bluuebunny/crossref_metadata_2025_split huggingface dataset:
605 Revision Surgery Following Severe Frostbite Compared to Similar Hand and Foot Burns
Authors: Coward Alexandra , Nygaard Rachel M , Endorf Frederick W 
Published: March 2022

Abstract

Introduction
Severe frostbite is associated with high levels of morbidity through loss of digits or limbs. The current practice is to salvage as much of the limb/digit as possible with the use of thrombolytic and adjuvant therapies. Sequalae from amputation can include severe nerve pain and poor wound healing requiring revision surgery. The aim of this study was to examine the rate of revision surgery after primary amputation and compare this to revision surgery in isolated hand/foot burns.

Methods
Frostbite and burn patients from 2006 to 2019 were identified in the prospectively maintained database at a single urban burn and trauma center. Patients with primary amputations related to isolated hand/foot burns or frostbite were included in the study. Descriptive statistics included Student’s T-test and Fisher’s Exact test.

Results
A total of 63 patients, 54 frostbite injuries and 9 isolated hand or foot burns, met inclusion criteria for the study. The rate of revision surgery was similar following frostbite and burn injury (24% vs 33%, P=0.681). There were no significant differences in age, gender, or LOS on the primary hospitalization. Neither the impacted limb nor the presence of infection or cellulitis on primary amputation were associated with future need for revision surgery. Of the 16 patients requiring revision surgery, 5 (31%) required additional debridement alone, 6 (38%) required re-amputation alone, and 5 required both. A total of 6 patients (38%) had cellulitis or infection at the time of revision surgery. Time from primary surgery to revision ranged from 4 days to 3 years.

Conclusions
Planned, delayed primary amputation is a mainstay of frostbite management. To our knowledge, this is the first assessment of revision surgery in the setting of severe frostbite injury. Our observed rate of revision surgery following frostbite injury did not differ significantly from revision surgery in the setting of isolated hand or foot burns. This study brings up important questions of timing and surgical planning in these complex patients that will require a multicenter collaborative study.
613 Evaluation of Non-Euphoric Phytocannabinoid Elixir 14 (NEPE-14) Application in Deep Partial-Thickness Burn Wounds
Authors: Larson David A , Carlsson Anders H , Nuutila Kristo , Christy Sean E , Jockheck-Clark Angela R , Christy Robert J 
Published: March 2022

Abstract

Introduction
Combat-related burn wounds can be caused by exposure to a wide variety of agents including heat, electricity, radiation, chemicals, and friction. Early intervention can decrease injury severity by preventing excess inflammation and improve long term healing outcomes. In recent years, numerous studies have demonstrated that cannabinoids can trigger anti-inflammatory responses and promote wound closure. This study investigates whether a proprietary, non-euphoric, topical cannabinoid formulation (NEPE-14) facilitates burn wound healing when compared with Silverlon®, the military standard of care for burns incurred while in the field.

Methods
Forty-eight deep-partial thickness burns were created on the dorsum of four anesthetized swine (Sus scrofa domestica) using a thermocoupled burn device at 100°C. One hour following burn, biopsies from each site were collected and either NEPE-14, NEPE-14 Vehicle Control, Silverlon®, or dry gauze was placed on the wound. Wounds were assessed on post-burn days (PBD) 3, 7 and 14. Assessments consisted of digital photographs, Laser-Speckle imagery (blood perfusion), FLIR imagery, MolecuLight® imagery and biopsies for histology and immunohistochemistry.

Results
By PBD 14, no significant differences in re-epithelialization or contraction were observed between any of the tested treatment groups. Silverlon® had the highest percent re-epithelialization with 42%, and the Vehicle control has the lowest percent re-epithelialization with 28 %. Both NEPE-14 and dry gauze performed intermediately with 29% and 34% re-epithelialization, respectively. On PBD 14, the wounds of the NEPE-14 treated wounds contracted 8%, the vehicle control 7%, Silverlon® treated wounds 10%, and gauze treated wounds showed 9% contraction compared with the original wound area. Blood perfusion at PBD 14 indicated that NEPE-14 treated wounds had the lowest amount of observed blood flow and the gauze treated wounds contained the highest amount of observed blood flow. However, no statistically significant differences were observed.

Conclusions
No statistically significant results were seen between treatment groups for contraction, re-epithelialization, or blood perfusion. Although not significant, blood perfusion results indicate that NEPE-14 treatment had the lowest amount of blood flow, which can be seen as an indicator of healthy underlying tissue and a wound re-epithelializing. At PBD 14, all treatment groups had slightly contracted after increasing in wound area on PBD 3 and 7, which is a pattern seen in similar burn injury studies. We are currently awaiting histological analysis to strengthen our re-epithelialization results and evaluate burn wound progression.
714 Safety and Efficacy of Enteral Nutrition During Burn Surgery: A Retrospective Chart Review
Authors: Toepfer Danielle M , Mangano Lacey , Eshraghi Niknam 
Published: March 2022

Abstract

Introduction
Burn injuries are life-threatening conditions consisting of elevated oxidative stress, severe inflammation, and an increased hypermetabolic and catabolic state. It is recommended to start enteral nutrition (EN) early in the burn injured patients. These patients undergo many operations, and with stopping of EN the intermittent caloric deficit multiplies. This leads to increased risk of negative outcomes. We sought to analyze the efficacy of continuing EN feedings during burn surgeries to maximize caloric intake while also evaluating for adverse outcomes such as pneumonia.

Methods
A retrospective chart review of intraoperative feeding and pneumonia rates in pediatric and adult burn patients admitted during 2011-2017 to a regional burn center was conducted. Inclusion criteria included patients with secured airway via endotracheal tube or tracheostomy, mechanical ventilation for at least four days, and those who received EN during operations. The 2017 National Burn Repository (NBR) was used as the control population with mechanical ventilation ≥4 days and a yes/no pneumonia diagnosis. Our assumption was that these patients likely did not receive intraoperative EN as this is not standard protocol at this time.

Results
67 patients from our center and 779 NBR patients met inclusion criterion. EN were provided in 49-79% of total operations in the study group. The study group had a longer length of stay (LOS: 62 ± 34.4 vs 41 Days ± 31.7; p&lt; 0.0001), Ventilator days (39 ± 28.9 vs 23 ± 43.9; p&lt; 0.0001) and total body surface area burn percentage (TBSA: 36 ± 21 vs 31 ± 23 p-0.029).
The relationship between pneumonia, inhalation injury, COPD, diabetes, and current smoking status was examined in the case population. The odds of a patient with inhalation injury developing pneumonia was 2.83 times greater than a patient without an inhalation injury. There was a higher pneumonia rate in the study group compared to control population (56.7% vs 18.9%; p&lt; 0.0001). However based on a multinomial logistics regression analysis, there was no statistically significant association between intraoperative feeding and pneumonia in the study group (p-0.597).

Conclusions
We found a significant difference in the occurrence of pneumonia in our patient group compared to the NBR population, but our patients had higher LOS, ventilator days and TBSA burns. This suggest that our study group may have had higher acuity increasing risk of pneumonia. Our pneumonia rates do correspond with the rates reported from other comparable populations of burn patients. Despite this we did not find and association suggesting intraoperative feedings as the cause.
717 Critically injured patients receiving kefir may have lower rates of Clostridium difficile
Authors: Lillie Andrea , Nordlund Megan , Stewart Barclay T , Gause Emma L 
Published: March 2022

Abstract

Introduction
Kefir is an easy to administer per feeding tube probiotic yogurt that does not contain the risk of powdered probiotics, which may contaminate patient wounds or intravenous lines. Previous studies show patients taking probiotics may decrease hospital-acquired infections (HAI) although kefir has not been well studied. We hypothesized that kefir would be well tolerated and prevent infections among critically injured patients including patients with burn injury on enteral nutrition (EN).

Methods
We performed a retrospective review of adult critically injured patients at a level 1 trauma and burn center from January 2018 to March 2021 who received EN. Patients with a history of clostridium difficile (C. diff) were excluded. Patients who received kefir were given 120ml twice daily. The kefir protocol was improved with input from clinical stakeholders. The rate of C. diff, catheter-associated urinary tract infection (CAUTI), and central line-associated blood stream infection (CLABSI) were compared between patients who received kefir and those who did not. Incidence rate ratios (IRR) and corresponding 95% confidence intervals were calculated to assess differences in these rates.

Results
3,814 patients met criteria, 545 of whom received kefir (14%). Suggested improvements to the kefir protocol by stakeholders were changing flavored to plain kefir to decrease the amount of carbohydrate, change to lactose-free kefir to improve usage in lactose intolerant patients, and educate nurses on flushing feeding tubes to avoid clogs.
None of the incidence rates of HAI were significantly different between patients who received kefir and those who did not (Table 1). Crude IRRs suggest that C. diff infections may have occurred less frequently among patients who received kefir while the reverse occurred for CLABSI infections, though these results are not significant.

Conclusions
The kefir implementation was refined by stakeholder feedback. Although no clear benefit of kefir was observed with HAI reduction, future research should investigate the potential association between kefir use and C. diff.
729 "Feets" of Strength: How Glabrous Skin Defied the Odds
Authors: Gernt Megan , O'Rourke Cassandra 
Published: March 2022

Abstract

Introduction
58 year old female with past medical history notable for IDDM with peripheral neuropathy presented to ER after stepping barefoot onto asphalt in August 2020. Patient initially presented to community ER who performed bedside debridement and referred patient to wound clinic for management. After presenting to wound clinic, patient was referred to Burn center. She arrived 10 days after burn and was found to have full thickness burns to the soles of bilateral feet, 3% TBSA. The majority of the soles of both feet were injured. The patient had little residual glabrous skin which was uninjured. Glabrous skin is highly specialized skin and grafting non glabrous skin to the soles of the feet does not have optimal functional outcomes.

Methods
The patient was extremely compliant and willing to do whatever was necessary to maintain function. The patient underwent one debridement, two debridements with allografting, and one debridement with wound vacuum application. Wounds were initially treated with daily silvadene dressings and transitioned to daily damp to dry and finally to daily xeroform dressings. Wounds were measured at each follow up appointment, plan was made to intervene only when wounds stopped showing progress, however this plateau was never reached, and wounds were allowed to heal without any further intervention.

Results
One year post burn, the right sole is fully healed while the left sole remains with small open area. The patient does have significant alterations to her gait pattern. However, the patient has managed to heal her wounds and is functioning independently.

Conclusions
Given patient’s IDDM, her perceived chances of healing a graft was low. Furthermore, her risk of infection and eventual amputation was high. Given a very compliant patient and diligent wound care, the patient was able to achieve significant healing of wounds without the need for amputation. Glabrous skin is specialized skin and grafting non glabrous skin to the soles of the feet does not have optimal functional outcomes. Allowing the patient’s own glabrous skin to pull across the bed and heal has provided for optimal functional outcomes.
738 Does A History of Malignancy Lead to Worse Outcomes in Burns?
Authors: Sljivic Sanja , Chrisco Lori , Nizamani Rabia , King Booker , Williams Felicia 
Published: March 2022

Abstract

Introduction
A history of malignancy is associated with worse outcomes in cardiac disease and trauma. Our objective was to determine if a past medical history of cancer portends increased morbidity or mortality in burns or skin-sloughing disorders.

Methods
Patients were identified using our institutional Burn Center registry and linked to the clinical and administrative data. All patients admitted between January 1, 2014 and June 30, 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 8,018 patients were admitted during this period, and of those patients, 436 had a history of cancer (5%). Patients with a history of cancer were older (56 years versus 44 years), p&lt; 0.0001. They had a significantly longer LOS. They had larger burns and higher hospital costs. They were more likely to be female and more likely to have a skin-sloughing disorder. Patients with a history of cancer also had higher mortality rates.

Conclusions
A history of cancer 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.
748 Burn Center Family Needs Study Brings Changes to The Unit Practice
Authors: Hsu Naiwei , Fox Jasmine 
Published: March 2022

Abstract

Introduction
Pediatric burn patient family needs have many similarities to adult burn patients. However, based on our abstract Family Needs of Adult & Pediatric Burn Patients study from 2013 to 2018, there is a difference. We found our desire to preserve the pediatric burn patient family members as the "safe, comforting person" prevented them from learning all the necessary skills to be the successful caregivers once the child was discharged.

Methods
An integrative review is conducted using a literature search from EBSCOhost, CINAHL, Scopus, Medline, and PubMed. We found very little information addressing this specific concern for our pediatric burn population. However, there is a lot of literature discussing how to involve pediatric family members with other childhood diseases and the benefits of making pediatric family members a part of the treatment team. We shared our literature findings along with the results of responses we got from our Family Needs of Adult & Pediatric Burn Patients study with our Shared Decision-Making (SDM) Council and implemented our new practice.

Results
An informal interview results showed much improved pediatric burn family member satisfaction. By the time the family takes the burn child home, they demonstrate proficient dressing change skills along with the knowledge of how to manage their pain, itch, nutritional needs, and how to contact their care team as needed.

Conclusions
While most of us know the importance of family centered care, putting this concept into practice need more structured approaches and administrative support. Unit based SDM Council and Journal Club can help to keep our nursing staff, especially the new hires to embrace this practice.
760 Wholistic View of Autografting Patients by %TBSA Burned: Medical Chart Abstraction Integrated with Administrative Claims
Authors: Hahn Helen D , Yu Tzy-Chyi , Teng Chia-Chen , Tan Hiangkiat 
Published: March 2022

Abstract

Introduction
The current literature of severe burns with autografting is scarce or limited to single data source. This study provides a wholistic view of the clinical and economic characteristics of the inpatient treatment of patients with burns using integrated medical chart abstraction with administrative claims.

Methods
Patients with thermal burns undergoing inpatient autografting between July 1, 2010 and November 30, 2019 were identified from large national health plans, representing over 50 million members in the US. The first observed hospitalization with autografting was regarded as the index event. Two hundred hospital patient medical records were abstracted for the clinical characteristics, using a standardized abstraction form, which were integrated with administrative data for economic characteristics. Those with large % TBSA were oversampled. Patients were stratified into three cohorts by %TBSA burned. A Bonferroni correction of alpha 0.017 was performed for post-hoc pairwise tests.

Results
Of 200 patients, 90 were categorized as low TBSA (&lt; 10%), 75 moderate TBSA (10 – 24%), and 35 high TBSA (25+%). Overall, the high %TBSA cohort appeared to be younger, requiring more intensive care, and thereby incurring higher costs of care. The extent of some undocumented critical fields in the medical records was significant, for example (%undocumented): donor size (80%), BMI (31%), mesh ratio (30%), etc.

1 mean (SD)
* compared with low TBSA, p&lt; 0.017

Conclusions
This study not only confirmed some conventional understanding of various TBSA cohorts, but also quantified their differences/similarities using multiple data sources. There was considerable incompleteness in many critical fields in the medical records, which limits the ability to generate broader insights. Despite the wide regard of medical records as a “gold standard” for outcomes analyses, future research should be aware of these limitations.
769 The association of a burn injury with social engagement: A Preschool-LIBRE1-5 study
Authors: Baird Maree , Skipton Romanowski Kathleen S , Ni Pengsheng , Patel Khushbu F , Kazis Lewis E , Ryan Colleen M , Palmieri Tina L 
Published: March 2022

Abstract

Introduction
Social engagement, primarily through peer interactions, is an active-coping strategy that is key to community re-integration after a burn injury. For young children, social engagement encourages standard development, with burn injuries potentially affecting their likelihood to engage with others. We utilized the parent-report Preschool-LIBRE1-5 (Life Impact Burn Recovery Evaluation) to explore factors that can influence a child’s social engagement.

Methods
Our participants were 426 parents of burned children ages one through five who completed the Preschool-LIBRE1-5. Four variables involving social engagement were assessed: “frequency of child avoiding other children,” “frequency of child playing alone,” “frequency of child wanting to be left alone,” and “frequency of child liking to be around other children.” Responses from a 5-point Likert scale ranging from never to always were recoded on a 3-point Likert scale such that a higher score indicated increased social engagement. A nominal logistic regression analysis was conducted with each social engagement variable as a separate dependent variable for each model. The age of the patient when the survey was completed and gender were independent variables. The models also were adjusted by the presence of a hand burn, a face burn, burn size, race, and ethnicity. A bootstrap analysis was conducted to assess internal validity of the significant findings.

Results
The sample characteristics included: mean age of 3.1+1.4 years, mean time since burn injury of 1.2+1.3 years, mean total body surface area (TBSA) of 4.2+7.9, 55.2% male, and 74.2% white. Findings did not reach significance for three of the dependent variables. However, the dependent variable “frequency of child liking to be around other people” was significant with an increased odds of 35.8% for older children compared to younger ones. (OR [95% CI] =1.358 [1.027, 1.795]). Further, boys were much less likely to want to be left alone (OR [95% CI] = 2.97[1.36,6.5]). Among 500 bootstrap samples, 59% and 79% of the samples replicated the significant findings respectively.

Conclusions
In preschool children with burn injuries, burn location, race, and ethnicity were not associated with the social engagement items tested in this study. Boys did show a higher likelihood of peer engagement suggesting that gender may influence a child’s desire to be alone.
771 Improving Burn Care in the Amish Community: A Qualitative Study of Strengths and Needs
Authors: Brumbaugh Jamey T , Kelleher Jennifer A , Snider Mira , Sturges Mariah , Aballay Ariel M , Duncan Christina L 
Published: March 2022

Abstract

Introduction
Amish communities present with a higher risk for sustaining traumatic burn injuries; thus, these communities have a high need for culturally competent burn care. Although homeopathic remedies for mild to moderate burn injuries have been studied in Amish communities, little is known about hospital-community partnerships to facilitate culturally competent burn care, particularly with more severe injuries. The current study aimed to 1) understand the successful aspects of an existing hospital-community partnership for facilitating culturally sensitive burn care for Amish communities, and (2) identify the ongoing physical, structural, and behavioral health needs of this population as the partnership continues to develop.

Methods
Qualitative data from 12 Amish caregivers who participate on a burn/wound team or an oil therapy team, were collected on through a focus group interview. Caregivers identified as White, were majority male (83%), and resided in Amish communities. Retrospective thematic analysis was used to analyze the qualitative data. Five major themes (i.e., informational needs, strengths of Amish burn care, behavioral health concerns, behavioral health resources, and preferred teaching methods) evolved.

Results
Results indicated that Amish caregivers displayed a great curiosity and openness to learning about all aspects of recommended burn care from the medical providers. Caregivers also cited their traditional (homeopathic) burn care procedures (e.g., oil therapy) as strengths, while simultaneously maintaining that their relationship to the hospital is a valuable part of their burn care. Relating to behavioral health, caregivers highlighted difficulties in helping their children cope with burn injuries and pain during rehabilitation and treatment. Caregivers emphasized the role of strong social support that the Amish community provides to burn survivors. Additionally, caregivers stressed the significance of delivering burn care information in a form that is culturally appropriate for their community.

Conclusions
Results of this study provide important considerations that other accredited burn centers may consider when establishing similar partnerships to enhance their delivery of culturally competent medicine for Amish burn survivors.