bluuebunny/crossref_metadata_2025_split huggingface dataset:
566 Single-Center Experience with Mass Paraquat Exposure
Authors: Williams Felicia N , McKinzie Brian , Powell Brandon , Hollowell Jamie , Maxwell Eli , Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker 
Published: April 2021

Abstract

Introduction
Paraquat dichloride is a widely used, highly toxic chemical herbicide and a leading cause of fatal poisonings. Toxicity is thought to be related to lipid peroxidation. Hours after exposure, patients may experience signs and symptoms ranging from nausea to multi-system organ failure. To prevent pulmonary complications and death, it is recommended to give patients repeated pulse therapy with cyclophosphamide and methylprednisolone administered over a 72-hour period. Our objective is to report our center’s experience treating patients who had been exposed to paraquat over a two-day period.

Methods
Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. Demographics, length of stay, costs and mortality were evaluated.

Results
There were nine patients admitted from the exposure. All were male. All survived. Eight were undocumented migrant farmer workers. The average age was 36 years (range 25–59 years). The average length of stay was 3.3 days (range 2–5 days). Fifty-six percent had cutaneous injury, but only one required debridement and placement of a skin substitute. Thirty-three percent complained of continued shortness of breath after discharge. Average total hospital cost was $28,131 ($9,500–51,000).

Conclusions
Paraquat is a highly toxic herbicide and exposure can be fatal if not treated promptly. Immediate decontamination and repeated pulse therapy with cyclophosphamide and methylprednisolone may be lifesaving.
569 Surrogate Decision Making: Who Has the Ultimate Say in Patient Care?
Authors: Huzar Todd F , Gerrek Monica L , Freet Daniel J 
Published: April 2021

Abstract

Introduction
Burn patients may present with an inability to communicate. In these cases, we need to rely on surrogates such as the Medical Power of Attorney (MPoA) or next of kin. A MPoA gives the agent the authority to participate in medical decision and in accordance with their wishes. The agent may consent to, refuse, withdraw, or withhold treatment, including life-sustaining interventions. At times, they may feel unable to participate in decision making without assistance (i.e. family members). The process can become more complicated and decision making can become “muddied” due to others influencing decisions. In our state, the MPoA is the proxy if the patient is unable to participate in decision making; however, there are cases when the patient doesn’t have an MPoA and the next of kin is the surrogate. In these cases, the next of kin would be consulted in the following order: spouse, adult children, parents, and nearest relatives. Some next of kin may not know the patient’s wishes complicating their care.

Methods
Two cases involving surrogates: #1: 60-year-old man with a history of HIV involved in a MVC and sustained 30% TBSA third and fourth degree burns to the face, torso, and extremities. The severity of his injuries and outcomes were discussed with his wife. She was not certain what her would want and she consulted her family because she did not know what to do; however, she knew that he would not want to live like this. After talking to the family, the kids “over-ruled” her. They wanted aggressive care despite the risks of complications and inability to perform ADLs because of his severe facial and hand burns.
Case#2: 40 something year-old man with a history of schizophrenia that sustained 65% TBSA third and fourth degree burns to his face, neck, torso, and extremities due to self-immolation. The patient’s mother was identified, and it was explained to the patient’s mother that if he did survive his injury, he will not be able to perform any of his ADLs due his hand and facial burns. The patient’s mother wanted everything done for her son.

Results
Both patients were unable to perform ADLs due to their injuries. One patient was discharged for further inpatient care and the other was discharged home because his mother refused further care. The first patient was unable to communicate about his thoughts on his outcome. The other patient was discharged home. He was upset about what he looked like. He also told the staff that he will do his best to finish what he started.

Conclusions
Complex issues can arise when the patient cannot communicate their wishes and the next of kin plays the role of surrogate. The family may disagree and alter the decision-making process. After seeing this scenario play out and patients not being happy about their outcomes, the policies regarding surrogate decision making should be re-evaluated.
570 A 10-year Retrospective Review of Pediatric Burn Care in a High-volume, Verified Burn Center
Authors: Fagan Shawn P , Cartie Richard , Ponte Raul , Hassan Zaheed , Homsombath Bounthavy , Jones Samuel W 
Published: April 2021

Abstract

Introduction
Historically, our pediatric admission population has comprised approximately one-third of all admissions. Periodically, it is beneficial to review demographics and outcomes. This type of review aids in planning, determining needed areas of improvement, efficiency in delivery of care, and it helps develop protocols which could be applicable to our other centers within the burn network. Moreover, it also establishes safety and adequacy of care for this specialized patient population in the face of potential life-threatening injuries. The purpose of this study is to create a demographic and clinical outcome profile of pediatric patients admitted to this burn center over the past ten years.

Methods
This retrospective chart review study was granted exemption from IntegReview IRB. Basic demographics and clinical outcomes were reviewed from data received from the Trauma Registry of the American College of Surgeons (TRACS) data base. The data reports for the 10-yr period were obtained in two 5-yr intervals. (01 Jan 2009 – June 2015 and July 2015 – December 31, 2019). As a result, the initial 5-yr period was not as detailed compared to the second 5-yr period. The authors summarized and accounted for as many differences in this documentation as possible, as the results will demonstrate.

Results
The study data was collected from data related to all pediatric burn admissions from January 1, 2009 – December 31, 2019. There was a total of 6354 admissions during this time.
***See attached diagram for further results data***

Conclusions
This review of data has demonstrated a safe and effective model of care in a large, growing burn center. As growth and change continue, it is imperative that we maintain regular self-assessments of this type to ensure continuity of this quality of care and to identify and address any gaps that exist to safeguard the health and outcomes of future patients.
575 A Retrospective Review Evaluating the Institution of Nurse Clinic Visits for the Treatment of Burn Patients Being Managed at Home
Authors: Solis-Gonzalez Stacy , Osborn Suzanne C , Richey Karen J , Foster Kevin N 
Published: April 2021

Abstract

Introduction
Most burn injuries can be managed at home; however appropriate follow up care is vital to prevent complications. Our center developed an outpatient dressing and care algorithm aimed at improving patient outcomes and optimizing the use of healthcare providers. The algorithm consisted of scheduling patients discharged home from the burn emergency department with a nurse visit (NV) within 3 days of discharge and a provider visit (PV) 1 week later. All NV could be converted to PV prn. The purpose of this study was to evaluate the effectiveness and safety of our nurse clinic visits.

Methods
This was a retrospective study of outpatients managed using the new care algorithm over a 1-year period. Patients whose NV was converted (CV) to a PV were compared to those who were not converted (NCV). Basic descriptive statistics were calculated.

Results
The charts of 259 patients scheduled for NVs were reviewed, mean age was 24.3 years and 51% were male. The population consisted primarily of Caucasians (47%) and Hispanics (35%). Most patients had a payor source with private insurance (40%) and Medicaid (31%) being the most common. Initial presentation to the burn ED was 1.56 days post injury, mean TBSA was 1.58% and most injuries involved the hands (36%) and arms (28%). The most common mechanism was scald (56%) followed by contact (28%). The most common dressing was petroleum gauze (41%) followed by silver impregnated foam (39%). NVs were converted to PV for 16% of the population. The most common reason for conversion was discharge from clinic (33%), followed by worsening (24%), therapy needs (24%) and change in dressing (19%). When CV patients were compared to NCV there were no significant difference in age, gender, past medical history, burn history (time to presentation, TBSA, mechanism, area of injury) or dressing type with the exception of enzymatic debriders (p=.0226). Native Americans (p=0.0257) and patients with Workman’s Compensation (p=0.026) were more likely to be converted to a PV. Hispanic patients were less likely to be converted to PV (p=.0357). The charges for NV ranged from $120-$185/visit with an average reimbursement of $60.88.

Conclusions
Overall compliance with the scheduling of nurse visits was poor. However, when scheduled per the algorithm, nurse visits were safe and effective, decreasing provider workload while still allowing for patients to be seen in a timely manner.
577 The Collaboration of Burn Outreach and Wound Care Nurses
Authors: Vohra Ekta 
Published: April 2021

Abstract

Introduction
Certified wound care nurses perform a vital role in skin health and management in the hospital setting. During the certification process, minimal time is spent on burn wound education, despite the fact that wound care nurses are consulted for various wound etiologies; one of those being burns. This construct created a need for collaboration between the burn team and wound care nurses. Although all burns are essentially wounds, the reality is that all wounds are not burns. The management of the burn wound is often different from the management of pressure injuries or surgical wounds. In speaking with the wound care nurses at this large urban academic medical center, a knowledge gap was identified in burn wound care education as well as appropriate and timely consultation of the burn team.

Methods
This knowledge improvement project focused on educating the wound care nurses in assessment and treatment of burns, and the process for burn service consultation. Burn education was provided through in-person didactic presentations. The lecture included burn wound photos with opportunities to classify the potential depth of burn wounds as well as typical complications. Additionally, it discussed when a burn consult is needed. A basic knowledge retrospective pre-posttest method was utilized.

Results
An educational plan was tailored to meet the learning needs of the wound care nurses to address the knowledge gap. Post test data results were tracked. Post scores were increased, indicating a successful educational intervention.
Also, while providing the education, the burn outreach coordinator identified an opportunity to expand the burn center’s presence among colleagues through collaboration with the wound care nurses. The wound nurses made excellent ambassadors for the mission of the burn service.

Conclusions
Provision of burn education across disciplines may improve recognition of burn wounds and facilitate definitive treatment.
580 Assessing Opioid Use After Discharge in Pediatric Burn Patients
Authors: Owens Victoria , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G , Sen Soman 
Published: April 2021

Abstract

Introduction
Opioids are frequently prescribed after burn injury. Prolonged use of opioids can increase dependence and potential for life threatening complications. For burn-injured children, optimizing opioid prescriptions in the outpatient setting can reduce these risks. Our aim for this study was to assess and analyze the outpatient opioid prescription use in children with burn injuries.

Methods
After approval from the institutional review board, pediatric patients admitted to our institution with £20% total body surface area (TBSA) burn were included. Data collected included age, gender, % TBSA burn, mechanism of injury, length of stay, surgical procedures, total morphine milligram equivalent (MME) given in last 24 hours prior to discharge and discharge pain prescriptions. 7 days after discharge, families tracked and provided daily usage of prescription opioids, acetaminophen, and ibuprofen, as well as daily pain scores. Families were given a follow up questionnaire about whether a prescription opioid was prescribed and filled, daily medication needs, pain scores, storage of opioids, quantity of medications remaining, and disposal of any remaining opioids. All mean values are mean±standard deviation, all median values are median(interquartile range).

Results
Twenty-nine patients were enrolled with a mean age of 7±5.8 years and mean TBSA of 10±6%. Daily outpatient pain scores ranged from 0–2. 18 patients underwent skin graft surgery (SUR) and 11 did not (NOSUR). The mean % of opioids that were not used was 50%±38% and 52% of families kept the left-over opioids for future use. For the SUR group, a median % of opioids that were not used was 64(14–90)% and for the NOSUR the median was 35(17.5–56)% and 56% of SUR families and 45% of NOSUR families kept the left-over opioids for future use.

Conclusions
For pediatric burn patients, opioids prescribed at discharge may be overestimating pain needs. In our study, half of the opioids were not used, and this was even more pronounced in patients who underwent surgery. More concerning is that the majority of families did not dispose the opioids and instead kept the medication for future use. We recommend optimizing opioid prescribing practices to reduce over-prescribing opioids to burn injured children and educating families on the need for proper disposal of left-over opioids.
583 Burn Care During Six Months Covid-19 Pandemic; Report of A Single Center
Authors: Aydogan Cem , Ayvazoglu Soy Ebru H , Turk Emin , Yabanoglu Hakan , Avci Tevfik , Gedik Ender , Haberal Mehmet 
Published: April 2021

Abstract

Introduction
The novel coronavirus (SARS-CoV-2) responsible for COVID-19 pandemic caused an unprecedented health care crisis. During pandemic burn centers had to preserve the ongoing burn care in a safe and ethical way. It is crucial to manage inpatients, outpatients, wards and staff carefully to prevent epidemia in burn units. Here, we aimed to report our burn care experience during the six months COVID-19 pandemic.

Methods
We retrospectively evaluated our ambulatory and hospitalized burn patients during the six months COVID-19 pandemic (from March to September 2020) with respect to the demographic data, wound care, surgery, intensive care management. Based on the model of our infection control team, we formed first to third degree prevention methods while contacting with burn patients in our outpatient clinic, semi-sterile ward (with beds) and intensive care unit (with 4 beds) which were sterilized and ventilated regularly. During hospitalization, we restricted the degree of interaction during multidisciplinary rounds. To screen for nosocomial infections, patients were routinely tested with PCR test.

Results
402 burn patients (158 paediatric, 244 adults) were managed as outpatients (n=332;82%) and in patients (n=70; 18%) in our burn centre. Total body surface area percentage of burn in hospitalized patients were 9, 95±2, 76 % in paediatric and 25, 34±3, 49 in adult group. Majority of the burns were scald (86.7% paediatric, 60.5% adults) burns. We successfully performed 66 surgical debridement and grafting procedures. Three adult patients had mechanical ventilation support during follow up and one of them died due to multi organ failure with negative PCR. We detected COVID-19 in 2 patients and both of them were discharged successfully.

Conclusions
According to our results, when precautions are taken, burn care can be managed successfully without posing any risk to patients during the pandemic period.
586 Patient Satisfaction for the Use of DVPRS in the Assessment of Pain in the Burn and Surgical ICU
Authors: Banks Michael C , Yesantharao Pooja S , Smith Lisa C , Werthman Emily h , Cox Carrie A , Javia Vidhi , Caffrey Julie 
Published: April 2021

Abstract

Introduction
The assessment and treatment of pain has become increasingly important in light of the opioid epidemic. Inadequately managed pain can lead to increased risk of psychiatric illness. The numeric rating scale (NRS) is used in most ICUs and only assesses pain intensity. Although it is reliable, valid, and user-friendly, other publications have criticized this one-dimensional pain assessment tools as offering little information about the impact of the pain on the patient’s life.
The defense and veterans pain rating scale (DVPRS) is a multi-dimensional tool designed to assess the patient’s pain intensity as well as how the pain interferes with the patient’s general activity, sleep, mood and stress. Studies have shown that it has good validity and reliability in the inpatient and outpatient military population with neuropathic and non-neuropathic pain. The DVPRS has not been evaluated in critical care patients. Thus, this study comparatively investigated ICU patients’ satisfaction with the DVPRS versus the NRS.

Methods
This was a prospective pilot study performed from September 2018 to July 2019 in a 10 bed burn intensive care unit (BICU) and 10 bed surgical intensive care unit (SICU) at a university teaching hospital. This was an IRB approved study. All enrolled patients were older than 18 years of age and were CAM-ICU negative. The participating staff members were educated on the use of the scales prior to the start of the study. Routine treatment of pain was not altered by the study. Pain was assessed by staff nurses randomly assigned to use the NRS or DVPRS tool. The selected tool was used on admission, during wound care and every 4 hours or upon patient need. The patients completed satisfaction surveys on the day of discharge.

Results
42 patients participated and 32 completed the study. 18 patients were in the DVPRS arm and 14 were in the NRS arm. Our primary outcome was patient satisfaction, ranked on a scale from 0–10, where 0 was the lowest score and 10 was the highest. Overall, patients in the DVPRS cohort had higher median satisfaction scores (median score: 10, interquartile range: 8–10) than the NRS cohort (median score: 8, interquartile range 7–9), though this difference did not reach statistical significance (p=0.16). However, DVPRS patients were significantly more likely to be “completely satisfied” than NRS patients (55.6% in DVPRS patients versus 21.4% in NRS patients; p=0.04). Furthermore, upon multivariate logistic analysis adjusting for age, gender, and ICU using the NRS pain scale conferred lower odds of complete satisfaction with pain management (odds ratio: 0.19, p=0.04).

Conclusions
Our study showed that ICU patients preferred the DVPRS over the NRS. The DVPRS appeared to be as effective as the NRS in pain relief and gave providers more information about patients’ pain.
588 Peripheral Nerve Blocks in Procedural Care for Burn Injuries Less Than 10% Total Burn Surface Area: A Retrospective Chart Review.
Authors: Maynell Kimberly , Chharath Khattiya , Tran Thanh , Taylor Loryn , Smith David J 
Published: April 2021

Abstract

Introduction
Pain control remains one of the major challenges in management of burn patients. Pain associated with procedural and post-procedural burn care such as excision and grafting, postoperative dressing changes, and postoperative physical therapies often requires patients to be on intravenous and oral analgesics leading to potential long-term dependence after hospital discharge. Peripheral nerve blocks (PNB) use for perioperative pain management in burn patients may present an alternative pain management modality to help decrease analgesic consumption and shorten length of stay following procedural care. Our hypothesis was tested by evaluating the outcomes from implementation of PNB with ultrasound guided catheter placement for burn procedural care in patients with ≤ 10% total burn surface area (TBSA) requiring excision and grafting.

Methods
After IRB approval, we retrospectively collected demographics, medical history, pain intensity (rated as “No Pain” [NRS=0], “Minor Pain” [NRS 1 to 3], “Moderate Pain” [NRS 4 to 6], “Severe Pain” [NRS 7 to 10]), postoperative analgesic consumption and time to hospital discharge of patients who underwent autografting procedures for burn injuries ≤ 10% TBSA from October 1, 2019 to December 31, 2019 (the start of our implementation of PNB for procedural burn care). Data was analyzed using chi square/Fisher exact test for categorical variables and t-test for continuous variables.

Results
Our preliminary data included 20 patients (10 patients had PNB) with average age of 53 years, 60% males and average TBSA of 4.8%. Patients in both PNB and non-PNB groups had unremarkable medical histories and scald and flame as mechanism of burns. There was no significant difference in TBSA (5.3% TBSA in PNB and 4.8% TBSA in non-PNB). Pain intensity before autografting procedure for both groups were reported as moderate to severe and managed with fentanyl, morphine, oxycodone, along with ibuprofen and acetaminophen. There was no significant difference in postoperative pain intensity and opioid consumptions; however, postoperative acetaminophen consumption was less in PNB group compared to non-PNB group (2762±3646 mg vs 3932±7511 mg, respectively), although not statistically significant. There was no significant difference between time from surgery to first physical therapy session; however, time to hospital discharge was shorter in PNB group compared to non-PNB group (5.7±1 days vs 10.5±9 days, respectively), although not statistically significant.

Conclusions
This evaluation shows a trend in reduction of inpatient postoperative analgesic consumption as well as time to hospital discharge with the use of PNB, although a bigger sample size is needed for further assessment.