bluuebunny/crossref_metadata_2025_split huggingface dataset:
39 Managing Burn Wounds with Silvadene
Authors: Lagziel Tomer , Born Louis J , Quiroga Luis H , Duraes Eliana , Shetty Pragna N , Slavin Benjamin R , Cox Carrie A , Javia Vidhi , Caffrey Julie , Hultman Charles S , Asif Mohammed 
Published: April 2021

Abstract

Introduction
Topical delivery of antibacterial agents is typically incorporated and is an essential component of burn wound therapy. The goal is to prevent infection and promote the healing process. Poorly treated wounds can result in scarring or severely in sepsis and multi-organ dysfunction. Topical SSD cream has been the gold-standard for initial local care in partial thickness or full thickness burns. Due to immediate burst release of the drug into the exposed areas, application is relatively frequent (usually twice daily). However, it remains unknown whether twice-daily SSD dressings are superior to once-daily.

Methods
We maintained a twice-daily dressing change standard of care until 01/01/2019. Patients admitted after that date had their dressing changed once-daily. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after. The main outcomes recorded are wound infection rates, hospital-acquire complications (non-wound related), pain scores, daily narcotic requirements, average amount of SSD used, and length-of-stay.

Results
Preliminary results of the 75 pre-change-of-practice and 75 post-change-of-practice patients showed slightly better outcomes in the post-change group. Wound-infection rates were the same for both groups (pre=5.33%, post=5.33%), average daily pain-levels for the pre-change group were slightly higher but the difference was negligible and not statistically significant (pre=5.76, post=5.69). The pre-change group had a higher average daily narcotic dosage (pre=6.81mg, post=6.38mg), hospital-acquired complication rates were higher pre-change (pre=10.67%, post=6.67%), and length-of-stay was longer in the pre-change group (pre=10.81, post=9.25). The average amount of SSD jars used per patient was higher as well (pre=6.30, post=2.85). Statistical analysis of the distribution of burn type, age, and burn depth showed no discrepancy and a generalized decreased length-of-stay with once-daily SSD dressing change.

Conclusions
Preliminary results show that once-daily dressing changes of SSD in burn wounds have no negative impact on wound outcomes. However, it is associated with a decreased length-of-stay, decreased pain levels, and less hospital-acquired complications. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. In addition, less hospital-acquired complications result in better patient recovery. Since the difference in wound outcomes is negligible and statistically insignificant, changing the standard-of-care to once-daily could prove beneficial.
40 Wildfire Burn Victims: A Unique Population
Authors: Stokes Sarah C , Romanowski Kathleen S , Sen Soman , Greenhalgh David G , Palmieri Tina L 
Published: April 2021

Abstract

Introduction
In the past ten years, wildfires have burned an average of 6.8 million acres annually. The frequency of wildfires is expected to increase with climate change. Wildfire burn victims have not been previously well characterized in the literature. As we prepare for more wildfires it is necessary to target populations at risk for sustaining burns with prevention efforts and to prepare hospital systems to meet these patients’ needs.

Methods
A retrospective review of patients admitted to a burn center between 2016 and 2019 was performed. Patients who were admitted after sustaining a burn attributable to wildfires were identified from the burn center database. Controls were matched to wildfire burn patients by age, gender and total body surface area of burn. The primary outcome was mortality. Secondary outcomes included number of operations, length of stay (LOS), intensive care unit (ICU) LOS, development of wound infections and pneumonia, wound culture microbiology.

Results
A total of 16 patients who had sustained burns in wildfires were identified and matched with 32 controls. There was no difference in mortality (19% wildfire vs. 9% non, p=0.386), LOS (18 days wildfire vs. 15 days non-wildfire, p=0.406), ICU LOS (17 days wildfire vs. 11 days non-wildfire, p=0.991) and number of skin grafts (1 wildfire vs. 0.5 non-wildfire, p=0.519). Patients who had sustained burns in a wildfire trended towards higher rates of pneumonia (31% wildfire vs. 13% non-wildfire, p=0.117), and higher rates of wound infection (31% wildfire vs. 19% non-wildfire, p=0.361). On evaluation of wound cultures for the 5 wildfire patients and the 7 non-wildfire patients who developed wound infections, more patients who sustained burns in wildfires had gram positive bacteria cultured from their wounds (100% wildfire vs. 29% non-wildfire, p=0.027). Patients who had sustained burns in wildfires trended towards increased likelihood of readmission (23% wildfire vs. 3% non-wildfire, p=0.080).

Conclusions
Patients who sustain burns in wildfires are likely at increased risk of readmission, of developing pneumonia and of developing gram-positive wound infections. Interventions for these patients should focus on pneumonia prevention and assistance with wound care after discharge.
47 COVID-19 Impact on Burn Care- A Summary of Weekly Bed Counts and Surge Capacity
Authors: Carter Jeffrey E , Phelan Herbert , Ryan Colleen M , Jeng James C , Mai Kathryn , Conlon Kathe M , Newman Annette F , Johnston Mark , Placek Judy , Wegryn Cindy , Joe Victor C 
Published: April 2021

Abstract

Introduction
The COVID-19 pandemic has raised global awareness of healthcare resource limitations. Specifically, the pandemic has demonstrated that burn disaster planning should involve non-burn disasters that threaten staff, supplies, or space. The ABA facilitated bed counts with the assistance of regional disaster coordinators from April through August of 2020. Our analysis examines the impact of the pandemic on burn surge and bed capacity in the U.S.

Methods
Bed availability was obtained by the ABA regional disaster coordinators through an initiative by the Organization and Delivery of Burn Care Committee. Bed availability was defined as immediately available burn beds and categorized as adult, pediatric, or flexible. Surge capacity was defined as the maximum number of patients that a burn center could admit in a surge situation. Data was deidentified by the central office with descriptive statistics to determine bed availability and surge capacity trends regionally and nationally.

Results
Bed counts were performed 6 times from 04/17/2020 through 08/14/2020. Response rates from the 137 North American burn centers varied from 86–96%. At least 6 burn centers (5%) were either closed or converted for COVID patients during the initial two bed counts. The total number of adult or pediatric burn beds was 2,082. Total bed availability decreased from 845 at the first survey down to 572 beds at the last survey. Surge capacity baseline was 1,668 beds and decreased from 1,132 beds in the initial survey down to 833 beds in the final survey.

Conclusions
Our study demonstrates a significant impact on burn bed availability due to the COVID-19 pandemic with a 37% reduction in available burn beds from April to August and a 26% reduction in surge capacity. This study demonstrates a substantial reduction in bed availability during the pandemic with additional analysis in process to examine regional trends.
50 A Retrospective Review of Enoxaparin Dosing Practices in Burn Patients
Authors: Quan Asia N , Aden Aisha , Islas Claudia , Richey Karen J , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Enoxaparin, a low molecular weight heparin, has been proven to safely and effectively prevent venous thromboembolism (VTE) in acutely ill patients. Burn patients may be particularly vulnerable to the occurrence of a VTE due to prolonged immobility, frequent operating room procedures, and low flow states. Treatment of acute VTE is associated with a direct medical cost of $12000-$15000 and subsequent complications increase costs to $18000 to $23000 per case. Current institutional protocol for initiation of enoxaparin an all burn adult patients is 40 mg administered subcutaneously every 12 hours. Anti-Xa levels are used to monitor anticoagulation prophylaxis, with 0.3–0.5 U/mL recognized as the prophylactic range. Doses are subsequently modified in 10 mg increments to achieve goal prophylaxis anti-Xa levels. The purpose of this study was to evaluate current practice (CP) and assess if the implementation of a published enoxaparin dosing algorithm could minimize delay in achieving anticoagulation prophylaxis.

Methods
A retrospective chart review was performed of 94 adult burn patients. The doses and time required to reach goal prophylaxis anti-Xa levels using current practice (CP) were compared to the predicted algorithm dose (AD). The number of dose adjustments and the number of days needed for adjustments for CP were documented. Charges related for laboratory determinations and medication administration were calculated.

Results
Of the 94 patients reviewed, the average age was 47 years, the majority were male (74%), mean actual weight 92 kilograms and mean TBSA 15.7%. The most common mechanism of injury was flash/flame (63%) with 18% suffering an inhalation injury. On average, using CP, it took 9.3 days to get to goal prophylaxis anti-Xa levels, with a mean of 2.86 anti-Xa lab tests needed and an average prophylactic dose of 55.5 mg. A total of 360 labs draws were performed and 74% were timed correctly. The CP average starting dose was lower than the AD 40 mg versus 45 mg (p &lt; .0001). If the algorithm had been used the number of dosing adjustments would have been 25% less. The algorithm overestimated the starting dose in only 2.1% of the population. The average charges until goal was met for enoxaparin were $2,933 and $787 for anti-Xa levels.

Conclusions
This study demonstrates increased clinical efficacy and cost-effectiveness for an algorithm driven enoxaparin dosing regimen for burn patients. Prospective study with larger patient numbers is warranted.
54 Modified Frailty Index is an Independent Predictor of Death in the Burn Population: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation (TRIBE) Study
Authors: Andre John A , Romanowski Kathleen S , Mandell Justin A , Greenhalgh David G , Palmieri Tina L , Sen Soman 
Published: April 2021

Abstract

Introduction
Previous studies in the burn population have noted frailty as an independent predictor of inpatient and outpatient mortality. The Modified Frailty Index (MFI) uses comorbidities tracked by the American College of Surgeons National Surgical Quality Improvement Program to help to predict morbidity and mortality in patients. The purpose of this study was to determine whether or not the MFI-5 and MFI-11 would predict mortality in the burn population.

Methods
A secondary analysis of the prospective, randomized, multicenter Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables were conducted. Frailty was determined using the MFI-5 (functionally dependent, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, hypertension) and MFI-11 (using the aforementioned 5, as well as myocardial infarction, hypertension, delirium, transient ischemic attack/cerebrovascular accident (without deficits), cerebrovascular accident (with deficits), peripheral vascular disease) from comorbidities included in the Burn Registry. Patients were considered frail if they had an MFI &gt; 1 on either scale. Multivariate regression was used to compare mortality between those who were and those were not considered frail based on this index.

Results
A total of 347 patients with a mean age of 43±17 years, 73 women and 274 men, were analyzed. Mean total body surface area burn (TBSA) was 38±18%, and 23% had inhalation injury. As continuous variables, MFI-5 (OR 1.86; 95% CI 1.11–3.11; p-value 0.02) and MFI-11 (OR 1.83; 95% CI 1.18–2.8; p-value 0.007) were independent predictors of mortality. In addition, TBSA total, age, and female gender were all independent predictors of mortality. Having a MFI-11 &gt; 1 was considered an independent predictor of mortality (OR 2.91; 95% CI 1.1–7.7; p-value 0.03); whereas, having a MFI-5 &gt; 1 was not considered an independent predictor of mortality (OR 2.6; 95% CI 0.95–7; p-value 0.06).

Conclusions
A MFI-11 &gt; 1 in the burn population was an independent predictor of mortality, as were total TBSA, age, and female gender. Given these findings, further study on the predictive value of MFI-11 in major burn injury is warranted.
55 Designing and Implementing an Obese Lund and Browder: A Pilot Study
Authors: Schoenborn Taylor , Thomas Mini , Miller-Willis Kelsey , Frerk Rita , Bernal Nicole O 
Published: April 2021

Abstract

Introduction
Accurate determination of the total body surface area (TBSA) burned is an essential element for the clinical management of burn care. The Lund and Browder (LB) is a tool that allows practitioners to calculate the TBSA burned, which is used to determine fluid needs, nutritional requirements, and graft site availability. Studies have shown that individuals with a body mass index (BMI) greater than 30 have an increase in surface area in the trunk and lower extremities, making the applicability of the traditional LB less accurate. The objective of this study was to develop and implement an electronic obese LB and compare it to the traditional LB.

Methods
Using the paper by Williams et al. as a guide, an obese LB was constructed for each body type: android, gynecoid and mixed (Table 1). Based on the patients BMI, the hospital’s Electronic Medical Record (EMR) would direct staff to the appropriate LB. All providers were formally trained on the obese LB, body types and changes in body surface area measurements. A retrospective chart review of adult patients admitted from January 2020 to September 2020 with a BMI≥30 was conducted. The BMI, body type, and location of burn was analyzed for each patient. The TBSA burned was recalculated for each patient using the traditional LB and compared to the obese LB completed at admission.

Results
A total of nineteen patients had a BMI≥30 and an admission obese LB completed. The TBSA burned ranged from 0.25–78.5%. The difference in TBSA burned calculated by the traditional and obese LB was 4.2±8.8 % (Figure 1). In patients with burns to the trunk or lower extremities (n=7) a difference of 12±10.5% was observed.

Conclusions
Limited research exists demonstrating the use of a standardized obese LB in clinical practice. No patient complications were identified with the use of the developed obese LB. Evaluation of the data revealed that the traditional LB often underestimated the TBSA burned in obese patients with burns to the trunk and/or lower extremities. This could lead to under-resuscitation and complications related to hypovolemia. In addition, expectations on patient survival and outcomes become inaccurate. As obesity grows in prevalence having a LB that recognizes the difference in surface area observed in the trunk and lower extremities can improve patient outcomes. Further research with a larger sample size is needed to gain a greater understanding of the clinical impact of an obese LB. We have shown that accurate determination of the burn area in obese patients can be done in a standardized fashion within the EMR.
57 Safety and Cost Effectiveness of Outpatient Surgery in Acute Burn Care
Authors: Zhang Zach Z , Golin Andrew , Papp Anthony 
Published: April 2021

Abstract

Introduction
Outpatient burn surgery is increasingly utilized for delivery of acute burn care. Reports of its safety and efficacy are limited. The purpose of our study was to evaluate the safety and cost reduction associated with outpatient burn surgery and to describe our centre’s experience.

Methods
This was a single centre, retrospective cohort study of consecutive patients who underwent outpatient acute burn surgery requiring split thickness skin graft or dermal regenerative template from January 2010 - December 2018. Patients with insufficient follow up to evaluate operative site healing were excluded. Patient demographics, comorbidities, burn etiologies, operative data and postoperative care were reviewed. The primary outcome is complication involving major graft loss requiring reoperation.

Results
165 patients and 173 procedures met the inclusion criteria. The average age was 44 years and 60.6% (100/165) were male. The number of annual outpatient procedures increased 48% from 23 to 34 cases over the 9-year period. The mean grafted total body surface area was 1.0 ± 0.9%. Rate of major graft loss requiring reoperation was 5.2% (9/172). Greater than 95% graft take was achieved in 80.9% of patients. Age, sex, co-morbidities, total body surface area, and procedure types were not significantly associated with postoperative complication rate. Outpatient burn surgery model was estimated to save CA$7,875 per patient from inpatient costs. This extrapolates to a total of over CA$1.36 million in savings over the 9-year study period.

Conclusions
Acute burn care at our centre is increasingly being delivered through an outpatient day surgery model. Our demonstration of its safety and considerable cost savings is compelling for further utilization. Our experience found the adoption of improved dressing care, appropriate patient selection, increased patient education, adequate pain control, and regimented outpatient multidisciplinary care to be fundamental for effective outpatient surgical burn care.
59 Impact of A Mature Burn Telemedicine Program On Inpatient, Outpatient, and Aftercare Programs During COVID19.
Authors: Bennett Bruce , Surgery Burn , Surgery Trauma , Altamirano Heidi M , Johnston Mark 
Published: April 2021

Abstract

Introduction
In 2014, a multidisciplinary burn telemedicine program was developed in order to increase access of burn specialists and improve care. This proved to be beneficial in the face of the pandemic through utilization of existing programs and development of new processes.

Methods
The basis of this burn telemedicine program utilizes a partnership approach. Visit types include inpatient and outpatient consultation, with visits occurring in in-patient settings, emergency departments, out-patient clinics, and in patient’s homes. During the COVID 19 pandemic, a weekly meeting was held with telemedicine program and clinic leadership, program coordinators, and our burn surgeon to triage patients to telemedicine or inpatient visit types. This often required the nursing staff to contact the patients to obtain more information about the injury and help them to securely upload photographs. The telemedicine visits were primarily video visits occurring either in clinic settings or the patient’s home. The burn psychotherapist and occupational therapists also utilized telemedicine for patient care. In addition, aftercare support groups, which originally were held twice each month onsite, transitioned to video and increased to three times. Telemedicine is also being utilized for school re-entry programming and the annual burn camps. The program is also tracking reimbursement for telemedicine activities.

Results
The pandemic resulted in a significant increase of telemedicine visits as compared to in person clinic visits often occurring directly into the patient’s homes. A greater number of burn patients were seen overall than previous to this process. Attached graphs show the comparison of in person visits compared to telemedicine visits during this time frame. Additional data will be presented showing the breakdown of visit location, provider (psychotherapist versus surgeon for example), and usage with aftercare programming.

Conclusions
This telemedicine program with established processes and partnerships, allowed transitioning alternative care due to the pandemic to be less stressful event. Benefits to patient care included the ability of the multidisciplinary burn team to see more patients safely via video especially in their own homes and allowed continuation and expansion of aftercare support. Challenges experienced included needing additional staff to ensure patients were triaged appropriately, scheduling of visits, and technology training for patients and families, and to ensure that patients were receiving medications and dressings as needed. The increased volume of patients seen could be attributed to more frequent visits and an increased volume of burn injuries.
69 Defining Numerical Cutoff Values for Mild, Moderate, and Severe Pain in Adult Burn Survivors
Authors: Carrougher Gretchen J , Bamer Alyssa M , Baker Claudia , Mason Stephanie A , Stewart Barclay T , Gibran Nicole S 
Published: April 2021

Abstract

Introduction
Pain is a common and often debilitating sequelae of a significant burn injury. Clinicians and researchers need clinically valid, reliable pain measures to guide treatment decisions and to provide evidence for study protocol development. Pain rating scores that represent mild, moderate, and severe pain in the burn survivor population have not been established. The aim of this study was to determine the numerical pain intensity rating scores that best represent mild, moderate, and severe pain in adult burn survivors.

Methods
Average pain intensity visual analog scale (VAS; 0–10) and customized PROMIS pain interference short form was administered to adult burn survivors (age ≥18) treated at a regional burn center at hospital discharge and at 6, 12, and 24-months postburn. To identify the optimal VAS scores for mild, moderate, and severe pain we computed F values and Bayesian Information Criterion (BIC) statistics associated with multiple ANOVA comparisons for mean pain interference scores by various VAS pain intensity cut points. Six possible cut points (CP) were compared: CP 3,6; CP 3,7; CP 4,6; CP 4,7; CP 2,5; and CP 3,5. For example, CP 3,6 refers to pain categorized as mild (0–3), moderate (4–6), and severe (7–10). Optimal cutoffs were those with the highest ANOVA F statistics. Models with similar F statistics were compared using changes in BIC.

Results
178 participants (85% white, 65% male, mean age of 46 years) with pain intensity and interference scores at one or more timepoints comprised the study sample. The optimal classification for mild, moderate, and severe pain at baseline and 12-months was CP 2,5. Although CP 3,6 had the highest F value at 6-months, there was not strong evidence to support CP 3,6 over CP 2,5 (BIC difference: 2.9); similarly, CP 3,7 had the highest value at 24-months, but the BIC difference over CP 2,5 was minimal (2.2).

Conclusions
We recommend that visual analog pain intensity scores for adult burn survivors be categorized as mild (0–2), moderate (3–5), and severe (6–10). These findings advance our understanding regarding the meaning of pain intensity ratings following a burn injury and provide an objective definition for clinical management, quality improvement, and pain research.