bluuebunny/crossref_metadata_2025_split huggingface dataset:
124 Autologous Skin Cell Suspension Achieves Closure of Donor Site Wounds Facilitating Early Re-harvesting for Large TBSA burn Injuries
Authors: Foster Kevin N , Molnar Joseph , Hickerson William L , Lee Jeanne , Hartman Brett C , Carter Jeffrey E , Kahn Steven , Sood Rajiv , Coffman Beretta C , Holmes James H 
Published: April 2021

Abstract

Introduction
Management of extensive burn injuries is complicated often resulting in significant morbidity and mortality. Current standard of care includes use of split-thickness skin grafts (STSG) to obtain definitive closure; however, this treatment is often limited by donor site availability, which requires repeated re-harvesting of donor sites to obtain definitive closure in large total body surface area injuries. Additionally, this limitation often leads to increased risk of infection, hypertrophic scarring, and extended hospital length of stay.
Autologous skin cell suspension (ASCS) prepared using the autologous cell harvesting device is an FDA approved point-of-care regenerative medicine technology that significantly reduces donor skin requirements to achieve definitive closure in acute thermal burn injuries across small and large burns. A prospective uncontrolled observational study (IDE 15945—NCT02992249) was conducted in which patients with life-threatening burn injuries were treated with ASCS. In this study, clinical outcomes were evaluated when ASCS was used in combination with wide meshed autografts for burn site treatment. Within the study, a subset of donor sites was also treated with ASCS and the purpose of the current work was to evaluate the clinical outcomes obtained to better understand impact on healing times and effect of re-harvesting in this compromised patient population.

Methods
ASCS was applied to the donor site after harvesting of split-thickness skin grafts. Clinical outcomes out to one year were evaluated, including the percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events.

Results
Subjects (n=96) from 22 burn centers received ASCS as part of their donor site treatment regimen (n=528). Mean subject baseline demographics were: 30.2 years of age, 54.0 ± 17.4% TBSA injury, and 89.4 ± 32.9 Baux score with 37% of subjects having a score greater than 100.
Percentage of donor sites healed, defined as &gt;95% re-epithelialization, was 37.1% and 82.7% after week 1 and week 2, respectively. Approximately 20% of the donor sites treated with ASCS were re-harvested multiple times following initial healing (up to four times). Of these donor sites 39.3% (n=84), 81.0% (n=79), and 85.7% (n=77) were healed by week 1, week 2, and week 4, respectively.
Scar assessments conducted on 427 donor sites after one year showed the majority had matched or mildly mismatched color, pigment, and texture. Safety analyses of adverse events (AEs) following ASCS treatment were unlikely or unrelated to the device.

Conclusions
This study demonstrates successful use of ASCS to achieve closure of donor site wounds in patients with extensive burn injuries.
131 Burn-Induced Coagulopathy: Burn Patient Plasma Causes Platelet Dysfunction
Authors: Gibson Breanne H , Duvernay Matthew T , Gondek Stephen , Schoenecker Jonathan G 
Published: April 2021

Abstract

Introduction
Burn-induced coagulopathy (BIC) greatly increases the risk of thrombosis, leading to organ dysfunction and death. Although BIC is attributed to a multitude of factors including hemodilution, SIRS, and excess coagulation, the exact molecular mechanisms are elusive. Determination of these mechanisms is essential to develop new strategies aimed at reducing the morbidity and mortality of BIC as commonly used anticoagulants are ineffective at preventing the consequences of BIC. Platelet dysfunction, which has been associated with bleeding, thrombosis, poor wound repair, and susceptibility to infection, occurs in BIC, but the etiology of this phenomenon is unknown. Burn injuries provoke a dramatic increase in plasma levels of inflammatory, coagulation, and fibrinolytic factors, potentially altering the physiology of blood cells and platelets. Therefore, we hypothesized that burn patient plasma pathologically alters normal platelet function.

Methods
In this prospective study, plasma samples were collected from 32 adult patients with burns &gt;10% TBSA at a regional burn center. To assess the effects of burn plasma on platelet function, platelets isolated from healthy individuals were incubated with heparinized plasma from burn patients or control plasmas (N=15) for 2 hours. Following incubation, platelets were stimulated with various agonists, and markers of platelet activation (GPIIb/IIIa activation and P-selectin expression) were measured using flow cytometry.

Results
Platelets incubated with burn plasmas exhibited a reduction in response to stimulation compared with those incubated with control plasma. Both GPIIb/IIIa activation and P-selectin expression were affected, suggesting a defect in platelet signaling. This dysfunction did not strongly correlate with TBSA affected or modified Baux score but was significant when compared to healthy controls (P&lt; 0.05). However, measurement of markers of inflammation, coagulation, and fibrinolysis in burn plasmas revealed a significant correlation of both plasma D-dimer (P&lt; 0.02) and soluble P-selectin (P&lt; 0.05) with induced platelet dysfunction. This suggests circulating factors indicative of coagulation, fibrinolysis, and endothelial dysfunction may play a role in platelet dysfunction observed in BIC.

Conclusions
This study demonstrates an in vitro effect of burn patient plasma on platelet function, suggesting a possible benefit for resuscitation with FFP. BIC is a principal source of morbidity and mortality in burn patients, and current thromboprophylaxis for burn patients may not address critical elements of BIC. Future studies are required to optimize resuscitation and minimize the consequences of BIC.
132 A Novel Murine Model of Burn-Induced Platelet Dysfunction
Authors: Gibson Breanne H , Duvernay Matthew T , Gondek Stephen , Schoenecker Jonathan G 
Published: April 2021

Abstract

Introduction
Platelet dysfunction has been demonstrated as a part of burn induced coagulopathy (BIC), however, the etiology and clinical significance are unknown. Determining the etiology and clinical significance of BIC platelet dysfunction is difficult in humans due to heterogeneity of injuries and treatment. The goal of this study was to develop a murine model of BIC burn-induced platelet dysfunction to allow for high-throughput investigation of the mechanisms and the possible effects platelet dysfunction has on burn outcomes.

Methods
Using an established murine model of burn injury, we investigated plasma and cellular markers of BIC. Under adequate anesthesia and analgesia six-week-old C57BL6/J mice were administered a ~30% TBSA dorsal burn by scalding. Sham animals received identical preparation and resuscitation without the burn injury. Blood was collected at 6-, 24-, and 48-hours post-burn for measurement of platelet function, and plasma was isolated for protein measurements of coagulopathy (N=5 per group per time point).

Results
Like findings in humans, mice exhibited systemic markers of BIC (excess coagulation, fibrinolysis, and inflammation) within the first 6–24 hours post-burn. Platelets in whole blood were treated with platelet agonists ADP and PAR4-activating peptide (PAR4AP), and markers of platelet signaling and function (P-selectin expression and GpIIb/IIIa activation) were measured by flow cytometry. At 6 hours post-procedure, platelets from burn mice exhibited a slight, insignificant increase in markers of activation and response to stimulation compared with platelets from sham mice. At 24 hours post-burn, burn mice exhibited a significant decrease in platelet count (P&lt; 0.02) and platelet function indicated by reduced GpIIb/IIIa activation (P&lt; 0.01) and P-selectin expression (P&lt; 0.05)in response to ADP and PAR4-AP compared with sham mice. Platelet function began to return at 48 hours post-burn with no significant difference between groups.

Conclusions
Platelet loss and dysfunction occur after burn injury, but the consequence of these effects is not well understood. The findings in this study are consistent across multiple experiments and resembled platelet dysfunction observed in different human traumatic injuries, validating the murine model as an inexpensive and efficient model of human injury in which to study platelet defects and the molecular mechanisms driving them.
136 Use of 816 Consecutive Burn Wound Biopsies to Inform a Histologic Algorithm for Burn Depth Diagnosis
Authors: Phelan Herb A , Holmes James H , COCKERELL Clay J , Hickerson William L , Shupp Jeffrey W , Carter Jeffrey E 
Published: April 2021

Abstract

Introduction
Burn experts are only 77% accurate when subjectively assessing burn depth, leaving almost a quarter of patients to undergo unnecessary surgery or conversely suffer a delay in treatment. To aid clinicians in burn depth assessment (BDA), new technologies are being studied with machine learning algorithms calibrated to histologic standards. Our group has iteratively created a theoretical burn biopsy algorithm (BBA) based on histologic analysis, and subsequently informed it with the largest burn wound biopsy repository in the literature. Here, we sought to report that process.

Methods
This was an IRB-approved, prospective, multicenter study. A BBA was created a priori and refined in an iterative manner, resulting in the current state of the algorithm seen in Figure 1. Patients with burn wounds assessed by burn experts as requiring excision and autograft underwent 4mm biopsies procured every 25cm2. Serial still photos were obtained at enrollment and at excision intraoperatively. Burn biopsies were histologically assessed for presence/absence of epidermis, papillary dermis, reticular dermis, and proportion of necrotic adnexal structures by a dermatopathologist using H&E with whole slide scanning. First degree and superficial 2nd degree were considered to be burn wounds likely to have healed without surgery, while deep 2nd and 3rd degree burns were considered unlikely to heal by 21 days. Biopsy histopathology results were correlated with still photos by 3 burn experts for consensus of final burn depth diagnosis.

Results
Sixty-six subjects were enrolled with 117 wounds and 816 biopsies. The BBA was used to categorize 100% of subjects into 4 categories: 7% of burns were categorized as 1st degree, 13% as superficial 2nd degree, 43% as deep 2nd degree, and 37% as 3rd degree. Therefore 20% of burn wounds were incorrectly judged as needing excision and grafting by the clinical team. As H&E is unable to assess the viability of papillary and reticular dermis, with time our team came to appreciate the greater importance of adnexal structure necrosis over dermal appearance in assessing healing potential.

Conclusions
Our study demonstrates that a BBA with objective histologic criteria can be used to categorize BDA with clinical misclassification rates consistent with past literature. This study serves as the largest analysis of burn biopsies by modern day burn experts and the first to define histologic parameters for BDA.
502 Adapting to COVID19: Can Virtual Burn Camp be as Impactful as Last Year’s In-person Camp?
Authors: Banks Jessica , Ferdock Matt , Nagle Jennifer 
Published: April 2021

Abstract

Introduction
Skin is not the only casualty following a burn accident. Many children suffer long term, debilitating emotional effects from their burn injury (Abdullah et al. 1994; Kornhaber et al. 2018). Armstrong-James et al. (2018) and Maslow and Lobato (2010) found that summer camps explicitly designed for burn survivor children can positively impact children’s adaptability to stares and comments and improve their sense of self-esteem. Camp Susquehanna has been a summer camp for burn survivors for the past 25+ years. When the COVID19 pandemic closed many businesses, we decided to transition our in-person camp to 100% online. Researchers demonstrated the positive effects of summer camp for burn survivors (Maslow & Lobato, 2010; Bakker et al. 2011). However, the effects of a 100% online camp are not known. Our concern was, are we able to transition and be as impactful as it is face to face at camp? What will the schedule and activities look like in this new format? How will we ensure all children participating will have access to online and the supplies necessary?

Methods
We opted to select a three-week format with two sessions a day divided into two age groups. We ensured every child had internet access then mailed out a “camp in the box.” It contained all the things needed for each planned activity. The critical question remained, however, will we be as impactful? The current research looks at quantitative and qualitative measures of self-esteem, happiness, and satisfaction following participation in a three-week summer program held in July 2020. We make comparisons to previous years’ results. The authors expected that self-esteem, happiness, and satisfaction levels matched or exceeded last years’ levels.

Results
We collected data from 42 campers and 22 volunteer camp counselors. Results show that campers were able to receive the support they needed, not only from the staff but also from their peers.

Conclusions
The delivery method was indeed different this year, but the positive effect on our campers remained the same.
504 Creative Aftercare Program Amidst Coronavirus Pandemic
Authors: Henry Shana M , Kopari Nicole M 
Published: April 2021

Abstract

Introduction
Coronavirus disease presented itself early in 2019 inducing a considerable degree of fear, worry, and unknown throughout the United States. National and State governed laws imposed social distancing measures, quarantining citizens, and isolating infected persons. Apart from its physical impact, COVID-19 pandemic has brought numerous changes to people’s lives affecting people both physically and psychologically. A key component of quality of life of burn survivors consist of maintaining a long-term burn center connection through support groups. Our burn center developed a virtual format for aftercare to provide psychological support during the pandemic.

Methods
Regular attendees and new burn survivors were contacted by the aftercare specialist from an American Burn Associated verified burn center. Participants were surveyed on the best mode of contact and current addresses were obtained. “Happy Mail” was mailed to support group participants 3 times/month. Items included in these packages ranged from motivational sayings, gift cards, essential oils, candies, art projects, and reminders to log onto the virtual support groups. The gift packages also included a mental health check-in icebreaker. These gift packages took the place of our in-person support groups and contained all materials needed to engage and guide participation in the virtual monthly support group. Participants were then invited to join a social media support group for our local burn center.

Results
Burn survivors continued to receive quality psychosocial support to cope with and process feelings as well as validate emotions. Attendees regularly expressed gratitude in receiving “Happy Mail” as it brought a feeling of connectiveness to a group of burn survivors who rely on each other for peer support. The gift packages also served as a reminder of the upcoming virtual aftercare support groups as our attendance did not see a decline at monthly meetings.

Conclusions
Our experience suggests that a method of offering “Happy Mail” as part of a curriculum to augment virtual aftercare can be a model to adapt to the emotional support burn survivors and their family members need during the pandemic.
505 Support Group Lives on Virtually Despite Pandemic
Authors: Deeter Lyndsay , Garber Rebecca 
Published: April 2021

Abstract

Introduction
Support group for burn survivors is immensely beneficial for reintegration and normalization of the burn recovery. The corona virus pandemic, however, limited in-person interactions significantly and decreased the travel capabilities. Our regional burn center serves an 8-state region, and as such, our every other month in-person support group consisted of survivors and family members from a large geographic area.

Methods
Support group volunteers and staff members recognized the need for continued support of survivors during the pandemic. Limitations of large, in-person meetings were implemented by our host organization to comply with pandemic safety guidelines. Evaluation of resources available led to development of a virtually supported meeting space. Email addresses were gathered to schedule. This allowed for interaction of survivors from an unlimited geographic area.

Results
Support group survivor volunteers and staff met to develop parameters, topics, IT support and logistics. Every other month support group was converted to a monthly gathering virtually due to easier access by survivors. Attendees completed a survey to evaluate and make recommendations for opportunities for improvement. The same number of survivors were present for in person and virtual meetings.

Conclusions
During this pandemic, limitations were placed that further isolate survivors. A virtually based support group has allowed for more frequent interactions between volunteers and new survivors. Various topics were discussed including survivor preparedness for public reintegration, worker’s compensation and care giver burnout. Speakers from multiple disciplines have been able to address issues requested by survivors. In this format, we have been able to continue the support of our survivors as they continue to recover. Social distancing has isolated many people during the pandemic; virtual support group has been paramount in continuing to connect our survivor family.
511 A Retrospective Review of the Timing of Tracheostomy in Mechanically Ventilated Patients
Authors: Foster Kevin N , Munaim Juzer R , Engineering Biomedical , Islas Claudia , Osborn Suzanne C , Spadafore Philomene , Richey Karen J 
Published: April 2021

Abstract

Introduction
Tracheostomy is indicated for prolonged mechanical ventilation. Tracheostomy provides various benefits over prolonged endotracheal intubation including improved airway care, diminished need for sedation, reduced airway resistance, and increased patient comfort. However, the timing and effectiveness of tracheostomies has been controversial. Several studies, have indicated that early tracheostomy reduces the length of ICU and hospital stay, decrease the time on mechanical ventilation, and reduces the incidence of nosocomial pneumonia. In contrast other studies have shown that early tracheostomy shows no benefit, or even extends the length of mechanical ventilation in some patients. The purpose of this study was to evaluate the timing and the appropriateness of timing of tracheostomy.

Methods
This was a retrospective study of burn patients requiring mechanical ventilation over a 5-year period. The main comparison groups were endotracheal tube only (ETT) vs tracheostomy (Trach) and early tracheostomy (ETrach) vs. late tracheostomy (LTrach). Tracheostomies that were performed within the first 7 days were considered to be ETrach.

Results
Age, gender, ethnicity, % TBSA burned, presence of inhalation injury did not differ between any of the groups. The Trach group demonstrated increased hospital length of stay (LOS) (22 vs. 39 days, p&lt; .0001), greater number of ICU days (11 vs. 31 days, p&lt; .0001), greater number of surgeries (3.7 vs. 6.6, p&lt; .0001) and patients in this group were more likely to be discharged to a post-acute care facility rather than home, when compared to the ETT group (p&lt; .0001). The Trach group also was more likely to develop ventilator-associated pneumonia (VAP) (23% vs. 48%, p&lt; .0001), and more likely to develop swallowing abnormalities. Similarly, the LTrach group demonstrated greater number of ICU days (25 vs. 32 days, p=.04), greater number of ventilator days (23 vs. 29 days, p=.03), greater number of surgeries (4.5 vs 7.2, p=.02), but fewer days to liberate from the ventilator (19.4 vs 13.6 days, p=.04). This group also was more likely to develop VAP than the ETrach group (28% vs 53%, p=.03).

Conclusions
This study demonstrates a number of improved outcomes of tracheostomy over continued endotracheal intubation, and a number of improved outcomes of early tracheostomy over later tracheostomy. The most significant improved outcomes were decreased incidence of VAP and decreased swallowing difficulties following extubation/decannulation.
512 Bedside Transthoracic echography volume Assessment in the BICU
Authors: Chambers Michael G , Garrett Britton , Cancio Leopoldo C 
Published: April 2021

Abstract

Introduction
Point-of-Care Ultrasound (POCUS) has been shown to be a useful adjunct in assessment of various shock states and utilized to guide resuscitative and post-resuscitation de-escalation efforts. POCUS use for guiding resuscitation in burn injured patient has not be described.

Objectives
characterize the use of bedside ultrasound examinations performed by advance practice providers and treating physicians in a regional burn intensive care unit

Methods
Daily beside ultrasound examinations were performed utilizing a bedside ultrasound device by an advanced practice provider prior to rounds POCUS examinations consist of:
Ultrasound images were archived to a centralized image repository and reviewed daily during multi-disciplinary rounds. Ultrasonographic volume assessment compared to clinical volume assessment made during daily multidisciplinary rounds.

Results
100 examinations were performed of those 32 were within the initial 72 hour window:

Conclusions
Our results demonstrate that bedside ultrasound aides in guidance of both resuscitative and post-resuscitative efforts. We identified a cohort of patients who appeared hypervolemic clinically but US findings supported hypovolemia, we refer to as pseudohypervolemia US volume assessment provides information that changes management. We believe point of care ultrasound is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.
521 Incidence of Bone Fracture Rate Post-Burn and Trauma in Role 2 and 3 Treatment Centers
Authors: Sousse Linda E , Staudt Amanda , VanFosson Christopher 
Published: April 2021

Abstract

Introduction
One of the hallmarks of critical illness and trauma is that it triggers resorptive bone loss, as well as an increase in bone fractures and a reduction in bone density. Sustained markers of bone resorption, bone formation, and regulators of bone signaling pathways are linked to prolonged inflammatory activities and the prolonged deterioration of bone microstructure. The objective of this study is to evaluate the bone fracture rate of the U.S Military, non-U.S. Military, North Atlantic Treaty Organization (NATO) Military, local civilian, and Coalition Forces population in Operation Enduring Freedom and Operation Freedom’s Sentinel with burns from 2005 to 2018 using the Department of Defense Trauma Registry (DoDTR; n=28,707). Our hypothesis is that there is a direct relationship between burn injury severity and bone fracture rates.

Methods
Pearson’s correlation coefficient and scatterplots were used in this retrospective, observational study to demonstrate the correlation between total body surface area (TBSA) burn and number of fractures by anatomical location.

Results
Approximately 15,195 patients (age: 26 ± 10 years) in Role 2 and Role 3 treatment centers reported fractures. Of those patients, 351 suffered from burns with 632 anatomical fracture locations. Facial fractures were most prominent (16%), followed by foot (12%), skull (12%), tibia/fibula (11%), hand (11%), and ulna/radius (10%). There was no initial correlation between
n increasing severity of TBSA burn and count of fracture locations (ρ=-0.03, p=0.8572).

Conclusions
There was no acute correlation between burn severity and bone fracture rates; however, further analyses are required to assess chronic post-burn fracture rates.