bluuebunny/crossref_metadata_2025_split huggingface dataset:
550 Considerations for Ophthalmologic Evaluation to Reduce Ocular Morbidity in Facial Burn Patients
Authors: Sweitzer Keith R , Forman Jessica , Bell Derek 
Published: March 2022

Abstract

Introduction
Advances in burn management have led to significant improvement in survival rates, even in patients with high total body surface area (TBSA) affected. Ocular morbidity in facial burn patients remains high, partially attributable to the life-threatening nature of these injuries. Previous studies have shown that early ophthalmologic intervention leads to better outcomes, however, specific risk factors for short and longer term ophthalmologic outcomes have not been elucidated. This study aimed to identify risk factors for short- and long-term ophthalmologic complications in facial burn patients to prioritize patients that require urgent ophthalmologic evaluation.

Methods
Retrospective review of facial burn patients presenting to an American Burn Association-verified regional burn center between June 2007 and May 2016 was conducted. Demographics, presentation, time to ophthalmologic consultation, and short- and long-term complications were recorded. Odds ratio and multivariate analyses were performed to assess for significant risk factors.

Results
A total of 1,126 facial burn patients were identified, of which 135 (12%) involved periorbital and orbital injury. Average TBSA burned was 9.68%, with an average facial surface area burned of 1.56%. The most common ocular injury was eyelid burn (65.9%). Ophthalmology was consulted for 118 (87.4%) patients. Short-term ophthalmologic complications were noted in 58 (43%) patients, most commonly chemosis (n = 34, 25.2%). Long-term complications were rare, occurring in only 7 (5.2%) patients.
Odds ratio analysis revealed that inhalation injury significantly increased the likelihood of both short- and long-term complications (OR 3.16 and OR 9.81, respectively). Active smoking increased the likelihood of long-term complications (OR 14.76). Ophthalmologic intervention, including need for consult, and use of lubricant, antibiotics, or steroids were each associated with increased risk of short-term complications.
On multivariate analysis, those with long-term complications tended to be older (p = 0.045). Those with corneal injury generally had worse outcomes, with higher likelihood of short- and long-term complications (p &lt; 0.001, p = 0.057, respectively).
Blindness did not occur in any patient, and no long-term complications occurred in those who did not receive ophthalmologic consult. Neither TBSA nor facial SA burned was associated with the development of short- or long-term complications.

Conclusions
Providers should obtain early ophthalmologic evaluation and frequent follow-up exams for facial burn patients presenting with advanced age, active smoking status, corneal injury, or inhalation injury to reduce development of long-term complications.
563 Fire safety in homeless encampments
Authors: Rehou Sarah , Cook Greg , Doucet Nathan , Jeschke Marc G 
Published: March 2022

Abstract

Introduction
It is well known that people experiencing homelessness are at a greater risk for burn injury. Our burn centre saw an increase in admissions of homeless individuals during the pandemic. Typically, we partner with our hospital’s communications staff to share burn prevention public service announcements. But our usual method of broadcasting information through media like newspapers, blog posts, Facebook, or Instagram was not necessarily going to reach people sleeping rough. This report describes the development of a partnership between a burn centre, outreach workers, and people with lived experience of homelessness to improve fire safety in encampments.

Methods
Our goal was to create a Fire Safety Manual and hold Fire Safety Training Sessions. We conducted surveys that asked encampment residents questions like, “What do you use fires for?” “What fire hazards do you see at encampments?” and “How do you think fires could best be prevented?”. We used the results of this survey to guide the training manual and held workshops to engage encampment residents and incorporate feedback into the manual.

Results
The manual uses harm reductions strategies and focuses on real-life situations encountered by folks living outdoors—the manual outlines how to safely start a fire and what to do if a fire occurs. The reality is that people are trying to survive freezing winters while sleeping outside; this means that some safety standards are not possible, and the guide had to reflect that. For example, we practiced fire escape plans during training sessions and had to think about obstacles like tents with only one way out. A solution was to keep a utility knife inside and outside the tent in case one had to cut through to escape or free someone. An encampment resident suggested hiding the knives so they would not be used as weapons. We purchased fire extinguishers, fire blankets, and first aid kits that we distributed during training.

Conclusions
Education is critical to prevent burn injuries. Burn centre staff may be experts on burn prevention, but we are not experts on surviving outside. We have to be accountable to this community. This means listening, building trust, and partnering with people living outdoors. People who did training sessions were empowered to start fire brigades in their encampments. Crucial concepts are to meet people where they are and always to include people with lived experience: “Nothing about us without us.”
571 Ethnicity and Etiology in Burn Patients for the American Burn Association National Burn Repository (NBR)
Authors: Al Hosni Ahmed M , McSweeney Connor , Jain Fagun , Papp Anthony 
Published: March 2022

Abstract

Introduction
The purpose of this study was to analyze data from the American Burn Association National Burn Repository (NBR)
with particular focus on patient ethnicity and burn etiology. We hypothesize that burn etiology, severity and other characteristics will be significantly different between differing ethnic groups throughout the database. This information can be used to augment burn prevention strategies by targeting at risk ethnic groups.

Methods
Data on burn patients was derived from the American Burn Association National Burn Registry including all burn entries for a 10 year period (2009 to 2018) from 46 burn centers. The ethnic categories for this study were White, Black, Hispanic, Indigenous and Asian. The study also involved analysis of patient demographics, burn severity, context of injury, and hospital course.

Results
White patients were the largest group (64.0%), had the highest proportion of flame injury (53.1%) and shared the highest mortality rate with indigenous patients (3.1% compared with 2.6% for all other ethnicities). Black individuals (22.2%) had higher rates of scald burns (53.2%), the shortest average hospital stay (16.8 days) and along with indigenous patients the highest rates of assault/abuse (2.0% and 1.9% respectively). Hispanic patients (10.0%) had more scald burns (47%), the largest proportion of men (66.5%), the highest incident of work-related injuries (18.0%) and the largest average TBSA at 10.1%. Asian patients (2.7%) had the largest proportion of scald injury (63.1%) and the smallest proportion of male patients (54.5%). Indigenous patients (1.1%) had higher rates of flame burns, suffered full thickness burns at the highest rate (32.8%), had the longest average stays in hospital (21) and the ICU (15) and had the highest rates of blanks for data entry.

Conclusions
This study found multiple significant differences in burn populations when compared by ethnicity. We have found that the indigenous population suffered full thickness burns at the highest rate and have had the longest average hospital stay as well average ICU stay. We have also had the unexpected finding of higher rates of unknowns in the indigenous population which may reflect racial bias at an institutional level nationally.
607 Use of Autologous Skin Cell Suspension (ASCS) for Full-thickness Burn Injuries Reduces Autograft Procedures
Authors: Holmes James H , Foster Kevin N , King Booker , Sood Rajiv , Carter Jeffrey E , Hickerson William L 
Published: March 2022

Abstract

Introduction
Pediatric burn patients and patients with large TBSA injuries are vulnerable to morbidity and mortality, requiring multiple autograft (AG) procedures to obtain definitive closure due to limited donor site availability. The primary objective of this study was to understand the impact of ASCS, as an AG-sparing technology, on the number of AG procedures required to achieve definitive closure of full-thickness (FT) acute thermal burns.

Methods
Retrospective analyses of real-world data were conducted, evaluating clinical outcomes of ASCS-treated patients in prospective, uncontrolled observational studies compared to control data from patients in the National Burn Repository version 8.0 (NBR) who had conventional AG (SOC). The pediatric population consisted of patients &lt; 18 years of age, inclusive of any size TBSA, and the adult cohort included patients ≥ 18 years of age with &gt;50% TBSA injury. Propensity score stratification was used to reduce bias attributable to potential differences in age, sex, %TBSA, and Baux scores between nonrandomized cohorts. Clinical outcomes evaluated included number of AG treatments, length of stay (LOS), healing, and mortality. Additional adverse events were evaluated and compared to historical SOC data sets.

Results
The median number of AG procedures for pediatric patients treated with ASCS and control NBR cohorts was 1.0 (1.0-5.0) and 2.0 (1.0-20.0), respectively. For adult patients, the ASCS-treated and NBR cohorts had medians of 2.0 (1.0-6.0) and 5.0 (1.0-32.0) treatments, respectively. Overall, ASCS lead to approximately 60% fewer mean AG procedures for both populations. By week 8, re-epithelialization was observed in 91.8% and 90.6% of wounds in the pediatric and adult ASCS-treated cohorts. Median LOS for both cohorts were not different between the treatment groups. No significant differences were observed for mortality between cohorts and no adverse events attributed to ASCS were reported.

Conclusions
ASCS treatment reduced the number of AG procedures needed to achieve closure, benefiting patients and offering burn centers reduced complexity and cost in the patient care pathway. While LOS was not significantly reduced in this study as seen in other reports, this finding may be confounded due to potential differences in the patient cohorts relative comorbidities and polytrauma, as well as variability in clinical site inpatient/outpatient management strategies for OT/PT.
612 A Novel Antimicrobial Bioresorbable Matrix is Compatible With A Collagen And Glycosaminoglycan Bioresorbable Wound Matrix
Authors: Schurr Michael 
Published: March 2022

Abstract

Introduction
Skin substitutes are indicated for clean wounds because their use in colonized or infected wounds can lead to non-adherence, loss of graft, and subsequent waste of resources. Wound colonization can be hard to detect, and skin substitutes can trap microbes and potentiate wound infection. Therefore, the aim of this study was to evaluate the compatibility of a novel bioresorbable antimicrobial wound matrix containing low levels of silver (Silver Matrix), with a widely used skin substitute composed of a crosslinked bovine tendon collagen and glycosaminoglycan matrix (Collagen Matrix), to assess effects on wound healing progression and bioburden management.

Methods
Clean and contaminated full-thickness wounds were made using a porcine model, and treated with either Silver Matrix or Collagen Matrix. Treatment groups included: 1) Clean treated with Silver and Collagen Matrix, 2) Clean treated with Collagen Matrix only, 3) Contaminated treated with Silver and Collagen Matrix, and 4) Contaminated treated with Collagen Matrix only. The Silver Matrix was applied directly to the wound bed, followed by the Collagen Matrix. Clean wounds were analyzed 14 and 27 days after treatment to evaluate wound healing progression as evidenced by angiogenesis, re-epithelialization, inflammation, and fibroplasia. Contaminated wounds were analyzed 5 days after treatment to measure bacteria reduction, as evidenced by colony forming units (CFUs).

Results
At day 14, angiogenesis, re-epithelialization and fibroplasia were insignificantly different, and inflammation markers were modestly higher in the Silver and Collagen Matrix group. At day 27, there were no statistically significant differences in these metrics between groups. At day 5, infected wounds treated with Silver and Collagen matrix showed a 2-log reduction in CFUs, whereas wounds treated with Collagen Matrix only did not show a reduction.

Conclusions
Covering full-thickness porcine wounds with a bioresorbable Silver Matrix before application of the skin substitute Collagen Matrix resulted in a significant decrease in bioburden without impairing wound healing progression.
708 Serratia infections in burn care
Authors: Rogers Alan D , Wallace David L 
Published: March 2022

Abstract

Introduction
Burn wound infections, ventilator associated pneumonia, line sepsis and urinary tract infections are common in patients with major burn injuries, and remain prominent causes of morbidity and mortality. Within the spectrum of organisms responsible for infections, some are more common, while others might be relatively more virulent. This study sought to determine the impact of Serratia infections within the context of a verified regional burn centre.

Methods
All patients admitted with a diagnosis of burn injury who developed an infection with Serratia Marcescens in the six years between 1 January 2015 and 31 December 2020, from any site, were included in the study. Data collected included demographic details, mechanism and extent of the burn, as well as the clinical course and complications.

Results
Twenty two patients were included in the study, with a mean age of 46.5 years (range 27-70). Most had at least one significant co-morbidity. The mean burn size was 28% TBSA (range 2% - 71%), nine sustained inhalation injury and 13 required mechanical ventilation. Most patients underwent several surgeries (mean 3.4, range 1-9). The mean duration of hospital stay was 32.2 days (range 8-65), or 1.8 days per percentage burn (range 0.73 -4). For those who died, the mean number of days from admission to diagnosis of Serratia infection was 3.8 days (range 2-7), as against 10.11 days (range 1-27) for survivors. Eight of the first cultures were from sputum, 11 wounds, 4 blood cultures, and 1 from the urine. No significant resistant strains were identified, and all patients received timely and appropriate antibiotic therapy. Five of the patients died.

Conclusions
Patients with major burn injuries are especially vulnerable to morbidity and mortality should they develop a systemic Serratia infection early in their hospital stay. Awareness of the natural history of these infectious episodes may improve the directed therapy required to improve outcomes.
730 Clinical utility of the portable pressure measuring device for garment therapy on burn scar
Authors: Lee Seung Yeol , Seok Hyun 
Published: March 2022

Abstract

Introduction
The experimenters developed a portable pressure measuring device using silicon piezoresistive pressure sensors. The purpose of this study was to determine the effectiveness of pressure garment therapy using proposed device with objective data obtained through a randomized controlled trial.

Methods
Pressure measurements were acquired through a readout circuit consisting of an analog-to-digital converter, a microprocessor, and a Bluetooth transmission module for wireless data transmission to an external device. This was a double-blinded, randomized, controlled trial in patients with hypertrophic scars. In the pressure monitoring group, garment pressures were monitored using the portable pressure measuring device, and the compression garment was adjusted so that the pressure was maintained at the therapeutic range of 15 – 25 mmHg. In the control group, non-surgical standard treatment of burn scars except for pressure monitoring was performed in the same manner.

Results
No significant intergroup difference was noted at the initial evaluations (p &gt;0.05) between two groups. The pre- to post-treatment change in the scar thickness (p=0.03) and erythema (p=0.03), more reductions were found in the pressure monitoring group than control group. There were no significant differences in the change measurements between the two groups for melanin levels (p=0.62) and transepidermal water loss (TEWL) (p=0.94). The changes (skin distensibility, biological skin elasticity, gross skin elasticity, and skin viscoelasticity) measured with the cutometer showed no significant differences between the two groups (p=0.87, p=0.32, p=0.37, and p=0.29, respectively).

Conclusions
Complementary characteristics such as wireless transmission to an external device may allow burn patients to continuously wear the device for real-time measurements. A Portable pressure monitoring device is effective for significantly improving burn-associated scar characteristics.
737 Prevalence and Outcomes of HIV Infection Among Burn Patients at a Single Institution
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia 
Published: March 2022

Abstract

Introduction
Burn injuries are a significant cause of morbidity and mortality worldwide. Pre-existing conditions may further complicate a patient’s outcome and delay wound healing. Human immunodeficiency virus (HIV) remains an ongoing problem globally and contributes to the morbidity of patients with burn injuries. According to the Centers for Disease Control and Prevention (CDC), the prevalence of individuals with HIV in the United States was 1.2 million in 2018. Burn patients and those with desquamating skin disorders are already in an immunocompromised state, and thus, the effect of HIV on the healing and recovery process can be significant. The objective of this study was to evaluate the prevalence and outcomes of HIV-positive patients admitted to our Burn Center.

Methods
This was a single-site, retrospective review using our institutional Burn Center registry. All adult patients (18 years or older) admitted to our Burn Center between July 1, 2010 and June 30, 2020 who were HIV-positive were included in this study. All adult patients who were HIV-negative and admitted during the same period were included for comparative purposes. Variables of interest included demographics, burn mechanism, length of stay (LOS), cost of hospitalization, and mortality.

Results
There were 32 HIV-positive burn patients and 16 HIV-positive patients with desquamating skin disorders (e.g., Stevens-Johnson syndrome/Toxic Epidermal Necrolysis). For the burn group, the mean age was 46.9 years +/- 10.6 years, and the mean total body surface area (TBSA) involvement was 3.2% +/- 4.2%. The mean LOS among HIV-positive burn patients was 9.13 days +/- 17.73 days, and the mean cost of hospitalization was $54,613. For the desquamating skin disorders group, the mean age was 47.1 years +/- 13.9 years, and the mean TBSA was 16.2% +/- 29.0%. The mean LOS was 17.25 days +/- 25.26 days, and the mean cost of hospitalization was $138,358. In terms of overall hospital mortality, there were no deaths among HIV-positive burn patients; however, the mortality was 25% among HIV-positive patients with desquamating skin disorders (n = 4). When both groups were compared to HIV-negative patients, overall hospital mortality remained higher among HIV-positive patients with desquamating skin disorders.

Conclusions
Management of HIV-positive burn patients presents a unique challenge for clinicians due to the immunocompromised state of this patient population. The challenge may even be more pronounced in HIV-positive patients with desquamating skin disorders as demonstrated in this study.
749 Healthcare Disparity Increases Risk of Dog Bites in the Pediatric Population
Authors: Carballo Christopher , Faulkner Justin , Gratton Austin , Baughman Samuel , Acquista Elizabeth , Powers William , Yon James R 
Published: March 2022

Abstract

Introduction
Long known to be a widespread source of injury, dog bites continue to occur and can frequently be devastating. There is lasting economic and personal hardship associated with this as many attacks can be severe, especially in children. This study describes the differences between dog bites and all other bites in the trauma patient population.

Methods
We included all patients from the National Trauma Data Bank (NTDB) from 2007 to 2016. All patients with an E-code for any type of bite were included. The following predictors were examined: year, age, gender, race, ethnicity, transfer, injury type, ED disposition, and ISS ≥15. Standard t-test for age, chi-squared test for all categorical variables. Wilcoxon test for non-normal quantitative variables. Statistical analyses were performed using R version 4.0.2 statistical software. “Under resourced” will be defined as Self-Pay and Medicaid. “Not known” is removed and replaced with NAs. All other insurance types are included in “Normal”.

Results
All variables tested as significant. All variables analyzed tested as significantly different between dog bites and other animal bites. When the group, pediatric subset, and adult subset are evaluated (Tables 1), pediatric patients are more likely to be dog bite patients if they are from an under resourced background (OR 1.3, p-value &lt; 0.001). Distribution of bites are not significantly different from Low to Normal resource adult patients.

Conclusions
Dog bites continue to be a public health problem and are more likely to be severe or fatal than bites from other animals and humans. Better methods of injury prevention and education need to be established. Children from under resourced backgrounds are at an increased risk of suffering a dog bite and all physicians should screen for and educate patients and families about this risk.