bluuebunny/crossref_metadata_2025_split huggingface dataset:
110 Does Discharge to a Post-acute Facility Predispose Burn Patients to a Deterioration of Their Wounds?
Authors: Osborn Suzanne C , Addison David , Islas Claudia , Richey Karen , Foster Kevin N 
Published: March 2022

Abstract

Introduction
The care of burn injuries requiring hospitalization is complex and highly specialized. In-hospital treatment results in discharging patients with stabilized, but unhealed wounds with the need for ongoing care. The expectation is that wounds continue to heal without complication. For patient who are unable to be discharged home, disposition is frequently dictated by finance and payor source. Post-acute facilities such as Skilled Nursing facilities (SNF), Acute Rehabilitation Centers (ARC) and Long-term Acute Care facilities (LTAC) are utilized. The purpose of this study was to evaluate the wound healing in patients being sent to SNF and ARC.

Methods
A retrospective chart review of patients discharged to a SNF or ARC over a one-year period was performed. Photographic review was done comparing photos from the first clinic visit to those from hospital discharge. Wounds were designated as “Improved” (IM) or “Worsened/No Change” (W/NC) by a single burn surgeon.

Results
Of the 963 charts reviewed, 719 patients suffered burn injuries, and of these 127 were discharged to post-acute facilities, 54 were either discharged to a LTAC or did not have photos available for review at their first clinic visit. Thus 73 were evaluable. The majority, 51% (n=37) worsened or showed no change (W/NC) and 49% (n=36) improved (IM). All patients returned to clinic within the first 2 weeks of discharge. There were no significance differences for age, gender, BMI, comorbidities, substance abuse, living situation, ICU days, ventilator days, length of stay, number of surgeries, payor source or facility type (SNF vs ARC). Mean TBSA was greater in IM 13.99% vs W/NC 8.31% (p=0.018). There were no significant differences between groups for mechanism, although IM was more likely to have suffered a flame/flash injury (n=20) and W/NC contact burns (n=21). A total of 30 different facilities were utilized for discharge.

Conclusions
Despite having smaller burn injuries, the majority of patients worsened if discharged to a post-acute facility. No patient factors were identified that were associated with worsening/no change in wound status at the first clinic visit post discharge. Given the number of discharge facilities utilized, we were unable to analyze the relationship between specific facilities and outcomes. The magnitude of the problem warrants further investigation. A Quality Improvement project is being developed to further identify areas for intervention.
115 Analyzing Temporal Trends and Outcomes Associated with High Prevalence Bacterial Infections in Burn Patients
Authors: Chokshi Shivan N , Golovko George , Song Juquan , Wolf Steven E , El Ayadi Amina , Joglar Alejandro A , Efejuku Tsola A , Corona Kassandra K , Haseem Maria , Gotewal Sunny , De La Tejera Giovanna , Keys Phillip H , Huang Lyndon G , Villarreal Elvia L , Bagby Shelby P 
Published: March 2022

Abstract

Introduction
Bacterial infections are a leading cause of complications in burn patients. However, ambiguity remains around the most common infectious etiologies and their resulting complications. Our study identifies which bacterial infections will lead to specific complications and tracks infection rates of these bacteria over time.

Methods
Burn patients diagnosed with a bacterial infection within 6 months of burn were identified in the TriNetX database using ICD-10 codes; those with bacterial infections prior to injury were excluded. Occurrence of the following outcomes within 12 months of injury were compared for those with bacterial infections and those without, including acute kidney injury (AKI), congestive heart failure (CHF), hypertrophic scarring, sepsis, and death. The top 4 bacterial infections, by incidence, were then identified and analyzed for the outcomes. Lastly, infection rates were stratified by year from 2010-2020. Data was analyzed using chi-square with p &lt; .05 considered significant, and regressions.

Results
We identified 457,383 burn patients, of whom 4,688 (1.0%) were diagnosed with a bacterial infection within 6 months of injury. The bacteria that constituted the highest proportion of infected patients were Staph aureus (51.1%), E. Coli (20.2%), Pseudomonas (17.6%), and Enterococcus (9.6%). When outcomes were stratified by bacteria, Enterococcus infection was associated with the highest incidence of AKI (23.1%), sepsis (25.2%), and mortality (16.03%). E. Coli was associated with the highest incidence of CHF (17.7%) and Pseudomonas was associated with the highest incidence of hypertrophic scarring (13.3%). All data was found to be statistically significant (p&lt; .05). Time trend data from 2010 to 2020 stratified by bacterial infection is displayed in Figure 1. Of note, Pseudomonas infection rates increased by 90% (r2 = 0.6717) while E. Coli infection rates increased by 33%. (r2 = 0.7223). In contrast, Staph Aureus infection rates have decreased since 2013. Lastly, Enterococcus infection rates displayed a fluctuating pattern with an increasing trend since 2017.

Conclusions
Species identification of a post-burn bacterial infection is an important step in outcome management. Despite its low incidence, Enterococcus infection was associated with the highest incidence of AKI, sepsis, and mortality, and has displayed recent increases in infection rates. Pseudomonas has shown a similar increasing trend and is notable for hypertrophic scar formation.
117 Evaluating Predicted vs. Actual Vancomycin Pharmacokinetic Target Attainment Using AUC Dosing
Authors: Boyd Allison N , Walroth Todd A , Bollinger Christopher , Candidate M B A , Hartman Brett C 
Published: March 2022

Abstract

Introduction
Vancomycin is a broad-spectrum antibiotic commonly used in burn patients. Traditionally, vancomycin has been managed with a trough level dosing strategy. However, recent literature and practice changes have encouraged utilizing an area under the curve (AUC) dosing strategy. The objective of this study was to evaluate the likelihood of attaining therapeutic targets using population kinetics in burn patients utilizing AUC.

Methods
This retrospective cohort included adult burn patients who received vancomycin dosed with an AUC strategy. Data collection covered 20 months following an institutional shift to AUC monitoring. Patients were excluded if they did not have pharmacokinetic (PK) data documented, received renal replacement therapy, or had a nonburn injury. The primary outcome was the difference between predicted and actual vancomycin AUC. Secondary outcomes included differences between additional PK parameters.

Results
The AUC analysis included 14 patients. Mean (SD) age was 47 (12) years, 57% were male, and mean (SD) TBSA was 30 (21). The mean (SD) AUC in the predicted and actual groups was 522 (42) and 455 (122) mg*h/L, respectively (p=0.05). A total of 6 patients were evaluated for additional PK analysis, summarized in Table 1.

Conclusions
Actual patient-specific AUC was significantly lower than predicted AUC. This corroborates previous trough-based data indicating burn patients dosed using standard population estimates are at risk of being subtherapeutic, likely due to their hypermetabolic state. Our findings suggest AUC monitoring is an appropriate dosing strategy for burn patients and potentially more accurate than a traditional trough-based approach.
127 Anxiety Disorder Symptomology Found to Be Prevalent in Burn-injured Youth
Authors: Brubaker Rimmer Ruth B , Bay R C C , Kalil Emile T , Chacon Daniel W , Foster Kevin N 
Published: March 2022

Abstract

Introduction
Anxiety Disorder (AD) is common in inpatient pediatric burn patients and likely related to pain/stress associated with acute care. This study ascertained if burn survivors reported higher anxiety levels based on sex, visibility of scars, or TBSA ≥ 50%.

Methods
Burn-injured youth completed the Screen for Child Anxiety Related Disorders (SCARED) with parental consent. This 41 item self-report measures DSM-IV pediatric anxiety disorder symptoms: panic disorder (PD), separation anxiety (SA), generalized anxiety disorder (GAD), social phobia (SP) school phobia (SCP) and total anxiety (TA). The percentage of respondents above threshold for each disorder was calculated.

Results
112 survivors, mean age of 13, included boys (51%) & girls (49%). 83 reported visible scars. Females had higher percentages for TA (53%) vs. males (21%) (p &lt; 0.001), PD (47%) vs. (7%) (p&lt; 0.001), GAD (40%) vs. (16%) (p &lt; 0.005), & SA (51%) vs. (21%) (p &lt; 0.001). Youth with TBSA ≥ 50% (n=22) had higher precents for GAD (46%) vs. &lt; 50% (24%) (p &lt; 0.01). The visibly scarred had higher percent for GAD (38%) vs. hidden (7%) (p&lt; .01).

Conclusions
Female, visibly scarred, and patients with burns &gt; 50% revealed increased AD symptoms. AD may be chronic, interfere with a child’s home & school function and lead to chronic distress, substance abuse, and isolation. Screening for anxiety in burn-injured youth is recommended.
504 Starting a Pediatric Burn Center: Challenges Faced in an Underserved Patient Population
Authors: Kopari Nicole M , Zagory Jessica A , Lindsey Kristen , Phelan Herb A , Carter Jeffrey E 
Published: March 2022

Abstract

Introduction
Burn injury is the third most common cause of childhood injury resulting in death. The CDC recognizing the South as having the highest rate of pediatric burn deaths in the U.S. Unfortunately, 10% of all child abuse cases involve burn injuries and 20% of all pediatric burn admissions are due to nonaccidental trauma. Our study demonstrated that aftercare was a major challenge in starting a pediatric burn center. We analyzed the rate of lost to follow-up in burn-injured children following surgery and our steps to address this need in our community through key partnerships within our state.

Methods
Our study is a single center review of pediatric burn-injured children undergoing surgery from 01/01/2021 through 09/30/2021. Lost to follow-up was defined as three or more consecutive months without clinic or telemedicine visits despite three of more documented communication attempts by attending surgeons and/or clinic staff. Children requiring child protective services (CPS) for suspected nonaccidental trauma were compared to those where nonaccidental trauma was not suspected. All children sustained burn injuries of sufficient severity to require excision and autograft with follow-up in the outpatient clinic. Families were provided with an after-visit summary reviewing the clinic appointment, transportation and meal assistance, and they received a call prior to clinic to remind them of the scheduled appointment.

Results
A total of 35 children required surgery with outpatient follow-up per protocol. 23% of the patients required CPS investigations. We reviewed 151 subsequent clinic visits and the associated cancellations, rescheduled appointments, and no-show visits. Children under the care of CPS had a higher rate of being lost to follow-up (50%) compared to other children (17%). Parents undergoing CPS investigation were 4x less likely to provide cancellation notice. Children placed in foster care had no cancellations, reschedules appointments, or missed visits despite a higher number of clinic visits overall.

Conclusions
Children suffering nonaccidental injuries represent an exceptionally vulnerable portion of our population. Burn injuries often are a public and personal reminder of severe trauma. CPS works to find a balance in securing a safe home while attempting to maintain a family unit. Our work demonstrated an unacceptably high rate of loss to follow-up for children requiring surgical intervention after injury especially in those with concerns for nonaccidental etiologies. As a result, our burn surgeons led an initiative with statewide burn directors and our state’s emergency response network to engage the state’s CPS department. Our goal was to raise awareness and increase education for CPS social workers and foster families on burn injury and aftercare needs.
506 Hidradenitis Suppurativa Reddit Support Group: Finding New Meaning in Social Media during the COVID-19 Pandemic
Authors: Yesantharao Lekha , Suresh Rachana , Cox Carrie A , Lerman Sheera F , Caffrey Julie 
Published: March 2022

Abstract

Introduction
Hidradenitis suppurativa (HS) is a chronic inflammation of sweat glands that can result in abscesses and scarring, significantly impacting quality of life. Online support groups provide a platform to connect with other HS patients – increasingly important with pandemic-related social isolation. The popular social media site Reddit allows users with common interests, like HS, to form a community and share information. This study characterizes HS patients’ use of Reddit and social media more broadly before and during the COVID-19 pandemic.

Methods
This study consisted of a cross-sectional survey of HS patients treated at our institution between May 2021 and July 2021, collecting data on patient demographics, HS status, and social media support group usage/interest. A longitudinal analysis of use of a popular HS support page on Reddit from January 2019 to August 2021 was also conducted, analyzing the number of subscribers over time.

Results
The number of subscribers to the subreddit r/Hidradenitis increased exponentially from January 2019 to August 2021 (R2= 0.9978 for exponential model fit to data); this suggests that the onset of the COVID-19 pandemic was associated with a greater increase in the number of subreddit subscribers. Further, 20 patients (90% female, mean age of 32.4 years) completed the survey that was administered. Participants were stratified into two groups: online support group users (n=8) and non-users (n=12). There were no significant differences in sex, age, education level, HS activity, antidepressant usage, and overall social media usage between these groups. However, there was a significant difference in Hurley staging between the two groups; 75% (n=6) of online support group users reported a Hurley III staging, while only 16.7% (n=2) of non-users self-reported as Hurley III (p=0.003). In terms of features patients desired to see in online support groups, non-users ranked the following categories of advice/information as important more frequently than current users: bandaging/dressing boils, living with HS, medical advice from professionals, causes of HS, and diet (p=0.047, p=0.043, p=0.043, p=0.047, and p=0.013, respectively).

Conclusions
This study demonstrates that online support group use is associated with patients with HS of higher clinical severity. Since virtual support groups have an unprecedented importance due to increased social isolation and limited access to in-person support groups and health resources, healthcare providers may encourage non-users to partake in these online support communities during these trying times. Based on the needs and expectations of these patients as identified in this study, recommendations can be made to moderators of online communities to help fill any existing lacunae.
507 Capturing Growth and Change Through the Burn Camp Experience
Authors: Mikolaj Kerry , Jackson Brad , Boulter Trudy , Schiffer Nichole M 
Published: March 2022

Abstract

Introduction
The American Camping Association (ACA) has asked in their study titled, Youth Development Outcomes of the Camp Experience: Evidence for Multidimensional Growth, “In what ways do children change because of camp experiences?” Our burn camp program wanted to answer this same question about the medical specialty camp experience. Camp counselors and staff have been addressing this question in their camp summary reports for years, focusing on independence, social relationships, and adventure/risk taking. This project asked campers and caregivers/parents to rate their experiences of change in these key areas of growth and development.

Methods
The ACA supported the development of the Camper Growth Index instrument. We selected items from this larger scale to address three areas of change in our burn camp population: Independence/Leadership, Adventure/Exploration, and Social Skills. Three to four items were selected for each area based on the strength of their factor scores in the original study, relevance to our medical specialty camp setting, and the growth we were already documenting in our counselor reports.
Campers ages 8–18 and their caregivers/parents rate items addressing these areas on a 4-point Likert scale (disagree a lot, disagree a little, agree a little, agree a lot). Sample questions are “I am good at doing things on my own”, “I like to talk to kids I don’t know yet”, and “My child likes to try new activities”. Items are phrased in positive and negative directions (reversed scored).
All 60 campers and caregivers received these questions prior to camp. The same questions will be sent 3 months post camp to assess change in these areas.

Results
Preliminary findings from the pre-camp responses indicate positive evaluations in these three areas. We will be gathering post-camp responses from youth and caregivers / parents to assess change over the camp experience and return to home and school.

Conclusions
Burn camps are a vital part of the burn rehabilitation and aftercare experience for young burn survivors and their families. Documenting the change we all believe happens at burn camp (and hear about anecdotally from our campers and families) remains an important task. The Camper Growth Index utilized by the broader ACA study allows us to assess the camper and caregiver/parent experience of this change.
510 5-Year Retrospective Analysis of a Vented Early Mobility Algorithm in the Burn ICU
Authors: ONeil Audrey M , Rush Cassandra , Griffard Laura , Roggy David , Hartman Brett C , Boyd Allison N 
Published: March 2022

Abstract

Introduction
The practice of early mobilization on mechanically ventilated patients in ICU settings has received significant attention within recent literature, however limited research to date has focused specifically on the burn population. The purpose of this single center retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine the safety and feasibility of early mobility programs in the burn population, expose limitations preventing mobility progression at our facility, and discuss unique challenges to early mobility with burn patients.

Methods
A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for all intubated patients from initial evaluation until each patient was either extubated or underwent a tracheostomy. Data was collected using the stages of the mobility algorithm.

Results
In the 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average TBSA of 22.8%. Of these patients, 25 were transitioned to comfort care measures due to the extent of their burn injuries but were included in the review. The average intubated days were 8.05 days and the average length of stay was 26 days. No adverse events occurred during treatment with the algorithm. Stage 1: PROM/AROM was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with only 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) including: unstable medical status, agitation, sedation, cultured epithelial autograft placement, and orthopedic restrictions. Line placement, including femoral and pedal catheters , was also found to be a barrier to the use of our algorithm in 21% of held patient treatments.

Conclusions
Retrospective analysis demonstrates that early mobilization during mechanical ventilation is safe and feasible with in the burn population despite challenges including airway stability, sedation, and line limitations. Dedicated burn therapy staff and team coordination is required to optimize management during the critical care stage of recovery and improve outcomes for survivors.
511 Characteristics of Inhalation Injury Management at a Referral Burn Center: A Ten-year Experience
Authors: Drake Mack , Leichtle Stefan , Todd Borchers C , Ali Naushin S , Labban Nayla , Feldman Michael J 
Published: March 2022

Abstract

Introduction
Variability exists in the diagnosis and treatment of upper airway and inhalation injury (UAII). Institutional algorithm at our ABA-verified burn center in part necessitates fiberoptic diagnostic laryngoscopy (DL) in patients at risk for UAII. We sought to determine patterns and characteristics of UAII management and complications over a ten-year period.

Methods
A retrospective review of burn admissions between January, 2011 and December, 2020 was performed. 253 patients with concern for UAII underwent DL upon presentation. Patients under age 18 were excluded. 66 patients were excluded for inability to tolerate/refusal/unreported results. Univariate and multivariate analyses were used to determine independent predictors of a positive DL.

Results
169 patients were analyzed. The population was frequently middle-aged, male, and overweight. 81 patients used tobacco and 34 patients had history of COPD. Examination of injury characteristics yielded median ISS of 6. 116 patients (69%) had no or &lt; 1% cutaneous thermal burns. 75 patients had facial soot or singed nasal hairs concerning for UAII. Of 169 patients who underwent DL, DL was positive in 106 (63%). Tracked complications in patients with positive DL yielded few unplanned intubations (n=2, 1%), unplanned ICU admission (n=2, 1%), unplanned extubation (n=4, 2%), VAP (n=1, 1%). Median ICU LOS was 2 days and average hospital LOS was 3 days. Mortality overall was 5% (n=8). Subgroup analysis was used to compare patients with positive versus negative DL. Patients with positive DL were older (54 vs 49 years, p=0.09), primarily male (63% vs 60%, p=0.7), had lower BMI (29 vs 30, p=0.94), were tobacco users (52% vs 41%, p=0.18), and often carried diagnosis of COPD (24% vs 14%, p=0.15). Median ISS was higher in the positive DL group (10 vs 4, p&lt; 0.0001). Cutaneous burns were absent or &lt; 1% (85 vs 58, p=0.05). Presence of facial burns and soot was significantly associated with positive DL (56 vs 19, p&lt; 0.0001, OR 15.9, 95% CI). With positive DL, median ICU LOS, hospital LOS, and mortality were significantly higher (p&lt; 0.0001, p&lt; 0.0001, and p=0.03, respectively).

Conclusions
These findings lend credit to an approach of aggressive diagnosis and subsequent management. Multivariate analysis of factors associated with positive DL highlighted obvious facial burns or soot and ISS (OR 1.1, 95% CI, p=0.01) as most predictive. Though rates of tracked complications were too low for subgroup analysis, no patient with negative DL on admission required unplanned intubation. Patients with positive DL at our institution are placed on an algorithm of ICU admission, 24-hour period of NPO, mucolytic therapy, enhanced pulmonary hygiene, and lung protective ventilatory strategies. Patients with positive DL exhibited longer ICU and hospital LOS and increased mortality.