bluuebunny/crossref_metadata_2025_split huggingface dataset:
87 Impact of Skin Substitute Use for Burns: An Analysis of the ABA National Burn Repository
Authors: Crombie Roselle , Witherel Claire 
Published: April 2024

Abstract

Introduction
Skin substitutes provide unique utility for the management of thermal injuries over the last 20 years and have evolved into over 75 available technologies today. They are used for patients where insufficient autograft was lacking. Despite demonstrated long term safety and efficacy, use of skin substitutes remains controversial with respect to health economic metrics, including length of stay (LOS), complications, timing of application, number and types of procedures, resource use, and depth of burn. Clinical studies investigate skin substitute use in smaller burns (~20% TBSA) or in some anatomical regions (face, neck), but few address impact within a large national registry inclusive of all burn sizes and locations. The goals of this study were to investigate skin substitutes use for burns over the last 13 years and to elucidate where skin substitutes have the most utility in the burn care continuum.

Methods
NBR data from 2008-2021 were analyzed (n = 388,775 patients). Surviving patients treated with a dermal regenerative graft during their care were identified via ICD-9 and ICD-10 codes (n=41,785 patients) and to show all surviving patients only and eliminating patients with data missing (n=32,428). Metrics including patient demographics (age, sex, race, comorbidities, burn degree, burn location/area) and outcome measurements (length of stay (LOS), total body surface area (TBSA) (2nd, 3rd, and combined), complications, resources, days in the ICU, number of procedures, number of excisional and non-excisional debridements). Additional analyses included determining the percentage of 2nd and 3rd degree burns (normalizing against total) and normalizing patients’ LOS per TBSA and investigating differences between skin substitute patients where their treatment was applied early (less than or equal to 7 days) or late (greater than or equal to 8 days).

Results
Patients with the majority of their burn being 3rd degree and their skin substitutes applied within the first 7 days of admission, particularly for 10-20% TBSA and 20-40% TBSA were associated with a significantly lower LOS/TBSA compared to the same patients who received their skin substitute 8 days or later. Skin substitute use was associated with LOS/TBSA over 1.5 for all size burns when applied early and over 1.7 when applied late (Fig1).

Conclusions
This study illustrates the first analysis of the ABA NBR investigating skin substitute use in burns, including high TBSA burns. Previous studies have limitations and overestimation of the traditional rule-of-thumb of LOS/TBSA near 1, including confounding variables such as age, complications, inhalation injury, and depth of burn. This study also shows that the care algorithm should be considered in outcome measures; future analysis will investigate this patient cohort to further understand the clinical and health economic implications of skin substitute use for burns.

Applicability of Research to Practice
Knowing when to apply a skin substitute
90 Outcomes of Minimally Invasive Excision with Epidermal Autografting in Pediatric Partial Thickness Burns
Authors: Maxey Julia , Wampler Mallory , Elkady Djoni , Williamson Kelly , Lou Richard B , Khandelwal Anjay 
Published: April 2024

Abstract

Introduction
The traditional approach to pediatric deep partial thickness burns has been a “watch and wait” attitude with frequent dressing changes, primarily due to evidence that pediatric burns will often heal, and that early debridement leads to removal of non-viable tissue. However, there is still significant morbidity with delayed healing, increased pain and dressing changes, prolonged hospital stays, added cost and hypertrophic scarring. Dermabrasion is a minimally invasive excisional technique that may preserve viable dermis while epidermal autografting can be used for partial thickness burns to facilitate wound healing. In an effort to improve outcomes, the authors evaluated the outcomes of dermabrasion with epidermal autografting in the pediatric population.

Methods
A retrospective review of pediatric patients (&lt; 18 years old) who underwent minimally invasive excision using dermabrasion with epidermal autografting as the only primary surgical intervention between January 2022 and July 2023 was performed. Patient information collected included: demographics, burn depth, mechanism of injury, percentage of total burn surface area (%TBSA), time to operating room (OR), length of stay (LOS), narcotic use (morphine equivalents), postoperative complications, need for autografting, and number of dressing changes requiring sedation. This was compared to previously conservatively managed patients as well as published historical data.

Results
A total of 46 patients [mean age: 4.95 years (range: 0.04-18)] were examined with an average %TBSA of 7.45 (range: 0.3-19.75). The majority of patients sustained a scald injury (74%). Most patients (66%) had involvement of critical areas including the hands, face, feet or genitalia. Approximately 40% of the patients had Fitzpatrick Skin Type V-VI. The average time to OR was 2.7 days (range 0-8). Average length of stay/%TBSA was 0.45 days. The total number of dressing changings requiring sedation was 1.6 (range 0-7). Almost all patients (96%) had wounds that were &gt;90% re-epithelialized by postoperative day 10. When compared to historical data, time to epithelialization was decreased by 5 days, grafting rate was decreased (11.5% to 6%), opiate usage was decreased in half (0.3 MME/kg/day to 0.15 MME/kg/day), infection rate was reduced to zero, and average LOS was decreased from 10.4 days to 3.6 days).

Conclusions
Within the pediatric population, minimally invasive excision with epidermal autografting may be superior to conservative management with decreased length of stay, fewer dressing changes, decreased infections, decreased need for autografting and decreased opiate consumption. Length of stay can be significantly decreased with earlier operating room availability and swift decision making.

Applicability of Research to Practice
There may be a viable alternative option to the traditional “watch and wait” approach to pediatric partial thickness burns.
125 Pain Management in Adult and Pediatric Burns: A Global Survey of Burn Care Providers
Authors: Gibson Cameron , Dewey Morgan , Baker Kori , Mueller Scott W , Balstad Blaire 
Published: April 2024

Abstract

Introduction
Pain management for burn injuries is an essential component of compassionate burn care. Practices may vary by region or socioeconomic status. This study aimed to assess current pain management practices in burn patients globally.

Methods
An online survey regarding the availability and use of drugs for burn pain management was sent to members of the International Society for Burn Injuries (ISBI) via email and shared in WhatsApp groups comprised of burn professionals. The primary outcome was to provide a cumulative data representation to increase knowledge regarding the state of global burn pain management. Data was analyzed for descriptive statistics by region and socioeconomic status.

Results
113 out of 197 surveys were completed (57%) from 44 different countries. 80% of respondents were MD’s, 15% RNs, and 5% other. By region, 38% were from North America, 21% from Asia, 14% from Africa, 12% from Europe, 9% from South America and 5% from Oceania. By socioeconomic status, 50.4% were from high-income countries (HICs), 22% upper middle-income countries (UMICs), 24.8% low middle-income countries (LMICs), and 2.6% low-income countries (LICs). Most respondents treat both adults and pediatric patients (65%) with an equal number caring for adults or pediatrics only (18% each). The most common drug for managing background pain was paracetamol for all patients and for wound care in pediatrics. Oral and IV opioids were unavailable at 29% and 16% respectively in LMIC/LICs, 36 and 8% in UMICs, and 5.3% for both in HICs. For wound care, IV opiates, paracetamol and benzodiazepines were the most common in HICs and UMICs, while paracetamol was the most common in LMICs/LICs. Ketamine and propofol were used more frequently in UMICs for wound care in adult patients. Non-pharmacological methods were rarely used in adults and in a minority of children.
Most respondents were aware of a pain guideline (72%) and have a pain management protocol at their facility (65%). HICs reported pain at their facility being managed “well” or “very well” (70%) versus half of respondents from UMICs (52%) or LMICs/LICs (50%). Only 11% of respondents from HICs thought pain was managed “somewhat poorly” or “poorly,” versus 16% of UMICs and LMICs/LICs. Those who reported having a protocol for pain management or who were aware of pain guidelines reported better perceived pain control for their patients compared to those who did not (p &lt; 0.05).

Conclusions
Practice around pain control for burn injuries and wound care vary mostly by socioeconomic status and drug availability. Perception of adequate pain control is associated with socioeconomic status, availability of drugs and having a pain protocol.

Applicability of Research to Practice
Burn centers can optimize pain management by establishing standard operating procedures based on existing guidelines. Centers with pain protocols should consider sharing them with other sites to use as a template.
126 Predictors of Lengthened Admission in Adult Burn Patients, a Secondary Analysis of 1796 Cases
Authors: Zhu Xi Ming , Tedesco Diana , Gallo Lucas , Shahrokhi Shahriar , Jeschke Marc G 
Published: April 2024

Abstract

Introduction
Existing research has examined the relationship between the amount of total body surface area (TBSA) burn and length of stay (LOS). As a result, the conventional ratio of 1day LOS/1% TBSA ratio has been updated to 1.5days LOS/1% TBSA. In this study, we aim to elucidate patient and injury characteristics that affect our prognostic indicator, leading to a prolonged LOS.

Methods
This was a secondary analysis of a cohort study of surviving patients admitted to a tertiary adult burn center between January 1, 2006, and June 30, 2021. Adult patients less than 60 years of age were stratified into expected LOS ( &lt; 1.5 days/%TBSA) and greater than expected LOS (&gt;1.5 days days/%TBSA). Patient demographics, TBSA, burn etiology, inhalation injury, pre-admission co-morbidities, and in-hospital complications were tabulated Logistic regression was performed using IBM SPSS Statistics 29 and Stata Statistical Software: Release 18.

Results
1796 patients with a mean age of 39 years were included for analysis of the adult population. 905 patients had the expected LOS/TBSA ratio, and 891 exceeded this ratio. Univariable analysis indicated patients with greater age [1.02 (1.01 – 1.03) p &lt; 0.0001], female sex [1.84 (1.49 – 2.27) p &lt; 0.001], diabetes [1.50 (1.00 – 2.24) p = 0.047], psychiatric illness [1.44 (1.11 – 1.88) p = 0.006], and those who experienced complications (such as infection, graft failure, pneumonia, sepsis) [1.44 (1.20 – 1.74) p &lt; 0.0001] during admission were more likely to exceed their predicted LOS.
Multivariate analysis found that greater age [1.02 (1.01 – 1.03) p &lt; 0.0001], female sex [1.64 (1.30 – 2.06) p &lt; 0.0001], inhalation injury [2.18 (1.50 – 3.15) p &lt; 0.0001], psychiatric illness [1.50 (1.01 – 1.87) p = 0.04], and complications [2.69 (2.11 – 3.43) p &lt; 0.0001] were contributing factors that increased the likelihood of patients exceeding predicted LOS. Diabetes was not a statistically significant contributor.

Conclusions
Progress has been made to identify patient and injury factors that increase the likelihood of increased LOS for adult patients with burn injuries. This provides valuable data for physicians to better assess patients and improve their quality of care.

Applicability of Research to Practice
Identification of key burn patient characteristics aids in prognostication. Determining length of stay aids with coordination of patient care with the multi-disciplinary team.
134 Early Split-Thickness Autografting over a Collagen-Elastin Dermal Matrix Aids in Vascularization and Decreased Contraction
Authors: Powell Heather M , Blackstone Britani , Swanson Susannah , Mukka Naomi , Campbell Autumn , Everett Zachary , Bailey John Kevin 
Published: April 2024

Abstract

Introduction
The dermis plays an important role in skin biomechanics and epidermal homeostasis. Following deep cutaneous injuries, restoration of the dermis is key for optimal functional and aesthetic outcomes. To regenerate a healthy, vascularized dermis, several dermal substitutes have been designed. The timing of split-thickness skin graft (STSG) application over these dermal substitutes is critical to success yet has not been studied systematically for some matrices.

Methods
To understand the impact of STSG application timing, a collagen-elastin dermal matrix (CEDM) was applied to 2 x 1 in full-thickness acute surgical wounds created on the dorsum of red Duroc pigs following an IACUC approved protocol (10 sites per pig, 5 pigs). CEDMs were applied to the sites after which sites were grafted with meshed (1:1.5) and expanded STSG immediately or 4, 8 or 14 days following CEDM application. Sites without a CEDM beneath the STSG served as controls. Non-invasive measurements of tissue perfusion and contraction were collected at each site along with normal pig skin (NPS) at all timepoints with transepidermal water loss, pigmentation, erythema, contraction, and biomechanical properties quantified following grafting. Values were normalized to NPS for each pig. Biopsies (4mm) were collected and stained/immunostained to examine inflammation, blood vessel formation and dermal remodeling. All quantitative data were analyzed using a One-Way ANOVA with a Tukey posthoc test.

Results
Engraftment rates were high when CEDM were grafted on D8 or earlier (&gt; 97% engraftment); however, engraftment was more variable when CEDM were grafted on D14. There was no delay in re-establishment of epidermal barrier function as a result of the presence of the CEDM or as a function of application time. Four days post CEDM application, all groups were ~4-fold more perfused than normal pig skin. Following grafting, perfusion reduced to 2-fold NPS within one week of grafting. Perfusion within the CEDM remained high (4.5-5.2-fold NPS) until STSG application with the D14 group remaining at elevated perfusion levels through 6 weeks post-injury. Graft area was inversely related to time of grafting with CEDM sites grafted on D0 105.2% original area whereas sites grafted at day 14 post injury 70.5% original area (control sites 107.4% original area at week 12).

Conclusions
In a porcine model, earlier application ( &lt; 8 days) of STSGs over CEDMs was related to greater levels of engraftment and reduced levels of scar contraction. The CEDM became rapidly vascularized which may aid in the ability to be grafted immediately or soon after application.

Applicability of Research to Practice
Data suggest immediate and early application of STSG over CEDMs does not result in graft loss or delayed re-epithelialization and may lead to improved outcomes.
135 Evaluation of Autologous Skin Cell Suspension on Re-epithelialization and Repigmentation in Pre-clinical Models
Authors: Bush Katie A , Kashgari Ghaidaa , Jahid Sohail , Powell Heather M , Kahn Steven A 
Published: April 2024

Abstract

Introduction
The autologous cell harvesting device prepares an autologous skin cell suspension (ASCS) from a thin skin sample at the point of care. This study reports on advanced cellular characteristics of ASCS and provides pre-clinical evidence of functional regeneration of the epidermis of full-thickness injuries including re-epithelialization, repigmentation, basement membrane formation, and barrier function.

Methods
Autologous skin cell suspension was prepared from excised discarded healthy donor tissue. Cellular density, viability, phenotypes, apoptotic activity, and number of aggregates were analyzed over 10 donors. To evaluate functionality, two pre-clinical model systems were used. The first system utilized an in vitro model composed of a 3D living dermal equivalent containing viable collagen and fibroblasts. ASCS was applied to the dermal equivalent and cultured over 21 days. The second model was an in vivo model, using full-thickness excisional wounds in Yorkshire pigs. ASCS was prepared and applied onto the wound bed in combination with 3:1 meshed autograft. Healing outcomes were recorded through visual observations and histology was assessed for epidermal morphology (cell localization, stratification), re-epithelialization, proliferation, and basement membrane formation.

Results
ASCS prepared from 4 cm2 donor skin had a mean of 2.41E6±1.03E6 total cells/ml and from 24 cm2 donor skin had a mean of 2.76E6±6.80E5 total cells/ml. The majority of cells found in ASCS were non-apoptotic single cells. Advanced phenotyping data suggests presence of basal keratinocytes and activated keratinocytes, both known to play a role in wound healing and epidermal regeneration.
The in vitro model demonstrated reconstruction of an epidermal layer with basement membrane formation, and localization of melanocytes and proliferative cells at the dermal-epidermal junction. Additionally, this model system demonstrated the functionality of the melanocytes, as pigmentation was macroscopically observed at 21 days.
Full-thickness wounds treated with ASCS+mSTSG in the porcine model successfully re-epithelialized, with a thin layer of epidermal cells present in the interstices of the expanded 3:1 mSTSG seen as early as 3 days post-wounding. At 6 days, average percent re-epithelialization in the interstices was 91%. The regenerated epidermis contained highly

Conclusions
These pre-clinical models demonstrate the functionality of ASCS and ability to regenerate a functional epidermis when the appropriate environment and signaling cues are present.

Applicability of Research to Practice
This data provides scientific evidence supporting clinical results obtained when ASCS is used in conjunction with a mSTSG for the treatment of full-thickness wounds.
514 GPT-4 Passes the Advanced Burn Life Support and Advanced Trauma Life Support Exams
Authors: Egro Francesco , Arellano Jose Antonio , Liu Hilary , Alessandri-Bonetti Mario , Donovan James , Corcos Alain C , Ziembicki Jenny A 
Published: April 2024

Abstract

Introduction
The Advanced Burn Life Support (ABLS) and Advanced Trauma Life Support (ATLS) exams assess medical professionals’ ability to effectively evaluate, stabilize, and treat burn and trauma patients in emergency situations. Recently, there has been a growing prevalence of Artificial Intelligence (AI)-powered Natural Language Processing (NLP) chatbots, giving rise to the question of how these technologies may be integrated into medical education. To determine if LLMs could serve as clinical or educational tools for burns and trauma, this study assessed their performance on the ATLS and ABLS exams.

Methods
GPT-3.5, Bard, and GPT-4 were prompted to answer the 2023 ABLS exam (50 questions) and three ATLS 10th edition exams (40 questions each). Answers produced by the AI chatbots were compared to the answer key provided by the American Burn Association (ABA) American College of Surgeons (ACS). Average exam scores were calculated, and the difference in the number of correct vs. incorrect answers between AI chatbots was evaluated using chi-square tests.

Results
GPT-3.5, Bard, and GPT-4 scored 86%, 70%, and 90% on the ABLS exam, respectively. GPT-3.5 and GPT-4 scored above the passing threshold (80%), as shown in Figure 1. No difference was found between GPT-3.5 and GPT-4 (p=0.538) and between GPT-3.5 and Bard (p=0.054), despite the borderline p-value. GPT-4 performed significantly better than Bard (p=0.012). There was no difference in LLM performance on clinical scenario questions, but GPT-4 was significantly better than Bard in answering direct questions (p=0.033).
Meanwhile, on the ATLS exams, GPT-3.5 scored an average of 65%, Bard scored an average of 61.7%, and GPT-4 scored an average of 83.3%. Only GPT-4 exceeded the passing threshold (75%), as shown in Figure 2. There was no significant difference in GPT-3.5 and Bard’s average scores (65.0% vs. 61.7%, p=0.59), but GPT-4 performed significantly better than both GPT-3.5 (83.3% vs. 65.0%, p=0.0012) and Bard (83.3% vs. 61.7%, p=0.0002). There was no significant difference in GPT-3.5, Bard, or GPT-4 performance on direct vs. clinical scenario question types.

Conclusions
The most recent and updated LLMs, such as GPT-4, have showcased a remarkable level of technical knowledge, to the extent of being able to successfully pass the ABLS and ATLS exams. With continued development, LLMs could become valuable resources for clinicians, enabling AI-augmented decision-making processes.

Applicability of Research to Practice
This study highlights the potential applicability of advanced language models like GPT-4 as valuable resources in the burns and trauma setting, particularly in the context of enhancing clinical decision-making processes through AI-augmented tools for healthcare professionals.