bluuebunny/crossref_metadata_2025_split huggingface dataset:
37 The Epidemiology of Burn Injury in A Large Southern Geographic Area
Authors: Haggerty Christopher , Ramsey Walter , O'Neil Christopher , Satahoo Shevonne , Kaufman Joyce , Pizano Louis , Schulman Carl 
Published: May 2023

Abstract

Introduction
Given the resource-intense nature of treatment for burn injuries and the knowledge of at-risk populations, a public health approach to reducing individual and societal burden is indicated. To accomplish this, it is critical to understand the regional distribution of these injuries and the risk factors influencing one’s susceptibility to being burned. We hypothesize that there are common sociodemographic trends in burn injuries in a large southern geographic area.

Methods
Data was retrospectively reviewed for all burn patients admitted between 08/2013 and 12/2021 at a major burn center in a large southern geographic area. Sociodemographic data, burn characteristics and outcomes were analyzed. Patients with isolated inhalation injuries were excluded. One-way ANOVA was used for continuous variables with a P-value &lt; 0.05. Binary logistic regression was used to evaluate independent risk factors for mortality. GIS software mapped injury locations alongside census data to augment statistics with visuospatial analysis.

Results
1753 patients were included with an annual incidence rate of 36 per 100,000 person-years. Most were male (68%), Caucasian (60%) and non-Hispanic (67%). The most common etiology was cooking-related (14%), with scald and flame burns collectively making up 80%. Flame burns were significantly larger when compared to scald, electrical and chemical mechanisms (p&lt; 0.05). Those between 19 and 45 years old were the largest age group (40%) with significantly larger burns compared to those 0-18 and 46-64 (p&lt; 0.05), but not those &gt; 65. Non-Hispanic patients had significantly larger burns than their Hispanic counterparts (p&lt; 0.05) but no difference in mortality (p=.306). Patients utilizing Medicare/Medicaid were over three times more likely to die compared to those with commercial insurance.

Conclusions
In this cohort, male patients are injured at higher rates, however, they do not have more severe burns. The larger burns are distributed in a bimodal fashion between those 19-45 and those &gt; 65, with hispanic ethnicity protective against larger burn injuries. This suggests separate mechanisms mediating larger burns in these two groups, and warrants further investigation. Insurance type, a surrogate for socioeconomic status (SES), is not associated with TBSA or LOS, however it does confer an increase in mortality in those with Medicare/Medicaid. GIS mapping verifies neighborhoods concentrated in more urban areas with lower median household incomes have higher injury rates. This highlights populations worth targeting for injury prevention, namely those between 19 and 45 of lower SES, particularly in the setting of cooking and food preparation.

Applicability of Research to Practice
Understanding regional trends in burn injury can target prevention efforts and identify at risk populations where further resources might be best allocated to ease the burden of burn injury.
59 Predictors and Impact of Pneumonia on Adverse Outcomes in Inhalation Injury Patients
Authors: Galet Colette , Richey Karen , Foster Kevin , Wibbenmeyer Lucy , Ronkar Nicolas 
Published: May 2023

Abstract

Introduction
Next to age and burn size, the presence of inhalation injury (II) is the third mortality prognostic factor for burn injury. II can lead to pulmonary complications such as pneumonia, acute respiratory distress syndrome (ARDS), and acute lung injury (ALI), all of which have been hypothesized to increase mortality in II. Herein, we aimed to identify variables associated with the risk of developing pneumonia and to determine the impact of pneumonia on selected outcomes.

Methods
De-identified data from the Prospective Inhalation study (ISIS) were used. II was confirmed by fiberoptic bronchoscopy. Baseline demographics, injury data, burn size, laboratory data, radiographic results, treatment, and hospital course were recorded. Ventilator use, complications, including pneumonia, ARDS, ALI, and death, were tracked daily for seven days and then weekly until discharge. Univariate and multivariate analysis were performed. Variables included in multivariate analysis had a p value of 0.1 or less. A p value of &lt; 0.05 was considered significant.

Results
Of the 108 ISIS study group, 106 had complete data and were included in the analysis. Median age was 48.5 y, 59.4% of the subjects were male, 76.4% White and 9.4% Black. Regarding complications, 46.2% of the subjects developed pneumonia, 11.3% ARDS, 9.4% ALI, and 17% died. On univariate analysis, subjects who developed pneumonia were more likely to be white (87.8% vs. 66.7%, p = 0.006), to present with higher total burn surface area (24.70 [8.00-49.50] vs. 2.85 [0.00-25.38], p = 0.002), and full thickness burn (55.1% vs. 31.6%, p = 0.018). On multivariate analysis, being white (p = 0.033) and receiving colloids in the first 24 h of admission (OR = 3.582 [1.157-11.087], p = 0.027) were associated with increased risk of pneumonia while higher level of MMP-9 in the plasma (OR = 0.999 [0.998-1], p = 0.041) lowered the risk. Admission radiographs, FB score, clinical examination findings, and other demographic factors were not related to developing pneumonia. Pneumonia was independently associated with increased risk of developing ARDS (OR = 8.496 [1.322-54.61], p = 0.024) but not with ALI or mortality. Pneumonia was also associated with a longer hospital length of stay (B = 15.2 [2.4-28], p = 0.020) and higher number of days on a ventilator (B = 15.6 [8.2-23], p &lt; 0.001).

Conclusions
Pneumonia is associated with increased LOS and ventilator days but not mortality. Those who received colloids were 3.5 times more likely to develop pneumonia. The relationship between colloid and pneumonia requires more research, however, the search for other intervenable clinical variables to prevent pneumonia remains elusive.

Applicability of Research to Practice
As colloids may affect the glycocalyx and contribute to inflammation, their role in developing pneumonia needs to be elucidated.
74 Secondary Immunohistochemical Analysis of Viable Cells as Determined by Hematoxylin and Eosin Staining
Authors: Carney Bonnie , D'Orio Cameron , Shupp Jeffrey , Carter Jeffrey , Hickerson William , Holmes James , Phelan Herbert 
Published: May 2023

Abstract

Introduction
Accurate clinical differentiation of deep partial-thickness (DPT) and full-thickness (FT) wounds is essential in justifying appropriate treatments for heterogeneous burns. Only recently has non-invasive burn depth imaging been ground-truthed with tissue punch biopsies; an endeavor that will no doubt improve AI imaging algorithms in the near future. Prior literature supports unique apoptotic and necrotic properties of DPT and FT wounds, suggesting a use for not only standard stains (H&E), but apoptotic marker staining in assisting clinical diagnosis of burn depth, progression and/or conversion.

Methods
The aim of this study was to evaluate the presence of apoptotic cells in DPT and FT samples previously diagnosed by a burn biopsy algorithm (BBA-V2) for burn depth and severity by expert review of H&E-stained slides. Eight paired biopsies were collected from DPT and FT wounds in four patients within 72 hours of thermal injury and were immunofluorescently labeled for apoptosis markers by detection of deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and cleaved caspase-3 (CC-3) staining. Fluorescence intensity in dermal appendages within images was used to quantify signal at 40x magnification for CC-3. % positive TUNEL cells were graded by an investigator blinded to the burn severity. A higher grade indicated higher % positivity. TUNEL grading was evaluated by Chi square test. CC-3 intensity was evaluated by Student’s t-test.

Results
Across all four patients, FT burns had higher levels of CC-3 in dermal appendages compared to DPT burns (Cy3:DAPI ratios: 1.53 ± 0.28 vs. 0.75 ± 0.13; p=0.1074). Within each patient, all FT biopsy sites had significantly higher levels of CC-3 versus DPT biopsy sites (p&lt; 0.05)(Table). DPT burns had a greater proportion of patients with increasing grades of TUNEL positive cells (DPT: Grade 1: 16%, Grade 2: 36%, Grade 3: 48%; FT: Grade 1: 42.3%, Grade 2: 23.1%, Grade 3: 34.6%, p=0.1178).

Conclusions
CC-3 and TUNEL levels within dermal appendages align with burn depth classification by H&E staining, wherein appendages graded as necrotic had higher levels of CC-3 and lower levels of TUNEL. Therefore, CC-3 and TUNEL are potential secondary histological markers for burn depth. Further analysis of isolated, individual dermal appendages is underway to identify what additional information this secondary marker may add to the diagnosis of burn depth.

Applicability of Research to Practice
For the first time there is access to a large tissue repository of biopsies from burn wounds. Although staining from these samples has been used to build diagnosis algorithms with success, much more can be learned from the cellular pathophysiology when secondary analyses are performed. These assays may help us understand the processes of burn conversion.
78 Improvement of Cell Viability in Temporary Storage of Split Thickness Skin Grafts
Authors: Couch Brandon , Batchinsky Maria , Pang Alan , Warraich Irfan , Melkus Michael , Kim Seungman , Bharadia Deepak , Griswold John 
Published: May 2023

Abstract

Introduction
Autologous split thickness skin grafts (STSGs) are the preferred donor tissue for restoration of large tissue deficits. Although grafting should be done at the time of donor harvest, various factors necessitate tissue storage, traditionally in saline solution (SS) at 4oC. However, STSGs often expire before grafting in these conditions. Patients then require further excision procedures or die due to inadequate skin coverage. For patients’ wellbeing, establishing a new storage protocol is imperative. This study sought to determine an effective storage media for prolongation of graft viability for subsequent incorporation into excision and grafting practice.

Methods
Following patient consent, excess tissue &gt;1cm2 was collected after grafting procedures. Tissue was stored at 4oC in RPMI, DMEM, and SS with penicillin/streptomycin. Samples were evaluated at 2, 5, 7, and 14 days. Cell viability was measured by Trypan blue dye exclusion test in an automated cell counter yielding percentage of viable keratinocytes (PVK). An unbiased pathologist assessed tissue integrity by epidermal-dermal junction, perinuclear keratinocyte halos, and collagen organization with higher scores denoting deterioration. Data were evaluated by ANOVA and Effect size.

Results
A total of 155 sets of two specimens each were collected from 13 patients. Mean PVK values at day 2, 5, 7, and 14: SS (57.38, 36.96, 38.38, 27.50), RPMI (69.46, 69.92, 70.33, 62.67), DMEM (63.17, 53.50, 54.83, 37.92). By pairwise comparison, RPMI preserved PVK better than SS at days 5, 7, and 14 (p = 0.001 for each day). DMEM preserved PVK better than SS when comparing all days (p = 0.011) but failed to produce a statistically significant difference at any specific day. RPMI preserved PVK greater than DMEM each day. However, statistically significant differences were only revealed at day 14 (p = 0.017) and when comparing all days (p &lt; 0.001). Effect size was large for overall group differences of PVK at day 5, 7, and 14 (Cohen’s f = 0.72, 0.73, and 0.75). Tissue integrity scores at day 2, 5, 7, and 14: SS (0.69, 1.0, 1.38, 2.0), RPMI (0.54, 0.92, 0.85, 1.54), DMEM (0.77, 0.92, 0.77, 1.15). Although culture media preserved tissue integrity greater than SS, no statistically significant differences were found.

Conclusions
RPMI preserved cell viability better than DMEM and SS. This suggests that STSGs stored in RPMI may prolong the time of which tissue could be stored and successfully amalgamated with skin.

Applicability of Research to Practice
Storing tissue in RPMI could benefit burn patients by decreasing tissue disposal therefore reducing future donor site area or eliminating repetitious excision procedures entirely. These effects decrease inpatient days and healthcare costs. Most importantly, successful tissue storage will save patients’ lives, especially those of large surface area burns who lack sufficient donor sites.
109 Effects of Fat-Rich Nutrients in the Pancreas of an Experimental Burn Model
Authors: Santelis Santiago , Abali Ayse Ebru , Basci Tutuncu Neslihan , Ozdemir B Handan , Ozgun Gonca , Bayraktar Nilufer , Colak Meric Yavuz , Haberal Mehmet 
Published: May 2023

Abstract

Introduction
Oversupply of nutrients overstimulates beta cells in standard conditions, and severe burn injuries increase the metabolic needs. In this study, we investigated the effects of fat-rich nutrients on the endocrine pancreas during the acute phase of severe burns.

Methods
Twenty-one Wistar albino rats were randomly divided into 3 groups. Two groups were fed with standard commercial rat chow (1 with sham procedure and 1 with burn procedure), and the third group (also with burn procedure) was fed a fat-rich diet (60% kcal fat). The burn procedure involved a 25% total body surface area fullthickness burn. Blood samples were taken at 36 hours and 7 days after burn injury or sham procedure. On postburn day 7, skin biopsies were taken and a pancreatectomy was performed. Pancreatic tissues were examined under light microscopy; islets size and cellularity were calculated and investigated immunohistochemically.

Results
Plasma glucose, C-Peptide, and insulin levels were similar in all the study groups 36 hours and 7 days after burn induction or sham procedure. There was a significant increase in the number of cells per one islet in the burn group given a fat-rich diet compared with the other groups (P = .05). Caspase-3 was strongly expressed in both groups with burn injuries.

Conclusions
Overconsumption of certain fats can lead to a compensatory response by beta cells that eventually can progress to beta-cell dysfunction during the acute phase of burns. Severe burns induce pancreatic islet cell hyperplasia. Providing excessive fat nutrients during the acute postburn period attenuates this response. Despite the morphophysiological changes observed in the pancreas, all animals in our study achieved similar glycemic homeostasis.

Applicability of Research to Practice
The delivery of nutritional support is a vital element of burn care, and the main goal is simply to avoid nutritional complications. Lipotoxicity contributes to multisystem organ failure and worse clinical outcomes in obese patients and mice with pancreatitis. Neutralization of IL-1β produces beneficial effects on postburn glycemic control and improves survival. apoptosis in the pancreas of patients with severe burns may be linked to a series of events that can induce Caspase-1 activation and IL-1β release, and these pathways may be influenced by the nutritional status, especially in the early postburn phase. Effective nutritional assessment and management can optimize wound healing and decrease complications and mortality.
114 Social Participation Trajectories: Results from the LIBRE Journey Study
Authors: Schneider Jeffrey , Shepler Lauren J , Kazis Lewis , Slavin Mary D , Ryan Colleen , Ni Pengsheng , Acton Amy , Kelter Brian , Santos Edward 
Published: May 2023

Abstract

Introduction
Social rehabilitation is a critical step in the recovery process post burn injury, yet there is limited published data on the topic. The LIBRE Profile was developed as a burn specific instrument to examine social participation outcomes across six domains. The objective of this study is to use the LIBRE Profile to measure social participation and explore the trajectories of recovery in each domain.

Methods
Data from the LIBRE Journey Study was analyzed, utilizing both the LIBRE Profile Computer Adaptive Test and fixed short forms. Demographic and clinical characteristics included age, gender, race, ethnicity, education, marital status, burn size and time since injury. LIBRE Profile scores collected at five time-points from baseline to two years, approximately 6 months apart, calculated score trajectories for each of the LIBRE Profile domains (Family and Friends (FF), Social Activities (SA), Romantic Relationships (RR), Sexual Activity (SX), Social Interactions (SI), and Work and Employment (WE)). Linear mixed models with the log of time since burn injury were applied to each domain, adjusting for demographic and clinical variables. Models were fit using the score trajectories with 95% confidence intervals to demonstrate change over time and significant impact of the covariates.

Results
Analyses included 454 participants with a mean age of 45.4 (SD 15.4) and mean burn size of 38.7% (SD 24.6). Time since burn injury ranged from 13 days to 71 years. All participants were included in analyses of the FF, SA, and SI, with 265, 292, and 288 participants included in the WE, RR, and SX domains based on screening questions for relevance, respectively. Multiple predictors were found to significantly effect LIBRE domain scores (Table 1), with all domain scores increasing with time since burn injury (p &lt; 0.0001) and decreasing with an increase in burn size (p &lt; 0.04), except for FF and RR.

Conclusions
Analyses showed significant improvement of social recovery post burn injury for both the short- and long-term in four of the six domains. Analysis of LIBRE Journey data demonstrates the social participation trajectories with findings that can establish future applications in clinical practice.

Applicability of Research to Practice
The LIBRE Profile is a tool used to monitor social participation after burn injury. Understanding the trajectories of social recovery after injury will inform and optimize both clinical care and resource allocation by providing the ability to benchmark an individual’s recovery with one’s peers.
501 The Role of a Tracheostomy in the Critically Ill Burn Patient
Authors: Saquib Syed , Jesic Lana , Carroll Joseph , Flores Carmen , Chestovich Paul , Fraser Douglas 
Published: May 2023

Abstract

Introduction
Tracheostomy is a commonly performed procedure in critically ill patients requiring prolonged mechanical ventilation. However, nationwide practice patterns for the role of a tracheostomy in critically ill burn patients have not been well described.

Methods
A 25-question Qualtrics online survey was distributed by the American Burn Association (ABA) to their physician members. Questions pertained to practitioner demographics, indications, type of tracheostomy performed, and timing of procedure. The questionnaire further ascertained how presence of inhalation injury and Total Body Surface Area (TBSA) influence timing of tracheostomy; if concurrent percutaneous endoscopic gastrostomy (PEG) tubes were performed, and whether enteral feeds were held prior to tracheostomy.

Results
Thirty-seven surgeons responded to the survey and worked primarily at ABA verified academic burn centers. Open tracheostomy was performed more frequently than percutaneous tracheostomy (73% vs 27%). Eighty-three percent of surgeons deferred concomitant PEG despite healthy overlying skin due to the belief that a patient would eventually pass a swallow evaluation (74%). Tube feeds were routinely held by 67% of surgeons, most commonly 6 or 8 hours prior. The most common indication for tracheostomy was prolonged mechanical ventilation. Fifty-four percent of surgeons routinely perform a tracheostomy through open uninfected 2nd degree neck burns. As for 3rd degree neck burns, 35% will perform a tracheostomy only after excision and grafting. For patients requiring prolonged mechanical ventilation 35% of surgeons had no standard time frame for tracheostomy regardless of TBSA. For mechanically ventilated patients with &gt;20% TBSA burns (excluding neck burns), 40% performed early tracheostomy (0-7 days) and 24% performed delayed tracheostomy (8+days). For ventilated patients with inhalational injuries and TBSA &lt; 20%, 35% had no standard time frame, 16% performed early tracheostomy and 49% performed delayed tracheostomy.

Conclusions
A national tendency toward open tracheostomy, deferring concomitant PEG, and holding tube feeds 6-8 hours prior to tracheostomy was identified. Patients with TBSA &gt;20% seem to undergo earlier tracheostomy more frequently, whereas those with TBSA &lt; 20% with inhalational injury more frequently undergo delayed tracheostomy. Although TBSA appears to impact timing of tracheostomy, evidence based guidelines are lacking to guide clinical practice and additional studies are needed.

Applicability of Research to Practice
Survey results infer practice patterns favoring consideration toward early tracheostomy for patients with &gt;20% TBSA burns requiring prolonged mechanical ventilation.
504 Single Center Outcome Comparisons of Skin Disorders Versus Burns: Time to Reconsider the Automatic Transfer?
Authors: Hollowell Jamie , Nam Jason , Matthew Robert , King Booker , Nizamani Rabia , Williams Felicia , Pak Joyce , Agala Chris 
Published: May 2023

Abstract

Introduction
Patients with complicated wound care, rashes, desquamating skin disorders and necrotizing soft tissue infections are often transferred to burn centers due to the multi-disciplinary expertise in wound care despite the pathophysiology of burn injury being different. Our objective was to critically evaluate outcomes of patients admitted to our institution with skin disorders to patients with burn injury.

Methods
Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All adult patients admitted between January 1, 2012 and June 30, 2022 were eligible for inclusion. Demographics, length of stay (LOS), and mortality were evaluated. Bivariate logistic regression and inverse probability of treatment weighting (IPTW) was performed, and significance was accepted as p&lt; 0.05.

Results
We included 9,821 patients in the study, of whom 805 (8.2%) were admitted with skin disorders. These patients were more likely to be older, Black, of female sex, have longer ICU stays, be on mechanical ventilation, and have complications, p&lt; 0.001. Unadjusted estimates show that patients with skin disorders had 3.84 higher odds of mortality compared to patients admitted for burn injury. However, after adjusting for age, involved body surface area, sex, race, intensive care unit days, mechanical ventilation, inhalation injury, and complications using IPTW, patients with skin disorders twice higher odds of mortality.

Conclusions
Patients with skin disorders have increased morbidity and mortality compared to burn injured patients even when controlling for age, involved body surface area, sex, race, intensive care unit days, mechanical ventilation, inhalation injury, and complications when admitted to our burn unit. Further study is warranted to investigate and mitigate these outcome disparities in this patient population.

Applicability of Research to Practice
This study may demonstrate that all skin conditions are not the same, and may warrant different specialties to improve and optimize outcomes.