bluuebunny/crossref_metadata_2025_split huggingface dataset:
761 Transforming Fluid Resuscitation Documentation to Improve Quality Outcomes
Authors: Thomas Shawna A , Roggy David , Fitzgerald Natalie , Tosino Kim , Magbanua Dennis , Grooms Cortni , Boyd Allison N 
Published: April 2024

Abstract

Introduction
Accurate and readily available documentation of burn fluid resuscitation is essential for decision-making by the multidisciplinary team during the first 24 to 48 hours of care. Fluid resuscitation documentation in the electronic medical record (EMR) is ideal. However, due to the limitations of the EMR, bedside nurses must navigate to various tabs to document fluids, view orders, document events, review labs, and notify providers. To decrease burden of care and improve the accessibility of accurate fluid resuscitation information, our multidisciplinary team embarked on a journey to create a new format in the EMR for fluid resuscitation with our information technology (IT) department.

Methods
In April 2022, the burn team initiated discussions to build a new and streamlined process for documentation of fluid resuscitation. The goal was to decrease the amount of navigation in the EMR during fluid resuscitation by the bedside nurse and improve the accessibility of meaningful hourly documentation for the multidisciplinary team.
During monthly meetings, a multidisciplinary team of nurses, a pharmacist, educators, and IT professionals collaborated on each component needed to capture the desired detailed documentation of each fluid resuscitation.

Results
The new format for fluid resuscitation documentation in the EMR is constructed as a navigator flowsheet and initiated in September 2023. The bedside nurse performs all documentation on this one flowsheet. Information from the Lund-Browder calculates initial fluid resuscitation rates and goal hourly urine output. Once the bedside nurse initiates the fluid resuscitation, navigating to any additional flowsheets or tabs in the EMR is unnecessary. Certain information also pulls in automatically from devices, such as vitals, bladder pressure, and urine output.
Documentation of hourly fluids infused, vital signs, urinary output, fluids changes, bedside procedures performed, provider notification, nursing notes, and consulting team interventions are all performed in the narrator. The bedside nurse can also access all orders, labs, and notes without navigating elsewhere in the EMR. Real-time documentation using the narrator allows multidisciplinary team access without disrupting the patient’s nursing care. The post-resuscitation report provides hour-by-hour documentation for debriefing and reviewing each fluid resuscitation.

Conclusions
The development of this new tool has afforded bedside nurses more time spent caring for the patient rather than navigating the EMR. Providers no longer go to the patient room to retrieve information to help guide fluid resuscitation and disrupt patient care. The post-resuscitation report provides an accurate account of the fluid resuscitation period for debriefing and review.

Applicability of Research to Practice
Our process can be shared with other burn centers hoping to replicate this process.
763 Is Central Venous Catheter the Main Culprit for Clinically Significant Venous Thromboembolism in Burn Patients
Authors: Caesar-Peterson Shannon , Libraro Kaitlyn M , Houng Abraham 
Published: April 2024

Abstract

Introduction
Venous thromboembolism (VTE) is a significant clinical problem for burn patients. The incidence of VTE has been reported as 0.25% to 47.1%. Known risk factors include large burn size, increasing age, male gender, active smoker or alcohol use, blood transfusion and surgeries. Central venous line (CVL) use is also a known risk factor for VTE. With all the known factors, we retrospectively analyzed our patients with VTE.

Methods
Retrospective chart review was performed on a single institution burn center in the calendar year of 2022. Pediatric patients were excluded. Following data were collected: age, burn size, mechanism, length of hospital stays, VTE diagnosis, VTE chemoprophylaxis, and central venous line days. VTE diagnosis was made using CT venogram or ultrasound. This project was a quality improvement initiative.

Results
There were 420 patients in the study period. Of all the admitted patients, there were 6 patients diagnosed with 7 VTE. One patient had 2 separate diagnoses of VTE at 2 distinct period and anatomical site. The incidence of VTE is 1.7%. Upon further chart review, all the VTE were at the site of central venous catheters. All the patients were on VTE chemoprophylaxis. The correlation between burn size, age, length of hospital stay and VTE was not significant.

Conclusions
Risk of VTE is high in burn patients due to the correlation with the Virchow’s Triad. All the patients admitted to the burn unit are placed on chemoprophylaxis unless contraindicated. The 7 patients diagnosed with VTE were on chemoprophylaxis. All the VTE were at the site of central venous catheter insertion sites, which is a known complication of catheters. The incident of 1.7% is on par with VTE incidents of burn patients, but much less than VTE caused by central venous catheters in non-burn patients. Large multicenter data collection is needed to validate this finding.

Applicability of Research to Practice
Directly appliable
775 A Unique Semirigid Silicone Neck Collar for Management of Hypertrophic Scars
Authors: Dwertman Michelle N , Freeman Catherine 
Published: April 2024

Abstract

Introduction
In the realm of burn injuries, the use of rigid hard neck collars, or soft collars, is indispensable for optimizing neck positioning and scar management. However, when injuries encompass the head and neck, a critical challenge arises only one rigid orthosis can typically be worn one at a time. We are introducing a novel solution: a semirigid neck collar crafted from flexible silicone. This collar combines the benefits of semirigid support with the freedom of natural neck and allows jaw movement and may be worn with a rigid facemask. Furthermore, it can be customized to effectively manage hypertrophic scarring, making it a promising advancement in burn injury care.

Methods
Our semirigid neck collar is crafted with High Consistency Rubber (HCR) silicone. The HCR can be fabricated as a solid sheet or perforated. This HCR applies a gentle, consistent minimum pressure of 20mmHg as displayed by the Kikuhime pressure monitoring device while remaining pliable enough to accommodate natural neck movements and TMJ mobility. The material is mixed, pigment tinted, and rolled to achieve the desired thickness. Following this, the HCR silicone is heated and molded based on a 3D scan of the patient's neck and fit to the patient.
A successful trial was conducted in a patient with severe facial and neck burns, resulting in improved neck ROM and hypertrophic scar progression. The resulting scar displayed improvement on the Vancouver Scar Scale yielded as reported on the Likert scale and the patient reporting increased compliance of the semirigid collar.

Results
In the trial involving a patient with severe neck and facial burns:
1. Improved Neck ROM, Eating, and Mandibular Movement: While using the semirigid silicone neck collar, the patient experienced improvements in neck ROM, eating comfort, and mandibular movement. The average Likert scale rating for these improvements was five out of five.
2. Decreased Scarring upon Vancouver Scar Scale displaying the difference between the initial and final VSS scores, indicating how much the scar improved.
3. Patient Preference: A preference for the semirigid silicone neck collar, upon rating it a perfect five on the Likert scale. The patient was able to wear it in combination with a hard TFO facial orthotic.

Conclusions
The semirigid silicone neck collar represents a move forward in the field of neck orthosis design, particularly concerning scar management. Its innovative blend of design elements, including flexibility, adaptability, and customizable features, holds great promise for individuals dealing with burn-related neck scarring.

Applicability of Research to Practice
This semirigid appliance offers increased comfort compared to traditional rigid collars and an option in the management of neck positioning and scar hypertrophy. Its flexible nature, including color-tinting, and cost-effective modification options make it a valuable tool for improving scar management outcomes neck for patients with neck and combined facial/neck scarring.
782 Process for Estimating Burn Clinical Research Staffing Needs and Measuring Work Output and Productivity
Authors: Wilson Joan , Price Austin , Hassan Zaheed , Homsombath Bounthavy F , Fagan Shawn P , Hardy Kade , Sood Rajiv 
Published: April 2024

Abstract

Introduction
In the setting of burn clinical research, no widely adopted tool exists that helps predict staffing needs. Additionally, there is very little reported on burn quality metrics at all. This results in a gap in practice when one considers that there is always a mix of funded versus non-funded projects, all of which require varying levels of workload and input. Adequate staffing is required, regardless of the work mix. While a few sources are available in the oncology research setting, none offer a valid tool for determining staffing for clinical research coordinators (CRCs). A comprehensive search for such a tool identified the TOPS tool (Tool for Operational Protocol Scoring). Because the tool considers protocol complexity, it gives the user a valid means of assigning needs for any project. This tool has allowed us to justify the number of protocols we can feasibly take on considering the number of CRCs on staff and remain fiscally and administratively efficient.

Methods
The TOPS tool was implemented to determine the overall complexity score for the work at hand and to verify that the number of coordinators on staff was adequate. Additionally, a complete list of tasks was developed to account for non-research-related work (i.e., admin, meeting attendances, daily rounds, training, etc.). Each employee estimated the time spent on every task they performed. To validate this, all staff were then asked to document their time. The Director and lead coordinator documented time spent on all other tasks not assigned to CRCs. At the end of 3 months, the time documented was very similar to the time estimated initially, so this time was then used to calculate workload distribution by percent effort. The total number of work hours in a year was used to calculate the portion of work time spent on each task to obtain percentage effort.

Results
According to the TOPS tool, protocol complexity indicated that staff was adequate to cover staffing needs at that time. All staff members worked at over 100% effort.

Conclusions
The TOPS tool is a very close predictor for staffing implementation for research work of varying complexity. Validating percent effort by role further validates staffing and work assignments. These activities are also helpful in planning future research activities and timelines.

Applicability of Research to Practice
There currently is a gap in practice to identify proper tools to predict the need for staffing of a burn research office. Specifically, how many coordinators does it take to run the number of studies and projects at any given time? This tool addresses that gap.
784 Burn Injuries During Pregnancy
Authors: Jacobs Jordan , Carter Elisabeth A , Williams Felicia , Chrisco Lori , King booker 
Published: April 2024

Abstract

Introduction
Burn injury during pregnancy is uncommonly studied, but represents a potentially devastating public health crisis. There is the potential for multiple people injured and lives lost. The aim of this study was to review our institution’s experience with this rare subgroup and to isolate specific trends.

Methods
A retrospective study of burn injuries in pregnant women, admitted from 2013-2023 to a single burn center, was conducted to determine outcomes of pregnant patients. Data on these patients were collected utilizing the burn registry and a manual chart review.

Results
Forty patients were identified and stratified by age, weeks of gestation, mechanism of burn injury, TBSA, length of stay, ICU status, surgical intervention, maternal and fetal mortality, and substance use. The mean average age was 27.6 years, and patients were, on average, 20.8 weeks pregnant. The majority of the injuries being sustained were from scald burns (22), followed by flame (12), chemical (3), contact (2), and electrical (1), with one reported inhalation injury. TBSA ranged from 0-40%, with an average TBSA of 4.5%. Length of stay averaged 5.3 days, and 12 patients were admitted to the ICU, with a mean ICU length of stay of 4.3 days. The majority of patients did not receive any surgical intervention, but for those who did, they received either skin replacement (11), or skin substitute (4). During this time, there was one live birth, and no maternal or fetal deaths. Of those admitted, 12 (30%) tested positive for illegal substance use (22.5% marijuana, 7.5% cocaine), and 5 (12.5%) identified as a smoker.

Conclusions
The high incidence of substance use in this population was a surprising finding and warrants further investigation. There is a need for a multi-center, retrospective study to better understand trends in this unique population, with a focus on substance use.

Applicability of Research to Practice
Investigating substance use in this population will help us understand how to better treat these patients.
786 Decreased Coagulation Activity in Burn Shock Patients Administered Albumin Supplementation
Authors: Hassan Taha F , Mathew Merry , Bingi Sai Pranathi , Yeater Thomas B , Shepherd Colton , Pang Alan , Griswold John A 
Published: April 2024

Abstract

Introduction
Burn shock is a systemic inflammatory response and potentially fatal complication of severe burns. Traditional management of burn shock utilizes fluid resuscitation, which involves the administration of crystalloid or colloid solutions. Commonly used colloid solutions include albumin and plasma. Albumin has recently gained traction as a component of this fluid resuscitation; however, it has demonstrated anti-coagulant activity. It is imperative that we study potential coagulation changes as burn patients are already at risk for various other complications.

Methods
This study aims to determine the effect of albumin administration in resuscitation therapy on coagulation in burn patients. To accomplish this goal, we used electronic medical records to compare the indicators of coagulation change in individuals receiving albumin as a part of resuscitation therapy versus those who are not. We posited that the coagulation activity of burn patients decreased in individuals receiving albumin as a component of fluid resuscitation compared to other solution types. A regression analysis was conducted using data from 245 observations for partial thromboplastin time (PTT) and 253 observations for prothrombin time (PT).

Results
The results indicated that total albumin levels showed a significant positive association with both PTT (β = 0.051, p &lt; 0.01) and PT (β = 0.008, p &lt; 0.01), suggesting an anti-coagulant effect. These findings highlight the potential role of albumin in influencing coagulation parameters. Total albumin was found to be correlated positively to the differences in partial thromboplastin time and prothrombin time, showing that albumin exhibits anti-coagulant activity.

Conclusions
The observed anti-coagulant effect of albumin highlights the importance of careful consideration and monitoring when using colloid solutions in burn management

Applicability of Research to Practice
These results build on existing evidence of albumin exhibiting an anticoagulant effect by binding to antithrombin, inhibiting clotting factors and platelet aggregation. Other studies have also found albumin to decrease coagulation in major surgery and oligemic shock patients. This study confirms the anti-coagulant effect of albumin in severe burn patients. The observed anti-coagulant effect of albumin highlights the importance of careful consideration and monitoring when using colloid solutions in burn management. The results of this study, as well as other studies with similar conclusions, will impact evidence-based guidelines for fluid resuscitation in burn patients.
609 The State of Burn Care Training During General Surgery Residency
Authors: Vrouwe Sebastian Q , Davis Brittany , Lacey Alexandra M 
Published: April 2024

Abstract

Introduction
There is an ongoing and looming shortage of burn surgeons. Workforce reports suggest possible hurdles attracting general surgeons into burn care include the removal of the general surgery training requirement of a formal burn rotation over a decade ago. The purpose of this study was to (1) determine the current state of burn care in general surgery residency and (2) identify what barriers might exist for general surgeons pursuing a practice that involves burn care.

Methods
Surveys were electronically distributed to General surgery program directors and residents, respectively, during the 2022–2023 academic year.

Results
A total of 82 programs (response, 13%) and 62 program directors (17%) agreed to send the surveys on to their residents. Of the participating programs, 48 had one or more residents complete a survey (59%), with a total of 250 general surgery residents (10%) participating. Burn care was felt to be an important component of training by most program directors (82%) and residents (81%). The majority of responding program directors included a burn unit rotation (61%), and the majority of responding residents had or would complete a burn rotation in their residency (59%). Of those residents who had completed a burn rotation, 33% felt it increased their interest, 44% felt it had no impact on their interest, and 24% felt it decreased their interest. Of the residents that did not have a formal burn rotation, 61% were interested in participating in one. Regardless of whether the residents had exposure to burn care, 50% of surveyed resident participants expressed interest in a career that involved some degree of burn care. The top factors that would discourage a trainee from practicing burn care in the future included the narrow scope of practice (44%), nature of burn operations (43%), nature of burn care (39%), and insufficient exposure during their training (32%).

Conclusions
This study indicates that burn rotations in general surgery training are important in establishing interest in burn care. Insufficient exposure to burn care may be one of the top factors discouraging trainees from a career in burn surgery.

Applicability of Research to Practice
In light of the projected workforce shortage, these findings may encourage programs to incorporate a regular burn rotation and increase exposure to a career in burn care for general surgery residents who would otherwise not pursue the field.
789 Six Year Experience with Autologous Skin Cell Suspension for Burn Wounds
Authors: West William , Moffitt Sarah , Nehila Timothy , Jupudi Rithvic , Buller Kristina , Le Nicole K , Whalen Kristen , Troy Jared , Laun Jake 
Published: April 2024

Abstract

Introduction
Autologous skin cell suspensions (ASCS) minimize the donor site required for addressing partial and full thickness burns. ASCS is currently FDA approved for use in combination with meshed split thickness skin grafts (STSGs) for full-thickness thermal burns in pediatric and adult patients. Besides the initial clinical trials of ASCS and STSG use for burn wounds, there are minimal studies reporting outcomes of their use. Here, we present our experience using ASCS in the past six years. We hypothesized that ASCS and STSG would result in a low reoperation and infection rate.

Methods
Retrospective review of patients seen at an American Burn Association verified burn center between 2017 and 2023 identified 15 patients treated with ASCS overlying STSG. Data collected included patient demographics, burn characteristics, surface area of ASCS usage, and patient outcomes. The primary outcome of interest was the requirement for reoperation following ASCS use. Secondary outcomes included hospital length of stay (LOS), ICU LOS, infection, and the necessity for scar revision via surgery or laser treatment. Data was analyzed using descriptive statistics with categorical variables presented as frequencies and percentages and continuous variables reported as medians and ranges.

Results
The median age of patients treated with ASCS was 36 years (13-67 years). The median BMI was 27.4 (17.7-35.4) and median total body surface area (TBSA) affected by burn was 18% (5.75-69.5%). Six patients (40%) had full thickness in addition to partial thickness burns. Most burns, 11 (73%) were the result of flames, although there were three grease burns and one friction burn. The median time to ASCS application was 10 days (1-39 days) and the median number of ASCS application sites was 2 (1-6). Most ASCS sites were on the upper or lower extremities or the torso; however, two patients had ASCS applied to their feet while another patient had it applied to their genitalia. Median ASCS surface area was 2,464 cm2 (289-20,000 cm2). Median LOS was 23 days (8-125 days) and median ICU LOS was 3 days (0-94 days). Four patients (26.7%) required reoperation on sites of ASCS application with the median time to reoperation being 40.5 days (28-66 days). Three patients (20%) required scar contracture surgery and three (20%) received laser treatments. There were no cutaneous infections in our cohort.

Conclusions
ASCS was effectively used to treat both partial thickness and full thickness burns and burns due to flame, grease, and friction. There did not seem to be any relationship between the necessity for reoperation after ASCS and the burn depth, etiology, surface area, or location.

Applicability of Research to Practice
Clinicians can look to our study for potential outcomes when using ASCS with STSG in a variety of situations.
802 Increase in Surgical Burn Management During the COVID-19 Pandemic
Authors: Chaker Sara C , Saad Mariam , James Andrew , Torres-Guzman Ricardo , Slater Elizabeth L , Lineaweaver William 
Published: April 2024

Abstract

Introduction
The COVID-19 pandemic has had a profound impact on healthcare systems worldwide. This study explores the consequences of the pandemic on pediatric burn management, specifically focusing on whether the pandemic contributed to a surge in the volume of pediatric burns requiring surgical interventions.

Methods
All surgical cases that had a post-operative ICD-10 diagnosis of a burn was collected from the National Surgical Quality Improvement Program Pediatric database. Patient demographics, procedure codes, and postoperative complications was collected.

Results
From 2018 to 2021, there was a total of 872 pediatric burns that required surgical intervention. The median age of the patients was 5.4 years. There was an 8.7% increase in volume of these cases from 2019 to 2020. The overall rate of complications was 8.4%. The predominant surgical approach employed in the majority of cases was the utilization of split-thickness autograft.

Conclusions
There was an increase in pediatric surgical burn treatment volume during the COVID-19 pandemic. Further investigation into the underlying causes and implications of this surge is warranted.

Applicability of Research to Practice
This analysis provides more information on the incidence of pediatric burns managed by surgical treatment and how it was affected by the COVID-19 pandemic.