bluuebunny/crossref_metadata_2025_split huggingface dataset:
24 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients
Authors: Calder Sara , Quan Asia N , Osborn Suzanne C , Richey Karen J , Bay Curt , Foster Kevin N 
Published: April 2021

Abstract

Introduction
The potential consequences of vitamin D insufficiency/deficiency (I/D), include increases in ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen.

Methods
A retrospective chart review was performed of all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one vitamin D hydroxy level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml.

Results
Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly positively correlated with %TBSA burn size (p&lt; 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days with an average weekly dose of 142,877 international units cholecalciferol. Many patients were discharged prior to reaching therapeutic levels. Time to reach therapeutic levels was also positively correlated with increasing burn size (p&lt; 0.05).

Conclusions
Vitamin D I/D is present is over 90% of burn patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the clinical consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted.
28 Timing of Enteral Nutrition Initiation in Severely Burned Patients
Authors: Curtis Nicolle M , Shields Beth A , Williams Alicia M , Vega Saul J , Cancio Leopoldo C 
Published: April 2021

Abstract

Introduction
Early initiation of enteral nutrition (EN) for severely burned patients (pts) has been found to be associated with decreased catabolism, decreased wound infections, lower sepsis rates, shorter intensive care unit (ICU) days and hospital days, and improved mortality. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends initiating EN within 4–6 hrs of injury for critically ill adult burn pts; however, they also recommend waiting for hemodynamic stability to be achieved before starting EN in all critically ill pts. The objectives of this performance improvement project (PIP) were to evaluate the timing of EN initiation and reasons for delays in initiating EN in our critically ill burn pts.

Methods
We performed a retrospective evaluation on pts admitted to our ICU in 2019 with at least 20% TBSA burns. Exclusion criteria were death within 72 hrs of admission, oral nutrition, and admission over 1 calendar day after injury. This PIP was approved by our regulatory compliance division. We clinically defined hemodynamic stability as lactate levels less than 3 mmol/L with vasopressor requirements of less than 10 mcg/min norepinephrine. Demographic data were collected along with timing of EN and reasons for delays in EN initiation.

Results
EN was initiated 28 ± 17 hrs after admission for the 19 included pts with the following characteristics: 44 ± 16 years old, 38 ± 16% TBSA burn, all required mechanical ventilation on admission. These pts had 16 ± 10 mechanical ventilator days and 42% mortality. The shortest time to EN initiation was 9 hrs after admission. EN was delayed for initial hemodynamic instability for 10 ± 17 hrs after admission. Other delays in EN initiation after initially achieving hemodynamic stability included time to feeding tube placement (1 ± 2 hrs) and x-ray confirmation (4 ± 9 hrs), and time to EN orders (8 ± 10 hrs). EN was initiated 6 ± 6 hrs after the preceding events occurred. Some of the delays in placement of EN orders and for EN initiation after the above criteria were met included procedures (2 ± 2 hrs), becoming hemodynamically unstable again (5 ± 7 hrs), and placement of a small bore, post-pyloric feeding tube when an orogastric or nasogastric feeding tube was already available for use (2 ± 4 hrs). We were not able to retrospectively identify reasons for delays during 5 ± 6 hrs per patient.

Conclusions
As a result of this PIP, we found EN was not initiated in any of our critically ill burn pts within the timeline recommended by ASPEN/SCCM. The primary reasons for delays included hemodynamic instability, feeding tube placement and confirmation, adding a post-pyloric feeding tube, and procedures.
41 Enhancing Burn Medical Care During a Disaster Using a Novel Augmented-Reality Application
Authors: Veazey Sena , SerioMelvin Maria , Luellen David E , Samosorn Angela , Helms Alexandria , McGlasson Allison , Fenrich Craig , Colston Patricia , Salinas Jose 
Published: April 2021

Abstract

Introduction
In disaster or mass casualty situations, access to remote burn care experts, communication, or resources may be limited. Furthermore, burn injuries are complex and require substantial training and knowledge beyond basic clinical care. Development and use of decision support (DS) technologies may provide a solution for addressing this need. Devices capable of delivering burn management recommendations can enhance the provider’s ability to make decisions and perform interventions in complex care settings. When coupled with merging augmented reality (AR) technologies these tools may provide additional capabilities to enhance medical decision-making, visualization, and workflow when managing burns. For this project, we developed a novel AR-based application with enhanced integrated clinical practice guidelines (CPGs) to manage large burn injuries for use in different environments, such as disasters.

Methods
We identified an AR system that met our requirements to include portability, infrared camera, gesture and voice control, hands-free control, head-mounted display, and customized application development abilities. Our goal was to adapt burn CPGs to make use of AR concepts as part of an AR-enabled burn clinical decision support system supporting four sub-applications to assist users with specific interventional tasks relevant to burn care. We integrated relevant CPGs and a media library with photos and videos as additional references.

Results
We successfully developed a clinical decision support tool that integrates burn CPGs with enhanced capabilities utilizing AR technology. The main interface allows input of patient demographics and injuries with step-by-step guidelines that follow typical burn management care and workflow. There are four sub-applications to assist with these tasks, which include: 1) semi-automated burn wound mapping to calculate total body surface area; 2) hourly burn fluid titration and recommendations for resuscitation; 3) medication calculator for accurate dosing in preparation for procedures and 4) escharotomy instructor with holographic overlays.

Conclusions
We developed a novel AR-based clinical decision support tool for management of burn injuries. Development included adaptation of CPGs into a format to guide the user through burn management using AR concepts. The application will be tested in a prospective research study to determine the effectiveness, timeliness, and performance of subjects using this AR-software compared to standard of care. We fully expect that the tool will reduce cognitive workload and errors, ensuring safety and proper adherence to guidelines.
53 Frailty is Not Only a Phenomenon of Elderly Burn Patients
Authors: Romanowski Kathleen S , Grigsby Melissa J , Sen Soman , Palmieri Tina L , Greenhalgh David G 
Published: April 2021

Abstract

Introduction
Recent evidence indicates that increased frailty is associated with increased mortality in patients with burn injuries over the age of 50 years old. This work found that 35.7% of burn patients over 65 years old were frail at the time of their burn admission while 19.2% of burn patients 50 to 64 years old were frail. While frailty is associated with increased age the two are separate entities suggesting that frailty may be present in much younger patients who present with burn injuries. We hypothesize that frailty exists in all age groups of patients presenting with burn injury and the prevalence increases with age.

Methods
Following IRB approval, a 5-year (2014–2019) retrospective chart review was conducted of all burn patients admitted to the burn center. Data collected includes age, gender, and burn size (% TBSA). Frailty was determined using the Modified Frailty Index 11 (MFI 11) from co-morbidities included in the burn registry. Patients were considered frail if they have an MFI ³ 2 and pre-frail for an MFI³1 and &lt; 2. Patients were assessed by decades for age. Statistical analysis included descriptive statistics, chi-square, and t-tests.

Results
A total of 2173 patients (mean age 46.1±17.3 years, 1584 males (72.8%), mean % TBSA 12.5±16.3%) were analyzed. All age groups included patients who were pre-frail (Table 1). In the under 20-year-old group, 8.5% were pre-frail. This increases with each age group to the 71-80-year-old group in which 41.7% of patients are pre-frail. The over 80-year-old group had slightly fewer pre-frail patients (35.9%). There were no frail patients in the under 20-year-old group. In the 21–30 there were 3 patients (0.7%) that had an MFI of 2 or more placing them in the frail group. Frailty was significantly different across the age groups (p&lt; 0.001). As patients age, the proportion of female patients increases (from 17.6% to 37.5%. p&lt; 0.0001). Frailty was also associated with gender with women having a higher percentage of frailty (p=0.0006). With respect to burn size, age category was not associated with burn size (p=0.12), but frail patients had smaller burns than non-frail or pre-frail patients (9.5% vs. 13.3% vs. 12.2%, p=0.0002).

Conclusions
Pre-frail patients were identified in all age groups. Frailty was present in all age groups except for those who are under 20 years of age. Frailty was associated with female sex and smaller burns. By not specifically looking for frailty in all burn patients admitted to the hospital we are potentially missing frail patients who may benefit from interventions to improve their outcomes.
64 Temperature Sensitivity Is Associated with Lower Satisfaction with Life After Burns
Authors: Oh Jamie , Seek Carolina , Sibbett Stephen H , Carrougher Gretchen J , Ryan Colleen M , Friedstat Jonathan S , Kowalske Karen J , Gibran Nicole S , Stewart Barclay T 
Published: April 2021

Abstract

Introduction
Temperature sensitivity is a common problem after burn injury. However, the impact of temperature sensitivity on health-related quality of life (QoL) is unknown. We aimed to describe characteristics associated with temperature sensitivity and determine its association with patient reported QoL. We hypothesized that temperature sensitivity negatively impacts both mental and physical health.

Methods
We reviewed a multicenter burn database for participants who had been asked about hot or cold temperature sensitivity 6, 12 and 24 months after injury. Outcomes of interest included the Satisfaction with Life Scale (SWLS) score and Veterans RAND 12 (VR-12) physical (PCS) & mental health summary (MCS) scores. Chi square and Kruskal-Wallis tests determined differences in patient and injury characteristics. Generalized linear regression models included burn size (%TBSA), graft size (%TBSA), location of burn, pruritis intensity, amputation status, study site, and review of systems questions at each follow-up visit as covariates to determine the impact of temperature sensitivity on QoL.

Results
The cohort was comprised of 637 participants. Prevalence of temperature sensitivity at each follow-up period ranged from 48%-54%. Those who experienced temperature sensitivity had larger burns, required more grafting, and had higher intensity of pruritus at discharge. Temperature sensitivity was associated with lower SWLS scores and lower VR-12 PCS and MCS at each follow-up period. After controlling for confounding variables, temperature sensitivity remained a significant independent predictor of lower SWLS scores (OR -3.2, 95% CI -5.4, -1.1) and VR-12 MCS (OR -4.4, 95% CI -7.4, -1.4) at 6 months follow-up.

Conclusions
Temperature sensitivity is a highly prevalent symptom after burn injury and an independent predictor of worse satisfaction with life and worse mental health recovery.
75 Geographic Location-Allocation Modeling to Optimize National Burn Care Delivery and Disaster Planning
Authors: Li Kevin , Mehta Kajal , Wright Ada , Lee Joohee , Pham Tam N , Nakarmi Kiran K , Stewart Barclay T 
Published: April 2021

Abstract

Introduction
The study country has a disproportionally high burn incidence rate compared to other low- and middle-income countries. Preventable death and disability are common due to poor population-level spatial access to organized burn care, including no organized system of ground or aeromedical transport. Currently, severe burns are referred to a single facility nationwide, often with suboptimal stabilization and/or significant care delay. Therefore, we aimed to identify existing candidate hospitals that would optimize population-level access to acute burn care if burn stabilization capabilities were strengthened in each hospital.

Methods
The 175 general hospitals that referred patients to the single national burn referral center between 2016–2020 were designated as candidate hospitals. Demand points for location-allocation modelling were derived from a 2020 estimated population density grid for the country (total population 30,184,338). Road network and national speed limit data were extracted from publicly available geodata to inform travel distance and time. Six models were developed (Models A-F) using cost-distance and network analyses to identify the 3 vs 5 candidate hospitals that would optimize population-level spatial access if their initial burn stabilization capabilities were strengthened. Three travel time thresholds (≤2, 6, and 12 hours) were used for both sets of models.

Results
Currently, 6,151,298 people (20.3% of the national population) have access to organized burn care within 2 hours of travel, 11,240,957 (37.2%) within 6 hours and 21,925,928 (72.6%) within 12 hours [Table 1]. If acute burn stabilization capabilities were strengthened, Models A-C of 3 chosen hospitals would increase population-level burn care access to 45.2%, 89.4%, and 99.8% of the national population at ≤2, 6, and 12 travel-hours, respectively. Models D-F demonstrated that 5 chosen hospitals would increase population-level burn care access to 53.4%, 95.0%, and 99.9% of national the population at ≤2, 6, and 12 travel-hours, respectively.

Conclusions
This exercise demonstrates two sets of models for increasing population-level access to acute burn stabilization in the study country. If acute burn stabilization capabilities were strengthened in the identified hospitals, approximately 90% of the national population would have access to burn care within 6 travel-hours in both the 3 and 5 hospital scenarios. Although the models with 5 strengthened hospitals reduce mean travel time, the percent of population with improved travel time access is only marginally higher. Strategic, organized efforts to increase burn stabilization capabilities might reduce the rates of preventable burn-related death and disability country-wide by reducing delays.
84 Pediatric Scald Burns: Using Geographic Information Systems to Identify High Risk Communities
Authors: Lee Jeanne , Higginson Sara , Strait Eli , Santorelli Jarrett E , Smith Alan , Costantini Todd , Doucet Jay , Godat Laura N 
Published: April 2021

Abstract

Introduction
Identifying modifiable risk factors for pediatric scald burn injury prevention efforts is an important function for burn registries. Geographic information systems (GIS) analysis can provide additional census tract data about patient home and injury location. We hypothesize that (GIS) analysis of burn registry data using census tract data could identify geographic areas and additional risk factors for pediatric scald burn injury prevention efforts.

Methods
The burn registry of a U.S. regional burn center was used retrospectively to identify burn admissions, ages 0–17, within the county from 1/1/2018 to 7/31/2020. Data collected included demographics, vitals, burn type and body surface area burned (BSA%), hospital charges, length of stay, complications, and mortality. GIS geocoding of patient home addresses with census tract data including poverty level, languages spoken at home and highest educational level was performed. Burn incident hot spot analysis to identify statistically significant burn incident clusters was done using the Getis Ord Gi* statistic.

Results
There were 1057 burn initial admissions during the study period, 152 (14.3%) patients were children 17 and younger with scald injury who were county residents. The average age was 4.0 ± 4.0 years, and 59.9% were male. Mean scald injury BSA was 4.9% ± 5.7, 14/152 admissions (9.2%) had a burn ≥10% BSA. There were no in-hospital deaths. 120/728 county census tracts were identified as high risk with higher rates of child scald injury admissions than the countywide mean of 1.27 cases/1000 children. Regression analysis of high-risk census tracts were more likely to have increased poverty levels (O.R. 3.30, 95% C.I.: 1.1–9.7, p&lt; 0.031) and lower educational attainment (O.R. 1.10, 95% C.I.: 1.0–1.18, p&lt; 0.047). Non-white race, unemployment level, living with grandparents and speaking Spanish at home were non-significant risk factors. GIS analysis identified geographic hot spots for child scald injury admissions (p&lt; 0.001).

Conclusions
GIS analysis of county burn registry data identified census tracts with increased poverty and lower educational attainment levels to have an increased risk of pediatric scald injury admission. Burn prevention efforts should be focused on these high-risk areas.
101 Homeless Status, Distance from Clinic, and Substance Dependence Associated with Low Follow-Up Rates for Burn-Injured Survey Respondents
Authors: Solomon Eve A , Phelan Elizabeth , Tumbaga Lilia G , Karashchuk Irina P , Greenhalgh David G , Sen Soman , Palmieri Tina L , Romanowski Kathleen S 
Published: April 2021

Abstract

Introduction
Over 25% of burn-injured patients at our institution never attended a follow-up appointment. A quality-improvement discharge survey (QIS) identified potential barriers to follow-up as distance from the clinic, transportation, and time off work. This study compares follow-up rates before and after the QIS was administered and correlates them with patients’ self-identified barriers.

Methods
Following IRB approval, a retrospective chart review was conducted using electronic medical records of adult burn-center admits who responded to the QIS and were discharged between September 2019 and July 2020. Controls were burn-center admits discharged from 2016–2018, prior to the survey period. Exclusions included patients with non-burn injuries, and those who died in the hospital were transferred to another hospital, did not require follow-up, or followed up elsewhere. Data analysis was conducted using chi-square, t-test, and logistic regression models.

Results
The post-survey group includes 272 patients (mean age 47 ± 16.8, 201 males (73.6%), mean burn size (TBSA) of 9.3% ± 9.6%). The pre-survey control group includes 878 patients (mean age 45.1 ± 16.8 years, 646 males (73.6%), mean burn size (TBSA) 10.16 ± 11.7%). Compared to the pre-survey group, post-survey patients had a lower frequency of missed appointments (MA) (47.3% post vs. 56% pre), but worse overall follow-up rates (63.7% post vs. 74.5% pre). Per multivariate analysis, different factors were associated with follow-up and MA in the two groups (Table 1). Rates of follow-up and MA were not significantly different before and after the onset of the Covid-19 pandemic.

Conclusions
Patients who were surveyed to identify barriers to follow-up had fewer missed appointments but worse overall follow-up rates. Patients fail to follow up due to homelessness, substance dependence, and distance to the hospital. These findings are consistent with patients’ self-identified barriers to follow-up in a QI survey.
117 Feasibility and Scar Outcome with a Single-use Adhesive Silicone in Pediatric Burn Survivors
Authors: Parry Ingrid , Sen Soman , Palmieri Tina L , Greenhalgh David G , Romanowski Kathleen S 
Published: April 2021

Abstract

Introduction
Silicone sheets are commonly used for prevention and treatment of burn scars and silicone-based products have recently been recommended as the gold standard non-invasive treatment choice. One problem with silicone gel sheets application is that the sheets lose their adhesive qualities making them difficult to affix to the patient and costly to replace when lost. A new ultra-thin, clear and adhesive silicone gel sheet layered on a semi-permeable polyester backing was trialed at our burn center. The silicone is designed to be a one-time application, worn during all activities until it naturally falls off, thus eliminating the need for daily removal and cleaning. The purpose of this study was to evaluate the feasibility and effectiveness of the single-use adhesive silicone sheets with pediatric burn survivors.

Methods
Medical records of pediatric burn survivors who used the adherent silicone sheets between September 2019 and July 2020 were retrospectively reviewed. Information regarding details of silicone use and scar outcome scores were extracted from the records. Data were analyzed using paired Student t-tests and Wilcoxon Signed Rank to compare scars before and after using the silicone.

Results
The silicone was applied to 22 body areas of 9 patients. The average age of the patients was 7.4 (±8.5) years and TBSA 53 ±17%. The time from injury or grafting to when the silicone was applied was 200.5 (±13.4) days. The silicone was worn without interruption for an average of 12.8 days. Total Patient Observer Scar Assessment Scale (POSAS) scores for both the patient and observer evaluations significantly improved after use with the single-use adherent silicone (↓13.83 patient p=.005, ↓5.4 observer p=.01). Evaluating individual scar parameters showed 4/7 patient reported and observed areas of the POSAS evaluation improved significantly with adherent silicone use (Figure 1). Only one patient reported a complication of itch at day 5 and the silicone was removed.

Conclusions
The single-use adhesive silicone investigated in this study appears to adequately adhere to patients over multiple days, thus overcoming common barriers to silicone use of the products falling off, getting lost and needing to be replaced. Use of such a product could improve ease and continuity with scar management. In addition, for this small cohort of patients, scar improvement was noted with silicone use. The results of this study indicate that larger prospective studies evaluating the silicone efficacy may be beneficial.