bluuebunny/crossref_metadata_2025_split huggingface dataset:
54 Prophylactic Antibiotics are Unnecessary for Routine CO2 Laser Burn Scar Treatment
Authors: Kevin Records , Munnerlyn Brittany , Kahn Steven 
Published: May 2023

Abstract

Introduction
Many providers utilize prophylactic cephalexin prior to Co2 ablation laser for hypertrophic scarring. Many providers use this as standard of treatment despite a paucity of high-quality literature supporting the practice. The purpose of this study is to report a single-center experience in performing laser-assisted delivery of triamcinolone and destruction of burn scars without the use of antibiotics.

Methods
This was a retrospective descriptive study from a single center with a new laser scar program. The first 14 patients received cephalexin 500mg by mouth every 6 hours starting the day of the procedure for 5 days and valaciclovir 1000mg by mouth daily for 5 days for their first two procedures- as per manufacturer recommendations. After that, cephalexin was no longer utilized nor were any antibiotics given at the start time of procedure. Valacyclovir is given on a case-by-case basis for patients with a history of cold sores, known herpes simplex, or extensive facial procedures. Burn team staff members followed up with the patients within 48 -72 hours by phone call. Burn staff called patients after each laser treatment to assess for any adverse reactions. Adverse reactions include open areas, rashes, or blisters to laser site. The two groups were compared with a Fisher’s exact test for number of infections.

Results
Patients who received cephalexin accounted for the first 28 cases and none developed an infection. In 201 cases without antibiotics, only one patient developed cellulitis (0.5%), p=1. This patient was noncompliant with restrictions on hand hygiene and used a cheap lotion with parabens, dyes, and perfumes on post operative day 2. Another patient experienced a self-limiting dermatitis on their back of uncertain etiology. In 36 cases, valacyclovir was given. None of the patients in either group developed vesicular lesions consistent with HSV.

Conclusions
There were no significant differences in number of infections whether patients treated with or without prophylactic antibiotics before laser treatment of hypertrophic burn scars. The authors continue to treat patients without administering prophylactic antibiotics.

Applicability of Research to Practice
laser programs are common in burn centers
56 The Impact of Inhalation Injury Grade on Bacterial Isolates from Diagnostic Bronchoscopy with Bronchoalveolar Lavage
Authors: Coston Taylor , Stewart Barclay , Gaskins Devin , Arbabi Saman , West T Eoin , McClellan John , Bailey Austin 
Published: May 2023

Abstract

Introduction
Inhalation injury is associated with increased incidence of pneumonia. Bacteria are commonly isolated from bronchoalveolar lavage (BAL) within 12-48 hours of injury with unclear clinical significance. We aimed to determine if grade of inhalation injury is associated with different bacterial species isolated from initial BAL, and if higher inhalation injury grade is associated with increased risk of pneumonia.

Methods
Abbreviated injury scores (AIS) and clinical microbiology isolates from diagnostic bronchoscopy with BAL performed within 48 hours of injury among adults with inhalation injuries from 2009-2022 were extracted from medical records at an ABA-verified burn center. CDC PNU1 criteria was used to identify pneumonia &gt;48 hours after admission. Modified Poisson regression with robust standard errors was used to assess the association of inhalation injury grade and subsequent pneumonia.

Results
Two hundred forty-six patients with inhalation injury who underwent diagnostic bronchoscopy for airway inspection and surveillance BAL within 48 hours of injury were included in this analysis. Fourteen (5.7%) were grade 0, 106 (43.1%) grade 1, 75 (30.5%) grade 2, 51 (20.7%) grade 3-4. The most common bacterial isolate was Streptococcus spp irrespective of AIS grade. Higher AIS grade was associated with increased incidence of pneumonia (IRR 1.3; 95% CI 1.09-1.61; p = 0.01) after adjustment for age, sex, and total body surface area of burn involvement.

Conclusions
Bacterial species isolated did not differ by inhalation injury grade. Higher inhalation injury grade was associated with increased risk of pneumonia.

Applicability of Research to Practice
Providers should be vigilant that patients with higher grade of inhalation injury are at increased risk of pneumonia. Further research is urgently needed to assess the clinical significance of organisms isolated on initial BAL and their role – if any – on the development of pneumonia.
70 Burn Injury is Not a Risk Factor for Long-term Opioid Use
Authors: Keeven David , Vacek Jonathan , Bozeman Matthew , Miller Keith , Nash Nicholas , Benns Matthew , Pera Samuel , Coleman Jamie , Risinger William , Franklin Glen 
Published: May 2023

Abstract

Introduction
The United States continues to suffer from a serious epidemic of opioid use. Exposure to opioids is a known risk factor for long-term use and dependence. This is of particular importance to burn care, as opioids are frequently essential to manage the pain associated with burn injuries. The purpose of this study was to characterize opioid use among burn patients after hospitalization and to identify any risk factors for long-term dependence.

Methods
All patients admitted to a burn center during a single year period (2/1/2020-2/1/21) were examined. Patients who died were excluded. A controlled substance reporting system was utilized to determine opioid use over a time period from 6 months prior to injury and up to 12 months post-hospital discharge. Reporting to this database is mandated by law and therefore includes all prescriptions regardless of prescriber, insurance, location, etc. Duration of opioid use was recorded for all patients in the study. Long-term use was defined as having an active opioid prescription at 12 months post-hospital discharge. Patient demographic information, burn injury characteristics, operative interventions, and hospital course were examined to determine risk factors for long-term opioid use following burn injury.

Results
A total of 185 patients were included in the study. Patients were predominantly male (76.2%) and had an average age of 47.5 years old. Patients had an average TBSA burn of 9.5% and a length of stay of 6.7 days. A total of 54.7% of patients received an opioid prescription at discharge. Only 17 patients (9.7%) had persistent opioid use at 1 year. The only independent risk factor identified for long term opioid use was pre-injury use (p&lt; 0.001). Among the 17 patients still on opioids at 1 year, 16 had filled 3 or more opioid prescriptions in the 6 months prior to injury. The solitary patient without a pre-existing opioid history had multiple readmissions and delayed operative interventions after their initial hospital course.

Conclusions
A majority of burn patients received opioids for pain control following hospital discharge. However, the duration of therapy was generally short among opioid naïve patients. Burn injury was not associated with long term opioid use among patients in the study.

Applicability of Research to Practice
When used judiciously and with caution, opioids can be safely prescribed to burn patients without fear of long-term opioid dependence.
84 The Association between Family Relations and School Outcomes in School-Aged Children 5-12 years old
Authors: McGwin Madeleine , Patel Khushbu , Ni Pengsheng , Stoddard Frederick , Branski Ludwik , Warner Petra , Schneider Jeffrey , Kazis Lewis , Ryan Colleen , Palmieri Tina , Surette Kate 
Published: May 2023

Abstract

Introduction
School-aged children between the ages of 5 and 12 years face new environments and experiences as they transition through grade school. They are still developing and learning as they engage within their home and carry these experiences into their school environment. This study is an assessment of the association between family relations and school outcomes in children 5 to 12 years of age as measured by the field-tested SA-LIBRE5-12 (School-Aged Life Impact Burn Recovery Evaluation), a new parent-reported outcome measure.

Methods
Within the social and family functioning domain of the SA-LIBRE5-12, 10 family relations and 13 school items were scored on a scale from 0 (Never) to 4 (Always). Scores were re-coded so that higher scores denote better functioning. An exploratory factor analysis (EFA) was conducted to confirm model fit. A regression model assessed the relationship between the school and family factors, controlling for demographic and clinical characteristics (child sex, race, ethnicity, age at survey completion, burn size, burns to critical areas, and pain severity).

Results
A total of 356 parents completed these items from the SA-LIBRE5-12. EFA resulted in four sub domains of family engagement, family stress impact, school success, and school difficulties. A univariate analysis of the demographic characteristics showed that the child being female (p=0.008) and non-white (p=0.0216) had a better mean score in school success (3.33 vs. 3.19 + 0.78 (SD) and 3.38 vs. 3.21 + 0.75 (SD), respectively). In addition, children with a burn size &lt; 1% had better school difficulties score (3.76 vs 3.61 + 0.38, p=0.0018). Regression analysis showed positive correlations between family engagement and school difficulties (r=0.26, p&lt; .0001), family engagement and school success (r = 0.56, p&lt; .0001), family stress impact and school success (r=0.21, p&lt; .0001) and family stress impact and school difficulties (r=0.49, p&lt; .0001).

Conclusions
This study indicates that a cohesive family relationship and home life may promote productive school outcomes in children between the ages of 5 and 12 based on parent reported outcomes.

Applicability of Research to Practice
This research will provide burn care providers, parents, and teachers with greater insight into the relationship between a child’s current family relations and their success in school. Results will guide caregivers in fostering a productive and healthy family environment.
89 Second-Degree versus Third-Degree Burn Differences in Length of Stay
Authors: Bandaru Vishal , Youssi Brandon , Morgan Ryan , Nguyen Kevin , Liu Xiyu , Chaudhury Tristin , Gani Zarif , Shaw Chip , Pang Alan , Griswold John 
Published: May 2023

Abstract

Introduction
Length of stay (LOS) is a crucial element to patient care plans, hospital profit, and a patient’s well-being. However, predicting LOS is difficult as burn injuries often have complications. The expectation for LOS in the burn ward is generally one day per percent total body surface area (TBSA) burned. This prediction approximates the average but rarely represents true patient LOS. Healing times for second and third-degree burns differ, yet most studies only evaluate TBSA rather than 2nd and 3rd degree burns separately. We hypothesized that third-degree burns would have a longer LOS than same sized second-degree burns.

Methods
We obtained a list of all patients diagnosed with Second/Third-degree and verified the inclusion of patients meeting the study criteria from July 01, 2011, to July 01, 2021. Afterward, data was manually extracted from electronic health records and separated from patients with inhalation injury. We placed the aggregate findings in a 3D scatter plot to develop a predictive LOS formula.

Results
The initial data set (n=678) decreased due to missing burn documentation and exclusion of the inhalation injury group yielding the final data set (n=388). For every one percent second-degree burn increase, the LOS (in days) increases by 0.587 + 0.057 (p= 3.07E-22). For every third-degree burn percent increase, LOS increases by 1.328 + 0.086 (p=1.4E-42). The intercept for the 3D scatter plot was set to 0 as a patient without burns or inhalation injury should have a LOS of 0. The r-squared value is 0.58 which shows a medium level of correlation. Our current equation – LOS = 0.587(2nd degree-burn) +1.328(3rd degree-burn).

Conclusions
The one day per percent TBSA rule does not accurately predict LOS. Third-degree burn percentage may double the length of stay when compared to second-degree burns. More closely following 2nd v. 3rd degree burn and other comorbidities will give patients a more accurate estimate of their LOS.

Applicability of Research to Practice
Insurance, physicians, and patients are all affected by LOS. Insurance companies require accurate depictions of LOS to ensure sufficient funding for their patients’ hospital stay. Physicians use LOS to assess course of healing and if other problems are hindering recovery. Furthermore, hospital stay changes a patient’s daily life, work, education, and family. Better predictions for LOS may allow patients to fully grasp what to expect with their recovery.
107 Meta-Analysis of Clinical and Preclinical Microbiome Data from Studies of Burn Injury
Authors: Horseman Timothy , Frank Andrew , Shupp Jeffrey , Burmeister David 
Published: May 2023

Abstract

Introduction
Following burn injury, the ecology of the host microbiota is disrupted to varying degrees and may leave the patient susceptible to opportunistic pathogens or disrupt the endogenous flora needed to potentiate recovery and homeostasis. Studies examining the microbiome post-burn injury usually have a limited sample size which, coupled with experimental and analysis variation, impacts overall interpretation of data.

Methods
We performed a meta-analysis of publicly available sequencing data from burn patients and burn animals to determine if there were consistent alterations in the microbiome across various anatomical sites and species. A MEDLINE search was used to identify applicable publications. Corresponding authors of papers without available data were contacted, and data were used if a response occurred. Ten human and animal 16S rRNA sequencing studies spanning respiratory, urinary, cutaneous, and gastrointestinal microbiomes were included. Raw sequencing data were systematically analyzed with taxonomic classification and α and β diversity metrics generated.

Results
Alpha diversity was consistently lower post-burn, except for human skin (Figure 1) due to perianal skin sampling of burn patients resulting in higher species richness than controls. Weighted UniFrac distance analysis showed that rodent specimens clustered less closely to humans than pig samples (P &lt; 0.0001) for both rectal and skin samples. Host species (R2 = 0.21, P = 0.001), and institute (R2 = 0.35, P = 0.001) had a significant impact on the β diversity. In rectal samples, bacterial composition in pig and human burn samples included Bacteroidetes, Firmicutes, and Proteobacteria, while rodent samples were dominated by over 90% Firmicutes. Burns induced an increase of Proteobacteria and a decrease in Bacteroidetes and Firmicutes in pig rectal samples. Proteobacteria and Firmicutes increased on burned skin in each host species. Longitudinal studies revealed a decrease in α diversity upon burn injury with β diversity and taxa shifts.

Conclusions
Overall, our results suggest that host species and the sequencing site strongly influence microbiome structure. Burn-induced alterations in microbiome diversity and taxa exist across hosts, with certain metrics more influenced by host.

Applicability of Research to Practice
Coordinated, multi-center studies, both clinical and pre-clinical, are needed to truly realize the diagnostic and therapeutic potential of the microbiome for improving outcomes post-burn.
108 Effects of Prior Hyperthyroidism Diagnosis on Burn Patient Outcomes
Authors: Soudah Chris , Karam Kathleen , Amador Dalton , Obias Isabel , Arceneaux Amy , Wolf Steven , Song Juquan , El Ayadi Amina , Golovko Georgiy 
Published: May 2023

Abstract

Introduction
The metabolic response to severe burns is described by an initial hypometabolic ‘ebb’ phase and followed by a hypermetabolic ‘flow’ phase. The hypermetabolic phase is mediated by hormonal and cellular dysregulation with elevated catecholamine levels. The role of thyroid hormone, however, is not described well. This study investigates relative risks of various outcomes in those with a previous diagnosis of hyperthyroidism following severe burn compared to those without.

Methods
This study obtained data from the TriNetX Research Network, a national database of de-identified electronic medical data from a secure network. The population was stratified to compare patients with and without a prior diagnosis of hyperthyroidism who sustained burns. Outcomes were measured within three years of injury in order to assess long-term effects occurring alongside the hypermetabolic phase. Outcomes observed for both groups included systemic inflammation and infection, sepsis, mortality, and infections of the skin and subcutaneous tissue.

Results
This study identified 5,250 patients with a prior diagnosis of hyperthyroidism who sustained burn injuries and 648,336 patients without hyperthyroidism prior to matching for demographics and diagnoses. Propensity score matching then yielded 5,077 patients with and without a prior diagnosis of hyperthyroidism. Both cohorts were balanced using propensity score matching for age, sex, race, ethnicity, and TBSA burned.
After assessing the outcomes for a three-year span since burn injury, patients with a prior diagnosis of hyperthyroidism had a higher risk of systemic inflammation and infection (risk ratio [RR], 1.599, p &lt; 0.0003), sepsis ([RR], 1.572, p &lt; 0.0001), mortality ([RR], 1.488, p &lt; 0.0001), and developing infections of the skin and subcutaneous tissue ([RR], 1.332, p &lt; 0.0001) compared to patients without prior diagnosis history.

Conclusions
Burned patients with a prior history of hyperthyroidism have increased risk of systemic inflammation and infection, sepsis, mortality, and infections of the skin and subcutaneous tissue. Thus, history of this condition or concomitant diagnosis with the injury is warranted.

Applicability of Research to Practice
This study encourages further insight into the relationship between the metabolic effects of burn injuries and concurrent metabolic conditions to modify patient treatment plans and customize practices.
119 Exercise in the ICU and its Effects on Physical and Mental Health in Pediatric Burn
Authors: Rego Andrea , Parry Ingrid , Sen Soman , Spratt Heidi , Lee Jong , Herndon David , Wolf Steven , Branski Ludwik , Suman-Vejas Oscar 
Published: May 2023

Abstract

Introduction
Suffering a severe burn is an event that can have lifelong physical and mental ramifications. Exercise after discharge from the hospital, has been shown to improve quality of life with better physical and mental status in children with severe burns. However, the effect of exercise, implemented in the acute care setting, on quality of life in the specific population of adolescent patients with burns needs more research. The purpose of this study was to determine the effects of aerobic exercising in the burn intensive care unit (BICU) on patient self-reported physical and mental health outcomes in severely burned children. We hypothesized that aerobic exercise would improve self-reported physical and mental outcomes.

Methods
This was a multi-center, prospective, randomized controlled trial. 48 children between the ages of seven and seventeen with ≥ 30% total body surface area (TBSA) burn were randomized in a 1:2 study design to standard of care (SOC) or standard of care plus receiving additional exercise with a cycle ergometer (SOC+Ex). Self-reported physical and mental health outcomes were obtained via surveys at admission and at discharge from the BICU.

Results
Pain, weakness, and tiredness scores were significantly decreased from admission to the discharge time point in both groups (p&lt; 0.05). Linear regression modeling revealed that there were no differences in pain, weakness, and tiredness levels due to treatment at any timepoint between groups. When controlling for age, gender, length of stay, number of exercise sessions, and %TBSA, time point makes a difference in pain, weakness, and tiredness levels (p &lt; 0.0001). Sleep, sadness and misery scores were significantly decreased from admission to the discharge time point in both groups (p&lt; 0.05). When controlling for age, gender, length of stay, number of exercise sessions, and %TBSA, time made a difference in sleep, sadness and miserable levels (p &lt; 0.0001). There was a significant interaction (p = 0.0285) between time and treatment for the misery score.

Conclusions
The findings of this study suggest that aerobic exercise in the BICU does not reduce self-reported physical and mental outcomes for severely burned children. Our recommendation is for all pediatric patients in the BICU to continue with the SOC and consult with their physician over the benefits of additional aerobic exercise. This study suggests that perhaps there is potential for increasing the amount of exercise that can be administered to pediatric burn survivors beyond SOC as we did not find aerobic exercise to result in any adverse events or to be of any harm to the patients if it is performed properly and under supervision.

Applicability of Research to Practice
Additional aerobic exercise in the acute care setting is beneficial for severely burned children in terms of self-reported physical and mental health outcomes.
122 Assessment of Frailty on Discharge Disposition and Long Term Functional Outcomes Following Burn Injury
Authors: Dellheim Vanessa , Cuerdon Elizabeth 
Published: May 2023

Abstract

Introduction
There is an increasing aging population. The goal of our study was to look at how frailty impacts discharge from acute hospitalization as well as long term function at 1 year following their burn.

Methods
After IRB approval, all patients over age 50 who were admitted September 2019-2021 were considered for enrollment. Exclusion criteria included, a non-survival burn and underlying co-morbidities that would affect long term outcomes independent of a burn. Data collected included: age, gender, TBSA, surgical intervention, Canadian Health and Aging Frailty Score (CFS), discharge disposition, Barthel index, and a functional questionnaire. Follow-up phone calls were completed 6 month-1.5 post.

Results
Follow up data obtained via phone call for 30 subjects; the average age was 71 (10.8) years old with 8.6 % (16.5) TBSA, with a CFS average of 2.89 (1.5). 20 (40%) were lost to follow-up. 90 % of patients returned to their baseline and prior living environment. Of the patients who did not return to their prior functional status all had impaired Bartel index prior to their burn injury as well as higher CFS &gt;5, as well as longer LOS (26 day), and were older. Discharge was assessed based on enrollment sample size (n=50), average age 71 yo (10.4), burn size of 7.4% TBSA (13.2), CFS of 3.4 (1.64), and length of stay 20 (25.09) days. 13 patients (26%) were discharge to an IRF, 10 patients (20%) to a SNF, and 27 patients (54%) to home. Patients who discharge home had Lower CFS 2.2, lower age, 69 y.o., and lower TBSA 5.6% compared to patients who were discharged to SNF and IRF. Patients who were discharge to an IRF were older (77yo), had larger TBSA (13.5) and a lower CFS (3) compared to patients who were discharged to a SNF. 80% of patients who discharge to a IRF returned to their prior level of function compared to 40 % who discharged to a SNF

Conclusions
This work helps structure discussions with the geriatric population about expectations to return to their prior level of function. Frailty appears to be associated with outcomes and discharge as lower CFS, older age and larger TBSA were more likely to discharge to IRF and recover to their baseline compared to patients with higher frailty score who were more likely to discharge to a SNF despite younger age and smaller TBSA. This shows that even relatively small burns (8% TBSA) in the elderly can affect ability to care for oneself and ability to go into the community 1 year after their injury.

Applicability of Research to Practice
This can be used by physicians and therapists to aide in discussions about discharge from the hospital as well as long term outcomes expected following their burn injury.