108 Length of Stay per Total Body Surface Area Relative to Burn Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S72-S73
Author(s):  
Kelli N Patterson ◽  
Kyle Horvath ◽  
Amanda Onwuka ◽  
Renata Fabia ◽  
Sheila Giles ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Quality Improvement Collaborative ◽  
Burn Care ◽  
Pediatric Injury ◽  
Total Body

Abstract Introduction Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients have been performed at single institutions and based on ranges of TBSA burn. A LOS to TBSA burn ratio of 1:1 has also been widely accepted but not confirmed over time across numerous institutions. The objective of this study was to use multi-institutional pediatric burn data to describe benchmarks associated with LOS per TBSA burn. Methods Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for 1004 patients (n=1004) treated at five pediatric burn centers from July 2018-March 2020. LOS/TBSA burn ratios were calculated for each site. LOS/TBSA burn by institution and mechanism were analyzed. Generalized linear regression models were used to model the effect of hospital and burn mechanism on the LOS/TBSA ratio. Results Among the 1004 injuries, the most common burn mechanism was by scald (64%), followed by contact (16%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.3 days (SD 2.2). Flame burns had a higher LOS/TBSA burn ratio than scald burns with a mean LOS/TBSA burn of 1.63 compared to 0.84. In adjusted models, scald burns, and chemical burns had the lowest LOS/TBSA burn ratio and electrical and friction burns had the highest LOS/TBSA burn ratio. The LOS/TBSA burn ratio was comparable across hospitals after adjustment for mechanism, with just Hospital 4 having a lower average LOS/TBSA burn of 0.49 days. Conclusions These data establish a multi-institutional ratio for the overall performance in LOS for pediatric burn patients. A LOS per TBSA ratio of about 1 was observed across PIQIC centers, except for a lower ratio at one center. Additionally, it provides evidence on the variance in LOS per TBSA burn relative to the sustained burn mechanism. Further collaborative data analysis will allow us to recognize specific patterns and outcomes in pediatric burn care, which is essential for the implementation of quality improvement standards.

Length of Stay per Total Body Surface Area Burn Relative to Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study

2021 ◽  
Author(s):  
Kelli N Patterson ◽  
Amanda Onwuka ◽  
Kyle Z Horvath ◽  
Renata Fabia ◽  
Sheila Giles ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Common Mechanism ◽  
Quality Improvement Collaborative ◽  
Pediatric Injury ◽  
Total Body

Abstract Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients are often limited to single institutions and are grouped in ranges of TBSA burn which lacks specific detail to counsel patients and families. A LOS to TBSA burn ratio of 1 has been widely accepted but not validated with multi-institution data. The objective of this study is to describe the current relationship of LOS per TBSA burn and LOS per TBSA burn relative to burn mechanism with the use of multi-institutional data. Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for patients across five pediatric burn centers from July 2018-September 2020. LOS per TBSA burn ratios were calculated. Descriptive statistics and generalized linear regression which modeled characteristics associated with LOS per TBSA ratio are described. Among the 1267 pediatric burn patients, the most common mechanism was scald (64%), followed by contact (17%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.2 (SD 2.1). In adjusted models, scald burns and chemical burns had similar LOS/TBSA burn ratios of 0.8 and 0.9, respectively, while all other burns had a significantly higher LOS/TBSA burn ratio (p<0.0001). LOS/TBSA burn ratios were similar across races, although Hispanics had a slightly higher ratio at 1.4 days. These data establish a multi-institution LOS per TBSA ratio across PIQIC centers and demonstrate significant variation in the LOS per TBSA burn relative to the burn mechanism sustained.

22 16-year State-wide Population-based Analysis of Burn and Inhalation Injury – Demographics, Injury Characteristics, Management, and One-year Outcomes

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S17-S18
Author(s):  
Philip D Hewes ◽  
Derek Bell
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Population Based ◽  
Inhalation Injury ◽  
Post Injury ◽  
Case Volume ◽  
Burn Care ◽  
Total Body

Abstract Introduction Estimates on frequency and outcomes of burn or inhalation injury in the United States are limited since reported databases are confined to specific phases of care, included facilities, length of follow-up, facility/provider/patient identification and/or lack of longitudinal tracking. A population-based database addresses these issues. Methods We queried a statewide mandated-reporting database for the years from 2000 through 2015 at the time of injury using a set of ICD9-CM codes for second degree or deeper burns, inhalation injury, and chemical and electrical burns. Burn total body surface area percentage by anatomical region was assigned as appropriate using modified and age-stratified Lund and Browder charts. Records for each patient were extracted out to one year pre- and post-injury, as available. Provider and facility burn volume and survival was stratified into quartiles. We applied the Committee on Trauma/American Burn Association referral criteria to the index presentation. Kaplan-Meier curves were generated to 1-year post injury for testing combinations of burn percent total body surface area of 20% and inhalation injury for age ranges < 15, 15 - 60, and >60 years. Regression models were developed to model the probabilities of in-patient, 90-day, and 365-day mortality and readmission. Results 56,712 patients were included. Overall, 22% of patients meeting referral criteria were never seen at a burn center within 1-year post-injury. The greatest positive predictors of in-patient mortality were facility case volume and burn percent total body surface area. The greatest negative predictors were high provider burn case volume (for highest quartile, adjusted odds ratio 0.08, 95% confidence intervals 0.06 – 0.12). The highest risk of unscheduled 30-day readmission was associated with index presentation to a non-burn care facility (p < 0.001). For all groups, the first 100 days had the greatest mortality rate, the most severe being among patients of age greater than 60 with >20% burn percent total body surface area and inhalation injury, with a 40% survival rate. Conclusions This study is the first to be able to simultaneously evaluate in-patient, post-discharge, and facility-based parameters for outcomes. A significant number of patients are not accounted with current databases. Applicability of Research to Practice A population-based approach with longitudinal tracking allows for greater realization of the outcomes of all patients following burn injury. Existing association-supported or government databases fail to account for a significant portion of burn victims, motivating further evaluation of burn care efforts.

57 Safety and Cost Effectiveness of Outpatient Surgery in Acute Burn Care

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S41-S41
Author(s):  
Zach Z Zhang ◽  
Andrew Golin ◽  
Anthony Papp
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Outpatient Surgery ◽  
Graft Loss ◽  
Total Body Surface Area ◽  
Split Thickness Skin Graft ◽  
Burn Care ◽  
Burn Surgery ◽  
Total Body

Abstract Introduction Outpatient burn surgery is increasingly utilized for delivery of acute burn care. Reports of its safety and efficacy are limited. The purpose of our study was to evaluate the safety and cost reduction associated with outpatient burn surgery and to describe our centre’s experience. Methods This was a single centre, retrospective cohort study of consecutive patients who underwent outpatient acute burn surgery requiring split thickness skin graft or dermal regenerative template from January 2010 - December 2018. Patients with insufficient follow up to evaluate operative site healing were excluded. Patient demographics, comorbidities, burn etiologies, operative data and postoperative care were reviewed. The primary outcome is complication involving major graft loss requiring reoperation. Results 165 patients and 173 procedures met the inclusion criteria. The average age was 44 years and 60.6% (100/165) were male. The number of annual outpatient procedures increased 48% from 23 to 34 cases over the 9-year period. The mean grafted total body surface area was 1.0 ± 0.9%. Rate of major graft loss requiring reoperation was 5.2% (9/172). Greater than 95% graft take was achieved in 80.9% of patients. Age, sex, co-morbidities, total body surface area, and procedure types were not significantly associated with postoperative complication rate. Outpatient burn surgery model was estimated to save CA$7,875 per patient from inpatient costs. This extrapolates to a total of over CA$1.36 million in savings over the 9-year study period. Conclusions Acute burn care at our centre is increasingly being delivered through an outpatient day surgery model. Our demonstration of its safety and considerable cost savings is compelling for further utilization. Our experience found the adoption of improved dressing care, appropriate patient selection, increased patient education, adequate pain control, and regimented outpatient multidisciplinary care to be fundamental for effective outpatient surgical burn care.

511 Point-of-care 3-dimensional Body Mapping for Determining Total Body Surface Area in Severely Burned Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S92-S93
Author(s):  
Julia Loegering ◽  
Kevin Webb ◽  
Jesse Ahlquist ◽  
Kevin Krause ◽  
Karen Xu ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Gold Standard ◽  
Burn Injury ◽  
Point Of Care ◽  
Total Body Surface Area ◽  
Body Mapping ◽  
Burn Care ◽  
Total Body

Abstract Introduction With severe burn injury, there is systemic fluid loss due to inflammatory responses in damaged tissue, leading to disruption of cellular processes. Patient fluid levels are restored with the calculation of total body surface area (TBSA). Clinically used TBSA equations are often outdated and inaccurate with error up to 20%, resulting in misinformed treatment and subsequent sequelae including prolonged hospital length of stay and increased mortality. Our objective, therefore, was to create a point-of-care (POC) system employing 3D imaging technology to accurately calculate TBSA for all patient population varieties. Methods Our team employed an iPad attachable, infrared scanner to create 3D models of the human body. From these models, TBSA can be extrapolated using scan processing software. Subject scans were collected on our device and on a gold standard scanner for comparison of TBSA output. Clinical testing on burn patients is occurring at present to establish scanning precision of TBSA in the burn care environment. Results Non-clinical verification tests of the 3D scanned TBSA revealed a 4.05% error when compared to the gold standard, and precision error of 3.8%. Additionally, we introduced the device into the burn unit for preliminary testing with a physician user and non-patient subjects. The subjects were scanned in a prone position to mimic burn care workflow. Clinician scanning error was 1.41% when compared to the gold standard scan of the same subject. Clinical precision study results are on-going in collection. Conclusions Our device introduces an improved method of TBSA estimation to assist clinicians in making accurate burn care decisions and further precision medicine with greater anthropomteric data, notably for children. This device is one of the first POC-3D scanning technologies to be used in a burn setting and may also be employed at outlying medical facilities. Destructive wildfires and combat burn injuries highlight the need for such a device to standardize the triage of burn victims with and away from experienced medical staff. Applicability of Research to Practice 3D body mapping points to an enhanced method of TBSA calculation and minimally disruptive to the burn workflow. Future developments of 3D scanning include deep learning algorithms to identify and better assess burned surface area. Additionally, further automation of TBSA scan processing to reduce user error in calculation and improve burn injury outcomes.

The Impact of No Next of Kin Decision Makers on End-of-Life Care

2020 ◽  
Author(s):  
Ryan K Ota ◽  
Maxwell B Johnson ◽  
Trevor A Pickering ◽  
Warren L Garner ◽  
T Justin Gillenwater ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Next Of Kin ◽  
Medical Decisions ◽  
Comfort Care ◽  
Burn Care ◽  
Total Body

Abstract For critically ill burn patients without a next of kin, the medical team is tasked with becoming the surrogate decision maker. This poses ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a next of kin affects treatment in burn patients. To evaluate this relationship, a retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care. Variables collected included age, gender, length of stay, total body surface area, course of treatment, and presence of a next of kin. In total, 67 patients met the inclusion criteria. Of these patients, 14 (21%) did not have a next of kin involved in medical decisions. Patients without a next of kin were significantly younger (P = .02), more likely to be homeless (P < .01), had higher total body surface area burns (P = .008), had shorter length of stay (P < .001), and were five times less likely to receive comfort care (P = .01). Differences in gender and ethnicity were not statistically significant. We report that patients without a next of kin present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care demonstrates a need for a cultural shift in burn care to prevent the suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present.

Safety and Cost Effectiveness of Outpatient Surgery in Acute Burn Care

2021 ◽  
Author(s):  
Zach Zhang ◽  
Andrew P Golin ◽  
Anthony Papp
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Outpatient Surgery ◽  
Graft Loss ◽  
Total Body Surface Area ◽  
Complication Rates ◽  
Burn Care ◽  
Burn Surgery ◽  
Total Body

Abstract Introduction Outpatient burn surgery is increasingly utilized in acute burn care. Reports of its safety and efficacy are limited. This study aims to evaluate the safety and cost reduction associated with outpatient burn surgery and to describe our centre’s experience. Methods This was a single centre, retrospective cohort study of consecutive patients who underwent outpatient burn surgery requiring split thickness skin graft or dermal regenerative template from January 2010 - December 2018. Patient demographics, comorbidities, burn etiologies, operative data and postoperative care were reviewed. The primary outcome is complications involving major graft loss requiring reoperation. Results One hundred and sixty-five patients and 173 procedures met the inclusion criteria. The average age was 44 years and 60.6% (100/165) were male. Annual outpatient procedure volume increased 48% from 23 to 34 cases over the 9-year period. The median (IQR) grafted percentage total body surface area was 1.0 (1.0)%. Rate of major graft loss requiring reoperation was 5.2% (9/172) and the most common site was the lower extremity (8/9, 88.9%). Age, sex, co-morbidities, total body surface area, and procedure types were not significantly associated with postoperative complication rates. The outpatient burn surgery model was estimated to save CA$8,170 per patient from inpatient costs. Conclusion Demonstration of the safety and cost savings associated with outpatient acute burn surgery is compelling for further utilization. Our experience found the adoption of improved dressing care, appropriate patient selection, increased patient education, adequate pain control, and regimented outpatient multidisciplinary care to be fundamental for effective outpatient surgical burn care.

Pediatric Treadmill Friction Burns to the Hand: Outcomes of an Initial Nonoperative Approach

2020 ◽  
Author(s):  
Nikita Batra ◽  
Yinan Zheng ◽  
Emily C Alberto ◽  
Omar Z Ahmed ◽  
Megan Cheng ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Cox Regression ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Cox Regression Analysis ◽  
Treatment Type ◽  
Total Body ◽  
Hand Burns

Abstract Treadmill burns that occur from friction mechanism are a common cause of hand burns in children. These burns are deeper and more likely to require surgical intervention compared to hand burns from other mechanisms. The purpose of this study was to identify the factors associated with healing time using an initial nonoperative approach. A retrospective chart review was performed examining children (<15 years) who were treated for treadmill burns to the hand between 2012 and 2019. Patient age, burn depth, total body surface area of the hand injury, and time to healing were recorded. Topical wound management strategies (silver sheet, silver cream, non-silver sheet, and non-silver cream) and associated treatment durations were determined. For patients with burns to bilateral hands, the features, treatment, and outcomes of each hand were assessed separately. Cox regression analysis was used to evaluate the association between time to healing and patient characteristics and treatment type. Seventy-seven patients with 86 hand burns (median age 3 years, range 1–11) had a median total body surface area per hand burn of 0.8% (range 0.1–1.5%). Full-thickness burns (n = 47, 54.7%) were associated with longer time to healing compared to partial-thickness burns (HR 0.28, CI 0.15–0.54, P < .001). Silver sheet treatment was also associated with more rapid time to healing compared to treatment with a silver cream (HR 2.64, CI 1.01–6.89, P = .047). Most pediatric treadmill burns can be managed successfully with a nonoperative approach. More research is needed to confirm the superiority of treatment with silver sheets compared to treatment with silver creams.

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