bluuebunny/crossref_metadata_2025_split huggingface dataset:
580 Regional Anesthesia for Autograft Donor Sites
Authors: Canady Kristina , Loyd Jacob M , Mueller Scott W , Gibson Cameron , Moorehead Brianna , Wiktor Arek J 
Published: April 2024

Abstract

Introduction
Pain control remains a significant problem in burn patients. To some extent, increased pain can be predicted during the first 24-48 hours following donor site placement and during donor site dressing takedowns. Our objective was to evaluate the utilization of regional anesthesia in the form of single shot nerve blocks (SSNB) on pain in the perioperative setting of a donor site placement and prior to a donor site takedown.

Methods
We performed a retrospective cohort study with prospective secondary survey examining SSNB effectiveness at our ABA verified burn center. Patients were candidates for SSNB if autograft donor sites were predicted to remain within femoral nerve sensory distribution zones. Opiate requirements 48 hours prior to and following SSNB as well as procedural requirements during the previous major wound care session or surgical case were collected. Procedural and overall opiate requirements were compared with and without a SSNB. Similar data were collected in a cohort of patients who did not receive a SSNB but otherwise would have qualified for one. A matched-pairs analysis compared each patient against themselves (pre-post). Surveys were administered to patients and staff on perceived effectiveness and pain scores.

Results
A total of 13 blocks were administered, 9 for a donor site take down. Patients were predominantly male (n=8) with a median (interquartile range) age of 44 (28.5, 58.5) and TBSA 3% (1.9, 6.8). SSNB was associated with less intra-patient procedural fentanyl and a trend in less midazolam requirements between matched groups, mean difference of 89.4mcg (p=0.049) and 0.62mg (p=0.055), respectively. Eleven patient and six staff surveys were completed. There were no significant differences in patient reported pain/effectiveness between matched groups (p=0.13). 4 patients reported zero pain, 2 had 50% or greater decrease. However, 4 patients reported increased pain/discomfort: 1 due to SSNB administration and 3 due to “heavy or numb sensation”, but not pain itself. Staff perception of pain control improved from agreed (83.3%) to strongly agreed (66.7%), p=0.04. Overall total opiate exposures were not different pre-post block at 0-24 or 24-48 hours, p=0.2 and p=0.14, respectively.

Conclusions
Utilization of regional anesthesia in a burn specific population may reduce the need for procedural opiates in anticipation of painful procedures. However, patient perceptions of pain/discomfort/numbness are varied, and education regarding expectations is warranted. Further research is needed to fully assess the effectiveness of SSNB for burn patients.

Applicability of Research to Practice
In selected patients, SSNB can be a useful adjunct to reduce procedural opiates.
583 Risk Factors Associated with Subtherapeutic Enoxaparin Levels in Burn Patients
Authors: Pinto Desiree , Lee Sophia , Johnson Cory , Halabi Rola A , Tejiram Shawn , Travis Taryn E , Moffatt Lauren T , Shupp Jeffrey W 
Published: April 2024

Abstract

Introduction
A hypermetabolic state develops after severe burn injury altering volume distribution, creatinine clearance (CrCl), and hepatic metabolism. This ultimately impacts pharmacokinetics of drugs, including enoxaparin, the standard prophylactic venous thromboembolism (VTE) anticoagulant. Understanding specific factors in burn patients that impact the pharmacokinetics of enoxaparin is necessary to reduce rates of VTE. This study aims to identify risk factors associated with subtherapeutic levels of enoxaparin, measured by peak anti-Xa levels, in burn patients.

Methods
Patients admitted to a regional burn center over a six-month period were included in this retrospective review. Patients on enoxaparin 40mg twice a day (BID) for VTE prophylaxis and had a peak anti-Xa level were included. Exclusion criteria included polytrauma, therapeutic anticoagulation or anti-platelet therapy, a history of chronic kidney disease, cirrhosis, coagulation disorder, heparin induced thrombocytopenia (HIT), or thrombocytopenia at admission. Patient demographics, burn injury characteristics, and lab values for peak anti-Xa levels and admission CrCl were obtained. For prophylactic enoxaparin, a therapeutic level is 0.2-0.4U/mL and a subtherapeutic level is &lt; 0.2U/mL. Patients were separated into groups based on therapeutic or subtherapeutic levels. Differences between groups were evaluated using two-sample t-test or Wilcoxon rank-sum test.

Results
Both the subtherapeutic and therapeutic groups had 13 patients. No patient developed a symptomatic VTE within 31 days of discharge. There were no significant differences in gender, BMI (30.4 vs 31.6 kg/m2), presence of inhalation injury, or ICU length of stay (5 vs 3 days) between groups. Patients in the subtherapeutic group were significantly younger (38 vs 48 years), with a higher TBSA (22.6% vs 6%), and a higher CrCl at admission (134.2 vs 104.8 mg/dL). In the subtherapeutic group, the highest dose needed to reach a therapeutic level of enoxaparin was 60mg BID and the median final dose was 50mg BID.

Conclusions
A delay in initiation of VTE prophylaxis is associated with increased rates of VTE in burn patients, and a delay to therapeutic levels of VTE prophylaxis will likely lead to increased rates of VTE as well. Factors associated with a delay to therapeutic enoxaparin levels were age, %TBSA, and CrCl. A uniform standard dose of enoxaparin may not be effective for all burn patients.

Applicability of Research to Practice
Burn patients are a unique subgroup that require special consideration in every aspect of care, including VTE prophylaxis. Risk factors associated with subtherapeutic enoxaparin levels after burn injury need to be identified to guide the development of effective VTE prophylaxis guidelines.
587 Pharmacy Residents Have a Significant Impact on Process Improvement at Verified Burn Center
Authors: Lauzon Megan , Ko Caroline , Lau Sherman , Vargas Vina , Zaballero Lea , Karanas Yvonne L , Sheckter Clifford C 
Published: April 2024

Abstract

Introduction
Quality and process improvement are vital for burn centers to maintain patient safety, systematically review complications, and adopt new practices involving technology, medications, and staff development. The pharmacy is involved in every facet of burn care from the intensive care unit to the operating room. Pharmacy residents participate in quality and process improvement projects during their training, but little published data exists on how pharmacy residents contribute to overall process improvement in a verified burn center.

Methods
Postgraduate Year-Two (PGY2) pharmacy residents specializing in critical care rotate through the Burn Intensive Care Unit (BICU) for 6 weeks. In addition to patient monitoring, advising, and multidisciplinary rounding, pharmacy residents develop a process improvement project for the burn center. Projects are determined in collaboration with the burn unit director, nursing management, and senior ICU pharmacist; agreement is decided with a Delphi process. After drafting, the project is presented and approved by the county hospital’s critical care sub-committee. Following completed sign-off by stakeholders, the project is presented to the Pharmacy and Therapeutics committee for official approval. Pharmacy residents spearhead implementation of the projects by further building out the electronic medical record interface.
We reviewed all PGY-2 Pharmacy Resident led process improvement projects from 2020 to 2023. The primary end point was the total number of projects and their topics. Secondary outcomes included the number of stakeholders per project along with success of each project which was determined by utilization endpoints

Results
There were a total of five projects completed over the 3-year period including: 1) smoke inhalation nebulizer panel, 2) advanced opioid analgesia, 3) stress ulcer prophylaxis panel for major burn patients , 4) delirium prevention and management, and 5) ketamine infusion for pain management. Since implementation, the burn inhalation panel has been used in 4/4 patients with confirmed smoke inhalation injury, the advanced opioid analgesia in 10/11 patients, stress ulcer prophylaxis panel in 17/17 patients, and delirium prevention and management in 91/91 patients. The ketamine infusion for pain management was recently approved and not yet live in the electronic health record.

Conclusions
Pharmacy residents are an innovative and potentiality underutilized resource for the development and implementation of pertinent process improvement projects at burn centers.

Applicability of Research to Practice
Other burn centers may wish to consider the benefits of pharmacy residents within the burn unit for targeted quality and process improvement projects.
594 A Novel Sequential Compression Appliance to Reduce Scarring of the Face
Authors: Dwertman Michelle N , Huson Henry B 
Published: April 2024

Abstract

Introduction
A transparent facial orthosis (TFO) is crucial for managing scars in burn cases. However, TFOs are typically static and rigid, lacking adaptability to facial movements. Their effectiveness depends on the ability to conform to each patient's unique facial contours and applying the correct amount of pressure to scars. Crafting or modifying TFOs is a time-consuming, skilled, and costly process. To address these challenges, we've developed the flexible and adaptable Sequential Compression Appliance to Reduce Scarring (SCARS) mask in collaboration with a local prosthetic and orthotic lab. This innovation is seamless, allows natural facial movement, and can be easily customized by a trained burn therapist, providing effective scar management.

Methods
SCARS Mask Design: The SCARS mask consists of two key components: a rigid transparent outer layer akin to traditional TFOs and a pliable High Consistency Rubber (HCR) silicone layer. These can be used together or separately. The inner layer offers a minimum 20mmHg pressure displayed by the Kikuhime device and remains flexible to accommodate natural facial movements, including temporomandibular joint (TMJ) mobility. The silicone layer is elastic, able to conform to facial contours, and can be color-tinted to individual skin tones. The mask features multidirectional embedded harness attachments, is lighter in weight than traditional orthotics, and can be trimmed with scissors.
Process: To create the SCARS mask, FDA-approved Platinum Silicone HCR is merged, pigment tinted, and rolled to the desired thickness. The HCR silicone is heated and molded based on a 3D scan of their face.
Clinical Trials: Successful trials on three patients with severe facial burns who exhibit significant scarring and microstomia progression, provided valuable insights. The SCARS mask's performance was noted, confirming its effectiveness.
Measurement: Each individual was given Likert scale to rate their experience.

Results
In the trials involving three patients with severe facial burns:
Patient Preference: All patients unanimously preferred the SCARS mask over traditional TFOs, rating it five on the Likert scale.
Improved Eating and Mandibular Movement: Patients experienced significant improvements in eating comfort and mandibular movement while using the SCARS mask, with an average Likert scale rating of five.

Conclusions
The SCARS mask represents a significant advancement in the field of facial orthosis. Its innovative design, flexibility, adaptability, and customizable features offer a promising solution for individuals with burn-related facial scarring, enhancing both comfort and treatment effectiveness.

Applicability of Research to Practice
This pliable appliance enhances comfort and adherence in managing facial scar hypertrophy. Its customization, allowing color-tinting to match skin tones, and cost-effective modification make it a valuable tool for improving scar management outcomes of facial scarring.
600 A Meta-analysis of Expected In-patient Burn Mortality Rates
Authors: Elloso Margarita S , Tedesco Diana , Jeschke Marc G 
Published: April 2024

Abstract

Introduction
Improvements in burn care have significantly decreased burn-related mortality over the last several decades. However, a small percentage of patients admitted to burn centers still die from their burn injuries. There is a paucity of information as to the rate of burn deaths at specific time points. The purpose of this study was to determine an updated estimate of overall burn mortality as well as expected event rates within 30-, 60- and 90- days post-burn admission.

Methods
A search of the existing literature was conducted using PubMed and Google Scholar databases in December 2022. An additional search of relevant primary literature and review articles was performed. Title and abstract screening was performed, followed by full-text reviews. Studies related to burns including patients ≥ 16 y/o with sample sizes ≥ 250 reporting overall in-hospital mortality and mortality at 30-, 60- and/or 90- days post-admission were included in the analysis. Studies including pediatric populations in analyses and patients with non-burn etiologies were excluded. A secondary analysis of adult patients admitted to our burn centre between 2006-2021 were included.

Results
A total of selected 9 studies were included in the meta-analysis (4 retrospective, 1 prospective, 1 double-blind, randomized, placebo-controlled trial, and 1 Phase III, multi-center, open label, investigator-initiated, randomized trial) in addition to 2611 patients admitted to our burn centre. A total of 10,824 patients were included in our analysis.
The overall mortality rate of the included studies is 8.51%. By 60-days post-admission, the overall mortality rate of 6 studies was 7.51%. By 90-days post-admission, the overall mortality rate is 11.66%.
The expected mortality rate at 30 days is 6.62%, at 60 days 2.99%, and at 90 days 0.91%. The mortality rate within the first 30 days of admission is 6.6% (95% CI 6.3-6.9%). A decreasing trend in mortality is noted at 60 days of admission which is 1.64% (95% CI 1.4-2%), 90 days of admission 0.5% (95% CI 0.43-0.67%), and 120 days of admission 0.3% (95% CI 0.17-0.37%).

Conclusions
The meta-analysis shows a higher rate of mortality during the first 30 days of burn admission followed by a decreasing trend in mortality at 60- and 90-days post-admission.

Applicability of Research to Practice
Our findings suggest further inquiry into factors contributing to increased mortality within the first 30 days of hospital admission as well as the development of effective therapeutic strategies to decrease the rate of mortality.
700 Early Heart Rate Trend Predicts Burn Mortality
Authors: Biswas Arushi , Kuo Keith T , Rajagopalan Shanmuga Priya , Tsou Terrence , Lagziel Tomer , Subramanian Madhu , Cooney Carisa M M , Caffrey Julie A 
Published: April 2024

Abstract

Introduction
During post-burn hypermetabolism, tachycardia is considered a compensatory response to sustain cardiac output and oxygenation to essential organs. Although heart rate variability predicts mortality in burn patients, many centers lack access to non-invasive measurement methods. We hypothesized that heart rate trend in the first 48 hours of admission (measured via vital signs monitor) could predict mortality in burn patients.

Methods
We performed a retrospective review of 128 patients treated for burns with TBSA ≥ 20% at a single institution between 2016 and 2021. We extracted demographics, burn characteristics (e.g. location, mechanism, depth, presence of inhalation injury), complications (surgical and hospital-acquired), and hourly vital signs for the first 48 hours of admission. We performed bivariate analyses to determine associations between mortality within 90 days of discharge and patient and burn characteristics. We conducted multivariate regression to examine the associations between heart rate trends and 90-day post-discharge mortality, adjusting for confounding variables.

Results
Of 128 patients, 73% were male. Median age at time of burn was 52 (IQR, 38-66). Mean TBSA was 40%. The most common burn mechanism was flame (86%). 29 (23%) patients died within 90 days of discharge. Bivariate analysis demonstrated significant associations between mortality and age, TBSA, length of hospital stay, smoking status, whether patients had surgical intervention (e.g. excision, debridement), and number of follow-up visits. On average, patients who survived experienced a 20% increase in heart rate between the 1st and 48th hour of admission, compared to a 9% increase in patients who died. Multivariate regression, controlling for age, TBSA, inhalation injury, renal injury, and vasopressor usage on admission, demonstrated that heart rate trend in the first 48 hours of admission was a significant predictor of mortality within 90 days of discharge (p&lt; 0.001).

Conclusions
Burn patients whose heart rate increased less than 20% in the first 48 hours of admission exhibit a higher mortality risk. This underscores the need for intensified clinical surveillance and intervention for such high-risk patients, optimizing outcomes.

Applicability of Research to Practice
The conclusion drawn from this study emphasizes the role of initial heart rate trends in recognizing burn patients at elevated mortality risk, serving as a guideline for clinicians in allocating attention and medical resources more efficiently.
702 Ethnicity Does Not Change Burn Resuscitation and Time to First Excision
Authors: Abdelfattah Kareem R , Coffey Rebecca , Faris Janie J , Clark Audra , Levi Benjamin 
Published: April 2024

Abstract

Introduction
Burn patients sustaining a greater than 20% total body surface area (TBSA) require a systematic approach for resuscitation as these patients have a large systemic inflammatory response causing large fluid shifts. Ethnicity has been shown to influence overall clinical outcome from burn injury, but differences in the initial resuscitation between ethnicities has not been explored. This study was to identify potential racial disparities that might exist during the initial resuscitation and time to first excision.

Methods
A convenience sample of all burn patients 14 years or older admitted to one burn center between 1/1/2020 and 12/31/2021 and require formal fluid resuscitation were included. Baseline demographics, burn data, past medical history, inhalation injury and mechanical ventilation (MV) were collected. Outcomes included hospital and ICU length of stay (LOS), duration of MV, total IV fluids (ml/kg/hr.), urine output (ml/kg/hr.), and hospital mortality. Nominal data was analyzed using fishers exact and Kruskal Wallis for continuous variables. A p value of &lt; 0.05 was considered significant.

Results
A total of 109 subjects were included in analysis. See table 1

Conclusions
Burn outcomes have been shown to be influenced by ethnicity, although the causes of these inequities are unknown. This is the first study to evaluate the potential impact of multiple ethnicities on initial burn fluid resuscitation and time to first excision. No statistically significant difference in baseline demographics, LOS, duration of MV or overall hospital mortality were found. There appeared to be no disparities in burn resuscitation and time to first excision based on ethnicity, however further studies are needed.

Applicability of Research to Practice
Effects of health disparities on burn treatment can affect outcomes
717 Survival Benefit with a Topical Anti-inflammatory with Antimicrobial Properties in Patients with &gt;15%; TBSA Burns
Authors: Dakin Myles H E , Kenny Tom D , Aspinall Richard 
Published: April 2024

Abstract

Introduction
Burn units acknowledge the challenges of burn-site infection including risk to graft survival and IL-6 mediated systemic inflammatory response, sepsis, concurrent multiple organ failure and death. The risk of repeated grafts, additional ICU time and mortality correlates highly with Pseudomonas spp infection. This risk is compounded by high levels of AMR species (up to 50%) in burns units. The mortality and economic burden are significant and likely to worsen without innovation as AMR becomes increasingly prevalent.

Methods
A novel drug, based on an endogenous immunomodulatory compound (a physiologic aqueous chlorine with the acronym PAC) has been shown to possess broad anti-IL6, anti-microbial and keratinocyte activation activity. In vitro studies confirm efficacy against pathogens including AMR species. The compound is not an antibiotic and is termed compound-PAC.
Over a 50 month period, a tertiary burns unit undertook a proof of concept, open label trial to assess the impact of the compound on survival in patients with confirmed Gram -ve bacterial infections in patient with &gt;15% TBSA. Patients with Gram -ve infection entered the study arm of the trial. Aqueous compound-PAC was administered topically via both hydrotherapy showers and soaked dressings, on a 4-6 hourly basis. In the control arm, showering was performed with normal sterile saline at every dressing change.
Data recorded age, gender, depth of burn + TBSA affected, confirmed Pseudomonas infection, length of stay, and overall survival.

Results
Results from audit analysis (blinded to treatment) revealed compound-PAC could be used to manage confirmed Gram -ve infection of burn-sites; clearing colonization of the wounds without adverse effect and maintaining this with continued use. Such treatment was also effective against other bacterial pathogens. Comparison of survival data of patients with confirmed infection treated with compound-PAC (n = 46) against patients without infection and not receiving this treatment (n= 94), revealed that study arm treatment statistically significantly improved survival compared with normal gold standard of recommended clinical care HR = 0.459 (95% CI 0.282 – 0.750 – P&lt; 0.002). In addition, in patients with &gt;50% TBSA, the use of compound-PAC doubled survival vs. control treatment.

Conclusions
Odds ratio analysis concluded patients receiving the study compound had 5x increased probability of survival vs the current standard of care.

Applicability of Research to Practice
The compound has ability to integrate into standard of care as a wash-drench, with potential survival, wound-healing and health-economic benefits. Further, potential, benefit may be the reduction on failure of skin grafts with reduced requirement for surgeries. A separate investigation is exploring the potential for use in treating inhalation burns.