122 Prevalence and Associated Predictors for Patients Developing Chronic, Neuropathic Pain Following Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S81-S82
Author(s):  
Kevin M Klifto ◽  
C Scott Hultman
Keyword(s):  
Mechanical Ventilation ◽  
Neuropathic Pain ◽  
Burn Injury ◽  
Hospital Length Of Stay ◽  
Direct Result ◽  
Medical Illness ◽  
Burn Patients ◽  
Chronic Neuropathic Pain ◽  
Burn Center ◽  
Burn Unit

Abstract Introduction Chronic pain, unrelated to the burn itself, can manifest as a long-term complication in patients sustaining burn injuries. The purpose of this study was to determine the prevalence and compare burn characteristics between burn patients who developed chronic neuropathic pain (CNP) and burn patients without CNP treated at a Burn Center. Methods A single-center, retrospective analysis of 1880 patients admitted to the adult Burn Center was performed from January 1, 2014 through January 1, 2019. Patients included were over the age of fifteen years, sustained a burn injury and were admitted to the Burn Unit. CNP was diagnosed clinically following burn injury. Patients were excluded from the definition of CNP if their pain was due to an underlying medical illness or medication. Comparisons between patients admitted to the Burn Unit with no pain and patients admitted to the Burn Unit who developed CNP were performed. Results One hundred thirteen (n=113) of the 1880 burn patients developed CNP as a direct result of burn injury over five years with a prevalence of 6%. Patients who developed CNP were a significantly older median age [54 vs. 46, p=0.002], abused alcohol [29% vs. 8.5%, p< 0.001], abused substances [31% vs. 9%, p< 0.001], were current everyday smokers [73% vs. 34%, p< 0.001], suffered more full-thickness burns [58% vs. 43%, p< 0.001], greater median %TBSA burns [6 vs. 3.5, p< 0.001], were more often intubated on mechanical ventilation [33% vs. 14%, p< 0.001], greater median number of surgeries [2 vs. 0, p< 0.001] and longer median hospital length of stay (LOS) [10 vs. 3 days, p< 0.001], compared to those who did not develop CNP, respectively. Median patient follow-up was 27 months. Conclusions The prevalence of CNP over five years was 6% in the Burn Center. Older ages, alcohol abuse, substance abuse, current everyday smoking, greater %TBSA burns, third degree burns, being intubated on mechanical ventilation, having more surgeries and longer hospital LOS were associated with developing CNP following burn injury. Applicability of Research to Practice The largest study to date assessing the prevalence of chronic nerve pain following burns. Identified new independent predictors for chronic neuropathic pain following burn injury, not previously assessed in the literature.

scholarly journals Prevalence and associated predictors for patients developing chronic neuropathic pain following burns

2020 ◽  
Vol 8 ◽  
Author(s):  
Kevin M Klifto ◽  
A Lee Dellon ◽  
C Scott Hultman
Keyword(s):  
Mechanical Ventilation ◽  
Neuropathic Pain ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Chronic Neuropathic Pain ◽  
Burn Center ◽  
Total Body

Abstract Background Chronic pain, unrelated to the burn itself, can manifest as a long-term complication in patients sustaining burn injuries. The purpose of this study was to determine the prevalence of chronic neuropathic pain (CNP) and compare burn characteristics between patients who developed CNP and patients without CNP who were treated at a burn center. Methods A single-center, retrospective analysis of 1880 patients admitted to the adult burn center was performed from 1 January 2014 to 1 January 2019. Patients included were over the age of 15 years, sustained a burn injury and were admitted to the burn center. CNP was diagnosed clinically following burn injury. Patients were excluded from the definition of CNP if their pain was due to an underlying illness or medication. Comparisons between patients admitted to the burn center with no pain and patients admitted to the burn center who developed CNP were performed. Results One hundred and thirteen of the 1880 burn patients developed CNP as a direct result of burn injury over 5 years with a prevalence of 6.01%. Patients who developed CNP were a significantly older median age (54 years vs. 46 years, p = 0.002), abused alcohol (29% vs. 8%, p < 0.001), abused substances (31% vs. 9%, p < 0.001), were current daily smokers (73% vs. 33%, p < 0.001), suffered more full-thickness burns (58% vs. 43%, p < 0.001), greater median percent of total body surface area (%TBSA) burns (6 vs. 3.5, p < 0.001), were more often intubated on mechanical ventilation (33% vs. 14%, p < 0.001), greater median number of surgeries (2 vs. 0, p < 0.001) and longer median hospital length of stay (LOS) (10 days vs. 3 days, p < 0.001), compared to those who did not develop CNP, respectively. Median patient follow-up was 27 months. Conclusions The prevalence of CNP over 5 years was 6.01% in the burn center. Older ages, alcohol abuse, substance abuse, current daily smoking, greater percent of total body surface area (%TBSA) burns, third degree burns, being intubated on mechanical ventilation, having more surgeries and longer hospital LOS were associated with developing CNP following burn injury, compared to patients who did not develop CNP following burn injury.

587 DVT Screening in Lower Extremity Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S135-S136
Author(s):  
Cameron J Gibson ◽  
Aakanksha Gupta ◽  
Abraham Houng
Keyword(s):  
Lower Extremity ◽  
Burn Injury ◽  
Compliance Rate ◽  
Delayed Presentation ◽  
Burn Patients ◽  
Central Lines ◽  
Burn Center ◽  
Increased Risk ◽  
Burn Unit ◽  
Screening Protocol

Abstract Introduction Burn patients are at in increased risk for developing deep vein thromboses (DVT), with rates as high as 6%. Known risk factors include large burn size, use of central lines, increasing age, male, active smoker or alcoholic, increased blood transfusions and surgeries. No study to date has looked specifically at burn location as a possible risk factor. We hypothesized that lower extremity burns with delayed presentation to our burn center are at in increased risk for DVT formation. Methods A DVT screening protocol was developed and implemented for all burn patients admitted to our burn unit starting in May 2017. Patients who presented with lower extremity burns >48 hours from their injury time underwent screening ultrasounds at admission to evaluate for DVT in the affected extremity. Data was collected from May 2017 through December 2018 for all lower extremity patients. Screened patients were identified by reviewing the burn registry for patients admitted >2 days from their injury date and then reviewing the electronic medical record for screening US. DVT rates were compared between screened patients and the overall rate for all admissions during the study period. Results There were 1041 patients admitted to the burn unit during the study period, including 445 lower extremity burns with 118 admitted >48 hours after their burn injury. The overall compliance rate with the screening protocol was 41.5% (49/118). There were a total of 4 DVT’s diagnosed among all admitted patients during the study period (1 lower extremity, 3 upper extremity), giving an overall rate of 0.5% for our unit. No DVT’s were identified in the delayed presentation group (p=0.46). Conclusions Our overall DVT rate was much lower than quoted rates in the literature. Patients with lower extremity burns and delayed presentation to a burn center do not appear to be at increased risk for DVT. Compliance with our screening protocol was relatively poor, which may be due to short hospital stays and unavailability of ultrasound on weekends for non-urgent studies. Applicability of Research to Practice Patients with lower extremity burns should receive routine DVT prophylaxis (chemical and mechanical) similar to other burn patients.

771 Psychiatric Illness Among Burn Patients: Experience at a Single ABA Verified Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S219-S220
Author(s):  
Spogmai Komak ◽  
James Cross
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Psychiatric Diagnosis ◽  
Psychiatric Illness ◽  
Burn Injury ◽  
Operative Intervention ◽  
Burn Patients ◽  
Psychiatric Consultation ◽  
Burn Center ◽  
Burn Unit

Abstract Introduction Burn injury is uniquely characterized by the initial traumatic event in addition to the psychiatric component associated with physical change and recovery. Recent work has highlighted the importance of pre-existing psychiatric illness on both recovery and final outcomes in burn patients (Tarrier et al 2005, Hudson et al 2017, Wisely et al 2009). We examined the prevalence and association of psychiatric illness in our ABA verified burn unit. Knowledge of this information is critical in allocation of limited resources aimed toward addressing both the physical and mental aspect of burn injury. Methods The burn registry at a single verified burn center was examined from July 2017-July 2018. All consecutive burn patients with psychiatric illness who were admitted were included. Psychiatric illness was broken down into: depression, anxiety, bipolar disorder, schizophrenia and delirium. Need for psychiatric consultation, %TBSA, length of hospital stay, and operative intervention was also examined. Results 416 patients were admitted during the study period—44 pts (10.5%) had a psychiatric diagnosis on admission. Seventy-five percent of pts were male. The average TBSA burned was 15.3%. Seventy-five percent of patients required psychiatric consultation, and 57% required operative intervention (Table 1). The most common psychiatric condition was anxiety (50%), followed by depression (36%), bipolar disorder (27%), schizophrenia (23%), and delirium (18%). Forty-eight percent of patients had multiple (>1) psychiatric conditions. Female patients had a significant less TBSA burn (5.8%) vs. male (18.2%), P=.001, as well as a shorter LOS (12.1 dys vs. 31.5 dys) p=.004. Conclusions The association between burn injury and pre-existing psychiatric illness is well known (Hudson et al 2017, Wisely et al 2009). We found that over 10% of pts admitted to our burn unit had a psychiatric diagnosis, and a large number of these required further inpatient psychiatry consultation. More than half of patients required operative intervention indicating that severity of burn injury was high, with optimization of pre-existing conditions especially important. Additionally, psychiatric illness did not occur in isolation--48% of pts had >1 psychiatric diagnosis —a finding which has implications for resource allocation for mental health/ dedicated psychiatrist for burn patients. Applicability of Research to Practice Implications for resource allocations for dedicated burn psychiatrist/ resources for mental health.

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

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.

826 Geographic Mapping to Target Adult Burn Prevention for an Urban Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S252-S252
Author(s):  
Mathangi A Chandramouli ◽  
Angela Rabbitts ◽  
Jamie Heffernan ◽  
Philip Chang
Keyword(s):  
Catchment Area ◽  
Burn Injury ◽  
Adult Population ◽  
Data Mapping ◽  
Burn Patients ◽  
Unequal Distribution ◽  
Burn Center ◽  
Burn Prevention ◽  
National Trends ◽  
Zip Code

Abstract Introduction Burn prevention is one of the core missions of burn centers. Geomapping has been instrumental for police departments to target resources for crime prevention. Similarly, geomapping could assist burn specialists in identifying “hotspots” of injury. The purpose of this study is to visually identify the incidence and location of adult burn injury within the catchment area of a single tertiary urban regional burn center. Data mapping can thus then be used to target burn outreach and prevention efforts. Methods Demographic and deidentified clinical data was collected from a single institution over a 3 year period. 1986 burn patients were admitted between 1/2016 and 12/2018. 1360 patients were 16 years of age or greater. Geriatric patients were defined as age 60 or greater to facilitate comparison with National Burn Repository data which breaks down age by decades. The patients were mapped by their home zip code. Results 1360 burn patients 16 years or older were admitted to this single tertiary burn center between 1/2016 and 12/2018 with an age range from 16–101. 393 patients were 60 years or older (28.9% of the adult population compared to 19.8% of the NBR population) 6 zip codes within the catchment area were identified as “hotspots” as having more than 30 inpatients listing that zip code as their home address (see figure). The results show an unequal distribution of patients over the burn center’s catchment area with hotspots (defined by > 30 burn admissions during the study period) in 6 zip codes. Conclusions The local demographics of this inpatient adult burn population follow national trends in etiology but differ with regards to age and race. The geomapping tool visualizes burn incidence by geography. Based on this analysis, outreach and prevention efforts should target elderly populations especially in the “hotspots.” Applicability of Research to Practice This research will inform targeted efforts towards burn prevention and education outreach.

scholarly journals Economic Burden of Drug Use in Patients with Acute Burns: Experience in a Developing Country

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Kolawole Olubunmi Ogundipe ◽  
Ismaila Abiona Adigun ◽  
Babatunde Akeeb Solagberu
Keyword(s):  
Drug Use ◽  
Developing Country ◽  
Economic Burden ◽  
Burn Injury ◽  
Burn Patients ◽  
Burn Unit ◽  
Antibiotics Use ◽  
The Cost ◽  
Financial Implication

Background/Objective. Burn injury is a devastating injury. The economic drain on the patient's purse is equally devastating. Few studies have examined the cost of managing burn patients particularly the drug component.Methods. The financial implication of drug use in the management of 69 consecutive patients admitted by the burn unit over a period of two years was retrospectively analysed.Results. Thirty-six (52.2%) patients were males and 33 (47.8%) females with a mean age of 17.9 years (). The patients spent an average sum of $91.21 to procure drugs; 84.3% of the costs were for antibiotics, 11.1% for analgesics, and 4.6% for others.Conclusion. Significant amount of money is spent on the procurement of drugs. Most of the money is spent on prescribed antibiotics. Measures that reduce antibiotics use in burn management might relief patients of the huge economic burden associated with its use.

508 Fungal Infections in Burn Patients from 2014–2019: A 5-year Retrospective Review

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S90-S91
Author(s):  
Kaitlin A Pruskowski ◽  
Julie A Rizzo ◽  
Leopoldo C Cancio
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Bacterial Infections ◽  
Burn Injury ◽  
Fungal Infections ◽  
Early Recognition ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Average Hospital ◽  
Time From Injury

Abstract Introduction Topical and systemic antibiotic agents used to treat burn wounds allow for fungal growth. Fungal infections often occur later in the hospital course and carry a higher mortality rate than bacterial infections in critically ill burn patients. The primary objective of this study was to describe the incidence and characteristics of fungal infections in our burn center. Methods This was a retrospective chart review. Subjects who were admitted between January 2014 and February 2019 after sustaining a burn injury and received a systemic antifungal agent were included. All cultures and histopathology results that were positive for fungus were recorded. Results Ninety one subjects were included in this analysis. The average age was 42.3±16.9 years and 74 (81.3%) subjects were male. Seventy four (81.3%) subjects were admitted after flame burn. The average burn size was 40.1±24.2% TBSA. The average hospital length of stay was 57.2±44.8 days. Thirty eight (41.7%) subjects died during their hospital stay. The 91 subjects had 220 cultures positive for fungi: 29 blood cultures, 19 BAL cultures, 23 sputum cultures, 118 tissue cultures, and 31 urine cultures. The most common fungal genera isolated were: Candida (n=146), Aspergillus (n=55), and Fusarium (n=44). Twenty six (28.6%) subjects had histopathology results that showed fungus in non-viable tissue, with an average time from injury to fungus of 20.4±11.8 days. Twenty six (28.6%) subjects had histopathology results that showed fungus in viable tissue, with an average time from injury to fungus of 22.7±16.7 days. Of note, these were not the group that had fungus in non-viable tissue. Twelve (13.2%) subjects had angioinvasion, with an average time to angioinvasion of 26.6±22 days. The 91 subjects received 133 courses of antifungals. The average course of antifungal therapy was 7.8±8.9 days. The most common antifungals used were: micafungin (n=54), fluconazole (n=53), and liposomal amphotericin B (n=44). Conclusions Patients who were started on a systemic antifungal had a high mortality rate. Common fungi isolated included Candida and Aspergillus, which is consistent with previous literature. Further research is needed on the early recognition, accurate diagnosis, and timely management of fungal infections in this patient population. Applicability of Research to Practice Fungal infections after burn injury carry a high mortality rate. Early recognition and timely management of these infections is paramount.

710 Use of Airway Pressure Relief Ventilation (APRV) in Burn Patients with and Without Inhalation Injury

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S186-S187
Author(s):  
Kevin N Foster ◽  
Dylon Buchanan ◽  
Timothy Durr ◽  
Karen J Richey
Keyword(s):  
Airway Pressure ◽  
Burn Injury ◽  
Demographic Data ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Pressure Relief ◽  
Arterial Blood ◽  
Ventilator Mode ◽  
Ventilator Settings

Abstract Introduction Burn patients often require ventilator management because of large % TBSA injury, the presence of inhalation injury, and/or other factors. Airway pressure relief ventilation (APRV) offers several advantages over conventional ventilation modes including improved alveolar recruitment, better oxygenation and hemodynamics, preservation of spontaneous breathing, and possibly less ventilator-induced lung injury. This study reviews the use of APRV as the primary ventilator mode in burn patients with and without inhalation injury. Methods A retrospective chart review of patients admitted to the burn center and requiring APRV ventilation over a ten year period was performed. Data collected included demographic data, burn injury data, ventilator settings, arterial blood gas data, and development of ventilator-associated pneumonia (VAP). Results There were 411 patients identified over the ten year period. Mean age was 46 years, and mean % TBSA burned was 33. Seventy-three percent were male. One-half (51%) of patients had an inhalation injury. Mean hospital length of stay was 32 days with 22 mean ventilator days. Average number of surgeries was 4.4 per patient. Mean high pressure (P high) was 23 mm Hg. Mean FiO2 was 88% on post-injury day (PID) 1, 65% on day PID 2, and 45% thereafter. Mean P/F ratio was 333. Mean pH was 7.40, mean pCO2 was 40 mmHg, and mean HCO3 was 25 mm Hg. Forty-six percent of patients met criteria for diagnosis of VAP. Conclusions These data demonstrate that burn patients requiring mechanical ventilation can be safely and effectively managed with APRV. Oxygenation, carbon dioxide removal, normal acid-base status, and excellent P/F ratios were maintained with relatively low ventilator settings such as peak airway pressure and FiO2. Patients were able to breathe spontaneously when able and were easily liberated form the ventilator at the appropriate time. Applicability of Research to Practice This study defines an unconventional and potentially improved ventilator mode use in burn patients.

scholarly journals Burns from ignited household aerosols in the kitchen: a case series

2017 ◽  
Vol 3 ◽  
pp. 205951311772820 ◽  
Author(s):  
Anant Dinesh ◽  
Thais Polanco ◽  
Ryan Engdahl
Keyword(s):  
Hospital Admission ◽  
Daily Living ◽  
Burn Injury ◽  
Case Series ◽  
Upper Extremities ◽  
Heat Sources ◽  
Burn Patients ◽  
Gaseous Mixtures ◽  
Food Grade ◽  
Burn Unit

Aerosol sprays are commonly used products in daily living. Aerosols in kitchen products have prompted for use of ‘food grade’ or chemically inert propellants; however, they commonly contain gases or gaseous mixtures such as butane, propane and dimethyl ether that are flammable. When such sprays are used near heat sources, such as kitchen appliances, combustibles in these products can result in ignition and burn injury. Given the ubiquity of such sprays, surprisingly burns sustained from household aerosols are not characterised in the literature. We conducted a retrospective search of all burn patients treated at our hospital which contains a burn unit. Three patients were identified with burn wounds due to household aerosol sprays. All three occurred in the kitchen. and were characterized as first-degree and second-degree burns over the head and neck or upper extremities with one requiring inpatient admission. Where it may be perceived a cause of minor injury, household aerosol burns may result in significant burn injury and hospital admission. Household aerosols and burn injury are reviewed.

scholarly journals The development and impact of heterotopic ossification in burns: a review of four decades of research

2017 ◽  
Vol 3 ◽  
pp. 205951311769565 ◽  
Author(s):  
Rachel Kornhaber ◽  
Nichola Foster ◽  
Dale Edgar ◽  
Denis Visentin ◽  
Elad Ofir ◽  
...  
Keyword(s):  
Heterotopic Ossification ◽  
Daily Living ◽  
Burn Injury ◽  
Rare Complication ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Recommended Treatment ◽  
Joint Range Of Motion ◽  
Joint Range

[Formula: see text] Introduction: Heterotopic ossification (HO) is the formation of lamellar bone within connective and other tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. The aim of this comprehensive review, therefore, was to synthesise the available evidence on the development and treatment of HO after acute burn injury. Methods: The review was based on a systematic search of five electronic databases PubMed, EMBASE, CINAHL, LILACS and Scopus. Results: Synthesis and analysis of the data highlighted that, despite the passage of time, little translatable evidence is available to guide any prevention, screening, diagnostic or pharmacological or physical management protocols. Discussion: Causes of HO remain confounded, therefore prevention is difficult. Although spontaneous resolution is possible, surgical resection remains the recommended treatment when ROM and activities of daily living are severely affected. Conclusion: The findings from this review indicate that multicentre data pooling is needed to understand the optimum pathway to prevention, identification and treatment of HO in acute burn patients.

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