bluuebunny/crossref_metadata_2025_split huggingface dataset:
32 Effect of Oral Ketamine on Analgesia During Burn Wound Care
Authors: Rozynski Jill , Larger Charlotte , Patton Alicia , Kohler Amber , Wiktor Arek J 
Published: March 2022

Abstract

Introduction
Pain and anxiety can be difficult to control in the burn patient. Ketamine, a NMDA receptor antagonist can be utilized, however intravenous (IV) dosing requires increased monitoring. In contrast, oral ketamine (O.K.) is reported to have fewer side effects, and can be administered without a higher level of care. Little is known about dosing and efficacy of O.K. in the treatment of burn patients. We sought to examine the use of O.K. in our burn population.

Methods
This was a cross-sectional comparative quality improvement study conducted at our ABA verified burn center from January 2021through September 2021. Inclusion criteria were in patients experiencing refractory pain and anxiety after receiving fentanyl and midazolam during wound therapy one day prior to first O.K. administration, along with completion of pre-post patient assessment surveys. Patients were administered 50mg-150mg of ketamine in an oral suspension mixed with 30mL-120mL juice. Effectiveness of the O.K. was measured using pre-post patient surveys, pre-post IV pain medication usage, and subjective staff evaluation of pre-post tolerance of debridement. Baseline demographics were recorded, along with adverse events. O.K. was deemed effective by improved survey scores, improved tolerance to debridement, and reduction in IV medication requirements. Students T-test was performed to determine significance.

Results
A total of 71 patients were given O.K, and 32 met inclusion criteria. Baseline demographics included: 19 male (59%), median age 36 years (range14-66), median TBSA 9.9% (range 1.6%-33.2%). O.K. reduced mean fentanyl use by 33% (pre 199.2mcg- post 123.5mcg, p&lt; 0.01) and mean midazolam use by 39% (pre 1.4mg - post 0.7mg, p&lt; 0.01). On a scale of 1-10 (1 best, 10 worst) mean pain scores improved 38.8% (pre 8 – post 4.6, p&lt; 0.01), anxiety by 36.6% (pre 6.5 – post 3.5, p&lt; 0.01), and overall experience by 37.5% (pre 5.9 – post 3, p&lt; 0.01). Mean O.K. effective dose was 50mg. Staff noted O.K. improved the patient’s ability to tolerate debridement; uncooperative and inconsolable patients participated in their own wound care, and reported to prefer tub time with O.K. One patient experienced psychotomimetic effects, while one patient requested discontinuation due to increased anxiety 4 hours after O.K. administration.

Conclusions
O.K. appears to be efficacious in improving pain and anxiety during wound care while being well tolerated by patients. It also subjectively improved the wound care therapy experience.
34 Using a National Burn Registry to Develop a Model for Risk-adjusted Length of Stay Benchmarking
Authors: Thompson Callie M , Bessey Palmer Q , Higginson Sara , Hoarle Kimberly , Hsu Naiwei , Pardon Darryl A , Phillips Bart D , Phillips Matthew H , Weber Joan M , Mandell Samuel P 
Published: March 2022

Abstract

Introduction
Length of stay (LOS) is a frequently reported outcome after a burn injury. Previous literature estimates LOS at 1 day per % total burn surface area (TBSA) but this varies considerably across patients & centers. LOS benchmarking will benefit individual burn centers as a way to measure their performance & set expectations for patients. We sought to create a nationwide, risk-adjusted model to allow for LOS benchmarking based on data from a national burn registry.

Methods
Using data from a national burn registry, we queried admissions from 7/2015-6/2020 & identified 126,129 records with LOS data reported by 103 centers. We selected 23 predictor variables on the basis of completeness (min. 75% required) & clinical significance. Missing data were multiply imputed with a Bayesian Ridge Regression estimator. All statistics were calculated in Python using Numpy & Scikit-Learn libraries. Comparisons of unpenalized linear regression & Gradient boosted (CatBoost) regressor models were performed by measuring the R2 & concordance correlation coefficient (CCC) on the application of the model to the test dataset. The CatBoost model applied to bootstrapped versions of the entire dataset was then used to calculate O/E ratios for individual burn centers. Confidence intervals (CI) for O/E ratios were calculated using a normal distribution parametric model. Analyses were run on 3 cohorts: all patients, 10-20% TBSA, &gt;20% TBSA.

Results
The CatBoost model outperformed the linear regression model with a test R2 of 0.68 & CCC of 0.81 compared to the regression model with R2=0.52, CCC=0.70. The CatBoost was also less biased for higher & lower LOS durations. Due to the CatBoost model’s superiority in predicting the outcome, this model alone was used for O/E ratio calculations. The O/E ratio data from the model for all 3 cohorts are shown in Figure 1.

Conclusions
Gradient boosted regression models provided greater model performance than traditional regression analysis. Using national burn data, we can predict LOS across contributing burn centers while accounting for patient & center characteristics, producing more meaningful O/E ratios. These models provide a risk-adjusted LOS benchmarking using a robust data source, the first of its kind, for burn centers.
53 Use of Polylactic-acid-membrane in Split-thickness Skin Graft Donor Sites: A Prospective, Comparative, Randomized Study
Authors: Möllhoff Nicholas , Ehrl Denis 
Published: March 2022

Abstract

Introduction
Polyurethane film (PU) dressings are commonly applied for coverage of split-thickness skin graft (SSG) donor sites, while previous studies have suggested reduced morbidity using a polylactic acid membrane (PLM). To further investigate the optimal treatment approach, the presented study compared outcome of donor sites in patients receiving either PLM or PU.

Methods
This randomized clinical trial allocated patients requiring SSG to receive either PLM or PU at the donor-site. Primary endpoint was difference in donor site scar appearance between groups 3 months postoperatively (Vancouver Scar Scale – VSS). Secondary endpoints included pain, the number of and time required for wound dressing changes, and costs related to the wound dressing.

Results
30 patients were allocated to each group. The median VSS scored lower for patients receiving PLM (PU: 3 (Q1: 2; Q3: 4) vs. PLM: 2 (Q1: 1; Q3: 3); p=0.049). Pain during change of wound dressing (PU: 2.0 ± 0.2 vs. PLM: 0.5 ± 0.2; p&lt; 0.001) and mobilization (PU: 0.8 ± 0.2 vs. PLM: 0.3 ± 0.1; p=0.032) was reduced in the PLM group. Patients with PLM required less dressing changes per day of hospital stay (PU: 0.44 ± 0.06 vs. PLM: 0.28 ± 0.02; p=0.015). Mean time for wound dressing changes per patient was higher in the PU group (PU: 74.50 ± 5.72 vs. PLM: 21.43 ± 2.61 min; p&lt; 0.001). Costs were higher in the PLM group (PU: 67.83 ± 5.56 vs. PLM: 162.79 ± 21.76 €; p&lt; 0.001).

Conclusions
PLM improves outcome of SSG donor sites, however, higher treatment costs must be taken into consideration.
59 Burns in Low- and Middle-income Countries: A Scientometric Analysis of Peer-reviewed Research
Authors: Collier Zachary J , Kanmounye Ulrick S , Naidu Priyanka , Tapia Maria Fernanda , Bustamante Atenas , Bradley Daniel , Msokera Chifundo , Dutton John , Magee William P , Gillenwater Justin 
Published: March 2022

Abstract

Introduction
Low- and middle-income countries (LMICs) account for 70% of all global burns. Due to this significantly disproportionate burden, it’s critical we identify barriers to burn care and prevention in LMICs. As a result, this study aimed to elucidate trends in LMIC-related burn research to create focused strategies for burn care training, research, and innovation. Accomplishing meaningful change from the study’s findings will be guided by the first 4 steps of Dr. John Kotter’s “8-Step Process for Leading Change” – 1) create urgency for change, 2) build a guiding team, 3) develop a vision and plan, 4) communicate with key stakeholders to obtain buy-in.

Methods
Web of Science’s 7 citation databases were searched through March 2, 2021 using synonyms of “burns” and “low- and middle-income countries.” After screening articles, metadata were uploaded to VOSviewer (Leiden, Netherlands) where citation and network metrics were generated. The Kruskal-Wallis test and linear regression were used for bivariable and multivariable analysis of factors influencing publications, citations, and total link strength (TLS) – the strength of association between a given research article, other articles, and additional institutions.

Results
Bibliometric analysis identified 2,027 articles by 8,602 authors in 692 journals. Two-thirds of journals published a single article (n=453, 65.5%) whereas only 3.6% published ≥10 articles. One-quarter of LMIC burn research was published in ISBI’s Burns (n=417 articles, 20.6%) and ABA’s Journal of Burn Care & Research (n=89 articles, 4.4%). Most authors published &lt; 5 articles (n=8521, 99.1%) but 19 (0.2%) had published ≥10. Authors were affiliated with 2,519 organizations in 132 countries. There was a strong positive correlation between total publications and citations (R=0.87, P&lt; 0.001). In addition, there was a significant difference in the number of publications (P=0.003, 0.07), citations (P=0.005, 0.03), and TLS (P=0.009, 0.008) by geographic and economic categories - North America had the highest while Latin American and the Caribbean had the lowest. The USA (n = 563), India (n = 161), and China (n = 154) published the most articles.

Conclusions
Given the disproportionate representation of high-income countries and authors in the current LMIC burn research landscape, there must be a sense of urgency to develop pathways for facilitating change. Local and regional candidates for mentors and leaders were identified using bibliometric findings. Assembling teams with these individuals and prolific authors using a well-defined vision for change will facilitate sustainable communication and collaboration within LMIC research.
60 Running Water While Bathing Is a Risk Factor for Pediatric Scald Burns
Authors: Moser William J , Bilka Kristen R , Vrouwe Sebastian Q , Glick Jill , Ramaiah Veena 
Published: March 2022

Abstract

Introduction
Scalds are the most common mechanism of burn in children, and a significant proportion of these injuries are associated with bathing. Burns sustained while bathing present a unique opportunity for injury prevention; previous studies have examined lowering water heater temperatures, however reputable infant bathing educational resources do not explicitly recommend avoiding running water and the risks that it could pose. In an effort to inform prevention programs, this study seeks to determine the incidence and circumstances of running water in bathing scald burns at our institution.

Methods
A retrospective review was performed of records from an American Burn Association verified center over a ten year period (1/1/2010 to 12/31/2019). This center treats both children and adults and is affiliated with an academic hospital in a major urban center. The burn database was queried for scald injuries in children less than three years involving bathing. The Child Advocacy and Protective Services team provides inpatient consultation for all children less than three years old with burn injuries allowing us to analyze the specific events surrounding the bathing scald burns in this cohort.

Results
A total of 123 patients met inclusion criteria. Three bathing safety risk factors were specifically noted in the chart review: (1) running water, (2) lack of caregiver presence for duration of bathing, and (3) failure of caregiver to check water temperature before bathing. Of the cases identified, 107 (87%) had clear documentation of running water as part of the history of injury, 66 (54%) cases involved failure of caregiver to check the water temperature before bathing and 53 (43%) cases did not have a caretaker present for the duration of the bath. In cases with only one risk factor, running water was identified in 34 (94%) out of 36 cases, and in cases with one or two risk factors, running water remained the primary risk factor with 38 (90%) out of 42 cases. When looking at the combination of risk factors, only three (2%) cases had no risk factors while 77 (63%) involved two or more risk factors.

Conclusions
The vast majority of bathing burn injuries in this series involved running water. In addition, a significant number of scald burns occurred from running water alone, even without the other identified risk factors. Conversely, only 2% of scald burns associated with bathing featured none of these three risk factors, suggesting that these injuries could be greatly impacted by safe bathing education.
73 Associations Between Pre-burn Occupation Type and Employment Outcomes at One Year
Authors: Shepler Lauren J , Carrougher Gretchen J , Gibran Nicole S , Kowalske Karen J , Stewart Barclay T , Ryan Colleen M , Schneider Jeffrey C 
Published: March 2022

Abstract

Introduction
Reintegration into the workforce after burn injury is an important issue for survivors. In a 2012 systematic review, 28% of burn survivors never returned to any form of employment. Although pre-burn employment status is strongly associated with post-burn employment, there are little data on the role of pre-injury occupation type on workplace reintegration. The aim of this project was to assess the impact of occupation type on employment outcomes after burn injury.

Methods
Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Longitudinal Database from 2015 to 2021 were used to investigate the association between occupation type and employment outcomes. Occupation type was classified into two groups, Labor and Non-labor, using the U.S. Bureau of Labor Statistics Standard Occupational Classification System. Demographic and clinical data were compared between groups. Mixed regression analyses examined associations between pre-burn occupation type and post-burn employment outcomes (employment at 1 year, days to return to work), controlling for age, gender, race, ethnicity, pre-injury employment, and burn size.

Results
Of the 600 patients who were employed pre-injury, 247 (41%) identified with a non-labor occupation and 353 (59%) with labor occupations. The Labor group was more male (82% vs. 61%) and Hispanic (23% vs. 6%), younger (mean age 42.1 vs. 48.3 years), less educated (high school or less, 25% vs. 11%) and more likely to have been injured at work (28% vs. 14%) compared to the Non-labor group (p&lt; 0.001 for all comparisons). Changes in occupation were seen from pre-injury to post-injury; 16% of working survivors changed from Non-labor to Labor and 13% from Labor to Non-labor occupation types. For those who did return to work after injury, the average time to return to work was greater for Labor compared to the Non-labor group (150 vs 100 days; p=0.003). Additionally, those in the pre-injury Labor group were less likely to be employed at 12 months compared to the Non-labor group (odds ratio = 0.41; p=0.009).

Conclusions
Pre-injury occupation type is associated with employment outcomes after injury. Therefore, occupation type can be used to inform vocational reintegration resources, such as vocational rehabilitation programs, to optimize survivor outcomes.
75 Patient Reported Outcome Measures Associated with Burn Severity
Authors: Saldana Golddy M , Greenhalgh David , Sen Soman , Palmieri Tina L , Skipton Romanowski Kathleen S 
Published: March 2022

Abstract

Introduction
Burns continue to be a leading cause of unintentional injury sustained by children. The lasting effects of burn treatment on pediatric patients’ quality of life are still poorly understood. Patient-Reported Outcomes Measurement Information System (PROMIS) is a reliable tool that evaluates a patient’s physical, mental, and social health. To measure the impact of burn injuries on quality of life, we integrated the use of PROMIS into our outpatient clinic. Our aim for this study is to determine the effects of patient demographics, burn treatment, and burn characteristics on PROMIS scores.

Methods
A retrospective review of patient and PROMIS data collected at our institution from June 2016 to August 2019 was conducted. Patient demographics, burn injury characteristics, PROMIS Pediatric Mobility, Upper Extremity, Pain Interference, and Peer Relationships scores were collected. Statistical analysis was conducted using Wilcoxon Two-Sample Test, Chi-Square, and Pearson’s Correlation Coefficient.

Results
163 pediatric burn patients completed PROMIS questionnaires. The median injury age was 5.94 years (interquartile range (IQR)= 6.9) and had a median total body surface area of 15% (IQR = 25.5). Individual burn characteristics did not impact Peer Relationships scores; however, they did have a significant effect on Upper Extremity, Mobility, and to a lesser extent, Pain Interference scores. Older injury age (-0.24, p = 0.02), longer length of stay (-0.25, p = 0.02), larger total body surface area (-0.27, p = 0.009), and more operating room visits (-0.28, p = 0.006), were associated with worse Upper Extremity scores. Similarly, older injury age (-0.2, p = 0.04), longer length of stay (-0.25, p = 0.01), more days in the intensive care unit (-0.24, p = 0.01), and more operating room visits (-0.26, p = 0.01) impacted Mobility scores. Worse Pain Interference scores were correlated with longer length of stay (0.24, p=0.01), and larger total body surface area (0.19, p=0.05). Upper Extremity scores correlated with Mobility scores (0.60, p &lt; 0.0001); Pain Interference (-0.23, p &lt; 0.02) and Upper Extremity (0.3, p &lt; 0.003) scores correlated with Peer Relationships scores; and Upper Extremity (-0.48, p &lt; 0.0001) and Mobility (-0.42, p &lt; 0.0001) scores correlated with Pain Interference scores.

Conclusions
Peer Relationships scores are not influenced by patient demographics or burn characteristics. This is in contrast with Upper Extremity, Mobility, and Pain Interference scores which are all directly affected by burn characteristics. The patients’ impression of their upper extremity function has the greatest impact on their perceived pain, peer relationships, and mobility.
82 Early Skin Excision Decreased the Risk of Skin Infection, Sepsis and Mortality Among Burn Patients
Authors: De La Tejera Giovanna , Song Juquan , Corona Kassandra K , Gotewal Sunny , Wermine Kendall , Efejuku Tsola A , Keys Phillip H , Joglar Alejandro A , Villarreal Elvia L , Huang Lyndon G , Chokshi Shivan N , Chaij Jasmine M , Bagby Shelby P , Haseem Maria , Golovko George , El Ayadi Amina , Wolf Steven E 
Published: March 2022

Abstract

Introduction
In lieu of outdated and limited patient studies on excision for severe burns, a more comprehensive analysis is indicated to determine the effects of early skin excision following burn. This study aims to address the outcomes of early excision.

Methods
Data collection and analysis was performed using TriNetX, a national research database. The study population included patients ranging from 0 to 90 years old who underwent excision for burns. Groups were stratified by the number of days after injury in which they received a skin excision treatment. Five outcomes were analyzed: death, cardiac stress, wound infection, blood transfusion, and sepsis. Risk and incidence of various health outcomes were compared between groups after matching for age, gender and race, using a z-test with p&lt; 0.05 considered significant.

Results
We identified 2,522 patients who underwent excision between 0-3 days, 825 between 4-7 days, and 419 between 8-14 days following burn. We found a significant decrease in risk of skin infection and sepsis for skin excision 0-3 days after burn compared to 4-7 days (p&lt; 0.05). Additionally, the frequency of blood transfusion significantly increased for those with excision 0-3 days after burn when compared to 4-7 days (p&lt; 0.05). There was a significant increase in the risk of mortality for patients who received skin excision 8-14 days after injury as compared to both 0-3 days (p&lt; 0.05) and 4-7 days (p&lt; 0.05). However, we found no statistical difference in cardiac stress, skin infection, blood transfusion or sepsis between 0-3 and 8-14 days nor 4-7 and 8-14 days.

Conclusions
Skin excision 0-3 days after burn injury results in a significantly lowered risk of skin infection and sepsis as compared to skin excision 4-7 days and 8-14 days after burn. Skin excision within the first 7 days after burn decreased the risk of mortality as compared to excision 8-14 days after burn. The risk of blood transfusion increased with early excision, which may be explained by the severity of the injury.
91 Comparison of a Polylactic Acid Skin Substitute to Porcine Xenograft for Pediatric Partial Thickness Burns
Authors: Pogson Kaylyn B , Chrisco Lori , Nizamani Rabia , Williams Felicia , King Booker 
Published: March 2022

Abstract

Introduction
In August of 2020, our institution transitioned from porcine xenograft to a polylactic acid skin substitute for the management of pediatric partial thickness burns. This change in treatment was due to the discontinuation of porcine xenograft by the primary supplier to the United States. We sought to make a length of stay (LOS), postoperative pain score, postoperative dressing change, and cost analysis of the polylactic acid skin substitute as compared to porcine xenograft for the treatment of pediatric burns.

Methods
Patients were identified using an institutional Burn Center registry and linked to clinical and administrative data. All pediatric patients admitted between January 1st, 2019 and March 31st, 2021 who sustained partial thickness burns were eligible for inclusion. LOS, burn etiology, total burn surface area (TBSA), postoperative pain scores, postoperative dressing changes, complications, infections, and hospital cost were evaluated.

Results
A total of 259 patients were identified, 47 of whom received the polylactic acid skin substitute and 212 of whom received xenograft. Average age for polylactic acid skin substitute patients was 5.4 years with 51.1% male, average age for xenograft patients was 4.6 years with 58.5% male. Average LOS for polylactic acid skin substitute patients was 3.4 days and 3.2 days for xenograft patients (p = 0.45). Etiology of burns was 83.0% scald and 10.6% flame for polylactic acid skin substitute patients and 80.2% scald and 9.40% flame for xenograft patients (p = 0.66 and p = 0.71, respectively). Polylactic acid skin substitute patients had an average TBSA of 5.3% and xenograft patients an average TBSA of 4.3% (p = 0.11). Postoperative pain scores on postoperative day (POD) 1 were 1.1 for polylactic acid skin substitute and 1.2 for xenograft (p = 0.13). Average number of inpatient postoperative dressing changes was equivalent between the polylactic acid skin substitute and xenograft (p = 0.62), while average day of first postoperative dressing change was POD 10.9 for the polylactic acid skin substitute and POD 9.9 for xenograft (p = 0.15). Neither group had postoperative infections, though xenograft had a complication rate of 1% with 2 patients while the polylactic acid skin substitute had 0%. Polylactic acid skin substitute patients had an average hospital cost of $28,415 and xenograft patients an average of $27,935 (p = 0.80).

Conclusions
A polylactic acid skin substitute is equivalent to porcine xenograft in LOS, postoperative pain, postoperative dressing changes, and cost in the setting of similar age, burn etiology, and %TBSA. More analysis with wound healing indices and safety profiles could determine the clinically superior choice.