bluuebunny/crossref_metadata_2025_split huggingface dataset:
512 Systemic Norepinephrine Impact on Tangential Split Thickness Skin Graft Outcomes in Burn Shock Patients
Authors: Terziyski Ilina , John Albin A , Snitman Annie , Sorensen Grant , Adams Callie M , Novello Matteo , Griswold John A 
Published: March 2022

Abstract

Introduction
Blood pressure supporting agents like vasopressors are often used to treat patients with burn shock. Norepinephrine is part of the algorithms used by regional burn centers for fluid resuscitation in burn shock. In our population of burn shock patients, we have noticed an association of poor graft take when norepinephrine is used. We undertook this study to assess the relationship between systemic norepinephrine use and split-thickness skin graft (STSG) healing.

Methods
We retrospectively identified burn patients who presented to our burn center from January 2014 –June 2020, who were treated with systemic vasopressors within the first 48 hours of admission, and received at least one tangential excision and STSG procedure as part of their treatment. We compared these patients to a matched control group of burn patients who did not receive vasopressors for resuscitative purposes. The primary outcome investigated was graft take percentage at time of graft takedown.

Results
During the time frame, we found 19 patients and 19 matched controls within the same time period who did not receive norepinephrine. The mean percent graft take for patients treated with systemic norepinephrine was 77.9% (SE = 3.00), which was significantly lower than that of the control group, 92.8% (SE = 3.56) (P= &lt; 0.001). Furthermore, patients who received norepinephrine had a statistically significant increase in both hospital (P= 0.038) and intensive care unit (ICU) length of stay (P= 0.009). The two populations were equivalent in all other characteristics such as TBSA, number of comorbidities, age, and resuscitation volumes.

Conclusions
In this retrospective assessment, the use of norepinephrine seems to have a significant association with worse graft take and longer length of stay. Since graft loss begets more graft reoperations and a longer stay, our findings would lead one to incorporate norepinephrine as a last resort in the treatment algorithm for burn shock.
518 Prescribing practices of atypical antipsychotics in the burn ICU
Authors: Gayed Rita , Robinson Kristen , Labatut Annalise , Mittal Rohit 
Published: March 2022

Abstract

Introduction
Atypical antipsychotics are commonly used in the management of agitation and delirium in the intensive care unit (ICU). Patients admitted to the burn intensive care unit (BICU) with burns with large total body surface involvement ( &gt;20%) require prolonged mechanical ventilation and prolonged ICU stay, putting them at risk of ICU delirium. Furthermore, patients with burn injuries often have underlying psychiatric conditions, and some can develop new psychiatric disorders secondary to the trauma associated with their burn. Due to these factors many burn patients receive scheduled oral atypical antipsychotics during their ICU stay. The purpose of this study was to retrospectively characterize the prescribing practices of atypical antipsychotics in the BICU.

Methods
This was a single-center, retrospective chart review of adults admitted to the BICU with a burn injury who received scheduled oral atypical antipsychotics. Prescribing patterns in the ICU and on all transitions of care were analyzed. Additionally, the appropriateness of AAP prescribing at discharge was evaluated. AAPs were considered to be appropriately prescribed at discharge if a patient was continuing a home medication, or if psychiatric consult services recommended continuing at discharge.

Results
During the five year study period, 440 adults were admitted to the BICU with a burn injury, 18.2% of which were prescribed an AAP during their ICU course. Of those prescribed an AAP, 28.8% had a documented underlying psychiatric condition. Most patients were male (70%) with an average age of 41 years, and a mean total body surface area burn of 32%. The average ICU length of stay was 32 days. AAPs were primarily used to treat agitation/delirium (72.5% of patients). Quetiapine was the most commonly prescribed AAP. On transfer to stepdown, AAPs were continued in 78.4% of patients. Additionally, 67.7% were discharged on an AAP. Of these patients, continuation was considered appropriate in 54% of patients.

Conclusions
Despite overall lower AAP prescribing in the burn ICU compared to other ICUs, over two thirds of patients initiated on AAPs in the BICU were prescribed AAPs at discharge. AAPs should be evaluated for appropriateness at each transition of care.
519 Congruence of clinical suspicion of invasive fungal wound infection and biopsy positivity in burn patients
Authors: Pruskowski Kaitlin A , Britton Garrett W , Mitchell Thomas A , Cancio Leopoldo C 
Published: March 2022

Abstract

Introduction
Invasive fungal wound infection (FWI) in burn patients is a high-mortality complication; early diagnosis and treatment may improve outcomes. Management of suspected FWI includes initiating broad-spectrum antifungals, obtaining a biopsy for histopathology and culture, and performing urgent surgical excision. However, the relationship between clinical suspicion (manifested by initiation of antifungals) and histopathological diagnosis is unknown.

Methods
Patients admitted between 2004 and 2019 to our burn center, and initiated on any systemic antifungal, were identified. The electronic medical record (EMR) was reviewed to determine the indication for such therapy. Patients were included if antifungals were initiated out of concern for FWI. If the indication was not clear, patients were included if the systemic antifungal agent(s) initiated were triazoles (not fluconazole), echinocandins, or amphotericin B.

Results
Two hundred one patients who received 251 courses of broad-spectrum antifungal therapy were included. Thirty six patients (17.9%) received more than one course of antifungal therapy. One hundred sixty five (82%) patients were male, with an average age of 41.1 ± 17.7 years. The average burn size was 49.7 ± 22.8% total body surface area (TBSA) and 60 (29.8%) patients had inhalation injury. The median time from injury to antifungal initiation was 17.5 days (IQR 10.7, 38.6 days).
One hundred sixty eight biopsies were obtained within 3 days of antifungal initiation. Seventy five biopsies showed FWC (44.6% of biopsies), 37 had FWI (i.e. fungi were identified either in viable tissue or angioinvasion) (22% of biopsies), and 56 had negative biopsies (33.3% of biopsies). Despite presence of fungi on histopathology, there were only 112 positive fungal wound cultures (44.6% of 251 antifungal courses) within 3 days initiation of antifungal therapy. Aspergillus was the most commonly isolated genus (n=47) followed by Candida (n=46), Fusarium (n=26), Mucor (n=10), and other (n=20). There were 35 instances where multiple fungal organisms were recovered in tissue culture. One hundred five patients (52.2%) died during their hospital stay; 38 of these patients had FWC, 25 had FWI, 20 had negative biopsies, and 22 did not have biopsies taken.

Conclusions
Of 251 systemic antifungal courses initiated out of concern for FWI, FWI was biopsy-proven 14.7% of the time. Antifungal stewardship is needed to better identify appropriate high-risk patients for FWI. The development of a novel criteria or scoring system may be warranted to assist in deciding when to initiate systemic antifungal therapy for FWI in burn patients.
521 Maintaining Central Line Patency in Burned Children
Authors: Arredondo Olivia , Palmieri Tina L , Sen Soman , Greenhalgh David G , Romanowski Kathleen S 
Published: March 2022

Abstract

Introduction
Children with major burn injury frequently require prolonged central venous access to assure appropriate fluid management and pain control. Central venous catheters in children frequently develop clots that prevent drug administration, requiring administration of tissue plasminogen activator (TPA). The purpose of this study was to identify the frequency and efficacy of TPA use in burned children with central venous catheters (CVC).

Methods
This retrospective chart review evaluated all children requiring CVC admitted to our tertiary pediatric burn center from 2018-2019. Data collected included patient demographics (age, burn size, hospital length of stay (LOS)), catheter-related data (number of central lines, lines replaced due to clotting), TPA administration (number of times administered, successful TPA administrations, how often repeated), and line clotting data (time from insertion to clot, interval between TPA order and administration).

Results
In 2018, 116 lines were place in 49 children with mean age of 8.4 years and mean burn size of 29%, intensive care unit LOS was 24 days. TPA was infused in 20% of lines to relieve obstruction and was successful in relieving the clot in 21% (5/23). The interval between identification of the obstructed line to TPA order was 191 minutes, with the administration of TPA 83 minutes after order placement. The average time from identification of obstruction to TPA administration was 257 minutes. In 2019, 150 lines were place in 65 children with mean age of 5.2 years and mean burn size of 25%, LOS was 13 days in the PICU. TPA was infused in 5% of lines to relieve obstruction and was successful in relieving the clot in 0 % (0/8). The interval between identification of the obstructed line to TPA order was 117 minutes, with the administration of TPA 49 minutes after order placement. The average time from identification of obstruction to TPA administration was 158 minutes.

Conclusions
The incidence of obstruction in pediatric central venous catheters in our unit decreased from 26% in 2018 to 3% in 2019. TPA was successful in clot resolution in only 5% (2018), and 0% (2019) . Based on our results, we targeted areas for improvement including: Standing order for TPA; staff education on TPA use; decreasing our average time to identify, order, and administer TPA; and standardizing the frequency of flushing unused central venous catheter lumens with heparinized saline flush.
522 Food Deserts and Burn Wound Healing - Does Geography in an Urban Environment Matter?
Authors: Donovan Brienne , Anderson Jeffrey , Akpunonu Chinaemelum , Rae Lisa , Zhao Huaqing 
Published: March 2022

Abstract

Introduction
Many burn injury victims in the United States live in regions designated as food deserts. The United States Department of Agriculture (USDA) defines food deserts as low-income areas where a substantial number of residents do not have access to a supermarket. Nutrition is known to be critical to wound healing. The purpose of this investigation was to determine if there is a relationship between residence in a USDA designated food desert, burn patient cormorbidities, and wound healing at an urban academic medical center.

Methods
We performed a retrospective review of burn injured patients at an ABA verified urban academic burn center between September 2018 and April 2021. Inclusion criteria were burn injury of less than 20% total body surface area (TBSA), age ≥ 18, and single operation for split thickness skin grafting. Zip codes were used in conjunction with the USDA Food Access Research Atlas to classify residence in food deserts. The primary outcome was donor site time to healing. A multivariable logistical regression analysis was performed to evaluate risk factors for poor wound healing at an urban academic burn center and to determine if residence in a USDA delegated food desert was one of those risk factors.

Results
A total of 150 patients were identified for inclusion from September 2018 through April 2021. There were 73 women (48.7%) and 77 men (51.3%). The median age was 48.5 (IQR 34.0, 58.0). The average body mass index (BMI) was 28.2 (6.6). Age (p=0.60), sex (p=0.35), hypertension (p=0.74), chronic obstructive pulmonary disease (p=0.076), hyperlipidemia (p=0.77), congestive heart failure (p=0.47), and BMI (p=0.37), and time to donor site healing (p=0.55) were not significantly different between patients who lived in food deserts and those who did not. Patients who lived in food deserts, however, had a higher incidence of diabetes (p=0.05). The multivariable model also shows that time to healing is not different between patients who live in food deserts and those who did not. However, the multivariable model shows that patients with diabetes have an increased time to healing (p=0.002).

Conclusions
Residence in a USDA delegated food desert does not significantly influence time to healing of donor sites in burn injured patients. However, diabetes is significantly higher in patients who live in USDA delegated food deserts, and diabetes demonstrates a significant delay in wound healing. This is the first study comparing residence in a USDA food desert, burn patient comorbidities, and time to wound healing in an urban burn population.
523 Reduced Incidence of Fractures After Treatment with Oxandrolone in Burn Patients
Authors: Walters Elliot , Whitley Kayleen , Wolf Steven E 
Published: March 2022

Abstract

Introduction
Bone density loss is a significant and well documented complication after major burns. Oxandrolone and bisphosphonates have both been used successfully to mitigate this outcome. Studies show these agents reduce both short-term and long-term bone loss, but no studies have examined the long-term clinical outcomes of these agents. This study investigates long-term outcomes of treatment with oxandrolone and bisphosphonates in burn patients.

Methods
We examined a deidentified database of electronic medical records across 55 healthcare organizations including over 75 million patients. ICD 10 codes were used to identify patients with thermal or chemical burns from January 1, 2010 to December 31, 2020. We included patients who received their first dose of oxandrolone or bisphosphonate within one month of injury. Propensity score matching was used to balance patient cohorts. ICD 10 and CPT codes were used to evaluate outcomes.

Results
We identified 280,367 patients with burn injuries during the study time period. Of these, 903 (0.32%) received at least one dose of oxandrolone and 307 (0.11%) received at least one dose of a bisphosphonate medication within 1 month of injury. Mortality was higher among matched patients receiving oxandrolone (OR: 3.146, CI: 2.224, 4.449) or a bisphosphonate (OR 3.027, CI: 1.8, 5.092). Fracture at any site and fracture of long bones were significantly lower among matched patients who received oxandrolone (OR: 0.704 CI: 0.542, 0.914, OR: 0.689, CI: 0.51, 0.931; respectively) compared to those who did not. No reduction of fractures was seen among patients who received bisphosphonates (p &gt;0.05). Among patients receiving oxandrolone acute kidney failure was increased (OR: 1.941, CI: 1.454, 2.592) compared to those not receiving the medication but chronic kidney failure was reduced (OR: 0.513, CI: 0.351, 0.749). There was no increase in acute or chronic kidney failure among patients receiving a bisphosphonate (p &gt;0.05). Liver injury was not increased among patients receiving either medication (p &gt;0.05).

Conclusions
Oxandrolone and bisphosphonate medications have been well studied and shown to decrease bone density loss after burn injury. Fractures of all bones and specifically long bones were reduced in patients receiving oxandrolone, suggesting that decreased bone catabolism during the acute recovery period may provide long-term injury protection. While we do see an increase in mortality with both of these medications, there is no we do not see any increase in liver failure or chronic kidney failure suggesting that factors unrelated to the administration of these medications are driving the increased mortality and may be related to selection bias. This is the first study to show that oxandrolone decreases the incidence of fractures after burn injury.
528 Evaluation of phosphate replacement practices in burn patients
Authors: Derisse Giae Surine S , Panter Elizabeth , Helder Angela M , Kiehle Nicole D 
Published: March 2022

Abstract

Introduction
Burn injury causes acute shifts in phosphorus leading to hypophosphatemia and negative sequelae, such as motor neuropathy, muscle weakness, cardiac failure, and respiratory failure. These patients require frequent phosphorus level monitoring and repletion beyond the needs of a general critical care patient. Data suggests patients with normal phosphorus levels have lower incidence of ventilator wean failure and positive clinical outcomes. There is limited data evaluating phosphate replacement practices in burn patients for their intensive care unit (ICU) length of stay while also evaluating those who concomitantly receive continuous renal replacement therapy (CRRT) as it is the primary mode of renal replacement therapy in this population and further depletes phosphorus levels.

Methods
This was a single-center, retrospective, observational study of patients with a burn injury admitted and discharged from a burn intensive care unit (BICU) from January 1, 2016 to June 30, 2020 who received phosphate. Patients less than 18 years of age and those admitted to the BICU for non-burn injuries were excluded. Burn injury type, number of phosphorus doses per day, and phosphorus levels were collected. Normal phosphorus was defined as 2.5-4.9 mg/dL and hypophosphatemia as &lt; 2.5mg/dL. Patient data was evaluated in 24-hour time intervals as defined as midnight to midnight. Phosphorus lab values were included in data analysis if there was corresponding phosphate administration in that 24-hour interval. The primary objective was to assess the temporal dose-response to phosphate replacement in burn patients.

Results
There were 291 patients who met criteria, 116 were selected in chronological order by admission date and were included in data analysis. The mean age was 51.51 years and the mean total body surface area burned was 21.48%. Flame burn accounted for 83.6 % (n=97) of patients and 37.06% (n=43) of patients had concomitant inhalation injury. The mean amount of phosphate given to a patient per day was 28.38 mmol and patients on CRRT received a mean amount of phosphate of 33.34 mmol per day. In response to phosphate administration, the mean change in phosphorus was 0.334 ± 1.08 mg/dL. In patients on CRRT, the mean change in phosphorus was 1.4 ± 1.89 mg/dL. Patients experienced hypophosphatemia 69.63% of the days that they received phosphate repletion and patients on CRRT had hypophosphatemia 87.39% of the days they received phosphate repletion.

Conclusions
Hypophosphatemia is common in the burn injury population and current phosphate replacement practices are insufficient to replete phosphorus in burn injury patients.
538 Partial Thickness Pediatric Burn Injuries Treated with Autologous Skin Cell Suspension
Authors: Kopari Nicole M , Gray Fabienne , Phelan Herb A , Carter Jeffrey E 
Published: March 2022

Abstract

Introduction
Management of pediatric burn injuries resulting in optimal aesthetic remains a significant challenge in burn care. Wound care and acute surgical intervention coupled with reconstructive interventions is an essential component of burn care. Incorporation of new technologies in burn care has challenged historic paradigms. Our goal was to evaluate the use of autologous skin cell suspension (ASCS) for the treatment of partial-thickness pediatric burn injuries.

Methods
A retrospective chart review from a single pediatric institution over a 10-month period was performed on patients undergoing treatment with ASCS. Patients with full-thickness injuries treated with autografting were excluded. Demographics and data collection included total burn surface area (TBSA), location of burn, mechanism of burn, time to ASCS application, time to &gt;90% re-epithelization, hospital length of stay, ASCS failure requiring repeat operation, and reconstructive procedures or laser interventions.

Results
26 pediatric patients ≤13 years of age charts were reviewed. 14 patients received ASCS and met inclusion criteria. 8 faces were included in our study along with 11 upper extremity burns, 5 lower extremity burns, and 8 torso burns or some combination of the above. The most common etiology was scald injury from hot water followed by noodle soup burns and grease burns. Other etiologies included road rash, flame burn, and a steam burn. ASCS was applied 2 days (range 1-4) after injuries and patients only required 1 operation. The average length of hospital stay was 4 days (range 1-10) and the average TBSA was 10% (range 4-17). The average time to &gt;90% re-epithelization was 7 days with one outlier with healing at day 24. This is the only patient in the ASCS group that required laser interventions. No patients required repeat procedures, subsequent autografting, or reconstructive procedures.

Conclusions
Pediatric patients with partial-thickness burns benefitted from the ASCS by having limited donor sites, short hospitalizations compared to %TBSA, improved time to &gt;90% re-epithelization, and no repeat surgical interventions. The fast-healing time and good cosmetic outcome decreases the need for compression garments and subsequent laser interventions. Key factors include patient selection and appropriate wound preparation.