scholarly journals 625 The Impact of COVID-19 on Burn Care at a Regional Burn Center

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S168-S168
Author(s):  
Alan D Rogers ◽  
Plast Surg
Keyword(s):  
Operating Time ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Nurse Specialist ◽  
Female Ratio ◽  
Burn Care ◽  
Burn Center ◽  
The Mean ◽  
The Impact ◽  
Clinic Visits

Abstract Introduction The COVID-19 pandemic has had a profound global impact, not least on hospital functioning. Institutions have all had to prepare and adapt to a large number of admissions, and the influence on elective and emergency surgical services, including burn care, has been significant; it may be some time before we know the full extent of this. While many centers were able to commence more normal activities for a while, we are now seeing an exponential rise in cases again, with potentially catastrophic consequences for the provision of burn care. Methods A review of all admissions, operative cases and clinic visits between 1 April and 31 August 2020 was undertaken at an American Burn Association verified burn center. These data were compared with the same five-month period in the preceding two years. Results Selected data highlights are tabulated (Table 1). During the five months in question, fewer patients were admitted than the previous two years (N=81 versus 121). The mean total body surface area was slightly higher this year (13.7%), and the mean length of hospital stay longer (18 days). The male-to-female ratio of admitted patients was greater during the five months of 2020, at 2.9:1, compared to 1.7:1. No significant differences in terms of etiology were detected, however. As expected, clinic visits reduced dramatically from a mean of 160 patient visits per month to just 81 per month, with the majority conducted virtually. During 2020 the operative cases were similar in number to previous years (N=176), but the mean duration was significantly longer (190 minutes). The total time utilised for burn surgery was similar to previous years (572 hours). Table 1. Selected burn center data comparing 2020 with 2019 and 2018. Conclusions This study demonstrates that although total admissions were slightly reduced, the demands on Burn ICU bed resources and burn operating time were similar. The data supports the notion that removing scheduled operating time for our service resulted in less efficient execution of acute burn surgeries and longer hospital stays. Although formal clinic visits were significantly reduced and were mainly conducted virtually, several patients were satisfied by a novel and user-friendly email service conducted by our clinic nurse specialist.

scholarly journals Impact of COVID-19 Infection Among Myasthenia Gravis Patients- a Cerner Real-world DataTM Study 

2021 ◽  
Author(s):  
Lakshmi Digala ◽  
Shivika Prasanna ◽  
Praveen Rao ◽  
Adnan Qureshi ◽  
Raghav Govindarajan
Keyword(s):  
Myasthenia Gravis ◽  
Real World ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Snomed Ct ◽  
Real World Data ◽  
Data Set ◽  
Female Ratio ◽  
The Mean ◽  
The Impact

Abstract Background: Myasthenia gravis (MG) is an auto-immune disease, and the mainstay of therapy is immunomodulation. Such patients are at high risk of acquiring any infections. Hence, we sought to determine the impact of the current global pandemic COVID-19 infection in MG patients.Methods: For our study, we used Cerner Real-World DataTM that was provided through Cerner’s HealtheDataLab research tool. We ran a database query from January 2019 to July 2020 in our study. To extract these patients’ data, we used ICD 9-CM, ICD-10, and SNOMED-CT codes. We report data using means, range, and prevalence rates. The p-values were calculated using the two-sample t-test and Pearson’s chi-squared test. Results:In the COVID-19 data set, a total of twenty-seven myasthenia patients were identified with a positive COVID-19 infection, and four diagnosed with an exacerbation. Male to female ratio was equal and one unknown gender (3.7%) with a mean (± SD) age of 64.33 ± 18.42 years. This study group was compared with a non-COVID-19 data set in which a total of sixty-four myasthenia patients were identified, and twenty-three had an exacerbation. Among the hospitalized patients in the two groups, the mean length of hospitalization for all the myasthenia patients in the COVID-19 data set was 8.28 days (n=7), and the non-COVID-19 set was 4.33 days (n=6), and it was statistically significant (p-value= 0.007). Conclusion: The mean length of hospital stay is prolonged in Myasthenia patients who tested positive for COVID-19.

scholarly journals 81 The Impact of COVID-19 on a Major Metropolitan Burn Center

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S56-S56
Author(s):  
Jesse A Codner ◽  
Rohit Mittal ◽  
Rafael De Ayala
Keyword(s):  
Medical Record ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Lag Time ◽  
Categorical Variables ◽  
Burn Care ◽  
Burn Center ◽  
Global Pandemic ◽  
Chi Square Analysis ◽  
The Impact

Abstract Introduction The current and long-term impact of the coronavirus disease 2019 (COVID-19) global pandemic on our healthcare system is still unknown. When healthcare resources were being diverted to only the most critical of needs, emergent surgical and burn care remained essential. Currently, no data exist on the impact of a global pandemic on a burn center. Our aim for this study was to understand how the COVID-19 pandemic affected admissions, hospital course, and discharges at a major metropolitan burn center. Methods This was a retrospective cohort study of admissions to our burn center. Our institution’s medical record was reviewed from 1/1–8/31 for years 2020, 2019, & 2018. We included all thermal, chemical, and electrical burn inpatient admissions over these time periods. Non-burn wound admissions and vulnerable patient populations were excluded. Our population included 1,358 patients. These patients were grouped by year 2020 (n=425), 2019 (n=470), and 2018 (n=463). The medical record was queried for admission, hospital course, and discharge variables. SAS 9.4 statistical software was used to compare the pre-pandemic 2018/2019 groups against the 2020 group. Group means were compared using two-sample two-tailed t-tests, and categorical variables were compared using Chi-Square analysis. Results In 2020 the burn center had 425 admissions compared to 470 and 463 in 2019 and 2018 respectively. On admission, there were no differences in age, gender, pediatric admissions, burn etiology, total body surface area (TBSA), TBSA >20%, work-related injuries, or suspected abuse related injuries. Of note, the mean days from injury to admission for the groups were (2020 2.5±4.9 vs 2019 1.4±4.3, p=0.001, vs 2018 1.5±4.3, p=0.0017). Groups were similar in respect to burns requiring surgery and mean OR visits. 2019 and 2018 had increased ICU admissions compared to the 2020 cohort (ICU: 2020 60-(14%) vs 2019 91-(19.4%), p=0.041, vs 2018 108-(23.3%), p=0.033). Inpatient mortality was lower in the 2020 cohort compared to the pre-pandemic cohorts (2020 2 (0.6%) vs 2019 9 (2.5%), p=0.04, vs 2018 14 (4.2%) p=0.0017). Conclusions Volume at our burn center remains high during the pandemic. There is an increased lag time from burn injury to hospital admission in the 2020 cohort. We hypothesize this is due to patients’ avoiding the hospital due to fear of contracting COVID-19. TBSA is similar across groups, but ICU admissions are down in the 2020 cohort. Further work is needed to understand whether the increased lag time has affected outcomes and whether the decreased ICU admissions are due to yearly variation or the pandemic.

66 The Effect of Transfer on Outcomes in Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S43-S43
Author(s):  
Elizabeth Bruenderman ◽  
Selena The ◽  
Nathan Bodily ◽  
Matthew Bozeman
Keyword(s):  
Tertiary Care ◽  
Total Body Surface Area ◽  
The United States ◽  
Infectious Complications ◽  
Burn Care ◽  
Burn Center ◽  
Total Body ◽  
Tertiary Care Centers ◽  
Inhalation Burn ◽  
Time From Injury

Abstract Introduction Burn care in the United States takes place primarily in tertiary care centers with specialty-focused burn capabilities. Patients are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aims to evaluate the effect of this treatment delay on outcomes. Methods Under IRB approval, adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. Cohorts were divided into patients who were initially taken to a non-burn center and subsequently transferred versus patients taken immediately to a burn center. Outcomes between the groups were compared. Results A total of 122 patients were identified, 61 in each cohort. There was no difference between the transfer and direct admit cohorts with respect to median age (52 vs. 46, p = 0.45), percent total body surface area burn (10% vs. 10%, p = 0.08), concomitant injury (0 vs. 4, p = 0.12), or intubation prior to admission (5 vs. 7, p = 0.76). Transfer patients experienced a longer median time from injury to burn center admission than directly admitted patients (1 vs. 8 hours, p < 0.01). Directly admitted patients were more likely to have inhalation burn (18 vs. 4, p < 0.01), require intubation after admission (10 vs. 2, p = 0.03), require an emergent procedure (18 vs. 5, p < 0.01), and develop infectious complications (14 vs. 5, p = 0.04). However, there was no difference between transfers and direct admits in ventilator days (9 vs. 3 days, p = 0.37), number of operations (0 vs. 0, p = 0.16), length of stay (3 vs. 3 days, p = 0.44), or mortality (6 vs. 3, p = 0.50). Conclusions This study suggests that significantly injured, hemodynamically unstable patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met ABA criteria for transfer were not affected by short delays in transfer to definitive burn care. Applicability of Research to Practice Initial triage and evaluation of hemodynamically stable patients at non-burn centers does not negatively impact outcomes in patients who meet ABA criteria for transfer to a burn center.

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.

A Retrospective Multicenter Study of 1898 Liquefied Petroleum Gas-Related Burn Patients in Eastern China From 2011 to 2015

2020 ◽  
Vol 41 (6) ◽  
pp. 1188-1197
Author(s):  
Ronghua Jin ◽  
Jiaming Shao ◽  
Jon Kee Ho ◽  
Meirong Yu ◽  
Chunmao Han
Keyword(s):  
Eastern China ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Categorical Variables ◽  
Liquefied Petroleum Gas ◽  
Chi Square ◽  
Burn Prevention ◽  
Chi Square Test ◽  
The Mean ◽  
The One

Abstract Liquefied petroleum gas (LPG) is a widely used environment-friendly fuel. Previous studies have shown an increasing number of LPG-related burns. Our study was designed to evaluate the epidemiologic pattern of these injuries and provide recommendations for burn prevention. This retrospective study included all patients with LPG-related burns from eight burn centers in Zhejiang Province, China between 2011 and 2015. Database variables included patient demographics, accident characteristics, and injury characteristics. The association between different categorical variables was identified using the chi-square test. And the association between two or more means of quantitative variables was analyzed by the one-way analysis of variance or t-test. A total of 1898 patients were included, 47.31% were males and 52.69% were females. The predominant age group was 31 to 70 years (74.50%), and the majority were poorly educated and the incidence peaked from June to September. The most common place of occurrence was home (74.08%) and gas leak (96.52%) was the most common cause. The four limbs (43.33%) were the most frequently affected areas; the mean burn area was 25.19 ± 20.97% of the total body surface area and most patients (46.89%) suffered from moderate burns. The mean length of hospital stay was 17.66 ± 16.55 days and the majority of patients (89.36%) recovered with a 0.84% mortality rate. Our findings reflected that the increase in incidence rate was alarming, and the causes resulting in LPG-related burns have not gained much attention yet. Therefore, this calls for simple but strict measures aiming at each hazardous step during the use of LPG to prevent these burn injuries.

scholarly journals Staged Bilateral Hip or Knee Arthroplasties

2007 ◽  
Vol 15 (2) ◽  
pp. 159-162 ◽  
Author(s):  
FR Hashmi ◽  
K Barlas ◽  
CF Mann ◽  
FR Howell
Keyword(s):  
Hospital Admission ◽  
Hospital Stay ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Complication Rates ◽  
Early Complication ◽  
Early Complications ◽  
Hospital Stays ◽  
The Mean

Purpose. To compare the operating time, amount of blood transfused, length of hospital stay, and early complications (within 6 months) between 2-week staged bilateral arthroplasties and matched randomised controls undergoing unilateral arthroplasties. Methods. From October 1992 to October 2000, 90 patients who underwent bilateral hip or knee arthroplasties with a 2-week interval were compared with matched randomised controls undergoing unilateral arthroplasties. A single surgeon performed all procedures. Results. After the match-up process, 30 pairs of patients were included in the analysis. There were no significant differences in the operating times, amount of blood transfused, and early complication rates. The mean difference in length of hospital stay was significant ( t= −3.552, df=29, p<0.001). Conclusion. Compared to staged procedures with an interval months apart, staged sequential arthroplasty with a 7- to 10-day interval during one hospital admission is more efficient, as it facilitates earlier rehabilitation without higher complication rates, and entails shorter hospital stays.

scholarly journals Transurethral fragmentation of bladder stone in children: Our experience

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Ghulam Mujtaba Zafar ◽  
Naseem Javed ◽  
Fawad Humayun ◽  
Asif Iqbal
Keyword(s):  
Hospital Stay ◽  
Operating Time ◽  
Bladder Stone ◽  
Average Hospital ◽  
Female Ratio ◽  
Bladder Stones ◽  
Stone Recurrence ◽  
Febrile Uti ◽  
The Mean ◽  
One Year

Background: This study is performed to find the outcome of transurethral fragmentation and clearance of bladder stones in children as well as assessment of stone recurrence after the procedure. Methods: It was a retrospective analysis of the medical record of 365 patients with bladder stones, treated with transurethral fragmentation at the Department of Pediatric Urology, The Children’s Hospital and the Institute of Child Health, Lahore, over a period of 5 years. Bladder stones were fragmented by using ureterorenoscope (URS) and pneumatic Lithotripsy under general anesthesia. Patients were asked to void next day for spontaneous passage of stone fragments. Duration of procedure, hospital stay, peroperative, and postoperative complications were recorded on a self-structured proforma. The collected data was analyzed with SPSS, version 22. Results: The mean age of the patients was 4.7 ±2.31 years, and male to female ratio was 6:1. Clinical presentation was painful micturition with milking of penis (55%), followed by straining during micturition (17.5%), urinary retention (10%), increased frequency of urine (8%), febrile UTI (7.5%), and hematuria (2%). The mean stone size on ultrasound was 17.2 ±3.8 mm (Range 7-25 mm). The average operating time was 18 minutes (Range: 12-35 minutes). The transurethral fragmentation was successfully done in all (100%) patients. Average hospital stay was 24 hours. Most patients (98.5%) passed all stone fragments in urine & were stone free at one week, confirmed by ultrasound and X-Ray Kidney, Ureter, and Bladder (KUB). Postoperative minor complications were found in (6%) patients including hematuria (3%), dysuria (2%), febrile UTI (1%), failure to void (0.5%). Stone recurrence was 0.27% and no urethral stricture was noted up to one year follow up. Conclusion: Endoscopic treatment of bladder stone in children appears effective and safe by fragmenting the stone into multiple small pieces, which passed out spontaneously without any need for extraction of stone. The associated complications and recurrence rate are very negligible.

scholarly journals Trends and patterns in total laparoscopic hysterectomy in tertiary care hospital

2018 ◽  
Vol 7 (6) ◽  
pp. 2170
Author(s):  
Sonali Ingole ◽  
Sameer Darawade
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Bladder Injury ◽  
Care Hospital ◽  
Estimated Blood Loss ◽  
The Mean

Background: Due to technical advances in the field of laparoscopy, there has been an increase in total laparoscopic hysterectomies all over the world in last decade. This study was conducted to analyse the technique and surgical outcome of total laparoscopic hysterectomy in tertiary care hospitalMethods: This is a retrospective cohort (observational) study, which included all patients who underwent Total Laparoscopic Hysterectomy (TLH) for benign conditions from January 2012 to December 2017 at the tertiary Care Hospital. The data so obtained was analysed for various parameters like indication for surgery, mean operating time, length of hospital stay, complications and conversion to abdominal route.Results: Total number of 2307 hysterectomies were performed over a period of 5 years. Of these, TLH were 270 (11.70%). Amongst those undergoing TLH, the mean age was 45±7.84 years. The most common indication for the surgery was fibroid uterus (38.14%), followed by dysfunctional uterine bleeding (28.88%), and adenomyosis (15.1%). The mean estimated blood loss was 106±4.34 ml. Hemorrhage (n = 2) and bladder injury (n = 4) were most common surgical complications.Conclusions: TLH is safe and effective procedure for most of the benign pelvic conditions. With adequate training TLH can be used more widely in tertiary care hospital and teaching institute.

scholarly journals Chronic Urticaria and Its Impact on the Quality of Life of Nepalese Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Sushil Paudel ◽  
Niraj Parajuli ◽  
Rabindra Prasad Sharma ◽  
Sudip Dahal ◽  
Sudarshan Paudel
Keyword(s):  
Quality Of Life ◽  
Chronic Urticaria ◽  
Demographic Data ◽  
Life Quality ◽  
Well Being ◽  
Female Ratio ◽  
Principle Component ◽  
The Mean ◽  
The Impact

Chronic urticaria (CU) is a skin condition characterized by sudden and recurrent episodes of wheals, angioedema, or both and commonly associated with itching for a duration of more than six weeks. The available data indicate that urticaria markedly affects both objective functioning and subjective well-being of patients. A review of patients’ records with chronic urticaria attending Civil Service Hospital from January 2018 to December 2019 was done. A detailed demographic data of all patients with chronic urticaria was also retrieved. Dermatology Life Quality Index questionnaire (DLQI) Nepalese version was used for the assessment of the impact of disease on life quality. Mann–Whitney U-test was applied to compare means, and principle component analysis for factor analysis was used. A total of 149 patients were included, with a male-to-female ratio of 1 : 1.9. The mean age of the study population was 32.86  ±  12.837 years. The mean DLQI score was 8.30  ±  6.73 with men having a significantly greater score than women ( p < 0.02 ). DLQI scores negatively correlated with age ( p < 0.01 ). There was a high internal consistency among items (Cronbach’s alpha 0.89), and all items had satisfactory correlation with each other as well. Principle component extraction revealed that there were two underlying factors in the DLQI questionnaire on measuring quality of life in chronic urticaria. Males had a greater impairment in quality of life than females due to chronic urticaria. Most severe impairment was seen in symptoms/feelings subdomain. It also revealed that there were two different underlying factors in DLQI questionnaire.

scholarly journals Can point-of-care testing shorten hospitalization length of stay? An exploratory investigation of infectious agents using regression modelling

2018 ◽  
Vol 25 (4) ◽  
pp. 1606-1617
Author(s):  
Eliona Gkika ◽  
Anna Psaroulaki ◽  
Yannis Tselentis ◽  
Emmanouil Angelakis ◽  
Vassilis S Kouikoglou
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Hospital Stay ◽  
Point Of Care ◽  
Length Of Hospital Stay ◽  
Laboratory Diagnosis ◽  
Final Diagnosis ◽  
Point Of Care Testing ◽  
The Mean ◽  
The Impact

This retrospective study investigates the potential benefits from the introduction of point-of-care tests for rapid diagnosis of infectious diseases. We analysed a sample of 441 hospitalized patients who had received a final diagnosis related to 18 pathogenic agents. These pathogens were mostly detected by standard tests but were also detectable by point-of-care testing. The length of hospital stay was partitioned into pre- and post-laboratory diagnosis stages. Regression analysis and elementary queueing theory were applied to estimate the impact of quick diagnosis on the mean length of stay and the utilization of healthcare resources. The analysis suggests that eliminating the pre-diagnosis times through point-of-care testing could shorten the mean length of hospital stay for infectious diseases by up to 34 per cent and result in an equal reduction in bed occupancy and other resources. Regression and other more sophisticated models can aid the financing decision-making of pilot point-of-care laboratories in healthcare systems.

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