bluuebunny/crossref_metadata_2025_split huggingface dataset:
96.5 Using Computer Vision-Based Algorithms Trained on Mobile-Device Camera Images for Monitoring Burn Wound Healing
Authors: Chan Hannah O , Joshi Rakesh , Morzycki Alexander , Pun Andrew C , Wong Joshua N , Hong Collins 
Published: March 2022

Abstract

Introduction
The appropriate characterization of burn depth and healing is paramount. Unfortunately, the accuracy of approximating thermal injury depth among all physicians is poor. While tools to improve detection accuracy, including laser doppler imaging and laser speckle imaging exist, these technologies are expensive and limited to specialized burn referral centres. They also do not provide an easy means for quantitative, interval tracking of burn healing. Considering these limitations, the application of artificial intelligence has garnered significant interest. We herein present the use of three novel machine learning and computer vision-based algorithms to track burn wound healing.

Methods
Convolutional neural network (CNN) models, were trained on 1800 2D color burn images, to classify them into four burn severities. These CNNs were used to develop saliency algorithms that identify the highest “attention” pixels used to recognize burns. Image-based algorithms that count these attention pixels of the CNN, count pixels representing red granulation of burns, and measure burns, were also developed. As proof-of-concept, we tracked the healing of a localized burn on a 25-year-old female patient. The patient suffered a scald on the dorsum of the foot, resulting in a deep partial-thickness burn. Opting out of surgical intervention, the patient visited the hospital over a 6-week period for treatment with non-adhesive dressings and silver nitrate. High-resolution images of the burn, with and without a fiducial marker, were captured with a smartphone camera every 7-days. Images were taken under institutional lighting and used as algorithmic inputs.

Results
Data analyses indicate that the healing of the open-wound area was accurately measured in millimetres (+/- 1.7 mm error) using a fiducial marker (18.3 mm diameter). The open-wound area shrank consistently from week 1 to week 6 seen in (Figure 1. a-b). The normalized, 2D colour images, where the “red” pixel value was counted (Figure 1. a-b), confirms the reduction of the red granulation in the wound. The saliency algorithm also measured a percentage reduction in the machine learning model’s total attention pixels over the 6-week period (Figure 1. c-d). This suggests that the model was less discerning of the healing burn wound over time, suggesting burn healing, which was also clinically validated.
107 Nursing Interventions in the Temperature Management of Acute Burn Patients in the Burn Operating Room
Authors: Polsgrove Nicole , Zieger Madeline , Roggy David , Hartman Brett C 
Published: March 2022

Abstract

Introduction
The development of hypothermia in the operating room is a known risk that has been well documented in the literature. The typical surgical patient undergoing general anesthesia experiences a temperature loss of approximately 4°F without warming interventions. Burn patients are at a higher risk for hypothermia due to the greater body surface area exposure and evaporative losses related to their burn injury and length of their operative interventions. The purpose of this review is to determine the average loss of body temperature of the burn surgical patient as it pertains to total body surface area (TBSA) injury and the use of warming interventions.

Methods
A two year retrospective review was performed on acute burn surgical cases in our two dedicated burn operating rooms within our burn center. Data obtained included TBSA of each case, pre and post-procedure patient temperatures, maximum OR room temperature, and use of adjunctive warming interventions. The surgical procedures were categorized by percent TBSA burn of &lt; 10%, 10-20%, 21-40%, and &gt;40%.

Results
We identified 415 cases that were included in this review from 2019 and 2020. As expected, patients with larger TBSA involvement led to a greater temperature decline. As seen in Table 1, forced warm air devices were utilized in 67.2% of cases. In our large Burn OR suite, we utilize a heat panel that is integrated in the ceiling above the OR table. Utilization of these devices is determined by the Burn OR nurse. They are either initiated prior to the start of the case or intra-operatively if the patient’s temperature is declining and intervention is required. Mean operating room temperatures were 80.1°F in all cases with cooler room temperatures in the smallest TBSA group. Our average patient temperature decline was 1.25°F in all cases. However, in the largest TBSA group, the mean temperature loss was 2.68°F which is significantly less than the 4°F loss in general anesthesia procedures without warming interventions.

Conclusions
The use of elevated ambient operative room temperatures along with other warming interventions aid in the maintenance of core body temperature in the burn surgical patient. Having dedicated burn operative nurses with investment in the outcome of the burn surgical patient contributes to the overall safety and the maintenance of temperature homeostatic state.
517 Outcomes of Patients with Burns Associated with Home Oxygen Therapy: An Institutional Retrospective Review
Authors: Yoon Joshua S , Khoo Kimberly H , Puthumana Joseph S , Keller Patrick R , Lagziel Tomer , Cox Carrie A , Werthman Emily H , Galiatsatos Panagis , Hultman Charles S 
Published: March 2022

Abstract

Introduction
Home oxygen therapy (HOT) is frequently prescribed for patients with pulmonary dysfunction, which predisposes them to a unique health hazard at home. Prior studies show that HOT burns carry high morbidity and mortality, in large part due to inhalational injury. A significant portion of HOT patients are active smokers, which is the most frequent cause of HOT ignition. We conducted a retrospective review of patients with HOT related burns at our institution to characterize demographics and outcomes in this patient population.

Methods
An IRB-approved single-institution retrospective review was conducted by querying our institutional burn registry for patients diagnosed with head and neck burns between July 2016 and January 2021. Patients with burns due to HOT ignition were included. Patients were separated into three groups: i) discharged from the emergency department (ED), ii) observed for less than 24 hours, and iii) admitted to the hospital. Demographic and clinical outcome data were compared between groups.

Results
We identified 100 patients with HOT burns, who were evaluated from 2016-2021, during which time we treated 3606 patients with burn injuries. Mean age was 66.6 ± 9.3 years with a male to female ratio of 1.3:1 and median TBSA of 1%. In these patients, 97% were on HOT for COPD and smoking caused 87.3% of burns. Thirteen were discharged from the ED, 35 observed for less than 24 hours, and 52 admitted. For admitted patients, 69.2% were admitted to the ICU with a median ICU stay of 1.5 days, 37% required intubation for a median duration of 1 day, and 11.5% required debridement and grafting with an average of 2.6 ± 1.6 procedures. Inhalational injury was found in 26.9% of patients, 3.9% underwent tracheostomy, and 17.3% experienced hospital complications. In-hospital mortality was 9.6% and 7.7% discharged to hospice. Among those admitted, median length of stay was 4 days and 67.3% discharged home. After discharge, 13.5% required readmission within 30 days. Patients admitted to the hospital had significantly higher rates of admission to the ICU, intubation, and inhalational injury compared to those that were not admitted (p &lt; .01).

Conclusions
Most HOT-related burns are caused by smoking and these injuries can result in significant morbidity and mortality. Efforts to educate and encourage smoking cessation with more judicious HOT allocation would assist in preventing these unnecessary highly morbid injuries.
526 Keep it up! Inpatient Weight Changes in Burn Patients with &gt;20%TBSA
Authors: Lagziel Tomer , Yoon Joshua S , Martinez Stephanie L , Cox Carrie A , Duraes Eliana F , Hultman Charles S , Caffrey Julie 
Published: March 2022

Abstract

Introduction
Burn patients with &gt;20%TBSA suffer from a hypermetabolic state causing loss of muscle mass as well as a compromised immune system and delayed wound healing. Weight loss is most severe in patients with &gt;20%TBSA with an initial gain of weight due to fluid resuscitation. These findings led the American Burn Association to propose new quality measures for burn-injury admissions, including weight loss from admission to discharge. We aim to assess how our institution’s outcomes adhere to the proposed measures and if our findings correlate with previously described results.

Methods
A retrospective review was conducted for adult patients admitted to our institution with burn injuries of &gt;20%TBSA since 2016. Three groups were established based on %TBSA: 20-29% (Group 1), 30-39% (Group 2), and &gt;40% (Group 3). We assessed weight changes from admission to discharge and performed a multivariate analysis to account for age, sex, number of surgical procedures, and hospital length-of-stay (LOS).

Results
Data from 40 patients suffering burn injuries of &gt;20%TBSA showed 11 patients with %TBSA of 20-29%, 10 patients with %TBSA of 30-39%, and 19 patients with %TBSA of &gt;40%. When comparing groups 1 and 2, we saw significantly more weight loss in group 2 over the course of admission without a significant change in total hospital LOS. The average %weight loss for group 1 was 1.46%, 8.36% for group 2, and 10.56% for group 3. No patients in group 1 had a weight loss &gt;15%. For group 2, patients with weight loss &gt;15% had a significantly longer LOS and underwent significantly more surgical procedures during their admission. For group 3, most patients that experienced weight loss &gt;20% did not have a longer LOS but did require more surgical procedures during their course of admission.

Conclusions
Analysis of the data demonstrates that patients with &gt;20%TBSA do suffer significant weight changes, likely due to extreme metabolic disturbances. Our data suggests that an increased length of stay is not a significant driver for weight loss changes between patients with %TBSA of 20-29 and 30-39, suggesting other pathophysiologic mechanisms in play. Our data supports the idea that patients with %TBSA&gt;40 are a unique subset of patients, requiring specialized nutritional protocols and metabolic analysis.
531 Comparison of Clinical Estimation and Stereophotogrammic Instrumented Imaging of Burn Scar Height and Volume
Authors: Bharadia Shyla K , Gabriel Vincent 
Published: March 2022

Abstract

Introduction
Descriptive clinical tools for the characterization of burn scar features are limited by variability between users and unknown sensitivity to change over time. We have previously described pre-clinical assessment of stereophotogrammetry as a valid measure of burn related scar and in this study compare the estimated vs. instrumented measurement of maximum height and total positive volume of burn scars in a tertiary care adult outpatient burn clinic.

Methods
This study was approved by our university’s research ethics board. All participants provided written informed consent. Persons 18 years or older presenting to an outpatient burn clinic with closed burn scar that may be captured in a single image were enrolled in the study. Patients with scars from other injuries or who were unable to provide consent were excluded. Photographs of burn scars were taken with a commercially available 3D camera. Three experienced wound care therapists estimated the maximum height and total positive volume of the collected images. The images were assessed with stereophotogrammic software with results exported to a spreadsheet for further analysis. Two factor analysis without replication was performed to calculate intra-class correlation coefficients (ICC) between the assessors estimated scar height and volume and the measured height and volume. Two sided Wilcoxon tests were performed comparing mean estimated height and volume between estimated and measured output.

Results
Fifteen participants with a mean age of 42.6 (21-68) were enrolled. Twenty-six scar images were taken from wounds that were managed by non operative treatment (20), excision and grafting (5), and 1 image was collected from a skin graft donor site. Scar images were taken of the trunk and extremities, but none of the head nor neck. The estimated maximum scar height ICC was 0.595 and volume 0.531. The measured scar height ICC was 0.933 and volume 0.890. Wilcoxon tests of estimated and measured volume were significantly different (z = -2.87, p = 0.041). Comparison of estimated and measured height were not significant (z = -1.39, p 0.161).

Conclusions
Stereophotogrammic measurement of maximum scar height and total scar volume is more reliable than clinical photograph assessment. Clinical estimation of scar volume is significantly less than instrumented measurement, although maximum estimated vs. measured scar height was not significant in this study. There are limitations in measuring scar properties for image capture that exceeds the visual field.
535 Pre-operative Expectations, Post-operative Satisfaction and Patient Directed Priorities for Clinical Burn Research
Authors: Bharadia Shyla K , Horch Jenny , Burnett Lindsay , Yu Zheng , Shen Hua , Gabriel Vincent 
Published: March 2022

Abstract

Introduction
Patients receiving split thickness skin grafting due to deep burns are left with scarring and chronically dysfunctional skin at the graft site. Given evidence that patients’ pre-operative expectations mediate post-operative outcomes and satisfaction, we sought to describe burn patients’ experience, expectations, and satisfaction with their skin graft, and their views towards a future cell-based clinical trial to improve their graft, over time. We also aimed to identify graft outcome measures for use in future studies.

Methods
This study was approved by our university's research ethics board. All participants provided written and informed consent. Data were collected via patient questionnaires pre-operatively, one, and three months post-operatively.

Results
Most patients had small burns. Expectations of graft function were consistent pre- and post-operatively. Expectations of graft appearance showed significant decrease over time (β 1 = -0.290, p = 0.008). Significant improvements in skin function (β 1 = 0.579, p = 0.000) and appearance (β 1 = 0.247, p = 0.025) at the wound site during recovery were observed, although patients noted great difference between grafted and normal skin. Patient satisfaction with their graft did not change significantly over time. Patients were willing to participate in a cell-based clinical trial that may improve graft symptomology. They prioritized diminished scarring, redness, and improved sensation and elasticity as the most salient aspects of grafts to be enhanced by cell-based therapy.

Conclusions
Patient graft concerns changed over time; outcome measures in trials advancing skin grafting should reflect chronic, patient prioritized limitations.
554 Preventing accidental central line removal: Early success through a novel securement device
Authors: Ha Aemilio W , Thomas Mini 
Published: March 2022

Abstract

Introduction
Central Venous Catheter (CVC) placement and maintenance can be difficult due to non-intact skin and possible surrounding weeping wounds. In addition, routinely used products require intact skin for the adherence of the central line dressing along with sutures or securement devices. With the increased number of line dislodgements, the Burn Intensive Care Unit (BICU) searched for alternative means of line securement. A subcutaneously anchored sutureless system (SASS) was found that could secure the line and allow for improved cleaning around the insertion site. The SASS is a device made of metal which resides in subcutaneous portion of the skin and anchors the CVC while allowing lifting of the catheter to clean underneath.

Methods
After identification of the SASS product, a trial was implemented. Nurses (RN) and providers were trained virtually by the product representative. Nursing champions were selected to be a liaison between the product representative and the staff. Patients included burn patients or Steven Johnsons (SJS) patients, with large open total body surface area, who had a CVC placed peripherally or centrally between September 2020 to June 2021. A survey was conducted upon insertion of the device, with dressing changes, and upon removal.

Results
In 2018, there were a total of 14 CVC dislodgements and 12 in the year 2019. For the year 2020, there were 4 dislodgements and 2 in 2021. Both adult and pediatric patients utilized approximately 12 SASS. From the nurses who cared for the patients, 19 responses were obtained regarding the SASS. Overall, 94% of staff recommended this product for use. No accidental removal of the CVC was reported with use of the SASS. With cleaning around the catheter insertion site, 53% believed that they were able to clean better while 47% felt that it was the same with the previous practice. In terms of duration of changing the dressing and maintaining the catheter, 53% felt that it was the same while 47% thought it was faster. During maintenance, the most discomfort reported by patients was 4/10.

Conclusions
The SASS can be implemented as another viable method to prevent accidental dislodgement of the CVC while securing CVC without sutures. In addition, RNs believed it allows for faster cleaning around the insertion site and faster dressing changes with minimal discomfort to the patient. More data can be collected over longer periods of time and to look at its efficacy in non-burn patients.
557 Introduction of a Pediatric Burn Education Program in an Adult Hospital
Authors: Snyder Emily 
Published: March 2022

Abstract

Introduction
At a newly developed burn unit, the program decided to expand further and start admitting pediatric patients. While there are many working parts to this endeavor, we will primarily address staff preparedness. Prior to the introduction of a burn education course entitled Burns in the Pediatric Population, only a handful of nurses had received any hospital-based education for caring for pediatric patients. A previous pediatric course had been taught, however, this course focused primarily on illnesses of childhood. Staff had voiced on many occasions that they felt the education they received was not adequate and felt uncomfortable taking care of pediatric burn patients.

Methods
All Burn Intensive Care (BICU) nurses, regardless of having received the prior pediatric education, were required to take Burns in the Pediatric Population (n=42). The course content was based on the Burn Nurse Competencies. The course consisted of didactic lectures and hands-on sessions. Each participant was required to take a pre-test before the class and a post-test at the conclusion. The test included knowledge-based questions and self-rated confidence level questions. In addition, each participant was sent a survey three months after the completion of the class to evaluate their knowledge and confidence level.

Results
At the conclusion of the class, the average test score went from 49.3% to 92.7%. Both the pre-test and post-test had each nurse evaluate their own confidence level for caring for a pediatric patient. Initially, 19.5% of the nurses stated that they had no confidence in caring for a pediatric patient. At the conclusion of the class, all nurses expressed some confidence with caring for a pediatric patient, with the majority, 72.7%, stating they had moderate or high confidence.
The return rate of the three-month evaluation was 81% (n=34). The knowledge-based test had an average score of 71%. 30.3% of the staff stated that their confidence in caring for a pediatric patient increased, 54.5% stated their confidence level remained the same, and 15.1% of those returning the survey stated that their confidence level decreased in the three month time period.

Conclusions
The results from the three-month survey have been utilized to edit and make our pediatric mock codes and course more specific to the needs of the bedside nurses. In addition, we are planning to increase the frequency and the level of participation in our pediatric mock codes. All Burn ICU nurses will need to participate in a pediatric mock code on a semi-annual basis. In addition, there will be a section that is added to each Burn ICU nurse’s annual competency specifically covering pediatric burns.
567 Features of Burn Injuries in Youth: A Single Center Experience
Authors: Ozkan Burak , Abali Ayse Ebru , Erkent Murathan , Aydogan Cem , Moray Gokhan , Haberal Mehmet 
Published: March 2022

Abstract

Introduction
Youth is categorized as combination of adolescence and young adulthood. Young people are prone to injuries, because this period involves essential changes in many aspects of life within a complicated physiological and mental developmental age. Our aim was to investigate the features of burn injuries in youth.

Methods
Subjects were 622 adolescents (10-18yrs, n=313) and young adults (19-24yrs, n=309) who were treated at our burn-center from 2010 to 2021. Data collected for each case were age, sex, social-security status, occupation, marital status, scene of injury, burn extent, burn cause, history of injury, affected major body sites, and need for inpatient-care (median±SD,mean±SD)(p&lt;.05).

Results
Median age was 18yrs±4,76. Male to female ratio was 0,66:1 with female predominance especially among young adults (0,48:1)(p˂.05). Most subjects were in civil social-security-system (n=612, 98,4%); most were students (n=475, 76,4%); a total of 103 subjects were in labour-force(16,5%); 44 were unemployed(7,1%). Most young people were single (n=600, 96,4%); 4 subjects in adolescent group and 18 subjects in young adult group were married(0,64% and %2,9 respectively); 15 of married cases were female(68,2%)(p&lt; .05). Injuries occurred mostly at home (n=411, 66,1%). Mean total body surface area (TBSA) burned was 3,21 % ± 7,5(min:0,2 max:75). The most commonly affected body site was the hand (n=165, 26,5%). Leading burn cause was scalds (n=433, 69,6%). Female subjects mostly suffered from scalds with mean TBSA burned of 2,0%±2,21 (min:0,2 max:18)(n=297, 79,2%). However, vast majority of flame burn victims were male (n=41, 82,0%) (mean TBSA burned: 12,8%±21,35, min:0,2 max: 75) and almost all severe electrical injuries happened to male subjects (n=13, 86,7%)(mean TBSA burned:14,2±14,81, min:0,2 max:40)(p˂.05). All cases were preventable accidents; the unique instance for ‘substance-abuse related burns’ was butane-lighter-liquid burns in 9 cases(1,4%). Inpatient-care was needed for 52(8,2%) victims. Mean TBSA burned for inpatients was 13,5%±19,6(min:1, max:75). All subjects survived.

Conclusions
Our results suggest that young female subjects are prone to burn injuries, but severe injuries happen to male and there are many other aspects that should be considered. Combined evaluation of adolescents and young adults may provide purposive data for burn repositories.