bluuebunny/crossref_metadata_2025_split huggingface dataset:
67 Transient Dysphagia After Burn Injury in Children: An Under-identified Problem
Authors: Bui Trang , Parry Ingrid , Ng Pauline W , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David , Sen Soman 
Published: March 2022

Abstract

Introduction
Severely burn injured pediatric patients are at risk of dysphagia (difficulty swallowing) due to prolonged intubation or tracheostomy placement. To improve the early identification and treatment of dysphagia, we implemented a swallowing assessment protocol. We hypothesized that the swallowing assessment protocol is effective for identifying and treating dysphagia after prolonged intubation.

Methods
Between October 2016 and December 2020, pediatric burn patients with facial burn injuries, prolonged mechanical ventilation, tracheostomy, inhalation injury and/or anoxic events were placed on the swallowing protocol. The protocol included a Transitional Swallow Screen (TSS) performed within 24 hours after extubation or decanulation by an advanced practice swallow occupational therapist. If signs of dysphagia were noted, recommendations on diet consistency and treatment for positioning and feeding were implemented. Regular reassessments continued until the patient was determined to have regained premorbid swallowing function. Data on patient demographics, burn characteristics, dysphagia, treatment and outcome were collected. Descriptive statistics were used to describe the population, treatments and outcome.

Results
A total of 33 pediatric burn patients were included. Mean age was 8.1±5.9 years and TBSA was 48.1±26.8%. Median time from injury to swallow assessment was 45 (21-81) days. The majority of patients suffered from flame burns (70%). Almost all of the patients were intubated (97%) and 85% underwent a tracheostomy. Patients had a facial burn (73%), inhalation injury (24%) or anoxic injury (15%). Transient dysphagia was diagnosed in 79% of patients. Subsequent therapeutic procedures as a result of the TSS included: neurologic re-education (30%), swallow therapy exercises (55%), desensitization (42%), and patient/ family training and supervision (79%). All patients eventually returned to normal swallow and regular diet. This occurred at an average of 72.5+46.7 days post injury and 8.2+18.0 days post swallow assessment.

Conclusions
Pediatric patients with substantial burn injury may not only be at risk for aspiration but also have other forms of dysphasia that require intervention. Implementation of a swallowing protocol can identify patients who required further therapeutic intervention and can guide the recovery of safe swallowing and functional oral intake.
69 Early Post-operative Mobilization After Treatment of Burn Wounds with Autologous Skin Cell Suspension
Authors: Kelly Jenna C , DeJournette Emma C , Kahn Steven A 
Published: March 2022

Abstract

Introduction
Early mobilization has become popular in the literature and the benefits in critically ill patients are well-documented. However, early mobilization in burn care is undefined. Clinical practice guidelines regarding post-operative mobilization (POM) of patients with burn injury, especially after autografting, are limited, resulting in significant practice variance among burn centers. Furthermore, data on mobilization after treatment with autologous skin cell suspension (ASCS), is even more limited, and wider practice variation exists. We hypothesize early POM is safe and does not compromise healing or lead to graft loss.

Methods
A retrospective chart review was performed to examine mobility interventions utilized for patients, with mixed partial and full thickness burns, who received ASCS with polylactic acid sheet, with or without meshed splint-thickness skin grafting (STSG), over 6 months. Data included demographics, operative procedure, dressing, post-operative restrictions, POM date by burn therapy, and presence of graft loss ( &gt;25% of grafted area with need for regrafting). The data was analyzed to corelate POM day and graft success. Initially, the authors utilized manufacturer splinting guidelines before becoming more judicious with aggressive early mobilization. Patients at risk of noncompliance and graft sheer were splinted.

Results
Fifteen patients were included in the study. In those patients, 25 body areas were grafted with 17 areas receiving ASCS with polylactic acid sheet and 8 areas additionally receiving STSG. On post-operative day (POD) 0, four areas were splinted and no range of motion (ROM) was performed at the joint. The authors splinted 3 out of 4 patients (75%) due to initial manufacturer splinting guidelines. The 4th patient was splinted due to compliance concerns. For the other 21 areas, active ROM, functional mobility and performance of activities of daily living with functional movement was allowed on POD 0. A burn therapist actively treated 64% of patients on POD 0-1 and 100% of patients were treated by POD 2. Minimal patchy graft loss (median 1.5%) was noted in 6 grafted areas including 1 area which crossed a knee despite immobilization. No graft loss was related to POM and was attributed to factors including infection or wound conversion and, by definition, no significant graft loss was found.

Conclusions
While the sample size is limited, this study suggests early POM of ASCS is safe and does not lead to graft loss. Considerations for mobilization techniques, such as ROM and functional mobility, should include joint involvement, presence of STSG with ASCS overspray, and other patient factors such as health literacy and compliance. Additional prospective studies should be dedicated to the examination of POM to develop clinical practice guidelines which can be widely utilized across burn therapy.
79 Factors Predicting Burn Survivor Group Interest in an Outpatient Burn Clinic
Authors: Ross Erin E , Colbath Rachel A , Yu Jeremy , Munabi Naikhoba , Gillenwater Justin , Yenikomshian Haig A 
Published: March 2022

Abstract

Introduction
Outpatient peer support groups have been demonstrated to help patients reintegrate with the community and improve self-acceptance following burn injury. Despite this, there is little data examining who desires participation. This is especially true for minority and socio-disadvantaged populations. The purpose of this study is to examine factors that influence desire to participate in burn survivor groups and actual participation rates.

Methods
Patients attending outpatient clinic were asked about participation in burn survivor group, interest in joining a group, and administered National Institute of Health Patient-Reported Outcomes Measurement Information System (PROMIS) Managing Emotions (ME) and Managing Social Interactions (MSI) questionnaires. Patient demographics, total body surface area burned (TBSA), initial hospital length of stay (LOS), and surgical intervention were collected from the medical record. While controlling for age and gender, indicators of injury severity and scores on PROMIS questionnaires were each examined for associations with survivor group interest using Firth or standard binary logistic regression.

Results
70 patients completed surveys in English (60%, 42/70) and Spanish (40%, 28/70). Current or past participation in burn survivor group was low (n=3/70, 4.2%), with greater interest in joining burn survivor group (n=20/66, 30.3%). Most patients interested in burn survivor group were Spanish speaking (65%, 13/20). Interest in joining a burn survivor group was associated with all collected measures of injury severity (Table 1). Scores on ME and MSI were not significantly associated with burn survivor group interest (ME p=.636, MSI p=.133).

Conclusions
There is a gap between interest and participation in burn survivor group, particularly among Spanish speaking patients. Patients with increase in TBSA, LOS, and undergoing surgery were more likely to express interest in burn survivor group participation. Interestingly, patients’ self-reported outcomes on emotional distress and interactions with others were not related to interest in burn survivor group.
84 Effects of Early, Non-excisional Debridement on Pediatric Burn Wound Re-epithelialisation Time
Authors: Griffin Bronwyn R , Bairagi Anjana , Holbert Maleea , Kimble Roy M 
Published: March 2022

Abstract

Introduction
Reported advantages of early excision for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. However, a paucity of evidence supports the best option for paediatric burns and the advantages of non-excisional (mechanical) debridement. This study aims to evaluate the association between early (&lt; 24hours post-injury) non-excisional debridement under general anaesthesia with burn wound re-epithelialisation time and skin graft requirements.

Methods
A cohort study of children (&lt; 17 years) presenting with burns &gt;5% total body surface area, using prospectively collected state-wide pediatric burns' registry between January 2013 to December 2019. Primary outcomes were: time to reepithelialization (tested using survival analysis) and skin graft requirements, tested using binary logistic regression for odds ratios). Using depth and size, we performed a propensity matched dataset to analyse effects of early non-excisional debridement in the operating theatre.

Results
Overall, 392 children met eligibility (males 58.2%). When propensity matched, early non-excisional debridement under general anaesthesia in the operating theatre, significantly reduced the time to re-epithelialisation (15.0 (CI: 11.00-20.00) versus 20.0 (CI:13.5 – 31.00) days) and the odds of requiring a skin graft (OR:0.319 (0.125 – 0.812).

Conclusions
This study is the first to demonstrate that early non-excisional debridement under general anaesthesia in the operating theatre significantly reduces wound re-epithelialisation time and subsequent need for a skin graft in paediatric burn patients. Analysis suggests that ketamine procedural sedation and analgesia in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.
85 Changes in Burn Surgery Operative Volume and Metrics Due to COVID-19
Authors: Yoon Joshua S , Khoo Kimberly H , Akhavan Arya A , Lagziel Tomer , Cox Carrie A , Caffrey Julie , Hultman Charles S 
Published: March 2022

Abstract

Introduction
Due to COVID-19, hospitals have had to undergo drastic changes to operating room (OR) policy to mitigate the spread of the disease. Elective surgeries were cancelled, and some ORs were repurposed to help withstand a surge of COVID-19 patients. Given these unprecedented measures, we aim to look at the changes in operative volume and metrics of the burn surgery service at our institution.

Methods
An IRB-approved single-institution retrospective review was conducted by querying our institutional OR database. We obtained case lists and OR metrics for the months of March to May for 2019, 2020, and 2021, which correspond with pre-COVID, early COVID (period without elective cases), and late COVID (period with resumed elective cases). Inclusion criteria were cases related to burns. These cases were then divided into the following groups: excision only, grafting only, excision and grafting, laser scar procedures, secondary reconstruction without grafting or flaps, secondary reconstruction with grafting, and secondary reconstruction with flaps. Types of cases and operative metrics were compared amongst the three time periods.

Results
The total number of cases performed by the entire hospital during 2019, 2020, and 2021 was 2375, 1184, and 2265 respectively. During those times, the burn surgery service performed 174, 124, and 212 total cases (138, 103, and 114 burn related cases) respectively. Compared to the hospital, the burn service had a smaller decrease in volume during early COVID (28.7% vs. 50.1%) and exceeded pre-pandemic volumes during late COVID (+21.8% vs. -4.6%). There was a significant increase in excision and grafting cases in early and late COVID periods (41, 84, 74 respectively; p &lt; .0001 and p &lt; .002). There was a significant decrease in laser scar procedures that persisted even during late COVID (69, 0, 14 respectively; p &lt; .0001). The projected and actual lengths of cases significantly increased and persisted into late COVID (p &lt; .01). The average length pre-COVID and late COVID were 109.9 ± 78.5 and 138.2 ± 79.2 minutes.

Conclusions
COVID-19 related OR closures lead to an expected decrease in the number of overall cases and elective cases. However, there was no significant decline in the number of burn specific cases performed. The elective cases were largely replaced with excision and grafting cases and this shift has persisted even after elective cases have resumed. This change is also reflected in increased operative times.
92 ASCS Treatment Impact on Length of Stay Data and Costs for Patients with Small Burns
Authors: Carter Jeffrey E , Carson Joshua S , Rae Lisa , Saquib Syed F , Wibbenmeyer Lucy , Hickerson William L 
Published: March 2022

Abstract

Introduction
Introduction: Small burns with a total body surface area (TBSA) of &lt; 20% account for the large majority (92%) of burn injury hospital admissions. Autologous skin cell suspension (ASCS) is a novel treatment for acute thermal burn injuries – including small burns -- that is associated with significantly lower donor skin requirements than split-thickness skin grafts, the traditional standard of care (SOC). The ASCS treatment indication was recently expanded from adult patients to include pediatric patients. Previously modeled analyses suggested that ASCS use is associated with a lower hospital length of stay (LOS) and costs savings versus SOC. This study evaluated whether real-world data (RWD) corroborate these findings in small burns and in both adult and pediatric populations.

Methods
Methods: Data were collected from January 2019 through August 2020 from 500 facilities in the United States. Adult patients (age ≥ 21) and pediatric patients (&lt; age 21) receiving inpatient burn treatment with ASCS were identified and matched to patients receiving SOC based on sex, age, TBSA &lt; 20%, and comorbidities. Based on typical BEACON model outcomes, LOS was assumed to account for 70% of total costs and was used as a proxy to assess the data. LOS was assumed to cost $7,554 per day. Mean LOS and costs were calculated for the ASCS and SOC adult and pediatric cohorts. The incremental revenue associated with changes in inpatient capacity was also analyzed.

Results
Results: A total of 151 ASCS and 2,243 SOC adult cases and 19 ASCS and 341 SOC pediatric cases were identified. In adults, the SOC cohort had a higher percentage of patients with TBSA &lt; 20% than the ASCS cohort (82.9% vs. 55.0%). For small burns, sixty-three matches were made for each adult cohort, and seven matches were made for each pediatric cohort. For adults, LOS was 18.5 days with ASCS use and 20.6 days with SOC use (difference: 2.1 days [10.2%]). For pediatrics, the ASCS LOS was 18.6 days, and the SOC LOS was 21.4 days (difference: 2.9 days [15.4%]). This difference led to cost savings of $15,587.62 per adult ASCS patient. Total cost savings with ASCS adult patients were $22,268.03 per patient. The reduced LOS with ASCS adult patients resulted in an increased capacity of 2.0 inpatients per bed per year, which was estimated to increase hospital revenue by $83,894 per burn unit bed annually. Pediatric cost results and savings were similar.

Conclusions
Conclusion: This RWD analysis shows that small burn treatment with ASCS is associated with reduced LOS and substantial cost savings compared with SOC in both adult and pediatric populations, supporting the validity of previous model projections. ASCS use may also significantly increase hospital revenue related to increased inpatient capacity.
112 Developing Outpatient Registry to Capture Data Post Hospitalization
Authors: Schmoker Bethany A , Urban Shane , Wiktor Arek J 
Published: March 2022

Abstract

Introduction
Per the 2019 ABA reverification requirements, a burn center must see &gt;75% of all inpatients (IP) who require an outpatient (OP) follow-up after discharge. In prior years, we utilized the inpatient registry and built a report to track patient follow-up. With the report, we were able to compare the number of Burn Clinic return patients against admissions to get the percentage. This process required hours of focused effort. We sought to optimize the process for determining IP follow-up at our ABA verified burn center. In addition, we hoped to better quantify the efficacy of our OP clinic.

Methods
An OP registry was developed in December 2019 utilizing an automated report from our electronic medical record (EMR) and imported into a custom built, secure, web-based software platform designed to support data capture for research studies. Employing various automation techniques, we were able to eliminate the need for manual abstraction by our burn registry team. Metrics tracked in the OP registry included: type of patient visit (New Patient, Return Patient, and Telehealth), diagnoses, zip-codes of patient residence, payer methods, and total number of clinic encounters per year. We collected data from January 2020 through the present, with 2020 being the first full year in the OP registry. The initial effort required to design, automate, and import data was approximately 18 hours. The report import takes approximately 5 minutes.

Results
The OP registry has given us the ability to create a multitude of graphs from the OP clinic data, like the one shown. During the review period our OP clinic saw patients from 19 different US states, encompassing 2,710 total OP visits. The median number of monthly OP clinic visits was 235 [IQR 210-246], see graph 1. The median number of clinic visits per patient was 2 [IQR 1-4]. The majority of clinic visits were return patients (55%, n = 1595), new patients (31%, n = 914), and telehealth visits (14%, n = 399). Finally, our analysis of the OP Clinic Registry demonstrated that we saw 82% (309/374) of inpatients that required follow-up care, exceeding the expected 75% by the ABA.

Conclusions
The creation of an automated OP registry can assist the tracking of discharged patients and reduce the amount of effort needed to track ABA required metrics. In addition, this OP registry can be expanded to track both IP and OP outcomes. This is crucial for quality improvement for the burn program as a whole.
500 Return To Work After A Burn Injury: Even The Small Burns Need Attention
Authors: Carmean Melissa , Joe Victor C , Bernal Nicole O , Burton Kimberly , Chin Theresa L 
Published: March 2022

Abstract

Introduction
An important part of burn recovery and reintegration involves the return to meaningful employment. Studies have determined that the workman’s compensation burn patient faces multiple barriers to return to work (RTW). Factors that increase time to RTW include increased TBSA burns, full thickness depth and grafting, burns to the hands and feet, and increased age. We hypothesize that patients with grafted burns, hand and feet burns, or psychological disorders following injury take longer to return to work.

Methods
A retrospective analysis was performed of burn patients seen in the outpatient burn clinic with work related injuries equal to or less than 5% TBSA, from 11/1/2016 to 5/31/2021. In addition to demographic data, also collected were locations of burns, dates of RTW, and positive PTSD and depression symptoms on screening.
Medians with interquartile ranges are reported due to nonnormal distribution, Wilcoxon Mann Whitney tests were performed using StataCorp. burn patients seen in the outpatient burn clinic with work related injuries.

Results
Of 118 patients, more injuries occurred in males (89%) than females with a median age of 36.5 years (IQR 26-49). The median TBSA was 1% (IQR .025-1.5) and the median time to return to work was 34 days (IQR 16-75). The 21 patients that were grafted took significantly longer to return to work (median 107.5 days; IQR 60-199.5) compared to 97 patients that were not grafted (median 28 days; IQR 13-59; p=0.0000]. Presence of a hand/foot burn trended towards increased time to RTW but was not significant, median 37 days (IQR 19-81) vs 26 days (IQR 14-61; p =.0306).
Patients with PTSD and depression (n=16) also took longer to return to work (Median 66; IQR 33-89.5) compared to patients (n=90) that showed no symptoms on screening (median 30.5; IQR 14-72; p=0.032).

Conclusions
The increased RTW for grafted, hand and foot burns is supported in the current research, however the addition of PTSD and depression and its interplay with RTW has not yet been fully vetted in determining return to work readiness. Within our population, positive screens for these psychological stressors profoundly affected their ability to return to employment. This study continues to validate the need for early screening and intervention in our population and the need to intervene as early as possible with psychological support services.
501 A Change to Virtual Peer Supporter Training and its Effect on Participant Readiness and Satisfaction
Authors: Cramolini Sandra J , Irven Jessica , Peterson Pam 
Published: March 2022

Abstract

Introduction
Peer support gives burn survivors and their loved ones hope for a brighter future helping speed and strengthen recovery for burn survivors and their loved ones. A strategic plan to explore a digital program change from in-person increasing access for burn survivors and burn programs was scheduled for the third quarter of 2021, but the global pandemic expedited the implementation. A 2-week asynchronous and a 4-hour virtual course was designed. This study sought to evaluate the effectiveness and participants' perceptions of asynchronous and virtual training and their post-course readiness in the role of peer supporter.

Methods
A 5-point Likert scale was used to evaluate the opinions, perceptions, and satisfaction of the participants. The scale, ranging from strongly agree to disagree strongly, evaluated the modular education (length, relationship to manual, preparation for the virtual course) and the usefulness of a condensed online manual. A 5-point Likert scale (ranging from extremely helpful to not at all helpful) was used to evaluate each component of the course group exercises and the participants' perception of skill development to become peer supporters. Open ended questions collected additional feedback to analyze potential changes to the new platform. The metric Net Promoter Score, or NPS, was used to measure the recommendation of the new program to others.

Results
Burn survivors (n=41) and medical professionals (n=3) participated in 6 courses over eight months. Participants reported the manual helped prepare for the course (86% strongly agree and 14% agree). Respondents felt the asynchronous modular education prepared them for the virtual component of the class (75% strongly agree and 25% agree). Additionally, respondents felt the 2-week timeline for module completion met their expectations (98% yes and 2% no). The participants felt the overall length of the course was just right (89%) to 9% too short and 2% too long. Participants rated their readiness (confidence level) to utilize their learned skills to support another burn survivor (52% extremely confident, 39% very confident, and 9% confident) after the virtual class. The combined courses rated an 82 NPS, equating to a positive participant experience and a course recommendation to others.

Conclusions
This study concluded the asynchronous and virtual education course provided an effective method to train burn survivors to become peer supporters. Overall, burn survivors expressed confidence in utilizing the skills learned from the new training program. Participants also experienced the use of virtual tools to meet the needs of burn survivors for peer support.