bluuebunny/crossref_metadata_2025_split huggingface dataset:
50 Assessment of Skin Graft in Pediatric Burn Patients Using Machine Learning Is Comparable to Human Expert Performance
Authors: Ribeiro Guilherme Aramizo , Ridelman Elika , Klein Justin D , Angst Beth A , Shanti Christina M , Rastgaar Mo 
Published: March 2020

Abstract

Introduction
Though widely used, current scar assessment scales are inaccurate and highly subjective, further complicating the already difficult task of determining the optimal management of burn patients. Additional disadvantages of these tools include the need for direct examination by an experienced clinician and the inability to retrospectively review them. The lack of an accurate assessment tool inevitably impairs any research examining novel therapeutic strategies designed to improve burn scar outcomes by introducing observer bias at every step. Common examples of these tools include the Vancouver Scar Scale and Visual analog scale. New imaging and processing technologies have the potential of bringing accuracy, reproducibility, and accessibility to burn scar assessments. With these goals in mind, our team developed a novel scoring system and a classification model based on Machine Learning algorithms and analyzed 87 pictures to obtain scores on Inflammation (I), Scar (S), Uniformity (U), and Pigmentation (P).

Methods
All algorithms were trained using both the sub-acute and the long-term phase pictures. The classification model is based on supervised learning, which requires many examples of annotated pictures and corresponding scar scores. The model used a Linear Discriminant Analysis (LDA) algorithm and visual features of the scars and the natural skin. To train and evaluate this model, four burn care providers individually annotated 186 pictures of skin grafts and later formed a committee to annotate by consensus a subset of representative pictures. While the individual predictions were used as an accuracy baseline, the consensus annotation was the true score and used to train the model.

Results
The model predictions were more accurate in scores mainly based on color (I and P), rather than texture (S and U), as shown by the micro-averaged Area Under the Curve (AUC) of 0.86, 0.61, 0.51, and 0.80 for I, S, U, and P, respectively (Figure 1). The model accuracy was higher than the human baseline for the I (F1 of 0.60 vs. 0.59±0.13, respectively) and P scores (0.54 vs. 0.51±0.09), but lower in the S (0.30 vs. 0.63±0.22) and U scores (0.62 vs. 0.86±0.19).

Conclusions
Our findings are encouraging and suggest that further improvement of the accuracy of the algorithm could be achieved on the second phase of our assessment development project by increasing the number of pictures it learns from and adding more visual features related to skin texture.

Applicability of Research to Practice
Our study provides an accurate and reproducible evaluation of burn scars, that leads to newer therapeutic strategies employed by specialized burn care facilities.
51 Negative Pressure Wound Therapy for Small-to-medium-sized Paediatric Thermal Burns: A Randomized Controlled Trial (SONATA in C)
Authors: Frear Cody , Griffin Bronwyn R 
Published: March 2020

Abstract

Introduction
In the setting of burns, negative pressure wound therapy (NPWT) has been widely adopted as a means of wound bed preparation prior to skin grafting and graft immobilization. Its role in the treatment of acute burns has been less well-studied, although there is limited evidence to suggest that it might facilitate physiological healing. This study aimed to assess its efficacy in the management of acute burns in children with small-to-medium-sized thermal injuries.

Methods
In this single-center, two-arm, parallel, randomized, controlled clinical trial, we assigned patients under 17 years of age with acute thermal burns covering &lt; 5% of their total body surface area to either an active control (nanocrystalline silver dressings) or an experimental treatment combining standard dressings with NPWT. Patients were excluded if their burn occurred &gt;7 days prior to presentation, affected the face, or was deemed by clinicians to be trivial. The primary outcome was time to re-epithelialization. Secondary outcomes included scarring, grafting, pain, ease of management, and adverse events.

Results
A total of 114 children underwent randomization. The median time to re-epithelialization was 8 days (interquartile range (IQR) 7–10) for the NPWT group and 10 days (IQR 8–12.25) for the control group (hazard ratio, 1.515; 95% confidence interval (CI) 1.003 to 2.289; P=0.048). Children administered NPWT within 48 hours of their injury (n=16) re-epithelialized in a median of 7 days (IQR 5–8; HR, 2.129; 95% CI 1.155 to 3.922; P=0.015). The proportion of children referred to scar management was 8.7% for the experimental group and 25.9% for the control group (odds ratio, 0.27; 95% CI 0.08 to 0.90; P=0.032). There were no significant differences in grafting (2.2% vs. 7.4%; odds ratio, 0.28; 95% CI 0.03 to 2.58; P=0.260), pain during dressing changes (P=0.946), or at-home pain between dressing changes (P=0.592). NPWT was associated with a greater treatment burden (P&lt; 0.001) and incidence of adverse events, which included minor blistering and wound maceration.

Conclusions
In children with small-to-medium-sized thermal burns, NPWT accelerated re-epithelialization and decreased the need for long-term scar management.

Applicability of Research to Practice
This study found NPWT to be a promising adjunct to standard care in the treatment of pediatric thermal burns. (Clinical Trials Registry number, ACTRN12618000256279.)
52 Developing a Topical Antibiogram in the Burn Unit
Authors: Robinson Andrew D , Walroth Todd A , Spera Leigh J , Sood Rajiv , Hartman Brett , Cheatham Megan , Relich Ryan 
Published: March 2020

Abstract

Introduction
Antibiograms display susceptibilities based on bacterial growth in response to systemic agents, utilizing automated systems performing bacterial identification and susceptibility testing. There is a paucity of literature regarding burn-specific antibiograms or susceptibility testing of organisms isolated from wound cultures against topical antimicrobials. Our goal was to create an institutional topical antimicrobial antibiogram in burn and dermatologic disorder patients.

Methods
Institutional topical antimicrobial agent susceptibilities were retrospectively reviewed from 1/1/18-12/31/18. Quantitative biopsies or swabs collected from patients were cultured. Susceptibility plates were prepared by wells aseptically punched into an agar plate and inoculated with antimicrobial creams. Bacterial isolates were then inoculated in melted agar, overlaid onto the susceptibility dish, and incubated. Zones of inhibition (ZOI) were reported in mm; susceptible being any measurable zone and resistant defined as a zone of 0 mm. Isolated organisms were grouped as Gram-positive cocci (GPC), Gram-negative rods (GNR), or yeast-like fungi (YLF).

Results
In 2018, 21 organisms were tested for susceptibility in 19 patients with positive cultures. Overall susceptibilities of isolates were 71–91%. Overall, susceptibility rates were: gentamicin 71%, mupirocin 77%, silver sulfadiazine 77%, and mafenide 91%. All C. albicans isolates were susceptible to nystatin. Excluding resistant isolates, the median (IQR) ZOI measurements were: gentamicin 10.0 (7.0, 15.0), mupirocin 12.0 (7.5, 27.0), silver sulfadiazine 8.0 (7.0, 10.5), and mafenide 14.5 (10.3, 19.8). Of organisms reported, there were 10 GNR (45%), 8 GPC (36%), and 4 YLF (18%), with P. aeruginosa, MRSA, and C. albicans being most common. For GPC, susceptibility rates were 63–88% and median (IQR) ZOI measurements were: gentamicin 16.0 (8.0, 30.0), mupirocin 27.0 (9.8, 35.5), silver sulfadiazine 10.0 (8.5, 19.0), and mafenide 15.0 (10.0, 22.0). For GNR, susceptibility rates were 70–90% and median (IQR) ZOI measurements were: gentamicin 10.0 (6.0, 11.0), mupirocin 12.0 (7.0, 18.0), silver sulfadiazine 7.5 (7.0, 9.5), and mafenide 15.0 (13.0, 19.0).

Conclusions
Based on susceptibility profiles of isolated organisms, mafenide appears to be an appropriate first-line empiric agent with an overall susceptibility rate greater than 90% and the largest ZOI amongst topical agents tested. When examining GPC, mupirocin demonstrated the largest ZOI and may be a more appropriate empiric choice if Gram-stain results are available.

Applicability of Research to Practice
To our knowledge, no previously published studies exist in burn patients examining susceptibilities to topical antimicrobials. These antibiogram-level data provide direction for empiric treatment of wound infections utilizing local susceptibilities for targeted topical coverage.
73 Objective Measurement of Adherence with Splint Use After Burn Injury
Authors: Parry Ingrid , Bastea Silvia , James Michelle , Greenhalgh David G 
Published: March 2020

Abstract

Introduction
The prescription of splints (orthoses) to help protect vulnerable structures and maintain range of motion after skin grafting is an integral and important part of burn recovery. The degree to which a patient adheres to wearing a prescribed orthosis is believed to play a major role in outcome. However, orthoses may be uncomfortable or undesirable to wear, affecting a patient’s adherence. At our burn center, orthosis application and wear is heavily dependent on staff when patients are in the ICU. As patients move to the acute ward, the responsibility for orthotic use is shared by family and staff and as outpatients, caregivers are primarily responsible. The purpose of our study was to use temperature sensors implanted in the orthoses to objectively determine compliance rates with splint wear during these three different stages of burn recovery.

Methods
Pediatric patients with skin grafting to the hands who were prescribed a hand splint had a temperature sensing device implanted into their orthosis when it was fabricated and prescribed for wear. The sensors detected higher temperatures when the orthosis was on the patient and lower temperatures when it was not, providing an objective means to determine frequency and duration of wear. The data collected for each patient was compared to the prescribed time as noted in the medical record by the treating therapist. Data was analyzed using descriptive statistics and one-way ANOVA.

Results
Data were recorded for an average of 50 days for 12 patients using 17 splints during three continuous phases of care: ICU, acute ward, outpatient. Patients in ICU wore their splints 10.4 hours per 24 hour period, resulting in a 102% hourly compliance based on the prescribed wear time. During acute ward care, patients wore their splints for 7.6 hours (89% hourly compliance). As outpatients, subjects wore their splints an average of 6.7 hours (82% hourly compliance). There was no statistical difference in orthotic adherence between the phases of care. Daily compliance (days worn/ days prescribed) showed a similar trend: ICU=100%, ward=90%, OP=88%. Patients or their caregivers were asked to rate their own adherence with splinting at 8 weeks after injury using a 1–4 Likert scale. All but one patient reported the highest level of compliance and described use “as instructed by therapist” (92%).

Conclusions
This is the first study to objectively measure patient adherence with wearing orthoses over the course of burn recovery. Results show high level of adherence in ICU but demonstrate declining adherence as the patient and caregiver assume more responsibility. This study highlights potential areas for improvement in patient education during transition of care from inpatient, and highlights the need for better understanding of the barriers that exist for long-term orthotic use after hospitalization.

Applicability of Research to Practice
Prevention of contracture with splints.
83 Multicenter Evaluation of the Use of Nebulized Heparin for Inhalation Injury (HIHI2 Study)
Authors: Cox Courtney , McIntire Allyson M , Bolton Kimberly , Foster David , Fritschle Andrew , Harris Serena , Pape Kate , Whitten Jessica , Hartman Brett , Sood Rajiv , Walroth Todd A 
Published: March 2020

Abstract

Introduction
Inhalation injury (IHI) causes significant morbidity and mortality secondary to local compromise of the respiratory system as well as systemic effects limiting perfusion and oxygenation. Nebulized heparin reduces fibrin cast formation and duration of mechanical ventilation in patients with IHI. To date, no study has compared both dosing strategies of 5,000 and 10,000 units to a matched control group. The objective of this study is to compare heparin 5,000 and 10,000 units to a historical control and determine which dosing strategy improves lung function and decreases mechanical ventilation duration.

Methods
This multicenter, retrospective, case-control study included adult patients with bronchoscopy-confirmed IHI. Each control patient, matched according to age and percent of total body surface area (TBSA), was matched to a patient who received 5,000 units and a patient who received 10,000 units of nebulized heparin, according to each institution’s inhalation injury protocol. Patients were excluded if they were pregnant, incarcerated, died within 72 hours of admission, terminally weaned for reasons other than burn or IHI, had a documented allergy to heparin or history of heparin-induced thrombocytopenia, history of pulmonary hemorrhage within 3 months, or history of a clinically important bleeding disorder. The primary endpoint of the study was total duration of mechanical ventilation (excluding patients who died or were not extubated). Secondary endpoints included 28-day mortality, ventilator-free days in the first 28 days, difference in lung injury scores, length of hospitalization, incidence of bronchoscopy, incidence of ventilator-associated pneumonia, and rate of bleeding events.

Results
Thirty-five matched patient trios met inclusion criteria. Groups were well-matched for age (p=0.975) and TBSA (p=0.855). When excluding patients who died or were never extubated, patients who received nebulized heparin, either 5,000 or 10,000 units, had 8–11 less days on the ventilator compared to controls (p=0.001). Mortality ranged from 3–14% overall, and no statistical difference was observed between groups. No major or minor bleeding events related to nebulized heparin were reported.

Conclusions
Mechanical ventilation days were significantly decreased in patients who received 5,000 or 10,000 units of nebulized heparin. There was no statistically significant difference in mortality between groups, supporting that either 5,000 units or 10,000 units of nebulized heparin should be used in IHI treatment.

Applicability of Research to Practice
To our knowledge, no previously published studies have simultaneously compared dosing strategies of 5,000 and 10,000 units to a control group. These results support the use of nebulized heparin for IHI to reduce the duration of mechanical ventilation.
96 Treatment of Donor Sites in Large TBSA Burn Injuries with an Autologous Skin Cell Suspension Supports Early Reharvesting
Authors: Foster Kevin N , Holmes James H , Hickerson William L , Shupp Jeffrey W , Sheridan Robert , Lee Jeanne , Rizzo Julie A , Short Tracee , Goverman Jeremy , Hartman Brett , Hodge Juvonda , Mullins Robert F , Litt Jeffrey , Huzar Todd F 
Published: March 2020

Abstract

Introduction
Treatment of large TBSA burn injuries is often limited by donor site availability and requires reharvesting to obtain definitive closure. Patients with severe injuries may have delayed closure compared to uncompromised patients that typically have their donor sites healed in 7–14 days.
Autologous skin cell suspension (ASCS) can be prepared to treat burn wounds at the point-of-care. The safety and effectiveness have not yet been established for use in the treatment of donor sites. This study presents the use of ASCS for the treatment of donor sites in patients with life-threatening burn injuries that were enrolled in a prospective uncontrolled observational study (IDE 15945—NCT02992249).

Methods
ASCS was applied to the donor site after harvesting of STSGs. Clinical outcomes out to one year were evaluated including percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events.

Results
Ninety-six subjects from 22 burn centers had their donor sites treated with ASCS as part of their treatment regimen. The average subject age was 30.1 and the average TBSA injury was 53.7 ±17.3%. The mean Baux score was 89.2 with 36% of subjects having a score greater than 100. Collectively, 528 donor sites were individually treated.
In this compromised patient population 37.5% were ≥95% re-epithelialized by week 1 (n=435), and by week 2, 82.7% of the donor sites were ≥95% re-epithelialized (n=434), regardless of how many times they were harvested.
Approximately 19% of the donor sites treated with ACSC were reharvested multiple times following initial healing (15% two times, 2.3% three times, and 7 donor sites were harvested 4 times) and retreated. Of donor sites harvested more than once, 39.3% (n=84), 81% (n=79), and 85.7% (n=77) of sites were ≥ 95% re-epithelialized by week 1, 2 and 4, respectively.
One-year data was available for 427 donor sites and the majority had matched or mildly mismatched color, pigment, and texture. Adverse events included one site with a hematoma, one patient with donor sites that had fragile skin loss secondary to traumatic friction, one patient with active bleeding, two patients with anemia secondary to donor site bleeding, one patient with delayed closure due to mild infection of staph species. All AEs were unlikely or unrelated to the device.

Conclusions
ASCS has been successfully used to achieve closure of donor site wounds without significant safety risk in patients with extensive burn injuries.

Applicability of Research to Practice
Application of ASCS for donor site healing may be particularly relevant for patients with large burn injuries requiring subsequent reharvesting to achieve definitive closure.
109 Vascular Composite Allotransplantation in Burn Reconstruction: Systematic Review and Meta-analysis
Authors: Peterson Joshua , Padilla Pablo , Gray Kelsey , Zapata-Sirvent Ramón , Norbury William , Branski Ludwik , Dziewulski Peter 
Published: March 2020

Abstract

Introduction
The first vascular composite allotransplantation (VCA) was performed in 1998, with the first post-burn VCA in 2003. Since then, 21 burn patients have been recipients of VCAs. Controversy exists regarding safety of VCA in burn patients due to high levels of immunologic sensitization attributed to use of cadaver allograft. We seek to understand unique considerations of VCA in burn reconstruction and its relative safety compared to VCA in non-burn reconstruction.

Methods
A systematic review of VCA in burn reconstruction was conducted using the PubMed, Media and EBSCO database to retrieve all articles and news stories studying VCA from Jan. 2000 to May 2019. Only articles containing composite tissue allotransplantation, VCA, and reconstructive surgery were included. Articles that did not report outcomes or patient information were excluded. Reported cases were grouped according to injury and tissue (face vs. upper extremity) with mortality as a dependent variable. Statistical analysis was performed with the Fisher exact test.

Results
Of 63 articles obtained, 21 met criteria. After secondary review by the senior author, 6 more articles were included. To date, 147 VCAs are reported in 112 patients, including 40 face VCAs and 107 upper extremity VCAs. Of these, 30 (20%) were performed for post-burn deformities, and 117 (80%) for non-burn deformities. A total of 21 post-burn patients received VCAs with 4 subsequent deaths (19%). Post-burn recipients of upper extremity VCAs had significantly higher mortality than non-burn recipients of the same (p = 0.01), but there was no significant difference in face VCA mortality (p = 1.0) or overall mortality (p = 0.06) between groups.

Conclusions
VCA is a forefront procedure employed worldwide for reconstruction of devastating injuries. Presently, burn patients are at greater risk of mortality after upper extremity VCA, but not face VCA. Burn patients will benefit from focused investigation of unique post-burn risk factors of VCA mortality.

Applicability of Research to Practice
Disparities between post-burn and non-burn VCA outcomes suggest the presence of unique risk factors in burn patients. Investigation of unique risk factors will improve safety of VCA for burn patients.
510 Incidence of Extubation Failure in a Burn Intensive Care Unit: Examination of Contributing` Factors
Authors: Rizzo Julie A , McMahon Ryan , Aden James K , Brillhart Daniel B , Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
Extubation failure is associated with negative outcomes making the identification of risk factors for failure paramount to patient selection. Burn patients experience a high incidence of respiratory failure requiring mechanical ventilation. There is no consensus on the acceptable rate of extubation failure and many conventional indices used in critical care do not accurately predict extubation outcome in burn patients. The purpose of this study was to examine the rate of extubation failure in the burned population and to examine the impact of inhalation injury, as well as other factors, on extubation outcome.

Methods
Burn patients from a single center over the period 2009–2017 were examined and included if they were intubated prior to arrival or within 48 hours of admission and underwent a planned extubation. Patients were excluded if they proceeded directly to tracheostomy, died prior to extubation, or experienced an unintentional extubation. From this cohort, a matched case-control analysis based on age, TBSA and gender was performed of patients who succeeded after extubation, defined as not requiring reintubation within 72 hours of extubation, to those who failed. Characteristics and clinical parameters were compared between these two groups to determine if any factor(s) could predict extubation failure.

Results
A 12.3% incidence of extubation failure was found in our cohort of 106 burn patients. In the matched case-control analysis of 48 extubation successes and 58 extubation failures, the presence of inhalation injury was surprisingly associated with extubation success as was a higher PaO2:FiO2 ratio immediately prior to extubation. Higher heart rate and lower serum pH was associated with extubation failure. ANCOVA analysis demonstrated that a sodium trending higher before extubation was associated with more successes, possibly indicative of a lower volume status.

Conclusions
Classic extubation criteria do not accurately predict extubation outcome in burn patients; analysis of other characteristics and clinical parameters may be able to provide better predictions. A constellation of these parameters needs to be studied prospectively.

Applicability of Research to Practice
Defining a constellation of parameters that can aid in identifying those at high risk of extubation failure could change practice.