bluuebunny/crossref_metadata_2025_split huggingface dataset:
T1 Healthcare Utilization After Thermal Injury: An Analysis Using a Commercial Claims Database
Authors: Lewis Aislinn E , Horns Joshua J , Fleming Irma D , Lewis Giavonni M , Thompson Callie M 
Published: March 2022

Abstract

Introduction
Burn Injuries directly affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decrease in unplanned healthcare utilization after acute care discharge following burn injury and increased healthcare costs in patients who have undergone grafting for burn injury. The goal of this study is to describe post-acute care hospitalization healthcare use in burn patients.

Methods
A retrospective commercial claims database review was performed of the Truven MarketScan (MS) database. In a 10 year MS sample, 23,262 patients with burn injuries were identified and were matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. For the burn patient population in the study, pre-burn and post-burn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, we defined their pre-burn and post-burn periods using the burn event date of the matched case adjusted by the pair’s relative difference in initial enrollment into the MS database, and then recorded the same utilization metrics. A series of negative binomial regressions were completed to evaluate the data.

Results
At the conclusion of the study, for every outcome, except skilled nursing facility, healthcare utilization was greater in the pre-injury burn group relative to controls. Healthcare utilization for the burn cohort post-injury was greater for every outcome compared to controls. Relative to controls, healthcare utilization remains higher for at least 25 months post-injury in the burn patients and does not return to pre-injury levels during this time frame.

Conclusions
In a commercial claims database study, the healthcare utilization of the burn patients is higher both before and after burn injury than matched controls. Utilization does not return to preburn levels in the 25-month follow-up period. Additionally, burn patients have higher healthcare utilization prior to injury compared to matched controls, which may indicate an important difference in baseline health of these patients, and an opportunity for injury prevention.
T5 Tracking Cardiac Output During Burn Resuscitation via Pulse Wave Analysis
Authors: Kao Yi-Ming , ArabiDarrehDor Ghazal , Oliver Mary A , Reese Adam D , Keyloun John W , Chung Kevin K , Moffatt Lauren T , Shupp Jeffrey W , Hahn Jin-Oh , Burmeister David M 
Published: March 2022

Abstract

Introduction
Urine output (UOP) still remains the primary endpoint utilized as a surrogate for cardiac output (CO) and adequacy of perfusion during burn resuscitation. The role of arterial blood pressure (BP) waveform as a guiding tool for burn resuscitation has not been rigorously explored. As we move toward developing and validating novel endpoint to complement UOP, we compared the potential of pulse wave analysis (PWA) of arterial BP waveforms for estimating cardiac output (CO) and stroke volume (SV) in a large animal model of 40% total body surface area (TBSA) burns with varying resuscitation paradigms.

Methods
Anesthetized swine were instrumented and hemorrhaged 15% of their blood volume, and sustained a 40% TBSA full-thickness contact burn with aluminum billets. Animals were kept in a surgical ICU setting overnight, during which anesthesia was maintained with a combination of propofol, ketamine, and fentanyl. Animals were randomized to 3 different intravenous fluid (lactated Ringer’s, LR) levels: under resuscitation with no IV fluids, adequate resuscitation protocolized with a clinical decision support tool, or over resuscitation with a starting rate of 500mL/hour. We computed 20 surrogate measures of CO and SV (10 each) via PWA of arterial BP, and calibrated them to reference CO via thermo-dilution and SV on a subject-by-subject basis. Surrogate performance was quantified in terms of correlation coefficient and root-mean-squared error (RMSE) relative to reference CO and SV.

Results
Animals received 0±0, 4.4±1.6, and 9.1±1.3 mL/kg/% TBSA in the under, adequate, and over resuscitation groups (p=0.0036), respectively. Among the ten surrogate measures of CO and SV, 4 surrogates had positive proportionality to reference CO and SV consistently. The best surrogate measure of CO and SV was [mean BP-diastolic BP]/[heart period] and [mean BP-diastolic BP], respectively, which yielded r value of 0.82+/-0.19 and RMSE of 0.23+/-0.14 lpm for CO and r value of 0.85+/-0.17 and RMSE of 2.7+/-2.0 ml for SV (Fig. 1).

Conclusions
The initial results suggest that PWA-based surrogates of CO and SV have the potential to track reference CO and SV in extremes of resuscitation post-burn. The current model produces under-resuscitated, adequately resuscitated, and over-resuscitated animals, making it possible to rigorously examine the efficacy of PWA-based tracking of CO and SV in a wide spectrum of burn resuscitation scenarios. Hence, PWA may provide metrics useful for developing surrogates of CO and SV as novel treatment endpoints of burn resuscitation that indicate perfusion and volume status of burn injury patients.
4 Risk Association Between Race and Complications Following Burn
Authors: Haseem Maria , Wermine Kendall , Gotewal Sunny , Efejuku Tsola A , Chokshi Shivan N , Huang Lyndon G , Chaij Jasmine M , De La Tejera Giovanna , Corona Kassandra K , Golovko George , Song Juquan , Wolf Steven E , El Ayadi Amina 
Published: March 2022

Abstract

Introduction
Racial minorities have been recognized to experience worse health outcomes for many medical conditions. However, it is not clear if these outcomes are associated with pre-existing conditions or the quality of care those patients receive. In burns, little information on the relationship between race and burn comorbidities is available. This study examines the risk association between race and burn complications, such as pneumonia, sepsis, and ARDS while controlling for common comorbidities that affect burn recovery such as diabetes and hypertension.

Methods
Burn patient cohorts were identified by ICD10 codes for burn injury using TriNetX, a federated network of real-world data. The cohorts were stratified by race and balanced in terms of age at index, gender, BMI, and pre-existing comorbidities such as diabetes and hypertension. The following post burn outcomes were selected for analysis: renal failure, cardiovascular disease, sepsis, ARDS, graft complication, pneumonia, ICU admit, respiratory failure, hypertrophic scarring (HTS), hyperglycemia, and mortality. A measure of association analysis was performed to compare risk outcomes in black vs. white burn patients. Statistical significance was set at p&lt; 0.05. The same cohorts were analyzed for treatment pathways to compare critical care billing CPT codes for the amount of time seen by a physician: Critical Care and Evaluation, first 30-74 minutes, and Critical Care and Evaluation, each additional 30 minutes.

Results
The balanced patient cohorts comprised 78,974 patients per cohort. Black patients experience a positive relative risk ratio (RR) to renal failure (p &lt; 0.0001, RR = 1.372, 95% CI: 1.314-1.435), cardiovascular disease (p &lt; 0.0001, RR = 1.115, CI: 1.08-1.15), sepsis (p &lt; 0.0071 RR = 1.081, CI: 1.021-1.144), and ARDS (p &lt; 0.0010, RR = 1.287 CI: 1.107-1.496) following burn injury. However, black patients experience a negative risk ratio to mortality (p &lt; 0.0006, RR = 0.935, CI: 0.89-0.982) and pneumonia (p &lt; 0.0014, RR = 0.937, CI: 0.901-0.975). The risk ratio was not significant for outcomes between black and white burn patients for respiratory failure, HTS, hyperglycemia, and ICU admit. Analysis of treatment pathways did not show significant differences in Critical Care and Evaluation billing between the two races.

Conclusions
Black burn patients are more likely to experience renal failure, cardiovascular disease, sepsis, and ARDS compared to white burn patients despite controlling for common comorbidities. They are less likely to experience pneumonia and mortality.
7 Impact of Chronic Alcohol Use on Fluid Resuscitation in Burn Patients
Authors: McEwan Sasha , Iles Kathleen A , Chrisco Lori , Pak Joyce , Agala Chris , Williams Felicia , King Booker , Nizamani Rabia 
Published: March 2022

Abstract

Introduction
Acute alcohol intoxication in burn patients has been associated with increased mortality, renal dysfunction and difficulty with adequate fluid resuscitation. It is less clear how chronic alcohol use, regardless of intoxication status on admission, impacts patient outcomes. In this study, we examine chronic alcohol use and both short- and long-term outcomes in burn patients.

Methods
Patients were identified using an institutional burn center registry and linked to clinical data. Adults admitted from 2017 to 2020 with a total body surface area (TBSA) % above 10% and a hospital stay greater than 2 days were eligible for inclusion. A total of 298 patients were enrolled and chart review completed for admission labs and fluid administration. Alcohol use was also examined and patients were staged based on severity and chronicity of alcohol use: none/minimal, early/moderate use, and problem/severe abuse. Renal dysfunction was defined based on Acute Kidney Injury Network criteria. Linear regression was used to assess the association between alcohol use and fluid resuscitation. Multiple logistic regression was used to assess alcohol use and renal dysfunction with adjustment for confounders.

Results
Compared to patients with none/minimal (NM) alcohol use and early/moderate (EM) alcohol use, patients in the problem/severe (PS) alcohol use category were older (NM 45.4 years, EM 44.1 years, PS 52.2 years; p=0.02), had larger mean TBSA burns (NM 18%, EM 14.9%, PS 23.1%; p=0.03), were more likely to have third degree burns (NM 53.8%, EM 36%, PS 72.4%; p=0.02), and more likely to have inhalation injury (NM 7.2%, EM 0%, PS 24.1%; p&lt; 0.001). Patients in the PS category also had a significantly longer hospital length of stay (LOS) (p&lt; 0.001), ICU LOS (p&lt; 0.001), and ventilator days (p=0.005). Mortality was higher for the PS group (21.7%) compared to the NM (6.6%) and EM (0%) groups; p=0.001. These correlated to higher mean hospital costs for patients in the PS category compared to those in the NM category ($394,964 versus $868,126, p&lt; 0.001). After adjusting for TBSA, patients in the PS category required more fluid resuscitation within 48 hours of admission compared to the NM category (p=0.0138), despite a lower mean admission BMI (27.1 vs 30.03, p=0.03). Although there was a trend toward increased rates of acute renal injury within 48 hours of admission in the PS group (32.7%) vs the NM group (21%), this did not reach statistical significance.

Conclusions
Chronic alcohol use was associated with more severe burn injury, increased morbidity and mortality, and greater resource use. Even after adjustment for comorbidities and TBSA, chronic alcohol use resulted in a need for increased initial fluid resuscitation.
11 A Twenty-one Year Review of Medical Malpractice Cases in Burn Care
Authors: Pham Christopher H , Dang Justin , Huang Melissa , Collier Zachary J , Gillenwater Justin , Garner Warren L , Kelly Richard 
Published: March 2022

Abstract

Introduction
Traumatic injuries are a common source of medical litigation but no prior studies have reported on the trends of medical malpractice in burn care. As a result, it is unclear what factors increase the likelihood that a medical professional caring for a burn patient will be named in a lawsuit. By understanding what drives patient discontent and the motivations behind their malpractice claims, burn care practitioners can better care for patients and decrease their own risk of involvement in medical litigation.

Methods
The Westlaw legal research database contains state and federal court documents from over 40,000 databases across the United States and was queried for all cases of burn injuries and medical malpractice from 2000 to 2021. All mechanisms-of-injury (e.g. flame, scald, electrical, chemical, Stevens-Johnson, etc.) were included. Case information including injury circumstances, plaintiff/defendant occupation, defendant burn care experience, and burn demographics (TBSA, mechanism) were recorded when available. The primary outcome was the case ruling (plaintiff or defendant), and settlement amounts were recorded when available.

Results
Forty of the 1,222 identified cases fit inclusion criteria. Twenty-seven percent (11/40) of cases involved treatment at a burn center and 82% of plaintiffs were men. The two most common mechanisms-of-injury were scald (38%) and flame burns (18%). The court ruled in favor of the plaintiff in 10% (4/40) of cases. When the court/jury ruled in favor of the plaintiff, the settlement amount ranged from $25,000 to $20,000,000. The most frequently sued medical specialty was Family Medicine (35%) and mid-level practitioners like physician assistants and nurse practitioners (35%). Physicians with a burn fellowship were named in only 5% (2/40) of cases. The most common claims were for burn depth misdiagnoses (7/40), deliberate indifference/treatments below standard-of-care (7/40), and delayed referrals to a burn specialist (6/40). All cases met American Burn Association transfer criteria. Patient mortality was the reason for litigation in 10% (4/40) of cases.

Conclusions
This study showed that most burn-specialized practitioners are not the subject of litigation. In fact, many patients filed malpractice claims because they were not referred to burn specialists. Based on case text analysis, all of the patients’ injuries fit American Burn Association transfer criteria and some lawsuits may have been avoidable.
15 Poverty and Frailty in Patients with Burn Injuries: Important but Unrelated
Authors: Wallace David L , Sloan Keturah , Williams Deborah , Heard Jason , Greenhalgh David , Palmieri Tina L , Sen Soman , Skipton Romanowski Kathleen S 
Published: March 2022

Abstract

Introduction
Previous work has demonstrated that frailty predicts mortality and patient disposition in burn patients &gt;50 years old. It is unknown to what extent poverty contributes to these outcomes. There has been no work demonstrating the interplay of these two variables on patients with burn injuries. The purpose of this study was to determine the relationship of frailty and poverty in burn patients over the age of 50, and their association with patient outcomes.

Methods
A 9-year retrospective chart review from 2009-2018 of patients &gt;50 years old admitted to an ABA verified burn center with acute burn injuries was completed. Patient demographics, burn characteristics, frailty scores and poverty levels were collected. Frailty scores were assigned using the Canadian Study of Health and Aging Clinical Frailty Scale (scored 1-7). Frailty was dichotomized with scores &gt;5 being frail. Poverty data were obtained using zip code and US census data. Poverty level was categorized according to whether a patient came from a zip code that had &gt;20% of people living in poverty. Descriptive statistics, univariate analysis, and multivariate analysis were completed to examine the relationship between frailty and poverty, as well as each variable independently on mortality and length of stay (LOS).

Results
A total of 953 patients were included. Mean age was 63.5 + 10.4 years and 675 (70.8%) were male. Mean %TBSA was 11.4%+14.2% and mean frailty score was 3.8 + 1.2. Upon admission, mean poverty score was 17.3+ 8.7. The overall mortality rate was 8.8%. Univariate analysis demonstrated that non-survivors had significantly higher chances of living in poverty (p=0.02). Similarly, univariate analysis showed that non-survivors were more likely to have frailty scores of 5 or greater compared to survivors. Multivariate logistic regression confirmed relationship between poverty and mortality (&lt;20% vs &gt;20%, OR 0.47 95% CI 0.25-0.89) and frailty and mortality ( &gt;5 vs 1-4, OR 2.9 95%CI 1.4-5.8). It also demonstrated that the combined variable of frailty and poverty was not significantly associated with mortality (Wald χ2 2.0, p=0.15). Neither poverty (&lt; 20% vs &gt;20%, p=0.26) nor frailty (1-4 vs &gt;5, p=0.52) were associated with LOS. Both poverty and frailty were associated with a patient’s disposition destination (p=0.03; p&lt; 0.0001). Univariate analysis did not show a significant correlation between poverty and frailty (p=0.08), though there was a trend towards significance.

Conclusions
Poverty and frailty each independently predict mortality and discharge destination in burn patients &gt;50, but they are not associated with LOS, and do not show a significant association with each other, nor a combined effect on mortality.
17 A Tissue-engineered Bi-layer Skin Substitute Polarizes Macrophages Towards an M2 Phenotype
Authors: Hernaez-Estrada Beatriz , Steele Lindsay , Spiller Kara 
Published: March 2022

Abstract

Introduction
Cellular and/or Tissue Product made of stratified keratinocyte-containing epidermis and fibroblast-embedded collagen dermis, has been shown to promote healing in patients with deep partial- thickness burns. The biological mechanisms behind these effects are poorly understood. Macrophages, the primary cell type of the innate immune system, are major regulators of all stages of tissue repair. They accomplish these diverse functions by shifting phenotype throughout the healing process from a pro- inflammatory population to a diverse population of phenotypes that orchestrate resolution of inflammation and healing. In burn injuries this transition is impaired. We hypothesized that skin substitutes promote this healthy transition in macrophage phenotype. The aim of this study was to analyze the crosstalk between skin substitutes and macrophages and to determine the influence of direct contact, secreted factors, and the substrate used in fabrication of the skin substitutes.

Methods
Primary human macrophages (N=4 donors) were co-cultured either directly or indirectly with a skin substitute via separation by transwell inserts. Macrophages were also cultured directly on the collagen scaffolds used in the skin substitute fabrication process or on low-activation plastic as an unactivated control. After 1 and 3 days, the macrophages were stained with a 10-marker flow cytometry panel to characterize macrophage phenotype: general marker (CD45), M1-related markers (CCR7, CD80, CD38 and PD-L1) and M2-related markers (CD206, CD209, CD163 and CXCR4). For a more thorough evaluation, multidimensional analysis was used to identify unique populations of macrophages. Large-scale Dimensionality reduction using triplets and clustering analysis with using FlowSOM algorithms were performed. Statistical analysis of individual marker expression or cell composition within clusters was performed with one-way ANOVA.

Results
In response to both direct and indirect interaction with skin substitutes, macrophages generally decreased M1 marker expression after 1 day in culture and increased M2 marker expression after 3 days. The suppression of M1 markers occurred when macrophages were co-cultured with skin substitutes, and in response to acellular collagen. The upregulation of M2 markers occurred only in response to direct or indirect interaction with cellular skin substitutes. Furthermore, multidimensional single cell analysis showed that contact with the skin substitutes also promoted unique populations of phenotypes that do not fit into the classical M1/M2 paradigm.

Conclusions
These results suggest that a potential mechanism by which skin substitutes promote healing is by promoting a transition of macrophages towards pro-reparative phenotypes.
31 Regional Anesthesia for Reducing Postoperative Opioid Use in Split Thickness Skin Grafting
Authors: Duggan Robert P , Mefford Austin T , Palackic Alen , Owolabi Adebukola , Branski Ludwik K 
Published: March 2022

Abstract

Introduction
Split thickness skin grafting is ubiquitous in the management of acute burns and burn reconstruction. Patients describe the resulting partial-thickness donor site wound as one of the most painful aspects of burn care. Managing donor site pain is challenging and frequently involves potent opioid regimens. Rapid reepithelization of the donor site makes long-acting local and regional anesthesia an attractive option for reducing opioid use. This study aims to determine the efficacy of graft donor site regional anesthesia at reducing postoperative opioid consumption in burn patients.

Methods
A retrospective review of burn patients undergoing split-thickness skin grafting at our institution was performed. Patient demographics, burn mechanism, and percent burned total body surface area were collected. The type of regional anesthesia, when it was performed, and the anesthetic agents used were also determined. Milligram morphine equivalents (MME) were calculated for three 24-hour periods postoperatively to quantify opioid usage. The total MME in 72h postoperatively was also determined and used to calculate per day MME requirements. Mean, and peak pain scores in the first 24h postoperatively were collected. Univariate and multivariate analyses were performed to determine the efficacy of regional anesthesia.

Results
Twenty-five patients were identified, 14 who received donor site regional anesthesia and 11 who did not. The two groups did not differ significantly in age, gender, race, BMI, or burn mechanism. The regional anesthesia group had a significantly lower percent burned TBSA (5.3 vs. 21.6, p &lt; 0.001). Still, donor site dimensions did not differ significantly between groups (363 cm2 vs. 411 cm2, p = 0.247). The use of regional anesthesia was associated with significantly lower MME requirements in the first 24h postoperatively (22.5 vs. 84.9, p = 0.023), lower total requirements after 72h (47.3 vs. 147.8, p = 0.016), and lower per day requirements (17.6 vs., 51, p = 0.014). The regional anesthesia group was discharged on average one week sooner (5.1 days vs. 12.4 days, p = 0.031). Multivariate analysis demonstrated the use of regional anesthesia independently predicted decreasing MME requirements in the first 24h after surgery, decreasing MME requirements in total, and decreasing per day MME requirements. No patients experienced anesthesia-related complications.

Conclusions
In a cohort of burn patients undergoing split-thickness skin grafting, the use of regional anesthesia was highly effective at reducing opioid requirements in the immediate postoperative period. We believe regional anesthetic blockades should be considered to provide long-lasting donor site analgesia. More investigation is warranted into ideal anesthetic agents, the maximum donor site dimensions, and the extent of cost savings.