bluuebunny/crossref_metadata_2025_split huggingface dataset:
711 Regional Burn Review: Brooke or Parkland, neither reaches the 85% accuracy mark for burn resuscitation
Authors: Azimzadeh Nava , Dahl Rachel A , Galet Colette , Wibbenmeyer Lucy 
Published: March 2022

Abstract

Introduction
Much has been written about burn resuscitation and, despite preponderant studies, the topic remains controversial. Over-resuscitation can result in burn wound conversion and other complications. Our team switched from using modified Parkland (PF) to Brooke formula (BF) in January 2020. Secondary to difficult resuscitations, we sought to review our data to identify factors associated with over-resuscitation using either formula. We hypothesized that the Brooke formula under-predicted resuscitation volumes compared to Parkland, particularly in older patients or in more severe burn injuries.

Methods
Medical records from patients who were admitted to the burn unit between 1/1/2019 and 8/29/2021 for a burn injury with %TBSA ≥15% were retrospectively reviewed. Exclusion criteria included age &lt; 18 years, weight &lt; 30 kg, patient not requiring resuscitation, or death within 24 h of admission. Demographics, injury information, resuscitation formula used, predicted 24-h resuscitation goal, the volume of resuscitation fluids, and time to reach maintenance were collected. Univariate analysis was performed to compare patients resuscitated using the BF vs. the PF. Multivariate analysis was performed to identify factors associated with over-resuscitation. Over resuscitation was defined as &gt;2.5 mL/kg/%TBSA for BF and &gt;5 mL/Kg/%TBSA for PF. P &lt; 0.05 was considered significant.

Results
Sixty-four patients were included; 27 were resuscitated using BF and 37 using PF. Neither age, sex, weight, BMI, or severity of burn injury were significantly different between the groups. Patients required a median of 3.59 mL/Kg/%TBSA for BF and 3.99 mL/kg/%TBSA for PF, p = 0.32. Over-resuscitation was more likely to occur when using BF compared to PF (59.3% vs. 32.4%, p = 0.043). Stepwise multivariate logistic regression showed that over-resuscitation was associated with longer time to reach maintenance (OR = 1.179 [1.042-1.333], p = 0.009) and arrival through ground transportation (OR = 10.523 [1.171-94.597], p = 0.036). Patients who arrived through ground transportation took longer to reach the burn center (3.98 h [2.65-5.15] vs. 2.57 h [1.93-3.2], p = 0.004) and presented with lower %TBSA (20.8 [18-27.9] vs. 31.3[21-55], p = 0.004).

Conclusions
Time to reach definitive care was the only independent variable associated with over-resuscitation. While not significant, compared to PF, using BF tended to be associated with over-resuscitation. More studies are warranted to determine if BF continues to underperform and, if so, the populations in which it underperforms will be identified.
713 Mortality Benefit After Addition of Mid-level Support in Burn Intensive Care Unit
Authors: Hollowell Jamie L , Williams Felicia , Blandon-Hendrix Daniel , King Booker , Chrisco Lori , Maxwell Eli , Nizamani Rabia 
Published: March 2022

Abstract

Introduction
Burn Intensive Care Units (BICU)s are resource-heavy and labor-intensive units with very sick patients. The removal of burns as a requirement from the surgical curriculum has decreased the number of rotating surgical trainees, but did not impact patient care needs. Our unit adopted an Advanced Practice Provider (APP) service model in fiscal year 2018 to provide consistent standardized clinical care, with surgical trainees rotating monthly, to mitigate the loss of residents over time. We aimed to critically evaluate the impact of an APP run BICU on mortality and quality improvement initiatives.

Methods
Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted to the BICU between July 1, 2016 and June 30, 2020 were eligible for inclusion. All central line associated blood stream infections (CLABSI), catheter associated urinary tract infections (CAUTI), ventilator associated pneumonias (VAP) and mortality rates were compared. Demographics, length of stay (LOS), co-morbid conditions and mortality were evaluated. Statistical analysis was performed with Students’ t-test, and chi-squared tests. Significance was accepted as p&lt; 0.05.

Results
There were no significant differences in admission rates over the study period. The number of CLABSIs significantly decreased each year (15 (2017), 6 (2018), 5 (2019), 3 (2020)). The number of CAUTIs significantly decreased ((13 (2017), 6 (2018), 1 (2019), 3 (2020)). The number of VAPs significantly decreased ((15(2017), 12 (2018), 7 (2019), 3 (2020)). Mortality was unchanged from 2017-2019 but significantly decreased in 2020 ((2.2% (2017), 2.4% (2018), 2.5% (2019), 0.9% (2020)).

Conclusions
There were no significant differences in admission rates over the study period. The number of CLABSIs significantly decreased each year (15 (2017), 6 (2018), 5 (2019), 3 (2020)). The number of CAUTIs significantly decreased ((13 (2017), 6 (2018), 1 (2019), 3 (2020)). The number of VAPs significantly decreased ((15(2017), 12 (2018), 7 (2019), 3 (2020)). Mortality was unchanged from 2017-2019 but significantly decreased in 2020 ((2.2% (2017), 2.4% (2018), 2.5% (2019), 0.9% (2020)).
723 Carbon Dioxide Laser Treatment Practices for Hypertrophic Burn Scars Amongst American Burn Association Burn Centers
Authors: Bruce Jon C , Dowdle Travis S , Schrader Kaylee B , Griswold John A 
Published: March 2022

Abstract

Introduction
Scarring is a major outcome of severe burn wound healing. Severe scars often persist and diminish quality of life by disfigurement, pain, and pruritis. In the last decade, utilization of ablative fractional carbon dioxide (CO2) laser therapy has become a popular treatment modality for severe burn scars. Although the efficacy of CO2 lasers for the treatment of hypertrophic burn scars has been established via systematic reviews, there have been no attempts to query the 63 American Burn Association (ABA) centers across the United States regarding specific treatment parameters involving serious, sometimes high, total body surface area (TBSA) burns.

Methods
Throughout October and November of 2020, a Qualtrics survey consisting of 14 questions was administered to burn surgeons practicing at all 63 ABA burn centers across the United States. Topics assessed were specific laser parameters utilized (5), treatment preferences (2), peri-operative follow-up (5), scar assessment practices (1), and TBSA treatment tolerance (1).

Results
Exploratory, descriptive data was analyzed. Surgeons practicing at 27 of the 63 total ABA burn centers responded to the survey (43% response rate). Data elucidates the level of variance regarding current initial management of hypertrophic burn scars via CO2 laser treatment. Surgeons demonstrated variation in the level of TBSA treatment tolerance and pulse energy settings, respectively.

Conclusions
Our findings show a substantial amount of variation in several aspects of CO2 laser hypertrophic scar revision between ABA centers across the country, including preoperative evaluation, laser settings, treatment regimen, and postoperative recommendations . Standardization of care when utilizing ablative fractional CO2 lasers should be further explored.
728 Chemical Burns and Eyebrow Tinting: An Unusual Case
Authors: Brondeel Kimberley C , Duggan Robert P , Kirk Katie , Palackic Alen , Branski Ludwik K 
Published: March 2022

Abstract

Introduction
Here we present the case of chemical burns following professional eyebrow tinting, a phenomenon rarely described in the literature.

Methods
A 50-year-old previously healthy female presented to our emergency department for evaluation and treatment of chemical burns to her eyebrows. Fifteen days prior, she underwent professional eyebrow tinting by a local esthetician. Blistering developed the following day, and progressive swelling prompted her to present to an outside hospital. There she was prescribed acyclovir, ketoconazole cream, and silver sulfadiazine, but despite these measures, her symptoms progressed, leading to her presentation to our facility. Both brows were remarkable for significant swelling with exudative crushing on the surface concerning for superficial infection of partial-thickness chemical burns. She was prescribed bacitracin, prednisone, and clindamycin and discharged with instructions to follow up in burn clinic. Six days later, both brows had developed 2x3 cm scabs, but no signs of infection were appreciated. She was instructed to apply bacitracin/polymyxin B ointment to the scabbing areas and open wounds. Forty-nine days after her tinting, both brows were noted to be completely healed with no alopecia.

Results
Burns following cosmetic procedures most commonly occur during hair lightening treatments where products frequently contain caustic chemicals such a hydrogen peroxide or persulphates leading to oxidation reactions lightening the hair. Thermal burns in hair salons have also been reported to heated hair-dressing instruments or external heat to hasten the highlighting process.
The periorbital area is becoming an increasingly popular target for nonsurgical cosmetic procedures, including permanent eyelid tattooing, eyelash dying, and extensions, more recently, eyebrow tinting. Eyebrow tinting involves the application of semipermanent dyes to give the appearance of a fuller brow. There are no FDA-approved brow tinting formulations, and many contain para-phenylenediamine (PPD), a dying agent frequently associated with allergic dermatitis and less commonly chemical burns. This patient underwent brow tinting in a professional setting and still experienced a chemical burn. As the popularity of brow tinting increases, some patients will undoubtfully seek out readily available, unregulated products for self-application. The potential for dermatitis and chemical burns following eyebrow tinting will only increase.

Conclusions
Eyebrow tinting is not a benign cosmetic procedure, and even professional application of dyes may lead to chemical burns. We believe an increased awareness of brow tinting and its potential complications is warranted given its increasing popularity, the preponderance of unregulated products, and the potential for poor cosmetic outcomes.
733 Massive Burn Injuries: Characteristics, Treatment Strategies and Outcomes from a Single Institution
Authors: Heard Jason , Wallace David L , Skipton Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G , Sen Soman 
Published: March 2022

Abstract

Introduction
Advances in burn care have led to improved survival, with survival after a 50% total body surface area (TBSA) or larger burn being more common. Traditionally, age, TBSA burned, inhalation injury, delayed resuscitation and evidence of early organ dysfunction have been predictive of survival. The goal of this study was to describe a large series of massive burn injuries, treatment strategies and identify factors related to survival.

Methods
Following IRB approval, a retrospective review of adult patients who sustained 50% TBSA or larger burn from 8/2009 to 7/2019 at an ABA verified burn center was conducted. Demographic, burn size/depth, mechanisms of injury, treatments, and outcome data were collected. Univariate and multivariate analyses were performed using R statistical software (R-project.org).

Results
155 patients were included which was 4.7% (155/3312) of all burn admissions during that time internal. Patients had an average age of 44±18 years, a male predominance (79%), and average TBSA burned of 70±15%. Overall mortality was 54% (83/155). One third of patients were transitioned to comfort care. The 103 treated patients were younger (37±12 vs 59±19 years; p=&lt; 0.0001), more likely to be male (85 vs 65%; p=0.006), had smaller average TBSA (66±13 vs 78±16%; p&lt; 0.0001) and more likely to have a psychiatric condition (31 vs 13%; p=0.02). Approximately 70% of treated patients survived to discharge. Survivors were more likely to have smaller TBSA (63±13 vs 73±13; p=0.001) and less third-degree burns (49±24 vs 61±24; p=0.01). One third of treated patients developed renal failure. One quarter of patients had a mental health condition, and these patients spent more time in the hospital (61 vs 31 days; p=0.009), more time on ventilator (29 vs 12 days; p=0.046), required more surgery (3 vs 2; p=0.048), and were less likely to die (36% vs 59%; p=0.02). On multivariate regression analysis of treated patients, psychiatric illness (OR 0.19; p=0.03) and burns related marijuana/hash oil production (OR 0.13; p=0.015) were protective against mortality.

Conclusions
Surviving burns &gt;50% TBSA is becoming more common as burn care continues to improve. Mortality in this study is lower than what would be predicted by an established revised Baux score regression model (predicted 61% overall mortality and 48% for treated). Care for these massive burn injuries is complex and requires an experienced multidisciplinary team. There is an established link between burn injuries and mental health conditions. Despite similar burn size/depth, patients with a mental health history spent significantly more time in the hospital, more time on the ventilator and required more surgery.
739 A 14 Year Experience of Pediatric Complex Skin Disorders in a Burn Unit
Authors: Altamirano Heidi M , Johnston Mark J , Miotke Sam A 
Published: March 2022

Abstract

Introduction
Complex skin disorders including Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN), Ritter's Disease (Staph Scalded Skin Syndrome), and Erythema Multiforme are uncommon, but result in significant injury to pediatric patients. Skin necrosis and desquamation occurs, which in some cases affects mucosa. Gynecologic, ophthalmologic, and dermatological complications also occur. The purpose of this work is to describe epidemiology and management trends in these cases.

Methods
Records were reviewed for all pediatric patients with skin disorders from 2006 - 2019 to evaluate trends in occurrence, age, length of stay, survivability, types of consultants, causative agent, and wound care strategies.

Results
One-hundred percent of pediatric patients were transferred from other hospitals for definitive management by the burn service. The incidence in pediatric patients was 21% compared to 79% in adults. Males were most often affected at 67% compared to 33% in females. The age range was 2-17 years, with an average of 9.2 years. The type most frequently seen was SJS/TEN at 60% of the cases. The total body surface affected ranged from 10-95%. Management of wounds commonly required operative management for dressing changes in children with large body surface area involvement, in addition to ophthalmologic and gynecologic procedures in patients with mucosal involvement. In the subset of patients with SJS / TEN, 100% had ophthalmology consults and 50% were seen by gynecology. The average hospital length of stay was 11.3 days. All children survived.

Conclusions
Complex skin disorders in pediatric patients require a multidisciplinary team approach to care and wound management and benefit from burn service care. Early transfer is beneficial in order to definitively diagnose the specific disorder and prioritize strategies in care such as nutrition, wound care, and psychosocial support.
744 Integrative Nursing framework in Burn ICU
Authors: Thomas Mini , Friedman Dina , Ha Aemilio W , Nunez Molly E 
Published: March 2022

Abstract

Introduction
Patient and staff experiences are enhanced through a holistic and relationship-based approach of care. An integrative nursing (IN) framework was created utilizing various therapeutic modalities to augment healing for patients. Additionally, staff RNs were encouraged to utilize some IN modalities to aid in their own well-being. In 2019, the Burn ICU (BICU) was selected as one of five pilot units in the hospital to implement the IN framework. Post-implementation, staff were surveyed on their attitudes regarding the IN framework.

Methods
The IN framework was created utilizing the IN principles and hospital policies. Two selected RN champions promoted this framework for staff and patients. In the BICU, over 95% of the RNs completed all five IN training modules: IN in Action, Acupressure, Clinical Massage, Aromatherapy, and Mind-Body skills. BICU was stocked with supplies, not limited to aromatherapy products, breathing ball, and massager chair. Additional resources were added including virtual reality (VR) and spiritual care. RNs documented interventions for pain/stress, anxiety/sleep, and nausea in the patient record. Post implementation, a self-report survey by RNs was utilized evaluated the IN framework.

Results
A total of 27 surveys were collected from 29 available RNs. Aromatherapy, VR, therapeutic touch were the most utilized patient modalities, while staff mostly utilized the massage chair, aromatherapy, and deep tissue massager. Lack of time and personal discomfort were the highest reported barriers to utilization of the IN modalities.

Conclusions
Creating and implementing an IN framework is achievable and can assist with improving patient and staff experiences in the hospital. Most staff and patients who utilized IN tools believed it provided benefits. Addition of IN modalities is the next step in providing patients with holistic care that treats not only the physical wounds but the whole patient.
763 Characteristics and clinical outcomes in patients with combined burn and trauma in Japan
Authors: Kumakawa Yasuaki , Kondo Yutaka , Suwa Kenshi , Takizawa Satoshi , Hirano Yohei , Sueyoshi Koichiro , Okamoto Ken , Tanaka Hiroshi 
Published: March 2022

Abstract

Introduction
Patients with combined burn and trauma are common in the United States and combined trauma in the burn increase the mortality. On contrast, their characteristics and outcomes remain unknown in Japan. The aim of present study was to elucidate the characteristics of trauma combined burn in Japan.

Methods
A multicenter retrospective study was performed between 2004 and 2017 using data from the Japan Trauma Data Bank (JTDB). We evaluated characteristics in burn patients (n=5,783) by segregating them into two groups cohorts: burn only (n=5,537) and combined burn and trauma(n=246). Clinical characteristics such as patient background, severity of burn and trauma, mechanism of injuries, total body surface area (TBSA), injury lesion, treatment and outcome were examined.

Results
The results showed significant differences in age between the burn only group and combined burn and trauma group (median [IQR]: 61 [43–76] for burn only group vs 51 [39–66] for combined burn and trauma group, p &lt; 0.001). Most patients were injured due to flame (burn only group, 65.7%; combined burn and trauma group, 54.9%). Furthermore, 40-89% TBSA was higher in burn only group (19.3%) than in the combined burn and trauma group (9.3%). In-hospital mortality in burn only group (18.2%) was higher than that in the combined burn and trauma group (6.9%).

Conclusions
We demonstrated that the characteristics of burn only and combined burn and trauma patients in Japan. Flame was main cause of burn and in-hospital mortality was higher in burn only group because of higher burn area.
764 Ain’t no sunshine when she’s burnt - An empowering approach to improving sunburn prevention
Authors: Bednarz Bartlomiej , Thakkar Mehul , Schrire Timothy , Sen Sankhya 
Published: March 2022

Abstract

Introduction
Outdoor activities and the associated sun exposure is a mainstay of summer activities for many children. This UV exposure presents a significant risk to children of Anglo-Saxon or Celtic origin. Whilst UV exposure is important for mood and vitamin D synthesis, too much results in premature ageing and increased risk of skin malignancy. We propose a classification system of these burns according to pattern of injury, related directly to patient age.

Methods
We collated data concerning paediatric sun burns over a five year period (2015-2019). This was collected from our Regional Burns Unit, covering a population of roughly 5 million. We present an analysis of age, sex, total body surface area and location of the burn, correlated with the local UV index on the day of injury.

Results
We identified 138 patients presenting with sunburn. They were predominantly (71%) in males, with an age range of 1m to 16y (average 7y9m median 6y10m). All burns were superficial partial thickness in nature and averaged 2.2% TBSA (range 0.1%- 15%). No patients required surgery, however, 19 required admission for analgesia (4 of whom stayed &gt;1 day). All burns occurred between the months of April and September, with 24 (17%) associated with foreign travel. The average UV index, where applicable, was 6.5 (ranging from 3.6 to 8). The majority of patients had no or little sun protection applied.
We propose three patterns of sunburn from analysing the data:
Neonatal and toddler sunburns usually happen in the presence of a caregiver, but with inadequate protection, such as muslin cloth or a poorly shaded area. These injuries, whilst typically small, have significant impact, as radiation injuries are cumulative and may affect future skin cancer risk for young patients.
Young (4-9 yo) children get sun burn whilst out with their friends or in the garden with parents. Inadequate sun protection or prolonged exposure is a key preventable factor.
Teenagers (12-16) are usually sun burnt whilst on a foreign trip to warmer countries or whilst with their friends during outdoor activities such as waterparks or surfing. Again minimal or no sunscreen application is a preventable cause.

Conclusions
In conclusion, this classification system, we seek to inform presenting units with a guide to management and common patterns, therefore improving the sun protection for children. Applicability of Research to Practice:
We identify three preventable patterns of sunburns in paediatric population. This allows parents and health professionals to be educated in a targeted way on prevention of injuries which may have a lifelong effect on skin cancer malignancies risk.