bluuebunny/crossref_metadata_2025_split huggingface dataset:
565 Impact of Municipal Ordinances on Firework-Related Injuries
Authors: Mefford Austin T , Duggan Robert P , Kirk Katie , Palackic Alen , Branski Ludwik K 
Published: March 2022

Abstract

Introduction
There is significant heterogeneity in firework-related legislation across the country, with some states outright banning sales, possession, and use. Others restrict the dates and types of fireworks that can be purchased. Municipalities often adopt firework ordinances that apply within their city limits, pushing the sale and use into unincorporated areas or permitting easy access to illegal fireworks for transport into city limits. We seek to understand how effective firework ordinances are at preventing firework injuries. We hypothesize lax municipal ordinances will have a limited effect on firework-related injuries.

Methods
Two time periods where the commercial sale of fireworks is legal were identified, and we reviewed patients presenting during those windows for the acute management of firework-related burns. This corresponds to June 24 – July 11 and December 20 – January 8. Patient demographics and burn outcomes were collected. Socioeconomic status was determined using a standardized scale (0-100) that incorporates Census data, with higher scores reflecting more disadvantaged communities. Legality was determined by a review of municipal ordinances and patient residence.

Results
Thirty-five patients were identified between December 2016 and January 2021. More injuries occurred around July 4th compared to New Year’s (54% vs. 46%). The cohort was predominantly men (77%) with an average age of 29 years. Patients most commonly came from suburban areas (34.3%), compared to rural (25.7%), urban (20%), or small towns (17.1%). Alcohol use at the time of injury was reported in 14% of cases. Explosive fireworks (e.g., mortar shells) (63%) were more common than sparklers. Hands were the most frequently injured area (83%), but no amputations, traumatic or surgical, occurred. Eye injuries occurred in 17.1% of patients, but no long-term damage to vision was sustained. Eight patients (23.9%) required inpatient management, and six (17.1%) required operative management. Split thickness skin grafting and local tissue rearrangement were the extent of the operations performed. One patient required neurosurgical intervention after a mortar shell detonated adjacent to their cranium, representing the lone fatality in the cohort. There was no significant difference in the number of legal (18) and illegal (17) firework injuries. Socioeconomic status was not different between legal and illicit groups (46 vs. 54, p = 0.101).

Conclusions
A substantial number of patients sustained firework-related injuries in municipalities where fireworks are banned, giving the impression that current ordinances are ineffective. Public health officials and legislatures may consider the more widespread implementation of regulations or increased penalties to combat firework-related injuries.
572 Burn injury from smoking electronic cigarettes while on supplemental oxygen
Authors: Kahn Steven A , Hollowed Kathleen , Ozhathil Deepak 
Published: March 2022

Abstract

Introduction
Burn injuries from exploding electronic cigarettes have been well documented in the medical literature and lay press, as have injuries from smoking conventional cigarettes while on supplemental oxygen. However, there is a paucity of literature regarding injuries from smoking electronic cigarettes while on supplemental oxygen. Empirically, it might seem safe to use e-cigarettes while on oxygen, but it can result in explosion. The electronic cigarette coil can heat up to 350°C and serve as a source of ignition. The purpose of this study is to describe and characterize this relatively novel and uncommon mechanism of injury.

Methods
This study was a descriptive review of 2013-2016 National Burn Repository (NBR) Data. Injury description fields were queried for “oxygen”, “O2”, “electronic cigarettes”, and various abbreviations and misspellings. Demographics, burn size, length of stay, expected length of stay using 1.1 days per %TBSA, and LOS index were reported. In addition, a Google search for lay press articles using the terms “smoking,” “’oxygen,” and “electronic (or e) cigarettes was performed, and these cases were tabulated.

Results
Of approximately 60,000 NBR entries, only 8 records of injury while smoking e-cigs on oxygen were found. Patients were predominantly male (63%) with a mean age of 63±9 years old, burn size of 3.4%±4 TBSA and LOS of 5.8±7 days. Inpatient stay averaged 1.65 days per %TBSA, which was 150% of expected LOS for the cohort. Two patients sustained third degree burns of 0.5% and 11%TBSA. Three patients were intubated, and had a mean of 3.33 ventilator days. Most injuries occurred at home (88%), while one occurred in a hospital. All 8 patients had Medicare and none of them suffered mortality. A google search revealed three distinct lay press articles regarding this topic.

Conclusions
Although an uncommon mechanism of injury, smoking electronic cigarettes on supplemental oxygen can result in injury and a significant hospital stay. Limitations in abstraction from the database and/or reporting might have resulted in an under capture of the true number of injuries. Circumstances resulting in this phenomenon warrant further investigation, as it is unclear if it occurs from malfunction or a hot coil alone. Patients who are prescribed home O2 should be warned about this potential danger.
584 Where Are They Now? - A Single-Center Survey of Burn Surgery Fellow Graduates
Authors: Prophete Justine , Lodin Daud , Gallagher Jim , Houng Abraham 
Published: March 2022

Abstract

Introduction
Burn surgery encompasses different surgical disciplines such as general surgery, trauma, surgical critical care and plastic surgery. Those who apply to burn fellowship also have various interests. This study’s purpose was to discern the various career paths of burn fellowship graduates. It also investigated the frequency of specific chosen specialties and workplace settings. The results of the study could be used to modify current clinical burn fellowship curriculum.

Methods
A survey was created using an internet tool and emailed to graduates of the clinical burn fellowship program from an American Burn Association verified burn center. The survey was sent to graduates of the last 10 years (2010-2020). The questions inquired about surgical field of work, board certification, additional training experience, work setting, and time since fellowship graduation. The participants’ responses were recorded anonymously to account for biases. The quantitative data was then collected for each question, and the data was calculated into percentages.

Results
Of the possible 17 fellows who graduated in the past ten years, 11 responded to our survey (64.7%). The most common surgical field pursued after the fellowship was plastic surgery with 5 graduates (45.5%). The following three fields all had 2 graduates each: burn surgery (burn/trauma), general surgery and wound care (18.2%). Almost all of the participants had completed additional training: 6 in plastic surgery (54.5%), and 4 in surgical critical care (36.4%). The work settings were primarily academic institutions (45.5%), followed by office-based practices (35.4%), ambulatory surgery centers (9.1%), and community hospitals (9.1%). Of the participants, 4 are board-certified in their chosen field, and 5 are board-eligible. Only 3 graduates are affiliated with a burn center.

Conclusions
The results of the study indicate the interests and career choices of previous burn fellows. This information can be used to modify burn fellowship curriculums to the needs and future career paths of the fellows. Traditional clinical burn fellowship programs emphasize burn critical care and acute burn surgery. Since some of the graduates are interested in plastic surgery, burn reconstruction could be added to the current curriculum. Plastic surgery faculty members could also serve as mentors to the fellows.
585 Focused Wound Care Handoff Improves Burn Center Physician-Nursing Communication and Wound Care Education
Authors: Rostami Sohayla , Kawaji Qingwen , Martinez Stephanie L , Lagziel Tomer , Orosco Rowena , Flores Carolina J , Hultman Charles S , Caffrey Julie 
Published: March 2022

Abstract

Introduction
Burn patients often require changing wound care routines dependent on wound characteristic and operative interventions. Unfortunately, order discrepancies on electronic medical systems, poor communication between providers, nursing, and wound care technicians leads to incorrect wound care treatment. By creating a daily dedicated wound care discussion involving integral components of the wound care team (provider, charge nurse, and wound care technicians), we hope to improve communication amongst team members and provide wound care education at all levels.

Methods
The study was carried out at a single-center burn unit. A pre-intervention, de-identified survey was distributed to the nursing staff to determine familiarity with wound care as well as assessment of communication regarding wound care in the burn unit. A planned intervention was then initiated for a period of four weeks. Daily, timed dedicated wound care rounds were carried out. The wound plan was then reflected on a personalized diagram for each patient, on electronic medical records and updated on resident/fellow notes. Nursing staff satisfaction and assessment of communication was completed again using a post-intervention, de-identified survey.

Results
Initial data from our planned four-week intervention showed that on average, we round on 7.9 patients on burn wound unit, 4 patients on intermediate care unit (IMC), and 2.9 patients on intensive care unit daily. During wound care handoff, we discussed 12.5 patients daily with an average time of 51 seconds per patient. When wound care routines are added to morning rounds, we spend 50 seconds per each burn wound unit patient, 120.5 seconds per each IMC patient and 735 seconds per each ICU patient. There was a total of 19 surveys collected prior to intervention. Four of the 19 surveys were filled by burn wound floor nurses and 15 were filled by ICU nurses. On average, nursing reported their wound care proficiency to be 4 out of 5 (5 being the highest score). Majority reported spending about 1-3 hours per shift on wound care (58%). Most nurses review wound care routine on nursing handoff (66%), resident/fellow notes (22%) and electronic medical record orders (11%). Mid-intervention satisfaction survey showed that most nurses felt that communication was improved, discrepancies between staff members were minimized, and that 100% of nurses wanted this intervention to be continued.

Conclusions
Adverse wound care events can happen despite nursing self-reported high level of wound care proficiency. To ensure accurate plan of care, wound care routine needs to be communicated at multiple levels: during rounds, in daily progress notes, and on electronic medical record orders.
586 Graft Loss: 5-year Review of a Single Burn Center’s Experience with an Institutional Grading Scale
Authors: Nosanov Lauren B , Travis Taryn E , Tejiram Shawn , Brantley Melissa , McLawhorn Melissa M , Moffatt Lauren T , Shupp Jeffrey W , Johnson Laura S 
Published: March 2022

Abstract

Introduction
Despite increasing attention on provisioning quality burn care, there continues to be no consensus definition of burn “graft loss”, nor a uniformly adopted scale to grade severity. The American Burn Association Burn Quality Improvement Project metric is a binary code identifying only "failure to achieve &gt;95% autograft take." We introduced an institutional graft loss scale in 2014 for quality improvement and reported initial results and interrater reliability. With additional data now available for analysis, a secondary review was undertaken.

Methods
All patients with graft loss were identified on departmental Morbidity and Mortality (M&M) reports between 7/2016-7/2021. Graft loss grades were assigned during clinical care per institutional scale (Table 1). Non-burn acute surgical wounds that underwent skin grafting were included, but chronic non-healing wounds were excluded. Data abstracted included demographics, medical history, injury details, surgical procedures, graft loss, and lengths of stay. In situations where the graft loss grade recorded on M&M documentation was discordant with the grade documented in the medical record, the grade assigned at the later point in time was used for analysis.

Results
Graft loss was noted in 260 instances for 200 patients. Mean age was 51.4(±7.5y)years. The majority were male (60.7%) and African American (48.0%). Smoking (26.0%) and diabetes (37.5%) were prevalent. Overall mortality was 4% (8/200). Graft loss percentages by grade are 28% (grade I), 28% (grade II), 13% (grade III), and 22% (grade IV). An additional 9% were deemed either unknown or due to a technical error. Overall reporting of graft loss grades improved over time as surgeons became more familiar with the scale. Reported percentages of Grades I and II graft loss also increased over time, indicating better compliance with the overall goals of this quality improvement project.

Conclusions
A graft loss grading scale can be applied to track split thickness autografting outcomes among a diverse group of surgeons. Regular reporting of low grade graft loss needs to be done to understand the complete distribution of graft loss after surgical intervention, including documentation of allograft and other skin substitute loss. Improved reporting in the medical record can optimize data collection for quality assessment purposes.
596 Implementation of a Burn Laser Program at a Children’s Hospital
Authors: Kopari Nicole M , Lindsey Kristen , Phelan Herb A , Carter Jeffrey E 
Published: March 2022

Abstract

Introduction
Carbon dioxide ablative fractional laser (CO2-AFL) therapy has become standard of care for adult burn hypertrophic scars (HTS). This therapy option has not been widely adopted in pediatric burn care and no established guidelines for treatment protocols have been published. We sought to modify our American Burn Associated Adult Verified Burn Centers laser protocol at our Children’s Hospital with hopes to provide optimal care to our pediatric burn population. We present our protocol and early experience of CO2-AFL therapy for pediatric burn HTS.

Methods
We conducted a retrospective chart review of pediatric burn patients undergoing CO2-AFL treatment of HTS during the study period of Jan 2021-Oct 2021. Pediatric burn patients were offered laser treatment if their scars were symptomatic with patient complaints of HTS, pruritis, neuropathic pain, and scar contractures. 37 pediatric patients ≤13 years of age were included in our review.

Results
We treated 13 pediatric patients for a total of 40 laser sessions with each patient averaging 3 sessions. Of the 13 patients that were treated with laser, 62% (8 of the 13 patients) had split-thickness skin grafting with 38% (3 of the 8 patients) of those having a staged grafting procedure with dermal substitute. 15% (2 of the 13 patients) healed primarily and 15% (2 of the 13 patients) required excision and closure. Only 1 patient treated with ASCS alone required laser therapy. Our protocol requires patients to receive pre-operative Tylenol, Benadryl, Pepcid, and Oxycodone. The patients then received MAC anesthesia with Toradol, Dexamethasone, Ketamine or Propofol, and Zofran. Patients with extensive HTS on the face or neck were intubated for the procedures. Oxycodone and/or Dilaudid were provided if needed in the post-operative phase. All patients were discharged with Tylenol or Motrin and Triamcinolone 0.1% ointment to be applied daily for 48 hours and then 3-4x/day until the follow-up clinic appointment at one week. Patients were able to resume normal activities the day following the procedure.

Conclusions
Patients and their parents have reported improvements in pigment, pliability, thickness, and pruritis following laser treatments. We created a protocol that allows on average 8 pediatric patients per day to receive laser treatment without it over burdening the pre-operative and post-operative recovery room nursing staff. We are currently tracking outliers of patients requiring increased post-operative analgesia and/or greater than 1 hour in the recovery phase. With the implementation of a laser protocol, we have successfully introduced laser therapy as a viable option for our pediatric burn survivors.
598 Reconstruction of Trochanteric Pressure Ulcers with Pedicled Vastus Lateralis-Anterolateral Thigh Flap
Authors: Ozkan Burak , Uysal Cagri A , Aydogan Cem , Haberal Mehmet 
Published: March 2022

Abstract

Introduction
Trochanteric region is one of the most frequent site for pressure ulcer development. High-voltage electric injuries with neurovascular damage is an important reason of paraplegia. These patients have prolonged hospitalization period and develop cachexia by time. Grade 3-4 sores with thoracanter major of femur exposition generally need flap reconstruction. Musculocutaneous flaps are preferred to cover exposed bone and fill the dead space. Although loco regional flaps such as tensor fasia lata, gluteus Maximus muscle flap have been used for thoracanteric ulcers, these flaps have mandatory muscles for ambulation in the following rehabilitation period. Another disadvantage of these flaps are the possible donor site problems due to pressure loading. Thus, we aimed to used vastus lateralis- anterolateral thigh(VL-ALT) flap for decreasing donor-site morbidity and tension.

Methods
Between 2019 and 2021 we have operated 6 trochanteric pressure ulcers in 5 patients. All patients had history of electric injury related paraplegia. The mean age of the patients was 33 (24-50) The defect size were ranging between 5x4cm and 10x12 cm. Flap size were planned according to exact size of the defect. VL muscle were harvested according to the size of dead space. The donor site was closed primarily in 3 patients. Split thickness skin graft were needed in 2 patients. Patients were hospitalized in lateral decubitus or supine position during follow –up.

Results
Mean follow up time was 10 months (6-18). All flaps were survived. Hematoma development were seen in 1 patient in the donor site which were treated with bedside debridement. No recurrence was seen during follow-up period. No restriction or morbidity were encountered during ambulation.

Conclusions
VL-ALT musculocutaneous flap provides the required tissue for dead space filling and defect closing simultaneously. The advantages of this flap are; lower donor site morbidity, perfect match in terms of skin quality and bulk, protecting the major muscles such as gluteus maximus and tensor fascia lata. The technique needs knowledge of quadratus femoris anatomy which has a short learning curve.
602 Foot burns in diabetic patients: A single center experience
Authors: Choi Katherine J , Gillenwater Justin , Pham Christopher H , Sheckter Clifford C , Collier Zachary J , Dang Justin , Huang Samantha , Yenikomshian Haig A , Garner Warren L 
Published: March 2022

Abstract

Introduction
The most significant sequelae of foot burns in diabetic patients is a non-healing wound that results in a diabetic foot ulcer, which has been a predictor for need for amputation and mortality. Even minor amputations in patients with diabetes have a significant mortality rate. Our systemic review found that when 60% of a diabetic patient cohort with foot burns was managed by skin grafting, 29% subsequently required amputations, which is concerning. The practice at our regional burn center has been to manage patients with foot burns and diabetes non-operatively with daily dressing changes, and we believe that this may result in better functional outcomes, ambulatory status, and lower amputation rates.

Methods
A retrospective review of patients with diabetes and foot burns admitted to an ABA verified regional burn center was conducted. The primary outcome was amputation. Secondary outcomes were ambulatory status, wound closure, and infection. Rank sum and fisher exact tests were performed to compare patient demographics, comorbidities, uncontrolled DM (A1c &gt;9%), and burn characteristics between patients who were treated surgically and those who received daily wound care only. These associations were subsequently evaluated with odds ratios (OR) and 95% confidence intervals (CI). A multivariable logistic regression was performed to evaluate for possible differentiating factors that resulted in maintaining ambulatory status at completion of burn care. Statistical significance was defined as p&lt; .05.

Results
Of 75 patients identified, median TBSA burned was 2% (IQR 2), and 61% (n=46) had full thickness burns. Mean A1c at admission was 9% (SD 2). In terms of management, 9% (n=7) were treated with debridement and/or skin grafting, and 9% (n=7) later required lower extremity amputations. Infection during first admission developed in 8% (n=6). At completion of burn care, 73% had normal or same ambulatory status, and older patients were less likely to maintain ambulatory status (p=.009, OR=0.92, 95% CI=0.86-0.98). Median time to wound closure was 95 (IQR 130) days, and 12% (n=9) of wounds never fully closed. Burn depth (second vs third degree), burn location (plantar burn vs other areas), uncontrolled DM, and surgical treatment did not result in a statistically significant difference in maintaining ambulatory status at completion of burn care.

Conclusions
Diabetic patients with foot burns are best managed non-operatively with daily dressing changes, and should be allowed to heal secondarily. This may result in a longer time to close the wounds, but the amputation rates were much lower when compared to surgical management. However, 5% of our cohort developed diabetic foot ulcers at completion of burn care, which is a complex disease process that carries a dire prognosis.