The Psychosocial Aspect of Burn Patient Recovery as it Informs Chaplain Interventions

2020 ◽  
Vol 74 (3) ◽  
pp. 175-181
Author(s):  
Robert J. Crandall
Keyword(s):  
Spiritual Care ◽  
Care Setting ◽  
Burn Patients ◽  
Psychosocial Aspect ◽  
Burn Care ◽  
Burn Patient

This article provides an understanding of how the psychosocial and spiritual aspects of burn patients informs the chaplain’s interventions. It was developed by taking existing literature, using it in a clinical burn care setting, and then developing an experiential model of spiritual care. It has been attempted to point out to the reader where the literature supports the discussion and when the model uses the author’s experience to expand on that literature.

Management of the Patient with Thermal Injuries

2016 ◽  
Author(s):  
Michael J. Mosier ◽  
Nicole S. Gibran
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Fluid Management ◽  
Clinical Manifestations ◽  
Injured Patient ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Burn Care ◽  
Burn Resuscitation ◽  
Burn Patient

Optimal care of the burn patient requires not only specialized equipment but also, more importantly, a team of dedicated surgeons, nurses, therapists, nutritionists, pharmacists, social workers, psychologists, and operating room staff. Burn care was one of the first specialties to adopt a multidisciplinary approach, and over the past 30 years, burn centers have decreased burn mortality by coordinating prehospital patient management, resuscitation methods, and surgical and critical care of patients with major burns. This review covers where to treat burn patients, fluid management, airway management, temperature regulation, airway control, nutrition, anemia, pain management, deep vein thrombosis prophylaxis, and putting it all together: an algorithmic approach to early care of the burn-injured patient. Figures show that the size of a burn can be estimated by means of the Rule of Nines, which assigns percentages of total body surface to the head, the extremities, and the front and back of the torso, the approach to the burn patient in the first 24 hours, and the approach to the burn patient during the second to fifth days after burn injury. Tables list American Burn Association criteria for burn injuries that warrant referral to a burn unit, criteria for outpatient management of burn patients, acute physiologic changes during burn resuscitation, acute biochemical and hematologic changes during burn resuscitation, measures of pulmonary function, mechanisms of pulmonary dysfunction and indications for mechanical ventilation, clinical manifestations of carbon monoxide poisoning, half-life of carbon monoxide–hemoglobin bonds with inhalation therapy, increased acute kidney injury in patients treated with hydroxocobalamin for suspected inhalation injury, clinical findings associated with specific inhaled products of combustion, bronchoscopic criteria used to grade inhalation injury, and formulas for estimating caloric needs in burn patients. This review contains 3 highly rendered figures, 12 tables, and 134 references

Obesity Paradox in the Burn Patient

2020 ◽  
Vol 41 (1) ◽  
pp. 30-32
Author(s):  
Erica L W Lester ◽  
Justin E Dvorak ◽  
Patrick J Maluso ◽  
Samy Bendjemil ◽  
Thomas Messer ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Obesity Paradox ◽  
Class I ◽  
Burn Patients ◽  
Obesity Class ◽  
Burn Care ◽  
Significant Difference ◽  
Underweight Patients ◽  
Burn Patient

Abstract Despite the fact that obesity is a known risk factor for comorbidities and complications, there is evidence suggesting a survival advantage for patients classified by body mass index (BMI) as overweight or obese. Investigated in various clinical areas, this “Obesity Paradox” has yet to be explored in the burn patient population. We sought to clarify whether this paradigm exists in burn patients. Data collected on 519 adult patients admitted to an American Burn Association Verified Burn Center between 2009 and 2017 was utilized. Univariable and multivariable logistic regression were used to determine the association between in-hospital mortality and BMI classifications (underweight <18.5 kg/m2, normal 18.5 to 24.9 kg/m2, overweight 25–29.9 kg/m2, obesity class I 30 to 34.9 kg/m2, obesity class II 35 to 39.9 kg/m2, and extreme obesity >40 kg/m2). For every kg/m2 increase in BMI, the odds of death decreased, with an adjusted odds ratio of 0.856 (95% confidence interval [CI] 0.767 to 0.956). When adjusted for total BSA (TBSA), being obesity class I was associated with an adjusted odds ratio of mortality of 0.0166 (95% CI 0.000332 to 0.833). The adjusted odds ratio for mortality for underweight patients was 4.13 (95% CI 0.416 to 41.055). There was no statistically significant difference in odds of mortality between the normal and overweight BMI categories. In conclusion, the obesity paradox exists in burn care: further investigation is needed to elucidate what specific phenotypic aspects confer this benefit and how these can enhance the care of burn patients.

Management of the Patient with Thermal Injuries

2016 ◽  
Author(s):  
Michael J. Mosier ◽  
Nicole S. Gibran
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Fluid Management ◽  
Clinical Manifestations ◽  
Injured Patient ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Burn Care ◽  
Burn Resuscitation ◽  
Burn Patient

Optimal care of the burn patient requires not only specialized equipment but also, more importantly, a team of dedicated surgeons, nurses, therapists, nutritionists, pharmacists, social workers, psychologists, and operating room staff. Burn care was one of the first specialties to adopt a multidisciplinary approach, and over the past 30 years, burn centers have decreased burn mortality by coordinating prehospital patient management, resuscitation methods, and surgical and critical care of patients with major burns. This review covers where to treat burn patients, fluid management, airway management, temperature regulation, airway control, nutrition, anemia, pain management, deep vein thrombosis prophylaxis, and putting it all together: an algorithmic approach to early care of the burn-injured patient. Figures show that the size of a burn can be estimated by means of the Rule of Nines, which assigns percentages of total body surface to the head, the extremities, and the front and back of the torso, the approach to the burn patient in the first 24 hours, and the approach to the burn patient during the second to fifth days after burn injury. Tables list American Burn Association criteria for burn injuries that warrant referral to a burn unit, criteria for outpatient management of burn patients, acute physiologic changes during burn resuscitation, acute biochemical and hematologic changes during burn resuscitation, measures of pulmonary function, mechanisms of pulmonary dysfunction and indications for mechanical ventilation, clinical manifestations of carbon monoxide poisoning, half-life of carbon monoxide–hemoglobin bonds with inhalation therapy, increased acute kidney injury in patients treated with hydroxocobalamin for suspected inhalation injury, clinical findings associated with specific inhaled products of combustion, bronchoscopic criteria used to grade inhalation injury, and formulas for estimating caloric needs in burn patients. This review contains 3 highly rendered figures, 12 tables, and 134 references

scholarly journals Nurse Staffing, the Clinical Work Environment, and Burn Patient Mortality

2020 ◽  
Vol 41 (4) ◽  
pp. 796-802 ◽  
Author(s):  
Amanda P Bettencourt ◽  
Matthew D McHugh ◽  
Douglas M Sloane ◽  
Linda H Aiken
Keyword(s):  
Work Environment ◽  
Nurse Staffing ◽  
Additional Patient ◽  
Future Research ◽  
Burn Patients ◽  
Thermal Burn ◽  
Cross Sectional ◽  
Burn Care ◽  
Hospital Nursing ◽  
Burn Patient

Abstract The complexity of modern burn care requires an integrated team of specialty providers working together to achieve the best possible outcome for each burn survivor. Nurses are central to many aspects of a burn survivor’s care, including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabilitation. Research suggests that in general, hospital nursing resources, defined as nurse staffing and the quality of the work environment, relate to patient mortality. Still, the relationship between those resources and burn mortality has not been previously examined. This study used a multivariable risk-adjusted regression model and a linked, cross-sectional claims database of more than 14,000 adults (≥18 years) thermal burn patients admitted to 653 hospitals to evaluate these relationships. Hospital nursing resources were independently reported by more than 29,000 bedside nurses working in the study hospitals. In the high burn patient-volume hospitals (≥100/y) that care for the most severe burn injuries, each additional patient added to a nurse’s workload is associated with 30% higher odds of mortality (P < .05, 95% CI: 1.02–1.94), and improving the work environment is associated with 28% lower odds of death (P < .05, 95% CI: 0.07–0.99). Nursing resources are vital in the care of burn patients and are a critical, yet previously omitted, variable in the evaluation of burn outcomes. Attention to nurse staffing and improvement to the nurse work environment is warranted to promote optimal recovery for burn survivors. Given the influence of nursing on mortality, future research evaluating burn patient outcomes should account for nursing resources.

89 The Effect of Trauma Center Status and Burn Verification Process on Burn Patient Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S61-S62
Author(s):  
Manuel Castillo-Angeles ◽  
Christopher J Burns ◽  
John C Kubasiak ◽  
Anupama Mehta ◽  
Robert Riviello ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Patient Outcomes ◽  
Trauma Center ◽  
Burn Patients ◽  
Trauma Centers ◽  
Burn Centers ◽  
Adjusted Analysis ◽  
Burn Care ◽  
Burn Center ◽  
Burn Patient

Abstract Introduction Burn center verification was implemented to ensure burn patients receive the best quality of care. As part of the of the organized burn care system, trauma centers that do not have a burn center within the hospital should refer burn patients to a designated burn center. However, more than 30% of burn patients are still being taken care of in non-verified burn centers. Our aim was to determine if trauma center status conferred a benefit in outcomes in a national sample of burn patients. Methods This is a retrospective study using State Inpatient Databases of 22 states in 2014. The inclusion criteria were all patients admitted for burn injury (ICD-9 codes 940–949). Hospitals were categorized as ABA verified centers (VBC) and non-verified burn centers (NVBC), as well as trauma centers (TC) and non-trauma centers (NTC) based on verification status at the time of admission. Main Outcomes were in-hospital mortality and length of hospitalization (LOS). Stratifying by burn center verification status, multivariable regression was used to identify the association between trauma center status and the outcomes. Results A total of 15,982 burn patients were identified. The overall in-hospital mortality rate was 2.45%. In our sample, we only had 26 hospitals that were both a TC and VBC (Table 1). The majority of patients (54%) were treated at a NVBC/TC. In unadjusted analysis, amongst verified centers, there was no difference in mortality between TC and NTCs (3.2% vs. 3.0%, p=0.877), but NTCs had longer LOS (14.7 vs. 10 d, p< 0.001). Amongst non-verified centers, TCs had higher mortality when compared with NTCs (2.4% vs. 1.1%, p< 0.001), but TCs had longer LOS (8.3 vs. 7.2 d, p=0.007). After adjusted analysis, within VBC, TC status was associated with shorter LOS (Coef -3.28, 95% CI -5.37 – -1.19, p=0.002), but not associated with mortality (OR 1.21, 95% CI 0.50 – 2.89, p=0.667). After adjusted analysis, within NVBC, TC status was associated with longer LOS (Coef 2.37, 95% CI 1.70 – 3.04, p< 0.001) and with mortality (OR 3.70, 95% CI 2.10 – 6.51). Conclusions Trauma center status does not confer any benefit for burn patient outcomes within the burn care verification system. Despite the regionalization of burn care through the development of verified burn centers, the majority of burn patients are receiving care at trauma centers with a non-verified burn center within the hospital.

613Pediatric Burn Bibliotherapy - An Initial Assessment of Novels About Young Burn Survivors and Their Collective Experiences

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S160-S160
Author(s):  
Philip H Chang ◽  
Antonella Barrios ◽  
Jamie Heffernan ◽  
Angela Rabbitts ◽  
Caroline Jedlicka
Keyword(s):  
Performing Arts ◽  
English Language ◽  
Psychosocial Support ◽  
Numerical Data ◽  
Recovery Phase ◽  
Initial Assessment ◽  
Burn Patients ◽  
The Past ◽  
Burn Survivors ◽  
Burn Patient

Abstract Introduction Bibliotherapy is the use of books as a therapeutic intervention for structuring interaction between facilitator and participant based on the mutual sharing of literature. Bibliotherapy has been utilized to address childhood teasing, healthy lifestyles in children, and eating disorders. With the dramatic improvements in survival of burn patients over the past decades, biographies and novels featuring pediatric burn survivors have emerged. These patients often face significant barriers in accessing psychosocial support. Our team hypothesized that bibliotherapy could benefit pediatric burn patients. In order to test this hypothesis, as a first step, our team conducted an assessment of the available burn survivor literature. Methods WorldCat book database was queried using the terms “Burn Patient Fiction” (45 results) and “Burn Patient Biography” (53 results). The authors identified 12 books out of these 98 results likely to be appropriate for adolescent and teenage burn patients based on the brief summaries. The 12 books were then read by the research team and analyzed for burn patient demographics and relevant clinical data when available. Simple descriptive statistics were utilized for numerical data Results Out of 12 books read, 5 were biographies & 7 fictional novels. Protagonists mean age at time of injury was 8.7±5.1 years (range 2–16), with 5 males and 7 females. Average injury size was 57±21% TBSA (range: 14–85). 10 of 12 protagonists suffered facial burns; 7 of 12 suffered hand burns. Oral health/dental issues were described in 4 of 12 books. Geographically, these English language novels spanned Australia (1), Canada 92), and the U.S. (9). Average page length was 237±88 pages (range: 64–372). In 11 of 12 books, mechanism of injury involved flame from car accidents (2), house fires (4), and campfires (2). With regards to sources of positive support during the recovery phase, family was the most commonly cited source (11 novels) followed by friends (10), spiritual/religious support (5), sports (3), burn survivor groups (3), hospital psychiatrists (3), and performing arts (2). Appropriate audience group for most books were teenagers (11) with 5 books deemed also appropriate for adults (only 1 book judged appropriate only for adults), and 2 books appropriate for adolescents. Conclusions Several novels and biographies with pediatric burn survivor protagonists have been written over the past 20 years. Commonalities across these books include flame burn etiology, relatively large TBSA, and burn injuries to visible body areas (face and hand). Family and friends were the most common emotional support for these protagonists. Most books were appropriate for teenagers.

45 Application of Machine Learning Models to Thermal Burn Patient Outcome Predictions in the Aftermath of a Nuclear Event

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S33-S34
Author(s):  
Morgan A Taylor ◽  
Randy D Kearns ◽  
Jeffrey E Carter ◽  
Mark H Ebell ◽  
Curt A Harris
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Regression Models ◽  
Large Scale ◽  
Prediction Models ◽  
Burn Patients ◽  
Thermal Burn ◽  
Logistic Regression Models ◽  
Burn Patient

Abstract Introduction A nuclear disaster would generate an unprecedented volume of thermal burn patients from the explosion and subsequent mass fires (Figure 1). Prediction models characterizing outcomes for these patients may better equip healthcare providers and other responders to manage large scale nuclear events. Logistic regression models have traditionally been employed to develop prediction scores for mortality of all burn patients. However, other healthcare disciplines have increasingly transitioned to machine learning (ML) models, which are automatically generated and continually improved, potentially increasing predictive accuracy. Preliminary research suggests ML models can predict burn patient mortality more accurately than commonly used prediction scores. The purpose of this study is to examine the efficacy of various ML methods in assessing thermal burn patient mortality and length of stay in burn centers. Methods This retrospective study identified patients with fire/flame burn etiologies in the National Burn Repository between the years 2009 – 2018. Patients were randomly partitioned into a 67%/33% split for training and validation. A random forest model (RF) and an artificial neural network (ANN) were then constructed for each outcome, mortality and length of stay. These models were then compared to logistic regression models and previously developed prediction tools with similar outcomes using a combination of classification and regression metrics. Results During the study period, 82,404 burn patients with a thermal etiology were identified in the analysis. The ANN models will likely tend to overfit the data, which can be resolved by ending the model training early or adding additional regularization parameters. Further exploration of the advantages and limitations of these models is forthcoming as metric analyses become available. Conclusions In this proof-of-concept study, we anticipate that at least one ML model will predict the targeted outcomes of thermal burn patient mortality and length of stay as judged by the fidelity with which it matches the logistic regression analysis. These advancements can then help disaster preparedness programs consider resource limitations during catastrophic incidents resulting in burn injuries.

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.

How Patients Experience Pastoral Care in a Tertiary Health Care Setting

2016 ◽  
Vol 70 (4) ◽  
pp. 272-280 ◽  
Author(s):  
Rev. Jenni Ashton ◽  
Deidre Madden ◽  
Leanne Monterosso
Keyword(s):  
Health Care ◽  
Pastoral Care ◽  
Spiritual Care ◽  
Care Setting ◽  
Private Hospital ◽  
Response Rate ◽  
Positive Impact ◽  
Care Provision ◽  
Consumer Experience ◽  
Patients Experience

This research aimed to establish the level of consumer experience with pastoral/spiritual care provision in a large tertiary private hospital. Two hundred and twenty-seven patients and bereaved carers of deceased patients who had received pastoral care were surveyed, with a response rate of 20% ( n = 44). The key finding was the positive impact of pastoral care encounters, with the majority of respondents reporting provision of pastoral care to be helpful, and offered with courtesy and respect.

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