Scald Burn Research Articles

Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource-Limited Setting in Sub-Saharan Africa.

Early excision and grafting remains the standard of care after burn injury. However, in a resource-limited setting, operative capacity often limits patient access to surgical intervention. This study sought to describe access to excision and grafting for adult burn patients in a sub-Saharan African burn unit and its relationship with burn-associated mortality. We analyzed patients recorded in the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi from 2011-2019. We examined patient characteristics, interventions, and outcomes for adults aged ≥16years. Modified Poisson regression modeling was used to identify risk factors for mortality. Five hundred and seventy-three patients were included. Median age was 30years (IQR 23-40) with a male preponderance (63%). Median percent total body surface area burned (%TBSA) was 15% (IQR 8-26) and 68% of burns were caused by flame. 27% (n = 154) had burn excision with skin grafting, with a median time to operation of 18days (IQR 9-38). When adjusted for age, %TBSA, and time to presentation, operative intervention conferred a survival benefit for patients with flame burns with a RR 0.16 (95% CI 0.06, 0.42). In a resource-limiting setting, access to the operating room is inadequate, and burn patients are not prioritized. While many scald burn patients may be managed with wound care alone, patients with flame burn require surgical intervention to improve clinical outcomes. Burn injury in this region continues to confer a high risk of mortality, and more investment in operative capacity is imperative.

PAEDIATRIC SCALD BURNS – EPIDEMIOLOGY AND PREVENTION IN DEVELOPING COUNTRY

Burns and burn-related trauma remain the most common form of injury in children. Pediatric burns occur commonly in developing countries, with incidence many times higher in low- and moderate-income group compared to high-income group [1,2]. Scalds consistently account for the majority of burns in childhood, typically representing approximately two thirds of burn injuries [3]. The predominance of this mechanism of burn injury in childhood has naturally helped to direct focus on prevention, first aid campaigns and wound management. The aim of this study was to provide recent prospective epidemiological data on pediatric burns, focusing important etiologies such as scald burns and suggesting preventive strategies. A prospective, single-center study of all paediatric burns presentations to the casuality and OPD of a regional burns centre in Jawaharlal Nehru Memorial Medical hospital, Aligarh was conducted.

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.

Effective enzymatic debridement of burn wounds depends on the denaturation status of collagen.

The treatment of burn wounds by enzymatic debridement using bromelain has shown promising results in our burn center. However, inadequate debridement occurred in a few cases in which the etiology of the burn was attributed to relatively low temperature burns. We hypothesized that bromelain is ineffective in burns in which collagen denaturation, which occurs approximately at 65°C, has not taken place. Our objective was to assess whether there is a relationship between the denaturation of collagen and the ability of bromelain to debride acute scald burn wounds of different temperatures. Ex vivo human skin from four different donors was cut into 1x1 cm samples, and scald burns were produced by immersion in water at temperatures of 40°C, 50°C, 60°C, 70°C, and 100°C for 20 minutes. Denaturation of collagen was assessed with histology, using hematoxylin and eosin (H&E) staining and a fluorescently labeled collagen hybridizing peptide (CHP), and with second harmonic generation (SHG) microscopy. Burned samples and one control sample (room temperature) were weighed before and after application of enzymatic debridement to assess the efficacy of enzymatic debridement. After enzymatic debridement, a weight reduction of 80% was seen in the samples heated to 70°C and 100°C, whereas the other samples showed a reduction of 20%. Unfolding of collagen, loss of basket-weave arrangement, and necrosis was seen in samples heated to 60°C or higher. Evident CHP fluorescence, indicative of collagen denaturation, was seen in samples of 60°C, 70°C and 100°C. SHG intensity, signifying intact collagen, was significantly lower in the 70°C and 100°C group (P <.05) compared to the lower temperatures. In conclusion, denaturation of collagen in skin samples occurred between 60°C and 70°C and strongly correlated with the efficacy of enzymatic debridement. Therefore, enzymatic debridement with the use of bromelain is ineffective in scald burns lower than 60°C.

The effect of traditional healer intervention prior to allopathic care on pediatric burn mortality in Malawi

IntroductionBurn injury is a significant contributor to mortality, especially in low and middle-income countries (LMICs). Patients in many communities throughout sub-Saharan Africa use traditional health practitioners for burn care prior to seeking evaluation at an allopathic burn center. The World Health Organization defines a traditional health practitioner as “a person who is recognized by the community where he or she lives as someone competent to provide health care by using plant, animal and mineral substances and other methods based on social, cultural and religious practices based on indigenous knowledge and belief system.” The aim of this study is to determine the prevalence of prior traditional health practitioner treatment and assess its effect on burn injury mortality. MethodsA retrospective analysis of the prospectively collected Kamuzu Central Hospital (KCH) Burn Surveillance Registry was performed from January 2009 through July 2017. Pediatric patients (<13 years) who were injured with flame or scald burns were included in the study and we compared groups based on patient or family reported use of traditional health practitioners prior to evaluation at Kamuzu Central Hospital. We used propensity score weighted multivariate logistic regression to identify the association with mortality after visiting a traditional healer prior to hospitalization. Results1689 patients were included in the study with a mean age of 3.3 years (SD 2.7) and 55.9% were male. Mean percent total body surface area of burn was 16.4% (SD 12.5%) and most burns were related to scald injuries (72.4%). 184 patients (10.9%) used traditional medicine prior to presentation. Only a delay in presentation was associated with prior traditional health practitioner use. After propensity weighted score matching, the odds ratio of mortality after using a prior traditional health practitioner was 1.91 (95% CI 1.09, 3.33). ConclusionThe use of traditional health practitioners prior to presentation at a tertiary burn center is associated with an increased odds of mortality after burn injury. These effects may be independent of the potential harms associated with a delay in definitive care. Further work is needed to delineate strategies for integrating with local customs and building improved networks for burn care, especially in rural areas.

A state-wide analysis of pediatric scald burns by tap water, 2016–2018

IntroductionUnsafe tap water temperatures (>120 °F) are a risk factor for pediatric burns, which may disproportionally impact low-income, urban communities. We sought to estimate the incidence and demographic characteristics of tap water burns and their association with housing characteristics. MethodsWe performed a secondary data analysis to summarize emergency department discharge records from 2016 to 2018 involving children <18 years with an ICD-10-CM code for tap water burn (X11), and town-level housing data from the American Community Survey. Unpaired student’s t-test and spearman’s correlation analysis were performed for comparative analyses. ResultsA total of 146 tap water burn visits were identified, representing an incidence of 2 per 10,000 ED visits. The majority of cases were male, non-Hispanic White, of public insurance type, and from an urban CT town. The median age was 3 years, with 58% of cases <5 years. Towns with at least one tap water burn had a significantly higher average percentage of multi-family unit and renter housing as compared to towns with no tap water burns (p < 0.0001). ConclusionsOur results identified a significant number of tap water burns in children. Primary prevention efforts targeting education or regulation of water temperatures may work to reduce burns in underserved areas.

Sildenafil Recovers Burn-Induced Cardiomyopathy.

Background: Severe burn injury initiates a feedback cycle of inflammation, fibrosis, oxidative stress and cardiac mitochondrial damage via the PDE5A-cGMP-PKG pathway. Aim: To test if the PDE5A-cGMP-PKG pathway may contribute to burn-induced heart dysfunction. Methods: Sprague–Dawley rats were divided four groups: sham; sham/sildenafil; 24 h post burn (60% total body surface area scald burn, harvested at 24 h post burn); and 24 h post burn/sildenafil. We monitored heart function and oxidative adducts, as well as cardiac inflammatory, cardiac fibrosis and cardiac remodeling responses in vivo. Results: Sildenafil inhibited the burn-induced PDE5A mRNA level and increased the cGMP level and PKG activity, leading to the normalization of PKG down-regulated genes (IRAG, PLB, RGS2, RhoA and MYTP), a decreased ROS level (H2O2), decreased oxidatively modified adducts (malonyldialdehyde [MDA], carbonyls), attenuated fibrogenesis as well as fibrosis gene expression (ANP, BNP, COL1A2, COL3A2, αSMA and αsk-Actin), and reduced inflammation and related gene expression (RELA, IL-18 and TGF-β) after the burn. Additionally, sildenafil treatment preserved left ventricular heart function (CO, EF, SV, LVvol at systolic, LVPW at diastolic and FS) and recovered the oxidant/antioxidant balance (total antioxidant, total SOD activity and Cu,ZnSOD activity). Conclusions: The PDE5A-cGMP-PKG pathway mediates burn-induced heart dysfunction. Sildenafil treatment recovers burn-induced cardiac dysfunction.

The Global Burn Registry: A Work in Progress.

In 2018, the World Health Organization (WHO) launched the Global Burn Registry (GBR). Its purpose is to help improve the understanding of burn injury worldwide. The purpose of this study was to identify early findings from this database. The GBR was accessed on January 5, 2020. Cases from centers in low income (LIC) and low-middle-income countries (LMIC) were combined into a low resource (LR) group, and cases in high income (HIC) and upper-middle-income countries (UMIC) were combined into a high resource (HR) group. Statistical analysis was performed with SAS 9.4. Data are expressed as mean ± SEM. Logistic regression was used to identify risk factors for death. Revised Baux Score (RBS) was calculated. Odds ratios are expressed as mean (95% confidence interval). The LA50 was calculated from the regression of death and total burn size (TBSA) for different age groups. At the time of analysis, there were 4307 cases in the GBR treated at 28 facilities in 17 countries (5 HIC, 5 UMIC, 4 LMIC, and 3 LIC). There were 2945 cases (68%) from HR countries and 1362 (32%) from LR countries. The mean age of patients in both LR and HR was similar (24.5 ± 0.5 vs 24.2 ± 0.4 years, P = .58), but LR had larger TBSA burns (30.5 ± 0.7% vs 19.8 ± 0.4% TBSA, P < .0001). There were fewer scald burns and more flame injuries in the LR countries (28.4 ± 1.3% vs 43.3 ± 1.0% and 55.2 ± 1.4% vs 39.0 ± 0.9%, P < .0001). Case fatality and RBS were greater in LR (31.9 ± 1.3% vs 9.4 ± 0.5% and 59.4 ± 1.1% vs 45.3 ± 0.6%, P < .0001). In regression analysis, LR was an independent risk factor for death with an odds ratio of 4.2 (3.2-5.4). The LA50 for HR countries was similar to that calculated from cases in the National Burn Repository of the American Burn Association (ABA NBR). For LR countries, the LA50 was lower for all ages except those 65 and older, ranging from 30% to 43% TBSA. Only a few facilities have contributed data to the GBR so far, with LR countries less represented than HR ones. The proportion of cases in the pediatric age group is much less represented in LR countries than in HR, possibly because many burned children in LR countries do not get burn care at specialized centers. Survival in HR countries is similar to that in North America. The GBR provides early insights into global burn care. Opportunities for improvement are greatest in LR countries. New Innovations may be necessary to increase participation from burn centers in LR countries. This report provides an early look at burn care across the globe based on cases in the GBR. It may inform further efforts to characterize and improve burn care in LR countries.

Multimethod assessing the prognosis affecting factors of hospitalized children with burns in Zunyi, southwest China.

Burns are acommon type of injury in children worldwide, which cause alarge number of casualties each year. This study aimed to explore the clinical epidemiological characteristics and assess the prognosis affecting factors of hospitalized children with burns using multimethods. This was across-sectional study of pediatric burns in southwest China. Demographic characteristics and mechanism of burns were surveyed and clinical data, the length of hospital stay (LOS) and outcome were extracted from the medical records. The prognosis affecting factors of burns were analyzed by both logistic regression and path analysis. Atotal of 111 children with burns were surveyed (63.06% males). The median age was 2.08 years (interquartile range, IQR 1.25-3.75), and most patients (69.37%) were under 3years old. Hot liquid was the major etiology (79.28%) and most burns occurred at home (83.78%). The total body surface area (TBSA) was mainly less than 10% (56.88%) with deep partial thickness (59.63%); however, 55.86% children did not receive any first-aid measures after burns. Path analysis showed that skin grafting surgery could reduce LOS, while TBSA greatly prolonged LOS. Multivariate analysis showed that age (hazard ratio, HR = 1.65) and burn depth (HR = 13.49) were risk factors for scarring. The TBSA (HR = 3.52) and burn depth (HR = 10.52) were risk influencing factors for limb mobility. In southwest China children under 3years old, scald burns are most common, and most burns occur at home. It seems that TBSA, skin grafting, age and burn depth are best predictors of the prognosis in hospitalized children with burns.

Brown adipose tissue recruitment in a rodent model of severe burns

BackgroundSevere burns results in a prolonged hypermetabolic response. Brown adipose tissue (BAT), abundant in uncoupling protein 1 (UCP1), plays a key role in non-shivering thermogenesis. We set out to determine if BAT is recruited in response to severe burns. MethodsMale balb-c mice underwent scald burns on approximately 20–25% of their total body surface. BAT was harvested from the interscapular fat pad of sham and burned mice at 3h, 24h, 4 days, and 10 days after injury. High-resolution respirometry was used to determine mitochondrial respiratory function in BAT. BAT protein concentration, and mitochondrial enzyme activity were also determined. ResultsRespiration increased in BAT of burned mice, peaking at 24h after injury (after injury, P<0.001). While UCP1 independent respiration was not significantly altered by burn, UCP1 dependent respiration increased >2-fold at 24h after injury when compared to the 3h and sham group (P<0.01). Normalized to citrate synthase activity, total uncoupled (P<0.05) and UCP1 dependent (P<0.01) respiration remained elevated at 24h after injury. ConclusionsWe show a time-dependent recruitment of rodent BAT in response to severe burns. Given recent reports that humans, including patients with severe burns, have functional BAT, these data support a role for BAT in the hypermetabolic response to severe burns.

Quality of Life in Adults With Lower Limb Burn Injury.

Burn injury is an unpredictable incident that may result in long-term disability. Complications after burn injury are most common, for example, contracture, hypertrophic scar, or infection. A descriptive cross-sectional study was conducted at a burn unit in Pakistan, and data were collected by "World Health Organization Disability Assessment Schedule (WHODAS) v 2.0 Self-Administered" from 140 burn victims with at least 6 months old injury. Subjects with at least 10% TBSA of either lower limb were included while patients suffering from any congenital or neurological disease or with amputation were excluded. The analyses were done by statistic version 16. Participant's mean age was 28.13 years and SD was ±7.87 years. Of the 140 patients, 96 (68.6%) were males and 44 (31.4%) were females. The cause of the burn injury was flame burn [72.9% (102)], chemical burn [5% (7)], scald burn [7.9% (11)], and electrical burn [14.3% (20)]. There were 74(52.9%) victims having burn injury at the right-hand side of the body and 47.1% (66) were with the left-hand side affected; 32.9% (46) were having burn injury at the hip joint, 37.9% (53) with the knee joint, 8.6% (12) ankle joint, and 20.7% (29) are having burn injury at whole limb. The mean disability score calculated by WHODAS v 2.0 self-administered was 13.96 with a SD of ±4.696. Burn injuries to the lower limb have a negative impact on all domains of quality of life of the victims. These individuals should be assessed at various times while developing a comprehensive rehabilitation treatment plan, especially focusing on the issues faced by such individuals to improve their quality of life.

Epidemiology of Burns Injury in dr. Iskak General Hospital Tulungagung: Two Years (2017-2018) Retrospective Study

Introduction: Burn injury is one of the leading causes of morbidity and mortality in low and middle-income countries. Yet in Indonesia, the epidemiology of burn is rarely reported. The study aims to obtain the epidemiological characteristics of burn patients in Dr. Iskak General Hospital.&#x0D; Methods: A retrospective analysis study was used and the medical records of patients with burns admitted at Dr. Iskak General Hospital between January 2017 and December 2018 were collected and analyzed statistically.&#x0D; Results: A total of 80 patients were involved in this study. The most burn victims fell in the adult group (&gt;18 years old), which was 56.3% (n=45). Children were six times more likely to sustain scald burn than adults (OR=6.75I; CI95% 2.47-18.41), meanwhile adults were three times more likely to sustain flame burn than children (OR=3.643; CI95% 1.186-11.190). Most of burn patients (91.25%) were treated surgically. The median of hospital stay was 8 days. Flame burn was the primary etiology for longer hospitalization and there was zero mortality in this study.&#x0D; Conclusion: We found that the adult group was at the highest risk of acquiring burns. Scald was the major cause of burns in children, while flame was the main etiology in the adult group that caused severe burn and prolonged hospitalization.

Childhood burns in Shisong, Northwestern Cameroon

Objective: The study aimed to highlight the pattern and treatment outcome of childhood burn injuries in northwestern Cameroon. Such reports are expected to provide preventive and improvement guidelines in our settings in the long run. Methods: Forty-two consecutive patients under fifteen with burns injuries managed at our facility were prospectively enrolled in the study. Results: The study population was 42 patients, which consisted of 23 (54%) male and 19 (46%) female, with the median 2.40±3.05 years, interquartile range of 1-14 years. The most frequent timing of burns was about mid-day (median 11:50 am). The majority of injuries were right at the patient's homes (70% cases). Interestingly, 4%, 15%, and 20% applied raw-egg, ice, and nothing as the first intervention for their children burns, respectively. Scald burns were the leading category of wounds (p&lt;0.012). The majority of the cases were minor burns injuries with TBSA of 1-12% (p=0.002), with a mortality rate of 4%. Conclusion: Burns is still a significant health problem among children in northwestern Cameroon. Considering the application of raw egg and others like local herbs, therefore pre-hospital interventions may be harmful in our settings. Early and prompt response may be desirable, with strong advocacy for aggressive and urgent public health enlightenment campaigns on the prevention of childhood.

551 Mixed Methods Assessment of Pediatric Scald Burns

Abstract Introduction CDC estimated more than 87,000 fire/burn injuries in 2017 among children 0–15 years old. Scald burns are the most common form of burn injury for children in the United States and are estimated to cost $44 million annually. Understanding the circumstances surrounding burn incidents and caretakers’ responses to them are needed to better guide prevention and education offerings. Methods We used a mixed methods approach to better understand pediatric scald burn mechanisms along with caregivers’ general knowledge, first aid responses and ability to accurately report characteristics of their child’s injury. Caregivers of children &amp;lt; 15 year old attending a burn follow up clinic with their child were recruited. Participants completed a 39-item, iPad-based survey that captured information about the circumstances, location and cause of the scald burn, whether first aid was provided, and caregiver/child demographics. With permission of the caregiver, the child’s medical record was accessed to collect burn descriptors (e.g., burn severity, total body surface area (TBSA), etc) to compare with parent self-report. Data collection occurred between May 2018 - May 2019. The study was approved by our institutional review board. Results Surveys were completed by 55 parents; 75% agreed to medical record review. The typical respondent was the female caregiver (80%) with more than a high school education (67%). The typical burn incident occurred in the kitchen (60%) of the family’s home (80%) and in the presence of the caregiver (71%). Seventy percent of respondents reported applying first aid; among those, 50% administered the proper first aid (using cool water on the burn) despite most (44%) reporting feeling “not confident” in the ability to do so. More than half (53%) didnot know their child’s TBSA; of those who did, self-reported TBSA ranged from 1 to 50%. Medical record review revealed that only 5 participants accurately reported their child’s TBSA. Conclusions Our data reveal that most scald burns occurred in the kitchen, of the child’s home, and in the presence of a caretaker. Half received incorrect first aid and few parents could accurately report their child’s TBSA. These results support the need to strengthen primary prevention offerings and improve parents’ understanding of their child’s burn injury. Applicability of Research to Practice The results of this research can help guide education efforts for primary prevention programs related to pediatric scald burn injuries. Furthermore, results can guide education practices for caregivers of children being treated for a scald burn injury.

98 A 10-year Retrospective Review of Older Adult Admissions at a Regional Burn Center

Abstract Introduction A verified regional burn center conducted a 10-year retrospective review of older adult patients admitted to the burn service. The primary goal of the review was to examine trends in mechanisms of injury, demographics, and outcomes to inform burn prevention programming. Methods Admission data from 2009–2018 was retrieved from burn center databases and combined into a Microsoft Excel spreadsheet. Older adults were defined as age 65 years and older. Patients admitted to the burn service for skin disorders or soft tissue infections were excluded. Patients with cutaneous burn injuries or inhalation only injuries were included. Results The total number of patients included was 697. Nearly a third of the patients were 65 to 69 years old, with incidence declining with each subsequent 5-year age group. Males accounted for 61.3% of admissions. Two thirds of the patients were White (67.6%). The other third consisted of Black (18.4%) and Hispanic (9.8%), Asian (1.9%) and Native American (0.14%) patients. Overall mortality was 14%. Mortality generally increased per 5-year age group: 65–69 (7.8%), 70–74 (10.6%), 75–79 (13.7%), 80–84 (20.6%), 85–89 (29.8%), 90–94 (24.2%), and 95–99 (42.9%). Baux scores ranged from 65 to 180. The highest Baux score that lived to discharge was 119. The average Baux score of the mortality group was 114 and the average of the lived group was 82. No patients with a Total Body Surface Area (TBSA) above 43% lived. Fire/flame burns accounted for 72.7%. Scald burns made up 19.9%, contact burns 3%, chemical burns 2.3% and electrical burns &amp;lt; 1%. Nearly a quarter (24.6%) of fire/flame burns were related to smoking on home oxygen therapy (HOT), which was also the overall most common mechanism at 17.8%. Other fire/flame mechanisms included housefires (21.2%), clothing catching on fire (16.9%), and gasoline-related injuries (11.7%). More than 70% of scald burns came from the three mechanisms: hot tap water, boiling water, and hot grease. For the mortality group, a third of patients had been injured in housefires (32.7%), followed by clothing catching on fire (17.4%) and HOT burns (12.2%). Conclusions Incidence rates decline with increasing age but mortality rates climb. Burn injuries with a TBSA greater than 40% are generally fatal in the older adult. Flame burns account for the majority of injuries with HOT and house fire injuries as the leading mechanisms. Scald burns were most often caused by hot tap water or boiling water. White older adults accounted for more than double the number of patients identified in all other races combined. Applicability of Research to Practice The demographics and mechanism of injury insight gained from this review can be utilized to inform prevention programming design in this region. Trends in mortality can help emphasize the seriousness of preventing older adult burn injuries and anticipate the mortality risk for older adults admitted to the burn center.

61 Tap Water: Still Burning After All These Years

Abstract Introduction Hot tap water has long been recognized as a cause of burns, especially for children. Standards for appliance manufacture and building codes were established several decades ago to avoid excessively high hot water temperature at the tap in order to reduce the incidence of these injuries. The purpose of this study was to determine the prevalence and impact of tap water scalds (TWS) seen at burn centers in a recent time period. Methods We reviewed the National Burn Repository (NBR) for the years 2015–2017. We identified all scald burn injuries from the primary ICD10 code (former ECodes in ICD9, now External Cause Codes in ICD10). The codes for the cause of burns include X00 – X19. The X11 series identifies TWS. The data fields were analyzed using SAS 9.4 (Cary, NC). Data are expressed as Mean ± SEM or Mean (95% CI). Differences in continuous variable means were tested with TTest and categorical variables with Chi square and Fisher’s Exact Test. Logistic regression analysis was used to test differences between groups and identify risk factors for death. Results There were 16,318 patients included in the two-year data set. Of those, 5,014 (30.7 ± 0.4 %) had scald burns identified by the Primary ICD10 code, and 1,029 (20.5 ± 0.6 %) of those were due to hot tap water. The prevalence of TWS among children &amp;lt; 5 with scald injuries was 21.8% (15.9–23.8); among children 5–14, 19.4% (15.9–22.8); among young adults 15–44, 14.7% (12.8–16.5); those 45-64 24.1% (21.3–26.8); and those 65 and older 27.9% (23.7–32.2). Burn size for those 45–64 tended to be larger with TWS than other scald injuries (3.3 ± 0.7 % TBSA vs 2.0 ± 0.2, p=0.08), and was significantly larger in those 65 and older (3.8 ± 0.9 % vs 1.2 ± 0.3, p&amp;lt; 0.01). Case fatality for all TWS was greater than that for all other scalds (1.4 ± 0.4 % vs 0.3 ± 0.1, p&amp;lt; 0.01). No patient less than 45 died following TWS. Case fatality for those 45–64 tended to be greater for TWS than other scalds (0.9 ± 0.6 % vs 0, p=0.06.), and it was substantially higher for 65 and older (10.0 ± 2.8 % vs 2.3 ± 0.8, p&amp;lt; 0.01). Among patients 65 and older, those with TWS were slightly older than those with other scalds (76.3 ± 0.7 years vs 74.6 ± 0.4, p&amp;lt; 0.05). Conclusions TWS burns still account for a substantial proportion of scald burns across the country, despite the wide application of building codes and manufacturing standards designed to prevent these injuries. They are most prevalent among children and older adults. In older patients they are more extensive than other scalds and result in an appreciable case fatality. Hot tap water continues to be a clear and potentially deadly hazard, especially for the elderly. Additional strategies to prevent these injuries should be sought. Applicability of Research to Practice Directly Applicable.

756 Homeless and Burned – A Retrospective Analysis of an Especially Challenged Patient Population

Abstract Introduction The undomiciled burned patient presents more challenges to the burn team with regards to safe disposition. Discharge planning is complicated by the lack of a safe, clean environment to perform requisite wound care, thus prolonging hospital stays. The purpose of our study was to analyze the homeless patients admitted to a major urban burn center. This data would then better help identify trends and characteristics that could inform development of support services for this unfortunate population. Methods Demographic and clinical data from inpatients was collected from a single urban ABA verified burn center over a 3 year period between 1/2016 and 12/2018. Simple descriptive statistical analysis was performed. Results 1985 patients were admitted over the 3 year period. 48 homeless patients were identified (2.4%). The average age of this population was 39.8±16.8 years (range 3 months to 63 years old). There were 5 children (10.4% of the homeless cohort) in this population (ranging from 3 months to 4 years of age). Only 2 homeless burn inpatients were greater than 60 years of age (2% of the homeless cohort). There were 15 females (31%) and 33 males (69%). The mean TBSA was 5.8±9.9%. The average length of hospital stay was 21.9±29 days. 27 of the 48 patients (56%) required operative treatment. The 3 most common etiologies of skin injury were flame burns (29%), scald burns (25%), and cold injury (19%). The vast number of patients (39 out of 48, 81%) were discharged back to “their previous condition” (i.e. homeless shelter or the streets). There was 1 mortality in this group. Conclusions Contrary to widespread assumptions about the homeless being overwhelmingly male and adult, a significant percentage of the homeless burn patients were female with a percentage of patients being pediatric as well. The length of stay was significantly longer for most patients given the relatively small average size of burn injury. Cold injury was more significant etiology in this population compared to the overall burn population. Applicability of Research to Practice This analysis of the undomiciled burn inpatient at a single urban burn center will help better describe this especially challenging population and help focus social support and discharge planning resources for this group.

118 Comparison of Contact and Scald Burns in a Porcine Model

Abstract Introduction Whether the depth and healing of scalds and contact burns are similar is controversial. Prior studies have not compared scalds and contact burns using identical temperatures and durations of exposure limiting direct comparison. We hypothesized that when exposed to similar temepratures and durations of exposure, burns caused by hot water and contact with hot metal would be similar. Methods Multiple 2.5 or 5 cm diameter standardized cutaneous burns were created in two anesthetized female domestic pigs (~45kg) using a brass bar or circulating heated water in replicates. The temperatures were controlled and kept constant using thermosensors. In one pig, the temperature was kept constant (95 degrees C) while the duration of exposure varied (5, 10, 15 sec.) In the second pig, the exposure time was kept constant (10 sec.) while the temperature of exposure varied (70, 80, 98 degrees C). Burns were covered with a topical antibiotic ointment and frequent dressing changes were performed for 4 weeks. Periodic punch biospies were taken to determine burn depth immediately after injury, percentage burns reepithelialized within 21 days, and depth of scar at 28 days. Analysis was performed using analysis of variance. Results When temperature was held constant, duration of exposure (5, 10, and 15 sec.) was associated with scar depth (2.1 vs 3.8 vs 5.0 mm respectively, P=0.001) and there was a trend for an association with burn depth (2.0 vs 2.2 vs 2.3 mm respectively, P=0.10). When exposure duration was held constant, temperature (70, 80, 98 degrees C) was associated with scar depth (0.6 vs 1.7 vs 3.6, P&amp;lt; 0.001) but not significantly associated with burn depth (1.2 vs 1.5 vs 1.7 mm respectively, P=0.21). For each pig a comparison of burn and scar depth by device generally showed that depths were greater for scald than contact burns although not significantly greater. Only scar depth in the first pig showed a difference with a significance of less than 0.10 (2.9 for contact vs 4.1 mm for scalds, P=0.08). After controlling for temperature the difference between scalds and contact burns was statistically significant (marginal means 3.0 for contact burns, 4.3 for scalds, P=0.008). When combining data from both pigs and controlling for temperatures and duration, scar depths for scalds (2.7 mm) vs contacts (1.9 mm) showed a significant difference (P=0.02) while burn depth was not quite significant (1.7 vs 1.5 mm, P=0.07). Almost all burns were reepithelialized by day 21. Conclusions Burns created in swine with circulating hot water tend to be deeper and result in deeper scars than those created by contact with a brass bar when controlling for temperature and duration of exposure. Applicability of Research to Practice Scalds of similar temperature and exposure times result in deeper scars than contact burns.

48 Burn Injury Impedes Late Erythropoiesis via Decreased Alpha Hemoglobin Stabilizing Protein and siglec1

Abstract Introduction Transfusions are of no benefit to burn patients with chronic anemia. We are elucidating the mechanisms of erythropoietin resistant anemia in burn injury using a mouse model in addition to a contrived system with human PBMCs. We have found that Alpha Hemoglobin Stabilizing Protein (AHSP), an erythroblast specific protein essential to effective hemoglobinization, is decreased in PBMC derived erythroblasts (EB) from burn patients (male + female). Hemoglobinization begins at the polychromatic EB (PolyE) stage and intensifies at the orthochromatic EB (OrthoE) stage, culminating in ejection of the nucleus and the cell becoming a reticulocyte (Reti). EB needs the support of a central island macrophage (EBI MØ) until they progress to maturation. We have seen in bone marrow from mice (male) following burn injury that Siglec1, an essential adhesion molecule is decreased in EBI MØ. It is these MØ that provide iron for the assembly of the hemoglobin unit in late erythropoiesis. EB maturation defects seen in burn injury could be due to the intrinsic changes in EB phenotype or the phenotype of supporting EBI MØ or a combination of the two. Our goal was to investigate in the animal model using male and female mice, how myeloid/erythroid intrinsic changes after burn impact the progression of late erythropoiesis from an EB and EBI MØ perspectives. Methods With IACUC approval, 12 male and female mice were anesthetized and subjected to sham burn or scald burn (15% TBSA) upon dorsal immersion in a 100oC water bath for 8 seconds. Animals were sacrificed on post burn day 7 (PBD 7). Total bone marrow cells (TBM) were harvested from bilateral femurs. Cells were characterized using CD71, Ter119, and Syto16 antibodies. EBI MØ were identified using a combination of F4/80, ERHR3, Vcam1, Ly6G and Siglec 1 antibodies. Geometric mean of fluorescence intensity (MFI) and cell counts were obtained by flow cytometric analysis and presented as x103 per million TBM cells. Peripheral blood was harvested via cardiac puncture and hemoglobin concentrations (g/dL) were obtained using a hematology analyzer. Results Among the erythroblasts, EEBs were 2.4 fold higher with a 2.4 fold lower AHSP expression in PBD 7 mice compared to sham as shown in left, top and bottom figures. Similarly, more EEBs were associated with EBIMØ with a lower Siglec1 expression as shown in right, top and bottom figures. Blood Hbg concentrations were lower in burn (sham=15.5±0.7 vs PBD 7= 13.1±0.5; p&amp;lt; 0.01). Conclusions The combined influence of Siglec1 and AHSP expression interferes with effective hemoglobinization impeding late maturation of erythroblasts following burn injury. Whether there is a synergistic action between the two deficiencies is being studied. Applicability of Research to Practice Underpinning the mechanism of erythropoiesis will lead to better options to ineffective transfusions in burn patients with anemia.

620 Impacting Teen Parents with Early Education for Burn and Fire Prevention

Abstract Introduction Unintentional fire or burn injuries are the 5th leading cause of injury deaths in the United States for children age 1–4 and the 3rd for those age 5–9. 24% of all burn injuries occur in children under the age of 15. Preparation and education are key elements in preventing fire tragedies in children. We recognized a trend in children of teen pregnancies presenting to our outpatient burn clinic with burn injuries and identified an opportunity to incorporate burn and fire prevention education into a pre-existing teen parenting program within local schools. Methods We utilized an established relationship with the local school district, which offers an elective course focusing on teen parenting in high schools with credit granted toward high school graduation. This course offers parenting classes and life skills training on a variety of topics including car seat safety, water safety, bike and pedestrian safely, and poison and first aid education. The Burn Prevention Coordinator partnered with the Fire Department Injury Prevention Specialist to teach a one hour lecture on burn and fire safety. Upon completion, the teen parents were provided with water testers to prevent scald burns, outlet protectors to prevent electrical injuries, temperature sensitive spoons for safe feeding, travel mugs, smoke alarms, and “First Aid for Burns” refrigerator magnets. Results We have taught 16 classes over the past 2 years and reached 600–800 teen parents per year. Teen parents received education regarding scald and contact burn prevention, home escape planning, smoke alarm education including contact information to have smoke alarms installed into their homes, and education regarding first aid and when to seek medical attention in regard to burn injuries. Post-lecture feedback forms have shown positive results. On average, each teen parent learned two new fire and burn prevention techniques for their child. Conclusions We identified a high risk population and partnered with a well-established teen parenting course to educate teen parents on burn and fire prevention. We provided teen parents with tools to assist them in creating a safer environment for their children. Applicability of Research to Practice Partnering with established community programs we were able to immediately make an impact focusing on burn and fire prevention.