bluuebunny/crossref_metadata_2025_split huggingface dataset:
506 Methamphetamine Intoxication and Inpatient Outcomes for Burn Patients
Authors: Stanton Eloise , Karanas Yvonne L , Gillenwater Justin , Pham Tam N , Sheckter Clifford C 
Published: April 2024

Abstract

Introduction
Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, less is known about the associated inpatient complications and perioperative management in users. This analysis aims to identify these trends on a national level.

Methods
The US National Trauma Data Bank was queried to identify burn patients between 2017-2021. Methamphetamine intoxication was identified on admission and compared to those who screen negative. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure, timing of surgery, admission vitals, length of stay (LOS), and days in the intensive care unit (ICU). Multivariable regressions modeled the effects on outcomes adjusting for available covariates including demographics, total body surface area (TBSA) burned, and inhalation injury. Bonferroni adjustments were applied.

Results
326,614 burn encounters were identified, and 5,380 (1.7%) had positive methamphetamine drug screens upon admission. Users were significantly older (35.2 versus 31.9 years, p &lt; .001), had a greater percentage of males (85.3 vs. 82.0, p &lt; .001), were more likely to have inhalation injury and overall had larger %TBSA burns (16% vs. 13%, (p &lt; .001). Users had significantly higher but clinically insignificant ED systolic blood pressures (132.1 vs. 129.9, p &lt; .001). There was no significant difference between the two groups regarding pulse rate &gt;120 (1.7% vs. 1.6%, p=.611). Users were not more likely to die, sustain an MI, or stroke during admission. In contrast, users were significantly more likely to have alcohol withdrawal (0.8% vs. 0.5%, p=.019), drug withdrawal (0.3% vs. 0.2%, p=.003), a pulmonary embolism (PE) (0.9% vs. 0.7%, p=.039), and delirium (1.2% vs. 0.4%, p=.003). Users had longer times to surgery adjusting for burn severity and demographics (1.6 vs. 1.4 days, p=.033). There were no significant differences in the average number of wound coverage procedures (1.50 vs. 1.45, p=.947). Users had significantly longer hospitalization (8.7 vs. 6.2 days, p &lt; .001); however, there was no significant difference between days in the ICU (6.7 vs. 6.4 days, p=.072).

Conclusions
While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, drug withdrawal, and delirium. Methamphetamine use was associated with delays in surgery and hospitalization.

Applicability of Research to Practice
Recognize the increased risk of complications and the need for tailored perioperative care for methamphetamine users. Additionally, burn centers may consider how to avoid delaying care for users and support interventions for withdrawal.
513 Predictive Values of MRSA Nasal Swabs for Pneumonia in Burn ICU Patients
Authors: Carlson Zachary , Stoianovici Robyn N , Young Sierra R , Louie Erin L 
Published: April 2024

Abstract

Introduction
Sepsis in burn-injured patients remains a leading cause of mortality in those who survive initial resuscitation. Methicillin-resistant Staphylococcus aureus (MRSA) is a common causative pathogen for pneumonia in burn-injured patients. Studies evaluating the predictive value of MRSA nasal swabs for pneumonia have largely excluded the burn-injured population.

Methods
Patients 18 years or older admitted to the Burn ICU at a tertiary medical center from 2016 to 2021 were included if they had any burns, a pneumonia ICD-10 code, an MRSA nasal swab obtained during admission, and any respiratory cultures associated with at least five consecutive days of antibiotics.

Results
There were 267 instances of pneumonia across 136 patients included. MRSA nasal swabs had an overall sensitivity of 39%, specificity of 98.7%, positive predictive value (PPV) of 84.2%, and negative predictive value (NPV) of 89.9%. MRSA nasal swabs obtained less than seven days from antibiotic initiation had a specificity of 98.6% and NPV of 98.6%; meanwhile, swabs obtained at least seven days from antibiotic initiation had a specificity of 98.7% and NPV of 86.4%.

Conclusions
The high specificity and NPV indicate that negative MRSA nasal swabs obtained less than seven days from antibiotic initiation may be used to de-escalate anti-MRSA antibiotics in clinically stable burn-injured patients with suspicion of pneumonia. The decrease in NPV suggests that it may be beneficial to obtain a repeat swab periodically or upon suspicion of pneumonia.

Applicability of Research to Practice
This study is the first to measure the sensitivity, specificity, PPV, and NPV of the MRSA PCR nasal swab in a cohort comprised only of patients admitted to a burn intensive care unit. The findings support the use of the MRSA nasal swab as a tool to aid in the decision to initiate or de-escalate anti-MRSA antimicrobials for pneumonia.
522 Testosterone Supplementation in Patients with Burn Hypermetabolism
Authors: DeWitt Alexandra , Ivanko Anastasiya , Schoen Jonathan E , Keating Aimee , Phelan Herb A , Carter Jeffrey E 
Published: April 2024

Abstract

Introduction
After major burn injuries, patients experience a hypermetabolic response that leads to hyperdynamic circulatory, physiologic, catabolic, and immune system responses. Many transdisciplinary approaches have been tested to mitigate this postburn hypermetabolic syndrome such as comprehensive burn rehabilitation, nutritional support, monitoring, and pharmacological interventions. Oxandrolone, a synthetic analog of testosterone, has been shown to have higher anabolic properties and minimal androgenic effects and studied intensely in burn care. In 2023, the FDA asked all manufacturers of oxandrolone to cease production and subsequently removed the drug from market on June 28, 2023. Our study examines the cost and operationalization of an intramuscular (IM) testosterone protocol as an alternative in male burn patients with ≥20% total body surface area (TBSA).

Methods
A cost analysis was conducted using the National Drug Codes (NDC) and commercially available benchmarking data. The cost of oxandrolone and testosterone were included in our analysis. Following a thorough literature review, a protocol was developed for adult male patients with &gt;20% TBSA burn injuries. Patients undergoing gender affirming hormone therapy, untreated obstructive sleep apnea, or hormonal blockers for cancer were excluded from the protocol.

Results
The protocol begins with total serum testosterone levels at the time of admission and weekly thereafter for male patients with ≥20% TBSA injury. Once a testosterone level &lt; 150 ng/dL is detected, supplementation of testosterone with 200 mg IM once weekly for two weeks is started. Weekly evaluations include total body weight, metabolic panels, and nutritional panels. Cost comparison between oxandrolone and testosterone show an equivalent unit cost of $8.62 versus $8.38, respectively.

Conclusions
Drug shortages and supply chain challenges are becoming more common in burn care. We hypothesize testosterone to be both a clinically effective and cost-effective alternative to oxandrolone in the setting of burn hypermetabolism in male patients with major burns. Currently, burn experts are working with endocrinologists to assess pharmacologic alternatives for female patients and have obtained IRB-approval to evaluate both safety and efficacy of testosterone supplementation in the setting of burn hypermetabolism.

Applicability of Research to Practice
This study evaluates the safety and efficacy of testosterone supplementation as an alternative to oxandrolone in the setting of burn hypermetabolism. This study helps provide guidance to other burn centers in filling the gap in therapy that now exists in the pharmacologic management of hypermetabolic syndrome in patients with severe burns.
540 Increasing Discharges Prior to 11am in Patients with Burn Injuries
Authors: Leonard Clinton D , Slater Elizabeth L , Hargis Denise , Graham Richelle , Troche Maria , McGrew Sabrina , Sigel Matthew , Wagner Anne L 
Published: April 2024

Abstract

Introduction
This study describes a quality improvement project to increase the number of patient discharges prior to 11am in a high-volume Burn Center.
A limited supply of staffed inpatient beds creates capacity constraints and can adversely affect patient flow. Discharging patients earlier has been shown to promote throughput, improving length of stay (LOS), patient satisfaction, and decrease costs. Burn patients face unique barriers to discharge compared to other inpatient groups.

Methods
This initiative utilized the Four Disciplines of Execution (4DX) framework, which focuses on identifying key drivers to achieve a specific, time-delimited quality improvement goal. Our primary target was increasing the number of discharges prior to 11am to 30% over the span of 6 months. Lead measures included (a) designation of a “priority discharge” patient, (b) discharge order entry prior to 0930, and (c) discharge prescriptions filled by the pharmacy the night before discharge. Baseline data was gathered from June 1st until Dec 11th 2022 and compared to the intervention period December 12th, 2022 through May 31st, 2023.

Results
Discharges prior to 11am increased from 11.8% to 27.1% over the course of the study. Median discharge time improved by 72 minutes. Discharge order entry time improved by 121 minutes. Potential special-cause variation was identified in January 2023.

Conclusions
Discharges prior to 11am were significantly increased after implementing a multidisciplinary approach between nursing, providers, case management and social work.

Applicability of Research to Practice
The techniques we used to increase early discharges should be easily transferable to other Burn Centers, with positive impact on LOS and amount of time patients spend boarding in the ED.
547 ADHD and Burn Injuries: The Hidden Readmission Risk in Pediatric Patients
Authors: Halevi Alexandra , Anaya Melanie , Emigh Brent , Harrington David , Kheirbek Tareq 
Published: April 2024

Abstract

Introduction
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with the hallmark characteristics of poor impulse control, inattention, hyperactivity, and other cognitive dysfunction; as a consequence, children with ADHD are at an increased risk of burn injury. We hypothesized that pediatric burn patients with ADHD have a higher rate of unplanned readmission compared to patients without a diagnosis of ADHD.

Methods
We analyzed the Nationwide Readmission Database (01/2018 - 10/2018) to compare 60-days readmission rates in children (&lt; 18 yo) with and without a diagnosis of ADHD who were treated for burn injuries on their index admission. Weighted multiple logistic regression was performed to obtain population estimates of odds ratios (OR), adjusting for patients’ demographics, burn severity and location, comorbidities, socioeconomic status, other psychiatric illnesses, and burn treatment on index admission.

Results
Our cohort included 1,879 children with burn injury. Of these, 79 (4.2%) had a diagnosis of ADHD. ADHD patients were more likely to be male (86.1% vs 59.8%, p=0.0002 ) and older (11.6 ± 3.7 vs 5.4 ± 5.3 years, p=0.0001). Children with ADHD were more likely to have other psychiatric diagnoses (26.6% vs 3.8%), specifically obsessive compulsive disorder (2.5% vs 0%, p=0.004), and other developmental disorders (15.2% vs 1.6%, p=0.0002). Patients with ADHD were more likely to be readmitted within 60 days of their index admission (15.2% vs. 4.8%, p=0.002). On weighted multiple regression analysis, ADHD had a higher adjusted odds ratio of readmission (OR: 2.66, 95%CI: 1.13-6.29).

Conclusions
Children with ADHD have a higher adjusted risk of readmission following thermal injury. This is potentially due to higher barriers to compliance with wound care, physical therapy, and scar management. Targeted discharge planning for patients with ADHD, including scheduled short-term follow-up appointments, home nursing assistance, and post-discharge phone calls, may potentially lower readmission risks in this vulnerable population.

Applicability of Research to Practice
Pediatric patients with ADHD are at higher than average risk for unplanned readmission within 60 days of discharge. Pediatric burn centers have the opportunity to adjust their post-discharge practice with these high-risk patients to decrease this risk. Interventions could include: more frequent clinic follow-up, longer duration with outpatient therapy, and additional coaching for caretakers on how to improve patient compliance.
548 Diabetic Foot Burns and Amputation Rates: A Systematic Review and Meta-analysis
Authors: Cannata Brigette , Malkoff Nicolas , Choe Deborah , Gillenwater Justin 
Published: April 2024

Abstract

Introduction
Diabetes mellitus (DM) is one of the most common chronic metabolic diseases. Comorbid peripheral neuropathy (PN) and peripheral vascular disease (PVD) puts this population at risk for foot burns and poor wound healing outcomes. There is a lack of consensus in the literature regarding the optimal approach for management of these unique injuries. The aim of this study is to systematically identify studies reporting on diabetic foot burns and critically evaluate outcomes including amputation rates among patients managed operatively versus non operatively.

Methods
A comprehensive search of PubMed, Embase, and Web of Science was completed. Screening was performed by two independent reviewers. Primary research studies published between 1980 to 2023 that discussed outcomes of foot burns in adult patients with DM were included. Studies that included pediatric (&lt; 18 years old) or animal subjects, had inaccessible full texts, or were written in a language other than English were excluded. All conflicts were resolved collaboratively. The included studies were critically appraised using Newcastle-Ottawa Scale (NOS), JBI critical appraisal tool for analytical cross-sectional studies, or a published methodological tool. Results are presented using descriptive statistics of aggregated data.

Results
The database search yielded 2,402 non-duplicate papers, which was narrowed to 105 full texts following initial screening. A total of 35 papers met inclusion criteria, 5 of which were removed for poor scores on critical appraisal. Nine papers were included for meta-analysis, including seven retrospective comparative analyses, one cross-sectional study, and one retrospective chart review. In sum, there were 1798 diabetic foot burn patients included for analysis. Mean age was 58.2 years (SD 4.12) and 73.1% (n = 1,314) were male. A total of 15.7% (n = 283) of patients were surgically managed, which included debridement (3.7%, n = 66), grafting (8.2%, n = 147), flap (0.2%, n = 3), and primary amputation (7.1%, n = 127). Secondary amputation rate, defined as amputation following initial surgery, was 4.9%, (n = 14). The overall amputation rate of the cohort was 7.8% (n = 141). Other complications included infection (4.0%, n = 72), osteomyelitis (1.9%, n = 34), and graft failure (8.2%, n = 12). Only 1 study reported functional status at last visit.

Conclusions
Diabetic foot burn patients that are managed operatively experience increased morbidity including graft failure, infection, and need for additional amputation. This can have damaging effects on functional outcomes after injury.

Applicability of Research to Practice
The global diabetic population is growing and vulnerable to poor health outcomes, driving the need for research on diabetic foot burns to help providers reach consensus on best management practices.
550 The Effect of COVID-19 in Hospital Length of Stay and Patient Population Following Burn Injury
Authors: Sheikh-Oleslami Sara , Papp Bettina , Papp Anthony 
Published: April 2024

Abstract

Introduction
Myriad medical services were complicated by the COVID-19 pandemic. Acute burn care is heavily resource dependent, and thus was greatly impacted by lack of specialized personnel, supplies, and other resources which grew scarce with the onset of COVID-19. The primary objective of this study was to examine the relationship between COVID-19 and the length of stay (LOS) in hospital following burn injury as prolonged hospital admission increases opportunity for hospital-related complications and has implications on both the individual and community level. Further, it has been shown that homeless patients are hospitalized longer than housed patients due to lack of respite care and resources post-discharge. As such, the secondary objective of this study was to see how COVID-19 affected the homeless burn population and its possible contribution to LOS.

Methods
Single-centre, retrospective cohort study using data from the Burn Registry and medical chart review with inclusion of all adult burn patients admitted to a quaternary provincial burn unit from April 1, 2016, to March 31, 2023. Patients admitted prior to April 1, 2020, were considered the pre-COVID cohort. Variables of interest included demographic characteristics as well as LOS. Homelessness was defined as lack of fixed address. We compared variables of interest by LOS.

Results
498 patients met inclusion criteria. Of these, 301 fell into the pre-COVID and 197 into the COVID cohorts. The mean age (years) and TBSA (%) (standard deviation, [SD]) were 48 (17) and 12 (13) in the pre-COVID cohort and 47 (15) and 14 (16) in the COVID cohort. Males comprised 75.4% and 75.6% of the pre-COVID and COVID cohorts, respectively. Only 9.3% and 14.2% of patients suffered inhalational injuries in the pre-COVID and COVID cohorts, respectively. Overall, there was no significant differences in LOS between cohorts, with COVID cohort patients staying in hospital for 22 (24) days compared to 20 (29) days in the pre-COVID cohort. However, a 169% increase in homeless patients was seen during COVID, with 16% (49/301) of admitted patients being homeless pre-COVID compared to 27% (53/197) during COVID.

Conclusions
COVID-19 pandemic did not affect the LOS in burn patients, but the results suggest that homeless patients were disproportionately affected by the pandemic.

Applicability of Research to Practice
This is important as prolonged hospital stays have serious implications for the patient and the healthcare systematic as a whole.
552 Pain in the Assessment: Improving Reassessment of Burn Patients in the Emergency Department
Authors: Richerbach Stacey , Granger Jenny , Hockenberry Tiffany , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Treatment of burn patients in the emergency department (ED) is challenging and often complicated by excruciating pain sparked by the burn injury. Unmanaged burn pain causes undue stress to the patient, both mentally and physically, and may result in physiologic manifestations. The physiologic impact of extreme burn pain may convolute a provider’s assessment and priorities of care. To facilitate appropriate treatment, RNs in the ED must perform timely pain reassessments. Our institutional benchmark for pain reassessment following medication administration is 90%. In 2021, we observed a drop in compliance in the ED to 73% and instituted a multidisciplinary, quality improvement (QI) approach to improve pain reassessment. The purposes of this project were to pinpoint education needs of nursing staff, improve compliance of pain reassessment, and to evaluate the efficacy of our interventions.

Methods
A survey was disseminated to Burn ED nursing staff to identify barriers to pain reassessment. QI interventions included a collaboration between Nursing, Informatics, and Quality Assurance to overcome barriers related to education, optimization of documentation in the electronic health record (EHR), and timely performance feedback. Education was disseminated via pre-shift nursing huddle, weekly newsletters, and educational posters. Modifications were made to the EHR software to alert nurses to reassessment needs and accounted for medication ‘indication.’ Quality Assurance increased report frequency to furnish reports weekly instead of monthly, enabling nursing leadership to expedite individualized feedback and education. Feedback was well-received by staff. Reassessment metrics were added to the quality board and posted in staff lounges. Top performers were acknowledged monthly in the department newsletter’s ‘Benchmark Brief.’ Performance was analyzed from April 2021 through June 2023, and was grouped quarterly.

Results
Following initiation of the QI project, pain reassessment increased by 18.8% to a 93.6% rate of timely reassessment.

Conclusions
Our multidisciplinary quality improvement project was successful, increasing complete and timely pain reassessment in the ED by 18.8%. Further, we discovered the need to reinforce education related to medication administration route, as PO medications had a higher incidence of pain reassessment non-compliance. To reduce the limitations of staff education, we continue to work with Informatics and the EHR vendor to refine the use of technology and better facilitate reassessment.

Applicability of Research to Practice
Further research is needed to evaluate efficacy of education related to pain reassessment following PO medication administration.
564 Adults with Head and Neck Burns Have Worse Long-Term Psychosocial Outcomes
Authors: Choe Deborah , McMullen Kara , Stewart Barclay T , Kowalske Karen J , Schneider Jeffrey C , Ryan Colleen M , Kazis Lewis E , Orton Caitlin M , Yenikomshian Haig A 
Published: April 2024

Abstract

Introduction
People living with burns of the head and neck (H&N) often experience serious physical (e.g., microstomia, ectropion) and psychological sequelae (e.g., adjustment and mood disorders). We aimed to compare long-term outcomes in key psychosocial domains between adults with and without H&N burns.

Methods
Adults with burn injuries after 2014 enrolled in the Burn Model System national longitudinal, multicenter database were included. Survey responses using the PROMIS-29 (Anxiety, Depression, and Participation in Social Roles), Satisfaction with Life Scale (SWL), and Burn Specific Health Scale (BSHS) at 6-, 12-, and 24 months post-injury were analyzed. Differences between participants with and without H&N burns were examined with non-parametric tests.

Results
This study included 1,247 participants: 579 had H&N burns and 668 had non-H&N burns. Compared to those with non-H&N burns, participants with H&N burns had significantly larger burn size (22.3 ±18.2 vs. 8.6 ±11.0 % total body surface area (TBSA), p&lt; 0.001) and longer hospital stays (32.6 ±38.3 vs. 16.9 ±16.5 days, p&lt; 0.001). At 12 months, participants with H&N burns reported significantly worse anxiety (51.2 ±10.6 vs. 48.3 ±9.4, p=0.001), depression (50.4 ±10.6 vs. 47.8 ±9.4, p=0.0026), and SWL (17.9 ±7.6 vs. 19.6 ±6.5, p&lt; 0.001). Participants with H&N burns also reported significantly worse body image at 6 months (2.5 ±1.3 vs. 3.0 ±1.2, p&lt; 0.001), 12 months (2.5 ±1.3 vs. 3.2 ±1.1, p&lt; 0.001), and 24 months (2.7 ±1.3 vs. 3.1 ±1.2, p&lt; 0.001).

Conclusions
Participants with H&N burns reported significantly worse outcomes in several psychosocial domains, including anxiety, depression, life satisfaction, and body image. These findings and evidence from early psychological intervention suggest that the presence of H&N burns is a potentially useful screening tool to identify an adult population who might benefit from early evaluation and treatment for psychological stress, coping and adjustment (e.g., cognitive processing therapy).

Applicability of Research to Practice
In addition to future studies, this study may be used when considering recommendations for psychotherapy or counseling services available to people living with H&N burns.