bluuebunny/crossref_metadata_2025_split huggingface dataset:
512 Mean Arterial Pressure, Morbidity, and Mortality Associated with Necrotizing Soft Tissue Infection
Authors: Grossman Holly , Marschke Brianna , Pang Alan , Griswold John , Bharadia Deepak 
Published: May 2023

Abstract

Introduction
Adequate mean arterial pressure (MAP), or the average pressure in arteries during one cardiac cycle, plays an important role in ensuring adequate blood flow and perfusion in critically ill patients. MAP values of 65 mmHg or greater have been widely regarded as the ideal value for hospitalized patients in the past, especially those suffering from septic shock. Necrotizing soft tissue infections (NSTIs) present a unique challenge due to their rapid progression and high mortality, which creates the need for specific diagnostic and treatment guidelines that differ from those directed toward the care of sepsis secondary to other causes. Further research is still required to better understand the complex interactions between mean arterial pressure and morbidity and mortality among those with necrotizing soft tissue infections.

Methods
Data was collected from a retrospective cohort study of 50 adult patients hospitalized with an NSTI from 2015-2021. MAP ranges in the first 48 hours of admission were sorted into four categories: under 60 mmHg, 60-69 mmHg, 70-79 mmHg, and above 79 mmHg. We investigated outcomes relating to increased morbidity, including need for repeat debridement, need for dialysis, or development of acute kidney injury. Statistical logistic regressions were fitted to model the outcome as a function of the available pool of predictors: demographic variables, co-morbidities, and hemodynamic variables, such as MAP and use of vasopressors.

Results
In this small study, we found no significant association between time spent in different MAP groups or vasopressor volumes on the need for repeat debridement for NSTI patients or overall patient morbidity and mortality (p=0.1742). Patients who were significantly more likely to need a repeat debridement included those with previously diagnosed diabetes and hypertension (p=0.0485 and 0.0252, respectively).

Conclusions
NSTI patients can tolerate mild fluctuations in MAP without these pressures significantly impacting their need for repeat debridement or other sources of morbidity. However, patients who are hypertensive at baseline or diabetic are significantly more likely to require a second surgery, necessitating a more extensive primary debridement.

Applicability of Research to Practice
Patients hospitalized for NSTI can fluctuate at pressures below the established MAP goal of 65 mmHg without a significant need for pressors. Those with a history of hypertension or diabetes should be followed closely for possible spread of infection after primary surgery.
513 Lovenox Titration in Burn Patients: Does a One Size Fits All Model Work?
Authors: Wamakima Anita , Anderson Jeffrey , Rae Lisa , Hyman Jessica , Romano Devon , Zhao Huaqing , Lu Xiaoning 
Published: May 2023

Abstract

Introduction
Venous thromboembolism (VTE) presents a significant morbidity to burn injured patients. The Western Trauma Association (WTA) and American Association of Trauma Surgeons (AAST) have recently developed guidelines for VTE prophylaxis dosing in trauma patients in which doses are adjusted based on anti-Xa levels. We sought to determine whether adopting these guidelines would lead to improved VTE prophylaxis in patients admitted to our burn service.

Methods
We initiated a protocol at our American Burn Association verified burn center of titrating VTE prophylaxis for our patients based on anti-Xa levels consistent with the WTA and AAST guidelines. We performed a retrospective chart review of all patients in which anti-Xa levels were measured between May and October 2022. Chi square, Fisher's exact, and ANOVA were used to analyze the data.

Results
A total of thirty six patients met our inclusion criteria. Age (49 [35.0, 61.0]), BMI (26.7 [6.8]), gender (67% male), and percent total body surface area (4.5 [2.0, 10.5]) were not statistically significant. Patients with a final lovenox dose of 30mg twice daily required a significantly lower dose adjustment than patients with a final lovenox dose of greater than 30mg (5.1 vs 7.9, p=0.0003). While not statistically significant, there was a trend for patients with a final lovenox dose of greater than 30mg twice daily to have larger percent TBSA affected (6.0 vs 13.6, p = 0.079). When comparing patients whose final dose of lovenox was less than, equal to, or greater than their initial dose, there was a significant difference in dose adjustment between patients whose lovenox had to be decreased as opposed to those who had to be increased (10.0 vs 15.8, p&lt; 0.0001). None of our patients suffered a VTE event over the study period.

Conclusions
A “one size fits all” approach to VTE prophylaxis in burn patients may lead to inappropriate prophylaxis. Our study demonstrates that titration of VTE prophylaxis with lovenox using anti-Xa levels in the burn population is feasible and that patients with burns may require individualized dosing for appropriate prophylaxis.

Applicability of Research to Practice
Our research demonstrates that titration of VTE prophylaxis in a burn population may be more appropriate than the traditional “one size fits all” approach.
516 Negative Pressure Wound Therapy in Burns: A Prospective, Randomized-Controlled Trial
Authors: Tapking Christian , Endlein Jonathan , Warszawski Jan , Kotsougiani-Fischer Dimitra , Gazyakan Emre , Hundeshagen Gabriel , Fischer Sebastian , Hirche Christoph , Kneser Ulrich 
Published: May 2023

Abstract

Introduction
Negative pressure wound therapy (NPWT) is a widely used tool for the treatment of complex wounds, including burns. However, there is only little data comparing NPWT to other wound dressings. This study aimed to evaluate the effectiveness of NPWT in small, acute burns of upper and lower extremities and to compare to the standard of care (SOC) at our institution.

Methods
Patients that were admitted to our institution with burns on extremities between 0.5 and 10% of the total body surface area (%TBSA) burned were included and randomized to either NPWT or SOC (polyhexanide gel, fatty gauze, and cotton wool). Treatment was performed until complete wound healing. Patients that required skin grafts, received NPWT independent on the group. Patients pain level, time to wound healing, number of dressing changes and functional outcomes were assessed.

Results
Sixty-two patients with burns, admitted between May 2019 and November 2021, were randomized into treatment with NPWT (n=32) or SOC (n=30). Both groups were similar regarding age (38.6±12.2 vs. 45.1±16.0 years, p=0.080), total burn size (2.95±2.42 vs. 3.31±2.93 %TBSA, p=0.595) and treated wound size (1.84±1.41 vs. 1.38±0.93 %TBSA, p=0.137). There were significant differences regarding healing time (11.19±4.92 vs. 8.70±3.58, p=0.027) and number of dressing changes throughout the study (2.19±1.49 vs. 3.97±1.69, p&lt; 0.001). There were no differences in necessity of surgery (12.5% vs. 13.3%, p=0.329) pain assessments or functional outcomes.

Conclusions
Healing time was longer in the NPWT, whereas NPWT group needed less dressing changes. This may be a psychological and logistical advantage. No differences were found regarding necessity of surgery pain and scarring.

Applicability of Research to Practice
NPWT is safe in small burns and can lead to fewer dressing changes and pain.
518 Autologous Skin Cell Suspensions for Reconstruction of Nonthermal Soft Tissue Wounds: A Case Series
Authors: Deville Paige , Lovick Elle , Carter Jeffrey , Phelan Herbert 
Published: May 2023

Abstract

Introduction
Based on studies showing the use of autologous skin cell suspensions (ASCS) leads to burn wound closure with significantly smaller amounts of harvested donor skin, the Food and Drug Administration approved the first ASCS for the reconstruction of thermal injuries in September, 2018. The benefit of needing less donor skin to heal a given soft tissue wound has led to off-label usage of ASCS in a variety of clinical situations, such as necrotizing soft tissue infections (NSTI), toxic epidermal necrolysis (TEN), and traumatic injuries with soft tissue loss among others. Here, we report on a single-institution case series of ASCS usage for closure of soft tissue wounds caused by nonthermal mechanisms.

Methods
We performed a retrospective chart review of all patients treated with ASCS for an indication of non-thermal soft tissue wounds at our American Burn Association-verified academic burn center between April 1, 2018 to June 1, 2022. Descriptive demographic data were collected.

Results
Eight patients (6 male/2 female, mean age 57 + 17 yrs, mean length of stay 46 + 30 days) were found to have undergone closure of their wounds using ASCS during the time period of the chart review. Indications were NSTI (n=2), frostbite (n=2), antiphospholipid syndrome (n=2), and TEN (n=2). ASCS was used as a sole therapy for the TEN patients while ASCS was used in combination with meshed autografting for all other patients. The mean size of wounds treated with ASCS was 2835 + 2670 cm2, and the mean ASCS take rate was 86 + 7%. No ASCS-related complications were found.

Conclusions
These results bolster the off-label use of ASCS solutions for closure of nonthermal wounds while the surgical world awaits the results of an ongoing Phase III trial on this question

Applicability of Research to Practice
This study seeks to contribute to the literature supporting off-label uses of ASCS in non-thermal injuries & diseases.
521 Silk A Biological Dressing for Superficial Burns Treatment: Randomized Controlled Trial Versus Silver Sulfadiazine
Authors: Dantzer Eric J 
Published: May 2023

Abstract

Introduction
Silver Sulfadiazine is currently the standard treatment for superficial second-degree burns. These burns are common and should not necessarily require hospital treatment. However, caretaking may become an issue: dressing technique is not always mastered by home health care nurses, their practical realization may be more difficult considering the surface to be treated; duration of care can also be too long and painful. We have evaluated the interest of a dressing based on natural silk with this indication.

Methods
In a preliminary study, we have compared SSD to silk dressing (S) in the treatment of 2nd degree burns. Following diagnosis, the topical to be used was determined by drawing of lots. The SSD associated with fatty gauze was applied and then covered with dry gauzes and bandages. Silk was applied directly on the lesion and then covered with dry gauzes and bandages. Dressings were changed every 48 hours. The SSD was changed with each dressing after cleansing the lesion with saline; the silk one was left in place until healing, only the dry gauzes and bandages were changed. Pain, duration of care and healing time were assessed.

Results
80 patients were included 25 men, 15 women (7 to 83years) were treated with SSD; 22 men, 18 women (17 to 84 years) with silk. The average surface area treated was 5% in both groups (1% to 20% SSD) and (1% to 23% S). Pain (EVA) was evaluated between 3 and 4/10 for the SSD group and 0 to 2 for the S group. Dressing duration was 20-30 minutes for the SSD group and 10-15 minutes for the S group. The average healing time was 13 days for both groups. 2 complications, as infections , were observed in each group.

Conclusions
The flexibility of silk facilitates smooth application on all surfaces and localisations like SSD. Silk treatment has the same healing time as that obtained with SSD, i.e. the physiological healing time of 2nd degree superficial burns. Silk has allowed shorter treatments, because it is technically simple, and less painful as the lesion was never exposed to air. This allowed reduction of analgesics. A larger study should confirm that 2nd degree burns can be managed with silk dressing as outpatients, by home health care nurses, inexperienced in burns and even for larger surfaces and reduce the cost effective of the treatment and the need for painkillers.

Applicability of Research to Practice
immediate
532 The Impact of a Clinical Pharmacist on Medication Management in an Adult Burn Clinic
Authors: Boyd Allison , Walroth Todd , Meadows Katherine , Spera Leigh , Hartman Brett 
Published: May 2023

Abstract

Introduction
Pharmacists in our burn center have historically assisted with discharges and transitions of care for patients sent home or to a facility. Despite these efforts, pharmacists were not formally involved in managing burn clinic patients. Collaborative Drug Therapy Management (CDTM) protocols allow pharmacists working within a defined context to independently assume responsibility for direct patient care activities. The goal of implementing this model in our clinic was to improve access to care and streamline management of pharmacologic issues. The objective of our study was to assess the impact of a clinical pharmacist on medication management in an adult burn clinic via a CDTM protocol.

Methods
The CDTM protocol allows pharmacists to independently manage the following disease states via in-person or telephone visits: pain, agitation, delirium, insomnia, venous thromboembolism, skin/soft tissue infections, and hypermetabolic complications. All treatment decisions, interventions, and education are documented in the electronic record. “Incident-to” billing is completed at Level 99211. All pharmacist visits between 1/1/22-9/21/22 were included for review in the study. Demographics were reported for unique patients, and interventions were included from each visit for patients with multiple pharmacist visits.

Results
A total of 19 patients were seen at 39 visits with a clinical pharmacist during the study. Patients were mostly males (84%) with a mean (SD) age of 45 (18) years. Majority of patients were in-state (95%), with 11 (58%) being from an outside county. Patients were seen for a median (IQR) of 2 (1,2) visits each. Additional interventions were made in 12 patients (63%) at 19 visits (49%), including medication reconciliation [16 (41%)], medications ordered [14 (36%)], labs ordered [2 (5%)], referrals placed [1 (3%)], and allergies addressed [1 (3%)]. At applicable visits, patients had a median (IQR) of 2 (1,2) interventions made or 2 (1, 3) medications ordered.

Conclusions
Historically, pharmacists were only involved with clinic patients when issues arose, serving in an “as-needed” capacity. Pharmacists are now able to proactively help with medication reconciliation, medication prescribing, ordering labs, and placing referrals. Implementing a CDTM protocol has allowed our pharmacists to become more formally involved in post-discharge follow-up and managing ambulatory burn patients.

Applicability of Research to Practice
To our knowledge, ours is the first burn center to implement a Clinical Pharmacist CDTM Protocol, which may serve as a framework for others. Future directions include continuing to track data for adherence, medication access, billing/reimbursement, and clinical outcomes.
535 Influence of Covid-19 Pandemic Conditions on the Features of Pediatric Minor Burn Injuries
Authors: Abali Ayse Ebru , Aydogan Cem , Kamilova Semra , Turkmen Nigar , Santelis Santiago , Haberal Mehmet 
Published: May 2023

Abstract

Introduction
Majority of pediatric burns are minor injuries. Social life changes due to Covid-19 pandemic may have influenced their characteristics. We compared the features of pediatric burn cases which were treated as outpatients at our center before and during Covid-19 pandemic.

Methods
The records of 658 patients were reviewed. The study group was evaluated in two groups; Group I: patients-treated between March 2018 and February 2020 (pre-pandemic) (n=350), Group II: patients-treated between March 2020 and February 2022(Pandemic) (n=308). Data collected for each case were age; sex; insurance status, place of residence; burn-causes, extent of burns; body-site affected; time and environment where the injury occurred, time-interval between occurrence of injury and admissions to the burn-center; (mean± SE, p&lt;.05).

Results
Mean age (years) was 4,32±0,24 for Group I, it was 4,32±0,18 for Group II; male:female ratio was 0,87:1 in Group I, it was 1,1: 1 in Group II; mean total surface area burned was 1,94±0,14 % (min:0,5, max:16) in Group I, and it was 1,98±0,26% (min:0,1 max: 16,1) in Group II (p&gt;.05). Most of the patients were from urban areas and were covered by social security system in both groups (p&gt;.05). Injuries occurred between 06:00 and 18:00 in 63,7% of Group I and in 62,6% of Group II (p&gt;.05). The most common scenario was the domestic environment for both groups with a rise in rates of outdoor-burns Group II (p&lt;.05) and this rise was observed during the ‘new normal’ period, but not during the ‘lock-down’(p&lt; .05). The most common burn-cause was the scalds for both groups (p &gt;.05). Hands, trunk, head and neck regions were less frequently involved in group II (p&lt;.05). Rates of direct admission were similar for both, but children in Group II were more frequently brought to our burn center on the day of injury (p&lt;.05).

Conclusions
The decrease in injuries to hands, trunk, head and neck, and the increase in admissions on the day of injury were remarkable during pandemic period. These results may be clues for enhanced care-giver precautions against injuries during ‘stay home’ days. Increased frequency of outdoor burns during ‘new normal’ may indicate the negative effects of this new unfamiliar social life on care-giver watchfulness. However, increased admissions on the day of the injury may be influenced both by the changing social conditions of care-givers and the uninterrupted service of our burn center while others were serving for covid-19 patients rather than burn victims.

Applicability of Research to Practice
This study helped to make recommendations for evidence-based interventions to decrease factors associated with pediatric minor burn injuries before, during and after pandemic
539 Contact Burns Associated with Concomitant use of Methamphetamines and Heat Stroke, Resulting in Neurological Sequela
Authors: Glennon Colleen , Richey Karen , Foster Kevin 
Published: May 2023

Abstract

Introduction
On a summer day in the desert southwest, ground surfaces can soar to 180 degrees Fahrenheit, posing significant risk to individuals who sustain contact with such surfaces, particularly if unable to get up. These individuals are also at risk for heat stroke. This summer, an increased number of patients admitted with contact burns were positive for methamphetamine and concomitant heat stroke. The purpose of this case series is to describe the hospital course and outcomes of this subset of patients.

Methods
A retrospective chart review of patients admitted between June and September 2022 was completed. Criteria for inclusion included contact burn, initial core body temperature &gt; 38.8°C, and a methamphetamine positive drug screen. Outcome measures included length of stay, discharge disposition, number of operations, admission Glasgow Coma Score, neurology work-up and sequela.

Results
A total of 23 patients were admitted who suffered contact burns and tested positive for methamphetamine. Ten of those patients had core body temperatures greater than 38.8°C upon initial evaluation. The mean age was 36.6 years (24-62), with an average temperature of 42.3°C (40.5-43.1°. All 10 were found down in the community with altered mental status, the average Glasgow Coma Scale was 5.9 (3- 12). CT scans were done on 9, all were negative for acute intracranial abnormalities. Neurology was consulted for 3 patients with 2 having EEGs performed, both displayed slowing and attenuation secondary to hyperthermia. Ten of these patients were concurrently positive for fentanyl. The mean total burn surface area burned was 9.6% (4-17.5%), The average number of operations was 4.1/patient (1-11). Of the 8 patients discharged the average LOS was 30 days (10-61), 2 patients remain hospitalized in the ICU with a current LOS of 61-71 days. Of the 8 patients discharged, all required post-acute care with only 1 meeting rehabilitation criteria.

Conclusions
Elevated temperatures in the Southwestern United States have been known to cause an increase in surface-related contact burns during the summer months. Historically, the at-risk patient population has been elderly individuals prone to falls with limited physical ability to get up. This summer highlighted a new phenomenon of younger individuals suffering both contact burns and heat stroke secondary to the combination of methamphetamine use and elevated summer temperatures. This patient population suffered significant morbidity, and none were able to be discharged home. This case series highlights the dangers posed by ambiently heated surfaces during the summer months, particularly in combination with illicit drug use.

Applicability of Research to Practice
This case series, demonstrates the increased risk of sequela associated with burn patients who have comorbid substance abuse disorder.
540 Psychiatric Illness and Substance Abuse: Unaddressed Factors in Burn Injury
Authors: Won Paul , Johnson Maxwell , Stoycos Sarah , Gillenwater Justin , Yenikomshian Haig 
Published: May 2023

Abstract

Introduction
Patients with psychiatric illness and substance use disorder have high rates of burn injuries. These patients require multidisciplinary care and experience prolonged admissions. Less is known about these patients after discharge due to challenges such as poor healthcare literacy and inequities to healthcare access. This study characterizes this marginalized population’s inpatient burn care and post-discharge outcomes compared to the general burn population.

Methods
Patients who were admitted to a single burn center from January 1st, 2018 to June 1st, 2022 were included. Patient demographics, history of psychiatric disorders, burn and psychiatric treatment data, and post-discharge outcomes were collected.

Results
A total of 1,660 patients were included in this study, of which 91 (6%) patients had psychiatric comorbidity and/or substance use disorder. These 91 patients had an average age of 36 years (standard deviation (SD): 12 years). In this cohort, the majority of patients were undomiciled (66%) and male (67%). On admission, 66 (72%) patients reported recent illicit substance use or had positive urine toxicology results. At the time of burn injury, 25 (28%) patients had a pre-existing psychiatric disorder. Patients were treated most for self-inflicted burns, with 36 (40%) patients presenting with burns secondary to self-immolation. In this population, 67 (74%) patients required inpatient psychiatric intervention, of which 31 (46%) were placed on a psychiatric hold. After discharge, 39 (43%) patients returned to the hospital for outpatient follow-up. The readmission rate for patients with psychiatric or substance use comorbidity was greater than 4 times higher than that of the general burn population (31% vs 7%). The most common cause of readmission were subsequent mental health crisis (40%) and inability to perform burn care (32%).

Conclusions
Burn patients with psychiatric disorders and substance abuse are most often young men who exhibit self-harm. These patients have limited outpatient follow up and access to support outside of the hospital. High readmission rates for subsequent mental health crises and inability to perform basic wound care exemplifies inadequate short-term care for this marginalized population.

Applicability of Research to Practice
In the short term, patients with psychiatric and substance use disorders may benefit from additional professional support and treatment to address burn care and comorbidities after burn injury.