bluuebunny/crossref_metadata_2025_split huggingface dataset:
60 A Retrospective Review of Factors Influencing Post-Hospital Discharge Follow-up in Patients with Burn Injuries
Authors: Taylor Ryan C , Islas Claudia , Richey Karen J , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Approximately 486,000 burn injuries, requiring hospitalization and/or outpatient care occur annually. Physical and psychosocial problems may develop at any time during recovery and it is important that care continue after discharge to maximize outcomes. Often, patients discharge themselves from clinic for unknown reasons. The purpose of this study was to identify factors related to self-discharge.

Methods
A retrospective chart review of patients admitted to the burn center and outpatient follow up visits in 2018 was performed. Patients were grouped by lost to follow up (LTF) versus completed patients (COM). The LTF were further stratified by distance from clinic (≤ 50 miles vs. &gt; 50 miles). COM were categorized as those who were discharged from clinic as PRN follow up visits.

Results
A total of 211 patients were scheduled for outpatient visits, mean age was 36.4 years and 74% were male. Most were Caucasian (41%) and Hispanic (31%). The most frequent payor sources were Medicaid (58%)/ Medicare (17%). Mean TBSA was 5.8 %, the most common mechanisms were Flame/Flash and Scald (30% each). Mean length of stay was 10.3 days, mean number of surgeries was 1.5. The majority of patients were discharged Home (71%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. LTF patients had a smaller TBSA (4.69%) compared to COM (9.62%). Comparison between LTF and COM, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=&lt; 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p&lt; 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group. When LTF were stratified by distance, Native Americans were significantly more likely to live &gt; 50 miles from the clinic (p &lt; .00001).

Conclusions
A large percentage of patients discharged themselves from clinic. Factors associated with self-discharge include healed wounds, no scarring issues, smoking, substance abuse and mental illness. Given the geographic distribution of races and ethnicities in our state, it is unsurprising that Native Americans live distant to our clinic. This provides an opportunity to expand our outreach efforts and incorporate the use of technology to improve access to care for this population.
62 The Essential Need of Having Dedicated Clinical Social Workers in Both the Burn Outpatient and Inpatient Setting
Authors: Dines Margaret , Smith Tyler M , Lambert Wagner Anne L 
Published: April 2021

Abstract

Introduction
By providing holistic support to the entire patient, a licensed clinical social worker (LCSW) plays an essential role on a Burn Center multidisciplinary team. A majority of our burn population exhibit difficulties in navigating the complex array of psychosocial issues in regard to basic needs such as employment, food, housing, and transportation. While these needs can be addressed with inpatients, our patients who follow-up in Burn Clinic face additional challenges. A need was identified to have a dedicated LCSW in the outpatient setting.

Methods
As with the continued growth of inpatient admissions in our burn center, our burn clinic encountered an even higher number of new patients. With limited bandwidth, our burn LCSW was seeing both inpatient and clinic patients. Recognizing the need for additional support, the hospital’s care management department approved a full-time outpatient Burn Clinic LCSW position. Their role will include trauma screens, mental health, and psychosocial support to patients in clinic rather than providing reactive support to the most acute patients.

Results
In FY2019, our Burn Center admitted 501 patients across a seven-state region. Our Burn Clinic saw 1132 patients with 1932 clinic visit encounters. In addition to seeing all admitted patients, our inpatient LCSW also saw 13.7% (n=155) of the clinic patients and had 175 documented encounters. Furthermore, 16.6% (n=188) of these clinic patients had a form of Medicaid Health Insurance.

Conclusions
The capacity to provide access and resources to our patients has been limited to the time of one LCSW. By hiring a dedicated Burn Clinic LCSW, we will be able to increase our patients’ abilities to navigate barriers, while limiting unnecessary hospital resources with Emergency Department visits and readmissions. The clinic LCSW will assist by finding primary care physicians, transportation and housing needs, applying for disability, and accessing community resources such as our SOAR support group.
83 Burn Injuries in Sub-Saharan Africa: A Global Burden of Disease Study
Authors: Collier Zachary J , Naidu Priyanka , Choi Katherine J , Pham Christopher H , Potokar Tom , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Over 1 million burns occur in Sub-Saharan Africa (SSA) each year leading to significant morbidity and mortality. Financial constraints, social stigma, political strife, inaccessible healthcare facilities, limited perioperative resources, and low workforce capacity results in steep barriers to obtaining timely and effective burn care. This study set out to better define the burn burden as well as the age and gender-related disparities within SSA, to identify specific sub-regions and countries that would benefit most from targeted interventions to enhance burn care.

Methods
Data for all 46 SSA countries were acquired from the 2017 Global Burden of Disease (GBD17) database of the Global Health Data Exchange. Information regarding fire, heat, and hot substance-related injuries was derived from 17,792 data sources to estimate burn-related incidence, deaths, and Disability Adjusted Life Years (DALYs) by year, sex, age, and location from 1990 to 2017. Summative statistics were created for burn incidence, deaths, DALYs, and mortality ratio (deaths: incidence; %). Spatial mapping was performed to identify burn burden for specific regions and countries.

Results
An estimated 28,127,199 burns occurred in SSA from 1990–2017. On average, SSA accounted for 16% of worldwide burns, 21% of burn deaths, and 25% of DALYs. Furthermore, the mortality rate was 2.2 times the global average and remained nearly double the entire 27-year period. While all SSA regions had higher incidence, deaths, and DALYs compared to the global cohort, the Southern SSA region consistently had the highest incidence (211 cases per 100,000), deaths (7 per 100,000), and DALYs (355 years per 100,000) throughout the time period, with Lesotho, Swaziland, and Zimbabwe having the highest rates. In contrast to gender similarities globally for burn indicators, all regions within SSA showed higher incidence rates (144 vs 136 cases per 100,000), deaths (5.4 vs 4.7 deaths per 100,000), and DALYs (289 vs 272 years per 100,000) for men than women when age standardized.

Conclusions
With an estimated 1.4 million burn injuries in 2017, SSA accounted for over 15% of all worldwide burns and 20% of global burn deaths. Although all trended rates improved over the years for each country, they were consistently worse and slower to improve in all regions of SSA compared to the rest of the world. While both Central and Southern SSA regions had the greatest burn burden, burns in Central SSA more significantly impacted those under 5 years whereas Southern SSA saw the greatest burden on the 15–49-year age group.
94 Agreement Between Proxy- and Self-Report PROMIS Scores in Pediatric Burn Survivors
Authors: Amtmann Dagmar , Bamer Alyssa M , McMullen Kara , Stewart Barclay T , Kazis Lewis E , Rencken Camerin A 
Published: April 2021

Abstract

Introduction
Reporting by proxy is necessary when patients are not able to report their own experience, such as young children or those too sick to respond. PROMIS pediatric proxy-report item banks are a set of generic measures that facilitate comparisons across populations and studies. Our objectives were to (1) examine agreement in pediatric burn survivors between child self- and caregiver proxy-report on multiple PROMIS domains and (2) examine factors associated with differences between self- and proxy-reports.

Methods
Data were collected from children 8–17 years with moderate to severe burn injury and their respective caregivers between 6 months and 15 years after injury. The PROMIS-25 and Anger v1.0 short form were completed by pediatric burn participants. Caregivers completed either custom (depression, pain interference) or standard (Physical Function (PF) 8a, Peer 7a, Anger 5a) PROMIS proxy short forms. Self- and proxy-report scores were compared using Wilcoxon sign rank test, Cohen’s effect size, and intraclass correlation coefficients (ICC(2,1)) and by agreement across severity of symptoms based on recommended cutoffs. Regression analyses examined child- (self-report score, age, gender, and ethnicity) and proxy-related (relationship to child) factors associated with score differences.

Results
A total of 274 child-caregiver pairs completed the PROMIS measures. Mean child age was 13.0 (SD:3) years. Caregivers reported significantly worse scores than the child on PF, pain, and anger (all p≤0.01). Cohen’s d ranged from 0.05 (depression) to 0.25 (PF), with all domains except PF in the small effect size range (&lt; 0.2). Similarly, ICCs were all of moderate agreement and ranged from 0.51 (pain) to 0.69 (depression). The percentage of dyads in agreement by severity groups was high with only 5% (pain), 8% (PF, peer relationships), and 9% (depression, anger) of pairs discordant. Regression models indicated only higher self-report score was associated (all p&lt; 0.05) with greater differences across all domains, though female gender was also associated with greater differences on depression only.

Conclusions
This study provides support for the use of pediatric proxy PROMIS depression, PF, peer relationships, pain interference, and anger scales in pediatric burn patients. Although agreement was moderate to good, proxy report should only be considered when self-report is not possible or practical. Caregivers typically report slightly worse severity of symptoms than children across all domains.
99 Barriers of Follow Up within the Burn and Wound Population.
Authors: Tay Erika , Ochtli Ché R , Kirby Katharine A , Carmean Melissa , Bernal Nicole O , Joe Victor C , Chin Theresa L 
Published: April 2021

Abstract

Introduction
Access to quality health care services is important for acute burn care, but comprehensive burn care goes beyond acute hospitalization. Follow up is an essential part of recovery, where providers can assess late effects of burn and help the patients with community re-integration, injury rehabilitation, and mental health. However, not all patients return for follow up after burn injury due to barriers in care and patient characteristics. We hypothesized that patients with neuropsychiatric comorbidities and 0–10% of total body surface (TBSA%) are more likely to be lost at follow up compared to patients with no neuropsychiatric comorbidities and higher TBSA.

Methods
A retrospective analysis was completed on patients that were admitted to a verified Burn Center from January 2016 to June 2019. Patients that were under 18 years of age and patients that died prior to discharge were excluded. Patient characteristics included were age, gender, TBSA, discharge location, payer, and comorbidities. Univariate analysis was completed using Tableau and multiple logistic regression analysis using Stata. Neuropsychiatric comorbidities were defined as dementia, alcoholism, major psychiatric disease, and drug dependence. Lost to follow up was defined as no follow up in clinic after inpatient discharge date within 1 month.

Results
Of 562 patients, 35.94% (n=202) were female and 65.12% (n=366) were Caucasian followed by Asian 13.7% (n=77) and Other Race 13.7% (n=77). Of the 562 patients, 157 (27.95%) were lost to follow up. After adjusting for insurance type, race, and medical comorbidities, patients with neuropsychiatric comorbidities had double the risk (OR 2.052; 1.377 - 3.057 p&lt; 0.001) to be lost at follow up compared with those that did not have neuropsychiatric disorders. Homelessness was collinear with neuropsychiatric comorbidities suggesting an association.
Patients with a TBSA &gt;20% (n=37) were 3 times more likely to be lost at follow up in comparison with patients with 0–10% TBSA. (OR 2.921; 1.455–5.861 p&lt; 0.003).
Race, medical comorbidities, and insurance status had no significant impact on follow up.

Conclusions
Patients with dementia, alcoholism, major psychiatric disease, and drug dependence were more likely to be lost at follow up. Contrary to intuition, patients with burns &gt;20% TBSA were also less likely to follow-up. Additional research is needed to better identify how psychosocial factors affect follow up in our burn patients and how to address those barriers. By focusing on our population and their needs, we can adjust our practices to make sure that we are providing holistic burn care.
106 Frailty Assessment in the Burn Population: A Single Center Retrospective Review
Authors: Horrell Erin Wolf , Mubang Ronnie , Folliard Sarah A , Beyene Robel , Gondek Stephen , Thompson Callie M 
Published: April 2021

Abstract

Introduction
Burn morbidity and mortality increases with advancing age. Frailty is characterized by reduced homeostatic reserves and is associated with an increased biological age compared to chronological age. Our primary aim was to determine whether frailty as assessed on admission would be predictive of outcomes in the burn population.

Methods
We conducted a single institution 7-month retrospective chart review of all admitted acute burn patients ages 45 and older. Patient and injury characteristics were collected and compared using standard statistical analysis. Frailty scores were assessed upon admission using the FRAIL Scale.

Results
Eighty-five patients met inclusion criteria and were able to complete the FRAIL assessment. Patient and injury characteristics are listed in Table 1. Mean burn size was 6.7%TBSA (95%CI 4.9–8.4%). 34 patients (40%) were classified as robust (FRAIL score 0), 26(30.6%) as pre-frail (FRAIL score 1-Patients in the pre-frail/frail cohort received more palliative care consultations (p=.096) and had a longer length of stay (3.3d vs 7.55d p = .002), while prefrail patients had a similar LOS to frail patients (7.46 vs 7.64d p =.938). Patients in the pre-frail/frail cohort were also more likely to be discharged to a higher level of care than they were admitted from(p=.032) with prefrail patients experience an escalation in level of care more frequently than frail patients. The distribution by age by half-decade ranges is in Figure 1. By age 55–59, the majority of patients were prefrail or frail.

Conclusions
We demonstrated that frailty as assessed by the FRAIL score was predictive of increased length of stay and an escalation in post discharge care. In addition, patients characterized as pre-frail experience outcomes similar to frail patients and should be managed as such. Given the prevalence of frailty and prefrailty in the younger group of patients, we advocate for routine frailty screening beginning at age 55.
108 Length of Stay per Total Body Surface Area Relative to Burn Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study
Authors: Patterson Kelli N , Horvath Kyle , Onwuka Amanda , Fabia Renata , Giles Sheila , Marx Daniel J , Aguayo Pablo , Ziegfeld Susan , Garcia Alejandro , Stewart Dylan F , Fritzeen Jennifer , Burd Randall S , Vitale Lisa C , Klein Justin D , Thakkar Rajan K 
Published: April 2021

Abstract

Introduction
Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients have been performed at single institutions and based on ranges of TBSA burn. A LOS to TBSA burn ratio of 1:1 has also been widely accepted but not confirmed over time across numerous institutions. The objective of this study was to use multi-institutional pediatric burn data to describe benchmarks associated with LOS per TBSA burn.

Methods
Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for 1004 patients (n=1004) treated at five pediatric burn centers from July 2018-March 2020. LOS/TBSA burn ratios were calculated for each site. LOS/TBSA burn by institution and mechanism were analyzed. Generalized linear regression models were used to model the effect of hospital and burn mechanism on the LOS/TBSA ratio.

Results
Among the 1004 injuries, the most common burn mechanism was by scald (64%), followed by contact (16%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.3 days (SD 2.2). Flame burns had a higher LOS/TBSA burn ratio than scald burns with a mean LOS/TBSA burn of 1.63 compared to 0.84. In adjusted models, scald burns, and chemical burns had the lowest LOS/TBSA burn ratio and electrical and friction burns had the highest LOS/TBSA burn ratio. The LOS/TBSA burn ratio was comparable across hospitals after adjustment for mechanism, with just Hospital 4 having a lower average LOS/TBSA burn of 0.49 days.

Conclusions
These data establish a multi-institutional ratio for the overall performance in LOS for pediatric burn patients. A LOS per TBSA ratio of about 1 was observed across PIQIC centers, except for a lower ratio at one center. Additionally, it provides evidence on the variance in LOS per TBSA burn relative to the sustained burn mechanism. Further collaborative data analysis will allow us to recognize specific patterns and outcomes in pediatric burn care, which is essential for the implementation of quality improvement standards.
114 The Patient’s Perspective: Burn Reconstructive Surgery During the Pandemic
Authors: Won Paul , Celie Karel-Bart , Gillenwater Justin , Yenikomshian Haig A 
Published: April 2021

Abstract

Introduction
The novel Coronavirus disease 2019 (COVID-19) has created profound challenges in healthcare delivery. Hospital systems have delayed or shut down elective surgeries and outpatient care. These measures resulted in profound disruptions to burn treatment regarding reconstructive care from surgery to therapy. This study aims to characterize burn patients’ perspectives on elective reconstructive surgery during COVID-19.

Methods
As part of a quality improvement initiative, a 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center during COVID-19 was conducted. Responses regarding willingness to undergo reconstruction during COVID-19, perceived medical and personal impacts of COVID-19, and perspectives on telehealth were gathered. Surveys were administered over the phone in English and Spanish to burn patients or to primary caregivers in the case of pediatric patients.

Results
We surveyed 23 participants who met our inclusion criteria. Average age was 23 and 43% were male. We found 22 (96%) patients were willing to undergo reconstruction during the COVID-19 pandemic. Table 1 outlines the responses to questions regarding telehealth and being a burn patient during COVID-19. Examples of stressors experienced by patients and their families due to COVID-19 included: inability to communicate with healthcare providers in person, increased anxiety in public places, delayed surgical care, and interruption of physical or occupational therapy. Family members in 5 out of the 8 Spanish speaking households lost their job due to COVID-19, resulting in financial stress for the burn patient.

Conclusions
The majority of patients expressed strong desires to return to surgical and therapy care delayed by COVID-19. Patients reported feeling especially vulnerable as burn patients and cited receiving healthcare and financial stressors as a result of the COVID-19 pandemic as the main causes.
115 The Impact of Burn Injury on Upper Extremity Prosthesis Users
Authors: Cancio Jill M , Borgia Matthew , Cancio Leopoldo C , Resnik Linda 
Published: April 2021

Abstract

Introduction
Burns with upper extremity (UE) amputation present a unique rehabilitation challenge. The purpose of this study of UE amputees who are active prosthesis users was to compare outcomes for those with and without burns.

Methods
This is part of a larger nationwide study of U.S. military members and veterans with UE amputations. In-person data were collected at 5 sites. An therapist measured passive and active range of motion (PROM, AROM); administered the Quick Disability of the Arm, Shoulder, and Hand; Community Reintegration of Injured Service Members-Computer Adaptive-Test; Trinity Amputation and Prosthetic Experience Scale; health-related quality of life (VR-12); Activities Measure for Upper Extremity Amputees; Southampton Assessment Procedure; 9-Hole Peg Test; and Jebsen-Taylor Hand Function Test (JTHF); and recorded residual and phantom pain; timing of prosthesis receipt; and current prosthesis use. The IRB approved this study.

Results
Data were collected on 126 individuals with UE amputation, of whom 105 had data on etiology and were included. Of these, 13 (12.4%) had burns (B) vs non-burn (NB). The majority were unilateral amputees (69% B, 90% NB). Most were transradial (TR) amputees (B 84.6%, NB 66.3%) as opposed to transhumeral (TH). A minority received their prosthetics within the first 3 months post-amputation (11.1% B, 28.8% NB) (p=0.15). Average age was 57.6 (SD 15.6) years for NB and 53.0 (20.6) years for B. Mean time since amputation was 22.5 (18.0) years for NB and 25.2 (17.3) years for B. The following non-significant differences in outcomes between B and NB were observed. Thirty-nine percent of B were employed full-time vs 18.9% of NB (p=0.15). The primary prosthesis was, for NB, a body-powered prosthesis (66.7%); for B, myoelectric (50%) or body-powered (50%). For unilateral UE amputees, there were no differences between B and NB on performance testing for dexterity and functional tasks or in self-reported disability, quality of life or prevalence or intensity of pain. B trended towards more moderate to severe PROM deficits with shoulder forward flexion (TH B 50%, TH NB 23.1% [p=0.444]; TR B 20%, TR NB 5.6% [p=0.197]) and shoulder abduction (TH B 50%, TH NB 26.9% [p=0.497]; TR B 30%, TR NB 16.4% [p=0.376]). Also, TR amputees with burns trended towards more PROM deficits with elbow flexion (B 20%, NB 6.9% [p=0.212]) and elbow extension (B 20%, NB 8.6% [p=0.272]). AROM deficits also trended greater in B.

Conclusions
We did not observe differences in physical function, pain levels, or quality of life between those with and without burns. Further studies with larger samples are needed, to include analysis of burn location, burn size, hospital length of stay, and rehabilitation care.