bluuebunny/crossref_metadata_2025_split huggingface dataset:
73 High Cost and Resource Utilization of Frostbite Readmissions
Authors: Endorf Frederick W , Nygaard Rachel M 
Published: April 2021

Abstract

Introduction
Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people.

Methods
Index hospitalizations and readmissions were identified in the 2016 and 2017 Nationwide Readmission Database. Weighted incidence and characteristics of readmissions associated with frostbite injury were calculated and adjusted for by using survey weight, sampling clusters, and stratum. Multivariable logistic regression was clustered by hospital and additionally adjusted for severe frostbite injury, gender, year, payor group, severity, and comorbidity index.

Results
The unplanned readmission rate following frostbite injury was 35.4% (95% CI 32.2 – 38.6%). In the two-year cohort, 1,065 index hospitalizations resulted in 1,907 total hospitalizations following frostbite injury. Most patients were male (80.3%), lived in metropolitan/urban areas (82.3%), and nearly half were insured with Medicaid (46.4%). Of the 842 readmissions, 53.7% were associated with complications typically associated with frostbite injury. Overall, 29% of frostbite injuries resulted in at least one amputation. The average total cost and total LOS of readmissions was $236,872 and 34.7 days. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission. Factors associated with multiple readmissions include discharge AMA and Medicare Insurance, but not drug or alcohol abuse or homelessness.

Conclusions
This is the first study examining readmissions following frostbite injury on a national level. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission, while only AMA discharge and Medicare insurance were associated with multiple readmissions.
78 A Retrospective Review of Contact Burns Occurring over the Past Five Years and the Impact of Daily High Temperatures
Authors: Foster Kevin N , Hockenberry Tiffany , Murray Derek , Richey Karen J 
Published: April 2021

Abstract

Introduction
Thermal burns as a result of contact with a hot surface are a frequent cause of injury. A unique subset of contact burns are those sustained as a result of exposure to a hot surface during summer days in geographic areas with excessive ambient temperatures. Under these conditions, external surface temperatures can reach 180 degrees Fahrenheit, and deep cutaneous burns can happen with only a brief contact. Often exposure occurs in patients with impairments that prevent them from removing themselves from such contact in an expeditious fashion leading to severe injury. The purpose of this study was to review and analyze patients admitted to a southwest burn center with burns caused by contact with a hot external surface during the summertime months.

Methods
This was a retrospective chart review of patients admitted to our regional burn center over a 6-year period, whose burns were sustained from contact with the ground during the months of June, July, and August. Patients were stratified into two groups those whose injuries occurred from 2015 – 2019 and those that occurred in 2020. Climate data was collected from the National Oceanic and Atmospheric Administration website.

Results
The mean high daily temperature for June, July, and August 2020 was 108.5oF compared to 106.3oF for June, July and August of the preceding five years 2015 to 2019 (p &lt; 0.0001) The number of days during this 3-month period with high temperatures exceeding 110oF was 48 for 2020 compared to a mean of 24 for years 2015 to 2019 (p &lt; 0.0001). Correspondingly, there were 104 inpatient admissions for contact burns during this 3-month period in 2020 compared to a mean of 70 patients each year for 2015 to 2019, a 49% increase. There was no difference in age, gender, % TBSA burned, length of stay, or comorbidities in the two groups of patients. There were differences noted in the ethnicity compositions between the two groups. While alcohol use was not different between the two groups, the admission blood alcohol level was significantly greater in the 2020 group versus the 2015–2019 group (p=.0477). Additionally, the 2020 group demonstrated significantly greater illicit drug use than the 2015 to 2019 group (p.0098).

Conclusions
This study shows that increasing summertime temperatures in the southwest USA results in a corresponding increase in the number of patients with hot surface contact burns, and this increase is also associated with significantly great drug and alcohol abuse.
79 Electronic Cigarette-Related Injuries Presenting to Five Large Burn Centers, 2015–2019
Authors: Flores Carmen E , Chestovich Paul J , Saquib Syed F , Carroll Joseph T , Daubs Mariam Al-Hamad , Foster Kevin N , Delapena Samantha , Richey Karen J , Lallemand Michael , Dennis Bradley M , Palmieri Tina L , Romanowski Kathleen S , Godat Laura N , Lee Jeanne 
Published: April 2021

Abstract

Introduction
Electronic cigarettes are advertised as safer alternatives to smoking cigarettes yet can cause serious injury. As consumer use of electronic cigarettes has increased, burn centers have witnessed a rise in both inpatient and outpatient visits to treat thermal and blast injuries related to their use.

Methods
A multicenter retrospective chart review of ABA burn registry data from 5 large burn centers was performed from January 2015 to July 2019 to identify patients who sustained Electronic Nicotine Delivery Systems (ENDS)-related injuries.

Results
A total of 127 patients with electronic cigarette-related injuries were identified, of which 113 were male (89%) and 14 were female (11%). Mean age was 34.0 years (SD 13.5%, range 1–75 years). The majority of patients (n=92, 72%) were treated on an inpatient basis, and average length of stay was 6.7 days. Most patients sustained less than 10% total body surface area burns (mean 3.8%, SD 2.6%, range 0.1% to 16.5%). 66% (n=85) sustained 2nd degree burns, and 36% (n=46) sustained 3rd degree burns. Most patients were injured while using the ENDS (n=100, 78%), while 18% (n=24) of patients reported spontaneous combustion. 2 patients (1.5%) were injured while changing their device battery, and 2 patients (1.5%) were injured while modifying the device. 3% (n=4) were injured by second-hand mechanism.
Burn injury was the most common injury pattern (100%), followed by blast injury (n=81, 63%). Flame burns were the most common (n=89, 70%) type of thermal injury, followed by contact burns (n= 70, 55%), flash burns (n=47, 37%), chemical burns (n=2, 1.5%), and electrical burns (n=1, 0.7%). The most commonly injured body region was the extremities. There were no ENDS-related deaths.
Silvadene was the most common topical agent used in the initial management of thermal injuries, followed by Bacitracin and Xeroform. 63% (n=80) of patients did not require surgery, while 36% (n=46) required surgical excision, and 15% (n=20) required split-thickness skin grafting. Multiple surgeries were uncommon. 22% of patients required one operation, 12% required two operations, and 2% required 3 operations.

Conclusions
Our data recognizes use of ENDS as a growing public health problem with potential to cause thermal injury and secondary trauma. Most injuries occur during use, however many result from spontaneous combustion while the device is not being used. Treatment of ENDS-related injuries is institution-dependent. Most patients are treated on an inpatient basis however the majority of patients treated on outpatient basis have good outcomes.
80 Minor Burns in Infants: What has Changed During the Last 15 Years?
Authors: Abali Ayse Ebru , Aydogan Cem , Turkmen Nigar , Haberal Mehmet 
Published: April 2021

Abstract

Introduction
Infants are prone to unintentional minor burns. Caregivers play a key role in prevention and first aid. So, updating communal burn-prevention education programs according to time-related social changes is of importance. Aim of the present study was to analyze features of minor burns in infants who were referred to our burn center in the last 15 years.

Methods
Subjects were 973 infants(1-24months) with minor burns who were treated at our burn center between 2005 and 2019. Subjects were divided into two subgroups; groupI: referrals between 2005 and 2014(n=465) and groupII: referrals between 2015 and 2019(n=508). Data collected for each case were age; sex; burn-cause; extent of burns; affected major body-sites; environment in which injury occurred; first-aid method used by the caregiver; referral history (time interval between injury and referral (TIIR) and other hospitals before arriving at our center). Socioeconomic status was investigated with social-security status; home-types and methods of home-heating.

Results
Median age was 1±0,2 both in groupI and in groupII; male/female ratio was 0,96/1 in groupI and it was 1,07/1 in groupII. Mean TBSA burned was 2,74±0,12%(min:0,1,max:18) in groupI and it was 2,22±0,11(min:0,1,max:18) in groupII. Most common burn-cause was scalds in both groups (groupI: n=351;75,5%, groupII: n=405;79,8%) (p˃,05). Chemical burns slightly increased, flame burns decreased in groupII (p˂,05). Hands continued to be the most common affected major body-site (n=334;34,5%)(p˃,05).Home was the most common environment in which injury occurred (groupI: n=428;92%, groupII: n=487;95,9%) (p˃,05). Tap water was the favorite first-aid method (groupI: n=366;78,9%; groupII: n=411;80,9%) (p˃,05). But tendency to herbal and/or unreasoning first-aid methods increased in groupII (groupI: n=10;2,2%, groupII: n=47;9,3%)(p˂,05). TIIR was under 3 days for 820 cases (84,3%)(p˃,05). Rates of unmediated referral to our burn-center were higher in groupII (groupI:n=221;47,5%,groupII:n=303;59,7%)(p&lt;,05). Most infants were in civil social-security-system, with an increased number of private-insurance in groupII (groupI: n=12;25,7%,groupII: n=29;74,3%)(p&lt;,05). Most lived at centrally heated homes(n=926; 95,2%), and number of infants who lived at stove-heated homes decreased in group II (groupI:n=31; 6,7%,groupII:n=16; 3,1%)(p˂,05).

Conclusions
Our results revealed that socioeconomic status has improved, direct referrals to burn center increased in the last 5 years. Unfortunately usage of herbal and unreasoning first aid methods also increased in the same period. Future communal education programs for caregivers should emphatically continue to focus on precautions against threats at homes and correct first-aid methods should be urged.
81 The Impact of COVID-19 on a Major Metropolitan Burn Center
Authors: Codner Jesse A , Mittal Rohit , De Ayala Rafael 
Published: April 2021

Abstract

Introduction
The current and long-term impact of the coronavirus disease 2019 (COVID-19) global pandemic on our healthcare system is still unknown. When healthcare resources were being diverted to only the most critical of needs, emergent surgical and burn care remained essential. Currently, no data exist on the impact of a global pandemic on a burn center. Our aim for this study was to understand how the COVID-19 pandemic affected admissions, hospital course, and discharges at a major metropolitan burn center.

Methods
This was a retrospective cohort study of admissions to our burn center. Our institution’s medical record was reviewed from 1/1–8/31 for years 2020, 2019, & 2018. We included all thermal, chemical, and electrical burn inpatient admissions over these time periods. Non-burn wound admissions and vulnerable patient populations were excluded. Our population included 1,358 patients. These patients were grouped by year 2020 (n=425), 2019 (n=470), and 2018 (n=463). The medical record was queried for admission, hospital course, and discharge variables. SAS 9.4 statistical software was used to compare the pre-pandemic 2018/2019 groups against the 2020 group. Group means were compared using two-sample two-tailed t-tests, and categorical variables were compared using Chi-Square analysis.

Results
In 2020 the burn center had 425 admissions compared to 470 and 463 in 2019 and 2018 respectively. On admission, there were no differences in age, gender, pediatric admissions, burn etiology, total body surface area (TBSA), TBSA &gt;20%, work-related injuries, or suspected abuse related injuries. Of note, the mean days from injury to admission for the groups were (2020 2.5±4.9 vs 2019 1.4±4.3, p=0.001, vs 2018 1.5±4.3, p=0.0017). Groups were similar in respect to burns requiring surgery and mean OR visits. 2019 and 2018 had increased ICU admissions compared to the 2020 cohort (ICU: 2020 60-(14%) vs 2019 91-(19.4%), p=0.041, vs 2018 108-(23.3%), p=0.033). Inpatient mortality was lower in the 2020 cohort compared to the pre-pandemic cohorts (2020 2 (0.6%) vs 2019 9 (2.5%), p=0.04, vs 2018 14 (4.2%) p=0.0017).

Conclusions
Volume at our burn center remains high during the pandemic. There is an increased lag time from burn injury to hospital admission in the 2020 cohort. We hypothesize this is due to patients’ avoiding the hospital due to fear of contracting COVID-19. TBSA is similar across groups, but ICU admissions are down in the 2020 cohort. Further work is needed to understand whether the increased lag time has affected outcomes and whether the decreased ICU admissions are due to yearly variation or the pandemic.
87 Identification of Critical Burn Knowledge Gaps within the USA Population: A Survey and Education on Burn Prevention and Preparedness
Authors: Xun Helen , Mafla Laura M , Cox Carrie A , Cooney Carisa , Duraes Eliana , Javia Vidhi , Caffrey Julie , Hultman Charles S 
Published: April 2021

Abstract

Introduction
Associations, institutions, and providers have made enormous efforts to educate the United States public on burn injury in the hopes of preventing burns. However, there are no reports to-date describing the level of public burn knowledge in the U.S. This study characterized the public knowledge of burn prevention and preparedness in the US. It also aimed to assess if our interactive quiz is an appropriate educational tool.

Methods
QualtricsTM surveys designed to test knowledge and educate about burns were crowdsourced to laypersons via Amazon MTurk. Demographics were self-reported. In section 1, respondents were presented six questions asking about causes and care for burns, in a quiz style with explanations provided immediately. In section 2, respondents self-reported personal experiences with burns, burn education, and knowledge of verified burn centers. In section 3, they reported attitudes towards burn care. Survey responses were analyzed using two-tailed Student’s t tests and chi square analyses.

Results
We received 402 completed survey responses, and 331 total were included for analysis; studies were excluded if they were completed in &lt; 5 minutes or had incorrect attention check questions. The mean age was 39.4 ± 12.08, and 51% male.
1. Knowledge: The average quiz score was 51% ± 8; while 65% of respondents knew to run scald burns under cool water, only 41% knew the optimal time of more than 20 minutes. The majority of respondents (92%) reported the quiz improved their burn knowledge. Also, while majority (63%) of respondents had heard of verified burn centers, only 44% knew where the closest one was.
2. Experiences: 72% of respondents had personally experienced a burn, of which 62% were treated in the emergency room. 57% of respondents had witnessed a burn injury occur, of which 92% applied first aid using cool running water (26%), ice (18%), burn gel (17%), and gauze (11%). Only 61% of respondents have participated in burn precautions at home. 56% of respondents have received formal burn training, such as from CPR class (21.4%) and recent first aid training (32.9%). Informal sources include from friends and family (66%), personal burn experience (63%), or social media (47.4%).
3. Attitudes: The majority of respondents agreed there should be more public education on risks/prevention (85%) and treatment of burns (78.6%). Only 63% believe acute burn care should be covered by insurance.

Conclusions
Our study demonstrates that despite personal experiences with burns and formalized courses, there remain gaps in public burn knowledge in the US. Further studies are required to characterize more detailed knowledge gaps and intervention strategies.
88 Substance Use Testing Upon Burn Admission: Insights from the National Burn Repository
Authors: Abrams Thereasa E , Nugent William R 
Published: April 2021

Abstract

Introduction
Knowledge of substance use history is important for treating patients with burn injuries due to increased risk of mortality, complications, and poor outcomes. Yet, there has been little research on how admitting medical providers make the determination of who to test for alcohol or drug use. Burn severity, etiology, and circumstances surrounding the burns are important factors that should be considered when determining who should be tested. The race of the victim should not. This study analyzed data from the National Burn Repository for years 2008–2017 to ascertain if there were associations between race and decisions to do alcohol and drug testing upon burn center admission, controlling for other demographics, burn severity, and circumstances surrounding burn injuries.

Methods
This study was a secondary analysis of 37,355 cases from the National Burn Data Repository (American Burn Association). The dependent variables were whether a burn victim was tested for alcohol or drug use. These were dichotomous dependent variables, so a binary logit regression analysis was used. Missing data were handled with full information maximum likelihood. The independent variables were age, gender, whether physical abuse was reported, mental health comorbidity, marital status, severity of burns, whether the injury was work related, injury circumstances, and etiology of injury. Race was the independent variable of focus. The hypothesis was that race was associated with whether a burn victim was tested for drug or alcohol use.

Results
Controlling for independent variables, race was associated with whether a victim was tested for alcohol use, X2(5) = 71.3, p &lt; .0001; race was also associated with whether a burn victim was tested for drug use, X2(5) = 66.5, p &lt; .0001. Odds ratios for comparing the likelihoods of victims of different racial categories being tested ranged from .69 to 2.3 for alcohol testing, and from .79 to 2.4 for drug testing. These results were consistent with racial bias in decisions to test burn victims for alcohol and/or drug use.

Conclusions
Because there is little written about criteria for alcohol or drug testing on admission for critical burn injuries, it is unclear what prompts admitting health care providers to test. Our study found several racial groups had differential likelihoods of being tested upon admission to a burn center. Using Critical Race theory as a framework, these findings suggest racial bias may have influenced decisions to test for substance use in reported burn admissions. There is a need to establish a protocol for alcohol and drug use testing upon burn center admission that is equitable across all populations.
93 Virtual Burn Camp 2020 vs. In-Person Burn Camp - Did It Hit the Mark
Authors: Brubaker Ruth B , Bay Curt , Chacon Daniel W , Carson Madeleine , Cahill Jade A , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Burn camps have served burn-injured youth in the U.S. for over 35 years. Camp is a rehabilitation program that has been recognized as an important part of young survivors’ recovery. The 2020 global pandemic made an in-person camp impossible, so volunteers rallied to provide a virtual experience. Registered campers received a “Camp in a Box” filled with activities, art supplies, a camp tee-shirt, and snacks to enjoy at Virtual Burn Camp (VBC). Participants connected with campers and counselors online. This study sought to determine how youth viewed VBC compared to in-person camp, how the pandemic was affecting their emotional status and whether VBC helped them.

Methods
The study asked participants to rate survey items regarding levels of comfort, connection, and support at VBC vs. in-person camp on a 4-point scale from 1. NO! 2. no 3. yes 4. YES! Multiple choice questions such as My favorite thing about virtual camp, and “Things I missed most about regular burn camp” - choose 2. General stress & anxiety levels related to Covid-19 were assessed, as well as if VBC helped to reduce their anxiety/stress levels.

Results
Pediatric burn survivors (n=77) participating in 2 virtual camps, demographic’s included mean age 13.8 years, male (n=39%), female (n=61%), visible scars (74%) vs. (10%) hidden scars with the majority representing racial/ethnic minorities (65%) vs. white (35%). Campers reported feeling more connected at in-person camp (84%) vs. VBC (38%). Feeling supported was higher at regular burn camp (84%), but the majority (76%) also claimed feeling supported at VBC. Camper’s favorite things about VBC were Camp in a Box (66%), Being Part of the Burn Community (51%), and Seeing Counselors (47%). Things missed most about regular burn camp were seeing Friends (83%) and Counselors (61%). Respondents reported high Covid-19 related stress/anxiety levels (66%) and (88%) said that VBC reduced their anxiety/stress. Top benefits included feeling Happy (48%) and Thankful (32%).

Conclusions
Pediatric burn survivors place a high value on their burn community involvement. Though not the preferred camp method, the VBC earned high marks for camper’s improved emotional status and for reducing their Covid-19 stress and anxiety levels. The program succeeded in helping Virtual Campers feel supported and provided an important venue for connecting them with their burn-injured peers and camp counselors.