bluuebunny/crossref_metadata_2025_split huggingface dataset:
511 Mobilization with Femoral Catheters in the Burn Intensive Care Unit: A Case Series
Authors: O'Neil Audrey , Rush Cassandra , Roggy David , Hartman Brett 
Published: May 2023

Abstract

Introduction
Femoral catheters are a known barrier for ICU therapy sessions and mobility progression due to the anatomical location and potential risk of complications. Safety and feasibility of mobilization has been studied in ICU populations but has not been explored specifically within the burn population. Burn survivors in the ICU have challenges in terms of line access and are at high risk of complications concerning thrombosis A previous retrospective study found that 21% of mobility sessions within the burn ICU on vented patients were limited due to line limitations. This case review was completed following implementation of new mobility guidelines allowing the mobilization of patients with femoral catheters within the burn ICU.

Methods
This retrospective case series was completed in the first year following implementation of new femoral catheter mobility guidelines within a 15-bed adult burn unit. Burn therapy notes were reviewed for burn admissions with at least one femoral catheter in place, including arterial and central lines. Mobility was recorded based on achieved activity levels achieved during each session. Passive interventions (stretching, ROM, and positioning) were excluded.

Results
13 patients were admitted with a total of 55 femoral catheters (8 arterial, 46 central venous) treated. Patients were seen by PT and OT for a combined 417 sessions with lines in place. A total of 65 active therapy sessions occurred with 112 mobility activities including bed exercises/cycle ergometry (11), chair mode (13), cardiac chair transfer (28), tilt table (1), sitting on the side of the bed (32), standing (15), active chair transfers (8), and ambulation (4). No catheter related complications including catheter malfunctions, removal, bleeding, or thrombosis occurred during any therapy sessions.

Conclusions
Active therapy sessions including out of bed activities are safe and feasible in burn ICU patients with femoral catheters. Early mobilization within ICU settings is necessary in preventing complications, combating muscle wasting, and improving long term outcomes for survivors. This study supports that the presence of femoral catheters alone should not limit the progression of mobility interventions.

Applicability of Research to Practice
Using clinical judgement and specialty training, burn therapists can safely mobilize burn ICU patients with femoral catheters in place.
515 Retrospective Review of Silver Sulfadiazine use in Sulfa Allergic Patients at a Regional Burn Center
Authors: Gemayel Kristina , McLaughlin Mariel , Laun Jake , Smith David 
Published: May 2023

Abstract

Introduction
Plastic Surgeons are commonly called upon to evaluate wounds. Most wounds in otherwise healthy individuals will heal with minimal intervention, however in patients with comorbid conditions and systemic disease the incidence of nonhealing wounds is much more prevalent. Silver sulfadiazine is the most common topical antimicrobial used in burn management. Current literature recommends avoiding the use of silver sulfadiazine in burn patients with sulfa allergies. The intent of this retrospective review is to examine the safety of silver sulfadiazine use in documented sulfa allergic burn patients at a level one trauma hospital and regional burn center.

Methods
After obtaining IRB approval for electronic chart review of patients who were treated with silver sulfadiazine, charts were reviewed and exclusion criteria applied. Patients included in the study had documented burns treated by burn team providers, application of topical silver sulfadiazine for primary burn management, and a documented sulfa allergy. Chart review identified 70 patients who met the stated criteria out of 2,644 patients treated over a five year period.

Results
None of the 70 patients with documented sulfa allergies suffered adverse reactions to silver sulfadiazine use for primary burn care. There were no documented systemic or anaphylactic reactions, hives, or additional adverse reactions after administration. No cessation of the medication was documented due to intolerance.

Conclusions
Silver sulfadiazine is a common topical antimicrobial treatment in acute burn care. It has previously been avoided in patients with documented sulfa allergy due to concern for cross reactivity. However, in this population of patients, there were no documented adverse reactions to topical silver sulfadiazine. This study suggests that withholding topical sulfonamides from patients with prior reactions to antibacterial sulfonamides may not be clinically justified.

Applicability of Research to Practice
We present evidence in our retrospective review that administration of topical silver sulfadiazine for primary burn care can be done in a safe manner, without adverse allergic reactions.
522 Safe Use of Thrombolytic Therapy for Severe Frostbite in Pediatric Patients
Authors: McCormick Melanie , Miotke Sam , Lacey Alexandra 
Published: May 2023

Abstract

Introduction
Frostbite in children is very rare with few citations in the literature. Thrombolytic therapy is commonly used to salvage threatened tissue in frostbitten adults, but there is little to no data on the use of such therapy in children. The aim of this case series is to advance our understanding of pediatric frostbite by describing risk factors and outcomes, as well as commenting on the safety of thrombolytic therapy in this population. To our knowledge, thrombolytic therapy has not been studied in children, and this is the largest case series of pediatric frostbite to date.

Methods
This is a retrospective, single-center study reviewing cases of pediatric (&lt; 14 years) frostbite from 2006-2022. Thirteen patients (6 males and 7 females) were found to fit inclusion criteria, and data was collected from the electronic medical record.

Results
A total of thirteen cases were reviewed. Nine patients were managed conservatively with diligent local wound cares, while four were prescribed thrombolytic therapy in an attempt at tissue salvage. Two patients underwent intravenous thrombolytic therapy, and two underwent intra-arterial thrombolytic therapy; there were no complications in either group. We also reviewed patient demographics. Thirty-eight percent of patients were documented as Black or African American, 23% Asian, 23% Caucasian, and 8% Hispanic or Latino. The remainder were unlisted. Notably, 31% of the children had trouble with communication (whether foreign speaking or non-verbal). None of the patients had a positive EtOH or urine drug screen. All of the children were poorly supervised when the frostbite occurred. Outcomes were as follows: 69% were completely healed upon follow up, 23% had very severe frostbite injury upon arrival with significant tissue loss likely requiring amputation (but did not return for follow up), and 8% never followed up.

Conclusions
The use of thrombolytics for the treatment of frostbite injury appears to be safe in children. We have found that risk factors for frostbite in this population include an inability to communicate and poor supervision at the time of injury.

Applicability of Research to Practice
We have been able to safely treat children presenting with severe frostbite injury with thrombolytic therapy. This work is highly applicable to practice. Specifically, the ability to administer intravenous thrombolytic therapy is nearly ubiquitous. This can be done at referring hospitals if there are issues with inclement weather or transportation that would delay transfer to a verified burn center.
523 Retrospective Application of Guidelines for Referral to Palliative Care for Persons Who Have Been Burned
Authors: Grossoehme Daniel , Bish Brianna , Lou Richard , Khandelwal Anjay , Brown Miraides , Brown Carrie , Teo Esther , Friebert Sarah 
Published: May 2023

Abstract

Introduction
Palliative Care (PC) is a limited resource, requiring allocation to those most likely to benefit. One currently underserved population is persons sustaining burns, as these injuries may severely limit quality of life, psychosocial and physical health. Additionally, treatment decisions must frequently be made on an emergent basis on behalf of someone unable to participate in decision making. PC services could benefit patients and caregivers substantially, yet only 2% of persons who have been burned are referred to PC. We developed empirically-derived referral criteria; the purpose of this study was to quantify the sensitivity, specificity, and predictive value of the criteria when retrospectively applied.

Methods
Retrospective review of regional burn center admissions (1/1/2019-1/31/2022) to determine adherence to criteria indicating referral to PC should be made or considered. Descriptive statistics characterizing the sample and criteria performance were calculated.

Results
N=388 admissions occurred study period (29.9% female; mean(SD) age=39.9 (24.1) years. N=28 persons were referred to PC; n=27 met consult criteria, and n=1 met consider criteria. Criteria for PC consultation indicated referral for n=62, and had 0.96 sensitivity, 0.90 specificity, 0.44 positive predictive value, 1.00 negative predictive value, 0.91 total accuracy. Criteria for considering PC consultation were indicated for n=181 and had 1.00 sensitivity, 0.45 specificity, 0.01 positive predictive value, 1.00 negative predictive value, 0.45 total accuracy.

Conclusions
Criteria for PC consultation were sensitive and specific, though the positive predictive value was low. Criteria for consideration show low values; however, documentation did not reveal whether referral was considered or not. Presence of comorbidities was the most commonly-met criterion for referral consideration. Despite the robust sample size, data from a single site may have limited generalizability. Criteria have promising characteristics, may be used as basis for quality improvement efforts, and merit ongoing study and revision to improve predictive ability.

Applicability of Research to Practice
These criteria advance clinical practice by providing guidance on identifying persons most likely to benefit from specialist PC.
536 Firework Injuries in Pediatric Patients: A 15 Year Review
Authors: Johnston Mark , Altamirano Heidi , Miotke Sam 
Published: May 2023

Abstract

Introduction
The United States Consumer Product Safety Commission (CPSC) estimated that 15,600 firework-related injuries were treated in US hospital emergency departments during calendar year 2020 and that there has been a trend of increased injuries from 2005-2020. The goal of this project was to look at the experience of one center with a large referral network, to identify trends and opportunities.

Methods
A retrospective chart review was performed to analyze data points including mechanism, age, sex, TBSA, injury locations, procedures performed, outcomes and complications length of stay, and services involved. The burn registry was utilized to identify cases throughout a 15-year period.

Results
During this period, 24 pediatric patients required admission for firework injuries. Eighty-four percent were males compared to 16% in females. Most injuries (67%) occurred while the patient was holding the firework and lighting it as opposed to being struck by a firework. Most of the injuries had small TBSA percentages (84% &lt; TBSA of 15). In addition, most were referred from outside facilities. Most common sites of injury included the hands and face, followed by the eyes. Sixty percent of patients required operative intervention for their injuries, some requiring multiple surgeries. The average length of stay was 2 days, while 8 patients stayed longer than 5 days. Ninety-two percent were admitted to the burn service with additional specialty consultants. Most children required multiple follow up visits.

Conclusions
Firework related injuries in children result in significant injury often requiring surgical procedures along with a long outpatient treatment course. This work highlights a need for continued advocacy, education, an intervention. This program uses a curriculum and process for children who are injured due to setting fires. The program is evaluating a similar model of intervention and 1:1 counseling for children injured due to fireworks.

Applicability of Research to Practice
This project is applicable to practice as it highlights the continued opportunity for intervention and prevention for firework related injuries. The trends are not decreasing, and the injuries are significant. Evaluation of a model for youth who have fireworks related injuries, similar to the youth fire-setting program, would be a beneficial next step.
548 Volatile Sedation in the Burn Intensive Care Unit: A Quality Improvement Initiative
Authors: Nardi Julie , Wong Lauren , Rogers Alan 
Published: May 2023

Abstract

Introduction
Achieving optimal sedation and analgesia in patients with major burn injuries can be challenging. Reliance on benzodiazepines results in longer durations of mechanical ventilation, delirium and withdrawal. Recent evidence and local experience in our critical care unit has supported the application of volatile agents such as isoflurane for sedation. A local audit determined that 70% of mechanically ventilated patients in our burn center are managed on 3 or more continuous sedative infusions. The aim of this initiative was to reduce the number of continuous sedative infusions to maintain target sedation range (SAS 2-4) by 25% in the 48 hour period following initiation of isoflurane.

Methods
A multifaceted education approach was applied to engage all bedside staff, including burn surgeons, respiratory therapists and nurses. Training occurred though self-directed modules, in-person learning and just-in-time training upon new patient initiation. Data from the 18 month period since implementation were collected retrospectively via manual chart review.

Results
Since implementation in March 2021, 18 patients were sedated using isoflurane in our burn intensive care unit (ICU). Within 48 hours of isoflurane initiation, 50% (9/18) of patients had a decrease in the number of sedative infusions and 56% (10/18) obtained an optimal level of sedation using isoflurane and hydromorphone alone.

Conclusions
Volatile agents provide a safe and reliable method of sedation in mechanically ventilated patients with major burn injuries. Despite limitations related to specialized equipment and training, the introduction of this strategy has been well received, with positive feedback relating to both ease of implementation and titration.

Applicability of Research to Practice
Patients with major burn injuries require multiple painful surgeries and dressing changes. Volatile sedation has been shown to reduce the number of sedative infusions, specifically, our reliance on benzodiazepines.
550 Retrospective Review of Fluid Resuscitation and Associated Complications for Adults in a Large Burn Center
Authors: Richerbach Stacey , Nikjou Devin , Osborn Suzanne , Dobbe Van , Kesler Natalie , Islas Claudia , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
The foundation for burn fluid resuscitation is well established, however an opportunity exists to improve outcomes for patients requiring such intervention. Resuscitation is influenced by a variety of factors, including associated complications. The purpose of this study was to establish a baseline at our center using historical performance and outcomes to drive quality improvement initiatives.

Methods
This was a retrospective chart review of patients admitted over a five-year period requiring resuscitation. Due to factors, such as early enactment of comfort care, patients who expired &lt; 48 hours of injury were excluded.

Results
Charts were reviewed for 346 patients with a total body surface area (TBSA) &gt;20%, 297 were adults. Of these, 32 died &lt; 48-hours post-injury and 127 did not undergo fluid resuscitation or complete records were not available. Thus 138 were evaluable. Averages at admission were age 44.9, weight 86.4 kg and TBSA 39%. Most patients were male (71%). Mechanism was predominantly flame (86%), followed by 7% scald, 3% contact, 2% electrical, and 1% chemical. Concomitant inhalation injury was diagnosed for 34%. Average hourly fluid resuscitation volume was 6.5mL/kg/TBSA with a duration of 31.8 hours. Total volume exceeded Parkland formula calculations for 80%. Continuous albumin was administered for 97%, initiated on average at 8 hours post-injury. Boluses of lactated ringer’s and albumin were administered for 43% and 36% of patients, respectively. Urine output averaged 91 mL/hr and we identified a mean low optimal urine output of 43.2 mL/hr and mean high optimal output of 69.1 mL/hr.
Associated complications during fluid resuscitation included temperature &lt; 36◦C (58%), vasopressor administration (12%), intra-abdominal pressure &gt;12 (59%) and/or &gt;19 (14%), and peripheral vascular pulses &lt; +1 (70%). Escharotomy was performed for 42%; 32% preventative, 2% required subsequent fasciotomy. Laparotomy/open abdomen was performed for 7.9%. Diagnosed complications were low for compartment syndrome (9.5%), abdominal compartment syndrome (6.5%), and acute respiratory distress syndrome (1.4%). Continuous renal replacement therapy was initiated for 11.5% of patients &lt; 48 hours post-burn and for 22.4% &gt;48 hours; 25% requiring CRRT had a dialysis or renal history. The overall survival rate for this population was 76.1%. Patients were discharged most often to rehab (37%), home (19%), or skilled nursing facility (12%).

Conclusions
A baseline for resuscitation in our center revealed a rate double historically accepted rates. Despite nonconformity with tradition, complications remain low. Outcomes have been favorable, yet opportunity for improvement endures.

Applicability of Research to Practice
Further research is needed to evaluate the predictive value of assessment measures to forecast associated complications.
566 Posterior Spinal Cord Syndrome after High Voltage Electrical Injury
Authors: Rodgers Ariel , Thompson Callie , Murphy Daniel , Fleming Irma , Lewis Giavonni , LaChapelle Christopher , Hobson Greg 
Published: May 2023

Abstract

Introduction
High voltage electrical injuries have been called “the grand masquerader”, and significant neurological sequalae have been described. Here, we report the case of a 73-year-old man who sustained a 14.5% total body surface area (TBSA) full thickness electrical burns, most significantly to his scalp (Figure 1). On initial evaluation, there was concern for loss of proprioception resulting in gait instability. A magnetic resonance image (MRI) of the cervical spine performed on post injury day 9 showed no evidence of cervical spinal cord injury.

Methods
A novel descriptive case report of a high-voltage electrical injury with incomplete spinal cord injury

Results
The patient underwent several operative interventions for wound coverage and preservation of function with the known challenges experienced with high voltage burn wounds. Despite lack of imaging confirmation, suspicion for an occult neurological injury remained high. Neurological consultation confirmed limited proprioception and loss of 2-point discrimination. Due to these specific findings that resulted in an inability to make significant rehabilitation gains, a subsequent MRI of his cervical spine performed on post-injury day 30 demonstrated T2 hyperintensity in the dorsal column in the cervical spine at the C2-3 and C5-6 levels, suggestive of myelopathy (Figure 2).

Conclusions
To our knowledge, this is the first reported case of an incomplete spinal cord injury (posterior spinal cord syndrome in this case) due to an electrical injury without bony abnormality the association of paralysis. With the knowledge of this injury, our burn therapists have been able to develop a rehabilitation plan with reasonable expectation and goals. While discussing prognosis with the patient and his family, we noted the absence of data regarding outcomes after injuries of this nature and sought to contribute to the literature with this case.

Applicability of Research to Practice
A novel case of delayed imaging confirmation of posterior cord syndrome contributes to the body of evidence for neurological sequelae due to electrical injuries.
571 Effectiveness of Compression Garments with Silicone versus Compression Garments Alone on Hypertrophic Scar
Authors: Robertson Karen , Wang David , Tran Khoa , Yun Ejun , Stevens Katelyn , Hartman Brett 
Published: May 2023

Abstract

Introduction
Only a few studies have looked at the effects of custom compression garments with silicone sheeting sewn into the garments versus garments alone on scar management. This retrospective study hypothesizes that garments with silicone will improve the Modified Vancouver Scar Scale (mVSS) total scores and sub-scores of pliability, vascularity and height of hypertrophic scars(HTS) when compared to garments alone.

Methods
This is a retrospective study of patients that were autografted or required &gt;21 days to heal and placed in compression garments with or without silicone between 2013 and 2020. Charts were reviewed and mVSS scores from 91 patients with 191 scar locations (134 silicone/57 non-silicone) were collected at 1,3,6,9,12 months. Descriptive statistics were used to describe the sample characteristics. The mean mVSS score and mean sub-scores for pliability, height and vascularity were computed at 1,3,6,9,12 months and reported for the silicone and non-silicone groups.

Results
When comparing the two groups at 9-months (with 45% of initial scars scored), the silicone group had a greater decrease in numerical value and overall % change from 1 to 9-months as compared to the non-silicone group in all areas. The results at 12-months (with 30% of initial scars scored) demonstrated the non-silicone group had a greater decrease in numerical value and % change in height and overall score. Pliability had a 25% improvement in silicone group compared to 16% change in non-silicone group. Vascularity % change was similar with a 47% change in non-silicone group and 46% change in silicone group. The scars in silicone group that were analyzed at 12-months were consistently scored higher across prior months.

Conclusions
Silicone group demonstrated improved %change in all categories at 9-months and in pliability %change at 12-months despite the decreased sample size. Pliability is improved with the use of silicone garments. Although the 12-month %change in mean for height, vascularity and total score did not show improvement over non-silicone, this reflects the return patients having significant scarring throughout treatment and needing continued interventions. These returning patients had scars in the non-silicone group as well that were also rated resulting in the disparity in the groups. The patients in the silicone group with improved scars did not continue follow-up at 12-months. Further research with focus on 9-18 month follow-up mVSS scores is warranted.

Applicability of Research to Practice
Effectiveness of adding silicone to garments in scar treatment.