bluuebunny/crossref_metadata_2025_split huggingface dataset:
598 Temperature profiles of sunlight-exposed surfaces in a desert climate: Determining the risks for pavement burns.
Authors: Chestovich Paul J , Saroukhanoff Richard Z , Saquib Syed F , Carroll Joseph T , Flores Carmen E , Moujaes Samir F 
Published: April 2021

Abstract

Introduction
In the desert climates of the United States, plentiful sunlight and high summer temperatures cause significant burn injuries from hot pavement and other surfaces. Although it is well known that surfaces reach temperatures sufficient to cause full-thickness burns, the peak temperature, time of day, and highest risk materials is not well described. This work measured continuous temperature measurements of six materials in a desert climate over a five-month period.

Methods
Six different solid materials common in an urban environment were utilized for measurement. Asphalt, brick, concrete, sand, porous rock, and galvanized metal were equipped with thermocouples attached to a data acquisition module. All solid materials except metal were placed in a 2’x2’x3.5” form, and identical samples were placed in both shade and direct sunlight. Ambient temperature was recorded, and sunlight intensity was measured using a pyranometer. Measurement time interval was set at three minutes. A computational fluid dynamics (CFD) model was created using Star CCM+ to validate the data. Contour plots of temperature, solar irradiance, and time of day were created using MiniTab for all surfaces tested.

Results
75,000 temperature measurements were obtained from March through August 2020. Maximum recorded temperatures for sunlight-exposed samples of porous rock was 170 F, asphalt 166 F, brick 152 F, concrete 144 F, metal 144 F, and sand 143 F. Peak temperatures were recorded on August 6, 2020 at 2:10 pm, when ambient temperature was 120 F and sunlight intensity 940 W/m2 (Table). Temperatures ranged from 36 F - 56 F higher than identical materials in the shade at the same time. The highest daily temperatures were achieved between 2:00 pm to 4:00 pm due to maximum solar irradiance. Contour plots of surface temperature as function of solar irradiation and time of day were created for all surfaces tested. Nearly identical results obtained from the CFD models to the experimentally collected data, which validated the experimental data.

Conclusions
Surfaces exposed to direct, continuous sunlight in a desert climate achieve temperatures from 143 F to 170 F in the early afternoon and are high enough to cause significant injury with sufficient exposure. Porous rock reached the highest temperature, followed closely by asphalt. This information is useful to inform the public of the dangers of exposed surfaces in a desert climate.
599 A Retrospective Outcome Analysis of the Involvement of Department of Child Services in Suspected Cases at a Major Regional Pediatric Burn Center
Authors: Senthil-Kumar Prabhu , Zieger Madeline , Shostrand Lisa M , Hartman Brett C 
Published: April 2021

Abstract

Introduction
Cases of child abuse are an important manifestation of pediatric burns owing to their nature and all too common occurrence. In our institution, the Department of Child Services (DCS) is often frequently involved in minimally suspicious cases in conjunction with or even before the internal child protective team involvement. To our knowledge, there is no recent literature evaluating the outcome of DCS involvement in suspected cases in pediatric burn populations.

Methods
We performed a retrospective chart analysis of the pediatric burn patient database at our institution from 2017–2020. We identified 116 out of 565 patients who matched our criteria for the involvement of DCS. We collected the following information: age, race, address at time of injury, payer source, where DCS involvement was initiated, and the outcome of the investigation.

Results
We found that 20.5 % of all the pediatric burn patients admitted from 2017–2020 had DCS involvement. Of the total admitted patients only 3.8% were removed from the previous caregivers. The factors that were found to be statistically significant were male sex, age under 3 years, Caucasian child with single parent and living in an urban setting. A higher incidence was noted in the capital city area compared to the rest of the state. There was no statistical difference noted among races, location of DCS notification, and payer source.

Conclusions
We conclude that vigilance and early reporting is essential in detecting child abuse. Involvement of the multidisciplinary child protection team at our institution may reduce the burden on DCS. Screening out high risk factors such as age less than 3 years old, male sex, and single parent of Caucasian race may assist in detecting the non-accidental burn victims. We will target prevention educational outreach programs to the community to decrease the occurrence of child abuse in the future.
600 Social Determinants and Their Impact on Burn Surgery Outcomes
Authors: Quiroga Luis H , Lagziel Tomer , Asif Mohammed , Fang Raymond , Rozycki Grace F , Hultman Charles S 
Published: April 2021

Abstract

Introduction
To our knowledge, no studies have been conducted assessing the social determinants of health and the impact on the outcomes for burn patients. Such studies are needed considering burn injuries are associated with high costs, severe psychological impact, and a high burden placed on the healthcare systems. The burden is hypothesized to be aggravated by the increasing amount of diabetes and obesity seen in the general population which put patients at increased risk for developing chronic wounds. Studies have shown that several socioeconomic status (SES) factors are associated with increased risk of burns, but none have documented the outcomes of burn patients based on their social determinants of health. In our study, we will be comparing patients in the burn ICU (BICU) to patients in the surgical ICU (SICU). The purpose of this comparison is to evaluate whether the same social determinants of health have similar influences in both groups.

Methods
We performed a retrospective analysis of population group data from patients admitted to the BICU and SICU from January 1, 2016, to November 18, 2019. The primary outcomes were length-of-stay (LOS), mortality, 30-day-readmission, and hospital charges. Pearson’s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups.

Results
We analyzed a total of 487 burn and 510 surgical patients. When comparing BICU and SICU patients, we observed significantly higher mean hospital charges and LOS in burn patients with a history of mental health (mean difference: $42,756.04, p=0.013 and 7.12 days, p=0.0085), ESRD ($57,8124.7, p=0.0047 and 78.62 days, p=0.0104), sepsis ($168,825.19, p=&lt; 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=&lt; 0.001 and 72.9 days, p=0.002). Also, higher mortality was observed in burn patients with ESRD, STEMI, sepsis, VTE, and diabetes mellitus. Burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus also had greater 30-day-readmissions rates.

Conclusions
This study sheds new knowledge on the considerable variability that exists between the different population health groups in terms of outcomes for each cohort of critically ill patients. It demonstrates the impacts of population health group on outcomes. These population groups and social determinants have different effects on BICU versus SICU patients and this study provides supporting evidence for the need to identify and develop new strategies to decrease overspending in healthcare. Further research to develop relevant and timely interventions that can improve these outcomes.
604 Epidemiology and Microbiologic Profile of Pediatric Burn Patients: Eight-years’ Experience in a Tertiary Hospital
Authors: Santos Stephen Matthew B , Jumao-as Jed-Waylon L 
Published: April 2021

Abstract

Introduction
Burn injury is major morbidity and is the third most common cause of mortality among the pediatric population.

Methods
This study retrospectively analyzed pediatric burn admissions from a tertiary hospital in an 8-year period from 2009–2016. A total of 218 pediatric patients were reviewed for demographics, burn incidence, characteristics, cause of burn and microbiologic profile.

Results
There were 107(49.08%) Infants, 47 (21.56%)Toddlers, 32 (14.68%) Preschoolers, 17 (7.79%) belonged to school age and 15 (6.88%) were adolescent. Most of the admitted patients were within the city 122 (56%) while 96 (44%) were from other localities outside the city. Scald burn was the most common cause of burn with 160 (73.39%) cases and was highest in the infant age group (49.8%). The mean total body surface area was 10%, the highest being caused by flame burn at 13% TBSA among toddlers and preschoolers having the highest total body surface area involved (12%). The most commonly involved body area is the chest (13.6%). The mean transfer time from injury to the admission of patients coming from within and outside the city was 8.8 and 28 hours respectively. The mean length of hospital stay was 9.08 days. There was also a decrease in mean transfer time and hospital stay from 2009 to 2016. Flame burn accounted for the longest hospital stay at 20.27 days. Microbiologic profile of burn wound cultures showed a predominance of gram-negative rods (90%) with Enterobacter cloacae and Klebsiella pneumonia as common isolates. Culture studies also showed amoxicillin-clavulanic, ampicillin-sulbactam, and cefuroxime have the highest resistance, while most isolates are still susceptible to Amikacin, Ertapenem, Meropenem, and Ciprofloxacin.

Conclusions
Patients belonging to the school-age group has the highest mean number of hospital days (27.3 days). On review of culture study results from wound tissue samples, Gram-negative rods were the most common and Enterobacter cloacae were the most common isolate. Antibiotics such as Amoxicillin clavulanic, ampicillin-sulbactam, cefuroxime, and ceftazidime had high resistance rates and therefore should not be initially used for patients suspecting of the infected burn wound.
607 Characteristics of Pediatric Burn Patients with Child Protective Services Involvement at an Academic Children’s Hospital
Authors: Sundesha Aashna , Seivert Nicholas , Ziegfeld Susan , Green Katerina , Garcia Alejandro , Thompson B Simone , Parrish Carisa 
Published: April 2021

Abstract

Introduction
Pediatric burns are typically accidental, but burns caused by caregiver abuse/neglect represent a significant proportion of patients. Literature on risk factors most associated with these injuries include younger age, male, African American, and larger burns. This study examined child and burn injury factors that were associated with Child Protective Services (CPS) involvement at an urban, academic children’s hospital.

Methods
At this institution, decision to report a burn patient to CPS is determined by a multi-disciplinary medical team. Criteria for referral is multifactorial and may include burn patterns consistent with forced immersion, a reported mechanism that does not match the burn pattern or the patient’s developmental capabilities, concern for lack of supervision, or a delay in seeking medical care. Data from inpatient admissions over a 3-year period (July 2016 – June 2019) were extracted from hospital charts, and analyses (chi-square, t-tests) examined age, sex, total body surface area (TBSA), burn severity, length of stay, insurance type, race/ethnicity, and whether a CPS report was made (i.e., yes/no). Records for the outcome and disposition of the CPS case, such as whether the CPS investigation confirmed the abuse/neglect allegations, were not readily available as the law requires confidentiality.

Results
389 children were admitted for burn treatment. 80% had partial-thickness burns; 33% White, 43% Black, 62% male; 10% had CPS involvement. 72% had Medicaid/other government insurance, 23% had private/commercial, 4% were uncovered, and 1% insurance status unknown. Medicaid/government insurance was overrepresented among burns compared to other inpatients at the hospital (72% vs 51%). Consistent with previous findings, CPS reports involved children who were younger (2.8 vs 4.8 years), had greater TBSA (8.4% vs 4.9%), and had longer admissions (7.5 vs 3.0 days). Children with Medicaid/governmental or no insurance were more likely to have CPS reports than commercial/private insurance (97% vs 3%). Importantly, contrary to prior findings, child sex, child ethnicity, and burn thickness were not significantly different between children with and without CPS reports.

Conclusions
Younger children with bigger burns and longer admissions were most associated with CPS involvement. Historical findings on risk factors of male sex, African American ethnicity, and greater burn thickness were not replicated. Prior literature may not be generalizable to many settings; the current study provides an important update. Further research is needed to examine outcomes of CPS involvement and long-term patient health outcomes. Findings are limited to only urban, inpatient pediatric burns.
612 Non-burn Injuries in the Emergency Department as Indicators for Future Burn Abuse
Authors: Rodriguez Guillermo , Ridelman Elika , Klein Justin D , Shanti Christina M 
Published: April 2021

Abstract

Introduction
Thermal burns are a common form of child abuse. They account for up to 20% of all abuse cases reported and are a significant cause of morbidity and mortality. It is imperative that healthcare professionals maintain a high degree of vigilance recognizing signs of abuse, however subtle they may be. This is necessary to protect these vulnerable patients and prevent further injury. Our study seeks to identify predictors of future abuse in patients presenting to the emergency department. This might allow us to identify at risk patients and employ earlier interventions to prevent future harm.

Methods
A retrospective data review was conducted on all pediatric patients admitted to our burn center between 2008–2018 who were also suspected victims of abuse. Data collected included patient demographics, length of stay, size of the burn, type, degree and location of burn, number of previous emergency room visits, and patterns of injury during previous emergency room visits. Abuse was suspected and investigated if the history was inconsistent with the injury or if it changed, if there was an unreasonable delay in seeking medical care. or if the patient was discharged to an alternative caregiver. Data was analyzed with SPSS Statistics version 10.

Results
Out of the 5915 total burn admissions between 2008–2018, abuse was suspected and investigated in 297 cases and confirmed in 131 of those suspected. Patients admitted for suspicious burn injuries had an average of 1.82 (SD=3.15, Min=0, Max=25) previous ED visits. Of these patients, 93.6% had medical insurance, 80.5% had a primary care physician, and 72.7% were up to date with their immunizations. The majority presented with 2nd degree burns (86.5%) and the most common mechanism of injury was scald (60.1%). Pediatric patients with confirmed abusive burn injuries had longer hospital length of stay (9.23 days vs. 3.90 days, p&lt; 0.001), and had greater total body surfaced area burned (9.24% vs 4.71%, p=0.001). Significant indicators of abuse included burn injuries to the bilateral lower extremities (thigh and legs) (p&lt; 0.001), bilateral feet (p=0.030), buttocks (p=0.047), and genitalia (p=0.018), as well as signs of abusive non-burn injuries during previous emergency room visits (p=0.005).

Conclusions
Non-accidental burns should be highly suspected in children presenting with injuries to the bilateral lower extremities, bilateral feet, buttocks, or genitalia, or those with a history of previous non-burn injuries suspicious of abuse. Furthermore, patients with non-accidental burn injuries had more extensive burns and longer lengths of stay in the hospital.
617 Who Benefits the Most from Burn Camps?
Authors: Radics-Johnson Jennifer B , Chacon Daniel W , Zhang Li 
Published: April 2021

Abstract

Introduction
Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child.

Methods
A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value&lt; 0.5.

Results
Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32).
There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?”

Conclusions
In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.
618 Clinical and Humanistic Burdens of Pediatric Burns: A Systematic Literature Review
Authors: Hahn Helen , Yu Tzy-Chyi , Rutan Randi L , Salyer David L 
Published: April 2021

Abstract

Introduction
Children face long-term clinical and psychological sequelae from burn injuries. This review summarizes the scientific literature on the clinical and humanistic burdens of pediatric burns.

Methods
A systematic review of literature published between Jan 2015 and Jun 2020 was conducted based on PRISMA guidelines in Embase, Biosis, and MEDLINE to identify publications examining the clinical, humanistic, economic, and/or epidemiologic burdens of illness associated with pediatric burns in the US.

Results
Of 2,286 unique articles identified, 28 met eligibility criteria. This analysis focused on studies relating to the clinical (n=8) and humanistic (n=9) burdens of pediatric burns. Across all studies, flame and scald were the most common burn etiologies. Among the 8 clinical studies, several evaluated outcomes (n=2) or treatments (n=3) in predominantly graft recipients. One study found that 64% of pediatric split-thickness autograft recipients exhibited hypertrophic scarring (HTS) at the donor site. Other variables (time to re-epithelialization, donor-site harvest depth, harvest in an acute burn care setting, thigh donor-site location) were associated with increased risk of HTS. An increase in percentage total body surface area (%TBSA) burned corresponded to increased number of autograft procedures, risk for HTS, and viral infection risk. Other reported outcomes included infections (eg, healthcare-associated, wound, viral), pain, inhalation injury, and sepsis. One study found that while the frequency and intensity of pruritis decreased over time, 63% of children continued to report symptoms at 2 years after injury. Among the 9 humanistic studies, 4 reported larger %TBSA corresponded to worse health-related quality of life assessed by various instruments. In a study of patients under age 5 with burns, Burns Outcomes Questionnaire (0–4) scores improved over time in multiple domains. In youth with a history of burn injuries, patient-reported pain interference with daily living was significantly associated with decreased physical functioning, depression, and impaired peer relationships. Two studies assessed caregiver burden, with one study finding that 19% of caregivers self-reported clinical or at-risk levels of distress following the child’s burn injury.

Conclusions
Pediatric burns place a substantial clinical and humanistic burden on patients and their caregivers. While outcomes appeared to improve over time, clinical and humanistic consequences of pediatric burns endured. More research on novel treatment products and procedures is needed to reduce the burden of burns for this population.
619 The Impact of Global / National Phenomena on Young Burn Survivors and their Families
Authors: Jackson Brad , Mikolaj Kerry , Boulter Trudy , Mayer Nichole F 
Published: April 2021

Abstract

Introduction
2020 brought numerous challenges for burn survivors and their families. This project assessed the impact of two major global / national phenomena, specifically the impact of a) COVID-19 and b) local / community / national actions around racism and policing on child and youth burn survivors and their families.

Methods
Our burn camp program moved to a virtual format for 2020. Campers (ages 8 – 18) and their caregivers / parents completed questionnaires about their year, rating and specifying the personal impacts of these phenomena. They rated how their year has been overall and selected “what has helped you get through tough times”. 47 campers and 47 caregivers / parents participated.
Results:
Impact of COVID-19
The majority of youth rated the impact of COVID-19 as “somewhat” to “highly” (78%), while the majority of caregivers rated “somewhat” (64%). Campers and caregivers identified the following impacts most often and to similar degrees: Online school/virtual learning, Friends/Social, Sports/Activities, Quarantine, Isolation, Worries, Quality time with family. Caregivers also highlighted: Getting creative at home and Uncertainties.
Impact of local / community / national actions around racism and policing on you and your family
The majority of campers and caregivers rated the impact as “Somewhat”, “Very Little” or “Not Impacted” (86%), although participants rating higher impact also provided moving personal experiences.
What has helped you get through tough times this year
Over 85% of campers and caregivers / parents rated their year overall as “OK” or “Pretty Good”.
Campers and caregivers endorsed Family, Friends, Faith, and What I learned recovering from my burn injury as factors helping them get through tough times.

Conclusions
Children, youth, and families who have experienced a burn injury report both negative and positive impacts from the global and national phenomena of COVID-19 and local / community / national actions around racism and policing. Not all youth and families are equally impacted. Family and friends were the greatest sources of support during tough times. One burn survivor family indicated that what they learned recovering from burn injury has helped them through this challenging year – “I have learned to just adapt and change because anything can happen at any point.” Most burn survivors and their families indicate the year has been “OK” or “pretty good”. Connection through burn camp provided the opportunity to share the impacts, but also the strengths and resiliencies in our burn community.