scholarly journals 58 Rate and Predictors of Outpatient Follow-Up Compliance of Pediatric Burn Patients During the COVID-19 Pandemic

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S41-S42
Author(s):  
Alejandro O Chara ◽  
Erica Hodgman ◽  
Susan Ziegfeld ◽  
Carisa Parrish ◽  
Daniel Rhee ◽  
...  
Keyword(s):  
Race And Ethnicity ◽  
Time Frame ◽  
Burn Injuries ◽  
Post Injury ◽  
Burn Center ◽  
Chi Squared ◽  
Level 1 ◽  
Demographic Patterns ◽  
Burn Depth

Abstract Introduction The effect of the COVID-19 pandemic has led to increased isolation of families at home and potentially decreased access to the healthcare system. We therefore evaluated the effect of COVID-19 on rates of compliance with recommended post-injury follow-up. We hypothesized that this isolation may lead to detrimental effects on adherence to proper follow-up for children with burn injuries. Methods We queried the registry at an ABA-verified Level 1 pediatric burn center for patients aged 0–14 years who were treated and released from March 30 to July 31, 2020, which represents the height of the pandemic. As a control, we searched the registry for patients treated during the same time frame from 2016 to 2019. Patient and clinical factors were compared between the COVID and pre-COVID cohorts. Predictors of follow-up were compared using chi-squared and Kruskal-Wallis tests. Multivariable logistic regression was used to evaluate for predictors of compliance with follow-up. Results A total of 401 patients were seen and discharged from the pediatric ED for burn injuries. The COVID cohort consisted of 58 (14.5%) of these patients. Burn characteristics and demographic patterns did not differ between the COVID and pre-COVID cohorts. Demographics, including age, gender, race, and ethnicity did not differ between patients with 2-week follow-up and those without. The rate of compliance with 2-week follow-up was also not affected (62.4% prior to COVID vs. 55.2% during, p=0.29). As expected, burn size, burn depth, and mechanism of injury all significantly predicted compliance with 2-week follow up (table 1). After adjusting for these variables, there was still no difference in the odds of appropriate follow up (OR 0.6, 95% CI 0.3 – 1.1; p=0.12). Conclusions Despite concerns about decreased access to healthcare during the pandemic, the experience at our Level 1 pediatric burn center, including rates of follow-up for those managed as outpatients, appears unchanged.

scholarly journals Predictors of Follow-Up Compliance in Pediatric Burn Patients During the Time of COVID

2021 ◽  
Author(s):  
Alejandro Chara ◽  
Erica Hodgman ◽  
Susan Ziegfeld ◽  
Carisa Parrish ◽  
Daniel Rhee ◽  
...  
Keyword(s):  
Time Frame ◽  
Access To Healthcare ◽  
Burn Injuries ◽  
Burn Patients ◽  
Post Injury ◽  
Burn Center ◽  
Chi Squared ◽  
Demographic Patterns ◽  
Burn Depth

Abstract The effect of the COVID-19 pandemic has led to increased isolation and potentially decreased access to healthcare. We therefore evaluated the effect of COVID-19 on rates of compliance with recommended post-injury follow-up. We hypothesized that this isolation may lead to detrimental effects on adherence to proper follow-up for children with burn injuries. We queried the registry at an ABA-verified Level 1 pediatric burn center for patients aged 0-18 years who were treated and released from March 30 to July 31, 2020. As a control, we included patients treated during the same time frame from 2016 to 2019. Patient and clinical factors were compared between the COVID and pre-COVID cohorts. Predictors of follow-up were compared using chi-squared and Kruskal-Wallis tests. Multivariable logistic regression was used to evaluate for predictors of compliance with follow-up. A total of 401 patients were seen and discharged from the pediatric ED for burns. Fifty-eight (14.5%) of these patients were seen during the pandemic. Burn characteristics and demographic patterns did not differ between the COVID and pre-COVID cohorts. Likewise, demographics did not differ between patients with follow-up and those without. The rate of compliance with 2-week follow-up was also not affected. Burn size, burn depth, and mechanism of injury all were associated with higher compliance to follow up. After adjusting for these variables, there was still no difference in the odds of appropriate follow up. Despite concerns about decreased access to healthcare during COVID, follow-up rates for pediatric burn patients remained unchanged at our pediatric burn center.

Cryogenic Refrigerant Burns: A Rare Occupational Hazard

2020 ◽  
pp. 216507992096553
Author(s):  
Suvashis Dash ◽  
Vamseedharan Muthukumar ◽  
Rajkumar R ◽  
Durga Karki
Keyword(s):  
Exposure Time ◽  
Treatment Plan ◽  
Hand Function ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Air Conditioners ◽  
Burn Center ◽  
Adequate Knowledge ◽  
Treatment Measures ◽  
Burn Depth

Background Cryogenic burns induced by coolant gases used in refrigerators and air conditioners are rarely encountered, despite the wide use of these gases. To date, only a few cases have been reported in the literature. This study examined the occupational circumstances leading to such injuries, relevant injury sites, types of chemicals involved, and treatment measures. Methods This study was conducted in a tertiary burn center in India between March 2015 and March 2019. The demographic details, chemicals involved, and burn regions and characteristics were analyzed. Findings There were 15 burn cases all involving injury to the hand. All injuries were managed initially with dressings and nonoperative management. One patient required anti-edema therapy with limb elevation and fingertip debridement, while another patient required skin grafting. All patients had satisfactory hand function after treatment. Conclusions/Application to Practice Cryogenic burn injuries caused by refrigerants are rare, and their etiology varies considerably. Exposure time is the primary factor that determines burn depth and severity; hence, reducing exposure time is important in first aid. Our findings suggest that after exposure, the patient should be treated in a specialized burn center. Adequate knowledge regarding the pathophysiology of these types of burn injuries and their management is necessary; otherwise, misjudgments in the treatment plan can lead to adverse consequences.

23 Triage and Transfer to a Regional Burn Center - Impact of a Mobile Phone App

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S18-S18
Author(s):  
Heather Carmichael ◽  
Kiran U Dyamenahalli ◽  
Patrick Duffy ◽  
Anne L Lambert Wagner ◽  
Arek J Wiktor
Keyword(s):  
Mobile Phone ◽  
Call Center ◽  
Demographic Data ◽  
Mobile App ◽  
Burn Injuries ◽  
Visual Component ◽  
Burn Center ◽  
Private Vehicle ◽  
Triage Decisions

Abstract Introduction The ABA designs referral criteria to guide providers in recommending appropriate patients for treatment at specialized burn centers. However, patients are typically triaged at local facilities where providers may not have expertise to assess burn injuries properly. Addition of a visual component to a consultation call can improve local triage decisions, including estimations of total burn surface area (TBSA). In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic data to the burn specialist in a HIPPA-compliant manner, facilitating the consultation. Our hypothesis is that use of the burn app can improve triage decisions, particularly in cases of intermediate TBSA (1–10%). Methods This is a retrospective review of all consults to our ABA-verified burn center from a single Level II trauma center (TC) approximately 70 miles from our institution. Data were integrated from our call center, burn registry, electronic medical record and the mobile app. Burns were classified as large (>10% TBSA), intermediate (1–10% TBSA), or small (< 1%). Patients were triaged to either a) immediate transfer via ground ambulance or helicopter, b) transfer via private vehicle, c) outpatient follow up at the burn center, or d) local facility/primary care management. Patients were considered to be “down-triaged” if they required transfer but could transfer via private vehicle, or if they could be managed locally. Results During the study period, 135 patient consultations were made by the TC for thermal or cold injuries. 82 patients (61%) were referred using the app. Most patients (n=56, 41%) presented with small burns of the hands, feet or face. Overall, 53 patients (39%) were transferred to the burn center. The majority required ambulance transfer (n=44). 60 patients (44%) were recommended for outpatient follow up, but only 43% (n=26) followed up. When the subset of intermediate burns was considered (n=54), the mobile app allowed for successful “down-triage” of 12 patients (30%) referred through the app. No patient referred without the app could be “down-triaged” (p=0.02). Conclusions A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow up and transfer mode. However, less than half of patients triaged to outpatient follow up were actually seen at the burn center. Applicability of Research to Practice Telemedicine can be used to assist in triage decisions and appropriate referral to a regional burn center. This technology could be optimized to assist in outpatient follow up.

scholarly journals 609. Implementation and Post-implementation Analysis of a Pilot Program for Inpatient Review of Outpatient Parenteral Antimicrobial Therapy Prior to Discharge

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S365-S366
Author(s):  
Delaney Hart ◽  
Hailey McCoy ◽  
Krista Gens ◽  
Michael Wankum ◽  
Andrew Tarleton
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
Blood Stream ◽  
Central Line ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Chi Squared

Abstract Background The Infectious Diseases Society of America OPAT (outpatient parenteral antimicrobial therapy) guidelines state that effective OPAT programs require a multidisciplinary team1. Currently within the health system, there is no formal OPAT program in place, and OPAT prescribing is not limited to any specialty. This project aimed to pilot a pharmacist-driven program across five hospitals. Methods Adult patients with OPAT ordered between February 1 and May 1, 2020 were included. Patients were excluded if the OPAT was prescribed by infectious diseases (ID) providers or if patients were on OPAT prior to hospital admission. An alert was generated in the electronic health record (EHR) when an order for an intravenous catheter was placed for patients with concomitant antimicrobials. Follow up was performed and documented via a progress note in the EHR as appropriate. Data was collected via retrospective chart review and statistical analysis was performed using Chi-squared test with Yates’ correction. Results 101 pre- and 7 patients post-implementation were included in this study. There were a total of 51 patients pre-implementation that received inappropriate OPAT care per the IDSA OPAT guidelines, and post-implementation 2 patients (50.5% vs 28.6%, p=0.47). The secondary outcomes of 30-day readmission rates were 17% and 0% (p=0.52); and complications related to OPAT (e.g. central-line associated blood stream infections) were 12% and 0% (p=0.73), respectively. 2 midline catheters were recommended by the OPAT team, and a cost savings of up to $6,796 was calculated. Conclusion This pilot showed a trend towards decreased inappropriate OPAT prescribing and cost avoidance of an ID pharmacist-driven review of OPAT prior to patient hospital discharge. Limitations to this pilot included being underpowered due to the limited time-frame of the post-implementation period, and an inability for follow up with patients discharged utilizing an alternative home infusion service. Disclosures All Authors: No reported disclosures

scholarly journals Epidemiology of Scars and Their Consequences: Burn Scars

2020 ◽  
pp. 37-43
Author(s):  
Margriet E. van Baar
Keyword(s):  
Risk Factors ◽  
Burn Injury ◽  
Healing Process ◽  
Total Body Surface Area ◽  
Female Gender ◽  
Burn Injuries ◽  
Post Injury ◽  
The People ◽  
Total Body ◽  
Burn Depth

AbstractPathological scarring in burn wounds can result in hypertrophic scars and/or contractures. Prevalences of hypertrophic scarring after burn injuries between 8% and 67% are reported. A recent prospective study revealed a prevalence of 8%. Data on prevalence of burn scar contractures are limited; reported prevalence at discharge varied between 38 and 54% and decreased with an increasing time post burn. About 5–20% of the people who suffered from burn injuries received reconstructive surgery after burns, up to 10 years post injury.Factors predicting pathological scar formation after burn injuries include patient, injury and treatment characteristics. Injury- and treatment-related characteristics are the main predictors of scar outcomes after burn injury. These characteristics are related to burn size (total body surface area burned) and burn depth (number or type of surgery) or the overall healing process in general (length of stay, wound healing complications). Intrinsic patient-related risk factors seem to play a role as well but are less consistent predictors of scar outcome. This includes the risk factors like the female gender and also a younger age and darker skin.Knowledge on risk factors for poor scar outcome can be used to tailor treatment, aftercare and scar prevention to these patients with a high-risk profile.

Clinical outcome analysis of male and female genital burn injuries: A 15-year experience at a Level-1 Burn Center

2012 ◽  
Vol 19 (4) ◽  
pp. 351-358 ◽  
Author(s):  
Nicole J Abel ◽  
Zachary Klaassen ◽  
E Hani Mansour ◽  
Michael A Marano ◽  
Sylvia J Petrone ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Burn Injuries ◽  
Outcome Analysis ◽  
Male And Female ◽  
Burn Center ◽  
Level 1 ◽  
Female Genital

scholarly journals A retrospective analysis of ambulatory burn patients: focus on wound dressings and healing times

2010 ◽  
Vol 92 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Gianpiero Gravante ◽  
Antonio Montone
Keyword(s):  
Healing Time ◽  
Wound Dressings ◽  
Burn Patients ◽  
Burned Areas ◽  
Partial Thickness ◽  
Chi Squared ◽  
Student’S T ◽  
Partial Thickness Burns ◽  
Burn Depth

INTRODUCTION In this study, we retrospectively analysed healing times of ambulatory burn patients after silver-based dressings were introduced in late December 2005, and compared the results with those obtained before. PATIENTS AND METHODS Data were collected in November–December 2005 and in January–February 2006. We excluded from the study: (i) admitted patients; (ii) patients with mixed superficial partial thickness and deep partial thickness burns; (iii) patients with full-thickness burns; and (iv) operated patients that came for follow-up. We recorded the age, sex, cause (flame vs scald), burn depth, dressings used and healing times. RESULTS We selected 347 patients corresponding to 455 burned areas (64.4% superficial and 35.6% deep; 47.7% treated in 2005 and 52.3% in 2006). During the years 2005 and 2006, there was an increase in the use of silver-based dressings (2005, 9.7%; 2006, 38.7%; chi-squared test, P < 0.001) and a decrease in the use of paraffin gauzes (2005, 66.4%; 2006, 40.3%; chi-squared test, P < 0.001). The healing time of overall burns and of superficial burns showed no significant differences between 2005 and 2006. However, in deep partial thickness burns, a significant reduction was present (2006, 19; 2005, 29 days; Student's t-test, P < 0.01). Among all dressings, paraffin gauzes had the shortest healing times in superficial burns (5 days); with silver-based dressings in deep burns, the healing times were nanocrystalline silver (16 days) and silver carboxymethylcellulose (21 days). CONCLUSIONS Results of our retrospective study would suggest that paraffin gauzes are a valuable option in superficial burns, while silver-based dressings are preferable in deep burns.

scholarly journals Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
J. L. Palmer ◽  
H. J. Siddle ◽  
A. C. Redmond ◽  
B. Alcacer-Pitarch
Keyword(s):  
Musculoskeletal Diseases ◽  
Cost Effective ◽  
Time Frame ◽  
Teaching Hospitals ◽  
Potential Cost ◽  
Foot Health ◽  
Telephone Consultation ◽  
Face To Face ◽  
Initial Intervention

Abstract Background Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.

Sign in / Sign up

Export Citation Format

Share Document