bluuebunny/crossref_metadata_2025_split huggingface dataset:
718 Estimation of Total Body Surface Area Burns in a Bilateral Above-Knee Amputee Patient
Authors: Peñarrieta-Daher Edgar , Treviño García Luis , Rodríguez Villa Paulina , Morales Ortiz Jorge , Leal-Gutierrez Jesus 
Published: May 2023

Abstract

Introduction
The burn injury extension estimate is necessary for the initial IV fluid resuscitation planning, however, current Wallace rule of nines, Lund & Browder charts as well as smartphone applications are based anatomical models with full body integrity.
The purpose of this paper is to accurately estimate the TBSA burned in a bilateral asymmetric above-knee amputee patient.

Methods
An amputation is defined as major amputation when the level is at or proximal ankle or wrist.
We present a case example of an 80-year-old patient with a past medical history of long-standing type 2 diabetes mellitus with inadequate metabolic control, left above-knee amputation seven years ago, as well as a contralateral asymmetric above-knee amputation seven months before hospital admission.
The patient was brought to the emergency department one hour after suffering burn injuries by fire at his shelter. Upon his arrival inhalational injury was ruled out, and at physical examination second and third-degree burns were noted circumferentially on both above-knee stumps, genitalia, right flank, lower abdomen and back, right hands and forearm, as well as left hand digits (Figure 1A-B).
Initial TBSA burned was estimated using the E-burn application yielding a 27% extension; however, this percentage would correspond to patient with full integrity of both lower limbs (Figure 2A)

Results
This is the first major amputee burned patient of 285 cases admitted for in-hospital treatment at our institution from March 2020 to October 2022.
After performing an online search on MEDLINE/Pubmed (keywords: TBSA, estimation, amputated) we found only one published paper in 2020 which presented a Correction Factor (CF) formula for a hypothetical burn patient with bilateral and symmetric fore-quarter amputation.
We estimated the amputated surface area (13.7%) with e-burn, to calculate the major amputee CF published in 2020 and test it on a clinical setting. By means of the following formula (Figure 1C): CF = 100 / (100 - % of amputated body part)
CF = 100 / (100 – 13.7)
CF = 100 / (86.3) = 1.15
Finally, the initial TBSA burnt was multiplied by the CF to adjust it accordingly to major amputations of the patient, as follows: Originally estimated TBSA burnt (27%) x CF (1.15) = 31.05 % (Figure 2B-C)

Conclusions
This case report serves as an example of the clinical application of the Correction Factor for major amputees burn patients which can be easily estimated with the aid of smartphone applications such as e-burn in mismatched bilateral amputations.

Applicability of Research to Practice
To our knowledge this is the first clinical application of the major amputee CF, which its simplified estimation by means of E-burn could be of use for burn centers with higher volume.
727 Development of an Acuity and Scheduling System for Wound Care
Authors: Salazar Elizabeth , Ruiz Alina , Ewing Amber , Terry Michelle 
Published: May 2023

Abstract

Introduction
Acuity systems have been used in nursing to quantify the care needed for each patient based on the patient’s nursing needs. The benefits for using an acuity system include avoiding over or understaffing and improving patient outcomes. To date no formal acuity system has been used to quantify the work associated with burn wound care. The purpose of this quality assurance project was to develop an acuity and scheduling system for burn patients and provide more effective and equitable staffing for burn wound care.

Methods
A wound care subgroup was formed by Unit Based Council to develop a point-based acuity scale for wound care. Numerical points were assigned for each body area dressed and wound care procedures such as surgical dressing take downs, moderate sedation, staple removal, wound vac change, wraps or casting, initial debridement, and discharge teaching (Fig. 1). Points were totaled and associated with a range of time: 1-5 points equals 45 minutes; 6-10 points equals 60 minutes; 11-15 points equals 75 minutes, and 16-20 points equals 90 minutes (Fig. 2). The total time of all dressing changes for the day based on the acuity system determines the RN and Tech staffing for wound care. After considering provider and therapy priorities, a schedule is posted in Microsoft Teams allowing for interdisciplinary collaboration and visibility on wound care scheduling.

Results
To date the acuity-based schedule has been used to schedule 500 consecutive dressings. Acuity based scheduling has helped to quantify the number of staff needed for wound care related to the amount of time needed each day. Prior to the initiation of this practice, wound care was assigned based on the number of patients instead of the workload required per patient leading to over or understaffing. The use of the acuity system has allowed the unit to predict the number of staff needed for wound care each day and adherence to the schedule with a margin of 30 minutes plus/minus was achieved.

Conclusions
Use of an acuity and scheduling system for burn wound care can improve staffing and will be a tool to quantify productivity.

Applicability of Research to Practice
Acuity systems and wound care scheduling can improve staffing for burn centers.
729 A Post-Pandemic Educational Program for New Burn Nurses
Authors: Klinkhamer Angela , Zynkian Megan , Lee Jeanne 
Published: May 2023

Abstract

Introduction
Transitioning into a nursing role within the burn center is clinically challenging and stressful. Due to the highly specialized nature of burn care, it is often difficult to find experienced nurses. Because of the shortage of experienced nurses, the burn center has been hiring many new graduate nurses. The COVID-19 pandemic greatly affected nursing schools, as clinical hours and experiences in the hospital were greatly reduced during peak outbreaks. Often, lab simulation and role playing were supplemented for clinical hours. In turn, nurses graduated with limited patient-nurse interactions and bedside experiences. From January 2020 through August 2022 our organization had an attrition rate of 27% for new graduate ICU nurses while the burn center saw a 25% attrition rate for new nurses. Our hypothesis is that an additional education program for new burn nurses will improve self-efficacy, knowledge and provide the support needed to promote long-term retention.

Methods
An educational program was created and implemented for two nursing cohorts. Twelve additional hours of hands-on skills and discussions were added over the course of the standard twelve-week orientation period. A pre and post exam consisting of identical questions was given to all participating staff to assess baseline knowledge and effectiveness of education. Discussions within each cohort identified learning needs and areas where additional support could be offered. The General Self-Efficacy Scale was used to assess pre and post program implementation. Results were analyzed using an unpaired t test.

Results
The average score in the eighteen-question pre-knowledge assessment exam was 72% and increased to 91% in the post-knowledge exam. The self-efficacy score increased from 1.68 to 3.36 (P value 0.0002). Based on self-efficacy results, nurses reported feeling more competent and less anxious about their new roles.

Conclusions
The post-pandemic population of new graduate nurses face a grave disadvantage when starting a new role due to limited clinical experiences, lack of available rotations and a reduction in clinical hours. This may set them up for failure due to decreased self-efficacy. Providing additional support and a proactive approach to educating new nurses has proven to be a valuable experience in the burn center.

Applicability of Research to Practice
Development of an educational program for new nurses was shown to improve self-efficacy and knowledge. Continuing this supplemental educational program for new nurses is beneficial to both new graduate and new burn nurses and has the potential to improve nursing retention.
730 Geographic Effects of Rural Burn Care Follow Up During the COVID-19 Pandemic
Authors: Bradshaw Evan , Garcia Liza , Anding Catherine , Pang Alan , Griswold John , Bharadia Deepak 
Published: May 2023

Abstract

Introduction
Follow-up appointments (FUAs) are crucial to monitor proper healing in burn patients. This study aims to determine if there is a predictive relationship between the distance a patient lives from the burn center and FUA attendance This study also aims to determine if the COVID-19 pandemic had any effect on FUA attendance at our burn center.

Methods
Data was collected from the Burn Registry of a rural, ABA verified Regional Burn Center on patients who were admitted for an inpatient stay and discharged from January, 2019 through December, 2020. For each patient, we recorded demographic factors, home zip code, TBSA, length of inpatient stay, and FUA outcome. We split the resulting cohort in two separate ways by FUA status and pandemic status based on if they did/did not attend followup and were admitted before 3/9/20 (pre-pandemic) or after 3/9/20 (intra-pandemic). Chi Square Tests were used to determine if the rate of followup differed across pandemic status. We then ran Mann-Whitney U Tests to compare all the variables across both pandemic status and FUA status.

Results
The cohort consisted of 511 patients. The pre-pandemic followup rate was 71.0% (n = 334) and the intra-pandemic followup rate was 71.2% (n = 177). This was not a statistically significant difference (Χ2 = 0.003, df = 1, p = 0.96). The next analysis compared the variables across pandemic status. The only significantly different variable between the groups was an increased percentage of 2nd degree burns in the intra-pandemic group (U = 24656.0, p = 0.018). The next analysis compared the variables across FUA status. Age, distance to the burn clinic, and amount of 3rd degree burns significantly differed across FUA status groups (U = 22789.0, p = 0.007; U = 19946.5, p = 0.000; U = 22738.5, p = 0.037, respectively), indicating the group that did follow up was younger, lived closer, and had more 3rd degree burns.

Conclusions
Furthermore, the results indicate that the distance a patient lives from our center is the highest predictive variable in determining whether or not a patient will attend followup.

Applicability of Research to Practice
This research is especially applicable to practitioners in rural environments or those evaluating the reasons for lack of follow-up in burn care.
731 Evaluation of PROMIS-10 Global Health Survey Implementation at a Regional Burn Center Clinic
Authors: Hunter Mary , Gaskins Devin , Hubbard Michelle , Carrougher Gretchen , Wiechman Shelley , Stewart Barclay , Chambers Mona , Gibran Nicole 
Published: May 2023

Abstract

Introduction
Patient-Reported Outcomes Measure System-10 (PROMIS-10) is a brief survey consisting of 10 items that evaluates patients’ global physical and mental health. PROMIS-10 was introduced into our burn clinic as a screening tool and serial measure of recovery. We aimed to assess the implementation of PROMIS-10 to improve its equitable use in outpatient clinics.

Methods
The PROMIS-10 was implemented in 2014 as part of a packet of other screening tools. The staff were trained in its use. Patients completed English-language surveys via paper/pen upon arrival at each of their burn clinic appointments while waiting to be roomed. Survey results were reviewed by clinic providers and addressed as part of routine care. Survey answers were entered into REDCap and merged with demographic and burn injury information. Data were collected and analyzed using univariate and bivariable statistics to evaluate equitable implementation.

Results
A total of 1,963 surveys were collected from 1,606 patients from January 2014 to December 2020 (Figure 1). After excluding patients with missing collection of survey and/or demographic data, our analysis included 1,072 patients. The mean number of surveys completed per visit was 0.53 (SEM=0.007) and 88% of patients completed 1 or more surveys. Patients who required intensive care during their index hospitalization or had an operation had higher mean surveys completed per visit (Highest Level of Care ICU=0.611 ± 0.02; Required an operation = 0.608 ± 0.015), whereas patients requiring an interpreter had lower mean surveys completed per visit (Required an Interpreter = 0.468 ± 0.031).

Conclusions
Although the majority of patients completed the PROMIS-10 during at least one clinic visit, there is significant room for improvement given our intent to use it as a screening tool for every encounter and metric of recovery progress over time. Focus on equity in completion is needed (e.g., coordinating interpreter-assisted completion, availability of translated forms, person-assisted completion for limited English proficiency, medical record integration for telemedicine and progress tracking). We did note that patients with markers of high burn severity (ICU stay, requiring an operation) had higher rates of survey completion per visit. This is a patient population in which serial evaluation is particularly helpful in monitoring recovery.

Applicability of Research to Practice
Use of PROMIS-10 can successfully be used as a screening and recovery progress metric in the outpatient setting. Equitable implementation should be assessed, and efforts to integrate such screening tools into the medical record should be considered.
733 Development of TeleBurn Utilizing Hospital Based EMR and Stroke Robot Photography
Authors: Bernal Nicole , McGuire Beth , Pezzopane Laura , Skornicka Susanna 
Published: May 2023

Abstract

Introduction
Our burn center is located in a state that takes referrals from rural areas up 160 miles away. Transfer to our often at capacity emergency department for burn wound care and to be discharged is an expense to the patient and the medical system.
Using existing transfer center nurses, the EMR system, and hospitals connected in the stroke network hypothesized we could create a TeleBurn program without additional equipment or resources. This was developed to expedite patient care and move the burn evaluation for smaller burns to the outpatient clinic from the emergency department. Calls were covered by the on-call trauma attending.

Methods
The TeleBurn program used 27 care connect hospitals in our stroke network. Calls were received through transfer center Figure 1. If the call was one where the physician was asking for opinion or possible follow up, the stroke robot was brought into the room, photographs taken and uploaded to EMR. A page/EMR message alerted call trauma attending physician. If the patient’s burn were small, they were set up for follow-up in clinic the next day in designate protected slots, if they needed surgery, admission for pain or wound care transfer, was arranged. The transfer center sent clinic staff message through EMR.

Results
Compared to previous year there was reduction of 3-10 ED visits per month and doubled new clinic visits in those same months. During the three-month pilot period, only one patient required admission when seen in clinic. Table 1. Our no show rate for protected slots was higher at 33% compared to no show rate of 12% for scheduled burn patients.

Conclusions
We demonstrated that TeleBurn triage can be done in a HIPPA compliant manor without having to purchase a new technology or platform. The development of a process with pictures and guaranteed followed up gave both the on call physician and transferring physician the confidence not to transfer a patent in middle of the night. More work is needed to determine why the no-show rate is high and how to adjust appointments to correct.

Applicability of Research to Practice
It is feasible to create a successful system that uses your EMR and limits additional steps for transferring physicians and on-call surgeon. Real time communication was utilized with the team to help vet issues quickly and allow for rapid feedback.
736 Burn Injuries During the Pandemic: Older Patients, Delays to Admission, and Longer Hospital Stays
Authors: Vuillier Jonathan , Rezwan Siam , Atayeva Rena , Cooney Carisa , Werthman Emily , Tiongco Rafael Felix , Ballou Jessica , Caffrey Julie 
Published: May 2023

Abstract

Introduction
The COVID-19 pandemic’s impact on school closures, workforce/employment status, and the enactment of stay-at-home orders may have resulted in changes in the incidence, mechanisms, and time to presentation for treatment of burn injuries. Given the need for prompt treatment of burn injuries to prevent worsening of the injury, infection, and/or critical illness, potential delays in burn treatment during the pandemic may have resulted in poorer patient outcomes. We hypothesize that burn patients demonstrated delays to presentation, changes in burn injury mechanisms, and increased mortality intra-pandemic compared to pre-pandemic.

Methods
We conducted a retrospective review of records from the burn registry of a tertiary urban burn center. Persons aged 0 to 99 presenting with a burn between March 2019 and March 2021 were included for evaluation (n=1524). Demographics, time to presentation, and admission type were compared for persons presenting pre-pandemic (March 11, 2019-March 10, 2020) to intra-pandemic cases (March 11, 2020-March 10, 2021). TBSA, length of stay, mechanism of injury, and final disposition were compared for inpatients presenting pre- to intra-pandemic. Chi-squared and Student’s t-test analyses were conducted for comparisons between the pre- and intra-pandemic groups; statistical significance was set at p&lt; 0.05.

Results
Pre-pandemic, 777 persons presented to the burn center with 239 (30.8%) admitted; intra-pandemic, 747 persons presented with 260 (34.8%) admitted. Presenting patient mean age pre-pandemic was significantly lower than intra-pandemic (41 vs. 44 years, p=0.001), as well as mean time to admission (1.41 vs 2.46 days, p=0.04). There was no statistically significant difference in patient gender, race, ethnicity, or admission type pre- vs. intra-pandemic. For inpatient admissions (n=499), there was a significant increase in length of stay pre- vs. intra-pandemic (8.31 vs. 11.26 days, p=0.042); no significant changes in TBSA, mechanisms of burn injury, or disposition were found.

Conclusions
Our results indicate that patients who presented intra-pandemic were significantly older and had greater injury-to-presentation times than those who presented pre-pandemic. The pandemic did not seem to have a significant effect on burn TBSA, mechanisms of injury, or disposition. These results may have important implications for the role of telehealth in burn care and public health programs for burn prevention and treatment during times of stress on the healthcare system.

Applicability of Research to Practice
Analysis of pre- and intra-pandemic burn injuries enables explorations of how pandemics impact both the ability of patients to seek treatment and the impact of delays in seeking treatment. Such analysis lends itself well to exploring the vital role of public health advocacy, use of telehealth, and burn prevention campaigns during crises.
738 Access to Burn Care: A 10 Year Perspective of Burn Centers in the U.S.
Authors: Lovick Elle , Carter Jeffrey , Phelan Herbert , Kearns Randy , Phillips Bart , Hickerson William 
Published: May 2023

Abstract

Introduction
Only 2% of US hospitals have designated burn centers (BC), of which 57% are verified by the American Burn Association (ABA). Further, of the non-verified burn centers, it is unclear which ones meet requirements set by their state departments of health. This gap in knowledge of BC verification and/or designation status combined with the lack of an accurate, publicly available database to route patients and characterize BC resources creates challenges in burn care, especially in disaster preparedness. The goal of our study was to characterize the net effect of domestic BC openings and closings over the last decade on US burn resources and, thus, access to care.

Methods
Our group has recently created the National Injury Resource Database (NIRD), a comprehensive list of every US Level I and II trauma center and/or burn center. NIRD was created by culling these facilities from 1) the current ABA burn center directory, 2) the current ABA burn center regional map, 3) the American Hospital Association database, 4) the American College of Surgeons Committee on Trauma database, and 5) data from all 50 State Departments of Health. Redundant entries were omitted, and 100% of the remaining institutions were then personally contacted by one of the study investigators to confirm or clarify the status of each center as well as the resources listed in the various databases. The NIRD database was then compared to the ABA’s 2012 burn center directory to compare the number, identities, and characteristics of those US BCs which had either closed or opened in the intervening ten years.

Results
In 2012, there were 127 total BC, 63 of which were ABA verified. Currently, NIRD shows that there are 134 total BC recognized by the ABA, 76 of which are verified. Since 2012, 11 BC have been removed from the ABA’s burn center directory after either closing or failing to maintain ABA recognition, while 18 BC have been added. In the same time frame, there have been changes in BC verification status across the US, with 14 BC gaining ABA verification and 1 BC losing verification. In comparing the ABA’s current BC directory to their burn center regional map, we found variability in 18 centers across 15 states (CA, DC, IL, IN, KS, MD, ME, MI, MS, MO, NY, TN, TX, VA, VT), i.e., instances in which 1 or more BC found on the ABA’s BC regional map were not found on the ABA’s BC directory list.

Conclusions
The last 10 years have shown an upward trend in the number of US BC. Further, we found variability in the ABA’s online resources in 15 states, suggesting that their resources are outdated. NIRD can serve as a resource for the construction of publicly available real-time tools to aid in routing burn patients.

Applicability of Research to Practice
NIRD can serve as a resource for the construction of publicly available real-time tools to aid in routing burn patients.