bluuebunny/crossref_metadata_2025_split huggingface dataset:
6 Burn Patient Insurance Status Influences Hospital Discharge Disposition Locations
Authors: Hulsebos Ian F , Johnson Maxwell B , Spera Leigh J , Hulsebos Elise M , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Post-discharge services, such as outpatient wound care, may affect long term health outcomes and post-recovery quality of life. Access to these services may vary according to insurance status and ability to withstand out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, or privately insured at the time of their burn unit admissions. We hypothesized that uninsured patients were more likely to be discharged to locations with fewer wound care resources.

Methods
A retrospective review from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. All inpatient burn admission patients were identified and categorized according to insurance payer type. Patient and burn characteristics were recorded. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance.

Results
In total, 284 uninsured, 565 publicly insured and 293 privately insured patients were identified. There were no significant differences in TBSA (P=0.3), presence of full thickness burn (P=0.3), inhalation injury (P=0.3), ICU days (P=0.09), ventilator days (P=0.2), or need for grafting (P=0.1). Uninsured patients were found to be younger (P&lt; 0.0001) and more likely to be male (P=0.03). For primary outcome, uninsured patients were more likely to be discharged without ancillary services (self-care) (80.3% vs. 66.7% vs. 66.9%, P&lt; 0.0001). Publicly insured patients were more likely to receive skilled nursing care (1.1% vs. 6.6% vs. 2.4%, P=0.0007). Privately insured patients were more likely to receive homecare (3.2% vs. 5.8% vs. 10.9%, P=0.0005) or transfer to other institutions for ongoing inpatient care (2.5% vs. 5.1% vs. 11.6%, P&lt; 0.0001). For secondary outcomes, there was no difference in burn unit readmission (P=0.5) while uninsured were more likely to follow up in the same institution’s outpatient burn clinic after discharge (82.4% vs. 72.0% vs. 75.4%, P=0.004).

Conclusions
Despite no differences in burn injury severity, uninsured patients were less likely to receive post-discharge resources. However, these patients were younger, which may partially explain their disproportionate discharge to self-care. Nevertheless, insured patients have greater access to non-emergent medical resources and a broader range of treatment options. Although there were no significant differences in hospital readmission, the long-term implication to differential post-discharge care is unknown. Additional studies are needed to better elucidate if discrepancies in long-term wound healing or perceived quality of life amongst these populations exist.
9 Impact of Methadone Initiation in Intubated Burn Patients: A Retrospective Review
Authors: Zavala Sarah , Wasilewski Gabrielle , Sharma Anisha , Bulakh Olga , Fahmy Joseph , Liu Yuk Ming 
Published: April 2021

Abstract

Introduction
Methadone can be used to wean opiates and reduce length of mechanical ventilation (MV) in critical care and burn patients. The objective of this study was to assess the impact of methadone use on ventilator-free days and clinical outcomes in burned patients requiring MV.

Methods
This was a retrospective study of adult patients admitted to a burn center for initial management of burn injuries who required MV for at least 48 hours between September 2013 and November 2019. Patients were excluded from the study if they had prior methadone use, total body surface area (TBSA) of less than 5%, or expired within the first 28 days of admission. The primary endpoint was the difference in ventilator-free days among those who received methadone compared to those who did not. Secondary endpoints include length of stay, mortality, sedative agent and average daily dose, analgesic agent and average daily dose, and incidence of delirium. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test, as appropriate. Multivariate regression was used to identify variables for possible association with MV duration.

Results
A total of 83 patients were included in the study; 52 received methadone and 31 were controls. Patients were generally well-matched between groups, however patients receiving methadone were younger (45.3 vs 56.2 years, p = 0.002) and had a larger TBSA (30.4 vs 19.1%, p = 0.001). Patients who received methadone had fewer ventilator free days of the first 28 (9.5 vs 15.0 days, p = 0.009) and a longer ICU stay (57.2 vs 35.8 days, p = 0.025). There was no difference between groups in terms of mortality, reintubations, and incidence of delirium. Patients who received methadone had longer duration of analgesia (20.7 vs 12.0 days, p = 0.011) and sedation (19.0 vs 12.4 days, p = 0.026) while on MV.

Conclusions
This study found that methadone use contributed to fewer ventilator-free days and longer ICU stays, which was unexpected but worth discussing. There are several limitations to this study. This study occurred during a time period in which the pain management and sedation strategies of this burn unit were evolving, and strategies may not have been consistent between providers. The study included a small sample size and baseline demographics demonstrated significant differences in age and TBSA between the two groups. Additionally, pain scores were not collected as part of this study, which would have provided better insight into the effectiveness of pain management. The use of methadone as an adjunct for pain control remains undetermined.
12 Outcomes in Ventilated Burn Patients with Acute Respiratory Distress Syndrome: An Evaluation of Early High-PEEP Strategy Using Berlin Criteria.
Authors: Perry Travis L , Pinette William , Lesch Heather , Parikh Priti , Miner Jason 
Published: April 2021

Abstract

Introduction
Acute respiratory distress syndrome (ARDS) remains a formidable sequela, complication, and mortality risk in patients with large burns with or without inhalation injury. Alveolar recruitment using higher positive end expiratory Pressures (PEEP) after the onset of ARDS has been tried with varying success. Subsequent studies have identified benefits for several rescue maneuvers in ARDS patients with refractory hypoxemia. A preventive strategy utilizing an early recruitment maneuver, however, has not, to our knowledge, been explored in ventilated burn patients. The purpose of this study was to evaluate the natural progression and clinical outcomes of ARDS severity (mild, moderate, and severe) using Berlin criteria in ventilated burn patients treated with an early high-PEEP ventilator strategy.

Methods
A single-center retrospective review of burn patients who were mechanically ventilated for more than 48 hours utilizing an early high-PEEP ventilator strategy was performed at our Level 1 trauma and regional burn center. ARDS severity was defined according to the Berlin criteria. Demographic data, as well as respiratory and clinical outcomes were evaluated.

Results
Eighty-three patients met inclusion criteria and were analyzed. According to the Berlin definition, 42.1% of patients met ARDS criteria on admission and nearly all patients (85.5%) developed ARDS within the first seven days: 28 (34%) mild, 32 (38.6%) moderate, and 11 (13.3%) severe ARDS. The mean percent total body surface area (%TBSA) was 24.6 ± 22.1, with 68.7% of patients diagnosed with inhalation injury. The highest incidence of ARDS was 57.8% on day 2 of admission. Most cases remained in the mild to moderate ARDS category with severe ARDS (2.4%) being less common by hospital day 7. Overall, 30-day in-hospital and inhalation injury mortality rates were 9.6% and 15.8%, respectively. No correlation was observed between plateau pressures (22.8), mean arterial pressures (84.4), or vasopressor requirements; and oxygen requirements down trended quickly over the first 24–48 hours.

Conclusions
In our study, prophylactic, immediate, high-PEEP in mechanically ventilated burn patients was associated with trends toward decreased severity and more rapid resolution of ARDS in the first week following burn injury. This correlated with lower 30-day in-hospital mortality in this population. This
38 Cost-effectiveness of Autologous Cell Harvesting Device for the Treatment of Burns Requiring Hospitalization: An Economic Evaluation Using Real World Data
Authors: Carter Jeffrey E , Hickerson William L , Carson Joshua S , Kowal Stacey 
Published: April 2021

Abstract

Introduction
Value is a prominent issue in healthcare measured by the clinical outcomes of good medical practices relative to the literal or figurative costs of care. As a result, cost effectiveness has become an essential measure when assessing new technologies in burn care. To help providers evaluate cost-effectiveness, the BEACON model was developed in 2018 using National Burn Repository (NBR) data. While the NBR data has tremendous value portraying a cumulative picture of burn care, it lacks resolution for new innovations such as autologous skin cell suspension (ASCS). In BEACON, ASCS was shown to reduce costs associated with the current treatment of severe burns, where this cost-saving was attributed to reductions in length of stay (LOS), the number of operations, the donor site size, and associated wound care. Our study examines the efficacy of the BEACON model by performing a multicenter real-world data (RWD) analysis of primary cost-savings measures of reduced LOS for patients treated with ASCS vs. standard of care (SOC).

Methods
De-identified electronic medical record data was collected over a 20-month period (1/2019 to 8/2020) from 43 burn centers in 14 states. Patients with burn injuries treated with ASCS were matched by age, gender, TBSA, and comorbidities to patients treated by current SOC treatment. Injury severity was calculated as categorical data with intervals: &lt; 10%, 10–19%, 20–29%, 30–39%, and 40–49% TBSA. Co-morbidities were also assessed to facilitate a 1:1 comparison of patients across the two cohorts. Cost analysis was determined prior peer-reviewed literature in burn care.

Results
A total of 2,438 patients were reviewed, and 162 were used in the matched cohort analysis (n=81 in each cohort). In these patients, 68% had &lt; 20% TBSA. When comparing patients matched on co-morbidities, burn %TBSA/extent, age, and gender, ASCS patients had a shorter LOS by 4.1 days. At an assumed cost of $6,795 per day, these differences in LOS produced a savings of over $28,000 in hospital bed costs alone per ASCS patient versus SOC. LOS was the same or shorter for ASCS patients in 63% of cases with an average reduction of 4.1 days resulting in an overall savings of $2,269,530 for ASCS-treated patients compared to SOC.

Conclusions
Our study is the largest RWD cost-effectiveness analysis of ASCS vs SOC. This analysis confirms the BEACON model with savings primarily originating from reducing LOS, even for small burns with 68% of patients having burns less than 20% TBSA.
42 COVID-19 Slowdown? Not in Our Burn Center!
Authors: Greenhalgh David G , Romanowski Kathleen S , Sen Soman , Palmieri Tina L 
Published: April 2021

Abstract

Introduction
There has been a great concern that the COVID-19 pandemic has interfered with burn care. The feeling has been that resources have been shifted to treating the COVID patients and that “shelter-in-place” requirements have reduced the risks for burn injury. The ABA and other organizations have sent biweekly surveys in order to determine how the pandemic has interfered with burn care. Despite these concerns, we seemed very busy.

Methods
The inpatient data was collected in our adult and pediatric burn centers between January 1, 2020 and August 31, 2020.

Results
During the COVID-19 pandemic there was an increase in burn admissions in both adult and pediatric centers. At the same time there were 1270 COVID-19 adult admissions and 4 COVID-positive admissions at the pediatric center. In the adult center, there was increase from 414 total admissions from fiscal year 2019 (7/2018-6/2019) of 414 to 495 for fiscal year 2020 (7/2019-6/2020). The average daily census also increased from 18.33 to 18.36 during the same period. The monthly number of burn admissions increased from 38.5/month for the last six months of 2019 to 44/month for the first six months of 2020. The admission rate continued in July (41) and August (47). In the first 8 months of 2020, there were 356 admissions with a mean TBSA of 11.3%. There were many large burns admitted in late summer. The mean TBSA of the 12 bed ICU on September 11, 2020 was 60.6% (range 25–85%). In the pediatric unit, there were 174 admissions through July 2020, a 6% increase from the preceding same period. There was a 6% decrease in burn reconstruction.

Conclusions
Despite a significant burden of COVID-19 patients, burn admissions also increased at the same time. There was no evidence that “shelter-in-place” requirements changed the risk for burn injuries. Resources for critical care needs should not be siphoned away from burn centers during pandemics. Risky behaviors leading to burns do not go away despite new health crises.
44 Examining the Impact of the COVID-19 Pandemic on Participants in a Longitudinal Study of Burn Outcomes
Authors: Kelter Brian M , Wolfe Audrey E , Abouzeid Callie , Gibran Nicole S , Holavanahalli Radha K , Kowalske Karen J , Ni Pengsheng , Kazis Lewis E , Ryan Colleen M , Schneider Jeffrey C 
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic has had widespread effects on healthcare and society at large. There are limited data on the impact of the pandemic on the long-term recovery of the burn survivor. This study aims to compare physical and psychosocial outcomes of the burn survivor population before and during the COVID-19 pandemic.

Methods
Data from the Burn Model System National Database (2015-present) were analyzed. Data were divided into pre- and during-pandemic groups (before and after March 1st, 2020). Outcomes were compared at four cross-sectional time points: 6, 12, 24, and 60 months after burn injury. The following patient reported outcome measures were examined: SF-12 Health Survey, PROMIS-29, Post-Traumatic Growth Indicator, Community Integration Questionnaire, Patient Civilian Checklist, Satisfaction with Life Scale, Burn Specific Health Scale, NeuroQOL Stigma, 4-D Itch, and CAGE Questionnaire (drug/alcohol misuse). Given the cross-sectional design, potential differences in clinical and demographic characteristics were examined for each group at each time point. Adjusted mean outcome scores at each time point were compared between groups using a two stage multi-variable regression model with propensity score matching. For each time point, subjects from each group were matched. The propensity score was calculated using the following matching variables: gender, age, race, ethnicity, etiology, length of stay, and burn size. The mean score difference of outcomes within each matched sample was examined.

Results
Sample sizes varied by time point with a range from 420 at 6 months to 94 at 60 months. The during-COVID group comprised 10% of the total sample size. There were no significant differences in demographic and clinical characteristics between the groups at any time point. There were no significant differences between the groups in adjusted mean outcome scores across the different time points.

Conclusions
This preliminary examination showed no differences in myriad long-term outcomes at multiple time points after injury among burn survivors before and during the start of the COVID-19 pandemic. The results may suggest an element of resilience, however given the sample size and cross-sectional limitations further investigation is required to better understand the impact of COVID-19 on the burn population.
48 Higher Admission Frailty Scores Predict Increased Mortality, Morbidity and Healthcare Utilization in the Elderly Burn Population
Authors: Iles Kathleen A , Duchesneau Emilie D , Strassle Paula , Chrisco Lori , Howell Thomas , King Booker , Williams Felicia N , Nizamani Rabia 
Published: April 2021

Abstract

Introduction
The Rockwood Clinical Frailty Scale is a validated rapid assessment of frailty phenotype, predictor of mortality and other clinical outcomes in the geriatric population, even when applied retrospectively. Using data from a large tertiary care burn center, we assessed the association between admission frailty in an elderly burn population and outcomes.

Methods
Retrospective analysis of burn patients &gt; 65 years, admitted to a tertiary care referral burn center from 2015–2019 (n= 652). Patients were assigned to Rockwood frailty subgroups, low (1–3), moderate (4–6), or high (7–9), based on comprehensive medical, social work, physical and occupational therapy assessments. Patients who did not have complete assessments to allow for appropriate frailty scoring were excluded. Hospital-associated infections (HAIs) were identified through the institutional epidemiology database and healthcare utilization data were extracted from burn registry and medical records. Cox proportional hazards regression was used to estimate associations between admission frailty and 30-day inpatient mortality.

Results
Our study included 644 patients (low: 262, moderate: 345, and high: 37 frailty subgroups). Frailty was associated with higher percent TBSA (median TBSA: low 2.0%; moderate 3.0%; high 3.0%; p=0.01) and older age at admission (p=0.0004). The 30-day cumulative incidence of mortality was 2.3%, 7.0%, and 24.3% among the low, moderate, and high frailty strata, respectively. After adjustment for age, TBSA and inhalation, high frailty was associated with increased 30-day mortality (HR 5.73; 95% CI 1.86, 17.62). Moderate frailty appeared to increase 30-day mortality, although estimates were imprecise (HR 2.19; 95% CI 0.87–5.50).
Morbidity and healthcare utilization results are reported in Table 1. Higher frailty was associated with any ICU stay during the hospitalization, need for mechanical ventilation, and higher median hospital cost/day. HAIs were infrequent in all frailty subgroups. The proportion of patients discharged to hospice, rehab, long and short-term care facilities was highest in the high frailty subgroup. Those in the moderate and low subgroups were more likely to be discharged home or home with services.

Conclusions
High admission frailty is associated with an increased 30-day mortality regardless of age group. Higher frailty correlates with increased morbidity and healthcare utilization.
61 Real-time Burn Outpatient Virtual Visits in the Home During the Era of COVID-19
Authors: Head William T , Garcia Denise I , Kahn Steven , Lesher Aaron 
Published: April 2021

Abstract

Introduction
The majority of burn injured patients travel long distances to receive burn care from regional burn centers, creating a burden on families and impairing outcomes. Recent federal policies in response to the COVID-19 pandemic have relaxed some of the barriers to virtual visits in the non-health care setting. We sought to review the experience of a comprehensive burn program in managing burn patients with a virtual platform.

Methods
A clinical quality database was maintained to evaluate virtual videoconference and in-person clinic visits for a comprehensive adult and pediatric burn program during the COVID-19 pandemic (March 2020 to August 2020). Virtual visits utilized a telemedicine platform that employs real-time audio and video communication. Demographic, burn severity, and visit quality data were recorded. Zip code data was also collected and then used to calculate the following estimated savings for the patient and their family: total miles, travel hours, driving costs, and wages.

Results
A total of 145 patients were included in this study with 96 (66.2%) male and 49 (33.7%) female. 91 (62.8%) were pediatric patients with a mean age of 6.2 ± 0.5 years and 54 (37.2%) were adult patients with a mean age of 40.4 ± 2.5 years. There were 320 total burn outpatient follow-up visits with 199 pediatric visits (40 virtual and 159 in-person) and 121 adult visits (24 virtual and 97 in-person). The majority of patients (73.1%) were treated as in-person visits while 6.9% had purely virtual visits, and 20.0% of patients had both virtual and in-person visits. The following savings were associated with virtual visits: 8562.6 total miles (average 133.8 ± 42.4), $6789.29 total driving cost (average $106.08 ± 33.61), 161.5 total travel hours (average 2.5 ± 0.7), and $4758.42 total wages lost to travel (average $74.35 ± 21.43). Technical issues were only reported in 14% of total visits (2.5% of pediatric virtual visits and 33.3% of adult virtual visits).

Conclusions
Outpatient virtual visits for burn care are a new frontier, driven by improvements in technology and reduced barriers to reimbursement. This study demonstrates that virtual visits are associated with major financial and temporal benefits for patients and their families. Technical issues remain an important barrier, particularly in the adult population. A clear understanding of this and other barriers may improve implementation of this new healthcare delivery paradigm.
66 Prescribing Patterns of Opioids and Adjunctive Analgesics for Patients with Burn Injuries
Authors: Yeung Celine , Kiss Alex , Rehou Sarah , Shahrohki Shahriar 
Published: April 2021

Abstract

Introduction
Large quantities of analgesics are prescribed to control pain among patients with burn injuries and may lead to chronic use and dependency. This study aimed to determine whether patients are overprescribed analgesics at discharge and to identify factors that influence prescribing patterns.

Methods
A retrospective review of patient charts (n = 199) between July 1, 2015 - 2018 were reviewed from a registry at a single burn center. Opioid, neuropathic pain agent (NPAs), acetaminophen, and ibuprofen quantities given before and at discharge were compared. Linear mixed regression models were used to identify factors that increased the amount of analgesics prescribed among burn care providers.

Results
On average, patients were prescribed significantly more analgesics at discharge compared to what was consumed pre-discharge (p &lt; 0.0001). Specifically, on average, providers did not overprescribe the daily dose of analgesics, but overprescribed the duration of pain medications required. For every increase in percent TBSA, 14 MEQ more opioids, 203 mg more NPAs, 843 mg more acetaminophen, and 126 mg more ibuprofen were prescribed (p &lt; 0.05). Surgery was a predictor for higher opioid and NPA prescriptions (p = 0.03), while length of stay was associated with fewer NPAs prescribed (p = 0.04). Fewer ibuprofen were given to patients with a history of substance misuse (p = 0.01).

Conclusions
The quantity of analgesics prescribed at discharge varied widely and often prescribed for long durations of time. Standardized prescribing guidelines should be developed to optimize how analgesics are prescribed at discharge.