Large Burns Research Articles

The Myofibroblast Fate of Therapeutic Mesenchymal Stromal Cells: Regeneration, Repair, or Despair?

Mesenchymal stromal cells (MSCs) can be isolated from various tissues of healthy or patient donors to be retransplanted in cell therapies. Because the number of MSCs obtained from biopsies is typically too low for direct clinical application, MSC expansion in cell culture is required. However, ex vivo amplification often reduces the desired MSC regenerative potential and enhances undesired traits, such as activation into fibrogenic myofibroblasts. Transiently activated myofibroblasts restore tissue integrity after organ injury by producing and contracting extracellular matrix into scar tissue. In contrast, persistent myofibroblasts cause excessive scarring-called fibrosis-that destroys organ function. In this review, we focus on the relevance and molecular mechanisms of myofibroblast activation upon contact with stiff cell culture plastic or recipient scar tissue, such as hypertrophic scars of large skin burns. We discuss cell mechanoperception mechanisms such as integrins and stretch-activated channels, mechanotransduction through the contractile actin cytoskeleton, and conversion of mechanical signals into transcriptional programs via mechanosensitive co-transcription factors, such as YAP, TAZ, and MRTF. We further elaborate how prolonged mechanical stress can create persistent myofibroblast memory by direct mechanotransduction to the nucleus that can evoke lasting epigenetic modifications at the DNA level, such as histone methylation and acetylation. We conclude by projecting how cell culture mechanics can be modulated to generate MSCs, which epigenetically protected against myofibroblast activation and transport desired regeneration potential to the recipient tissue environment in clinical therapies.

Scale effects on rotating detonation rocket engine operation

Rotating detonation rocket engines are propulsive devices employing detonation waves moving circumferentially around an annular channel that consume axially fed propellants. Theoretically, this provides benefits with respect to combustion pressure gain and thermodynamic efficiency when compared to deflagration-based combustors. To facilitate size scaling of these devices, the relationships between geometric parameters, performance, and wave dynamics have been investigated with gaseous methane-oxygen propellant. Empirical relations were derived between combustor geometry, fueling conditions, and engine operation, as well as correlation to thermodynamic parameters calculated with chemical kinetics codes. The radius of curvature effects were explored in annular combustors having outer diameters of 25 mm, 51 mm, and 76 mm with a fixed gap width of 5 mm. The injectors were scaled to have same oxidizer-to-fuel injector port area ratio, impingement distance, and injector-to-gap area ratio. Larger combustors had higher wave counts during operation at a given mass flux and equivalence ratio. Combustor axial pressures were found to be more dependent on propellant mass flux and equivalence ratio than geometry. Mass flux and the inner-to-outer radius ratio, the latter of which was related to other geometric ratios, dictated the operating mode transition thresholds and the number of resulting waves, respectively.

Effect of Passive Pre-chamber Igniting Position on the Large Bore Natural Gas Engine Combustion Characteristics

Effect of Passive Pre-chamber Igniting Position on the Large Bore Natural Gas Engine Combustion Characteristics

Case report of pharmacokinetic analysis of continuous intravenous infusion of fentanyl in a patient with severe burn: burn shock stage complicates pain management

BackgroundFentanyl is widely used as an analgesic and sedative for patients with severe burn injuries in intensive care units. However, pharmacokinetic (PK) data for fentanyl, particularly for continuous intravenous infusion during the acute phase of burn injuries, are limited. Here, we report the clinical course and changes in blood fentanyl concentrations during the acute phase in a patient with severe burns treated with continuous intravenous infusion of fentanyl.Case presentationA woman in her 40s, with burns caused by a gas cylinder explosion, was transported to our hospital. The patient had burn wounds on face, neck, shoulders, and all four extremities, with a total burn area of 39.0%. For pain relief, the patient received a continuous infusion of 0.01 mg/mL fentanyl (20–30 µg/h) with a target blood concentration of 1.0–1.5 ng/mL, but continued to suffer from pain due to burning during the acute phase. We measured the blood fentanyl concentrations and found that all concentrations obtained during the acute phase were subtherapeutic. Notably, during the burn shock stage, blood concentrations of fentanyl were 0.50 ng/mL on day 1 and 0.66 ng/mL on day 2, indicating that the blood concentration did not rise sufficiently for the dosage. From days 0 to 2, the patient was administered a massive fluid load for burn shock. After the burn shock stage resolved, fentanyl concentrations gradually approached the target range, and the pain rating scale improved, even though the fentanyl administration rate remained unchanged (30 µg/h).ConclusionsMajor changes in the fluid volumes of body compartments that occur with large burns might increase the volume of fentanyl distribution, thereby lowering its concentration when a standard dose is administered. Our findings indicate that the PK of fentanyl in patients with severe burns can be substantially affected, especially during the shock phase, implying the importance of titrating analgesics for clinical efficacy in the acute phase.

Experimental and numerical investigation on combustion characteristics of double large cube RDX-based NEPE solid propellant burning in an atmospheric environment

When two solid propellant fire sources are in close proximity, their combustion characteristics may interact, leading to the phenomenon known as dual-fire source solid propellant fire. This study aims to comprehensively evaluate the combustion behavior of two NEPE (Nitrate Ester Plasticized Ether) solid propellant fires in an open-air environment. Experimental findings indicate that the combustion dynamics of dual-fire source solid propellants are significantly influenced by factors such as propellant size, inter-source spacing, and environmental wind conditions. Various distinctive phenomena were observed during the combustion process, including independent flame development, flame fusion, and intermittent independent flame decay. These phenomena resulted in notable fluctuations in flame temperature, with temperatures between dual-fire sources being lower compared to their single-fire source counterparts. Additionally, a three-dimensional combustion-flow coupling computational model was developed, integrating models for random particle trajectories, vortex dissipation, and radiation. The numerical simulations effectively replicated the observed effects, showing that increasing environmental wind speed enhances the occlusion behavior between the two propellant flames, leading to reduced flame height and diminished flame radiation intensity.

Selective enzymatic debridement and modified Meek technique in the treatment of extensive burns: Preliminary observations.

Selective bromelain-based enzymatic debridement (BED) has emerged as a valid alternative for the treatment of extensive burns, with Total Body Surface Area (TBSA) > 20%. Autologous skin grafting represents the procedure of choice but the scarcity of donor sites remains the main reconstructive challenge. The modified Meek micro-grafting technique may represent a valid strategy to optimize the final outcome. A single-cohort retrospective analysis was performed, involving nine burn patients (TBSA > 20%) who underwent both BED and subsequently modified Meek technique. Demographic and clinical data (mechanism of injury, surgical treatment, complications, necessity of re-grafting, further surgery and esthetic outcome) were collected. All patients had large burns of mixed and deep dermal thickness (first, second, and third degree). All burns were enzymatically debrided postadmission and covered by the modified Meek technique. Local infection due to poor general conditions was the main complication for all patients. All but two patients survived. The selectiveness of the enzymatic debridement and dermal preservation seemed to improve the quality of scars resulting from micro-grafting. Evaluations performed at 12 ± 2 months postburn showed superior scar quality compared to areas treated with traditional (sheet/mesh) grafts. Combined BED and Meek techniques may provide an effective synergic combination for the treatment of extensive burns.

Pathophysiology of the gastrointestinal tract in burn disease

The review of foreign publications resulted in a generalisation of medical reports on the pathological changes of the gastrointestinal tract in burn disease. Burn disease produces an immediate reaction in all organs and systems, which are not always able to maintain homeostasis and frequently suffer pathophysiological and morphological damage. One of those target systems is the gastrointestinal tract. Only in very rare cases do severe (mainly electrical) burns cause direct injury to the abdominal cavity organs, thus resulting in a very severe clinical course and high mortality. Patients of all ages who have experienced a burn injury have an increased overall risk of developing gastrointestinal diseases, which include pathology of the esophagus, stomach, and intestines, as well as lesions of the gallbladder, biliary tract, and pancreas. With a burn area of 40—95%, 5.7% of the victims were diagnosed with pathology of the abdominal organs. Among them, 26.0% had an abdominal catastrophe (infarction or perforation), 37.0% had bleeding from the upper parts of the gastrointestinal tract, 32.0% had paralytic intestinal obstruction, and 5.0% developed pancreatitis and acute necrotizing cholecystitis. Large burns are usually associated with a significant decrease in splanchnic perfusion. After severe burns, intestinal ischemia and hypoxia disrupt the intestinal epithelial barrier and enteric bacterial translocation, leading to serious complications such as systemic inflammatory response syndrome, sepsis, and multiple organ failure. Peritonitis or gastrointestinal bleeding accounted for 88.2% of deaths among patients with gastrointestinal dysfunction. In general, gastrointestinal dysfunction was more common in patients with inhalation injuries, burn shock, large burn areas, and high analgesic requirements.

Cultured Skin in the Modern Era and the Impact of Infrastructure Volatility on Learning Curves: A 33-Year Institutional Review.

Finding a perfect epidermal transplant remains a holy grail of burn surgery. The epidermis is a site of stem cells that allows for epithelial regeneration. The use of cultured epithelial autografts (CEA) for the treatment of major burns was first reported in 1981. CEA requires specialized skills; thus, reports from different burn centers have shown mixed results. Comparing our modern data with past data shows how this field has advanced while maintaining institutional control. We performed a retrospective analysis of all patients admitted between January 1, 1988 and December 31, 2021 for massive burns that were managed with CEA. Patients were divided into pre-defined groups: G1 (early-era) = 1988-1999, G2 (pre-modern-era) = 2000-2010, and G3 (modern-era) = 2011-2021. We compared demographics, %TBSA, presence of inhalation-injury, length of hospital stay (LOS), complications, and mortality. We treated 52 patients with CEA during the study period. In the modern-era, we found 11 patients; in the pre-modern-era, 10; and in the early-era, 31. Injury characteristics, including %TBSA and the presence of inhalation-injury, were not significantly different between the groups. We observed lower mortality rates in G1 and G3 (G1:20% vs. G2:42% vs. G3:27%, P < 0.05), although the predicted mortality was not significantly different between the groups (G1:50% vs. G2:47% vs. G3:49%, NS). Patients in G1 also had a shorter hospital LOS, in days, (G1:90 vs. G2:127 vs. G3:205, P < 0.05). Finally, the surface-area grafted per patient was the highest in G2 (G1:2,000cm2 vs. G2:4,187cm2 vs. G3:4,090cm2, P < 0.01). CEA has not gained popularity despite proven positive outcomes. Our retrospective analysis showed that CEA should be considered as a treatment option for patients with large burns, given proper training and infrastructure.

Effectiveness of Autologous Skin Cell Suspension in Large Total Body Surface Area Burns: Analysis of Clinical Outcomes and Patient Charges.

Autologous skin cell suspension (ASCS) is an adjunct to conventional split-thickness skin grafts (STSG) for acute burns, enhancing healing and reducing donor site requirements. This study validates ASCS's predictive benefits in hospital stay reduction and cost savings by analyzing outcomes and real-world charges post-ASCS implementation at a single institution. A retrospective study (2018-2022) included burn patients with ≥10% TBSA. The study population comprised 2 groups: burns treated either with a combination of ASCS ± STSG or with STSG alone. Outcomes included LOS, surgeries, infection, complications, days on antibiotics, and adjusted charge per TBSA. The ASCS ± STSG group demonstrated significantly shorter LOS (Mdn: 16.0 days, IQR: 10-26) than the STSG group (Mdn: 20.0 days, IQR: 14-36; P = .017), and fewer surgeries (Mdn: 1.0, IQR: 1-2) versus the STSG group (Mdn: 1.0, IQR: 1-4; P = .020). Postoperative complications were significantly lower in ASCS ± STSG (11% vs. 36%; P < .001). The STSG group had a longer distribution of antibiotic days (IQR: 0-7.0, min-max: 0-76) than the ASCS ± STSG group (IQR: 0-0, min-max: 0-37; P = .014). Wound infection incidence did not differ (P = .843). ASCS ± STSG showed a lower distribution of adjusted charge per TBSA (IQR: $10 788.5-$28 332.6) compared to the STSG group (IQR: $12 336.8-$29 507.3; P = .602) with a lower mean adjusted charge per TBSA ($20 995.0 vs. $24 882.3), although this was not statistically significant. ASCS ± STSG utilization demonstrated significant reductions in LOS, surgeries, postoperative complications, antibiotics, and potential cost savings. These findings underscore the practicality of integrating ASCS in burn management, offering substantial benefits to patients and healthcare institutions.

A new surgical concept for the efficient treatment of large and deep burns.

Effective burn surgery is based on two fundamental principles: prompt excision of necrotic tissue and definitive coverage preserving functional dermis and body contour. There is often compromise, either prioritizing the urgency of excision or opting for patient stability and optimal conditions prior to autografting. We propose a surgical concept that addresses this critical treatment gap. In 2022 we implemented a new three-phase protocol, EDM: (Excision phase, E) Immediate excision of the burn wound preserving body contour; (Dermis phase, D) definitive temporization of the wound bed, using Biodegradable Temporizing Matrix (BTM), to prepare it for successful grafting. (Meek phase, M): Upon complete dermal temporization, full autologous coverage in a single micrografting procedure. We performed a retrospective single-center cohort study to characterize the EDM protocol compared to the prior standard of care (>40%TBSA, n=5 in EDM vs. n=10 matched controls). Primary outcomes were total surgeries required, total surgeries to achieve>90% healing, uninterrupted recovery time without surgery, and time on mechanical ventilation. The EDM group required fewer surgeries in total (5 vs. 9.5 ; p=0.01) and to achieve>90% healing (3 vs. 6.5; p=0.001). EDM patients experienced longer uninterrupted recovery (24 vs. 14 days, p=0.001). Additionally, EDM patients spent less time on mechanical ventilation (210 vs. 1136 hours, p=0.005). The EDM protocol could improve surgical efficiency, ultimately having the potential to expedite rehabilitation in severely burned patients. The study underscores the potential of combining fundamentals of burn surgery, with innovative surgical techniques and materials, in order to bridge the gap between excision and grafting.

Forest pollinator richness declines with distance into burned areas

The effects of prescribed fire on forest pollinator communities are complex and incompletely understood. One of the least-studied questions concerns how these organisms are affected by the size, or spatial scale, of fire. We sought to address this by sampling bees (Hymenoptera: Apoidea), butterflies (Lepidoptera), and hover flies (Diptera: Syrphidae) at different distances along 500 m transects into forests burned every three years in the southeastern United States. We found combined pollinator richness to decline significantly with distance, being about 23.9 % lower near the centers of burn units than near the edges, and this did not change with time since fire. These patterns held true when small and large pollinators were analyzed separately, as well as for the richness of bees and butterflies (but not hover flies), and regardless of bee nesting guild. We found no relationship between the abundance of all pollinators and distance. However, the abundance of small pollinators decreased with distance whereas that of large pollinators increased. A competing model provided no support for the alternative hypothesis that the observed effects of distance can be explained by the length of road edges nearby as opposed to distance from unburned habitat. The richness and abundance of all pollinators combined and most taxonomic groups and species analyzed separately increased with increasing canopy openness as well as with increasing plant richness. Although pollinator richness declined with distance into large burns and small species appear to be particularly sensitive, we also found the richness and abundance of pollinators to decrease with time since fire. Our results show that fire can improve local conditions for pollinators but that unburned habitats serve as important refugia or sources of flowers following fire, underscoring the importance of pyrodiversity in managed landscapes.

Food Security: An Unmet Need in Outpatient Burn Care.

Nutrition is paramount for wound healing after burn injury. With rising food prices and time off work due to burn injuries, access to adequate nutrition may be a significant financial stressor. We asked patients at an outpatient burn clinic to complete the Household Food Security Module, which queries about food security over the preceding 12 months. Demographics and burn characteristics were abstracted from the medical record. We assessed the overall prevalence of food insecurity, risk factors for food insecurity, and potential effects of food insecurity on nutritional status and wound healing time. Wound healing time was assessed via Cox regression while adjusting for burn depth, total body surface area burned, and diabetes. Over 40% of participants reported experiencing food insecurity; it was more common in patients who preferred Spanish language (P = 0014) or were unemployed (P = .049). Just over half of participants experiencing food insecurity were using any food assistance resources. Among patients more than 30 days from burn injury, patients who were food insecure had larger burns (P = .01). Experience of food insecurity was not associated presence of malnutrition on nutrition-focused physical exam (P = .47). Wound healing time for burns managed in the outpatient setting was associated with burn depth (P < .001), but not food insecurity (P = .95), burn size (P = .17), or diabetes (P = .14). Although food insecurity did not result in malnutrition or negatively impact wound healing time, it is important for providers to routinely screen for food insecurity due to increased nutritional requirements and loss of wages after burn injury.

The Application of a Synthetic Biodegradable Temporizing Matrix in Extensive Burn Injury: A Unicenter Experience of 175 Cases.

Objectives: Addressing extensive and deep burn wounds poses considerable challenges for both patients and surgeons. The NovoSorb® Biodegradable Temporizing Matrix (BTM) emerged as a novel dermal substitute and has been subjected to evaluation in large burn wound cases, with a specific focus on identifying risk factors associated with suboptimal take rates. Methods: All patients with burn wounds greater than 10% body surface that underwent BTM treatment between March 2020 and November 2023 were eligible for inclusion. Univariate analyses and linear regression models were employed to discern risk factors and predictors influencing the take rates of both the BTM and split-thickness skin grafts (STSGs). Results: A total of 175 patients (mean age 56.2 ± 19.8 years, 70.3% male) were evaluated. The mean take rates of the BTM and STSGs were 82.0 ± 24.7% and 87.3 ± 19.0%, respectively. There were significant negative correlations between BTM take and the number of surgeries before BTM application (r = -0.19, p = 0.01), %TBSA and STSG take (r = -0.36, p = <0.001) and significant positive correlations between BTM and STSG take (r = 0.41, p ≤ 0.001) in addition to NPWT and STSG take (r = 0.21, p = 0.01). Multivariate regression analyses showed that a larger number of surgeries prior to BTM application (OR -3.41, 95% CI -6.82, -0.03, p = 0.04) was associated with poorer BTM take. Allograft treatment before BTM application (OR -14.7, 95% CI -23.0, -6.43,p = 0.01) and failed treatment with STSG before BTM application (OR -20.8, 95% CI -36.3, -5.23, p ≤ 0.01) were associated with poorer STSG take, whereas higher BTM take rates were associated with overall higher STSG take (OR -0.15, 95% 0.05, 0.26, p = 0.01). The Meek technique was used in 24 patients and showed similar take rates (BTM: 76.3 ± 28.0%, p = 0.22; STSG: 80.7 ± 21.1, p = 0.07). Conclusions: This study summarizes our findings on the application of a BTM in the context of large burn wounds. The results demonstrate that successful treatment can be achieved even in patients with extensive burns, resulting in satisfying take rates for both the BTM and STSG. The data underscore the importance of promptly applying a BTM to debrided wounds and indicate good results when using Meek.

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.

523 Weight Loss in Patients with Large Burns

Abstract Introduction The deleterious effect of weight loss in those with burns is well known. However, guidelines for monitoring loss are limited. This descriptive study evaluated weight loss incidence in patients with large burns admitted to a regional burn center. Methods Medical records for adult patients admitted to a regional burn center (2019-2021) with burns ≥20% total body surface area burned (TBSA) were reviewed. Patients with amputations were excluded. Data collection included burn size/depth, resuscitation fluids (pre- and post-admission), initial and final weight (last week of admission) and nutritional interventions. Patients were divided into three groups based on %TBSA: 20-29%, 30-39% and ≥40%. Results From 2019-2021, 722 patients with new burn injuries were admitted of whom 542 were over 18 years of age. Fifty-two (94% male) met inclusion criteria. Those with smaller burns had fewer surgeries and shorter stays. (Table 1). Most patients (85%) received resuscitation fluids prior to admission (PTA) with an average of 2782 mL PTA and a total of 21,079 mL after admission. Larger burns received high resuscitation volumes both pre- and post- admission. Over half of patients lost weight though 23 had a net weight gain. Most patients (56%) lost some weight but nearly half (48%) discharged within 5% of admission weight. The average loss across all groups was only 2.6% of admission weight (Table 2). Patients with larger burns were more likely to lose weight and also had more weight loss. Almost all (94%) patients required enteral nutrition and all transitioned to full oral intake prior to discharge; no one required parenteral nutrition. Again, patients with larger burns required more enteral intake. Conclusions Most patients lost weight though some had net weight gain. Those with larger burns lost more weight than those with smaller burns. Weight loss is a risk factor for malnutrition even with nutritional support. Weight loss in burn patients should be monitored—particularly in those with burns &amp;gt;30% TBSA--and be considered as an outcome measure in burn care. Applicability of Research to Practice Weight loss in burn patients should be monitored and considered as an outcome measure in burn care.

505 Fusarium Isolates in Burn-injured Patients: Clinical Characteristics and Susceptibility Patterns

Abstract Introduction Fusarium species are ubiquitous in the environment and can cause opportunistic infections in burn-injured patients. Patients with larger burns, prolonged lengths of stay, concomitant antimicrobial use and invasive lines are at higher risk for Fusarium infections. Little data exists on clinical characteristics and in vivo antifungal susceptibilities in burn-injured patients. Methods All positive Fusarium species cultures were retrospectively identified between November 2017 to June 2023 at a regional burn center. Demographic, clinical and microbiologic susceptibility data was collected from the electronic medication record. Descriptive statistics were used to describe the cohort. Results A total of 18 patients had positive Fusarium wound cultures during the study period. The average age was 38.4 ± 11.9 years. The average %TBSA was 54.5 ± 23.4 % and R-Baux score of 92.9 ± 29.3. The most common mechanism of injury was thermal burn (17 patients, 94%). This cohort experienced prolonged ICU (68.9 ± 31.9 days) and hospital (73.6 ± 38.2 days) lengths of stay. The average time from burn injury to positive Fusarium cultures was 19.6 ± 9.0 days. Mechanical ventilation was prolonged (46.1 ± 23.3 days). The average central line duration prior to Fusarium infection was 9.8 ± 10.2 days. Susceptibility data was obtained for voriconazole in 15 patients and for amphotericin in 14 patients. For voriconazole, 5/15 tested isolates had an MIC of 4, 1/15 had an MIC of 8, and 9/15 (60%) isolates returned with MIC ≥ 16. A majority (13/14, 93%) of the MICs tested for amphotericin were ≤ 1. Patients were taken to the OR for source control in all cases. Ten of 18 patients with Fusarium positive infections survived to hospital discharge (55%). The most common cause of death was multi-system organ failure and sepsis (88%). Recorded adverse drug events possibly due to voriconazole and posaconazole included transaminitis (4 cases), QTc prolongation (1 case), and hallucinations (1 case). Amphotericin was suspected of contributing to an acute kidney injury in 1 case. Conclusions This case series reports the clinical characteristics and susceptibility data on Fusarium isolates in a burn-injured population. This cohort was critically ill based on the %TBSA, R-Baux score, and high rate of mechanical ventilation. The MIC results obtained for voriconazole demonstrated a majority of isolates with relatively high MIC values ≥ 16. A majority of the MICs for amphotericin were &amp;lt; 1. It is important to note that no established breakpoints exist for Fusarium species and clinical outcomes are dependent on a variety of factors beyond the susceptibility data. Applicability of Research to Practice Empiric double coverage with voriconazole and amphotericin or amphotericin monotherapy should be considered when Fusarium is a suspected primary pathogen.

570 Adult Self-Inflicted Burn Demographics in West Texas

Abstract Introduction Self-inflicted burns (SIB) are a subset of burns defined based on self-injury, sometimes also referred to as self-immolation. The United States generally reports SIB in the context of psychiatric ailment. However, due to the difference in geographic locations, the West Texas burn coverage has never been checked for SIB patients. We hypothesize that patients with SIB have higher rates of psychiatric disorders and are generally older men. Methods We obtained a list of all patients admitted to the burn intensive care unit (BICU) with a Second/Third-degree burn. After, we verified the inclusion of patients meeting the study criteria from July 01, 2011, to July 01, 2021, ages between 18 and 89, and a completed Lund-Browder Chart. Data was collected from a mix of manual chart review from electronic health records and electronic data retrieval. Patients were split into two groups, SIB and non-intentional burns (NIB). Bivariate analysis was conducted using Mann Whitney U test and either Fisher’s exact test or Chi-square test when independent variables were categorical. Results The initial data set (n=2,875) decreased due to missing burn documentation, burn intensive care unit admission, and incomplete records and was split into two groups: SIB (n=49) and NIB (n=1,243). The average age and percentage of male patients compared between NIB and SIB were not significant (p=0.32, p=0.39). However, TBSA, frequency of inhalation injury, burn symmetry, suicidal ideation, history of drug abuse, history of self-harm, history of mental illness, past mental health hospitalization, and mortality were all significantly higher in the SIB group (p&amp;lt; 0.001). There was also a statistically significant higher frequency of psychological disorders in the SIB group for depression, acute schizophrenia, borderline personality disorder, bipolar disorder (p&amp;gt;0.001), anxiety disorders (p=0.02), post-traumatic stress disorder (p=0.006), atypical psychosis, drug-induced psychosis, and delirium (p=0.04). Conclusions The demographics of the West Texas SIB population are comparable to that of the United States, predominantly older male patients. Similarly, many psychiatric disorders occur at a higher frequency in SIB patients than NIB: depression, acute schizophrenia, borderline personality disorder, anxiety disorder, post—traumatic stress disorder, bipolar disorder, atypical psychosis, drug-induced psychosis, and delirium. Applicability of Research to Practice While SIB patients make a small portion of the total burn population, there burns are often associated with worse outcomes – mortality, larger burns, and length of stay. The severity of their injuries begs the need for further analysis and hopefully prevention of SIB. Addressing psychiatric facilities and preventing these incidents from occurring may offer preventative methods.

763 Is Central Venous Catheter the Main Culprit for Clinically Significant Venous Thromboembolism in Burn Patients

Abstract Introduction Venous thromboembolism (VTE) is a significant clinical problem for burn patients. The incidence of VTE has been reported as 0.25% to 47.1%. Known risk factors include large burn size, increasing age, male gender, active smoker or alcohol use, blood transfusion and surgeries. Central venous line (CVL) use is also a known risk factor for VTE. With all the known factors, we retrospectively analyzed our patients with VTE. Methods Retrospective chart review was performed on a single institution burn center in the calendar year of 2022. Pediatric patients were excluded. Following data were collected: age, burn size, mechanism, length of hospital stays, VTE diagnosis, VTE chemoprophylaxis, and central venous line days. VTE diagnosis was made using CT venogram or ultrasound. This project was a quality improvement initiative. Results There were 420 patients in the study period. Of all the admitted patients, there were 6 patients diagnosed with 7 VTE. One patient had 2 separate diagnoses of VTE at 2 distinct period and anatomical site. The incidence of VTE is 1.7%. Upon further chart review, all the VTE were at the site of central venous catheters. All the patients were on VTE chemoprophylaxis. The correlation between burn size, age, length of hospital stay and VTE was not significant. Conclusions Risk of VTE is high in burn patients due to the correlation with the Virchow’s Triad. All the patients admitted to the burn unit are placed on chemoprophylaxis unless contraindicated. The 7 patients diagnosed with VTE were on chemoprophylaxis. All the VTE were at the site of central venous catheter insertion sites, which is a known complication of catheters. The incident of 1.7% is on par with VTE incidents of burn patients, but much less than VTE caused by central venous catheters in non-burn patients. Large multicenter data collection is needed to validate this finding. Applicability of Research to Practice Directly appliable

20 Large Burn Injury Leads to Pathological Alteration of Hematopoietic Stem and Progenitor Cell Lineage Commitment

20 Large Burn Injury Leads to Pathological Alteration of Hematopoietic Stem and Progenitor Cell Lineage Commitment

Association Between Burn Location and Psychological Distress: A Burn Model System National Database Study.

Burn injuries often lead to psychological distress, from depression and anxiety to adjustment concerns and posttraumatic stress. There is some evidence that the anatomical location of burn injuries (eg, head/neck, feet) has a specific negative effect on psychological functioning. The purpose of this study was to examine the associations between burn injury location and emotional distress. First, we administered self-report questionnaires to burn survivors with ≤ 5% TBSA at a single adult outpatient burn clinic. Second, we used a cross-sectional analysis of the Burn Model System National Database. The mean values of each measure of psychological distress (ie, quality of life, self-esteem, depression, posttraumatic stress, anxiety, and, for contrast, posttraumatic growth) were examined for each anatomical location for those participants with a burn in those anatomical areas against those with burn in other areas. Using Kruskal-Wallis tests to compare psychological distress, we found no significant differences in outcome measures in either sample analyzed in our study. These findings contrast with prior literature indicating the negative psychological effect of burn injuries on certain locations in the body. Further research should explore whether larger burns (ie, < 5% TBSA) affecting critical areas of the body may be associated with psychological distress.