bluuebunny/crossref_metadata_2025_split huggingface dataset:
25 Baseline Copper Levels are Associated with Worse Outcome in Burn Patients with Overweight and Obesity
Authors: Dhanasekara Chathurika S , Schrader Kaylee , Chandrahas Sheila , Aickareth Genesy , Dissanaike Sharmila D , Griswold John A 
Published: April 2021

Abstract

Introduction
While copper (Cu) has been shown to be beneficial in wound healing, high levels of circulating Cu are also associated with increased oxidative stress. Interestingly, elevated baseline Cu levels have been seen in obese patients, and theoretically, this is associated with higher baseline oxidative stress. Overweight (OW) and Obesity (OB) are common conditions in the US; therefore, a significant proportion of burn patients will be potentially affected. We examined the interactive effects of Cu and obesity on outcomes of burn patients; specifically, we hypothesized that higher baseline Cu levels in OW and OB burn patients are associated with worse clinical outcomes.

Methods
A retrospective review of patients with burns ≥20% TBSA between 2015–2019. Patients were grouped according to body mass index (BMI) (i.e., NW:18–24.9; OW:25–29.9; and OB: ≥ 30 kg/m2). Baseline characteristics were compared using ANOVA and χ 2 tests. The interactions between baseline Cu and BMI groups on 1) lengths of ICU stay (ICUS), 2) overall hospital stay (LOS), and 3) the number of operative procedures, were examined in a series of multiple regression models in R.

Results
Data of 160 patients met eligibility (NW: OW: OB = 53: 38: 69). BMI groups did not differ significantly on demographics, TBSA, degree of burn, inhalational injury, or mortality. Regression models revealed that NW patients with high baseline Cu levels had shorter ICUS (p&lt; 0.001) and LOS (p=0.003) and also had fewer operations (p = 0.001). While OW and OB were protective at low Cu levels, patients with OW or OB who had high baseline Cu levels had longer ICUS (p&lt; 0.001 and p=0.033), LOS (p=0.001 and p=0.063), and a greater number of operations (p&lt; 0.001 and p=0.066) (Table 1).

Conclusions
High baseline Cu seems to be beneficial for NW burn patients, yet associated with adverse outcomes in burn patients with OW and OB. While further evidence is needed to confirm this notion, caution is advised when supplementing Cu for burn patients with OW and OB.
43 COVID Crisis: A Burn Approach
Authors: Heffernan Jamie , Gallagher James 
Published: April 2021

Abstract

Introduction
The net effect of the COVID-19 pandemic on this northeastern, urban healthcare system during March, April and May 2020 was the redirection of virtually all resources to the care of the affected population. Conversion of the majority of the hospital’s assets, including staff and infrastructure, to COVID care created a large reduction in resources for other clinical problems. The burn service was among those few essential disciplines that continued to receive acutely affected individuals during the crisis. The preservation of the burn center’s ability to continue its mission within the walls of a COVID hospital is the subject of this review.

Methods
All of the hospital’s ICU rooms, including all those on the burn unit, post anesthesia care units, some step-down units, and over 90% of the operating rooms (ORs) converted to COVID care ICUs. These vital actions by hospital administration enabled an increase in ICU beds from 114 to 270. Staff were redeployed to cover the massive influx of critical COVID patients.
Burn inpatients during the transition were categorized by severity and age for disposition consideration. Of the 17 inpatients, 4 pediatric patients discharged home and 1 transferred to our associated children’s hospital; 7 adults discharged home, 2 transferred to our associated inpatient psychiatric hospital, 1 to inpatient rehab, and 2 transferred to a neighboring orthopedic hospital converted into an adult acute care hospital.
The commitment to keep the burn center operational for both children and adults was facilitated by protecting the burn ICU hydrotherapy room, a large patient care space in the center of the burn ICU. Children, initially admitted and cared for in the hydrotherapy room until stable, transferred to our network Children’s hospital for continued care. Critical adult burns were admitted to the inpatient ICU with the COVID patients, acute burns were housed on the few remaining medical surgical units. Burn care was performed in the patients’ rooms to keep the hydrotherapy room “clean”.

Results
During the 3-month period described the burn service admitted and cared for 92 adult and 25 pediatric patients while maintaining a full ICU census. Although 3 admitted burn patients were COVID +, no burn patients housed in the ICU became COVID + during their stay.

Conclusions
The commitment to protect the burn hydrotherapy space for burn triage and care from the top level of administration was critical and notable given the widespread conversion of the subspecialty ICUs and most other patient care areas to COVID care units. Strict adherence to infection prevention guidelines and protection of the hydrotherapy room allowed burn patients to receive timely and appropriate care during a pandemic.
51 We Test Everyone… Really? Bias in Drug Screening in an Academic Burn Center
Authors: Sloan Keturah , Greenhalgh David G , Sen Soman , Palmieri Tina L , Romanowski Kathleen S 
Published: April 2021

Abstract

Introduction
Previous studies have found that burn-injured patients who use illicit substances, such as methamphetamines, have worse outcomes and longer hospital lengths of stay when compared to those who do not use illicit drugs. It is our units’ stated practice to perform a urine drug screen on all patients admitted with a burn injury. We hypothesize that, while we intend to test all patients, we fall short of this goal. The purpose of this study is to examine our urine drug screening practices.

Methods
Following IRB approval, a retrospective chart review was conducted using electronic medical records of all adult patients admitted to the burn center from 2016–2018. Data collected included information on the burn injury, drug screening, and demographics. Due to the fact that many patients receive opioids and benzodiazepines for pain and anxiety related to their burn injury, these were not considered positive if present on drug screen without gas chromatography to confirm use. Data analysis was conducted using chi-square, t-test, and logistic regression models.

Results
A total of 1134 patients (mean age 45.9 ± 17.3 years, 855 males (75.4%), mean burn size (TBSA) 12.1±15.5%) were analyzed. Of the 1134 patients admitted, 65% had a urine drug screen performed. Of those who were not screened, 12.1% had a test ordered but not performed while 87.8% had no test ordered. Globally, amphetamines/methamphetamines were the most commonly detected substances in 262 patients (23.1%) followed by cocaine with 14 patients (0.2%) Those with larger burns were more likely to be tested with the mean burn size of those tested being 15.0% while the mean size of those not tested was 6.6%, p&lt; 0.0001. When looking at the effect of age on drug screening, those at the extremes of age (&lt; 20 years (37.5%), 61–70 years (38.9%), 71–80 years (51.5%) and &gt;80 years (76.9%)) were more likely to not be tested (p&lt; 0.0001). All other age groups had a rate of not testing between 30.3% and 33.3%. Additionally, overall men were more likely to be tested than women (68.3% vs. 54.8%, p&lt; 0.0001). On multivariate logistic regression, age (OR 0.99 (0.98–0.99), p&lt; 0.0001), burn size (OR 1.07 (1.05–1.08), p&lt; 0.0001), and female gender (OR 0.61 (0.45–0.81), p=0.0008) were independently associated with a patient receiving a urine drug screen.

Conclusions
Although our intention is to perform a urine drug screen on all patients admitted with burn injury, we fall short of this goal. A significant number of patients do not get tested and these tend to be older patients, those with smaller burns, and women. Given that drugs of abuse can alter patient outcomes we need to be more rigorous in our efforts to obtain tests on all patients.
65 Pain Management Practices in the Elderly Patient with Burn Injury
Authors: Hutchison Ciara , Gayed Rita , Mittal Rohit 
Published: April 2021

Abstract

Introduction
Opioids are key to pain management in burns but have increased side effects like falls and delirium in the elderly. However, comorbidities prevalent in this population (e.g., chronic kidney disease) limit use of non-opioid adjuncts, making pain control for these patients a difficult balance. Little data exists regarding pain control practices in elderly burn patients. We aim to retrospectively characterize pain management strategies (including opioids and non-opioid adjuncts) in this patient population.

Methods
This is a retrospective cohort of patients age &gt;65 with burns &lt; 20% total body surface area (TBSA) admitted to the burn stepdown unit from 2014 to 2019. The primary outcome was to quantify opioid use inpatient and at discharge in morphine milligram equivalents (MME). Secondary outcomes included percent of patients receiving opioids and adjunct analgesics at these timepoints. Mean MME inpatient vs. at discharge were compared using paired t-test. Percent of patients receiving opioids and non-opioid adjuncts were compared using McNemar’s test.

Results
One hundred elderly patients (mean age 73.9, SD 6.7) with mean TBSA of 5.6% (SD 4.5) were included. Fifty-two percent required autografting; the remainder received porcine or non-operative therapy. Mean daily inpatient MME was 18.0 (SD 20.8) and mean discharge MME was 28.0 (SD 20.5) (p=.001), equivalent to 12mg and 18.5mg of oral oxycodone. Inpatient, 72% of patients received opioids vs. 83% at discharge (p=.041). Acetaminophen was the most commonly prescribed non-opioid adjunct inpatient and at discharge; other adjuncts like non-steroidal anti-inflammatories (NSAIDs) and gabanoids were infrequently used.

Conclusions
Elderly burn patients are discharged with more opioids than utilized while inpatient. Aside from acetaminophen, non-opioid adjuncts used commonly in younger patients such as NSAIDs and gabanoid medications are under-utilized, presumably due to concern for comorbidities.
67 Identifying Risk Factors that Increase Analgesic Requirements at Discharge Among Patients with Burn Injuries
Authors: Yeung Celine , Kiss Alex , Rehou Sarah , Shahrohki Shahriar 
Published: April 2021

Abstract

Introduction
Opioids and neuropathic pain agents (NPAs) like gabapentin and pregabalin are commonly prescribed in large doses to achieve adequate pain control among patients with burn injuries. This patient population is therefore at greater risk of becoming dependent and misusing analgesics following their injuries. Factors that increase the risk of chronic use of opioids or NPAs among this patient population has not yet been characterized. The purpose of this study was to identify factors that increase the amount of analgesics required by patients with acute burn injuries at the time of discharge.

Methods
Patient charts from July 1, 2015 - 2018 were reviewed retrospectively to determine opioid and neuropathic pain agent (NPAs) requirements 24 hours before discharge (n = 199). Regression models were performed to determine whether the following risk factors increased analgesic requirements at discharge: surgical intervention; age; gender; TBSA; history of psychiatric disorder; and history of substance misuse.

Results
Patients with a history of substance misuse or who were managed surgically required higher doses of opioids at discharge compared to those without a history of misuse or those who were managed conservatively (p = 0.01 and 0.02, respectively). Similarly, patients who had undergone surgery required more NPAs compared to those who did not have surgical debridement of their injuries (p &lt; 0.001). For every percent increase in TBSA, patients required 14 mg more NPAs (p = 0.01). In contrast, older patients and those with a longer hospital stay required fewer amounts of NPAs before they were discharged from hospital. For every increase in years of age, patients required on average 7 mg less NPAs (p = 0.006), and for each additional day in a patient’s length of stay, patients required 6 mg less NPAs (p = 0.009).

Conclusions
Predictors of high analgesic requirements at discharge include patients with a history of substance misuse, those who underwent surgical debridement of their burn injuries, and patients with higher TBSA. Characterizing patient risk factors that increase analgesic requirements may help burn care providers tailor how much narcotics and NPAs to prescribe each patient at discharge.
74 Epidemiology and Outcomes of Cooking and Cookstove-related Burn Injuries: A World Health Organization (WHO) Global Burn Registry (GBR) Report
Authors: Mehta Kajal , Thrikutam Nikitha , Nakarmi Kiran K , Hoyte-Williams Paa Ekow , Peck Michael , Stewart Barclay T 
Published: April 2021

Abstract

Introduction
Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally. A cookstove is any apparatus that provides heat and is used for cooking (e.g., three-stone fire, traditional or improved cookstove). There are limited data on patterns of cooking behaviors and CSBs to inform prevention initiatives and advocacy. We aimed to describe the epidemiology, risk factors and outcomes of cooking-related burns and CSBs, specifically.

Methods
Patients with cooking and non-cooking related burns from 2018 to 2020 were identified in the World Health Organization (WHO) Global Burn Registry (GBR). Patient demographics, cooking arrangement, injury characteristics [mechanism, total body surface area (TBSA), revised Baux score] and outcomes were described. Differences in proportions and medians were compared. Bivariate regression was performed to identify risk factors associated with occurrence of CSB.

Results
GBR contained data of 6,965 burn-injured patients from 17 countries; 88% were from middle-income countries. One quarter of burn injuries (1,723 burns) were cooking-related. More than half of cooking-related burns (55%) occurred in females. Median age for cooking-related burns was 11 years (IQR 2–35). Of cooking-related burns, 22% were cookstove-related burns (CSBs; 311 burns). The most common mechanism in CSB was flame (87%), whereas the most common mechanism in other cooking burns was scald (62%). Patients with CSBs were more often female (65% vs 53%; p&lt; 0.001) and much older than patients with other cooking burns (32 years, IQR 22–47 vs 5 years, IQR 2–30). CSBs were significantly larger in TBSA size (30%, IQR 15–45% vs 15%, IQR 10–25%; p&lt; 0.001), had higher revised Baux scores (70, IQR 46–95 vs 28, IQR 10–25; p&lt; 0.001) and more often resulted in death (41 vs 11%; p&lt; 0.001) than other cooking burns (Table1). Patients with CSBs were more likely to be burned by fires (OR 4.74; 95% CI 2.99–7.54) and explosions (OR 2.91, 95% CI 2.03–4.18) than other cooking injuries. Kerosene had the highest odds of CSB than all other cooking fuels (OR 2.37, 95% CI 1.52–3.69).

Conclusions
Cooking-related burns are common and have different epidemiology than CSBs, specifically (e.g., more often female, older, larger burn size, higher mortality). CSBs were more likely caused by structural factors (e.g., explosion, fire) than behavioral factors (e.g., accidental movements) when compared to other cooking burns.
76 Survival Outcomes from Burn Injury in Rural Africa
Authors: Hunter Mary A , Sylvester Kimutai , Vivier Patrick M , Harrington David T , White Russell , Parker Robert K 
Published: April 2021

Abstract

Introduction
Burn injuries contribute a considerable burden of disease in variable-resource settings, often resulting in mortality. Despite contributing a substantial burden, outcomes from burn injuries in rural Africa are rarely described. The objective of this study was to examine factors associated with mortality from burn injury in rural Africa.

Methods
A retrospective chart review was conducted for all patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in eastern Africa. Bivariate analysis was used to compare patients who survived the hospital stay with those who did not. Using total body surface area (TBSA), the LD50 (Lethal Dose 50, burn size with a lethality of 50% of patients), and the modified-Baux score were calculated. Due to small sample size, lasso inference techniques for logistic regression were utilized to avoid overfitting a model and to determine relevant risk factors for mortality, by evaluating burn severity, age, sex, location of residence, payer status, time from injury to arrival, distance from hospital, presence of full thickness burns, inhalational injury, and referral status.

Results
A total 171 burn injury patients were reviewed for this study; two were excluded due to missing data. Among 169 patients, 14.8% (n=25) experienced mortality prior to hospital discharge. Fifty patients suffered an adverse event (29.6%) including: 17 wound infections, 10 urinary tract infections, 10 with sepsis, and 25 with respiratory complications. The LD50 for TBSA was 42%. The LD50 for the modified-Baux score was 81. Non-survivors had higher average TBSA (31.0±5.0% vs 11.5±0.8%; p&lt; 0.01), more inhalational injury (44% vs 2.8%, p&lt; 0.01), full-thickness burns (56.5% vs 23.9%, p&lt; 0.01), and complications (88% vs 19.4%, p&lt; 0.01). Odds of mortality increased 1.06 times for every percent increase in TBSA burn (95%CI: 1.02, 1.11; p&lt; 0.01) and 13.9 times with inhalational injury (95%CI: 3.4, 56.4; p &lt; 0.01).

Conclusions
Mortality from burn injury represents a substantial portion of patients at a hospital in rural Africa. Factors of larger TBSA and inhalational injury represent the greatest risk.
96 Relation of Coping Strategies to Social Functioning and Self-Concept in Pediatric Burn Survivors
Authors: Snider Mira , Young Sarah , Enlow Paul , Ahrabi-Nejad Corrine , Leonard Linda , Aballay Ariel , Duncan Christina 
Published: April 2021

Abstract

Introduction
Burn survivors can experience challenges in social functioning (e.g., bullying, stigmatization) and self-concept (e.g., body image concerns). Use of coping strategies is associated with engagement in social supports and positive self-concept in pediatric oncology and physical injury populations; however, their relation has not been examined in pediatric burn survivors. This study aims to explore coping as it relates to social functioning and self-concept in these youth.

Methods
Fifty-one pediatric burn survivors aged 7–17 years (M=12.53; SD=2.68), and their primary caregiver participated. Youth and caregivers completed questionnaires, including the Child Coping Strategies Checklist (CCSC; youth report); the Burn Injury Social Questionnaire (BISQ; parent & youth report; higher scores = more social problems); and the Piers-Harris Children’s Self-Concept Scale-2 (PH-2; youth report). Associations between the BISQ, coping strategies (Active, Avoidance, Distraction, Support), self-concept, yearly family income, and burn injury characteristics (e.g., total body surface area; TBSA, participant grafting) were examined via bivariate correlations. Hierarchical linear regression was used to examine whether coping strategies (with significant bivariate correlations) predicted BISQ and PH-2 scores above and beyond burn injury and demographic variables. Three hierarchical regression models were run, one each for parent- and youth-report BISQ and youth-report PH-2 scores.

Results
Our sample is predominantly male (62.7%) and Caucasian (82.4%) with average TBSA of 8.74% (SD=11.02). Parent- and youth-reports on the BISQ were positively correlated with TBSA (r=.61 and .37, respectively) and negatively correlated with family income (r=-.37 and -.36, respectively). Parents of youth who had a skin graft reported higher BISQ scores (rho=.34). Distraction coping was significantly associated with youth-reported BISQ scores (r=-.31); no coping strategies were correlated with parent-report BISQ scores. In regression models, TBSA significantly predicted of parent-report BISQ (B=.27, p&lt; .001). Higher family income (B=-.40, p=.04) and greater distraction coping (B=-3.41, p=.004) significantly predicted better youth-report BISQ scores. Greater active coping significantly predicted better self-concept (B=6.21, p=.01).

Conclusions
Results suggest that use of positive coping strategies relates to better youth-reported social functioning and youth-reported self-concept after burn injury in addition to injury characteristics and socioeconomic variables.
126 Early Transcriptomic Response to Burn injury: Prolonged Inflammatory Response is Associated with Mortality
Authors: Keyloun John W , Campbell Ross , Detwiler Leanne , Miller Stacy-Ann , Guatam Aarti , Moffatt Lauren T , Carney Bonnie C , Hammamieh Rasha , Jett Marti , Shupp Jeffrey W 
Published: April 2021

Abstract

Introduction
Burn injuries are associated with high morbidity and mortality. Burn care has improved significantly in the last few decades with emphasis on early surgical management, improvements in local wound care, and specialized critical care. While survival rates are improving, mortality remains high in certain patient populations, including those with larger burns. Burn injury induces a systemic hyperinflammatory response with detrimental side effects. Prior studies have offered early insights into the biochemical changes that occur after severe burn injury. The underlying cellular response is still largely unknown. The goal of this work is to characterize the blood transcriptome of severe burn injury and compare this response between patients who live or subsequently die of their injuries.

Methods
Burn patients presenting to a regional center between 2012–2017 were prospectively enrolled. Blood was collected on admission and at predetermined timepoints (Hours 2, 4, 8, 12, 24) over the first 24 hours. mRNA was isolated and a transcriptomic microarray was used to measure global transcript levels over time. To identify differentially regulated genes (FDR≤0.1) by injury severity, patients were grouped by burn size (TBSA &gt;20%) and mortality. Microarray data was analyzed using bioinformatics software and pathway analysis. Descriptive statistics were generated with Mann-Whitney, Chi-Square, and Fisher’s exact test as appropriate.

Results
Sixty-eight patients were included in this analysis, most patients were male with a median age of 41 (IQR, 30.5–58.5) years, and TBSA of 20% (IQR, 11–34%). Thirty-five patients suffered %TBSA injury &gt;20%, and this group experienced greater mortality (26% vs. 3%, p=0.008). There were no significant differences in age, race, or gender. Comparative analysis of genes from patients with &lt; /&gt;20% TBSA revealed 1250, 444, 209, 20, 865, and 557 differentially regulated genes at hours 0, 2, 4, 8, 12 and 24 respectively. Pathway analysis reveals an initial upregulation in several immune/inflammatory pathways within the &gt;20% TBSA groups between hours 0–2 followed by shutdown between hours 12–24. Immune pathways include Th17 activation pathway and natural killer cell signaling, inflammatory pathways include EIF2 signaling. These pathways remain upregulated in the group of patients with &gt;20% TBSA who died.

Conclusions
Severe burn injury is associated with an early proinflammatory immune response followed by shutdown of these pathways. Burn patients who die show continued upregulation in the first 24 hours after injury in several proinflammatory pathways compared to those who live.