bluuebunny/crossref_metadata_2025_split huggingface dataset:
56 Friction Burns: Defining the Rub of Road Rash
Authors: Perkins Louis , Munter Sadie , Johnston William A , Lee Jeanne , Haines Laura , Doucet Jay , Santorelli Jarrett E 
Published: April 2024

Abstract

Introduction
There is a paucity of literature on friction burns. The involvement of burn surgery teams and the need for surgical intervention in these cases remain relatively unexplored. This study aims to characterize friction burns resulting from motorcycle accidents, evaluate the role of specialized burn surgery teams, and assess the need for operative intervention.

Methods
The trauma registry of a Level 1 Trauma Center was queried for all admissions after motorcycle accidents between January 2018 and December 2022. Patients were included if there was an external cause of injury code for an abrasion. Abstracted data included demographics, location of abrasion, injury severity score, and presence of protective clothing. Further chart review was conducted to confirm a road rash injury, identify burn consultation, need for operating room (OR) procedure with burn service, need for skin grafting, days of burn nurse care, wound care recommendations, and burn outpatient follow-up. Potentially unnecessary burn consults were defined as consults which required no burn nursing care and where outpatient follow-up was not planned. Multivariate logistic regression was used to explore trends in burn consultation.

Results
Among the 810 patients meeting inclusion criteria, the cohort was 91.5% male, 45.6% Hispanic, with median age of 33 (IQR 26-44), and median ISS 8 (IQR 5-14). 32.7% of patients were wearing protective clothing at the time of injury. The extremities were most affected by friction burn followed by the abdomen, thorax, and face. Burn surgery was consulted in 6.9% (n=56) of cases which had a median TBSA of 3.75% (IQR 2.0-5.2%); 21.4% (n=12) of these patients underwent excision in the OR, 16.1% (n=9) required autografting, and 60.7% were referred for burn outpatient follow-up. Consults to burn were more likely in female (OR 3.67, p=0.006) and African American patients (OR 3.73, p=0.023) and those with involvement of the upper extremity, abdomen, or thorax. The median days of burn nursing care was one day (IQR 0 – 5.3 days) and 39.4% of consults made by non-burn trained trauma providers were suspected to be unnecessary.

Conclusions
We have provided a better understanding of the characteristics and treatment of friction burns, which have previously been under studied in the burn literature. Local wound care is sufficient for a vast majority of these injuries and the need for specialized burn care and operative intervention is rare.

Applicability of Research to Practice
Applicable; this study characterizes the nature of friction burns after motorcycle trauma and the role of burn surgery teams in evaluation and treatment.
57 HIV Infection Increases Risk of Sepsis and Other Complications in Burn Patients
Authors: Amador Dalton , Obias Isabel B , Segura Carolina , Ramgopal Yash , Soudah Chris K , Song Juquan , Ayadi Amina E I , Golovko Georgiy , Wolf Steven E 
Published: April 2024

Abstract

Introduction
Infection with human immunodeficiency virus (HIV) confers an immunocompromised status that renders patients susceptible to various pathogen-related morbidities, eventually progressing to acquired immunodeficiency syndrome (AIDS) absent antiretroviral therapy. Burn patients are also susceptible to infection due to trauma-related tissue breakdown and organ dysfunction impairing host defense and providing avenues for pathogen entry and proliferation. The purpose of this study is to explore the respective relative risks of pathogen-related complications in burn patients with HIV infection compared to those without.

Methods
This study utilized a research database that provides real-time access to de-identified medical records. Burn patients were identified using the relevant ICD-10 codes and were stratified between those who had and had not received a previous diagnosis of HIV. Subsequently risk ratios and differences between the two groups for sepsis, pneumonia, myocardial infarction, respiratory failure, acute kidney injury, and death occurring within three months of injury were generated and analyzed using the database.

Results
664,357 burn patients from 59 healthcare organizations were identified using the database. These patients were then sorted according to infection with HIV (N = 2,437) and without infection with HIV (N = 661,920) cohort. The two cohorts were balanced using (1:1) propensity score matching for age, sex, race, ethnicity, and total burn surface area (TBSA).
Burn patients with HiV infection demonstrated a greater risk of developing sepsis (risk ratio [RR], 2.800; 95% confidence interval, [1.686, 4.650]; p &lt; 0.001), pneumonia (RR, 3.000; CI, [1.897, 4.745]; p &lt; 0.001), myocardial infarction (RR, 2.167; CI, [1.096, 4.284]; p = 0.023), respiratory failure (RR, 1.535; CI, [1.050, 2.244]; p = 0.026), acute kidney injury (RR, 2.319; CI, [1.655, 3.249]; p &lt; 0.001), and mortality (RR, 2.000; CI, [1.139, 3.512] p = 0.014) within three months of injury.

Conclusions
HIV infection was associated with a greater risk of sepsis, pneumonia, myocardial infarction, respiratory failure, acute kidney injury, and death in burn patients within three months of injury.

Applicability of Research to Practice
HIV infection in burn patients may be regarded as a risk factor for the various complications and morbidities analyzed in this study and guide anticipatory clinical decision-making. Future studies may explore these associations more.
68 Screen & Intervene: Mental Health Screening in the Burn Center
Authors: Alarcon Amanda R , Colarusso Linda , Strait Eli , Lee Jeanne , Smith Alan M , Minassian Arpi 
Published: April 2024

Abstract

Introduction
Depression, Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder (PTSD) in burn patients are common during the first year of recovery and beyond. Mental health screening of patients at all burn centers is recommended. The purpose of this study was to determine how depression or PTSD symptoms may evolve from inpatient to outpatient care in burn patients.

Methods
From March of 2022 through September of 2023, the PHQ-2 and PC-PTSD were administered to 280 outpatients via a self-report screening questionnaire. For pediatric patients &lt; 12 years old, the primary caregiver filled out the questionnaire. A score of 2 or more on either of the screening tools resulted in further assessment by the social worker to determine appropriate next steps and provide community referrals. A subset of these patients were also screened in the inpatient setting via interview by the psychology team using the PHQ-2 and a modified PC-PTSD. The chi-square test was used to analyze the data collected.

Results
A total of 106/280 (38%) outpatients screened positive for depressive symptoms, 110/280 (39%) screened positive for ASD/PTSD symptoms, and 77/280 (27.5%) screened positive for both depressive and ASD/PTSD symptoms. Patients with facial burns were significantly more likely to have ASD/PTSD in both inpatient (14/29, p&lt; 0.001) and outpatient (29/53, p=0.011) settings. Lower extremity burns were associated with depression as outpatients (64/148, p=0.049). Female outpatients were more likely to report depression (52/103 p=0.001) & ASD/PTSD (44/103, p=0.339) though ASD/PTSD was not statistically significant. For a number of patients, results varied between inpatient & outpatient screenings. About 35% of patients who screened negative for depression or ASD/PTSD as an inpatient then screened positive as an outpatient. Similarly, some patients screened positive for depression (23%) or ASD/PTSD (34%) as an inpatient and then screened negative as an outpatient.

Conclusions
Mental health screening of individuals in our burn center yielded a significant number of positive screens for depression and ASD/PTSD symptoms, validating the need for screening of all burn patients. Comparisons of inpatient and outpatient screens for previously hospitalized patients showed changes in depression and PTSD symptoms over time. Positive screens resulted in referrals to community and mental health resources.

Applicability of Research to Practice
Mental health screenings should be performed at multiple stages of recovery from burn injuries as manifestations of depression and ASD/PTSD may change over time.
47 Pediatric Burn Admissions: Where and When Matters
Authors: Ross Erin E , Gillenwater Justin , Yenikomshian Haig A 
Published: April 2024

Abstract

Introduction
There have been variable trends reported in seasonality of pediatric burns. Furthermore, risk for burn injury and mortality after burn have been associated with poorer socioeconomic status. The Childhood Opportunity Index (COI), comprised of 29 parameters of childhood well-being across the domains of Education, Health & Environment, and Social & Economic, may be a more comprehensive metric by which to assess rates of pediatric burn admission. Here, we explored trends in pediatric burn admissions seasonally, geospatially, and by COI quintile.

Methods
After IRB approval, home zip code and date of injury for all pediatric burn admissions from 2016-2022 at an urban regional burn center. Each zip code in the US is assigned to a COI quintile from Q1 (very low) to Q5 (very high) opportunity, with a roughly equal number of children living in each quintile. Population of each zip code was obtained from US Census data. We assess the number of pediatric burn admissions by month of year and zip code, and risk for pediatric burn admission for children living in very high versus very low opportunity COI quintiles.

Results
Across 470 pediatric burn admissions, there was a clear temporal trend with greater admissions in June, July and December, when children are out of school (Figure 1). Admissions for burn in children were also clustered in urban areas with higher population density (Figure 1). For all three COI sub-domains, there was an approximately five-fold increase in risk for admission for a burn for children residing in very low opportunity areas compared to children in very high opportunity areas. (Education OR 5.08 95% CI 3.54-7.27, Health & Environment OR 4.91 95% CI 3.34-7.12, Social & Economic OR 4.84 95% CI 3.41-6.86).

Conclusions
Severe pediatric burns are clustered in areas with low educational, environmental, and socioeconomic opportunity. Given the temporal association burns with the school year and strong relationship of pediatric burns with educational opportunity, child supervision is a potential target for further study.

Applicability of Research to Practice
Identifying community-level risk factors and region-specific temporal trends in pediatric burn injury can help identify highest yield areas for education and injury prevention efforts.
49 Lower Prealbumin and Albumin Levels in Unhoused Burn Patients Is a Marker for Poorer Outcomes
Authors: Donohue Sean J , Speiser Noah , Pickering Trevor A , Pham Christopher H , Gillenwater Justin , Yenikomshian Haig A 
Published: April 2024

Abstract

Introduction
Unhoused (UH) individuals experience burn injuries at a higher rate than the domiciled population, and have poorer outcomes following injuries. One such mechanism proposed for worsened outcomes is secondary to poor nutrition. Access to proper nutrition and food insecurity are major barriers. Malnutrition has been shown to decrease wound tensile strength, increase infection rates, and prolong healing. The purpose of this study was to understand if albumin and prealbumin could help determine outcomes in UH patients and identify at risk patients earlier in their hospital course.

Methods
A retrospective chart review was conducted of UH patients from 2019 through 2023 at a large urban safety net hospital. Data collected included admission laboratory values including albumin and prealbumin. Outcomes studied included length of stay, ICU days, ventilator days, and mortality. Data analysis included Wilcoxon rank sum test and of dichotomous variables using Pearson’s Chi-squared test, zero-truncated negative binomial model for length of stay, a negative binomial hurdle model for ICU length of stay and ventilator days, and logistic regression for mortality.

Results
385 patients met inclusion criteria in the cohort, of which 238 had albumin and 234 had prealbumin information. Each unit (g/dL) decrease in albumin was associated with 1.25 times the length of stay (95% CI = 1.01, 1.55), 1.52 times the odds of being on a ventilator (95% CI = 1.00, 2.29), and 4.46 times the odds of death (95% CI 2.13, 9.98). Each unit (mg/dL) decrease in prealbumin was associated with 1.13 times the odds of death (95% CI 1.02, 1.28). Table 1 demonstrates the relationship of admission albumin across the four patient outcomes studied.

Conclusions
Decreased admission albumin and prealbumin levels are associated with worse burn outcomes in UH patients. These nutritional biomarkers may aid in determining which UH patients are suffering from food insecurity at injury onset. Obtaining these values on admission may help burn providers target nutritional goals in their most vulnerable patients.

Applicability of Research to Practice
Albumin and Prealbumin are associated with worse burn outcomes and thus early nutritional support is of vital importance in the care of UH patients.
86 Hypothyroidism Associated with Increased Risk of Developing Contractures and Skin Disorders in Severe Burn Patients
Authors: Obias Isabel B , Amador Dalton , Segura Carolina , Ramgopal Yash , Soudah Chris K , Song Juquan , ayadi Amina E I , Golovko Georgiy , Wolf Steven E 
Published: April 2024

Abstract

Introduction
Patients who suffer severe burns are prone to develop various musculoskeletal and dermatological complications in the years following their injury. Hypothyroidism is classically associated with a number of muscle and skin disorders. The aim of this study is to explore the association between hypothyroidism and the emergence of these complications in severe burn patients.

Methods
Severe burn patients, defined as those with burns encompassing at least 20% total body surface area (TBSA), were identified in a research database that provides access to de-identified medical records. These patients were categorized into two groups based on whether they had previously been diagnosed with hypothyroidism. Risk ratios and risk differences of contractures, including those of the muscle, joint, and skin; atrophic disorders of the skin, including hypertrophic scarring and keloid formation; and rhabdomyolysis occurring within three years of insult between the two cohorts were generated using the database’s measure of association analysis. One-year mortality between the two groups was also analyzed.

Results
A total of 10,662 severe burn patients across 59 healthcare organizations were identified. The cohort with a previous diagnosis of hypothyroidism (N = 325) and the cohort without a previous diagnosis of hypothyroidism (N = 10,194) were balanced using (1:1) propensity score matching for age, sex, race, ethnicity, and TBSA.
The hypothyroidism cohort showed a greater risk of developing contractures (risk ratio [RR], 1.545; 95% confidence interval [CI], [1.094, 2.184]; p = 0.012) and atrophic skin disorders (RR, 1.502; CI, [1.002, 2.252]; p = 0.047) within three years of injury. There was no statistically significant difference in rhabdomyolysis between the two groups (RR, 1.000; CI, [0.422, 2.369]; p = 1). The hypothyroidism cohort showed a decreased risk of one-year mortality (RR, 0.589; CI, [.441, .789]; p &lt; 0.001).

Conclusions
Hypothyroidism in severe burn patients is associated with an increased risk of developing contractures and atrophic disorders of the skin in the three years after their injury. It was not associated with an increased risk of rhabdomyolysis during this same timeframe but was associated with a decreased risk of mortality within one year of injury.

Applicability of Research to Practice
Hypothyroidism in severe burn patients may be regarded as a risk factor for musculoskeletal and dermatological complications pending further research. The association between hypothyroidism and lower mortality in this same population may be explored and guide the discovery of new treatments.
93 Burn Patient Perspectives on Disability Weights and the Philosophy of Disability
Authors: Won Paul , Celie Karel-Bart , Yenikomshian Haig A 
Published: April 2024

Abstract

Introduction
Disability-adjusted life years (DALYs) have a ubiquitous presence in academic global health, including attempts to understand the global burden of burn injuries. An important component of the DALY is the “disability weight” (DW)—a number from 0 to 1 that assigns a “badness” to the disease state in question. The numbers assigned by DWs depend on the individuals being queried, as well as the underlying philosophical model of disability that is being assumed. The present scoping review aimed to examine: first, whether DWs for burns were derived from actual burn patients (rather than from clinicians/lay public); second, whether the existing literature indicates which of the three most common philosophical models of disability aligns with burn patient experiences.

Methods
A systematic search of six databases was conducted for articles published any time until January of 2023. Inclusion criteria were studies in English, studies with human subjects, and studies investigating burn patient perspectives on disability. Study aims, methodology, and results were collected, and general themes were identified and described. The Critical Appraisal Skills Program (CASP) checklist was utilized to evaluate included studies.

Results
764 articles were returned, and 10 met criteria for in-depth review. Regarding our first aim, no studies were found that directly queried burn patient for DWs. Regarding our second aim, 4 studies contained data that could be extrapolated to burn patient perspectives on the philosophy of disability. These articles utilized semi-structured interviews and reported qualitative analysis of thematic elements such as return to work and social integration. In all studies, a recurring theme was that burn injuries are instrumentally detrimental, with modulation based on the patient’s social environment. For example, patients with manual occupations often reported a significant burden of disease and cited resumption of work as a significant factor to their social adjustment and recovery. This aligns most with a philosophical model of disability known as the welfare account.

Conclusions
This scoping review highlights a significant gap in literature. First, no studies were found that directly queried burn patients for DWs. Second, the philosophical model informing the concept of ‘disability’ in global health remains under-explored. These two themes should be prospectively studied in the burn population.

Applicability of Research to Practice
Currently employed DWs use public and health expert opinions with limited input from burn patients. This study demonstrates two significant gaps in the literature that emphasize the importance of obtaining burn patient perspectives. A solid foundation for how ‘disability’ is understood—and subsequently employed in DWs—will help to more accurately triage resources and improve patient care.
119 Single Center Central Line Associated Bloodstream Infection with Implementation of Central Venous Catheter Policy
Authors: Olehnik Scott , Libraro Kaitlyn M , Dao Sylvia H , Houng Abraham 
Published: April 2024

Abstract

Introduction
Central venous line (CVL) associated bloodstream infection (CLABSI) occurs at a much higher rate in burn patients. The incidence of CLABSI in burns has been reported to be two to three times that of other critical care patients. Many burn centers have their own central line policy; however, the policies are not consistent across different burn centers, and no guidelines have been published. In this study, we analyzed our institution’s CLABSI rate retrospectively after implementing a strict CVL policy.

Methods
Retrospective chart review was performed on a single institution burn center in the calendar year of 2022 and 2017-2018. The time period was chosen to account for any discrepancies due to the COVID-19 pandemic. Pediatric patients were excluded. Following data were collected: age, burn size, mechanism, length of hospital stays, CVL days, blood stream infection, and organism. CLABSI bundle information was also collected: optimal site, aseptic maintenance, timely removal, and education. This data was compared with pre-implementation data in 2017-2018. This was a quality improvement project.

Results
There were 420 patients in the study period in 2022. There were 56 patients with CVL for a total of 441 line-days. Of all the patients with CVL, there was only one CLABSI, with the incident of CLABSI being 2.27 per 1000 line days in 2022. The CLABSI standard infection ratio (SIR) was calculated to be 0.08 (SD 0.11). The decrease in CLABSI was statistically significant when compared with pre-intervention SIR of 0.77 in 2017-2018 (SD 0.169), p=0.02. The absolute incident of CLABSI went from 5 to 1, p=0.01.

Conclusions
This institution’s CVL policy consists of quantifying the line into burn CVL or non-burn CVL. Burn CVL is any line within 5cm of a burn wound. Burn CVL is changed every 3 days, and non-burn CVL is changed every 7 days. The policy allows for one over-wire CVL exchange. A new site is needed after the over-wire exchange. From the CLABSI data, this policy decreased the CLABSI SIR and absolute CLASI incidents. A multi-center implementation of the policy is needed to provide a more robust data and help combat CLABSI in the burn unit.

Applicability of Research to Practice
Directly applicable.