bluuebunny/crossref_metadata_2025_split huggingface dataset:
721 Defining Bleeding Characteristics in Frostbite Patients Managed with tPA
Authors: Murphy Jenna E , Winters M Kenett , Rogers Charlotte , Walter Ellen , Neumann Nichole , Weber Lynn , Lacey Alexandra M , Punjabi Gopal , Endorf Frederick W , Nygaard Rachel M 
Published: March 2022

Abstract

Introduction
Frostbite is caused by exposure to cold temperatures and can be a severe injury leading to hospital admissions, surgeries, or amputations. Disease progression involves endothelial injury, thrombosis, and tissue necrosis; therefore, management of patients involves a process of rewarming and restoration of blood flow to the affected area. Tissue plasminogen activator (tPA) is a thrombolytic agent that has demonstrated efficacy at restoring tissue perfusion in patients with frostbite. The goal of frostbite management with tPA is to salvage tissue without causing clinically significant bleeding, a documented adverse effect of tPA administration. The purpose of this study was to characterize specific bleeding complications associated with tPA administration. The secondary objective was to compare the rate of bleeding complications in frostbite patients treated with intravenous (IV) tPA to frostbite patients that did not receive tPA.

Methods
This single center retrospective study included all adult patients with severe frostbite who presented between October 2013 and March 2020. tPA was given to patients per institutional protocol. To assess for bleeding events, patient charts were reviewed and any instance of bleeding was categorized based on severity. Bleeding was categorized as: 1) none, 2) mild: not clinically significant (bandage or moved IV site), 3) moderate: change of management (tPA stopped, enoxaparin held, or specialty consult), and 4) severe: included a change and intervention (transfusion, fasciotomy for compartment syndrome). Any change in management or any additional therapies used to control bleeding were documented, as well as the timing of bleeding in relation to tPA administration.

Results
Over a 7-year period 209 patients were analyzed and 202 patients were included. For patients with bleeding events requiring intervention, the mean time to bleed was 105.5 hours (range 4 to 576 hours). Of these, 4 (3 transfusions and 1 fasciotomy for compartment syndrome) were temporally associated with tPA administration (within 24 hours). Two of the 4 patients had minor to moderate traumatic injury prior to admission, the 3rd patient had incomplete work-up at referring center that initiated tPA prior to transport, and the 4th patient was in restraints. Of the patients who did not receive tPA, 3.39% had a severe bleeding event requiring intervention compared to 6.99% of patients treated with tPA (P=0.516).

Conclusions
Though there was a higher incidence of bleeding in tPA-treated patients, for the majority of patients studied, tPA was safe for the treatment of severe frostbite. Bleeding events occur in frostbite patients treated with or without tPA and warrant close follow-up for these infrequent complications.
722 Collagen-elastin matrix for defect coverage in exposed bradytrophic tissue after severe burn and degloving injuries
Authors: Oehlbauer Markus 
Published: March 2022

Abstract

Introduction
Despite successful defect coverage by means of complex skin or muscle flaps, particularly large and deep problematic wounds with exposed bradytrophic tissues after soft tissue loss are very susceptible to surgical revision.
A dermal matrix, consisting of native collagen (collagen type I, III and V) supplemented by an elastin hydolyzate was first used for the treatment of burns, predominantly those that were full-thickness. Subsequently, its use was extended to defect coverage especially after soft tissue loss caused by degloving injuries.

Methods
52 patients with exposed bradytrophic tissues caused by severe burn or degloving injuries were treated the same way.
In all patients operative debridement showed soft tissue loss with free bone or free periostal structures, exposed tendons or joint capsules.
In all patients after accurate wound bed preparation defect coverage was performed with collagen-elastin matrix and unmeshed split skin grafts in combination with negative pressure wound therapy for fixation of dermal matrix and split skin grafts.

Results
Two-years follow up of these collagen-elastin matrix procedures in defect coverage showed an excellent functional outcome:
Up until now, no areas with unstable scars have occurred, no surgical scar revisions were required. The patients were still able to wear normal footwear, clinical gait analysis showed perfect functional outcome.

Conclusions
The application of collagen-elastin matrix in patients with exposed bradytrophic tissues after severe burn or degloving injury treated so far represents an excellent reconstruction method, from initial coverage to scar development.
724 Role of synthetic dermal matrix for reconstruction of complex non-graftable wound defects
Authors: Concannon Elizabeth , Wagstaff Marcus 
Published: March 2022

Abstract

Introduction
The aim of this study was to investigate the role of a synthetic dermal matrix, Biodegradable Temporising Matrix (BTM), for coverage of complex wounds. The authors defined complex wounds as wounds not amenable to reconstruction with skin grafting alone due to an inherent avascularity of the wound bed, such as the presence of exposed bone, tendinous or neural structures.

Methods
A retrospective review of a prospectively maintained database of complex wounds as defined above was carried out. Clinical and operative notes were reviewed along with review of an extensive photographic database demonstrating wound healing progress using staged dermal matrix (BTM) and autologous skin graft reconstruction.

Results
55 patients were identified who underwent staged dermal matrix and autologous skin graft reconstruction for complex wounds affecting a wide variety of patient demographics, treatment indications and body sites. Wound aetiology varied between burn injury, non-burn related trauma including degloving injury and infective complications. We discuss caveats relating to successful application of a dermal matrix, technique tips, prevention and management of complications.
Dermal substitutes play an integral role in providing biological wound cover for avascular wound beds which may otherwise require complex distant flap or microsurgical free flap reconstruction. BTM is a completely synthetic dermal matrix comprised of a 2-mm-thick sheet of biodegradable polyurethane foam bonded to a non-biodegradable polyurethane sealing membrane. Our department has developed significant expertise in the use of BTM throughout its development from initial animal studies through to recent human clinical trials. The synthetic composition of BTM does not require rapid neo-vascularisation for its integrity or survival. As such, two-stage BTM reconstruction has proven robustness in the face of unfavourable wounds compared with other popular dermal matrices, physiologically covering avascular structures, allowing for early graft take, expediting rehabilitation and mobilisation with excellent scar cosmesis and limited contracture formation.

Conclusions
Dermal matrices such as BTM play an important role in complex wound healing, frequently achieving excellent results with a low complication profile. BTM has been used successfully in cases where biological matrices would not routinely be considered as demonstrated by this clinical series. It has provided a valuable alternative to free-tissue transfer in patients with significant co-morbidities, vascular insufficiency and/or those for whom long operations are undesirable.
727 Novel silver based â€œsuitâ€#157; dressing technique for Steven Johnson Syndrome and other cutaneous exfoliative conditions
Authors: Laun Jake , Maynell Kimberly Brown , Taylor Loryn , Simmons Lancia , Krenitsky Amanda , Smith David J 
Published: March 2022

Abstract

Introduction
Exfoliative skin conditions such as Steven Johnson Syndrome (SJS)/toxic epidermal necrolysis (TEN) and other significant drug related reactions are complex medical conditions that provide a challenge to the burn surgeon, especially with regards to local wound care. Various modalities of wound care require frequent dressing changes; however, these changes put the patient through significant pain and potentially harmful experiences that could lead to worse skin exfoliation, scarring and pigmentation changes. As part of our burn unit, we have created a dressing utilizing silver impregnated nylon sheets that limits the amount of wound care performed and therefore the amount of potential exfoliative damage.

Methods
We have employed this means of dressing in all our Steven Johnson patients with significant open or blistered areas. We performed a retrospective analysis looking at our patients who were admitted with Steven Johnson Syndrome/toxic epidermal necrolysis or other exfoliative skin disorder over the last 7 years. We had 52 patients who ranged from having 2-100% of skin involved with significant blistering or exposed areas. The suit is made specific to the patient as each area is measured and the silver sheets are formed to the patient and secured in place. The silver sheets are saturated with sterile water and rewet with saline every four hours and changed every three days.

Results
By utilizing these silver-based dressings, we have limited the amount of dressing changes and concomitant pain for patients while also limiting skin infections to only 1 out of our 52 patients. For blisters on the face, a local antibiotic ointment was used; and once the skin lesions had healed, a moisturizing lotion was used.

Conclusions
Steven Johnson Syndrome and other exfoliative skin conditions require significant wound care. By minimizing dressing changes, one can lessen the pain to patients and by utilizing dressings that are infused with silver, one can also potentially decrease the risk for infection as was seen in our patient population.
731 Utilizing call for burn admissions to guide clinical staffing decisions for Advanced Practice Providers (APP)
Authors: Alam Atique , Coffman Beretta C , Presberry Yusuf , Wilson Joan 
Published: March 2022

Abstract

Introduction
Over the past decade, the Advanced Practice Provider (APP) role has expanded into various care settings. The literature confirms that APPs contribute positively to the ICU setting, where better patient outcomes are noted, and they are seen as a safe adjunct to the ICU team. The VA recognizes the need for a more significant presence, and practice-based variations are considered crucial as restructuring goals are established. In 2014, Edkins et al. recognized the need for APPs in the burn setting as the number of residents declined. They stressed appropriate utilization and ongoing educational opportunities to develop the role in burns further.

Methods
This project was conducted by establishing a protocol within our burn referral call system to adequately and efficiently ensure accurate data is accumulated and leveraged to make staffing decisions. Implementation of the protocol began in January of 2018 and is well established. The primary purpose of the protocol is to efficiently store and transfer patient data to make informed decisions across both clinical and administrative departments. The Customer Relationship Management (CRM) System, Salesforce, was the primary software to implement and maintain this process.

Results
For three years, a total of 42,460 referral calls came through our burn call system. The number of patient calls that required admission to a regional burn center totaled 15,293. 70% of total patient referral calls came during the hours of Noon-Midnight; similarly, 72% of admission patient calls came during Noon-Midnight. Hourly trends were similar for both total patient call volume and admission patient referral call volume as they both had the highest number of referral calls between the hours of Noon-Midnight. The majority (32%) of total patient referral calls came in during earlier days of the week (Monday and Tuesday), while the majority (30%) of admission patient referral calls came in during the later days of the week (Friday or Saturday).

Conclusions
Our study demonstrates the benefits of implementing a collaborative protocol that allows sharing data and information across all facets of a burn center. Opportunities for additional studies include implementing similar protocols for administrative staffing and analysis of patient outcomes to see how staffing utilization has affected patient care.
732 Examining Staff Views and Perceptions After Implementation of a Laser Doppler Imaging Device Into Practice
Authors: Tejiram Shawn , Washburn Thomas , Shupp Jeffrey W 
Published: March 2022

Abstract

Introduction
Laser doppler imaging (LDI) has been established as an accurate diagnostic tool to assess burn depth and measure healing potential. Despite this, its use in burn centers remain limited. While studies have examined challenges to LDI use, there is a paucity of literature factoring staff views and attitudes as a barrier to implementation into burn practice. The aim of this work was to assess and examine attitudes and perspectives following implementation of an LDI protocol into acute burn injury assessment.

Methods
Following institutional approval, a 22-question survey was disseminated among staff involved with implementation of an LDI device as a point of care tool to assess acute burn injury at a single ABA verified burn center. The survey focused on questions examining device ease of use, understanding of the underlying LDI technology, interpretation of imaging generation from wounds, and perceptions of patients’ experience. Questions were answered on a standard 5-point Likert scale. All survey data was collected anonymously into an electronic database for assessment.

Results
Overall, there were 15 respondents to the survey questions. Five respondents found the LDI device difficult to use (33%). Barriers to device ease of use included difficulty with device movement (60%), incorporation of scanning into wound care and dressing placement (60%), and management of hardware or software issues that arise during use (60%). Challenges noted by respondents external to device use was mainly high patient census (80%). Despite this, 60% of respondents found the device easier to use after performing several scans in one or more patients and 60% found that scans generated matched their assessment of burn depth. Among respondents, 66% found patients amenable to the scanning process and 80% did not feel that that the scanning process worsened patients’ pain.

Conclusions
Challenges in LDI device use, implementation with wound care and dressing placement, and high patient census were identified as barriers to LDI use. Despite this, ease of device use improved with more frequent use. Identification of views and perceptions such as these can lead to protocol changes and additional training that facilitate ease of LDI use. Further examination will be required to better elucidate this information.
735 Early Treatment with NSAIDs Improves Blood Clotting Function in Severely Burned Patients
Authors: Huang Lyndon G , Song Juquan , Corona Kassandra K , Wermine Kendall , Villarreal Elvia L , Keys Phillip H , De La Tejera Giovanna , Gotewal Sunny , Joglar Alejandro A , Efejuku Tsola A , Chokshi Shivan N , Bagby Shelby P , Chaij Jasmine M , Haseem Maria , El Ayadi Amina , Golovko George , Wolf Steven E 
Published: March 2022

Abstract

Introduction
The risk of coagulopathy is increased in severe burns. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in burn patients to relieve pain and reduce inflammation. This study investigates the impact of NSAIDs on burn induced coagulopathy in severely burned patients.

Methods
Severe burn patients (total body surface area [TBSA] &gt;20%) were identified with TriNetX, a North American federated health research network from 51 health-care organizations (HCOs) and categorized for those receiving NSAIDs during the first week following injury; those with NSAID use prior to injury were excluded. NSAIDs included in this study were ibuprofen, oxaprozin, indomethacin, aspirin, diclofenac, celecoxib, and naproxen. Burn induced coagulopathy was defined as international normalized ratio (INR) levels ≥1.5. Statistical significance of the rate of burn-induced coagulopathy in the week following injury among the two groups was analyzed with measures of association using chi-squared tests.

Results
We identified 709 severely burned patients receiving NSAIDS during the week after burn and 1,032 severely burned patients without NSAID use. Among those receiving NSAIDs, ibuprofen and aspirin were the most prescribed at rates of 80% and 36%, respectively. After cohort matching, the risk of burn induced coagulopathy was significantly decreased in patients taking NSAIDs (17.7%) compared to patients not receiving NSAIDs (32.3%) (p&lt; 0.0001). The protective nature of NSAIDs was greatest on the same day (p=0.0002) and first day following burn injury (p=0.0026). On average, those not taking NSAIDs had an elevated risk of developing coagulopathy compared to those who did as %TBSA increased in 10% intervals. This observation was confirmed in a linear regression analysis with slopes of 0.0453 and 0.0293, respectively. Furthermore, patients taking NSAIDs were less likely to develop sepsis (p=0.0046) and thrombocytopenia (p=0.0003) and die the first week following injury (p&lt; 0.0001).

Conclusions
The early protective effects of NSAIDs at reducing the risk of coagulopathy occurs during the acute phase of burns, though selection bias cannot be excluded. The potential risk of burn induced coagulopathy increased more with %TBSA in patients without NASIDs.
742 Is There a Mortality Benefit of Being Well-Insured in Burns?
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia 
Published: March 2022

Abstract

Introduction
The purpose of the Affordable Care Act was to make affordable health insurance available to more people, to cover adults with fewer resources, and to facilitate delivering health care in a cost-effective way. Burn care is both financially and medically intense, expensive, and prolonged. We aimed to compare outcomes of patients treated at a tertiary care center with no insurance, those considered under-insured (Medicare/Medicaid), and those with private/commercial insurance.

Methods
Patients were identified using our institutional Burn Center registry and linked to the clinical and administrative data. All adult patients admitted to the Burn Center between January 1, 2011 and December 31, 2020 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions and mortality were evaluated. Statistical analysis was performed with Students’ t-test and chi-squared.

Results
A total of 9,306 patients were admitted during the study period. Forty-one percent of patients had private/commercial insurance. Thirty-four percent were under-insured, while 25% of patients had no insurance. Total body surface area (TBSA) of the burn was significantly higher for the under-insured, p&lt; 0.05. Mortality was significantly higher for the under-insured, p&lt; 0.05. The average LOS for the under-insured was 14.7 days, which was significantly longer than that for the insured (9.2 days) and for those without insurance (7.4 days), p&lt; 0.05.

Conclusions
There are outcome disparities secondary to insurance coverage in burns. Under-insured patients had poorer outcomes than those with private/commercial insurance and those without insurance.
747 Standardization of Upper Extremity Elevation
Authors: Miller Hannah 
Published: March 2022

Abstract

Introduction
Elevation of burn-injured extremities is crucial to preserve function, prevent contracture and scar formation. Limited data leading to various techniques utilized across burn centers has resulted in no local, national, or international standard of practice. The absence of standardized documentation of these interventions prevents data tracking and outcome analysis.

Methods
A literature review was conducted to assess the various methods of upper extremity elevation in burn patients. A request was sent to ABA verified burn centers to collect feedback on elevation practices. The interdisciplinary team was consulted for their professional expertise and opinion. The unit practice council reviewed all data to establish a standard of practice for upper extremity elevation. A procedure was written explaining the purpose, proper implementation, and potential complications. Documentation in the electronic medical record (EMR) was updated to reflect the practice change. Education will be disseminated to bedside staff. Return demonstration will be required, completed with a trained validator to ensure staff competency. Data will be collected and analyzed through EMR audits.

Results
Information gathered via literature review proves there is inconsistent practice of upper extremity elevation post-burn injury. ABA verified burn center survey results support the current literature findings, and the importance elevation plays in preserving function and quality of life in burn survivors.

Conclusions
Upper extremities are frequently impacted by burn injury, potentially resulting in significant disability. A common physical complication of burn injury is contracture of major joints, leading to further surgical intervention and/or permanent disability. Standardizing the practice of upper extremity elevation has the potential to preserve joint function and range-of-motion. A procedure has been written and published hospital-wide. Staff compliance and documentation audits will assist in evaluating the efficacy of the upper extremity elevation. Barriers to optimal outcomes include staff compliance, documentation inconsistencies, and limited sample size.
765 Treatment of burns due to application of hair extensions and braiding in younger female patients
Authors: Coffman Beretta C , Wilson Joan , Hardy Kade , Parker Farrah , Addison Shana 
Published: March 2022

Abstract

Introduction
Burn injury due to hair styling processes have been reported in the literature, but most of those have been reported to involve flat irons or chemical processing during hair coloring. Moreover, these injuries have predominantly involved adult patients. In the past, our center has seen similar injuries intermittently, with the addition of hot comb burns to the scalp as well.
More recently, a number of younger female patients have been treated for a more uncommon injury related to application of hair extensions. The hair extensions are curled with hot boiling water which is usually taken from the microwave. The ends of the extensions are dipped in the hot water and when they are applied to the hair, the hot water burns the back, shoulders, and scalp.
The purpose of this project is to describe the mechanism of injury from this type of hair styling process and to identify the population at risk. This will serve to raise awareness in the community so that preventive measures might be considered.

Methods
This is a case series describing an unusual mechanism of burn injury reviewing admissions from January 2016 through June 30, 2021.

Results
A total of 35 patients were admitted for this type of burn during this time. 32 were children and 3 were adults. Though this type of injury occurs more commonly in children, it can occur in adults as well. For purposes of this study, the focus will be injuries occurring in children.

Conclusions
This case series serves as a public service announcement to alert parents of young girls obtaining hair extensions and parents braiding the hair of young children of the potential danger of burn injury from the process. Burn clinicians are obligated to provide education that serves to help prevent such injuries. This presentation serves that purpose as well.