scholarly journals The Patient’s Perspective: Burn Reconstructive Surgery During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Paul Won ◽  
Karel-Bart Celie ◽  
Violeta Perez ◽  
T Justin Gillenwater ◽  
Haig A Yenikomshian
Keyword(s):  
Reconstructive Surgery ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Burn Treatment ◽  
Burn Care ◽  
Postoperative Therapy ◽  
Burn Center ◽  
Increased Risk ◽  
Average Patient ◽  
Hospital Systems

Abstract During the Covid-19 pandemic, hospital systems delayed or halted elective surgeries and outpatient care, profoundly disrupting reconstructive burn treatment ranging from surgery to postoperative therapy. This study aims to characterize burn patients’ perspectives on reconstructive surgery during Covid-19. A 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center was administered. Responses regarding willingness to undergo reconstruction, perceived medical and personal impacts of Covid-19, and perspectives on telehealth were gathered. Surveys were administered to patients/caregivers over the phone in English and Spanish. Inclusion criteria consisted of burn patients who had elective reconstructive surgeries delayed or canceled as a result of the pandemic. 51 patients met our inclusion criteria. Of those, 23 patients responded to our survey (45%). Average patient age was 23, 43% were male, and a majority (52%) were pediatric. 22 (96%) patients were willing to undergo reconstruction during the Covid-19 pandemic, despite a perceived increased risk. 43% disagreed or strongly disagreed that telehealth adequately enabled communication with their burn care provider. 78% agreed or strongly agreed that they felt more susceptible to Covid-19 as burn patients. 83% agreed or strongly agreed that the Covid-19 pandemic had created stressors specifically related to their burn care. The majority of patients expressed a strong desire to return to surgical and therapeutic care delayed by Covid-19. Patients reported feeling especially vulnerable to the Covid-19 pandemic as burn patients, and cited difficulty obtaining care and financial stressors as the main causes.

scholarly journals 114 The Patient’s Perspective: Burn Reconstructive Surgery During the Pandemic

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S76-S77
Author(s):  
Paul Won ◽  
Karel-Bart Celie ◽  
Justin Gillenwater ◽  
Haig A Yenikomshian
Keyword(s):  
Reconstructive Surgery ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Surgical Care ◽  
Quality Improvement Initiative ◽  
Burn Patients ◽  
Burn Treatment ◽  
Hospital Systems ◽  
Novel Coronavirus ◽  
Burn Patient

Abstract Introduction The novel Coronavirus disease 2019 (COVID-19) has created profound challenges in healthcare delivery. Hospital systems have delayed or shut down elective surgeries and outpatient care. These measures resulted in profound disruptions to burn treatment regarding reconstructive care from surgery to therapy. This study aims to characterize burn patients’ perspectives on elective reconstructive surgery during COVID-19. Methods As part of a quality improvement initiative, a 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center during COVID-19 was conducted. Responses regarding willingness to undergo reconstruction during COVID-19, perceived medical and personal impacts of COVID-19, and perspectives on telehealth were gathered. Surveys were administered over the phone in English and Spanish to burn patients or to primary caregivers in the case of pediatric patients. Results We surveyed 23 participants who met our inclusion criteria. Average age was 23 and 43% were male. We found 22 (96%) patients were willing to undergo reconstruction during the COVID-19 pandemic. Table 1 outlines the responses to questions regarding telehealth and being a burn patient during COVID-19. Examples of stressors experienced by patients and their families due to COVID-19 included: inability to communicate with healthcare providers in person, increased anxiety in public places, delayed surgical care, and interruption of physical or occupational therapy. Family members in 5 out of the 8 Spanish speaking households lost their job due to COVID-19, resulting in financial stress for the burn patient. Conclusions The majority of patients expressed strong desires to return to surgical and therapy care delayed by COVID-19. Patients reported feeling especially vulnerable as burn patients and cited receiving healthcare and financial stressors as a result of the COVID-19 pandemic as the main causes.

scholarly journals The Presence of Nucleated Red Blood Cells as an Indicator for Increased Mortality and Morbidity in Burn Patients

2021 ◽  
Author(s):  
Phillip M Jenkins ◽  
Fadi Al Daoud ◽  
Leo Mercer ◽  
Donald Scholten ◽  
Kristoffer Wong ◽  
...  
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Burn Care ◽  
Risk Of Death ◽  
Nucleated Red Blood Cells ◽  
Increased Risk ◽  
Severity Scores

Abstract Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of NRBCs in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient. This retrospective observational study was conducted from 2012 to 2017. Inclusion criteria for this study included all burn patients with total body surface area > 10% who were aged ≥ 15 years. Demographic and clinical data were collected from the electronic medical record system. Data analysis consisted of descriptive and comparative analysis using SPSS. Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for NRBCs. The presence of NRBCs had an increased mortality rate with an odds ratio of 6.0 (P = .001; 2.5, 14.5); was more likely to appear in older patients (P < .001); and was associated with increased hospital length of stay (P < .001), injury severity scores (P < .001), and complications. The presence of NRBCs even at the low concentrations reported in our study showed a 6-fold increase in the rate of mortality. With the current improvements in burn care leading to higher survival rates, the need to improve upon the numerous models that have been developed to predict mortality in severe burn patients is clear given the significantly increased risk of death that the presence of NRBCs portends.

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.

Pavement Burns Treated at a Desert Burn Center: Analysis of Mechanisms and Outcomes

2020 ◽  
Vol 41 (5) ◽  
pp. 951-955
Author(s):  
Matthew Eisenberg ◽  
Paul Chestovich ◽  
Syed F Saquib
Keyword(s):  
Radiant Energy ◽  
Retrospective Chart Review ◽  
Skin Grafting ◽  
Common Mechanism ◽  
Burn Patients ◽  
Ambient Temperatures ◽  
Burn Center ◽  
Public Health Initiative ◽  
Increased Risk ◽  
Split Thickness Skin Grafting

Abstract Burns from contact with hot pavement are a common mechanism treated at burn centers located in desert climates. Previous work has shown increased risk of pavement burns as ambient temperatures rise above 95 degrees. In direct sunlight, pavement absorbs radiant energy causing the temperature to rise high enough to cause second-degree burns in seconds. The goal of this study is to review the mechanisms and outcomes of patients suffering pavement burns and to compare patients who presented with hyperthermia to their normothermia counterparts. A retrospective chart review was performed on pavement burns at an ABA-verified Burn Center for 5 years from 2014 to 2018. A total of 195 patients were identified. It was found that 50.5% of admitted pavement burn patients required burn excision and 35.9% required split-thickness skin grafting. The leading causes of pavement burn admissions were found down by EMS and walking on pavement at 21.6% each, followed by mechanical falls at 15.1%. We found that patients with recorded hyperthermia had statistically significant increase in 30-day hospital mortality, intensive care unit days, surgical procedures, and %TBSA. Data provided from this study can be used for a public health initiative to help patients who may be at risk of acquiring pavement burns. The data may also be helpful for clinicians gaining information about the management, mechanism, and outcomes of pavement burn patients.

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

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

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

scholarly journals 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.

scholarly journals The Effect of Transfer on Outcomes in Burns

2021 ◽  
Author(s):  
Nathan E Bodily ◽  
Elizabeth H Bruenderman ◽  
Neal Bhutiani ◽  
Selena The ◽  
Jessica E Schucht ◽  
...  
Keyword(s):  
Total Body Surface Area ◽  
Infectious Complications ◽  
Burn Injuries ◽  
Burn Patients ◽  
Burn Care ◽  
Burn Center ◽  
Field Versus ◽  
High Acuity ◽  
Total Body ◽  
Inhalation Burn

Abstract Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. A total of 122 patients were evenly divided into two cohorts – those directly admitted to a burn center from the field, versus those transferred to a burn center from an outlying facility. There was no difference between the transfer and direct admit cohorts with respect to age, percent total body surface area burned, concomitant injury, or intubation prior to admission. Transfer patients experienced a longer median time from injury to burn center admission (1 vs. 8 hours, p &lt, 0.01). Directly admitted patients were more likely to have inhalation burn (18 vs. 4, p &lt, 0.01), require intubation after admission (10 vs. 2, p = 0.03), require an emergent procedure (18 vs. 5, p &lt, 0.01), and develop infectious complications (14 vs. 5, p = 0.04). There was no difference in ventilator days, number of operations, length of stay, or mortality. The results suggest that significantly injured, high acuity burn 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.

scholarly journals Evaluating real-world national and regional trends in definitive closure in US burn care: A survey of US Burn Centers

2021 ◽  
Author(s):  
Jeffrey E Carter ◽  
H Amani ◽  
Damien Carter ◽  
Kevin N Foster ◽  
John A Griswold ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Resource Use ◽  
Real World ◽  
Practice Patterns ◽  
Treatment Patterns ◽  
Inpatient Setting ◽  
Burn Treatment ◽  
Burn Care ◽  
Burn Center ◽  
Number Of Patients

Abstract To better understand trends in burn treatment patterns related to definitive closure, this study sought benchmark real-world survey data with national data contained within the National Burn Repository version 8.0 (NBR v8.0) across key burn center practice patterns, resource utilization, and clinical outcomes. A survey, administered to a representative sample of US burn surgeons, collected information across several domains: burn center characteristics; patient characteristics including number of patients and burn size and depth; aggregate number of procedures; resource use such as autograft procedure time, and dressing changes; and costs. Survey findings were aggregated by key outcomes (number of procedures, costs) nationally and regionally. Aggregated burn center data were also compared to the NBR to identify trends relative to current treatment patterns. Benchmarking survey results against the NBR v8.0 demonstrated shifts in burn center patient mix, with more severe cases being seen in the inpatient setting and less severe burns moving to the outpatient setting. An overall reduction in the number of autograft procedures was observed compared to NBR v8.0, and time efficiencies improved as the intervention time per TBSA decreases as TBSA increases. Both nationally and regionally, an increase in costs were observed.The results suggest resource use estimates from NBR v8.0 may be higher than current practices, thus highlighting the importance of improved and timely NBR reporting and further research on burn center standard of care practices. This study demonstrates significant variations in burn center characteristics, practice patterns, and resource utilization thus increasing our understanding of burn center operations and behavior.

40 Wildfire Burn Victims: A Unique Population

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S30-S31
Author(s):  
Sarah C Stokes ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh ◽  
Tina L Palmieri
Keyword(s):  
Wound Care ◽  
Total Body Surface Area ◽  
Wound Infections ◽  
Gram Positive ◽  
Burn Victims ◽  
Burn Center ◽  
Populations At Risk ◽  
Increased Risk ◽  
Hospital Systems ◽  
Total Body

Abstract Introduction In the past ten years, wildfires have burned an average of 6.8 million acres annually. The frequency of wildfires is expected to increase with climate change. Wildfire burn victims have not been previously well characterized in the literature. As we prepare for more wildfires it is necessary to target populations at risk for sustaining burns with prevention efforts and to prepare hospital systems to meet these patients’ needs. Methods A retrospective review of patients admitted to a burn center between 2016 and 2019 was performed. Patients who were admitted after sustaining a burn attributable to wildfires were identified from the burn center database. Controls were matched to wildfire burn patients by age, gender and total body surface area of burn. The primary outcome was mortality. Secondary outcomes included number of operations, length of stay (LOS), intensive care unit (ICU) LOS, development of wound infections and pneumonia, wound culture microbiology. Results A total of 16 patients who had sustained burns in wildfires were identified and matched with 32 controls. There was no difference in mortality (19% wildfire vs. 9% non, p=0.386), LOS (18 days wildfire vs. 15 days non-wildfire, p=0.406), ICU LOS (17 days wildfire vs. 11 days non-wildfire, p=0.991) and number of skin grafts (1 wildfire vs. 0.5 non-wildfire, p=0.519). Patients who had sustained burns in a wildfire trended towards higher rates of pneumonia (31% wildfire vs. 13% non-wildfire, p=0.117), and higher rates of wound infection (31% wildfire vs. 19% non-wildfire, p=0.361). On evaluation of wound cultures for the 5 wildfire patients and the 7 non-wildfire patients who developed wound infections, more patients who sustained burns in wildfires had gram positive bacteria cultured from their wounds (100% wildfire vs. 29% non-wildfire, p=0.027). Patients who had sustained burns in wildfires trended towards increased likelihood of readmission (23% wildfire vs. 3% non-wildfire, p=0.080). Conclusions Patients who sustain burns in wildfires are likely at increased risk of readmission, of developing pneumonia and of developing gram-positive wound infections. Interventions for these patients should focus on pneumonia prevention and assistance with wound care after discharge.

scholarly journals A 3-Year Review of an Outpatient Burn Sedation Program in a Tertiary Burn Care Centre: Is It Safe and Does It Work?

2019 ◽  
Vol 27 (4) ◽  
pp. 305-310
Author(s):  
Rayleigh Chan ◽  
Aaron C. Van Slyke ◽  
Marija Bucevska ◽  
Cynthia Verchere
Keyword(s):  
Adverse Events ◽  
Deep Sedation ◽  
Tertiary Care ◽  
Common Mechanism ◽  
Burn Patients ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Burn Treatment ◽  
Burn Care ◽  
Treatment Room

Introduction: The burn treatment room at our tertiary-care centre is run by a multidisciplinary team, providing care to primarily burn patients who require moderate to deep sedation to undergo dressing changes in a monitored setting outside the operating room. There is little literature on the safety, efficacy, and logistics of treating outpatient pediatric burn patients in this manner. This study reviews the safety of deep sedation in the burn treatment room. Methods: A retrospective chart review of patients with burns treated in the burn treatment room from 2013 to 2015 was conducted. Patient demographics, diagnosis, procedure details, sedation, and adverse events were recorded. Data were analyzed descriptively. Results: Sevety-four patients with burns had a total of 308 visits in the burn treatment room for burn bath and/or dressing changes. Scald burns were the most common mechanism of injury (n = 56). Most burns were superficial and mid-dermal (54%), initially estimated at 5% to 10% TBSA (50%). Of the 308 visits, 304 required sedation. Adverse events were recorded in 11 (3.6%) of 304 sedated procedures. None of these events were critical: 7 patients required intravenous conversion due to inadequate oral sedation, 2 experienced brief apnea episodes but recovered spontaneously, and 2 had delayed discharge of more than 2 hours due to residual sedation. Conclusion: The burn treatment room is a safe and effective setting for treating pediatric burn patients, bypassing what might historically require operating suite inpatient management.

Sign in / Sign up

Export Citation Format

Share Document