bluuebunny/crossref_metadata_2025_split huggingface dataset:
549 Lessons Learned from Two Survivors of Greater Than 90% Total Body Surface Area Full Thickness Burn Injuries Using a Dermal Biodegradable Substitute and Autologous Skin Cell Suspension: A Case Series
Authors: Malkoc Aldin , Wong David 
Published: April 2021

Abstract

Introduction
Advances in burn injury knowledge, critical care, and pharmacological developments have increased survival rates among extensive burn patients. Survival now dependents not just on skin coverage, but effective control of SIRS response, metabolic derangement, fluid loss and sepsis. Novel synthetic dermal substitutes create robustness, thickness, and pliability of the skin in addition to an improved aesthetic appearance while; point-of-care autologous skin cell harvesting enhances treatment by amplifying small split-thickness skin samples to produce an autologous skin cell suspension (ASCS) to cover a larger burn area. This study reports on two survivors with greater than 90% total body surface area full-thickness burns utilizing a combined treatment of a dermal substitute along with ASCS and traditional burn management strategies.

Methods
Chart review of two patients with &gt;90% burns and inhalation injury after being trapped in a burning vehicle following a traffic collision occurred. Most of the burns in both patients were “leathery” and consistent with full thickness, sparing only the plantar and dorsal aspect of the feet and bilateral small areas of the hip in Patient 1. Patient 2 had fourth-degree burns in some areas of the chest and flank with only the bilateral groin regions and feet spared. The patients were treated with a multi-step process which included using allograft, dermal substitute, and ASCS with split-thickness skin grafts (STSG) in place of cultured epidermal autograft to achieve coverage of &gt;90% burns with high meshed ratio.

Results
The dermal substitute was limited to deep burns that penetrated down to fat, muscle, and/or joints. Fluid loss was well controlled by the dermal substitute during initial resuscitation. Post reconstruction, areas covered with the dermal substitute and grafted with autogenous STSG with ASCS exhibited less hypertrophy and contracture bands. The elbow and knee joints showed minimal restriction with passive motion and good skin compliance, but contractures persisted in areas where 4th degree tendon and fascia thermal injury occurred. Areas that showed signs of infection were trimmed or unroofed and allowed to drain while maintaining the remainder of the dermal substitute.

Conclusions
The use of dermal substitutes and ASCS allowed the care team to achieve SIRS control, improved fluid management, enhanced skin coverage, and reduced hospitalization stay. The process experienced in these cases shows promise for future patients with extensive burns. Both patients were able to survive and show improvement during rehabilitation.
558 Use of Forward-Looking Infrared (FLIR) Technology to Assess Burn Depth and Healing Potential: A Systematic Review and Meta-Analysis
Authors: Dang Justin , Lin Matthew E , Huang Samantha , Hulsebos Ian F , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Burn wound depth assessments are an important component of determining patient prognosis and making appropriate management decisions. Clinical appraisal of the burn wound by an experienced burn surgeon is standard of care but has limitations. Forward-looking Infrared (FLIR) is a new technology in burn care that can provide a non-invasive, quantitative method of evaluating burn wound depth. FLIR utilizes a specialized camera that can capture the infrared emissivity of the skin, and the resulting images can be analyzed to determine burn depth and healing potential of a burn wound. Though FLIR has great potential for burn wound assessment, its use for this has not been well documented. Thus, we have conducted a systematic review and meta-analysis of the current use of FLIR technology to assess burn depth and healing potential.

Methods
A systematic review of the literature was performed on PubMed and Google Scholar between June 2020-August 2020 using the following keywords: thermal imaging, FLIR, forward looking infrared, burn, burn depth. Meta-analysis was performed on the mean sensitivity and specificity of the ability of FLIR to predict healing potential. Inclusion criteria were articles investigating the use of FLIR for burn wound assessments in adults, pediatric patients and animal models. Reviews and non-English articles were excluded.

Results
A total of 11 articles were included in the final review. Statistically significant correlations were found between FLIR and laser doppler imaging (LDI) in 3/3 clinical studies. A case report of a single patient found that FLIR was more accurate than LDI for assessing burn depth. Three articles investigated the ability of FLIR to predict healing potential, with all three reporting statistically significant results. Significant temperature differences between burnt and unburnt skin were found in 2/2 articles. FLIR was compared to clinical assessment by burn surgeons in two articles; one article found that FLIR was more accurate for assessing burn depth, while the other article found that clinical assessment was more accurate for predicting healing potential &lt; 21 days. Mean sensitivity and specificity of the ability of FLIR to determine healing potential &lt; 15 days was 44.5 and 98.8 respectively. Mean sensitivity and specificity of the ability of FLIR to determine healing potential &lt; 21 days was 44.0 and 77.4 respectively.

Conclusions
FLIR is an accurate, simple, and cost-effective method of burn wound assessment. FLIR has been demonstrated to have significant correlations with other methods of assessing burns such as LDI and can be utilized to accurately assess burn depth and healing potential.
574 A Nurse Educational Program to Promote Spiritual Care Delivery: Development and Pilot Testing
Authors: Henderson Tammy L , Bender Miriam , Joe Victor C , Thompson Patrick E , Thomas Mini 
Published: April 2021

Abstract

Introduction
Spiritual Care (SC) is crucial for the holistic care of patients. Findings from a needs assessment conducted on an 8-bed burn Intensive Care Unit (ICU) (n=34, 88% response rate) revealed 90.3% of nurses believed SC was important for the overall care of their patient, but only 13% felt confident to provide the religious care. Of the respondents, 77% had come across a time when they were unable to obtain SC for their patients. The survey revealed 39% were interested in obtaining education to enhance their provision of holistic care. Based on this data, we developed and pilot tested an innovative SC educational course to examine feasibility, learning, and preliminary outcomes.

Methods
The IRB-approved study involved a two-hour evidence-informed class developed by a burn nurse and chaplain. The course was offered on a voluntary basis for all nurses in the critical care division (5 units overall). The class consisted of PowerPoint presentation, case studies and practice utilizing spiritual care assessment tools. Data was collected before and after the class at one- and two-months post class completion.

Results
Participants (n=12) were mostly female (82%), Bachelors prepared (82%), affiliated as Christian (73%) and had not had spiritual education in the past (73%). Nurses also agreed the spiritual assessment tools were useful and they were confident using them. Mean total score for Nurses’ Spiritual Care Practice increased 14% over time. Practices with the largest increases included reading/offering spiritual writings to patients (67/57%) and documentation of meeting spiritual needs (40%). The Spiritual Care Perspective scale increased 7% overall with changes in the beliefs of SC being a significant part of Advanced Nursing Practice (ANP) (10% increase), the domain of APN includes SC (15% increase) and nurses should assist a patient in using his/her spiritual resources to cope with illness (9% increase). At 2-months post training, participants felt comfortable (4.25/5.0 and confident (4.0/5.0) providing SC.

Conclusions
SC is an essential element of holistic nursing practice that has become even more relevant in this pandemic year. Our 2-hour educational class was considered well organized, provided relevant education and tools for use, and increased nurses confidence, comfort, and documentation of providing SC to their patients.
584 Increase in Cancellation Rates with Follow-Up Telemedicine Visits in a Burn Clinic Setting
Authors: Wiley Nicholas A , Chrisco Lori , King Booker 
Published: April 2021

Abstract

Introduction
Telemedicine is a resource to help limit in-person contacts, which has become increasingly utilized during the Coronavirus pandemic. In the last year, most health care systems have attempted to limit in-person visits in order to help decrease Coronavirus transmission. A retrospective analysis was conducted to determine if the use of telemedicine resulted in an increase in cancellation rates. The data on cancellation rates of a burn clinic using telemedicine was collected for a seven-month period in 2020. The increased rate of cancellations for telemedicine visits compared to in-person visits was found to be statistically significant.

Methods
A retrospective analysis of patient cancellation rates for 2,463 burn outpatient visits seen in a burn clinic associated with a large tertiary referral burn center was performed covering the time period between April 1st and August 30th of 2020. Cancellations of initial visits for new or recently discharged patients were not included as telemedicine visits were only offered for established burn outpatients. Rescheduling rates for both groups were calculated to assess a potential impact on cancellations. Telemedicine visits consisted of patient encounters conducted by phone or by live video chat. Statistical significance was determined using chi-square test with an accepted p &lt; 0.05.

Results
The study included 2,463 scheduled outpatient visits comprising 511 telemedicine visits and 1,952 in-person visits. A cancellation rate of 47% occurred for telemedicine visits and a cancellation rate of 40% was observed with in-person visits. Patient visits conducted using telemedicine were associated with a higher cancellation rate (p=0.013). The reschedule rate for telemedicine visits was 22% while in-person visits had a rate of 25% showing no significant association (p = 0.45).

Conclusions
Telemedicine follow-up visits were found to have an increased rate of cancellations compared to in-person visits. Rates of rescheduling showed no significant difference between groups.
594 Racial and Ethnic Disparities in Burn Patient Outcomes: A Review of the Literature
Authors: Peters Jasmine N , Bello Mariel S , Spera Leigh J , Gillenwater Justin , Yenikomshian Haig A 
Published: April 2021

Abstract

Introduction
Racial and ethnic disparities in outcomes for surgical trauma populations has been an expanding field in recent years. Despite this, disparities in prevention, treatment, and recovery outcomes for burn patients of racial and ethnic minority backgrounds have not been well-studied. Our study aims to review the literature regarding risk factors and burn outcomes among racial and ethnic minority populations to develop culturally-tailored burn care for minority burn patients.

Methods
A systematic review of literature utilizing PubMed was conducted for articles published between 2000–2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Asian OR Hispanic OR Latino OR Native American OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the U.S. that discussed disparities in burn injury outcomes or burn injury risk factors associated with race/ethnicity.

Results
1,031 papers were populated, and 38 articles were reviewed. 26 met inclusion criteria (17 for adult patients, 9 for pediatric patients). All but 4 of the included papers were written in the last 10 years. 17 of the 26 articles describe differences in outcomes or risk factors for Black Americans, 8 discuss Latinx, 5 discuss Native Americans, 3 discuss Asian Americans, and 1 referred to “Non-White” minorities, collectively. Majority of studies showed that racial and ethnic minorities (vs. Whites) exhibited poorer burn injury outcomes such as higher mortality rates, greater scar complications, and longer duration for length of stay.

Conclusions
Few studies exist on outcomes for minority burn populations. Interestingly, most have been published in the last 10 years, which may indicate a trend in increased awareness. There is also a discrepancy in which minorities are included in each study with the least amount of data collected on Asian, Latinx, and Native American communities. More research with a larger base of minority populations will help further investigate this problem and develop better culturally-appropriate burn treatment.
595 The COVID Effect: Exploring the Impact of Coronavirus on an Academic Burn Center
Authors: Moore Meredith , David Parizh , Dale Elizabeth , Slater Julia C 
Published: April 2021

Abstract

Introduction
Globally, medical centers have faced unprecedented times with the onset of the Novel Coronavirus pandemic. Emergency departments (ED) and burn units have had to adapt to uncertainty and new challenges. At our institution, we had to alter our daily burn practice, physically moving our burn unit to our surgical intensive care unit to accommodate staff cohorting. While some hospitals have seen patient surges, most have endured dramatic decreases in productivity. A UK burn unit documented lower ED presentations and reduced referrals from other centers, with 50% fewer patients admitted to their burns ward (Farroha). In Israel, a 66% decrease in adult burn patients was noted (Kruchevska et al.). We sought to identify the impact of COVID-19 on burn injury epidemiology in our burn unit based in a large, urban, academic medical center.

Methods
We conducted a retrospective review of our burn database for ED visits and admissions related to burn injuries between March 1st and June 30th in the years 2017, 2018, 2019, and 2020. We looked at the age and sex of patient, type of visit, length of stay (LOS), the mechanism of injury, the setting in which injury occurred, and the details of the injury. We compare annual trends, with emphasis on comparison of 2020 to previous years.

Results
From admissions and ED data records, 215 patient encounters were reviewed. We saw a yearly rise in total burn patients seen in the ED or admitted to our burn unit 2017–2020 (39, 43, 63, and 70 respectively) with the highest volume of patients in 2020. Mean patient age ranged from 45 (2020) to 51 (2017). More males were burned in all years (male:female ratio 3.9 in 2017, 2.1 in 2018, 2.5 in 2019, 1.9 in 2020). Median LOS in 2020 was 2.5 days, consistent with 2017–2019 values (2, 3, 3, respectively). Between 2017 and 2019, 10%, 2%, and 8% respectively of patients evaluated were treated on an outpatient basis, while in 2020, 20% were outpatient. Rates of flash, scald, flame, chemical, electrical, and contact burns were stable over the period. Of those patients who were admitted, 1.8% sustained work-related burns in 2020 versus 8.9% over 2017–2019. In 2020, 23% of burns were cooking related versus 18% over the prior 3 years.

Conclusions
Despite documented decreased burn admissions in some units, our unit saw an increase in burn injuries presenting for evaluation in the first 3 months of the COVID-19 pandemic as compared to the analogous period in the three years prior. Burns were less often tied to work-related incidents and more frequently related to cooking injuries. Even with more patients treated and released from the ED, inpatient admission numbers were maintained. These findings support the importance of protecting our staffing and burn unit resources in a pandemic setting in order to appropriately treat regional patients and an increase in home-based injuries.
601 Burn Injuries Associated with At-home Hair Braiding
Authors: Shakir Afaaf , Teele Megan , O’Connor Annemarie , Gottlieb Lawrence J , Vrouwe Sebastian Q 
Published: April 2021

Abstract

Introduction
Hair braiding that incorporates synthetic extensions has increased in popularity across all age groups. During the styling process, the ends of the braid are commonly dipped in hot water. As a result of this practice, an increasing number of patients have presented to our Burn Center after containers of recently boiled water are accidentally tipped over and spilled onto patients. Here, we report on patient demographics, outcomes, and our experience managing this injury pattern.

Methods
A retrospective chart review was performed of all patients who sustained burn injuries associated with at-home hair braiding presenting to an ABA-verified Burn Center between January 1, 2006 and July 31, 2020. Data on patient demographics, injury characteristics, wound management and, burn outcomes was collected.

Results
A total of 41 patients presented over the study period with burn injuries related to at-home hair braiding. The frequency of this type of burn increased over time, with 54% of injuries occurring in the last three years (2018–2020). The mean patient age was 7.5 years (range 0.7 – 32 years). Demographically, the vast majority of patients were under 18 years of age (90%), female (95%), and African American (98%). Seventy-three percent of injuries occurred at the patient’s home and 88% of incidents involved another person in the hair braiding process. The mean total body surface area of burn was 5% (range 1–20%). The most commonly involved areas were the back (54%), thigh/leg (37%), neck (24%), shoulder (24%), and arm/forearm (22%). Ninety percent were entirely partial thickness injuries with 10% of patients suffering some degree of full thickness injury. Ninety percent of patients required inpatient admission, and 36% of patients required at least one operative procedure. For those managed as inpatients, the average length of stay was 5.4 days (range 1–30 days). Three patients were reported to experience complications with one developing respiratory failure and two with delayed wound healing.

Conclusions
Hair braiding, with the use of scalding water to seal and set the ends of braids, can lead to significant accidental burn injuries. At our institution, these injuries occur predominantly in young African-American females. These burns can result in acute hospitalization and the need for surgical intervention. This is the largest series of this injury type to date with trends towards increasing frequency in the most recent time period.
602 Concomitant Pediatric Burns and Craniomaxillofacial Trauma: A Pediatric Burn Center’s Experience over 20 Years
Authors: Xun Helen , Mafla Laura M , Caffrey Julie , Hultman Charles S 
Published: April 2021

Abstract

Introduction
Recent progress in pediatric burn care has reduced the mortality rate by 48.1% (Armstrong, 2020). Although it is well understood that mortality increases with increased number of systems involved, prior studies have not documented the effect of concomitant pediatric burn and craniomaxillofacial (CMF) trauma in pediatric patients. This retrospective cohort study is the first known to characterize presentation, management, and long-term outcomes of concomitant burns with CMF trauma in pediatric patients.

Methods
We performed a retrospective cohort study of all pediatrics patients who presented at a tertiary care center between the years 1990 to 2010 with CMF fractures and burns. Patient charts were reviewed for demographics, mechanism of injury, burn characteristics (TBSA %, location, and degree), imaging and interventions, involvement of child protective services, and long-term outcome. Data was analyzed using two-tailed Student’s t tests and chi square analysis.

Results
Of the 2,966 pediatric CMF trauma patients (64.0% boys; average age 7 ±4.7 years) that were identified, a total of 10 (0.34%) patients were identified to have concomitant burn injuries. Patients with concomitant burn and CMF injuries were less likely to have sustained blunt injuries (P &lt; 0.0001) and had longer hospital lengths of stay (13 □ 18.6 vs 4 □ 6.2 days, P &lt; 0.0001). Approximately 60% of CMF fractures were upper-third injuries. The CMF fractures of all 10 cases (100%) were managed non-operatively. 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. Of the four patients who presented due to child abuse, CMF trauma was incidentally found on imaging. One (13 months, female) child-abuse case was found to have 32% TBSA 2nd and 3rd degree burns to bilateral lower extremities after being submerged in hot bathwater and had concomitant orbit/skull fractures. Two other child abuse cases presented with hand burns and concomitant nasal/skull fractures. All four child abuse patients presented in a delayed fashion.

Conclusions
Concomitant burns and CMF trauma is rare injury pattern in pediatric populations and is associated with longer hospital lengths of stay. Child abuse and motor vehicle accidents caused 80% of the cases.
608 Perceived Burnout among Burn Surgeons: Results from a Survey of American Burn Association Members
Authors: Kinslow Kyle , Elkbuli Adel 
Published: April 2021

Abstract

Introduction
Burnout is a significant and increasingly recognized issue. We aimed to investigate burn surgeons’ (BSurg) perceptions regarding burnout, contributing factors, and implications to better identity possible targeted interventions.

Methods
42-question anonymous online survey was distributed by the ABA to BSurg members. Respondents included BSurgs in university or non-university hospital settings.

Results
Experience of burnout was reported among 89.8% of university and 84.6% of non-university hospital affiliated respondents. After adjusting for confounders, university BSurgs exhibited higher risk of perceived burnout compared to non-university settings (aOR 1.081, 95%CI:0.237,4.937). Women BSurgs were at 5 times higher risk of reporting burnout compared to men (aOR 5.048, 95%CI:0.488,52.255). BSurgs aged 40–44 had twice the risk of reporting burnout as ≥50 (aOR 1.985, 95%CI:0.018,216.308). Practicing for 21–30 years had 12 times higher risk of reporting burnout than practicing &gt;30 (aOR 12.264, 95% CI:0.611,246.041). Those working &lt; 50 hours/week reported burnout more frequently than those who work ≥80 hours/week (aOR 2.469, 95% CI:0.80,76.662).

Conclusions
Overall reports of burnout were high amongst burn surgeon respondents. Those with 21–30 years of clinical practice were at significantly higher risk of reporting burnout despite believing that their colleagues’ burnout was more frequent than their own. Interventions addressing perceived burnout in younger burn surgeons may be limited by lack of participation due to fear of repercussions from administration or peers. Future administration-led burnout initiatives should acknowledge the differences between burn surgeon groups and offer resources unique to the individual physician’s needs for burnout prevention to be successful.