bluuebunny/crossref_metadata_2025_split huggingface dataset:
66 Key Features of Virtual Reality Impact Effectiveness of Pain Reduction in Pediatric Burn Patients
Authors: Xiang Henry , Armstrong Megan , Thakkar Rajan , Fabia Renata , Noffsinger Dana , Ni Ai , Groner Jonathan 
Published: May 2023

Abstract

Introduction
Virtual reality (VR) is a safe and effective pain management during burn dressing. However, key features of VR that impact the effectiveness of pain reduction remains unknown.

Methods
Our randomized clinical trial included 90 children aged 6 to 17 years who were treated in the outpatient clinic of an American Burn Association–verified pediatric burn center. Active VR participants (n=31) played a VR game while passive VR participants (n=30) were immersed in the same VR environment without interactions. VR groups were also compared with a standard care group (n=29). The primary outcome was self-reported overall pain and worst pain during burn dressing using a visual analog scale (VAS; range, 0-100). Participants in the active and passive VR groups reported 3 key features of the VR game (engaging, fun, realistic) and all participants (VR and standard care group) reported how much time he/she thought about pain during the burn dressing. Key features of the VR game and time thinking about pain were reported using a scale ranging from 0 (not at all) to 100 (very much). A composite score was created by ranking scores of the 3 key features of the VR game and then summarizing them into one final composite score. Our study hypothesis was that the key features of the VR game significantly impact the effectiveness of VR in reducing pain during burn dressing care.

Results
Nonparametric Spearman correlation analysis indicated the active VR group reported statistically significant higher average scores for all 3 key features of VR (engaging: 78.9, 95% confidence interval (CI)=68.5-89.3; fun: 85.7, 95%CI=76.6-94.7; realistic: 73.1, 95% CI=62.3-83.8) in comparison with the passive VR group (engaging: 72.7, 95% CI=59.9-85.5; fun: 77.3, 95%CI=65.6-89.0; realistic: 59.1, 95% CI=44.7-73.5) (all p-value &lt; 0.01). The composite VR score was also significantly correlated with how much time the participant thought about pain during the burn dressing (coefficient= -0.344, p=0.007). The final multivariate logistic regression model of reporting moderate-to-severe pain found that key features of the VR game were statistically significant factors for overall pain and worst pain after adjusting for age, race/ethnicity, healing degree, pain medication use within 6 hours, and anxiety score (p&lt; 0.01).

Conclusions
This study provides evidence that key features of VR significantly impact its effectiveness in pain management among pediatric burn patients.

Applicability of Research to Practice
Active VR game is more effective and should be used for pediatric pain management.
72 Multi-Spectral SWIR Imaging in Humans Reveals Correlations with Distinct Skin Burn Depths
Authors: Nunez Johanna , Levi Benjamin , Hong Jonathan , Carlson Deborah , Huebinger Ryan , Chan Rodney , Wan Bingchun , Mironov Sergey , Mandell Samuel , Goverman Jeremy , Akarichi Chiaka , Berenfeld Omer , Arnoldo Brett , Clark Audra 
Published: May 2023

Abstract

Introduction
Burn depth determination is a critical aspect of burn patient care but currently lacks accuracy in clinical practice. We have shown first in animal models and then in a two-patient characterization that Short Wave Infrared (SWIR) imaging, which penetrates tissue better than visual or near-infrared light and is very sensitive to water content, can distinguish between superficial and deep tissue necrosis. Here we present the findings from our pilot study of 10 patients showing the use of multi-spectral SWIR imaging of human burn injury as a potential technique for burn depth determination.

Methods
Ten patients admitted for mixed depth thermal injuries between 5-40% TBSA were analyzed using our SWIR assessment tool. Prior to burn excision the SWIR system was used to image burn areas and normal skin at 4 different SWIR wavelengths (Figure 1A). Standard photographs from imaged areas were collected and presented for 5 independent, blinded, surgeons’ assessments. Using the visual and SWIR images, 5-15 regions of interest (ROI) were selected from each of the burned areas and normalized to adjacent normal skin and the reflected light intensity in each ROI was averaged at each wavelength. Statistics were done using Mann-Whitney U tests.

Results
Visual and SWIR images were collected from burn areas in 10 patients for a total of 273 burn ROIs. The ROIs were assessed by the surgeons with ROIs being agreed upon as being superficial or superficial partial thickness (SPT) (n=47), deep partial thickness (DPT) (n=97), or full thickness (FT) (n=129) burns by a majority (60% or above) consensus. As seen in Figure 1B, the reflectance intensities (RIs) from superficial and SPT burns were significantly different than the DPT burns at the 1940 nm wavelength (p=0.05) and significantly different than FT burns at 1200 nm (p=0.008) and 1940 nm (p=0.009). When DPT and FT burns were compared there was a significant difference a 1200 nm (p=0.003) and 2250 nm (p=0.01).

Conclusions
Here we present a 10 patient SWIR pilot study demonstrating distinct ROIs of SWIR wavelengths for different burn depths based on consensus surgeon assessments. Overall, as burn depth increases, the 1200 and 2250 nm wavelengths show increasing RIs and 1940 nm show decreasing RIs. These results motivate further studies of SWIR imaging including pending histological analysis in the hope to non-invasively and accurately identify operative versus non-operative burns.

Applicability of Research to Practice
This new SWIR technology may enable us to more objectively assess burn depth, leading to improved surgical decision making and better patient outcomes.
81 Post-Burn Psychosocial Outcomes in Pediatric Minority Patients: A Burn Database Cross-sectional Study
Authors: Won Paul , Ding Li , McMullen Kara , Yenikomshian Haig 
Published: May 2023

Abstract

Introduction
Racial and ethnic minority burn patients often face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database show adult minority patients report worse psychosocial outcomes during burn recovery in domains such as body image or social re-integration. No study to date has investigated differences in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This study examines eight outcomes in minority pediatric patients to better characterize potential differences in the pediatric patient population.

Methods
Patients under 18 years old treated for burn injury between 2009 and 2019 consented to participate in a multi-center longitudinal study were included in the current sample. We analyzed eight outcomes using the National Institute of Health Toolbox and PROMIS-25 measures with higher reported scores indicating worse symptom severity. Multi-level, linear mixed effects, regression modeling analyzed associations between race/ethnicity and outcomes at three time points (discharge after index hospitalization, 6- and 12- month post-injury.

Results
The total cohort of 277 patients were 81% male (n = 182) and on average 8.78 years old (range: 3-18 years at time of injury). When surveyed 12 months after injury, pediatric Hispanic patients reported a mean fatigue score of 45.8 (95% confidence interval (CI): 41.6, 49.9) compared to pediatric non-Hispanic patient score of 43.0 (95% CI: 37.1, 48.9). At 12 months, Hispanic patients reported a mean anxiety score of 46.1 (95% CI: 42.7, 49.5), compared to 41.4 (95% CI: 25.8, 47.1) reported by non-Hispanic patients. At 12 months after injury, Hispanic patients reported a mean peer relationship score of 51.1 (95% CI: 47.2, 55.1) compared to non-Hispanic patients' score of 55.5 (95% CI: 50.3, 60.6). Hispanic patients also reported a mean pain interference score of 44.7 (95% CI: 42.3, 47.0) compared to non-Hispanic patients' score of 38.3 (95% CI: 34.9, 41.6) at 12 months after injury.

Conclusions
Following burn injury, pediatric Hispanic patients report worse outcomes in several psychosocial domains compared to pediatric non-Hispanic patients, although differences were not statistically significant. However, as significant differences in outcomes exist in adult Hispanic/Latino patients, this study supports the need for further evaluation into potential factors that lead to worse outcomes in Hispanic populations.

Applicability of Research to Practice
Although pediatric Hispanic patients do not report significantly worse outcomes than non-Hispanic patients in short term burn recovery, these patients may benefit from further counseling and psychosocial support after injury.
82 Comparison of Parent vs. Burn-Injured Youth Scores on the Strengths and Difficulties Questionnaire
Authors: Rimmer Ruth , Bay Curt , Kalil Emile , Chacon Daniel , Mendoza Erika , Foster Kevin 
Published: May 2023

Abstract

Introduction
Research regarding the prevalence of psychopathology issues in burn-injured youth is limited. The Strength and Difficulties Questionnaire (SDQ) is valid for both self- and parent-report, and is widely used. This study sought to evaluate the level of agreement between the youth self-report and parental response.

Methods
Respondents included 36 adolescent/parent dyads. The youth included 11-18 years old, 14% African American, 19% Hispanic and 44% White, 19 females, 17 males with 58% reporting both visible & hidden scars. The SDQ is a widely used behavioral screening tool assessing children’s positive & negative attributes on 5 scales: 1) Emotional Symptoms, 2) Conduct Problems, 3) Hyperactivity/Inattention, 4) Peer Problems, 5) Prosocial Behavior as well as a Total Difficulties Score.

Results
Youth reported significantly higher scores than parents on Total Difficulty (P &lt; 0.001). They had significantly higher scores on all scale scores – Emotional Problems (P = 0.01), Hyperactivity (P = 0.001), Conduct Problems (P = 0.041), Peer Problems (P=0.041), Internalizing (P = 0.005), and Externalizing Behaviors ((P &lt; 0.001), but not the Pro-Social Scale (P=0.303). Correlations between self- and parent-report were significant only for the Hyperactivity scale, r=.40, p=0.017.

Conclusions
The large difference in youth vs. parent responses is of concern because study parents appear to be unaware of psychosocial issues challenging their children. This study mirrors other research which has documented a lack of awareness of parents regarding children’s reported anxiety disorder symptomology.

Applicability of Research to Practice
Healthcare providers & parents should discuss burn-injured youths’ feelings regarding their progress. Providers should not rely solely on parents when determining the well-being of pediatric survivors. This survey can be completed easily by youth and parents in the aftercare setting and used as a tool for recommending intervention when difficulties are present.
83 Screen & Intervene : Mental Health Screening in the Burn Clinic
Authors: Colarusso Linda , Strait Eli , Lee Jeanne , Smith Alan 
Published: May 2023

Abstract

Introduction
Studies have demonstrated an increased prevalence of depression and PTSD in individuals with burn injuries during the first year of recovery. Mental health screening of patients at all burn centers is recommended. With the addition of an outpatient social worker, our burn center identified a need to standardize the burn clinic’s mental health screening process to address the mental health needs of patients. This performance improvement project sought to improve mental health screening in the burn clinic and subsequent referrals to community resources.

Methods
From March to August of 2022, the PHQ-2 and PC-PTSD were administered to 99 clinic patients during one of the patient’s initial visits. Patients completed the screening independently using a paper form. For pediatric patients &lt; 12 years old, the primary caregiver filled out the form. Of the 99 patients who completed the screening, 51 were previously admitted to our inpatient burn center and 48 were treated only as outpatients (F=36, M=63). The age range of patients was 10 months to 88 years old. TBSA % burned ranged from .15% to 70%. A score of 2 or more on either of the screening tools resulted in further assessment by the social worker to determine appropriate next steps. The chi-square test was used to analyze the data collected.

Results
A total of 36/99 patients screened positive for depressive symptoms, 33/99 screened positive for Acute Stress Disorder (ASD)/Post Traumatic Stress Disorder (PTSD) symptoms, and 23/99 screened positive for both depressive and ASD/PTSD symptoms. All patients with a positive screen on either tool were provided with education regarding mental health resources and offered a referral for services. Of the 99 patients screened, 26 accepted a referral to the local burn foundation and/or an alternate mental health provider for support services. The other 73/99 declined a referral for follow up. There were statistically significant correlations between positive ASD/PTSD screenings and inpatient hospitalization (22/99 p=0.033), PTSD and median TBSA (p= 0.011), and PTSD and age (45-64yo, p=0.028). Females (19/36, p=0.01) were more likely than males to report symptoms of depression and both PTSD & depression (p=0.001), while females (12/36) and males (21/63) were equally likely to report symptoms of PTSD.

Conclusions
Mental health screening of individuals in our burn clinic yielded a significant number of positive screens for depression and ASD/PTSD symptoms, validating the need for a standardized screening process. Positive screens resulted in increased referrals to community and mental health resources.

Applicability of Research to Practice
Performing mental health screenings in the outpatient arena is vital to address the mental health needs of individuals with burn injuries.
88 Does Weight Matter? A Secondary Analysis from ABRUPT
Authors: Fine Jeffrey , Taylor Sandra , Greenhalgh David , Cartotto Robert 
Published: May 2023

Abstract

Introduction
Burn shock resuscitation fluids should be titrated to achieve a urine output (UOP) of 0.5 to 1 mL/kg/hr. It is unknown whether this UOP goal should be indexed to actual body weight (ABW) or predicted body weight (PBW). The purpose of this study was to evaluate differences related to ABW and PBW-indexed UOP using data from ABRUPT.

Methods
We queried the database from ABRUPT, which was a multicenter prospective observational study of acute fluid resuscitation practices involving 379 adults treated at 21 burn centers between 4/2017 and 6/2020. Values are presented as the mean ± SD or median (IQR) as appropriate.

Results
There were 379 subjects (age 46 ± 15.9 yrs, %TBSA burn 31.6 (18), 12.7% with inhalation injury). ABW (N=379) was 90 ± 24.8 kg and PBW (N=375) was 69.5 ± 10.4 kg. ABW exceeded PBW in 84% of subjects. In the 1st 24 h post burn, UOP was 0.87 (0.51) mL/kg ABW/h compared to 1.1 (0.6) mL/kg PBW/h (Figure). Total UOP in the 1st 24 h did not differ between body mass index (BMI) categories. Neither ABW UOP nor PBW UOP was predictive of the decision to initiate 5% albumin (OR and 95% CIs 0.914 [0.754, 1.109] and 0.882 [0.687, 1.133], respectively). We compared subjects with a mean hourly UOP &lt; 0.5 mL/kg/h based on ABW but still &gt; 0.5 mL/kg/h based on PBW (N=61) with subjects whose mean hourly UOP remained &gt; 0.5 mL/kg/h based on ABW (N=283). Subjects whose UOP was &lt; 0.5 mL/kg ABW/h but &gt; 0.5 mL/kg PBW/h were significantly older than subjects whose UOP was &gt; 0.5 mL/kg ABW/h (51.2 [15.6] Vs 44.4 [15.4] yrs, p=0.002), but otherwise we found no significant differences within the 1st 24 hours between these two groups in heart rate, blood pressure, peak lactate, creatinine, total fluids administered, or SOFA score. There were no significant differences in SOFA at 48 and 96 hours, ventilation days, need for dialysis in the 1st 96 hours, or survival.

Conclusions
ABW in a large majority of the ABRUPT population was greater than PBW. Consequently UOP was numerically lower when indexed to ABW than when indexed to PBW. Patients whose UOP was &lt; 0.5 mL/kg ABW /h but &gt; 0.5 mL/kg PBW/h did not appear to have any worse outcomes than those whose UOP remained &gt; 0.5 mL/kg ABW/h.

Applicability of Research to Practice
This study generates a hypothesis and a question as to whether titration based on PBW UOP rather than ABW might result in more aggressive titration and administration of less resuscitation fluid, since PBW-indexed UOP ‘looks’ higher. While this can only be answered in a randomized comparison between the two approaches, our study did not identify any adverse outcomes in patients who had a UOP &lt; 0.5 mL/kg ABW/h but &gt; 0.5 mL/kg PBW/h, which might indicate that titration to &gt; 0.5 mL/kg PBW is feasible.
90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes
Authors: Rizzo Julie , Coates Elsa , Serio-Melvin Maria , Aden James , Stallings Jonathan , Foster Kevin , AbdelFattah Kareem , Pham Tam , Salinas Jose 
Published: May 2023

Abstract

Introduction
Initial fluid infusion rates for resuscitation of burn injuries typically use formulas based on patient weight and total body surface area (TBSA) burned. However, the impact of this rate on overall resuscitation volumes and outcomes have not been extensively studied. The purpose of this study was to determine the impact of initial fluid rates on 24 hour volumes and outcomes using the Burn Navigator (BN).

Methods
The BN database is composed of 300 patients with &gt; 20% TBSA, &gt;40kg that were resuscitated utilizing the BN. Four study arms were analyzed based on the initial formula – 2ml/kg/TBSA, 3 ml/kg/TBSA, 4 ml/kg/TBSA or the Rule of Ten. Total fluids infused at 24 hours after admission were compared as well as resuscitation-related outcomes.

Results
A total of 296 patients were eligible for analysis. Higher starting rates (4 ml/kg/TBSA) resulted in significantly higher volumes at 24 hours (5.2 + 2.2 ml/kg/TBSA) than lower rates (2 ml/kg/TBSA resulted in 3.9 + 1.4 ml/kg/TBSA). No shock was observed in the high resuscitation cohort, whereas the lowest starting rate exhibited a 12% incidence, lower than both the Rule of Ten and 3 ml/kg/TBSA arms. There was no difference in 7-day mortality across groups.

Conclusions
Higher initial fluid rates resulted in higher 24-hour fluid volumes. The choice of 2ml/kg/TBSA as initial rate did not result in increased mortality or more complications. An initial rate of 2ml/kg/TBSA is a safe strategy.

Applicability of Research to Practice
Utilizing a lower starting fluid rate is a safe strategy and should considered after severe burn injury.
91 Precursors to Oliguria During Acute Burn Resuscitation: A Secondary Analysis of a Prospective Observational Study
Authors: McHargue Cody , Rizzo Julie , Aden James , Pham Tam 
Published: May 2023

Abstract

Introduction
Though commonly used to tailor fluid resuscitation, urine output may be a late indicator of impending burn shock. We sought to identify precedents of an early oliguric episode within 6 hours of admission. We hypothesize that specific variables may indicate early at-risk features during resuscitation.

Methods
We performed a secondary analysis of adults enrolled in the Burn Navigator resuscitation trial. We divided into two cohorts: those with oliguria (&lt; 30ml/hr) and those without. Variables were compared by descriptive statistics.

Results
A total of 146 adults met inclusion criteria. More oliguric patients experienced systolic pressures &lt; 90 mmHg (p=0.02) or Diastolic pressures &lt; 40 mmHg (P=0.01). The minimum bicarbonate level (p=0.04), larger TBSA (p=0.01) and larger full thickness component (p=0.004) were all predictors of early oliguria. There were also more female patients (p=0.003) in the oliguric group. No cohort difference was observed for these variables: burn mechanism, percent partial thickness, HR &gt;140 beats per minute (BPM) or hourly change in HR &gt;10 BPM, temperature &lt; 36C, hourly MAP drop &gt;10 mmHg, creatine kinase, age, body mass index, hematocrit level, alcohol level, or methamphetamine use.

Conclusions
Specific variables and physiological derangement thresholds precedes the first oliguric episode during major burn resuscitation. These variables constitute at-risk features that may help derive future algorithms for efficient burn resuscitation.

Applicability of Research to Practice
Precursor variables of an early oligouric episode identify patients needing closer fluid titration.
94 A Review of the Utility of the Readmission Risk Scale in Hospitalized Burn Injured Patients
Authors: Patel Jay , Richey Karen , Islas Claudia , Foster Kevin , Bay Curt , Kesler Natalie 
Published: May 2023

Abstract

Introduction
The burden of wound care post-hospitalization is often overwhelming, not only for patients and their families but also for home health nurses and intermediate care facilities. Inadequate wound care following hospital discharge can lead to wound deterioration and hospital readmission. These readmissions impact the patient, as well as healthcare institutions, physicians, payor sources, and policy makers. Readmission Risk Scales (RSS) exist but typically focus on those patients with chronic illness. Our hospital’s RRS consists of 16 items: patient without a primary care physician (PCP), active problem list &gt; 2, past medical history &gt; 2, age ≥ 50, lives alone, high fall risk, length of stay &gt; 10 days, mental health disorder, diabetes, heart failure, COPD, alcohol abuse, drug use, uninsured/Medicaid, &gt; 2 ED visits in previous 6 months and prior readmission within 30 days. The purpose of this study was to evaluate the fit of our current RSS for burn patients and identify other variables that may be predictive of readmission in burn patients.

Methods
This was a retrospective chart review of burn patients admitted over a 1-year period. Primary outcome measures were RSS scores, individual RSS variables, social determinants of health and incidence of readmission within 30 days of discharge. Readmitted patients were compared to those who did not require readmission. Descriptive statistics were calculated, and bivariate and multivariable logistic regressions (forward LR) were used to identify variables that contributed uniquely to readmission.

Results
A total of 600 burn patients were admitted over the study period of which 449 met inclusion/exclusion criteria. Thirty-two (7%) of these patients were readmitted within 30 days of their initial hospital discharge. In bivariate analyses, only 4 of the current RRS variables were statistically significant predictors of readmission within 30 days, patient without a PCP (p=.019), active problem list &gt; 2 (p&lt; .001), mental health disorder (p=.004) and drug use (p&lt; .00004). However, when these variables were tested simultaneously in one predictive equation, only drug use remained significantly predictive. The total RSS score accounted for only 1.1% of the variance in readmission within 30 days.

Conclusions
The national readmission rate is 12%, and our overall rate was substantially below this. However, our current Readmission Risk Scale is not predictive in identifying those patients at risk for being readmitted within 30 days of discharge. Further investigation is warranted to identify additional variables to identify at risk patients.

Applicability of Research to Practice
A valid readmission risk assessment tool, would be beneficial to identify patients who are at risk for readmission and enhancing discharge planning.