bluuebunny/crossref_metadata_2025_split huggingface dataset:
590 Nonpharmacologic Pain Management in Pediatric Burn Patients: A Systematic Review
Authors: Gillum Matthew , Huang Samantha , Kuromaru Yuki , Dang Justin , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Pain is a universal feature of pediatric burns that is associated with long-term mental health consequences in this population. While pharmacologic therapy can alleviate pain, it does not always provide complete control and carries its own risks. Current literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct in pediatric burn patients. The aim of this systematic review is to summarize the literature of nonpharmacologic pain management in pediatric burn patients.

Methods
A systematic review was conducted using PubMed, Ovid MEDLINE, Scopus, and Web of Science. Keywords included: analgesia, pain, children, pediatric, paediatric, child, young, adolescent, burn, and scald. Papers were included if they were randomized, controlled, had original data, collected pain scores as a function of nonpharmacologic treatment, and were conducted on pediatric burn patients. Reviews, case reports, and opinion papers were excluded. Data were extracted on pain scale, pain score during and after treatment, and significance of results. Pain reduction was calculated as the percent difference between experimental and control pain scores, and treatments with significant pain reduction were considered effective.

Results
Sixteen studies were included, with nonpharmacologic treatments categorized as interactive (n=12) or passive (n=4). Interactive treatments required patient activity throughout treatment and included virtual reality (n=6), distraction devices (n=3), child life therapy (n=1), directed play (n=1) and digital tablet games (n=1). Passive treatments included cartoons (n=1), hypnosis (n=1), massage therapy (n=1) and music (n=1). Mean age was 8.39 years and percent total body surface area (%TBSA) burned was 5.95%. Treatment was effective in 9 out of 16 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 24.3% (n=12) and post-procedure pain by 33.6% (n=5). Of the studies reporting mid procedure pain, pain reduction was greater in interactive treatments (32.3% n=10) than in passive treatments (-15.6% n=2) (p=.016).

Conclusions
Nonpharmacologic therapy can be an effective adjunct in pediatric burn pain management. Significantly greater pain reduction in interactive treatments suggests distraction may lead to greater analgesia; however, the number of passive treatments for comparison was low. This study shows promise in the application of nonpharmacologic therapy, and further research will allow standardized algorithms to integrate nonpharmacologic therapy with medications.
593 Mortality of Burn patients over two decades: Improving outcomes in the elderly
Authors: Grigsby Melissa J , Romanowski Kathleen S , Sen Soman , Palmieri Tina L , Ponzini Matthew D , Taylor Sandra , Greenhalgh David G 
Published: April 2021

Abstract

Introduction
Shifting paradigms in the care of burn patients over the past two decades have led to the improved survival of adult and pediatric patients, but the same trend has not been manifested in the elderly population. We aimed to review our patient population, particularly the elderly, for the last twenty years and examine the relationship of age to the TBSA (total burn surface area) LD50 (lethal dose, 50%).

Methods
This IRB approved study retrospectively analyzed acute burn patients admitted at two academic regional burn centers from January 1, 1999 to August 1, 2019. Data collected included age, gender, TBSA, mortality, mechanism of burn, inhalation injury, and presence of full-thickness burn. The relationship between mortality and TBSA and age was assessed using logistic regression. The TBSA LD50 was calculated conditional on age and confidence intervals were constructed based on 1000 bootstrap samples.

Results
A total of 9,721 patients were admitted for treatment of acute burn injury between the two institutions. In our population, flame was the most common cause of burn injury (51%), full-thickness burns were present 47% of the time, and mean TBSA was 13%. The average patient age was 28, although there were 789 patients over the age of 65. The TBSA LD50 relationship to age best fit a cubic regression model with a peak of 81% TBSA LD50 at 17 years of age, rapid decrease early in the 5th decade and a general leveling out at the nadir of 27% TBSA (Figure). The LD50 did not reach 30% until 78 years of age.

Conclusions
Over the past two decades, elderly patients treated at our hospitals appear to have improved survival in comparison to the outcomes reported nationally. Due the ongoing rapid aging of the population, it is important that we continue to focus on both improving survival and delivering the best care to this vulnerable part of the population. Moreover, this continuous model could be used to track improvements in care within our institution and serve as a template for a national model.
597 Non-Survival Distributions in Paediatric Burn Patients; A Comparative Study of Two National Databases
Authors: Wermine Kendall , Gotewal Sunny , Schober Marc , Africa Robert , Hallman Taylor , Cuartas-Olarte Andres , Torres Mark Jason , Peterson Joshua M , Golovko George , Song Juquan , El Ayadi Amina , Wolf Steven E 
Published: April 2021

Abstract

Introduction
A contemporary, age-specific model for the distribution of burn mortality in children has not been developed for over a decade. Using data from both TriNetX, a global federated health research network, and the American Burn Association’s Nation Burn Repository (NBR), we investigated non-survival distributions for paediatric burns in the United States.

Methods
Paediatric burn patients ages 0–20 between 2010–2020 were identified in TriNetX from 41 Health Care Organisations (HCOs) using ICD-10 codes (T.20-T.30) and identified as lived/died. These were compared to the non-survival data from 90 certified burn centers in NBR database between 2016–2018. The patient population was stratified by age into subgroups of 0–4, 5–9, 10–14, 15–20 years. Descriptive statistics were generated and statistical analysed by chi-square; p &lt; .05 was considered significant.

Results
81,507 and 21,442 unique paediatric burn patients were identified in the TriNetX and NBR databases, respectively. Overall non-survival rates were 0.62% and 0.52%, respectively. Boys had a higher incidence of mortality than girls in both databases (0.34% vs. 0.28% NBR, p = 0.13 and 0.31% vs. 0.21% TriNetX, p = &lt; 0.001). When comparing age subgroups in TriNetX, burned children ages 5–9 had significantly increased frequency of non-survival, constituting 65% of all deaths (p = &lt; 0.001). However, NBR data suggested that children 0–4 experience the highest frequency of mortality (p = &lt; 0.001). Comparison of ethnic cohorts between 2010–2015 and 2016–2020 subgroups showed that non-survival rates of African-American children increased relative to white children (TriNetX, p = &lt; 0.001), however evidence was insufficient to conclude that African-American children die more frequently than other ethnicities (NBR, p = 0.054).

Conclusions
Large sample size databases such as TriNetX and NBR afford sufficient statistical power to reflect relative non-survival rates in burned children. TriNetX also captures a unique demographic of burn patients not treated at ABA certified centers reporting to NBR, informing inferences on results. However, differences in reporting time periods must also be considered. Furthermore, potential ethnic disparities in paediatric non-survival outcomes were identified, meriting further investigation.
606 Is Social Media Contributing to a New Trend of Burns in Youth?
Authors: Ramos Margarita , Yerokun Oluwatobi , Lerman Sheera F , Caffrey Julie , Hultman Charles S 
Published: April 2021

Abstract

Introduction
Burn injuries in adolescents in the United States continue to occur at significant rates despite the many different programs focused on burn education and prevention. With the introduction of social media earlier in life and more social media targeting younger populations, our burn center has experienced a new class of burn injury: risky behavior promoted or encouraged as part of gaining social media popularity. Adolescents are likely the most vulnerable population in this type of risky behavior because of their access to social media and their willingness and ability to attempt the challenges, but younger children can also be burnt as bystanders or recruited participants by older minors. This study seeks to understand the content in social media which may lead to this risky behavior in minors.

Methods
We performed a term search in a popular social media application (TikTok) which included “burn”, “fire”, and “fire challenge””. We screened the top 50 most popular videos for each word search. Only videos which included footage of a person or body part being set on fire whether real or through a hologram or filters. We excluded videos showing professionals use fire (i.e. cooks, entertainers, welders, artisans), video game characters, videos with no body parts on fire. Metrics included in the social media were number of likes and number of views, as well as date posted.

Results
Six hundred and twelve videos were screened (153 videos in each search term category). A total of 20 (3.2%) of videos contained a demonstration of a risky behavior with fire. The most common content was four videos (20%) were the subject was setting one hand on fire. Two videos were pranks involving burning the pranked. Sixteen videos (80%) involved real fire and 4 (20%) involved a hologram of fire. The “likes” on the videos ranged from 1.9 million to 189. The comments ranged from 0 to 11,200. All of the authors were young adolescents or young adults. The videos had been there from 6 weeks to 21 months.

Conclusions
TikTok is a fast way to disseminate videos a large number of viewers. The majority of videos with content of risky behavior around fire are of individuals which are playing with fire or simulating playing with fire and often have no other overt agenda but to want attention and popularity. A minority of these videos are purposefully spreading risky behavior around fire as a “challenge” or “trend” to be copied by other TikTok viewers.
622 Enhanced Recovery After Surgery for Fractional CO2 Laser Treatment of Burn Scars
Authors: Virgadamo Lacy , G’Sell David , Smith Sydney , Mai Kathryn , Lavis Amy K , Jastram Charles W , Salinas Orlando , Phelan Herbert , Carter Jeffrey E 
Published: April 2021

Abstract

Introduction
Healthcare systems have adopted enhanced recovery after surgery (ERAS) programs as evidence-based, multimodal, and multidisciplinary perioperative approaches to mitigate complications and improve early recovery. ERAS programs modify psychological and physiological response to surgery with standardized care pathways that range from preoperative assessment and education through pharmacologic and surgical interventions. Our study demonstrates a burn scar specific ERAS protocol with pre- and post- intervention outcomes.

Methods
As part of a quality and performance improvement initiative, a multidisciplinary panel at an ABA-verified burn center consisting of burn nurses, burn surgeons, burn physician assistants, burn therapist, clinical pharmacist, certified medical laser safety officer, and anesthesiologist reviewed the available literature regarding pain, laser treatments, and medication histories of prior fractional CO2 laser treatments. The ERAS program was designed with preoperative, perioperative, and postoperative interventions to reduce pain and complications defined as unscheduled visits/admission to the ER or burn center, narcotic administration &gt;1 hour post procedure, or wound complications secondary to laser treatment requiring dressing changes &gt;1 week post-procedure. Quality and performance metrics were collected as a component of the burn registry program and reviewed twice monthly. The ERAS protocol preoperative phase included standardization of outpatient screening, assessment, and electronic medical record documentation. The perioperative phase included standardization of preprocedural medications including multimodal analgesia. The intraoperative phase included standardization of medications and dressing application. Post procedural phase included standardized instructions for wound care and follow-up.

Results
Pre-implementation complications over a three-month period included one patient requiring wound care &gt;1 week post laser treatment and 4 patients requiring narcotic administration &gt;1 hour post procedure (16% of laser cases). Post-implementation of the ERAS program no complications were identified in 62 cases over a three-month period.

Conclusions
At our institution a burn scar specific ERAS protocol reduced perioperative complications following fractional CO2 laser procedures. While many opportunities exist to improve scarring and pain, the multidisciplinary approach in burn care is as essential for outpatients as it is for inpatients at reducing avoidable complications.
624 A Simple Survey for Tracking Burn Wound Assessment Skill
Authors: Wengerter Brian C , Lee Christina , Rabbitts Angela , Gallagher James 
Published: April 2021

Abstract

Introduction
The assessment of burn wound surgical need is a critical skill of a burn provider. In an attempt to determine whether burn wound reading by physical exam is a skill that can be measured, this article describes a simple, survey-based method developed and employed at a single, high-volume urban burn center for gauging and tracking success at predicting surgical need.

Methods
This study was conducted from August 8, 2019 to October 31, 2019. Study participants were care team providers, including attending physicians, fellows, residents and physician assistants. They were divided into expert and novice groups according to prior burn wound care experience. After in person examination of the burn wounds, participants were sent an electronic link to a de-identified survey. Survey answer choices included: 1 (surgical excision not required), 2 (unsure need for excision), and 3 (clear need for excision). Correctness was judged by whether or not the patient ultimately required surgery. Evaluation surveys that were unanimous among all expert and novice providers were excluded, as these were deemed inadequate for assessing wound reading skill. Weighted group mean success rates were calculated, and statistical analysis of the means was performed using a weighted, two-tailed t-test.

Results
During the study period a total of 112 survey events were recorded, 23 of which met exclusion criteria. The percentage of correct responses was 63±3% in the expert group (n=440 votes) and 48±15% in the novice group (n=304 votes). Weighted, two-tailed t-test analysis revealed a statistically significant difference between the expert and novice groups (p &lt; 0.01).

Conclusions
This pilot study demonstrates that the current survey method of assessing burn wound surgical need was able to discriminate the wound reading skill of a group of expert providers from that of a group of novices, suggesting that burn wound reading is a skill that can be quantitatively measured. Further development of a formative assessment could aid in the formulation of an educational module to improve wound reading skills.
626 Female External Urinary Collection Device Utilization in a Female Burn ICU Patients: A Quality Improvement Project
Authors: Peters Jasmine N , Grote Andrea C , Spera Leigh J , Gillenwater Justin , Yenikomshian Haig A 
Published: April 2021

Abstract

Introduction
A significant portion of intensive care unit (ICU) patients require a Foley catheter during their admission. Foley use has become more criticized as nationwide quality improvement processes attempt to reduce catheter associated urinary tract infections (CAUTI). Burn patients in the ICU have a higher rate of catheter utilization due to difficult fluid management, need for accurate volume measurements, and significant wound care. Males may have a condom catheter exchanged once they are stabilized. Historically, a noninvasive alternative to the Foley has not been available for females. While the female external catheter has existed for quite some time and hospital systems are increasingly encouraging their use, there is no standard of practice for when they are best utilized. Specific to the burn population, potential barriers include body habitus, perineal burns, and pain on frequent changing of the device. Our study aims to evaluate the current female external catheter use in our burn ICU in order to develop a standard protocol to increase utilization while thoughtfully delineating the contraindications.

Methods
A quality improvement project for guidelines on the use of a female external urinary collection device was conducted. All female patients admitted to the burn ICU during 2019 were included. Data was collected on burn TBSA, anatomic location, ICU days, ventilator days, and foley catheter days. Foley catheter days, external urinary catheter days, urinary tract infection (UTI) rates, and incidence of failure of external device were collected.

Results
Of the 46 total female burn patients, 31 required a foley catheter at some point during their stays. 11 patients used an external urinary collection device. Of the 11 users, one urinary device had to be removed due to skin breakdown. One other patient required replacement with a Foley catheter as a result of oliguria and the need for closer fluid management. 5 of the successful users of the external catheter were clinically obese. No patients contracted a UTI while using the external catheter. 3 UTI’s developed in women while using a Foley catheter. Patients who had altered mental status and perineal wounds were not eligible to use the external catheter.

Conclusions
In our practice, we found contraindications to external female catheter use to include altered mental status and perineal wounds. Obesity was not a contraindication and device usage may be most beneficial in incontinent patients. Further investigation is needed to better optimize female external urinary collection device usage within the burn ICU setting. This may help minimize CAUTI’s among female burn patients.
631 Burn Unit Design – The Missing Link for Quality and Safety
Authors: Gus Eduardo , Barnes David , Eng Biomed , Sjöberg Folke , Steinvall Ingrid , Elmasry Moustafa , van Zuijlen Paul , Brekke Ragnvald L , Almeland Stian K , Singer Yvonne , Cleland Heather j 
Published: April 2021

Abstract

Introduction
The relationship between infrastructure, technology, model of care and human resources influences patient outcomes and safety, staff productivity and satisfaction, retention of personnel, and treatment and social costs. This concept underpins the need for evidence-based design and has been widely adopted to inform hospital infrastructure planning. The aim of this review is to establish evidence-based, universally applicable key features of a burn unit that support function in a comprehensive patient-centred model of care.

Methods
A literature search in medical, architectural, and engineering databases was conducted. Burn associations’ guidelines and relevant articles published in English, between 1990 and 2020, were included, and the available evidence is summarized in the review.

Results
Few studies have been published on burn unit design in the last thirty years. Most of them focus on the role of design in infection control and prevention, and consist primarily of descriptive or observational reports, opportunistic historical cohort studies, and reviews.

Conclusions
The evidence available in the literature is not sufficient to create a definitive infrastructure guideline to inform burn unit design, and there are considerable difficulties in creating evidence that will be widely applicable. In the absence of a strong evidence base, consensus guidelines on burn unit infrastructure should be developed, to help healthcare providers, architects and engineers make informed decisions, when designing new or renovated facilities.
637 Free Abdominal Tissue Transfer and Utilization of the Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose and Throat Defects: A Case Series
Authors: Laun Jake , Pribaz Julian 
Published: April 2021

Abstract

Introduction
Head and neck defects, whether from burns or cancer resections, are complex and often require free flap reconstruction. Radial forearm and anterolateral thigh (ALT) flaps are commonly used due to their thin and versatile nature. However, abdominal based free tissue transfer is one valuable alternative that can cover large defects and may become a more appropriate option on the reconstructive ladder when the defect includes reconstruction of a tubular structure, such as the external auditory canal, a neck tracheostomy/stoma site or an external nasal opening. We present a novel utilization of abdominal free tissue transfer for coverage of large ear and scalp burn defects as well as neck and midface defects with usage of the umbilical stalk for tubed reconstruction.

Methods
Four patients presented for reconstruction: two patients had sustained large ear and scalp burns resulting in complete ear loss; one had a large neck defect resulting from recurrent cancer resection which necessitated a laryngectomy and stoma creation; and one patient had a large central face defect post-cancer resection. All four patients underwent an abdominal based free tissue transfer with reconstruction of the external auditory canal in the ear and scalp burns, stoma creation in the neck defect, and the external nasal opening in the central face defect, all utilizing the vascularized umbilical stalk for the tubed reconstruction.

Results
All patients recovered post-operatively without any reported complications such as tubular stenosis or contracture while maintaining umbilical stalk tubular patency.

Conclusions
Reconstruction of a tubed structure in head and neck defects, whether the external auditory meatus, an external nasal opening or a neck stoma post burn or cancer resection, can be a difficult and challenging operation fraught with potential complications. We present a novel method of reconstruction of large defects employing the use of the uniquely thin and vascularized umbilical stalk for tubular reconstruction.