Burn Care Research Articles

Manufacture and use of transparent facial orthotic masks for treating facial burn scars: A systematic review

BackgroundCustom-made transparent facial orthoses (TFOs) (face masks) are used to improve facial burn scars. We conducted a systematic literature review on TFO manufacture and use. MethodsPubmed and Cochrane databases were searched without restrictions for relevant articles. TFO manufacture details and use according to international recommendations (20–32 mmHg pressure, TFO worn 20–23 h/day for ≥2 months) were extracted. ResultsOf 279 retrieved articles, 11 published over the last 41 years (four in the last 5 years) discussed TFO manufacture/use. There were five technical notes, five case reports, and a patient-cohort study (total patients in the studies=21). TFO-manufacture methods could be categorized as classical, digital, or mixed classical-digital. Relative clinical efficacies and cost advantages were unclear. The plastics used, harness materials, harness-point number, and silicone-interface use differed from study to study. Target pressure, actual pressure, expected daily wearing time, and treatment duration ranged widely and often did not meet current guidelines. Actual wearing time and treatment duration were never measured. ConclusionsAlthough TFOs play an important global role in burn care, there is a grave paucity of research. Further research is needed to promote the standardization of TFO-related practices and thereby improve the outcomes of facial-burn patients.

Applications of telemedicine: Plastic surgery in the COVID-19 era

Applications of telemedicine: Plastic surgery in the COVID-19 era

Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care.

Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they limit range of motion, complicate airway management and create significant cosmetic deformities. Traditional methods have been used to release contractures and improve function. However, they are subject to variable results, residual neck tightness, recurrence and suboptimal cosmetic appearance. Microvascular free tissue transfer is a more technically challenging and time-consuming method, but it offers the potential to overcome the long-term limitations of simpler options. In this paper, we present our experience with microvascular free flaps for the release of burn scar contractures of the neck as a potential high-quality permanent solution. Methods: Over a 10-year period, nine free flaps were performed on burn patients with total body surface area (TBSA) burns between 20 and 70%, who developed moderate to severe neck contractures. Four anterolateral thigh (ALT) flaps, four radial forearm free flaps (RFFFs) and one ulnar forearm flap were used to release neck contractures. Results: All nine flaps were completed successfully with significant improvement in the neck’s range of motion. Good aesthetic results were achieved with smooth contour and thin coverage. Overall, the patients were satisfied. However, five out of nine cases required at least one secondary procedure for flap defatting to reach optimal results. Conclusion: Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Consequently, cervical contractures can be prioritized when planning reconstruction for burn patients. Free flaps can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries.

An Observational Study Of Knowledge Of First Aid For Burns Among Parents In Indonesia.

Burns represent a large portion of injuries attending emergency departments each year, with children accounting for the biggest proportion. Appropriate first aid has been shown to help improve the outcome of burns and decrease the need for surgical intervention. Several studies outside of Indonesia demonstrate inadequate parental knowledge of burns first aid, but few evaluated interventions to improve knowledge. A period of data gathering from June to September 2022 was include the parents who have offspring aged between 18 and 12. This questionnaire was developed to achieve the objectives of this study and was based on others of a similar nature. A total of 102 participants were included in this study. 102 parents (79.4% female (n=81), 20.6% male (n=21)) were questioned. Baseline knowledge was found to be poor overall; it was found that nearly 91% of parents did not know the first-aid procedures for treating pediatric burns. However, educational initiatives were effective in advancing this knowledge. When a child got burned, nearly 68% of parents knew to use cold running water, and about 70% knew to get help from a doctor. Cold running water being applied is an extremely positive sign, which can have the most beneficial effect on the healing of the injury. No other variables analysed were shown to be statistically significant predictors of pre- or post-test scores (all p > 0.05). This study concluded that educational knowledge was effective to improve the parents' ability in performing first aid for burn care.

Documented nutritional therapy in relation to nutritional guidelines post burn injury – a retrospective observational study

Intensive nutritional therapy is an essential component of burn care. Regarding post-minor burn injuries, the literature is lacking. The aim of this study was to evaluate documented nutritional therapy in relation to international guidelines after both minor and major burn injuries. The secondary aim of this study was to evaluate the adequacy of energy and protein intake compared to individual nutritional goals post-burn injury. A retrospective observational single-centre study including patients admitted between 2017 and 2019at a burn centre in Sweden was performed. The patients included in the study were ≥18 years old and in need of hospital care for ≥72h post-burn injury. Information about patients' demographics, nutritional therapy, and clinical characteristics of burn injury was collected. The patients were divided according to total body surface area burnt (TBSA %) into minor burn injuries (TBSA <20%) and major burn injuries (TBSA ≥20%). Descriptive statistics were used to analyse data. Adherence to guidelines was established by comparing 24 nutritional therapy recommendations to documented treatment. If documented nutritional treatment were in accordance with guidelines, adherence was considered high (≥80%), moderate (60-79.9%) or low (<59.9%). One hundred thirty-four patients were included, 90 patients with minor burn injuries and 44 patients with major burn injuries. Documented adherence to the nutritional guideline was overall low. After minor burn injury, 8% (2/24) of nutritional therapy recommendations had a high adherence (fat intake <35% of total energy intake and enteral nutrition as prioritized feeding route), 17% (4/24) a moderate adherence, and 75% (18/24) a low adherence. In patients treated after a major burn injury, there were two recommendations with documented high adherence (Vitamin C and Zinc); 25% (6/24) had moderate adherence, and 67% (16/24) had low adherence. In addition, quite a large amount of missing data was found. Adequacy of documented nutritional intake, compared to the individual documented goal, was 78% (±23%) for energy and 66% (±22%) for protein after minor burn injury. After major burn injury, the adequacy was 89% (±21%) for energy and 78% (±19%) for protein, respectively. This study revealed low adherence to nutritional guidelines in patients treated for minor and major burn injuries. Compared to major burn injuries, lower documented adequacy for both energy and proteins was found in minor burn injuries. Given the disparity between guidelines and documented nutritional therapy, and the lack of specific guidelines for minor burn injuries, there could be a considerable risk of inadequate nutritional therapy post-burn injury.

Examining Obesity and Its Association With Burn Injury: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation Study

IntroductionLiterature examining the connection between obesity and burn injuries is limited. This study is a secondary analysis of a multicenter trial data set to investigate the association between burn outcomes and obesity following severe burn injury. Materials and methodsBody mass index (BMI) was used to stratify patients as normal weight (NW; BMI 18.5-25), all obese (AO; any BMI>30), obese I (OI; BMI 30-34.9), obese II (OII; BMI 35-39.9), or obese III (OIII; BMI>40). The primary outcome examined was mortality. Secondary outcomes included hospital length of stay (LOS), number of transfusions, injury scores, infection occurrences, number of operations, ventilator days, intensive care unit LOS, and days to wound healing. ResultsOf 335 patients included for study, 130 were obese. Median total body surface area (TBSA) was 31%, 77 patients (23%) had inhalation injury and 41 patients died. Inhalation injury was higher in OIII than NW (42.1% versus 20%, P = 0.03). Blood stream infections (BSI) were higher in OI versus NW (0.72 versus 0.33, P = 0.03). Total operations, ventilator days, days to wound healing, multiorgan dysfunction score, Acute Physiology and Chronic Health Evaluationscore, hospital LOS, and intensive care unit LOS were not significantly affected by BMI classification. Mortality was not significantly different between obesity groups. Kaplan–Meier survival curves did not significantly differ between the groups (χ2 = 0.025, P = 0.87). Multiple logistic regression identified age, TBSA, and full thickness burn as significant independent predictors (P < 0.05) of mortality; however, BMI classification itself was not predictive of mortality. ConclusionsNo significant association between obesity and mortality was seen after burn injury. Age, TBSA, and percent full- thickness burn were independent predictors of mortality after burn injury, while BMI classification was not.

Burn Prevention in Spanish: Assessment of Content Accuracy, Website Quality, and Readability of Online Sources.

Burn prevention information may be inadequate or inaccessible to communities with non-English language preference. Our objective was to systematically analyze the content accuracy, website quality, and readability of online Spanish information for burn prevention in the home and compare it to English websites. We collected the top ten burn prevention results from a search on Google, Bing, and Yahoo using a list of Spanish key terms. Using recommendations from national organizations and a burn care expert team, content accuracy was evaluated for each website. We assessed website quality following the "Health on the Net" Code of Conduct. Readability was scored by averaging five validated readability tests for the Spanish language. After using the same protocol, a comparison was made with English websites as a control. Once duplicates and non-relevant search results were removed, 23 Spanish websites were assessed. Out of 21 possible points for content accuracy, the top website scored 14 (67%) and the average score was 6.6 (31%). For website quality, the average score was 50%. The average grade level needed to read the websites was 8.6. Compared to English, Spanish websites were less accurate (31% vs 41%), harder to read (9.8 vs 7.8), but were of higher website quality (50% vs 43%). Online burn prevention information in Spanish is often inaccurate, incomplete, and inferior to available English language websites. We propose a call to action to increase the quality of online burn prevention material available in Spanish.

A NATURAL PERSPECTIVE ON THE MANAGEMENT OF BURN WOUNDS CAUSED BY ACID AND BOILED WOUNDS

Burns are one of the most traumatic incidents that one can experience. Burns are of various types, depending on the severity and depth of the burn wound. The patient undergoing treatment tolerates a lot, including excruciating pain, infection, and burn scars-related issues. Traditional approaches are one of the most effective methods to treat burn injuries. Traditional remedies have the ability to reduce the risk of infection additionally they are cost-effective and free of side effects. Despite the fact that there are many advanced technologies for burn care, natural treatments are needed to avoid more complications because these technologies can have significant side effects and toxicity. The aim of this review is to provide readers information on traditional and herbal treatments for both boiled and acid attack burns. This article focuses on natural resources. This is an effort to investigate and study the pathophysiology of acid and boiled burn wounds in order to learn more about how to treat them effectively. Further scientific studies on enlisted natural resources would be useful for better future management of the above mentioned conditions.

144. The Role of Plastic Surgery in Addressing the Global Burden of Disease: Plastic Surgery and the Sustainable Development Goals

PURPOSE: Surgical conditions account for nearly one-third of the global burden of disease. Plastic surgeons play a vital role in treating many of these conditions, including congenital deformities, wound care, acute burn care and reconstruction, traumatic injuries, and oncologic reconstruction. We examine the role of plastic surgeons in addressing the sustainable development goals (SDGs), a 17-part call to action adopted by the United Nations. METHODS: We reviewed each of the 170 subgoals of the 17 SDGs and analyzed them for relevance to plastic surgery. We conducted a literature review to identify evidence of how plastic surgery supports each subgoal and SDG. RESULTS: Plastic surgical interventions can advance 50 of the 170 (28%) subgoals and 11 of the 17 SDGs (65%). Most applications were evident in SDG 3: “Ensure healthy lives and promote well-being for all at all ages.” Examples of plastic surgery applications in the SDGs include reconstructive efforts for congenital anomalies, traumatic and accidental injuries, such as road traffic accidents, encouragement of smoking cessation, and mitigating mortality and morbidity from environmental and chemical exposures. CONCLUSION: Our study identifies the meaningful and unique ways that plastic surgery can advance the SDGs and address the global burden of surgical disease. This supports the integration of plastic surgery into broader public health efforts to build surgical capacity.

722 Select Survey of Human Cadaver Skin Allograft Utilization by 21 Senior Academic Burn Surgeons

Abstract Introduction As of 2022, cryopreserved human cadaver skin allograft remains the gold standard by which all other skin substitutes used for burn care are compared. The 2015 Taiwan Color Dust Explosion burn mass casualty engendered the transfer of emergency tranches of skin allograft from reserves in both the US and EU to Taiwan. HHS/ASPR/BARDA/CBRN led an after-action fact-finding mission to Taiwan and concluded that skin allograft would still play a central role as a safety net in US national burn care preparedness, even as BARDA invested in the development of other burn medical countermeasures that would be part of the preparedness strategy. However, before investments in a skin allograft based national strategy could be built, it was critical that the leaders of the Disaster Committee and Organization and Delivery of Burn Care (ODBC) Committee of the American Burn Association (ABA) commission a survey to verify current practice patterns of senior academic burn surgeons on the use of skin allograft. Methods The committee chairs curated a list of 21 leading academic burn surgeons in North America. These surgeons’ credentials included having been an ABA president, a member of the ABA Board of Trustees, or having chaired a standing committee of the ABA. All 21 surgeons were actively practicing burn care daily. The survey contained 18 questions and was intentionally kept brief (Survey to be provided as Appendix). Results Of the 21 surgeons selected, there was 100% participation and completion of the survey. Most were in practice &amp;gt;15 years (62%) and manage &amp;gt;200 patients surgically per year (71%). The predominant use of allograft is to temporize the wound bed when there are inadequate donor sites (48% “Almost Always”). It is “Often” (48%) used to temporize wound beds prior to autografting. However, most are looking for alternatives to allograft (43% “Sometimes”, 43% “Often”). With ongoing development of skin substitutes, most indicated their allograft use will likely decrease, with only 19% indicating “Probably Not”. Conclusions Human skin allograft continues to play a central role in surgical burn care management. For the foreseeable future, new technologies are not likely to displace allograft use but rather blend with its use. This brief, select survey is not powered but provides a snapshot of the current role of skin allograft. In the future, we may conduct a broader survey to obtain a validated and more granular view of the use of allograft in modern burn care. Applicability of Research to Practice Armed with this information, the US Federal Government acted to increase preparedness after a burn mass casualty. In February 2022, a Request for Proposals for a large vendor-managed inventory of human cryopreserved skin allograft was answered by two separate tissue banks. As of September 2022, $38M was awarded to two partners for procurement and expansion of a vendor managed inventory of cryopreserved human skin allograft to ensure preparedness for rapid response to a burn mass casualty incident.

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 &amp;gt;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 &amp;gt;50 miles) and time to &amp;gt;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.

720 Transcultural Collaboration in Burn Mass Casualty Response Under Austere Conditions

Abstract Introduction Burn mass-casualty incidents (BMCI) overwhelm local resources challenging communication, triage, basic care provision and education of non-burn specialist personnel. This is more acute in austere conditions such as the recent international BMCI in November, 2021, in an extremely resource-limited developing country. Greater than 250 severely burned survivors overwhelmed local resources requiring an international response. Effective burn care dictated adapting to austere conditions, educating local providers and cultural competence, vital to teaching and obtaining feedback in ways meaningful to host providers and building burn care capacity. Methods Needs assessment showed local healthcare providers needed burn care education focused on wound care, fluid management, pain management and assessment. Cultural competence/cultural humility were integral in avoiding ethnocentrism and collaboration barriers. Understanding local language and communication styles (including nonverbal cues) was prioritized. Pre-test/post-test measured baseline burn care knowledge vs. education efficacy. Lecture/discussion, case study, clinical application and class participation were used to disseminate content. Attention was paid to pace of content discussion and nonverbal indications of understanding as English was not the learners first language. Pacing/terminology was adjusted to optimize understanding. Meaningful recognition was accomplished by public congratulations and formal completion certificates. Results Pre-test: Number of students-57; high score-80%; low score-27.5%; average score-53.9%. Content was presented as described in methods section and supplemented with bedside instruction. Post-test: Number of students-38; high score-95%; low score-55%; average score-79.3%. Almost immediately, many participants framed and posted their completion certificates and quickly utilized education content when delivering care. Conclusions Optimal interdisciplinary/international collaboration for burn care and education in austere conditions mandates cultural humility and a spirit of inquiry on the part of international guest providers to best understand cultural norms in host countries. A spirit of inquiry on local communication and cultural nuances is integral to optimal collaboration, education and building effective local burn care capacity. Applicability of Research to Practice When providing care internationally in austere settings, proactive cultural humility, understanding local cultural and communications nuances and developing education/content delivery that can be readily utilized in addressing critical needs is essential. Meaningful recognition for healthcare team members in host countries develops good will and helps build capacity to continue providing health care upon conclusion of the immediate crisis.

524 Traveling Pediatric Burn Care on Wheels

Abstract Introduction Many burn patients initially seek treatment at a community hospital after suffering a burn injury and are then transferred to various hospitals before being evaluated by a burn specialist. Due to the increased volume of patients in the emergency department, pediatric burn patients in the past have waited on average 90 minutes to be assessed by a burn provider. A new process was implemented to decrease wait times and increase overall patient and family satisfaction. A breakdown in the process, noted by burn care staff, was the availability of burn care supplies located in the emergency department. Methods • A process developed for burn unit nurses to respond to the emergency department to evaluate all pediatric burn patients was implemented. • A survey was sent to burn nurses looking for the most used supplies while caring for a pediatric burn patient. • Collaborative efforts with the pharmacy department to obtain space in the medication pyxis for the most used ointments in burn care. • Collaborative efforts with the Child Life Specialist to stock the cart with stickers, small toys, and distraction items for pediatric patients. • Collaborative efforts with the attending burn surgeon to develop and implement a protocol for burn team response. • Collaborative efforts with infection control department to ensure proper regulation standards of the cart. Cart Contents: • Gauze • Securement wraps • Wound cleansers • Silver impregnated foam dressing • Non-stick petroleum gauze • Staplers • IV start supplies • Paper tracking tool • Discharge &amp; dressing change instructions • Stickers, small toys, &amp; distraction items Results The Hydro on Wheels cart was implemented in January 2022. A retrospective study of data including pediatric burn patients seen in 2021 was completed. The average wait time to be seen by a burn provider in the emergency department decreased from 90 minutes in 2021 to 34 minutes in the first 6 months of 2022. A follow up survey was sent to hydrotherapy burn nurses to assess the satisfaction of the new process and equipment available. Conclusions Overall decreased wait time for pediatric burn patients to be evaluated by a burn care provider. Burn care nurses felt prepared when responding to a pediatric burn patient in the emergency department. Applicability of Research to Practice The burn unit plans to continue this approach to improve patient and family satisfaction &amp; patient outcomes Future considerations to further improve the process would be to include a patient and family follow up satisfaction survey.

769 Racial, Ethnic, and Socioeconomic Disparities in Burn Care Access

Abstract Introduction While racial, ethnic, and socioeconomic disparities in burn care have been identified, there is a paucity of research into specific means by which these disparities manifest. Here, we consider time to initial burn surgery consult. Methods Through a retrospective review of electronic health records, we reviewed all patients evaluated by the burn surgery service at a single regional burn center from Jun 2020 to Apr 2022. We excluded patients without data for time of onset of burn injury. We analyzed differences in time to burn consult, rate of surgical management, and average length of stay (LOS), stratifying by patient race (Caucasian, Black, Asian, Native American, Other), ethnicity (Latino, non-Latino, Other), and insurance payor (Medicaid, Private, Medicare, Other, None). Time to burn consult was defined as time from onset of burn injury to time of burn consult. Results 365 patients met the inclusion criteria. Average age was 33.3 years; 65.8% were male. Average (standard deviation) time to burn consult was 17h7m (1d23h21m). No significant differences in time to burn consult existed when the study group was stratified by race, ethnicity, or insurance payor. Rate of surgical management (Chi-squared p=0.05) and LOS (ANOVA p&amp;lt; 0.0001) differed by insurance payor, but not race or ethnicity. Medicare patients had higher rates of surgical intervention and longer average LOS; patients with no insurance had lower rates of surgical intervention and shorter average LOS. Conclusions Our results indicate that time to burn consult is unlikely to contribute meaningfully to racial, ethnic, and socioeconomic disparities in burn care. Further studies are needed to better understand other aspects of care that may contribute to these disparities. Applicability of Research to Practice Time to burn consult is unlikely to contribute to disparities in burn care. Burn care providers should be mindful of other ways that disparities may manifest.

762 A Systematic Review of Surgical Simulation in Burn Surgery: Education, Assessment, and Management

Abstract Introduction Proper assessment and management of burn patients requires practical knowledge and timely interventions in a high-stakes setting. Although much of burn care emphasizes critical care, nuances exist among this patient population, creating challenges for surgeons-in-training. As a result, low- and high-fidelity burn simulations have become increasingly popular means to educate burn care physicians and their teams in a safe environment without compromising care or endangering patients. The aim of this report is to systematically review the literature for existing simulations related to burn care. Methods A systematic review was conducted using the following databases: PubMed, Scopus, Embase, Web of Science, and Cochrane. Inclusion criteria were peer-reviewed articles about surgical simulation models related to burn care and surgery. Skills and techniques taught, assessment methods, model type, fidelity, and equipment were extracted from included studies. Conference proceedings, reviews, non-English and non-burn-specific literature were excluded. Results Our search criteria identified 2,585 articles, 16 of which met inclusion criteria. Simulation methods included 7 simulation courses (43.8%), 6 synthetic benchtop models (37.5%), 2 augmented/virtual reality interfaces (12.5%), and 2 iOS applications (12.5%). There were no burn-specific animal or cadaveric models. Model fidelities included 9 (56.3%) high-, 3 (18.8%) medium-, and 4 (25.0%) low-fidelity. The most common topics included in the simulations were burn wound assessment/management (n=10, 62.5%), escharotomy (n=6, 37.5%), fluid management (n=2, 12.5%), electrical burns (n=1, 6.2%), skin graft harvest (n=1, 6.2%), tangential excision (n=1, 6.2%), and cricothyrotomy (n=1, 6.2%). Conclusions Burn management requires an expansive breadth of intensive care knowledge and surgical expertise combined with a distinct, burn-specific skill set. A paucity exists in the literature for augmented/virtual reality and animal/cadaver models unique to burn care and surgery. Our review identified a need to expand simulator options to improve training in skin grafting, burn reconstruction, and burns-specific intensive care management. Applicability of Research to Practice Given the rapidly expanding emphasis on remote learning in the post-COVID era, developing accessible surgical simulation infrastructure adjacent to clinical training may better prepare global burn providers for the complexity of burn care.

47 Burn Injury Assessment Study (BIAS): Is There Room To Improve?

Abstract Introduction The treatment of burn injured patients requires accurate wound assessment to determine appropriate interventions. Clinical assessment of burn depth, even by experts in the field, has an accuracy of only 60–80%. The purpose of this study is to estimate the performance of burn wound assessment by burn care professionals from still images. Methods This was an IRB-approved prospective cohort study in which burn care providers used a tablet-based digital interface to answer a 10-item questionnaire and to identify non-healing burn wounds from 5 patients scenarios. Each wound was evaluated using a polygon software interface to mark non-healing regions within the wound. Each wound had a ground truth determined by a consensus panel of study investigators using still photograph at 21-days post-injury to discern healing and non-healing regions. A power analysis and sample size of 100 participants produced a two-sided 95% confidence interval with a width equal to 0.20 when the sample proportion is 0.60. Continuous variables were analyzed by mean, standard deviations, median and quartiles while categorical data was analyzed as exact number and percentage. Burn wound assessment performance metrics for the providers were calculated for the whole cohort and then for subgroups using point estimate at a pixel level. Accuracy, sensitivity, specificity, area positive predictive value (APPV), and area negative predictive value (ANPV) were calculated from the ground truth and participants selected regions of non-healing wounds. Results One hundred fifty-six healthcare providers enrolled (50 physicians, 14 APPs, 63 nurses, 24 therapists, and 5 paramedics) with 9.96 ± 9.49 mean years of experience and 70% employed at a verified burn center. All five regions were represented in the analysis (Eastern Great Lakes (4%), Midwestern (6.5%), Northeastern (22%), Southern (53.5%), and Western (14%). 29.3% of the participants selected “schedule for surgery” when reviewing images of wounds that healed without surgery. 28.7% of the participants selected, “local wound care no surgery needed or, “local wound care, reassess in 7+ days for possible surgery.” Performance measures were not associated with years of experience. Overall performance is available in Table 1. Conclusions Improving burn wound assessment performance could improve our use of limited resources in burn care by optimizing patient transfers/treatments and avoiding unnecessary surgeries. Our study expands upon prior work in the field and demonstrates that burn wound assessment has significant room for improvement. These findings open the proverbial door for diagnostic devices found in other fields of medicine and our partnership with emergency room providers to advance burn care. Applicability of Research to Practice More accurate wound assessment will lead to improved treatment and triage by EM and Burn practitioners.

540 Psychiatric Illness and Substance Abuse: Unaddressed Factors in Burn Injury

Abstract Introduction Patients with psychiatric illness and substance use disorder have high rates of burn injuries. These patients require multidisciplinary care and experience prolonged admissions. Less is known about these patients after discharge due to challenges such as poor healthcare literacy and inequities to healthcare access. This study characterizes this marginalized population’s inpatient burn care and post-discharge outcomes compared to the general burn population. Methods Patients who were admitted to a single burn center from January 1st, 2018 to June 1st, 2022 were included. Patient demographics, history of psychiatric disorders, burn and psychiatric treatment data, and post-discharge outcomes were collected. Results A total of 1,660 patients were included in this study, of which 91 (6%) patients had psychiatric comorbidity and/or substance use disorder. These 91 patients had an average age of 36 years (standard deviation (SD): 12 years). In this cohort, the majority of patients were undomiciled (66%) and male (67%). On admission, 66 (72%) patients reported recent illicit substance use or had positive urine toxicology results. At the time of burn injury, 25 (28%) patients had a pre-existing psychiatric disorder. Patients were treated most for self-inflicted burns, with 36 (40%) patients presenting with burns secondary to self-immolation. In this population, 67 (74%) patients required inpatient psychiatric intervention, of which 31 (46%) were placed on a psychiatric hold. After discharge, 39 (43%) patients returned to the hospital for outpatient follow-up. The readmission rate for patients with psychiatric or substance use comorbidity was greater than 4 times higher than that of the general burn population (31% vs 7%). The most common cause of readmission were subsequent mental health crisis (40%) and inability to perform burn care (32%). Conclusions Burn patients with psychiatric disorders and substance abuse are most often young men who exhibit self-harm. These patients have limited outpatient follow up and access to support outside of the hospital. High readmission rates for subsequent mental health crises and inability to perform basic wound care exemplifies inadequate short-term care for this marginalized population. Applicability of Research to Practice In the short term, patients with psychiatric and substance use disorders may benefit from additional professional support and treatment to address burn care and comorbidities after burn injury.

79 Psychosocial Screener Outcomes for Adults in an Outpatient Burn Clinic

Abstract Introduction Burn survivors are at greater risk for mental health issues, which can persist after the acute phase of injury. Many burn centers use psychological screeners for individuals receiving burn care, though few studies have reported on these results. Our study reports on the results of a routine questionnaire to screen for symptoms of depression, anxiety, PTSD, substance abuse, and suicidality in an outpatient burn clinic. Methods We screened 669 adult patients who were receiving care at a burn clinic from October 2016 to January 2022. Each patient completed a questionnaire comprised of validated, brief measures for depression, anxiety, PTSD, alcohol use, and substance abuse. Based on scoring cutoffs, each patient’s overall score was categorized as positive/high risk (“A”), positive/moderate risk (“B”), or negative/low risk (“C”). A binary logistic regression analysis was conducted to examine potential demographic (e.g., age, gender, race/ethnicity) and injury-related predictors (e.g., TBSA, burn severity) in relation to patient screener outcomes (positive vs. negative). Results Patients were aged 18-91 (M = 40.4; SD = 15.7) with the majority being male (N = 408; 60.6%). The mean for TBSA was 2.60 (SD=4.31) and 33.4% of the sample had 3rd to 4th degree burns. Patients were mostly non-Hispanic White (N = 572; 85.5%) and 11.2% (N = 75) were Black/African American. Most patients screened negative/low risk for psychosocial concerns (N = 502; 75%). Almost a quarter (N = 157; 23.5%) of patients screened positive/moderate risk and less than 2% (N = 10) were positive/high risk. Positive screeners were flagged most often for anxiety (i.e., occurring for 12.4% of sample). Patients also had positive screeners for depression (8.2%), PTSD (7.7%), alcohol and substance abuse (2.3%), and suicidality (1.6%). Female (OR = 1.93; p &amp;lt; .001) or Black/African American (OR = 2.11; p =.02) burn patients were significantly more likely to have a positive score compared to male or White patients. Burn severity significantly predicted screener outcome (OR = 1.51; p = .033; i.e., greater depth was positively related to increased risk for positive screener), whereas TBSA did not predict screener outcome. Conclusions These findings suggest that burn care providers should be sensitive to increased risk for psychosocial difficulties in female and Black/African American burn survivors, as well as patients who sustained a more severe (i.e., depth) burn injury. Experiencing chronic racial and gender discrimination may be pre-existing factors that negatively impact psychological well-being following a burn injury. Applicability of Research to Practice Our results highlight the importance of burn care centers incorporating routine procedures to screen for psychosocial concerns in all patients. Practitioners should also be aware of certain risk factors (e.g., burn depth; female or Black/African American patients) for poorer mental health outcomes to provide the most comprehensive care.

87 An Augmented Reality Burn Management Application to Guide Care in Austere Environments

Abstract Introduction Novel medical technologies are necessary to support virtual health in low bandwidth environments. When tele-mentoring is not possible, advanced clinical decision support tools can deliver essential medical knowledge to assist novice clinicians. These tools can fill knowledge gaps in specialty fields, like burn. We developed the Augmented Reality Burn Assist Manager (ARBAM), a novel, comprehensive augmented reality (AR)-based burn management platform to address key tasks in burn care. Methods A randomized 2x2 cross-over design was used to investigate if ARBAM could enhance a user’s ability to care for a simulated burn patient as compared to standard clinical practice guidelines (CPGs). We developed the software for use on a mixed reality, head-mounted device. Participants were clinicians with little to no burn care experience, and were asked to complete 4 key tasks, twice each, using either paper copies of the Joint Trauma System’s CPGs and supplemental worksheets first (Paper) or our AR technology. Tasks included calculating burn size (TBSA), performing medication dosage calculations (MC), managing a burn fluid resuscitation (FR), and performing a simulated escharotomy (EC). All tasks were evaluated for completion time and accuracy. Cross-over analysis of treatment effects used a two-sided, two-sample t-test or Wilcoxon Rank-Sum test as appropriate. Results Eleven participants were randomized: 5 started with Paper and 6 started with AR. Time to perform FR was statistically different (p&amp;lt; 0.05) with AR taking less time than Paper (4.8 vs. 7.0 mins, respectively). FR clinical performance was also better in the AR group with a mean accuracy score of 99% vs. 52% for Paper (p&amp;lt; 0.001). EC completion times were not clinically or statistically different. However, EC accuracy was 93% for AR compared to 55% for Paper (p&amp;lt; 0.001). Although not statistically different, MC performance accuracy was considerably better for AR (91%) than for Paper (66%). No differences between groups were observed for TBSA or MC completion times nor TBSA accuracy. Conclusions Compared to traditional tools, AR may enhance a clinician's ability to complete key tasks in the initial management of a burn patient. This technology may be helpful during disasters when tele-mentoring is not available. Limitations of this study include a small sample size, limited user training on the AR device, and potential carry-over effects. Therefore, generalizations cannot be made about wide-scale usage. Nonetheless, this study showed that AR may be helpful in managing lifesaving burn tasks. Applicability of Research to Practice ARBAM may enhance decision making by novice clinicians when caring for burn patients. Our data demonstrate the potential for AR-based support tools to improve burn care delivery and reduce error rates for novice clinicians, which could lead to reductions in morbidity and mortality. Future research is needed to investigate how AR technology can be used for other lifesaving interventions.