bluuebunny/crossref_metadata_2025_split huggingface dataset:
502 Estimation of Return to Work After Burn Injury
Authors: Ifland Aidan , Hsu Naiwei , Reiss Matthew J 
Published: March 2022

Abstract

Introduction
A major milestone of recovery from a burn injury is returning to work (RTW). A systematic review by Mason et al. suggested that perhaps 28% of burn survivors do not return to work, while other studies have identified complex factors that affect RTW, including patient age, pre-existing mental health issues, injury locations such as hands, and type of work they do. Due to the large number of complex interactions involved, predicting a timeline for RTW is challenging.
We anticipate that underestimations of RTW may result in frustration, and perhaps contribute to negative psychological outcomes. Therefore, we wished to exam the accuracy of our surgeons estimates of RTW.

Methods
A retrospective chart review of inpatients treated at our center with burn injury, with Worker's Compensation as insurance, with follow up at our outpatient clinic, and admitted during the calendar years 2018 to 2019, produced 23 records with sufficient documentation. Hospital admission was taken as the starting point, and number of days until the (first) estimated RTW date was compared to the number of days until the actual date of RTW if documented, or else the final documented surgeons estimate.

Results
Limited demographic information and results are found in table 1. in 6 cases (23%), patients had not returned to work by one-year post hospitalization. Reasons for non-return to work in all cases included chronic pain requiring a pain management specialist, or psychologic sequelae requiring psychological treatment, or both.
We found that our surgeons estimated an average RTW date 65 days post admission date, whereas the average actual RTW was 177 days after admission. Expressed as a ratio, the actual time was 2.9x the estimated time, and expressed as a difference, the surgeons underestimated by 112 days.

Conclusions
The actual time needed for RTW was much longer that the surgeons initial assessment. These findings suggest that despite a wealth of experience in burn care, surgeons are prone to underestimate recovery time and especially time to RTW.
508 A Case Report of Trichosporon asahii Burn Infection: A Not-So-Fungi
Authors: Boyd Allison N , Walroth Todd A , Blunier Abbie , Harris William H , Hartman Brett C 
Published: March 2022

Abstract

Introduction
Trichosporon asahii is a yeast-like basidiomycete that can cause infections in immunocompromised hosts including superficial infections, pneumonia, meningitis, fungemia, and disseminated trichosporonosis. These infections have become more common over the last 30 years in patients with burns or other immunosuppressive conditions. Disseminated T. asahii is intrinsically difficult to treat and carries a mortality rate as high as 70% despite the availability of effective medications.

Methods
A 61-year-old male was admitted after falling into a vat of pig manure which was 160 degrees F, resulting in approximately 75% total body surface area injury to his anterior and posterior trunk, and bilateral upper and lower extremities. Throughout his hospital course, he underwent surgical debridement on multiple occasions with placement of homograft, autograft, and spray keratinocytes. The earliest cultures to demonstrate T. asahii growth were obtained on post-burn day (PBD) 23 and growth continued until PBD 32. Quantitative colony counts ranged from 600-365000000 CFU/g from left lower and upper extremities and chest. Cultures were obtained in preparation for cultured epithelial autograft placement which occurred on PBD 36. Susceptibility testing was sent and the minimum inhibitory concentration (MIC) results are reported in Table 1. Clinical and Laboratory Standards Institute (CLSI) guidelines for interpretation of susceptibility are not available for T. asahii, but suggested breakpoints are summarized in Table 1.

Results
On PBD 23, topical amphotericin B irrigation and voriconazole oral suspension were initiated. A voriconazole level was obtained on PBD 31, which was subtherapeutic, and dosing was subsequently adjusted. In total, the patient received 13 days of topical amphotericin B and 21 days of voriconazole for treatment. Subsequent cultures demonstrated microbiologic cure of T. asahii.

Conclusions
This immunocompromised burn patient was successfully treated for Trichosporon asahii using a combination of topical and systemic antifungal agents.
513 Fluid Over-Resuscitation in Burn Patients After Initial 24-Hours of Care is Associated with Increased Mortality
Authors: Kishawi Sami K , Badrinathan Avanti , Kohler Casey L , Dvorak Justin E 
Published: March 2022

Abstract

Introduction
Fluid resuscitation is a cornerstone of modern burn care. Despite the use of well-established formulae to determine the appropriate amount of fluid resuscitation for the first 24 hours of care, there is increasing recognition that patients receive fluids in excess of predicted volumes, a phenomenon termed fluid creep. Underscoring the significance of this phenomenon is the association between large volumes of fluid resuscitation and adverse outcomes. Although research in non-burn ICU patients reveals a clear association between overall fluid intake and increased morbidity, minimal burn-related literature exists regarding fluid patterns after the initial 24-hour period and their impact on outcomes. We hypothesized that increased fluid administration after the standard initial resuscitation period is associated with increased morbidity and mortality.

Methods
A retrospective chart review was performed for 113 patients with ≥20% TBSA burns admitted to an American Burn Association-verified burn center between 2010 and 2020. Patients admitted with Stevens-Johnson Syndrome and/or Toxic Epidermal Necrolysis, with length of stay ≤ 72 hours, who required renal replacement therapy (RRT) within 72 hours of admission, and those with withdrawal of care ≤ 7 days of admission were excluded. Univariate and multivariate logistic regression was used to determine the association between the primary outcome of in-hospital mortality and secondary outcomes of increased ventilator days, acute kidney injury, need for RRT, and hospital length of stay, with increasing total and net fluid volumes from days 2 through 7 of treatment. Additionally, the association between first OR day and total fluid volumes in the first week were assessed.

Results
Median age was 41 years (IQR 23-55) and TBSA was 31% (IQR 24-43). 21 patients (18.6%) died during hospitalization. Increase in net fluid balance from days 2-7 were associated with increased mortality (OR 1.016, 95% CI 1.00 – 1.03, p = 0.013). Increasing total fluid volumes were significantly associated with increased ventilator days (OR 1.027, 95% CI 1.008-1.047, p = 0.006) and acute kidney injury (OR 1.003, 95% CI 1.000-1.006, p = 0.017). Early first OR day was associated with decreased net fluid balance between hospital days 2-7 (OR 0.993, 95% CI 0.989-0.997, p = 0.001).

Conclusions
Similar to studies on other ICU populations, increasing total fluid volumes and net fluid balance is associated with adverse outcomes in critically ill burn patients. Additionally, earlier initial OR is associated with less total fluid volumes and lower net fluid balance in the first week of hospitalization. Further investigation is needed to elucidate optimal markers of resuscitation in burn patients in an effort to decrease adverse fluid administration.
514 The Outcomes of Tracheostomy on Burn Inhalation injuries
Authors: Ruiz Samuel G , Puyana Salomon , Hai Shaikh A , Mckenney Mark G , Mir Haaris 
Published: March 2022

Abstract

Introduction
Tracheostomy has been proposed for patients with expected prolonged intubation and it has been shown to be beneficial for trauma patients with severe brain injury; however, the benefit of performing tracheostomy on burn inhalation injuries has not been extensively investigated. Our study aims to determine the outcomes of performing tracheostomy on patients with burn inhalation injuries requiring mechanical ventilation.

Methods
Retrospective review of our institutional burn registry from 2011 to 2019. We compared the outcomes of all burn patients that met our inclusion criteria which included: adequate data recording of inhalation injury within the registry, ventilator support for at least 24 hours, and a TBSA burn injury of &lt; 15%. We stratified the patients into two groups: tracheostomy (group 1) versus no tracheostomy (group 2). Outcome measures included: in-hospital mortality rate, hospital length of stay, ICU length of stay, ventilator days, and ventilator associated pneumonia (VAP). Chi-squared and t-test analyses were used with significance defined as p&lt; 0.05.

Results
A total of 33 burn patients met our inclusion criteria. Group 1 consisted of 10 patients and group 2 consisted of 23 patients. There was no statistically significant difference between the two groups in terms of %TBSA (p =0.24, t-test). There was a significantly higher ICU length of stay at 23.8 days in group 1 compared to 3.16 days in group 2 (p=0.0001, χ2). There was a significantly higher hospital length of stay at 28.4 days in group 1 compared to 5.26 days in group 2 (p=0.0001, χ2). Ventilator days was also significantly higher in group 1 with 20.8 days compared to 2.5 days in group 2. There was no statistically significant difference between the two groups in terms of mortality, however, the incidence of VAP was significantly higher in group 1 than in group 2, with six cases compared to zero cases, respectively(p=0.0001, χ2).

Conclusions
The ideal timing and implementation of tracheostomy with inhalational injury has yet to be determined. In our study, tracheostomy was associated with much longer lengths of stay and pneumonia. The impact of the underlying lung injury, versus the tracheostomy itself on these observations, is unclear. The challenge of characterizing the severity of an inhalation injury based on early visual inspection remains.
532 Cross-Reactivity Between Topical and Systemic Sulfa Antibiotics
Authors: Powelson Ian A , Ketheeswaran Suvethavarshini , Hultman Charles S 
Published: March 2022

Abstract

Introduction
Silver sulfadiazine cream 1% is a sulfa derivative topical antimicrobial commonly used in burn care, in part due to its wide spectrum of activity, particularly against Pseudomonas aeruginosa. Contact dermatitis due to sulfadiazine component is a known but rare complication of silver sulfadiazine. In contrast, systemic sulfonamide antimicrobials are a commonly reported allergy and have been implicated in multiple hypersensitivity reactions. Some authors recommend avoidance of all sulfonamide antimicrobials regardless of route of administration for a patient with a known allergy to a sulfonamide antimicrobial due to structural similarities between all drugs in the class, resulting in a high risk of cross-reactivity. Clinical reports are lacking, however, and the few reports that do exist implicate silver as the culprit rather than the sulfadiazine component. Therefore, while the theoretical risk of reactivity to a topical application of sulfadiazine exists, there is no data to support this in practice.

Methods
A retrospective review of 42 patients with a sulfa allergy who were admitted to the burn unit of an academic medical center between June 2016 and June 2021 were reviewed. Inclusion criteria were age &gt; 18, burn requiring admission, sulfa allergy, and receiving topical sulfa antimicrobial therapy. Data on the reported allergen, reaction, and any adverse reaction from the use of topical sulfa agents were recorded.

Results
Forty-two patients were identified. Of these, 32 (76%) reported a non-specific “sulfa” allergy, while 10 (24%) reported a specific allergy to trimethoprim-sulfamethoxazole. The reactions were reported as unknown (20, 48%), rash (9, 21%), hives (6, 14%), gastrointestinal (4, 9%), or other (3, 7%). One patient had a history of respiratory distress with trimethoprim-sulfamethoxazole administration. All 42 patients received treatment with topical silver sulfadiazine and 10 also were treated with topical mafenide acetate solution. There were no reported adverse events and no patients discontinued therapy. Two patients were identified with no previous sulfa allergy but who discontinued topical silver sulfadiazine due to burning sensation, a rare but previously reported side effect of this medication.

Conclusions
Silver sulfadiazine remains one of the most commonly used topical antimicrobials in burn care due to its broad spectrum of activity, low cost, and ease of use. Adverse reactions to topical silver sulfadiazine and mafenide acetate are rare, even in those with reported sulfa allergies. Topical sulfa anti-microbials can likely be used safely in most patients with allergies to systemic sulfa antibiotics, and the rate of cross-reactivity appears to be low. A test patch is recommended prior to application over a large area.
533 Human Case Characterizations of Skin Burn Using Novel Multi-Spectral Short Wave Infrared Imaging
Authors: Nunez Johanna H , Park Caroline , Clark Audra , Akarichi Chiaka , Arnoldo Brett , Mandell Samuel P , Carlson Deborah L , Huebinger Ryan M , Chan Rodney K , Goverman Jeremy , Mironov Sergey , Levi Benjamin , Berenfeld Omer 
Published: March 2022

Abstract

Introduction
Determining the depth of skin burns in patients is critical for surgical decision making, but currently lacks accuracy in clinical practice. Short-wave infrared (SWIR) light penetrates tissue more than visual or near-infrared light and is very sensitive to water content. We have shown in animal models that imaging of skin burns in the SWIR range distinguishes between superficial and deep tissue necrosis. Here we present the first 2 cases of multi-spectral SWIR imaging of human burn injury as a first step toward a non-invasive, label-free, technique for burn depth determination.

Methods
Two subjects admitted for mixed depth, thermal, 6% and 7% total body surface area (TBSA), burns were studied. Prior to burn excision, a novel system, based on a specialized camera, imaged the burn areas and normal skin at 4 different SWIR bands. Standard photographs from imaged areas were collected and presented for 5 independent, blinded, surgeons’ assessments. In SWIR images, 3-5 regions of interest (ROIs) were selected in burned and adjacent normal skin and the reflected light intensity in each ROI was averaged.

Results
Visual and SWIR images were collected for 9 burn areas in the hands, arms, and shoulder of 2 patients (Panel A). Fifty ROIs from the burn areas were assessed by the surgeons and 30 (60%) ROIs were agreed as being superficial or superficial partial thickness (n=5), deep partial thickness (n=11), or full thickness (n=14) burns by a majority (60% or above consensus together with a possible disagreement only between deep partial and full thickness burn). In Panel B the cumulative SWIR reflectance intensity at the 4 SWIR bands for the 3 burn groups, determined by expert surgeon evaluation, and normal skin are compared. The reflectance from superficial and superficial partial thickness burns (yellow) were 102.7±1.2%, 102.3±0.7% and 103.4±1.4% of the normal skin reflectance for 1200, 1650 and 1940 nm, respectively. On the other hand, the reflectance from deep partial thickness burns (grey) were 96.7±0.1% and 94.7±0.1%, and for full thickness burn (red) were 96.1±1.4% and 93.7±1.6% of normal skin reflectance for 1650 and 1940 nm, respectively.

Conclusions
We present the first human SWIR study demonstrating a distinct reflectance intensity of SWIR wavelengths for different burn depths based on surgeon assessments. The results motivate further studies of SWIR imaging of burns in the hope to non-invasively and accurately identify operative versus non-operative burns.
544 Southern US Burn Centers, Surge Capacity and 15 Months of the COVID19 Pandemic
Authors: Kearns Randy D , Flores Carl A , Hickerson William L , Carter Jeffrey E 
Published: March 2022

Abstract

Introduction
Burn mass casualty incident (BMCI) planning efforts have been in practice and publication for 40+ years. Through these ongoing efforts, we know there are measurable limits to burn center capacity and capability through modeling and real-world events relying on conventional and contingency standards of care, even when the only focus is those patients with burn injuries. The southern region of the American Burn Association (ABA) includes 37 burn centers and continues to play a critical role in the BMCI preparedness process.
COVID-19 has emerged as the greatest pandemic in terms of morbidity and mortality since the 1918 influenza pandemic. While COVID-19 has no direct connection to burn injuries, the impact of COVID-19 on the American Healthcare System to include burn care was and remains significant.

Methods
We conducted a retrospective analysis of (southern) regional data voluntarily submitted to the ABA from March 2020 to June 2021 and generally coincides with the first three waves of the pandemic. We focused on the self-reported data specific to the three critical components in managing a surge of patients: staffing, space, and supplies (to include pharmaceuticals and equipment).

Results
Staff: These data were collected over a period that coincided with the first three waves seen in the region. Staffing shortages were noted during each of the surges but were most excessive when a regional surge paralleled surges in other parts of the country (November-December 2020).

Space
Late November and early December 2020, space was in short supply with the surge of patients for more of the region than at any other time during the 28 weeks of reporting. While single facilities reported other episodes of limited space or supplemented with temporary structures, the peak was early December.

Supplies
As the first surge began to subside, the supply shortages were abated. However, as additional surges occurred, the supply chain had not recovered. Supply shortages were reported in greater numbers than either space or staffing needs through the multiple waves of the pandemic.

Conclusions
The surge of patients that had to be managed by the greater healthcare community placed a substantial strain on the burn centers to keep beds dedicated for patients with burn injuries. The pandemic directly led to a diminished available capacity for burn care in such a way that it could have compromised our ability to confront a surge of burn-injured patients. Future BMCI planning efforts must consider this aspect of the process. Crisis Standards of Care may come into play during such an event.
551 Age Does Not Predict Admission Culture Positivity
Authors: Ivanko Anastasiya , Skipton Romanowski Kathleen S , Man Angela , Wall Joyce E , Allabadi Najib M , Jeschke Marc G , Savetamal Alisa , Schulz John T 
Published: March 2022

Abstract

Introduction
Burn patients are susceptible to wound infections, urinary tract infections, pneumonia, and bloodstream infections. With rising rates of community colonization with multidrug-resistant organisms (MDRO), the colonization of wounds with commensal organisms is more concerning than ever, which is particularly true in patients with recent hospital admissions, advanced age, or institutional living situations. The purpose of this study was to examine if age was a factor in obtaining admission cultures and if older patients were more likely to have positive cultures.

Methods
A retrospective chart review was conducted involving burn patients admitted at three ABA verified burn centers from January 2016 - December 2017. Data collected included demographics, burn injury, and cultures obtained within 24 hours of admission. Patients were divided into 10-year age increments from 20 to ≥ 80 years old. Data analysis was conducted using Chi-square, Fisher Exact, and Kruskal-Wallis tests.

Results
A total of 1615 patients (mean age 45.9± 17.7 years, 1145 males (70.9%), mean burn size (TBSA) 9.6± 14.2%) were analyzed. Admission cultures obtained were: 656 (40.6%) wound cultures, 196 (12.1%) urine cultures, 139 (8.6%) blood cultures, and 1445 (89.5%) Methicillin-Resistant Staphylococcus Aureus (MRSA) screen. In all age groups, there were no significant differences between patients who had wound cultures (p = 0.97), blood cultures (p = 0.39), or MRSA screening (p = 0.9). As patients aged, they were more likely to have urine cultures obtained (p=0.01); - 23% of patients &gt;80 years old had urine cultures ordered at admission compared to 8.6-16.9% of younger patients. Positive results by age group: wound cultures (p= 0.09), urine cultures (p= 0.16), blood cultures (0.10), MRSA screen (p=0.98). In looking at increased exposure to MDROs prior to admission by age groups, patients in the 61–70year (8.33%), 71–80-year (5.68%), and &gt;80-year (6.67%) age groups were more likely to have a recent (within 30 days) hospitalization (p = 0.02), but there was no significant difference in pre-hospital institutionalization (i.e., prison, skilled nursing facility) by age group (p = 0.06). With a recent hospitalization, MRSA screening was more likely to be positive (11.3% vs. 4.9%, p = 0.05).

Conclusions
All burn patients are susceptible to infections. Urine cultures were more likely to be obtained in older burn injured patients who are 80 years of age or older. There was no significant difference in culture positivity by age. Apart from MRSA screen positivity, there was no increased risk of urine, wound, or blood culture positivity with recent hospitalization or institutionalization. The utility of screening all patients for MDROs on admission should be considered for patients 20 years of age and older.
556 Entering Into a Helping Relationship: A Novel Approach to Burn Center Staff Education/Orientation
Authors: Quinn Kristen C , Schnebly Drew , Gravis P J , Lewis Giavonni M , Thompson Callie M 
Published: March 2022

Abstract

Introduction
In the past, our regional burn center’s staff orientation was a robust overview of the interdisciplinary team’s dynamic approach to patient care. 2020 illuminated gaps in our staff orientation and education process, along with seeing increased levels of staff turnover. The need to truly prepare staff to do the work of caring for burn injured patients while also caring for themselves was identified.
A novel approach to orientation was developed; this included the development of a four hour workshop designed to increase awareness of vicarious trauma, the neurobiology of trauma and its impacts on the care we deliver, our home life and our emotional wellbeing. Social taboos surrounding self-care were addressed. A deep dive into trauma informed care formed the foundation of the workshop. Participants were given tools they can use at work, home, for patients and themselves to increase self-awareness regarding vicarious trauma and implement change in their daily lives.

Methods
Registration was prioritized for new burn staff and open to veteran members of the team. Material was presented via a variety of modalities: art, team build exercise, didactic lecture and discussion. This course will be offered bi-annually. A post course survey was completed; see attached evaluation and graphed likert scale.

Results
The 17 participants included nurses, CNS’s and paramedics;15 from the burn center and 2 from the emergency department. Evaluations were overwhelming positive (see graph). Comments included “it really helped me understand more of the psychological part of my own care”, “it taught me to look at my family and my patient’s family through their world view”, “this was the most important class I’ve ever been given as a nurse”.

Conclusions
Given the success of this novel approach to nursing education/orientation, we are looking for additional pathways to offer this workshop. Follow up discussions with participants have indicated sustained benefits from this program. We are exploring options to measure these outcomes and impacts on longevity and retention.