740 Mechanisms, Outcomes and Management of Pavement Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S201-S202
Author(s):  
Matthew T Eisenberg ◽  
Paul J Chestovich ◽  
Syed F Saquib
Keyword(s):  
At Risk ◽  
Average Length ◽  
Radiant Energy ◽  
Retrospective Chart Review ◽  
Skin Grafting ◽  
Operative Management ◽  
Body Region ◽  
Burn Patients ◽  
Increased Risk ◽  
Split Thickness Skin Grafting

Abstract Introduction Burns from contact with hot pavement are commonly seen at burn centers located in desert climates. Previous work has shown increased risk of pavement burns as ambient temperatures rise above 95 degrees. In direct sunlight pavement absorbs radiant energy causing it to rise to temperatures high enough to cause second degree burns in under 35 seconds. This study aims to review the experience of treating pavement burns in a desert climate. Methods A retrospective chart review was performed on pavement burns at an ABA-verified Burn Center for 5 years from 2014–2018. The data collected included %TBSA, surface area per body region, cause, operative management, comorbidities, complications, incident location and cause of death. Patients were separated by cause into groups which included found down, walked on pavement, heat/dehydration, mechanical fall, syncope, seizure, trauma, substance/psych and unknown. Results A total of 185 patients admitted for pavement burns were identified in the study period. The average length of stay for survivors was 16.7 days. Of the survivors, 23% spent time in the ICU with an average stay of 11.4 days. The average TBSA was 5.5% (IQR 2–7.5%) with a maximum of 25%. TBSA breakdown by body region is shown in figure 1. It was found that 50.5% of admitted pavement burn patients required burn excision and 35.9% required split thickness skin grafting. The leading causes of pavement burn admissions were being found down by EMS and walking on pavement at 21.6% each, followed by mechanical falls at 15.1% (See figure 2). Of the 185 patients admitted 17.8% were under the influence of alcohol or drugs. Comorbidities were common; 32.4% had hypertension, 21.6% had diabetes, 13.5% had neuropathy, 2.2% had coronary artery disease, 5.4% had chronic kidney disease. Of the patients that walked on pavement to receive their burns, 50% also had peripheral neuropathy. Rhabdomyolysis developed in 5.4%, and hospital 30-day mortality was 4.9%. Conclusions Pavement burns are a common burn mechanism in hot and sunny climates, but may be seen in other locations during periods of high heat. Patients at risk are those with medical comorbidities and who come in contact with hot pavement for long time periods. Applicability of Research to Practice Data provided from this study can be used for a public health initiative to help patients who may be at risk of acquiring pavement burns. The data may also be helpful for clinicians gaining information about the management, cause and outcomes of pavement burn patients.

Pavement Burns Treated at a Desert Burn Center: Analysis of Mechanisms and Outcomes

2020 ◽  
Vol 41 (5) ◽  
pp. 951-955
Author(s):  
Matthew Eisenberg ◽  
Paul Chestovich ◽  
Syed F Saquib
Keyword(s):  
Radiant Energy ◽  
Retrospective Chart Review ◽  
Skin Grafting ◽  
Common Mechanism ◽  
Burn Patients ◽  
Ambient Temperatures ◽  
Burn Center ◽  
Public Health Initiative ◽  
Increased Risk ◽  
Split Thickness Skin Grafting

Abstract Burns from contact with hot pavement are a common mechanism treated at burn centers located in desert climates. Previous work has shown increased risk of pavement burns as ambient temperatures rise above 95 degrees. In direct sunlight, pavement absorbs radiant energy causing the temperature to rise high enough to cause second-degree burns in seconds. The goal of this study is to review the mechanisms and outcomes of patients suffering pavement burns and to compare patients who presented with hyperthermia to their normothermia counterparts. A retrospective chart review was performed on pavement burns at an ABA-verified Burn Center for 5 years from 2014 to 2018. A total of 195 patients were identified. It was found that 50.5% of admitted pavement burn patients required burn excision and 35.9% required split-thickness skin grafting. The leading causes of pavement burn admissions were found down by EMS and walking on pavement at 21.6% each, followed by mechanical falls at 15.1%. We found that patients with recorded hyperthermia had statistically significant increase in 30-day hospital mortality, intensive care unit days, surgical procedures, and %TBSA. Data provided from this study can be used for a public health initiative to help patients who may be at risk of acquiring pavement burns. The data may also be helpful for clinicians gaining information about the management, mechanism, and outcomes of pavement burn patients.

scholarly journals A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 225
Author(s):  
Frederik Schlottmann ◽  
Vesna Bucan ◽  
Peter M. Vogt ◽  
Nicco Krezdorn
Keyword(s):  
Skin Grafting ◽  
Burn Patients ◽  
Skin Substitutes ◽  
Therapeutic Approaches ◽  
The Past ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Burn Surgery ◽  
History Of ◽  
Transplant Immunology

Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant progress in the field of tissue engineering has led to the development of promising therapeutic approaches. However, scientific advances in the field of allografting and transplant immunology are of great importance. The achievement of various milestones over the past decades has provided thought-provoking impulses in the field of skin allotransplantation. Thus, biologically viable skin allotransplantation is still not a part of the clinical routine. The purpose of this article is to review the achievements in burn surgery with regards to skin allotransplantation in recent years.

Risk factors for complicated grief (CG) and utilization of a hospice bereavement program.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19588-e19588
Author(s):  
Elizabeth Henry ◽  
Rong Guo ◽  
Aziz Ansari ◽  
Theresa Kristopaitis ◽  
Mark Speyer ◽  
...  
Keyword(s):  
At Risk ◽  
Average Length ◽  
Caregiver Relationship ◽  
Phone Calls ◽  
Increased Risk ◽  
Bereavement Counseling ◽  
One Year ◽  
Lost To Follow Up ◽  
Benefit Mandates

e19588 Background: The Medicare hospice benefit mandates that bereavement services be provided to a surviving caregiver for a period of one year following a patient’s (pt) death. Identifying caregivers at risk for CG is essential so that appropriate interventions can be provided. Methods: Our objective was to identify specific features predicting for CG in surviving caregivers of pts with a malignancy enrolled in an academic based hospice program and determine utilization of Medicare’s bereavement services. Hospice charts for 65 patients whose caregivers were consecutively discharged from bereavement follow-up between January 2009 and December 2011 were reviewed. Assessments for CG features were performed with use of chaplain and social worker visits, and phone calls from a trained bereavement volunteer to caregivers at 6-8 wks and 6 months after a pt’s death. A discharge assessment was completed at 13 months. Results: Fifty (77%) hospice pts had a cancer (ca) diagnosis and tended to have a shorter average length of hospice enrollment than non-ca pts (34 vs 60 days, p=0.11). There was no difference in risk of caregiver CG between ca vs non-ca diagnoses (p=0.12). Twenty-one (42%) of ca pt caregivers were identified at risk for CG. Ca pts ≤ 50 yrs at the time of hospice enrollment were more likely to have caregivers identified at risk for CG compared to those ≥ 50 yrs (3, 100% vs 18, 38%, p=0.07). At risk ca caregivers had a lower average pt age at time of hospice enrollment than lower risk caregivers (mean pt age 67 vs 76 yrs, p=0.03). Eight ca caregivers (38%) identified at risk for CG received intensive bereavement counseling; 13 (62%) subsequently received routine bereavement follow up; none were lost to follow up. Length of enrollment, caregiver employment status and caregiver relationship did not predict for risk of CG. No ca caregivers required intensive bereavement services beyond 12 months post pt death. Conclusions: Young patient age at time of hospice enrollment is associated with an increased risk of caregiver CG.Intensive bereavement counseling was required by 38% of ca caregivers, and none required >1 yr of service. Further study needs to be done to see if caregivers are receiving adequate bereavement support through the hospice benefit.

Real-world outcomes of genetic testing in a GU genetics clinic and evaluation of current guidelines.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 668-668
Author(s):  
Annelise Pace ◽  
Ashley Henriksen Woodson ◽  
Rebecca Slack-Tidwell ◽  
Molly S. Daniels ◽  
Patrick Glen Pilie ◽  
...  
Keyword(s):  
At Risk ◽  
Genetic Testing ◽  
Retrospective Chart Review ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Clinical Criteria ◽  
Increased Risk ◽  
Genetic Test Results ◽  
History Of ◽  
Cancer Syndromes

668 Background: Several known hereditary cancer syndromes confer an increased risk for genitourinary (GU)-related malignancies. Various guidelines indicate when to refer patients to genetic counseling for GU cancers, but there are limited data on the performance of these guidelines in clinical practice, and the association between testing outcome and clinical and familial features that may delineate a heritable syndrome. The purpose of this study is to determine the most common indications for ordering genetic testing in a GU Genetics Clinic and evaluate the relationship between the indication for germline testing and outcome. Methods: An IRB-approved retrospective chart review was performed for 350 patients seen in a GU Genetics Clinic at a single comprehensive cancer center from 2014-2018. Subgroups of patients were formed based on their indication for genetic testing. Exact binomial tests were used to compare the proportion of patients with a positive (pathogenic or likely pathogenic) germline variant for those with vs. without each indication. Results: All patients had a genetic evaluation due to a personal or family history of GU cancer. The majority (324 of 350, 92.5%) were evaluated for either renal cell carcinoma (RCC) or prostate cancer (PrCa). Among patients seen for RCC-related evaluation (n = 159), 23 patients (14.5%) tested positive. Meeting published clinical criteria for a hereditary RCC syndrome significantly predicted positive testing ( P< 0.001). No other indication for testing, including RCC diagnosis ≤ 46 years, predicted for positive germline genetic test results. No positive patients were identified by age of RCC onset alone. Among patients seen for PrCa-related evaluation (n = 173), 13 (7.5%) individuals tested positive; all positive variants were in ATM or BRCA2. A single patient (1/13) was identified by metastatic PrCa status alone. Conclusions: Our data suggest current algorithms lack specificity for selecting individuals with RCC or PrCa at risk for germline mutations, and need to be revised. Evaluation of pedigrees and identifying presence of syndromic features are essential and increase the probability of identifying individuals at risk for harboring a germline mutation.

T2 Safety of Early Post-operative Range of Motion in Burn Patients with Newly Placed Hand Autografts

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S1-S2 ◽  
Author(s):  
William S Dewey ◽  
Kyle B Cunningham ◽  
Sarah K Shingleton ◽  
Kaitlin A Pruskowski ◽  
Ashley M Welsh ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Graft Loss ◽  
Skin Grafting ◽  
Operative Management ◽  
Adult Patients ◽  
Thickness Skin ◽  
Additional Surgery ◽  
Split Thickness Skin Grafting ◽  
Hand Burns

Abstract Introduction Patients who suffer hand burns are at a high risk for developing contractures, partly due to the presence of numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting (STSG) are often immobilized post-operatively for graft protection. Restricting mobility following a STSG is thought to protect against subdermal edema and shear forces, despite limited evidence. Early range of motion (EROM) has been described previously. Recent practice at our burn center includes EROM following hand STSG to limit unnecessary immobilization. The purpose of this retrospective study was to determine if EROM is safe to perform after hand STSG and if there is any clinical benefit. Methods In an approved, retrospective, matched case-control study of adult patients who sustained hand burns, patients who received EROM were defined as cases; patients who did not receive EROM were considered controls and received the standard 3–5 days of post-operative immobilization in a resting hand splint. Adult patients admitted over a 3-year period were eligible for inclusion. Patients were evaluated for graft loss and range of motion. Results Seventy-two patients were included in this study; 37 EROM patients and 35 matched controls. EROM patients tended to have a larger area excised (170.4 ± 69.8cm2 vs. 132.9 ± 76.2cm2; p=0.034) and grafted (171 ± 70.8 cm2 vs. 132.9 ± 76.2 cm2; p=0.033). Most patients were male, with an average age of 39 years. Patients had an average of approximately 5% TBSA burns with 1.5% to the hands. On post-op day (POD) 1 and 2, patients received EROM for an average of 30 minutes (29.25 ± 14.9 vs. 31 ± 16.4 minutes). Six patients experienced minor graft loss. Three patients (8%) experienced graft loss not attributable to EROM. One patient (2.7%) experienced graft loss pre-EROM on POD2 and 3 patients (8%) experienced graft loss post-EROM on either POD1 or POD2. All graft loss was less than 1 cm in greatest dimension and no patient who experienced graft loss required additional surgery as they all closed by their first outpatient follow-up. Significantly more patients who received EROM achieved full digital flexion by the first outpatient visit (25/27=92.6% vs. 15/22=68.2%; p=0.028). Conclusions Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow up. Further prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas. Applicability of Research to Practice Clinical change in post-operative management after hand grafting.

scholarly journals Perioperative Multimodal Analgesia Reduces Opioid Use Following Skin Grafting in Nonintubated Burn Patients

2020 ◽  
Vol 41 (6) ◽  
pp. 1202-1206
Author(s):  
Richard Lennertz ◽  
Haley Zimmerman ◽  
Timothy McCormick ◽  
Scott Hetzel ◽  
Lee Faucher ◽  
...  
Keyword(s):  
Rating Scale ◽  
Oral Morphine ◽  
Retrospective Chart Review ◽  
Skin Grafting ◽  
Multimodal Analgesia ◽  
Numeric Rating Scale ◽  
Burn Patients ◽  
Opioid Use ◽  
Perioperative Analgesia ◽  
University Of Wisconsin

Abstract Hundreds of patients are treated for burn injuries each year at University of Wisconsin School of Medicine and Public Health. Pain management is particularly challenging during dressing changes and following skin grafting procedures. We performed a retrospective chart review from January 2011 through June 2018 to evaluate the effect of nonopioid analgesic medications on opioid use in nonintubated patients. Our primary outcome was the change in opioid use following the procedure. We found that most patients (69%) report severe pain (Numeric Rating Scale ≥7) immediately after autologous skin grafting. On average, patients required an additional 52 mg of oral morphine equivalents (ME) in the 24 h after the procedure compared with the 24 h before. The use of perioperative nonopioid analgesia varied between patients (acetaminophen 29%, gabapentin 29%, ketamine 35%, and all three 8%). Patients who received either gabapentin or a combination of acetaminophen, gabapentin, and ketamine had a smaller increase in their opioid use than patients who did not receive the medications (−25 ME, 95% confidence interval [−46, −4]; P = .018 and −47 ME, [−81, −11]; P = .010, respectively). These results support using a combination of acetaminophen, gabapentin, and ketamine for perioperative analgesia in burn patients undergoing autologous skin grafting.

Management of Fasciotomy Wounds-Does the Dressing Matter?

2011 ◽  
Vol 77 (12) ◽  
pp. 1656-1660 ◽  
Author(s):  
Sarah E. Matt ◽  
Laura S. Johnson ◽  
Jeffrey W. Shupp ◽  
Tareq Kheirbek ◽  
Jack A. Sava
Keyword(s):  
Primary Closure ◽  
Average Length ◽  
Skin Grafting ◽  
Wound Management ◽  
Categorical Variables ◽  
Closure Rate ◽  
Exact Test ◽  
Gauze Packing ◽  
Split Thickness Skin Grafting ◽  
Level I

Fasciotomy is a limb-saving procedure in the management of ischemic extremities. Little evidence exists as to the best method of fasciotomy wound management. We hypothesized that the use of vacuum dressing (VAC) or creation of dynamic tension (DYN) would increase rates of primary closure, reducing the need for split thickness skin grafting (STSG). The records of a large urban Level I trauma center were used to identify fasciotomy recipients over a 10-year period and were retrospectively analyzed. Data collected included injury characteristics, wound management, and outcomes. Wound management was dictated by surgeon preference, and categorized as gauze packing, DYN, or VAC. The primary outcome was primary closure versus need for STSG. Wound management cohorts were compared using logistic regression. Fisher's exact test and χ2 were performed to compare proportions and categorical variables respectively. From 2000 to 2009, 227 patients had a fasciotomy performed. Mechanism, age, and incidence of fracture were different between the groups. There was a trend towards increased primary closure with DYN (83%). Average length of stay (LOS) was 21 days for those receiving primary closure and 27 days for STSG. There was a significant decrease in LOS for the DYN group (average 16 days) when compared with gauze packing and VAC. In this series of 227 patients who underwent fasciotomy, no technique of wound management produced a significant improvement in primary closure rate. A trend toward more primary closure was seen in the DYN group. LOS was longer for patients receiving STSG. The DYN cohort had a significantly shorter LOS.

24 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S21-S21
Author(s):  
Sara Calder ◽  
Asia N Quan ◽  
Suzanne C Osborn ◽  
Karen J Richey ◽  
Curt Bay ◽  
...  
Keyword(s):  
Vitamin D ◽  
Retrospective Chart Review ◽  
Vitamin D Insufficiency ◽  
Infectious Complications ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Weekly Dose ◽  
Burn Patients ◽  
Increased Risk ◽  
Vitamin D Levels

Abstract Introduction The potential consequences of vitamin D insufficiency/deficiency (I/D), include increases in ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen. Methods A retrospective chart review was performed of all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one vitamin D hydroxy level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml. Results Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly positively correlated with %TBSA burn size (p&lt; 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days with an average weekly dose of 142,877 international units cholecalciferol. Many patients were discharged prior to reaching therapeutic levels. Time to reach therapeutic levels was also positively correlated with increasing burn size (p&lt; 0.05). Conclusions Vitamin D I/D is present is over 90% of burn patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the clinical consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted.

667 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S178-S179
Author(s):  
Sara Calder ◽  
Asia N Quan ◽  
Suzanne Osborn ◽  
Virginia Nisbet ◽  
Karen J Richey ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Burn Patients ◽  
Burn Center ◽  
Increased Risk ◽  
Vitamin D Levels

Abstract Introduction The potential consequences of vitamin D insufficiency/deficiency (I/D) in critically ill patients include: increased ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen. Methods A retrospective chart review was performed on all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one 25-hydroxy vitamin D level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml. Results Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly negatively correlated with increasing % total body surface area (TBSA) burn size (p&lt; 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days, requiring an average of 116,125 units cholecalciferol weekly. Time to reach therapeutic levels was also positively correlated with increasing burn size (p&lt; 0.05). Many patients, however, were discharged prior to reaching therapeutic levels. Conclusions Vitamin D I/D is present in over 90% of burn center patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted. Applicability of Research to Practice This study documents common and severe vitamin D deficiency in burn patients, and difficulty in correcting this deficiency.

Sign in / Sign up

Export Citation Format

Share Document