Acute Burn Research Articles

533 Medical Photo Application–Delivering Expert Burn Care in the Intermountain West

Abstract Introduction As the only verified Burn Center in the Intermountain West, we are faced with the challenge of providing care and support to a referral area spanning five states. In an effort to make consulting with our Burn Center more efficient and direct, we provide TeleHealth services. We typically provide real-time facility-to-facility consultation, facility-to-patient consultation, phone consultation, and photo consultation. Prior to development of our medical photo application (MedPic app), photo consults were completed via encrypted email. The consult process was inefficient resulting in multiple phone calls for one consult. As a result, we received requests to improve the process, making it more user friendly and HIPPA compliant. Initially, our Burn Center created a photo consultation website that enabled referring providers to go to a webpage and upload photos. The consult began with a phone call from the referring provider. The Burn Center staff would inform the referring provider of the photo website and the referring provider would upload the photos. This improved the photo consult process, however it was still inefficient. Based on these requests from our referring providers, staff, and patients, we developed the MedPic app. With the new MedPic app, we provide an easy to access and efficient process to consult with our Burn center; thus improving efficiency, reducing unnecessary hospital admissions, and associated medical transport costs. Methods The photo app was created and made available in March of 2020. The app streamlined the consult process by creating a direct link from referring providers to Burn providers. Burn providers receive images as soon as they are uploaded through the app. The MedPic app is a photo consultation tool and requires three steps: 1. Take photos of the wounds; 2. Enter patient information; and 3. Enter a return call back number. A plan of care is communicated back to the referring provider within 30 minutes. Photos taken within the app are not saved to any device. The images are encrypted to protect patient information making the app HIPPA compliant. We collected encounter data generated by photo consultation to our burn center prior to and after the MedPic app development (January 2016- September 2022). Results Since the MedPic app was released in March of 2020 we have noted 2,071 app downloads and have seen a steady increase in photo consultations. Figure 1 shows the total number of photo consultations to our Burn Center from January 2016 through September 2022. Conclusions Our Burn Center created the MedPic app resulting in over 2,000 downloads. The app is integrated into our Burn Center Telehealth consultation workflow. By providing a direct approach to acute burn injury consultations, we are able to efficiently assess patient wounds and ensure the patient receives the level of care they need in a timely manner. Applicability of Research to Practice This directly impacts triage and management of outpatient acute burn injuries.

701 Impact of Alcohol and Methamphetamine Use on Burn Resuscitation

Abstract Introduction Mortality associated with burn injuries is declining with improved critical care, including resuscitation. However, patients admitted with concurrent substance use have increased risk of complications and poor outcomes. The impact of alcohol and methamphetamine use on acute burn resuscitation has been described in single center studies, however, has not been studied since implementation of computerized decision support for resuscitation. The purpose of this study was to evaluate resuscitation volumes for patients with alcohol and methamphetamine use within a large prospective observational trial at 5 major US burn centers. Methods We performed an observational trial across five institutions with > 20% total body surface area (TBSA) burn, weighing >40kg that were resuscitated utilizing computerized decision support. Patients were evaluated based presence of alcohol, with a minimum blood alcohol level of 0.10, or positive methamphetamines on urine drug screen. Fluid volumes and urine output were examined over 48 hours and Wilcoxon Method was utilized to compare patient groups. Results A total of 296 patients were analyzed. 37 (12.5%) were positive for methamphetamine use, 50 (16.9%) were positive for alcohol use, and 209 (70.1%) with negative for both. Patients positive for methamphetamine received a mean of 5.30 ±2.63 cc/kg/TBSA, patients positive for alcohol received a mean of 5.41 ± 2.49 cc/kg/TBSA, and patients with neither received a mean 4.33 ± 1.79 cc/kg/TBSA. Patients with methamphetamine or alcohol use had significantly higher fluid requirements than those who were negative for both substances. In the first 6 hours patients with alcohol use had significantly higher urinary output in comparison to patients with methamphetamine use which had similar output to patients negative for both substances. Conclusions This study demonstrated that patients with alcohol and methamphetamine use had statistically significantly larger fluid resuscitation requirements compared to patients without. The effects of alcohol as a diuretic align with previous literature. However, patients with methamphetamine lack the increased urinary output as a cause for their increased fluid requirements. Methamphetamine’s neurologic and cardiovascular effects due to increased release of dopamine, serotonin, and norepinephrine are known. Further investigation is required to better understand the mechanism underlying the need for increased resuscitation after burn injury in patients positive for methamphetamines. Applicability of Research to Practice The impact of alcohol and illicit substances on burn care, especially during the initial resuscitation, aids providers in guiding early critical care.

565 Rehabilitation Time to Evaluation Report: A Quality Improvement Study

Abstract Introduction Successful rehabilitation of patients with burn injuries requires an in-depth occupational therapy (OT) and physical therapy (PT) evaluation early in the acute phase of a patient’s injury to develop a detailed therapy plan of care. In addition, it is a standard of the American Burn Association for verified burn centers to have a comprehensive rehabilitation program designed for burn patients within 24 hours of admission. However, there is no standardized report for tracking timeliness of issuing PT/OT orders or completion of therapy evaluations by PT/OT after a patient is admitted to a burn unit. This quality improvement study details the creation of a “Time to PT/OT Order Placement and Evaluation Completion Report” and results of a quality improvement process used to improve these metrics. Methods A multi-disciplinary workgroup was created and included a burn surgeon, PT and program nurse coordinator and an electronic report was created in collaboration with the hospital’s business intelligence team. The report included the following metrics: average time from admission to PT/OT order placement, average time from PT/OT order placement to therapist acknowledgement, and average time from PT/OT order placement to therapist completion of initial evaluation. A baseline report was run (3-months) and results were analyzed. A quality improvement process was then put into place including education of burn attending physicians, fellows, and rotating residents on timeliness of therapy order placement, therapy staff education on findings and a new process for morning coordination of burn therapist caseloads to prioritize new evaluations, and initiation of monthly reporting at the burn joint practice committee meetings. The report was then run for an additional 3-months and results were analyzed. Results Baseline and post-quality improvement process results (3-month averages) were as follows: Average time from admission to PT/OT order placement increased from 3.4 to 8.3 hrs, average time from PT/OT order placement to therapist acknowledgement decreased from 43.2 to 31.5 hrs, and average time from PT/OT order placement to therapist completion of evaluation decreased from 43.6 to 35.1 hrs. Conclusions After development of this report findings showed that the quality improvement process used to improve timeliness of inpatient PT/OT initial evaluation completion was effective. In addition, this report has been useful for metric reporting during burn joint practice committee meetings, the ABA verification process and burn therapy staffing/daily caseload management. Applicability of Research to Practice This report could be used by other burn centers to help track and improve timeliness of initial PT/OT evaluations for acute burns. In addition, metrics created from this report could be used for the ABA verification process and help justify burn unit therapy staffing needs.

517 Long Term Scarring Assessment of Burn Wounds Treated with Bioengineered Allogeneic Cellularized Construct

Abstract Introduction Bioengineered allogeneic cellularized construct (BACC) has recently been proven to be effective for treatment of burn wounds and now has FDA approval. There is a paucity of data describing long term (≥1 year) scar characteristics following treatment with BACC, including its potential to modulate the formation of hypertrophic scar (HTS). HTS causes significant physical and psychosocial implications which can result in diminished quality of life. This study aims to characterize post-burn scars resulting from BACC-treated wounds compared to within subject matched autografted wounds using clinical and histologic metrics. Methods Adult patients (n=5) were previously enrolled in a Phase III clinical trial for treatment of their deep partial thickness acute burn wounds. Subjects had clinical scar examinations including imaging, Scar Assessment Scales (POSAS), and non-invasive skin measurements to quantify skin elasticity, erythema, and melanin. Punch biopsies were collected and fixed in formalin from the autograft-treated site (A), the BACC-treated site (B), the donor-site (D), and an area of normal skin (NS). The formalin-fixed biopsies were then embedded in paraffin, sectioned, and stained with H&E, Picrosirius Red, and Herovici. Results The use of BACC produced no difference in POSAS score and achieved elasticity measurements comparable to NS (Table 1). The erythema measurement demonstrated differences between scar sites and each scar site was different from NS. The donorsite also had some variation from NS. The measured melanin levels were different between each scar site, and both were different from NS. The donorsite also had detectable differences in melanin from NS. Measurements of epidermal thickness demonstrated differences between scar sites with BACC being similar to NS. Rete ridge ratio were different between scar sites and between autograft vs. NS. Papillary dermis cellularity had minor differences between scar sites and both scar sites were different from NS. Reticular dermis cellularity was equivalent between autograft and BACC sites and both were different from NS. Papillary and reticular alignment were not different between scar sites. Reticular orientation was not different between autograft and BACC but was different in BACC vs. NS. Papillary dermal thickness was different between autograft and BACC. Conclusions The HTSs resulting from wound closure achieved using BACC are similar to autografting in metrics related to clinical POSAS scores, extracellular matrix, and collagen structure. Scars following autografting or the use of BACC to achieve wound closure differ in metrics related to pigmentation, epidermal structure, and papillary dermal thickness and cellularity. Applicability of Research to Practice These findings may suggest that the use of BACC is a more optimal treatment for certain burn depths in certain patients because some HTS outcomes are equivalent, and it eliminates the need for a donor site.

91 Precursors to Oliguria During Acute Burn Resuscitation: A Secondary Analysis of a Prospective Observational Study

Abstract Introduction Though commonly used to tailor fluid resuscitation, urine output may be a late indicator of impending burn shock. We sought to identify precedents of an early oliguric episode within 6 hours of admission. We hypothesize that specific variables may indicate early at-risk features during resuscitation. Methods We performed a secondary analysis of adults enrolled in the Burn Navigator resuscitation trial. We divided into two cohorts: those with oliguria (< 30ml/hr) and those without. Variables were compared by descriptive statistics. Results A total of 146 adults met inclusion criteria. More oliguric patients experienced systolic pressures < 90 mmHg (p=0.02) or Diastolic pressures < 40 mmHg (P=0.01). The minimum bicarbonate level (p=0.04), larger TBSA (p=0.01) and larger full thickness component (p=0.004) were all predictors of early oliguria. There were also more female patients (p=0.003) in the oliguric group. No cohort difference was observed for these variables: burn mechanism, percent partial thickness, HR >140 beats per minute (BPM) or hourly change in HR >10 BPM, temperature < 36C, hourly MAP drop >10 mmHg, creatine kinase, age, body mass index, hematocrit level, alcohol level, or methamphetamine use. Conclusions Specific variables and physiological derangement thresholds precedes the first oliguric episode during major burn resuscitation. These variables constitute at-risk features that may help derive future algorithms for efficient burn resuscitation. Applicability of Research to Practice Precursor variables of an early oligouric episode identify patients needing closer fluid titration.

530 Utilization of Advanced Practice Provider for Quality Virtual Burn Care

Abstract Introduction From the plains of North Dakota to the lakes of Minnesota and beyond, for our patient population, telemedicine has grown to be an important burn care delivery method. Specialized burn care is essential to ensure successful patient outcomes from burn injury. Our institution utilizes an advanced practice provider (APP) either physician assistant or nurse practitioner to lead the telemedicine care instead of the burn surgeon. Given most of the burn care is non-operative management, an APP can deliver burn expertise and high-quality care to the burn patient. Methods A retrospective chart review performed via data extraction from the electronic medical record at a single ABA-verified Burn Center. Dates of review ranged from January 1, 2022, through June 30, 2022. Patient population was Regions Hospital Outpatient Burn Clinic and Telemedicine Clinic volumes. Data review included patient location, mode of visit (in-person or virtual), and time to >95% healed. Inclusion was acute burns of all ages and mechanisms of injury. Exclusion was non-burn wounds, scar management and frostbite patients. Results A total of 1300 (87%) of all outpatient visits performed by APPs with 328 (25%) of these visits conducted via telemedicine. Varying by month, 7-13% of patients were treated exclusively via telemedicine not requiring any in-person burn care. When comparing the patient distance from the burn center (1-50 miles and >50 miles) and time to >95% healed, there was no correlation. Patients who were treated exclusively via telemedicine, lived an average of 205 (5-580) miles from the burn center, had an average TBSA of 2.2 (0.25-55) % and had an average of 18.3 (7-62) days until 95% healed. Compared to patients treated in-person only or combination of in-person and telemedicine, lived an average of 91 (1-631) miles, had an average TBSA of 2.5 (0.25-67) % and had an average of 24.6 (5-80) days until 95% healed. Conclusions A burn telemedicine program led by APPs can facilitate remote expert burn care, all while maintaining standard of care. Limitations were a narrow review window, single center retrospective analysis, and the exact date for time to 95% healed is difficult to determine due to interval follow up windows. Our goal is to further review and analyze our telemedicine and clinic data to optimize burn care delivery with the utilization of APPs, investigate quality of care indicators within telemedicine and reduce transfers and travel for specialized burn care. Applicability of Research to Practice APP led telemedicine improves surgeon availability to do hands on treatment in the Burn Center and allows for outreach and specialized expertise to be delivered across remote distances. It allows for the ability to triage patients and optimize burn clinic resources. Telemedicine can be performed in any location and reduce travel. Telemedicine is reimbursable. Barriers include wound care supply access, technological limitations, state licensing and institutional credentialing.

T1 Burn Behavioral Health: Development and Preliminary Results of Burn Center-Based Stepped-Care Program for Burn Survivors

Abstract Introduction Annually, nearly half a million people in the U.S. receive medical treatment for burns, 40,000 of whom are hospitalized. Burn patients experience significant psychological burden during acute burn treatment. Long-term psychiatric problems are highly prevalent compared to patients with other injuries. Undetected or untreated psychiatric symptoms can complicate recovery, increase length of stay, and cause long-term problems and readmission. Burn centers are ideally suited to provide these services to burn patients on an inpatient and outpatient basis; however, few burn centers in the U.S. have mental health programs to address patients’ needs. This presentation will describe the Burn Behavioral Health (BBH) program, a burn center-based technology-enhanced stepped-care model of delivering mental health services for burn survivors, spanning the inpatient to outpatient continuum. This model was adapted from the Trauma Resilience and Recovery Program which has been successful in meeting the needs of traumatic injury patients. Methods Data were collected as part of clinical care. BBH includes 4 main steps: (1) initial screening, education, and early intervention; (2) symptom self-monitoring and self-help resources; (3) follow-up screening 30 days post-injury; and (4) provision of best-practice mental health treatment for patients who need it, using both in-person and telehealth modalities, including individual and skill-based group therapy. Results Between February 2021 and September 2022, 384 patients were identified as eligible for BBH services. Of these, 342 (90%) were enrolled in BBH and completed initial screening. 50% of patients screened positive for depression/PTSD risk or symptoms and were offered brief intervention. 54% of enrolled survivors received brief intervention, 21% of whom completed more than one session. We reached 84% of patients for the 30-day follow-up, 20% of whom screened positive for depression/PTSD and 29% were connected to mental health services. Conclusions This study provides preliminary support demonstrating that BBH is sustainable and capable of reaching and engaging a large proportion of burn patients across the inpatient to outpatient continuum. In the U.S., only 25% of burn centers have structured screening in place for inpatient and 11% for outpatient burn survivors. Data from the traumatic injury population (which includes burns) suggest only 10% of patients received intervention after a positive screen and 42% did not know how or where to get help. Psychological recovery is an essential component of a comprehensive burn program and availability of psychological screening and intervention is a requirement for the ABA verification. Applicability of Research to Practice BBH shows promise in increasing access and quality of mental health care to address the unique needs of burn survivors.

534 If You Build It, They Will Come: Everyday Burn Clinic Enhanced Access to Care

Abstract Introduction Prior to 2020, our small burn center had 1x/wk adult burn clinic and 1x/wk pediatric burn clinic. This schedule did not allow for optimal access to care for the geographic area our burn center serves. Also, our inpatient daily census was steadily increasing, and we identified many barriers to discharge for our acute burn survivors that would help to justify to hospital administration the need for increasing the frequency of our burn clinic to daily. These barriers to discharge included decreased availability of visiting nurse agencies for dressing changes, poor quality of rehabilitation services through visiting nurse agencies, and comfort and/or competence with family and/or caregivers being able to provide quality needed burn care. Methods Our burn leadership team developed a business plan for an everyday burn clinic to provide to hospital administration. This daily burn clinic would allow for both adult and pediatric burn survivors to be seen Monday-Friday, provide rehabilitative services a space within our burn clinic, and availability of daily dressing changes in burn clinic. The business plan was reviewed by hospital administration, meetings were held with hospital administration, rehabilitation department leadership and ancillary services leadership to help validate the need for the daily burn clinic. Results Hospital administration approved our daily burn clinic in July of 2020 allowing for improved outpatient dressing and wound management, easy access to quality burn rehabilitation, translating to decreased length of stay. Communication was sent to all area emergency rooms, urgent cares, pediatrician offices and primary care offices to inform them of the increased availability of the burn clinic. This communication included the American Burn Association transfer criteria, a referral form to facilitate access to our burn clinic, and a simple algorithm for assistance with triaging burn care. Prior to the everyday burn clinic in 2019, we were seeing 1,155 outpatient visits annually and in 2021 we saw 1,728 visits in our burn clinic. This is a 150% increase in outpatient burn clinic visits in two years. Conclusions Increasing accessibility to outpatient care for the burn survivor can benefit many aspects in their journey to recovery as well as support the surrounding community in quick access to quality burn care. Burn survivors benefit from shorter hospital stays with the availability of a daily burn clinic for ongoing dressing management while maintaining quality rehabilitation services to maximize their functional outcomes. Applicability of Research to Practice Data could be collected to evaluate the true impact the creation of the daily burn clinic had on burn survivors’ length of stay. Also, data can be collected regarding the number of burn survivors treated at other local emergency rooms and/or urgent care facilities prior to the creation of the daily burn clinic to evaluate the efficacy of the communication provided to the community.

708 Clinical Impact of a Revised Burn Resuscitation Guideline at an Adult Burn Center

Abstract Introduction The American Burn Association recommends volume resuscitation at 2-4ml/kg/TBSA; however, in practice, fluid resuscitation often exceeds these goals. Additional strategies used for burn resuscitation include the use of colloid rescue and high dose ascorbic acid (HDAA). In 2018, our institution moved from a fluid resuscitation strategy which included calculating fluid requirements using 4ml/kg/TBSA and HDAA infusion for burns > 30% TBSA to a strategy that calculated fluids using a 2ml/kg/TBSA with the removal of HDAA. Additionally, the guidance for colloid rescue was updated to provide specific time points for evaluation of the need for initiation of this intervention. The primary objective of this study was to compare outcomes of the new institutional resuscitation strategy to the previous one. Methods This was a retrospective cohort study evaluating outcomes for acute burn resuscitation between the previous institutional resuscitation guideline with the updated guideline. This study included adult patients admitted for burn injury with >20% TBSA between August 1, 2016, to September 30, 2021. The primary outcome was a composite safety endpoint which included incidence of acute kidney injury and intra-abdominal hypertension requiring intervention. Acute kidney injury was defined as a serum creatinine increase 1.5 times baseline. Statistical analyses utilized the Mann-Whitney U test for non-normally distributed continuous data and the chi-squared and Fischer’s exact test for categorical data. A p-value of < 0.05 was considered statistically significant. Results The final analysis included 43 in the pre-group and 52 in the post-group update. Baseline characteristics between the groups were similar. The primary composite safety outcome was non-statistically significantly lower in the post-guideline update group (39.5% vs. 28.8%, p= 0.273). Total fluid volume administered (3.74 ml/kg/TBSA vs. 2.97 mL/kg/TBSA, p=0.007) and hourly urine output within the first 24 hours (1.26 mL/kg/hour vs. 0.75 mL/kg/hour, p=0.007) were significantly lower in the post-group. No differences were observed in vasopressor use (32.6% vs 36.5%, p=0.63), vasopressor duration (70.3 hours vs. 50.4 hours p=0.24), or duration of mechanical ventilation (5.1 days vs 10.4 days, p=0.113). Conclusions The burn resuscitation guideline update resulted in significantly lower 24 hour- fluid volumes, without negative hemodynamic consequences. Applicability of Research to Practice The comparison of two resuscitation protocols provides evidence for other institutions to help optimize their resuscitation practice

525 Tiered Orientation Model for Nurses in a Burn Unit

Abstract Introduction As an acuity adaptable unit is is sometimes difficult to get nurses through an orientation in a manner that doesn't scare them off but still covers all their educational needs. The number of fluid resuscitations seen is approximately 30 per year which means that when one occurs new nursing staff needs to have exposure. However, it is a difficult experience to work through a large ICU admission as a new nurse even with preceptor support. Due to these issues the unit adopted a tiered orientation process. This process set forth task blocks as a focus during orientation versus entire patient care. For example, the new nurse and preceptor assignment could be the new fluid resuscitation in week one of orientation. However, the new nurse would only work on documentation of patient care. The preceptor would be responsible for procedures, dressing changes, fluid, and pharmacologic management that goes into caring for the acute burn. the new nurse could also be a part of these processes but that is not their focus during Tier 1. In Tier 2 the new nurse would start providing more patient care in addition to their documentation, the preceptor would still perform ICU level care items. In the final tier the orientee would do all direct care of the patient including documenation. This tiered approach allowed nurses to experience all levels of patient care without overwhelming them. Methods The process was brought to the shift coordinators to give them all a sense of how staffing assignments would be made during orientation. Education was presented to preceptors at unit council meetings and then in 1 on 1 meetings as needed. Additional, touch base meetings occurred every other week during the start of this process starting in May of 2022. During this time 7 new nurses were on-boarded. 7 unique preceptors were utilized. New hires were met with weekly on an informal basis from weeks 1-5 by either the clinical educator or the nurse manager. Each new nurse and their preceptor had formal meetings with the nurse manager, clinical educator or both at 6, 10 and 12 weeks. A short survey was sent to all preceptors following the initial 5 months of this new process. Results 50% of all preceptors found this new model to be an improvement over the previous model. 33% did not agree or disagree on if the process was an improvement. 2 out of the 7 preceptors had not precepted before which might account for the 33%. 40% of the preceptors felt satisfied with the overall process for orientation. 83% of the preceptors felt that they had adequate resources to orient new nurses to the unit. Conclusions It appears that the adoption of a tiered process worked well during the initial evaluation phase. However, the n was small and additional evaluation would be beneficial to further address how impactful a tiered orientation process is for on-boarding new nursing staff. Applicability of Research to Practice It important for nursing leaders to evaluate and update how to best meet the needs of staff to create competency and safety.

75 Tranexamic Acid Reduces Burn Wound Conversion and Lung Inflammation in a Murine Comb Burn Model

Abstract Introduction Burn wound conversion is a process where superficial partial thickness burns convert into deep partial and even full thickness burn injuries. Unfortunately, the pathophysiology of this phenomenon is poorly understood. A therapeutic intervention that may prevent secondary progression and cell death in burn-injured tissue is desirable. Recent work by our group has established that tranexamic acid (TXA) has significant anti-inflammatory properties in addition to its well-known anti-fibrinolytic effects. This study investigates tranexamic acid as a novel therapeutic treatment to mitigate burn wound conversion and reduce systemic inflammation. Methods Sprague-Dawley rats were subjected to a hot comb burn contact injury using a 150-g brass comb preheated to 100°C, to create four rectangular burns, separated by three unburned interspaces. A subset of animals underwent the comb burn injury with an adjacent 30% TBSA contact injury using solid brass rods. The interspaces represent the ischemic zones simulating the zone of stasis. The treatment group received IP injection of TXA (100mg/kg) immediately after injury and once daily until sacrifice. Sham animals underwent an identical procedure, with application of a room temperature comb. Animals were sacrificed at 6hrs and 7-day time points post-injury. Photo images were obtained of the comb burn injury. Full-thickness biopsies from the ischemic zones and lung tissue were assessed with established histological and immunohistochemical (IHC) techniques. Results At 7-days post injury, the percentage of ischemic zones with necrosis was significantly reduced in the treatment group when compared with untreated burn controls by photographic image analysis. When compared with controls, the treatment groups had significantly less progression of ischemic zones to necrosis when assessed by standard microscopy. These findings were consistent in both the comb burn only and comb burn + 30%TBSA injury models. The TXA treatment group demonstrated significantly more expression of the regeneration marker (CTHRC-1) and a trend toward increased expression of the Ki-67 proliferation marker when compared to untreated burn group. At 6 hours post-injury, TXA significantly decreased infiltration of neutrophils in the lungs for the 30%TBSA burn injury model. Furthermore, systemic levels of mitochondrial DNA, IL-1α and TNFα were significantly lower in TXA treated animals when compared to untreated burn controls. Conclusions Animals treated with tranexamic acid demonstrated reduced burn wound conversion and decreased burn-induced SIRS response. Lung inflammation was also significantly reduced by administration of TXA after injury. Applicability of Research to Practice Tranexamic acid and agents with similar mechanisms of action may provide a treatment to reduce burn wound conversion. This therapy could be easily incorporated into standard acute burn care practices.

80 Examining the Relationship between Burn Injury Acuity and Risk for Developing PTSD and Depression Symptoms

Abstract Introduction Individuals who experience traumatic events are at heightened risk for developing adverse mental health outcomes, specifically posttraumatic stress and depressive symptoms. Those hospitalized following a burn injury experience significant psychological and emotional burden during acute burn treatment. Symptoms of depression and posttraumatic stress are common following a traumatic burn injury; however, little is known about the impact of burn-related intensive care unit (ICU) admission on future risk of developing posttraumatic stress disorder (PTSD) and depression. Thus, the current study examined the associations between burn injury acuity (defined by admission to ICU vs. non-ICU) and risk for developing mental health problems (i.e., depression and PTSD) among burn center patients assessed within the initial 30 days following their injury. Methods Participants included 286 patients admitted to the burn center at a southeastern academic medical center (Mage = 46.79, SD = 17.47; 53% White; 66% Male; 94% Non-Hispanic; 25% admitted to ICU). Patients were assessed by the hospital’s burn behavioral health program. Risk of PTSD and depression was assessed via the Injured Trauma Survivor Screen (ITSS), a validated measure used to determine risk of PTSD and depression following an injury. Results Independent samples t-tests revealed that ICU admission was associated with an increased risk for developing posttraumatic stress (p = .022) and depressive symptoms (p = .016) as compared to non-ICU admitted patients when assessed within the initial 30 days following a burn injury. Conclusions Though preliminary, results highlight the importance of considering burn acuity when evaluating risk of developing psychopathology following a burn injury. Admission to ICU appears to play a key role in individuals’ risk for developing PTSD and depressive symptoms. Both physical and emotional healing are critical components of a patient’s recovery process following a burn injury. Applicability of Research to Practice Given these results, it is important to prioritize promoting psychological recovery following a potentially traumatic burn injury in those admitted to ICU through early screening and intervention. Early intervention should emphasize reducing avoidance of feared stimuli, gradual exposure, relaxation strategies, social support, and behavioral activation techniques particularly for patients admitted to the ICU to help mitigate negative effects of trauma exposure that may lead to increased psychopathology.

Laser speckle contrast imaging, an alternative to laser doppler imaging in clinical practice of burn wound care derivation of a color code

ObjectiveTo develop a color code and to investigate the validity of Laser Speckle Contrast Imaging (LSCI) for measuring burn wound healing potential (HP) in burn patients as compared to the reference standard Laser Doppler Imaging (LDI). MethodA prospective, observational, cohort study was conducted in adult patients with acute burn wounds. The relationship between mean flux measured with LDI and mean perfusion units (PU) measured with LSCI was expressed in a regression formula. Measurements were performed between 2 and 5 days after the burn wound. The creation of a LSCI color code was done by mapping the clinically validated color code of the LDI to the corresponding values on the LSCI scale. To assess validity of the LSCI, the ability of the LSCI to discriminate between HP < 14 and ≥ 14 days and HP < 21 and original ≥ 21 days according to the LDI reference standard was evaluated, with calculation of receiver operating characteristics (ROC) curves. ResultsA total of 50 patients were included with a median age of 40 years and total body surface area burned of 6%. LSCI values of 143 PU and 113 PU were derived as the cut-off values for the need of conservative treatment (HP < 14 and ≥ 14 days) resp. surgical closure (HP < 21 and ≥ 21 days). These LSCI cut off values showed a good discrimination between HP 14 days versus ≥ 14 days (Area Under Curve (AUC)= 0.89; sensitivity 85% and specificity = 82%) and a good discrimination between HP 21 days versus ≥ 21 days (AUC of 0.89, sensitivity 81% and specificity 88%). ConclusionThis is the first study in which a color code for the LSCI in adult clinical burn patients has been developed. Our study reconfirms the good performance of the LSCI for prediction of burn wound healing potential. This provides additional evidence for the potential value of the LSCI in specialized burn care.

Who Gets Burned in Brazil?

Burns are preventable injuries that still represent a relevant public health issue. The identification of risk factors might contribute to the development of specific preventive strategies. Data of patients admitted at the Hospital due to acute burn injuries from May 2017 to December 2019, was extracted manually from medical records. The population was analyzed descriptively, and differences between groups were tested using the appropriate statistical test. The study population consisted of 370 patients with burns admitted to the Hospital burn unit during the study period. The majority of the patients were males (257/370, 70%), median age was 33 (IQR:18-43), median TBSA% was 13 (IQR 6.35-21.5 and range 0-87.5%), and 54% of patients had full-thickness burns (n = 179). Children younger than 13 years old represented 17% of the study population (n = 63), 60% of them were boys (n = 38), and scalds was the predominant mechanism of burn injury (n = 45). No children died, however 10% of adults did (n = 31). Self-inflicted burns were observed in 16 adults (5%), of whom 6 (38%) died during admission, however self-inflicted burns were not observed in children. Psychiatric disorders and substance misuse were frequent in this subgroup. White adults male from urban areas who had not completed primary school degree were the major risk group for burns. Smoking and alcohol misuse were the most frequent comorbidities. Accidental domestic flame burns were the predominant injuries in the adult population and scalds in the pediatric.

Kiwi Ingenuity – How New Zealand Healthcare Adapted for the Whakaari/White Island Disaster

Introduction:New Zealand is widely known across the globe as an adventure tourism destination. On December 9, 2019, the natural wonders of the country became a major disaster that impacted the lives of many and stretched the resources of the New Zealand healthcare system.Whakaari/White Island is an uninhabited, privately owned island 50 km off the North Island of New Zealand. It contains two strato-volcanoes, which were and remain a popular tourist destination. While an international tourist group were enjoying their guided tour of the crater, one of the volcanoes erupted, sending superheated debris and gas into the air. Of the 47 individuals on the island at the time, 39 were rescued. Overall, 25 people survived. The mortality of this event was significantly lower than historic volcanic eruptions involving ballistic and pyroclastic injuries. We are fortunate to present information specifically on the chemical and physiological changes noted from exposure to volcanic ash.Located in New Zealand’s largest city is Middlemore Hospital, home of the National Burns Center. This center is supported by three regional burn centers throughout the country. Prior to Whakaari, mass-casualty plans were in place, however, system-wide adaptations were required on many levels to ensure delivery of healthcare. This included changes in pre-hospital triage, support for regional burns centers and repatriation to home countries.This poster presentation takes you on the journey of adaptation experienced within the National Burns Service, focusing on operating theater, intensive care and acute burns management.Method:Case StudyResults:.Conclusion:.

Protocol for a feasibility, acceptability and safety study of the PICO device (negative pressure wound therapy) in acute paediatric burns

IntroductionNegative pressure wound therapy (NPWT) in acute burn care may decrease the time to re-epithelialisation by more than 20%. Despite this, the perceived burden of use; including therapeutic, physical and...

Analysis of real-world length of stay data and costs associated with use of autologous skin cell suspension for the treatment of small burns in U.S. centers.

Autologous skin cell suspension (ASCS) is a treatment for acute thermal burn injuries associated with significantly lower donor skin requirements than conventional split-thickness skin grafts (STSG). Projections using the BEACON model suggest that among patients with small burns (total body surface area [TBSA]<20%), use of ASCS±STSG leads to a shorter length of stay (LOS) in hospital and cost savings compared with use of STSG alone. This study evaluated whether data from real-world clinical practice corroborate these findings. Electronic medical record data were collected from January 2019 through August 2020 from 500 healthcare facilities in the United States. Adult patients receiving inpatient treatment with ASCS±STSG for small burns were identified and matched to patients receiving STSG using baseline characteristics. LOS was assumed to cost $7554/day and to account for 70% of overall costs. Mean LOS and costs were calculated for the ASCS±STSG and STSG cohorts. A total of 151 ASCS±STSG and 2243 STSG cases were identified; 63.0% of patients were male and the average age was 44.2 years. Sixty-three matches were made between cohorts. LOS was 18.5 days with ASCS±STSG and 20.6 days with STSG (difference: 2.1 days [10.2%]). This difference led to bed cost savings of $15,587.62 per ASCS±STSG patient. Overall cost savings with ASCS±STSG were $22,268.03 per patient. Analysis of real-world data shows that treatment of small burn injuries with ASCS±STSG provides reduced LOS and substantial cost savings compared with STSG, supporting the validity of the BEACON model projections.

Acute burns during the COVID-19 pandemic: A one-year retrospective study of 611 patients at a referral burn centre in northern Iran.

Patients with acute burns are more vulnerable to COVID-19 because of physiologically weak immune systems. This study aimed to assess and compare individual characteristics, clinical features, and clinical outcomes of acute burn among COVID-19 and non-COVID-19 patients. A retrospective study, with data collected from 611 acute burn patients with or without a COVID-19 diagnosis referred to a burn centre in Iran. Data were collected from April 2020 to 2021. The mean age of acute burns patients with COVID-19 was higher compared with acute burns patients with non-COVID-19 (47.82 vs. 32.59 years, P < .001). Acute burns occurred more frequently in COVID-19 patients with comorbidities compared with non-COVID-19 patients (48.72% vs. 26.92%, P = .003). 58.97% of COVID-19 patients and 55.42% of non-COVID-19 patients had grade II & III and II burns, respectively (P < .001). The mean total body surface area of the burn was higher in COVID-19 patients compared with non-COVID-19 patients (32.69% vs. 16.22%, P < .001). Hospitalisation in the intensive care unit (ICU) was higher in COVID-19 patients than in non-COVID-19 patients (76.92% vs. 15.73%, P < .001). Length of stay in hospital and ICU, the cost of hospitalisation, and waiting time for the operating room was higher in COVID-19 patients compared with non-COVID-19 patients (15.30 vs. 3.88 days, P < .001; 9.61 vs. 0.75 days, P < .001; 30 430 628.717 vs. 10 219 192.44 rials, P = .011; 0.84 vs. 0.24 min, P < .001, respectively). Intubation and mortality in-hospital were higher in COVID-19 patients compared with non-COVID-19 patients (41.02% vs. 6.99%, P < .001; 35.90% vs. 6.12%, P < .001, respectively). Therefore, it is recommended that health managers and policymakers develop a care plan to provide high-quality care to acute burns patients with COVID-19, especially in low-income countries.

Effects of exercise training on muscle wasting, muscle strength and quality of life in adults with acute burn injury

ObjectivesExercise training during the acute phase of burns is difficult to implement but offers potential benefits. This multicenter trial explored the effects of an exercise program on muscular changes and quality of life during burn center stay. MethodsFifty-seven adults with burns ranging between 10% and 70% TBSA were allocated to receive either standard of care (n = 29), or additionally exercise (n = 28), consisting of resistance and aerobic training, commenced as early as possible according to safety criteria. Muscle wasting (primary outcome), quantified by ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), muscle strength and quality of life (Burn Specific Health Scale-Brief (BSHS-B) and EQ-5D-5L) were assessed at baseline, four and eight weeks later, or hospital discharge. Mixed models were used to analyze between-group changes over time with covariates of interest added in stepwise forward modeling. ResultsThe addition of exercise training to standard of care induced significant improvements in QMLT, RF-CSA, muscle strength and the BSHS-B subscale hand function (ß-coefficient. 0.055 cm/week of QMLT, p = 0.005). No added benefit was observed for other quality-of-life measures. ConclusionsExercise training, administered during the acute phase of burns, reduced muscle wasting, and improved muscle strength throughout burn center stay.

Patient, or Prisoner? - Acute Burn Injuries in Prisoners: The Birmingham Burns Centre Experience.

Increased risk of violence and self-harm means prisoners are a vulnerable population with complex health needs. They account for a small proportion of patients with burn injuries, however present a unique set of challenges. This study investigates the incidence, pattern and outcomes of burn injuries in prison population. Prisoners referred from 2010-2021 were identified using the International‎‎‎‏‏‎ Burn Injury Database(iBID). Patient demographics, burn injury characteristics and outcomes were collected. Patients were then stratified based on mechanism of injury, treatment modality (surgery/conservative), hospital admission (inpatient/outpatient) and compliance with outpatient follow-up, for subgroup analyses. Sixty-eight prisoners sustained burns during the study period, with a median age of 28.5 years and TBSA of 3%. The majority were male (98.5%) and required hospital admission (75%). Scalds were the most common injury type (77.9%) and assault the most frequent cause of burns (63.2%). Eighteen patients (26.5%) underwent a surgical procedure and there were two mortalities. Of patients for whom follow-up was planned, 22% attended no appointments, with a further 49% of prisoners missing at least one appointment. Relative to patients managed non-operatively, prisoners undergoing surgery had a longer stay and all attended outpatient follow-up appointments. Prisoners represent a unique population with exceptional challenges. Attention should be given to protecting vulnerable patients at risk of assault, education of prison staff around burn prevention and first aid, and ensuring that prisoners are able to access burns follow-up to minimise long term sequelae. Opportunities exist to aid this such as the adoption of telemedicine.