579 Benefits of Licensed Clinical Social Worker Utilization in an Adult Burn Clinic: More Than Just Checking the Box

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Michelle Broers ◽  
Jodi Wojcik ◽  
Lindsey k Journey
Keyword(s):  
Peer Support ◽  
Social Worker ◽  
Suicide Risk ◽  
Acute Stress ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Community Resources ◽  
Clinical Social Worker ◽  
Burn Patients ◽  
One Year

Abstract Introduction Our burn institution cares for critically ill burn patients and provides post-acute care for a large referral base. The clinic is staffed by a wound certified physical therapist, an advanced practice registered nurse and a licensed clinical social worker (LCSW), with consult access to Trauma/Burn Surgeons. The incidence of acute stress symptoms after burn injury is noted in up to 35% to 40% of patients. Therefore, it is important to identify symptoms of anxiety and depression early and begin symptom management. Burn patients have access to a multi-disciplinary team, and a licensed therapist, that can identify symptoms of acute stress and make recommendations for appropriate treatment in concert with the medical staff. This project seeks to determine the prevalence of acute stress in post-acute burn patients seen in an adult burn clinic and the benefits of utilizing a Licensed Clinical Social Worker to perform screening. Methods For a one-year period all burn patients in the burn clinic were screened by the LCSW. The subjects underwent initial screenings for depression, anxiety, and suicide risk at their first clinic visit. The PHQ-2 and PHQ-9 were utilized to assess depression, the GAD-7 for anxiety and the Columbia Suicide scale to assess suicide risk. Patients were initiated into multi-modal therapies based on specific scoring. These intervention strategies were based on the Depression Screening Protocol which included education on depression, and/or anxiety, with or without participation in a Trauma/Burn Peer Support Group. Patients were prescribed medication per provider discretion, and/or connected to community resources such as, counseling, and psychiatric mental health services. Results During the one-year assessment period screening compliance was >90%. During this period, >50% of patient’s scores were clinically significant for acute stress. Over half of those that screened positive were connected to community resources of counseling services or psychiatric care. 100% of those that screened positive were given education and connection to peer support services. An incidental correlation was noted between increased total body surface area involvement and work-related accidents with increased symptomology. Conclusions The inclusion of an LCSW in the burn clinic has improved the overall care of the burn injured patient. The assessment of depression and anxiety related to the burn injury has led to an increase in peer support participation and an increase in referrals to counseling and/or psychiatric services.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

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).

664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S177-S177
Author(s):  
Kate Pape ◽  
Sarah Zavala ◽  
Rita Gayed ◽  
Melissa Reger ◽  
Kendrea Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Future Research ◽  
Burn Patients ◽  
Thermal Burn ◽  
Increased Risk ◽  
Significant Difference

Abstract Introduction Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy. Methods This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST. Results A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality. Conclusions Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis. Applicability of Research to Practice Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.

scholarly journals A prospective observation on nutrition support in adult patients with severe burns

2019 ◽  
Vol 121 (09) ◽  
pp. 974-981 ◽  
Author(s):  
Fengmei Guo ◽  
Hua Zhou ◽  
Jian Wu ◽  
Yingzi Huang ◽  
Guozhong Lv ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Burn Injury ◽  
Early Stage ◽  
Energy Requirement ◽  
Total Body Surface Area ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Burn Patients ◽  
Severe Burn ◽  
Severe Burns

AbstractNutrition therapy is considered an important treatment of burn patients. The aim of the study was to delineate the nutritional support in severe burn patients and to investigate association between nutritional practice and clinical outcomes. Severe burn patients were enrolled (n 100). In 90 % of the cases, the burn injury covered above 70 % of the total body surface area. Mean interval from injury to nutrition start was 2·4 (sd 1·1) d. Sixty-seven patients were initiated with enteral nutrition (EN) with a median time of 1 d from injury to first feed. Twenty-two patients began with parenteral nutrition (PN). During the study, thirty-two patients developed EN intolerance. Patients received an average of about 70 % of prescribed energy and protein. Patients with EN providing <30 % energy had significantly higher 28- d and in-hospital mortality than patients with EN providing more than 30 % of energy. Mortality at 28 d was 11 % and in-hospital mortality was 45 %. Multiple regression analysis demonstrated that EN providing <30 % energy and septic shock were independent risk factors for 28- d prognosis. EN could be initiated early in severe burn patients. Majority patients needed PN supplementation for energy requirement and EN feeding intolerance. Post-pyloric feeding is more efficient than gastric feeding in EN tolerance and energy supplement. It is difficult for severe burn patients to obtain enough feeding, especially in the early stage of the disease. More than 2 weeks of underfeeding is harmful to recovery.

Is the Use of Routine Echocardiogram Warranted in Large Pediatric Burns?

2021 ◽  
Author(s):  
I Wilmot ◽  
P H Chang ◽  
L Fowler ◽  
P Warner
Keyword(s):  
Left Ventricular Dysfunction ◽  
Cardiac Dysfunction ◽  
Ventricular Dysfunction ◽  
Burn Injury ◽  
Early Recognition ◽  
Total Body Surface Area ◽  
Left Ventricular ◽  
Burn Patients ◽  
Severe Left Ventricular Dysfunction ◽  
Pediatric Burns

Abstract Introduction Cardiac dysfunction can develop in large pediatric burns during the acute and recovery phase. When occurring in this population, the cardiac abnormality appears as left ventricular dysfunction or dilated cardiomyopathy. Recent studies have demonstrated perioperative and long-term cardiac dysfunction resulting in longer hospital stays for patients over 40% total body surface area. The objective of this study was to assess if early use of echocardiograms in large burns would allow for early recognition of patients at risk for cardiac dysfunction. Material and Methods Pediatric burn patients ages 0-18 years who sustained a burn injury of 30% TBSA or more or developed cardiac dysfunction during hospital course were evaluated. Echocardiograms were obtained upon admission with monthly repeats until three normal studies were attained or the patient was discharged and when symptomatic. Results Of the 130 acute burn patients admitted during 7/2017-10/2018, 10 patients met criteria for enrollment in this study. The average age was 5 years (0.8 to 10 yrs), 70% were males and 90% sustained flame injuries.Total TBSA average was 45% (24-70%) with average full thickness burns of 33% (0-67%). Twenty echocardiogram studies were obtained. One patient with 25% TBSA burn, demonstrated severe left ventricular dysfunction with an EF of 25% from post arrest myocardial stunning. Repeat echocardiogram studies demonstrated full recovery with normal EF. The remaining patients, despite large TBSA injuries, did not exhibit any abnormalities on ECHO examinations. No cardiac interventions were required. Conclusions Use of echocardiograms is best performed on symptomatic burn patient populations.

scholarly journals Burn Patients at Western Regional Hospital of Nepal: An Epidemiological Study

2020 ◽  
Vol 3 (1) ◽  
pp. 225-228
Author(s):  
Amar Gurung ◽  
Dilip Baral ◽  
Narendra Vikram Gurung ◽  
Arjun Acharya ◽  
Suresh Raj Poudel ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Epidemiological Study ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Total Duration ◽  
Morbidity And Mortality ◽  
High Rate ◽  
Burn Patients ◽  
Prolonged Hospital ◽  
Epidemiological Characteristics

Background: Burn injury is one of the major causes of morbidity and mortality in our country. Study of epidemiological characteristics of burn injury helps in planning of the prevention and upgradation of its treatment facility. Material and Methods: This is a hospital based retrospective epidemiological study of the burn patients admitted in our center from September 2018 to April 2019. Results: In total 52 patients were included in this study. There was a slight preponderance of female patients over male patients. Mean age of the patients was 34.77± 29.16 years. Eighty percentage of burn injury occurred inside house. Majority of burn cases were scald burn followed by flame burn. Percentage total body surface area involved in burn had a mean of 14.183 ± 8.224. Lower extremity was the most commonly involved area. Total duration of hospital stay was 18.21 ± 13.656 days. Out of total patients only four patients needed admission in Intensive Care Unit (ICU). Regarding outcome, 88.5% patients survived while 9.6% patients died and 1.9% patient went on discharge on request. Conclusion: Burn injury is a preventable condition with high rate of morbidity and mortality. Burn patients have prolonged hospital stay as recovery is slow. Awareness programs for prevention of burn injury are needed to decrease the incidence of the burn injury.

scholarly journals Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

2017 ◽  
Vol 38 (12) ◽  
pp. 1441-1448 ◽  
Author(s):  
Paula D. Strassle ◽  
Felicia N. Williams ◽  
David J. Weber ◽  
Emily E. Sickbert-Bennett ◽  
Anne M. Lachiewicz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Burn Injury ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Cox Proportional Hazards ◽  
Future Research ◽  
Healthcare Associated Infections ◽  
Burn Patients ◽  
Inhalational Injury ◽  
Healthcare Associated

OBJECTIVEBurn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.DESIGNRetrospective cohort study.SETTINGTertiary-care burn center.PATIENTSAdults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.METHODSHAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.RESULTSOverall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.CONCLUSIONSLarger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.Infect Control Hosp Epidemiol 2017;38:1441–1448

scholarly journals Sodium variability is associated with increased mortality in severe burn injury

2017 ◽  
Vol 5 ◽  
Author(s):  
Soman Sen ◽  
Nam Tran ◽  
Brian Chan ◽  
Tina L. Palmieri ◽  
David G. Greenhalgh ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Multivariate Logistic Regression Analysis ◽  
Median Number ◽  
High Plasma ◽  
Plasma Sodium ◽  
Burn Patients ◽  
Severe Burn ◽  
Severe Burn Injury

Abstract Background Dysnatremias are associated with increased mortality in critically ill patients. Hypernatremia in burn patients is also associated with poor survival. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients. Methods We performed a retrospective review of adult burn patients with a burn injury of 15% total body surface area (TBSA) or greater from 2010 to 2014. All patients included in the study had at least three serum sodium levels checked during admission. We used multivariate logistic regression analysis to determine if hypernatremia, hyponatremia, or sodium variability independently increased the odds ratio (OR) for death. Results Two hundred twelve patients met entry criteria. Mean age and %TBSA for the study was 45 ± 18 years and 32 ± 19%. Twenty-nine patients died for a mortality rate of 14%. Serum sodium was measured 10,310 times overall. The median number of serum sodium measurements per patient was 22. Non-survivors were older (59 ± 19 vs. 42 ± 16 years) and suffered from a more severe burn injury (50 ± 25% vs. 29 ± 16%TBSA). While mean sodium was significantly higher for non-survivors (138 ± 3 milliequivalents/liter (meq/l)) than for survivors (135 ± 2 meq/l), mean sodium levels remained within the laboratory reference range (135 to 145 meq/l) for both groups. Non-survivors had a significantly higher median number of hypernatremic (&gt; 145 meq/l) measurements (2 vs. 0). Coefficient of variation (CV) was significantly higher in non-survivors (2.85 ± 1.1) than survivors (2.0 ± 0.7). Adjusting for TBSA, age, ventilator days, and intensive care unit (ICU) stay, a higher CV of sodium measurements was associated with mortality (OR 5.8 (95% confidence interval (CI) 1.5 to 22)). Additionally, large variation in sodium ranges in the first 10 days of admission may be associated with increased mortality (OR 1.35 (95% CI 1.06 to1.7)). Conclusions Increased variability in plasma sodium may be associated with death in severely burned patients.

628 Venous Thromboembolism Prophylaxis in Burn Patients: Analyzing the Effectiveness of a Standardized Protocol

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S169-S170
Author(s):  
Sarah A Folliard ◽  
Jared L Gabbert ◽  
Kelli Rumbaugh ◽  
Callie M Thompson ◽  
Cathy Oleis
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Thromboembolism Prophylaxis ◽  
Surgical Interventions ◽  
Vte Prophylaxis ◽  
Improve Compliance

Abstract Introduction Burn patients have a high risk of developing venous thromboembolism (VTE) due to extensive immobilization, surgical interventions, endothelial injury, and the presence of polytrauma. Studies have shown VTE rates ranging from 0.25% to 23.3% in this patient population. Although burn patients have a greater risk for VTE compared to other hospitalized patients, there are no standardized guidelines on how to approach VTE prophylaxis in the burn population. In March 2018, the Burn Intensive Care Unit (BICU) implemented a new VTE prophylaxis protocol that stratified patients based on risk factors for VTE. Patients were started on enoxaparin 30mg every 12 hours or 40mg every 12 hours depending on body mass index (BMI). The purpose of this study was to examine compliance with the new protocol and overall rates of VTE in the burn population. Methods A single-center, retrospective analysis was conducted from March 1, 2018 to July 31, 2018. Patients included were admitted to the BICU with a documented burn injury for at least 48 hours and were ≥ 18 years of age. The primary outcome was compliance with the VTE prophylaxis protocol. Secondary outcomes included reasons for non-compliance and incidence of VTE events. Results Out of 105 patients that met inclusion criteria (median age, 53 years [36 to 63]; BMI 27.1 kg/m2 [25.7 to 33.2]; total body surface area 6% [3% to 18%]), the protocol was correctly utilized in 81 patients (77%). The most common reason for non-compliance to the protocol was incorrect dosing (60.9% [14/105]). Of 105 patients, 1 (0.9%) developed a VTE. Conclusions Overall, the compliance to the Burn Intensive Care Unit VTE pharmacologic prophylaxis protocol has room for improvement. Despite following the protocol, one VTE event occurred during the five-month study period. To improve compliance, additional education and training regarding the dosing of and monitoring anti-coagulants was provided to nursing and medical staff.

scholarly journals Soluble CD163: A novel biomarker for the susceptibility to sepsis in severe burn injuries

2011 ◽  
Vol 44 (01) ◽  
pp. 118-124
Author(s):  
Andrzej Piatkowski ◽  
Gerrit Grieb ◽  
Rittuparna Das ◽  
Ahmet Bozkurt ◽  
Dietmar Ulrich ◽  
...  
Keyword(s):  
Time Course ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Serum Levels ◽  
Burn Injuries ◽  
Burn Patients ◽  
Serum Samples ◽  
Soluble Cd163 ◽  
Bivariate Correlation ◽  
Total Body

ABSTRACT Objective: Soluble CD163 (sCD163) has been previously shown to play a role in inflammatory and infectious diseases. This study, for the first time, investigates the characteristics and potential values of sCD163 in burn patients. A first look is taken on the changes of sCD163 levels in burn patients by comparing predefined subgroups at single time points. Materials and Methods: Serum samples of 18 patients with burn injuries were collected for biochemical analysis at the time of admission and in a chronological sequence of 12, 24, 48 and 120 h after the injury and were matched to clinical parameters. Statistical analysis was performed using the Mann-Whitney test, Wilcoxon signed rank and Pearson bivariate correlation. Results: Patients with sepsis showed a significant increase of sCD163 levels. sCD163 was correlated with leukocytes (P=0.035) over the time course of 120 h. Patients characterized by a burn size exceeding 25% of the total body surface area (TBSA) showed a significant increase of sCD163 between 12 and 48 h after burn injury (P=0.038). Conclusions: The first view on the characteristics of sCD163 in the serum of burn patients points out that sCD163 seems to be an early indicator for the susceptibility to sepsis. Furthermore, the changes in sCD163 serum levels within the first hours after burn trauma have great potential for early prediction of organ failure after burn injury.

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