bluuebunny/crossref_metadata_2025_split huggingface dataset:
527 Practical Use of Biomarkers During Nutritional Support of Pediatric Burn Patients
Authors: Shiel Jennifer , Prelack Kathy 
Published: March 2022

Abstract

Introduction
Current guidelines for evaluating nutritional risk in acutely ill patients incorporate the assessment of inflammation and disease burden. Inclusion of laboratory measures such as C-reactive protein (CRP) in screening criteria used to identify nutritional risk has gained credibility. Other biomarkers influenced by inflammation include visceral proteins albumin (ALB) and pre-albumin (PAB). While visceral proteins are not valid indicators of nutritional status, they may be indicators of nutritional risk, which could potentially lead to poor clinical outcome. The purpose of this study is to evaluate if PAB, ALB, CRP, are useful markers for predicting clinical outcomes in children with severe burn injury.

Methods
As part of our quality assurance program, we collect data on all nutrition support interventions, monitoring and outcome in children admitted to our hospital with significant burn injuries. This analysis describes data collected from 2006-2019 in children who had a burn injury and received nutritional support for five days or greater. Data elements collected include general demographics, weekly measures PAB, CRP, ALB; length of stay (LOS), number of intensive care unit (ICU) days, days to wound closure, and days on nutrition support. Biomarkers PAB, ALB, CRP and burn size (as an indicator of disease burden) were entered into a multiple regression model using a stepwise procedure for each dependent outcome variables (LOS, ICU LOS, Days to Wound Closure, and Days on Nutrition Support).

Results
A total of 182 patients, 7.0 ± 5.0 years of age with 41.1 ±16.9 % total body surface area (TBSA) burns were included in the analysis. TBSA, mean CRP and mean PAB were significant predictors of hospital LOS (R=0.60; p &lt; 0.001); TBSA and PAB were significant predicters of ICU LOS (R=0.67; p&lt; 0.000), days to wound healing (R= 0.37; p &lt; 0.000) and days on nutrition support (R=0.60; p&lt; 0.000). Albumin was not a significant predictor for any of the clinical outcome measures.

Conclusions
Our findings indicate that monitoring PAB and CRP is useful for identifying risk of poor outcome. Mean PAB was inversely associated with LOS, ICU LOS, days to wound healing, and days on nutritional support even when controlling for CRP and burn size.
534 Allogeneic Cellularized Living Tissue in Pediatric Deep Partial Thickness Burns Reduces Need for Donor Sites
Authors: Gibson Angela , Short Tracee , Joe Victor C 
Published: March 2022

Abstract

Introduction
Healing potential of deep partial thickness burns is not easily determined early after injury. Prolonged and continued inflammation can contribute to burn wound conversion. Early excision compared to a wait and see approach to wound healing decreases inflammation, shortens length of stay, and decreases painful wound procedures. However, early excision is at the expense of removing tissue that may otherwise heal without autografting. Use of a cryopreserved, allogeneic cellularized scaffold living tissue product (CTP) in pediatric deep partial thickness wounds with dermal elements remaining after excision is an alternative approach to wound closure. CTP may allow early excision without compromising healing potential, thereby minimize donor site morbidity, infectious complications and decrease length of stay. This case series describes the expanded access experience of a CTP on pediatric patients with thermal injury.

Methods
Expanded use approval of a CTP was obtained through the FDA for pediatric patients with burns at three burn centers. Patients were taken to the operating room for excision and grafting of burns at the discretion of the attending surgeon. In wounds with dermal elements present after excision, CTP was grafted to the wound bed (Table 1). Postoperative wound care and follow up was per institutional standards of care.

Results
Six pediatric patients (9 weeks – 13 years old) with mixed depth burns having dermal elements remaining after excision were treated successfully with a CTP. Donor site surface area was reduced in all patients. No serious adverse events related to the CTP were noted in any of the cases. Average time to heal wounds treated with the CTP was approximately 2-3 weeks. In wounds ultimately deemed to be full thickness, CTP was not detrimental to subsequent autograft take. See Table 1.

Conclusions
This case series demonstrates that use of a CTP in pediatric patients is donor site sparing without any serious adverse events. Furthermore, use in full thickness burns is not detrimental to subsequent autograft take. The degree of dermal elements necessary to support wound healing is unknown and requires further study. This case series supports the application for a clinical trial investigating the safety and efficacy of CTP as an adjunct to wound healing in pediatric deep partial thickness burns.
548 Toward a Burn Risk Calculator
Authors: Bessey Palmer Q , Phillips Bart D , Phillips Matthew H , Mandell Samuel P , Thompson Callie M 
Published: March 2022

Abstract

Introduction
Risk adjusted statistical modeling of deaths in burns has two major purposes. One is to enable comparison of outcomes between centers (Benchmarking). That requires as precise a model as possible and is applied retrospectively. The other objective is to inform patient and family discussions about prognosis and plans of care. These models are applied prospectively based on limited clinical data. The purpose of this study was to derive a model that could be the basis for such a risk calculator.

Methods
We identified 128,252 records in a national burn registry for initial patient admissions to 103 burn centers between July 2015 through June 2020. Cases from centers with &lt; 100 admissions annually were omitted. We compared a logistic regression model based on the revised Baux score (RBS) (age, burn size, inhalation injury) with a logistic regression model involving age, age2, burn size, presence of 3rd degree burn, inhalation injury, respiratory failure, burn etiology, gender, and admission year. We compared the Adjusted R2, c statistic and average precision for each model. All calculations were done using CatBoostClassifier in Python.

Results
There were 127,018 patients that served as the basis for these analyses. The RBS model had an Adjusted R2 of 0.41 compared with 0.54 for the more detailed model, a c statistic of 0.95 vs 0.98, and an average precision of 0.69 vs 0.76.

Conclusions
Both statistical models of mortality following burn injury demonstrated good accuracy. The model with the most predictor variables had better precision. Both models could serve as useful risk calculators for patients following burn injury.
555 The Art of Caring
Authors: Quinn Kristen C , McCoy Nan , Strawn Mary A , Thompson Callie M , Lewis Giavonni M 
Published: March 2022

Abstract

Introduction
Providing Burn Care is a physically and emotionally demanding job. AND, it is a rewarding and inspiring profession. 2020 and 2021 saw unprecedented rates of burn out and turn over in staff. Our concern for the well being of staff as well as our need to increase retention motivated our desire to provide staff with tools to build resiliency and coping strategies. Traditionally, this education comes in the form of teaching mindfulness, breathing exercises or self care outside of the burn center. We recognized that while these approaches are important and effective, they are not the right fit for everyone. The current times require us to use a multipronged approach to the tools we offer our burn teams.
Our regional burn center partnered with a community based arts education nonprofit to re-think how we provide staff with tools for adaptability. A curriculum was formulated that provided therapeutic art to nursing staff via four weekly zoom meetings. This resulted in a novel approach to resiliency building and self care.

Methods
The program was opened to all burn center staff members. Staff registered in advance for the four week program; the arts organization mailed each participant a box containing all the supplies they would for need. Each week, a different art modality/artist was paired with therapeutic discussions grounded in a trauma informed approach. Discussions focused on emotional and physical safety, building a community of support, finding balance between work and home and identifying coping skills to use to help ground ourselves during times of stress.

Results
Seven burn center staff members signed up for this program. Weekly attendance averaged 6-7. A program evaluation was completed by participants at the end of the final session. Questions were divided into three sections: program logistics, community building and the artistic process. Results indicated that this was an extremely valuable experience for participants. In addition, staff made comments such as "allowing myself to be vulnerable in the process has built trust and connection between myself and the other participants", "I don't remember the last time I did something like this just for myself", "I feel like I can add art to my list of coping strategies, despite never thinking of myself as an artist".

Conclusions
Offering burn center staff with an alternative program to help build resiliency resulted in an increased sense of trust between staff members, provided one more outlet for self care and allowed participants to build resiliency in a new way.
573 Interfacility Transfers for Burn Patients with Concomitant Traumatic Injuries
Authors: Kirkland Kevin D , Gratton Austin , Mentzer Caleb , Kubasiak John , Yon James R 
Published: March 2022

Abstract

Introduction
Burn patients with concomitant traumatic injuries suffer increased morbidity and mortality. Complex care coordination for these patients often requires interfacility transfers. We sought to examine the outcomes for traumatically injured burn patients to identify the occurrence and associated reasons for trauma system transfers in this group.

Methods
The National Trauma Data Bank was examined from years 2007 to 2016 for 6,565,577 patients with traumatic, burn, and concomitant burn & traumatic injuries to evaluate demographic data, ED and hospital dispositions, length of ICU stay, ventilator days, mortality, and interfacility transfers. There were 5,068 patients with both traumatic and burn injuries, 145,890 patients with burn injuries, and 6,414,619 patients with traumatic injuries. Non-parametric Kruskal Wallis, analysis of variance, chi-square, Mann Whitney, and T-tests were utilized for comparisons.

Results
Patients were 69.1% male in the trauma/burn, 67.1% male in the burn, and 62.2% male in the trauma groups (P&lt; 0.001). Trauma/burn patients were more often admitted to the ICU from the ED at 35.5% compared to 27.1% for burn and 19.4% for trauma (P&lt; 0.001). ICU stay was longer for trauma/burn patients at 5.00 median days (IQR 2.00, 15.00) versus 3.00 (IQR 1.00, 10.00) for burn and 3.00 (IQR 1.00, 5.00) for trauma (P&lt; 0.001). Trauma/burn patients had more ventilator days at 3.00 median days (IQR 1.00, 11.75) compared to 2.00 (IQR 1.00, 9.00) for burn and 2.00 (IQR 1.00, 7.00) for trauma (P&lt; 0.001). Trauma/burn patients had increased mortality at 4.9% versus 2.5% for burn and 3.2% for trauma (P&lt; 0.001). For hospital disposition, trauma/burn patients required more interfacility transfers 2.5% compared to 1.7% for burn and 1.3% for trauma (P&lt; 0.001). For level 1 trauma centers, 5.5% of trauma/burn, 7.1% of burn, and 0.5% of trauma patients required interfacility transfers. For level 2 trauma centers, 29.1% of trauma/burn, 47.0% of burn, and 2.8% of trauma patients required interfacility transfers.

Conclusions
Among level 1 and level 2 trauma centers, patients with only burns and burn patients with concomitant traumatic injuries required more interfacility transfers, and level 2 trauma centers required more interfacility transfers for all patients.
587 Ambient temperatures in the burn operating room: A QI initiative
Authors: Rogers Alan D , Cartotto Robert , Wallace David L , Moltaji Syena 
Published: March 2022

Abstract

Introduction
Patients with burn injuries are particularly susceptible to perioperative hypothermia, which is associated with a range of complications, including infection, bleeding and delayed wound healing. Raising the operating room (OR) ambient temperature is an important strategy to prevent hypothermia, but we were uncertain about how strictly we do this. The purpose of this study was to determine the ambient OR temperatures during acute burn surgery as the first step of a quality improvement initiative to ensure we are maintaining a warm OR environment.

Methods
Between 1/3/2020 and 28/2/2021, ambient temperatures during surgery in the burn OR of an ABA-verified burn center were recorded every 15 minutes. Temperatures were measured using a wall-mounted smart sensor, transmitted to a mobile smartphone application via Bluetooth. All patients undergoing acute burn excision and closure procedures lasting &gt; 2 hours were included in the study. Hypothermia was defined as a core temperature &lt; 36°C.

Results
Of the 119 patients, the majority were male (n=86; 72.3%), the mean age was 49.8 years (range 18-89) and the mean total body surface area (TBSA) was 15.8% (range 1-62%). They underwent 261 operations (mean 2.2 cases per patient; range 1-15) with a mean duration of 211.1 minutes (range 120-468 minutes). Sixty-two patients underwent 1 surgery, and 31 had 2 surgeries. Eight patients (6.7%) died. Thirty-three patients (27.7%) were hypothermic at the end of 43 cases (16.5%).
The mean ambient temperature was 24.8oC (range 18.7oC to 29.6oC). Hypothermic patients (n= 33 patients, 43 cases), did not differ significantly in age or operative duration from non- hypothermic patients (n= 86 patients, 218 cases) but did have significantly larger %TBSA burns [32.3 vs 24.8 (p= 0.02)]. Hypothermic cases experienced significantly lower ambient temperatures at the start of surgery (p=0.007), and mean temperature during surgery (p=0.009), and tended to experience a lower ambient temperature at the end of surgery (24.5 C vs 25.1 °C , p= 0.06). [Table]

Conclusions
We have identified that the ambient temperature in our burn OR is lower than desirable and that this is directly related to development of hypothermia. These results now indicate that a QI intervention (stricter attention and manoeuvers to ensuring a warm operating room at the start and during surgery) is required.
591 Transition to an Advanced Practice Provider led burn service: process and lessons learned
Authors: Bard Maryke , Lewis Lauren , Ward Christopher , Frabotta Anna , Lou Richard B , Crow John , Khandelwal Anjay 
Published: March 2022

Abstract

Introduction
Burn is not a required rotation for general surgery residency training. Additionally, mandates on resident work hours have created a deficiency in resident support for many burn programs across the country. Subsequently, the need to transition to an Advanced Practice Provider (APP) service was identified. At our institution, a medium volume (~250 admissions/year) burn center, we created an APP service and evaluated the evolution and lessons learned during the transition.

Methods
Timeline of recruitment of APPs was reviewed along with the recruitment process, onboarding process and orientation process. Exit interviews were conducted with all APPs who resigned to delineate strengths and weakness of the APP program. Functionality of the institution’s APP recruiter, manager and Lead Burn APP (LAPP) were reviewed as well.

Results
Between 2014 and 2021 the daytime burn APP service expanded from two to six APPs and the Night House Officer (NHO) APP service was created and expanded to four APPs. Based on thorough review of the APP program, key changes were made including improvements in team communication, daily nurse-driven rounds, the 90-day focused professional performance evaluation (FPPE), enhanced and structured education, and critical care exposure.
The need for a LAPP was identified and designated in 2019. The LAPP is responsible for making an equitable schedule, execution of new APP orientation, organizing the 90 day FPPE and ongoing professional performance evaluation (OPPE), monthly APP peer review and APP meetings, coordinating OR coverage, and functioning as an APP advocate at division leadership. The LAPP enacted changes to the existing hiring/onboarding process as described below.
All APPs are now recruited through an APP recruiter who discusses the hospital contract and salary as well as organizes the logistics of the interview, formalizes the offer, and aids with the transition to credentialing. All new APPs are given a hospital onboarding checklist, that includes hospital orientation, APP boot camp, simulation and electronic health record training classes. In addition they are given a clinical orientation checklist, which includes BLS/ABLS/ACLS/ATLS certification, exposure to various phases of patient care, tracking of quantitative patient care metrics, participation in monthly burn APP peer review and burn triage simulation. There are subtle differences with the NHO APP clinical checklist. After 90 days of employment a new employee FPPE is held with the LAPP and burn director. This allows for direction of areas to focus on, comprehensive feedback, and discussion about increasing autonomy.

Conclusions
Through a focused process, APPs can play an integral role in the daily functioning of a burn center. We believe that a similar effective and financially sound model can be created for similar sized units.
601 Bromelain Based Enzymatic Debridement Followed by Application of Autologous Cell Suspension for Treatment of Burns
Authors: Williams Ashley , Mbaka Maryann , Ledbetter Kate , Huett Wilson , Simmons Jon D , Bright Andrew 
Published: March 2022

Abstract

Introduction
Bromelain based enzymatic debridement has been shown to have a unique selectivity for nonviable tissue and is being evaluated for its use in the treatment of select burn wounds. The treatment has potential to augment more traditional operative eschar excision. Herein, we retrospectively review our tertiary burn center’s early experiences in cases in which bromelain based enzymatic debridement (BBED) is paired with autologous cell suspension (ACS).

Methods
Patients whose burn wounds were deemed eligible for BBED at our institution from July 2020 to June 2021 were queried for concurrent treatment with ACS. Inclusion criteria by study design consisted of 18 years of age or older, non-electrical and non-chemical burns, predominance of deep partial and/or full thickness burn, and less than 30% total body surface area. Success of escharotomy by BBED, grafting methods, infections, transfusions, inflammatory response, and response to grafting were analyzed.

Results
Seven patients met inclusions criteria from July 2020 to June 2021. The mean age was 44 (IQR: 39-53). The mean TBSA was 13.7% (IQR 8-20). The mean time from injury to BBED was 2.1 days (IQR 1.5-2.0). The mean time to ACS after BBED was 1.3 days (IQR 1.0-1.5). The mean area debrided with BBED was 2347 sq cm (IQR 1367-3534). All patients were determined to have complete eschar removal on the day of application by the multidisciplinary burn team. All seven cases had deep partial thickness areas treated with ACS alone, with a mean area of 1574sq cm (IQR 877-2327). The total area treated was 11,016 sq cm. Only two patients required delayed grafting, a combined total of 1573 sq cm, meaning that 86% of the total burn area treated with ACS alone was recovered. Five patients had ACS paired with split thickness autografts, with a mean area of 867 sq cm (IQR 519-1328). Graft imbibition was noted to be rapid with &gt;95% wound closure by postoperative day eight. There were no graft infections, and no transfusions required. White blood cell (WBC) counts decreased after BBED, then increased marginally after grafting. Only two patients had WBC &gt;20,000 and this aided in diagnosis of one donor site infection and one pneumonia.

Conclusions
In our series, BBED within three days of injury paired with ACS within two days of BBED resulted in excellent split thickness graft take and recovery of 86% of the burn wounds treated with ACS alone.
610 Myofibroblasts Are Not Characteristic Features of Keloid Lesions
Authors: Supp Dorothy M , Hahn Jennifer M , McFarland Kevin L , Combs Kelly A , Powell Heather 
Published: March 2022

Abstract

Introduction
Keloids are disfiguring, fibroproliferative lesions that can result from an abnormal wound healing process. Keloids are characterized by excessive and abnormal deposition of extracellular matrix and unrestrained expansion beyond the original wound boundary. Keloids are challenging to treat, with low response rates to current interventions and high recurrence rates. Development of more effective, targeted therapies will require a deeper understanding of the mechanisms driving keloid pathology. It has been widely reported that keloids are characterized by the presence of myofibroblasts, which are specialized, contractile fibroblasts that express alpha-smooth muscle actin (αSMA) and play important roles during wound healing and tissue remodeling. However, the evidence supporting a role for myofibroblasts in keloid development is inconclusive, with conflicting reports in the literature. This complicates development of more effective therapies, as the benefit of interventions targeting myofibroblasts is unclear. The current study evaluated the presence of αSMA+ myofibroblasts in keloids, and analyzed αSMA expression in keloid-derived fibroblasts, to determine whether myofibroblast presence can be considered diagnostic of keloid lesions.

Methods
Keloid, hypertrophic scar (HTS), and normal human skin samples were collected with Institutional Review Board approval and primary fibroblast cultures were established. Myofibroblasts in tissue sections were localized by αSMA immunostaining, and αSMA expression in pericytes of blood vessels was distinguished from αSMA+ myofibroblasts by collagen IV immunostaining of vessels. Expression of αSMA mRNA (ACTA2 gene) was measured using quantitative real-time PCR. Statistical analysis via t test was performed using SigmaPlot.

Results
Normal human skin samples did not exhibit αSMA+ myofibroblasts (0/8), but myofibroblasts were identified in 53% of keloids (8/15) and 60% of HTS (3/5) tissue samples. When present in keloids or HTS, the αSMA+ cells were not uniformly distributed, but were often observed in clusters in the deeper regions of the lesions. Comparison of ACTA2 mRNA expression did not reveal any significant differences between normal skin and keloid tissues (N=3/group), or between normal fibroblasts (N=7 donors) and keloid fibroblasts (N=9 donors).

Conclusions
The results suggest that although many keloids contain αSMA+ myofibroblasts, these cells do not appear to be diagnostic for keloids. Therefore, therapies that target myofibroblasts may not be effective for all keloid lesions. However, a limitation of this study is that only excised keloid and HTS tissues, which tend to be larger, more mature lesions, were examined; thus we cannot rule out a potential role for myofibroblasts in early development of abnormal scars.