bluuebunny/crossref_metadata_2025_split huggingface dataset:
538 Lessons Learned: Helping Non-Burn Facilities Prepare for Burn Mass Casualty Disasters
Authors: Steinert Amy , Mendelson Julia K 
Published: April 2024

Abstract

Introduction
At the request of the state, our burn center updated and rewrote the State Mass Burn Casualty Plan (MBCP) with a specific emphasis on helping local hospitals prepare to care for burn patients longer than the normal 96 hours. Grants funded outreach events to educate the various entities in the health regions on the new MBCP and practice implementing it in tabletop exercises (TTE). The goal of the TTE is to test the new state MBCP and identify barriers to successful implementation of the plan in a mock region-specific Burn Mass Casualty Disaster (BMCD).

Methods
Two outreach events for three regions were performed. On 4/7/23 at 0820, an event for region 6 & 9 occurred on Teams with 20 participants. The second event, for region 2, took place on 4/14/2023 at 0800 at a county fairground with 16 participants.
Each event began by explaining the new MBCP, focusing on education, triaging, and caring for burn patients for &gt;96 hrs. until transfers became available. Next was the TTE in which participants responded to a mock region-specific BMCD. The phases of the TTE included: Phase 1 (first 30 minutes), Phase 2 (30 minutes-2 hours), Phase 3 (up to 96 hours) and Phase 4 (96+hrs). The participants decided who and how the different entities would respond during each phase. All actions and communication were informed by real-time data acquired from the hospitals’ nursing supervisors and the state’s database capacity system.

Results
The results are broken down by region. Region 2 is urban. The TTE lasted 4 hours. The scenario involved an explosion at a chemical plant during the day shift. The chemical plant and local EMS are immediately overwhelmed and call for help. 7 hospitals, on average 29 miles from the accident can offer support.
Region 6&9 are rural or frontier. The TTE lasted 193 minutes. A small plane crashes into a parade. Multiple burns and traumas are caused from the crash, leaking fuel, and burning parade wagons. Local EMS are immediately overwhelmed. 9 hospitals, on average 102 miles from the accident can offer support.
All regions experienced similar problems: difficulty establishing control at the scene and the initial responding hospital, insufficient decontamination supplies, traffic and delays in transporting patients necessitating the holding of burn patients longer than 96 hrs., and lack of staffing.

Conclusions
Since both regions, despite their differences, share the same issues, this suggests that hospitals must update their internal and external disaster plans to address the problems listed above.

Applicability of Research to Practice
When updating BMCP, consider adding a section where all regions incorporate mitigation plans for the expected issues: establishing scene control, decontamination, transportation of patients and delays, and staffing.
563 Self-management Interventions and Outcome Measures for Individuals with Chronic Traumatic Injury: A Scoping Review
Authors: Coates Caitlin P , Shepler Lauren , Velasquez-Cano Mariana , Ryan Colleen M , Schneider Jeffrey C , Kazis Lewis E 
Published: April 2024

Abstract

Introduction
Self-management education programs have demonstrated efficacy in various chronic conditions to empower and educate patients to manage their treatment intervention options, work through disease related challenges, gain confidence about their treatment related decisions and ultimately improve their quality of life. Burns are increasingly recognized as a chronic condition, however there is limited data on self-management interventions in this population. Therefore, the purpose of this study is to perform a scoping review of self-management education programs for chronic traumatic injury populations to identify self-management interventions and gaps in knowledge in this population.

Methods
Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines were used to conduct a comprehensive search of peer-reviewed literature for articles from 2013-2023 using keywords relating to ‘self-management’ and ‘chronic traumatic injury’ in the following databases: PubMed (MEDLINE), Embase, Scopus, and ScienceDirect. Article inclusion criteria included: papers written in English, participants over the age of 18 years, studies focusing on physical traumatic injury populations. This scoping review is inclusive of studies focusing on participants of all races, genders, educational status, and employment status.

Results
A total of 810 studies resulted from the initial database searches, resulting in 6 studies that met the inclusion criteria for the scoping review. Of the resulting literature 3 studies focused on individuals with Traumatic Brain Injury and 3 with Spinal Cord Injury. There were no studies in the burn population. Total sample size ranged from 7 to 84 participants in the included studies. Interventions were applied for varying study durations with a minimum of 21 days up to 586 days across the studies reviewed. There were 5 studies that utilized telephone calls to apply their intervention, making this the most common intervention modality. Notably of the studies reviewed, 5 studies showed a benefit to the self-management intervention applied meaning that they described an increase in either self-efficacy scores or overall participant satisfaction with the intervention.

Conclusions
There are limited research studies examining self management interventions in the chronic traumatic injury population, thus identifying a gap in the knowledge surrounding self-management interventions in these populations. Of the six included studies, most demonstrated benefits with self-management interventions.

Applicability of Research to Practice
This review establishes the need for scientific testing of a self-management intervention in the chronic traumatic injury population, inclusive of individuals living with a burn injury.
570 Adult Self-Inflicted Burn Demographics in West Texas
Authors: Bandaru Vishal , Tran Vivie , Youssi Brandon , Wagnon Coltyn , Fakhreddine Aya Bou , Conkin Lauren , Pendse Rohan , Meers Kaylen J , Griswold John A , Pang Alan 
Published: April 2024

Abstract

Introduction
Self-inflicted burns (SIB) are a subset of burns defined based on self-injury, sometimes also referred to as self-immolation. The United States generally reports SIB in the context of psychiatric ailment. However, due to the difference in geographic locations, the West Texas burn coverage has never been checked for SIB patients. We hypothesize that patients with SIB have higher rates of psychiatric disorders and are generally older men.

Methods
We obtained a list of all patients admitted to the burn intensive care unit (BICU) with a Second/Third-degree burn. After, we verified the inclusion of patients meeting the study criteria from July 01, 2011, to July 01, 2021, ages between 18 and 89, and a completed Lund-Browder Chart. Data was collected from a mix of manual chart review from electronic health records and electronic data retrieval. Patients were split into two groups, SIB and non-intentional burns (NIB). Bivariate analysis was conducted using Mann Whitney U test and either Fisher’s exact test or Chi-square test when independent variables were categorical.

Results
The initial data set (n=2,875) decreased due to missing burn documentation, burn intensive care unit admission, and incomplete records and was split into two groups: SIB (n=49) and NIB (n=1,243). The average age and percentage of male patients compared between NIB and SIB were not significant (p=0.32, p=0.39). However, TBSA, frequency of inhalation injury, burn symmetry, suicidal ideation, history of drug abuse, history of self-harm, history of mental illness, past mental health hospitalization, and mortality were all significantly higher in the SIB group (p&lt; 0.001). There was also a statistically significant higher frequency of psychological disorders in the SIB group for depression, acute schizophrenia, borderline personality disorder, bipolar disorder (p&gt;0.001), anxiety disorders (p=0.02), post-traumatic stress disorder (p=0.006), atypical psychosis, drug-induced psychosis, and delirium (p=0.04).

Conclusions
The demographics of the West Texas SIB population are comparable to that of the United States, predominantly older male patients. Similarly, many psychiatric disorders occur at a higher frequency in SIB patients than NIB: depression, acute schizophrenia, borderline personality disorder, anxiety disorder, post—traumatic stress disorder, bipolar disorder, atypical psychosis, drug-induced psychosis, and delirium.

Applicability of Research to Practice
While SIB patients make a small portion of the total burn population, there burns are often associated with worse outcomes – mortality, larger burns, and length of stay. The severity of their injuries begs the need for further analysis and hopefully prevention of SIB. Addressing psychiatric facilities and preventing these incidents from occurring may offer preventative methods.
582 Predictors of Care Discontinuity in a National Sample of Burn Patients
Authors: Castillo-Angeles Manuel , Shepler Lauren , Orton Caitlin M , Ryan Colleen M , Schneider Jeffrey C , Mehta Anupama 
Published: April 2024

Abstract

Introduction
Continuity of care has become a widely accepted metric of quality of care. It has been shown that care discontinuity is associated with worse outcomes in the surgical and burn populations. However, there is a scarcity of data on factors leading to this discontinuity. The aim of this study was to determine predictors of care discontinuity in a national sample of burn patients.

Methods
This was a retrospective study using a multicenter longitudinal database from 1996 to 2021. All adult burn patients from participating sites were included. The main outcome was care discontinuity. This was defined by having therapy or burn-related surgeries at non-index (different hospital than the one for the original admission). Multivariable logistic regression was used to examine the association between multiple demographic and clinical factors and care discontinuity.

Results
A total of 4,167 burn patients were included. Mean age was 43.36 (SD 15.85) years, 73% were male and 70% were white. 505 (12.1%) burn patients reported having therapy or burn-related surgeries at a non-index hospital. After adjusted analysis, we identified several predictors of care discontinuity in the burn population. Older age (Odds Ratio [OR] 1.02, 95% Confidence Interval [CI] 1.01 – 1.03), female sex (OR 1.28, 95% CI 1.01 – 1.62), Total Body Surface Area burned (OR 1.01, 95% CI 1.01 – 1.02) and number of trips to the operating room (OR 1.26, 95% CI 1.19 – 1.32) were associated with higher odds of being readmitted to a non-index hospital. However, racial minority (OR 0.65, 95% CI 0.49 – 0.88) and a longer hospital stay (OR 0.99, 95% CI 0.98 – 0.99) were associated with a lower risk of care discontinuity.

Conclusions
Care discontinuity was not that common in the burn population, and it is mainly driven by patient demographic and burn-specific clinical characteristics. Further research should focus on developing strategies targeted to address these disparities in order to improve continuity of care in the burn population.

Applicability of Research to Practice
Understanding the predictors of care discontinuity in the burn population may help clinicians develop strategies to address these disparities, decrease care fragmentation and subsequently have better outcomes.
588 Early Physical Therapy Improves Burn Rehabilitation: Nationwide Study of Patients ≤30% Total Burn Surface Area
Authors: Richter Christopher G , Krishna Sunskruthi , Shah Suhaib , Segura Carolina , Ramgopal Yash , Durand Jean Pierre , Golovko Georgiy , Suman-Vejas Oscar E , Wolf Steven E , Ayadi Amina E I , Song Juquan 
Published: April 2024

Abstract

Introduction
While the benefits of physical therapy (PT) in burn patient rehabilitation is highlighted to great extent in literature, there are no national estimates on the effects of time from admission to initial PT evaluation. This study aims to evaluate how expedited PT evaluations influence outcomes in ≤30% total burn surface area (TBSA) patients.

Methods
A national database of deidentified patient records from 2015 to 2021 was analyzed. Thermal and chemical burn patients were categorized based on the time from initial injury to PT evaluation: &lt; 48 hours (early) or ≥ 48 hours (delayed). The study included patients with well-documented injury severity of ≤30% TBSA, while those with unspecified burn injuries or respiratory tract involvement were excluded. The outcomes, measured at one year, included continued pain, disability, psychological burden, and mortality. Analysis was performed using independent z-tests with a set value of p&lt; 0.05.

Results
The study included 2,386 patients with 58.6% evaluated by PT in the early cohort and 41.4% in the delayed cohort. The mean number of PT sessions per patient was consistent between both groups (6 sessions). At one year, the early evaluation cohort demonstrated significantly lower rates of pain (RR=0.579; CI=0.437-0.677; p&lt; 0.0001), psychological burden (RR=0.702; CI=0.547-0.902; p=0.0052), and disability (RR=0.464; CI=0.234-0.855; p=0.0122). No significant difference in mortality was observed.

Conclusions
This study highlights the significant benefits of expedited PT evaluation within 48 hours of admission for patients with ≤30% TBSA. The timely initiation of PT not only reduces pain and disability but also diminishes psychological burden at one year among patients with similar injuries. These findings emphasize the importance of prompt interprofessional integration for improved quality of life outcomes in burn patients.

Applicability of Research to Practice
This study offers a focused examination of the tangible benefits associated with early PT evaluation in mild to moderate burn patients. The findings have the potential to substantially impact interprofessional standards of practice and patient care protocols.
589 An Examination of Balance Problems in the Burn Population
Authors: Santos Edward , Chacon Kaitlyn , Shepler Lauren , McMullen Kara , Slavin Mary D , van de Rijn Marc , Kowalske Karen J , Ryan Colleen M , Schneider Jeffrey C 
Published: April 2024

Abstract

Introduction
Balance is an important daily functional ability that is dependent on many intrinsic and extrinsic factors; balance impairments can lead to loss of independence, injury, falls, and quality of life limitations. However, balance is not well studied in the burn population. The aim of this study is to describe the frequency of balance impairments and associated long-term factors after burn injury.

Methods
Data from a multicenter longitudinal database from August 2015 to January 2023 was analyzed. Self-reported trouble with balance was collected at discharge and at 6, 12, 24 and 60 months after injury. The population was divided into those with and without balance impairments at 12 months. Demographic and clinical variables were compared between groups. Regression analyses examined the association between demographic and clinical characteristics and self-reported balance impairments at 12 months.

Results
Of the 572 participants that met inclusion criteria, 153 reported balance impairments at 12 months. Balance impairments were most frequently reported at discharge (40.3%) and continued over the five-year follow up periods (26.8 to 36.0%). Those with reported balance impairments were older (53.1±15.7 vs. 45.0±15.9 years) and less likely to be employed (49.0% vs. 74.2%); additionally, they were more likely to have Medicaid or Medicare insurance (22.7% or 31.3% vs 12.7% or 15.1%), inpatient rehabilitation (34.7% vs 21.3%), outpatient physical or occupational therapy at 12 months (41.7% vs 23.7%), vision problems (26.2% vs. 7.0%), leg or feet burns (79.8% vs. 62.1%), numbness in their feet (55.7% vs. 16.8%), and swollen feet or legs (46.3% vs. 14.9%) compared to those without balance impairments (p&lt; 0.001 for all comparisons). Regression analysis demonstrated 4% increased odds of a balance impairment for every increase in year of age (p=0.001). Participants employed at the time of injury had 76% lower odds of reporting a balance impairment at one year (p&lt; 0.05). Additionally, trouble with balance was 279% higher for participants who received outpatient physical or occupational therapy (p=0.005) and 537% higher for those that reported drug misuse (p=0.020).

Conclusions
This study found that balance impairments are commonly reported at discharge and persist for up to 5 years after injury. Results suggest that trouble with balance is more likely to be reported by individuals who are older, unemployed at the time of injury, receiving outpatient therapy services, and misusing drugs.

Applicability of Research to Practice
Balance assessments during inpatient care and follow up appointments may be used to identify persons living with burn injury that may benefit from balance interventions.
596 Elevated Cardiac Troponin I Level Within 72 Hours Correlated to Cardiac Dysfunction in Burned Patients
Authors: Segura Carolina , Obias Isabel B , Ramgopal Yash , Richter Christopher G , Krishna Sunskruthi , Shah Suhaib , Amador Dalton , Song Juquan , Golovko Georgiy , ayadi Amina E I , Wolf Steven E 
Published: April 2024

Abstract

Introduction
Severe burned patients are under a hyperadrenergic and hypermetabolic states. Without proper treatment, patients developed cardiac dysfunction and heart failure. Cardiac Troponin I (cTI) is released from cardiac tissue which is considered as having a high predictive value in cardiac injury. However, its biomarker potential in cardiac insult continues to be under investigation in burn patients. The purpose of this retrospective research study is to evaluate the role of cTI and its association to patients with burns.

Methods
The patients' de-identified data was analyzed and collected from a national database. 8,092 patients 18 years old or older with burns who had cTI lab value were enrolled in this study. Patients were grouped by the cTI mean level within 72 hours including patients with high cTI levels at &gt;0.3 ng/mL (n= 1,879 patients), and patients with normal cTI level less than at 0.04 ng/mL (n= 3,265). The cohorts were further stratified by less than 20% TBSA and &gt;20% TBSA to replicate the severity of burns. The 30-days incidences of acute myocardial infarction (MI), sepsis, and mortality were observed after two cohorts were stratified into severe or mild burns. The cohorts were balanced using propensity score matching of covariates: age at index, sex, race, and ethnicity.

Results
The groups that were further stratified into mild burn and severe burn had the following

results
The mild burn risk ratio (RR) and 95% confidence interval (CI) for MI was (0.146/0.091-0.235), sepsis (0.662/0.48-0.914), and mortality was (0.433/0.305-0.615). The severe burn cohort had a RR and a 95% CI for MI of (0.236/0.121-0.462), sepsis (1.194/0.766-1.859), and mortality (0.547/0.416-0.719).

Conclusions
The patients with earlier elevated cTI level within 72 hours had worse outcomes of MI and mortality in both severe and mild burns.

Applicability of Research to Practice
The study indicates the cTI predictive potential which could be applied to monitor the high risk of complications in severe injured patients.
599 To Titrate or Not to Titrate, That Is the Burning Question: Enoxaparin and VTE Prophylaxis
Authors: Vega Kevin , Palumbo Morgan , Cheng Ke , Anderson Jeffrey 
Published: April 2024

Abstract

Introduction
Patients who sustain burn injury undergo metabolic and physiologic changes that place them at elevated risk of developing venous thromboembolism (VTE). Although the benefit and safety of enoxaparin titration for prevention of VTE in trauma patients is well established, there is a lack of evidence regarding its applicability for burn injured patients. In this study, we sought to determine the safety and applicability of enoxaparin titration for burn injured patients admitted for treatment of their injury.

Methods
We performed a single center retrospective study of burn injured patients admitted to our American Burn Association verified burn center from June 2022 to June 2023. In May 2022, our burn center adopted the American Association for Surgeons in Trauma (AAST) protocol for enoxaparin dosing. This includes twice daily administration of enoxaparin, followed by measurement of anti-Xa levels prior to administration of the fourth or fifth dose. We previously administered a standard dose of 30mg twice daily. Anti-Xa levels were used to guide enoxaparin dose adjustments to remain within prophylactic range. Patients hospitalized for under 48 hours, with glomerular filtration rate less than 30, and with repeated refusal of enoxaparin were excluded.

Results
Eighty seven patients met our inclusion criteria. Fifty six patients started at 40mg twice daily dosing; the remainder started at 30mg twice daily dosing. Of these patients, forty two (48%) required dose adjustments by anti-Xa levels. Of those who required dose adjustment, thirty three (78%) required an increase. There was no significant difference in BMI (p=0.25) or inhalation injury (p=0.62) between patients who did and did not require enoxaparin titration. Patients who required titration had a non-significant trend toward larger percent total body surface area affected (p=0.08). There was also a significantly greater change in dosing for patients who required an increase in dose adjustment as opposed to those who required a decrease in dose adjustment (p &lt; 0.0001). Finally, there was no difference in post-operative bleeding between patients who did and did not require dose titration (p=0.57).

Conclusions
Our results demonstrate that an individual approach to VTE prevention through enoxaparin titration is necessary in order to maintain appropriate prophylactic doses in burn injured patients. Furthermore, adoption of the AAST guidelines is safe and does not result in an increase in post-operative bleeding events.

Applicability of Research to Practice
This work highlights the safety and benefit of enoxaparin titration in burn injured patients to prevent VTE.