response, and geographic proximity to a children’s hospital however pediatric consultation was obtained in the majority of cases.

Conclusions
The survey responses were helpful to communicate some degree of burn center community standard although more centers and increased specificity would have strengthened the argument for a burn center remaining the preferred location for all pediatric burn admissions.

Applicability of Research to Practice
Sharing of our experience and recommendation that the ABA establish a burn community standard, especially one that takes how to manage competing specialties into consideration, will be helpful to all burn centers who could face this same challenge.
654 Investigation of Germ Patency of a Polylactic Acid-based Membrane for the Treatment of Burns
Authors: Haller Herbert , Held-Föhn Evi 
Published: March 2020

Abstract

Introduction
Infections are a very serious complication during the treatment of burns. To avoid such infections, burn care dressings and skin substitutes should be impermeable to germs. Polylactic membranes (PLM) are based on polylactic acid (PLA) and as an elastic membrane it mimics the natural skin. They are indicated for superficial (2a°) and deep dermal/partial thickness (2b°) skin loss diseases like burns. While being permeable to oxygen and water vapor, they provide a physical barrier for microorganisms. The infection rate of the PLM in burns was about 2,9% on average and was published in 11 studies. The effectiveness of the physical barrier for microorganism was tested in an in-vitro model.

Methods
The sterile PLM samples were aseptically transferred into sterile petri dishes and inoculated with 100 µl each of a bacterial suspension. The test strains Staphylococcus aureus (ATCC 6538) with approximately 730 colony forming units (cfu) and Pseudomonas aeruginosa (ATCC 10145) with approximately 350 CFU / sample were used. The bacterial suspension was spread over the surface and dried. PLM were transferred to Tryptic Soy Agar (TSA) plates.
The incubation was carried out in each case with 3 batches per test strain after 1 day and 3 days at 37°C.
After incubation, the PLM samples were visually examined for microbial growth under the samples and photographically documented. A control group with inoculation of culture medium and covered with PLM was also tested.

Results
There was no growth of bacteria detectable after 1 day and after 3 days under the PLM indicating that the PLM is not permeable to germs. The control group resulted in growth of bacteria and colony forming units and thus confirms that test method works well.

Conclusions
PLM is an effective physical barrier for microorganisms as germs do not pass the PLM.

Applicability of Research to Practice
immediately.