bluuebunny/crossref_metadata_2025_split huggingface dataset:
70 Measuring Itch Intensity in Young Children with Burns: What We Learnt from Parents. A Mixed-Methods Study
Authors: Lin Yuting 
Published: April 2021

Abstract

Introduction
Despite the persistence and debilitating symptoms among inflicted children and their families, little is known about children’s itching behavior as perceived and described by parents. This study examined the parental description of young children’s itching behavior corresponding to the itch intensity rating, which can inform the future development of itch measurements for young children.

Methods
This analysis was part of a larger descriptive study that examined parental behavioral and psychological responses to children’s itch following the child’s unintentional burn injury. Parents of young children with deep second or third-degree burns were recruited. Parents were asked to rate the child’s itching intensity under four situations during the 7-day time frame using a 0–10 numerical rating scale (0 indicates no itch, and 10 indicates the worst itch possible). Parents were subsequently interviewed to describe the child’s observed behavior that reflected the itch intensity rating. The four itch situations were the current itch, the worst intense itch, the least intense itch, and the itch by a mosquito bite. Qualitative data were analyzed using inductive content analysis methods.

Results
Twenty parents of children 34 (±11.5) months old participated in the study. The average length of time since the child’s burn accident was 6.4 (±3.1) months. The mean ratings of the current itch, the worst intense itch, the least intense itch, and the itch by a mosquito bite were 3.45 (±2.4), 8.35 (±2.3), 1.5 (±1.7), and 4 (±1.2), respectively. Two themes that described a child’s itching behavior were identified: the level of a child’s needs for parental comfort and the frequency and disturbance (to activity and sleep) of scratching behavior.

Conclusions
Results suggest that the parent’s description of a child’s needs for parental comfort and scratching behaviors may serve as objective indicators of itching intensity. Interpreting inching intensive based on a child’s needs for parental comfort offered a creative way to evaluate itch considering the developmental perspective in young children. Future development of itch measures for children under 5 years of age shall consider these two important aspects.
72 Parent Behavioral Responses to Children’s Itching following Unintentional Burns: Persevering Through Devastation. A Mixed-Methods Study
Authors: Lin Yuting 
Published: April 2021

Abstract

Introduction
Postburn itch is one of the disturbing symptoms that persist throughout the burn wound healing period. Parents often assume the responsibility to respond to their child’s symptoms; consequently, their responses to their child’s symptoms contributed to the child’s symptom experience and long-term outcomes. To date, literature examining parental behaviors in response to symptoms has been limited to children with pain. This study examined parents’ behavioral responses to itching in young children with burns.
Methods:: This analysis was part of a larger descriptive study that examined parental behavioral and psychological responses to children’s itch following the child’s unintentional burn injury. Parents of young children with deep second or third-degree burns were recruited. Semi-structured interviews were conducted with parents to learn about parental behavioral responses to the child’s itching. The Adult Responses to Children’s Symptoms (ARCS) scale was used to evaluate parental responses as part of the interview. The ARCS scale consists of 29 items that allow parents to self-report their responses to children’s itch. However, four items were excluded: three items were not appropriate to the study sample; one item related to sleep because children’s sleep pattern has been dramatically disturbed. We used the inductive content analysis that adapted from Grounded Theory to analyze the data.

Results
Twenty parents of children 34 (±11.5) months with moderate to severe burns 11.2% (±8.7%) total burn surface area (TBSA) participated in the interview. The mean length of time since burn injury was 6.4 (±3.1) months. Persevering through Devastation was the core construct that captured the lived experience of parental itching management. Parental behavioral responses to their child’s itch involved shifting their children’s attention, touching the scar, and tending to the itching scar. Data triangulation revealed that the ARCS scale captured parent behaviors in response to their child’s itch that was not reported in the interview.

Conclusions
Parents were devastated when they struggled on their own to relieve their child’s incessant itching during the prolonged wound healing stage. They cared for children with perseverance in the face of traumatic burn event; however, some parents responded to their child’s distress and call for comfort with anger or reactive behavior.
77 Insurance Status Plays a Role in Burn Patient Disposition Following Burn Injury
Authors: Comish Paul B , Abraham Sarah , Meier Jennie , Arnoldo Brett , Carlson Deborah 
Published: April 2021

Abstract

Introduction
According to the Emergency Medical Treatment and Labor Act (EMTALA), patient insurance status has no role in stabilization and treatment of patients brought into the emergency department. However, uninsured patients with burn injuries are more likely than insured patients to face early hospital discharge, and less likely to receive care in skilled facilities for post-hospital rehabilitation. Following trauma, insured patients are more likely to have longer hospital lengths of stay (LOS) compared to uninsured patients, resulting in a loss of clinical equipoise. The purpose of this study was to evaluate whether insurance status affects morbidity, mortality, LOS, and post-discharge care for patients with burn injuries. We hypothesized that insured patients would experience fewer complications but would more frequently be referred to skilled facilities for extended post-discharge care.

Methods
We retrospectively queried our prospectively collected burn database for all patients suffering from burn trauma and admitted to our burn facility from July 2015-December 2015. Patients under the age of 18 years and those without documented insurance status were excluded. Our primary outcome was any complication. Secondary outcomes included LOS, ICU days, mortality, and disposition. Chi-square and multivariate logistic regression analyses were performed using Stata.

Results
A total of 451 patients were included (74% male, median age 51 years, TBSA 20% ± 1.1, 27% were uninsured). Univariate analysis showed that uninsured patients were less likely to have complications following burn injury, as well as less likely to have any comorbidities (28.5% vs. 40.6%, p=0.02; 55.3% vs. 72.3%, p=0.001, respectively). After controlling for confounding variables (Baux score, comorbidities, gender, and smoking) we found there was no association between complications and insurance status (OR 1.45, 95% CI 0.91–2.33). Using the same regression model, we secondarily found that there was a significant association between disposition after hospital admission and insurance status (OR 1.94, 95% CI 1.04–3.62) as well as an association between mortality and insurance status (OR 0.35, 95% CI 0.17–0.72).

Conclusions
At our institution, insurance status for burn patients was not associated with differences in length of stay or complications. Despite this, insured patients were more likely to be discharged to skilled facilities and less likely to die from burn injury. Disparate outcomes between insured and un-insured burn patients remain a significant concern, and more studies are needed to understand underlying etiologies.
82 The Significant Burden of Burn Injuries in the Middle East: An Epidemiological Study of Nineteen Countries over 27 Years
Authors: Collier Zachary J , Samaha Yasmina , Naidu Priyanka , Choi Katherine J , Pham Christopher H , Potokar Tom , Amarin Marzouq , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Despite ongoing improvements in burn care around the world, the burden of burn morbidity and mortality has remined a significant challenge in the Middle East due to ongoing conflicts, economic crises, social disparities, and dangerous living conditions. Here, we examine the epidemiology of burn injuries in the Middle East (ME) relative to socio-demographic index (SDI), age, and sex in order to better define regional hotspots that may benefit most from sustainability and capacity building initiatives.

Methods
Computational modeling from the 2017 Global Burden of Disease (GBD17) database was used to extrapolate burn data about the nineteen countries that define the ME. Using the GBD17, the yearly incidence, deaths, and Disability-Adjusted Life Years (DALYs) from 1990 to 2017 were defined with respect to age and sex as rates of cases, deaths, and years per 100,000 persons, respectively. Mortality ratio represents the percentage of deaths relative to incident cases. Data from 2017 was spatially mapped using heat-mapping for the region.

Results
Over 27 years in the ME, an estimated 18,289,496 burns and 308,361 deaths occurred causing 24.5 million DALYs. Burn incidence decreased by 5% globally but only 1% in the ME. Although global incidence continued to decline, most ME countries exhibit steady increases since 2004. Compared to global averages, higher mortality rates (2.8% vs 2.0%) and DALYs (205 vs 152 years) were observed in the Middle East during this time although the respective disparities narrowed by 95% and 42% by 2017. Yemen had the worst death and DALY rates all 27 years with 2 and 2.2 times the ME average, respectively. Sudan had the highest morality ratio (3.7%) for most of the study, twice the ME average (1.8%), followed by Yemen at 3.6%. Sex-specific incidence, deaths, and DALYs in the ME were higher compared to the global cohorts. ME women had the worst rates in all categories. With respect to age, all rates were worse in the ME age groups except in those under 5 years.

Conclusions
For almost three decades, ME burn incidence, deaths, DALYs, and mortality rates were consistently worse than global average. Despite the already significant differences for burn frequency and severity, especially in women and children, underreporting from countries who lack sufficient registry capabilities likely means that the rates are even worse than predicted.
85 Did Shelter-in-place Mandate Lead to an Increase in Suspected Abuse Cases?
Authors: Williams Felicia N , Sljivic Sanja , Chrisco Lori , Maxwell Eli , Hollowell Jamie , Nizamani Rabia , King Booker 
Published: April 2021

Abstract

Introduction
The shelter-in-place mandate to mitigate the effects from the 2019 severe acute respiratory syndrome coronavirus 2 was associated with an increase in admissions of school-aged children to our burn center but a decrease in adult admissions. It was unclear how many admissions were from suspected abuse. Our objective was to determine the social impact of the shelter-in-place mandate on the number of burn admissions secondary to suspected abuse during the COVID pandemic compared to previous years.

Methods
Patients were identified using Institutional Burn Center registry and linked to the clinical and administrative data. All patients admitted from January 1, 2016 to July 31, 2020 with suspected abuse were eligible for inclusion. Demographics, patient and burn characteristics were evaluated. Statistical analysis was performed with Students’ t-test, and chi-squared test.

Results
There were 7177 patients included in the study. Prior to 2020, each year the percentage of cases with suspected abuse decreased compared to previous years (19% decrease in 2017, 23% decrease in 2018, 30% decrease in 2019). Compared 2019, the number of patients admitted with suspected abuse during the COVID pandemic increased 257%, p=0.00046. There were no significant differences in race, ethnicity, sex, burn mechanism, or burn size in those admitted with abuse-related injuries. The average age of patients with abuse-related injuries in 2020 was 13 years old, compared to an average age of 28 years old for the period from 2016–2019 (p&lt; 0.003).

Conclusions
There is a significant increase in number of patients admitted for suspected abuse. Shelter-in-place mandate limited viral transmission of COVID-19 but led to unfathomable increases in abuse cases at our institution.
89 The Effect of Trauma Center Status and Burn Verification Process on Burn Patient Outcomes
Authors: Castillo-Angeles Manuel , Burns Christopher J , Kubasiak John C , Mehta Anupama , Riviello Robert , Salim Ali , Nitzschke Stephanie 
Published: April 2021

Abstract

Introduction
Burn center verification was implemented to ensure burn patients receive the best quality of care. As part of the of the organized burn care system, trauma centers that do not have a burn center within the hospital should refer burn patients to a designated burn center. However, more than 30% of burn patients are still being taken care of in non-verified burn centers. Our aim was to determine if trauma center status conferred a benefit in outcomes in a national sample of burn patients.

Methods
This is a retrospective study using State Inpatient Databases of 22 states in 2014. The inclusion criteria were all patients admitted for burn injury (ICD-9 codes 940–949). Hospitals were categorized as ABA verified centers (VBC) and non-verified burn centers (NVBC), as well as trauma centers (TC) and non-trauma centers (NTC) based on verification status at the time of admission. Main Outcomes were in-hospital mortality and length of hospitalization (LOS). Stratifying by burn center verification status, multivariable regression was used to identify the association between trauma center status and the outcomes.

Results
A total of 15,982 burn patients were identified. The overall in-hospital mortality rate was 2.45%. In our sample, we only had 26 hospitals that were both a TC and VBC (Table 1). The majority of patients (54%) were treated at a NVBC/TC. In unadjusted analysis, amongst verified centers, there was no difference in mortality between TC and NTCs (3.2% vs. 3.0%, p=0.877), but NTCs had longer LOS (14.7 vs. 10 d, p&lt; 0.001). Amongst non-verified centers, TCs had higher mortality when compared with NTCs (2.4% vs. 1.1%, p&lt; 0.001), but TCs had longer LOS (8.3 vs. 7.2 d, p=0.007). After adjusted analysis, within VBC, TC status was associated with shorter LOS (Coef -3.28, 95% CI -5.37 – -1.19, p=0.002), but not associated with mortality (OR 1.21, 95% CI 0.50 – 2.89, p=0.667). After adjusted analysis, within NVBC, TC status was associated with longer LOS (Coef 2.37, 95% CI 1.70 – 3.04, p&lt; 0.001) and with mortality (OR 3.70, 95% CI 2.10 – 6.51).

Conclusions
Trauma center status does not confer any benefit for burn patient outcomes within the burn care verification system. Despite the regionalization of burn care through the development of verified burn centers, the majority of burn patients are receiving care at trauma centers with a non-verified burn center within the hospital.
90 Discrepancies in Mortality Metrics Between National Datasets
Authors: Ozhathil Deepak K , Gutierrez Garret , Mulay Sagar R , Ahmed Adil , Song Juquan , El Ayadi Amina , Golovko George , Wolf Steven E 
Published: April 2021

Abstract

Introduction
The National Burn Repository (NBR) is the recognized standard for data collection models within the academic burn community. Despite its robust capabilities, the NBR poses challenges to access and exploration that can be intimidating to some researchers. As a result, user-friendly alternative databases have grown in popularity. We compared the NBR to two commercially available large datasets using the well-recognized relationship between age and total body surface area (TBSA) on mortality as our metric to assess correlation.

Methods
We accessed the TriNetX Global Health Research Network and queried the Diamond network (medical clearinghouses) and Research network (41 healthcare organizations (HCO)) for all-cause mortality within 3 years following burn injuries that occurring between 2000 – 2020 using ICD-10 codes (T31-32). We explored the distribution of TBSA and age across these cohorts and compared the variance in the distribution to the 2008–2017 NBR report using one proportion z-tests for each age-TBSA matched sub-group. We also compared demographics and lethal area for 50% mortality (LA50).

Results
The Diamond network identified 336,965 entries with an all-cause mortality rate of 3.21% and an LA50 of &lt; 10%. Demographics showed 50% male, 81% unknown race and a mean age of 39. In 2016 - 2017, 56,430 entries were reported. The Research network identified 114,778 entries with a mortality rate of 2.54% and an LA50 of &lt; 10%. Demographics showed 61% male, 58% white, 24% unknown and 16% black with a mean age of 37. In 2016 - 2017, 14,164 entries were reported. In comparison, the NBR database reported 185,239 entries with a mortality rate of 2.96% and an LA50 of &gt;70%. Demographics showed 67% male, 59% white and 3.6% unknown with a mean age between 20–29. In 2016 - 2017, 42,402 entries were reported. Comparison of mean mortality between age-TBSA matched subgroups in the Diamond and the Research networks relative to NBR showed correlation among pediatric populations but lacked significance.

Conclusions
The Diamond and Research networks are large datasets, which appear to be statistically different from the NBR dataset and are derived from different populations (insured patients, academic healthcare organization and accredited academic burn centers). The exact overlap between datasets is unknown, but demographics suggest that they are very different populations. The Figure depicts the relationship between age and TBSA on mortality for each database. Each database is large enough to achieve statistically significant conclusions, but caution should be used when contrasting conclusions between datasets due to the significant degree of divergence.
91 Current Practices and Beliefs Regarding Screening Burn Patients for Acute Stress Disorder and Post-Traumatic Stress Disorder: A Survey of the American Burn Association
Authors: Smith Mallory B , Wiechman Shelley A , Mandell Samuel P , Gibran Nicole S , Vavilala Monica , Rivara Frederick P 
Published: April 2021

Abstract

Introduction
The prevalence of Acute Stress Disorder (ASD) after burn injury may be up to 30% and the prevalence of Post-Traumatic Stress Disorder (PTSD) is as much as 40% at six months post-burn injury. The American Burn Association (ABA) published a consensus statement in 2013 recommending screening for ASD and PTSD in all patients with a burn injury. To our knowledge, the current practices of screening for ASD and PTSD in patients with burns is not known. This study aims to describe the current screening practices and provider beliefs regarding screening for stress disorders in burn patients in the US.

Methods
Interviews with psychologists and clinicians from our regional burn and injury center were utilized to generate a 31-question survey to assess burn center screening practices and provider beliefs regarding screening for ASD/PTSD. The Survey was approved by the ABA and distributed to its US membership in July 2020. Percentages of responses were generated, and chi-square tests were used to compare answers by profession type.

Results
There were 121 respondents out of 1500 recipients. The respondents were surgeons (27%), psychologists (6%), therapists or social workers (16%), nurses (31%), and advanced practice providers (13%). About half of the respondents (47%) worked at institutions that admit over 300 adult burn patients a year and had over 10 years of experience (52%). Seventy-five respondents (62%) indicated their institution formally screens for ASD and/or PTSD, 35 do not formally screen, and 11 respondents were unsure. Of the 35 centers that did not screen, the most common reason was a lack of mental healthcare providers (46%), lack of funding (26%) and lack of time (20%). The timing of screening, person administering the screening, and method of screening varied greatly across centers for pediatric and adult patients. Most respondents thought screening pediatric (83%) and adult (87%) patients with burns for ASD/PTSD was important, and 87% thought it should be standard of care. However, only 32% of respondents were comfortable screening pediatric patients and 62% were comfortable screening adults.

Conclusions
Whereas screening for ASD and PTSD is recommended for patients with burns, our study indicates that, despite general consensus that it should be, screening is not a current standard of care. Lack of mental health providers, funding, and time are contributing factors. Among those institutions that screen, a uniform screening protocol does not exist for pediatric or adult patients.
92 Is Virtual Burn Camp as Effective as In-Person Burn Camp?
Authors: Radics-Johnson Jennifer B , Zhang Li , Huang Anwen , Chacon Daniel W 
Published: April 2021

Abstract

Introduction
Burn camps provide a safe haven for child burn survivors to socialize and participate in recreational activities away from the unwanted stares from the public. But when a worldwide pandemic forced one of the world’s largest burn camps to forgo an in-person camp and pivot to a virtual camp, would the virtual burn camp prove as effective as an in-person burn camp?

Methods
In a 4-year retrospective review of camper evaluations within 2017–2020, we aimed to assess if the campers’ evaluation responses of virtual camp were consistent with their responses from past in-person camp evaluations. Camper self-evaluation forms were reviewed to record camper responses to questions regarding their opinions on camp. Camp rosters were reviewed to determine which campers attended virtual Burn Camp in 2020 as well as in-person Burn Camp among the years 2017–2019, and matched sample comparisons were reviewed (2020 vs. 2017; 2020 vs. 2018 and 2020 vs. 2019). Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To assess if the responses to each question were consistent between 2020 vs. 2017, 2018 and 2019, McNemar’s test was used. Statistical significance was declared based on a p value&lt; 0.05.

Results
Within 2017–2020, there were 444 camper evaluations submitted. In 2020, there were 137 registered campers. Sample size of this study was small due to a low response rate to evaluation form requests from virtual Burn Camp participants. There were 31 individual completed evaluations forms (23% response rate). Among 31 campers, 20, 22 and 20 campers attended 2017, 2018, and 2019 in-person Burn Camp, respectively.
Participants’ demographic characteristics are summarized in Table 1. Comparisons between 2020 vs. 2017, 2018 and 2019, in general, the campers’ responses were consistent. However, for Question #8 (Did you learn anything new from the other burn survivors at this event?) in 2020, more people (n=8) answered Not/A little while they answered Yes/Mostly in 2019 (p=0.046). Participants’ responses to Question#8 are summarized in Tables 2 and 3.

Conclusions
Virtual Burn Camp was generally as effective as in-person Burn Camp in almost all areas of assessment, except for the ability for burn-injured children to learn from other burn-injured children. The virtual Burn Camp model provided some interaction between counselors and campers, but did not allow for much interaction between campers, resulting in a greater response of “A Little” or “Not at All” to the question “Did you learn anything new from the other burn survivors at this event?”