Burn Center Research Articles

Burns Resulting from Electric Vehicle Manufacturing in Silicon Valley.

The development of electric vehicles (EVs) has introduced novel technologies and manufacturing processes that expose workers to new risks of burn injury. We identified six patients who were admitted to our burn center for injuries that occurred while working in EV manufacturing facilities. The burns fell into three categories: flash flame burns due to lithium-ion battery explosions, high-voltage electrical injuries, and burns caused by contact with molten metal. Recognizing these recurrent patterns of injury should inform future prevention efforts and prepare health systems to evaluate and treat patients burned in EV manufacturing.

Sex Differences, Age, and Burn Size Contribute to Risk of PTSD and Depression After Burn Injury.

The prevalence of psychological symptoms in burn survivors has been well documented; however, the role of biological sex requires further investigation. This study explored sex differences among burn survivors and examined the impact of sex, age, and total body surface area (TBSA) of the burn injury on (1) the risk of developing PTSD and depression and, subsequently, (2) the influence of initial risk on symptom outcomes 30 days post-injury. Participants included 374 adult patients enrolled in the Burn Behavioral Health program at a regional Burn Center. T-tests and chi-square tests were conducted to determine differences between sexes on outcome measures. A path analysis was conducted to evaluate relationships between variables of interest. Findings revealed significant sex discrepancies in risk and symptom outcomes. Compared to men, women reported greater total risk scores of developing PTSD and depression (p = .005) early after their burn injury. A subscale analysis showed that women reported greater risk scores on depression (p < .001), but not on PTSD. Women did not report higher depression scores 30 days post-injury compared to men but did report higher PTSD scores than men (p = .020). When sex, age, and TBSA were included in a path analysis, female sex (p=.001), younger age (p<.001), and larger TBSA of the burn injury (p=.024) were associated with greater risk. Additionally, risk scores significantly predicted PTSD (p<.001) and depression (p<.001) symptoms 30 days post-injury. Our research shows how sex, age, and TBSA affect the risk of PTSD and depression among burn survivors. It underscores the importance of accounting for sex and age differences in mental health risk, especially in women and younger patients. This emphasizes the urgency of early screening and intervention.

Program evaluation of cognitive behavioral therapy in burn survivors.

Mental health is a component of care that should be addressed for burn patients while they are hospitalized. Unfortunately, dedicated burn psychotherapists are rare in burn centers in the United States (US), and it can take months for patients to be seen by a mental health professional after referral. Our burn center has a dedicated licensed clinical social worker who sees patients within two business days of referral. She uses cognitive behavioral therapy (CBT), which is designed to alleviate symptoms of anxiety, depression, and acute stress by modifying the individual's maladaptive thoughts. To evaluate the timely use of CBT as a treatment for depression in burn patients, we measured depressive symptoms before and after psychotherapy. Burn clinic nurses administered the Patient Health Questionnaire (PHQ-9) depression screener as part of standard care. We computed difference scores to determine change in PHQ-9 scores at both group and individual levels. At a group level, psychotherapy significantly improved symptoms of depression, indicated by a decreased mean PHQ-9 score. On an individual level, half of the patients (50.7%) experienced a meaningful improvement in their symptoms, indicated by a change in their PHQ-9 depression category, while 35.6% showed no change. Although it was not an effective solution for all patients in this study, timely use of CBT could be an important component of burn care for many and should be considered as part of standard care in burn centers across the US.

Cefiderocol in Difficult-to-Treat Nf-GNB in ICU Settings

BackgroundThe efficacy and safety of cefiderocol in ICU patients with difficult-to-treat resistance (DTR) non-fermenting Gram-negative bacteria (Nf-GNB) are not as well-established. Consequently, we conducted a cohort study to compare Cefiderocol with the Best Available Therapy (BAT) in ICU patients.MethodsWe included adult patients from 9 different ICUs, including a burn ICU unit, from 2019 to 2023 treated with Cefiderocol for DTR Nf-GNB isolated from the blood or lungs. We matched each patient at a 1:2 ratio based on the same DTR Nf-GBN isolated pathogen, and when possible, within the same type of ICU (burn unit or not). The primary endpoint of the study was the clinical cure at 15 days, with secondary endpoints including clinical cure at 30 days, relapse, and in-ICU mortality. For each outcome, adjusted odds ratios were estimated using bidirectional stepwise regression in a final model, which included 13 preselected confounders.ResultsWe included 27 patients with cefiderocol, matched with 54 patients receiving the BAT. Four patients were not exactly matched on the type of ICU unit. Characteristics were comparable between groups, mostly male with a Charlson Comorbidity Index of 3 [1–5], and 28% had immunosuppression. Cefiderocol patients were most likely to have higher number of antibiotic lines. The main DTR Nf-GNB identified was Pseudomonas aeruginosa (81.5%), followed by Acinetobater baumanii (14.8%) and Stenotrophomonas maltophilia (3.7%). Pneumonia was the identified infection in 21 (78.8%) patients in the Cefiderocol group and in 51 (94.4%) patients in the BAT group (p = 0.054). Clinical cure at 15 and 30-day and the in-ICU mortality was comparable between groups, however relapse was higher in the cefiderocol group (8-29.6% vs. 4-7.4%;aOR 10.06[1.96;51.53])ConclusionCefiderocol did not show an improvement in clinical cure or mortality rates compared to BAT in the treatment of DTR Nf-GNB, but it was associated with a higher relapse rate.

Burn Care Funding in the Era of Price Transparency-Does Verification Signal Bargaining Power?

The Price Transparency Rule of 2021 forced payors and hospitals to publicly disclose negotiated prices to foster competition and reduce cost. Burn care is costly and concentrated at less than 130 centers in the US. We aimed to analyze geographic price variations for inpatient burn care and measure the effects of American Burn Association (ABA) verification status and market concentration on prices. All available commercial rates for 2021-2022 for burn-related Diagnosis Related Groups (DRG) 927, 928, 929, 933, 934, and 935 were merged with hospital-level variables, ABA verification status, and Herfindahl-Hirschman Index (HHI) data. For the DRG 927 (most intensive burn admission) a linear mixed effects model was fit with cost as the outcome and the following variables as covariates: HHI, plan type, safety net status, profit status, verification status, rural status, teaching hospital status. Random intercepts allowed for individual burn centers. There were 170,738 rates published from 1541 unique hospitals. Commercial reimbursement rates for the same DRG varied by a factor of approximately three within hospitals for all DRGs. Similarly, rates across different hospitals varied by a factor of three for all DRGs, with DRG 927 having the most variation. Burn center status was independently associated with higher reimbursement rates adjusting for facility-level factors for all DRGs except for 935. Notably, HHI was the largest predictor of commercial rates (p<0.001). Negotiated prices for inpatient burn care vary widely. ABA-verified centers garner higher rates along with burn centers in more concentrated/monopolistic markets.

An Analysis of Hospitalized Burn Injuries in a Burn Care Unit of Northern Bangladesh

Introduction: Burn injuries remain a significant public health issue, especially in low- and middle-income countries where comprehensive data is scarce. This study provides a detailed analysis of burn injuries in Northern Bangladesh, focusing on epidemiological characteristics and factors influencing burn severity and incidents. Methods: This retrospective study analyzed 477 cases of acute, unintentional burns recorded between January 2022 and December 2022 at the Rangpur Medical College Hospital's Burn and Plastic Surgery unit. Data on demographics, burn types, etiology, and severity were collected from hospital registers. Statistical analysis, including chi-square tests and logistic regression, was used to identify predictors of burn severity. Result: Of the 477 documented cases, females represented 62.05% (296 cases) and males 37.95% (181 cases). Flame burns predominated, comprising 70% of incidents, significantly impacting females engaged in cooking activities. The data revealed a distinct seasonal trend with a significant peak in January, where 40% (191 cases) of annual burn incidents occurred due to campfire exposure. The analysis further demonstrated that burns covering more than 30% of total body surface area (TBSA) were significantly associated with higher morbidity and mortality, with third-degree burns occurring in 92.9% of females compared to 55.8% of males. Logistic regression identified age (OR = 1.28, CI [1.13-2.71]), gender (OR = 1.75, CI [1.11-1.47]), and the cause of ignition (OR = 0.56, CI [0.41-0.76]) as significant predictors of burn severity. Conclusion: The findings emphasize the need for targeted interventions to address the high incidence of burns among young to middle-aged women, particularly through safer cooking practices and awareness campaigns. Additionally, public health strategies should consider seasonal risks and promote safer heating methods during colder months. This study underlines critical areas for intervention and highlights the importance of culturally tailored public health strategies to reduce burn injuries in Northern Bangladesh.

Life Cycle Assessment of Wheat Straw Pyrolysis with Volatile Fractions Chemical Looping Combustion

Life Cycle Assessment of Wheat Straw Pyrolysis with Volatile Fractions Chemical Looping Combustion

Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan

Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan

Techno-economic analysis of chemical looping processes with biomass resources for energy production and CO2 utilization. Comparison of CLC and CLOU technologies

Bioenergy coupled with carbon capture utilization and storage (BECCUS) is an attractive greenhouse gas mitigation technology that can produce negative CO2 emissions by combining bioenergy resources with the utilization or geological storage of the captured CO2.The main objective of this work was to evaluate the technical and economic feasibility of two BECCUS technologies based on chemical looping concept with two biomass waste as fuels, i.e., swine manure and pine sawdust, for the production of thermal energy and a pure CO2 stream that is subsequently used as raw material in agricultural greenhouses. Direct use of solid biomass resources was considered for the Chemical Looping with Oxygen Uncoupling option, whereas biogas production was the starting point for Chemical Looping Combustion.The profitability of the chemical looping scenarios was assessed through the Levelized Cost of CO2. This parameter was estimated at 218.31 €/t CO2 for the Chemical Looping Combustion scenario, a value much higher than those for the Chemical Looping with Oxygen Uncoupling scenarios (73.04–87.32 €/t CO2) due to the limited conversion degree of the carbon present in the fuel waste to biogas and the need for an additional experimental plant to the Chemical Looping Combustion unit, i.e., the biogas production plant. Comparing the Chemical Looping with Oxygen Uncoupling scenarios, the economic analysis revealed that the profitability of the biomass-fueled chemical looping facility was markedly sensitive to the selling price of the biomass resource. Furthermore, the values of the Levelized Cost of CO2 parameter for the Chemical Looping with Oxygen Uncoupling scenarios were lower than those estimated in other research studies that implemented BECCUS technologies and utilized the captured CO2 for identical purposes. In the particular case of swine manure, this result becomes even more noteworthy since it demonstrates that the energy use of this biomass resource through Chemical Looping with Oxygen Uncoupling technology is an economically profitable and environmentally sustainable solution to the difficult challenge of managing this livestock waste. Therefore, it can be concluded that Chemical Looping with Oxygen Uncoupling processes fed with biomass are a very attractive BECCUS technology for heat generation where, in addition, the pure CO2 stream obtained at the outlet of the fuel reactor can be considered a marketable, high value-added product.

Assessing antibacterial efficacy of a polyhexanide hydrogel versus alginate-based wound dressing in burns.

Burn injuries pose a heightened risk of infection, which is primarily responsible for increased morbidity and mortality. Factors such as extensive skin damage and compromised immunity exacerbate this vulnerability. Pseudomonas aeruginosa and Staphylococcus aureus are frequently identified in burns, with Gram-negative Pseudomonas aeruginosa often resistant to antibacterial agents. While Flaminal, an alginate-based wound dressing (Flen Health, Belgium), aids wound healing, its antibacterial effects are limited compared with 1% silver sulfadiazine (1% SSD). In contrast, Prontosan Wound Gel X, a betaine and polyhexanide-based hydrogel (B. Braun Medical AG, Switzerland), has been shown to effectively combat various microbes and promotes wound healing. In this study, two research cohorts were retrospectively established (control group: patients receiving standard of care with the alginate-based wound dressing; intervention group: patients receiving the polyhexanide hydrogel wound dressing), comprising patients admitted to a burn centre between 2019 and 2022. Patients were eligible when continuous wound treatment with either of the two wound dressings was performed. Laser Doppler imaging (LDI) scans were conducted. Regions of interest (ROIs) were selected based on LDI scans and divided into healing time categories. Wound swabs were collected and the presence of Pseudomonas aeruginosa and Staphylococcus aureus was documented. Bacterial load was evaluated using a semiquantitative scale. Wound healing was recorded. The control group consisted of 31 patients with 93 ROIs, while the intervention group had 67 ROIs involving 29 patients. Both groups exhibited similar proportions of healing time categories (p>0.05). The polyhexanide hydrogel dressing outperformed the alginate-based dressing in antiseptic efficacy by significantly reducing the incidence of Pseudomonas aeruginosa- and Staphylococcus aureus-positive cultures in patients' wounds. Wound healing time for conservative treatment was comparable between groups. In this study, the polyhexanide hydrogel dressing minimised Pseudomonas aeruginosa and Staphylococcus aureus colonisation in burn wounds, demonstrating strong antibacterial properties, emphasising its potential to minimise infections in burn injuries.

A five-year retrospective antibiogram review in the paediatric burns unit at a tertiary South African Hospital

BackgroundThere is a global concern regarding increasing colonization and/or infection of paediatric burns patients with multi-drug-resistant organisms, especially in Africa. Surveillance of antimicrobial resistant patterns enables clinicians to opt for the most appropriate empiric antimicrobial agent according to the unit’s susceptibility profile. ObjectiveThis study sought to compile unit-specific antibiograms comparing the organism prevalence and their antimicrobial resistance trends in the paediatric burns unit, Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2015 to December 2019. MethodsA retrospective, laboratory-based review was conducted of bacterial and fungal isolates including antimicrobial susceptibility testing (AST) data from blood cultures and tissue samples. Enterobacterales, non-fermenters, gram-positive organisms, and yeasts were analysed as a percentage of total positive blood cultures comparing 2015–2017 to 2018–2019 data. Analysis of antimicrobial resistance trends was performed for extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Enterobacterales (CRE), extensively-drug-resistant (XDR) Acinetobacter baumannii, and meticillin-resistant Staphylococcus aureus (MRSA) for the years 2015, 2017, and 2019. ResultsA total of 1243 blood culture isolates were studied with A.baumannii (208/1243;17 %), coagulase negative staphylococci (141/1243; 11 %) and Candida auris (53/1243; 4 %) representing the predominant gram-negative bacteria, gram-positive bacteria, and yeast, respectively. A significant decrease in ESBLs (p = 0.00) was noted with a rise in CREs (p = 0.00) during the study period. Majority of the A. baumannii were XDR (≥77 %) despite an appreciable decrease. A notable decrease in MRSA (p = 0.00) isolates was observed. pseudomonas aeruginosa (72/275; 26 %) was the leading organism recovered from a total of 275 tissue isolates. ConclusionThe results of this study encourage review of the current antimicrobial choices in the unit for empiric antibacterial cover. Due to the low numbers of yeasts, we cannot comment on the institution of early antifungal strategies. We support reinforced infection prevention and control practices as well as antimicrobial stewardship initiatives.

The impact and validity of the Berlin criteria on burn-induced ARDS: Examining mortality rates, and inhalation injury influences. A single center observational cohort study

BackgroundAs several recent studies have shown low mortality rates in burn injury induced ARDS early (≤7 days) after the burn, the Berlin criteria for the ARDS diagnosis in this setting may be disputed. Related to this issue, the present study investigated the incidence, trajectory and risk factors of early Acute Respiratory Distress Syndrome (ARDS) and outcome in burn patients, as per the Berlin criteria, along with the concurrent prevalence and influence of inhalation injury, and ventilator-acquired pneumonia (VAP). MethodsOver a 2.5-year period, burn patients with Total Burn Surface Area (TBSA) exceeding 10% admitted to a national burn center were included. The subgroup of interest comprised patients with more than 48 h of ventilatory support. This group was assessed for ARDS, inhalation injury, and VAP. ResultsOut of 292 admissions, 62 sustained burns > 10% TBSA. Of these, 28 (45%) underwent ventilatory support for over 48 h, almost all, 24 out of 28, meeting the criteria for ARDS early, within 7 days post-injury and with a PaO2/FiO2 (PF) ratio nadir at day 5. The mortality rate for this early ARDS group was under 10%, regardless of PF ratios (mean TBSA% 34,8%). Patients with concurrent inhalation injury and early ARDS showed significantly lower PF ratios (p < 0.001), and higher SOFA scores (p = 0.004) but without impact on mortality. Organ failure, indicated by SOFA scores, peaked early (day 3) and declined in the first week, mirroring PF ratio trends (p < 0.001). ConclusionsThe low mortality associated with early ARDS in burn patients in this study challenges the Berlin criteria’s for the early ARDS diagnosis, which for its validity relies on that higher mortality is linked to worsening PF ratios. The finding suggests alternative mechanisms, leading to the early ARDS diagnosis, such as the significant impact of inhalation injury on early PF ratios and organ failure, as seen in this study. The concurrence of early organ failure with declining PF ratios, supports, as expected, the hypothesis of trauma-induced inflammation/multi-organ failure mechanisms contributing to early ARDS. The study highlights the complexity in differentiating between the contributions of inhalation injury to early ARDS and the related organ dysfunction early in the burn care trajectory. The Berlin criteria for the ARDS diagnosis may not be fully applicable in the burn care setting, where the low mortality significantly deviates from that described in the original Berlin ARDS criteria publication but is as expected when considering the actual not very extensive burn injury sizes/Baux scores as in the present study.

The health workforce conundrum for burn care in Uttar Pradesh, India: a qualitative exploration

ABSTRACT Delivering specialised care for major burns requires a multidisciplinary health workforce. While health systems ‘hardware’ issues, such as shortages of the healthcare workforce and training gaps in burn care are widely acknowledged, there is limited evidence around the systems ‘software’ aspects, such as interest, power dynamics, and relationships that impact the healthcare workforce performance. This study explored challenges faced by the health workforce in burn care to identify issues affecting their performance. Qualitative in-depth interviews were conducted with a purposively selected sample (n = 31, 18 women and 13 men) of various cadres of the burn care health workforce in Uttar Pradesh, India. Inductive coding and thematic analysis identified three major themes. First, the dynamics within the multidisciplinary team where complex relations, power and normative hierarchy hampered performance. Second, the dynamics between health workers and patients due to the clinical and emotional challenges of dealing with burn injuries and multitasking. Third, dynamics between specialised burn units and broader health systems are narrated in challenges due to inadequate first response and delayed referral from primary care facilities. These findings indicate that burn care health workers in India face multiple challenges that need systemic intervention with a multipronged human resource for health framework.

A 10-year Retrospective Review of Patient-to-Patient Transmitted Pathogens in Culture-Positive Burn Wounds at a Tertiary Burn Center

Introduction: Burn wound infection can progress to sepsis and is a significant source of morbidity and mortality. Prevalence of multidrug-resistant organisms are high in burn patients; these organisms can be transmitted between patients leading to poor outcomes. Objectives: To characterize patient-to-patient transmission of pathogens causing burn wound colonization at a single tertiary hospital burn center in Hamilton, Canada from 2011 to 2020. Methods: Retrospective chart review of patients admitted to the burn trauma unit at Hamilton General Hospital between 2011 and 2020. Antibiotic susceptibility panels of pathogens cultured from burn patients’ wound swab/tissue cultures were compared against pathogens cultured from other burn/nonburn patients with overlapping admission dates. Pathogens were categorized into likely, possible, or unlikely transmission, or normal skin flora on a case-by-case basis. Results: There were 173 burn patients with positive wound culture and 613 nonburn patients included in the study. Included burn patients had median age 52 years, mostly male (73%) with flame injury (65%), and median total body surface area 18%. There were 18 patients (10%) with likely transmission and 54 patients (31%) with possible transmission. Most frequently implicated pathogens for likely patient-to-patient transmission were methicillin-resistant Staphylococcus aureus (MRSA) (7 patients) and methicillin-resistant coagulase-negative Staphylococci (4 patients). Both burn and nonburn patients were implicated. Conclusion: The burden of patient-to-patient transmission in culture-positive burn wounds was estimated to be between 10% and 41%. Greater care should be taken to avoid patient-to-patient transmission of pathogens to minimize burn infection morbidity and mortality. Prospective studies should be conducted with genomic sequencing and correlation with clinical outcomes.

The Impact of Surgical Wait Time and Hospital Stay on the Incidence of Burn Wound Infection and Related Complications at a Single Tertiary Hospital Centre: A 10-Year Experience

Introduction: Admitted patients with burn injuries require prompt treatment and shorter hospital stays to avoid hospital-acquired infections and associated complications. This study aimed to determine the impact of time to the first surgery, and total length of hospital stay on the incidence of BWI and associated complications in adult patients with moderate burn injuries at a single tertiary hospital burn center. Methods: A retrospective chart review identified burn patients admitted to the Burn Unit between January 2011 and January 2021. The incidences of BWI and complications were documented. Univariate logistic regressions were performed, with significance set at P &lt; .05. Results: A total of 171 patients were included in the study. The mean age was 50.8 years (range, 94-18 years), with 64 (37.4%) females. The mean wait time for surgery and total hospital stay was 2.6 days (SD = 2.5; 1-15 days) and 18.6 days (SD = 16.0; 1-125 days), respectively. Precisely, 47 patients (27.5%) were associated with positive burn wound cultures, with 23 patients (13.5%) experiencing clinical burn wound complications. Wait time to surgery did not significantly impact the incidence of BWI (OR = 0.97, P = .72) or related complications (OR = 0.97, P = .61). Total hospital stay was significantly associated with the incidence of BWI (OR = 1.05, P &lt; .001) and related complications (OR = 1.02, P = .03). Conclusions: Delay to surgery may not be a significant risk factor of BWI and related complications in patients with burn injuries. Half of positive burn wound cultures are associated with objective clinical infection and subsequent complications. However, total hospital stay may be clinically important.

СРАВНИТЕЛЬНАЯ ОЦЕНКА СХЕМ ПЛАВНОГО РЕГУЛИРОВАНИЯ МОЩНОСТИ ГАЗОГОРЕЛОЧНОГО УСТРОЙСТВА

Large-scale gasification of agricultural enterprises, personal subsidiary plots and farms, for which the most energy-intensive processes are the preparation of feed, food, and home heating, has revealed the need to automate digesters. The peculiarity of the operation of digesters is due to the fact that as the contents of the cooking container are heated to boiling temperature, the heat consumption decreases, and when the product boils, the heat consumption drops below 10%. It has been established that the lack of automatic gas control leads to excessive heat release into the atmosphere during the combustion of gaseous fuel. Previously, a gas burner unit was developed based on a partially automatic industrially produced gas burner device of the AGU-T-M type for digesters, which makes it possible to regulate gas flow in proportion to the consumed heat flow. The task was set to develop a promising scheme that would make it possible to regulate the gas flow in the digester in proportion to the consumed heat flow. This article describes two variants of schemes for proportional control of gas flow in a digester: the first is an improved scheme based on an automated gas burner device of the AGU-T-M type; the second is a circuit developed on the basis of Peltier semiconductor modules, a control solenoid with a gate valve. An assessment is given indicating the advantages and disadvantages of these schemes. It is shown that the first scheme is efficient and energy-independent; its use is most effective in remote settlements where there are frequent interruptions in the centralized power supply. The second scheme corresponds to the latest achievements of scientific and technological progress.

Airway Management for Acute and Reconstructive Burns: Our 30-year Experience.

Airway management in both acute and reconstructive burn patients can be a major challenge for evaluation, intubation, and securing the airway in the setting of altered airway structure. Airway evaluation in both acute and reconstructive patients includes examination for evidence of laryngeal and supraglottic edema and structural changes due to trauma and/or scarring that will impact the successful approach to acquiring an airway for surgical procedures and medical recovery. The approach to acquiring a successful airway is rarely standard laryngoscopy and often requires fiberoptic bronchoscopy and a variety of airway manipulation techniques. Tracheostomy should be reserved for those with classic requirements of ventilatory and/or mechanical failure or severe upper airway burns. Even securing an airway for surgical procedures, especially with patients suffering injuries involving the head and neck, can be nonstandard and requires creative and flexible approaches to be successful. After much trial and error over the past 30 years in a large burn center, our multidisciplinary team has learned many valuable lessons. This review will focus on our current approach to safe airway management in acute and reconstructive burn patients.

Primary and specialty palliative care utilization at a regional Burn center.

There is little research informing appropriate specialty palliative care consultation over primary palliative care practice, or the ability of the burn surgeon to perform skills such as effective goals of care discussions. We sought to characterize patterns of palliative care utilization and hypothesized that greater modified Baux (mBaux) and systemic organ failure assessment (SOFA) scores would correlate with increased specialty palliative involvement but have no relationship with primary palliative involvement. A retrospective chart review was conducted at a regional burn center between 2020-2021 including patients admitted with burns or inhalation injury and a mBaux score over 60, detailing circumstances of palliative consultation and goals of care discussions. 163 patients met criteria. Odds of specialty palliative consultation increased by 3.9% for each additional mBaux score point and 23.3% for every SOFA score point. The odds of a goals of care discussion by a burn surgeon increased by 3.5% for each mBaux score point and 23.9% for each SOFA score point. Those receiving palliative consultation tended to have greater burn surface area, graft complications, code status changes, and more goals of care discussions by any provider at admission; there was no difference in symptom control or hospital length of stay. Higher mBaux and SOFA scores correlate with increased odds of both specialty and primary palliative involvement in our cohort. There is bias in diverting both primary and specialty palliative care resources toward acutely ill patients and those with less immediate projected mortality may need additional attention.

Retrospective analysis of pathogens for guided creation of an EMPIRic antibiotic prEscribing pathway (EMPIRE).

The objective of this study was to evaluate the susceptibilities of pathogens isolated from cultures within the first 7 days of admission to the burn center and in the absence of healthcare-associated infection risk factors (HAIRF) to determine if current empiric antibiotics can be narrowed for refinement of an empiric antibiotic prescribing pathway according to suspected source. A 3-year sample of patients and cultures was utilized in hopes of obtaining at least 30 isolates of the most common pathogens and their respective susceptibilities. Two-hundred and sixty-eight clinically-relevant (e.g., deemed infectious, versus colonization) pathogens were included in the final sample with sources including wounds, respiratory, blood, urine, and bone. Of the 268 pathogens included, 45% were Gram-negative and 69% of all pathogens were isolated from wound cultures. The existing empiric pathway, vancomycin plus cefepime, covered 98% and 84% of all Gram-positive and Gram-negative pathogens, respectively. In patients without HAIRF, coverage rose to 98% and 90%, respectively. Initial use of vancomycin and cefepime remains adequate for pathogens isolated within one week of admission in patients without HAIRF. For pneumonias, a narrower spectrum beta-lactam would not sufficiently cover respiratory pathogens isolated within the first week of admission. Regarding early wound infections, difficult-to-treat pathogens remain as a rare isolate of wound cultures within one week of admission.

Safe environment of a medical organization for patients of the burn unit

One of problems of modern medicine is the organization of an emergency aid and intensive therapy by the victim with thermal defeats [1]. The number of victims of burns around the world, especially in industrialized countries, steadily grows. High death rate in state of shock or after it requires in the nearest future further enhancement of the organization of assistance to patients, intensive therapy and surgical treatment.