bluuebunny/crossref_metadata_2025_split huggingface dataset:
97 Animals Are People Too: Comparing Human and Animal Burns in a Large Wildfire
Authors: Epstein Larissa , Peyton Jamie L , Coward Alexandra , Heard Jason , Sen Soman , Romanowski Kathleen S , Palmieri Tina L 
Published: April 2024

Abstract

Introduction
Although human burns have been studied in depth, there are few studies involving animal burns, and even fewer studies that compare the two. However, recent wildfires across the globe, like the 2019 Australian bushfire, have drawn attention to the plight of animals. Our study aims to compare effects of wildfire burns between humans and animals. Animals have adaptations that may protect them from burns: fur/feathers, agility, innate fight or flight response, and burrowing/swimming/flying abilities. We hypothesize that humans would have deeper burns and a higher mortality rate than their animal counterparts.

Methods
After IRB approval, a retrospective chart review was conducted using electronic medical records for humans with burns in 2018 wildfires at a university hospital and burned animals treated at the veterinary hospital. Animals were split into 2 groups: companion animals (CA) and non-companion animals (NCA). Data collected included demographics, burn and hospitalization characteristics, treatment, discharge, and outcomes. Analysis was conducted with SAS statistical software, version 9.4 (SAS Institute, Cary, NC, USA) using Chi-squared and Kruskal-Wallis tests.

Results
In all, 123 animals and 10 humans were analyzed. Ninety-four animals were identified as CA (dogs, cats) and 29 NCA (turtles, cattle, llamas, etc). All groups had mean total body surface area (TBSA) below the 20% TBSA resuscitation guidelines (70% human vs. 98.9% CA vs.72.5% NCA). There was no difference between location or burn severity, between groups. The most common location of burns in humans was the head (80%) and hands and feet (80%). Similarly, animals most commonly burned their paws (97.9% CA vs. 62.1% NCA). The median time to presentation was significantly different between humans, CAs, and NCAs (Day 0, 5, 8; p&lt; 0.001). Humans and CAs sustained mainly 2nd degree burns (90% vs. 76.6%) while NCAs suffered mostly from 3rd degree burns (65.5%). Median number of hospital days (HD) between humans, CAs, and NCAs differed significantly between groups (16.5, 27, 8; p=0.025). Survival to discharge was highest in humans (90.0% human vs. 92.4% CA vs. 72.4% NCA, p=0.039). Humans were treated with surgery (100%). Fewer animals underwent surgical excision at initial presentation (16% CA vs.40.7% NCA p&lt; 0.001).

Conclusions
Humans and animals burned by wildfires had different injury extent, survival, and burn distribution. CAs had the most HDs, yet had the fewest surgeries. There are major differences in treatment between human and animal burn treatment and outcomes. Current animal burn care does not follow human medical standards.

Applicability of Research to Practice
Most burn outcomes and research are focused on humans. More attention is being brought towards burned animals, which can be used to further research into animal care.
102 The Consequences of a Career in Burn Surgery: An Economic Analysis to Aid Prospective Clinicians
Authors: Carter Jeffrey E , Ivanko Anastasiya , Schoen Jonathan E , Phelan Herb A , Hickerson William L , Kearns Randy D 
Published: April 2024

Abstract

Introduction
Many factors are assessed by prospective resident physicians and medical students when considering a career in healthcare. A rising awareness of educational costs, physician burnout, and well-being have many considering the economics of their decisions. Coupled with the projected physician shortage, burn surgeons are a vulnerable population consisting of less than 0.4% of all surgeons in the U.S. Our study examines the economic consequences of a career in burn surgery as compared to other surgical specialties.

Methods
Using AAMC benchmark salary data, we calculated a net present value (NPV) for 12 surgical specialties. NPV was selected as it incorporates revenue and liabilities over the career period with the time value of money. Conservative assumptions from established references were used to determine resident salary, medical school debt, interest, opportunity costs, federal income taxes, and career duration (retirement at age 65). The model also assumes no delays in education or training, practice at an academic institution, and evaluated 2-year vs 1-year burn fellowship pathway against 11 other surgical careers: general, neurosurgery, orthopedic, pediatric, plastic and reconstructive, surgical oncology, cardiothoracic, transplant, trauma, urology, and vascular surgery.

Results
Without loan forgiveness programs for medical school, physicians attending public institutions should expect to pay $509,173 over the life of the loan. Each year of fellowship after general surgery residency results in $257,641 of lost income after taxes. Neurosurgery, orthopedic, and cardiovascular performed &gt;30% above the average NPV for all surgical specialties while surgical oncology and 2-year burn performed the worst at 28% and 23% below the average NPV, respectively. Selecting a 1-year burn fellowship improved performance to 11% below the average, while still outperforming trauma.

Conclusions
The consequences of a career in healthcare are immense with few students or residents understanding the economic liabilities they assume because of historical perspectives that are unquestionably inaccurate in today’s climate. A career in burn surgery is rewarding but the economic considerations must be accounted for especially in a climate with limited resources. Our model takes many assumptions into consideration but does not take into account the productivity of burn surgeons relative to other surgical specialties making the inequity even more concerning. Additional research is needed to discern the complexity and intensity of burn care to aid future advocacy efforts.

Applicability of Research to Practice
This study aids prospective burn docs to consider fellowship costs.
104 Wildland Firefighters Suffer Increasing Risk of Job-Related Death
Authors: Glover Kelsey G , Kahn Steven A , Mittal Rohit 
Published: April 2024

Abstract

Introduction
Wildland firefighting is a niche specialization in the fire service - inherently dangerous with unique risks. Over the past decade, fatalities amongst all firefighters have decreased; however, wildland firefighter fatalities have increased. This subject has only been described in the grey literature, and a paucity of medical literature exists. With the recent wave of large-scale fire disasters across the US and Canada, the aim of this novel study is to analyze and better understand the trend of fatalities to eventually improve safety measures.

Methods
The United States Fire Administration’s online fatality database was queried for on duty mortality between 1990 and 2022. The year 2001 was excluded due to the 340 deaths that occurred on September 11th. Data collected included demographics, incident characteristics, and nature of fatality. The data was then compared between the decades using a Fisher’s exact test.

Results
From 1990-2000, there were 25 wildland fatalities out of 1,119 total firefighter fatalities, which increased to 75 wildland fatalities out of 1,190 total from 2002-2012. Between 2013-2022, there were 96 wildland fatalities out of 968, an increase from 2% to 10% of the total fatalities (p &lt; 0.00001) from the first to last decade - a 500% relative increase. Despite the recent wave of 2023 wildfires across North America, the average annual number of wildfires has actually decreased 23% (from 79,829 to 61,377) between 1990-2000 and 2013-2022. Burn related fatalities have increased over time, from 9% of fatalities to 27% (p &lt; 0.01), while trauma and motor vehicle crash fatalities have decreased significantly. MI accounted for 16% of total fatalities, with no significant change over time - however, number of years on the job was an independent risk factor for death from stress/exertion and MI, while age was not.

Conclusions
Although wildfires have become less common over the past decade, there was a 5-fold increase in wildland firefighter fatalities. Burn related fatalities have also increased over time. Total number of years on the job increases the risk of death, while age does not, suggesting the job itself creates the risk of death - either from catastrophic incident or from cumulative inflammation from stress or byproducts of combustion. Further investigation, including analysis of 2023 data, is required to augment development of health and safety measures for these heroes. Multidisciplinary collaboration is necessary to mitigate the inherent job-related risk in this unique population.

Applicability of Research to Practice
Burn centers are involved in caring for firefighters, thus must understand the relevant epidemiology and aid in risk mitigation for this population.
110 Seven-Year Analysis of National Rehabilitation Trends and Outcomes Among Burn Patients
Authors: Little Darby , Mason Stephanie A 
Published: April 2024

Abstract

Introduction
The recovery journey for individuals with major burns is often protracted, necessitating extended stays at rehabilitation facilities before they can return home. We aimed to describe national resource utilization and outcomes related to inpatient rehabilitation following burn injury.

Methods
In this retrospective population-based study, we examined all admissions to inpatient rehabilitation facilities from April 1, 2016-March 31, 2023, available from a national repository of health administrative data. This database aggregates information from participating adult inpatient rehabilitation facilities (including 104 programs by May 2022) in 9 provinces.

Results
During the 7-year study period, we identified 513 burn patients who were admitted to inpatient rehabilitation in the database. Burn patients were overall younger, with a greater proportion of burn survivors under 45 years of age (25.9%-54.2%) compared to the general rehabilitation population (5.5%-6.1%). Throughout the study period, burn patients consistently experienced a longer median length of stay, which generally increased from 26.5 days in 2017 to 30.5 days in 2023. In contrast, the median length of stay for the general rehabilitation population remained stable between 22.0-23.0 days. Throughout the study period, 66.1% of burn patients reported improved pain levels upon discharge from the rehabilitation facility. Moreover, burn patients demonstrated enhancements in their motor functional scores, with an average increase score of 20.3-29.8 per year, as determined by the 18-item Functional Independence Measure instrument.

Conclusions
Burn patients experience extended rehabilitation admissions when compared to the general rehabilitation population. Their improvements in pain and functional scores emphasize the importance of rehabilitation in facilitating their recovery and improving their quality of life.

Applicability of Research to Practice
This national population-based study underscores the importance of rehabilitation services in the recovery of burn patients.
113 A Study in Precision and Ergonomics: A Cadaveric Study
Authors: Aickareth Genesy , Brown Elizabeth , Pang Alan , Griswold John A , Kurtz Debra J 
Published: April 2024

Abstract

Introduction
Split-thickness skin grafts have remained the mainstay treatment for 2nd and 3rd-degree burns. Traditional dermatome (TD) and dermatome with a rotating circular blade (DRO) are devices that have been used for skin grafting since the 1900s and 2013, respectively. Few studies have been conducted analyzing graft harvesting with the DRO. Our study analyzed skin depth consistency when harvesting with the DRO versus the TD. We conducted this study using varying levels of skin grafting expertise, gathered with both devices, and compared depth consistency across the graft.

Methods
The study was conducted on a deidentified cadaver. There were 4 levels of harvesters: pre-clinical medical students, residents, a burn fellow, and a surgical technician with 10+ years of skin harvesting experience. All harvesters underwent basic training using each product’s instructional videos/training curriculum. The depth gauge of each device was set to 0.009 inches. Each subject harvested a 5-in length graft using each tool from the back and leg. The TD and DRO harvest occurred side-by-side at each location to minimize confounding. Each harvested 5-in section was punched in three locations diagonally with a 6 mm punch biopsy blade. Each punch was analyzed by dermatopathology for depth and sufficient graft harvest. The punches from each graft were analyzed for variance in depth against the gauge setting, and grafts from both devices were compared for depth consistency.

Results
A total of 118 grafts were analyzed (Table 1). Grafts taken by the TD were significantly thicker than the DRO (p-value of &lt;=.046). When compared to the depth gauge setting of 0.009 inches, the TD averaged 33% thicker and the DRO averaged 11% thinner. There were no significant differences between the levels of the harvesters nor the body location of the grafts.

Conclusions
There are only a few studies that have been conducted comparing the DRO to the TD. In this study, the DRO was closer to the desired depth value than the TD regardless of skill level. This is significant because the participants had drastically varying familiarity with the tools themselves. This study was the medical student’s first time using the instruments, while the surgical technician used them for years. Additionally, the depth of the grafts taken by DRO was similar throughout all skill levels ranging from .0071-.0083. When using the DRO, all skill levels had decreased variability of thickness across the specimen. DRO is easier to use correctly as evidenced by the medical student and the resident who had similar depths of .0082 and .0081 respectively.

Applicability of Research to Practice
This preliminary study shows that DRO offers skin grafts that are more consistent with the desired thickness and are uniform throughout the graft. A more constant graft thickness could possibly lead to better graft take and improved healing of the donor site.
510 Antibiotic Serum Concentrations in Burn Patients with Augmented Renal Clearance and Adjusted Regimens
Authors: Mueller Scott W , Gibson Cameron , Wiktor Arek J 
Published: April 2024

Abstract

Introduction
Burn patients have altered pharmacokinetics, in part, due to a high incidence of augmented renal clearance (ARC). Augmented renal clearance is associated with subtherapeutic antibiotic concentrations necessitating dosing regimens that are greater than FDA approved doses. The objective of this cohort analysis was to assess antibiotic concentrations in patients with ARC specifically when real-time therapeutic drug monitoring was not available for the antibiotic.

Methods
This retrospective descriptive cohort was performed at an ABA verified burn center. All patients with an antibiotic serum concentration measured between 2/2022 and 7/2023 and confirmed ARC were included. Patients were excluded if the only antibiotic concentration available was an aminoglycoside or vancomycin.

Results
In all, 10 patients (90% male) had 15 non-real time antibiotic concentration assessments. The median (range) age, weight, TBSA, day since injury, serum creatinine and urine collection creatinine clearance corresponding to the drug concentration were 38 years (18-53), 85 kg (51-190), 24% (3-68.25), 13 days (6-32), 0.77 mg/dL (&lt; 0.2-1.53), and 200 mL/min (96-336), respectively. The most common antibiotic concentration assessed was piperacillin (PIP, n=9), followed by meropenem (MER, n=3), cefepime (n=2), and linezolid (n=1). Piperacillin/tazobactam was administered as 22.5g/day continuous infusion and resulted in a median (range) PIP concentration of 43.7 mg/L (25-117). A single outlier of 117 mg/L occurred in a patient who was no longer in ARC, but reexhibited ARC days later and had a follow-up PIP concentration of 32 mg/L. Two MER concentrations representing a 2g every 8 hours using a 6 hour infusion were 13.9 mg/L at the end of infusion and 7.3 mg/L one hour after infusion. MER 1g every 8 hours with a 3 hour extended infusion resulted in a trough concentration of 1.2 mg/L. Cefepime 2g every 6 hours with a 3 hour extended infusion resulted in a peak and trough of 43.8 and 29.6 mg/L. Linezolid 600mg orally every 8 hours resulted in a trough of 4.21 mg/L. No adverse events were identified.

Conclusions
Burn patients with ARC may require more aggressive dosing regimens to reach adequate antibiotic concentrations. A large prospective study is required to identify appropriate antibiotic dosing strategies to overcome pharmacokinetic alterations in this population, especially in the setting of pathogens with high minimum inhibitory concentrations.

Applicability of Research to Practice
Although antibiotic target concentrations have not been established in the burn population, this cohort suggests antimicrobial regimens should be adjusted in burn patients with ARC. The lack of timely therapeutic drug monitoring for most antimicrobials may hamper patient specific dosing regimens to adequately treat infectious pathogens with elevated minimum inhibitory concentrations.
516 Fluid Resuscitation and Acute Kidney Injury in the Electric Burn Patient. Reconsidering Initial Resuscitation Goals
Authors: Bernal Sandra J , Nasiff Laura S , Navarrete Norberto 
Published: April 2024

Abstract

Introduction
In burn patients, multiple studies have confirmed the risks of acute kidney injury (AKI) and mortality attributed to both under or over-volume resuscitation. Nonetheless, electrical burns patients are systematically excluded from these studies due to their unique pathophysiology, high incidence of rhabdomyolysis, and poor correlation between TBSA and injury severity. Recommendations regarding volume management vary and remain controversial as the literature is limited. The objective of this study is to describe fluid resuscitation while concurrently evaluating its association between sub-optimal or excessive fluid administration and the incidence of early AKI (eAKI).

Methods
Retrospective cohort study. Registry data for adult patients admitted to Burn ICU during the first 48 hours after electrical injury, between 2007 to 2013 was analyzed. Descriptive statistics were calculated. The primary outcome was eAKI, according to the AKI network criteria. eAKI was modeled using multivariable logistic regression, including age, sex, TBSA, time to treat (between injury to start of treatment), and creatine phosphokinase maximum (CPKmax). CPK, fluid requirements, and urine output (UO) were recorded in the first week (Day 0-6 of admission). The protocol targets were UO &gt;1.5 ml/kg/h in rhabdomyolysis or &gt;2 ml/kg/h if macroscopic myoglobinuria were present.

Results
A total of 456 patients were included. The median TBSA was 5% (2%-12%). 27 patients (5,9%) developed eAKI. None of the patients underwent renal replacement therapy. There were no significant differences in age, sex, CPK, or CPKmax value between eAKI and Non-eAKI patients, except for CPK3 (p=0.0483). Although volume infused in 0-2 days were lower in the eAKI group, there were no significant differences regarding under or over-resuscitation frequency and the hourly fluid resuscitation volume. The UO0 and UO1 (ml/hr) were significantly lower in the eAKI group (37.9 v. 139.1 ml/hr, p&lt; 0.001 and 162.0 v. 187.6 ml/hr, p=0.005 respectively). The UO0 was the only variable independently associated with the development of eAKI (OR: 0.984, 95% CI: 0.976 - 0.992).

Conclusions
Neither the time to treat nor the fluid volume resuscitation are associated with the development of eAKI in electrical injuries. However, reduced diuresis during the day of admission is associated with the development of eAKI.

Applicability of Research to Practice
Estimating fluid volume according to TBSA is insufficient in electrical injuries, mainly when TBSA is less than 12%. Crystalloid infusion guided by urinary output may result in a lower incidence of eAKI.
554 Implementation of the Abbreviated Burn Specific Pain and Anxiety Scale
Authors: Harms Jonny , Treftz Morgan , Dispalatro Paige , Bode Courtney , Worthington Hailey 
Published: April 2024

Abstract

Introduction
This project targeted the use of the Abbreviated Burn Specific Pain and Anxiety Scale (BSPAS) in patients 18 or greater with 10-50% TBSA burns undergoing dressing change and/or therapy. The BSPAS is recognized by the ABA and was implemented to improve both patient care and nursing practice. Currently, in our standard of care there are no tools available to specifically assess anxiety related to pain. This can drastically impact the overall care of burn patients in various stages of care including treatment, recovery, and rehabilitation.

Methods
Pre-data surveys were used to assess nursing staff’s perceptions of incorporating the BSPAS into practice. Per the survey, nurses felt they did not have a consistent scale to measure the burn patient’s pain and anxiety. Our implementation of the BSPAS consisted of 5 questions asked by the nurse to better understand the patient’s pain and anxiety prior to treatment.

Results
A post-implementation survey revealed that nurses felt the BSPAS was a consistent and effective way to better understand and communicate a patient’s pain and anxiety related to the anticipation of burn care.

Conclusions
Our sample size was small due to limited burn patient admissions during the pilot phase of this project. The current nurse residency group has continued to implement and evaluate the use of the BSPAS to improve the quality and overall standard of care within our unit.

Applicability of Research to Practice
Our project can help burn units better understand patient’s anxiety and pain related to burn dressing changes and therapy.