bluuebunny/crossref_metadata_2025_split huggingface dataset:
27 Oral Supplementation for Burn Patients: Would YOU Eat That?
Authors: Savetamal Alisa , Ebdon Melissa 
Published: April 2021

Abstract

Introduction
The metabolic demands of burn injury often require that patients consume a high-calorie diet. For patients taking nutrition solely by the oral route, this can be challenging, and supplementation is necessary. The burn team is sometimes frustrated at patients’ inability or perceived unwillingness to consume the daily prescribed supplementation. The purpose of this study was to expose the burn team to the various nutritional supplements offered to patients, and to gain a better understanding of the palatability those supplements.

Methods
Nine volunteers from the burn team participated in this blinded study: an attending surgeon; surgical residents (2); students (1); therapists (2); and nurses (3). Samples of 9 different nutritional supplements were placed in numbered cups, with the contents known only to the dietitians. The supplements consisted of: “milkshake” consistency drinks (#1,4,6,7, 9); gelatin (#2); frozen custard (#3); clear thin liquid (#5); and pudding (#8). Each participant received one cup of each supplement and was asked to rate the contents on a scale of 1 to 10, with 10 being tastiest. Mean, trimmed mean, and median taste scores were noted. Data were analyzed by t-test and by regression to assess for differences based on protein content.

Results
The highest mean and trimmed mean scores (7.3 and 7.4) were given to product #8. Product #1 had slightly lower scores (6.4 and 6.1). Product #9 received the lowest mean score (2.2); the trimmed mean was even lower (1.7). Median scores for the products upheld these results, and most of the remainder of the products received median scores of 4 or 5. T-test analysis showed significant differences in preference for products 1 and 8 versus the rest of the products (with means of 2.2 to 5.3). Regression analysis suggests that taste scores tend to be higher for products with a lower percentage of calories from protein, while the higher protein products fare less well in taste (a decline of roughly 0.47 in mean taste score for every 10-percentage point increase in percentage of calories from protein).

Conclusions
A blinded taste test of commonly offered supplements revealed that most products are, at best, moderately acceptable (median score 4–5). This suggests two potential changes in the approach to oral supplementation. First, the burn team should be sympathetic to the challenges that patients face with oral supplements, particularly the high-protein versions. Second, the burn team may need to be innovative. Chilling the drinks, offering different flavors, mixing flavors, or mixing with other liquids may help patients to take oral supplements more enthusiastically. Sampling these oral supplements has helped our team to understand better what we ask our patients to do to achieve their nutritional goals.
29 The Effectiveness of Laser Therapy for Hypertrophic Burn Scars in Pediatric Patients: A Prospective Investigation
Authors: Zuccaro Jennifer , Fish Joel , Kelly Charis 
Published: April 2021

Abstract

Introduction
Laser therapy has emerged as a valuable treatment option for hypertrophic burn scars over the past decade. Improvements in scar symptoms have been found using the ablative fractional carbon dioxide laser (AFCL) as well as the pulsed dye laser (PDL). However, research regarding the use of laser therapy among pediatric burn patients remains limited. Thus, the aim of this study was to investigate the effectiveness of using laser therapy to improve hypertrophic burn scars in a pediatric population using a comprehensive set of subjective and objective scar assessment tools.

Methods
A single-center, prospective observational study was carried out at a tertiary pediatric hospital. Twenty participants with hypertrophic burn scars that had not received previous laser treatment were included. Laser procedures were administered at approximately two-month intervals and each participant attended five study visits over the course of one year. A comprehensive set of scar assessment tools including the Vancouver Scar Scale, the Patient and Observer Scar Assessment Scale, conventional ultrasound, ultrasound elastography, and a multi-parameter skin analysis device were used to evaluate scar properties at each study visit.

Results
Seventy-one laser procedures were carried out with most participants receiving treatment with both the AFCL and the PDL at the same session (83%). All participants underwent at least three laser procedures with no complications noted. From baseline to study completion, statistically significant improvements in all scar measures, both subjective and objective, were observed (p &lt; 0.05). More specifically, improvements in overall scarring and in specific scar properties including thickness (p &lt; 0.05), stiffness (p &lt; 0.05), and color (p &lt; 0.05) were found.

Conclusions
To our knowledge, this is the most comprehensive study to date to evaluate the effect of laser treatment on hypertrophic burn scars in a pediatric population. Our findings suggest that laser therapy is a highly beneficial treatment for burn-injured children that should be integrated into current scar treatment practices. In addition to obtaining strong evidence to support the use of laser therapy, we utilized rigorous scar assessment and laser treatment protocols that can be easily adopted by other clinicians.
34 Rete Ridges are Decreased in Dyschromic Burn Hypertrophic Scar: A Histological Study
Authors: Carney Bonnie C , Travis Taryn E , Deldar Romina , Moffatt Lauren T , Johnson Laura S , McLawhorn Melissa M , Shupp Jeffrey W 
Published: April 2021

Abstract

Introduction
Dyschromic hypertrophic scar (HTS) with areas of hyper- and hypo-pigmentation is a common sequelae of burn injury. The mechanism behind the development of dyschromia has not been elucidated. In this study, we provide a histological analysis of these scars with a focus on rete ridge presence. Rete ridges occur in epithelial tissues such as oral mucosa and skin and can be described as undulating “pegs” that are interdigitated with dermal papillae. Rete ridges enhance adhesion of the epidermis to the dermis. We hypothesize that rete ridge presence is important for normal skin physiology, and their absence or presence may hold mechanistic significance in post-burn HTS dyschromia.

Methods
Subjects with post-burn dyschromic HTS were consented and enrolled (n=27). Punch biopsies of hyper-, hypo-, and normally pigmented scar and skin were collected and stored in formalin. Biopsies were paraffin embedded, sectioned, stained with H&E, and imaged. The number of rete ridges were investigated by calculating a rete ridge ratio from the length of the basement membrane and the length of the epidermis.

Results
The patient population was predominantly female (55.5%), black (70.4%), and had Fitzpatrick skin Type V (51.9%). The injuries were primarily as a result of flame (37%) and scald (33.3%) and resulted in a median TBSA burn of 7%. The median age of the scar at the time of sample acquisition was 12.2 months. The rete ridge ratio of normally pigmented, un-injured skin was above 1 (1.31 ± 0.04), indicating that normal skin’s basement membrane is longer than its epidermal length due to the presence of rete ridges. HTSs resulting from burn wounds that healed without split thickness autografts were first investigated. The number of rete ridges was higher in normal skin compared to HTS that was either hypo- or hyperpigmented (1.31 ± 0.04 vs. 1.13 ± 0.05 and 1.14 ± 0.04 vs, p&lt; 0.05). This difference was similar despite pigmentation phenotype. When hyper-pigmented scars resulting from wounds that were treated with split thickness autografts (Hyper(+)) were investigated, rete ridge number was significantly higher than in Hyper(-) (1.89 ± 0.23, p&lt; 0.01). Patient age showed a weak correlation (R=-0.33) with rete ridge ratio where older patients had lower rete ridge ratios in normal, un-injured skin. Hyper(+) showed a weak correlation between rete ridge ratio and age of scar (R=-0.38).

Conclusions
Post-burn HTS that is dyschromic has fewer rete ridges than normal skin. This finding may explain the decreased epidermal barrier function that is associated with HTS.
36 Using Pressure Mapping to Understand and Prevent Hospital-Acquired Pressure Injuries in the Burn ICU
Authors: El Eter Leen , Yesantharao Pooja S , Javia Vidhi , Werthman Emily h , Cox Carrie A , Orosco Rowena , Cooney Carisa , Caffrey Julie 
Published: April 2021

Abstract

Introduction
Real-time pressure mapping devices may help prevent hospital-acquired pressure injury (HAPI) in Burn ICU (BICU) patients who are at a high baseline risk for HAPIs. While prior studies have demonstrated the utility of pressure monitoring devices in preventing pressure injuries, there has been little investigation into using pressure mapping data to better understand HAPI development, and to determine specific predictors of HAPIs. Such data could help risk stratify patients upon admission to the BICU and result in improved patient care as well as cost savings. This study retrospectively investigated the utility of pressure mapping data in predicting/preventing pressure injury among BICU patients, and estimated HAPI-related cost savings associated with the implementation of pressure monitoring.

Methods
This was a retrospective chart review of real-time pressure mapping in the BICU. Incidence of HAPIs and costs of HAPI-related care were determined through clinical record review, before and after implementation of pressure mapping. Multivariable-adjusted logistic regression was used to determine predictors of HAPIs, in the context of pressure mapping recordings.

Results
In total, 122 burn ICU patients met inclusion criteria during the study period, of whom 57 (47%) were studied prior to implementation of pressure mapping, and 65 (53%) were studied after implementation. The HAPI rate was 18% prior to implementation of pressure monitoring, which declined to 8% after implementation (chi square: p=0.10). HAPIs were more likely to be less severe in the post-implementation cohort (p&lt; 0.0001). Upon multivariable-adjusted regression accounting for known predictors of HAPIs in burn patients (BMI, length of stay, co-morbidities, age, total body surface area burned, mobility), having had at least 12 hours of sustained pressure loading in one area significantly increased odds of developing a pressure injury in that area (odds ratio 1.3, 95%CI 1.0–1.5, p=0.04). When comparing patients who developed HAPIs to those who did not, pressure mapping demonstrated that patients who developed HAPIs were significantly more likely to have had unsuccessful repositioning efforts prior to HAPI development, defined as persistent high pressure in the at-risk area (60% versus 17%, respectively; p=0.02). Finally, implementation of pressure mapping resulted in significant cost savings ($2,063 prior to implementation, versus $1,082 after implementation, p=0.008).

Conclusions
The use of real-time pressure mapping decreased incidence of HAPIs in the burn ICU patients and resulted in significant cost savings.
45 Application of Machine Learning Models to Thermal Burn Patient Outcome Predictions in the Aftermath of a Nuclear Event
Authors: Taylor Morgan A , Kearns Randy D , Carter Jeffrey E , Ebell Mark H , Harris Curt A 
Published: April 2021

Abstract

Introduction
A nuclear disaster would generate an unprecedented volume of thermal burn patients from the explosion and subsequent mass fires (Figure 1). Prediction models characterizing outcomes for these patients may better equip healthcare providers and other responders to manage large scale nuclear events. Logistic regression models have traditionally been employed to develop prediction scores for mortality of all burn patients. However, other healthcare disciplines have increasingly transitioned to machine learning (ML) models, which are automatically generated and continually improved, potentially increasing predictive accuracy. Preliminary research suggests ML models can predict burn patient mortality more accurately than commonly used prediction scores. The purpose of this study is to examine the efficacy of various ML methods in assessing thermal burn patient mortality and length of stay in burn centers.

Methods
This retrospective study identified patients with fire/flame burn etiologies in the National Burn Repository between the years 2009 – 2018. Patients were randomly partitioned into a 67%/33% split for training and validation. A random forest model (RF) and an artificial neural network (ANN) were then constructed for each outcome, mortality and length of stay. These models were then compared to logistic regression models and previously developed prediction tools with similar outcomes using a combination of classification and regression metrics.

Results
During the study period, 82,404 burn patients with a thermal etiology were identified in the analysis. The ANN models will likely tend to overfit the data, which can be resolved by ending the model training early or adding additional regularization parameters. Further exploration of the advantages and limitations of these models is forthcoming as metric analyses become available.

Conclusions
In this proof-of-concept study, we anticipate that at least one ML model will predict the targeted outcomes of thermal burn patient mortality and length of stay as judged by the fidelity with which it matches the logistic regression analysis. These advancements can then help disaster preparedness programs consider resource limitations during catastrophic incidents resulting in burn injuries.
46 Increased Concomitant Burn and Trauma Injuries Follows an Increase in Overall Trauma Volume: A Descriptive Analysis
Authors: Komak Spogmai , Jiang Chuantao , Crocker Rebecca , Khan Saleem , Freet Daniel J , Wainwright David J , Huzar Todd F , Wandling Michael W , Adams Sasha D , Kao Lillian S , Harvin John A , Wade Charles E 
Published: April 2021

Abstract

Introduction
Concomitant traumatic injury in the burn patient complicates care coordination and increases morbidity and mortality. The incidence of concomitant injury, however, is uncommon and reported to range from 5–7%. In May 2020, our level 1 trauma center began seeing 40% more patients per month that the 12 months prior. We sought to determine the incidence of concomitant injury in burn patients during this time of increased trauma volume and to examine the associated traumatic injuries in this group.

Methods
The burn registry at a single ABA-verified burn center was examined from 5/20–9/20. Patients with concomitant burn and traumatic injury were examined with respect to: %TBSA burn, mechanism of injury, operative interventions, associated traumatic injuries, and length of hospital stay. Continuous data was presented as mean (standard deviation).

Results
Eighty-nine burn patients were admitted during this period, of whom 24 (26.9%) had concomitant traumatic injuries. The cohort was young and mostly male; the mean TBSA was 16% () (Table 1). The most common mechanism of injury was motor vehicle collision (12 or 50%), followed by fall after high voltage electrical injury (6 or 25%) and motorcycle collisions (5 or 21%).
The most common associated injuries were: pulmonary contusions 29.1% (7/24); long bone fractures 25% (6/24); pelvic/acetabular fractures 20.8% (5/24); femur fractures 16.6% (4/24); and solid organ injury: 16.6% (4/24).
Twenty patients (83.3%) required burn or trauma operative intervention during hospital stay. Of the 20 patients who required operative intervention, 85% underwent burn surgery and 55% underwent trauma surgery (solid organ or orthopedic). Forty percent of these patients required operation for both burn and traumatic injury. In looking specifically at the electric injury group, all six patients required operative intervention for burn injuries, and four required extremity fasciotomy. Patients with electrical injury had a significantly longer hospital stay relative to their TBSA (p&lt; 0.04).

Conclusions
Concomitant trauma and burn injuries are infrequent yet present a major clinical challenge. Our recent increase in overall trauma volume was paralleled by an increase in patients with concomitant burn injuries. The associated traumatic injuries require a multi-disciplinary approach to minimize morbidity and restore function.
52 Impact of National Marijuana Legalization on Delirium Rates and Opioid Use in Acute Burns
Authors: Ziolkowski Natalia , D’Abbondanza Josephine , Rehou Sarah , Shahrohki Shahriar 
Published: April 2021

Abstract

Introduction
Cannabis use has been associated with larger total burn size areas, longer hospital stays, and an increased number of operations. Legalization of marijuana in Colorado has led to marked increases in burn injuries. Tetahydrocannabinol (‘THC’) use has been shown to increase psychosis, anxiety, and depression, however, it is unknown how this has impacted rates of ICU related delirium in the burn context. Further, observational studies have shown that marijuana use has decreased opioid-related overdoses, but it is unknown how chronic marijuana use affects opioid consumption in the ICU. Thus, it is unknown how national marijuana legalization has impacted ICU rates of delirium and opioid use. As such, the objectives of this study are to describe trends of marijuana legalization on burns and determine if the amount of delirium and opioid use while in hospital has increased after national marijuana legalization.

Methods
We conducted a retrospective cohort study of 514 patients admitted to an ABA-verified centre one year prior to national marijuana legalization and one-year afterwards. Inclusion criteria consisted of an acute burn injury admission. Data included demographics, toxicology screening information, hospital rates of delirium, and pain medication use. Statistical analysis consisted of student’s t-test, one-way ANOVA, Kruskal-Wallis, Mann-Whitney U, Fisher’s exact, and χ2 test. P value of &lt; 0.05 was considered statistically significant.

Results
Out of 514 patients, 422 were included; 203 prior to legalization (‘PL’) and 219 afterwards (‘AL’). Cohorts were similar regarding age, gender, inhalation injury, and smoking history. TBSA, length of stay, police custody, major psychiatric illness, alcoholism, and drug dependence were significantly higher in the AL cohort. Positive cannabinoid screens were similar in each cohort (13.3 versus 13.7%), however in both cohorts a large proportion of admissions did not have a toxicology screen completed (58.4–63.5%). Delirium rates (PL=0.5%, AL=4.1%; p=0.02) and opioid use (PL=48%; AL=52%;X2(1, N=422)=5.7, p=0.02) were significantly higher in the AL cohort.

Conclusions
National legalization of marijuana is associated with increased in-hospital delirium rates and opioid consumption in the acute burn context. Every effort should be made to ensure toxicology screens are completed on admission with the appropriate use of both opioid and adjunct pain medication regimens. In addition, for those not eligible for a toxicology screen due to delayed arrival time to the burn centre, an in-depth discussion should be completed to elicit drug history.
58 Rate and Predictors of Outpatient Follow-Up Compliance of Pediatric Burn Patients During the COVID-19 Pandemic
Authors: Chara Alejandro O , Hodgman Erica , Ziegfeld Susan , Parrish Carisa , Rhee Daniel , Garcia Alejandro 
Published: April 2021

Abstract

Introduction
The effect of the COVID-19 pandemic has led to increased isolation of families at home and potentially decreased access to the healthcare system. We therefore evaluated the effect of COVID-19 on rates of compliance with recommended post-injury follow-up. We hypothesized that this isolation may lead to detrimental effects on adherence to proper follow-up for children with burn injuries.

Methods
We queried the registry at an ABA-verified Level 1 pediatric burn center for patients aged 0–14 years who were treated and released from March 30 to July 31, 2020, which represents the height of the pandemic. As a control, we searched the registry for patients treated during the same time frame from 2016 to 2019. Patient and clinical factors were compared between the COVID and pre-COVID cohorts. Predictors of follow-up were compared using chi-squared and Kruskal-Wallis tests. Multivariable logistic regression was used to evaluate for predictors of compliance with follow-up.

Results
A total of 401 patients were seen and discharged from the pediatric ED for burn injuries. The COVID cohort consisted of 58 (14.5%) of these patients. Burn characteristics and demographic patterns did not differ between the COVID and pre-COVID cohorts. Demographics, including age, gender, race, and ethnicity did not differ between patients with 2-week follow-up and those without. The rate of compliance with 2-week follow-up was also not affected (62.4% prior to COVID vs. 55.2% during, p=0.29). As expected, burn size, burn depth, and mechanism of injury all significantly predicted compliance with 2-week follow up (table 1). After adjusting for these variables, there was still no difference in the odds of appropriate follow up (OR 0.6, 95% CI 0.3 – 1.1; p=0.12).

Conclusions
Despite concerns about decreased access to healthcare during the pandemic, the experience at our Level 1 pediatric burn center, including rates of follow-up for those managed as outpatients, appears unchanged.
68 Opioid Tolerance and Pharmacogenetics in Pediatric Burn Patients
Authors: Stokes Sarah C , Palmieri Tina L , Romanowski Kathleen S , Sen Soman , Greenhalgh David G , Grimsrud Kristin N 
Published: April 2021

Abstract

Introduction
Opioids are the predominant analgesic for pediatric burn patients. Burned children are frequently critically ill and require prolonged hospitalization with multiple surgical interventions. Pain associated with burns is severe, and failure to appropriately manage burn pain acutely can lead to long term negative consequences for these children. Prolonged opioid use, however, can lead to tolerance. While tolerance is anecdotally observed to develop at different rates in individual patients, the impact of genetic variability on the rate of development of tolerance is not known. This prospective study assesses the impact of genetic variability on opiate requirement in burned children.

Methods
A pilot study of pediatric burn patients was performed. Whole exome sequencing was used to evaluate genes involved in the metabolism and response to opioids. Oral morphine equivalents by weight (OME/kg) were calculated by day. Tolerance was determined by evaluating the rate of decline of OME/kg following the final major surgical procedure. Patients in the lowest third for rate of decline of opioid use were compared to other patients.

Results
Nine pediatric burn patients with median total body surface area of burn of 22% (IQR 12–36) and median age 7 years (IQR 5–13) were analyzed. Significant variability in the rate of decline of OME was observed, ranging from a decline 0.0971 OMEs/kg/day to an incline of 0.0057 OME/kg/day. Patients with a rate of decline in the lower third had a high frequency of missense mutations with predicted functional impact in the mu opioid receptor: 67% had a variant predicted to have functional impact, compared to 50% of patients in the upper two thirds. Two patients overall had missense mutations with predicted functional impact in the delta opioid receptor, with one having more rapidly developed tolerance.

Conclusions
The rate at which pediatric burn patients develop tolerance is variable. Variants in the mu opioid receptor may contribute to the rate at which patients develop tolerance. The function of many variants identified in this study is unknown, and their contribution to the development of tolerance requires further studies. Large scale studies to evaluate the rate of variants in the population and their relationship to tolerance development are critical to formulate personalized pain management for burned children.