bluuebunny/crossref_metadata_2025_split huggingface dataset:
85 The Severity of Burns and Associated Psychiatric Risk Factors in Self-Immolation
Authors: Mannekote Thippaiah Srinagesh , Ramos Gilbert , Richey Karen , Foster Kevin , Ayub Ibraheim , Challita Youssef 
Published: May 2023

Abstract

Introduction
Self-Immolation is the act of setting oneself on fire to inflict death or self-injury. It is most commonly seen in developing nations and is associated with high mortality. In developed countries, self-immolation is uncommon and occurs mostly in middle-aged males with a history of mental illness, substance abuse, and unemployment. In the United States, it is an extreme act of suicide or self-injurious behavior with a mortality rate of 11.4% and exhibits a significant burden on healthcare systems. In this study authors aimed to characterize and explore psychiatric risk factors for self-immolation; broader understanding helps to optimize patient care and reduce the future recurrence of self-immolation act.

Methods
This was a retrospective review of all inpatient admissions from July 2015 to August 2022 with a history of self-immolation were included in the study. Data collection included demographics, total body surface area burned (TBSA), Suicide attempt or Self injurious behavior, urine drug screen, length of stay and psychiatric history. Twelve patients without incomplete data were excluded. Patients were divided into mild (&lt; 20%), moderate (20-40%), and severe ( &gt;40%) burns based on percent of TBSA. Data analysis was conducted using Chi-Squared, and Fisher's Exact tests in SPSS v28.

Results
We identified 103 patients who attempted self-immolation. Mean TBSA was 27 ± 33 with 66 (64%) experiencing mild, 11 (10%) with moderate, and 27 (26%) with severe burns. Mortality in this population was 21%. The majority were male (70.9%), Caucasian (63.1%), and single (79.6%) with a mean age of 38 ± 14 years old. Urine drug screen was positive in 44% upon admission, and 63% reported chronic drug use. Methamphetamine (37%), and alcohol (30%) were in the highest prevalence upon admission. Additionally, 83% of patients had underlying psychiatric illnesses including major depressive disorder (36%) and Schizophrenia spectrum disorders (27%). The presence of suicidal intent (n=68) was a predicted risk factor for severe burns (p &lt; 0.001).

Conclusions
Our study found that patients undergoing self-immolation were more likely to have suicidal intent and that suicidal intent strongly predicted burn severity. Although no specific psychiatric disorder predicted burn severity, the overwhelming majority of self-immolation patients suffered from underlying psychiatric illnesses.

Applicability of Research to Practice
There is limited data on the triggers and risk factors for self-immolation. Due to the large prevalence of drug use and underlying psychiatric disorders, providers should obtain an early psychiatric assessment for self-immolation patients to minimize recurrence and optimize inpatient care. Similarly, home safety education for patients with suicidal intent and their families may help reduce the frequency and severity of self-immolation in the outpatient setting.
93 Inhalation Injury: Which Providers Can Assess the Need for Intubation?
Authors: Adams Laura , Perkins Louis , Santorelli Jarrett , Lee Jeanne , Smith Alan , Doucet Jay 
Published: May 2023

Abstract

Introduction
Previous studies have suggested many burn patients undergo unnecessary intubation due to concern for inhalation injury. There is a lack of clear consensus guidelines for intubation and thus there is significant variation in practice pattern. In this study we hypothesized intubation rates would differ between Acute Care Surgeons with specialized burn training and those without.

Methods
A retrospective analysis of 388 patients admitted to an ABA verified level 1 burn center who presented emergently following burn injury from 7/2015 to 12/2021 was performed. Patients excluded include polytrauma patients, isolated friction burns, and patients intubated prior to hospital arrival. All providers performing initial evaluation are Acute Care Surgeons, with a subset having additional specialized fellowship training and/or extensive burn experience. Our primary outcome was intubation rates between burn and non-burn trained providers. The Chi-Square and Mann-Whitney U statistical tests were used to compare categorical and continuous variables, respectively.

Results
There were 465 major burn patients admitted through the trauma bay and screened during the study period with 388 patients meeting inclusion criteria. The population was 72% male, with mean age of 44 years +- 21, TBSA of 12%, and COHgb level of 2.9%. In total, 73 (19%) of patients underwent intubation. The patients in the two provider groups did not differ in terms of age, gender, race, TBSA, COHgb level, or airway exam findings. 240 (62%) patients were evaluated by a burn provider and 148 (38%) were evaluated by a non-burn provider. There was no significant difference in the rate of emergent intubation of patients treated by burn vs non-burn trained providers (RR 0.71, CI 0.47 - 1.07). Of the patients who were intubated, there was no significant difference between burn and non-burn providers in the diagnosis of inhalation injury on bronchoscopy (RR 1.3, CI 0.91-1.85). In both groups, objective evidence of inhalation injury was found in only 68% of patients undergoing routine bronchoscopy following emergent intubation.

Conclusions
There was no significant difference in intubation rates between burn and non-burn trained acute care surgeons. This demonstrates that following standard ATLS and ABLS principles provides appropriate training in the evaluation, diagnosis, and treatment of inhalation injury. Interestingly, 32% of all patients intubated did not have evidence of inhalational injury on bronchoscopy following intubation. This study suggests that further research is needed to determine objective criteria for intubation guidelines when inhalation injury is suspected in the acute burn patient population.

Applicability of Research to Practice
Applicable
100 Long Term Outcomes for Inpatient Visits in Bcqp - Feasibility to Bridge the Gap
Authors: Weber Joan , Malic Claudia ,   QBR Outpatient Work Group, Lynch Brian 
Published: May 2023

Abstract

Introduction
The ABA burn registry is designed to improve the quality and cost of burn care by collecting and exchanging information on burn injuries and outcomes. The BCQP has data related to inpatients visits only. Data on long term outcomes from outpatient settings are not yet available in the ABA’s Quality Burn Registry, but there is agreement that such data should be collected. With any expansion of the registry, attention should be given to the type of data that are collected and the efforts needed to gather accurate data. A pilot phase (alpha pilot) is required before embarking on a larger scale of data gathering.

Aim
This alpha pilot aims to determine what outcomes should be selected to continue data collection for patients who were discharged from a burn center and are followed up within outpatient settings.

Methods
The QBR Outpatient Work Group identified 9 items (5 clinical and 4 psychosocial outcomes) that could define the long term outcomes after discharge from the initial admission related to the thermal injuries. A five questions survey was developed to evaluate the length of time spent by registrars to gather the data, and around data quality assurance. Seven verified burn centres were enrolled on voluntary basis on the alpha pilot. Each centre had to enter a patient in each of the predefined categories (age and burn extent related) for the 12 months post discharge divided in 3 monthly periods. The data gathering finished in April 2022.

Results
A total of 29 patients were entered in the alpha pilot, with 5 patients &lt; 18 yrs of age and 6 over the age 65. The most frequent cause of burn injury was flame (18/29). Fourteen patients sustained burn injuries &gt;20% TBSA. The 95% wound closure was documented in 79.3% and follow up was complete or ongoing for 89.7%. Details about any surgical procedures after discharge was well documented (100%). The burn scar appearance was present in the chart in 69.2% of the cases and only in 3 patients pressure garments was not documented. Presence of depression or PTSD was not documented in 50% of the cases, whereas the presence of pain and itch was documented between 79% to 83%. Registrars found that it took up to 20 minutes to retrieve the data from the charts.

Conclusions
The findings were presented to the Quality and Burn Registry Committee. As alpha pilot was the first PDSA cycle for this project, further amendments were made to the definitions and layout of the data. A beta pilot (14 hospitals) is ongoing currently as second PDSA cycle in order to identify further barriers for large scale implementation of long term outcomes in the burn registry.

Applicability of Research to Practice
implementation of long term outcomes in the ABA Burn Registry
103 Analysis of Arterial Blood Pressure Waveform Features in a Porcine Model of Burn and Resuscitation
Authors: Arabidarrehdor Ghazal , Kao Yi-Ming , Hahn Jin-Oh , Burmeister David , Parajuli Babita , Carney Bonnie , Keyloun John , Moffatt Lauren , Shupp Jeffrey , Reese Adam , Oliver Mary 
Published: May 2023

Abstract

Introduction
Functional arterial blood pressure waveform (ABW) features are incompletely understood in the context of burn injury and resuscitation. In this work, we analyzed the variability of pulse pressure (PPV), systolic pressure (SPV), stroke volume (SVV), and five measures of heart rate variability (HRV) in time and frequency domains as potential indicators of burn resuscitation adequacy in a large total body surface area (TBSA) porcine model with varying degrees of intravenous fluids.

Methods
Data were collected from 21 anesthetized and mechanically-ventilated pigs (32±4 kg weight, 40% TBSA), which were instrumented for continuous hemodynamic monitoring for 24 hours. Urinary output (UO), hematocrit (HCT) and cardiac output (CO) were also measured at various time points. The animals were divided into Paradigm 1 (P1): no resuscitation (N=7); Paradigm 2 (P2): fluid titration to UO (N=8); and Paradigm 3 (P3): deliberate over-resuscitation with consistent high fluid rates (N=6). We calculated PPV, SPV, SVV, and five widely used HRV measures: normalized low-frequency power (NLF), high-frequency power (NHF), very-low-frequency power (VLF), low-frequency-high-frequency (LFHF) ratio, and the root-mean-squared of the duration difference in consecutive beats (RR-RMS). All features were averaged on an hourly basis and their potential in tracking reference CO and SV was investigated via linear regression and correlation analysis after calibrating the data to SV and CO on an individual basis.

Results
PPV, SPV, SVV, and RR-RMSE showed statistically distinguishable trends for different paradigms, as depicted in Figure 1, along with averaged trends for lab measurement. PPV, SPV, and SVV tracked the CO the best and were comparable to UO, however, SVV was far superior in tracking SV. A regression analysis between these four features and UO showed a very low level of agreement despite comparable tracking of SV and CO. HRV measures did not distinguish resuscitation paradigms and were inferior in tracking CO and similar in tracking SV to aforesaid features.

Conclusions
PPV, SPV, SVV, and RR-RMSE may potentially complement UO in the hemodynamic assessment of the burn patients and outperform other HRV measures in general. Future work will optimize the extraction of strategic informative features of ABW analysis in the various fluid status states post-burn injury.

Applicability of Research to Practice
Titrating burn resuscitation rates to have protocols including PPV, SPV, SVV, and RR-RMSE alongside other standard metrics may offer precision medicine strategies to fine-tune IV fluid rates.
116 Relationship between Smartphone-tracked Physical Activities and Psychosocial Outcomes for Burn Survivors Living in the Community
Authors: Deng Huan , Abouzeid Cailin A , Shepler Lauren J , Slavin Mary D , Herrera-Escobar Juan P , Kazis Lewis , Ryan Colleen , Schneider Jeffrey 
Published: May 2023

Abstract

Introduction
Following burn survivors in the community is critical to understand their problems and needs. Physical activities automatically recorded by smartphones have shown to be a convenient and burdenless method for post-discharge assessment. However, it is unclear if physical activities are associated with burn survivors’ physical and psychosocial outcomes. This study aims to examine the relationship between smartphone-tracked physical activities and scale-based outcomes.

Methods
Adult burn survivors living in the community were included in this study. A mobile application was downloaded to participants’ smartphones and automatically recorded daily number of steps, travel miles and activity minutes. Participants received weekly surveys assessing pain (Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Interference), depression (Patient Health Questionnaire (PHQ-8)), anxiety (PROMIS Anxiety) and social participation (Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities). Correlation coefficients between physical activities and survey results were examined and interpreted as “very weak” (|r|≤0.19), “weak” (0.20≤|r|≤0.39), “moderate” (0.40≤|r|≤0.59), “strong” (0.60≤|r|≤0.79), and “very strong” (0.80≤|r|≤1.00).

Results
There were 24 burn survivors with an average of 24 years after injury included in this study. The 180-week data collected between November 2021 and August 2022 was analyzed. Daily number of steps, travel miles and activity minutes separately showed relationships with PROMIS Pain Intensity (r=-0.312, p&lt; 0.001; r=-0.247, p=0.001; r=-0.239, p=0.001), PROMIS Pain Interference (r=-0.375, p&lt; 0.001; r=-0.318, p&lt; 0.001; r=-0.291, p&lt; 0.001), PHQ-8 (r=-0.403, p&lt; 0.001; r=-0.357, p&lt; 0.001; r=-0.311, p&lt; 0.001), PROMIS Anxiety (r=-0.310, p&lt; 0.001; r=-0.209, p=0.007; r=-0.150, p=0.054), LIBRE Social Interactions (r=0.272, p&lt; 0.001; r=0.291, p&lt; 0.001; r=0.328, p&lt; 0.001) and LIBRE Social Activities (r=0.381, p&lt; 0.001; r=0.414, p&lt; 0.001; r=0.404, p&lt; 0.001).

Conclusions
Daily number of steps demonstrated a moderate correlation with depression while both daily travel miles and activity minutes showed moderate correlations with social participation. The results support that smartphone-tracked physical activities are related to burn survivors’ psychosocial outcomes.

Applicability of Research to Practice
This study may inform future use of smartphone-tracked physical activities to understand and track burn recovery and ultimately improve care.
118 Outcomes of Amputation Following Electrical Burn Injuries: A Five-Year Follow-Up
Authors: Kim Eunyeop , Kowalske Karen , Solis Kyra Jeanine , Wan Bingchun 
Published: May 2023

Abstract

Introduction
Studies have acknowledged the prevalence of amputation in patients with electrical burns; however, the exact probability of amputation as a result of electrical injuries and the effect of amputation on the long-term health remain unclear. The purpose of this study was to analyze electrical burn survivors with amputation using a large multi-center database and assess their corresponding long-term physical and mental health, compared with a non-electrical burn population with amputation.

Methods
Retrospective reviews of burn patients from 1993 to 2021 were performed using the Burn Model System National Database, that yielded 408 patients with electrical etiology and 6341 with non-electrical etiology. The variables for analysis included the Veterans RAND 12-Item Health Survey and the Patient-Reported Outcomes Measurement Information System 29, collected at discharge, six months, 12 months, 24 months, and five years post-burn.

Results
Electrical burn patients showed a higher amputation rate (30.3%) than non-electrical burn patients (6.6%) (p &lt; 0.0001). Electrical burn patients with amputation showed significantly lower physical component scores (PCS=34.1) and physical function scores (PFS=37.1) at discharge than electrical burn patients without amputation (p &lt; 0.05). No significant differences were found in mental component scores, anxiety, depression, sleep, or fatigue between patients regardless of burn type or amputation. Electrical burn patients experienced similar post-injury trends compared with non-electrical burn patients. Non-electrical burn survivors with amputation had the worst outcomes of all patient groups. The Hispanic population comprised the largest percentage of the electrical burn group (80%).

Conclusions
This study shows that patients with amputation need extra attention to their physical impairment at discharge. Early rehabilitation in electrical burn patients with amputation should be emphasized. Non-electrical burn survivors with amputation need the most support from both physical and psychological perspectives. This study like many others supports that regardless of burn etiology, all burn survivors require psychological support at discharge. The study also accentuates the need for better electrical injury prevention and rehabilitation program for those who speak Spanish.

Applicability of Research to Practice
More intensive and comprehensive interventions for electrical burn survivors with amputation in the earlier stages of rehabilitation can help ensure better long-term physical, psychological, and social outcomes. In contrast, rehabilitation plans for patients with non-electrical burns with amputation should concentrate more on the long-term management for up to a minimum of two years post injury, as these patients face significantly longer and severe difficulties than electrical burns patients with and without amputation.
123 Flexion Glove Modification to Isolate Proximal and Distal Interphalangeal Joint Range of Motion
Authors: Rodriguez Joshua , Vocke Scott , Andre Gregory , Dean Brooke 
Published: May 2023

Abstract

Introduction
Flexion gloves are a quick and easy way to provide a dynamic stretch to the digits for patients with limited composite flexion range of motion (ROM) or who are at risk for digit extension burn scar contractures. However, the flexion glove has been observed clinically to bias metacarpal phalangeal (MCP) joint flexion ROM when compared to the proximal and distal phalangeal (PIP and DIP) joints. The purpose of this case study is to demonstrate the use of a custom thermoplastic hand-based splint to block MCP joint motion in order to better isolate PIP and DIP joint ROM for a patient with primary PIP and DIP flexion ROM limitations.

Methods
A custom, thermoplastic, palmer hand-based splint was fabricated with an opening for the thumb and the splint extending to the proximal phalanxes stopping below the PIP joints in order to block MCP joint flexion ROM as seen in Figure 1b. Composite flexion passive ROM (PROM) measurements were taken for all MCP, PIP, and DIP joints of digits 2-4 with only the flexion glove donned and with the hand-based splint applied over the flexion glove as seen in Figure 1a and 1c.

Results
An increase in combined PIP and DIP joint PROM was found for all digits when the hand-based splint was donned over the flexion glove compared to the flexion glove only (see Table 1). These increases in combined PIP and DIP PROM included 35° for the index finger, 10° for the middle finger, 20° for the ring finger and 30° for the small finger, with an overall mean increase of 23.75°

Conclusions
This easy splinting technique combined with a flexion glove was effectively used to bias stretch of the PIP and DIP joints into flexion for a patient with adequate MCP flexion ROM and impaired PIP and DIP flexion ROM caused by burn scar contracture.

Applicability of Research to Practice
Using an off the shelf flexion glove and a basic hand-based splint, therapists can use this technique to easily adjust the angle of pull to maximize the benefit from a flexion glove to address specific joint limitations of the finger caused by burn scar contracture.
500 Wound Coverage for Massive Burn Injuries ≥50% TBSA – A Systematic Review and Meta-Analysis
Authors: Hundeshagen Gabriel , Kneser Ulrich , Tapking Christian , Abdulrazzak Obada , Palmer Jack , Veeramani Anamika , Tchiloemba Bianief , Stögner Viola , Haug Valentin 
Published: May 2023

Abstract

Introduction
Early wound coverage remains one of the most essential variables influencing survival of extensively burned patients, especially with a total burned surface area (TBSA) of more than 50%. In patients with limited donor sites, techniques such as e.g. the Meek micrograft procedure or cultured epidermal allografts have proven to be viable methods. In this systematic review (SR) and meta-analysis (MA) we studied the outcomes of different techniques for wound coverage in patients with massive burn injuries ≥50% TBSA within the last 17 years.

Methods
According to PRISMA guideline the medical databases PubMed, Cochrane, Embase, Web of Science Medical records were screened in 5 languages from 01/2005 until 01/2022 by three reviewers, independently. Inclusion criteria were prospective or retrospective studies on patients with massive burns of ≥50% TBSA.

Results
After a two-stage review process, 33 studies were identified for the SR and MA. Regions of publication were Asia (n=15), North America (n=8), Europe (n=7), Australia (n=3). In total, 1678 patients with a mean age of 31.4 ± 14.2 years were included. The male to female ratio was 2.25 : 1. Mean TBSA was 66,5 ± 12.2%. Methods of wound coverage consisted of Meek micrografts, cultured epithelial autografts and/or allografts. The mean length of stay was 76.5 ± 32.4 days. Initial graft-take was 78,0 ± 15.8%. Grafting techniques did neither substantially differ in the length of stay nor the healing rate.

Conclusions
In patients with massive burn injuries of ≥50% TBSA the length of stay and the healing rates were comparable between Meek micrograft procedure, cultured epithelial allografts and combined techniques.

Applicability of Research to Practice
Wound coverage by Meek micrograft procedure with expansion of up to 1:10 and a potential combination with cultured epithelial allografts should be considered early in patients with massive burn injury.