bluuebunny/crossref_metadata_2025_split huggingface dataset:
524 Use of Broad-Spectrum Antibiotics and Sepsis-3 Criteria in Burns
Authors: Meza Luis E , Rehou Sarah , Shahrohki Shahriar 
Published: April 2021

Abstract

Introduction
Sepsis is a diagnostic challenge in critically ill patients; especially so in the burn population because the signs and symptoms of sepsis are pervasive after injury. The Sepsis-3 criteria identify organ dysfunction as an acute change in SOFA score ≥ 2 points consequent to infection. The objective of this study was to evaluate if Sepsis-3 criteria were fulfilled when broad-spectrum antimicrobial therapy was started in a burn cohort.

Methods
We included all adult (≥ 18 years) patients with an acute burn admitted to our burn centre within 2 days of injury between 2016 and 2019. Only patients that received meropenem or piperacillin/tazobactam during their acute hospitalization period were included. Patients were stratified based on the Sepsis-3 definition using evidence of infection and evaluation of organ failure in the 48-hour period prior to the administration of antibiotics.

Results
We studied 70 patients, with 24 patients in the control group and 46 patients in the Sepsis-3 group. Demographics were similar among the control and Sepsis-3 groups: mean age was 44 ± 18 versus 48 ± 18 years (p=0.372); but injury severity was significantly different: median percent TBSA burn 18% vs. 32% (p=0.003) and proportion of inhalation injury 13% vs. 50% (p=0.002). Length of stay (LOS) was significantly longer in the Sepsis-3 group, control group median 23 days vs. median 43 days (p&lt; 0.001). However, LOS/TBSA was not significantly different in the control group compared to the Sepsis-3 group: median 1.6 vs. 1.4 days per percent TBSA burn (p=0.777). Mortality was similar among the groups: 13% vs. 20% (p=0.526). The proportion of patients diagnosed by a physician with sepsis was also similar with 21% in the control group vs. 33% in the Sepsis-3 group (p=0.406).

Conclusions
Though the Sepsis-3 group had greater injury severity, mortality, and LOS in-hospital, when normalized to TBSA, was similar. Patients were diagnosed by a physician with sepsis in less than a third of cases. This raises the question of why broad-spectrum antibiotics were started. Potentially, patients were treated based on clinical suspicion of sepsis instead of delaying treatment until diagnosis was confirmed. Benefits of early antibiotic administration must be considered in conjunction with antimicrobial stewardship.
525 Biomarkers for the Early Diagnosis of Sepsis in Burns: Systematic Review and Meta-analysis
Authors: Li Andrew , Moussa Anthony , Gus Eduardo , Paul Eldho , Yii Erwin , Romero Lorena , Lo Cheng H , Cleland Heather j 
Published: April 2021

Abstract

Introduction
Early clinical diagnosis of sepsis in burns patients is notoriously difficult, and many biomarkers have been proposed as adjuncts to clinical assessment. We aimed to evaluate the diagnostic performance of all previously studied biomarkers for the early diagnosis of sepsis in hospitalized patients with burns.

Methods
We conducted a systematic literature search to February 2020 of Medline, Embase, Cochrane Central, Biosis Previews, Web of Science, and Medline In-Process. Only diagnostic studies utilising a sepsis definition of positive blood cultures or a combination of infection, systemic inflammation, and organ dysfunction were included. Where possible, contingency tables were used as reported or constructed from original data using a cut-off based on Youden’s index. Pooled sensitivity and specificity estimates were derived for each biomarker using random effects meta-analysis.

Results
We included 27 studies evaluating 56 different biomarkers. Procalcitonin was moderately sensitive and specific for sepsis in patients with burns (sensitivity 72%, specificity 74%). CRP was also moderately sensitive and specific (74% and 64% respectively). White cell count had poor sensitivity and specificity (46% and 59% respectively). All other biomarkers had insufficient studies to include in a meta-analysis, however cell free DNA, nuclear DNA, BDG, BNP, and SVI showed the most promise in single studies. There was considerable heterogeneity between studies reflecting different definitions and cut-offs.

Conclusions
The most widely studied biomarkers are poorly predictive for sepsis in burn patients. Several promising candidates have been reported which should be evaluated in further studies. A standardized approach to the evaluation of diagnostic markers (including time of sampling, approach to cut-offs and outcome) would be useful.
527 Use of Bioelectrical Impedance Analysis for Assessing Phase Angle, Hydration Status, and Predicting Outcomes in Critically Ill Patients: A Systematic Review and Meta-Analysis
Authors: Dang Justin , Lin Matthew E , Huang Samantha , Hulsebos Ian F , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Bioelectrical impedance analysis (BIA) is a simple, noninvasive method of assessing body composition. BIA operates by sending a low-voltage electric current through the body and measuring the impedance to that current. Parameters obtained from BIA have been used to investigate a range of variables such as nutrition and hydration status in a variety of patient populations. Phase angle is also a unique parameter that is thought to reflect cellular health. BIA parameters can undergo further analysis by bioelectrical impedance vector analysis (BIVA) which can provide information about hydration status. Burn and critical care patients pose a unique challenge because they are particularly sensitive to fluid shifts and metabolic derangements which are associated with poorer outcomes. The utility of BIA and BIVA in this patient population has not been well studied. Thus, we have conducted a systematic review and meta-analysis of the ability of BIVA and BIA parameters to assess cellular health and hydration status in critically ill adults and whether they can be correlated with outcomes.

Methods
A search was performed on PubMed and Google Scholar in accordance with PRISMA guidelines between June 2020-August 2020 utilizing the keywords: bioelectrical impedance analysis, critical care, critical, body composition, phase angle, water, fluid. Inclusion criteria were articles investigating the relationship between BIA, BIVA and outcomes with regards to phase angle, hydration, and fluid status in critically ill adults. Reviews, non-English articles, and studies involving pediatric patients were excluded. A meta-analysis was conducted on the correlation between mean phase angle and mortality.

Results
The final analysis included 21 articles; 4 articles were included in the meta-analysis. Statistically significant correlations were found between phase angle and mortality in 9/13 articles, hospital length of stay in 4/7 articles, ICU length of stay in 5/7 articles, and mechanical ventilation duration in 1/4 articles. For meta-analysis, mean phase angle in survivors and non-survivors was 4.5 and 3.9 respectively, and this difference was statistically significant (Figure 1, p&lt; 0.01). Significant correlations were found between ECW/TBW and mortality in 4/7 articles, and BIVA derived hydration status and mortality in 6/7 articles.

Conclusions
BIA and BIVA may be used as a prognostic indicator for outcomes in critical care patients. Further investigations are needed to explore this relationship in the burn patient population.
535 Vitamin C in the Management of Burn Patients: A Review of Benefits and Risks
Authors: Siddiqi Mahwash , Bryan Francesca , Bokhari Faran 
Published: April 2021

Abstract

Introduction
Burns are global public health problem. Micronutrients play an essential role in defense mechanisms and immunity. Vitamin C has fostered a growing interest. We reviewed current evidence regarding the effects of Vitamin C on management of burn patients and aims to understand its benefits and risks.

Methods
A narrative review was performed from January 2000 through September 2020 via PubMed by searching the terms “vitamin C”, “ascorbic acid” and “burns”. The search yielded a total of 170 journal articles. The following were excluded: commentaries, experimental research and studies on non-human subjects. Ultimately, 20 articles qualified for review.

Results
A total of 924 patients were studied. The literature collectively endorsed a difference in patient outcomes when vitamin C is administered on the first day of admission. The average age across the studies was 15–45 years old. Only 10% of studies included vulnerable age groups (2–15 years old). The Mean Total Body Surface Area (TBSA) of patients was 31%. Most of the studies excluded patients with co-morbidities.
The benefits of vitamin C in various aspects of burn management were documented in 70% of studies. Patients who were given vitamin C exhibited a decrease in fluid requirement in 42% of the studies when compared to controls. Additionally, a decrease in wound healing time was reported in 35% of studies, a decreased rate of post-burn infections was reported in 28%, and 14% of studies state that patients given vitamin C had reduced edema.
The effect of vitamin C dosing methods on outcomes was also examined. It was reported by 14% of Studies that low-dose Vitamin C infusion does not improve outcomes, while 50% of studies that used high-dose infusion revealed improved results. Additionally, when comparing oral route of administration 20 % of studies used high-dose with favorable results.
In regards to risk, oxalate nephropathy, acute kidney injury, and renal failure was documented by six studies.

Conclusions
Our review concludes that there is decreased fluid requirement, improvement in edema, healing time and post burn infections when high-dose vitamin C (66mg/kg/hr) is given to adults on first day of admission and continuously infused for 24 hours in 1st and 2nd degree burn involving 10 to 40% TBSA. However, there is an associated risk of acute kidney injury and renal failure.
536 Use of Bioelectrical Impedance Analysis for Assessment of Nutritional Status: A Systematic Review
Authors: Dang Justin , Lin Matthew E , Huang Samantha , Hulsebos Ian F , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Nutritional support is an essential component of caring for burn patients. Burns can induce a hypermetabolic state greater than twice the normal metabolic rate which can lead to higher rates of lean tissue mass breakdown. Despite its importance, there is no clear gold standard for monitoring nutritional status in the burn and critical care population. Many current methods of assessing body composition can be costly, labor-intensive, and inaccurate. Bioelectrical impedance analysis (BIA) is a promising new technology for assessing body composition that functions by sending a low-voltage current through the body and measuring the impedance to that current. Parameters derived from BIA have been demonstrated to reflect cellular health and correlate with nutritional status. The use of BIA to assess nutritional status in the critical care and burn population has not been well investigated. Thus, we have conducted a systematic review of the use of BIA to assess nutritional status in critically ill adults.

Methods
A search was conducted on Pubmed and Google Scholar in accordance with PRISMA guidelines between June 2020-August 2020 utilizing the keywords: bioelectrical impedance analysis, critical care, critical, nutrition, body composition, lean body mass, phase angle, water, fluid. Inclusion criteria were articles investigating the relationship between BIA and nutritional status in critically ill adults. Reviews, non-English articles, and studies involving pediatric patients were excluded.

Results
Our final study included 14 articles. BIA measured muscle mass was compared to a CT scan in two studies, with both reporting a statistically significant correlation. One article compared the ability of BIA and ultrasound to assess muscle mass, and this relationship was statistically significant. BIA derived phase angle was compared to NUTRIC and Subjective Global Assessment scores in four articles with all four reporting significant correlations. BIA was also compared to biochemical markers of nutrition such as albumin and two of three articles found significant correlations. One article compared BIA with gas exchange measured by indirect calorimetry and found that BIA could accurately assess body cell mass. No articles were found comparing BIA with other common nutritional markers such as prealbumin or nitrogen balance.

Conclusions
BIA shows promise as a method of assessing body composition and nutritional status in the critically ill patient population.
546 Management of Pediatric Pavement Burns
Authors: Saquib Syed F , Chestovich Paul J , Carroll Joseph T , Flores Carmen E 
Published: April 2021

Abstract

Introduction
Pavement burns are common in a dry high heat climate. This study reviews the etiology, management and outcome of pavement burns in children.

Methods
All patients age &lt; 18 who suffered contact burns from hot pavement from Jan 1, 2014 to Dec 31, 2019 were reviewed. A total of 45 patient charts met inclusion criteria. High ambient temperature on each date, and zip code of each injury was extracted from Weather Underground (www.wunderground.com)

Results
In this study, 45 patients met criteria and were reviewed, of whom 27 patients (60%) were male. Average age was 3.29 years (SD 0.69), made up two discrete age groups: age under 3 (n= 40, 89%) and 14+ (n=5, 11%). 38 patients (84%) had no known medical history. All had 2nd degree burns and one patient (2%) had third degree burns. Mean total body surface area (TBSA) was 2.5% (SD 1.4%, range 0.75% to 5.5%). Burn etiology included 31 patients (69%) walking barefoot on pavement, 6 (13%) falling onto pavement, and other/unknown etiology for the remaining 8 patients (18%). 30 patients (67%) had injuries on the plantar aspect of bilateral feet, 2 (4%) to bilateral palms of hands, 4 (9%) to other parts of upper extremities and 10 (22%) to other parts of lower extremities.
Thirty-four (34) patients (76%) were managed without any hospitalization. Those that were hospitalized had an average length of stay (LOS) of 2.72 days (range 1–9 days). All burns were managed non-operatively with topical therapy alone. 35 patients (78%) were managed initially with Silvadene, and 6 (13%) with bacitracin. Aquacel was utilized in 10 patients at a follow-up visit (22%). Three patients (6.7%) were treated with collagenase enzyme therapy. One patient developed a superficial infection requiring oral antibiotic therapy. There were no mortalities in this group. The high ambient temperature on date and location of each injury was 101 F (SD 1.10 F, range 73F-111F). Of the thirty that continued to follow up in clinic, the average time to the burn being 95% healed was 10.50 days (SD 8.97 days, range 2–40 days).

Conclusions
Pavement burns in children are partial thickness and are safely managed with topical therapy alone, with good outcomes. Patients age 3 and under are a vulnerable population and therefore at particular risk of injury.
553 Treatment of Scalp Pressure Ulcers with an Aerosol Formula with Silver Sulfadiazine, Lidocaine and Vitamin A: Early Clinical Experience
Authors: Aguilar Hernan , Basso Robertino , Dolino Florencia , Diaz Ana , Tessore Nadia M , sanroman eduardo , Mayer Horacio F 
Published: April 2021

Abstract

Introduction
Management of scalp pressure ulcers (SPU) in patients admitted to intensive care units (ICU) remains a challenge. The impossibility of freely moving the head due to different factors such as the intubation, enteral nutrition, dialysis and use of extracorporeal membrane oxygenation among others, makes the management of these wounds problematic. Herein, we present our early clinical experience in the treatment of SPU with a novel aerosol formulation of silver sulfadiazine.

Methods
A prospective study including all patients with SPU who were treated with an aerosol formula that includes silver sulfadiazine, lidocaine and vitamin A was carried out. Wound dressings were changed every 12h and consisted in wound cleansing, aerosol application and occlusion with sterile gauze.
Evolution of each SPU was controlled with pictures and measures on the affected area every 48 hours. In order to determine the total wound area, pictures were analyzed using the Informatics Image System from the U.S National Institute of Health.

Results
Six patients were prospectively followed and were included in this study. There were 2 females and 4 males. Average age was 70.8 years (range 41–99), while average hospital stay in the ICU was 14 days (range 5–22).
None of these patients experienced wound progression to a more critical stage. One patient had a favorable evolution from stage IV to stage II. Also, none of them showed clinical signs of a local infection of the SPU.
The average quantity of aerosol used per dressing was 1.3 ml which represents 2,6 mm/day and a cost of A$106,16 (U$S 1,45). As the cost of hydrocolloid dressings, at our institution, is A$602 per dressing (U$S 8,24), this represented an important saving in costs.

Conclusions
In this case series, the use of this novel aerosol formulation of silver sulfadiazine has shown promising results in the treatment of SPU in patients admitted to ICU, facilitating the application and saving costs. Further and larger studies to confirm our encouraging preliminary results are warranted.
554 A Comparison of Intact Piscine Skin, Split-thickness Skin Graft, and Lactic Acid Membrane in Treating Superficial and Deep Burn Wounds Following Enzymatic Debridement
Authors: Wallner Christoph , Holtermann Jana , Drysch Marius , Wagner Johannes Maximilian , Dadras Mehran , Sogorski Alexander , Sacher Maxi , Becerikli Mustafa , Lehnhardt Marcus , Behr Björn 
Published: April 2021

Abstract

Introduction
The optimal therapy for deep burn wounds is based on the principle of rapid necrectomy and coverage in order to achieve healing that is as scar-free as possible. The available infrastructure and the patient’s condition represent limitations. With enzymatic debridement, selective bedside debridement can now be performed, however the optimal cover after enzymatic debridement has not been elucidated to date. In this study we compare superficial dermal and deep dermal wounds, which are either covered with lactic acid membrane, piscine skin, or split-thickness skin graft. To validate our approach the healed burn wounds were examined for objective (elasticity, water content, sebum, wound healing) and subjective skin quality as part of our standard follow-up care.

Methods
In this study, 12 patients who had received piscine skin, lactic acid membrane, or split-thickness skin graft after enzymatic debridement were retrospectively examined objectively and subjectively for scar quality as part of follow-up care 12 months after the accident. The wound healing process was also documented.

Results
Acceleration of wound healing was observed with the application of piscine skin vs split-thickness skin graft or lactic acid membrane. Skin elasticity was comparable to that of split-thickness skin graft but significantly better than lactic acid membrane. The sebum production in wounds treated with piscine skin was higher compared to lactic acid membrane covered wounds. The water storage capacity in the piscine skin treated wounds was also significantly higher than in lactic acid membrane or split-thickness skin graft treated wounds. Using the POSAS score, an improvement in elasticity, thickness, pigmentation, and relief was shown in piscine skin treated wounds, as well as a reduction in pain and itching, compared to split-thickness skin graft or lactic acid membrane.

Conclusions
The use of intact piscine skin immediately following enzymatic debridement in burn wounds results in faster wound healing and better patient outcomes compared to split-thickness skin graft or lactic acid membrane.
563 “After the Fire”; The Legacy of a College Dormitory Fire Twenty Years Later
Authors: Conlon Kathe M , Dimler Margaret A , Petrone Sylvia J , Marano Michael A 
Published: April 2021

Abstract

Introduction
In January 2000 fire erupted at a local college. Panicked students, many who failed to attend school-sponsored fire drills or ignored the alarms that night, found themselves scrambling to escape. Seven students were admitted for severe burns to a near-by burn center (BC), with 54 initially staged in the Emergency Department. While this dormitory fire took place more than twenty years ago, its legacy is still being felt today.

Methods
History shows that, with any tragedy, there are lessons to learn that lessen the impact of property destruction, injury or death. Literature review of several major fires looked at their impact promoting burn care and fire safety to correlate those lessons with this fire. Four key areas of improvement emerged: disaster preparedness, media relations, legislation, and fire prevention.

Results
Changes to BC disaster preparedness included formation of a more comprehensive plan, revisions to triage and transfer protocols, new guidelines for unit staffing, creation of a mid-Atlantic group of BCs that eventually morphed into the Eastern Regional Burn Disaster Consortium, and installation of a medical command center for regional disaster response. Media relations saw a collaboration with law enforcement, due to criminal investigation, and a partnership with a syndicated newspaper to document the journey of two survivors. A series of articles eventually resulted in a Pulitzer Prize-finalist book, with award winning photographs displayed at a national museum. Redesigned fire safety programs targeted high school and college students emphasizing escape plans, and clinical education included disaster drills. Two survivors became motivational speakers, sharing their personal story on campuses across the United States. New legislation mandated sprinkler installation in dormitories nationwide, and a non-profit foundation was formed to improve burn care. The anniversary of this fire is still commemorated each year with a ceremony and wreath-laying on campus.

Conclusions
Despite this dormitory fire being ranked as the deadliest in state history, all these years later the legacy of this landmark event remains one of triumph and resilience as its lessons still to resonate today