DIFFERENCE IN RECOVERY TIME BETWEEN GENDERS AFTER CONCUSSION

Background: Recent literature has shown that between the two sexes, females sustain concussions at a higher rate than males. However, other studies have shown that males take a longer time recover after a concussion than females. Currently, there is limited research done on gender and recovery time in adolescents. Sex is defined as a biological concept that is assigned at birth whereas gender is defined as somebody’s internal self-identification. This study aims to determine if there is a difference in recovery time between genders. Methods: Patients diagnosed with a concussion in our sports medicine clinic were prospectively enrolled into a mild traumatic brain injury (mTBI) repository. 300 patient charts were reviewed. Age, non-binary gender identification, date of injury, first appointment date, and clearance date (Level V) were identified. Post-concussive syndrome (PCS) was also noted. Patients were also recognized if they were lost to follow up. Level of clearance was determined by the 4th International Conference on Concussion in Sports (Zurich 2012) with the following supervised protocol: Level 4: Non-contact training drills, Level 5: Full contact training after medical clearance. Results: 60% (180/300) of patients were cleared for return to play. 57% (171/180) of patients were cleared for a Level V and 5% (9/180) patients were cleared for a Level IV with gradual return to play. 120 (40%) patients were lost to follow up and not cleared, 60% (73/120) identified as male and 40% (47/120) identified as female. For the patients that were cleared, 67% (121/180) of patients identified as male (mean age=13 years) (range 5 to 18 years) and 33% (59/180) of patients identified as female (mean age=14 years) (range 5 to 20 years). From date of injury to recovery time, male patients were cleared on average after 62 days and female patients were cleared on average after 82 days. There was no significant difference between the two genders identified in this specific population (p=0.17). 14% of females and 15% of males were diagnosed with PCS. From date of injury to first appointment with a physician, male and female patients reported going an average 17 days post injury, with no significant difference (p=0.53). Conclusion: Rate of recovery time for patients that sustained a concussion showed no significant difference among genders. Further research is necessary for a comprehensive review of all genders to identify recovery time and appropriate treatment management.

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Direct Comparison of Modified Jobe and Docking Ulnar Collateral Ligament Reconstruction at Midterm Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546518812421 ◽

2018 ◽

Vol 47 (1) ◽

pp. 144-150 ◽

Cited By ~ 3

Author(s):

Justin W. Arner ◽

Edward S. Chang ◽

Stephen Bayer ◽

James P. Bradley

Keyword(s):

Reconstructive Surgical Procedures ◽

Ulnar Collateral Ligament ◽

Return To Play ◽

Shoulder Injuries ◽

Collateral Ligament ◽

Level Of Evidence ◽

Overhead Athletes ◽

Additional Surgery ◽

Significant Difference

Background: The modified Jobe and docking techniques are the 2 most commonly employed techniques for ulnar collateral ligament (UCL) reconstruction among overhead athletes. However, no study has directly compared these techniques performed by a single surgeon. Current comparisons of these techniques have relied solely on systematic reviews and biomechanical studies. Hypothesis: There will be no difference in outcomes or return to play between the modified Jobe and docking techniques in elbow UCL reconstruction surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-five modified Jobe and 26 docking UCL-reconstructive surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway Scale, years played, sex, handedness, sport, position, palmaris versus gracilis graft type, concomitant or future arm/shoulder injuries, and need for additional surgery were compared between the groups. Patients who underwent future shoulder or elbow surgery, no matter the cause, were included. Results: No difference was seen between the modified Jobe and docking reconstruction cases in regard to KJOC scores (mean ± SD: 78.4 ± 19.5 vs 72.0 ± 26.0, P = .44), Conway Scale (return to play, any level: 84% vs 82%, P = .61), years played (14.7 ± 6.2 vs 15.2 ± 5.8, P = .52), sex ( P = .67), handedness ( P ≥ .999), sport ( P = .44), position ( P = .60), level of competition ( P = .59), and future surgery (12% vs 4%, P = .35). Palmaris graft type had significantly higher KJOC scores than hamstring grafts (82.3 ± 20.0 vs 57.9 ± 21.2, P = .001). The mean follow-up was 6.1 years in the modified Jobe group and 7.3 years in the docking group (mean = 6.7, P = .47). Conclusion: The modified Jobe and docking techniques are both suitable surgical options for elbow UCL reconstruction. There was no statistically significant difference between the techniques in regard to return to play, KJOC score, or need for subsequent surgery at 6.7-year follow-up. This is the first direct clinical comparison of these 2 techniques by a single surgeon at midterm follow-up.

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Abstract 14598: Multiple Arterial Coronary Bypass Grafting is Associated With Improved Survival in Females

Circulation ◽

10.1161/circ.142.suppl_3.14598 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Derrick Tam ◽

Rodolfo Rocha ◽

Jiming Fang ◽

Maral Ouzounian ◽

Joanna Chikwe ◽

...

Keyword(s):

Coronary Artery ◽

Propensity Score ◽

Propensity Score Matching ◽

Administrative Databases ◽

Rank Test ◽

Bypass Grafting ◽

Female Patients ◽

Significant Difference ◽

Arterial Grafting

Introduction: Multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) is associated with improved survival and freedom from major adverse cardiac and cerebrovascular events (MACCE) in observational studies of mostly males. It is not known whether the MAG is beneficial in females. Herein, we compared the late clinical outcomes of MAG versus single arterial grafting (SAG) in females undergoing CABG for multivessel coronary artery disease (CAD) Methods: Clinical and administrative databases for Ontario, Canada, were linked to obtain all female patients with angiographic evidence of left main, triple, or double vessel disease undergoing isolated non-emergent primary CABG from 2008-2019. Baseline characteristics were compared and 1:1 propensity score matching was performed to account for differences. 30-day mortality was compared in the matched groups. Late mortality and MACCE ( composite of stroke, myocardial infarction, repeat revascularization, and death) was compared between the matched groups with a stratified log rank test and Cox-proportional hazard model. Results: In total 2,961 and 7,954 females underwent CABG with MAG and SAG respectively for multivessel CAD. Prior to propensity-score matching, compared to SAG, those that underwent MAG were younger (66.0 vs. 68.9 years) and had less comorbidities. After propensity-score matching, 2,446 well-matched pairs were formed. In matched patients, there was no significant difference in 30-day mortality (1.6% vs 1.8%, P=0.43) between MAG and SAG. The median and maximum follow-up was 5.0 and 11.0 years respectively. Over the entire follow-up, MAG was associated with improved survival (Figure, hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.75-0.98) and freedom from MACCE (HR: 0.85, 95%CI: 0.76-0.95). Conclusions: MAG was associated with improved survival and freedom from MACCE and should be considered for female patients with good life expectancy requiring CABG.

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A-31 Association Between Cognitive Activity and Recovery Outcomes in College Students Following Concussion

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa036.31 ◽

2020 ◽

Vol 35 (5) ◽

pp. 627-627

Author(s):

K M Petit ◽

A J Zynda ◽

M Anderson ◽

C P Tomczyk ◽

T Covassin

Keyword(s):

College Students ◽

Symptom Severity ◽

Recovery Time ◽

Cognitive Activity ◽

Symptom Reporting ◽

Future Research ◽

Symptom Scale ◽

Post Injury ◽

Medical Clearance ◽

The Relationship

Abstract Objective To evaluate the relationship between self-reported cognitive activity and recovery outcomes (symptom reporting, recovery time) in college students following concussion. Method Cognitive activity was defined as self-reported minutes spent in class and studying during the first 5 days following concussion. Self-reported symptoms were reported at day 5 post-injury using the Post-Concussion Symptom Scale (PCSS). The PCSS evaluates 22 symptoms on a 7-point Likert Scale from 0 (none) to 6 (severe). Recovery time was defined as total days from injury to unrestricted medical clearance. Separate Spearman’s rank correlations assessed the relationship between total cognitive activity (minutes in class and studying) and recovery outcomes (symptom total (22), symptom severity (132), and recovery time). Alpha level set a priori at 0.05. Results Twenty-one participants (14 female, 7 male, 19.5 ± 1.3 years) averaged a total of 653[IQR = 348] minutes of cognitive activity during the first 5 days after concussion (334[IQR = 149] minutes in class, 273[IQR = 313] minutes studying). Five days after injury, participants self-reported 3[IQR = 8] total symptoms yielding a severity of 4[IQR = 12]. Participants took 15 [IQR = 8] days to reach unrestricted medical clearance. No associations were found between total cognitive load and any post-concussion recovery outcomes (symptom total: Rs = −.299, p = .19; symptom severity: Rs = −.230, p = .32; recovery time: Rs = −.041, p = .86). Conclusions Preliminary analyses suggest that concussed college students can be encouraged to gradually return to normal levels of cognitive activity, as it may not be associated with future symptom reporting or recovery time. Future research is needed to assess specific cognitive activities immediately influence on post-concussion symptom reporting.

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Migraine phenotype prolongs recovery time in traumatic brain injury (TBI)

Neurology ◽

10.1212/01.wnl.0000550689.41463.91 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S17.3-S18

Author(s):

Cynthia Bennett-Brown ◽

Sarah Ostrowski-Delahanty ◽

Tracy Lynn Johnson ◽

M. Cristina Victorio ◽

Susan K. Klein

Keyword(s):

Recovery Time ◽

Outpatient Visit ◽

Office Visit ◽

Return To Play ◽

Behavioral Symptoms ◽

Patients Âgés ◽

Prolonged Recovery ◽

Post Traumatic ◽

Id Migraine

We proposed that children and adolescents who had headache of migraine phenotype at initial neurologic assessment after mild TBI would take longer to clear for return to play than those who did not have those headache characteristics. Additionally, we predicted that those with migraine phenotype would be more likely to have comorbid mood or cognitive symptoms, which would also contribute to prolonged recovery. To test this, we assessed all new patients for the presence or absence of migraine phenotype with the Three-Item ID migraine screener (Lipton et al. 2003) at the first outpatient visit. Over the 5 months follow up interval (October 2017–February 2018), office visit data for 121 patients (ages 0–19 years) showed that 61% presented initially with a migraine phenotype. In that interval, 48% % (N = 58) were cleared for return to play. Those with migraine phenotype headache took longer to clear (99 vs 71 days respectively, p = 0.004). Neither age nor gender made a significant impact on length of recovery when only the presence or absence of migraine phenotype alone was considered. If patients had a migraine (vs non-migraine) phenotype headache and comorbid cognitive or behavioral symptoms (38% in our sample), their time to recovery was prolonged (109 vs 74 days respectively; F (1, 56) = 7.215, p = 0.009). These data suggest that early identification of migraine phenotype in assessment of post-traumatic headache can lead to aggressive treatment of headache, thus shortening the interval of disability after TBI. Cognitive and behavioral symptoms seem to have additional impact on recovery and should be addressed and supported in rehabilitation.

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Efficacy, Safety and tolerability of the once-daily 10 cm² rivastigmine patch formulation in the patients with dementia (with probable Alzheimer’s disease)

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v29i1.56165 ◽

2013 ◽

Vol 29 (1) ◽

pp. 5-14

Author(s):

Anisul Haque ◽

Quazi Deen Mohammad ◽

Nirmalendu Bikash Bhowmik ◽

Biplob Kumar Roy ◽

Md Rafiqul Islam ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Adverse Event ◽

Adverse Events ◽

Patch Size ◽

Tolerability Profile ◽

Rivastigmine Patch ◽

Significant Difference ◽

Lost To Follow Up

Back ground: Treatment compliance in patients with Alzheimer’s disease is particularly important as patients receiving regular treatment have a greater chance of slowing or delaying disease progression. Transdermal delivery has the potential for providing continuous drug delivery and steady plasma levels. Current study aimed to evaluate safety and tolerability of rivastigmine patch, to assess patient compliance and to assess the efficacy of treatment in patients with dementia (with probable Alzheimer’s disease). Methods: A total of 112 dementia patients (with a diagnosis of probable Alzheimer’s disease) from 12 centers were enrolled who were residing with someone in the communities throughout the study. After eligibility, and baseline assessments, patients were entered a 24-week open label treatment phase. All patients were started with application of one 5 cm² patch, followed by an up-titration to the target dose of 10 cm² patch size. Efficacy assessments were performed at weeks 12 and 24 in terms of MMSE and GDS score. Safety was monitored at all assessment points based mainly on the frequency of adverse events. Results: Analysis of baseline and available data until the drop out revealed no significant differentials. Around 95% of the study participants could receive 10 cm² patch size, showing a very high tolerability of the patch. Concurrent medication use also showed significant reduction to 16.3% patient in the end from 25% at baseline. The average MMSE score increased to 19.3 (±3.1) at 12th week and to 20.6(±3.4) at 24th week from 16.8 (±3.2) at baseline. GDS score reduced to 3.7 (±1.4) at 12th week and to 3.2 (±1.3) at 24th week from 4.3 (±1.5) at baseline. Only eight occasions of adverse event was reported (8.2%); no serious adverse event (SAE) were reported. Lost to follow up in the study was 14 (12.5%). Analysis of baseline data shows no significant difference. Their withdrawal seems to be unrelated to the adverse events and treatment outcome. Among the lost to follow up only one 1 (7.1%) had some side effect. Conclusion: Our study supports the pharmacokinetic rationale for the rivastigmine patch, indicating that smooth and continuous delivery of rivastigmine translates into an improved tolerability profile versus conventional oral administration, while maintaining clinical effectiveness. Bangladesh Journal of Neuroscience 2013; Vol. 29 (1) : 5-14

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LO057: Association between metoclopramide treatment in the ED for concussion and persistent post-concussion headaches: a propensity score matching analysis

CJEM ◽

10.1017/cem.2016.94 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S50-S50

Author(s):

N. Bresee ◽

M. Aglipay ◽

N. Barrowman ◽

F. Momoli ◽

A. Dubrovsky ◽

...

Keyword(s):

Propensity Score ◽

Propensity Scores ◽

Secondary Analysis ◽

Self Report ◽

Multivariate Logistic Regression Model ◽

Control Groups ◽

Post Injury ◽

Significant Difference ◽

Persistent Headache

Introduction: There is a paucity of pediatric literature regarding effective treatment for post-concussion headache. The objective of this study was to assess whether metoclopramide treatment in the Emergency Department (ED) within 48 hours of injury was associated with reduced persistent headache symptoms post-concussion at 1-week and 1-month post-injury. Methods: Children aged 8-18 years with acute concussion were enrolled across 9 EDs of the Pediatric Emergency Research Canada network in a prospective cohort study [Predicting and Preventing Post-concussive Problems in Paediatrics (5P)] from August 2013 to June 2015. Treatments administered in ED (including metoclopramide) were collected using standardized forms. Self-report symptom questionnaires were rated at baseline, at 7 and 28 days follow-up using the validated Post-Concussion Symptom Inventory (PCSI). Propensity scores for treatment with metoclopramide were calculated using a multivariate logistic regression model including confounders. Intervention and control groups were matched 1:4 on the logit of the propensity scores using a greedy algorithm and nearest-neighbour approach. The primary outcome was headache persistence at one-month. Results: 2095 patients met inclusion criteria and completed baseline assessment. At 1 and 4 weeks respectively, 54% (963/1808) and 26% (456/1780) of participants completing follow-up had persistent headache symptoms. 50 metoclopramide treated participants were propensity score matched to 234 controls (1:4 matching). At 4 weeks, no statistically significant difference in persistent headache symptoms was observed between the treatment and propensity score matched control groups (OR: 0.67; 95% CI: 0.33-1.36, p=0.26). There was also no statistically significant difference between the groups at 1-week post-concussion (OR 0.58; 95% CI: 0.32-1.05, p=0.07). Conclusion: This secondary analysis was unable to detect a statistically significant association between acute ED treatment with metoclopramide and reduced medium and long-term headache symptoms post-concussion. Nevertheless, the 1-week results hold promise, but require a well-powered RCT to fully address confounding issues to determine the benefit of metoclopramide post-concussion.

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A comparative study of fracture shaft of femur in adults treated with broad dynamic compression plate versus intramedullary interlocking nail

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v12i2.15453 ◽

2016 ◽

Vol 12 (2) ◽

pp. 66-69

Author(s):

Sushil Thapa ◽

Shrawan Kumar Thapa ◽

Shankar Dhakal ◽

Rudra Marasini ◽

Bhadra Hamal ◽

...

Keyword(s):

Dynamic Compression ◽

Femoral Shaft ◽

Plate Versus ◽

Femoral Diaphysis ◽

Medical Sciences ◽

Significant Difference ◽

Lost To Follow Up ◽

Mean Time ◽

Time From Injury

Background and Objectives: Diaphyseal femur fracture is one of the commonest fractures to present in an emergency room. The objective of the study was to compare femoral shaft fractures treated using nail with those using plate and screws. Patients and Methods: We studied a total of 62 patients of fracture shaft of femur admitted in the Bharatpur Hospital, Bharatpur, Chitwan and National Academy of Medical Sciences, BirHospital,Kathmandu. Two cases were lost to follow up. Thirty cases were treated with plating and 30 cases with nailing. The age group was from 16-30 years. Fifty-three were male and seven were females. Fifty-eight patients had closed fracture and two had Gustillo Anderson grade I openfracture. Result: Time from injury to surgery was 19 days on an average. Mean time for union was more in patients treated by plating, 19.46 weeks as compared to nailing 14.78 weeks. We found one case of infection with plating and breakage of plate in four patients. One patient with nailing did not show any signs of healing and two had failure in case of nailing. Our series revealed 23(38.3%) excellent, five (8.3%) good and two (3.3%) poor results in patients who had nailing while 15 (25.5%) excellent, nine (15%) good, one (1.7%) fair and five (8.3%) poor in patients who had plating out of 30 patients in each group. Conclusion:In our study we found that there was no significant difference in outcomes between plating and intramedullary nailing of femoral diaphysis fracture in terms of union, infection and implant failure.JCMS Nepal. 2016;12(2):66-9.

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Multidisciplinary Management of Pediatric Sports-Related Concussion

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.312 ◽

2016 ◽

Vol 44 (1) ◽

pp. 24-34 ◽

Cited By ~ 16

Author(s):

Michael J. Ellis ◽

Lesley J. Ritchie ◽

Patrick J. McDonald ◽

Dean Cordingley ◽

Karen Reimer ◽

...

Keyword(s):

Clinical Characteristics ◽

Return To Play ◽

Multidisciplinary Management ◽

Duration Of Symptoms ◽

Clinical Criteria ◽

Pediatric Concussion ◽

The Mean ◽

Concussion Recovery ◽

Lost To Follow Up

AbstractObjectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.

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Association of serum uric acid levels with COVID-19 severity

BMC Endocrine Disorders ◽

10.1186/s12902-021-00745-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fang Hu ◽

Yifan Guo ◽

Jianghong Lin ◽

Yingjuan Zeng ◽

Juan Wang ◽

...

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Linear Regression Analysis ◽

Healthy Controls ◽

Time Points ◽

Female Patients ◽

Significant Difference ◽

Severe Group ◽

Male Patients

Abstract Aims Hyperuricemia has attracted increasing attention. However, limited concern has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in patients with COVID-19. Therefore, we aim to explore whether patients with COVID-19 had SUA lower than normal and the relationship of SUA and the severity of COVID-19. Methods This was a case–control study based on 91 cases with COVID-19 and 273 age- and sex-matched healthy control subjects. We first compared SUA levels and uric acid/creatinine (UA/Cr) ratio between patients with COVID-19 and the healthy controls. Then, we examined the association of SUA levels and UA/Cr ratios with COVID-19 severity in COVID-19 cases only, defined according to the fifth edition of China’s Diagnosis and Treatment Guidelines of COVID-19. Results SUA levels in patients with COVID-19 were 2.59% lower, UA/Cr ratios 6.06% lower at admission compared with healthy controls. In sex stratified analysis, levels of SUA and UA/Cr were lower in male patients with COVID-19 while only level of SUA was lower in female patients with COVID-19. Moreover, SUA and UA/Cr values were 4.27 and 8.23% lower in the severe group than that in the moderate group among male COVID-19 patients. Bivariate and partial correlations analysis showed negative correlations between SUA or UA/Cr ratio and COVID-19 after adjusting for age, sex, BMI and eGFR. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent risk factors associated with lower SUA levels. Male patients with COVID-19 accompanied by low SUA levels had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11, 14.72) at admission. Comparing SUA and UA/Cr ratio at three time points (admission, discharge, and follow-up), we found that male patients experienced severe symptoms had lower SUA and UA/Cr ratio levels comparing to moderate patients, but no significant difference between three time points. On the contrary, female patients had lower SUA and UA/Cr ratio at discharge than those at admission, but no significant difference of SUA and UA/Cr ratio between moderate and severe group. Conclusion Patients with COVID-19 had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher crude risk of developing severe symptoms than those with high SUA levels. During disease aggravation, the level of SUA gradually decreased until discharge. At the follow-up exam, the level of SUA was similar to the levels at admission.

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60 A Retrospective Review of Factors Influencing Post-Hospital Discharge Follow-up in Patients with Burn Injuries

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.064 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S43-S44

Author(s):

Ryan C Taylor ◽

Claudia Islas ◽

Karen J Richey ◽

Kevin N Foster

Keyword(s):

Substance Abuse ◽

Mental Illness ◽

Native Americans ◽

Length Of Stay ◽

Retrospective Chart Review ◽

Burn Injuries ◽

Outpatient Visits ◽

Significant Difference ◽

Lost To Follow Up

Abstract Introduction Approximately 486,000 burn injuries, requiring hospitalization and/or outpatient care occur annually. Physical and psychosocial problems may develop at any time during recovery and it is important that care continue after discharge to maximize outcomes. Often, patients discharge themselves from clinic for unknown reasons. The purpose of this study was to identify factors related to self-discharge. Methods A retrospective chart review of patients admitted to the burn center and outpatient follow up visits in 2018 was performed. Patients were grouped by lost to follow up (LTF) versus completed patients (COM). The LTF were further stratified by distance from clinic (≤ 50 miles vs. > 50 miles). COM were categorized as those who were discharged from clinic as PRN follow up visits. Results A total of 211 patients were scheduled for outpatient visits, mean age was 36.4 years and 74% were male. Most were Caucasian (41%) and Hispanic (31%). The most frequent payor sources were Medicaid (58%)/ Medicare (17%). Mean TBSA was 5.8 %, the most common mechanisms were Flame/Flash and Scald (30% each). Mean length of stay was 10.3 days, mean number of surgeries was 1.5. The majority of patients were discharged Home (71%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. LTF patients had a smaller TBSA (4.69%) compared to COM (9.62%). Comparison between LTF and COM, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=< 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p< 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group. When LTF were stratified by distance, Native Americans were significantly more likely to live > 50 miles from the clinic (p < .00001). Conclusions A large percentage of patients discharged themselves from clinic. Factors associated with self-discharge include healed wounds, no scarring issues, smoking, substance abuse and mental illness. Given the geographic distribution of races and ethnicities in our state, it is unsurprising that Native Americans live distant to our clinic. This provides an opportunity to expand our outreach efforts and incorporate the use of technology to improve access to care for this population.

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