bluuebunny/crossref_metadata_2025_split huggingface dataset:
710 Assessing the Impact of Prone Positioning Among Adult Burn Patients with Acute Respiratory Distress Syndrome
Authors: Nemec Hannah , Cheng Abigail , Chestovich Paul , Saquib Syed , Fraser Douglas , Flores Carmen , Ho Joshua , Batra Kavita 
Published: May 2023

Abstract

Introduction
Critically-ill burn patients are at high risk for extensive adverse systemic complications due to the severe inflammatory reaction following deep thermal injury. A common but dangerous pulmonary complication associated with deep burns is acute respiratory distress syndrome (ARDS), with incidence and mortality ranging up to 24% and 31%, respectively. Prone positioning (PP) as a means of improving mortality in patients with ARDS has become more widely utilized. However, PP is not well described in the burn population and remains controversial due to the risk of wound complications. We hypothesize that PP in burn patients with ARDS would improve mortality compared to non-prone (NP) patients without adverse outcomes.

Methods
Retrospective data were collected for all burn patients with ARDS from 2018-21. A total of 7 patients who underwent prone positioning (PP) were matched via TBSA, age, and gender 1:2 with 14 patients not proned (NP). Categorical variables were presented as count (percentage) and continuous variables presented as mean (SD). P values were two-sided and P&lt; 0.05 significant.

Results
A total of 58 adult burn patients with ARDS were identified from the burn registry between the years of 2018-2021 and 7 of these were identified as having been treated with PP. Matching was completed to identify 14 NP burn patients with ARDS. Characteristics of these groups are shown in Table 1. The PP patients had significantly higher APACHE II scores, airway pressure release ventilation (APRV) usage, and tracheostomy placement. For the PP patients, mean days to ARDS diagnosis from injury was 4.7±2.6, mean days to PP from ARDS diagnosis was 4.1±6.0, and total days prone was 4.3±3.5. P/F ratios for both the PP and NP groups are shown in Figure 1. P/F ratios for the PP group were declining prior to PP and increased after PP. P/F ratios for the NP group gradually improved without PP. There was no difference in mortality between the two groups (PP=42.8%,NP=57.1%,p=0.6) despite the significantly increased APACHE II scores. No wound complications were noted in the PP group.

Conclusions
ARDS remains a significant cause of mortality in burn patients. The PP patients had similar mortality compared to the NP group despite a two-fold increased expected mortality estimated by the Apache II scores. None of the PP patients had wound complications due to PP. PP appears to be a safe and useful adjunct therapy for burn patients with severe ARDS.

Applicability of Research to Practice
ARDS is a significant cause of mortality in severe burn patients, this study evaluates PP as a treatment.
713 Acute Change in qSOFA Score as a Prognostic Tool for Diagnosing Sepsis in Burn Patients
Authors: Avery Emma , Zhu Jane , Rehou Sarah , Sharohki Shahriar 
Published: May 2023

Abstract

Introduction
Sepsis is a diagnostic challenge in all critically ill patients, but particularly so in the burn patient population. The objective of this study was to evaluate if the modified sepsis-3 criteria defined as an acute change in SOFA score ≥2 was predictive of clinical infection.

Methods
The hospital database was reviewed between 2016 and 2019 to identify patients who received broad spectrum antibiotics within 2 days of sustaining their injury. Culture specimens taken at the time of antibiotic administration determined presence of a clinical infection.

Results
Between 2016 and 2019, a total of 98 patients were admitted to the burn unit within 2 days of their injury and received prophylactic meropenum and/or piperacillin/tazobactam for suspicion of clinical infection. When stratified based on an acute change in SOFA score within 48 hours prior to receiving antibiotics, 67 (72%) patients received antibiotics with an acute change in SOFA score ≤1, and 26 (27%) patients received antibiotics with an acute change in SOFA score ≥2. Of those patients with the acute change in SOFA score ≥2, 22 patients (85%) had positive cultures associated with the timing of prophylactic antibiotics, as compared to 60 patients (90%) with a change in SOFA score ≤1 (p value 0.05).

Conclusions
Our data suggests that the modified sepsis-3 criteria is not a reliable tool for diagnosing burn sepsis.

Applicability of Research to Practice
Improving our ability to accurately predict sepsis in burn patients can improve patient outcomes and decrease unnecessary administration of broad spectrum antibiotics.
714 Actinomyces Necrotizing Soft Tissue Infections: A Case Series from a Single Institution
Authors: Lewis Aislinn , Prazak Ann Marie , Thompson Callie 
Published: May 2023

Abstract

Introduction
Necrotizing soft tissue infections (NSTI) are rare, severe infections that can lead to septic shock. NSTI have a mortality rate of 20-50% in patients who require intensive care. Management includes surgical debridement and broad-spectrum antibiotics until definitive culture results. Actinomyces is a slow-growing bacterium found in the mouth, skin, genitourinary, and gastrointestinal tracts, with several case reports of actinomyces related NSTI. At this single institution, NSTI are managed by burn surgeons. The goal of this study is to quantify patients with actinomyces-related infections, identify modifiable risk factors, and demonstrate the pharmacology of effective antibiotic treatment.

Methods
All patients with actinomyces-related infections admitted to a single institution’s burn center from January 2020 to September 2022 were included. Patients were identified via the institution’s data warehouse. Patient demographics, infection location, associated injuries or illnesses, antibiotic exposure, and treatments required were obtained. Results were recorded and compared using descriptive statistical analysis.

Results
A total of 22 patients with actinomyces infections were identified, 18 with NSTI and 4 with non-NSTI infections (1 hidradenitis suppurativa, 1 Job’s syndrome, and 2 burn-related). Average age was 50.3 years old, and 68% of patients were male. Seventy-four percent of patients were obese, and average BMI for obese patients was 40.3 kg/m2. Fourteen NSTI patients had diabetes or pre-diabetes (mean A1c 9.4%), and two were taking a sodium-glucose co-transporter 2 inhibitor. All NSTI patients underwent surgical debridement and broad-spectrum antibiotic treatment. The groin was the most common site of infection. Time from collection of sample to culture resulting with Actinomyces was 44 to 185 hours (mean 111 hours). Species isolated were A. europaeus, A. radingae, A. turicensis, A. odontolyticus, and A. funkei. Three of the NSTI patients died. Among NSTI survivors, average length of stay was 34 days, duration of antibiotics was 10.7 days (6 to 16 days), and 50% of patients were de-escalated to either ampicillin/sulbactam, or ertapenem.

Conclusions
To our knowledge this is the largest single institutional series to date for patients affected by Actinomyces related NSTI. The high percentage of patients with diabetes, 73% of NSTI patients, suggests an increased susceptibility to infection for these patients. A variety of Actinomyces isolates are present in NSTI. The mortality rate (17%) of these ICU admitted NSTI patients agrees with prior studies.

Applicability of Research to Practice
Novel findings of actinomyces infection in NSTI patients
720 Transcultural Collaboration in Burn Mass Casualty Response Under Austere Conditions
Authors: Arbour Richard 
Published: May 2023

Abstract

Introduction
Burn mass-casualty incidents (BMCI) overwhelm local resources challenging communication, triage, basic care provision and education of non-burn specialist personnel. This is more acute in austere conditions such as the recent international BMCI in November, 2021, in an extremely resource-limited developing country. Greater than 250 severely burned survivors overwhelmed local resources requiring an international response. Effective burn care dictated adapting to austere conditions, educating local providers and cultural competence, vital to teaching and obtaining feedback in ways meaningful to host providers and building burn care capacity.

Methods
Needs assessment showed local healthcare providers needed burn care education focused on wound care, fluid management, pain management and assessment. Cultural competence/cultural humility were integral in avoiding ethnocentrism and collaboration barriers. Understanding local language and communication styles (including nonverbal cues) was prioritized. Pre-test/post-test measured baseline burn care knowledge vs. education efficacy. Lecture/discussion, case study, clinical application and class participation were used to disseminate content. Attention was paid to pace of content discussion and nonverbal indications of understanding as English was not the learners first language. Pacing/terminology was adjusted to optimize understanding. Meaningful recognition was accomplished by public congratulations and formal completion certificates.

Results
Pre-test: Number of students-57; high score-80%; low score-27.5%; average score-53.9%. Content was presented as described in methods section and supplemented with bedside instruction. Post-test: Number of students-38; high score-95%; low score-55%; average score-79.3%. Almost immediately, many participants framed and posted their completion certificates and quickly utilized education content when delivering care.

Conclusions
Optimal interdisciplinary/international collaboration for burn care and education in austere conditions mandates cultural humility and a spirit of inquiry on the part of international guest providers to best understand cultural norms in host countries. A spirit of inquiry on local communication and cultural nuances is integral to optimal collaboration, education and building effective local burn care capacity.

Applicability of Research to Practice
When providing care internationally in austere settings, proactive cultural humility, understanding local cultural and communications nuances and developing education/content delivery that can be readily utilized in addressing critical needs is essential. Meaningful recognition for healthcare team members in host countries develops good will and helps build capacity to continue providing health care upon conclusion of the immediate crisis.
732 Economic and Environmental Benefits of Telemedicine Expansion
Authors: Miotke Sam , Oxton Emily 
Published: May 2023

Abstract

Introduction
The COVID-19 pandemic mandated a robust expansion of our program’s telemedicine bandwidth. Despite the lifting of pandemic restrictions, the number of telemedicine visits has stayed consistent, which is a credit to both the quality of care provided and to the convenience of receiving care via computer or smartphone. We sought to quantify some aspects of this convenience to more thoroughly understand the benefits of our program's expansion.

Methods
We examined home addresses for all patients seen via telemedicine from June, 2021 through May, 2022. We estimated the distance that telemedicine saved each patient by searching a navigation website for the most time efficient route from their hometown to our burn center. Patients who lived in the same city as our center were assigned a distance of 1 mile. Hours saved were estimated by assuming a driving speed of 70 miles per hour. Fuel money saved was estimated by assuming an average fuel economy of 24.2 miles per gallon and an average gas price of $3.61. The overall carbon footprint was estimated by assuming an average CO2 emission of 411 grams/mile.

Results
1,794 patient visits were conducted via telemedicine over this 12 month span. The total estimated amount of roundtrip travel saved was 621,718 miles which equated to 8,882 hours and $92,744 dollars saved. The carbon footprint saved was 255.5 metric tonnes. On average, our telemedicine program saved an estimated 4.95 hours and $51.70 in gasoline per patient-visit.

Conclusions
Even when ignoring the potential hurdles of transportation access, family care, missed time at work, and parking fees there are clear quantifiable reasons behind the program’s popularity. The environmental benefit is an important byproduct of its convenience.

Applicability of Research to Practice
Our telemedicine program requires dedicated staffing and significant patience with technology but has remained popular due to the outlined advantages and has facilitated the expansion of our program into a broader catchment area.
741 Implementation and Effectiveness Outcomes of Geriatric Burn Bundle at a Regional Burn Center
Authors: Pham Tam , Blayney Carolyn , O'Connell Kathleen , Oehlers Julia , Stewart Barclay , Arbabi Saman , Tucker D Andrew 
Published: May 2023

Abstract

Introduction
Strong evidence supports geriatric consultation and targeted management in the care of older injured patients. We developed and implemented a geriatric care bundle that includes clinical frailty screening, mini-nutritional assessment and feeding protocol, and reduction in initial prescribed opiate doses for patients ≥65 years. Clinical frailty scores and co-morbidities trigger consultation to geriatric and palliative care services rather than chronological age. We sought to evaluate process adherence, length of stay (LOS) and mortality as measures of bundle implementation and effectiveness.

Methods
We performed a retrospective medical record review of older burn-injured patients aged ≥65 years hospitalized at a regional burn center over the first two years of implementation (July 2019 to June 2021). We reviewed patient and injury characteristics. Primary outcome was adherence to specific bundle components: clinical frailty scale (CFS-9) and mini-nutritional screening rates, and geriatric and palliative consultation rates, stratified by implementation year. Secondary outcomes included LOS and mortality.

Results
All 127 older adult patients admitted to the acute burn service were analyzed. Median age was 71 years (IQR67-78), median burn size was 6% TBSA (IQR2-13), median frailty score was 3 (IQR3-4), and median mini nutrition score was 11 (IQR9-14). CFS-9 scoring and mini nutrition completion rates, as well as geriatric service consultations increased over 2 years (Table). In contrast, palliative care consults decreased over 2 years (from 34% to 16%). LOS and mortality decreased each year from 9 to 7 days and 14 to 10%, respectively.

Conclusions
Implementation of a geriatric burn bundle demonstrated a sustained increase in utilization of geriatric focused interventions, tailored to patients most likely to benefit based on frailty and comorbidities. Electronic medical records system integration during the initial implementation phase of the geriatric burn bundle was effective in obtaining high compliance and completion rates. However, there is still progress to be made toward full compliance with screening.

Applicability of Research to Practice
Implementation of a targeted bundle should be considered for optimal geriatric burn care.
742 Evaluation of Anti-Xa Levels and Venous Thromboembolism Prophylaxis with Enoxaparin in Burn Patients
Authors: Boyd Allison , Walroth Todd , Hartman Brett , Bjornstad Matthew , Garelli Alyssa , Spera Leigh , Grooms Cortni 
Published: May 2023

Abstract

Introduction
Previous studies have found that standard dose enoxaparin is inadequate in achieving goal prophylactic anti-Xa levels in burn patients. A new venous thromboembolism (VTE) prophylaxis protocol was implemented at our institution (Table 1). The objective of this study was to assess the efficacy and safety of the updated VTE prophylaxis protocol to determine if goal anti-Xa levels can be achieved earlier compared to the previous enoxaparin dosing protocol.

Methods
This was a retrospective cohort study evaluating a historic protocol group from 3/1/21 to 5/31/21 and a new protocol group from 10/1/21 to 12/31/21. Revisions were made to the new protocol group and evaluated from 7/1/22 to 8/31/22. Adult patients admitted with cutaneous and/or inhalation burn who received enoxaparin for VTE prophylaxis and had anti-Xa monitoring were included. The primary endpoint was protocol efficacy defined as percentage of initial anti-Xa levels within goal range and time to goal anti-Xa level. Secondary endpoints included protocol adherence, rate of VTE occurrence, number of missed or held doses if VTE occurred, correlation to published enoxaparin dosing equations in burn patients, and bleeding events.

Results
Results can be found in Table 2. The median (IQR) initial anti-Xa level in the historical (n=29) vs. new protocol group (n=22) was 0.09 (0.04-0.14) units/mL vs. 0.15 (0.10-0.19) units/mL (p=0.036). After adjusting the BMI cutoff in the new protocol from 40 kg/m2 to 35 kg/m2, the median initial anti-Xa was 0.16 (0.12-0.22) units/mL vs. 0.24 (0.19-0.28) units/mL (p=0.018). The mean ± SD time for patients to achieve goal anti-Xa level was 5 ± 3 days in the historical protocol and 5 ± 2 days in the new protocol group (p = 0.456). After protocol modification, the median time to goal anti-Xa level was 4 (3-6) days vs. 2 (1-3) days (p=0.002). No differences were noted in secondary outcomes.

Conclusions
The new protocol resulted in a higher initial anti-Xa level with more patients within goal anti-Xa range which was reached in less time after modification of the BMI cutoff for weight-based dosing. The maximum anti-Xa level in the modified group was still within the prophylactic range with the new protocol, indicating no increase in supratherapeutic levels compared to previously utilized dosing strategies and there were no differences in major or minor bleeding events which supports its safety.

Applicability of Research to Practice
This protocol can be replicated and utilized by other burn centers with the potential for a multicenter analysis and provides a framework for developing standardized VTE prophylaxis dosing recommendations with enoxaparin in burn patients.
750 Development of a Guideline for the Integration of Speech-Language Pathology into the Burn Multidisciplinary Team
Authors: Cappel Heather , Mohr Tiffany 
Published: May 2023

Abstract

Introduction
Speech Language Pathology roles include assessment and treatment of communication, orofacial contractures and oral motor weaknesses, head and neck mobility, ventilator weaning, progression towards tracheostomy decannulation, and swallowing. Specific services may include augmentative and alternative communication, speaking valve implementation on and off the ventilator, advance instrumental assessment of swallowing, and innovative therapeutic interventions. The speech-language pathologists at a single verified burn center recognized a gap in knowledge regarding the scope services they provide resulting in underutilization by the multidisciplinary burn team. The purpose of this study was to develop and disseminate a proposed clinical guideline leading to the inclusion of the speech-language pathologist in the multidisciplinary burn team.

Methods
Two hospital-based Speech-Language Pathologists undertook an exploratory research approach with an extensive review of available literature describing and defining their professional role both within the hospital system, and, more specifically, as a member of the burn multidisciplinary team. Burn team members were queried regarding their knowledge of speech services and appropriate patient referrals. Interviews and discussions with fellow professionals at other verified burn centers provided practice examples for comparison and consideration.

Results
Results from the review of literature and interprofessional discussions within our institution and with other verified burn centers were synthesized into the development of a structured practice guideline. Speech-Language pathology was officially included in the burn multidisciplinary team at our institution. The guideline was shared with outside Speech-Language Pathologists who were not yet a part of their burn multidisciplinary teams to describe and validate the role.

Conclusions
This foundational study led to increased awareness of Speech-Language pathology and the potential benefits to the hospitalized adult burn population. Active participation in the burn multidisciplinary conference has expanded patient care planning and led to generation of appropriate new consultations. Dissemination of the guideline supports the inclusion of Speech-Language in the burn multidisciplinary team.

Applicability of Research to Practice
This guideline details the many specialty services provided by speech-language pathology and provides the foundation for future research to detail the impact on burn patient outcomes.
764 Comparison of Topical Silver Sulfadiazine and Triple Antibiotic Ointment in a Porcine PT Burn Model
Authors: Sober Samara , Wong Stacey , Sandoval Steven , Singer Adam 
Published: May 2023

Abstract

Introduction
The standard of care for partial thickness burns is topical antibiotics or occlusive dressing. Silver Sulfadiazine (SSD) emerged at a time of burn wound infection and sepsis prevalence and is now the most used topical worldwide. Despite its antimicrobial benefits, SSD has been shown to inhibit keratinocytes and there is concern that it might delay wound healing. This study compared time to complete wound closure and reepithelialization in partial thickness porcine burns treated with SSD, triple antibiotics ointment or petrolatum ointment

Methods
We created 21 deep partial thickness (DPT) burns per animal on the backs and flanks of 3 anesthetized domesticated pigs (30-35 kg) using an established vertical progression model (aluminum bar preheated to 80° C for 20s). In each pig, burns were randomly assigned SSD, triple antibiotic ointment, or petrolatum ointment (in a 1:1:1 ratio) applied daily for two weeks followed by twice weekly for another 2 weeks. Healing progression was measured by wound digital photography and punch biopsies to assess gross wound closure, reepithelization and scar depth respectively.

Results
The median (IQR) days to complete wound closure were 17 (17-21), 17 (14-21), and 21 (17-21) for wounds treated with SSD, petrolatum and triple antibiotic ointment respectively (p=0.06). The mean percentage of wound reepithelization at days 10, 14, 17, 21, and 28 for wounds treated with, SSD, petrolatum, and triple antibiotic ointment were 10%±20 vs. 8%±14 vs. 3%±12 (p=0.34), 45%±49 vs. 37%±44 vs. 48%±42 (p=0.74), 82%±38 vs. 86%±20 vs. 90%±27 (p=0.7), 74%±38 vs. 65%±50 vs. 93%±16 (p=0.049), and 92%±17 vs. 91%±28 vs. 98%±5 (p=0.4). The mean scar depth was 3.9 (1.1), 4.2 (0.9), and 3.4 (0.9) mm for wounds treated with SSD, petrolatum, and triple antibiotic ointment respectively (p=0.07). RMANOVA analysis showed significant change over time (p&lt; 0.001) and a near significant difference between groups (p=0.054). On macroscopic analysis, appreciable pseudoeschar formation and erythematous allergic reactions were identified on wounds treated with SSD and triple antibiotic ointment respectively.

Conclusions
No significant differences in wound healing were found between groups in this porcine DPT burn model. SSD did not delay closure. Hypersensitivity to topical triple antibiotics was common.

Applicability of Research to Practice
This study provides insight into the topical ointment standard of care for burns and helps establish the standard comparator topical treatment for future preclinical and clinical studies.