bluuebunny/crossref_metadata_2025_split huggingface dataset:
572 Burn Epidemiology in Drug Users
Authors: Criscione Jaynie X , Randolph Ellie , Jupudi Rithvic , Moffitt Sarah , Koussayer Bilal , Le Nicole K , Whalen Kristen , Buller Kristina , Troy Jared , Laun Jake 
Published: April 2024

Abstract

Introduction
Our state has the second highest rate of drug overdose deaths in the country, with an epicenter located in our greater metropolitan area. Burn patients using drugs can fall victim to burns commonly related to drug use or risky behavior while intoxicated. As our institution is the safety net for this community, we aimed to analyze burn presentation and outcomes of burn patients with active drug use to help clinicians anticipate challenges related to drug usage and limited socioeconomic support.

Methods
Retrospective cohort analysis was performed of patients over the age of 18 years presenting to our institution from 2015 to 2020 with burn injuries. We considered drug use to include marijuana, intravenous drug use, cocaine, methamphetamines, opiates, and alcohol use disorder. We analyzed admission rate with logistic regression, controlling for differences in inhalation burns, related traumatic injury, and other confounding factors.

Results
We reviewed a total of 1339 burn patients with 30.19% reporting drug use. On presentation, burn patients using drugs had a greater percentage of full thickness burns (+0.56%, p&lt; 0.02), TBSA (+1.84%, p&lt; 0.03), burn related trauma (+8.53%, p&lt; 0.01), and concomitant inhalation burns (+3.65%, p&lt; 0.01). Flame burns were most common overall, with scald (-6.15%) and explosion burns (+2.61%) showing the greatest change in frequency for patients using drugs (p&lt; 0.03).
During their hospital course, a larger proportion of burn patients using drugs were admitted (+16.75%, p&lt; 0.01), and drug use was associated with a 2.4 increased log odds of admission (p&lt; 0.01, 95% CI: 1.7-3.4). LOS, surgical intervention, ICU days, and infection showed no significant difference between cohorts. Patients using drugs were less likely to follow-up (-7.39%, p&lt; 0.01) after discharge.

Conclusions
Burn victims who use drugs do not experience clinically significant increase in burn severity, such as TBSA and depth, compared with non-drug users, but were more likely to have inhalation burns and associated traumatic injury. A larger proportion of burn patients using drugs were uninsured or on Medicaid, suggesting the presence of unmanaged chronic conditions that could better explain higher rates of admission after controlling for their burns.
Drug use furthermore where more likely to be lost to follow-up, possibly attributed to decreased access to healthcare secondary to insurance status and limited financial resources. Therefore, we must carefully consider discharge disposition and barriers to care to minimize post burn complications.

Applicability of Research to Practice
We aim to help clinicians treat burn patients who use drugs by anticipating challenges related to their usage and limited socioeconomic support.
581 Ketamine Use for Initial Sedation: A Consensus Statement from the Pediatric Injury Quality Improvement Collaborative
Authors: Vitale Lisa C , Malaniak Mariah , Klein Justin D , Giles Sheila Sheila A , Horvath Kyle , Thakkar Rajan K , Surgeon Pediatric , Marx Daniel J , Skultety-Robinson Debra 
Published: April 2024

Abstract

Introduction
The importance of adequate pain management for children during burn debridement is well recognized. Safe and effective procedural sedation is a fundamental quality metric for patient care in pediatric emergency departments (ED). Current literature suggests that a relatively low percentage of pediatric patients receive adequate analgesia and sedation in ED settings. The Pediatric Injury Quality Improvement Collaborative (PIQIC), an established network of five pediatric trauma and burn centers, benchmarks burn data to improve patient care and evaluate outcomes.

Methods
Data was obtained across the five centers between March 2022 to August 2023 from the PIQIC database. A crosstab analysis was utilized to compare the total body surface area (TBSA) of burn injury to medication selection for sedation during initial burn debridement in the ED. A total of 698 patients (n=698) met the inclusion criteria of presenting to ED with subsequent need of admission to the burn center.

Results
Among the 698 patients, the most selected sedative used amongst the 5 centers for burn debridement was ketamine. Patients with 0-1% TBSA received ketamine 59.3% of the time, respectively 1.1-5% was used 76.4%, 5.1-10% was used 76.6%, 10.1-15% was used 75%, 15.1-20% was used 78.9%, and 20.1-99% was used 42.9% of the time.

Conclusions
The care of the pediatric burn patient is complex, and inadequate sedation for debridement can lead to acute and long-term psychological sequelae. Inappropriate initial sedation has also been shown to make subsequent dressing changes more difficult. Intravenous ketamine sedation provides safe and effective sedation that allows the health care team to complete adequate debridement, dressing application, and caregiver education. This data from 5 pediatric burn centers suggests that the use of intravenous ketamine sedation should be considered more broadly amongst other burn centers that care for pediatric patients.

Applicability of Research to Practice
Further evaluation with prospective case controlled studies are needed to standardize this further.
586 Show Me the Wound Closure! Burn Registry Data Compilation Project
Authors: Michelli Pamela , Martinez Sandra , Swain Jeana , Richards Sherrina , Bozoian Brooke 
Published: April 2024

Abstract

Introduction
The ABA requires that a verified burn center report wound closure percentage on discharge for patients with burns &gt;10% TBSA. Multiple data elements are entered by the burn registry staff into the registry. One data point, wound closure percentage (WCP) was not being captured consistently in the registry, because the data point wasn’t being reported. The initial rates of wound closure capture for 2021 and 2022 were 7% and 43% respectively and the ABA BCQP platform requires 100% capture of this data element. The purpose of this project is to develop a reliable process for the burn registrars to capture this data element.

Methods
We performed a retrospective review for this quality improvement project using data collected from our burn registry. Inclusion criteria included: burn patients 18 years or older who were admitted to a single burn center that had a TBSA ≥ 10% from January 1, 2021 – August 31, 2023.
Data collected was presented in our multidisciplinary Burn Quality Meeting to optimize ways to capture this data point. Suggested implementations included: Discharge summary documentation in the Electronic Medical Record (EMR), reporting WCP at weekly burn multidisciplinary rounds (MDR). Education was developed and disseminated to physicians and registry staff.

Results
815 burn admissions from January 1,2021 to August 31,2023 were reviewed, 171 patients were admitted with a burn of TBSA ≥ 10%. Discharge summary documentation of WCP was implemented October 2021 and a yearly review demonstrated a 39% capture rate. MDR reporting was implemented November 2022, a seven-month review demonstrated a 58% capture rate.

Conclusions
The initial implementation, discharge summary documentation resulted in very little improvement in capture of WCP. The MDR improved our capture rate further but did not meet the 100% data compliance goal. A daily discharge EMR care plan note was developed to help social work with planning for discharge for our patients to decrease the length of stay rate. It was decided to include WCP in this note to increase the capture rate. Moving forward, we found this to be an opportunity for improvement and will utilize the care plan note in combination with MDR reporting for WCP capture. The combination of MDR reporting and review of the daily discharge EMR care plan note is proving to be the most efficient way to capture WCP for our registry staff. The Burn Clinical Coordinator (BCC) is present for MDR reporting and can enter WCP in the registry as needed.

Applicability of Research to Practice
Utilization of documentation of WCP in the discharge summary, MDR reporting of WCP, and the review of the daily discharge EMR care plan note will allow for 100% compliance of data capture of WCP.
722 Factors Affecting Split Thickness Skin Graft Loss in Elderly Burn Patients
Authors: Reiss Matthew J , Chang Naiwei Hsu 
Published: April 2024

Abstract

Introduction
Advanced age is one of the more established predictors of morbidity and mortality in patients with burn injuries. It is predicted that by 2030, the number of people 65 years or older may double. This demographic shift may lead to a concomitant increase in burn injuries. The elderly population is at higher risk for burn injuries due to physiological changes that includes impairment of cognition, coordination, vision, mobility and deterioration of reflexes which may lead to decreased responses in dangerous situations. Other factors that may impair the healing process can include increased co-morbidities, polypharmacy, malnutrition in the setting of hypermetabolism, and decreased physiological reserves. Due to this, there is an increased incidence of graft loss in the elderly burn population. Our study aims to identify other factors that may affect or contribute to graft loss in elderly burn patients.

Methods
A retrospective chart review was performed on patients aged 65 years old and above who were admitted at our Burn Center for Burn injuries from January 2020 to September 2022. Medical Records of 54 patients were examined with regards to patients’ demographics, co-morbidities, site of wound graft placement, and technique used in wound graft application. Graft loss, which was determined to be &lt; 80% take, was examined at 1-week intervals in the post-operative period and patient outcomes at 1 to 2 weeks were included.

Results
It was noted that out of the 54 patient charts reviewed, 24 patients underwent Split Thickness Skin Graft with autologous skin donor. The population consisted of more male (70.8%) than female (29.2%) patients. The average graft take 1 week after surgery was 87.5% and 80.2% at 2 weeks after surgery. About 33.3% of this geriatric burn patients suffered graft loss. Half of these patients were noted to have Diabetes Mellitus, Hypertension and/or had a significant smoking history. The most frequently used surgical grafting technique was meshed skin grafts. It was observed that 50% of patients who sustained graft loss had 4:1 meshed graft placement and 37.5% had 2:1 meshed skin graft placement. 40% of the skin graft loss were on the upper extremities and 37.5% were on lower extremities.

Conclusions
Elderly burn patients in our population who have DM, HTN, smoking history have a higher incidence of graft loss. These patients have improved outcome with 2:1 meshed autograft and the location of the graft placement did not play a significant difference in graft take.

Applicability of Research to Practice
The aim of this retrospective study is to indicate and predict populations with increased risk factors to formulate a therapeutic plan of action to decrease possibility of graft failure. More effective methods may be implemented to avoid increased incidence of graft loss such as use of bolster dressing vs NPWT, orthopedic devices such as splints, and close monitoring of skin graft using bedside measurement tools.
732 An Evidenced Based Approach to Capturing Growth and Change Through the Burn Camp Experience
Authors: Jackson Brad , Mikolaj Kerry , Boulter Trudy J , Schiffer Nichole , Kierulf Genevieve 
Published: April 2024

Abstract

Introduction
The American Camping Association (ACA) explored “in what ways do children change because of camp experiences” (Thurber et al, 2007). Our burn camp approached this same question about the medical specialty camp experience assessing readiness and change in three key areas of growth: Independence / Leadership, Adventure / Exploration, and Social Skills.

Methods
The ACA supported the development of the Camper Growth Index (Henderson et al, 2006). For our medical specialty camp, a subset of items was selected for each area based on the strength of factor scores in the original study, relevance to our camp setting, and the growth being documented in counselor reports.
Campers ages 8 – 18 and caregivers rated items addressing these areas on a 4 point likert scale from disagree to agree. Sample questions are “I am good at doing things on my own”, “I like to talk to kids I don’t know yet”, and “My child likes to try new activities”.
Campers and caregivers received the questionnaires across a 3 year period.

Results
Pre-Camp ratings from campers and caregivers are consistent across the 3 years (Table 1). When campers were queried on the last day of camp, their adventure / exploration scores trended upwards, however that trend did not continue at 3 months, but independence / leadership trended upwards instead. Caregivers rated all three categories higher at the 3 month post camp assessment. Variation in the responses between individual items suggests discriminant validity and that certain items might be more sensitive to capturing the benefits of the burn camp experience.

Conclusions
Burn camps are a vital part of the burn rehab and aftercare experience for young burn survivors and their families. Documenting change through burn camp remains an important task. Change in these growth areas supports our targeted and intentional programming. The Camper Growth Index utilized by ACA allows us to assess the camper and caregiver experience of change, while linking the burn camp experience to the larger youth camp community of research.

Applicability of Research to Practice
We are evaluating the sensitivity of this abbreviated measure within a burn camp setting. Along with other measures of growth and change, we are hoping to document the magic of burn camp.
740 Injury Prevention Program Targeting Tap Water Scald Burns in Pediatric Patients
Authors: Vitale Lisa C , Zarr Renee , Malaniak Mariah 
Published: April 2024

Abstract

Introduction
Children in our urban ABA verified pediatric burn center have low socioeconomic status: 57.6% live in poverty, 67.9% receive food assistance and 65% are Medicaid-eligible. Research has consistently shown a correlation between childhood poverty and increased risk of unintentional injury and death. Using demographic and injury incidence data, our Injury Prevention Program developed education on scald burn prevention targeting expectant mothers and families with children ≤ 5 years.

Methods
A safety assessment was completed by caregivers and responses evaluated to customize the safety education. A tailored safety educational workshop was created based on burn registry data and pre assessment responses from caregivers. An immediate post workshop follow-up assessment was given to the caregivers about their educational workshop gauging their knowledge retention and comprehension. A one-month post assessment is then given to at least 25% of workshop attendees to assess knowledge retention.

Results
Caregiver pre and post comprehension assessments were evaluated to determine the program’s overall effectiveness. In 2022, the program pre-test assessment scores averaged 40%. Post-test assessment scores then improved to an average of 84%. P-Values were also calculated to determine that the injury prevention program was highly statistically significant with all correct assessment responses having a P-Value of &lt; .0001. At one-month post course, caregivers are re-assessed for knowledge retention. Of those re-evaluated 94% of participants had retained critical knowledge and were noted to score ≥80% on one month post course evaluation.

Conclusions
It is well known that scald burns are the most common pediatric burn injury. From 2021-2022 there was a 10% decrease in patients presenting to our center with tap water scald injuries. This data suggests a targeted injury prevention program may help to increase caregiver knowledge and decrease common pediatric burn injuries.

Applicability of Research to Practice
Regular evaluation of prevention programs is critical in assessing for effectiveness. More research is needed to understand parental behavior pre and post course, along with knowledge retention to maximize efficiency of injury prevention programs.
742 Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community
Authors: Ross Erin E , Speiser Noah , Donohue Sean J , Gillenwater Justin , Yenikomshian Haig A 
Published: April 2024

Abstract

Introduction
Unhoused patients represent a unique and vulnerable population of burn survivors. Burn injuries in unhoused patients are more likely to be related to assault, drug use, and mental health issues compared to the general population. Here, we explore the more specific circumstances and activities contributing to burn admissions among unhoused patients to better inform injury prevention efforts.

Methods
After IRB approval, the burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019-2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics.

Results
There were 254 admissions to the burn unit for unhoused patients. Patients were mostly male (76.8%), Hispanic (49.6%), and middle aged (IQR 33-55 years). 58.1% of patients were positive for stimulants on admission. The most common burn etiologies were open flame (27.6%), burning clothing or bedding (17.7%), and accelerants (14.2%). Most burns were self-reported accidental (69.7%), 9.8% assault, and 7.1% self-inflicted (missing = 34). Among accidental injuries, 11.3% were related to cooking, 10.1% involved cooking or using methamphetamine, 9.6% involved smoking, 7.3% were due to bonfires, and 5.6% were caused by candles.

Conclusions
Most burn injuries among unhoused patients were accidental. Although methamphetamine use was directly related to only a small proportion of accidental injuries, more than half of unhoused patients were positive for stimulants upon admission. Most burn injuries among unhoused patients were preventable, with many accidental injuries related to cooking, smoking, and open flames for warmth or light.

Applicability of Research to Practice
Analysis of admission patterns and subjective history can reveal potential interventions for preventable causes of injury. Safe consumption sites, as well as outreach efforts to educate unhoused patients about situational awareness, accelerants, safe smoking practices, and safe cooking practices may be effective tools in reducing burn admissions in this vulnerable population.
752 Holding the Line: Decreasing CLABSI Rates in Burn Patients
Authors: Simpson Robertino , Dwars Brooke , Wellsandt Sara , Schneider Jolyn K , Slagel Matthew , Galet Colette , Wibbenmeyer Lucy 
Published: April 2024

Abstract

Introduction
Burn patients are at higher risk of hospital-associated infections (HAI) secondary to loss of the protective property of skin. Hospitals systematically track central line blood stream infections (CLABSI) with a goal of zero infections. We noted an uptick in our CLABSI rates from 2017 to 2019. A quality improvement project (QI) was implemented to improve CLABSI rates.

Methods
All burn patients 15 years and older admitted from 2017-2022 with a central line placed during their stay were included. The burn team instituted a multidisciplinary CLABSI intervention in three phases. The intervention began in 11/2019. It included education focused on occlusive dressings, protection from water during hydrotherapy, and daily discussion on the need for the central line. Prior to implementation, catheters were changed at the discretion of the team. Catheters were changed every 7 ± 2 days starting in 11/2019 (phase 1), every 7 days ± 1 day starting in 9/2020 (phase 2) and every 7 days in 3/2021 (phase 3). CLABSI rates were defined as number of infections per 1000 central line days. The pre-implementation period (1/2017 to 10/2019) served as the control. Demographics, burn injury, and central line data information were collected on patients who developed CLABSIs

Results
CLABSI rate was 3.6% during the control period. It went up to 7.5% and 6.7% after phase 1 and 2, respectively, and decreased to 1.3% after phase 3 with no CLABSIs in 2022. The median number of central line days were 8 [4-14] overall, 11 [8-14] pre-implementation, 7 [4-8] post-phase 1 and 2, and 7 after phase 3. Patients who developed CLABSI were mostly male (80%) with a median age of 45.5 y [19-78]; 40% presented with diabetes, 30% with hypertension, and 20% were smokers. Median %TBSA was 54.5% [11%-88%], and 20% had inhalation injury. The median length of stay was 104 [11-273] days. A week prior to CLABSI, their average blood glucose level was 203 ± 51.5mg/dl. Candida and Pseudomonas accounted for most of the infections (n= 4 (40%) for each). Four patients developed CLABSI in winter, 3 in summer, 2 in spring, and one in fall.

Conclusions
Increasing nurse education and strict 7-day central line replacement led to a decrease in the CLABSI rates in burn patients with zero infections in phase three. There was a spike in blood glucose levels the week prior to CLABSI documentation. The relationship between blood glucose control and infections requires more investigation

Applicability of Research to Practice
CLABSI rates can be reduced by nurse-led education and strict adherence to a 7-day central line replacement