bluuebunny/crossref_metadata_2025_split huggingface dataset:
531 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State
Authors: Matthews Marc R , Calder Sara , Kowal-Vern Areta , Spadafore Philomene , Richey Karen J , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations.

Methods
This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed.

Results
The mean ±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with &lt; 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p &lt; .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the &lt; 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p &lt; .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for &lt; 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the &lt; 40 %TBSA patients, p &lt; .0001. The &lt; 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the &lt; 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the &lt; 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5.

Conclusions
Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.
533 Evaluation of growth hormone use in patients with large burns and complex wounds
Authors: Gayed Rita , Lindsey Lindsey , Mittal Rohit , Hodge Juvonda , Ingram Walter L 
Published: April 2021

Abstract

Introduction
Large burn injuries lead to an extensive and prolonged catabolic state that results in loss of body mass and impaired wound healing. To combat this hypermetabolic response, different strategies have been employed including early excision and grafting, infection control, early nutrition and anabolic therapies such as oxandrolone. Human growth hormone is of interest for burn patients because of its anabolic properties. While its use has been associated with worse outcomes in the critically ill adult with sepsis, it has shown improved outcomes when used in pediatric burn patients.
The purpose of this study was to retrospectively evaluate the appropriateness of human growth hormone use, its adverse events and cost in patients with large burns or complex wounds and poor wound healing.

Methods
This was an IRB approved, retrospective, single center chart review from 2011 to 2019 assessing human growth hormone prescribing patterns in the burn unit. The primary objective was appropriateness of use, defined as documentation of poor wound healing prior to initiation despite adequate nutrition delivery and use of standard anabolic therapies (i.e. oxandrolone). Secondary objectives included perceived benefit, adverse events and median therapy cost per patient of human growth hormone.

Results
Thirty-eight patients were included in the study, 79% of which were adults, with a median total body surface area involvement of 50% (IQR 40 to 71). Only forty-one per cent of patients receiving human growth hormone met our predefined criteria for appropriateness; this was primarily driven by poor documentation of wound healing. However, 80% of patients were receiving adequate nutrition and oxandrolone, indicating appropriate clinical use. Most adult patients received a dose of 20mg daily, while pediatrics received the weight based 0.2mg/kg daily dose. The median duration of treatment was 24 days (IQR 13–35) and median time from admission to growth hormone initiation was 27 days (IQR 12–34). Overall clinical improvement was noted in 53% of patients, as evident by increased weight, prealbumin and/or documentation of improved wound healing. The most common adverse effect noted was hyperglycemia, followed by new sepsis onset. The median therapy cost per patient was $42,000.

Conclusions
Human growth hormone may serve as a salvage therapy for large burns with poorly healing wounds. Prior to initiating therapy, nutrition must be optimized and standard, more researched anabolic therapies should be started. While receiving therapy, patients should be monitored for both hyperglycemia and the development of new sepsis.
534 Persistent Copper and Zinc Deficiency in Excess of 30 Days Post Burn Injury
Authors: Sullivan Louisa , Quan Asia N , Richey Karen J , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Copper and zinc deficiencies are common after burn injury, with the lowest levels usually occurring within seven days. Both trace elements are important for wound healing, but due to competition for absorption in the small intestine, oral replacement of zinc and copper may not be sufficient. Nutritional guidelines recommend copper and zinc replacement for up to 30 days, but little data is available to guide long-term trace element replacement.

Methods
This case series includes four patients with 15% or larger total body surface area burns who had hypocupremia at least 30 days after admission despite receiving at least the recommended daily allowance of copper via tube feeds.

Results
In two patients, copper levels increased following discontinuation of oral zinc tablets. However, one patient had continued hypocupremia and increasing zinc levels while receiving zinc only from tube feeds, suggesting this amount of zinc may decrease dietary copper absorption. For one patient with 95% TBSA burns, hypocupremia was associated with polyneuropathy and osteopenia. Another patient experienced an acute drop in zinc levels associated with bacteremia and sepsis.

Conclusions
In this case series, hypocupremia was associated with anemia and zinc deficiency with poor wound healing. Additional multicenter practice reviews of copper and zinc supplementation in burn centers would be beneficial.
541 72 Facial Burns Treated with Autologous Skin Cell Suspension- A Real World Data Analysis Across 5 U.S. Burn Centers
Authors: Carter Jeffrey E , Phelan Herbert , Kopari Nicole M , Kahn Steven , Molnar Joseph , Bailey John K , Saraswat Anju , Holmes James H 
Published: April 2021

Abstract

Introduction
Optimal management of facial burn injuries remains a significant challenge in burn care. Acute surgical intervention is often coupled with delayed reconstructive procedures as an essential option for burn care. Experience with new surgical technologies could challenge historic reconstructive ladders. Our goal was to pragmatically assess the rate of successful intervention with autologous skin cell suspension (ASCS) for the treatment of facial burn injuries from real-world data.

Methods
A retrospective review from five burn centers over a three-year period was performed from deidentified registry data for facial burn injuries initially treated with ASCS. Cases of non-acute thermal burn and burns not involving the face were excluded. Data collection included: date of surgery, last follow-up date, need for grafting (split or full thickness skin graft, STSG or FTSG, respectively) or reapplication of ASCS within the same hospitalization, and reconstruction not including laser procedures due to scarring during the follow-up period. Descriptive statistics were calculated and data are reported as median with interquartile ranges where appropriate.

Results
A total of 72 burn injuries were treated with ASCS for facial burn injuries. Two burn centers treated 4 patients each, one treated 18, and the remaining two treated 22 and 24 patients. The median follow-up was 199 days (range 9 -1,150 days). Acute failure requiring a second treatment with ASCS or application of a full-thickness or split-thickness autograft occurred in 12 (16%) of the patients with 5 undergoing re-application of ASCS and 7 undergoing FTSG or STSG. reconstruction secondary to scarring during the follow-up period occurred in 10 (14%) of patients. Reconstruction was required in 1 of 5 patients that underwent a second treatment with ASCS as opposed to 4 of 5 patients treated with FTSG or STSG.

Conclusions
This study represents the largest experience with the use of ASCS for the management of facial burn injury in the reported literature. Use of ASCS from real-world data indicated that ASCS successfully resulted in definitive wound closure in 90% of the patients treated with facial burn injuries, with 10% requiring secondary intervention. This failure rate is below the previously published rate of 33%, indicating the disruptive potential of this technology for the management of facial burn injuries.
542 A Prospective Observational Trial of Clinical Burn Wound Imaging with Spatial Frequency Domain Imaging
Authors: Rowland Rebecca , Ponticorvo Adrien , Kennedy Gordon T , Bernal Nicole O , Burmeister David M , Chin Theresa L , Christy Robert J , Durkin Anthony , Joe Victor C 
Published: April 2021

Abstract

Introduction
While visual assessment is the standard for burn severity evaluation, new technologies are attempting to increase objectivity. Burn depth assessment accuracy improves over time as the appearance changes, but earlier diagnosis potentially leads to prompt treatment and shorter recovery. Laser Speckle Imaging (LSI), FDA approved for grading burns, is typically done 72hrs after injury. Spatial Frequency Domain Imaging (SFDI), a novel technology only tested in animal burn models, uses multiple wavelengths of patterned light to quantify tissue absorption (hemodynamics) and scattering (structure). SFDI has shown the potential to differentiate burns as early as 24hrs postburn by measuring scattering (µs’) changes due to collagen damage. Here, we examine SFDI burn severity assessment in clinical patients, and compare against LSI and clinical assessment.

Methods
5 burn cases were imaged with LSI and SFDI approximately 24 and 72hrs postburn. The clinician was blinded to imaging results and made diagnoses on their standard of care.

Results
One patient received no surgical intervention, one received excision and xenograft, and two received excision and autograft. An autograft was recommended for one patient, but not performed due to preexisting conditions. SFDI measurements at 24hrs showed low µs’ values in regions that eventually required autografts, and high µs’ in burns that did not. While clinical decisions were made no earlier than 72hrs postburn, µs’ maps at 24hrs postburn were able to illustrate severity in these regions. In 2 of 3 autograft cases, LSI was unable to determine the severity until 72hrs postburn.

Conclusions
Here, we compared SFDI to LSI in a clinical setting to quantify burn wound severity. Similar to animal models, SFDI was demonstrated to accurately characterize severity earlier than the perfusion-based LSI. This is likely due to sensitivity of µs’ measured by SFDI to the structural changes in damaged collagen (i.e., zone of coagulation) that occur immediately postburn.
551 Fish Skin Compared to Cadaver Skin as a Temporary Coverage and Wound Bed Preparation for Full Thickness Burns: An Early Feasibility Trial.
Authors: Shupp Jeffrey W , McLawhorn Melissa M , Moffatt Lauren T 
Published: April 2021

Abstract

Introduction
Full-thickness thermal burns may require staged procedures with temporary coverage to ensure the wound bed is optimized for autografting. A potential dermal substitute for thermal injury is fish skin grafts. These are made in Iceland from freeze dried, sterilized, decellularized skin of North Atlantic cod (Gadus morhua). The gentle processing of the fish skin removes the risk of viral disease transmission to humans and retains its naturally occurring Omega3 fatty acids which are known for their pain and inflammation modulating effects. Fish skin graft has a shelf life of 3 years at room temperature, whereas cadaver skin, the current standard of care at many institutions, has to be cryopreserved, is donor derived, and contains only trace amounts of Omega3. While fish skin graft has been cleared by the FDA as a medical device for use in acute, surgical, chronic wounds, and partial thickness burns, it has not yet been indicated for use in full-thickness burns. The purpose of this clinical trial is to assess the safety and efficacy of decellularized, freeze dried fish skin as an alternative to cadaveric skin (standard of care) for temporary coverage in the setting of a full-thickness burn requiring staged grafting.

Methods
Patients with full thickness burns to their extremities and/or chest were randomized to have two adjacent areas (70–140 cm2 each) covered with either fish skin or cadaver skin for one week following excision. Patients then received a split thickness skin graft (STSG). Healing was observed by blinded assessors for each area weekly for three weeks, with a scarring assessment completed at 3 months post STSG. Background pain was measured by a visual analogue scale (VAS) for pain and wounds were photographed at each time point.

Results
Five patients are included in this initial analysis and all completed the 3-month post STSG follow up. TBSA ranged from 8–37%.
The fish skin treated area was assessed to be 90% healed at the same timeframe or earlier than cadaver treated areas in all subjects. There was a trend towards a reduction in pain in the fish skin covered areas. One patient was unable to give a pain score due to heavy sedation.
Adverse events were reported in all five patients, but none were associated with the use of the investigational product. Graft failures were observed in two cadaver skin covered areas and one partial failure in a fish skin covered area.

Conclusions
Results from this trial so far indicate that the fish skin is safe and non-inferior to cadaver skin as an early coverage for full thickness burns. Enrollment in this study is still ongoing, and patients will be followed up for 12 months.
555 Early Application of a Water-soluble Surfactant Dressing for Partial-thickness Burn Wounds to Reduce Wound Conversion
Authors: Hill David M , Mahmood Ammar O , Mitchell Matthew B , Allen Jakob H , Hickerson William L , Velamuri Sai R R , Director Medical 
Published: April 2021

Abstract

Introduction
Surfactant-based wound dressings have been utilized in chronic, non-healing wounds and small burn wounds to soften and aid removal of wound debris. In vitro data suggest enhanced healing properties are due to the ability to stabilize and potentially reseal plasma membranes, thereby, retaining cellular integrity and enhance wound healing. Further, surfactant-based wound dressings are non-ionic and may facilitate removal, sensitize, or prevent bacterial biofilms. Biofilms are an evolved, protective mechanism bacteria utilize to reduce antimicrobial efficacy. Removal or penetration of biofilms is essential for bacterial eradication. This case series presents outcomes from use of a water-soluble surfactant dressing (WSD) is used at hospital admission for treating partial thickness (PT) burn wounds.

Methods
This retrospective, single-center, electronic health record review, included patients, if they were admitted between August 1, 2019 - January 31, 2020, at least 18 years old, and sustained a PT burn wound treated with WSD on admission. Pregnant or incarcerated patients were excluded. The WSD was applied following initial wound debridement, and then twice daily until either discharge or it was deemed burn wound excision would be required. PT tissue salvage was calculated from body mass index (BMI), PT total body surface area (TBSA) burned, and cm2 requiring autografting. SigmaPlot 11.0 was utilized for statistical analysis.

Results
Thirty-two patients were included. All but one patient had a TBSA burned less than 20% with median (IQR) of 6% (3.5,9). Fifteen also had some full thickness injuries. Seventy-eight percent had flame injuries; 19% contact. Two had inhalation injuries. All but four had a significant past medical and/or social history. Fifty-nine percent had a history of substance abuse and 22% had diabetes. Nine patients had a delayed admission. The median BMI was 26 (24.3,34.2). There were no deaths. Seven patients were discharged within 48 hours to complete outpatient treatment. Median length of stay was 7 days (4.8,12.8). There was lack of any full thickness conversion to the applied areas in 69% of patients; 91% demonstrated either complete or some tissue salvage. Median % PT tissue salvage was 100 (75.3,100). The WSD was well tolerated and no patients developed a wound infection to the applied area.

Conclusions
Understanding inherent design limitations, this case series demonstrates feasibility of early application, and potential efficacy preventing wound conversion in a complex population with comorbidities and polysubstance abuse.
556 The Use of a Concentrated Surfactant Based Gel to Promote Burn Wound Healing
Authors: Coffey Rebecca , Penny Rachel 
Published: April 2021

Abstract

Introduction
Strategies to remove necrotic tissue from burn wounds include excisional and non-excisional debridement. Alternative treatments could promote burn wound healing while minimizing patient discomfort and the need for surgery. We evaluated the usage of a concentrated surfactant gel (CSG) to promote burn wound healing in those with indeterminate depth and full thickness burn injuries.

Methods
An IRB approved retrospective study was conducted during a 10-patient new product trial period with enrollment between September and October 2019. Patients included in this study had indeterminate or full thickness burn wounds and were treated with a concentrated surfactant-based gel. Patients with non-burn diagnoses were excluded. Data collected included demographic information, injury descriptors, and additional burn wound characteristics.

Results
A total of 10 patients were included in this study as part of a new product trial. The subjects were 80% male with an average TBSA of 7.5%. 40% had indeterminate and 60% had full thickness burn wounds. Prior to initiation of the CSG, the burn wounds had been open for an average of 41 days. There were no infections or complications with usage of the CSG. 90% of patients reported less pain than the standard of care topical agents for burns. Average duration of treatment with the CSG until healing was 28 days. After usage of the CSG, no patients required surgery.

Conclusions
Our findings support the usage of a concentrated surfactant-based gel in patients with burn wounds. Patients reported decreased pain during dressing changes and ease of use compared to the standard topical agent in burn care. It also prevented surgical debridement in those with indeterminate and full thickness burn injuries.
560 Vacuum Assisted Dressing can be Used as an Effective Dressing Over Non-cultured, Autologous Skin Cell Suspension (ASCS) Combined with Wide Meshed Split Thickness Autografts (mSTSG)
Authors: Olivi Joe A , Rodgers Megan D 
Published: April 2021

Abstract

Introduction
There are accounts of various dressings being applied over epidermal spray cell suspension graft(s) (SCSG) with varying success and no one perfect dressing. We present 3 patients with ASCS grafts used in combination with mSTSG that were treated with vacuum assisted dressing with excellent outcomes.

Methods
All 3 of our patients received surgical debridement, down to healthy viable tissue with exposed tendon. BTM Dermal matrix was used in 2 of the 3 patients with exposed tendon. All three patients had mSTSG with ACSS autografts. All grafts were covered with telfa ™ clear, followed by tacky macroporous silver dressing, then a vacuum assisted closure device. These were left undisturbed until post operative day (POD) 5.

Results
All patients had their dressings taken down on POD #5 with excellent results. The interstices were closed quickly with no negative outcome noted from the vacuum dressings. All patients had excellent wound closure and good function postoperatively.

Conclusions
Vacuum assisted closure devices can be used to cover ASCS and wide meshed grafts with good outcomes. They provide patients with a stable dressing that does not need to be changed and leads to excellent graft take and wound closure.
562 Burn Bed Availability in the Northeast Region During the COVID-19 Pandemic
Authors: Lee Christina , Conlon Kathe M , Marano Michael A , Dimler Margaret A , Lee Robin , Houng Abraham 
Published: April 2021

Abstract

Introduction
The coronavirus disease pandemic has placed enormous strain on all medical services with ICU capabilities throughout the Northeast region. The surge in ICU beds might severely limit burn centers to accept burn patients in a regional mass casualty incident.

Methods
Burn bed data was collected by a regional burn disaster consortium. Open burn bed census was collected via telephone from each burn center in the consortium on April 15th, May 7th, May 21st, June 4th and June 18th of 2020. This data was compared to published data from 2009 to 2016.

Results
The results are listed in Table 1. Lowest available burn bed was 35 beds on April 15th, 2020.

Conclusions
Although a disaster may impact surrounding local and state hospitals, it does not always impact a burn center’s ability to transfer patients from a local trauma center or nearby burn center. A pandemic however affects a larger region and impacts all hospitals within that region.
Peak ICU utilization in the Northeast was between the second and third week of April. During the peak utilization time, burn bed census was about 50% of the historical average. Burn bed census did not return to historical average until May 7, 2020. If a mass casualty event occurred in the pandemic region, the Northeast region would have to reach out to other ABA designated regions for assistance.
Historically, burn mass casualty plans are based on the capacity to move burn patients to other burn centers in order to relieve surge capacity at the affected center. This data illustrates that, in a pandemic, burn beds are being utilized for non-burn patients. The ability to follow these plans will be greatly impacted.