scholarly journals Predictors of Follow-Up Compliance in Pediatric Burn Patients During the Time of COVID

2021 ◽  
Author(s):  
Alejandro Chara ◽  
Erica Hodgman ◽  
Susan Ziegfeld ◽  
Carisa Parrish ◽  
Daniel Rhee ◽  
...  
Keyword(s):  
Time Frame ◽  
Access To Healthcare ◽  
Burn Injuries ◽  
Burn Patients ◽  
Post Injury ◽  
Burn Center ◽  
Chi Squared ◽  
Demographic Patterns ◽  
Burn Depth

Abstract The effect of the COVID-19 pandemic has led to increased isolation and potentially decreased access to healthcare. We therefore evaluated the effect of COVID-19 on rates of compliance with recommended post-injury follow-up. We hypothesized that this isolation may lead to detrimental effects on adherence to proper follow-up for children with burn injuries. We queried the registry at an ABA-verified Level 1 pediatric burn center for patients aged 0-18 years who were treated and released from March 30 to July 31, 2020. As a control, we included patients treated during the same time frame from 2016 to 2019. Patient and clinical factors were compared between the COVID and pre-COVID cohorts. Predictors of follow-up were compared using chi-squared and Kruskal-Wallis tests. Multivariable logistic regression was used to evaluate for predictors of compliance with follow-up. A total of 401 patients were seen and discharged from the pediatric ED for burns. Fifty-eight (14.5%) of these patients were seen during the pandemic. Burn characteristics and demographic patterns did not differ between the COVID and pre-COVID cohorts. Likewise, demographics did not differ between patients with follow-up and those without. The rate of compliance with 2-week follow-up was also not affected. Burn size, burn depth, and mechanism of injury all were associated with higher compliance to follow up. After adjusting for these variables, there was still no difference in the odds of appropriate follow up. Despite concerns about decreased access to healthcare during COVID, follow-up rates for pediatric burn patients remained unchanged at our pediatric burn center.

scholarly journals 58 Rate and Predictors of Outpatient Follow-Up Compliance of Pediatric Burn Patients During the COVID-19 Pandemic

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S41-S42
Author(s):  
Alejandro O Chara ◽  
Erica Hodgman ◽  
Susan Ziegfeld ◽  
Carisa Parrish ◽  
Daniel Rhee ◽  
...  
Keyword(s):  
Race And Ethnicity ◽  
Time Frame ◽  
Burn Injuries ◽  
Post Injury ◽  
Burn Center ◽  
Chi Squared ◽  
Level 1 ◽  
Demographic Patterns ◽  
Burn Depth

Abstract Introduction The effect of the COVID-19 pandemic has led to increased isolation of families at home and potentially decreased access to the healthcare system. We therefore evaluated the effect of COVID-19 on rates of compliance with recommended post-injury follow-up. We hypothesized that this isolation may lead to detrimental effects on adherence to proper follow-up for children with burn injuries. Methods We queried the registry at an ABA-verified Level 1 pediatric burn center for patients aged 0–14 years who were treated and released from March 30 to July 31, 2020, which represents the height of the pandemic. As a control, we searched the registry for patients treated during the same time frame from 2016 to 2019. Patient and clinical factors were compared between the COVID and pre-COVID cohorts. Predictors of follow-up were compared using chi-squared and Kruskal-Wallis tests. Multivariable logistic regression was used to evaluate for predictors of compliance with follow-up. Results A total of 401 patients were seen and discharged from the pediatric ED for burn injuries. The COVID cohort consisted of 58 (14.5%) of these patients. Burn characteristics and demographic patterns did not differ between the COVID and pre-COVID cohorts. Demographics, including age, gender, race, and ethnicity did not differ between patients with 2-week follow-up and those without. The rate of compliance with 2-week follow-up was also not affected (62.4% prior to COVID vs. 55.2% during, p=0.29). As expected, burn size, burn depth, and mechanism of injury all significantly predicted compliance with 2-week follow up (table 1). After adjusting for these variables, there was still no difference in the odds of appropriate follow up (OR 0.6, 95% CI 0.3 – 1.1; p=0.12). Conclusions Despite concerns about decreased access to healthcare during the pandemic, the experience at our Level 1 pediatric burn center, including rates of follow-up for those managed as outpatients, appears unchanged.

scholarly journals A retrospective analysis of ambulatory burn patients: focus on wound dressings and healing times

2010 ◽  
Vol 92 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Gianpiero Gravante ◽  
Antonio Montone
Keyword(s):  
Healing Time ◽  
Wound Dressings ◽  
Burn Patients ◽  
Burned Areas ◽  
Partial Thickness ◽  
Chi Squared ◽  
Student’S T ◽  
Partial Thickness Burns ◽  
Burn Depth

INTRODUCTION In this study, we retrospectively analysed healing times of ambulatory burn patients after silver-based dressings were introduced in late December 2005, and compared the results with those obtained before. PATIENTS AND METHODS Data were collected in November–December 2005 and in January–February 2006. We excluded from the study: (i) admitted patients; (ii) patients with mixed superficial partial thickness and deep partial thickness burns; (iii) patients with full-thickness burns; and (iv) operated patients that came for follow-up. We recorded the age, sex, cause (flame vs scald), burn depth, dressings used and healing times. RESULTS We selected 347 patients corresponding to 455 burned areas (64.4% superficial and 35.6% deep; 47.7% treated in 2005 and 52.3% in 2006). During the years 2005 and 2006, there was an increase in the use of silver-based dressings (2005, 9.7%; 2006, 38.7%; chi-squared test, P < 0.001) and a decrease in the use of paraffin gauzes (2005, 66.4%; 2006, 40.3%; chi-squared test, P < 0.001). The healing time of overall burns and of superficial burns showed no significant differences between 2005 and 2006. However, in deep partial thickness burns, a significant reduction was present (2006, 19; 2005, 29 days; Student's t-test, P < 0.01). Among all dressings, paraffin gauzes had the shortest healing times in superficial burns (5 days); with silver-based dressings in deep burns, the healing times were nanocrystalline silver (16 days) and silver carboxymethylcellulose (21 days). CONCLUSIONS Results of our retrospective study would suggest that paraffin gauzes are a valuable option in superficial burns, while silver-based dressings are preferable in deep burns.

Cryogenic Refrigerant Burns: A Rare Occupational Hazard

2020 ◽  
pp. 216507992096553
Author(s):  
Suvashis Dash ◽  
Vamseedharan Muthukumar ◽  
Rajkumar R ◽  
Durga Karki
Keyword(s):  
Exposure Time ◽  
Treatment Plan ◽  
Hand Function ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Air Conditioners ◽  
Burn Center ◽  
Adequate Knowledge ◽  
Treatment Measures ◽  
Burn Depth

Background Cryogenic burns induced by coolant gases used in refrigerators and air conditioners are rarely encountered, despite the wide use of these gases. To date, only a few cases have been reported in the literature. This study examined the occupational circumstances leading to such injuries, relevant injury sites, types of chemicals involved, and treatment measures. Methods This study was conducted in a tertiary burn center in India between March 2015 and March 2019. The demographic details, chemicals involved, and burn regions and characteristics were analyzed. Findings There were 15 burn cases all involving injury to the hand. All injuries were managed initially with dressings and nonoperative management. One patient required anti-edema therapy with limb elevation and fingertip debridement, while another patient required skin grafting. All patients had satisfactory hand function after treatment. Conclusions/Application to Practice Cryogenic burn injuries caused by refrigerants are rare, and their etiology varies considerably. Exposure time is the primary factor that determines burn depth and severity; hence, reducing exposure time is important in first aid. Our findings suggest that after exposure, the patient should be treated in a specialized burn center. Adequate knowledge regarding the pathophysiology of these types of burn injuries and their management is necessary; otherwise, misjudgments in the treatment plan can lead to adverse consequences.

23 Triage and Transfer to a Regional Burn Center - Impact of a Mobile Phone App

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S18-S18
Author(s):  
Heather Carmichael ◽  
Kiran U Dyamenahalli ◽  
Patrick Duffy ◽  
Anne L Lambert Wagner ◽  
Arek J Wiktor
Keyword(s):  
Mobile Phone ◽  
Call Center ◽  
Demographic Data ◽  
Mobile App ◽  
Burn Injuries ◽  
Visual Component ◽  
Burn Center ◽  
Private Vehicle ◽  
Triage Decisions

Abstract Introduction The ABA designs referral criteria to guide providers in recommending appropriate patients for treatment at specialized burn centers. However, patients are typically triaged at local facilities where providers may not have expertise to assess burn injuries properly. Addition of a visual component to a consultation call can improve local triage decisions, including estimations of total burn surface area (TBSA). In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic data to the burn specialist in a HIPPA-compliant manner, facilitating the consultation. Our hypothesis is that use of the burn app can improve triage decisions, particularly in cases of intermediate TBSA (1–10%). Methods This is a retrospective review of all consults to our ABA-verified burn center from a single Level II trauma center (TC) approximately 70 miles from our institution. Data were integrated from our call center, burn registry, electronic medical record and the mobile app. Burns were classified as large (&gt;10% TBSA), intermediate (1–10% TBSA), or small (&lt; 1%). Patients were triaged to either a) immediate transfer via ground ambulance or helicopter, b) transfer via private vehicle, c) outpatient follow up at the burn center, or d) local facility/primary care management. Patients were considered to be “down-triaged” if they required transfer but could transfer via private vehicle, or if they could be managed locally. Results During the study period, 135 patient consultations were made by the TC for thermal or cold injuries. 82 patients (61%) were referred using the app. Most patients (n=56, 41%) presented with small burns of the hands, feet or face. Overall, 53 patients (39%) were transferred to the burn center. The majority required ambulance transfer (n=44). 60 patients (44%) were recommended for outpatient follow up, but only 43% (n=26) followed up. When the subset of intermediate burns was considered (n=54), the mobile app allowed for successful “down-triage” of 12 patients (30%) referred through the app. No patient referred without the app could be “down-triaged” (p=0.02). Conclusions A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow up and transfer mode. However, less than half of patients triaged to outpatient follow up were actually seen at the burn center. Applicability of Research to Practice Telemedicine can be used to assist in triage decisions and appropriate referral to a regional burn center. This technology could be optimized to assist in outpatient follow up.

scholarly journals Burn recidivism: a 10-year retrospective study characterizing patients with repeated burn injuries at a large tertiary referral burn center in the United States

2019 ◽  
Vol 7 ◽  
Author(s):  
Sarah L. Laughon ◽  
Bradley N. Gaynes ◽  
Lori P. Chrisco ◽  
Samuel W. Jones ◽  
Felicia N. Williams ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
The United States ◽  
Burn Injuries ◽  
Hospital Charges ◽  
Burn Patients ◽  
Burn Center ◽  
Trauma Recidivism

Abstract Background Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma, known as trauma recidivism. The epidemiology of burn recidivism, specifically, has not been described. This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists (RCs) with non-recidivists (NRCs). Methods A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record. Continuous variables were reported using medians and interquartile ranges (IQR). Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic, burn, and hospitalization characteristics between NRCs and RCs. Results A total of 7134 burn patients were admitted, among which 51 (0.7%) were RCs and accounted for 129 (1.8%) admissions. Of the 51 RCs, 37 had two burn injuries each, totaling 74 admissions as a group, while the remaining 14 RCs had between three and eight burn injuries each, totaling 55 admissions as a group. Compared to NRCs, RCs were younger (median age 36 years vs. 42 years, p = 0.02) and more likely to be white (75% vs. 60%, p = 0.03), uninsured (45% vs. 30%, p = 0.02), have chemical burns (16% vs. 5%, p &lt;  0.0001), and have burns that were ≤ 10% total body surface area (89% vs. 76%, p = 0.001). The mortality rate for RCs vs. NRCs did not differ (0% vs. 1.2%, p = 0.41). Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs (75% vs. 15%, p &lt;  0.001). Median total hospital charges per patient were nearly three times higher for RCs vs. NRCs ($85,736 vs. $32,023, p &lt;  0.0001). Conclusions Distinct from trauma recidivism, burn recidivism is not associated with more severe injury or increased mortality. Similar to trauma recidivists, but to a greater extent, burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs. Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.

scholarly journals 609. Implementation and Post-implementation Analysis of a Pilot Program for Inpatient Review of Outpatient Parenteral Antimicrobial Therapy Prior to Discharge

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S365-S366
Author(s):  
Delaney Hart ◽  
Hailey McCoy ◽  
Krista Gens ◽  
Michael Wankum ◽  
Andrew Tarleton
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
Blood Stream ◽  
Central Line ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Chi Squared

Abstract Background The Infectious Diseases Society of America OPAT (outpatient parenteral antimicrobial therapy) guidelines state that effective OPAT programs require a multidisciplinary team1. Currently within the health system, there is no formal OPAT program in place, and OPAT prescribing is not limited to any specialty. This project aimed to pilot a pharmacist-driven program across five hospitals. Methods Adult patients with OPAT ordered between February 1 and May 1, 2020 were included. Patients were excluded if the OPAT was prescribed by infectious diseases (ID) providers or if patients were on OPAT prior to hospital admission. An alert was generated in the electronic health record (EHR) when an order for an intravenous catheter was placed for patients with concomitant antimicrobials. Follow up was performed and documented via a progress note in the EHR as appropriate. Data was collected via retrospective chart review and statistical analysis was performed using Chi-squared test with Yates’ correction. Results 101 pre- and 7 patients post-implementation were included in this study. There were a total of 51 patients pre-implementation that received inappropriate OPAT care per the IDSA OPAT guidelines, and post-implementation 2 patients (50.5% vs 28.6%, p=0.47). The secondary outcomes of 30-day readmission rates were 17% and 0% (p=0.52); and complications related to OPAT (e.g. central-line associated blood stream infections) were 12% and 0% (p=0.73), respectively. 2 midline catheters were recommended by the OPAT team, and a cost savings of up to $6,796 was calculated. Conclusion This pilot showed a trend towards decreased inappropriate OPAT prescribing and cost avoidance of an ID pharmacist-driven review of OPAT prior to patient hospital discharge. Limitations to this pilot included being underpowered due to the limited time-frame of the post-implementation period, and an inability for follow up with patients discharged utilizing an alternative home infusion service. Disclosures All Authors: No reported disclosures

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 Epidemiology of Scars and Their Consequences: Burn Scars

2020 ◽  
pp. 37-43
Author(s):  
Margriet E. van Baar
Keyword(s):  
Risk Factors ◽  
Burn Injury ◽  
Healing Process ◽  
Total Body Surface Area ◽  
Female Gender ◽  
Burn Injuries ◽  
Post Injury ◽  
The People ◽  
Total Body ◽  
Burn Depth

AbstractPathological scarring in burn wounds can result in hypertrophic scars and/or contractures. Prevalences of hypertrophic scarring after burn injuries between 8% and 67% are reported. A recent prospective study revealed a prevalence of 8%. Data on prevalence of burn scar contractures are limited; reported prevalence at discharge varied between 38 and 54% and decreased with an increasing time post burn. About 5–20% of the people who suffered from burn injuries received reconstructive surgery after burns, up to 10 years post injury.Factors predicting pathological scar formation after burn injuries include patient, injury and treatment characteristics. Injury- and treatment-related characteristics are the main predictors of scar outcomes after burn injury. These characteristics are related to burn size (total body surface area burned) and burn depth (number or type of surgery) or the overall healing process in general (length of stay, wound healing complications). Intrinsic patient-related risk factors seem to play a role as well but are less consistent predictors of scar outcome. This includes the risk factors like the female gender and also a younger age and darker skin.Knowledge on risk factors for poor scar outcome can be used to tailor treatment, aftercare and scar prevention to these patients with a high-risk profile.

scholarly journals Severe burn injury in late pregnancy: a case report and literature review

2015 ◽  
Vol 3 ◽  
pp. 1-4 ◽  
Author(s):  
Yan Shi ◽  
Xiong Zhang ◽  
Bo-Gao Huang ◽  
Wen-Kui Wang ◽  
Yan Liu
Keyword(s):  
Burn Injury ◽  
Late Pregnancy ◽  
Clinical Problem ◽  
Burn Injuries ◽  
Burn Patients ◽  
Severe Burn ◽  
Burn Center ◽  
Maternal Survival ◽  
Low Incidence ◽  
Severe Burn Injury

Abstract The management of serious burn injuries during pregnancy is an unsolved clinical problem because of the low incidence of this disease. Although it has been documented that the effect of burns on fetal and maternal survival is detrimental, there have been conflicting reports among the different burn centers regarding the mortality of burned pregnant women and the management of burn patients during pregnancy. We report a case of severe burn in late pregnancy treated at our burn center. Additionally, we searched and summarized the literature concerning the management of pregnant patients to provide useful information for their treatment.

745 Pediatric Burn Transfers: A 10 Year Analysis of Adherence to ABA Transfer Criteria

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S205-S206
Author(s):  
Janine Roller ◽  
Rebecca Courtemanche ◽  
Marija Bucevska ◽  
Sally Hynes
Keyword(s):  
Pediatric Patients ◽  
Burn Injuries ◽  
Physician Education ◽  
Accurate Estimation ◽  
Burn Patients ◽  
Burn Care ◽  
The Past ◽  
Medical Disorders ◽  
Referral Criteria ◽  
Burn Depth

Abstract Introduction Severe burn injuries require complex care at certified burn centres to minimize morbidity and mortality. The ABA Burn Centre Referral Criteria was developed to aid clinicians in determining which patients warrant transfer as physician comfort with the management of pediatric burns, accurate estimation of TBSA, and burn depth varies. We hypothesize that pediatric patients are often transferred despite not meeting referral criteria. The aim of this study was to review pediatric patients with burn injuries that were transferred to the provincial burn centre over the past 10 years to better understand the reasons for the transfer. Methods A 10-year retrospective review from January 2008 to December 2018 was performed using the provincial Burn Registry. Pediatric burn patients under 18 years old who were transferred for burn care were identified and their demographics, burn characteristics, and the basis for transfer was analyzed against the ABA Burn Referral Criteria. Results A total of 130 pediatric burn patients were transferred from 42 different hospitals of varying trauma levels. Patients on average were 5 years old, predominantly male (59%), and scalds were the most common etiology (53%). Most patients were transferred by a fixed-wing ambulance (54%) and the average transport time was 1.5 days after the initial injury. All children met 1 or more ABA Referral Criteria for transfer. The most common reasons for transfer were for a TBSA greater than 10% (42.2%), burn to the hand (27.7%) or perineum (11.5%), 3° burn depth (12.3%), or significant pre-existing medical disorders (9.2%). Conclusions Over the past 10 years, all pediatric burn patients met ABA Burn Centre Referral Criteria based on TBSA, burn depth and burn location alone. This study is limited in that we were not able to capture all pediatric burn patients to identify those that warranted a referral but were not transferred. Applicability of Research to Practice The results indicate that burn-related transfers to the provincial burn centre were appropriate. The dissemination of this information to the referring centres may serve to reinforce these positive referral patterns. Furthermore, this audit provides insight into the geographic origins of pediatric burn referrals in the province to help direct burn prevention and physician education efforts, as well as resources for initial burn care and post-discharge rehabilitation services.

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