bluuebunny/crossref_metadata_2025_split huggingface dataset:
752 Burn Rehab Guidelines Following Application of Cultured Epithelial Autografts For Closure of Large Burn Wounds
Authors: Sabbatini Sarah , Hill David 
Published: May 2023

Abstract

Introduction
As the use of CEA by burn surgeons becomes more widespread, the existence of an experienced and dedicated burn therapy team, educated in post-operative care and treatment of CEA, is essential to short and long-term success of patients post-CEA, and their ability to achieve and maintain maximum functional status. Early mobilization of patients is an important aspect of treatment in the BICU, and has demonstrated a positive effect on patient outcomes throughout the continuum of care. However, postoperative treatment practices following application of CEA vary across burn centers, depending on experience and perceptions of CEA fragility and expense.
The objective of this case series is to review one burn center’s therapy treatment plan before and after CEA application, and short and long-term outcomes in response to early implementation of therapy interventions. The hypothesis is early mobilization of patients after CEA can be achieved without negative consequence of graft loss.

Methods
This single-center, retrospective case series utilized electronic chart review to assess patients admitted between Apr '15 and Apr '20 who received CEA. Demographics, injury characteristics, surgical procedures collected. Therapy interventions and outcomes also collected, including postoperative therapy treatment plans, functional status at and following discharge, and occurrence of graft loss and contracture formation. Data collected analyzed with descriptive statistics.

Results
8 patients met inclusion criteria for the case series. Median post-operative day for initiating positioning techniques post CEA application was POD0 (0,0); POD6.5 (3.75,7) for active, passive elongation; POD12 (11,15) for out of bed mobilization, functional mobility training; POD25 (17.75,25) for return to treatment in therapy clinic. All 8 patients demonstrated 0% occurence of graft loss and 0% contracture formation; none of the patients required reconstructive surgical procedures as a result of decreased joint mobility. In addition, 6 out of the 8 patients were admitted to the burn-specific inpatient rehab program, and all achieved a functional status of independent community locomotor upon discharge, including return to work and leisure activity.

Conclusions
Early implementation of therapy interventions by burn therapists trained in post-op treatment of CEA resulted in optimal short and long-term functional patient outcomes following closure with CEA. Early mobilization of patients in the BICU post-CEA did not result in any graft loss related to therapy treatment, despite the increased risk for shearing due to the physiological structure of CEA. 75% of patients reviewed in this case series achieved functional mobility skills required for independent living upon discharge, as well as return to work or leisure activities, after receiving treatment in a burn-specific inpatient rehabilitation facility within the burn center.

Applicability of Research to Practice
n/a
754 A Longitudinal Study of Compression Therapy in Pediatric Burn Patients
Authors: Tran Sinh , Han Syra , Saade Daoud Maria , Gupta Deepak 
Published: May 2023

Abstract

Introduction
Compression Therapy is crucial to managing and preventing hypertrophic scarring. The pediatric population can be especially at risk for hypertrophic scarring due to rapid growth periods and/or discomfort which interferes with compliance. Our previous practice was for pediatric patients to be scheduled every 6 -12 months like the adult burn population. To address this issue, we hypothesized pediatric patients would benefit from more frequent follow up visits. We arbitrarily determined to follow our pediatric patients every 3-4 months for garment remeasuring to improve proper garment fit, efficacy and compliance.

Methods
A longitudinal study was conducted to determine whether 3–4 month interval check-ups would improve compliance of garment wearing and presumably efficacy of overall management of hypertrophic scarring. Data was collected between June 2020 – December 2021 (1 ½ years). The data was manually retrieved from our Electronic Medical Record.

Results
Prior to June 2021, children were routinely scheduled in the Burn Clinic at intervals between six and twelve months for scar checks (same as adults). Children were not able to participate in long term compression therapy for the entire interval for several reasons including growth, size changes, garment failure, expired insurance authorization, and possibly lack of knowledge.
We decided to schedule consistent follow-up of pediatric patients every 3-4 months, to ensure consistent remeasuring of garments was completed.
Pre intervention results noted that only 35% of patients had a 2nd garment remeasured as compared to our post intervention results which showed that 88% of patients successfully had a 2nd garment remeasured.

Conclusions
Our data suggests that short interval follow up with pediatric burn patients for scar management has led to improved rates of compression therapy compliance and presumably efficacy.

Applicability of Research to Practice
We have continued the practice of short term follow up in pediatric burn patients for scar management and our data has also provided opportunities to reinforce education with patients and their families. We have found that with better understanding, our patients and families are motivated to seek out and comply with longitudinal care.
757 Diabetes Mellitus Associated with Worse Outcomes in Stevens-Johnson Syndrome and Related Diseases
Authors: Chandran Keshav , Ozhathil Deepak 
Published: May 2023

Abstract

Introduction
Stevens-Johnson Syndrome(SJS),toxic epidermal necrolysis(TEN), and SJS/TEN Overlap Syndrome are on the same spectrum of severe blistering skin diseases affecting mucosal surfaces of the body.They have an immunological etiology and are caused by toxins, drugs, or infectious agents. The mortality rate for patients with these conditions ishigh, but there is limited research on the outcomes for those patients with additional comorbidities.This study investigates the association of inflammatory conditions such as diabetes mellitus, obesity, and tobacco usage have on the outcomes of patients with SJS or related disease. It was predicted that each of these comorbidities would be associated with higher rates of mortality and disease complications.

Methods
This study is a retrospective observational cohort study using the TriNetX Research Network, which provides deidentified electronic medical data from health care organizations all over the world. TriNetX was used to perform a search and analysis for patients with SJS, SJS-TEN Overlap Syndrome, and TEN as well diabetes mellitus(DM), tobacco usage(TU), or overweight/obesity status.A fourth, control cohort of patients without any comorbidities was also included. In total, 8,962 patients were included in the study: 6,348patientsin the control group;426 patients in the TU group; 1,186 patients in the DMgroup, and 1,002 patients in the Obesity group. Outcomes measured were rate and incidence of pneumonia, sepsis, and endotracheal intubation. Outcome variables from each of the four cohorts were analyzed with a total of six unique comparisons. Statistical analyses used included measure of association, Kaplan-Meyer Survival Curve, and measure of incidence.

Results
Compared to the control group, the DM group had a mortality rate14.3% higher(CI 95%, 11.8% -16.9%), pneumonia rate7.6% higher (CI 95%, 5.4%-9.9%), sepsis rate 4.7% higher (CI 95%, 6.9%-11.4%), and endotracheal intubation rate of 1.9% higher (CI 95%, 0.8%-3.0%). Furthermore,compared to the Obesity group, the DM group had a mortality rate 11.6% higher (CI 95%, 8.5%-14.8%)and sepsis rate 4.7% higher (CI 95%, 1.7%-7.6%). Compared to the TU group, the DM group had a mortality rate 12.4%higher(CI 95%, 8.5%-16.3%)and sepsis rate 8.1% higher (CI 95% 4.7%-11.6%). Besides this data on the DM group, the Obesity group showed statistically significant worse outcomes as well. Compared to the control group, the Obesity group showed a mortality rate 2.7% higher (CI 95%, 0.5%-4.9%), pneumonia rate 5% higher (CI 95%, 2.7%-7.3%), sepsis rate 4.5% higher (CI 95%, 2.3%-6.6%), and intubation rate of 2.1% higher (CI 95%, 0.8%-3.4%).

Conclusions
Diabetes mellitus is associated with worse outcomes for patients with SJS, SJS-TEN overlaps, or TEN compared to obesity and tobacco usage.

Applicability of Research to Practice
This data argues the importance of examining a patient’s past medical history when evaluating their prognosis for SJS, SJS-TEN overlaps or TEN.
758 Correlation between initial and diagnostic bronchoalveolar lavage isolates among patients with inhalation injury and pneumonia
Authors: Gaskins Devin , Coston Taylor , Arbabi Saman , McClellan John , West T Eoin , Stewart Barclay , Bailey Austin 
Published: May 2023

Abstract

Introduction
Inhalation injury is associated with increased risk of pneumonia. Bronchoscopy with bronchoalveolar lavage (BAL) is commonly used to diagnose and grade inhalation injury while obtaining a microbiological sample. It has been shown that a quarter of patients with inhalation injury have a single bacteria isolated from initial BAL within 12-48 hours of injury. The clinical significance of this and role of antibiotics in this setting are unknown. We investigated the incidence that bacteria isolated during a pneumonia episode were previously isolated on surveillance BAL among patients with inhalation injury.

Methods
Among patients with inhalation injury admitted to a large ABA-verified burn center from 2009-2022, microbiological isolates from initial BAL and subsequent culture obtained during a pneumonia episode (BAL, sputum), were extracted from medical records. Abbreviated injury severity score (AIS) was used to grade inhalation injury. Hospital-acquired pneumonia (HAP) was defined using CDC PNU1 criteria, and ventilator-associated pneumonia (VAP) was defined using PNU2 criteria with BAL cutoff &gt;10,000 colony forming units (CFU).

Results
Two-hundred forty-eight patients with inhalation injury who underwent bronchoscopy for airway inspection and surveillance BAL within 48 hours of injury were included in the analysis. Of the 111 who had a bacterial isolate from initial BAL, 23 (21%) subsequently developed HAP or VAP during the hospitalization. Median (IQR) days between bronchoscopy and pneumonia diagnosis was six (2-8.5). In three of the 11 VAP cases (27%), the organisms identified at pneumonia diagnosis matched the organisms identified on initial BAL. Antibiotic use on admission was not associated with re-culture of initial BAL organism during a subsequent pneumonia episode (p=0.071).

Conclusions
Among patients with inhalation injury and bacteria isolated on surveillance BAL, 21% developed pneumonia during their hospital stay, usually with different bacteria than those isolated at initial bronchoscopy. There was no association between empiric antibiotic use and incidence of initial BAL organisms re-cultured during subsequent pneumonia episode.

Applicability of Research to Practice
Findings suggest initial BAL isolates cannot guide empiric coverage of pneumonia for patients with inhalation injury. This remains an important area of future research.
759 Comparing Burn Model System and ABA Registries: Differences in Sample Demographics and Burn Characteristics
Authors: Bamer Alyssa , Humbert Andrew , McMullen Kara , Carrougher Gretchen , Stewart Barclay , Gibran Nicole , Kowalske Karen , Schneider Jeffrey , Solis Kyra Jeanine , Suman-Vejas oscar , Yenikomshian Haig , Amtmann Dagmar 
Published: May 2023

Abstract

Introduction
The Burn Model System (BMS) collects longitudinal data on burn survivors. This provides a unique resource for the burn research community, however, as patients are only enrolled in select sites across the United States, it is important to examine how similar the BMS participants’ demographics and burn characteristics are compared to the broader burn community. The purpose of this study was to compare burn survivors in the BMS to those in the American Burn Association’s (ABA) National Burn Registry (NBR).

Methods
Demographic (age, sex, and race/ethnicity), injury (total burn surface area, etiology, presence of inhalation injury), and treatment (length of acute hospital stay, ventilator days) characteristics (as categorical variables) were compared between the BMS and ABA NBR for those with acute burn injuries from 2009 to 2014 who survived to hospital discharge. Differences and 95% confidence intervals were calculated for each category for adult and pediatric participants. Due to the large sample size and high power to detect non-meaningful differences, clinical significance was determined with the following criteria: a difference of &gt;10% was major, 5-10% was minor, and &lt; 5% was inconsequential.

Results
A total of 1,080 BMS (765 adult; 315 pediatric) and 111,270 ABA NBR (77,528 adult; 33,742 pediatric) burn survivors were analyzed. Among adults, no notable differences were present for demographic characteristics. However, adults in the BMS had lower rates of injuries caused by scalding, higher rates of burn size over 15%, hospital stays more than 7 days, and any ventilator use. Similar trends were seen in children, however, BMS pediatric participants tended to be older, identified more frequently as Hispanic, and had higher rates of inhalation injury compared to the ABA NBR.

Conclusions
Differences in demographic characteristics were inconsequential between the BMS and ABA NBR among adults. As expected, given the BMS inclusion criteria, BMS participants had more severe burns on average. Among children, major differences existed in many demographic, injury, and treatment characteristics. In part, these differences can be attributed to the difference in enrollment criteria between the databases and the over-representation of children from a single BMS site. Expanding the number of BMS centers and standardization of variables to allow for matching on inclusion criteria may improve the ability to compare the BMS with other samples.

Applicability of Research to Practice
Due to differences in inclusion criteria, the BMS and ABA NBR differ in many patient characteristics.
767 Tracking Changes in Pain Ratings between Admission to Discharge at a Regional Burn Center
Authors: Smith Lisa , Khan Iman , Lagziel Tomer , Cox Carrie , Caffrey Julie , Lerman Sheera 
Published: May 2023

Abstract

Introduction
The complex nature of burn pain has debilitating effects on burn patients’ physiological and psychological wellbeing. Characterized by its overwhelming intensity and extensive duration, burn pain involves inflammatory and neuropathic components. These pain responses vary in depth, severity, and sensation during and after the healing process. Despite best efforts, burn pain remains a widespread challenge for providers to effectively predict and address.

Methods
A retrospective chart review of 442 patients admitted to the Burn Center for treatment of burn injuries between January 2015 and February 2022 was conducted. Charts of patients age &gt;18 and length of stay &gt;4 days were included in the analysis. Mean age on admission was 50.13±17 years and 34% of the sample were female. Data on clinical and demographic factors was extracted electronically and manually from patients’ electronic medical records. Numerical pain scale ratings documented by nursing were averaged for the first and last 48 hours of patients’ hospital stay. Linear regression analysis was performed to assess significant predictors of pain prior to discharge.

Results
We controlled for TBSA, length of stay, gender and psychiatric diagnosis and discovered that pain within the first 48 hours of admission and age were statistically significant predictors of average pain prior to discharge. Specifically, younger age was associated with increased pain ratings. When comparing average pain levels between the first and last 48 hours, 22% reported an increase of more than 1 point in their pain, 42% had no difference in average pain ratings, and 36% reported a decrease of more than 1 point. Prior to discharge, 36% of the sample reported pain higher than 6 and 17% reported pain greater than 7.

Conclusions
Heightened pain is challenging in burn injuries even prior to discharge, especially for younger patients and those who report initial high levels of pain. For many burn survivors, pain remains the same or worsens from admission to discharge, putting them at risk for negative outcomes such as chronic pain, PTSD, suicidality, sleep disturbances, and reduced function. Future research is needed to determine if early intervention can serve to mitigate these risks and improve long term recovery and quality of life.

Applicability of Research to Practice
Patients at risk for increased pain upon discharge can be identified by understanding the factors contributing to this phenomenon during early treatment. Early, targeted, evidence-based interventions during treatment and following discharge will allow effective management of pain. Younger patients and patients with higher initial pain should be closely monitored and given multimodal pain interventions, thereby enhancing their comfort and overall recovery process.
768 Intraoperative Use of Intravenous Methadone and Post-Operative Opioid Requirements in Adult Burn Patients
Authors: LaChapelle Christopher , Ringqvist Jenny , Pham David , Shukla Vrinda , O'Connor Caitlin , Wu Braden , Ambardekar Aditee 
Published: May 2023

Abstract

Introduction
Post-operative pain management can be a significant challenge in patients undergoing burn excision. Standard pharmacologic pain management strategies include both opioid and non-opioid medications. Given the national overuse of opioids and the associated negative repercussions, it is prudent that we find ways manage pain with fewer or no opioids. We hypothesize that intraoperative administration of intravenous methadone will reduce the total morphine milligram equivalents (MME) used in the 36 hours following surgery.

Methods
This is a retrospective single-center cohort study of adult burn patients who underwent a first excision of full thickness burn between January 2019 through January 2021. The exposure group received intraoperative methadone while the control group did not. The primary outcome was total MME utilized in the 36 hours following surgery. Secondary outcomes included average pain score and post-anesthesia care unit (PACU) total MME utilized. Chi squared tests were used for statistical analysis of categorical variables and unpaired t-tests were used for continuous variables.

Results
The control group contained 35 subjects and the methadone group contained 19 subjects who did not differ in baseline characteristics. The average burned total body surface area (TBSA) was 9% in the control group and 18% in the methadone group (t(53)=-3.9, p &lt; 0.01). Intraoperative narcotic requirements did differ between groups due to intravenous methadone utilization in the intervention group (t(53)=-15, p &lt; 0.01). In the early post-operative period, the methadone group received 155 MME while the control group received 137 MME (t(53)=-0.36, p = 0.72). While in the PACU, patients in the methadone group received 5 MME while the control group received 12 MME (t(53)=1.60, p=0.12). Patient pain scores did not differ significantly between the groups (t(53)=-0.15, p=0.88).

Conclusions
Intraoperative utilization of methadone for burn surgery did not affect post-operative opioid usage in the first 36 hours or post-operative pain scores in a statistically significant manner. We acknowledge the data set is not large enough to power the study to detect a significant difference; additional data collection is ongoing to include several hundred subjects. Confounding variables such as different multimodal pain regimen techniques, % TBSA, extent of surgical excision, and history of opioid tolerance may exist within this data set. Further analysis is warranted to adequately power this study and account for potential confounding variables.

Applicability of Research to Practice
Intraoperative use of intravenous methadone may reduce use of opioid medications in the early post-operative period.
774 Providing Essential Burn Reconstructive Surgery in Resource-Limited Environments Using a Cleft Organization
Authors: Collier Zachary , Tapia Maria Fernanda , Bustamante Atenas , Daradkeh Heba , Celie Karel-Bart , Magee III William , Gillenwater Justin , Amarin Marzouq 
Published: May 2023

Abstract

Introduction
Cleft non-governmental organizations (NGOs) collaborate with multidisciplinary teams of healthcare professionals to provide safe and effective cleft surgery in resource limited environments. Unfortunately, other significantly disabling conditions like burns, which require similarly multidisciplinary reconstructive interventions, often lack the same degree of local and international support. Therefore, cleft NGOs are well positioned to support essential reconstructive burn care through sustainable service delivery models like those developed for cleft care.

Methods
An NGO with experience delivering global cleft care established a collaborative effort in COUNTRY between local and international burn experts from to provide burn care. Preoperative screening was performed by a local burn surgeon to identify patients. Virtual conferences were held bi-weekly to discuss candidates and operative planning. Following 3 months or preparation, a 5-day surgical program with a mixed team of COUNTRY and international volunteers was held. Patient demographics, interventions, and outcomes were monitored to determine efficacy of this Cleft NGO at delivering essential burn reconstruction.

Results
Of the 52 burn patients who were screened, 32 were surgical candidates, and 20 received a total of 26 surgeries during the 5-day program. Average age was 17 ± 16 years with 65% (13) females and 25% (5) refugees. Most had scald (65%) or flame (30%) burns from household accidents with average age at burn of 8 ± 12 years. Random pattern flaps were used in all cases. Only 1 patient required supplementary skin grafting. Seven patients had multiple operative sites that were addressed with a 2-team approach. No perioperative complications occurred. All patients were followed-up by the in-country team between 7 and 42 days. Five patients presented with minor complications - 5 flaps with partial necrosis and 2 partial dehiscence. None required surgical intervention.

Conclusions
Cleft NGOs have the resources and experience that allows them to implement impactful surgical programs for other conditions that are critically lacking access to essential reconstructive care.

Applicability of Research to Practice
Cleft NGOs can provide safe and effective burn surgery through collaborative local and international efforts aimed at sustainability and capacity building.