bluuebunny/crossref_metadata_2025_split huggingface dataset:
621 Ethical Considerations to Prevent Burns in Patients Who Smoke While Receiving Home Oxygen Therapy
Authors: Khoo Kimberly H , Yoon Joshua S , Hultman Charles S , Caffrey Julie 
Published: March 2022

Abstract

Introduction
Home oxygen therapy (HOT) is prescribed to patients with pulmonary dysfunction as a means of improving survival and quality of life. However, ignition of HOT can lead to burns that carry significant morbidity and mortality. This is especially true for patients who actively smoke while on HOT, with prior studies showing that 87.3% of HOT-related burns were due to smoking. An ethical issue thus arises for providers who routinely treat this patient population: how to balance providing beneficial treatment for a patient with the responsibility to protect that patient from suffering unnecessary burn injuries.

Methods
A literature review was conducted to determine the conversations surrounding this ethical dilemma in the scientific community. Thought was given to various solutions to address issues, and each solution was analyzed with respect to the traditional ethical principles of autonomy, beneficence, nonmaleficence, and justice.

Results
Multiple prevention considerations should be made for this patient population of active smokers on HOT. The first is to encourage more judicious prescription of home oxygen. This approach supports the principle of nonmaleficence as utilizing more prudence with prescription may prevent unnecessarily putting a patient at risk. A second strategy would be to discontinue a patient’s HOT if they were found to be an active smoker despite proper education; however, this solution conflicts with beneficence, especially if the patient relies heavily on HOT. A third, more drastic approach would be to withhold treatment of patients who repeatedly present with burns acquired secondary to smoking while on HOT. Refusal to treat conflicts not only with beneficence and maleficence but also with justice, as social factors play into which patients are more likely to smoke and, thus, may present with smoking-related burns while on HOT. Lastly, it is possible to address this challenge with broader, upstream solutions such as more thorough, longitudinal patient education on smoking cessation and the risks of smoking while on HOT. By doing so, physicians support all four of the traditional ethical principles.

Conclusions
Patients who suffer from burn injuries secondary to HOT ignition present a unique ethical challenge. Though physicians are tasked with the duty to provide optimal care for these patients, they are also shouldered with the responsibility of patient education and advocacy. Physicians should address this outstanding dilemma by thinking more critically about potential solutions that are bolstered by ethical considerations.
625 Patient Centered Depression and Anxiety Screening in an Adult Burn Clinic
Authors: Wojcik Jodi 
Published: March 2022

Abstract

Introduction
Depression and anxiety are seen in burn patients at rates up to 45%. Untreated, they can lead to long-term complications of posttraumatic stress disorder. Treating the psychological consequences of burn injury leads to increased quality of life for patients.

Methods
Rapid-cycle quality improvement using four plan-do-study-act cycles was used to evaluate interventions. Reviewing the data helped guide new tests of change each cycle. Data were analyzed using run charts to assess each intervention's impact.

Results
A medical screening rate of 100% was achieved. Thirty three percent of patients screened were positive for depression and/or anxiety. Of the patients who screened positive, 100% chose an intervention on the Shared Decision Making Tool.

Conclusions
Universal screening increases recognition of anxiety and depression in a vulnerable population of burn patients. Using a Shared Decision Making tool increases patients centerdness and selecting an intervention for treatment.
704 Ceftazidime / Avibactam Efficacy for Treating Carbapenem-resistant Infections in Critically Ill Patients with Thermal Injuries
Authors: Hill David M , Martin Kelsey , Arif Faisal , Sultan-Ali Ibrahim , Velamuri Sai R 
Published: March 2022

Abstract

Introduction
Rising antimicrobial resistance is a pressing public health concern. Emergence of carbapenem-resistant organisms has led to increased use of novel antibiotics, such as ceftazidime/avibactam (CZ/AV). However, recent studies have shown increasing treatment failures and resistance rates associated with ceftazidime/avibactam use. The efficacy of CZ/AV has not been studied in patients with thermal injuries, where pharmacokinetic derangements are common and longer lengths of stay augment risk of requiring several antimicrobial courses, leading to higher resistance rates. The objective of this study was to evaluate the outcomes of patients with thermal injuries including clinical success, the frequency of adverse effects, and emergence of resistance.

Methods
The design was a retrospective chart review. Patients were included if admitted with thermal injuries and receiving at least 48 hours of CZ/AV between Jan. 1, 2017 and July 2020. Demographics and treatment data were reported using descriptive statistics. Treatment success, description of treatment failures, and adverse events were described. Logistic regression was used to control and analyze failures.

Results
Fifteen patients with 17 courses evaluated. Most were male (87 %) and African American (53 %). The mean age and weight was 47.7 ±13.6 and 96.3 ± 29.4. Seventy-three percent had a flame injury. Mean TBSA was 34 ± 18.7. Twenty percent had an inhalation injury and 80 % a significant substance use history. Clinical success occurred in 65% (11/17) although 29% died. E. cloacae (88%) was the most common treated pathogen, but 81% were polymicrobial. The most common sources were wounds (29%), blood (29%), and lungs (26%). Median days until CZ/AV initiation was 32 (14,76). CZ/AV was dosed at 2.5 g every 8 hours in all courses. Median treatment duration was 12 days (9,14). Fifty-three percent received CVVH with a mean delivered dose of 47.6 ± 9.5 ml/kg/hr. Resistance developed in 19% (3/17) of courses, but follow up sensitivities were rarely available. Logistic regression did not reveal any variables significantly associated with failure. There were no adverse events attributed to CA/AV

Conclusions
Although lower than desired, clinical success rates in this sample were similar to other reported populations treated with CZ/AV. However, the emergence of resistance occurred more frequently, and was likely underreported in this sample. HVHF did not contribute to failure, but CZ/AV was aggressively dosed in this cohort.
712 Association between administration of hydroxycobalamin and acute kidney injury in patients with burn injury
Authors: Lo Marcus , Cartotto Robert , Ho George , Mason Stephanie A 
Published: March 2022

Abstract

Introduction
Hydroxycobalamin (HC) is administered to patients with suspected hydrogen cyanide poisoning. Some reports suggest that this practice may be associated with acute kidney injury (AKI). We aimed to evaluate the association between HC administration and AKI after burn injury.

Methods
We conducted a retrospective matched cohort study. All adults admitted to a regional ABA-verified burn center within 24 hours of injury between 2015-2019 with &gt;10% total body surface area (TBSA) flame burn injury were reviewed. We excluded patients who were palliated within 48 hours of admission, and those with pre-existing renal disease. Patients who received HC, either pre-hospital, in the emergency department, or the burn center, were matched on age (+/-2 years) and %TBSA (+/-5%) to up to 5 patients who did not receive HC. Rates of AKI within 7 days of admission, as defined by KDIGO criteria, were then compared. Secondary outcomes included receipt of renal replacement therapy, death, ventilator days, and discharge disposition.

Results
We identified 10 patients who received HC; these patients were matched to 42 patients who did not receive HC. The median age of the HC group was 57 (IQR 43-66), compared to 65 in the non-HC group (IQR 57-65) (p= 0.98). The median %TBSA burn and %TBSA full thickness burn in the HC group and control was 16.5 (14-19) vs 13.5 (11-18) respectively (p= 0.22) and 3.5 vs 3.5 (0-9.5) respectively (p= 0.93). The incidence of inhalation injury in the HC group (n=8, 80%) was significantly higher than in the non-HC group (n=7, 17%)(p&lt; 0.001). All HC patients were intubated within 24 hours of admission vs. only 48% of controls (p=0.003). The HC group also had significantly higher median SOFA scores on admission (9.5 vs 4, p&lt; 0.001) and had a significantly higher admission creatinine [1.08 (0.95-1.26) vs 0.86 (0.71-1.02) mg/dl), p= 0.02]. The median 24-hour crystalloid fluid administered was 5911 mL/kg/%TBSA in the HC group vs 2774 mL/kg/%TBSA burn in controls (p= 0.004). All patients in the HC group developed AKI (n=10, 100%), compared to 64% (n=27) of non-HC patients (p=0.03). There was no significant difference in rates of death (20% vs 10%, p=0.35), Renal Replacement Therapy (20% vs 7%, p=0.21), discharge disposition, or ventilator days between groups.

Conclusions
We identified a small number of patients who received HC over a 5-year period at our burn center. There was an association between HC administration and development of AKI, but there were no differences in mortality, RRT, or ventilator days. HC administration is rare, and our data suggest that the sickest burn injured patients receive it. Larger studies are required to determine if HC administration is associated with AKI, or whether the increased rate of AKI in our study reflects illness severity.
719 Effects of Obesity on Outcomes of Adult Burn Patients at a Single Institution
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia 
Published: March 2022

Abstract

Introduction
Obesity is a global epidemic that continues to worsen. In 2016, more than 1.9 billion adults were considered overweight worldwide and over 650 million were obese. It is well-known that excess adipose tissue may alter inflammatory and immune mediator regulations, which can lead to challenges in managing resuscitation efforts, respiratory support, and thromboprophylaxis of burn patients. The objective of this study was to evaluate the outcomes of burn patients with obesity at our institution.

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, 2013 and June 30, 2021 who were classified as obese (i.e., body mass index &gt; 30.0) were included in this study. All adult patients who were classified as underweight, normal weight, or overweight were also included for comparative purposes. Variables of interest included demographics, burn mechanism, length of stay (LOS), cost of hospitalization, and mortality.

Results
There were 7,626 patients included in this study, with the largest percentage of patients included in the obese category (38.4%). Among the obese population, most of the patients (53.2%) were classified under ‘Obesity Class I’ (i.e., body mass index 30.0 – 34.9). The majority of patients in each category were male, except in the ‘Obesity Class III’ category (i.e., body mass index &gt; 40.0) where 54.8% of the population were female. The mean age of the entire study sample was 44.9 years +/- 17.5 years, while the mean total body surface area (TBSA) involvement was 5.1% +/- 10.0%. The mean LOS of the entire study population was 10.3 days +/- 22.6 days, with patients in the ‘Obesity Class III’ category having the longest LOS with 14.0 days +/- 36.5 days. The cost of hospitalization was lowest in the overweight group with $82,661, while the highest cost was in the ‘Obesity Class III’ group with $130,683. The overall hospital mortality for the entire study population was 3.0% with the highest mortality noted in the ‘Obesity Class III’ group (4.7%).

Conclusions
Obesity affects all aspects of a burn patient’s care throughout their hospitalization. In our study, obesity was associated with longer LOS, cost of hospitalization, and mortality; therefore, it is imperative to understand the negative effects that obesity can have on burn patients, not just in terms of their acute management, but also their continued care after hospitalization.
741 Burn Injury Elevates the Risk of Sepsis in Pregnant Women
Authors: Bagby Shelby P , Song Juquan , Wermine Kendall , Golovko George , El Ayadi Amina , Wolf Steven E 
Published: March 2022

Abstract

Introduction
Pregnancy naturally strains a woman’s body, and is exacerbated by additional stressors, such as severe burn. This study seeks to establish a national incidence rate of burns during pregnancy, as well as categorize the patients epidemiologically and by percent total body surface area (%TBSA) burned. We posit that pregnancies complicated by burn injuries have worse outcomes in mortality and comorbidities in comparison to pregnancies not complicated by burns.

Methods
Using an electronic medical record database, TriNetX, a retrospective cohort study was performed to identify burned pregnant patients within the last 20 years. The burn cohort included all pregnant women aged 12-55 who experienced a burn injury on the same day as pregnancy or anytime within nine months after the first record of pregnancy. The non-burned cohort included women who did not experience a burn within nine months of the recorded pregnancy. Outcomes compared were sepsis, pregnancy with abortive outcome, ectopic pregnancy, spontaneous abortion, complications of labor and delivery, preterm labor, postpartum hemorrhage, maternal mortality, and acute respiratory distress syndrome (ARDS). After matching for age at pregnancy, each outcome was compared at one, three, and five years after pregnancy. Risk ratios (RR) with a 95% confidence interval (CI) were used to compare cohorts, and a p-value &lt; 0.05 was deemed significant.

Results
The TriNetX database contained 21,438,975 females between the ages of 12-55. Among these, pregnant women with burn injuries were found to have an incidence of 4.32% in the United States in the last 20 years (pregnant females with burn n = 4,721; females with burn n = 109,294). Of burns categorized by %TBSA burned, 84% were between 1-10%. Within one year of pregnancy, burned patients have a three-fold increase in risk of development of sepsis compared to non-burned women (RR = 3, 95% CI = 1.518, 5.929), but are less likely to experience pregnancy with abortive outcome (RR = 0.612, 95% CI = 0.509, 0.735), complications during labor and delivery (RR = 0.863, 95% CI = 0.803, 0.928) or spontaneous abortion (RR = 0.707, 95% CI = 0.556, 0.899).

Conclusions
Pregnancy complicated by burn injury has a lower national incidence rate than the generally accepted 7% of reproductively aged females. Burned patients were more likely to experience sepsis than their non-burned counterparts one year after pregnancy, however, risk of maternal mortality was the same between the burned and non-burned patients within one year after pregnancy with a curious decrease in miscarriage and labor and delivery complications.
743 Virtual burn care - friend or foe? A systematic review
Authors: Malic Claudia , Mondor Eli , Barnabe Jaymie , Laguan Robyn M 
Published: March 2022

Abstract

Introduction
Interest in virtual care has grown, but evidence surrounding its use for burn injuries is variable. This systematic review assesses the impact of virtual burn care in the past decade (2010-2020) by providing an overview of recent advances in the field. Data on efficacy, feasibility, cost-effectiveness, usability, pros/cons, satisfaction/acceptability, clinical outcomes, and triage effects are presented. Conclusions on its post-pandemic sustainability are drawn.

Methods
A systematic review with qualitative synthesis was performed according to PRISMA guidelines. Quality of included studies was assessed by validated tools. CINAHL, OVID MEDLINE, APA PsycINFO, and the CENTRAL trials registry were searched. Grey literature was searched for in OAIster, Duck Duck Go, Bandolier Knowledge, LILACS and McMaster Health Systems Evidence. Primary literature published between 01/01/2010-12/31/2020 investigating any of the noted outcomes of interest was retrieved for data extraction.

Results
A total of 486 studies were identified for screening. 412 and 26 citations were excluded in title/abstract and full text screening, respectively. After removing 8 unretrievable works and 3 straggling duplicates, 50 citations were included. Most works were published from 2016-2020 (n=35, 70%). The most common uses (with some overlap) were acute assessment (n=35, 70%), remote follow-up (n=18, 36%) and tele-rounding (n=4, 8%). Remote photographic burn size (not depth) estimation was found feasible and acceptably accurate. Patient and provider satisfaction was high overall. Patient outcomes with virtual follow-ups were largely comparable to equivalent in-person services, though some adjunct programs saw little benefit. Increased specialist access, more accurate assessment/triage and saved travel time/cost were commonly noted. Challenges included logistics and language barriers for international interventions, IT issues and internet access limitations, HIPAA compliance and some wound/scar assessment challenges (e.g. burn depth and scar vascularity).

Conclusions
Evidence suggests that virtual burn care is largely safe, efficacious and could be feasible for continued use post-COVID-19 provided technological infrastructure is attainable and suitable regulation exists. Virtual acute specialist burn assessment is particularly well supported.
746 Nurse Driven Fluid Resuscitation in the Burn Center
Authors: Werthman Emily H , Cox Carrie A , Caffrey Julie 
Published: March 2022

Abstract

Introduction
The prior practice of the burn center was to resuscitate burn injuries over 20% total body surface area (TBSA) using a provider led modified Brooke fluid resuscitation formula. In that model of fluid resuscitation, the burn center provider ordered an initial fluid rate and adjusted hourly, where appropriate based on nurse recorded outputs. In Q4 2020 a nurse-driven fluid resuscitation was implemented in the adult Burn Intensive Care Unit (BICU). The primary purpose of the survey research is to evaluate the effect of the nurse-driven fluid resuscitation on nurse and physician communication.

Methods
Survey research was initiated in Q3 2020 with a pre-practice change survey for BICU staff. The 3-part survey included 10 questions. The post survey will be repeated in August and remain open through October or until 70% of participants have completed the survey, whichever comes first.

Results
Paired t-tests will be used compare survey research results pre and post-protocol implementation. In the pre-implementation survey there was a response rate of 44% (11/25). The average years of experience in the burn center was 11.64 years (median 7, SD 10.66). All survey questions were asked based on a 5-point Likert scale with anchors of 1 “strongly disagree” and 5 “strongly agree.” Question 1 the average score was 3.67. Question 2 the average score was 3.5. Question 3 the average score was 3.58. Question 4 the average score was 3.33. Question 5 the average score was 3.5. Content analysis was used to explore responses to open-ended questions. Three themes were identified: training, lack of communication, and over-resuscitation.

Conclusions
The pre-implementation survey revealed highest scores on nurses and physicians having a good map of each other’s skills and lowest on providers and nurses discussing ways to prevent errors. Content analysis also revealed common concerns about miscommunication and lack of resuscitation training leading to over resuscitation. Upon completion of the post-implementation survey, we anticipate reporting changes in low scoring questions. We look forward to reporting these results as part of this abstract.
752 Baking Bread and Other New Hobbies: Characterizing Burn Center Admissions During the COVID-19 Pandemic
Authors: McLawhorn Melissa M , Burkey Sarah E , Delatore Cara , Brantley Melissa , Moffatt Lauren T , Johnson Laura S , Shupp Jeffrey W 
Published: March 2022

Abstract

Introduction
The effects of the ongoing COVID19 pandemic are wide-reaching and still emerging. Fear of the virus, public health messaging, and government-instituted lockdowns have altered how Americans live, work, and use the healthcare system. There is minimal data that assesses how the COVID-19 pandemic and associated stay at home orders have influenced the etiology of burn injuries. With the majority of burns occurring in the home, it is possible lock down orders have significantly impacted etiology of major burn injuries. This project aims to characterize the demographics and injury characteristics of burn patients seen at a regional burn center during the COVID-19 pandemic.

Methods
Following IRB approval, our institution queried it’s burn registry from March 2020-June 2021. Data on demographics, injury circumstance and details, interventions, COVID-19 status, and outcomes were collected. Descriptive statistics were obtained for the population.

Results
There were 622 inpatient admissions during the study timeframe. Patients were primarily Black (44.4%) or Caucasian (32.6%) males (65.6%) identifying as Non-Hispanic (81.8%). The mean age was 46.73±18.6 years. Mean total TBSA burned was 6.7±10.7%, 2nd and 3rd degree percentages were 2.11±4.64 and 0.62±5.2 respectively with 47 total inhalation injuries. Top burn etiologies were 244 (39.2%) scald and 175 (28.1%) flame with 249 (40%) coded etiology associated with food prep or consumption.
The majority of the burns occurred at home (93%). Time from injury to admission was 616.98±2199.42 minutes and time to first excision from admission was 4314.3 ± 5657.3 minutes. ICU and hospital length of stay were 12.7±18.3 and 8.73±13.3 days. In-hospital mortality was 31 (5%). Nineteen patients tested positive for COVID-19 during this time.

Conclusions
Nearly half of all burn center admissions were for cooking related etiologies during this time. Time to admission was over 10 hours in a population dense area. More information of site specific pre-pandemic etiology and treatment data are needed to fully understand these initial findings. Further sub-analyses may also elucidate the influence of pandemic related behavioral changes as public health mandates evolved over time.