594 Racial and Ethnic Disparities in Burn Patient Outcomes: A Review of the Literature

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S148-S149
Author(s):  
Jasmine N Peters ◽  
Mariel S Bello ◽  
Leigh J Spera ◽  
Justin Gillenwater ◽  
Haig A Yenikomshian
Keyword(s):  
Risk Factors ◽  
Native American ◽  
Burn Injury ◽  
Ethnic Disparities ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Burn Care ◽  
Race Ethnicity ◽  
Injury Outcomes ◽  
Racial And Ethnic Minority

Abstract Introduction Racial and ethnic disparities in outcomes for surgical trauma populations has been an expanding field in recent years. Despite this, disparities in prevention, treatment, and recovery outcomes for burn patients of racial and ethnic minority backgrounds have not been well-studied. Our study aims to review the literature regarding risk factors and burn outcomes among racial and ethnic minority populations to develop culturally-tailored burn care for minority burn patients. Methods A systematic review of literature utilizing PubMed was conducted for articles published between 2000–2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Asian OR Hispanic OR Latino OR Native American OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the U.S. that discussed disparities in burn injury outcomes or burn injury risk factors associated with race/ethnicity. Results 1,031 papers were populated, and 38 articles were reviewed. 26 met inclusion criteria (17 for adult patients, 9 for pediatric patients). All but 4 of the included papers were written in the last 10 years. 17 of the 26 articles describe differences in outcomes or risk factors for Black Americans, 8 discuss Latinx, 5 discuss Native Americans, 3 discuss Asian Americans, and 1 referred to “Non-White” minorities, collectively. Majority of studies showed that racial and ethnic minorities (vs. Whites) exhibited poorer burn injury outcomes such as higher mortality rates, greater scar complications, and longer duration for length of stay. Conclusions Few studies exist on outcomes for minority burn populations. Interestingly, most have been published in the last 10 years, which may indicate a trend in increased awareness. There is also a discrepancy in which minorities are included in each study with the least amount of data collected on Asian, Latinx, and Native American communities. More research with a larger base of minority populations will help further investigate this problem and develop better culturally-appropriate burn treatment.

The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature

2021 ◽  
Author(s):  
Jasmine Peters ◽  
Mariel S Bello ◽  
Leigh Spera ◽  
T Justin Gillenwater ◽  
Haig A Yenikomshian
Keyword(s):  
Systematic Review ◽  
Native American ◽  
The United States ◽  
Current Status ◽  
Surgical Trauma ◽  
Insurance Status ◽  
Inclusion Criteria ◽  
Burn Care ◽  
Race Ethnicity ◽  
The Impact

Abstract Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000-2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the US that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. 1,169 papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally-tailored medical care and address the needs of disadvantaged burn survivors.

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.

104 Comorbidity Does Not Predict Outcomes After Burn Injury in the Elderly

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S68-S68
Author(s):  
Isabel Bernal ◽  
Rosemary Paine ◽  
Damien W Carter ◽  
Carolyne Falank
Keyword(s):  
Elderly Patients ◽  
Wound Infection ◽  
Burn Injury ◽  
Pearson Correlation ◽  
Graft Loss ◽  
Kidney Injury ◽  
The Elderly ◽  
Burn Patients ◽  
Discharge Disposition ◽  
Burn Care

Abstract Introduction As the population ages; burn centers, especially those with a large rural catchment, will be expected to care for older adults with complex medical co-morbidities. Recent work has shown that %TBSA at which 50% of patients would be expected to die (LD50) for elderly patients is up to 20% lower than non-elderly patients. However, the factors contributing to mortality are unclear. We undertook this study to characterize our experience with elderly burn patients in our rural state and to understand how mortality is affected by comorbid disease. Methods We performed a retrospective review of all burn patients ≥50 years old admitted to our burn center over a 5 year period between January 2014 and December 2018. We collected demographic and injury data including %TBSA, mechanism, inhalation injury status, discharge disposition, length of stay as well as complications including pneumonia, kidney injury, wound infection and graft loss. We calculated the modified Baux score, Charlson Comorbidity Index (CCI) and overall mortality for each patient. The %TBSA and CCI were correlated with complications and mortality using the Pearson correlation coefficient analysis. Results There were 243 patients (35%) who met inclusion criteria out of total of 688 burn admissions during that period. The median age was 60 years (mean 62.2, range: 50–95) and 72.4% were male. The median TBSA was 4% (mean: 8.2%, range: 0.5% - 55%). We found weak correlations between CCI and both pneumonia (R=0.177, p=0.005) and mortality (R=0.1297, p=0.0434). There was also a weak correlation between %TBSA and pneumonia (R=0.3302, p < 0.001), kidney injury (R=0.205, p=0.001), wound infection (R=0.1295, p=0.045) and graft loss (R=0.2616, p< 0.001). Interestingly, in the subgroup with > 15% TBSA burns (n=35), there was no significant correlation with increased complications. For the entire cohort, the predicted mortality based on the mean modified Baux score was 16%. The actual observed mortality was 4.1%. Conclusions Our findings suggest that, in our center, CCI is not predictive of burn related complications or mortality and %TBSA is not predictive of complications or death. The observed to expected mortality ratio was remarkably low. Applicability of Research to Practice As we treat older burn patients, it is important to identify the individual patient factors and hospital specific burn care factors that may improve outcomes in the elderly population.

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

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S4-S5
Author(s):  
Ryan K Ota ◽  
Maxwell B Johnson ◽  
Trevor A Pickering ◽  
Warren L Garner ◽  
Justin Gillenwater ◽  
...  
Keyword(s):  
Critically Ill ◽  
Decision Maker ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Next Of Kin ◽  
Medical Decisions ◽  
Comfort Care ◽  
Burn Care ◽  
The Impact

Abstract Introduction For critically ill burn patients without a next of kin (NOK), the medical team is tasked with becoming the surrogate decision maker. This poses difficult ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a NOK affects treatment in burn patients. This study is the first to evaluate this relationship. Methods A retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care from a single burn center from 2015 to 2019. Inclusion criteria were age ≥18 years and mortality within 4-weeks of admission. Exclusion criteria were death from dermatologic disease or trauma. Variables collected included age, gender, mechanism of injury, length of stay (LOS), total body surface area (TBSA), revised Baux score, and the presence of a NOK. Fisher’s Exact Test and Student’s t-test were used for analysis. Results In total, 67 patients met inclusion criteria. Of these patients, 14 (21%) did not have a NOK involved in medical decisions. Table 1 shows the means and odds ratio between the two groups. Patients without a NOK were younger (p < 0.05), more likely to be homeless (p < 0.01), had higher TBSA (p < 0.01), had shorter LOS (p < 0.01), and were 5 times less likely to receive comfort care (p < 0.05). Gender and ethnicity were not statistically significant. Conclusions Patients without a NOK 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 between the two groups demonstrates a need for a cultural shift in burn care to prevent suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present. Applicability of Research to Practice We report that the absence of a NOK has a significant impact leading to a decreased initiation of comfort care in critically ill burn patients. National protocols should be created to allow burn providers to act as a surrogate to prevent prolonged suffering.

scholarly journals County‐Level Factors Associated With Cardiovascular Mortality by Race/Ethnicity

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Bongeka Z. Zuma ◽  
Justin T. Parizo ◽  
Areli Valencia ◽  
Gabriela Spencer‐Bonilla ◽  
Manuel R. Blum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Healthcare Access ◽  
Ethnic Disparities ◽  
County Level ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Hispanic White ◽  
Cvd Mortality

Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity‐specific CVD mortality and county‐level factors. Methods and Results Using 2017 county‐level data, we studied the association between race/ethnicity‐specific CVD age‐adjusted mortality rate (AAMR) and county‐level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; R 2 values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non‐Hispanic White, non‐Hispanic Black, and Hispanic/Latinx individuals). There were 659 740 CVD deaths among non‐Hispanic White individuals in 2698 counties; 100 475 deaths among non‐Hispanic Black individuals in 717 counties; and 49 493 deaths among Hispanic/Latinx individuals across 267 counties. Non‐Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100 000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100 000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation ( R 2 ) in CVD AAMR was explained by physical inactivity for non‐Hispanic White individuals (32.3%), median household income for non‐Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county‐level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non‐Hispanic White individuals (35.3%), socioeconomic factors for non‐Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity‐specific age‐adjusted CVD mortality and county‐level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.

scholarly journals A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

2021 ◽  
Vol 2 (4) ◽  
pp. 293-300
Author(s):  
Stephen Frost ◽  
Liz Davies ◽  
Claire Porter ◽  
Avinash Deodhar ◽  
Reena Agarwal
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Burn Injury ◽  
Burn Injuries ◽  
Burn Patients ◽  
Review Of The Literature ◽  
Respiratory Compromise ◽  
Burn Care ◽  
Membrane Oxygenation ◽  
Regular Time ◽  
Major Burn

Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.

scholarly journals Myelo-erythroid commitment after burn injury is under β-adrenergic control via MafB regulation

2017 ◽  
Vol 312 (3) ◽  
pp. C286-C301 ◽  
Author(s):  
Shirin Hasan ◽  
Nicholas B. Johnson ◽  
Michael J. Mosier ◽  
Ravi Shankar ◽  
Peggie Conrad ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Molecular Mechanisms ◽  
Burn Injury ◽  
Ex Vivo ◽  
Limiting Factor ◽  
Burn Patients ◽  
Adrenergic Stimulation ◽  
Peripheral Blood Mononuclear ◽  
Burn Care ◽  
Multipotent Progenitors

Severely injured burn patients receive multiple blood transfusions for anemia of critical illness despite the adverse consequences. One limiting factor to consider alternate treatment strategies is the lack of a reliable test platform to study molecular mechanisms of impaired erythropoiesis. This study illustrates how conditions resulting in a high catecholamine microenvironment such as burns can instigate myelo-erythroid reprioritization influenced by β-adrenergic stimulation leading to anemia. In a mouse model of scald burn injury, we observed, along with a threefold increase in bone marrow LSK cells (linnegSca1+cKit+), that the myeloid shift is accompanied with a significant reduction in megakaryocyte erythrocyte progenitors (MEPs). β-Blocker administration (propranolol) for 6 days after burn, not only reduced the number of LSKs and MafB+cells in multipotent progenitors, but also influenced myelo-erythroid bifurcation by increasing the MEPs and reducing the granulocyte monocyte progenitors in the bone marrow of burn mice. Furthermore, similar results were observed in burn patients’ peripheral blood mononuclear cell-derived ex vivo culture system, demonstrating that commitment stage of erythropoiesis is impaired in burn patients and intervention with propranolol (nonselective β1,2-adrenergic blocker) increases MEPs. Also, MafB+cells that were significantly increased following standard burn care could be mitigated when propranolol was administered to burn patients, establishing the mechanistic regulation of erythroid commitment by myeloid regulatory transcription factor MafB. Overall, results demonstrate that β-adrenergic blockers following burn injury can redirect the hematopoietic commitment toward erythroid lineage by lowering MafB expression in multipotent progenitors and be of potential therapeutic value to increase erythropoietin responsiveness in burn patients.

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 Guidelines for burn rehabilitation in China

2015 ◽  
Vol 3 ◽  
pp. 1-10 ◽  
Author(s):  
◽  
Ying Cen ◽  
Jiake Chai ◽  
Huade Chen ◽  
Jian Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Burn Injury ◽  
Medical Science ◽  
Current Medical ◽  
Team Work ◽  
Burn Patients ◽  
Burn Treatment ◽  
Burn Care ◽  
Chinese Association

Abstract Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.

Abstract P152: Do Self-reported Race, Socioeconomic Status And Genetic Ancestry Influence Fasting Glucose? Preliminary Results From the Ongoing Bach Prediabetes Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
James B Meigs ◽  
Gavin Miyasoto ◽  
Bianca Porneala ◽  
Lisa Marceau ◽  
John B McKinlay
Keyword(s):  
Socioeconomic Status ◽  
Native American ◽  
Fasting Glucose ◽  
African Ancestry ◽  
Ethnic Disparities ◽  
Community Dwelling ◽  
Genetic Ancestry ◽  
European Ancestry ◽  
Epidemiologic Survey ◽  
Race Ethnicity

Background: Race/ethnic disparities in type 2 diabetes (T2D) may have both biophysical and social determinants that likely arise before T2D diagnosis. We examined the association of self-reported (SR) race/ethnicity, socioeconomic status (SES) and genetic ancestry with levels of fasting glucose (FG) in individuals not known to have T2D. Methods: The Boston Area Community Health (BACH) Prediabetes study is an ongoing epidemiologic survey of community-dwelling residents of inner-city Boston. A stratified random sample of 3,300 subjects are being drawn from the parent BACH cohort study, recruiting approximately equal numbers in pre-specified age (30–79 years), sex and race/ethnicity groups. Fasting blood is collected, including FG, other health and SES information, during an early AM in-home interview. SES is measured as a standardized composite score of income and education. Genetic ancestry informative markers (AIMs, n=63) that discriminate European, African and Native American continental ancestry are currently available on a random subset. We compared FG levels across groups using ANOVA, testing independent associations of SR race/ethnicity SES using multiple linear regression with significant P=< 0.05. Results: Of 2,933 participants recruited, 63% were women and 70% were older than 50 years. Black, Hispanic and white SR race/ethnicity comprised 32%, 33% and 35% of the sample, respectively. The majority had low SES (57%), 35% had moderate SES and 8% had high SES. FG varied significantly by SR race/ethnicity (mean±SD, mg/dL): 113±37 for white, 119±46 for Hispanic and 121±49 for black subjects (P<0.001). FG was inversely associated with SES (low 122±49, medium 113±39, high 106±23, P<0.001). In joint SR race/ethnicity and SES models adjusting for age and sex, both main effects were attenuated but remained associated with FG (SR race/ethnicity P=0.01; SES P<0.001). For the subsample with AIMs data (n=373), predominant AIMs ancestry, defined as the ancestry most likely as predicted by AIMs, was closely linked to SR race/ethnicity. European ancestry was predominant in 100% of 110 SR white respondents, while African ancestry was predominant in 95% of 129 SR black respondents. In 134 SR Hispanics, 43% were predominantly European, 41% African and 16% Native American. FG varied with predominant AIMs ancestry (European 115±45 mg/dL, African 121±53 and Native American 127±67), although not significantly so (P=0.33), likely due to the limited sample size. Conclusions: Both self-reported race/ethnicity and SES are associated with FG in community-based individuals without known T2D, and they share explanatory information reflecting a common effect. A larger sample with AIMs will help disentangle the degree to which FG variation is socially patterned in the community versus a biophysical phenomenon determined in part by genetic ancestry.

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