bluuebunny/crossref_metadata_2025_split huggingface dataset:
508 Retrospective Review of Early Pulmonary Mechanics After Inhalation Injury
Authors: Lam Eric , Frerk Rita , Chin Theresa , Burton Kimberly , Joe Victor , Jeng James 
Published: May 2023

Abstract

Introduction
Management of inhalation injury is largely supportive and consists primarily of mechanical ventilation, bronchodilators, muscarinic receptor antagonists, and inhaled mucolytics and anticoagulants. The purpose of this study is to examine the early changes in pulmonary mechanics after inhalation injury and see if the use of NT affects lung function.

Methods
Retrospective study was done on Inhalation injury patients over a 12 years period from 01/2009 to 01/2021. Patients’ data collected from their medical records, included patient demographics and outcomes, percentage Total Body Surface Area (TBSA), Carboxyhemoglobin level upon admission, Respiratory Treatments (bronchodilator, Mucolytic and Heparin), Tobramycin treatment, Oxygen requirement, Lung compliance (peak airway pressure & Mean airway Pressure), Mode of Ventilation, total Ventilator Day, and number of Hospital Days. Patients with inhalation injury from 2009-2019 were retrospectively reviewed for treatment of inhalation injury. Univariate analysis and multiple logistic regression were performed using Excel and Stata.

Results
Of 90 patients with inhalation injury, median age was 53.5 (IQR:31-65) with 30% (n=28) women and median TBSA of 15%(IQR:2-38%). The median length of stay was 21 days (IQR:6-47). Median ventilator days was (8.5, IQR:3-21) and median ICU days was 12 (IQR:3-28). After adjusting for grade of inhalation injury, patients who did not receive NT were 2.7 times as likely to get pneumonia compared to patients who received NT (p=0.037). Initial median carboxyhemoglobin was 3.9 (IQR: 2-9.1). Overall mortality was 21%, but the incidence of death increased with grade of injury
The Median Mean Airway Pressures were Day 1: 9.5mmHg, Day 2: 11mmHg, Day 3: 13mmHg, Day 4: 12mmHg
The median peak pressures were Day 1; 20mmHg, Day 2: 21mmHg; Day 3: 22.5mmHg; Day 4: 21mmHg

Conclusions
Patients with inhalation injury are susceptible to Acute Respiratory Distress Syndrome, indicated by a decrease in lung compliance and increase in the patient’s oxygenation support. The lung compliance of these patients being to change resulting in an increase in their Peak Airway Pressure and Mean Airway Pressure within the first 72 hours. Moderate hypoxemia is present in these patients with the progress of the smoke inhalation injury. The usage of NT did not have a direct benefit to the pulmonary mechanics for inhalation injury when used as a prophylactic strategy. Additional research and clinical trials are needed to better understand the effect of inhalation injury on pulmonary mechanics.

Applicability of Research to Practice
Analysis of pulmonary mechanics in patients with inhalation injury can allow clinicians to better tailor ventilator settings to improve clinical outcomes.
520 Use of Phenobarbital for Alcohol Withdrawal in Small Burn Patients: Evaluation of a Pilot Protocol
Authors: Drabick Zachary , Cochran Amalia , Driscoll Ian 
Published: May 2023

Abstract

Introduction
Phenobarbital is a long-acting barbiturate that has primarily been used an antiepileptic in clinical practice. However its use as a sedative has seen a resurgence recently especially for the prevention and/or treatment of alcohol withdrawal. It has several characteristics that make it appealing for this indication, including its long half-life and its distinct binding to GABAA receptors that, unlike benzodiazepines, does not depend on endogenous GABA to produce its effects. Several recent studies have evaluated its use for the treatment of alcohol withdrawal both inside and outside of the ICU setting, however reports of its use in patients with burn injury are sparse. A pilot treatment protocol utilizing phenobarbital for patients with less than 20% TBSA burns at high risk of alcohol withdrawal was formulated and put into practice at our center in January of 2022. We sought to evaluate the safety and efficacy of this protocol for quality improvement.

Methods
This was a retrospective chart review of patients admitted from January to August 2022 with less than 20% TBSA burns who received treatment with phenobarbital for alcohol withdrawal at a major burn center in North Central Florida. There were no exclusion criteria. This project was registered as a Quality Improvement Project with the institution.

Results
Ten patients were included in the evaluation. Median age was 63 yo, 90% were male, and 70% were Caucasian. Median % TBSA burn was 6.5% (range 0.5-12%) and median length of stay was 16 days (range 9-50 days). Most patients were injured by Fire/Flame (80%). Most patients had a history of binge drinking (70%), and most reported drinking at least 3-4 alcoholic drinks 4 or more times per week (70%). Of those that had a detectable blood alcohol concentration on admission, the median was 163 mg/dL (range 44-325 mcg/dL). Over half of the patients (60%) received an IV bolus (either 5 or 10 mg/kg based on ideal body weight) of phenobarbital followed by an oral taper, with the remaining 40% having received an oral taper without a bolus dose. Median RASS prior to initiation of the protocol was +1, and the majority of patients remained RASS +1 or less throughout the duration of the protocol (70%). No rescue benzodiazepines were needed, no seizures were identified, and no intubations occurred while patients were on the protocol.

Conclusions
The phenobarbital protocol was well tolerated and controlled agitation in the majority of the patients who received it. No obvious safety concerns were identified during this review. Although this was a small sample size, these results are encouraging and support continued use of phenobarbital in preventing and controlling symptoms of alcohol withdrawal in patients with less than 20% TBSA burns.

Applicability of Research to Practice
Phenobarbital may be a safe and effective benzodiazepine-free option for preventing and/or treating alcohol withdrawal in small burn patients.
542 Identifying Psychosocial Factors Impacting Burn Survivors
Authors: Kilmer Debra , Cottrill Paula , Rose Amanda 
Published: May 2023

Abstract

Introduction
Burn survivors often suffer from profound psychosocial stress. Following a traumatic burn, new stressors and mental health symptoms can arise, and previously existing factors can be amplified. Alleviation of these stressors can facilitate healing, treatment compliance, and favorable outcomes.
We sought to better identify psychosocial factors that impact the lives of adult burn survivors. Our primary aim was to develop a psychosocial screening battery and brief screener to identify stressors common among such patients at our hospital-based outpatient burn center.

Methods
A survey was administered to adult burn survivors at a monthly support group. Participants were instructed to endorse items from a list of 39 possible stressors and symptoms that impacted them after their burn injury. The most frequently endorsed items were considered for inclusion in the screening tool.

Results
A total of 17 surveys were completed, nine (53%) of whom were men and eight (47%) of whom were women. Ages ranged from 18 to 79 years. The earliest burn injury occurred in 1990, and the most recent occurred in 2022. There were 17 survey items endorsed by 29% or more of the respondents (Table 1).

Conclusions
Numerous symptoms and stressors endorsed by participants align with mental health conditions like acute stress disorder, post-traumatic stress disorder (PTSD), anxiety, and depression. We decided to implement the Primary Care PTSD Screen and the Generalized Anxiety Disorder 7-Item within our outpatient clinic in addition to the depression screen already in use. Items not addressed by questions on these mental health screens were included in our brief burn survivor stress screening measure.

Applicability of Research to Practice
Implementation of this screening battery will enable identification of psychosocial factors impacting adult burn patients previously hospitalized as a result of their injuries. This will allow us to address patient concerns, offer recommendations for support and resources, and guide treatment planning to improve compliance and outcomes. In the future, this information will facilitate the development of additional programs to assist burn survivors.
556 Minimally Invasive Contracture Release Improves Function in Patients with Burn Contractures
Authors: Blome-Eberwein Sigrid , Schwartz Adam 
Published: May 2023

Abstract

Introduction
Scar contracture bands after burns are a persistent problem that cause discomfort and physical and aesthetic limitation. Standard treatment for contracture bands in burn scars involves physical therapy, stretching, splinting and laser treatment, as well as surgical releases with local/distant flaps and grafting. A minimally invasive transcutaneous approach for the release of scar bands was initiated in our institution 6 years ago. The method was derived from techniques pioneered by Jose Daher and Raul Gonzalez to interrupt platysma bands in neck rejuvenation.
With IRB approval we evaluated this new approach regarding long term outcomes.

Methods
A retrospective review of 45 patient charts was conducted for those with burn scars who received subcutaneous contracture release from May 1, 2016, through March 31, 2022. The procedure involves introducing a braided suture to loop the contracture band and moving it in a sawing motion until it cuts through the band in multiple sites along the contracture. Demographic data, total burn surface area (TBSA), location, amount of contracture release increments, scar size, and duration of treatment was recorded. Concurrent scar treatments and whether performed under anesthesia was also noted. In follow up visits 3-12 months post release patients were surveyed on satisfaction with the treatment and whether they noticed increased mobility after the procedure. The Vancouver Scar Scale was administered pre- and post-treatment. Patient range of motion was measured pre-and post treatment to assess for change in mobility at treated sites.

Results
Male to female ratio was 51%:49%, average age was 38.8(6 to 68), 58% were white . TBSA ranged from 0.5% to 85%, with an average of 36.1 ± 22.3. The release was applied to 11 different sites spanning the entire body, 39% on the neck . The procedure involved an average of 19.0 ± 8.8 incremental releases, and the average scar size for treatment was 174.4 ± 140.0 cm2. 93% of the procedures involved laser treatment, 76% were done under anesthesia because of the laser, and 84% involved a site that was skin grafted. Only one of the 45 patients reported bleeding post-discharge, and none had an infection at a puncture site. Out of 20 responses, 13 patients reported being “satisfied” and 3 “very satisfied”; none reported being “dissatisfied”. 19 noted an increase in mobility at the contracture site and one did not. On average, patient range of motion increased by 13.6 degrees.

Conclusions
The minimally invasive contracture release described is a versatile, safe, and well-tolerated procedure that can help patients regain form and function after a burn injury. It was successfully applied to a large range of age groups, burn sizes, and scar contracture sites. Encouraging data regarding patient recovery and gain in mobility supports the use of this contracture release technique. Further studies should include prospective multicenter trials.

Applicability of Research to Practice
Immediate
557 Adverse Events Associated with Fractional CO2 Laser Therapy for Hypertrophic Burn Scars
Authors: Won Paul , Cooper Michael , Gillenwater Justin , Yenikomshian Haig 
Published: May 2023

Abstract

Introduction
Laser therapy is a growing intervention in hypertrophic scar treatment. This therapy is associated with minimal risks, however these are poorly studied in the burn population. Anecdotal reports of adverse effects such as pain and dyspigmentation exist. As patients, stakeholders, and insurance companies decide on reimbursement for this therapy, a better studied safety profile is necessary. This study is a retrospective review of all laser therapies for adverse events.

Methods
A retrospective review of patients who underwent laser therapy at two centers between May 2019 and June 2022. Patient demographics, details of laser treatments, adverse events, and scar characteristics before and after laser therapy were collected.

Results
A total of 167 patients underwent 533 laser treatments. There were 75 (44.9%) males and 92 (55.1%) females, with an average age of 26 (SD: 20.6) years. In total, 94 patients (56.3%) were Hispanic or Latino, 24 (14.4%) Caucasian, and 49 (29.3%) identified as "Other". All patients were treated for hypertrophic scars after burn injuries. For all patients, average number of laser treatments was 3 (SD: 2.2), with a range of 1 to 17 sessions. There were 9 (1.68%) instances of adverse events out of the total laser encounters. There were 5 (0.93%) reports of increased pain, 1 (0.18%) of an open wound, 2 (0.37%) of increased scar discoloration, and 1 (0.18%) of decreased scar pliability. Of the 5 (2.98%) total patients who encountered adverse events, 3 continued with laser therapy. There was no correlation between number of laser treatments and adverse events.

Conclusions
Patients undergoing laser treatment for burn scar management rarely face adverse events, of which the most common were increased scar pain and dyspigmentation. Even so, most patients experiencing adverse events chose to continue treatments. Laser therapy remains effective in burn scar treatment with minimal risks regarding safety profile.

Applicability of Research to Practice
This review will assist patients in making more informed decisions when considering laser therapy for burn scar management.
558 Wound Care Program Development to Advance Physical Therapy Practice in a Specialized Burn Unit
Authors: Gerlich Nicole , Tepe Melinda 
Published: May 2023

Abstract

Introduction
There is a nation-wide shortage of nurses which is true at our institution as well. As a result, there is a lack of consistent, qualified staff to perform wound care in our burn center. Wound care is within a physical therapist’s (PT) scope of practice and we felt this was an area for opportunity and expansion for PT practice at our institution as we had not previously been involved in wound care services for any patient population.

Methods
We posted on the ABA PT/OT SIG page asking other burn centers about PT involvement in daily wound care. Respondents then participated in an online question/answer session. Based on this information, additional education resources, and our own institution’s practice model for nursing, we developed a PT checklist for demonstrating competency with theory and practice for burn wound care. The 2 primary burn PTs completed a 4 week training under the direction of the nurse clinical coordinators and advanced practice providers (APPs) and were deemed competent. The attending MDs have signed off on our process. We have now developed a training program to ensure more PTs are competent with wound care for the burn patient.

Results
Of 186 members of the OT/PT SIG who had access to the original post, we received only 8 responses. Five of eight had PTs partially involved in wound care in the inpatient setting with burn patients. PTs are the primary wound care providers in 2 of 8 responding burn centers. In the remainder, PTs were primarily involved in wound care only in the outpatient setting. Four centers participated in the online video question and answer sessions. Despite all of them following ABA guidelines, there was no standardization of developing a wound care program. Our program includes 1:1 orientation to the burn unit for 3-4 weeks, direct supervision of wound care and dressing changes by the primary burn PTs, completion of knowledge-based quiz, and demonstration of skills checklist.

Conclusions
It was feasible to create a new wound care program including PTs in a burn center. We found variation in practice due to regional preferences, physician preferences, availability of different dressings, and staff training. We feel confident in our competency process as it includes both a written knowledge assessment as well as requiring demonstration of techniques. Developing this program has increased the trust between the PTs, physicians, and APPs thereby allowing us to advance our PT practice. We can now perform high quality wound care and complete more aggressive functional mobility without fear of disrupting dressings. Based on actual visualization of the wounds, we can provide more thorough patient education and perform more specific range of motion stretching.

Applicability of Research to Practice
Utilizing PTs knowledge of all soft tissue healing may be of benefit. We encourage other PT departments to advocate to participate in wound care of the burn patient.
572 Trace Element Supplementation in Burn Patients: A Quality Improvement Project
Authors: Kurjatko Alexander , Weigel Isaac , Galet Colette , Suarez Justin , Cavanaugh Kelly , Wibbenmeyer Lucy 
Published: May 2023

Abstract

Introduction
Patients with major burns suffer deficiencies in trace elements (TE), which can affect their clinical course. We established a quality improvement (QI) project to supplement TE (multivitamins with TE, vitamin C, and zinc). Herein, we assessed the impact of QI implementation on outcomes.

Methods
We queried the burn registry for burn patients admitted from 8/1/2019-5/31/2022 who weighed &gt; 40 Kg and stayed &gt;14 days. Demographics; comorbidities; injury, and hospital course information were collected. Post-implementation, TE levels (zinc, copper, and selenium) as well as C reactive protein levels were measured at 2 weeks. Analyses were performed to assess differences between the pre- and post-groups and post-group patients with major burns (≥20%TBSA) and smaller burns (&lt; 20%TBSA). P &lt; 0.05 was considered significant.

Results
We included 111 patients, 45 in the pre- and 66 in the post-group. Overall, the population was male (79.3%) with a median age of 53 years. Age and sex were not significantly different between the pre- and post-groups. The post-group had higher TBSA (p = 0.005). They were more likely to smoke (p =0.018) and have an alcohol use disorder (p = 0.035). There was no significant difference observed in mortality, complications, or LOS/TBSA (2.1 days [1.2-5.5] vs. 1.7 days [1.2-3.1], p = 0.300) between the groups. Focusing on the post-group, 37 presented with smaller burns and 29 with major burns. Patients with major burns were younger (p =0.003) and healthier than patients with smaller burns. At 14 days, 81.5% and 33.3% of patients with major burns were deficient in zinc and copper, respectively. Zinc (47.6 µg/dL vs.79.2 µg/dL p &lt; 0.001), copper (80.2 µg/dL vs.121.9 µg/dL p &lt; 0.001), and selenium (98.7 µg/L vs.135.5 µg/L, p = 0.003) levels were significantly lower in patients with major burns. C-reactive protein levels were high in both groups but significantly higher in patients with major burns (p &lt; 0.001). Patients with major burns were more likely to have infectious complications (p = 0.004); however their LOS/TBSA was significantly lower than that of patients with smaller burns (1.21 days vs. 2.43 days, p &lt; 0.001). Zinc levels of patients with major burns significantly increased overtime from 47.6 µg/dL at 14 days post-admission to 73.5 µg/dL at 53 ± 16 days (p &lt; 0.01).

Conclusions
Our data show that TE supplementation was efficient in bringing zinc levels close to the normal range in patients with burns ≥20%TBSA who stayed up to 50 days in hospital. Controlled for TBSA burned, supplementation of TE significantly decreased LOS of patients with major burns compared to patients with smaller burns.

Applicability of Research to Practice
Further studies are needed to evaluate the correlation between supplementation of TE and improvement of patient LOS.
717 Management of Gynecologic Involvement in Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrolysis Syndrome (TENS)
Authors: Knapp Rachel , Ciccone Marcia , Yenikomshian Haig , Gillenwater Justin 
Published: May 2023

Abstract

Introduction
Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrolysis Syndrome (TENS) are rare and potentially life-threatening dermatologic conditions that require interdisciplinary management (Shanbhag et al., 2020). One of the most painful and traumatic is vaginal mucosal involvement. Gynecologic complications have been historically undermanaged, and lack of acute intervention can lead to dyspareunia, adhesion formation, and increased risk for vaginal cancers (Kaser et al., 2011). Unfortunately, treatment is variable but typically involves use of vaginal dilators, which can be painful, and often traumatic for both patient and provider. The purpose of this study was to analyze the utilization of these treatments and to observe any sequelae from gynecological involvement.

Methods
Retrospective chart review was completed for all female patients with a diagnosis of SJS/TENS who were admitted to a single center burn unit from 2015-2022. Trends in age, gynecologic involvement, wound care strategies, and outcomes were assessed.

Results
Twenty-nine patients met inclusion criteria. These patients ranged from 9-82 years of age with a mean of 43 (STD 21). Ten percent died in the hospital, 14% were transferred to another hospital, and the remaining patients were discharged to home or a rehabilitation facility. Of these 29 SJS/TENS patients, 59% had gynecologic involvement of which 52% received gynecologic interventions. Gynecologic interventions included use of vaginal dilators (67%), topical steroids (60%), antifungal ointment (33%), and menstrual suppression (13%). For pediatric populations, patient discomfort and family concerns limited pelvic exam and vaginal interventions. Accommodations for pediatric patients included completion of examination and treatment under anesthesia and education of parents about the treatment process. While 2 patients were confirmed to have no vaginal adhesions in follow up appointments, documentation of future vaginal complaints was not available for most patients.

Conclusions
Gynecologic management is an important part of SJS/TENS treatment with wide variability in practice patterns not only nationally but at a single setting institution. Outcomes from treatment versus non treatment with steroids +/- dilation is equivocal. Providers must be better at screening for symptoms in outpatient follow up. When forming new algorithms, special consideration among pediatric populations and invasive management needs to be considered.

Applicability of Research to Practice
There is wide practice variability on the gynecological management of SJS/TENS patients with variable outcomes. Longitudinal studies on outpatients would better help create algorithms for patient management.