bluuebunny/crossref_metadata_2025_split huggingface dataset:
541 Designing a web-based technology system to support burn disaster response
Authors: Conlon Kathe M , Marano Michael A , Lee Robin A , Montgomery Kevin 
Published: March 2022

Abstract

Introduction
Accurately transmitting information in a burn mass casualty incident (BMCI) is critical. Modern technology, including “apps” and web-based systems coordinated through a central command center addresses this need. The system should 1.) Function as a real-time link between on-scene personnel, local hospitals or trauma centers and regional burn centers; 2.) Organize triage in accordance with accepted burn mass casualty national standards; and 3.) Match acuity of age and percent burn to immediate open beds, either direct from the scene or from secondary hospitals, without overwhelming any one particular facility.

Methods
Extensive literature review was conducted to do a comparative study of similar/existing commercial data management tools; investigate technology designs of mobile apps and web browsers accessible to cloud-based systems, and identify what data and processes needed to be tracked and coordinated across diverse stakeholders to deliver real-time situational awareness for definitive medical planning capabilities.

Results
Development of a Burn Patient Transfer System (BPTS) web-based application with mobile access resulted. The BPTS is series of dashboards designed for specific patient management for both referring (RF) and receiving facilities (RC), coordinated through a central command center. Focus for RFs includes an ability to list number of patients by acuity, addition of new patients, transfer status confirmation and situational awareness throughout the BMCI. RCs report or modify open bed availability of both immediate and eventual beds, for adult or pediatric patients. With this information, appropriate receiving facilities are identified by command personnel to coordinate approval of patient transfer, mode of transport and maintain situational awareness between medical personnel at referring and receiving facilities without exceeding facility surge capability. Clinical experts are responsible for final decisions on a case-by-case basis at both RF and RCs, as defined by a patient transfer algorithm matching patients by age and acuity.

Conclusions
The BPTS is an accessible communications system designed to serve three critical functions; A). Provide a mechanism and platform to report both immediate and surge burn bed capacity; B). Match patient acuity with available open beds at registered medical facilities and burn centers in accordance with ABA Disaster Triage recommendations and C). Track patient movement in real-time. Its core functionality is patient transfer management to and from locations where appropriate care can be delivered based upon clinical needs. This may include initial transfer to a local hospital or trauma center for primary stabilization, or direct to a burn center if and when weather, security and infrastructure permit.
549 Length of Stay per Total Body Surface Area Burn: Validation Using the National Burn Repository
Authors: Patterson Kelli N , Onwuka Amanda , Thakkar Rajan K 
Published: March 2022

Abstract

Introduction
A length of stay (LOS) of one day per percent total body surface area (TBSA) burn has been widely accepted in clinical practice but not validated in current pediatric burn studies. Additionally, TBSA burn data is often presented in ranges, which lacks granular details. The primary objective of this study is to validate our previous Pediatric Injury Quality Improvement Collaboration (PIQIC) findings by using a national burn registry to evaluate LOS per TBSA burn relative to burn mechanism, sociodemographic characteristics, and clinical factors which influence this ratio.

Methods
We evaluated patients 0-18 years old who sustained a burn injury and whose demographics were submitted to the National Burn Repository (NBR) dataset from July 2008 through June 2018. Patients sustaining inhalation injury and electrical burns were excluded due to LOS being significantly increased unrelated to cutaneous injury. Mixed effects generalized additive regression models were then performed to identify characteristics associated with the LOS per TBSA ratio, a nonparametric variable.

Results
Among 51,561 pediatric burn patients, 45% were Non-Hispanic White, 58% were male, and the median age was 3 years old (IQR: 1, 9). The most common burn mechanism was scald (55.9%), followed by flame (19.4%), and contact (16.4%), with most burns occurring at home (82.2%). The median LOS per TBSA burn ratio across all cases was 0.9 (IQR: 0.4, 1.8). In adjusted models, scald burns and radiation burns had similar LOS per TBSA burn ratios (mean predicted values: 1.22 vs 1.77), while all other burn mechanisms had a significantly higher LOS per TBSA burn ratio (p&lt; 0.0001). Chemical burns had the highest ratio (predicted mean: 4.8), followed by contact burns (mean predicted value: 2.8; Table 1, Figure 1). Non-Hispanic White patients had lower LOS per TBSA ratios than all other races and ethnicities (p&lt; 0.05) with mean predicted values of 1.6. Native Americans and Hispanics had the highest ratios (2.0 and 1.8 respectively, (Table 1).

Conclusions
These data substantiate evidence on variance in LOS per TBSA burn relative to burn mechanism, previously demonstrated by PIQIC centers. It also validates differences in LOS per TBSA burn ratios among race/ethnicity.
552 DFB: Tiny burn, big problem - the implications of a diabetic foot burn
Authors: Uche Stanley , Gayed Rita , Mittal Rohit , Ingram Walter L 
Published: March 2022

Abstract

Introduction
In the United States, &gt;30 million people (10.5% of the population) have diabetes, both diagnosed and undiagnosed. Many of these patients go on to develop diabetes related complications, such as peripheral neuropathy. Patients with diabetes are also prone to foot injury. The purpose of this study is to determine clinical outcomes associated with foot burns in patients with diabetes.

Methods
A retrospective chart review of adult patients (≥18yo) admitted to a major metropolitan burn center at a safety-net hospital from 2008-2021 with an isolated burn to the lower extremity and a diagnosis of diabetes mellitus. Patients were categorized based on admission hemoglobin A1C. The primary outcome was hospital length of stay and secondary outcomes were time to presentation, infection, amputations, and mortality.

Results
A total of 136 patients were included in the study, 79% of which were male.84% of the patients were &lt; 65yo and the mean age was 54.1yo and an average HbA1C of 9%. Scald injury was most common mechanism of injury (54%) followed by radiant (24.3%) and contact burns (16.2%). The average burn size was 2.3% TBSA. The median length of stay was 7 days (3 days per percent TBSA). Patients presented on average 5.2 days following injury with 44.8% patients presenting with an infection. More than half (54%) of the patients had peripheral neuropathy at baseline. A majority (74%) of the patients underwent surgical excision. About 18% of the patients underwent an amputation and 3.7% were admitted to the intensive care unit with an average ICU length of stay of 7 Additionally, there was 1 inpatient mortality.

Conclusions
Our study found that lower extremity burns in patients with diabetes were associated with a prolonged hospital stay, high infection rate, need for surgical intervention and high morbidity/disability rate as evident by the number of patients requiring amputations despite the small size of the burn. Peripheral neuropathy may be one of the reasons leading to delayed presentation to a burn center following injury. Hence, burn prevention in this patient population through intense education on proper foot care and inspection along with adequate glycemic control are key to improving outcomes for patients with diabetes.
553 Does COVID-19 Lead to Worse Outcomes in A Burn Center?
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia 
Published: March 2022

Abstract

Introduction
The global pandemic caused by severe acute respiratory syndrome coronavirus-2 (COVID-19) has exhausted resources and devastated at-risk populations. Our objective was to determine if COVID-positive patients have worse outcomes compared to COVID-negative patients after burn injury or desquamating skin disorders.

Methods
Patients were identified using our institutional Burn Center registry and linked to the clinical and administrative data. All patients admitted between March 1, 2020 and August 31, 2021 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions, and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results
A total of 1,994 patients were admitted during this period, and of those patients, 1,467 were adults. Twenty-three adults were COVID-positive. There were no significant differences in age, LOS, total body surface area (TBSA) involvement, hospital costs, sex, race or ethnicities of patients. There were no significant differences in percentage of patients presenting for burn or desquamating skin disorders. COVID-positive adult patients had a significantly higher mortality after injury than COVID-negative adults, p=0.003. There were no differences in COVID-positive pediatric patients admitted to our burn center.

Conclusions
A positive COVID test is associated with worse outcomes in patients admitted for burn injury or skin-sloughing disorders. Further study is warranted to investigate and mitigate what aspect of their care could be adjusted to improve outcomes.
560 A National Analysis of Discharge Disposition in Older Adults with Burns Estimating Independence at Discharge
Authors: Cobert Jason , Sheckter Clifford C , Pham Tam N 
Published: March 2022

Abstract

Introduction
Whereas older age strongly predicts higher burn mortality, the impact of age on discharge disposition is less well defined. Both providers and patients need a better understanding of the likelihood of discharge to non-independent living, as this factor may matter most to older patients. This investigation assesses the relationship between older age and discharge disposition after burns, in a nationally representative sample.

Methods
We queried the 2007-2015 National Trauma Data Bank (NTDB) for burn hospitalizations in older adults. Pre-defined age categories were 55-64 years (working age group), 65-74 years (young-old), 75-84 years (middle-old), and 85+ years (old-old). Covariables included inhalation injury, comorbidities, burn total body surface area (TBSA), injury mechanism, and race. Discharge to non-independent living (nursing home, rehabilitation, and other facilities) was the primary outcome. Logistic regression was used to assess the association between older age and discharge to non-independent living, adjusting for covariables.

Results
There were 25,840 burn hospitalizations in older adults with complete data during the study period. Working-age patients comprised 13,563 (53%) of admissions. Young-old accounted for 7,342 (28%), while middle-old comprised 3,876 (15%), and 1,059 (4%) were classified as old-old. Discharge to non-independent living steadily increased with burn TBSA and older age in survivors (Table). Beginning in the 65-74 age group (young-old), most patients with burns ≥20% TBSA were discharged to non-independent living. After adjusting for patient and injury factors, odd ratios for discharge to non-independent living were 2.1 for young-old, 3.5 for middle-old and 7.6 for old-old patients, when compared to working-age patients (all p&lt; 0.001).

Conclusions
Older age is a strong predictor of discharge to non-independent living after burns. These findings provide a realistic discharge framework for providers and older adults with acute burns.
566 Burn Disparities: Do Race, Gender and Insurance Status Affect Mortality?
Authors: Satahoo Shevonne , Hodge Juvonda , Joe Victor C 
Published: March 2022

Abstract

Introduction
The National Inpatient Sample (NIS) provides ideas of trends across the country. A recent study in trauma patients found that there were no differences in race or insurance status in regard to mortality. As such, we sought to examine these effects in burn patients and hypothesized that these trends would be similar.

Methods
The NIS was queried for all patients age ≥18 years with ICD-9 codes for total body surface area (TBSA) burn ≥ 20% and non-elective admissions. Years included were 2013 to the third quarter of 2015. Age, race, insurance status, TBSA, median household income for patient's zip code quartile and mortality were recorded. Cases with missing data for race, insurance status and mortality were excluded. Statistical analysis was done with student’s t-test and Chi-Square testing, as appropriate. Mortality was then used to run a binary logistic regression using these variables. A p-valve ≤0.05 was considered significant.

Results
There were 5685 weighted cases. Females encompassed 28.3%. The mortality rate was 21.1%. The patients that died were older (58.6 ± 19.1 years versus 44.7 ± 17.1 years for survivors, p&lt; 0.001).

On multi-variate analysis of mortality using these variables, older age (p&lt; 0.001), female gender (odds ratio (OR) 1.26 [1.05-1.50], p=0.011), lower median household income zip code quartile (highest quartile compared to lowest OR 0.69 [0.51-0.80], p&lt; 0.001) and insurance status (compared to government insurance, private insurance OR 0.59 [0.47-0.72]; self pay OR 1.51 [1.18-1.93], p&lt; 0.001) were associated with mortality. Increasing TBSA was also associated with mortality. Race was not a significant contributor (p=0.432).

Conclusions
While there was a trend towards a higher rate of mortality in the black population, race was not associated with mortality in a statistically significant manner. Socioeconomic factors were associated with higher mortality. The dynamics between race and
other social determinants of health, and the potential impact of structural racism and bias should be the focus of future research rather than on race itself, especially considering that access and resources vary by state.
568 Virtualization of In-school, Teacher-Directed Prevention Programs for Children
Authors: Banks Jessica L 
Published: March 2022

Abstract

Introduction
While remote/virtual teaching has been used for many years, Covid-19 increased the need for quality educational programs in virtual format. BPN has two in-school, school-based programs, Flicks Fire and Burn Safety for grades 1-5 and The Great Escape for grades 6-8. These teacher-directed programs cover essential topics such as home fire safety, stop drop and roll, youth fire misuse, and home fire escape. They have, historically, been deployed as hard copy curriculum, student workbooks, and associated educational videos, which were physically mailed directly to classrooms within the BPN’s 24-county service area. When Covid-19 became the new reality, the need to pivot to a different type of program delivery became apparent.

Methods
BPN recruited professional educators from targeted grade levels, representing varying geographic locations and socioeconomic backgrounds to recreate these programs in a format that will work in a remote learning environment. This team researched various e-learning platforms to determine what would work best for our content and is commonly used across all school districts. We determined that Google Classroom combined with Bitmoji would best serve our needs. We recreated a set of age-appropriate lessons for each grade level from 1-8. Each grade has information that ties each lesson to the appropriate academic standard for education. We employed multiple content formats based on best practices, including videos, audio tracks, text-based articles, and more. Lastly, we virtualized activities by turning them into on-screen interactive games, puzzles, quizzes, worksheets, etc.

Results
Our result is a virtual program for grades 1-8 conducive to both classroom and remote learning environments. It is linked directly to academic standards for education for each grade level and includes engaging, interactive content in various forms. This format not only gives us the ability to update and add new content quickly it also gives us the ability to expand geographic distribution seamlessly.

Conclusions
By utilizing platforms preferred by professional educators and integrating fire safety and burn prevention lessons into existing mandated educational standards, we can more effectively and cost-efficiently expand quality educational programming to children ages 6 – 14.
574 Want some s’more? The hidden risks of marshmallows
Authors: Ghini Francesca , Thakkar Mehul , Schrire Timothy , Bednarz Bartlomiej 
Published: March 2022

Abstract

Introduction
Marshmallows are a spongy confectionery commonly made with gum Arabic or gelatine, corn syrup, sugar, and flavouring. It is common, in many Anglophone countries, to toast marshmallows as an outdoor childhood pastime. Being an aerated aqueous mixture, marshmallows have unique properties when exposed to high temperatures, resulting in a Maillard reaction between the sugars and proteins. They therefore present a distinctive and significant method of burn injury.

Methods
We reviewed our regional online burns database for marshmallow related burns in the last six years to collate data on patient demographics, burn size and depth, method of injury, and outcome.

Results
Between 2015-2020, our Regional Burns Centre treated 35 patients with an average age of 8.3 years (range 4-14). The most commonly injured area was the face in 44% of the cases (lips specifically in 25%), followed by hands in 36%. The burn depth extended from deep dermal to full thickness in 6% of cases and the total body surface area affected was 0.3% on average. No admission or surgical intervention was required. A significant proportion of burns were associated with camping, open fires or barbecues (63%), however the recorded mechanisms of injury were not limited to these activities alone. 77% of injuries occurred between Friday and Sunday.

Conclusions
Marshmallow burns are hazardous due to their composition and response to heat. The adhesive nature of a toasted marshmallow leads to a deeper pattern of burn injury, even though, the majority can usually be managed conservatively due to the limited area affected.
575 Are There Racial Disparities in Burn Center Care?
Authors: Bessey Palmer Q , Heffernan Jamie M , Gallagher Jim 
Published: March 2022

Abstract

Introduction
Events in the past two years highlighted disparities in outcomes based on race for several disease conditions. There have been reports suggesting racial disparities may exist for burn care. This burn center has long been committed to serving all groups within the city. The purpose of this study was to determine if race might influence the outcome of burn care at this center.

Methods
We reviewed inpatient admissions for eight years, 2012 through 2019. Racial identity was reported by patients and their families and categorized as Asian, Black, Latino, or White. Place of residence was categorized by Zip code. Other variables were recorded. The revised Baux Score (RBS) was calculated according to Osler and Hosmer (2010). Several logistic regression models were tested for each racial group. They related death to RBS as well to age, burn size, and inhalation injury. An additional predictor variable for race was then added to each regression model. Statistical calculations were performed using SAS 9.4 (SAS Institute Inc., Cary, NC).

Results
5,440 patients were admitted as inpatients. Of these 4,626 (85%) resided in a zip code within this city, and patients lived in essentially every zip code. The racial distribution of the patients reflected the racial distribution of the city and of the several neighborhoods within the city. Death was strongly related to RBS or to age, burns size, and inhalation injury for all groups. In all cases, an additional predictor for race was not significant.

Conclusions
This burn center serves all areas and populations of the city. Outcome of burn center care was related to burn extent, age, inhalation injury. There were no detectable differences in the outcome of burn center care associated with race. Burn Center care should be equally effective for all races.
578 A Multi-pronged Approach to Improving Communication, Collaboration and Outcomes in the Burn ICU
Authors: Hockenberry Tiffany , Richerbach Stacey , Richey Karen , Foster Kevin N 
Published: March 2022

Abstract

Introduction
Effective communication between members of the burn healthcare team is vital as it impacts both patient outcomes and staff satisfaction. Discontinuity is a consistent barrier to communication. Fragmented communication may occur for a variety of reasons, including delineated shifts for staff, a decreased presence of physicians and allied health professionals at night, and variable levels of collaboration between nursing, therapy, allied health professionals and physicians. The purpose of this quality improvement project (QI) was to evaluate 3 interventions aimed at improving communication, collaboration, and ultimately patient outcomes.

Methods
The 3 interventions included the use of daily goal cards, increased frequency of interdisciplinary bedside rounds from once daily to twice daily and expanded in-house burn team coverage to include a burn-specific Physician Assistant/Nurse Practitioner (PA/NP) staffed in the center from 3:00pm to 11:00 pm. A 12-item survey consisting of a 5-point Likert scale and open-ended questions was distributed to team members to evaluate effectiveness of the interventions. Incidence of code events were evaluated as an indicator of patient outcomes.

Results
There were a total of 29 respondents, including physicians, allied healthcare professionals, therapists, and nurses. Sixty-nine percent of participants felt that the daily goal cards were an effective means of communication however only 45 % strongly agreed/agreed that achievement of daily goals had increased. The expanded coverage by a burn PA/NP was viewed as an improvement to patient care by 90 % of respondents, with 79 % strongly agreeing/agreeing that the expanded coverage prevented errors. When evaluating afternoon rounds 69 % of respondents either strongly agreed/agreed that it improved patient care and 52% found it to prevent errors. Nocturnal code events decreased by 56% over the one-year period following the institution of expanded coverage. There was no added expense associated with any of the three interventions.

Conclusions
While the results of this QI project were overwhelmingly positive, the expanded coverage by a dedicated burn PA or NP was viewed to be the most beneficial change. Temporally, the expanded coverage was also associated with a marked decrease in nocturnal code events. The addition of afternoon rounds was the next most beneficial change noted with positive findings in both effectiveness and improvement of patient care. There was a dichotomy between the effectiveness of the daily goal cards and the accomplishment of the goals that were set forth that needs further exploration.