bluuebunny/crossref_metadata_2025_split huggingface dataset:
561 Ethnicity Influences Outcomes of Adult Burn Patients
Authors: DiPaolo Nicola , Hulsebos Ian F , Yu Jeremy , Gillenwater Justin , Yenikomshian Haig A 
Published: March 2022

Abstract

Introduction
Outcomes of burn survivors is a well-studied field of research for burn providers; however, there has been little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any disparities in burn outcomes of broad ethnic groups. Adjustment was made for demographic, social and pre-hospital clinical factors to help isolate ethnic disparities that might not be explainable by other factors.

Methods
A retrospective chart review of an American Burn Association verified burn center identified adult inpatient admissions from 2015 to 2019 with documented insurance status. A total of 1142 patients were categorized by recorded primary ethnicity: 142 Black (or African American), 72 Asian, 479 Hispanic (or Latinx), 90 white, 215 other, and 144 patients whose race or ethnicity was not indicated. Firth logistic regression was used to study the relationship between ethnicity and each of several binary outcomes. Zero-truncated negative binomial regression was used to examine hospital length of stay (LOS) and intensive care unit LOS. Adjustment was made for several confounders (age, gender, homelessness, primary insurance type, diabetes, inhalation injury, primary burn depth, percentage of total body surface area injured) to clarify the statistical effect of ethnicity. The specific adjustment set used depended on the outcome type or frequency.

Results
Relative to white patients, surviving Black patients had an estimated 29% higher average hospital LOS (ratio 1.29; 95% CI 1.01-1.64; unadjusted P=.04). Had the average surviving patient in this sample been Black, their hospital stay would be 2.7 days longer (95% CI 0.1-5.4). Relative to white patients, the odds of being discharged home with or without services, or to hospice care, were an estimated 123% higher for Hispanic patients (OR 2.23; 95% CI 1.28-3.88; unadjusted P=.005). Compared with non-Hispanic ethnicity, Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (OR 0.56; 95% CI 0.34-0.92; unadjusted P=.022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P=.041, P=0.011 respectively).

Conclusions
Even when controlling for burn severity, age, and other factors, Black patients had longer hospital stays. Hispanic patients were more likely to be discharged to home or to hospice care. The causes of these disparities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery or insurance coverage.
576 Comparison of Survival Benefit Between Direct Emergency Department Admissions and Inter-hospital Transfers in Burn Victims
Authors: Hulsebos Ian F , Collier Zachary J , Yenikomshian Haig A , Gillenwater Justin 
Published: March 2022

Abstract

Introduction
Severe burn injuries create systemic insults that are life threatening and require immediate stabilization, resuscitation, and, potentially, emergent surgery. Non-burn emergencies, such as stroke, have shown improved survival benefit and outcomes when patients are immediately transferred to specialized facilities. Our objective was to compare the outcomes between burn patients who were transferred to the burn unit from outside hospitals (HT) to controls who were directly admitted from our own emergency department (ED). We hypothesized that HT patients were at increased risk for mortality, wound healing complications, and infectious sequelae relative to the ED cohort.

Methods
A matched retrospective cohort study from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. HT patients were identified and matched with ED patients by age and percent total body surface area burned (TBSA). HT and ED cohorts were compared as a whole and then stratified into groups according to % TBSA burned (&lt; 10%, 11-20%, 21-40%, and &gt; 40%). Patient and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes included total length of stay (LOS), ICU requirement and complications.

Results
A total of 410 HT and 377 ED patients were identified. There were no significant differences in age (P=0.17), burn severity (TBSA: P=0.27; full thickness burns: P=0.13), and inhalation injury (P=0.29). There were no demographic differences when comparing cohorts according to TBSA. For the primary outcome, there were no significant differences in mortality in the cohorts at large (P=0.48) nor between the groups when stratifying for TBSA (&lt; 10% : P=0.35; 11-20% : P=0.44; 21-40% : P=0.30; &gt;40% : P=0.26). For the secondary outcomes at large, there was no significant difference in LOS (P=0.35), ICU requirement (P=0.17), or wound and infectious complications (P=0.14). HT patients at large, however, spent less time in the ICU (P=0.03).

Conclusions
There was no significant difference in overall mortality rates between the HT and ED groups regardless of TBSA. Additionally, there was no difference in hospital course between the cohorts except for longer ICU stays in those admitted directly from the ED. Once the transfer process is initiated, our unit maintains close physician-to-physician communication with the transferring facility throughout the transfer process, including guiding initial resuscitation efforts. This may play a role in the parity of outcomes between groups.
594 Dermal Matrix versus Autologous Grafting for Full-Thickness Burns of Head and Neck: Trends, Outcomes, Cost
Authors: Di Chiaro Bianca A , Galicia Kevin E , Anstadt Michael J , Patel Purvi P , Portalatin Manuel E , Ton-That Hieu H , Gonzalez Richard , Carson Joshua S , Kubasiak John 
Published: March 2022

Abstract

Introduction
Burns of the head and neck are particularly devastating, commonly occurring due to accidental flame or scald injury. Autologous grafting has traditionally been used for reconstruction in this area. Recently the use of dermal matrices as a reconstructive alternative has increased. This study compares annual trends, outcomes, and hospital costs between head and neck burn patients who underwent reconstruction with dermal matrix or autologous grafting.

Methods
The U.S Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was queried from 2012 to 2016. Patients with head and neck burns treated with dermal matrix or autologous graft were identified using International Classification of Disease Ninth and Tenth Revision diagnosis and procedure codes. Demographic, clinical characteristics, and outcome measures were reported. χ 2 and Student’s t-tests were used for univariate survey-adjusted comparisons between groups. Multivariate survey-adjusted linear regressions were used to identify associations between surgical intervention, length of stay and cost of hospitalization. Analyses were conducted with RStudio (1.4.1717).

Results
A total of 6,730 patients met inclusion criteria; 2,855 underwent reconstruction dermal matrix and 3,875 with autologous graft. There was an increasing number of patients undergoing dermal matrix reconstruction each year, peak in 2016 (1,450, 50.8%). The dermal matrix group was younger (33.7 vs 39.9, p&lt; 0.001) had fewer females (27.3% vs 38.2%, p=0.003) and fewer inhalation injury (4.0% vs 11.0%, p&lt; 0.001). The dermal matrix group had a shorter length of stay (11.2 vs 27.8, p&lt; 0.001) and more home discharges (80.4% vs 53.4%, p&lt; 0.001); they had lower Elixhauser Comorbidity Index score for readmission (6.57 vs 11.92, p&lt; 0.001) and in hospital mortality (4.76 vs 9.69, p&lt; 0.001). Median cost of care was lower for the dermal matrix group ($17,858 vs $59,860, p&lt; 0.001). Multivariable regression demonstrated that reconstruction with dermal matrix was independently associated with decreased length of stay (11.01 [7.95 - 14.07], p&lt; 0.001) and decreased cost ($38,297 [23,813], p&lt; 0.001).

Conclusions
Operative management of head and neck burns with dermal matrix is associated with a shorter hospital stay, greater likelihood of home discharge, and decreased hospital costs. Patients with autologous grafting had higher rates of inhalation injury, which may account for longer hospital stays and increased discharges to nursing facilities. A limit of this study is the inability to differentiate patients undergoing staged procedures. Further study is needed to evaluate factors contributing to faster discharges home in the head and neck burn population.
595 Hypochlorous Acid for Skin Preparation in Fractional Ablative CO2 Laser Treatment of Burn Scars
Authors: Bekeny Jenna C , Shupp Jeffrey W , Travis Taryn E 
Published: March 2022

Abstract

Introduction
While complications from fractional ablative CO2 laser treatment for burn hypertrophic scar (HTS) are relatively rare, the risk of surgical site infection (SSI) after laser treatment exists. When infection occurs, it has been linked to further morbidity, such as scar development in previously unaffected skin. Hypochlorous acid is a non-flammable and colorless antiseptic solution that has been used to treat wounds and is believed to be a less cytotoxic alternative to other agents such as betadine and chlorhexidine. This study aims to investigate the use of hypochlorous acid solution as a skin prep for patients undergoing laser scar revision for HTS and determine its efficacy in preventing SSI.

Methods
All patients undergoing fractional ablative CO2 laser revision of HTS at a single center from September 2016 through September 2021 were retrospectively reviewed. Data pertaining to patient demographics, skin characteristics, treatment sessions, and post-treatment complications were recorded. All patients underwent topical skin preparation with hypochlorous acid-soaked laparotomy pads for 10 minutes before laser treatment. No perioperative oral or topical antibiotics were given to any included patient. Patients were excluded from analysis if they were not treated with a fractional ablative CO2 laser, were treated for a scar etiology outside of burn injury, or if insufficient follow-up was documented.

Results
A total of 208 patients undergoing a total of 758 laser treatments were identified. Average patient age was 45 years (SD 16), with 112 (53.8%) patients being female and 96 (46.2%) being male. Median number of laser treatments was 3 (IQR: 1-5). Patients from all Fitzpatrick skin types were treated, with the most common type being type 5 (n=54, 26.0%). None (n=0, 0.0%) of the 208 patients experienced a surgical site infection after any of the laser treatments received.

Conclusions
Hypochlorous acid is a safe and effective skin preparation for patients undergoing laser burn-scar revision to prevent SSI. Moreover it is non-flammable, colorless and does not need to dry prior to procedure.
603 Timing of autologous spray cell suspension: better early than late
Authors: Komak Spogmai 
Published: March 2022

Abstract

Introduction
Autologous spray cell suspension is associated with multiple beneficial outcomes, however, the optimal timing of use has not been determined. We examined the timing of spay cell application, and hypothesize that early (&lt; 72 hr) use is associated with faster definitive wound coverage, impacting multiple clinical outcomes compared to late ( &gt;72 hr) use of spray cells.

Methods
A retrospective review of 28 patients with spray cell application from March 2020 -- May 2021 was conducted. Pediatric patients &lt; 16 yrs (n=1) as well as deaths (n=2--including 1 withdrawal) were excluded, leaving 25 patients. Those that received spray cells early (&lt; 72 hrs, n=14) were compared to late ( &gt;72 hrs, n=11). Time to index operation, time to spray cell application, rate of complete wound coverage, number of OR trips required for wound closure, wound infection rates, LOS / %TBSA, and overall hospital LOS were examined.

Results
There was no difference in demographics or % TBSA burn (21.4% vs. 23/5%), between early and late spray cell groups. The early group had a significantly faster time to index operation (1.2 dys vs. 2.5 dys P= .05), and faster time to spray cell application (1.6 dys vs. 18.1 dys P=.036) (Table 1). The early group had a greater wound coverage rate at index operation —64.2% complete coverage vs. 18.1% in the late group (p&lt; .03). The total number of OR trips needed for wound coverage was less in the early group (1.5 trips / pt) vs. the late (7.0 trips / pt) P=0.03. The early group had less wound infections, a shorter LOS / % TBSA burn ( 0.83 dys vs. 1.85 dys P=0.005), and shorter overall LOS (16.5 dys vs. 46.9 dys P=0.03).

Conclusions
Autologous spray cell use has multiple beneficial outcomes, however, the optimal timing of application has not been determined. We report that early (&lt; 72 hr) application of spray cells is associated with greater rate of complete wound coverage at index operation, decreased total number of operations needed for wound coverage, less wound infections, shorter LOS / %TBSA, and shorter overall LOS. This is likely related to earlier definitive wound coverage and closure, which is afforded by the large expansion ratio of spray cells.
609 Available non-invasive skin probes distinguish between normal skin and hypertrophic scar but not laser-treated scar
Authors: Carney Bonnie C , Jimenez Lesle M , Oliver Mary A , Keyloun John W , Moffatt Lauren T , Shupp Jeffrey W , Travis Taryn E 
Published: March 2022

Abstract

Introduction
Skin fibrosis is the most under-studied fibrotic condition, and as such, there are limited treatment options for hypertrophic scar (HTS). HTS is difficult to study because scars improve over time, thus making the distinction between natural improvements and interventions difficult. In addition, clinical, histologic, cellular, and molecular outcome metrics are not agreed upon among providers/researchers. It was hypothesized that a set of non-invasive skin probes would be able to distinguish between HTS and normal skin (NS), but not between HTS before and after treatment with fractional ablative laser, despite histologic-level evidence showing improvement with treatment.

Methods
Wounds were created and HTS were allowed to form (n=8 scars). At Day 77, HTS and NS (n=4) were assessed with non-invasive skin probes measuring elasticity and trans-epidermal water loss (TEWL). HTS were then treated with CO2 fractional ablative laser (FLSR) at 70 mJ, 250Hz, and 1% density. The same data, sample collection, and FLSR treatment was carried out at weeks 1, 2, 3 and 4. Formalin-fixed biopsies were processed and stained with H&E, Herovici, Masson’s Trichrome, and Picrosirius red stains. Collagen type and architecture were qualitatively evaluated. Rete ridge ratio (RRR) was calculated from H&E stains.

Results
All stains distinguished between HTS and NS with ease. Herovici stain showed differences in collagen architecture and collagen type after treatment with FLSR. Pre laser treatment, elasticity was different between HTS and NS (290.50±32.90 N/m vs. 90.92±5.61 N/m, p&lt; 0.001). However, elasticity did not change after FLSR at 1, 2, 3, or 4 weeks (248.17±48.54, 215.54±44.68, 295.29±37.5, 290.79±30.17, p &gt;0.05). RRR was different between HTS and NS (1.22±0.11 vs. 1.51±0.03, p=0.08). FLSR induced a significant increase in RRR in HTSs (pre=1.3±0.1 vs. week 4=1.9±0.1, p&lt; 0.05). Pre-treatment, TEWL was different between HTS and NS (12.96±1.99 g/m2h vs. 8.72±1.11 g/m2h, p=0.09). However, TEWL did not change after FLSR at 1, 2, 3, or 4 weeks (15.95±1.99, 20.35± 3.15, 15.9±1.96, 14.01±2.22, p &gt;0.05).

Conclusions
Outcome metrics that non-invasively measure the qualities of scar are critical for HTS research to evaluate treatment effectiveness. Currently available technologies distinguish between NS and HTS well. However, they are inadequate to distinguish scars pre- and post-treatment despite evidence at the histologic level that changes occur. New technologies should be developed that are able to more effectively demonstrate changes to HTS after treatment.
616 Application of Antibacterial Thermosensitive Collagen-Based Hydrogel in Wound Healing
Authors: Amiri Nafise , Ghaffari Sahand , Hassanpour Ida , Chae Taesik , Jalili Reza B , Kilani Ruhangiz Taghi , Ko Frank , Lange Dirk 
Published: March 2022

Abstract

Introduction
Burn wound infections are a serious complication of thermal injury. Among the many factors that may limit effective wound healing in patients with burn, bacterial infection and poor cell recruitment appear as the leading causes for prolonged healing. Thus, a novel strategy that aims to prevent bacterial infection within the wound, while at the same time providing structural scaffolding that promotes endogenous tissue repair, would be of great interest. As a nutritional protective barrier for the wound, we developed a thermosensitive collagen-based matrix called MeshFill (MF) that contains all nutrition required for cell growth with the ability to fill up all the cavities and void areas in wounds regardless of their geometry. In a previous study, MF was successfully combined with partial-thickness mesh grafted skin in a porcine model and improved healing and aesthetic outcomes. In the present work, we report on the development, and in vitro and in vivo testing of a new formulation of MF containing silver nanoparticles (AgNPs), which simultaneously prevent bacterial infection and promote skin regeneration.

Methods
We fabricated MF/Ag formulation by loading different concentrations of AgNPs in MF hydrogel. The antibacterial activity of MF/Ag formulation against Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) was examined in vitro. The wound healing efficacy of the formulation was evaluated in a silicon ring splinted delayed wound healing model in rats. The splinted full-thickness wounds were generated on the back of rats and treated with either MF or MF/Ag with different concentrations of AgNPs or were bandaged with no treatment (NT) as a control. The healing process was monitored for 18 days. Clinical wound measurements and histological assessments were performed to compare different treatment regimens

Results
The results of in vitro antibacterial study showed MF/Ag released a sufficient concentration of silver which caused a marked reduction in colony forming units (CFU) of MRSA and PA as compared to MF alone. MF/Ag did not show any cytotoxicity to human fibroblast. Moreover, the result of the animal study confirmed the safety and efficacy of applying different concentrations of AgNPs loaded in MF without compromising the healing outcome in our rat model.

Conclusions
These findings suggest that AgNPs loaded MF would be a safe, nutritional, flowable hydrogel that provides an ideal moisture environment for healing while protecting the wound from bacteria and can potentially be used as a functional scaffold in partial-thickness mesh grafted skin in burn patients.
620 The Effectiveness of Aromatherapy in an Urban-Based, Safety-Net Hospital on Pain and anxiety
Authors: Coffey Rebecca , Buchert Justin , Ruiz Alina , Alcorn Jillian , Van Hoose June 
Published: March 2022

Abstract

Introduction
Essential oils have been used for centuries for their calming properties. This alternative medicine therapy is gaining popularity in the inpatient setting for symptom management including pain, anxiety, nausea, and insomnia. The purpose of this project is to evaluate the effectiveness of aromatherapy complement as an alternative and/or treatment for pain and anxiety ion the acute care setting at on Health and Hospital System, The target population for this study was patient who were receiving care in the Surgical Services inpatient units including burn patients.

Methods
This study included all surgical patients admitted to one hospital and this is an analysis of the burn cohort enrolled thus far in this study. All adult burn patients that met inclusion criteria were included to evaluate the impact of aromatherapy on the administration of pain and anxiety medications (PANX). After introducing the patient to the study and obtaining informed consent a Lavender-Sandalwood scented aromatherapy sticker was placed on the patients' gown. The aroma last from the sticker last for twelve hours and could be replaced upon patient request. The stickers were used for a total of three days. Survey data was collected to describe the experience with the sticker as well as PANX medication administration and demographic information. Pain scores were recorded for each patient before PANX administration within the 72 hour time period after surgery or burn wound care procedures.

Results
To date a total of fourteen patients were enrolled in the study mean age was 44 years old, 71% of the patients were male and the mean TBSA was 5%.Two patients withdrew one because the scent gave them a headache and one because there were no study logs completed. Each of the twelve patients used a total of 6 stickers over the 3 days of the intervention. Prior to the start of the study the average pain score was 8.6 (range 7-10). On day one of the intervention the mean pain score was 4.75 (range 3-8), day two 4.25 (range 2-8), and on day three 4.3 (range 0 - 9). Post intervention pain scores were 5.75 (range 0-9). Comparison of the pain scores pre and post intervention were statistically significant t= -2.904(95% CI = -4.85 to -0.81) p = 0.0082. Of note patients reported that sleep was improved while using the aromatherapy sticker.

Conclusions
Aromatherapy may provide a natural alternative to reduce opioid pain medications and improve sleep in the burn patient thereby improving long term outcomes.