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.

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.

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.

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.

611 Screening Adults for Depression and Suicidality in an Outpatient Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S149-S150
Author(s):  
Amanda Rose ◽  
Alan D Gilbertson ◽  
Heather Belacic ◽  
John Crow
Keyword(s):  
Mental Health ◽  
Suicidal Ideation ◽  
Mental Health Services ◽  
Health Services ◽  
Suicide Risk ◽  
Compliance Rate ◽  
Quality Improvement Initiative ◽  
Burn Patients ◽  
Initial Visit ◽  
Burn Center

Abstract Introduction In response to NIH recommendations and ABA verification standards, a protocol was initiated to screen adult burn patients in an outpatient verified burn center for depression and suicidality. It utilized the Patient Health Questionnaire (PHQ-9), a widely recognized depression screening tool. The protocol dictated patients scoring 10 or greater, or endorsing the suicide risk question would require further assessment. This project was part of a quality improvement initiative to assess initiating the protocol, identifying at-risk patients, and making appropriate referrals. Methods The initial visit of adults (ages 19 and over) seen over a one year period were retrospectively reviewed. For adults screening positive in the EMR, a Data Collection Form was completed gathering information on PHQ-9 scores, mental health treatment and diagnosis, and burn injuries. Results There were 748 adults seen for an initial visit at the burn center, ages 19–85, 61% men and 39% women. Of those patients, 572 had a PHQ-9 score documented in the EMR, demonstrating a 76% compliance rate with administration. Of those screened, 52 met criteria for inclusion by scoring 10 or greater or endorsing the suicide risk question on the PHQ-9. Scoring ranges on the PHQ-9 were as follows (N=52): 15.4% mild; 50% moderate; 19.2% moderate-severe; and 15.4% severe. Sixty percent of patients endorsed some suicidal ideation. Fifty two percent of patients were documented clearly as being on psychotropic medication or in specialized mental health services. Results were reviewed or discussed with patients in 81% of the initial visit notes. Nineteen of the 52 patients were offered a referral for mental health services. Conclusions Initiating this protocol creates an opportunity to begin conversations about mental health and offer additional support to patients. Approximately 9% of the outpatients screened at the burn center endorsed significant symptoms of depression and or suicidal ideation. Nearly half of these patients were not actively receiving treatment for these symptoms and could potentially benefit from mental health services. This project highlighted that compliance with administering and documenting the PHQ-9 and referral for follow-up services could be improved at this institution. Applicability of Research to Practice This protocol supports the need for continued evaluation and screening for depression and suicide risk in adult burn patients. Consideration should be given for monitoring other mental health conditions that could create barriers to care or compliance with treatment, such as anxiety, PTSD, psychosis, etc.

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 Comparison of PRE and POST COVID-19 Pandemic burn statistics: Initial experience from Rawalian Burn Center, Holy Family Hospital, RMU, Rawalpindi, Pakistan

2021 ◽  
Vol 25 (1) ◽  
pp. 48-52
Author(s):  
Sajid Rashid
Keyword(s):  
Mortality Rate ◽  
Surface Area ◽  
Burn Injury ◽  
Control Period ◽  
Burn Patients ◽  
Chi Square ◽  
Cross Sectional ◽  
Burn Center ◽  
Chi Square Test ◽  
Surgery Department

Objectives: To determine the change in the trend of burn patient epidemiology after the COVID-19 pandemic in terms of frequency of burn injury and mortality rate.Material and Methods: This cross-sectional descriptive study was carried out at Rawalian burn center, Plastic Surgery Department, Holy Family Hospital RMU Rawalpindi from 1st March to 31st July over a period of 05 months. All burn patients reporting to the Rawalian burn center during the specified period were included in this study by consecutive sampling. Patients were mainly admitted from emergency and some from OPD following the standard admission, inclusion, and exclusion criteriaResults: Mean age of patients in the pre-COVID (Control) period March to July 2019 was 28.84 years with an SD of ±3.73. There were 63% females and 37% males. The total burn surface area range was 8-65% during this period. Whereas in the post-COVID period, March to July 2020 mean age of patients was 29.13 years with an SD of ±4.06. There were 60% females and 40% males. Whereas the total burn surface area range was 10-61% during this period. Frequency per month of burn injury progressively reduced to 58 patients and mortality rate to 1 in July 2020 (post-COVID period). The overall frequency of burn injury (n) during the control period was 367 patients whereas in the post-COVID period is reduced to 326 patients. So there was an 11.17% reduction as compared to the control period. A Chi-square test was applied and was found significant.Conclusion: Based on the current study it can be concluded that there is a progressive fall in frequency of burn injury and mortality rate during the ongoing COVID-19 pandemic as compared to the PRE-COVID period however further studies are needed to explore the cause of this falling trend.  

scholarly journals Severe burn injury in late pregnancy: a case report and literature review

2015 ◽  
Vol 3 ◽  
pp. 1-4 ◽  
Author(s):  
Yan Shi ◽  
Xiong Zhang ◽  
Bo-Gao Huang ◽  
Wen-Kui Wang ◽  
Yan Liu
Keyword(s):  
Burn Injury ◽  
Late Pregnancy ◽  
Clinical Problem ◽  
Burn Injuries ◽  
Burn Patients ◽  
Severe Burn ◽  
Burn Center ◽  
Maternal Survival ◽  
Low Incidence ◽  
Severe Burn Injury

Abstract The management of serious burn injuries during pregnancy is an unsolved clinical problem because of the low incidence of this disease. Although it has been documented that the effect of burns on fetal and maternal survival is detrimental, there have been conflicting reports among the different burn centers regarding the mortality of burned pregnant women and the management of burn patients during pregnancy. We report a case of severe burn in late pregnancy treated at our burn center. Additionally, we searched and summarized the literature concerning the management of pregnant patients to provide useful information for their treatment.

32 Major Psychiatric Illness and Drug Dependence Both Influence Burn Outcomes, but Not in the Same Way

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S23-S23
Author(s):  
Kathleen S Romanowski ◽  
Tina L Palmieri ◽  
Soman Sen ◽  
David G Greenhalgh
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Length Of Stay ◽  
Surface Area ◽  
Body Surface ◽  
Drug Dependence ◽  
Psychiatric Illness ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Total Body

Abstract Introduction Studies of trauma patients indicated that as many as 17% of patients have major mental illness. The prevalence of mental illness in burns is not well known, but is thought to be similar to that seen in trauma. In this study we aim to examine the effect of mental health on outcomes following burns less than 20% total body surface area (%TBSA). We hypothesize that mental illness is associated with longer length of stay (LOS), length of stay per % TBSA (LOS/TBSA), and number of readmissions. Methods Following IRB approval, a 2-year (2016–2018) retrospective chart review was conducted of burn patients with burns less than 20% admitted to the burn center. Data collected include: age, sex, % TBSA, LOS, LOS/TBSA, discharge disposition, mortality, presence of mental health diagnoses (Drug Dependence, and Major Psychiatric Illness). Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables was conducted. Values expressed as mean ± standard deviation. Results A total of 961 patients with a mean age of 46.2±17.4 years, 717 men and 244 women, were analyzed. Mean total body surface area burn (TBSA) was 6.72±5.5%, and 6.14% had inhalation injury. In this study population 27.6% had drug dependence, and 15.4% had major psychiatric illness. The mean length of stay was 11.4±16.7 days, and 12 patients (1.25%) died. In examining the effects of major psychiatric illness, there was no difference in age (46.4 vs. 46.2 years, p=0.87), no difference in %TBSA (6.30% vs. 6.77%, p=0.328). Length of stay (LOS) (15.2 vs. 10.7 days, p=0.0009) and LOS/TBSA (4.03 vs. 2.90 days, p = 0.03) were increased in patients with major psychiatric illness. There was no difference in the rate of readmissions (8.11% vs. 6.56%, p=0.49). In examining the effects of drug dependence, patients were younger (40.4 vs. 48.4 years, p< 0.0001), suffered a larger %TBSA (7.70% vs. 6.31%, p=0.0008), and had a longer length of stay (13.7 vs. 10.5 days, p=0.04). There were no differences in LOS/TBSA (2.94 vs. 3.12 days, p = 0.66), and rate of readmissions (6.04% vs. 7.09%, p=0.56). Conclusions In burns < 20% TBSA, both major psychiatric illness and drug dependence influence patient’s outcomes. Major psychiatric illness does not affect burn size but does increase length of stay. Drug dependence leads to larger burn size which secondarily increases length of stay. Based on these increases in length of stay, it is likely that hospital costs are also higher for these patients. Further work must be done to mitigate the effects of mental illness on burn outcomes, even in small burns. Applicability of Research to Practice Many burn patients have mental health problems. These can influence their recovery from burn injury. We should work to minimize the effects of their mental illness on their outcomes.

784 Automated SIRS Alert Systems Are Ineffective at Predicting Sepsis in Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S226-S226
Author(s):  
Melissa Grigsby ◽  
Tina L Palmieri ◽  
Soman Sen ◽  
Kathleen S Romanowski ◽  
David G Greenhalgh
Keyword(s):  
Burn Injury ◽  
Clinical Status ◽  
Clinical Suspicion ◽  
Future Research ◽  
Burn Patients ◽  
Burn Center ◽  
Starting Point ◽  
Burn Surgery ◽  
Sirs Criteria ◽  
Order Set

Abstract Introduction Burn injury patients represent a population at particularly high risk for sepsis and sepsis mortality due to the severe immunological insult. Because of the unique nature of burn injury, this population has largely been excluded from studies developing protocols for identification and treatment of sepsis. In our institution, the protocolized approach to sepsis starts with an alert if two SIRS criteria are met, regardless of the patient’s diagnosis. We examined whether the SIRS alert was an effective way to identify and treat sepsis in burn patients. Methods Patients admitted to the burn surgery service at an academic regional burn center were identified by querying the “SIRS alert” dashboard from the hospital’s quality and safety department. The dashboard is a record of every patient whose clinical status triggered a SIRS alert during hospital admission, and whether a screening order set was opened. The SIRS alert and order set usage data were analyzed directly from the dashboard. Each patient’s chart was then reviewed to decide whether there was clinical suspicion of sepsis at the time an order set was released. We determined that there was clinical suspicion of sepsis if antibiotics were initiated or escalated within 6 hours of a SIRS screening order set being opened. Results From January 1, 2019 until September 14, 2019 there were 225 patients admitted to the burn surgery service at an academic regional burn center. 70 patients, specifically receiving treatment in the burn ICU, met the criteria to trigger a SIRS alert at least once in that time. Across those 70 patients, a total of 1381 SIRS alerts were acknowledged by the nursing staff. Due to a lack of clinical suspicion for sepsis, the SIRS screening order set was opened 8.5% of the time an alert was acknowledged. Only two times in the 1381 alerts was an order set opened and then followed by the initiation or escalation of antibiotics within 6 hours. Conclusions SIRS criteria appear to be ineffective at helping clinicians to identify and treat sepsis in the burn patient population. This is consistent with the fact that burn patients are in a virtually constant state of inflammation, making SIRS alerts futile at picking up subtle changes that could indicate early sepsis. Applicability of Research to Practice Hospitals should abandon the use of the standard SIRS criteria as a starting point for sepsis protocols when treating burn patients. There does not yet exist a validated criteria set to replace the standard SIRS criteria. In the meantime, the Burn Sepsis Consensus Conference definitions could be used as a guideline to modify the criteria, and future research should continue seeking to identify early predictors of sepsis in the burn population.

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