bluuebunny/crossref_metadata_2025_split huggingface dataset:
569 Burn Registries State of Affairs: A Scoping Review
Authors: Gus Eduardo I , Brooks Stephanie , Multani Iqbal , Zhu Jane , Zuccaro Jennifer , Singer Yvonne 
Published: March 2022

Abstract

Introduction
Registry science applies observational study designs to interpret large secondary databases. It can be utilized to understand disease and injury, answer research questions, inform regulatory decision making, and engender benchmarking of quality-of-care indicators. Numerous burn registries exist globally, however their contributions to the science of burn epidemiology, care and treatment have not been summarized. The objective of this study is to characterize the available literature on burn registries.

Methods
We conducted a scoping review, having registered the protocol a priori. A comprehensive literature search across several databases, including the grey literature, was carried out. Studies of all methodological designs were included provided they utilized, analyzed, and/or critiqued burn registry data. Pilot projects from registries in development were included as well. Studies involving non-burn specific registries or registries from a single burn centre were excluded.

Results
Two hundred and sixty-eight studies were included, encompassing 16 existing burn registries. Although registry science has been used to investigate burn care since 1970, the majority of studies were published after 2007. Most studies utilized the American Burn Association Burn Registry or one of its previous versions (75.7%) and the Burns Registry of Australia and New Zealand (10.4%). Main limitations of existing registries are the inclusion of patients admitted to burn centres only, deficient capture of outpatient and long-term outcome data, and lack of data standardization across registries.

Conclusions
Registries are an invaluable source of data for research, delivery of care planning, and benchmarking of processes and outcomes. Efforts should be made to stimulate other jurisdictions to build and maintain burn registries, to incorporate data linkage from administrative and other secondary databases, and to standardize data collection, in order to maximize the potential of registry science in burn care.
570 Burn-Related Injuries Treated at Two Gulf Coast Hospitals During Following a Category 4 Hurricane
Authors: Kopari Nicole M , Rivera Mario , Phelan Herb A , Kearns Randy D , Carter Jeffrey E 
Published: March 2022

Abstract

Introduction
Natural disasters are commonly associated with mass destruction and severe injuries. On August 29th, 2021 a category 4 hurricane made landfall before mandatory evacuations were ordered in a major metropolitan community. The powerful storm challenged disaster management teams and first responders as communities struggled to recover. Our study analyzes the demographics of those injured and the injury patterns treated at our state’s only verified burn/trauma center and the adjacent children’s hospital in the aftermath of the hurricane.

Methods
A retrospective chart review was performed on patients seeking emergent care following the hurricane. Demographic data was abstracted from the medical records along with injury pattern including age, gender, mechanism of injury, total body surface area (TBSA), surgical interventions, and length of stay. In addition, brief surveys of fire chiefs from the two most impacted regions were performed to assess prehospital challenges.

Results
41 patients (76% male) presented to our ER with a median age of 44 (7 patients &lt; 12 years of age). 85% of injuries occurred at home while 15% occurred at work. Of the 78% requiring admission, 66% underwent excision and autograft with a mean TBSA of 17% (range 1-80%). Power outages resulted in increased gas generator usage across the region. Most of the burn injuries following the storm were due to generator and cooking accidents (56%). Each fire chief reported up to 91 calls/day due to suspected carbon monoxide poisoning for the two weeks following the storm. A single event resulted in 8 inhalation injuries treated in our ER with one burn ICU admission. The mean hospital length of stay was 1.11 days/%TBSA for those undergoing surgery.

Conclusions
Hurricanes are more common today with many coastal cities as risk for similar natural disasters. Despite our generator safety media outreach efforts prior to the storm, this remains an opportunity for improved injury prevention. Many patients suffered delays in discharge as their homes/nursing facilities suffered structural damages and were without power and water. Disaster planning should account for limited disposition options during severe storms. Our study is the first to describe burn-related injuries from a category 4 storm and our communities’ response.
582 Expanding Burn Expertise Through Telemedicine for the Frontliners during the COVID-19 Pandemic
Authors: Firaza Myra Alexandra P , Abella Maria Redencion B 
Published: March 2022

Abstract

Introduction
Inexperience of frontliners and referring physicians from non-specialty centers in burn wound assessment results to the incorrect triage of patients, thereby aggravating the current hospital situations and causing unnecessary exposures. Emergency care in burn centers in developing countries must strike a balance between doctor and patient safety, and uncompromised care of burn patients. Telemedicine is deemed a valid and sound option to maintain social distancing and promote safety, yet provide proper burn care. It is a valuable and indispensable tool for all doctors of all branches of medicine and surgery. Although many of its limitations in developing countries are still being unraveled, the benefits of this technology are being realized worldwide. This study determined the accuracy and timeliness in diagnosing and classifying burn patients assessed by a frontliner non-burn specialist in-person (NBSP), a Burn Specialist online (BSO), and a Burn Specialist in-person (BSP).

Methods
All burn patients (January to March 2021) with signed consent for participation were photographed in a standardized manner by the NBSP and referred to a BSO via an online messaging application. These patients were also assessed independently by the BSP. The % total body surface area (TBSA), burn depth classification, and the time the patients were seen by the NBSP, the time the online referrals were sent to the BSO through the messaging application, the time the BSO sent the diagnoses, and the time of assessment by the BSP, were recorded. One-Way Repeated Measures Analysis of Variance (ANOVA) with and without blocking were done.Post-hoc Tukey-Test was used to analyze the pair-wise differences for any ANOVA that showed significant statistical differences.

Results
Data gathered from 82 patients throughout the 3-month study duration demonstrated that burn size (% TBSA) among the three different physicians (NBSP, BSO, BSP) was not statistically significant (p=0.8794). Our analysis also showed no statistical difference for the 19 different body parts per patient and burn depth classification (p=0.9718). One-way ANOVA tests on timeliness were statistically significant with a p-value of p&lt; 0.0001. A post-hoc comparison using Tukey test revealed no statistical significance between the BSO and BSP (p=0.892).

Conclusions
Smartphone telemedicine platform through photographic transfer and analysis is an accurate method in estimating burn size and depth classification. Timeliness can be improved with a dedicated 24/7 online available burn specialists and a reliable network access. Hence, frontliners can refer to burn specialists in a developing country using this telemedicine platform for optimum burn care with an accurate diagnosis and overcome the challenges during and even after this pandemic.
589 Video-Enhanced Telepresence for Burn Care may Improve Patient and Staff Satisfaction
Authors: Cordova Alfredo C , Kane Chelsea , Miller Samuel M , Heller Margaret , Bernal Nicole O 
Published: March 2022

Abstract

Introduction
Telemedicine and telepresence technology successfully contributes to the care of patients in different medical disciplines. Burn care is a highly specialized field that requires a multidisciplinary team and frequent visual evaluation of a patient’s injuries. Wound care can be extensive and demanding. Physician availability at the “Wound Care Room” is often limited by other responsibilities in the operating room, emergency department, surgical clinic, or academic conferences. We hypothesized that the incorporation of a telemedicine platform would provide greater access to surgical providers (SP- burn surgeons, general and plastic surgery residents) and allow for more efficient evaluation and prompt decision making. We also predicted that it would improve communication among SP, nursing staff (NS- nurses and nurse aides), and burn patients (BP) in real time without compromising BP privacy and comfort.

Methods
A dual-way video and voice telemedicine platform was incorporated into burn care at a Level-1 Trauma Center and ABA-verified Burn Center. The video module was positioned so that SP were able to remotely assess the progression of burn injuries during wound care. Patients included were hospitalized and undergoing wound care by NS. Adult BP were included regardless of age, burn thickness, and burn surface area. BP, SP, and NS were asked the following questions after wound care had been provided:
1. Did you feel comfortable using this technology?
2. Was the patient’s sense of privacy compromised?
3. Did use of the video module enhance the provision of care?
4. Did use of the video module improve team communication?
5. Overall, were you satisfied with the use of the platform?

Results
BP with ages ranging from 18-74 years old and with injuries involving 8-44% TBSA were included. Interviews from 38 patient encounters were conducted, and included input from 4 SP, 6 NS, and 24 BP.
The BP, SP, and NS surveyed all reported comfort using this technology. There were no reports of concern for patient’s privacy. SP felt they could make a final management plan in 74% of the cases, with difficulty arising in 26% of cases due to image resolution. BP reported that use of the video modules contributed positively to their care in 87% of cases, with issues related to communication and lack of understanding arising in the other 13%.

Conclusions
Telemedicine was well accepted by all the BP, SP, and NS. The perception from NS and SP was that it enhanced prompt communication contributing to better patient care. Final management decisions were achieved in most cases, with picture resolution being identified as an area for improvement. With improved picture quality, this technology can likely be used as a reliable decision-making tool to improve care.
589 Burn Center Trainees: Not Just for Surgery or Plastic Surgery Residents
Authors: Nosanov Lauren B , Houng Abraham 
Published: March 2022

Abstract

Introduction
The Burn unit offers a unique training environment for residents. The Accreditation Council for Graduate Medical Education (ACGME) requires all General Surgery trainees to have knowledge of burn physiology and experience with initial burn management. However, there are no burn requirements for other ACGME-sponsored training programs except for Plastic Surgery. Since care of the burned patient spans multiple settings – the intensive care unit, operating room, wards, outpatient clinic, and the emergency department – having residents from varied specialties might benefit not only the trainee, but also the Burn Center.

Methods
A retrospective review of all residents rotated to the burn center of an American Burn Association verified unit was performed. Data from the 7/2018-6/2018 academic year were collected by analyzing resident rotational and call schedules of both intra institutional and inter-institutional residents. The specific time period was chosen to account for COVID affecting the number of residents more recently.

Results
A total of 48 residents rotated at the burn center during the studied academic year. Within the institution, there were 34 residents (71%): 12 general surgery interns (8 categorical, 4 preliminary), 2 plastic surgery interns, 10 emergency medicine (EM) residents, and 10 anesthesia residents. There were 14 residents (29%) from 3 outside institutions: 3 plastic surgery residents, 8 surgery interns from one program, and 3 surgery interns from another program. All surgical specialty trainees were interns, whereas other specialties, EM and anesthesia, were PGY2 trainees.

Conclusions
While most residents were from general surgery and plastic surgery programs (58%) due to ACGME requirement, a significant portion of the resident complement (42%) was from non-surgical specialties. EM residents gain competency in wound reading as well as burn critical care. Anesthesia residents learn surgical management of the burn patient and critical care procedures. Since the burn center is a tertiary referral center, having outside residents rotating in the burn unit might facilitate transfers and increase knowledge of proper resuscitation.
593 Development of a Burn Center Multi-Disciplinary Debriefing Process
Authors: Wyatt Shannon 
Published: March 2022

Abstract

Introduction
The purpose of debriefings are to help facilitate a healthier work environment for team members, improve processes, and improve patient outcomes. Debriefing staff members after specific events provides a time to support team member’s emotional needs, improve communication among the team members, and improve patient outcomes (Schulman, Jhanwar, and Shara, 2015; Wolfe et al., 2014). Multi-disciplinary team members working in Burn Units are repeatedly exposed to stressful patient events such as end of life, escalation of care, major burn admissions, or mass casualty events. These traumatic exposures can all increase the risk of staff burnout, which is negatively associated with resilience (Colville et al., 2017).
In 2019, our Burn Unit had 7 events that met criteria for a formal debrief but had no process for conducting these debriefs. Without a formal team debrief there is no loop closure of an event for staff and no platform to discuss potential ways to improve practice. The purpose of this project was to develop a formal debrief process and institute the process on the Burn Unit.

Methods
Criteria for debriefing were identified as adults and pediatrics requiring CPR, end-of-life care, and emergent escalation of care. Six registered nurses volunteered to be Debrief Facilitators (DFs) and underwent training utilizing real-time simulation scenarios conducted by the Simulation Education Center. DFs were provided a Process Map along with debrief tools and resources needed to conduct a formal debrief. Facilitators were responsible for initiating, organizing, facilitating, and documenting a debrief after an event that met criteria.

Results
The formal debrief process was initiated in September of 2020. Since the initiation, 12 events have met criteria for debrief. 12 formal debriefs were conducted during the following 10 months.

Conclusions
After a formal debrief process was identified and education provided by the Simulation Education Center the Burn Unit conducted 100% of events that met criteria for debriefing through June of 2021. In conclusion, giving team members formal processes, tools, and educational opportunities has proven successful for formal debriefs in the Burn Unit.
599 Eyelash Reconstruction Utilizing a Strip Graft for Burn-related Madarosis: A Case Report and Operative Technique
Authors: Driscoll Daniel N , Dabek Robert J 
Published: March 2022

Abstract

Introduction
Facial burns are a common occurrence with a small percentage causing injury to the periocular region. Although the eye itself is often spared, madarosis may occur from deep burn injury to the eyelid. Reconstruction of the eyelid margin is technically difficult due to the challenging aesthetic region, as well as specific characteristics of eyelashes. Although there are several options for eyelash grafting there is no established gold standard, and there is little to no-literature related to procedures involving burn madarosis.

Methods
Here we describe a case of unilateral eyelash grafting utilizing a composite strip graft in a 20-year-old female who sustained a 70% flame injury at the age of two.

Results
The presented results show the efficacy of this technique at restoring function and providing a good aesthetic result which is maintained at 1 year follow up.

Conclusions
Utilization of a composite strip graft to recreate the eyelid margin is a viable choice for reconstruction of burned upper eyelids in the appropriate patient. Further exploration regarding procedure timing and choice of donor site are warranted.
611 Progressing necrosis, how to make it stop? Clostridial collagenase debridement salvages the zone of stasis
Authors: Sood Rajiv , Bearden Robert N , Frederick Rosie 
Published: March 2022

Abstract

Introduction
In burns, conversion of partial thickness to deeper, full-thickness burns is largely attributed accumulation of chemical and mechanical mediators altering physiologic processes of tissue viability. Studies suggest that c. collagenase debridement digest denatured collagen without degrading otherwise intact collagen in granulation and healthy tissue. Moreover, modulating cellular responses to foster an anti-inflammatory milieu. To better understand c. collagenase effects in treatment of burns and salvaging the zone of stasis, we evaluated its ability to effectively debride while minimizing secondary necrosis for translative understanding associated with our clinical algorithm

Methods
In this prospective, controlled animal study, deep-partial thickness burns were created on the caudal dorsa. Following burn injuries, wounds were immediately cleaned and treated with either c. collagenase or a hydrogel. Daily treatment was provided. At selected time points, punch biopsies were obtained from unburned interspaces, fixed and prepared for evaluation. In tandem with pathological and histological assessment, samples were examined for cellular and analyte constituents

Results
Gross images and histology revealed, c. collagenase treatment reduced necrosis and apoptosis. In control burns, papillary and reticular dermal collagen was shown to be disorganized and advancing in necrosis as exhibited by significant (p&lt; 0.001) staining of HMGB1. In contrast, the interstices of c. collagenase treated burns demonstrated earlier sloughing of the epidermal layer with a clearly defined basement membrane and significantly (p&lt; 0.001) reduced HMGB1 staining. Moreover, activated caspase 3a staining was significantly (p&lt; 0.05) reduced in c. collagenase treated burn wounds. In assessing the inflammatory response, c. collagenase-treated wounds exhibited significantly (p&lt; 0.05) greater neutrophil influx at day 1, with macrophage recruitment throughout days 1, 2, and 4. In further evaluation, macrophage polarization to MHC II and vascular network maintenance was significantly (p&lt; 0.05) increased in c. collagenase treated wounds

Conclusions
These data corroborate our clinical treatment algorithm, supported by presented case studies. Providing further evidence to potential cellular mechanisms to complement the clinical scenario. Thus, warranting inclusion of early treatment of c. collagenase debridement to preserve tissue from progressive necrosis
623 Multi-Modal Analgesia for &gt; 10% TBSA Pediatric Burns
Authors: Wratney Angela , Beitz Erin , Roberts Tamara , Anderson Margaret 
Published: March 2022

Abstract

Introduction
A review of literature revealed no analgesia or opioid sparing treatment guidelines for &gt; 10% TBSA pediatric burns. Clinicians may benefit from an analgesia support guidance tool for the management of critically ill PICU and non-PICU inpatient pediatric burn patients with &gt; 10% TBSA.

Methods
A multi-disciplinary team of experts created a pediatric analgesia support guidance tool for clinicians managing non-procedural pain in critically ill pediatric burn patients in the PICU and non-PICU inpatient setting. Agent selection was at the discretion of the clinician based on FLACC scoring. We performed a retrospective chart review, Jan 2019 to Jun 2021, of pediatric patients age 1 month to 14 years of age admitted to the Pediatric Burn Trauma service with &gt; 10%TBSA. Analgesia was categorized as Yes/No for acetaminophen, ibuprofen, opioids (morphine, fentanyl, oxycodone, hydromorphone), gabapentin, alpha 2-agonists (dexmedetomidine, clonidine).

Results
16 pediatric burn patients age 2 months to 14 years. 75% male, 4 (25%) PICU, 3 (19%) mechanically ventilated. Average LOS 7.19 days, range 1 to 25 days. 9 (56%) received standing acetaminophen, 1(6%) ibuprofen, 12 (75%) opioids, 4 (25%) gabapentin, 3 (19%) alpha-2 agonists.

Legend
Y, years; M, months; TBSA Total Body Surface Area; MOI mechanism of injury; LOS length of stay; vent ventilator; PICU pediatric intensive care unit;

Conclusions
We found 75% of our pediatric patients received opioids, and only 56% received standing acetaminophen. 7 patients (43.8%) received either gabapentin and/or alpha-2 agonists. Our pediatric analgesia support guidance tool influenced clinician pain management practice for the pediatric burn patient. With continued use, we will determine if this multimodal approach can reduce an over reliance on opioid analgesia regimens.