Poster 105 The Impact of Comorbidities and Complications on Burn Injury Inpatient Rehabilitation Outcomes

BACKGROUND Stroke is a worldwide cause of disability, 40% of stroke survivors sustain cognitive impairments, most of them follow inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are already integrated into clinical settings. The impact of a task execution depends on the ratio between the skills of the treated patient and the challenges imposed by the task itself. Thus, treatments personalization requires a trade-off between patients’ skills and tasks difficulties, which is still an open issue. In this work we propose Elo ratings to support clinicians in representing patients’ skills and supporting tasks assignations to optimize rehabilitation outcomes. OBJECTIVE i) perform a stratification of patients with ischemic stroke at early stage of rehabilitation in three levels according to their Elo rating ii) show the relationships between the Elo rating levels, tasks difficulty levels and rehabilitation outcomes iii) determine if Elo rating obtained at early stages of rehabilitation is a significant predictor of rehabilitation outcomes. METHODS The PlayerRatings R library was used to obtain the Elo rating for each patient. Working memory was assessed using the DIGITS subtest of Test Barcelona and the Rey Auditory Verbal Memory Test (RAVLT) was used to assess verbal memory. The three subtests of RAVLT were used: RAVLT learning (RAVLT075), free-recall memory (RAVLT015) and recognition (RAVLT015R). Memory predictors were identified using forward stepwise selection to add covariates to the models which were evaluated by assessing discrimination using the area under the receiver operating characteristics curve (AUC) for logistic regressions and adjusted R2 for linear regressions. RESULTS Three Elo levels (Low, Mid and High) with the same number of patients (n=96) in each Elo group, were obtained using the 50 initial tasks executions (from a total of 38,177) for n=288 adult patients consecutively admitted for inpatient rehabilitation in a clinical setting. The highest proportion of patients that improved in all 4 memory items were from Mid Elo level: 56.7% of them improved in DIGITS, 67.1% in RAVLT075, 58.8% in RAVLT015 and 53.7% in RAVLT015R (p < 0.001). The proportion of patients from the Mid Elo level that performed tasks at difficulty levels #1, #2 and #3 were: 32.1%, 31.0% and 36.9% (p < 0.001) respectively, showing the highest match between skills (represented by Elo level) and tasks difficulties, considering the set of 38,177 tasks executions. Elo ratings were significant predictors in 3 of the 4 models and quasi-significant in the other. When predicting RAVLT075 and DIGITS at discharge we obtained R2=0.54 and R2=0.43 respectively, meanwhile in RAVLT075 and DIGITS improvement predictions we obtained AUC= 0.73, 95% CI(0.64-0.82) and AUC= 0.81 95%CI(0.72-0.89). CONCLUSIONS Elo ratings can support clinicians at early rehabilitation stages in identifying cognitive profiles that can be used to assign tasks’ difficulty levels.

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Rehabilitation Outcomes Among Burn Injury Patients With a Second Admission to an Inpatient Rehabilitation Facility

PM&R ◽

10.1016/j.pmrj.2014.05.010 ◽

2014 ◽

Vol 6 (11) ◽

pp. 999-1007 ◽

Cited By ~ 1

Author(s):

Margaret A. DiVita ◽

Jacqueline M. Mix ◽

Richard Goldstein ◽

Paul Gerrard ◽

Paulette Niewczyk ◽

...

Keyword(s):

Burn Injury ◽

Inpatient Rehabilitation ◽

Rehabilitation Outcomes ◽

Rehabilitation Facility ◽

Inpatient Rehabilitation Facility

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Poster 67: The Impact of Body Mass Index and Hip Abductor Brace Use on Inpatient Rehabilitation Outcomes Following Total Hip Arthroplasty

PM&R ◽

10.1016/j.pmrj.2009.08.084 ◽

2009 ◽

Vol 1 ◽

pp. S132-S133

Author(s):

Heather K. Vincent ◽

Gerben DeJong ◽

Don J. Mascarenhas ◽

Kevin R. Vincent

Keyword(s):

Body Mass Index ◽

Total Hip Arthroplasty ◽

Body Mass ◽

Hip Arthroplasty ◽

Inpatient Rehabilitation ◽

Total Hip ◽

Rehabilitation Outcomes ◽

Hip Abductor ◽

The Impact

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11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.016 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S13-S14

Author(s):

Sarah Zavala ◽

Kate Pape ◽

Todd A Walroth ◽

Melissa A Reger ◽

Katelyn Garner ◽

...

Keyword(s):

Vitamin D ◽

Length Of Stay ◽

Vitamin D Deficiency ◽

Burn Injury ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Hospital Length Of Stay ◽

Burn Patients ◽

Comfort Care ◽

The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

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Inpatient Rehabilitation: Prediction of Changes in Sensorimotor Performance in Multiple Sclerosis: A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10102177 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2177

Author(s):

Philipp Gulde ◽

Joachim Hermsdörfer ◽

Peter Rieckmann

Keyword(s):

Multiple Sclerosis ◽

Time Pressure ◽

Inpatient Rehabilitation ◽

Unhealthy Lifestyle ◽

Rehabilitation Outcomes ◽

Relapsing Remitting ◽

Steps Per Day ◽

Rest Time ◽

Impacting Factors ◽

Sensorimotor Performance

Inpatient rehabilitation has been shown to be an effective intervention for sensorimotor performance in multiple sclerosis (MS) patients. So far, predictions of the rehabilitation outcomes are limited. The objective was to predict inpatient rehabilitation outcomes by changes in the Watzmann Severity Scale (WSS), a statistical estimation of the EDSS by sensorimotor capacity. Sensorimotor performance and physical activity during rehabilitation (by actigraphy) were assessed in a sample of 28 MS patients at a facility for neurorehabilitation. Daily changes in the WSS were predicted by a model of multiple linear regression. The resulting model had an R2adjusted of 0.48 (p < 0.01) and revealed five impacting factors (a reduction in the WSS represents an improvement): the number of steps (β-weight = 0.52, p < 0.01), the duration of nocturnal rest time (β-weight = 0.46, p = 0.01), the EDSS at entry (β-weight = 0.38, p = 0.03), a relapsing-remitting MS (β-weight = 0.37, p = 0.03), and the performance in a visuomotor pursuit task with time pressure (β-weight = −0.35, p = 0.04). One standard deviation improvement was predicted when the patient at admission yielded 6600 fewer steps per day, 94 min less rest per night, −2.7 points in the EDSS at entry, a relapsing-remitting MS, and a pursuit task performance that decreased by 2.2 standard deviations. Overall, the patients improved by −0.22 ± 0.51 WSS points during 19.3 ± 4.5 d of inpatient rehabilitation. Different potential explanations of the findings are discussed, one of which proposes that the results reflect an unhealthy lifestyle which, in addition to MS, would explain the higher predicted improvements by rehabilitation tackling both MS and the patients’ lifestyle.

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617 Who Benefits the Most from Burn Camps?

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.267 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S162-S163

Author(s):

Jennifer B Radics-Johnson ◽

Daniel W Chacon ◽

Li Zhang

Keyword(s):

Retrospective Review ◽

Burn Injury ◽

Statistical Significance ◽

Categorical Variables ◽

P Value ◽

Continuous Variables ◽

Self Evaluation ◽

Significant Difference ◽

Return Home ◽

The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value< 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

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Once-Daily Amikacin Dosing in Burn Patients Treated with Continuous Venovenous Hemofiltration

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00374-11 ◽

2011 ◽

Vol 55 (10) ◽

pp. 4639-4642 ◽

Cited By ~ 19

Author(s):

Kevin S. Akers ◽

Jason M. Cota ◽

Christopher R. Frei ◽

Kevin K. Chung ◽

Katrin Mende ◽

...

Keyword(s):

Burn Injury ◽

Continuous Venovenous Hemofiltration ◽

Burn Patients ◽

Small Reduction ◽

Target Attainment ◽

Clinical Pharmacokinetics ◽

Once Daily ◽

Renal Replacement Therapies ◽

Rapid Clearance ◽

The Impact

ABSTRACTAmikacin clearance can be increased in burn injury, which is often complicated by renal insufficiency. Little is known about the impact of renal replacement therapies, such as continuous venovenous hemofiltration (CVVH), on amikacin pharmacokinetics. We retrospectively examined the clinical pharmacokinetics, bacteriology, and clinical outcomes of 60 burn patients given 15 mg/kg of body weight of amikacin in single daily doses. Twelve were treated with concurrent CVVH therapy, and 48 were not. The pharmacodynamic target of ≥10 for the maximum concentration of drug in serum divided by the MIC (Cmax/MIC) was achieved in only 8.5% of patients, with a small reduction ofCmaxin patients receiving CVVH and no difference in amikacin clearance. Mortality and burn size were greater in patients who received CVVH. Overall, 172 Gram-negative isolates were recovered from the blood cultures of 39 patients, with amikacin MIC data available for 82 isolates from 24 patients. A 10,000-patient Monte Carlo simulation was conducted incorporating pharmacokinetic and MIC data from these patients. The cumulative fraction of response (CFR) was similar in CVVH and non-CVVH patients. The CFR rates were not significantly improved by a theoretical 20 mg/kg amikacin dose. Overall, CVVH did not appear to have a major impact on amikacin serum concentrations. The low pharmacodynamic target attainment appears to be primarily due to higher amikacin MICs rather than more rapid clearance of amikacin related to CVVH therapy.

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