bluuebunny/crossref_metadata_2025_split huggingface dataset:
549 Diabetic Foot Burns: A Single-Institution Retrospective Study Assessing Operative and Non-operative Outcomes
Authors: Cannata Brigette , Malkoff Nicolas , Choe Deborah , Manasyan Artur , Wang Sarah , Choi Katherine , Gillenwater Justin 
Published: April 2024

Abstract

Introduction
Foot burns in patients with diabetes mellitus (DM) tend to be more severe with delayed presentation due to comorbid peripheral neuropathy (PN) and peripheral vascular disease (PVD). Impaired wound healing in diabetes further complicates management. Currently, there is no consensus on best management of diabetic foot burns. Our regional burn center has adopted a treatment algorithm that prioritizes non-operative local wound care instead of early excision and grafting. Here we characterize the diabetic foot burn patients treated at our institution to compare the outcomes of patients treated operatively and non-operatively.

Methods
A retrospective review of all patients with DM admitted to a large urban burn center between 1/1/2015 and 6/30/2023 was conducted. Adult (age &gt;18) patients with burns involving the foot were included for analysis. Patients with inaccessible charts and patients with burns greater than 20% total body surface area (TBSA) were excluded. In addition to descriptive statistics, linear and multinomial regression analyses were performed.

Results
A total of 3,035 DM patients were identified, of which 197 (6.5%) were adults with burns involving the foot. After additional screening, 172 patients were included for analysis. The mean patient age was 56.3 years (standard deviation 11.6), and 134 (77.9%) were male. Admission hemoglobin A1C was &gt;7% in 66.9% (n = 115) of patients. Common comorbidities included PN (44.2%), PVD (8.1%), and obesity (37.2%). The majority of burns were partial thickness (72.1%, n = 124) and affected 2.5% TBSA or less (75.6%, n = 130). The plantar foot was involved in 50% (n = 86) of cases.
Only 12.8% (n = 22) of patients were managed operatively, including debridement (9.9%, n = 17), grafting (5.8%, n = 10), and amputation (4.1%, n = 7). While 5 patients (2.9%) were primarily amputated, 2 patients (9.1%) were secondarily amputated, defined as amputation after initial debridement and grafting. Surgical management was significantly associated with increased days to wound closure (standardized coefficient = 0.251, p = 0.002) and increased length of stay (standardized coefficient = 0.576, p &lt; 0.001). Surgical management (OR 9.3, p = 0.02, CI = 1.34 - 64.39) and peripheral neuropathy (OR 6.9, p = 0.03, CI = 1.24 - 38.68) were independent predictors of wheelchair-dependency at discharge compared to normal ambulatory status.

Conclusions
Surgical management of foot burns in diabetic patients is associated with greater morbidity, including longer wound closure times, longer hospitalization, and decreased functional status at discharge. These findings suggest that local wound care of diabetic foot burns may yield better clinical outcomes than operative management.

Applicability of Research to Practice
This study can be considered when recommending treatment options for diabetic foot burn patients.
566 Burn Camp Volunteers Exhibit High Levels of Emotional Intelligence; Attributes to Consider for Volunteer Recruitment
Authors: Rimmer Ruth Brubaker , Bay Curt C , Kalil Emile T , Chacon Daniel W , Robaina Tess , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Volunteers are the lifeblood of burn camp. However, there is a paucity of information regarding the individuals who donate significant time and resources to the camp process. This study sought to assess participant demographics and to measure their emotional intelligence. Higher emotional intelligence (EI) is associated with the ability to monitor and label one’s own and others' emotions and use these skills to pay better attention, be more engaged and more empathetic to others while developing positive relationships; all skills important for working successfully and effectively with burn-injured youth.

Methods
Burn camp volunteers from 3 U.S. burn camps completed the Assessing Emotions Scale (AES), a 33-item valid self-report screen measuring Emotional Intelligence (EI). Respondents rate themselves using a 5-point Likert scale ranging from 5 (strongly agree) to 1 (strongly disagree). A total score is calculated from the sum of all items. A higher score indicates a higher level of EI.

Results
Participants included 119 adult volunteers, female (n=64), and male (n=53). By ethnicity, counselors were Caucasian (75%), Hispanic (13%), African American (3%), and Asian (3%), with the majority in the 20-45-year age range (76%). Volunteers’ professions included firefighters (24%), medical professionals (16%), educators (5%), business (11%), and other (49%). Many (34%) reported being burn survivors, and 26% reporting visible scarring. Female and male participants scored significantly higher than normative means - females 130.05 vs. norm of 121.1. (p&lt; 0.001) and males 129.4 vs. norm of 107.01 (p&lt; 0.001). Burn survivors and Hispanics both reported notably high mean scores of 132. Educators had the highest mean at 137.

Conclusions
It appears that the participating burn camps are doing a good job of recruiting volunteers with high emotional intelligence. This is important because it indicates the participant characteristics include optimism, impulse control, and greater empathic perspective-taking. Of note, the majority of participating counselors were Caucasian, as compared to only 33% of campers.

Applicability of Research to Practice
A concerted effort for the continued recruitment of counselors exhibiting high EI attributes is advised. EI testing may be a beneficial screening tool for volunteer applicants as the competition for burn camp volunteer slots.
571 The Trauma Burden of Pediatric Burns in Low- and Middle-Income Countries: A Systematic Review
Authors: Park Flora , Ruiz Andres , Pang Jonathan , Young Kirsten , Roth Bradley , Smith Emily , Chin Theresa L 
Published: April 2024

Abstract

Introduction
Pediatric burns place a disproportionate burden of injury on low- and middle-income countries (LMICs). With this systematic review, we aimed to illustrate trends in pediatric burn epidemiology in LMICs and describe possible areas for international intervention.

Methods
We performed a systematic review of existing literature on pediatric burns in LMICs. PubMed and MEDLINE databases were searched for primary studies conducted in LMICs reporting pediatric burn incidence, male-to-female ratio, mortality, and mechanism of injury. A quality assessment analysis was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results
The search yielded 867 unique articles, of which 14 studies met MINORS criteria. The included studies covered pediatric burn data from 9 LMICs: Rwanda, Malawi, Uganda, Bangladesh, Sudan, Pakistan, Cameroon, Kenya, and Fiji. Upon qualitative analysis, burns were found to be the most common mechanism of injury and cause of death compared to other traumatic injuries in children under 5-years-old. The most common mechanism of burn was reported to be scald injury due to cooking accidents. Incidence of pediatric burn injury was difficult to calculate for LMICs as only three studies reported this information. The incidence of pediatric burns per 100,000 in Sudan, Kenya, and Fiji respectively were reported to be 1010, 4887, and 32.6. Lower socioeconomic status and access to surgery were cited as the most common barriers to adequate burn care in LMICs.

Conclusions
The burden of pediatric burn injury on LMICs is significant and can be characterized using a quality-controlled systematic review. Further standardized studies must be conducted in collaboration with LMICs on this topic.

Applicability of Research to Practice
Our study illuminates potential routes for improvement in pediatric burn management and prevention in LMICs, and we hope to encourage more conversation around this topic led by LMIC researchers and healthcare providers.
592 Pressure Garment Use by International Pediatric Patients During the COVID-19 Pandemic: A QI Study
Authors: Minter Debbie , Freeman Lauren , Greenhalgh David G , Palmieri Tina L , Romanowski Kathleen S , Sen Soman , Heard Jason 
Published: April 2024

Abstract

Introduction
Pressure therapy is a standard intervention for the treatment of hypertrophic scars. Due to the COVID-19 pandemic, our international burn outreach programs were canceled between March 2020 and June 2022 so the ability to monitor pressure garments was lost. During this time, patients were discharged from our burn unit with two sets of properly fitting pressure garments (PGs) but were unable to be provided with replacement sets in their home country. Our burn team used this unique opportunity to perform a QI study of how this lack of access to follow up care impacted our patients’ pressure therapy programs.

Methods
Surveys were given to pediatric patients in three of our reinstated international burn outreach clinics in 2023. Surveys were in the patient's native language with written instructions and were completed by the caregivers while waiting for their appointment. Patients with a date of injury occurring in 2019 or later who were discharged with PGs to their home country from our facility were included in the survey. Patients who were still using PGs were excluded.

Results
Fifty-four patients were included in the study with mean age at time of discharge of 6yr3mo and age range 10mo-17yr. The length of time that PGs were worn is summarized in Figure 1 with 46% of patients stopping PG use between 4-6 months and 39% stopping at one year or greater. The reasons for terminating PG use are summarized in Figure 2 with 68% of patients stopping due to outgrowing the garments. In terms of alternate solutions used, only 9% of patients tried to alter or repair the PGs or sought inexpensive off-the-shelf products as replacements. 17% used bandages when the PGs no longer fit.

Conclusions
A significant number of patients in our outreach clinics stopped using PGs between 4-6 months. This is considerably shorter than the one-year standard of care received by our local patients. A high number of patients also reported wearing them for a year, however, it is questionable how effective the initial sets of PGs would be after this length of time given that evidence suggests garments have significant pressure loss within the first two months. More studies are needed to determine the impact of reduced garment wear on these patients.

Applicability of Research to Practice
Compliance to pressure therapy programs is impacted by access to care. In order to follow best practice guidelines, solutions need to be explored to improve availability of serial sets of properly fitting pressure garments. Additionally, families may benefit from education that empowers them to make alterations and repairs as needed and to seek inexpensive off-the-shelf options when the custom PGs no longer fit.
597 Hypercalcemia in Burn Intensive Care: A Retrospective Analysis with Implications for Patient Outcome Prediction
Authors: Bandaru Vishal , Chaudhury Tristin , Chaudhury Hannah , Tran Vivie , Meltan Shakira , Keshvani Caezaan , Pang Alan 
Published: April 2024

Abstract

Introduction
Burn injuries account for significant acute hospitalizations in the US and are a global concern with approximately 180,000 deaths annually. These injuries elicit drastic changes in serum calcium levels due to physiological systems and factors such as imbalances in bone formation/resorption, Acute Renal Failure (ARF), burn severity (BSA) and patient immobilization. This study aims to explore the multifaceted causes of hypercalcemia in burn patients at our university hospital. We conducted a preliminary study of n= 200 burn patients and noted a strong positive correlation between peak calcium with acute renal failure, cardiac arrest, and TBSA (total body surface area).
We hypothesize that patients with higher burn severity, longer hospitalization, and renal complications will experience a more significant increase in serum calcium. Additionally, patients with hypercalcemia are expected to have higher morbidity and mortality rates than those with normal calcium levels.

Methods
This was a retrospective hypothesis-driven study of n= 832 burn patients that aims to analyze calcium levels by utilizing our hospital burn registry and Electronic Medical Record to gather pertinent data.

Results
After adjusting for age, comorbidities, and TBSA percentage, there was a strong negative correlation between nadir calcium and arrhythmia (r = -0.21), renal failure (r = -0.34), and morbidity (r = -0.34). There was no correlation between peak calcium and these three categories mentioned. Nadir calcium was negatively correlated with total length of stay (r = -0.47), mortality (r = -0.26), and total TBSA (r = -0.38). In addition, admission calcium levels had a strong positive correlation with nadir (r= 0.31) and peak calcium (r= 0.44) levels.

Conclusions
Compared to the preliminary study, a positive correlation was not observed between peak calcium and arrythmia, renal failure, and total TBSA. This data gathered emphasized nadir calcium as a potential marker for patient outcomes for admitted burn-related injuries. In addition, nadir calcium’s strong correlation with admission calcium suggests large fluctuations between these variables could help assess patient outcomes.

Applicability of Research to Practice
This study suggests potential connections between burn-related injuries and nadir calcium levels, underscoring the necessity for further research and rigorous statistical analysis. These findings could potentially prompt the adoption of nadir calcium as an admission marker for detecting potential adverse effects in clinical practice.
705 C. difficile Enterocolitis Diagnosis Elevated in Critically Ill Burn Patients Following Antibiotic Treatment
Authors: Nicot-Cartsonis Mathilda , Hallman Taylor , Song Juquan , Golovko Georgiy , Wolf Steven E 
Published: April 2024

Abstract

Introduction
C. difficile colitis (C diff colitis) is identified in up to 500k infections/year in the US, with up to 30,000 people per year dying with the diagnosis. Previous studies established risk factors for this condition including long-term antibiotic use. Burn patients are typically exposed to many antibiotics over long periods of time, and may have lengthy hospitalizations similar to other critically ill patients. Neither of these populations have been studied in terms of C diff colitis, risk and outcomes alike. Our aim is to compare C diff colitis rates among critically ill and non-critically ill burn populations, and to investigate the use of antibiotics prior to diagnosis.

Methods
All analyses were generated with TriNetX platform software (TriNetX, Cambridge, MA) in 2023. We compared incidence of C diff colitis in non-critically ill and critically ill burn populations, and non-burn injury control groups. Cohorts were propensity matched for age at diagnosis, sex, and race/ethnicity. The difference between groups was tested using the log-rank test and quantified with hazard ratios (95% CI), calculated with TriNetX Analytics features. We examined length of hospital stay of cohorts, antibiotic use prior to C diff colitis diagnosis, death within 1 year, and colectomy/toxic megacolon diagnosis.

Results
We found critically ill patients are diagnosed with C diff colitis at similar rates (OR = 1.065, 95% CI = 0.89, 1.276), but non-critically ill burn patients have a higher rate of C diff colitis compared to non-burn injury counterparts (OR = 1.713, 95% CI = 1.471, 1.995). Antibiotics use up to 2 weeks prior to C diff colitis diagnosis was higher in C diff colitis patients in all four cohorts. Specifically for critically ill burn C diff colitis patients, penicillin (p=0.0072), quinolones (p&lt; 0.0001), tetracyclines (p=0.0037), trimethoprim (p=0.0011), vancomycin (p&lt; 0.0001), clindamycin (p&lt; 0.0357), metronidazole (p&lt; 0.0001), and sulfonamides (p=0.0005) were all given more frequently as compared to counterparts without C diff colitis.

Conclusions
Critically ill burn patients are at an increased risk of C diff colitis compared to non-critically ill burn, as are critically ill non-burn patients. C diff colitis remains significantly associated with antibiotic use, and in the setting of critical illness and burn, is a notable risk factor.

Applicability of Research to Practice
C diff colitis remains a threat to hospitalized and burn patients, for the critically and non-critically ill, and antibiotics treatment could be more aware of the worse consequence.
716 Autologous Skin Cell Suspension for Dorsal Hand Burn Treatment
Authors: Maestas Joseph , Stanton Eloise , Cohen Kenzie , Johnson Maxwell B , Gillenwater Justin 
Published: April 2024

Abstract

Introduction
Intermediate and deep partial-thickness dorsal hand burn injuries require timely and appropriate care to preserve both form and function. Split-thickness autografting (STAG) remains the standard of care but requires postoperative immobilization and a large donor site. Autologous skin cell suspensions (ASCS) are prepared from a small piece of autograft and are an alternative to STAG for partial thickness burns. They have minimal donor site morbidity and do not require postoperative immobilization. This study aims to assess the utility of ASCS in the treatment of intermediate and deep partial thickness burns of the dorsal hand.

Methods
This IRB-approved retrospective case series identified patients at a regional burn center with intermediate and deep partial-thickness hand burn injuries who were treated with ASCS alone. Data on injury etiology, demographic information, complications, functional variables, and treatment outcomes were collected.

Results
Ten male right-hand dominant patients with intermediate to deep partial thickness dorsal hand burns were identified, with a mean total body surface area involvement of 12.0±9.3%. On average, patients received ASCS alone for their hand burns on post-burn day 7.3±2.5. All ten patients resumed occupational therapy on postoperative day one. Nine patients had full upper extremity range of motion on day of discharge, which occurred on average 9.1±7.0 days after surgery. Four patients developed hypertrophic scarring without range of motion limitation of the ASCS treated hand. One patient experienced ASCS failure and required autografting for wound closure.

Conclusions
This retrospective case series presents ASCS as an effective wound closure strategy for intermediate to deep partial thickness hand burn injuries. In select patients, ASCS minimizes donor site morbidity and permits immediate upper extremity rehabilitation with excellent functional outcomes..

Applicability of Research to Practice
This research highlights the potential benefits of using ASCS for the treatment of dorsal hand burn injuries and thus suggests a possible change in current burn would management.
733 Pediatric Burns: A Single Institution Retrospective Review of Incidence, Etiology, and Outcomes in 685 Patients
Authors: Chaudhry Bilal M , Lee Subin , Pineda Jonathan , Marano Michael A , Lee Robin A , Song Cherry , Lee Christina J 
Published: April 2024

Abstract

Introduction
Nearly 300 children die from burn injuries every year, and over 100,000 are admitted to a hospital or treated in an emergency department in the United States. Although largely preventable, burns remain a leading cause of morbidity in the pediatric population globally. This study assesses all pediatric burn admissions to a State Wide Certified Burn Treatment Center to evaluate trends in demographics, burn incidence, and cause across different age groups.

Methods
Demographic and clinical data were collected on all pediatric burn admissions during an 8 year period (2015-2022). These patients were stratified by age into "age 0 to 6," "age 7 to 12," and "age 13 to 18." Data were analyzed using standard statistical methodology. A state wide map was created allocating all patients into their respective zip codes to aid in targeting pediatric burn prevention programs.

Results
A total of 685 burn patients under age 18 were treated between 2015 and 2022. A total of 511 (74.6%) patients were ages 0 to 6, 89 (12.9%) were 7 to 12, and 85 (12.4%) were age 13 to 18. A total of 362 (52.8%) were male and 323 (47.2%) were female (male: female ratio of 1.12:1). Hispanics had the highest burn admissions across all age groups (35.8%), followed by African-Americans (23.6%). Caucasian teenagers formed the largest part (41%) of the teenage admissions. Mean TBSA burned was 8.9%, with torso being the most common site (68%). Scald burns constituted the majority of cases (83.4%, n = 571), with 70% attributable to hot liquids related to cooking, including coffee, tea or soup. In the 0-6 age group scald burns were the overwhelming cause (92.6%). In the teenage group, flame burns were the dominant cause (47.1%). Overall mean length of stay was 10.9 days for all patients. A total of 159 patients (23.2%) required an ICU admission. Seventeen patients (2.6 %) required a ventilator. Overall mortality was 0.4% (n = 3).

Conclusions
The majority of pediatric burn admissions were caused by scald burns, ages 0-6 were the most vulnerable in this regard. Flame burns predominated in the teenage population. Mean TBSA burned was 8.9% with the torso being the most likely to be involved. Mean length of stay was 11 days, 23% required ICU and 2.6% required a ventilator. Mortality was 0.4%.

Applicability of Research to Practice
The results of this study emphasize the need to target etiology specific burn prevention programs against scald burns in the very young (0-6yrs) and flame burns in the teenage population. Geographic depiction aids in highlighting the more vulnerable counties in our state.