bluuebunny/crossref_metadata_2025_split huggingface dataset:
129 Are There Differences in Scar Assessments as a Function of Fitzpatrick Skin Type
Authors: Carney Bonnie C , Lee Davon T , Travis Taryn E , Allely Rebekah R , Tejiram Shawn , Shupp Jeffrey W 
Published: April 2024

Abstract

Introduction
Skin type, as organized within the Fitzpatrick scale, may be an important variable in scar severity. Fitzpatrick skin type II (FST-II) and Fitzpatrick skin type V (FST-V) were chosen, to compare scar outcomes of lighter and darker skin patients with burn injuries. It was hypothesized that patients with FST-V skin have worse scar outcomes than patients with FST-II skin.

Methods
Demographic variables were obtained from the EMR including patient age, age of scar at time of assessment, gender, etiology of burn injury, and location of injury for this retrospective chart review. A variety of scar assessment scales and non-invasive measurements of scar qualities were administered during visits with the rehabilitation team around 4 months post-burn. These included The Patient and Observer Scar Assessment Scale (POSAS) which was broken up into: POSAS-Observer (O) avg, POSAS-Patient (P) Itch, POSAS-P Pain, and POSAS-P avg. This evaluation also included the Vancouver Scar Scales (VSS), and pliability, erythema, and melanin objective measurements.

Results
Thirty patients were included in the analysis, 15 in each group. In FST-II, 53% of subjects were female, 47% were male. In FST-V, 33% of patients were male, while 67% were female (p&gt;0.05). There are no significant differences in categorical patient age ( 42.2±4.6 vs 45.6±4). Approximately 67% of FST-II patients had flame burns, 33% scald injuries. Similarly 62% of FST-V subjects had flame burns, and 38% had scald injuries. The location of injuries was variable in both groups, but not different among groups. Scars were evaluated at 3.7±0.3 months with a range from 1-8 months post-burn and this evaluation time was not different between groups. For observer driven scar assessment (POSAS-O avg and VSS), there were no differences in scores between the groups (6.2±0.4 vs. 6.1±0.4 and 6.1±0.4 vs. 5.8±0.5). POSAS-P Itch scores and Melanin levels were higher in FST-V (7.3±0.6 vs. 5.3±0.7, p&lt; 0.05, 896.4±9.5 vs. 727.2±9.8, p&lt; 0.0001). Erythema was higher in FST-II (463.7±6.4 vs. 398.7±11.4, p&lt; 0.0001). There was no statistical difference in POSAS-P Pain or pliability scores between FST-II and FST-V groups.

Conclusions
These findings suggest that patients rate their scars as being equally morbid regardless of skin type. There may be a correlation between higher melanin levels and pruritis in burn scars. Although scars in darker patients is thought to result in worse outcomes, the data shows that observers rate them equally. These findings bring into question the validity of current scar assessment scales and whether they adequately measure scars within different FST groups.

Applicability of Research to Practice
Performance of current scar scales in different skin types could affect treatment decisions. New metrics may need to be added to current scar assessment tools.
503 Should Co-morbid Conditions Be Factored in Mortality Prediction Models for Burn Injury: Single Center Evaluation
Authors: Hollowell Jamie L , Levine Ashley , Bodek Benjamin , Agala Chris B , Maxwell Eli , Chrisco Lori , Matthews Robert W , King booker , Williams Felicia 
Published: April 2024

Abstract

Introduction
Comprehensive conversations about prognosis in burns currently neglect the impact of co-morbid conditions on outcomes. Currently, the most often quoted burn mortality predictors focus on age, burn size and depth, and inhalation injury. We suspect comorbidities increase the risk of mortality from a large burn. Our aim is to identify and quantify the magnitude of impact pre-existing comorbidities may have on the outcomes of our burn patients.

Methods
Patients were identified using Institutional Burn Center registry and linked to the clinical and administrative data. Adult patients admitted from Jan 1, 2012, to June 30, 2023, were included. Demographics, length of stay (LOS), and mortality were evaluated using logistic regression to create a predictive model. LASSO regularization was used for variable selection; model was fit with a training dataset (n=7948) and evaluated on a validation dataset (n=1975).

Results
We evaluated 23 variables to identify variables with independent predictive power. Fourteen variables had increased predicted risk of mortality: female sex (0.07), increasing age (0.065), etiology other than burn(0.36), burn size (0.8), public insurance (0.27), inhalation injury (1.92), positive alcohol status upon admission (0.07), COPD (0.85), congestive heart failure (0.56), stroke (0.36), diabetes (0.08), renal failure (0.97), alcoholism (0.64), and substance abuse (0.51). Conversely, 5 variables led to a decreased predicted risk of mortality: other/unknown insurance status (-0.23), unknown alcohol history (-0.24), positive cocaine status upon admission (-0.22), asthma (-0.18), and hypertension (0.24). The model’s AUC on the validation dataset was 0.926.

Conclusions
Not all co-morbid conditions effect outcomes negatively. Additionally, the lack of association of some variables may be attributed to the presence of other comorbidities accounting for their impact. Next steps are to determine if any of these factors are modifiable with changes in treatment strategies regardless of the chronicity of the co-morbid condition.

Applicability of Research to Practice
Current burn mortality predictors lack many comorbid factors, so further work needs to be done to determine if additional comorbid conditions should be considered in formal mortality predictions.
504 Revised Baux Score Identifies a New Risk Factor for Mortality: History of Diabetes
Authors: Nehila Timothy , Mikhael Marian , Arora Shreya , Jupudi Rithvic , Criscione Jaynie X , Le Nicole K , Whalen Kristen , Buller Kristina , Troy Jared , Laun Jake 
Published: April 2024

Abstract

Introduction
Mortality following burn injury is influenced by many objective factors. Over the past several decades, numerous predictive formulas have been developed to estimate the probability of death from burn injury. Despite the preponderance of models, there are relatively few widely accepted objective measures found to impact mortality in burn patients. These factors include sex, age, burn depth, TBSA, and presence of inhalation injury. In this study, we retrospectively analyzed mortality in the burn patients at our level one trauma center to identify prognostic factors.

Methods
A retrospective chart review was performed on all patients between 2015-2020 over the age of 18 that presented to our trauma center for burns. Significant risk factors for the prediction of mortality based on a set of objective variables were identified using a stepwise forward logistic-regression analysis.

Results
Of the 963 patients (mean [±SD] age, 47±17; mean TBSA, 9±13), 96% lived to discharge. The identified risk factors for death were increased age (OR 1.08, 95% CI 1.04-1.11, p&lt; 0.001), increased TBSA (OR 1.10, 95% CI 1.06-1.13, p&lt; 0.001), the presence of inhalation injury (OR 4.72, 95% CI 1.49-14.94, p=0.008), third degree burn depth (OR 6.09, 95% CI 1.15-32.00, p=0.033), and having diabetes (OR 3.61, 95% CI 1.17-11.08, p=0.025 (Table 1). The probability of death from patients who experience burns is described by the equation:
probability=1/(1+e^(-log f ()it))
With logit equal too:
logit = -9.584 + 0.072*(Age) + 0.090*(TBSA) + 1.804 (Presence Third Degree Burns) -2.231 (Presence Second & Third-Degree Burns) + 1.282 (Presence Diabetes) + 1.551 (Presence Inhalation Burns)
Categorical values should be treated as 1 if they are present and 0 if they are absent.

Conclusions
Between 1990 and 2010 the number of people living with diabetes tripled, and the annual incidence doubled. Diabetic wound healing is characterized by excessive inflammation and reduced angiogenesis, resulting in increased risk for complications. Diabetes is an established comorbidity in burn patients, but has never been identified as a significant risk factor for mortality.

Applicability of Research to Practice
Analysis of burn patients at our level 1 trauma center identified history of diabetes as a significant risk factor for mortality and suggests that the inclusion of diabetic status in future mortality models would increase their prognostic value in comparable populations.
517 Continuous Post-Pyloric Tube Feeds During Prone Operations Do Not Significantly Increase Rates of Pneumonia
Authors: Sather Kristiana , Lacey Alexandra M 
Published: April 2024

Abstract

Introduction
It is well established that nutrition is critical for burn patients due to their catabolic, hypermetabolic, and inflammatory states, and enteral nutrition is the preferred route. For patients with significant burns and those who are unable to meet caloric demands, tube feeds are the preferred method of nutrition. It is important to minimize interruptions in nutrition and in collaboration with the anesthesia colleagues at our institution patients continue to receive continuous post-pyloric tube feeds intraoperatively regardless of positioning. We hypothesized that the rates of post-operative pneumonia would not increase despite receiving post-pyloric tube feeds while in prone positioning.

Methods
This retrospective cohort study includes all pediatric and adult burn patients admitted to our institution between January 2022 through July 2023. The primary outcome was the rate of post-operative pneumonia in patients receiving continuous tube feeds during prone positioning in the operating room compared to the rates of pneumonia in all admitted burn patients. Pneumonia is defined as pneumonia discussed at our Morbidity and Mortality conference and in the continuous tube feeds during prone positioning group, this was further defined as being documented within 48 hours post-operatively. The secondary outcome is the rate of post-operative pneumonia following all prone operative cases in which patients received continuous post-pyloric tube feeds. A p value &lt; 0.05 is considered statistically significant.

Results
Of 855 burn admissions during this time frame, 46 patients received continuous post-pyloric tube feeds while in prone positioning during at least one trip to the operating room. Of these 46 patients, 4.3% developed post-operative pneumonia compared to a 2.2% rate of pneumonia in all admitted burn patients (p = 0.178). Considering some patients required multiple operations, there were a total of 94 operative cases involving patients that received continuous post-pyloric tube feeds while prone and the rate of post-operative pneumonia when these cases were analyzed as individual events was 2.1%.

Conclusions
Although continuous post-pyloric tube feeds during prone cases in the operating room was associated with an increase in pneumonia compared to all burn patients, this was not statistically significant. Furthermore, when the rate of post-operative pneumonia was stratified by total number of prone cases rather than by number of patients, the rate of pneumonia decreased to the same rate of pneumonia in the general burn population.

Applicability of Research to Practice
The purpose of this project is to promote uninterrupted nutrition in burn patients and encourage other institutions to consider continuing post-pyloric tube feeds during prone operating room positioning.
541 In-Process Quality Improvement Action Following an Urban Residential Explosion
Authors: Hagg Emily , Fuchko Danielle H , Bharadia Shyla K , Gabriel Vincent 
Published: April 2024

Abstract

Introduction
Burn centers need specialized plans for the management of burn mass casualty incidents for best outcomes. The ABA burn disaster response plan distributed in 2023 provides a communication plan for the association and burn centers. However, individual centers must develop local response plans. In this case, a Level 1 trauma and burn center with an institutional all-hazards, non-burn specific disaster plan responded to a home explosion in a city of 1.1 million. This event prompted a quality improvement project to assess the opportunities for development of burn-specific disaster response needs within the existing plan.

Methods
The Define, Measure, Analyze, Improve, and Control (DMAIC) approach to quality improvement was utilized. Defining the problem and measuring current performance was conducted based on information derived from the electronic medical record system, Fire Department report and team debriefs of the incident response.

Results
Seven male patients with a mean TBSA of 19% were admitted to the burn centre in a 1100 bed tertiary care hospital on a Monday morning. Three required ICU level care. The burn center had zero available beds at the time of incident and surge capacity was utilized. The total number of surgical procedures performed was 17. Mean length of stay was 34 days. There were 95 outpatient encounters in the six months following the incident (Table 1). All patients received specialized burn care and were discharged back to the community independent of basic activities of daily living. Increased human resources, equipment and consumable product use by physio and occupational therapy at the time of incident and in follow up was noted to be greater than anticipated. Social work needs exceeded capacity. On hand local specialized dressing supplies were exhausted within the first 24 hours and supplemental products were acquired from other centers and commercial vendors until available stock depleted. Strategies to improve initial communication have been implemented. Burn unit expansion is under discussion with the regional health authority. Stock levels and acquisition planning for supplies is underway. Additional physio, occupational therapy and social work needs require further measurement and analysis.

Conclusions
Assessment of this center’s response to multiple simultaneous burn patient presentations offered an opportunity to optimize an existing all-hazards disaster response plan. Simulated burn disaster response is necessary to further assess the changes implemented and proposed.

Applicability of Research to Practice
After event review may improve disaster response planning.
608 Timing of Nanocrystalline Silver-based Dressing Application – a Retrospective Single-center Pediatric Cohort Study
Authors: Thibedeau Marshall , Wenskus Julia , Zuccaro Jennifer , Gus Eduardo I 
Published: April 2024

Abstract

Introduction
Nanocrystalline silver-based dressings (NSBD) are commonly used at different stages of the treatment of burn wounds. They have been shown to reduce the incidence of surgical procedures, time to re-epithelialization in partial thickness burn injuries, and decrease pain with dressing changes compared to silver sulfadiazine in adult and pediatric populations. Recent evidence has demonstrated anti-inflammatory properties in addition to the known antimicrobial properties. We hypothesized that the timing of nanocrystalline silver-based dressings application ( &lt; 24h after burn injury) may impact surgical treatment rates.

Methods
This study was a retrospective single-center cohort study. All pediatric patients ( &lt; 18 years old) treated at a single academic pediatric center for acute partial thickness burn injuries, between January 1, 2020 and December 31, 2021 were included. Bivariate analysis and multivariable logistic regression were used to compare timing of nanocrystalline silver application and surgical treatment rates.

Results
Four hundred seventy-six patients were included for analysis. One hundred four (21.85%) had NSBD and 372 (78.11%) had non-silver non-adherent dressings applied within the first 24 hours post injury. No statistically significant difference was found in surgical treatment, age, sex, mechanism, anatomic location, or total body surface area (TBSA) on bivariate analysis. The multivariable logistic regression identified three statistically significant variables as predictors for surgical treatment: age (OR = 1.14, 95% CI [1.06-1.23]), TBSA (OR = 1.15, 95% CI [1.06-1.25]), and burns to buttocks/lower extremity burns (excluding feet) (OR = 2.39, 95% CI [1.26-4.53]). Immediate ( &lt; 24h) application of NSBD has not been demonstrated to decrease the likelihood of surgical treatment.

Conclusions
Immediate ( &lt; 24h) application of nanocrystalline silver-based dressings does not affect surgical treatment rates. Prospective randomized studies are required to investigate the potential anti-inflammatory benefits of early nanocrystalline silver-based dressings in the treatment of pediatric burn injuries.

Applicability of Research to Practice
Use of nanocrystalline silver should be recommended as per clinical indications.
711 Neuropathic Pain in Burn Patients - A Common Problem with Little Literature: A Systematic Review
Authors: Stanton Eloise , Won Paul , Manasyan Artur , Gurram Sandeep , Shirinian Anait , Gillenwater Justin , Yenikomshian Haig A 
Published: April 2024

Abstract

Introduction
The prevalence of neuropathic pain (NP) in burn patients is reported in the literature to be as high as 80%1. Given the complexity of NP in burn patients and the wide range of treatments available, a systematic review of the literature is warranted to summarize our current understanding of management and treatment of NP in this population.

Methods
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The following databases were queried to identify relevant articles: PubMed, Cochrane, Embase, Scopus, Ovid, and Web of Science. The main outcome measures were incidence and management of NP. Secondary outcomes included risk factors for NP.

Results
Included articles presented findings from 11 different countries, capturing outcomes for 4,366 patients. Risk factors for chronic pain in burn patients were identified, including older age, alcohol and substance abuse, current daily smoking, greater % total body surface area burns (TBSA), and longer hospitalizations. Pharmacologic treatments included gabapentin/pregabalin (n=7), ascorbic acid (n=1), and lidocaine (n=1). Overall, the studies showed varied results regarding the efficacy of pharmacological treatments. While certain studies demonstrated gabapentanoids to be effective in reducing neuropathic symptoms, others found conflicting results. With regards to non-pharmacologic treatments, electroconvulsive therapy (n=1), electropuncture (n=1), nerve release/reconstruction (n=2), and somatosensory feedback rehabilitation (n=1) were used and demonstrated promise in reducing pain intensity and improving functionality.

Conclusions
Despite NP afflicting the majority of burn patients long after their injury, this systematic review demonstrates that there is insufficient evidence on the pathophysiology, outcomes, and risk factors in NP, as well as the efficacy of various therapies. Future prospective and randomized studies evaluating the etiology of these factors can substantially improve our treatment strategies. This can allow for the development of well-delineated and evidence-based protocols in NP management in hopes of improving quality of life and both psychological and physical function in burn patients.

Applicability of Research to Practice
Neuropathic pain is a common cause of chronic morbidity in burn patients, often lasting for years and causing limitations in regard to quality of life and function, yet there is currently a lack of understanding in regard to optimal treatment regimens for this devastating condition. The current review summarizes our knowledge of existing treatment modalities and identifies gaps that can help guide future research.
713 Prevalence and Outcomes of Toxin Producing Staphylococcus Aureus in Paediatric Burn Wounds
Authors: Couves Adam , McGill David , Ramsay Sharon , Arkoulis Nikolaos 
Published: April 2024

Abstract

Introduction
Toxic Shock Syndrome is a rare but serious complication of burn injury in children. Illness is mediated by Toxic Shock Syndrome Toxin -1 (TSST-1) producing strains of staphylococcus aureus. Little is known about the prevalence of TSST-1 producing staphylococcus aureus in burn wounds and as such the role of antibiotic prophylaxis is unclear.

Methods
A prospectively maintained buns database was retrospectively reviewed for all cases of burn injury in paediatric patients of any aetiology over a three year period. Patients presented as inpatients or outpatients to the national burns centre in Scotland, UK. Patients were aged 0-16 years. Burn wounds were routinely swabbed on initial review. Specimens yielding staphylococcus aureus were sent for an overnight culture in enrichment medium followed by a commercially available latex agglutination assay to determine TSST-1 production. Electronic patient notes were reviewed to correlate clinical outcomes in these cases.

Results
1313 children attended with burn injuries with a total of 1365 swab results. No bacterial growth was present in most cultures (69%). The most common pathogen yielded was staphylococcus aureus: 293 results (21%) of which 12 (0.8%) were TSST-1 producing. All TSST-1 strains were sensitive to flucloxacillin. 3 patients (all under 2 years old) developed signs of toxic shock syndrome: 1 was already an inpatient and 2 were admitted from the community who had previously not been referred to the burns service and had not received standard treatment. No patients had severely altered physiology to warrant admission to a critical care environment or require anti-toxin therapy with fresh frozen plasma or immunoglobulin.

Conclusions
4% of staphylococcus aureus strains in our patient population were TSST-1 producing under laboratory conditions. The prevalence of TSST-1 producing staphylococcus aureus in paediatric burn wounds is 0.9%. We have demonstrated an acceptable safety profile of not giving routine antibiotic prophylaxis in paediatric burns to prevent toxic shock syndrome.

Applicability of Research to Practice
Latex agglutination assays to determine toxin production is an effective way of highlighting potentially at-risk patients to clinicians to refine the population exposed to prophylactic antibiotics.