89 The Effect of Trauma Center Status and Burn Verification Process on Burn Patient Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S61-S62
Author(s):  
Manuel Castillo-Angeles ◽  
Christopher J Burns ◽  
John C Kubasiak ◽  
Anupama Mehta ◽  
Robert Riviello ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Patient Outcomes ◽  
Trauma Center ◽  
Burn Patients ◽  
Trauma Centers ◽  
Burn Centers ◽  
Adjusted Analysis ◽  
Burn Care ◽  
Burn Center ◽  
Burn Patient

Abstract Introduction Burn center verification was implemented to ensure burn patients receive the best quality of care. As part of the of the organized burn care system, trauma centers that do not have a burn center within the hospital should refer burn patients to a designated burn center. However, more than 30% of burn patients are still being taken care of in non-verified burn centers. Our aim was to determine if trauma center status conferred a benefit in outcomes in a national sample of burn patients. Methods This is a retrospective study using State Inpatient Databases of 22 states in 2014. The inclusion criteria were all patients admitted for burn injury (ICD-9 codes 940–949). Hospitals were categorized as ABA verified centers (VBC) and non-verified burn centers (NVBC), as well as trauma centers (TC) and non-trauma centers (NTC) based on verification status at the time of admission. Main Outcomes were in-hospital mortality and length of hospitalization (LOS). Stratifying by burn center verification status, multivariable regression was used to identify the association between trauma center status and the outcomes. Results A total of 15,982 burn patients were identified. The overall in-hospital mortality rate was 2.45%. In our sample, we only had 26 hospitals that were both a TC and VBC (Table 1). The majority of patients (54%) were treated at a NVBC/TC. In unadjusted analysis, amongst verified centers, there was no difference in mortality between TC and NTCs (3.2% vs. 3.0%, p=0.877), but NTCs had longer LOS (14.7 vs. 10 d, p< 0.001). Amongst non-verified centers, TCs had higher mortality when compared with NTCs (2.4% vs. 1.1%, p< 0.001), but TCs had longer LOS (8.3 vs. 7.2 d, p=0.007). After adjusted analysis, within VBC, TC status was associated with shorter LOS (Coef -3.28, 95% CI -5.37 – -1.19, p=0.002), but not associated with mortality (OR 1.21, 95% CI 0.50 – 2.89, p=0.667). After adjusted analysis, within NVBC, TC status was associated with longer LOS (Coef 2.37, 95% CI 1.70 – 3.04, p< 0.001) and with mortality (OR 3.70, 95% CI 2.10 – 6.51). Conclusions Trauma center status does not confer any benefit for burn patient outcomes within the burn care verification system. Despite the regionalization of burn care through the development of verified burn centers, the majority of burn patients are receiving care at trauma centers with a non-verified burn center within the hospital.

scholarly journals Effect of American College of Surgeons Level 1 Trauma Center Designation on Management of Adult Severe TBI Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Matthew Helton ◽  
Austin Porter ◽  
Kevin Thomas ◽  
Jeffrey C Henson ◽  
Mason Sifford ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Patient Outcomes ◽  
Trauma Center ◽  
Trauma Centers ◽  
Cranial Surgery ◽  
American College Of Surgeons ◽  
Severe Tbi ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center

Abstract INTRODUCTION Severe traumatic brain injury (TBI) remains a leading cause of morbidity and mortality. There is a wide variability in treatment paradigm for patients with severe TBI. American College of Surgeons (ACS) level 1 trauma centers have access to 24 h neurosurgical coverage. In this study, we use the National Trauma Database (NTDB) to evaluate if ACS trauma center designation correlates with the management and outcomes of severe TBI in adults. METHODS Adult patients (<65 yr) with a severe isolated nonpenetrating TBI were identified in the NTDB from years 2007 to 2014. ICD-9 procedure codes were used to identify primary treatment approaches: intracranial pressure monitoring and cranial surgery. Multivariate logistic regression was used to determine the impact of ACS designation on procedures and patient outcomes. Patient and injury characteristics were included in the analysis. RESULTS A total of 54 769 TBI patients were identified. Among those, 22 316 (42%) were treated at an ACS level 1 trauma center and 31 835 (58%) were treated elsewhere. Level 1 designated patients had significantly more intracranial pressure (ICP) monitors placed (12.3% vs10.8%; P < .0001) and more cranial surgeries performed (17.7% vs 15.7%; P < .0001). A greater percentage of patients were admitted to the intensive care unit (ICU; 89.9% vs 83.9%; P < .0001) and had a longer hospital stay (16.1 vs 15.2; P < .0001) at ACS level 1 trauma centers. In a regression analysis, patients at level 1 centers were associated with a 14% and 17% increased odds of obtaining a cranial surgery or ICP monitor, respectively. Patients treated at a level 1 center were associated with a 6% decrease in odds of mortality (P = .01). CONCLUSION ACS level 1 designation did correlate with increased rates of neurosurgical intervention and ICU admissions. This translated into patient outcomes as those treated at level 1 facilities were associated with lower rates of mortality.

590 Is There a Burn Center Community Standard on How to Best Manage Pediatric Burn Patients?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Emily Helmold ◽  
Niknam Eshraghi
Keyword(s):  
Pediatric Patients ◽  
Multidisciplinary Care ◽  
Standard Of Care ◽  
Teaching Hospitals ◽  
Burn Patients ◽  
Burn Centers ◽  
Children's Hospital ◽  
Burn Center ◽  
Children’S Hospital ◽  
Community Standard

Abstract Introduction A burn center is defined by the American College of Surgeons as a program that facilitates the provision of specialized multidisciplinary care in a designated setting. The Children’s Hospital Association states that pediatric patients need age specific health care delivered by specialty trained clinicians in an environment designed just for kids. When these two different specialty areas within one organization cross paths, how does the organization determine all the factors that go into determining the standard of care? One burn center found itself at the heart of this question when asked to determine the best location and how to care for pediatric burn patients. Methods An email survey was sent to burn centers verified with the American Burn Association (ABA) to care for both adult and pediatric patients and located within their region or with a similar volume. The questions included: Results Thirteen burn centers responded. Nine of the thirteen were located within the western region, two in the mid-west, one each in the south and northeast regions. Eight burn centers were categorized as academic and the other five as teaching hospitals. Bed size ranged from 8–44 with an average of 18 beds. Eighty-five percent of the respondents stated they admitted most if not all pediatric burn patients to the burn unit with two of those centers being the only location within their hospital for pediatric patients. Over seventy-five percent provided 24/7 provider coverage. There was more variability in answers regarding rate of pediatrician consultation, code blue team response, and geographic proximity to a children’s hospital however pediatric consultation was obtained in the majority of cases. Conclusions The survey responses were helpful to communicate some degree of burn center community standard although more centers and increased specificity would have strengthened the argument for a burn center remaining the preferred location for all pediatric burn admissions. Applicability of Research to Practice Sharing of our experience and recommendation that the ABA establish a burn community standard, especially one that takes how to manage competing specialties into consideration, will be helpful to all burn centers who could face this same challenge.

Geospatial Mapping as a Guide for Resource Allocation Among Burn Centers in India

2019 ◽  
Vol 41 (4) ◽  
pp. 853-858
Author(s):  
Kavitha Ranganathan ◽  
Charles A Mouch ◽  
Michael Chung ◽  
Ian B Mathews ◽  
Paul S Cederna ◽  
...  
Keyword(s):  
Burn Injury ◽  
Cross Sectional ◽  
Burn Centers ◽  
Optimal Outcomes ◽  
Burn Care ◽  
Burn Center ◽  
Level Data ◽  
Burn Units ◽  
Time Required ◽  
Reallocation Of Resources

Abstract Timely treatment is essential for optimal outcomes after burn injury, but the method of resource distribution to ensure access to proper care in developing countries remains unclear. We therefore sought to examine access to burn care and the presence/absence of resources for burn care in India. We surveyed all eligible burn centers (n = 67) in India to evaluate burn care resources at each facility. We then performed a cross-sectional geospatial analysis using geocoding software (ArcGIS 10.3) and publicly available hospital-level data (WorldStreetMap, WorldPop database) to predict the time required to access care at the nearest burn center. Our primary outcome was the time required to reach a burn facility within India. Descriptive statistics were used to present our results. Of the 67 burn centers that completed the survey, 45% were government funded. More than 1 billion (75.1%) Indian citizens live within 2 hours of a burn center, but only 221.9 million (15.9%) live within 2 hours of a burn center with both an intensive care unit (ICU) and a skin bank. Burn units are staffed primarily by plastic surgeons (n = 62, 93%) with an average of 5.8 physicians per unit. Most burn units (n = 53, 79%) have access to hemodialysis. While many Indian citizens live within 2 hours of a burn center, most centers do not offer ICU and skin bank services that are essential for modern burn care. Reallocation of resources to improve transportation and availability of ICU and skin bank services is necessary to improve burn care in India.

Management of the Patient with Thermal Injuries

2016 ◽  
Author(s):  
Michael J. Mosier ◽  
Nicole S. Gibran
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Fluid Management ◽  
Clinical Manifestations ◽  
Injured Patient ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Burn Care ◽  
Burn Resuscitation ◽  
Burn Patient

Optimal care of the burn patient requires not only specialized equipment but also, more importantly, a team of dedicated surgeons, nurses, therapists, nutritionists, pharmacists, social workers, psychologists, and operating room staff. Burn care was one of the first specialties to adopt a multidisciplinary approach, and over the past 30 years, burn centers have decreased burn mortality by coordinating prehospital patient management, resuscitation methods, and surgical and critical care of patients with major burns. This review covers where to treat burn patients, fluid management, airway management, temperature regulation, airway control, nutrition, anemia, pain management, deep vein thrombosis prophylaxis, and putting it all together: an algorithmic approach to early care of the burn-injured patient. Figures show that the size of a burn can be estimated by means of the Rule of Nines, which assigns percentages of total body surface to the head, the extremities, and the front and back of the torso, the approach to the burn patient in the first 24 hours, and the approach to the burn patient during the second to fifth days after burn injury. Tables list American Burn Association criteria for burn injuries that warrant referral to a burn unit, criteria for outpatient management of burn patients, acute physiologic changes during burn resuscitation, acute biochemical and hematologic changes during burn resuscitation, measures of pulmonary function, mechanisms of pulmonary dysfunction and indications for mechanical ventilation, clinical manifestations of carbon monoxide poisoning, half-life of carbon monoxide–hemoglobin bonds with inhalation therapy, increased acute kidney injury in patients treated with hydroxocobalamin for suspected inhalation injury, clinical findings associated with specific inhaled products of combustion, bronchoscopic criteria used to grade inhalation injury, and formulas for estimating caloric needs in burn patients. This review contains 3 highly rendered figures, 12 tables, and 134 references

Obesity Paradox in the Burn Patient

2020 ◽  
Vol 41 (1) ◽  
pp. 30-32
Author(s):  
Erica L W Lester ◽  
Justin E Dvorak ◽  
Patrick J Maluso ◽  
Samy Bendjemil ◽  
Thomas Messer ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Obesity Paradox ◽  
Class I ◽  
Burn Patients ◽  
Obesity Class ◽  
Burn Care ◽  
Significant Difference ◽  
Underweight Patients ◽  
Burn Patient

Abstract Despite the fact that obesity is a known risk factor for comorbidities and complications, there is evidence suggesting a survival advantage for patients classified by body mass index (BMI) as overweight or obese. Investigated in various clinical areas, this “Obesity Paradox” has yet to be explored in the burn patient population. We sought to clarify whether this paradigm exists in burn patients. Data collected on 519 adult patients admitted to an American Burn Association Verified Burn Center between 2009 and 2017 was utilized. Univariable and multivariable logistic regression were used to determine the association between in-hospital mortality and BMI classifications (underweight &lt;18.5 kg/m2, normal 18.5 to 24.9 kg/m2, overweight 25–29.9 kg/m2, obesity class I 30 to 34.9 kg/m2, obesity class II 35 to 39.9 kg/m2, and extreme obesity &gt;40 kg/m2). For every kg/m2 increase in BMI, the odds of death decreased, with an adjusted odds ratio of 0.856 (95% confidence interval [CI] 0.767 to 0.956). When adjusted for total BSA (TBSA), being obesity class I was associated with an adjusted odds ratio of mortality of 0.0166 (95% CI 0.000332 to 0.833). The adjusted odds ratio for mortality for underweight patients was 4.13 (95% CI 0.416 to 41.055). There was no statistically significant difference in odds of mortality between the normal and overweight BMI categories. In conclusion, the obesity paradox exists in burn care: further investigation is needed to elucidate what specific phenotypic aspects confer this benefit and how these can enhance the care of burn patients.

785 Beyond the Burn Center: Creating Nursing Clinical Guidelines for Pediatric Burn Patients That Present to Community Emergency Departments

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S226-S227
Author(s):  
Jillian Nickerson ◽  
Paul C Decerbo
Keyword(s):  
Emergency Department ◽  
Clinical Guidelines ◽  
Community Hospital ◽  
Burn Patients ◽  
Collaborative Effort ◽  
Hospital Emergency ◽  
Initial Resuscitation ◽  
Burn Center ◽  
Initial Care ◽  
Burn Patient

Abstract Introduction The goal of this project was to improve the initial care of pediatric burn patients that present to community hospital emergency departments before transfer to a burn center. The pediatric burn center received a transfer of a burn patient from a community emergency department that showed there was room for improvement on the initial care before transfer to the burn center. Methods This was a quality improvement project between the pediatric emergency department in conjunction with an outside community hospital emergency department to develop clinical guidelines using the burn centers handbook as well as the most recent ABA and ABLS guidelines to develop standards of care for a pediatric burn patient. These clinical guidelines would serve as recommendations in regards of calculating the total body surface area (TBSA) effected, the calculations of required fluid resuscitation including the addition of maintenance fluids, pain control recommendations, as well as when to transfer to a burn center. Results This project resulted in a multi-site collaborative effort which produced a thorough and easy to follow algorithm which takes the care provider through each step of the initial resuscitation of a pediatric burn patient. The algorithm initiates with the primary survey and moves through to the secondary survey with individual color coded categories for each thickness of burn. These categories run through the treatment recommendations while adhering to burn center’s treatment recommendations. This all terminates into a disposition determination for both minor and major burns. The major burn category runs through the transport criteria set forth by The American Burn Association. Conclusions Phase one of this project concluded with a collaborative effort between a Community Hospital ED and a Level 1 Burn Center ED. This coordination established an evidence based practice guideline allowing two completely separate departments within the state to provide synergistic and coordinated care to one of the most vulnerable populations. Applicability of Research to Practice The algorithm produced by this project while detailed, is a universal approach and can be implemented and adapted by any first line or receiving facility. Moving forward there will be collaborative efforts to conduct exercises involving identification, stabilization, and initial resuscitation of a simulated pediatric burn case at the community hospital for which this diagram was developed for. It is our goal to keep this momentum going and conduct these simulations regularly in order to test the system and make improvements to the algorithm.

123 Burn Patients’ Pain Experiences and Perceptions at a Regional Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S82-S83
Author(s):  
Emma R Duchin ◽  
Megan Moore ◽  
Gretchen J Carrougher ◽  
Emily K Min ◽  
Debra B Gordon ◽  
...  
Keyword(s):  
Content Analysis ◽  
Qualitative Content Analysis ◽  
Wound Care ◽  
Burn Patients ◽  
Pain Education ◽  
Pain Experience ◽  
Burn Care ◽  
Burn Center ◽  
Pain Medications ◽  
Pain Experiences

Abstract Introduction Burns are often painful injuries, associated with a long recovery. Little is known about patients’ pain experience or understanding of burn pain. Patients may also not be receiving sufficient pain education to optimize their pain experience. The aim of this project was to obtain patients’ perspectives to inform future burn pain education efforts at a regional burn center. Methods We conducted mixed-methods interviews in inpatient and outpatient units. Participants were &gt;=14 years with acute burn injury, who received at least two wound care episodes, and were able to cognitively participate. Provider stakeholders designed the interview using a modified Delphi technique. Survey questions focused on patients’ pain experiences, understanding and desire to gain knowledge of burn pain and management. Descriptive quantitative analysis was performed on categorical data. Recorded interview segments were transcribed for content analysis using an online, HIPAA-compliant software. Results We interviewed 21 adult burn patients. Participants reported variable pain and pain management effectiveness, with inpatients reporting more severe pain than outpatients. Only 11% of inpatients reported having received enough pain information, compared to 50% of outpatients. Participants expressed, in decreasing order of importance, a need for more information on burn-related pain, medications and alternative treatments, analgesic weaning, and addiction risk. In-person education ranked as the most desirable education method, followed by pamphlets and video education. Qualitative content analysis yielded 3 major themes: patient’s pain experience, range of expectations, and clinical information/services desired. Mental and physical effects were key parts of participants’ pain experiences, with many participants reporting mental anguish in addition to pain. Most participants’ pain expectations were matched by their experience, while some individuals described higher pain levels than they anticipated. Positive experiences with the burn care team primarily revolved around provided education and information on pain, whereas negative experiences concentrated on wound care events. Participants desired more information on sleep and pain medications, realistic expectations of recovery timelines, and available mental health services. Conclusions Burn patients report variable pain experiences and a strong desire to receive additional pain education. This project informs key strategies to educate burn patients on pain. A high-level of interest in pain, pharmacologic and alternative therapies, weaning and addiction risks indicates a need for newer targeted education materials. Applicability of Research to Practice Burn patients’ perspectives help inform strategies and content creation for education materials that burn centers can provide.

scholarly journals Association of Postburn Fatty Acids and Triglycerides with Clinical Outcome in Severely Burned Children

2013 ◽  
Vol 98 (1) ◽  
pp. 314-321 ◽  
Author(s):  
Robert Kraft ◽  
David N. Herndon ◽  
Celeste C. Finnerty ◽  
Yaeko Hiyama ◽  
Marc G. Jeschke
Keyword(s):  
Fatty Acids ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Acute Phase Protein ◽  
Burn Patients ◽  
Pediatric Hospital ◽  
Organ Function ◽  
Metabolic Markers ◽  
Burn Center ◽  
Phase Protein

Abstract Context: Free fatty acids (FFAs) and triglycerides (TGs) are altered postburn, but whether these alterations are associated with postburn outcomes is not clear. Objective: The aim of the present study was to analyze lipid metabolic profiles in pediatric burn patients and to correlate these profiles with patient outcomes and hospital courses. Design and Setting: We conducted a prospective cohort study at an academic pediatric hospital burn center. Patients: Our study included 219 pediatric burn patients. Main Outcome Measures: Patients were stratified according to their plasma TG and FFA levels. Main patient outcomes, such as postburn morbidity and mortality, and clinical metabolic markers were analyzed. Results: All groups were similar in demographics and injury characteristics. Patients with elevated TGs had significantly worse clinical outcomes associated with increased acute-phase protein synthesis indicating augmented inflammation and hypermetabolism, whereas increased FFAs did not seem to profoundly alter postburn outcomes. Conclusions: Elevated TGs, but not FFAs, postburn are associated with worsened organ function and clinical outcomes.

scholarly journals 562 Burn Bed Availability in the Northeast Region During the COVID-19 Pandemic

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S131-S131
Author(s):  
Christina Lee ◽  
Kathe M Conlon ◽  
Michael A Marano ◽  
Margaret A Dimler ◽  
Robin Lee ◽  
...  
Keyword(s):  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Published Data ◽  
Burn Patients ◽  
Northeast Region ◽  
Burn Centers ◽  
State Hospitals ◽  
Burn Center ◽  
Mass Casualty Event ◽  
Local Trauma

Abstract Introduction The coronavirus disease pandemic has placed enormous strain on all medical services with ICU capabilities throughout the Northeast region. The surge in ICU beds might severely limit burn centers to accept burn patients in a regional mass casualty incident. Methods Burn bed data was collected by a regional burn disaster consortium. Open burn bed census was collected via telephone from each burn center in the consortium on April 15th, May 7th, May 21st, June 4th and June 18th of 2020. This data was compared to published data from 2009 to 2016. Results The results are listed in Table 1. Lowest available burn bed was 35 beds on April 15th, 2020. Conclusions Although a disaster may impact surrounding local and state hospitals, it does not always impact a burn center’s ability to transfer patients from a local trauma center or nearby burn center. A pandemic however affects a larger region and impacts all hospitals within that region. Peak ICU utilization in the Northeast was between the second and third week of April. During the peak utilization time, burn bed census was about 50% of the historical average. Burn bed census did not return to historical average until May 7, 2020. If a mass casualty event occurred in the pandemic region, the Northeast region would have to reach out to other ABA designated regions for assistance. Historically, burn mass casualty plans are based on the capacity to move burn patients to other burn centers in order to relieve surge capacity at the affected center. This data illustrates that, in a pandemic, burn beds are being utilized for non-burn patients. The ability to follow these plans will be greatly impacted.

scholarly journals The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

2021 ◽  
Vol 10 (8) ◽  
pp. 1700
Author(s):  
Charlie Sewalt ◽  
Esmee Venema ◽  
Erik van Zwet ◽  
Jan van Ditshuizen ◽  
Stephanie Schuit ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Hospital Volume ◽  
Injury Severity ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
Level 1 ◽  
Injured Patients ◽  
Level 1 Trauma Center

Centralization of trauma centers leads to a higher hospital volume of severely injured patients (Injury Severity Score (ISS) > 15), but the effect of volume on outcome remains unclear. The aim of this study was to determine the association between hospital volume of severely injured patients and in-hospital mortality in Dutch Level-1 trauma centers. A retrospective observational cohort study was performed using the Dutch trauma registry. All severely injured adults (ISS > 15) admitted to a Level-1 trauma center between 2015 and 2018 were included. The effect of hospital volume on in-hospital mortality was analyzed with random effects logistic regression models with a random intercept for Level-1 trauma center, adjusted for important demographic and injury characteristics. A total of 11,917 severely injured patients from 13 Dutch Level-1 trauma centers was included in this study. Hospital volume varied from 120 to 410 severely injured patients per year. Observed mortality rates varied between 12% and 24% per center. After case-mix correction, no statistically significant differences between low- and high-volume centers were demonstrated (adjusted odds ratio 0.97 per 50 extra patients per year, 95% Confidence Interval 0.90–1.04, p = 0.44). The variation in hospital volume of the included Level-1 trauma centers was not associated with the outcome of severely injured patients. Our results suggest that well-organized trauma centers with a similar organization of care could potentially achieve comparable outcomes.

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