bluuebunny/crossref_metadata_2025_split huggingface dataset:
505 Risk Stratification by TBSA for Acute Kidney Injury in Burn Patients Following Combination Antibiotic Therapy
Authors: Brondeel Kimberley , Palackic Alen , El Ayadi Amina , Wolf Steven , Lee Jong , Song Juquan , Golovko Georgiy 
Published: May 2023

Abstract

Introduction
Burn patients are susceptible to infections and are often treated with broad-spectrum antibiotics. Vancomycin is a common antibiotic administered alone, or in combination with piperacillin-tazobactam (Pip/Tazo). This combination therapy was associated with increased rates of acute kidney injury (AKI) in burn patients when compared to Vancomycin alone or in combination with other antibiotics. However, recent studies failed to demonstrate these findings. We sought to determine the degree of nephrotoxicity of Vancomycin, Pip/Tazo, and their combination, with burn severity.

Methods
A retrospective, multi-institutional study was performed utilizing TriNetX Global Health Research Network that encompasses de-identified patient records from 55 health care organization across the US. We identified the population of burn patients between 2000-2020 and stratified them into 3 groups by TBSA &lt; 10%, 10-39%, or 40%+. Patients were further stratified into cohorts by administration of broad-spectrum antibiotics within 3 months of their burn: Vancomycin, Pip/Tazo alone, in combination (Combo), or neither. Cohorts were propensity score matched for age at index, gender, race, ethnicity, and pre-existing conditions that predispose to AKI. We explored patient distribution and conducted a comparative outcome analysis to determine the risk of developing AKI in 7- and 90-day outcome windows.

Results
Vancomycin and Pip/Tazo were compared to control groups and showed increased risk of AKI in all TBSA groups and time outcomes(p&lt; 0.0001). Before stratifying by TBSA, all burn patients administered combination antibiotics showed increased risk of AKI when compared to control, Vancomycin alone, and Pip/Tazo. In patients under &lt; 10% TBSA, combo antibiotics increased AKI incidence in both 7- and 90-days when compared to all other groups. In the 10-39% TBSA group, combination therapy increased the risk of AKI when compared to Pip/Tazo at 7-days. Increased risk of AKI occurred in the combo group when compared to both Vancomycin and Pip/Tazo in 90-days. In the 40%+ TBSA cohort, combination antibiotics did not increase the incidence of AKI in either time period or when compared to Vancomycin and Pip/Tazo. The results of the comparative analysis are included in Table 1.

Conclusions
Broad-spectrum antibiotics use in burn patients is associated with increased risk of AKI, this risk is higher with Vancomycin and Piperacillin/Tazobactam combination. Combo therapy increased AKI in &lt; 10% and 10-39% but not 40%+ TBSA. These findings can be used to monitor for early manifestations of AKI when using broad-spectrum antibiotics.

Applicability of Research to Practice
The decision to initiate antimicrobial therapy is crucial in burn patients as they are already at risk for AKI. TBSA can be a useful tool for guiding risk stratification.
507 Earlier Graft Takedown Using Autologous Keratinocyte Suspension in Conjunction with Split Thickness Skin Grafting for the Treatment of Deep 2nd and 3rd Degree Burns
Authors: Credo Roald , Brown Elizabeth , Dhaiti Cris , Pang Alan , Raghuram Akshay , Bharadia Deepak , Griswold John 
Published: May 2023

Abstract

Introduction
Autologous split-thickness skin grafts (STSG) have been the gold standard concerning treatment of both full and partial thickness burns. However, new treatments are emerging such as spray-on autologous keratinocyte suspensions (AKS). AKS is composed of a patient’s own keratinocytes, fibroblasts, and melanocytes. STSG in conjunction with AKS has showed promising results for the treatment of deep partial and full thickness burns. The standard graft takedown with STSG has historically been on postoperative day (POD) 6. Once graft take down occurs, occupational therapy can begin along with cessation of continuous splinting leading to more convenience and comfortability for the patient. With AKS, we propose that faster wound healing allows graft take down to occur earlier on POD 4.

Methods
A retrospective chart review was conducted at TTUHSC’s UMC Burn Center looking at patients that underwent STSG with AKS for the treatment of their burn. Patients were divided based on graft takedown on POD 4 or 6. Factors such as time to complete wound closure and postoperative complications were analyzed.

Results
The average age and total burn surface area in both groups was 43 years old and 28%. In the POD 4 group (n=10) the average time to healing was 2 months while the POD 6 group (n=21) had an average healing time of 3.1 months. Graft take and percentage of patients with changes in postoperative mobility and hypertrophic scarring were the same across both groups (98%, 30%, and 50%, respectively).

Conclusions
While time to healing was slightly different, there was not a statistically significant difference between the two groups. From this study we can conclude that graft take down can occur earlier in patients treated with STSG in conjunction with AKS. This allows for earlier therapeutic intervention and more convenience for the patient.

Applicability of Research to Practice
• Graft takedown can occur earlier on postoperative day 4 instead of 6 in patients treated with split-thickness skin grafting in conjunction with autologous keratinocyte suspension.
• Earlier graft takedown allows for earlier occupational therapy and reduces the need for extensive splinting which can be uncomfortable for the patient.
• Graft takedown can occur earlier in those treated with split-thickness skin grafting in conjunction with autologous keratinocyte suspension due to the rapid healing the suspension offers.
514 Incidence, Manifestation, Treatment and Outcomes related to Adrenal Insufficiency in Adult Burn Patients
Authors: Segura Ana , Curry Dominick , Rainey Andrew , Smith Susan 
Published: May 2023

Abstract

Introduction
In the setting of hypotension, serum cortisol levels are obtained to eliminate adrenal insufficiency as a contributing cause. Morbidity, prolonged length of intensive care unit and mechanical ventilator dependent days with higher mortality rates have been associated with adrenal insufficiency. The primary objective was to identify patient characteristics and treatment indications, approaches, and outcomes in adult burn – injured patients diagnosed with adrenal insufficiency.

Methods
This is a single center, five-year retrospective medical record review of adult patients aged 18 years and older admitted to the burn service were included. The data was analyzed using simple and correlational statistics to describe categorical data. Logistic regression, One-way ANOVA, and univariate analyses were conducted in Statistical Analysis System (SAS)® v 9.4.

Results
Sixty nine patients were included, 64% male, 51years old, with 27 % total body surface area, nearly half with smoke inhalation, and 32% mortality.
Duration of hydrocortisone therapy in days, total dose in milligrams, duration of wean in days, and number of times therapy reinitiated were found to be (unadjusted) significantly related to intensive care length of stay, p = &lt; 0.001. Hydrocortisone total dose in milligrams was found to be significantly related with increased vasopressor hours, p = 0.00927, p = 0.0163.

Conclusions
Hypotension, leading to shock, directly correlates with overall burn survivability. Functional adrenal insufficiency may result for shock and sepsis. Hypotension was the instigating factor for hydrocortisone therapy. Random cortisol levels were obtained in all patients included in the study, with an average of 14 mcg/dl which did not exclude adrenal insufficiency as a contributing cause.

Applicability of Research to Practice
This exploratory research will assist with formalizing a list of triggers for initiation of adrenal replacement therapy. These results are foundational in development of outcomes resulting from treatment with varying doses of hydrocortisone and lengths of therapy.
519 Weekend Admission for Patients with Hidradenitis Suppurativa Have Better Outcomes than Weekday Admission
Authors: Atayeva Rena , Tiongco Rafael Felix , Cooney Carisa , Caffrey Julie , Lee Jonathan 
Published: May 2023

Abstract

Introduction
Hidradenitis suppurativa (HS) is a condition that involves recurring inflammation and fibrosis of intertriginous areas. With increasing inpatient hospitalization rates in patients with HS, our study sought to examine differences in outcomes between weekend and weekday admission. The authors hypothesized that patients admitted on a weekend will have worse in-hospital mortality rates when compared to those admitted on a weekday.

Methods
We used a national database to perform a cross-sectional study focusing on 12,365 patients with a primary diagnosis of HS from 2017-2019. The variables measured were weekend or weekday admission, age, gender, race, and zip income quartiles, with the latter four identified as confounding factors controlled for in the logistic regression analysis. Descriptive analyses were performed to determine frequencies, means, and significance. Statistical significance was set at p&lt; 0.05.The multivariate binomial logistic regression was used to calculate the odds ratio (OR) for the identified outcomes. The primary outcome was in-hospital mortality. The secondary outcomes were morbidity factors (infection and wound dehiscence rates, postoperative complications), time from admission to first procedure, and resource utilization (total hospitalization charges and costs, and length of hospitalization).

Results
Weekend admission is not associated with worse inpatient mortality in patients with HS (p=0.345). From 2017-2019, 5 patients died, all of whom were admitted on a weekday. Compared to weekday, weekend admission had significantly lower incidences of wound dehiscence (0.38% vs 0%; p=0.007) and postoperative complications (0.24% vs 0%; p=0.035). No significant difference was observed for incidence of infection in weekday (0.43%) vs weekend admission (0.27%) (p=0.311). Weekend admission was also not found to have significant difference in the odds of contracting an infection (OR=0.74 (0.29-1.90); p=0.536). Weekend admission had significantly lower length of stay (mean days=6.40 vs 4.94; p=0.001), total charge ($64598.94 vs $44616.44; p&lt; 0.001), and total cost ($14441.22 vs $10082.79; p&lt; 0.001).

Conclusions
In contrast to previous studies focused on other pathologies that have shown increased morbidity, treatment metrics, and resource utilization on weekend admission, our study demonstrates that specifically for patients with HS, weekend admission is associated with lower rates of morbidity, length of stay, and charge.

Applicability of Research to Practice
Given that patients with HS who have a weekday admission have worse outcomes than a weekend admission, it is imperative for the medical team providing care to this group of patients on a weekday to be aware of this and begin to identify any potential factors.
524 Traveling Pediatric Burn Care on Wheels
Authors: Pruitt Mary , Queale Lydia 
Published: May 2023

Abstract

Introduction
Many burn patients initially seek treatment at a community hospital after suffering a burn injury and are then transferred to various hospitals before being evaluated by a burn specialist. Due to the increased volume of patients in the emergency department, pediatric burn patients in the past have waited on average 90 minutes to be assessed by a burn provider. A new process was implemented to decrease wait times and increase overall patient and family satisfaction. A breakdown in the process, noted by burn care staff, was the availability of burn care supplies located in the emergency department.

Methods
• A process developed for burn unit nurses to respond to the emergency department to evaluate all pediatric burn patients was implemented.
• A survey was sent to burn nurses looking for the most used supplies while caring for a pediatric burn patient.
• Collaborative efforts with the pharmacy department to obtain space in the medication pyxis for the most used ointments in burn care.
• Collaborative efforts with the Child Life Specialist to stock the cart with stickers, small toys, and distraction items for pediatric patients.
• Collaborative efforts with the attending burn surgeon to develop and implement a protocol for burn team response.
• Collaborative efforts with infection control department to ensure proper regulation standards of the cart.
Cart Contents:
• Gauze
• Securement wraps
• Wound cleansers
• Silver impregnated foam dressing
• Non-stick petroleum gauze
• Staplers
• IV start supplies
• Paper tracking tool
• Discharge & dressing change instructions
• Stickers, small toys, & distraction items

Results
The Hydro on Wheels cart was implemented in January 2022. A retrospective study of data including pediatric burn patients seen in 2021 was completed. The average wait time to be seen by a burn provider in the emergency department decreased from 90 minutes in 2021 to 34 minutes in the first 6 months of 2022.
A follow up survey was sent to hydrotherapy burn nurses to assess the satisfaction of the new process and equipment available.

Conclusions
Overall decreased wait time for pediatric burn patients to be evaluated by a burn care provider.
Burn care nurses felt prepared when responding to a pediatric burn patient in the emergency department.

Applicability of Research to Practice
The burn unit plans to continue this approach to improve patient and family satisfaction & patient outcomes
Future considerations to further improve the process would be to include a patient and family follow up satisfaction survey.
526 Results of Implementation of a Nurse Driven Fluid Resuscitation Protocol in a Regional Burn Center
Authors: Werthman Emily , Caffrey Julie , Cox Carrie 
Published: May 2023

Abstract

Introduction
Our prior research has demonstrated the effect of nurse driven fluid resuscitation on provider and nurse team dynamics. Our primary purpose with this new research on our nurse driven fluid resuscitation protocol is to determine the effect of the nurse-driven fluid resuscitation protocol on resuscitation associated complications (i.e., acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and abdominal compartment syndrome). The study hypothesis is that the rate of resuscitation associated complications will remain stable or not increase post-protocol implementation.

Methods
Retrospective review for all patients within a one-year period pre-protocol implementation and post-protocol implementation was completed. 44 patients were included in the total sample, 22 in the pre-implementation group and 22 in post-implementation group. Exclusion criteria for patients included in nurse driven fluid resuscitation included delayed presentation, morbid obesity, electrical injury, cardiac history, DKA, polytrauma, and renal failure.

Results
Pre and post nurse driven fluid resuscitation implementation samples of 22 patients with total body surface area (TBSA) greater than 20% were analyzed. The incidence of serious complications including ARDS, compartment syndrome, and wound conversion was not statistically significantly different between samples. Rates of acute kidney injuries were similar across groups. In addition, the mean and median TBSA were not statistically significantly different pre and post implementation. The length of stay for the pre-implementation sample was on average longer than for the post-implementation sample. Our results are limited by the significant comorbidities of the pre-implementation group.
Please note tables and graphs were not yet available by time of submission. Attached tables are from prior analysis at approximate half-way of study. Updated graphs and tables will be complete by conference time.

Conclusions
As hypothesized, there were no differences in outcomes between patients receiving nurse driven fluid resuscitation. Our results indicate that nurse driven fluid resuscitation is a safe and clinically effective practice in the burn center. Coupled with our previous results that indicate a significant increase in nurse satisfaction with interdisciplinary communication associated with nurse driven, these results signal the importance of implementing nurse led resuscitations.

Applicability of Research to Practice
Nurse driven fluid resuscitation is a safe and effective. Further research into barriers to implementation is warranted.
527 Opportunity Amongst the Opportunistic: Improving Administration of Time-Critical Medications within a Burn Center
Authors: Richerbach Stacey , Hockenberry Tiffany , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
The absence of skin places patients with burns at an increased risk for a compromised immune system, thus susceptible to opportunistic infection. The use of time-critical medications (TCM) is often required for treatment. By definition, untimely administration may result in suboptimal therapy and put the patient at risk for harm. Our institutional goal for administration is 90%. In 2021 we observed a drop in compliance to 86.8% and instituted a multidisciplinary, quality improvement (QI) approach to improve TCM administration. The purpose of this study was to evaluate the efficacy of our interventions and identify trends in medication administration by staff type.

Methods
QI interventions included a collaboration between Nursing, Pharmacy, and Informatics to overcome barriers to timely administration related to unavailability of medication, education, and options for documentation in the electronic health record (EHR). Medication dispensing systems were floor stocked with eligible TCMs and pharmacists were instructed to refrain from scheduling TCMs within 30 minutes of shift change. Education was disseminated via weekly newsletter, staff huddle, and individual feedback was provided for low performers. TCM metrics were added to the quality board and top performers were acknowledged in a ‘Benchmark Brief.’ Lastly, the EHR was updated to enhance documentation. Medication administration was grouped by year. Staff was identified as burn staff or non-burn staff; comprised of internal resource, contract, and float staff.

Results
Following initiation of the QI project, timely administration increased by 8.6% to a 95.4% rate of timely administration.

Conclusions
Despite increases in annual inpatient admissions, our multidisciplinary quality improvement project was successful, increasing administration of TCM by 8.6%. Further, improvement by burn staff exceeded that of non-burn staff in the burn center. This supports a need to enhance quality initiatives for non-burn staff in the center.

Applicability of Research to Practice
Further research is needed to evaluate efficacy of education, specifically related to temporal dissemination amongst non-burn staff.
529 Job Sharing: An Innovative Approach to Increasing Research Resources and Improving Staff Satisfaction
Authors: Richey Karen , Hockenberry Tiffany , Dobbe Van , Kesler Natalie , Osborn Suzanne , Islas Claudia , Foster Kevin 
Published: May 2023

Abstract

Introduction
Pre-pandemic job openings for clinical research staff increased by nearly 10% a month nationwide yet was outpaced by an increase of greater than 12% in clinical trial activity. With the onset of the pandemic, the gulf between supply and demand widened in research. Simultaneously hospitals were stretched to capacity, staff suffered extreme burn-out and there was a dire need for additional bedside nurses. The pandemic shown a bright light on an age-old problem in nursing, whereas for a nurse to grow professionally, it often required leaving the bedside and giving up vital clinical skills, skills that were suddenly in great demand. The purpose of this project was to create a novel new job role, utilizing existing burn nursing staff to job share a research position, while maintaining their clinical expertise.

Methods
Nurse leaders from both areas worked in concert with the burn center’s director of research, senior hospital administration, human resources and existing staff to develop a new job role. The job description incorporated the scope and standards for nursing practice in both areas into one document. Additionally, a second-level position was created which allowed bedside nurses to trial the new role without a formal commitment to the permanent position. Staff were scheduled to rotate every 2 weeks between the two areas. Two months following implementation, core research staff and job-sharing staff were polled for feedback on benefits and challenges.

Results
Staff members (n=4) provided feedback independently from each other. A total of 41 comments were received, 27 benefit responses vs 14 challenges responses. Responses were grouped into themes and both benefits and challenges had 6 themes each. Benefit themes included: increased interdepartmental collaboration / trust (26%), professional growth (26%), supported learning (22%), enhanced screening for research patients (11%), unit-based resources (7%) and prevention of burnout (7%). Challenge themes included: scheduling (29%), variability in training opportunities (21%), role transitioning (21%), communication (14%), success personnel driven (7%), compensation (7%). Anecdotally, study investigators have expressed great satisfaction with the new position and there has been an increased interest expressed by other bedside staff in research involvement.

Conclusions
The response to the new position has been overwhelmingly positive. Staff entered the trial period realizing that it may be “messy” at first but quickly adapted and have worked through many of the challenges. Based on this early success, we are exploring the viability of cross training additional staff.

Applicability of Research to Practice
Cross training has been demonstrated to increase efficiencies, improve collaboration, trust and job satisfaction.