bluuebunny/crossref_metadata_2025_split huggingface dataset:
67 Patient Self-grading of Itch within Hypertrophic Scar Does Not Correlate to Mast Cell Concentration
Authors: Molina Esteban , Travis Taryn , McLawhorn Melissa , Shupp Jeffrey , Carney Bonnie 
Published: May 2023

Abstract

Introduction
Pruritus is a common and disturbing symptom among patients with hypertrophic scars (HTSs) that contributes to morbidity after burn injury. It can impact quality of life through sleep disturbance, limitation of daily activities, and psychosocial impairment. The pathophysiology and mechanisms behind HTS itch remain unclear but HTSs have previously been reported to have higher substance P (SP) nerve fiber density, greater SP levels, and an increased number of mast cells. Itch may be due to multiple contributing factors, and is commonly treated with various drugs with different targets including anti-histamines to target mast cells. We hypothesized that patients with self-reported high itch in HTS would have a higher concentration of mast cells compared to HTSs reported to have low itch. Here, we further investigate the involvement of mast cells in HTS itch.

Methods
Patients with post-burn HTS were enrolled into an observational clinical trial. Patient and observer scar assessment scales (POSAS) were used to assess itch, among other parameters. Punch biopsies were collected from regions of HTS and normal skin (NS). Biopsies were embedded in paraffin, sectioned, and stained with Giemsa stain to identify mast cells. Patients were stratified by POSAS-itch scores into high ( &gt;5, n=6 patients) and low (&lt; 5, n=5 patients) and mast cell numbers were compared between the two groups using a Student’s t-test.

Results
The high itch group was 83.3% female while the low itch group was 40.0% female. Other patient demographics did not significantly differ between the high itch group and the low itch group, including age (47±7.25 vs 48±7.07 years), Fitzpatrick skin type (5/6 type V vs 2/5 type V), and age of scar (8.4±2.16 vs 25.5±9.95 months). On histologic examination, the high itch group had an average of 16.25±24.1 mast cells per high powered field vs 5.70±3.6 mast cells in the low itch group (p=0.336). Regardless of itch score, HTS had an average of 11.45±18.1 mast cells vs 5.7±5.4 mast cells in normal skin (p=0.334).

Conclusions
HTSs self-graded as having high itch did not have a significantly different number of mast cells present in tissue punch biopsies compared to biopsies of HTSs self-graded as low itch. Mechanisms behind scar itch remain unclear, but are likely due to other factors that are more contributory than the presence of mast cells. Further investigation of scar itch is warranted due to the burden associated with this distressful symptom.

Applicability of Research to Practice
This research shows that mast cells may not be as contributory to itch symptomatology as previously thought, which may help explain why traditional antihistaminergics are often ineffective for HTS itch. Elucidating other pathways, such as those initiated by laser treatment which has been shown to decrease itch, may provide more opportunity to characterize potential targets to effectively treat HTS itch.
75 Tranexamic Acid Reduces Burn Wound Conversion and Lung Inflammation in a Murine Comb Burn Model
Authors: Carter Damien , Kacer Doreen , Turner Elizabeth , Prudovsky Igor 
Published: May 2023

Abstract

Introduction
Burn wound conversion is a process where superficial partial thickness burns convert into deep partial and even full thickness burn injuries. Unfortunately, the pathophysiology of this phenomenon is poorly understood. A therapeutic intervention that may prevent secondary progression and cell death in burn-injured tissue is desirable. Recent work by our group has established that tranexamic acid (TXA) has significant anti-inflammatory properties in addition to its well-known anti-fibrinolytic effects. This study investigates tranexamic acid as a novel therapeutic treatment to mitigate burn wound conversion and reduce systemic inflammation.

Methods
Sprague-Dawley rats were subjected to a hot comb burn contact injury using a 150-g brass comb preheated to 100°C, to create four rectangular burns, separated by three unburned interspaces. A subset of animals underwent the comb burn injury with an adjacent 30% TBSA contact injury using solid brass rods. The interspaces represent the ischemic zones simulating the zone of stasis. The treatment group received IP injection of TXA (100mg/kg) immediately after injury and once daily until sacrifice. Sham animals underwent an identical procedure, with application of a room temperature comb. Animals were sacrificed at 6hrs and 7-day time points post-injury. Photo images were obtained of the comb burn injury. Full-thickness biopsies from the ischemic zones and lung tissue were assessed with established histological and immunohistochemical (IHC) techniques.

Results
At 7-days post injury, the percentage of ischemic zones with necrosis was significantly reduced in the treatment group when compared with untreated burn controls by photographic image analysis. When compared with controls, the treatment groups had significantly less progression of ischemic zones to necrosis when assessed by standard microscopy. These findings were consistent in both the comb burn only and comb burn + 30%TBSA injury models. The TXA treatment group demonstrated significantly more expression of the regeneration marker (CTHRC-1) and a trend toward increased expression of the Ki-67 proliferation marker when compared to untreated burn group. At 6 hours post-injury, TXA significantly decreased infiltration of neutrophils in the lungs for the 30%TBSA burn injury model. Furthermore, systemic levels of mitochondrial DNA, IL-1α and TNFα were significantly lower in TXA treated animals when compared to untreated burn controls.

Conclusions
Animals treated with tranexamic acid demonstrated reduced burn wound conversion and decreased burn-induced SIRS response. Lung inflammation was also significantly reduced by administration of TXA after injury.

Applicability of Research to Practice
Tranexamic acid and agents with similar mechanisms of action may provide a treatment to reduce burn wound conversion. This therapy could be easily incorporated into standard acute burn care practices.
80 Examining the Relationship between Burn Injury Acuity and Risk for Developing PTSD and Depression Symptoms
Authors: Shoemaker Hannah , Gavrilova Yulia , Kahn Steven , Cerre Raleigh , Gaymon Shay , Ficalora Julia 
Published: May 2023

Abstract

Introduction
Individuals who experience traumatic events are at heightened risk for developing adverse mental health outcomes, specifically posttraumatic stress and depressive symptoms. Those hospitalized following a burn injury experience significant psychological and emotional burden during acute burn treatment. Symptoms of depression and posttraumatic stress are common following a traumatic burn injury; however, little is known about the impact of burn-related intensive care unit (ICU) admission on future risk of developing posttraumatic stress disorder (PTSD) and depression. Thus, the current study examined the associations between burn injury acuity (defined by admission to ICU vs. non-ICU) and risk for developing mental health problems (i.e., depression and PTSD) among burn center patients assessed within the initial 30 days following their injury.

Methods
Participants included 286 patients admitted to the burn center at a southeastern academic medical center (Mage = 46.79, SD = 17.47; 53% White; 66% Male; 94% Non-Hispanic; 25% admitted to ICU). Patients were assessed by the hospital’s burn behavioral health program. Risk of PTSD and depression was assessed via the Injured Trauma Survivor Screen (ITSS), a validated measure used to determine risk of PTSD and depression following an injury.

Results
Independent samples t-tests revealed that ICU admission was associated with an increased risk for developing posttraumatic stress (p = .022) and depressive symptoms (p = .016) as compared to non-ICU admitted patients when assessed within the initial 30 days following a burn injury.

Conclusions
Though preliminary, results highlight the importance of considering burn acuity when evaluating risk of developing psychopathology following a burn injury. Admission to ICU appears to play a key role in individuals’ risk for developing PTSD and depressive symptoms. Both physical and emotional healing are critical components of a patient’s recovery process following a burn injury.

Applicability of Research to Practice
Given these results, it is important to prioritize promoting psychological recovery following a potentially traumatic burn injury in those admitted to ICU through early screening and intervention. Early intervention should emphasize reducing avoidance of feared stimuli, gradual exposure, relaxation strategies, social support, and behavioral activation techniques particularly for patients admitted to the ICU to help mitigate negative effects of trauma exposure that may lead to increased psychopathology.
92 Effect of Blood Transfusion on Outcomes After Major Burns
Authors: Merchant Maryum , Hu Scott , Smith Malcolm , Cohen stella , Janga Geethika , Maddineni Saineha 
Published: May 2023

Abstract

Introduction
Severely burnt patients frequently receive blood transfusions to treat anemia, increase blood volume and improve wound healing. However, transfusion is not a safe prescription as it is associated with infections and immunosuppression.

Aim
Understand blood transfusion practices and assess patient transfusion-related outcomes.

Methods
A single-center retrospective review of 113 ICU patients with &gt;20% TBSA burns from Jan 2014 to June 2022 was performed. Data collected: Age, type of burns, prior use of blood thinners, # of burn operations, hematocrit level pre and post-last transfusion, # of infections, AKI, ARDS during hospitalization, and hospital and ICU length of stay (LOS)

Statistical analysis
For univariate analysis comparing groups below to the above median of transfusions per hospital stay, a Fisher test was used to compare proportions, and either a t-test or a Wilcoxon test was used to compare continuous features. Cox proportional hazards model and logistic regression were used to analyze the survival and ARDS in multivariate analysis.

Results
Demographics
Out of 113 patients:
•94 survived admission
•54 had a concurrent inhalational injury
•21 developed ARDs
•38 developed AKI
•95 received at least 1 blood product
Median Data:
•Age: 43 years
•TBSA: 34%
•Hospital LOS: 37 days
•ICU LOS: 18 days
Mean Data:
PRBC transfusion/patient: 12
PRBC per 1% TBSA burnt: 0.36
Univariate analysis comparing the median # of transfusions per hospital LOS.
Patients who had more transfusions were mostly men, had higher TBSA burns, less inhalational injury, longer ICU and hospital stays, and more burn surgeries. They also had higher hemoglobin levels before their first transfusion and more infections. There was no difference in terms of mortality, AKI, or ARDS.
Having anemia (defined here as hemoglobin &lt; 8g/dL) before burn injury did not affect survival. After controlling for the revised Baux score and hemoglobin before initial transfusion, more transfusions per hospital day were associated with decreased survival and increased infections.
There was no association between ARDS in multivariate analysis and increased transfusions.

Conclusions
The number of transfusions per hospital day was associated with decreased survival, although not meeting statistical significance (likely due to the small sample size). Hemoglobin &lt; 8 g/dL before burns was not associated with decreased survival in multivariate analysis. On exploratory analysis, more transfusions per hospital day were significantly associated with increased infection, offering a possible reason for the negative survival association.

Applicability of Research to Practice
Understanding blood transfusion practices and outcomes improve the utilization of blood in severely burnt patients.
98 Care Discontinuity in Burn Patients: Does it Impact Long-Term Outcomes?
Authors: Castillo-Angeles Manuel , Shepler Lauren J , Orton Caitlin , Ryan Colleen , Schneider Jeffrey , Mehta Anupama 
Published: May 2023

Abstract

Introduction
Care discontinuity, or the care that is provided by disparate healthcare professionals when patients are readmitted to a hospital different than their original admission (non-index hospital), has been associated with worse outcomes among surgical patients. However, little is known about its effect on burn patients. Our aim was to determine the impact of care discontinuity on long-term outcomes in a national sample of burn patients.

Methods
The longitudinal Burn Model System National Database was queried from 1996 to 2021. All adult burn patients from participating sites were included. Care discontinuity was defined by having therapy or burn-related surgeries at non-index hospitals. The main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6 and 12 months after injury. Multivariable regression was used to examine the association between care discontinuity and long-term outcomes, adjusting for patient characteristics and burn injury severity.

Results
A total of 1,866 burn patients were included. Mean age was 43.36 (SD 15.85) years, 73% were male and 76% were white. Mean PCS scores were 43.56 (SD 10.95) and 45.17 (SD 11.18); and mean MCS scores were 48.00 (SD 12.60) and 48.25 (SD 12.55) at 6 and 12 months, respectively. Care discontinuity was reported in 423 (22.6%) burn patients, who reported having therapy or burn-related surgeries at a non-index hospital. In adjusted analyses, care discontinuity was associated with worse PCS at both 6 months (Coefficient -2.18, 95% Confidence Interval [CI] -3.44 – -0.91, p=0.001), and 12 months (Coefficient -2.16, 95% CI -3.50 – -0.82, p=0.002), compared to patients having therapy/surgery at index hospitals. Care discontinuity was not associated with MCS scores at 6 (Coefficient 0.54, 95% CI -0.04 – 2.03, p=0.473) and 12 months (Coefficient -0.90, 95% CI -2.49 – -0.67, p=0.262).

Conclusions
Care discontinuity was significantly associated with lower physical health component scores at long-term follow up, but not with mental health component scores. Future studies should focus on developing strategies to ensure continuity of care and/or identifying out of system patients to provide targeted resources.

Applicability of Research to Practice
Understanding the implications of care fragmentation on longitudinal outcomes may help clinicians develop strategies to ensure care continuity and consequently better outcomes.
115 The Association between Burn Characteristics and Body Image in School-Aged Children years 5 to 12
Authors: Patel Khushbu , Surette Kate , Ni Pengsheng , Warner Petra , Stoddard Frederick , Kazis Lewis , Schneider Jeffrey , Ryan Colleen , McGwin Madeleine , Branski Ludwik , Palmieri Tina 
Published: May 2023

Abstract

Introduction
Children ages 5 to 12 are in pivotal stages of psychological development as they become more self-aware. Body image can be a formation of both internal experiences and influences from the surrounding environment. This perceived image adapts during this age group and can be negatively impacted by the changes in physical appearance due to the burn injury. Previous research indicates older age and the presence of larger, visible burns can impact body image and self-esteem in the present and long-term. This study assessed the association between burn characteristics and the child’s ability to maintain positive body image in this age group using a new parent-reported instrument for assessment of child outcomes after burn injury.

Methods
Preliminary data was obtained from the School-Aged Life Impact Burn Recovery Evaluation (LIBRE)5-12 study, which is currently in stages of field-testing. Classic test theory methods were used to assess body image items (n = 13) from the Psychological domain. Each item was scored on a 5-point Likert scale ranging from 0 (never) to 4 (always). Data was recoded for selected items such that higher scores denote better functioning. Multivariate linear regression analyses measured the association between burn injury characteristics and body image (controlling for sex, race and ethnicity, burn injury to critical areas, total body surface area burned (TBSA), and age at survey completion). Mean body image score was calculated.

Results
Data was obtained from 356 surveys with completed body image items from parents of children with burns. The mean age at survey completion was 8.6 + 2.4 years and mean total body surface area burned (TBSA) was 9.2 + 13.9 with 55% male and 66% white. Items from body image subdomain were identified as a unidimensional scale (α = 0.91, item-total correlations &gt;0.4, ratio of the 1st and 2nd eigenvalues = 4.98). The mean body image score was 3.5 + 0.6. The presence of a foot burn (p = 0.0099), genitalia burn (p = 0.0449) and TBSA &gt;1% (p = 0.0013) resulted in a lower body image score (3.3 + 0.6, 3.1 + 0.8, and 3.4 + 0.7, respectively). In the regression model, age at survey completion was also associated with decreased body image score (β = 0.074, p &lt; 0.0001).

Conclusions
Parents reported older school-aged burn survivors often had difficulty with body image. Presence of larger burn size and injury to critical areas also worsened body image.

Applicability of Research to Practice
Burn-care providers and family members can utilize body image score to understand the burn survivor’s current body image satisfaction and assist in fostering positive body image after burn injury through assessment and early intervention.
120 A Review of Certified Burn Therapist’s Involvement in JBCR
Authors: Warthman Renee , Murray Derek , O'Neil Audrey 
Published: May 2023

Abstract

Introduction
Burn therapist certification (BT-C) was introduced in 2018 to recognize therapists with specialized skill in burn rehabilitation and promote quality burn therapy. There are currently 32 BT-Cs, representing a small fraction of therapists who rehabilitate burn patients. Barriers to certification described in a Letter to the Editor by O’Neil in 2022 included an indifference to therapy research and program development. Despite efforts to call for additional support of therapy advancement and research, therapist publications continue to be sparse. This review analyzed BT-C therapists involved in publications as one indicator of a positive impact on the field.

Methods
A review of therapist-authored manuscripts and abstracts published in the Journal of Burn Care and Research from 2018-2022 was performed. Therapy authored publications included any manuscript or abstract with a therapist listed as a lead or contributing author. Publications with only SLP, PTA, or OTA credentials were excluded. Therapists were only considered to be certified if they had achieved BT-C at the time of publication.

Results
BT-C make up not more than 15% of therapists practicing in burns, yet the percentage of therapy-authored manuscripts published from 2018-2022 with a BT-C credited author is 50%. When examining supplemental editions, 31% of accepted therapy-authored submissions from 2018-2022 included a BT-C therapist. The table compares the percentage of therapy-authored manuscripts and therapy-authored submissions from BT-C versus the percentage of BT-C using the 215 identified PT and OT members from 2008 as a conservative estimate of the floor of the number of PT and OT providing routine burn care, with the current count of BT-C at 32.

Conclusions
Estimations of the number of PT and OT working in burn rehabilitation are difficult to determine. It is assured that therapists providing care to burn patients routinely are larger in number than those who are active members in the American Burn Association in any given year. One publication revealed 215 active PT and OT members in 2008. Despite BT-C therapists making up a small percentage of the therapy community working in burn rehabilitation, BT-C therapists contributed to half of therapy publications and almost a third of abstract submissions in each area respectively, indicating that certified burn therapists have a profound, and disproportionately large, impact on formal investigation and research.

Applicability of Research to Practice
Currently there is a lack of objective information that can be presented to administrators to validate support of the burn therapist certification. Supporting certification may promote quality care through involvement in research furthering best practice.
503 The Accuracy of the Revised Baux Score in Predicting Burn Mortality: A Systematic Review
Authors: Bond Stephanie , Edgar Michael , Jiang Sam , Scharf Isabel , Bejarano Geronimo , Vrouwe Sebastian 
Published: May 2023

Abstract

Introduction
Osler et al. revised the Baux score in 2010 to include inhalation injury, attempting to improve upon the original 1961 model given the significant advances in modern burn care. Other predictive models of burn mortality have similarly been developed using use an assortment of other variables, however there is no consensus on the preferred formula to use. This systematic review aims to investigate the accuracy of the revised Baux (rBaux) score in comparison to other models when determining mortality risk in patients with burn injuries.

Methods
A systematic review was performed by two independent reviewers using electronic databases (PubMed, EMBASE, Scopus) from March 1, 2010 to May 22, 2022. The majority of studies were classified as “high” quality and no studies were excluded due to risk of bias. Articles were included if they were published in English and assessed risk of mortality from burns using the rBaux model and an alternative model. The PRISMA statement was followed, and all the PROBAST quality appraisal checklist was used during data extraction.

Results
The search identified 79 non-duplicate citations, of which 33 underwent full-text review, and 21 met inclusion criteria. They assessed the predictive ability of the rBaux score in comparison to the original Baux score, Belgian Outcome for Burn Injury, Abbreviated Burn Severity Index, APACHE II, Sequential Organ Failure Assessment score, Boston Group/Ryan scores, the FLAMES model, the Prognostic Burn Index, and several other equations that have not been externally validated. The accuracy of mortality prediction (area under ROC curves) for the rBaux score ranged from 0.68 to 0.99 and 14 studies found a value greater than 0.90. These ROC values were found to be lowest in the two studies with subgroupings for age, demonstrating an ROC of 0.01 in children, and 0.68 and 0.92 in the elderly. Eleven studies described sensitivity, specificity, or both, with sensitivity ranging from 12% to 96%, and specificity ranging from 80% to 100%.

Conclusions
The rBaux score offers a relatively easy method to rapidly assess the mortality risk from burn injury in a broad range of patient populations based on age, percent total body surface area burned, and presence/absence of an inhalation injury. This tool remains valid despite the exclusion of patient comorbidities and other injury-related factors. However, this study also identified the rBaux’s ability to predict mortality risk was limited when applied to patients at the extremes of age, highlighting an important area for future research. At present, given its relative simplicity and generalizability, the rBaux score remains a useful clinical tool for predicting mortality.

Applicability of Research to Practice
The rBaux score remains a simple yet powerful predictor of mortality in burn patients, which can be applied at the bedside on initial presentation across diverse patient populations.