865 Assessing Opioid Administration in Pediatric Burn Patients with Nonsurgical Management

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S271-S271
Author(s):  
Holden Richards ◽  
Junxin Shi ◽  
Rajan Thakkar ◽  
Sheila Giles ◽  
Krista K Wheeler ◽  
...  
Keyword(s):  
Temporal Trend ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Simple Linear Regression ◽  
Nonsurgical Management ◽  
Pain Scores ◽  
Opioid Administration ◽  
Vast Literature ◽  
Total Body ◽  
Burn Depth

Abstract Introduction Despite the vast literature studying the opioid crisis, there is sparse data in the pediatric burn population. This study sought to assess patient-level characteristics and their potential effects on opioid administration in nonsurgical pediatric burn inpatients. Methods Admitted burn patients from 2013–2018 with nonsurgical management at an American Burn Association (ABA) verified pediatric burn center were retrospectively identified. Morphine milligram equivalents by weight (MME/kg) per admission were evaluated through a multiple loglinear regression with race, sex, age, total body surface area burned (TBSA), and burn depth as predictors. Simple linear regression was used to evaluate the temporal trend of median opioid utilization. Results A total of 806 patients (55% White, 35% Black, 5% Hispanic, 5% Other) were included. In an adjusted analysis, no differences in opioid administration were seen by sex, burn degree, or for Blacks and Hispanics when compared with Whites. Increased MME/kg was associated with older age (10–18 years; p< 0.0001) and larger burns (>5% TBSA burned; p< 0.0001). From 2013 to 2018, median MME/kg per admission declined significantly (2013:0.21, 2018:0.09; p=0.0103). Conclusions Nonsurgical burn patients who were older and presented with larger TBSA experienced marked increases in opioid utilization. Overall, opioid administration decreased over time. Applicability of Research to Practice Future pediatric burn research should evaluate disparities in opioid administration based on injury location and surgical management. Further, the accuracy of pain scores for non-verbal pediatric burn patients should be studied as discrepancies in opioid utilization exist.

Assessing opioid administration in pediatric burn patients with nonsurgical management

Burns ◽  
2020 ◽  
Author(s):  
Holden W. Richards ◽  
Junxin Shi ◽  
Rajan K. Thakkar ◽  
Sheila Giles ◽  
Krista K. Wheeler ◽  
...  
Keyword(s):  
Burn Patients ◽  
Nonsurgical Management ◽  
Opioid Administration

5 -Year Retrospective Analysis of a Vented Mobility Algorithm in the Burn ICU

2022 ◽  
Author(s):  
Audrey Marie O'Neil ◽  
Cassandra Rush ◽  
Laura Griffard ◽  
David Roggy ◽  
Allison Boyd ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Recent Literature ◽  
Total Body Surface Area ◽  
Early Mobilization ◽  
Burn Patients ◽  
Mechanically Ventilated ◽  
Line Placement ◽  
Total Body ◽  
Stage 1 ◽  
Significant Attention

Abstract Early mobilization with mechanically ventilated patients has received significant attention within recent literature, however limited research has focused specifically on the burn population. The purpose of this single center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average total body surface area of 22.8%. No adverse events occurred. Stage 1 (Range of motion) was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges including airway stability, sedation, and line limitations.

scholarly journals A Comparative Study between C-Reactive Protein and Procalcitonin in Iraqi Burn Patients

2017 ◽  
Vol 28 (1) ◽  
pp. 41
Author(s):  
Alia E. Al-Ubadi
Keyword(s):  
Burn Injury ◽  
Total Body Surface Area ◽  
Latex Agglutination ◽  
Burn Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Survivor Group ◽  
Significant Difference ◽  
The Mean ◽  
Total Body

Association between Procalcitonin (PCT) and C-reactive protein (CRP) and burn injury was evaluated in 80 burned patients from Al-Kindy and Imam Ali hospitals in Baghdad-Iraq. Patients were divided into two groups, survivor group 56 (70%) and non-survivor group 24 (30%). PCT was estimated using (Human Procalcitonin ELISA kit) provided by RayBio/USA while CRP was performed using a latex agglutination kit from Chromatest (Spain). Our results declared that the mean of Total Body Surface Area (TBSA %) affected were 63.5% range (36%–95%) in non-survivor patients, while 26.5% range (10%–70%) in survivor patients. There is a significant difference between the two groups (P = 0.00), the higher mean percentage of TBSA has a significant association with mortality. Serum PCT and CRP were measured at the three times of sampling (within the first 48hr following admission, after 5thdays and after 10th days). The mean of PCT serum concentrations in non-survivor group (2638 ± 3013pg/ml) were higher than that of survivor group (588 ± 364pg/ml). Significantly high levels of CRP were found between the survivor and non-survivor groups especially in the 10th day of admission P=0.000, present study show that significant differences is found within the non-survivor group through the three times P= 0.01, while results were near to significant differences within survivor group through the three times (P= 0.05).

scholarly journals A Framework for Automatic Burn Image Segmentation and Burn Depth Diagnosis Using Deep Learning

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hao Liu ◽  
Keqiang Yue ◽  
Siyi Cheng ◽  
Wenjun Li ◽  
Zhihui Fu
Keyword(s):  
Deep Learning ◽  
Total Body Surface Area ◽  
High Morbidity ◽  
Learning Technology ◽  
Human Errors ◽  
Burn Wounds ◽  
Output Structure ◽  
Network Output ◽  
Total Body ◽  
Burn Depth

Burn is a common traumatic disease with high morbidity and mortality. The treatment of burns requires accurate and reliable diagnosis of burn wounds and burn depth, which can save lives in some cases. However, due to the complexity of burn wounds, the early diagnosis of burns lacks accuracy and difference. Therefore, we use deep learning technology to automate and standardize burn diagnosis to reduce human errors and improve burn diagnosis. First, the burn dataset with detailed burn area segmentation and burn depth labelling is created. Then, an end-to-end framework based on deep learning method for advanced burn area segmentation and burn depth diagnosis is proposed. The framework is firstly used to segment the burn area in the burn images. On this basis, the calculation of the percentage of the burn area in the total body surface area (TBSA) can be realized by extending the network output structure and the labels of the burn dataset. Then, the framework is used to segment multiple burn depth areas. Finally, the network achieves the best result with IOU of 0.8467 for the segmentation of burn and no burn area. And for multiple burn depth areas segmentation, the best average IOU is 0.5144.

Prevalence of Psychiatric Disorders in Burn Patients in a Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3389-3391
Author(s):  
Imran Khan ◽  
Taimur Khan ◽  
Shakil Asif ◽  
Syed Azhar Ali Kazmi ◽  
Subhan Ullah ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Care Hospital ◽  
Burn Patients ◽  
Total Body

Background and Aim: Burn injuries patients generally suffer from various psychological and mental disorders especially in lower socio-economic groups. It can adversely affect their wellbeing and health. Proper consultation and clinical diagnosis need to be carried out on burns injuries patients from the early critical phase to rehabilitation phase recovery. The current study's aim was to determine the prevalence of psychiatric disorders in burn patients in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted on 82 attempted burn suicides, adult patients in Khattak Medical Center Peshawar, Khyber Teaching Hospital Peshawar and Divisional Headquarter hospital, Mirpur AJK for duration of six months from June 2020 to December 2020. All the patients admitted with suicides burns were of either gender and had ages above 15 years. The convenience technique was used for sampling. The patients’ demographic details such as psychiatric illness, self-immolation act motivation, burn injury depth, burn total body surface area, inhalation injury, hospitalization duration, and mortality was recorded on pre-designed proforma. Data analysis was carried out with SPSS version 20. Results: The mean age of all 82 patients was 28.9±5.2 with an age range of 14 to 55 years. Of the total, 66 (80.5%) were female while 16 (19.5%) were male. In this study, the most frequent suicidal attempt was made by the marital conflicted patients 50 (61%) followed by love affair failure 8 (9.7%). An overall mean of 53.6±19.6 was observed for total body surface area affected with a range of 15-100%. The hospital duration mean was 8.2±5.9 with a range of 1-38 days. Young, married, and rural area illiterate housewives were the most common self-inflicted/suicide burn injuries. The prime cause of such injuries was getting married. The mortality rate was found at 82.3%. Conclusion: Our study concluded that patient’s well-being and mental health could be severely affected by burn injuries. Prevalent depression was noted among severe burn injuries patients. Depression related to deformity could be prevented with early grafting, wound management, proper splinting, coping ability, intense physiotherapy, and long-term rehabilitation. Keywords: Burn; Depressed mood, Psychiatric morbidity, Posttraumatic stress disorder

564 Managing California’s Creek Fire Mass Casualty’s Incident

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S132-S132
Author(s):  
Shana M Henry ◽  
Nicole M Kopari ◽  
Mary Wolfe
Keyword(s):  
Operating Room ◽  
Disaster Response ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Rescue Operation ◽  
Burn Victims ◽  
Burn Center ◽  
Response Planning ◽  
Response Team ◽  
Total Body

Abstract Introduction California’s Creek Fire is not only the largest single wildfire in a state known for huge and destructive blazes, it spawned two rare fire tornados with winds over 100mph, a day after the fire started in early September. Huntington Lake and Mammoth Pool were the sites of these rare events leading to hundreds of trapped campers. An air rescue operation airlifted hundreds of trapped people to safety. Twenty days after the start of the fire, it had burned >300,000 acres with only 36% containment by fire crews. This review is an evaluation of our hospitals response team and the events surrounding that night. Methods Our on-call surgeon had called in the back-up surgeon to run a second trauma operating room. It was at this time, the news had reported trapped campers near Mammoth Pool. The burn surgeon was notified and reported to the emergency department (ED) as word of 65 possible victims spread. Local disaster response planning was initiated with an ED physician triaging patients at the regional airport. Initial calls were made to the division chief and burn medical director. The nursing director was notified along with any available nursing staff with 8 ICU nurses volunteering to report. Immediately, lateral transfer orders were placed for all burn patients housed in the burn center which has 10 ICU bed capabilities. Results The first helicopter landed with 5 of the burn victims presenting to our hospital. 4 of the victims were male and 1 female with ages ranging from 17 to 27. Total body surface area burn was estimated on each with 2 minor burns < 10% and 3 moderate sized burns of roughly 25%. These patients were quickly triaged in the ED and traumatic injuries evaluated. 3 of the patients were placed in ICU level care with the 2 remaining patients housed in the ED as word trickled in about another rescue effort with an additional 95 people. By morning, an additional 2 patients were transferred to our burn center from the surrounding hospitals and another 2 patients evaluated for burns sustained in separate events. All patients were taken to the operating room over the next 24–48 hours for excision and autologous spray on skin cells (ASCS) in combination with widely meshed skin grafts or ASCS alone. Conclusions Communication, teamwork, and personnel that are dedicated to the care of burn patients made this tragic incident manageable. The Creek Fire hit home for many of the burn staff not only because of the patients that were cared for, but because this area of California was a beloved respite for many. A debriefing with a chaplain, grief counselor, and psychotherapist, was held within 2 weeks of the incident to provide support to the staff during this devastating time.

524 Effectiveness of Burns Wound Cleansing by Comparison of Prewash and Post Wash Swab Reports

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M A Sayed ◽  
S Jabeen ◽  
A Soueid
Keyword(s):  
Bacterial Load ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Burn Patients ◽  
Burn Wound ◽  
Staph Aureus ◽  
Sex Type ◽  
Total Body ◽  
Burns Unit ◽  
Type Of Injury

Abstract Aim The main aim and objective were to optimise wound healing through infection prevention. This clinical audit aimed to investigate the effectiveness of burn wound cleansing in decreasing bacterial load by comparing pre-wash and post-wash swab results against local burn wound management and aseptic non touch technique (ANTT) guidelines. Method The audit was conducted retrospectively on children admitted to Burns Unit during August 2019, excluding resuscitation burn patients. Pre- and post-wash swabs taken on admission were included and the results obtained from Chameleon database. Data were collected on excel spread sheets including demographic variables such as age, sex, type of injury, percentage total body surface area (TBSA) and mechanism of injury. Data were analysed and results compiled. Results Fifty patients were admitted over a month period; amongst those 60% were male and 40% female of ages ranging from 5 months to 14 years. Scald (50%) was found to be the most common mode of injury followed by contact burn (36%) involving 0.30 to 9% TBSA. Among 50 patients, 30 (60%) showed no growth in pre-wash and 36 (72%) in post-wash swabs. However, 6% post-wash swabs that were initially negative later showed bacillus cereus, staph aureus, Enterobacter, and Acinetobacter. Similarly, another 4% post-wash swabs developed new microorganisms as compared to pre-wash swabs. Conclusions The most common bacteria colonising both pre- and post-wash swabs was staph aureus. Overall, cleansing had reduced the bacterial load significantly around 82% very effective. It is imperative to stick to local guidelines to reduce morbidity and mortality in burn patients.

scholarly journals 653. Diagnosis of Burn Sepsis Using the FcMBL ELISA: A Pilot Study in Critically Ill Burn Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S300-S300 ◽  
Author(s):  
Kevin S Akers ◽  
Taylor Schlotman ◽  
Lee C Mangum ◽  
Gerardo Garcia ◽  
Amanda Wagner ◽  
...  
Keyword(s):  
Dynamic Range ◽  
Total Body Surface Area ◽  
Healthy Controls ◽  
Burn Patients ◽  
Burn Survivors ◽  
Mannose Binding ◽  
Antimicrobial Management ◽  
Fungal Organisms ◽  
Total Body ◽  
Molecular Patterns

Abstract Background Infection is the leading cause of death among burn survivors, with sepsis associated with more extensive burns. Conventional diagnostic criteria are insensitive in this population. We examined a novel diagnostic ELISA based on Mannose-Binding Lectin (MBL) linked to an immunoglobulin Fc domain, which measures the concentration of Pathogen-Associated Molecular Patterns (PAMPs) across a broad range of bacterial and fungal organisms, for diagnosis and antimicrobial management of sepsis in burn patients. Methods We prospectively enrolled burn patients with ≥15% Total Body Surface Area (TBSA) burns into groups of noninfected, sepsis, or incipient infection, and healthy volunteers. Sepsis was defined by clinical actions responsive to sepsis. The FcMBL ELISA was performed daily using fresh whole blood. Burn subjects were sampled daily until completing antimicrobials, for 14 days if noninfected, and once for healthy controls. Differences in median PAMP concentrations between groups were assessed with the Kruskal–Wallis test, including multiple comparisons between categories. Results 14 burn patients (3 noninfected, of whom 1 died prior to sampling, 4 Sepsis, 7 Incipient) were enrolled. The median (25–75% CI) PAMP concentration was 0.53 (0.12–1.34) ng/mL in healthy controls, 3.725 (2.53–5.94) ng/mL in noninfected, 2.22 (1.42–4.62) ng/mL in incipient, and 1.59 (0.83–2.29) ng/mL in sepsis groups. PAMP concentrations in sepsis were different (P = 0.0057) from noninfected, but incipient did not differ from noninfected (P = 0.2025). The dynamic range was lower in healthy controls (2.69 ng/mL) than incipient (4.57 ng/mL), sepsis (4.70 ng/mL), or noninfected (5.90 ng/mL). PAMP elevations correlated with clinical deterioration from infection, and were not associated with OR visits for debridement and grafting. 7 of 11 infected patients had declining PAMP levels at completion of antimicrobial therapy. 2 subjects had PAMP elevations associated with Aspergillus molds in their burn wounds. Conclusion The FcMBL ELISA assay may be useful for diagnosis of infection in burn patients, and may facilitate earlier discontinuation of antimicrobials. This assay may also have a novel utility for early diagnosis of Invasive Fungal Infection. Disclosures All authors: No reported disclosures.

scholarly journals Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

2020 ◽  
Vol 41 (5) ◽  
pp. 963-966
Author(s):  
Michael Wright ◽  
Jin A Lee
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multimodal Analgesia ◽  
Burn Patients ◽  
Area Burned ◽  
Total Body ◽  
The Impact

Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).

scholarly journals A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients

2009 ◽  
Vol 42 (02) ◽  
pp. 176-181
Author(s):  
P. S. Baghel ◽  
S. Shukla ◽  
R. K. Mathur ◽  
R. Randa
Keyword(s):  
Wound Healing ◽  
Average Duration ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
The Mean ◽  
Total Body ◽  
Time Of Admission ◽  
And Control ◽  
Burn Contractures

ABSTRACTTo compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: ‘honey group’ and ‘SSD group’. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37) and SSD cream over the wounds of patients in SSD group (n=41), everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group) and control (SSD group) was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100%) who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound healing, makes the wound sterile in lesser time, has a better outcome in terms of prevention of hypertrophic scarring and post-burn contractures, and decreases the need of debridement irrespective of time of admission, when compared to SSD dressing.

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