bluuebunny/crossref_metadata_2025_split huggingface dataset:
35 The Impact of Hand Burns on Strength; An Analysis of the ACT Database
Authors: Warthman Renée , Bay Curt C , Pirsig Whitney , Murray Derek , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Although hand burns comprise a small TBSA percentage, they can have significant functional implications. Multiple studies show grip strength as a predictor of health and quality of life. A decrease in grip strength has been reported in multiple populations with hospital admission; however, there is limited evidence concerning how burns affect hand strength. The purpose of this study was to examine the impact of burns on grip strength, measured at hospital discharge.

Methods
This study is a retrospective review of data from the prospective Burn Patient Acuity Demographics, Scar Contracture and Rehabilitation Treatment Related to Patient Outcome Study (ACT). Patients had grip strength measured of both hands 3 times consecutively at discharge. Data related to grip strength of patients with burn injuries were compared to age- and sex-matched normative values. Burn characteristics, including presence of hand burns, skin grafting, and length of stay were evaluated.

Results
There were 307 participants in ACT; 195 (63.5%) had hand burns and met inclusion for analyses. Among those with hand burns, the majority were male (72.8%), right-hand dominant (84.1%), mean ±SD age was 42.9±17.0; LOS, 23.3±22.8 days; and TBSA, 14.5%±13.3. Among patients with hand burns, 112 (57.4%) received skin grafts to at least one hand. Expressed as the percentage of grip strength loss relative to normative data, those with a burn injury to the hand averaged -55.8±33.4%, while those with no burns to the hand averaged -25.7%±36.3%, p &lt; .001. Patients with a skin graft to the hand averaged -65.8±27.2% grip strength, while those with hand burns, but no grafts averaged -36.1%±35.5%, p &lt; .001. Decreased grip strength is associated with increased length of stay, r= .21, p &lt; .001.

Conclusions
This study of hand strength in burn survivors at the time of hospital discharge corroborates previous reports regarding nosocomial strength loss but specific to the hand. Overall, patients hospitalized with burn injuries lose hand grip strength but more-so if a hand is burned and furthermore if a hand is skin grafted.

Applicability of Research to Practice
Understanding of the impact of burns on grip strength may help guide clinical decision making, allowing therapists treating those with burn injuries to anticipate deficits and subsequent functional impact. Expectation of a loss of grip strength in patients without burns to the hands should inform treatment planning during acute hospitalization to promote improved function and quality of life.
73 Examining Health-Related Quality of Life in Hispanic Adults with Burn Injuries
Authors: Dominguez Tamara Alcala , McMullen Kara , Orton Caitlin M , Yenikomshian Haig A , Flores Elizabeth , Schneider Jeffrey C , Ryan Colleen M , Stewart Barclay T 
Published: April 2024

Abstract

Introduction
The intersectionality of an individual’s social and political position shapes their lived experience and can be associated with inequities. Thus, historically ethnicity has been used as a contextual indicator of inequity and often as a proxy of economic disadvantage. A resulting presumption is that the interplay of ethnic identity and socioeconomic (SES) factors can compound the burden faced by individuals during recovery and affect overall health related quality of life (HRQOL). In this analysis, we hypothesize that Hispanic adults with burn injuries and who had low SES status prior to injury reported decreased HRQOL post-injury compared to those with average-SES.

Methods
Data from adult participants in a national multicenter longitudinal database was analyzed. Ethnicity was provided by self-report or medical record. SES was classified as low ( &lt; $49,000 annual income or no high school diploma/GED), average ($50,000-$99,999 annual income or completion of high school/GED), and high (&gt;$99,999 annual income or at least some college or trade school). VR-12 and PROMIS Global-10 measure HRQOL in both physical and mental health domains, through validated physical component scores (PCS) and mental component scores (MCS). Kruskal Wallis tests were used to test differences of PCS and MCS between subsets of Hispanics and non-Hispanics with low, average, and high SES.

Results
Out of 952 participants, 19.5% were Hispanic. The average age was 40.6 years. Nearly half reported less than a high school education (47.3%), 40.3% were high school graduates, and 12.4% had either a vocational degree or some form of higher education. Non-Hispanic participants averaged 47 years of age, with 14.6% reporting less than a high school education. Nearly a third of Hispanic participants experienced low SES (34.4%), 38.7% experienced average SES, and 26.9% experienced high SES. Conversely, non-Hispanic participants experienced low and average SES less commonly (8.1 and 30.9%, respectively) and 61% experienced high SES (all differences p&lt; 0.001). Burn surface area, sex, and PCS were not statistically different between groups. Notably, the low SES Hispanic group consistently reported statistically significantly higher MCS, compared to all other cohorts, at 6-months (59.6, p=0.0008), 12-months (59.7, p=0.001), and 24-months (60.6, p=0.003) post-injury follow-up (Figure 1).

Conclusions
Hispanic adults with low SES reported higher mental health scores, signifying better HRQOL in this domain, than their average SES Hispanic and non-Hispanic counterparts over a 24-month follow-up period.

Applicability of Research to Practice
These results underscore the complexity of burn recovery experiences and could be suggestive of underlying protective factors that should be explored for possible utilization in culturally nuanced approaches to rehabilitation.
76 Social Reintegration After Burn Injury Is Negatively Impacted by Sensory Impairments
Authors: Pacleb Maiya I , deGrauw Xinyao , Orton Caitlin M , Schneider Jeffrey C , Yenikomshian Haig A , Stewart Barclay T 
Published: April 2024

Abstract

Introduction
Social reintegration is an important goal of recovery for people living with a burn injury. Sensory impairments are common after major burn injury and can compound challenges related to burn recovery more generally. Therefore, we aimed to describe social integration outcomes of people living with burn injury who have hearing, vision, or dual sensory impairment (DSI, hearing and vision impairments) when compared to those with no sensory impairment (NSI). We hypothesized that those with sensory impairments would have lower social integration when compared to those without.

Methods
Adult participants in a multicenter national longitudinal database who provided responses for the abbreviated Community Integration Questionnaire (CIQ) were included. CIQ evaluates social integration on a scale of 0 (no community integration) to 12 (excellent community integration). Participants self-reported (yes/no) sensory impairment at discharge (pre-injury recall) and 6, 12, and 24 months after injury and were then grouped into cohorts with hearing impairments, vision impairments, DSI, and NSI. Mixed effect regression models evaluated the impact of sensory impairments on CIQ compared to pre-injury scores and the differences between cohorts at each timepoint.

Results
852 participants were analyzed, with older participants (≥55 years) more likely to have sensory impairment (p &lt; 0.001). There were 11% (n=95) with hearing impairment, 9% (n=72) with vision impairment, 3% (n=30) with DSI, and 77% (n=655) with NSI. Those with vision impairment reported a significantly lower CIQ score pre-injury compared to those with NSI (p &lt; 0.01). Compared to pre-injury, participants with DSI had significantly lower CIQ at 6, 12, and 24 months (p &lt; 0.01), and participants with NSI had lower CIQ at 6 and 12 months (Figure 1, p&lt; 0.01). Compared to those with NSI, participants with DSI had more CIQ score loss at all follow-up timepoints (0.97 at 6 months, p&lt; 0.05; 1.07 at 12 months, p&lt; 0.05; 1.43 at 24 months, p&lt; 0.01). The CIQ for those with DSI continued to decrease 24 months post-injury, whereas those with hearing impairment, vision impairment, and NSI improved.

Conclusions
While all groups’ social integration decreased after burn injury, significantly lower CIQ scores were reported by those with DSI. Importantly, those with hearing impairment, vision impairment, or NSI had CIQ scores that gradually improved over time. Future studies should evaluate the effect of systematic screening and delivery of key resources for those with sensory impairments after burn injury to aid their community reintegration.

Applicability of Research to Practice
Those who experience sensory impairments after burn injury may need focused rehabilitation efforts and adapted recovery resources that address their unique health and social needs to achieve a successful reintegration.
115 Examination of Voice Changes up to Five Years After Burn Injury
Authors: Chacon Kaitlyn , Santos Edward , McMullen Kara , Shepler Lauren , Clark Audra , Akarichi Chiaka O , Yenikomshian Haig A , Orton Caitlin M , Tierney-Hendricks Carla , Ryan Colleen M , Schneider Jeffrey C 
Published: April 2024

Abstract

Introduction
Voice plays a prominent role in verbal communication and social interactions. Acute burn care often includes intubation, mechanical ventilation and tracheostomy, which may impact voice quality. However, the issue of long-term dysphonia remains underexplored. Thus, this study aims to examine the frequency of and associated factors with voice changes long term in the burn population.

Methods
Adult data from a multicenter longitudinal database from 2015-2023 were analyzed. The frequency of self-reported vocal changes (yes/no) was examined at discharge and 6, 12, 24, and 60 months after injury. Demographic and clinical data were compared between those with and without vocal changes at 12 months after injury. An omnibus chi-square test examined the incidence of voice changes among burn survivors based on ventilator days. Additionally, the percentage of tracheostomies by ventilator days was observed and compared amongst those with and without a voice change. Logistic regression analysis examined the associations between demographic and clinical factors and self-reported voice change at 12 months.

Results
A total of 582 individuals with burn injuries were included (65 with and 517 without voice change at 12 months). Voice changes were most commonly reported at discharge (16.4%) and persisted over the 60-month follow up period (11.6-12.7%). Those with voice changes were more likely to have had a flame burn, inhalation injury, tracheostomy, outpatient speech-language pathology, head/neck burn, larger burn size, mechanical ventilation, more ventilator days, and multiple trips to the operating room than those who reported no voice changes (p &lt; 0.001). Increasing frequency of voice changes is associated with greater ventilator days (p &lt; 0.001). For those on a ventilator more than 21 days, 48.7% experience voice changes at 12 months and 83.3% had received a tracheostomy. The regression analysis demonstrates that individuals that were placed on a ventilator and received a tracheostomy were more likely to report a voice change at 12 months (284%, p=0.027 and 431%, p&lt; 0.001, respectively).

Conclusions
Voice changes were frequently observed in people living with a burn injury, showing that symptoms can persist for up to five years after injury. Mechanical ventilation and tracheostomy were the primary factors associated with persistent voice changes after injury. Future studies could explore the impact of speech-language pathology and other interventions on individuals experiencing long-term dysphonia following burns.

Applicability of Research to Practice
This study emphasizes the need to understand the long-term voice effects of intubation and tracheostomy in burn care.
117 QuickDASH Quantifies Perceived Upper Extremity Function in Acute Burn Rehabilitation: A Quality Improvement Project
Authors: Coakley Katie , Berry AnnMarie , Serrano Jaime 
Published: April 2024

Abstract

Introduction
A patients’ perception of their abilities to complete daily tasks post-burn injury can be difficult to measure and warrants more research. To ensure patients with an upper extremity (UE) burn injury are gaining the functional outcomes they desire, one burn center developed a quality improvement (QI) project focused on burn patients’ perceived ability to complete daily tasks.

Methods
Occupational Therapists (OTs) assessed burn patients’ perceived UE function at evaluation and discharge with the QuickDASH, a self-reported outcome measure. Scores range from 0-100, higher scores indicate greater perceived deficits. The minimal clinically importance difference (MCID) is 15.9. Inclusion criteria was at least 18 years old, UE burn injury, hospitalized for &gt; 48 hours, and cognitively able to participate. Data was collected & analyzed using Microsoft Excel. Normative data including means and standard deviations were reported. An analysis of variance (ANOVA) was performed to identify if changes in QuickDASH scores were significantly different for operative and non-operative patients.

Results
115 patients met inclusion criteria from Sept. 2022 - Sept. 2023. 70.1% patients were male, 29.9% were female. The average total body surface area burned was 9.8%. The ANOVA did not find a significant difference in changes in QuickDASH scores between operative and non-operative patients (p=.79). The number of patients from initial data collection period to most recent who met the inclusion criteria increased, of those, the amount that completed a QuickDASH upon evaluation and discharged increased. See Table 1 below for the three data collection periods.

Conclusions
The QuickDASH is a helpful tool for OTs working in the acute phases of burn rehabilitation. Tracking QuickDASH scores for patients with an UE burn injury contributes to continuous efforts of improving the quality of care and promoting patients’ achievement of desired outcomes. The QuickDASH can identify therapy needs beyond an acute care setting and promotes patient engagement.

Applicability of Research to Practice
This QI project promotes continued growth for the burn center and adds to the body of knowledge about acute phases of burn rehabilitation. An area of opportunity for a future QI project includes implementing the QuickDASH in an outpatient setting, which would allow comparison to the patient’s acute care discharge score to promote continued progression towards desired outcomes. The presenters will continue to collect and analyze data prior to presentation if accepted.
123 National Study of the Increased Incidence of Complex Regional Pain Syndrome Following Severe Burn Injury
Authors: Krishna Sunskruthi , Shah Suhaib , Segura Carolina , Ramgopal Yash , Durand Jean pierre , Richter Christopher G , Wolf Steven E , ayadi Amina E I , Song Juquan 
Published: April 2024

Abstract

Introduction
Complex Regional Pain Syndrome (CRPS) is a clinical condition that presents after an operation, trauma, or burn injury with allodynia, hyperalgesia, and myasthenia. The etiology of CRPS remains poorly understood and there is a notable gap in literature linking the severity of burns to the risk of developing CRPS. Our study aims to address this by investigating retrospective patient data to determine the relationship between the degree and total body surface area (TBSA) of burn injury and the incidence of CRPS.

Methods
Patient records were accessed through a national database of de-identified electronic patient medical records from 2010 to 2019. Specific ICD-10 codes were used to define cohorts and outcomes. Three cohorts were established among patients with a history of burns- those with first-, second-, and third-degree burns. Two additional cohorts of TBSA of burns of ≤20% and &gt;20% were established. These cohorts were analyzed for the risk of developing CRPS (type 1 and 2) within 6 months of first instance of burn injury. A z-test was performed after propensity score matching with age, sex, race, and ethnicity with significant p-value &lt; 0.05.

Results
0.274% of third-degree burn patients (n= 2,682), 0.213% of second-degree burn patients (n= 2,009), and 0.221% of first-degree burn patients (n= 2,686) were diagnosed with CRPS within 6 months of the first instance of burn injury. Patients with third-degree burns were at a significantly higher risk for developing CRPS compared to patients with first-degree burns (p= 0.0270), second-degree burns (p=0.0102), and first- and second-degree burns combined (p &lt; 0.001) within 6 months post-burn injury. Patients with more severe burns of TBSA&gt;20% (n= 6,628) were more likely to develop CRPS with a risk of 0. 422% (p= 0.0305). Additionally, burn patients with CRPS were more likely to be female than without CRPS for first- (74%), second- (67%), and third- degree burns (53%), and TBSA&gt;20% (62%).

Conclusions
Patients who undergo third-degree burns or burns of TBSA&gt;20% have a significantly greater risk for developing CRPS post-injury. Based on hypothesized mechanisms, the extensive tissue damage of more severe burns will result in a higher incidence of CRPS.

Applicability of Research to Practice
These results indicate a need for a proactive risk assessment and more comprehensive post-hospital care to limit and manage the risk of CRPS in burn patients. Future research can inquire about other predisposing factors and complications of CRPS in the burn population and explore incidence of CRPS for other time periods post-injury.
507 Decrease in Total Leukocyte Count Is Associated with Acute Kidney Injury After Severe Burn
Authors: Aden James K , Rizzo Julie A , Schauer Steven G , Pham Tam N , Salinas Jose , Johnson Laura S , Harris Rachel 
Published: April 2024

Abstract

Introduction
Whereas leukocytosis is common immediately after major burn injury, total leukocyte count (TLC) often decreases 72-96 hours post-injury. It is reported that up to 50% of patients may experience leukopenia during this timeframe, which is typically self-limiting. The incidence of early (&lt; 72 hours) leukopenia and its implications have not been well-described. This analysis sought to determine if early and extreme decreases in TLC after burn injury was associated with increased fluid requirements or resuscitation-related complications in patients after burn injury.

Methods
The Burn Navigator (BN) database is composed of patients with &gt; 20% TBSA, &gt; 40kg that were resuscitated utilizing the BN. Patients were split into study arms based on decreases in TLC relative to admission value within the first 24 hours after injury. Demographics were collected on the two study arms as well as resuscitation volumes, resuscitation-related complications and 7-day survival.

Results
A total of 295 patients were included in the analysis. Demographics were similar between the two groups. Patients with a larger decrease in TLC from admission had more full-thickness burns (14.2 [2,36]) and greater overall TBSA (41 [30.2, 57.4]) than those with a smaller decrease (7.7 [0.3, 14.8], 7.5 [23, 36], both p &lt; 0.001). Patients with a decrease in TLC from admission greater than 15 points had a higher incidence of admission myoglobinuria (55.6%) than those with a TLC decrease less than 15 (44.4 %, p = 0.01). Patients with a greater TLC drop had an increased incidence of developing acute kidney injury (AKI) in the first 48 hours of resuscitation (62.9% vs. 37.1%, p = 0.003) despite receiving more fluid. After controlling for TBSA, patients with a greater TLC drop still had a higher incidence of AKI. Patients with a TLC drop greater than 15 had significantly decreased 7-day survival (66.7% lived) compared to those with a TLC drop of less than 15 (83.7% lived, p&lt; 0.001).

Conclusions
Acute leukopenia alone was not associated with mortality after thermal injury. An early, severe decrease in TLC was found to be associated with early AKI and this may be readily identified by admission myoglobinuria. Future studies need to investigate the mechanism behind this association and possible early therapeutic interventions to prevent AKI and decrease mortality after severe burn injury.

Applicability of Research to Practice
Variability in leukocyte response to thermal injury may help guide both clinician optimization of organ function, and allow for realistic goals of care to be discussed with patient advocates.
523 Weight Loss in Patients with Large Burns
Authors: Graves Caran , Thompson Callie M , LaChapelle Christopher R , Fleming Irma D , Lewis Giavonni M 
Published: April 2024

Abstract

Introduction
The deleterious effect of weight loss in those with burns is well known. However, guidelines for monitoring loss are limited. This descriptive study evaluated weight loss incidence in patients with large burns admitted to a regional burn center.

Methods
Medical records for adult patients admitted to a regional burn center (2019-2021) with burns ≥20% total body surface area burned (TBSA) were reviewed. Patients with amputations were excluded. Data collection included burn size/depth, resuscitation fluids (pre- and post-admission), initial and final weight (last week of admission) and nutritional interventions. Patients were divided into three groups based on %TBSA: 20-29%, 30-39% and ≥40%.

Results
From 2019-2021, 722 patients with new burn injuries were admitted of whom 542 were over 18 years of age. Fifty-two (94% male) met inclusion criteria. Those with smaller burns had fewer surgeries and shorter stays. (Table 1).
Most patients (85%) received resuscitation fluids prior to admission (PTA) with an average of 2782 mL PTA and a total of 21,079 mL after admission. Larger burns received high resuscitation volumes both pre- and post- admission.
Over half of patients lost weight though 23 had a net weight gain. Most patients (56%) lost some weight but nearly half (48%) discharged within 5% of admission weight. The average loss across all groups was only 2.6% of admission weight (Table 2). Patients with larger burns were more likely to lose weight and also had more weight loss.
Almost all (94%) patients required enteral nutrition and all transitioned to full oral intake prior to discharge; no one required parenteral nutrition. Again, patients with larger burns required more enteral intake.

Conclusions
Most patients lost weight though some had net weight gain. Those with larger burns lost more weight than those with smaller burns. Weight loss is a risk factor for malnutrition even with nutritional support. Weight loss in burn patients should be monitored—particularly in those with burns &gt;30% TBSA--and be considered as an outcome measure in burn care.

Applicability of Research to Practice
Weight loss in burn patients should be monitored and considered as an outcome measure in burn care.