bluuebunny/crossref_metadata_2025_split huggingface dataset:
51 The Association Between Neighborhood Disadvantage and Patient-Reported Outcomes in Burn Survivors
Authors: Biswas Arushi , Zamore Zachary H , Aslami Zohra V , Tiongco Rafael Felix P , Ali Ayman , Cooney Carisa M M , Fisher Mark , Caffrey Julie A , Lerman Sheera F 
Published: April 2024

Abstract

Introduction
Burns are a leading cause of morbidity and mortality, with long-term complications including pain and poor physical function. While neighborhood disadvantage has been shown to be associated with burn severity, its relationship with long-term burn complications has not yet been investigated. Therefore, we hypothesized that higher area of deprivation index (ADI), an aggregate marker of neighborhood disadvantage, will be associated with increased likelihood of pain and poor physical function post-burn.

Methods
We obtained data from the Burn Model System (BMS) database. We linked patient data with ADI state decile 1-10 (1=least and 10=most disadvantaged) using year of injury and Census Block Group based on residence at time of injury. We used bivariate analyses to identify associations between ADI and patient and burn characteristics. We used multivariate regression to determine whether ADI was associated with self-reported pain and physical function (PROMIS-29 subscales) 6 and 24 months post-burn. Significance was p &lt; 0.05.

Results
We included 780 patients who were admitted to one of three BMS centers between 2014 and 2021 of whom 538 (69%) were male. Most identified as White (83%), Black (9.8%), or Asian (2.5%). Mean age at time of burn was 46.2 years, mean ADI state decile was 5.75, and mean TBSA was 15.2%. Bivariate analysis demonstrated significant associations between ADI and age at injury, ethnicity, race, pre-injury household income, pre-injury education, increased pain intensity at 6- and 24-month follow-ups, and worse physical function at 24-month follow-up. Multivariate regressions controlling for TBSA, race, age, sex, anxiety, depression, and pain interference demonstrated that ADI was a significant predictor of higher pain intensity at 6- (p=0.008) and 24- (p=0.020) month follow up and worse physical function at 24-month follow up (p=0.011).

Conclusions
Burn patients living in areas of higher neighborhood disadvantage are more likely to report increased long-term pain and reduced physical function, even after controlling for other known risk factors. Further investigation into the relationship between neighborhood disadvantage and post-burn outcomes in larger, nationally representative samples is warranted.

Applicability of Research to Practice
Along with existing literature, our findings suggest that policy targeting neighborhood disadvantage may help improve short- and long-term post-burn outcomes and assist in identifying patients who are at increased risk for negative health-related outcomes.
98 Assessment of Burn Center Providers’ Professional Quality of Life
Authors: Grauer Christine M , Yelvington Miranda L 
Published: April 2024

Abstract

Introduction
Professional Quality of Life encompasses concepts related to compassion satisfaction and compassion fatigue. Healthcare professionals experience compassion satisfaction as they enjoy caring for others and achieve success in their work. Compassion Fatigue has been associated with physical symptoms and illness among affected individuals, increased staff turnover, and decreased patient safety and satisfaction. The purpose of this study was to assess the professional quality of life of staff at one Burn Center.

Methods
Multidisciplinary healthcare providers who care for adult and pediatric patients at a single Burn Center completed a demographic and Professional Quality of Life Health Measure (ProQOL Health) survey. The ProQOL Health consists of five subscales: Compassion Satisfaction (CS), Perceived Support (PS), Burnout (BO), Secondary Traumatic Stress (STS), and Moral Distress (MD). For each subscale, scores are defined as low ≤ 12, moderate 13-23, and high ≥ 24.

Results
Forty-four participants completed this pilot survey of staff who care for people who sustained burn injuries. Twelve participants identified as non-burn team (NBT) members, and 32 identified as members of the burn team (BT). ProQOL Health subscale scores were calculated and analyzed. Mean, standard deviation, and range are reported for all participants and by subgroup (Table 1).
This cross-sectional study demonstrated moderate levels of CS, PS, BO, STS, and MD among healthcare providers who work directly with adult and pediatric burn survivors. An independent samples t-test was used to evaluate differences in subscale scores of the ProQOL Health based on burn team (n = 32) or non-burn team (n = 12) self-selection. There was a statistically significant difference in STS mean score between burn team and non-burn team members, t(40.63) = 2.81, p = .004. Mean BT STS scores (15.53 ± 4.54) were higher than mean NBT STS scores (12.75 ± 2.01). The BT mean STS score was 2.78 (95% CI, 0.78 to 4.78) higher than the NBT STS score. Groups were not significantly different for other subscales.

Conclusions
Higher STS subscale scores among BT members may be due to repeated exposure to patients who have experienced traumatic and stressful events related to their burn injuries or the care they require.

Applicability of Research to Practice
Interventions designed to address professional quality of life should be considered for all healthcare providers who care for burn survivors and not exclusively those who consider themselves members of the BT.
100 Negotiated Commercial Rates for Burn Care in the Era of Price Transparency—Does Verification Signal Quality?
Authors: Stanton Eloise , Swaminathan Akshay , Rizk Nada , Pedreira Rachel , Sheckter Clifford C 
Published: April 2024

Abstract

Introduction
The Price Transparency Rule was enacted in 2021 to facilitate disclosure of negotiated rates between payors and hospitals with the goal of reducing the cost of healthcare. Burn care is intensive and costly; to date there have been no national analyses of price variation. In particular, we aimed to investigate the relationship between prices, market competition and American Burn Association (ABA) verification status.

Methods
All available commercial rates for 2021-2022 for Diagnosis Related Group (DRG) codes 927 (extensive burn with grafting, mechanical ventilation &gt;96 hours), 928 (extensive burn with grafting or inhalation injury with complication/comorbidity), 929 (extensive burn with grafting or inhalation injury without complication/comorbidity), 933 (extensive burn without grafting, mechanical ventilation &gt;96 hours), 934 (extensive burn without grafting, no mechanical ventilation), and 935 (non-extensive burn without grafting) were merged with hospital level variables, burn center verification status, and Herfindahl-Hirschman Index (HHI, marker of healthcare market competition). For each DRG code, a linear random effects model was fit with cost as the outcome and the following variables as covariates: HHI (categorical), plan type (categorical), safety net status (binary), nonprofit status (binary), verified burn center status (binary), rural status (binary), teaching hospital status (binary). A random effect was included for each unique facility to respect endogenous variation with hospitals.

Results
There were 170,738 rates published from 1541 unique hospitals. Rates for the same DRG varied by a factor of 3 within hospitals. Similarly, rates across hospitals varied by a factor of 3 for all DRGs, with DRG 927 having the most variation. ABA verification status was independently associated with higher reimbursement rates adjusting for facility level factors for all DRGs except for 935. Notably HHI was the greatest predictor of commercial rates, suggesting that market competition is the dominant force in determining burn center payments.

Conclusions
Regional market competition was the dominant factor in determining burn care remuneration. ABA verification status for burn centers was independently associated with increased payments, suggesting a signal for leverage/quality.

Applicability of Research to Practice
For the first time we have national benchmarks for inpatient burn commercial rates which vary substantially within and between hospitals. Burn centers may leverage this information when negotiating rates. In particular, verification status garners greater payments.
103 The Long-Term Economic Burden of Burn Injury
Authors: Dougherty Jacob M , Maqsood Hannan A , Fan Zhaohui , Wang Stewart C , Hemmila Mark R , Sangji Naveen F 
Published: April 2024

Abstract

Introduction
The long-term economic burden of burn injury on patients and payors for outpatient burn care has not been previously described. For small burns deemed appropriate for outpatient treatment alone, costs can still be significant. While initial hospitalization and intensive care is not required, outpatient burn care may require regular wound care, debridement, skin graft operations, eventual hospital admission, laser treatments, and follow-up appointments placing a large burden on payors and patients. We investigated index and post-acute payor and out-of-pocket (OOP) costs related to burn injury for outpatient care at 30 days, 12 months, 24 months, and 36 months following initial injury to better understand the long-term economic burdens for patients treated for burns without inpatient admission at the time of initial injury.

Methods
An observational cohort study was conducted using a commercial claims database from IBM Watson Health® Marketscan. Patients age ≤ 65 years with an ICD9/10 diagnosis code of burn injury that did not initially require inpatient treatment between 2010 and 2016 were identified and tracked for a three-year period following injury. This cohort was used to determine the payor and OOP costs for burn care during the initial treatment and three-year period following their index encounter through 2019.

Results
We identified 63,540 patients who were treated in an outpatient capacity following their index visitation between 2010 and 2016 (Table 1). Of this cohort, 95.8% received only outpatient treatment while 4.2% received inpatient care within 30 days of their initial visit. The mean inflation-adjusted index out-patient evaluation or emergency room costs were $186 during the study period (Table 1). The mean incremental payor costs for burn care were $2,896 at 30 days, $237 at 12-months, $31 at 24-months, and $15 at 36 months (Table 2). The mean incremental OOP costs for burn care were $588 at 30 days, $27 at 12-months, $4 at 24-months, and $2 at 36 months post-injury for each year from 2010 to 2016 (Table 2).

Conclusions
Burn injury creates significant financial burdens even when the initial injury does not require admission at presentation. This economic burden is highly impactful to both patient and providers, and further investigation of the economic considerations regarding burn injury is an area of interest in burn care.

Applicability of Research to Practice
Allows for a burn team to be cognizant of patient costs associated with ongoing treatment and to provide social work and other resources to patients.
105 Burn Injury Severity: Proposed Definitions Based on the National Burn Research Dataset
Authors: Heard Jason , Ren Yunyi , Sen Soman , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G 
Published: April 2024

Abstract

Introduction
Overall care of the burn injured patient has improved substantially leading to improved survival and outcomes. However, despite these improvements, how burn severity is classified based on total body surface area burned (TBSA) and depth has not changed. No recent work has employed data-driven methods to distinguish burns as minor, moderate, severe, or massive. Our aim was to leverage the National Burn Repository to develop data driven definitions of burn severity.

Methods
We used the American Burn Association (ABA) Burn Research Dataset encompassing all burn admissions from contributing burn centers from 2008-2018. Exclusion criteria were aged &lt; 18 years, death, or hospice care within 7 days of admission, or burn etiology of cold injury, trauma, electrical burns, or no cutaneous injury. Latent class analysis (LCA) was performed using the following categorized patient variables: length of stay, ICU length of stay, number of complications, bedside procedures (central line, arterial line, feeding tube placement, and bronchoscopy), amputation, tracheostomy, excisions, grafting, and transfusions. Hierarchical clustering was then applied to the most severe burn group identified through LCA to further stratify severe from massive burn injuries.

Results
There were 112,297 unique records included in analysis. The LCA identified three clusters termed minor (N=63,637), moderate (N=37,320) and severe (N=11,340). The severe group was further split into two groups: severe (N=9,975) and massive (N=1365) using HCA. The mean (SD) total TBSA burned in the groups were 4.2(4.9) in mild, 7.8(7.9) in moderate, 23.4(18) in severe and 39.8(22.4) in massive group. The mean rBaux score in the mild group was 48.2(18.2), 55.0(19.5) in moderate, 80.3(22.8) in severe and 94.5(24.7) in the massive group.

Conclusions
While burn injuries exist on a continuum of severity there are advantages to grouping burn injury severity based on size. Objective and modern categorization can not only help triage patients with burn injuries, but also will be helpful in burn research. There are variable definitions for severe and massive burn injuries in the literature which leads to ambiguity when comparing studies on this unique patient population. This analysis supports a definition of &lt; 10% TBSA for minor burns, 10-20% TBSA for moderate burns, 20-40% TBSA for severe burns and &gt;40% TBSA for massive burns.

Applicability of Research to Practice
This research can help burn and non-burn centers triage patients based on expected resource utilization. However, this research will be most applicable to research that aims to study patients based on burn severity now that more homogenous groups have been defined.
106 Concordance of ChatGPT with American Burn Association Guidelines on Acute Burns
Authors: Arellano Jose Antonio , Pandya Sumaarg , Alessandri-Bonetti Mario , Liu Hilary , Jeong Tiffany , Ziembicki Jenny A , Egro Francesco 
Published: April 2024

Abstract

Introduction
Burn injuries often require immediate assistance and specialized care for optimal management and outcomes. The emergence of accessible artificial intelligence technology has just recently started being applied to healthcare decision-making and patient education. However, its role in clinical recommendations is still under scrutiny. This study aims to evaluate whether ChatGPT general expertise on domestic burn management and appropriate responses to commonly asked questions regarding acute burn injuries compared to the American Burn Association guidelines.

Methods
Twelve commonly asked questions were formulated by a fellowship-trained burn surgeon to address the American Burn Association’s recommendations on burn injuries, management, and patient referral. These questions were prompted into ChatGPT, and each response was compared with the aforementioned guidelines, the gold standard for accurate and evidence-based burn care recommendations. Three burn surgeons independently evaluated the appropriateness and comprehensiveness of each ChatGPT response based on the guidelines according to the modified Global Quality Score scale.

Results
The average score for ChatGPT-generated responses was 4.56 ± 0.65, indicating the responses were exceptional quality with the most important topics covered and in high concordance with the guidelines. Overall, 58% of the questions were focused on first aid and management of acute burns, while 42% focused on patient referral criteria. Of the twelve questions asked, two (16.7%) ChatGPT-generated responses scored a perfect 5.00 ± 0.00, demonstrating perfect concordance with the ABA guidelines. Nine (75.0%) ChatGPT answers between good and excellent quality, with average GQS scores ranging from 4.33 to 4.67. One (8.3%) response describing chemical burn referral recommendations scored a 3.33 ± 0.58, indicating somewhat concordance with the ABA guidelines.

Conclusions
This initial comparison of ChatGPT-generated responses and the American Burn Association guidelines demonstrates that ChatGPT can accurately and comprehensibly describe appropriate treatment and management plans for acute burn injuries. We foresee that ChatGPT may play a role as a complementary tool in medical decision-making and patient education, having a profound impact on clinical practice, research, and education.

Applicability of Research to Practice
This research enhances burn injury care and education by using ChatGPT as a complementary tool to provide accurate guidance to help aid healthcare decisions, patient education, and medical training.
107 Genital Burn Injuries: A Nationwide Analysis of Patient Outcomes
Authors: Najafali Daniel , Pozin Michael , Gangidi Suma , Govande Mukul , Camacho Justin M , Tran Quincy K 
Published: April 2024

Abstract

Introduction
Burn injuries to the genitals can lead to devastating injury with lifelong sequela that can impair function, aesthetics, and hygiene, directly impacting a patient’s quality of life. There is limited research investigating burn injuries to the genitalia. This study aims to characterize the outcomes of patients with burn injuries to their genitals.

Methods
Burn encounters to the genitals were isolated from ABA Burn Care Quality Platform between January 2008 to December 2018. Cohorts were separated based on age: adult and pediatric. Descriptive statistics summarized patients’ demographics, injury characteristics, treatment course, and ultimate dispositions. Multivariable logistics regressions evaluated any complications, length of stay, and mortality.

Results
A total of 7,096 patients had burn injuries to the genital region, of which 4,478 (63%) were adults. The majority of patients were male (66%), Caucasian (49%), and had a mean (SD) age of 31 (26) years. The most common cause of injury for adults was flame-based (34%), whereas scald injuries were responsible for 80% of the genital injuries for the pediatric population (p &lt; 0.001). Median (IQR) TBSA burned was 18% [5-54%] for adults and 6% [3-15%] for pediatric cases (p &lt; 0.001). When isolating the percent of body surface area that was directly impacting the genital region the median was 6% [2-17%]. Most patients had no complications (75%) and survived their burn injury (84%). Factors significantly associated with complications during treatment were pediatric patients (OR 2.0, 95%CI 1.68-2.30) and having a higher proportion of the burn concentrated to the genital region (OR 1.02, 95%CI 1.01-1.02). Longer lengths of stay were observed in black patients (OR 1.22, 95%CI 1.04-1.44) and patients with rash or skin infections (OR 18.9, 95%CI 12.4-29.8), whereas shorter lengths of stay were associated when burns were concentrated on the genitals (OR 0.97, 95%CI 0.97-0.98). Mortality was significantly associated with race, etiology of injury, TBSA, and a greater proportion of burn concentrated on the genitals.

Conclusions
This study highlighted outcomes for burn injuries to the genital region and found that most patients are discharged. We observed that a greater burn concentration to the genital area significantly correlated with increased complications. Paradoxically, these cases were associated with shorter hospital stays. To better support patients with genital burns, we recommend the development of specialized post-discharge care protocols to mitigate potential complication and ensure optimal long-term outcomes.

Applicability of Research to Practice
There is a gap in the literature regarding burn injuries sustained to the genitals and their management. Focusing on identifying populations at increased risk of poor outcomes will inform managing providers.
111 The Association of Burn Center Profit Status and Trauma Designation with Racial/Ethnic Diversity and Transfers
Authors: Steeman Samantha , Lakhlani Devi , Stanton Eloise , Sheckter Clifford C 
Published: April 2024

Abstract

Introduction
Health equity has become a prominent focus in conversations on improving healthcare delivery. Concerns have arisen that for-profit burn centers without trauma status may engage in patient selection practices that favor commercially insured patients, potentially resulting in underrepresentation of minority patients. This study investigates the relationship between profit status and trauma center designation in burn centers in relation to diversity of patients treated.

Methods
Using the California Department of Health Care Access and Information (HCAI), 2009-2019, all inpatient encounters at verified and non-verified burn centers were identified using ICD-9/10 and diagnosis related group codes. Primary outcomes of interest included proportion of burn transfers accepted with Medi-Cal or uninsured and the proportion of minority patients treated. Key covariates included burn center safety net status, profit status, American Burn Association (ABA) verification status, and American College Surgeons (ACS) Level 1 trauma center designation. Adjusted covariates were burn size, gender, age, and payer type. Linear regression modeling was performed and analyses were conducted at the level of individual burn centers, annually. Bonferroni adjustments were applied for multiple testing.

Results
There were 12 burn centers over 11 years. The median proportion of Black and Hispanic patients treated per burn center per year was 44.7%, (IQR 37.4%, 53.2%). On multivariable analysis, for profit burn centers were negatively associated with proportion of Black and Hispanic patients treated (coef -9.2%, p=0.008), and burn centers with trauma center designation were positively associated with higher proportion (coef 8.1%, p=0.011). Safety-net status and verification did not have a significant relationship, though safety-net burn centers care for significantly more MediCal (Medicaid) patients (coef 9.9%, p=0.001). There was not a single ED to burn center transfer for an uninsured patient at for-profit burn center, compared to 9 uninsured transfers to non-profit burn centers. There were only 2 ED to burn center transfers for MediCal (Medicaid) patients at for-profit centers compared to 239 for non-profit burn centers.

Conclusions
For-profit burn centers care for disproportionately few Black and Hispanic patients, while burn centers with trauma center designation care for more. For-profit burn centers have disproportionately fewer transfers with Medi-Cal (Medicaid) payer or uninsured compared to other burn centers.

Applicability of Research to Practice
In the pursuit of delivering high equity burn care across the US, this study identifies disparities related to profit status and trauma center designation in burn centers, underscoring the need for targeted, equity-based interventions and policy development.