bluuebunny/crossref_metadata_2025_split huggingface dataset:
2 Examination of Burn Resuscitation Complications from the Burn Navigator Observational Trial
Authors: Rizzo Julie A , Coates Elsa , Salinas Jose , Serio-Melvin Maria , Pham Tam N , Abdelfattah Kareem R , Foster Kevin N , Liu Nehemiah T 
Published: March 2022

Abstract

Introduction
Burn care continues to focus on providing enough fluid resuscitation to perfuse end organs with the least amount of fluid necessary in order to prevent complications related to excess fluid. In this observational trial of 5 ABA-verified burn centers that utilized the Burn Navigator (BN), a clinical decision support tool, we sought to examine resuscitation-related complications that occurred in the first 48 hours after burn injury. Since minimal literature exists regarding the incidence of resuscitation-related complications in the acute phase after burn injury, we aimed to present our data for future comparison.

Methods
An observational study of adult patients undergoing burn resuscitation utilizing the BN was conducted. Data were gathered hourly for the first 48 hours for patients on fluid infusion rates, laboratory data, critical care elements to include ventilator settings and clinically relevant outcomes. Morbidities were classified based on each burn center’s definition as related to over or under-resuscitation and variables associated with these outcomes were extracted from the data set.

Results
Three hundred patients were enrolled into the study, and 156 resuscitation-related complications were documented in 92 patients in the first 48 hours after admission. Compartment syndromes (abdominal, extremity, ocular) accounted for 62 (40%) of the complications. ARDS occurred in 9 patients. ARDS patients were the most severely injured, reflected by highest Baux score. None of the ARDS patients had an inhalation injury. The under-resuscitation morbidities of shock and acute kidney injury accounted for 81 (52%) of the complications. Patients experiencing shock received greater than the Parkland formula in the first 24 hours after injury. Most patients with AKI continued to make adequate urine during their resuscitation period, with 59% making an average of &gt;30 ml/hr over the first 24 hours. Nearly half of patients with AKI were placed on renal replacement therapy in the first 48 hours. Seventeen patients (18.5%) experienced both a compartment syndrome and either AKI or shock.

Conclusions
This large observational study demonstrates variables associated with different complications across 5 major burn centers and shows that complications associated with over- and under-resuscitation can occur within the same patient during resuscitation after burn injury. Additional comparative studies are needed to better understand the cause of these complications, to determine the incidence of these complications in a larger population and criteria used to define each complication.
6 Risk Factors and Comorbidities Associated with Post-burn Hypertension
Authors: Efejuku Tsola A , Joglar Alejandro A , Chokshi Shivan N , Corona Kassandra K , Wermine Kendall , Gotewal Sunny , De La Tejera Giovanna , Golovko George , Haseem Maria , Keys Phillip H , Song Juquan , Wolf Steven E , El Ayadi Amina 
Published: March 2022

Abstract

Introduction
Hypertension (HTN) is a prevalent condition in the United States and leads to an increased risk of developing other comorbidities. However, the impact of hypertension following severe burns on patient outcomes is not known. We hypothesize that post-burn hypertension is associated with an increased risk of other comorbidities and mortality.

Methods
This study used data from TriNetX, a global federated health research network. Burned patients who were diagnosed with essential hypertension at least 1 day after injury were identified in the TriNetX database using specific ICD codes and were compared to those who did not develop essential hypertension; neither cohort was diagnosed with hypertension prior to injury. Each cohort was balanced for age, gender, race, and ethnicity. Occurrence of the following within 3 days of burn was compared between the two cohorts: acute kidney injury (AKI), hyperglycemia, heart failure, coronary artery disease, and death. These patient cohorts were then stratified by gender, percent total body surface area (TBSA) burned, and age. Statistical analysis for the measures of association used an odds ratio with a 95% confidence interval and a risk ratio with a z-test. Significance for the z-test was set at a p-value of &lt; 0.05.

Results
The search identified 460,977 burn patients of whom 87,808 were diagnosed with hypertension at least 1 day after burn injury. Those diagnosed with hypertension were 7.25 times as likely to develop AKI, 5.45 times as likely to develop hyperglycemia, 7 times as likely to develop heart failure, 7.17 times as likely to develop coronary artery disease, and 1.78 times as likely to die. Men were at greater risk of experiencing AKI, heart failure, coronary artery disease, and death, however, women were 1.51 times as likely to develop hyperglycemia. Stratification based on % TBSA burned indicated an increased risk for all outcomes for patients with a high percentage of total body surface area burned (60% to &gt; 90% TBSA burned was higher than &lt; 10% to 50-59% groups). Subgroup analysis based on age indicated elevated risk of developing AKI, heart failure, coronary artery disease, or death with age. However, we found a spike in risk for all outcomes in the 0-9 age group. All data was significant at p &lt; .0001.

Conclusions
A new hypertension diagnosis in severely burned patients is highly associated with other comorbidities including acute kidney injury, heart failure, coronary artery disease, and death. Overall, males, older patients, and those with a higher percent TBSA burned are at a higher risk of developing these comorbidities.
40 Evaluation of a Multidisciplinary Approach to Pressure Injury Prevention Among Patients in a Burn Center
Authors: Richerbach Stacey , Hockenberry Tiffany , Richey Karen , Foster Kevin N 
Published: March 2022

Abstract

Introduction
Compromised skin integrity in tandem with the prolonged length of stay necessitated by patients in a burn center has the capacity to result in an increased incidence of hospital acquired pressure ulcers (HAPUs). A HAPU increases the cost of a hospital stay by approximately $43,000. Many interventions exist to reduce their occurrence; however, interventions have been largely compartmentalized by discipline. One burn center’s dramatic increase in HAPUs from 2018 to 2019 led to further evaluation of prevention efforts. Upon detecting a 117% increase of HAPUs and a threefold increase in cost for specialty bed rental, a multidisciplinary approach to pressure injury prevention was employed. The frequency of multidisciplinary patient rounds was increased from once to twice daily, and involved discussions regarding functional status, mobility, and nutrition. The practice of ordering specialty beds was modified to require three-part approval by the Medical Director of Burn Services, Nursing Director, and a burn therapy supervisor. The purpose of this QI project was to examine the implementation of the multidisciplinary approach to pressure injury prevention among patients in a burn center and to identify trends in HAPUs and specialty bed expenses.

Methods
This was a retrospective review of patients admitted to a Burn Center between January 1, 2018 and June 30, 2021. Preexisting pressure ulcers were identified upon admission and were not regarded as HAPUs. Patients were grouped by year of their admission date.

Results
A total of 941 patients were admitted for inpatient care in 2020, six HAPUs (1.35%) were identified for this population. As compared to the prior year, this revealed a 53% decrease in incidence of HAPUs. The specialty bed rental cost from 2019 to 2020 was reduced by $110,181.76 (68%).

*Data provided for 2021 is from 01/01/2021 to 06/30/2021

Conclusions
Following implementation of a multidisciplinary approach to pressure injury prevention, we were able to reduce the incidence of HAPUs and dramatically reduce the expense associated with specialty bed rental. This supports an effort to identify additional practices which may increase quality while decreasing cost.
65 Therapist Confidence Utilizing Virtual Range of Motion Methods
Authors: Yelvington Miranda L , Parry Ingrid , James Michelle , Bettencourt Kory , Taylor Sandra , Greenhalgh David 
Published: March 2022

Abstract

Introduction
Since the SARS-CoV-2 virus (COVID-19) was officially declared a pandemic, there has been a marked increase in virtual clinical care. Between 2019 and 2020, telehealth (TH) visits, including tele-rehabilitation (TR), increased from 11% to 46%. While many therapy interventions can be performed with verbal guidance or demonstration, objective tool-based outcomes such as goniometrics , a valuable tool to determine burn survivor progress, have proved more challenging. The purpose of this study was to evaluate the level of confidence of therapists using three different remote methods of measuring finger range of motion (ROM).

Methods
Therapists evaluated finger ROM position of a mannequin model via a simulated TH visit using three different methods: Goniometry (GON), Visual Estimation (VE), and Electronic Protractor (EP). Pre and post-questionnaires were used to assess the participant’s experiences and comfort with each method of measurement. Descriptive statistics are used to report clinician opinions. A linear mixed effect model was used to determine the interaction of bias as a function of clinician characteristics (i.e., experience, familiarity, etc.).

Results
A total of 30 therapists and one hand surgeon participated. All reported some (30%) or a lot (70%) of familiarity with standard GON, and most reported some (30%)or a lot (40%) of familiarity with finger-specific goniometry. Post-testing, clinicians reported VE (80%) as the most difficult method and EP (73%) as the easiest. Only 7% reported feeling more confident with TR compared to in-person measurements, 27% felt equally confident, and 67% felt less confident. The average time to conduct the remote assessment measurement was 11:45 minutes using GON, 4:27 minutes using VE and 9:47 minutes using EP. There was not a significant relationship between performance bias and years of experience (p=0.587), familiarity with GON (p=0.406), familiarity with finger GON (p=0.709) or profession (p=0.281).

Conclusions
Despite the transition to virtual care, the mandate for valid and accurate documentation of functional outcome measures, including ROM, remains. Our study showed that the tools used for TR may not be the same as for in-person and clinicians need to adapt their approaches and skillsets. In addition, training with these new tools is essential for clinician confidence. In addition, there was not a relationship between experience and performance, suggesting that TR joint measurement is accessible to clinicians of all experience levels with proper training.
70 Effect of of Virtual Reality on Pain Reduction in Robot Training in Burn Patients
Authors: Joo So Young , Seo Cheong Hoon 
Published: March 2022

Abstract

Introduction
Burn injuries and their treatment are extremely painful. This study aimed to determine whether virtual reality (VR) can reduce pain during robot-assisted gait training (RAGT) in burn patients, by analyzing the cerebral blood flow (CBF) in the prefrontal cortex over time, using functional near-infrared spectroscopy (fNIRS).

Methods
The patients included in this study complained of a pain score≥5 on a visual analog scale (VAS) during RAGT, which was performed 10 times for 2 weeks. Each session consisted of 15 min of VR application, a 2 min break, and 15 min without VR. The average values of oxy-hemoglobin and deoxy-hemoglobin in the prefrontal cortex using fNIRS were calculated at four stages: temporal delay time with only RAGT, RAGT without VR, temporal delay time with RAGT and VR, and RAGT with VR. The pain scores and CBF were evaluated in sessions 1, 5, and 10 of the RAGT.

Results
The mean VAS pain scores were significantly lower (P&lt; 0.05) in the experimental condition than in the control condition. Oxy-hemoglobin in the prefrontal lobe increased significantly when RAGT was performed with VR.

Conclusions
Therefore, VR may be a strong non-pharmacological pain reduction technique for burn patients during physical therapy.
81 Post-operative Self-adherent Compression Wrapping of the Hand and Its Impact on Skin-graft Viability
Authors: Vocke Scott F , Puthumana Joseph S , Dean Brooke , Andre Gregory , Rodriguez Joshua , Mercadante Misao , Hultman Charles S , Lifchez Scott , Kawaji Qingwen , Rostami Sohayla , Martinez Stephanie L , Caffrey Julie 
Published: March 2022

Abstract

Introduction
Potential complications of autografting for burn wound coverage of the hand include edema, hematoma formation, and bleeding; all of which can lead to graft failure. Self-adherent elastic wraps are commonly used by burn rehabilitation clinicians to minimize complications by providing graft protection and decreasing edema post-operatively; however, there is a lack of evidence on its impact on graft healing. The purpose of this study was to determine if the application of self-adherent elastic wraps to the hand in the operating room after autografting improves the percentage of graft viability.

Methods
A retrospective chart review was performed for 37 patients with burned hands who underwent autografting from January 2017 to July 2021. Grafted hands were categorized into 2 groups: post-operative dressings with and without self-adherent elastic wraps. Post-operative day 4 pictures for both groups were collected from the medical record and a blinded digital photograph analysis of graft viability was performed by 5 expert raters including 3 Burn Surgery Fellows,1 Burn Attending Surgeon and 1 Hand Attending Surgeon. A rating system was developed based on percentage of graft take as seen in Table 1 and presence of hematomas were assessed.

Results
Patients who received self-adherent elastic wraps suffered burns with significantly larger TBSA (p=0.007) and were admitted for a longer duration (p=0.009) than patients who did not. Patients with elastic wrap had a higher percentage of grafts with &gt;95% take (64.0% vs 41.7%, p=0.227) and a lower rate of hematoma formation (24.0% vs. 41.7%, p=0.443). Intra-class correlation coefficient across raters was 0.90 for graft take and 0.87 for determining presence of hematomas, indicating excellent interrater reliability.

Conclusions
Despite suffering larger burns requiring longer hospitalizations, patients who received elastic wrap had a higher rate of &gt;95% graft take than those without. This study is limited by a relatively small sample size, however these findings warrant continued research in the use of self-adherent elastic wrap to maximize graft take in hand burns.
83 The Impact of Tracheostomy on Long-term Patient Outcomes: A Burn Model System National Database Study
Authors: Galicia Kevin E , Kubasiak John , Mehta Anupama , Kowalske Karen J , Gibran Nicole S , Stewart Barclay T , Wolf Steven E , Ryan Colleen M , Schneider Jeffrey C 
Published: March 2022

Abstract

Introduction
Management of the upper airway is crucial to burn care, especially in the setting of inhalation injury or burns to the face or neck. Endotracheal intubation is often performed to secure the airway; however, tracheostomy may be necessary in patients requiring prolonged ventilatory support. This study compares long-term outcomes of burn patients with and without tracheostomy.

Methods
Data from the Burn Model System National Database, collected from 2013 to 2020, were analyzed. Demographic and clinical data were compared between those with and without tracheostomy. The following patient-reported outcome measures, collected at 6-, 12-, and 24-months, were analyzed: Veterans Rand 12 Physical Component Summary Score (VR-12 PCS), Veterans Rand 12 Mental Component Summary Score (VR-12 MCS), Satisfaction with Life (SWL), Community Integration Questionnaire (CIQ), Patient-Reported Outcomes Measurement Information System (PROMIS-29), employment status, and number of days to return to work. Regression models were used to assess the impact of tracheostomy status on long-term outcome measures, controlling for demographic and clinical variables.

Results
Of the 714 patients included in this study, 39 (5.46%) received a tracheostomy and 675 (94.54%) did not. The two groups were similar across all demographic data collected. Tracheostomy patients were more likely to have flame injury, inhalation injury, larger burn size, more trips to the operating room, longer hospital stay, and greater number of days on a ventilator (p&lt; 0.001). Regression model analyses demonstrated that tracheostomy was associated with worse VR-12 PCS scores at 6-, 12-, and 24-months (6.6 [95% CI 1.5, 11.8], p=0.012; 11.5 [6.2, 16.8], p&lt; 0.001; 10.8 [4.2, 17.5], p=0.001). Tracheostomy was also associated with worse scores in two PROMIS-29 domains, physical function and pain interference. For physical function, the association was seen at 6-, 12-, and 24-months (7.4 [3.0, 11.8], p=0.001; 9.6 [5.2, 14.0], p&lt; 0.001; 11.3 [5.8, 16.9], p&lt; 0.001). For pain interference, the association was only seen at 12-months (-5.3 [-10.0, -0.55], p=0.029).

Conclusions
After burn injury, patient-reported outcome measures of physical function and pain interference were significantly worse with tracheostomy.
86 Outcomes for 43 Hand Burns Treated with 2:1 Meshed and Epidermal Autografts with Abundant Donors
Authors: Yoo Daniel , Taylor IV Malcolm M , Barnett Scott , Tuggle Charles T , Kopari Nicole , Carter Jeffrey E , Phelan Herb A 
Published: March 2022

Abstract

Introduction
Our group has previously reported our experience in treating hand burns with 2:1 meshed autografting and simultaneous application of autologous skin cell suspension (ASCS) even when donor sites are abundant. Here, we sought to expand on this experience. We hypothesized that the use of 2:1 meshed autografting and ASCS (MA/ASCS) would provide comparable outcomes to hand burns treated with sheet graft.

Methods
A retrospective review was conducted of all subjects operated on for deep 2nd and 3rd degree hand burns at our ABA-verified burn center from April, 2018 to May, 2021. Exclusion criterion was a burn of &gt;20% TBSA. The cohorts were those subjects treated with MA/ASCS versus those treated with split thickness sheet, pie-crust, or 1:1 meshed autograft alone (STAG). Outcomes included proportion returning to work (RTW), length of time for RTW, and time to wound closure. Mann-Whitney U test was used for comparisons of continuous variables, and Fishers Exact test for categorical variables. Values are reported as median and interquartile range.

Results
Sixty-eight subjects fit the study criteria (MA/ASCS n=43, STAG n=25). The MA/ASCS group was significantly older than the STAG cohort (45.5 yrs [32, 59.25] vs 35 [28, 45], p=0.013) with larger %TBSA burns overall (11.5% [7, 16.25] vs 2% [1, 3], p &lt; 0.0001), and larger hand burns (186 cm2 [124.75, 330.5] vs 104 cm2 [56, 164], p=0.001). Comparable results were seen between MA/ASCS and STAG, respectively, for time to wound closure (8 days [7, 13] vs 8 [6, 14], p=0.48), proportion RTW (51% vs 64%, p=0.33), and days for RTW among those returning (38 [29.25, 62.75] vs 34.5 [20.75, 57], p=0.471). Fractional ablations were performed in 14% of the MA/ASCS group and 12% of the STAG group.

Conclusions
Despite being significantly older, having larger hand wounds, and larger overall wounds within the parameters of the study criteria, patients with 20% TBSA burns or smaller whose hand burns were treated with 2:1 mesh and ASCS overspray had comparable time to wound closure and return to work as subjects treated with 1:1, pie-crust, or sheet STAG.
93 Foot Burns in Persons with Diabetes outcomes from the National Trauma Data Bank
Authors: Perrault David , Cobert Jason , Gadiraju Veda , Gurtner Geoffrey , Pham Tam N , Sheckter Clifford C 
Published: March 2022

Abstract

Introduction
Diabetes Mellitus (DM) is an epidemic in the US that complicates the treatment of burn injuries. Lower extremity burns in diabetic patients, particularly the feet, are challenging problems with predictably unfavorable outcomes, as demonstrated by single-institution studies. National evaluations are absent, especially with regard to limb salvage. We aim to characterize lower extremity burns in persons with DM and evaluate the likelihood of amputation. We hypothesize that the incidence of DM associated foot burns is increasing in the US, and these patients are more likely to undergo lower extremity amputation than those without DM.

Methods
The National Trauma Data Bank (NTDB) was queried from 2007-2015 extracting encounters with primary burn injuries of the feet using International Classification of Diseases (ICD) 9th Edition codes. DM is a predefined comorbidity within the NTDB, allowing for cohort comparisons. Logistic regression modeled predictors of lower extremity amputation. Patient covariables included age, sex, race/ethnicity, and comorbidities. Burn covariables included % burn total body surface area (TBSA), mechanism, and region of burn center. Poisson regression evaluated for significance in temporal changes in DM foot burns.

Results
There were 116,796 adult burn encounters of which 7,963 (7%) had foot burns. Of this group, 1,308 (16%) had DM. DM foot burn encounters were older, more likely to be male, and had more comorbidities than non-DM foot burn encounters (all p&lt; 0.001). DM foot burn encounters were more likely to sustain a scald injury (compared to flame) and had smaller %TBSA (all p&lt; 0.001). Additionally, 5.6% of encounters with DM foot burns underwent amputation compared to 1.5% of non-DM encounters (p&lt; 0.001). Independent predictors of lower extremity amputation included DM (OR 3.70, 95% CI 2.98 – 4.59), alcohol use, smoking, chronic kidney disease, burn size &gt;20%, African American/Black race, male sex, and age &gt;40 years (all p&lt; 0.01). The incidence of DM foot burns increased over the study period with an incidence rate ratio (IRR) of 1.09 (95% CI 1.07 – 1.12, p&lt; 0.001).

Conclusions
In the largest cohort study to date, DM was associated with nearly a 4-fold increase in amputation after adjusting for available confounders. Furthermore, the incidence of DM foot burns is increasing. Strategies for optimizing care in persons with DM foot burns are need to improve limb salvage.