bluuebunny/crossref_metadata_2025_split huggingface dataset:
35 Using a New Quality Registry System to Improve Data Completeness for a National Burn Registry
Authors: Phillips Bart D , Bessey Palmer Q , Mandell Samuel P , Thompson Callie M , Phillips Matthew H , Hoarle Kimberly , Higginson Sara , Hsu Naiwei , Pardon Darryl A , Weber Joan M 
Published: March 2022

Abstract

Introduction
The burn care community has demonstrated a long-standing commitment to quality of care, improved outcomes, and research by collecting and sharing clinical data through burn registries. The key to optimizing the value creation from these registries is data quality. In 2019 a new registry platform incorporating the latest, standardized, data definitions and sophisticated audit controls was piloted with 12 burn centers. The following year it was introduced to the broader burn care community along with a robust registrar education and training program. We sought to evaluate the effect of this new system on quality of data collection.

Methods
We compared data from 27 centers that collected data on the new system against their data collected on prior registry systems. We analyzed 26 data elements, across four different variable categories (Admissions (n=6), Demographics (n=5), Injury (n=10), and Outcomes(n=5)) that have been consistently collected over time, for data completeness. A two-proportion z test was used to assess statistical significance of differences in data completeness rates.

Results
The 27-center cohort entered data on 4,524 inpatient burn admissions between January 1, 2020 and June 30th 2021 and 7,259 admissions between July 1st, 2019 and June 30th, 2020 in their legacy system. The data elements were harmonized to maximize longitudinal comparability.
When comparing data from the same centers but using different registry software (graphic 1) 16 of 26 variables profiled had a higher percentage of completeness in the new registry system (all statistically significant), 5 variables were statistically significantly lower, and 5 variables were not significantly different. Overall, this subset of data elements showed a 14% improvement in data completeness between the new and legacy systems (90% vs 75%).

Conclusions
The development of a clinical registry requires significant commitment and leadership from the healthcare association and broader clinical community. The resources and effort that the burn community has expended to improve data quality has produced important gains in data quality with the introduction of a new, high-quality registry. The burn care community should continue to emphasize education, innovation, and collaboration to collect the highest quality data at the lowest burden from all burn centers.
50 Rise of the (Learning) Machines: Artificial Intelligence for the Assessment of Adult Thermal Burns
Authors: Carter Jeffrey E , Phelan Herb A , Hickerson William L , DiMaio J Michael , Shupp Jeffrey W , Holmes James H 
Published: March 2022

Abstract

Introduction
Burn depth assessment (BDA) is an essential component of the physical exam used in the treatment and triage of burn injured patients. And while many specialties incorporate labs and imaging to determine diagnoses, burn professionals must rely on a physical exam that is accurate in only 70-80% of cases. Our goal was to assess the accuracy of a new imaging technology called Multispectral imaging (MSI) combined with a machine learning algorithm to aid in rapid BDA. We present the results of the first multi-center study using this technology in adult burn injuries.

Methods
In a multi-center IRB-approved study, an MSI device was used to image subjects &gt;18 years of age with thermal burn injuries. The imaging device captured a set of images measuring the reflectance of visible and near-IR light. Subjects were enrolled and imaged within 72 hours of injury with serial imaging as permitted. The images were used to develop a type of machine learning algorithm called a convolutional neural network (CNN) that could identify the regions of non-healing burn within an image. Non-healing burn areas were determined by a panel of three burn surgeons using two standards: a) images confirming 21-day spontaneous healing; or b) pathology reports detailing histologic changes from multiple punch biopsies taken prior to burn excision. From this data, an ensemble of eight separate CNN algorithms was used to automatically identify non-healing burn tissue. Training and test accuracies of the ensemble CNN were calculated using cross-validation at the level of the subject.

Results
One hundred (100) adults were enrolled and imaged. The population had a mean age 45.6 ± 16.7; mean TBSA 13.0 ± 9.3; and was 31% female. From these adults, 210 burn regions were serially imaged. The estimated performance result from the ensemble CNN for identification of non-healing burn regions was AUC of 0.96. Based on the ROC curve, an ideal threshold showed an accuracy of 92.0%, sensitivity 91.9%, and specificity 92.0%.

Conclusions
Our study demonstrates a non-invasive technology that rapidly determines an accurate DBA relative to traditional bedside exam. More accurate burn wound assessment could lead to avoiding unnecessary surgeries or delays in treatment and dramatic cost savings. Use of such a device in a disaster has additional value to better align a patient’s burn care needs and available resources.
58 Burn Injuries in Asia: A Global Burden of Disease Study
Authors: Collier Zachary J , McCool Katherine , Magee William P , Potokar Tom , Gillenwater Justin 
Published: March 2022

Abstract

Introduction
Burn injuries disproportionately affect low- and middle-income countries. Work conditions, rapid industrialization, social conditions, cultural activities, political conflict, and lack of access to safe and affordable surgery are key barriers to effective burn care in Asia. This study aimed to better define the burn burden in Asia, its sub-regions, and related sex and age disparities to elucidate populations where targeted burn care interventions are most needed.

Methods
The 2019 Global Burden of Disease (GBD19) of the Global Health Data Exchange was used to acquire 151,741 sources of epidemiological data on fire, heat, and hot substance-related injuries for 53 countries in Asia from 1990 to 2019. Measures used to derive summative statistics included incidence, deaths, disability-adjusted life years (DALYs), and mortality ratio (deaths: incidence) by year, sex, age, and location. Spatial mapping was performed to geographically delineate burn indicators.

Results
From 1990 to 2019, an estimated 117 million burns occurred in Asia. The relative proportion of global burns, deaths, and DALYs from Asia increased during that time. By 2019, 46% of global burn cases, 47% of deaths, and 46% of DALYs were from Asia. The two most burdened regions were South and Southeast Asia, accounting for 30-40% of all global cases, deaths, and DALYs. Compared to global averages, the incidence, death, and DALY rates for Asia were 32%, 22%, and 23% higher. Central Asia had the worst rates, averaging 2.9, 2.3, and 2.6 times the global averages. Throughout Asia, men were 32%, 63%, and 47% more likely to be burned, die, and suffer DALYs than women versus the global disparities of 7%, 26%, and 10%. Only South Asia’s trend was reversed with women suffering 15%, 20%, and 27% more burns, deaths, and DALYs than men. In Asia, those under 5 years were most impacted by DALYs (314 years/100,000 people), 5-14 year olds had the highest burn rate (219 cases/100,000), and 70+ year olds had the highest death rate (8.4 deaths/100,000) and mortality ratio (54%).

Conclusions
In 2019, Asia had an estimated 3.8 million burns comprising nearly half of all the world’s burn cases, deaths, and DALYs. While Asia’s burn indicators have declined since 1990, global improvements have surpassed Asia’s. South and Southeast Asia accounted for the greatest burden of burn morbidity and mortality, but Central Asia consistently had the highest rates relative to overall population. Men were more affected than women, except in South Asia, and the extremes of age (&lt; 5 and 70+ years) suffered the greatest rates of disability and death.
72 Burn Rehabilitation Non-invasive Approach; Lower Extremity Burns
Authors: Funk David H , Fletchall Sandra , Velamuri Sai R 
Published: March 2022

Abstract

Introduction
An increase intolerance to weight-bearing or ambulation was noted when second degree burns were sustained in the lower extremities, specifically knee distally. Patients were noted to request additional pain medication and/or additional time in the bed, which are not this burn center’s burn rehabilitation activity protocol.
Use of double ace wraps, from knee distally, was initiated to increase patient’s participation in burn rehabilitation therapy. A retrospective chart review was used to determine if there were similar factors could be identified to anticipate use of a lower extremity double ace wrap.

Methods
Retrospective chart review from July 2020 to August 2021 was performed to identify lower extremity burns. Inclusion criteria included: age 13 or greater; admitted to this burn center w/LOS greater than 24 hours, received burn rehabilitation therapy; second and third degree burns located below the knee; and pre-admission status of independent ambulator.
Chart review included 104 patients, with criteria met by 19 males and 5 females. The average age was 38.9 years with a range of 13 to 78 years. Length of stay ranged from 1 to 30 days and pre-exiting medical history included diabetes, type II in 8.3% and hypertension in 16.7% of the patients.
The TBSA ranged from 1.15% to 42%. Surgical procedures of BWE w/dermal/epidermal skin substitute application from knee distally, occurred in 50% of the patients; 37.5% underwent BWE w/allograft and within 5-7 days underwent meshed split thickness skin grafts; 4% underwent BWE with placement of xeroform. 8.3% did not require surgery.

Results
All patients involved in the study required use of double ace wraps during hospital stay. Duration of use of double ace wraps depended on subjective report of abnormal sensations. Use was required mainly in the acute phase of burn injury prior to autografting, in partial thickness burns that underwent surgical procedure for application of dermal/epidermal skin substitute, or in patients that did not require autografting.
Patient’s verbalizations of abnormal sensations with attempts to immediately weight bear or ambulate included: shooting pain, stinging pain, throbbing sensation, pins and needles. Reports of abnormal sensations and increased compliance with burn rehabilitation therapy was noted immediately following application of double ace wrap.

Conclusions
Burn Rehabilitation therapy protocol now includes close identification of superficial or deep second degrees located distally to the knee and patient’s verbal descriptions of abnormal sensations with attempts to place feet into a dependent position. Burn Rehabilitation therapy has developed a wearing schedule of the double ace wrap which has resulted in no adverse effects and positive patient compliance and participation.
97 Arterial Waveform Variations as Measures of Resuscitation Adequacy in a Porcine Model of Burn Injury
Authors: ArabiDarrehDor Ghazal , Kao Yi-Ming , Oliver Mary A , Reese Adam D , Carney Bonnie C , Keyloun John W , Chung Kevin K , Moffatt Lauren T , Shupp Jeffrey W , Hahn Jin-Oh , Burmeister David M 
Published: March 2022

Abstract

Introduction
Optimized fluid resuscitation of burn patients is a clinical care challenge as both under- and over- resuscitation have deleterious consequences. The gold-standard endpoint guiding burn resuscitation is urinary output (UO), which is known to have limited efficacy. We investigated the potential of the dynamic indices of fluid responsiveness derived from arterial blood pressure (BP) waveforms in conveying information about burn resuscitation. In particular, we investigated pulse pressure variation (PPV) and systolic pressure variation (SPV), which have been shown to be valuable in a number of other indications.

Methods
We conducted a retrospective analysis of arterial BP waveform data acquired from six anesthetized and mechanically-ventilated pigs (33±5 kg weight and 40% total burned surface area) which were instrumented for hemodynamic monitoring for 24 hours. The animals were either under-, over-, or adequately-resuscitated (guided by a burn resuscitation decision support system), with two animals in each group. PPV and SPV were calculated on an hourly basis. Fluid responsiveness thresholds of 15% and 6% were used respectively for PPV and SPV, as per literature.

Results
All of the animals experienced an immediate rise in PPV and SPV following the injury (PPV and SPV start from large values as seen in Fig. 1 and Fig. 2). In the under-resuscitated group, PPV and SPV increased above the threshold, reaching maximum values in the last eight hours (PPV: 49.8±20%, SPV: 24.7±3.6%), indicating severe hypovolemia. In the over-resuscitated group, PPV and SPV decreased below the threshold, reaching their minimum in the last eight hours (PPV: 8.7±3.6%, SPV: 4.1±1.9%), indicating major hypervolemia. In the adequately-resuscitated group, PPV and SPV maintained closer to the threshold throughout the duration of the experiment, and at the end, PPV was 15.6±4.2% and SPV was 6.2±2.6%.

Conclusions
Our initial results suggest that PPV and SPV may help distinguish under-, adequately-, and over-resuscitated burn patients, and potentially complement UO in the hemodynamic assessment of the burn injury patients.
101 Adrenergic Receptor Expression Is Increased in Carotid Smooth Muscle from Severely Burned Rats
Authors: Song Juquan , Jay Jayson W , Wang Ye , Huebinger Ryan M , Wolf Steven E 
Published: March 2022

Abstract

Introduction
Severe burn disrupts cardiovascular function which can lead to critical shock. To counteract cardiovascular collapse, there is a systemic increase of catecholamines released in response to severe burn. Previous studies showed that β1- adrenergic receptor (AR)_ protein expression was significantly increased in the cardiac right ventricles (RV) following burn injury, which is correlated with compromised cardiac dysfunction. Vascular smooth muscle contraction served to modulate blood pressure and improve circulatory perfusion. We hypothesize that ARs expression in major arteries are modified to initiate vascular functional changes following severe burn. In the current study, we report temporal ARs expression in murine carotid artery smooth muscle following severe burn.

Methods
Thirty-four adult Sprague-Dawley male rats received a 40% total body surface area (TBSA) scald burn followed by fluid resuscitation using the Parkland formula. Control animals received a sham burn procedure. Animals were serially euthanized between 6 hours and 14 days after burn and endothelium-intact common carotid arteries were harvested for histological analysis.

Results
Immunohistochemical staining data demonstrated expression of adrenergic receptors (AR) (α1, α2, β1, and β2) were differentially changed in response to injury over time. α1a-AR expression significantly increased within the carotid artery tunica media 7-days after burn (p&lt; 0.05). As a negative feedback of inhibitory of norepinephrine signaling, AR-α2a expression did not significantly change. AR-β1 expression also had no change over time after burn. Interestingly, functioning to relax vascular smooth muscle, a significant elevation of β2-AR expression within the carotid artery tunica media was observed only at 1-day after burn (p&lt; 0.05).

Conclusions
In summary, immunohistochemistry showed that carotid arterial adrenergic receptor expressions of α1a-AR and β2-AR are significantly altered in response to severe burn, which may contribute to vascular contractility in burn rats.
106 Nursing Documentation Variability Among Burn Centers Using the Burn Navigator
Authors: Coates Elsa , Rizzo Julie A , Salinas Jose , Serio-Melvin Maria 
Published: March 2022

Abstract

Introduction
Managing burn fluid resuscitation for large burns is challenging and relies heavily on accurate nursing documentation. The Burn Navigator (BN) is a clinical decision-support system designed to guide clinicians in burn fluid resuscitation. However, data entered into the BN do not auto-populate into the electronic medical record (EMR), thus requiring nurses to document in two systems. We sought to compare differences in nursing documentation of data entries between the EMR and the BN on burn patients with ≥ 20% total body surface area (TBSA) undergoing intravenous (IV) fluid resuscitation.

Methods
Institutional Review Board approval was obtained for a multi-center observational study of burn patients undergoing fluid resuscitation using the BN. Data were collected and analyzed between the EMR and BN entries entered into the REDCap database from 5 American Burn Association (ABA)-verified burn centers. The following variables were analyzed: time of burn injury, weight, TBSA burned, urine output (UOP), and hourly IV crystalloid fluid volume.

Results
Analysis included 296 subjects (of 300 enrolled). Results show no significant difference between burn centers for mean weight (BN 87.02 ± 22.9 kg vs. EMR 87.1 ± 23.3 kg), TBSA (BN 40.71 ± 19.24% vs. EMR 40.97 ± 19.29%), or time of burn injury (&lt; 1 hour). The time of injury recorded in the BN versus EMR was later in 44.6% (n=132) of patients and earlier in 46.4%, (n=138) and the same in 8.8% (n=26) of records. Additionally, in 293 records, there was no significant difference between centers in patient UOP (BN 0.91 ± 0.52 ml/kg/hr vs. EMR 0.91 ± 0.63 ml/kg/hr). One site had a significant difference in hourly fluid rates (Figure) due to a lack of inclusion of pre-hospital fluids.

Conclusions
When comparing the data between the EMR to BN, it was observed that pre-hospital fluids tended not to be documented in the EMR, causing a statistically significant difference in total fluids administered in one burn center. Overall, the nursing documentation variability was minimal across all sites even though the nurses had to document the data in two different systems, while simultaneously caring for critically ill patients with large burn injuries. Close monitoring of the nursing documentation during burn fluid resuscitation should always be a priority.
119 Identifying Temporal Patterns in Burn Admissions
Authors: Beyene Robel , Stonko David P , Mubang Ronnie , Gondek Stephen , Morrison Jonathan , Dennis Bradley M 
Published: March 2022

Abstract

Introduction
Temporal variations in trauma admissions, based on the time of day, day of week, and day of year, have been previously demonstrated. These variations, which could inform decision making regarding staffing and resource utilization, have not been evaluated with respect to burn admissions. Very little has been published on predicting temporal distribution stratified by total body surface area (TBSA). We hypothesize that temporal patterns exist in the distribution of burn admissions at all TBSA as it relates to time of day, day of week, and day of year.

Methods
This was a cross-sectional observational study of a single burn center over nearly 5 years, from 7/1/2016-3/31/2021, including both pediatric and adult admissions. We captured and plotted bivariate absolute and relative frequency data from all patients who met inclusion criteria in heat-maps showing time of day versus day of week. Frequency analysis was also performed grouped by TBSA against time of day and relative encounters against day of year.

Results
2657 burn patient encounters were analyzed, averaging 1.53 burns per day. Temporal variations were skewed towards evening admission, primarily between 15:00-0:00 hours (p&lt; 0.001). In figure 1, each block of the heatmap represents a one hour block of one day of the week over the nearly five year study period. The color corresponds to the relative frequency of contacts per hour, where 1 represents the mean number of trauma contacts per hour. Evenings (15:00-0:00) have more burn admissions than the rest of the day or night. Figure 2 shows this temporal trend is seen in burn encounters below 20% TBSA as well as those at or greater than 20% TBSA. Unlike trauma admission distribution, which has been shown to increase on weekend, day to day variation does not conform to weekend or weekday distribution. There is no cyclical yearly trend in burn admissions, suggesting that there is no seasonal variation to burn admissions, though individual holidays were not assessed.

Conclusions
We identify temporal variations in burn admissions, including the peak admission window late in the day. However, there is no predictable variation in weekend vs weekday distribution of burns. Furthermore, there is no cyclical annual variation to guide staffing and resource allocation.
124 The Relationship Between Social Functioning and Psychological Status: A preschool-libre1-5 Study
Authors: Patel Khushbu F , Ni Pengsheng , Rodríguez-Mercedes Silvanys L , Surette Kate E , Rencken Camerin A , Fabia Renata , Tully Carrie , Palmieri Tina L , Romanowski Kathleen S , Warner Petra , Stoddard Frederick J J , Schneider Jeffrey C , Kazis Lewis E , Ryan Colleen M 
Published: March 2022

Abstract

Introduction
Dallas ages one to five are learning to make friends and interact with peers in situations where their social functioning may have a direct relationship with their mood. Dallas may be isolated from peers during the acute phase of burn recovery and face rejection by their peers during recovery. This could influence their psychological health through feelings of anxiety, loneliness, social withdrawal and/or defiant behavior. This study evaluates the relationship between social and psychological functioning using the data collected from the field-tested Preschool-LIBRE1-5 instrument.

Methods
Parents of burn survivors (n=426) completed Preschool-LIBRE1-5. Items from the psychological (48 items) and social (37 items) functioning domains were coded on a 5-point Likert scale ranging from 0 (never) to 4 (always) where higher scores denote better functioning. Confirmatory factor analysis was conducted for individual items in the social and psychological domains respectively. Regression model assessed the relationship between the social and psychological domains, controlling for demographic characteristics (gender, race, ethnicity, age at survey completion, burn size, and pain severity).

Results
Factor analysis identified three factors for social functioning: play, peer relations, and peer rejection. The psychological items confirmed a single factor that included dysregulation (negative behaviors and sleep), externalization (impulsivity and aggression), internalization (general anxiety and depression), and trauma (fear and avoidance). Distress items, also in the internalizing subdomain, weren’t strongly confirmed as part of this single scale. The subdomains with the lowest and highest mean scores in psychological domain were dysregulation (2.68 + 0.58) and depression (3.50 + 0.37), and in social domain were peer relation (2.39 + 0.95) and peer rejection (3.42 + 0.64) respectively. Adjusted regression analysis demonstrate that the social functioning domain has a significant relationship with psychological status (p &lt; 0.004).

Conclusions
Analysis suggests a significant association between social functioning and psychological status. Results provide a basis for understanding the importance of these domains in relationship to each other.