Burn Etiology Research Articles

Epidemiology and Knowledge of First Aid Treatment Related to Burn Injury in the Rural Region of Kulon Progo, Indonesia

BACKGROUND: We investigated the epidemiology and the knowledge of first aid regarding to burns in the rural area of Kulon Progo, located in Indonesia. Although 44% of Indonesia’s population resides in rural areas, data of burn in Indonesia are very limited to national referral centers located in Indonesia’s largest cities. We also surveyed the patients and families of these burn patients to try to understand their knowledge on the first aid of burns.
 AIM: We wanted to explore and discover what myths and misperceptions existed in rural communities.
 MATERIALS AND METHODS: A retrospective study analyzing the medical records of patients with burns admitted to two of Kulon Progo’s largest referral hospitals between January 2018 and December 2019. A survey was distributed to the patients and their families regarding their knowledge on the first aid of burns. We wanted to analyze if certain groups of the population were more at risk for specific types of burn etiologies, the correlation between burn etiology and length of stay, the correlation between total body surface area (TBSA) of burns and length of stay in the hospital, and the correlation between education level of survey participants’ and their knowledge of first aid of burns.
 RESULTS: A total of 115 patients were reviewed in this study. The highest proportion of total burn injuries occurred in the age group of 1–14 years old (38%). The major etiology of all burn cases were caused by scald (54%). Housewives and children were at a higher risk for scalds and laborers were at a higher risk for electrical and chemical burns (p = 0.001). There was no significant correlation between etiology and length of stay (p = 0.29). There was a statistically significant correlation between the TBSA and the length of hospital stay (p = 0.0001). The majority of survey respondents (66%) had poor knowledge on the first aid of burns. There was no significant correlation between education level and knowledge of first aid of burns (p = 0.07547).
 CONCLUSIONS: Children, laborers, and housewives have a significant risk of suffering from a burn injury. A majority of people still have poor knowledge on the first aid of burns. There was no correlation between education levels and knowledge of first aid burns.

Paediatric chemical burns: a clinical review.

Although they account for a small proportion of burns in paediatrics, injuries from chemicals can be just as devastating as other mechanisms of burn injury. At least 25,000 chemicals exist which can cause burns: in children, they are often caused by household chemicals via accidental exposure. The mechanism by which corrosive substances produce chemical burns highlights the importance of early and plentiful irrigation of the burn area, removal of contaminated clothes and careful clinical assessment. Surgical intervention is uncommon but often follows the principles for thermal burns. This article reviews the aetiology, incidence, clinical presentation, management, complications and prevention of chemical burns. What is Known • Chemical burns in paediatrics are often caused by accidental exposure to chemicals available at home • Differences in the pathophysiology of chemical burns reinforces the need for early irrigation What is New • New irrigation fluids show promise in adults and need further study in children • The nature of chemical cutaneous burns can make assessment of wound depth difficult. Laser Doppler Imaging (LDI) is an accurate technique that can be used clinically to determine burn depth in thermal burns and is an area of future interest in the assessment of chemical burns.

Epidemiological analysis of burn patients in Hospital Melaka, Malaysia

Background: Burn injury remains one of the most frequent public frequent public health concerns that are associated with significant morbidity and mortality. This study aims to understand the epidemiological profile of burn patients admitted to Burn Unit, Hospital Melaka between January 2016 and December 2018. Methods: A retrospective study was conducted to review burn cases that were admitted to Burn Unit, Hospital Melaka from January 2016 to December 2018. The epidemiological data of 241 patients were collected and studied. Results: The etiology of burn was determined: 230 (95.4%) thermal burns, 4 (1.7%) electrical burns, and 7 (2.9%) chemical burns. In 230 cases of thermal burn, 85 (37.0%) of accidents were caused by flames, 119 (51.7%) by scalds, and 26 (11.3%) by contact with hot objects. One hundred and eighty-nine (63.2%) of the patients were male, the remaining 110 patients (36.8%) were female. The female/male ratio was 1:1.7. The duration of hospitalization stay was 8 days. Mortality rate was 3.34% with 50% of deaths following major burn were due to sepsis with multiorgan failure. Conclusion: This study provides an overview on demographic features of burn patients admitted to Hospital Melaka.

Comparison of scald burns caused by hot water, tea and milk in preschool children

Aim: Burn injury is an important health problem with physical, psychological and economic effects with children being affected the most. The aim of this study is to present the epidemiological and demographic data and clinical results of preschool pediatric patients with scald burns which are treated in a tertiary reference burn center.Materials and Methods: Preschool children admitted between January 2014 and August 2019 was included in the study. The demographic and epidemiological data, burn etiology, percentage of burned total body surface area and treatment results of patients were evaluated retrospectively from the patient files and the hospital registry.Results: A total of 1010 preschool children with scald burns were treated in our burn center from January 2014 to August 2019. Patients were grouped by the etiology as; group 1: water, group 2: tea and group 3: milk scalds. There were 628 patients in group 1, 304 in group 2 and 78 in group 3. The percentage of burned total body surface area was higher for scalds with milk and was found as 15.54±12.1 and the difference was statistically significant. The intensive care and the total hospital stay were also higher in scalds with milk. There were similar results with infection, grafting and mortality rates as being higher in the milk group. Conclusion: The majority of preschool patients in our burn center were scalds with water but the percentage of burned total body surface area, skin grafting and complication rates were higher in scalds with milk. Childhood burns were usually seen indoors at preschool period, necessitating training programs for family members supervising these children and raising the awareness of parents.

Impact of the affordable care act’s medicaid expansion on burn outcomes and disposition

BackgroundWe aimed to analyze the impact of the Affordable Care Act’s Medicaid Expansion on clinical outcomes and patient disposition after burn injury. We hypothesized that increased insurance coverage results in improved outcomes and higher rates of discharge to inpatient rehabilitation. MethodsWe reviewed the University of Washington Regional Burn Center registry data for patients admitted from 2011 to 2018. Patients were grouped into two categories: before (2011–2013) and after (2015−2018) Medicaid expansion; we excluded 2014 data to serve as a washout period. Outcomes assessed included length of hospital stay, patient disposition, and mortality. Multivariable logistic and linear regression models with covariates for sex, age, burn size, ethnicity ethnicity, distance from burn center, etiology of burn, and presence of inhalation injury were used to determine the impact of Medicaid expansion on outcomes. ResultsRates of uninsured patients decreased while Medicaid coverage increased. Despite increased median burn size after Medicaid expansion, inpatient mortality rates did not change, but average acute care length of stay increased. More patients were discharged to rehabilitation centers. ConclusionsOur study corroborates prior findings of increased insurance coverage since Medicaid expansion. Increased insurance coverage is associated with higher rates of discharge to inpatient rehabilitation programs after burn injury.

Characteristic Of Hospitalized Burn Injury Patients In Zainoel Abidin General Hospital Year 2016-2017

Background: The epidemiology pattern of patients with burn injury varies widely in different parts of the world. This study aimed to identify epidemiological data from hospitalized burn injury patients in Zainoel Abidin General Hospital, a referral Hospital in Aceh. Methods: All hospitalized burn injury patient data from January 2016 to December 2017 were collected from the medical record. Data taken included Gender, age, length of stay (LOS), mortality, severity, and extent of the burn, and etiology of burn. Results: From all hospitalized patients with burn injury, the male to female ratio is 1,6:0,9. The mortality rate is 9%, while the others survive. From all etiology of burn, 57% is flame injury, 19% is electrical injury, 18% is scald burn injury, 4% is contact burn injury, and 1% is a chemical burn injury. No patient with first-degree burns was hospitalized, while 13 patients had third-degree burn injuries, and the rest had second-degree burn injuries. Conclusion: An increasing number of hospitalized patients from 2016 to 2017, from 25 patients to 42 patients. It might happen because of increasing knowledge about burn injury in society and physicians in rural areas to refer patients to the hospital with better facilities.

Burn Case Prevalence In Dr Kariadi General Hospital Semarang From 2012 to 2014

Background: Burns is a type of trauma that requires treatment and rehabilitation, which is still difficult and requires perseverance, a high amount of costs, and trained and skilled personnel. Morbidity and mortality of burns are relatively high, especially in developing countries where burn prevention and treatment systems are inadequate. The prevalence of burns is expected to be an advantage for the development of science in further research and could help clinicians prevent and curative burn care efforts. Method: The study subjects were burned patients examined and hospitalized at Dr. Kariadi General Hospital, Semarang. Data from each sample's clinical examination results were then collected to be described based on gender, age, burns degree criteria, and etiology of burns. Results: The total sample obtained was 72 samples, including 61 patients (85.53%) with new burns and 11 non-emergency patients (14.47%). From a total of 61 new burn patients, eight female patients (13.11%) and 53 male patients (86.89%) were obtained; 10 patients (16.40%) were children (0-18 years), 50 (81.96%)were adults (18-65), and one patient (1.64%) belonged to geriatric (> 65 years) ); based on the degree of the burns, seven patients (11.48%) had a moderate degree and 54 patients (88.52%) had a severe degree; there were 28 patients (45.90%) who suffered burns caused by fire, 20 patients (32.79%) due to electricity, six patients (9.84%) caused by scald, and seven patients (11.47 %) with an unknown cause. Of the 61 new burn patients, there were five patients (8.20%) who died. Conclusion: Burn prevalence in Dr. Kariadi General Hospital, Semarang in 2012-2014 are mostly experienced by men, adults, with severe burn criteria, with the most common etiology is fire.

A Structured Review to Assess the Current Status of Cost-Based Burns Research in Nepal.

The management of burns is costly and complex. The problem is compounded in low and middle income countries (LMICs) where the incidence of burn injuries is high but infrastructure and funding for management and prevention is limited. Cost of illness studies allows for quantification of the costs associated with public health problems. Without cost quantification, focus and allocation of funding is challenging. The authors explored the availability of cost-focused burns research data in a target LMIC. The focus of their research was Nepal. A structured literature review including published papers, Ministry of Health (MOH) and World Health Organization (WHO) statistics was conducted to identify cost of illness studies or evidence relating to burn-related resource and costs. Gaps in the evidence base were highlighted. Research methodologies from other LMICs were reviewed. We found 32 papers related to burn injury in Nepal, one key MOH document and one relevant WHO data source. Most research focused on the epidemiology and etiology of burns in Nepal. Of the papers, only 14 reported any type of burn-related resource use and only 1 paper directly reported (limited) cost data. No studies attempted an overall quantification of the cost of burns. MOH statistics provided no additional insight into costs. Our study found an almost complete lack of cost-focused burns research in Nepal. Primary research is needed to quantify the cost of burns in Nepal. Initial focus could usefully be on the cost of care in tertiary hospitals. A full cost of burns for Nepal remains some way off.

Analysis of the Efficacy of Iloprost Treatment in Amputations Due to Burn.

The aim of our study was to demonstrate the decrease in amputation rates with iloprost treatment in patients who develop vascular injury due to burns. The data of 366 adult burn patients who were admitted to the emergency department of our hospital between 2016 and 2019 were analyzed. Demographic characteristics, burn factors, vascular examination findings, medical treatments, amputation rates, and levels were recorded. The amputation rates of the patients who were treated with iloprost and who were not treated with iloprost were compared. The mean age of 366 adult patients treated for burns was 37.8 ± 16.4 years, and of these patients, 220 (59.9%) were under 40 years of age. Although heat burns (n = 331.85%) were the most common burn etiology, it was found that the incidence of vascular injury was higher in burns caused by electricity (11.7%) and cold (3.3%) (P < 0.001). Vascular injury was detected in 60 (16.3%) of the patients and 21 (35%) of these patients were treated with iloprost. Amputation was observed in 20 (5.5%) of all burn patients, but only one of the patients treated with iloprost underwent amputation (P < .001). The individual and social impacts of amputations caused by burns are unquestionable. The authors are of the opinion that iloprost treatment is effective in reducing amputations due to burns.

Small Pediatric Burns Can Be Safely Managed on an Outpatient Basis

American Burn Association (ABA) guidelines recommend that all pediatric burns be transferred to a burn center if their presenting hospital lacks the necessary personnel or equipment for their care. Our institution often treats small burns (<10% TBSA) in pediatric patients in an ambulatory setting with a nondaily dressing. The aim of this study was to determine whether small pediatric burns could be safely managed on an outpatient basis. A retrospective review at a single ABA-verified burn center was conducted, including 742 pediatric patients presenting to the burn evaluation clinic in a 3-year period. Postburn day, age, sex, TBSA, burn etiology, body area burned, burn dressing type, outpatient versus inpatient management, reason(s) for admission, and any operative intervention were collected. Overall, the most common burn etiologies were scald (68%), contact (20%), and flame (5%). In this cohort, 14% (101) of patients were admitted on evaluation to the burn center with a mean TBSA of 9%. The remaining 86% (641) of patients were treated outpatient with a mean TBSA of 3%. Of those who were treated outpatient, 96% (613) successfully completed outpatient care and 4% (28) were subsequently admitted. The patients who were successfully managed in an ambulatory setting had a mean TBSA of 3%, whereas the patients who failed outpatient care had a mean TBSA of 4%. The primary reason for the subsequent admission of these patients was nutrition optimization (61%). The vast majority of small pediatric burns can be effectively treated on an outpatient basis with a nondaily dressing.

Airbag Burns: An Unfortunate Consequence of Motor Vehicle Safety.

Thousands of people are injured in motor vehicle collisions daily and the mandated installation of airbags protects passengers but can also cause injuries from deployment including cutaneous burns. We sought to characterize the patterns and outcomes of burns resulting from airbag deployment by performing a retrospective review of all patients evaluated by the burn service from May 1, 2015 to April 30, 2019. Inclusion criteria were patients of all ages with burn injuries related to airbag deployment. Demographic data, burn characteristics, and outcomes were reviewed. Seventeen patients met the inclusion criteria: 82.4% female and 17.6% male. The average age was 40.4 years. Fifteen patients had second-degree and two had third-degree burns. The average TBSA was 0.45%. The hands or upper extremity (88%) were most often injured, but there were two chest, one neck, and one anterior thigh burns. Eight patients suffered multiple burns. Burn etiology (chemical vs thermal) was often not specified. No patients required hospitalization or surgical intervention, and all wounds healed with wound care. The average time to re-epithelialization was 11 days. Although airbags prevent mortality and serious injury, the exothermic chemical reaction that inflates the airbag is responsible for deployment-related burns. Since there is a chemical and thermal component, all airbag-related burns should undergo chemical decontamination on the initial presentation. Burns related to airbag deployment tend to be small and do not require grafting; however, patients suffer from associated pain, scarring, and burn management can be a financial and time burden to the patient.

Characterization and analysis of exhaust pipe (muffler) contact burns: An unsuspecting culprit

Introduction Thermal injury due to contact with engine exhaust systems represents a distinct subgroup of acute contact burns. Temperatures generated by motor vehicle, radiator, and lawn mower engines can exceed 250℃, at which point relatively deep tissue loss occurs with less than 0.06 seconds of cutaneous exposure. While prior studies have helped elucidate the demographic characteristics of exhaust pipe contact burns, our analysis was aimed at both demographics and burn severity, as indicated by rate of full-thickness injury and requirement for tangential excision and skin grafting. Methods Data were obtained from a retrospective review of admissions at a regional burn center between 1 July 2012 and 30 August 2016. Patients of all ages with muffler, exhaust, motorcycle, lawn mower, and radiator burn injuries were included. Extensive demographic information, percent total body surface area burned (TBSA), burn etiology and location, third-degree and fourth-degree burn percentage, and subsequent operative information were analyzed for patients who sustained exhaust pipe contact burns. These data were then compared with all contact burn injuries from the same time period, matched for %TBSA range, using Fisher exact and unpaired t-tests. Results A total of 110 patients suffered exhaust pipe contact burns during the study period; 65 (59%) were males, and mean age was 30. Nearly two thirds of the muffler burns were sustained from motorcycles with TBSA ranging from 0.05% to 3.14%; at least 61% had some third-degree burn. The average number of operating room visits per patient was 0.54, though this varied significantly, with 38 patients (35%) requiring 59 total surgeries (range 1–6). Muffler burn patients were older than the matched control group. The most common location of burn injury was the lower leg with no difference between adults and children. Pediatric patients understandably had smaller burn surface area but similar TBSA compared to adults. The majority of injuries occurred in May, June, and July. Conclusions Exhaust pipe contact burns comprise a specific subset of low %TBSA contact burns with relatively high morbidity, evidenced by a significantly higher proportion of full-thickness tissue loss and eventual need for skin grafting when compared with nonexhaust burn controls. Awareness of the increased severity of exhaust pipe contact burns may lead to more expedient surgical intervention as well as further education regarding preventative measures.

Work-Related Burn Injuries in a Tertiary Care Burn Center, 2013 to 2018.

The features of work-related burn (WRB) injuries are not well defined in the literature and they vary depending on geographical location. We wanted to describe these characteristics among patients treated in the UNC Burn Center to evaluate the potential impact of commonly accepted prevention efforts. Adults of working age, admitted between January 1, 2013, and December 31, 2018, were identified using our Burn Center Registry. Demographic data, characteristics of injury, course of treatment, and patients' outcomes were described. Differences between work-related and non-work-related injuries were evaluated using the Chi-square test and Student t-test where appropriate. Three thousand five hundred and forty-five patients were included. WRB cases constituted 18% of the study population, and this proportion remained relatively stable during the study timeframe. Young white males were the majority of this group. When compared with non-WRB patients, they were characterized by fewer co-morbidities, decreased TBSA burns, decreased risk of inhalation injury, shorter time of intensive care treatment, shorter lengths of hospital stay, and lower treatment cost. In contrast to non-WRB, among which flame injuries were the main reason for admission, work-related patients most often suffered scald burns. They also had a dramatically increased proportion of chemical and electrical burns, making the latter the most common cause of death in that group. WRB are characterized by a characteristic patient profile, burn etiologies, and outcomes. Learning specific patterns at this group may contribute to optimize work safety regulations and medical interventions.

720 Scalds and Contact Burns: Are They Really Different?

Abstract Introduction Prior studies comparing scalds and contact burns rarely address the affect of burn etiology on burn depth. However, it is commonly believed that scalds tend to heal faster than similarly sized contact and flame burns. As a result, expectant therapy is often preferred after scald injuries. We compared the percentages of full-thickness burns based on burn etiology controlling for burn size, location and patient age. We hypothesized that the percentage of full thickness burns would be lower after scalds compared with contact and flame burns. Methods We performed a retrospective chart review of a prospectively collected burn registry of all patients admitted to a regional burn center between 2000–2010. Data collection included patient and burn characteristics including age, gender, body location, and burn etiology. We compared the percentages of full thickness burns among scald, contact and flame burns using Chi-square tests. Stepwise logistic regression was used to adjust for age, location, and burn size. Results There were 1038 patients in the study with either scald (n=537, 52%), fire/flame (n=434, 42%) or contact (n=67, 6%) burn. Mean (SD) age was 29 (25); 75% were male. Mean (SD) total body surface area (TBSA) was 11 (13)%. Mean (SD) length of stay was 10 (18) days. The percentages of full thickness burns by etiology were scalds 13.1%, fire/flame 34%, and contact burns 45% (P&amp;lt; 0.001). Patients with scalds were younger (22+/-24) than patients with contacts (32+/-28) and fire/flame (38+/-22) burns. Multivariate analysis for predicting full thickness burns found that compared with contact burns, scalds were less likely full thickness (OR 0.23, 95%CI 0.11–0.48) while fire/flame burns were as likely to be full thickness (OR 0.54, 95%CI 0.26–1.15). TBSA and age were also associated with full thickness burns (OR 1.06, 95%CI 1.04–1.09 and OR 1.015, 95%CI 1.007–1.024, respectively). Burns on the head and neck were less likely to be full thickness (OR 0.30, 95%CI, 0.11–0.82). Conclusions Scald burns are significantly less likely to be full thickness than contact or fire/flame burns. Applicability of Research to Practice Based on these results, expectant therapy may be more appropriate for scalds than contact or fire/flame burns.

724 Factors Influencing Healing Time After Enzymatic Debridement

Abstract Introduction Enzymatic debridement (ED) as a noninvasive method is widely used and has been researched in several studies. The influence of key components of the trauma and overall treatment on healing time are often underrepresented. This paper describes the results from 56 wounds treated in a burn unit to evaluate factors influencing the healing time. Methods From all patients admitted to our unit from the year 2014 to 2016, 56 were treated with ED. Preclinical data and clinical data were compared in a retrospective review. Patients were divided into two groups with a separator of healing time of 30 days. Results ED was provided in 56 wounds in 52 patients on average to 7.0% ± 6.0 %, median 4.8% of patient’s body surface area. Comparing the group with a healing time of more than 30 days and less than 30 days. Statistically significant differences with a p&amp;lt; 0.05 were found in the rate of preclinical intubations, inhalation injuries, the application of fluids before admission, the type of dressing used and the BAUX index. Highly significant differences with a p&amp;lt; 0.01 were found in the ratio of pseudoeschars which had to be operated on and in the modified BAUX index (MBI). Mostly used dressings were a polylactic membrane (PLM) and silicone dressings. In the silicone group, MBI was significantly higher than in the polylactic group and healing time was significantly faster in the PLM group. Comparing groups with a higher than average MBI of 67.5 the PLM and the silicone group had a comparable MBI (p=0.337), but the PLM group had a five days shorter healing time of 43 days (p=0.2768). In a logistic regression formula over all PLM and Silicone patients (Days for healing after ED = 1.53 + 8.9 * dressing (PLM=1, silicone=2) + 0.35*MBI - 5.15483*incomplete debridement (Yes=1, No=0) + 7.96*pseudoeschar to be operated on (Yes=1, No=0) the influence of dressings could be demonstrated. No statistical differences (p &amp;gt;0.05) could be found in age, etiology of burn (fire scald, electric current injury or electrical arch with a p=0.4), location of accident out- or inside a building, cold water therapy applied or not, in TBSA, percentage of partial deep burns and full-thickness burns or the percentage of patients taken to ICU as inpatients and the timing of ED as well as the completeness of ED and in ABSI. Conclusions Healing time was dependent on parameters such as preclinical intubations, inhalation injuries, dressings used, and the severity calculated by MBI. Dressings are one of the few settings which can be changed proactively to achieve better outcomes. PLM over all clinical conditions have a shorter healing time (31 days) compared to silicon dressings (49 days) Applicability of Research to Practice Immediate.

610 Small Pediatric Burns Can Be Safely Managed on an Outpatient Basis

Abstract Introduction American Burn Association guidelines recommend that all pediatric burns be transferred to a burn center if their presenting hospital lacks the necessary personnel or equipment for their care. Our institution often treats small (&amp;lt; 10% TBSA) burns in pediatric patients as outpatients with a non-daily dressing. The aim of this study was to determine if small pediatric burns could be managed in an outpatient manner and risk factors for failure. Methods A retrospective chart review was conducted from July 2016 to July 2019 at a single ABA-verified burn center. All patients under the age of 18 who presented for evaluation were included. Post burn day, age, sex, TBSA, burn etiology, body area burned, burn dressing type, outpatient versus inpatient management, reason(s) for admission, and any operative intervention were collected. Results In total, 742 patients were included in our cohort (Table 1). The most common burn etiologies were scald (68%), contact (20%), and flame (5%). From initial presentation, 101 patients (14%), mean TBSA 9%, were admitted to the burn unit and 641 patients (86%), mean TBSA 3%, were treated outpatient. Of those, 613 (96%) were treated entirely outpatient and 28 (4%) were admitted at a later date. There were no significant differences in age (p=0.6) nor gender distribution between those who were successfully treated outpatient and those who failed. There was a significant difference (p &amp;lt; 0.001) in TBSA between the patients who were treated successfully as outpatients (3±2%) versus those who failed outpatient care (4±3%). The primary reason for admission of these patients was nutrition optimization (61%). Conclusions The vast majority of small pediatric burns can be treated as an outpatient with a non-daily dressing with good results. Over 80% of pediatric patients seen in our clinic were successfully managed in this manner. As suspected, when the burns are larger in size (&amp;gt;4% TBSA) there is a potential increased risk for admission especially with regards to poor PO intake, so this requires close monitoring and family education. Applicability of Research to Practice Pediatric patients with small burns can be safely managed in an outpatient setting with a non-daily dressing. Those who fail will most likely fail from poor PO intake at home.

572 Examination of Gender Differences in Return to School and PROMIS-25® Outcomes for Pediatric Burn Survivors

Abstract Introduction Gender differences in pediatric burn outcomes are not well-known. Long-term physical and mental health outcomes, in addition to school status, serve as important markers in recovery for school-aged burn survivors. This study aimed to assess the impact of gender on school status and health outcomes in pediatric burn survivors. Methods Data from pediatric burn survivors, age 8–17 years at time of injury that are participating in the Burn Model System National Database (2015–2019) were analyzed. Descriptive statistics were generated for demographic and clinical characteristics. Scores on the seven subscales of the PROMIS-25 (physical function, anxiety, depression, fatigue, peer support, pain interference, and pain intensity) and school status at 12 months post-injury were examined. All demographic, clinical, and outcome data were compared by gender using Chi-square tests of association and two-sample t-tests for categorical and continuous variables, respectively. Results A total of 104 individuals (76 male, 28 female) were included in the demographic analysis. Additionally, 60 individuals had complete PROMIS-25® data at 12 months post-injury and were included in analysis. Demographic and clinical characteristics including age at time of burn injury, race/ethnicity, burn etiology, burn location and burn size did not differ by gender. No differences were found in PROMIS-25® subscales (p=0.22–0.87; Table 1) or school status by gender. Nearly 80% of male and female burn survivors were in school at 12-months post-injury (76.6% male vs. 88.2% female; p=0.307). Conclusions In this study, burn survivors between the ages of 8 and 17 years old did not experience any differences in long-term PROMIS-25® outcomes or school status at 12 months post-injury based on gender. Applicability of Research to Practice Preliminary data suggest similar physical, mental, and school outcomes for school aged children based on gender. A more robust examination of long-term pediatric outcomes and school status are needed in the future.

543 Acute Carpal Tunnel Syndrome from a Solar Panel Electrical Injury: A Case Report and Literature Review

Abstract Introduction The utilization of solar panels for residential and industrial purposes is increasing. Electrical injury from solar panels has not been well defined. Most of the literature on electrical burns is predominately from alternating current (AC) injuries instead of direct current (DC) as seen in solar panels. The implication of solar panel electrical injury in the pathogenesis of acute carpal tunnel syndrome has yet to be reported. Methods A retrospective chart review of a patient presenting to our burn unit following a solar panel electrical injury was performed. Results The patient was a 46 year old otherwise healthy male who presented after 5–10 seconds of high voltage (~7500V) direct current injury to his right forearm. The patient had deep partial thickness burns to his right hypothenar eminence and a full thickness defect with exposed muscle on his right volar forearm. On admission he had complete function, but within hours developed an inability to move his hand. He was taken for exploration on hospital day 2 because of mildly elevated compartment pressures, pain, and paresthesia. The hypothenar injury was noted to have converted to full thickness injury and a distal right volar forearm fasciotomy and carpal tunnel release was performed. On hospital day 3, the patient’s pain and neurologic examination improved. At 3 month follow-up, the patient had some restored function of his hand, but reduced grip strength, and mild persistent pain and paresthesia in the volar wrist and hand. Conclusions Solar panel injuries are expected to rise. The use of high voltage direct current energy has the potential to cause serious harm and appropriate awareness can lead to thorough management and better outcomes of burn victims. With electrical injuries to the hand, providers should have a low threshold for carpal tunnel syndrome, whose symptoms may be complicated by concomitant compartment syndrome of the hand and/or forearm. Lastly, as with most burn injuries a multidisciplinary approach should be established with focus on long term care. Applicability of Research to Practice We suspect that this new etiology of electrical burn is on the rise as we see more solar panels being utilized. Physician should be familiar with potential complications in this complex patient population.

728 The Faces of Autologous Skin Cell Suspension as Epidermal Grafts

Abstract Introduction Facial burns are frequently severe and are difficult to skin graft, which may lead to increased morbidity including chronic pain, scarring, and psychosocial stigma. The aim of this study was to describe outcomes of patients with facial burns who received autologous skin cell suspension as an epidermal graft. Methods A retrospective chart review of patients with facial burns admitted to an ABA verified Burn Center from January 2019 to August 2019 was performed. Each patient underwent tangential excision of superficial and deep partial-thickness burn wounds followed by autologous skin cell suspension applied as an epidermal autograft. The wounds were covered with a non-adherent dressing along with bismuth-impregnated, petroleum-based gauze. The dressings were secured in place with sutures to prevent disruption. On post-operative day 6 the dressings were removed with transition to an antimicrobial ointment applied to any remaining open wounds or a moisturizing lotion. Results Five patients, aged 41–89 years, were included. Total body surface ranged from 7–50%. Etiology of the burns included: flame from metal fabricating, assault followed by dousing the patient in gasoline and lighting on fire, flash flame from a water heater explosion, hot oil contact, and involvement in a house fire. 3 of the 5 patients had complete healing noted by post-operative day 6 with excellent results. Two patients required a second excision and application of autologous skin to small portions of the lateral face after healing the majority of the face. One patient developed mild microstomia requiring oral splinting. One of the two patients that required a second application developed ectropian to one of her eyes which was treated with temporary tarsorrhaphy. The second patient that required a second application, died during her hospitalization secondary to complications from her burns and underlying medical co-morbidities. Surviving patients reported satisfaction with the cosmetic outcomes. Conclusions Autologous skin cell suspension as an epidermal graft is a viable option for cosmetically important areas such as the face. This case series provides evidence for its validity when treating partial-thickness burns utilizing the above described protocol in conjunction with a multidisciplinary care team within a burn center. Applicability of Research to Practice By sharing our institutions experience with this relatively new technique we hope to share our positive outcomes as an alternative to stand excision and grafting to areas of significant cosmetic outcomes.

Reconstruction of postburn contractures due to tandir oven

The aim of the study was to evaluate postburn contracture reconstructions caused by high temperature such as tandir. The records of our 58 patients who were operated for burn contracture between 2008 and 2018 were retrospectively reviewed. Duration elapsed after the burn, localization of contracture, surgery applied, and the recurrence rates were recorded. McCauley classification was used to evaluate the severity of hand contractures. One hundred and thirty-seven contracture release operations were performed in 45 hands in 40 cases. Five patients had bilateral hand contractures. One hundred and sixty-three (84.9%) surgeries out of total 192 contracture release surgery were applied to the hand and foot region. FTSG alone was the most common method of treatment. Z-plasty was used the most frequently by our team as the flap surgery. Tissue damage is more severe due to very high temperature of the tandir and as a result, more frequent and heavier burn contracture occurs on hands and feet than other burn etiologies develops, and reconstructive operations are needed more frequently.