bluuebunny/crossref_metadata_2025_split huggingface dataset:
56 Evaluation of a Smartphone Application as a Method for Calculating Total Body Surface Area Burned
Authors: Colson Cindy D , Alberto Emily A , Milestone Zachary P , Batra Nikita , Salvadore Tyler , Fooladi Hadi , Cleary Kevin , Izem Rima , Burd Randall S 
Published: March 2022

Abstract

Introduction
Current methods of burn estimation can lead to incorrect estimates of the total body surface area burned, especially among injured children. Inaccurate estimation of burn size can impact initial management, including unnecessary transfer to burn centers and fluid overload during resuscitation. To address these challenges, we developed a smartphone application that calculates the total body surface area of a burn using a body-part by body-part approach. The aims of this study were to assess the accuracy of the smartphone application and compare its performance to three established methods of burn size estimation (Lund-Browder Chart, Rule of Nines, Rule of Palms).

Methods
Twenty-four healthcare providers used each method to estimate burn sizes on moulaged manikins. The manikins represented different ages (infant, child, adult) with different total body surface area burns (small &lt; 20%, medium 20-49%, large &gt;49%). We calculated the accuracy of each method as the difference between the user-estimated and actual total body surface area. We used multivariable modeling to control for manikin size and method.

Results
Among all age groups and burn sizes, the smartphone application had the greatest accuracy for burn size estimation (-0.01%, SD 3.59%) followed by the Rule of Palms (3.92%, SD 10.71%), the Lund-Browder Chart (4.42%, SD 5.52%), and the Rule of Nines (5.05%, SD 6.87%).

Conclusions
The smartphone application may improve the estimation of total body surface area burned compared to existing methods.
61 A Burn Center’s Experience with COVID-19 Positive Burn Patients
Authors: McLawhorn Melissa M , Carney Bonnie C , Burkey Sarah E , Delatore Cara , Brantley Melissa , Moffatt Lauren T , Johnson Laura S , Shupp Jeffrey W 
Published: March 2022

Abstract

Introduction
The emergence of SARS-COV-2 and the COVID-19 pandemic has complicated the presentation, treatment, and prognosis of all types of patients. Further characterization and analysis of how concomitant COVID-19 infection impacts different patient populations is important for improving treatment strategies. Patients with burn injures often require ICU-level care, mechanical ventilation, and extensive surgical intervention. Concomitant COVID-19 infection in this population presents a new challenge to clinical teams. The purpose of this project is to compare COVID-19 positive burn patients treated at a regional burn center with those that are not.

Methods
Following IRB approval, our institution’s burn registry was queried from March 2020-June 2021. Data on demographics, injury circumstances, COVID-19 status, and outcomes were collected. Continuous variables were nonparametric and\compared using Mann-Whitney U test. Categorical variables were compared using Chi-squared with Fischer’s Exact test, where appropriate.

Results
Of the 622 patients admitted at our institution, 19 tested positive for COVID-19 during their hospitalization. Demographic and injury information is reported in Table 1. There were statistically significant differences between the COVID-19 positive and negative groups in regard to race and presence of inhalation injury (p=0.0002, p=0.0002). The TBSA burned was slightly higher in the COVID-19 positive group (9.1 vs 6.7%). COVID-19 positive patients spent more time ventilated (48±32.5 vs.12.2 ± 16.2 days, p=0.0035**) and had both longer ICU (42.71±37.41 vs 11.1±15.4 days, p=0.0175*) and hospital (26.32±32.14 vs 8.177±11.95 days, p&lt; 0.0001***) lengths of stay (LOS). No COVID-19 positive patients died while 5% of the COVID-19 negative patients did. All outcomes were statistically significant.

Conclusions
Despite similar TBSA injury burden and age breakdown, patients at our institution who tested positive for COVID-19 required more time on the ventilator and were hospitalized longer. People of color had a higher percentage of positive tests than their Caucasian counterparts. While mortality rates were higher in the COVID-19 negative cohort, morbidities associated with longer LOS must be considered.
63 Left out in the Cold: The Impact of Psychosocial Comorbidities on Victims of Frostbite
Authors: Tran Aurelie , Glick Hannah , Shen Mary R , Bettencourt Amanda , Vercruysse Gary 
Published: March 2022

Abstract

Introduction
Patients with psychiatric or substance use disorders (SUD) and those experiencing homelessness have been identified as populations likely disproportionately affected by frostbite injury. However, the literature is sparse in regards to morbidity and mortality in these patients. As such, we sought to examine and characterize factors associated with worse outcomes and increased resource utilization in this patient population.

Methods
Adult patients admitted to a single ABA-accredited burn center for frostbite between 2013-2021 were identified using an institution-specific data registry. A retrospective chart review was conducted on patients meeting inclusion criteria, as identified by ICD-10 and ICD-9 codes. The primary outcome was morbidity and mortality associated with frostbite, including hospital length of stay, number of operations, and readmission. Chi-square and t-tests were utilized to compare patients with and without SUD (alcohol, drug, or positive urine drug screen), psychiatric disorders, or homelessness.

Results
In total, 54 patients were identified (70% male), 19% had documented non-alcoholic SUD, 50% had alcohol use disorder, and 14% were homeless. No significant differences were found between these patients and others in terms of the number of operations or amputations required. However, patients with positive SUD screen (32.0% vs 8.0% p=0.03), positive UDS (46.7% vs. 0%, p=0.015), psychiatric disorders (27% vs. 0%, p=0.034), active drug use (50% vs 14.3%, p=0.01), or homelessness (50% vs 15%, p=0.026) were more likely to be readmitted with wound infections or progression of gangrene. Finally, patients with psychiatric disorders were more likely to require additional operations (1.8 vs 0.6, p=0.02) and longer length of hospital stay (16.0 +/- 2.9 vs 7.7 +/- 2.8, p=0.046).

Conclusions
Our results suggest significant differences in resource utilization and morbidity between those with and without a history of SUD, psychiatric disorder, or homelessness. Subsequent allocation of resources should target outpatient needs of at-risk patients to avoid similar outcomes. Future research should be focused on elucidating reasons for these differences which may include issues accessing follow-up care, inability to adhere to wound care, and more.
66 The Association of Burn Size and Global Functioning: A Preschool LIBRE1-5 Study
Authors: Surette Kate E , Ni Pengsheng , Patel Khushbu F , Rodríguez-Mercedes Silvanys L , Rencken Camerin A , Fabia Renata , Tully Carrie , Palmieri Tina L , Romanowski Kathleen S , Warner Petra , Stoddard Frederick J J , Schneider Jeffrey C , Kazis Lewis E , Ryan Colleen M 
Published: March 2022

Abstract

Introduction
Between the ages of one and five, children gain increased mobility and begin to explore their surroundings. This makes them a particularly vulnerable age group for burn-related injuries, which can influence a child’s physical and psychosocial development. Previous research in adult burn survivors associated larger burn size with poorer functional outcomes for social activities. Currently, there are limited data on the association in preschool aged survivors between burn size and functioning. The aim of this study is to understand how demographic characteristics, particularly burn size, correlate with the global functioning items using data from the Preschool-LIBRE1-5 study.

Methods
The Preschool-LIBRE1-5 was field-tested with 426 parents of burn survivors. Eight global items assessed change in functioning in four domains (physical, psychological, communication & language, and social) compared to pre-burn functioning. Demographic variables included gender, race, age at survey completion, total body surface area burned (TBSA), ethnicity, and pain severity. Post-burn abilities were assessed with “Following the burn injury, my child lost abilities he/she had before the burn injury in…”, measured with a yes or no response and compared to other children without burns with, “Compared to other children in the same age, in general, how would you rate your child’s…”, measured with a 5-point Likert scale ranging from much worse to much better. Multivariate logistic regression with multiple imputation for missing values were used to measure the association between demographic characteristics and global items.

Results
The population had a mean age at time of burn injury of 1.9 + 1.1 years and mean TBSA% of 4.2 + 8.0. Of the 426 participants, 305 have a TBSA &lt; 5%, 45 have a TBSA between 5%-15% and 45 have a TBSA &gt;15%. Larger TBSA was associated with lower odds of abilities in functional status for all four global functioning items. Adjusted odd ratios with 95% CI’s included communication and language 0.57(0.35,0.93), physical function 0.55(0.37,0.83), social function 0.33(0.2,0.52), and psychological/behavioral function 0.49(0.31,0.75). There was also a negative correlation of larger TBSA with weaker social abilities of the child compared to other children without burns.

Conclusions
The findings of this study show a negative association between a child’s burn size and parent-reported functioning in the four domains post-burn injury. These findings may help clinicians improve pediatric recovery and rehabilitation.
71 Burn Intensive Care Unit Early Mobility Competency Based Orientation
Authors: McGillicuddy Jennie , Bello Gina , Bergeron Kiane , Lee Jeanne 
Published: March 2022

Abstract

Introduction
Competencies in healthcare are used to teach practice standards, to establish expectations for professional growth, and to evaluate and improve the effectiveness of educational programs. Benefits of early mobilization of Burn Intensive Care Unit (BICU) patients include improved ICU related weakness and delirium, range of motion, and decreased length of stay while promoting functional independence. A rehabilitation competency was developed for early mobility with the patient in the BICU using nationally agreed-upon standards for competence. By design this competency for BICU early mobility is part of a tiered training structure, with the burn rehabilitation and pediatric competencies serving as additional tiers of burn therapist training at our organization. The goal of this competency is to provide direct therapist training, including alignment with the inter-professional team involved with this intervention.

Methods
A pretest was issued regarding BICU early mobility competency. The pretest asked the therapist to indicate their perceived level of competence in the areas of functional mobility, indications and contraindications of BICU early mobility, Respiratory Care Provider (RCP) protocols and documentation of BICU early mobility. Based on the results of this pretest, it was identified that BICU early mobility would be prioritized as the next training tier. The BICU Early Mobility Competency was created in Competency Based Orientation (CBO) format, including nationally agreed-upon standards for burn therapist competence. The method of this training is designed to occur with an ongoing patient case study for validation, with the CBO as the teaching tool.

Results
Creation of this competency as part of a tiered training allows our burn center to have an educational program which aligns with the nationally agreed-upon standards for burn therapist competence. Creation of this competency resulted in direct communication channels between rehabilitation, RCP, nursing and physician teams.

Conclusions
This tiered system allows for time management of the validator signing off on competencies, and encourages use of current resources and literature in the areas of burn therapist competence and professional development.
74 The Association Between Burn Injury and Peer Relations: A preschool-libre1-5 Study
Authors: Patel Khushbu F , Ni Pengsheng , Rodríguez-Mercedes Silvanys L , Surette Kate E , Rencken Camerin A , Fabia Renata , Tully Carrie , Palmieri Tina L , Romanowski Kathleen S , Warner Petra , Stoddard Frederick J J , Schneider Jeffrey C , Kazis Lewis E , Ryan Colleen M 
Published: March 2022

Abstract

Introduction
Children ages one to five years old are naturally curious and build their personality and social skills through interactions with others. Positive peer relations are especially important after a burn injury as bullying and peer rejection can delay development of social skills. This study assessed the association between burn injuries and burn survivors’ ability to connect with and maintain peer relations in this age group using the Preschool-LIBRE 1-5 (Life Impact Burn Recovery Evaluation).

Methods
The Preschool-LIBRE1-5 was field-tested with 426 parents of burn survivors. Each item was scored on a 5-point Likert scale ranging from 0 (never) to 4 (always). Data was recoded for selected items such that higher scores denote better functioning. Classic test theory methods were used to assess the peer relation items from a social functioning domain. Individual items and mean scores in the domain were examined. Multiple linear regression analyses (controlling for gender, race and ethnicity, pain severity, burn injury to critical area, burn size, and age at survey completion) measured the association between demographic and clinical characteristics and calculated a peer relation score based on multiple imputation samples.

Results
The mean age was 3.06 + 1.41 years, mean time since injury of 1.16 + 1.34 years, mean total body surface area (TBSA%) of 4.21 + 7.92, and 55.16% male and 74.18% white. Items from peer relations item pool (n=15) were identified as a unidimensional scale (α=0.92, item-total correlations for all 15 items &gt;0.4, ratio of the 1st and 2nd eigenvalues (8.729/1.287=6.78) = &gt; 4). The mean peer relation score was 2.86 + 0.76. The two items with the lowest and highest score were “My child would ask for things nicely when playing with other children” (x̄ = 2.09) and “My child liked to play near and be with family members and friends (x̄ = 3.59) respectively. Results indicated that age was a significant predictor, such that older age at survey completion was significantly associated with higher peer relation score (β = 0.16, p &lt; 0.0001). With each year of age increase, peer relationship score increased by 0.16 + 0.21 points.

Conclusions
Preschool-aged burn survivors, as reported by parents, often had the ability to connect with peers through imitation and participating in play activities, and maintained peer relationships well. These findings emphasize the importance of promoting early interventions that build social skills, allowing for positive interactions with peers and improving social functioning in the long-term.
80 Validation of PROMIS-25 Among Children Living with Burn Injuries
Authors: McMullen Kara , Bamer Alyssa M , Humbert Andrew , Ryan Colleen M , Schneider Jeffrey C , Kazis Lewis E , Stewart Barclay T , Suman-Vejas Oscar E , Amtmann Dagmar 
Published: March 2022

Abstract

Introduction
Patient-reported outcomes are important for burn injury research and clinical practice. The NIH-funded Patient Reported Outcomes Measurement System (PROMIS)-25 profile has been validated for use in diverse populations of children with many conditions, though not among children living with burn injuries. The purpose of this study was to examine the reliability and validity of PROMIS-25 scores in children living with burn injury.

Methods
Data were provided by children who were participating in a multi-center longitudinal study of outcomes after burn injury. The PROMIS-25 Profile, which includes 4 items for each domain of physical function mobility, anxiety, depression, fatigue, peer relationships, and pain interference, was evaluated for reliability and validity. Floor and ceiling effects, unidimensionality, internal consistency, and reliability were examined. Correlations with other measures (Post-Traumatic Growth Inventory-Child (PTGI-C), Child PTSD Symptom Scale (CPSS) and Burn Outcome Questionnaire Body Image Scale (BOQBI)) were calculated to assess concurrent validity.

Results
256 children living with burn injury who sustained a moderate to severe injury provided responses on PROMIS-25 domains 6 months-10 years post burn. Participants’ age ranged from 8-18 years at time of assessment; mean years since injury was 4.3 (SD 4.1). All PROMIS-25 domains showed high internal consistency (Cronbach’s α=0.90–0.95). Substantial portions of the sample reported no symptoms (anxiety [58.2%], depressive symptoms [54.6%], fatigue [50.8%], pain [60.1%]). There was a large ceiling effect on peer relationships (46.8%) and physical function mobility (57.5%). One-factor confirmatory factor analyses supported unidimensionality for all domains (all CFI &gt;0.98). Reliability was credible for group mean comparisons ( &gt;0.8) across at least some trait levels for all domains except fatigue and anxiety which had low reliability (&lt; 0.8) across the entire trait range. The magnitude and direction of correlations were as anticipated (0.32 for peer relationships and body image; 0.51 for depressive symptoms and PTSD) with the exception of weak negative correlations between PTGI-C and the anxiety and depression domains.

Conclusions
The results provide some evidence of reliability and validity of PROMIS-25 scores among children living with burn injury. Reliability of all domains was low to moderate and would likely be improved, and ceiling effects reduced, by administering the PROMIS-37, which includes 6 items per domain.
88 Pediatric Postburn Ear Reconstruction of Significant Cartilage Defects
Authors: Buta Martin , DePamphilis Matthew , Bojovic Branko , Driscoll Daniel N 
Published: March 2022

Abstract

Introduction
The ear is a protruding appendage with multiple functional and aesthetic implications. Literature indicates that up to 40-60% of facial burns involve the ear. Ear burns with considerable tissue loss and sensory deficits can negatively impact quality of life, psychosocial functioning, and physical health. Successful ear reconstruction mitigates these undesirable outcomes. The complex architecture of the external ear presents a formidable surgical challenge after burn injury, when scar tissue, impaired blood supply, and trauma to cartilage all influence reconstructive options. A lack of materials that truly replicate the characteristics of uninjured elastic cartilage also presents a longstanding surgical dilemma. In this retrospective study, the authors highlight the utility of reconstructive techniques to address significant cartilage deficits, including conchal transposition flap, composite graft, costal cartilage graft, and porous polyethylene implant.

Methods
A retrospective review was conducted on patients aged 0 to 21 years who underwent cartilage framework reconstruction between January 2004 to January 2021 at a specialized pediatric burn center. Medical records from the hospital’s patient database were screened, and 52 patients (60 ears) who met study criteria were identified. Patient demographics, procedural characteristics, and patient outcomes were analyzed.

Results
For helical rim cartilage defects, 20 patients (23 ears) with an average age of 15 ± 4 years underwent a conchal transposition flap, which was associated with no major complications. In cases involving repair of small to medium cartilage deficits, 9 patients (9 ears) with an average age of 13 ± 5 years underwent a composite graft, which was associated with one case of infection. A total of 20 patients (23 ears) with an average age of 13 ± 6 years underwent porous polyethylene implantation, which was associated with two cases of exposure and one case of infection. Of these porous polyethylene cases, 20 ears involved helical rim reconstruction and 3 involved total ear reconstruction. Costal cartilage grafting was performed in 4 patients (5 ears) with an average age of 13 ± 5 years and was associated with one case of infection. Costal cartilage grafting was utilized to reconstruct 2 helical rims and 3 total ears.

Conclusions
In cases of focal cartilage defects or medium-sized helical rim cartilage loss, highly aesthetic results and minimal complication rates can be achieved with composite graft or conchal transposition flap. When presented with large to total helical rim loss or total ear loss, either costal cartilage graft or porous polyethylene implantation is typically necessary.
89 Pooled Safety Analysis Evaluating Bioengineered Allogeneic Cellularized Construct in Patients with Deep Partial-thickness Thermal Burns
Authors: Holmes James H , Cancio Leopoldo C , Faucher Lee D , Foster Kevin N , Gibson Angela 
Published: March 2022

Abstract

Introduction
Autograft (AG) is the standard of care treatment for deep burns but requires creation of a donor site wound prone to pain and scarring. Treatment with a bioengineered allogeneic cellularized construct (BACC) is an alternative approach that can reduce or eliminate the need for autografting. The BACC is a bilayer construct that was recently approved in the US for the treatment of adult deep partial-thickness (DPT) burns. Here, we report the analysis of pooled safety data from two open-label, randomized, controlled trials (STRATA2011 [NCT01437852] and STRATA2016 [NCT03005106]) that evaluated efficacy and safety of BACC versus autografting in patients with DPT burns.

Methods
The trials enrolled 101 patients aged ≥18 years with 3–49% total body surface area (TBSA) thermal burns. In each patient, two DPT areas on the torso or extremities were randomized to receive BACC or AG, where the mean total BACC dosage was 234.8 cm2 (range: 12.0–960.0 cm2). The safety endpoints assessed at each visit included: 1) treatment-emergent adverse events (TEAEs), treatment-related AEs (TRAEs), and serious AEs (SAEs); 2) changes in immunologic responses (panel reactive antibodies [PRA], anti-bovine serum albumin [BSA] antibody response [STRATA2016 only]); 3) persistence of allogeneic DNA; and 4) laboratory exam and vital signs.

Results
Eighty-seven patients (86.1%) experienced TEAEs, 30 patients (29.7%) experienced TRAEs, and 16 patients (15.8%) experienced SAEs. The most frequent TEAEs reported by ≥10% of patients in the pooled analysis were pruritus (n=31, 30.7%) and blister, hypertension, and hypertrophic scar (n=11, 10.9% each). The most frequent TRAEs (≥5% of patients) were pruritus (n=13, 12.9%) and blister (n=5, 5%). The most common SAEs were transplant (BACC or AG) failure, pneumonia, and deep vein thrombosis (n=2, 2% each), where only one SAE (impaired healing of moderate severity) was possibly related to BACC. One patient (1%) discontinued the trial due to a TEAE (traumatic brain injury). Two patients (2%) experienced SAEs that led to death, neither related to BACC. The number of patients with positive PRA values that were negative at baseline were 36 (38.7%) at Day 28 and 20 (22%) at Month 3. The number of patients with reactivity to HLA I class alleles found in the BACC increased from 4 (4%) at baseline to 39 (40.9%) at Day 28, then decreased to 22 (24.2%) at Month 3. No persistence of allogeneic DNA from the BACC was detected.

Conclusions
BACC is well tolerated and is not associated with any unexpected SAEs or TEAEs. The safety profile at BACC treatment sites is similar to that at AG treatment sites. Thus, BACC may offer a safe alternative to autografting for the treatment of DPT burns.