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Patel KF, Ni P, Surette KE, Rencken CA, Rodríguez-Mercedes SL, McGwin MB, Fabia R, Tully C, Warner P, Romanowski KS, Palmieri T, Stoddard FJ, Schneider JC, Kazis LE, Ryan CM. Development of the Preschool Life Impact Burn Recovery Evaluation (PS-LIBRE1-5) Profile. J Burn Care Res 2024; 45:136-144. [PMID: 37703100 PMCID: PMC10872560 DOI: 10.1093/jbcr/irad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Indexed: 09/14/2023]
Abstract
Physical, social, and psychological outcomes have been identified as relevant to the rehabilitation process of children with burn injuries. Existing legacy measures are limited in item content and only cover a few constructs. Condition-specific outcomes are highly relevant to gauge early growth and development. Computerized adaptive tests (CATs) leveraging advanced psychometric technologies minimize respondent burden. This project developed PS-LIBRE1-5 Profile CAT (Preschool Life Impact Burn Recovery Evaluation) to measure relevant postburn outcomes in children aged one to five. Responses to the field-tested PS-LIBRE1-5 Profile (188 items) were measured on a scale of frequency or ability. Scores were coded from 0 to 4 where higher scores reflected better functioning. Factor analysis identified the items retained in the final item bank of each scale. CAT simulations were conducted to estimate the mean score of each scale. The simulated CAT score and full item bank scores were compared based upon the score range, ceiling and floor effects, and marginal reliabilities. The child mean age was 3.0 ± 1.5 years (n = 500). Average burn size and time since burn injury were 4.2% TBSA and 1.1 years, respectively. Psychometric analysis resulted in eight scales: Physical, Communication and Language, Emotional Wellbeing, Mood, Anxiety, Peer Acceptance, Play, and Peer Relations. Ceiling effects were acceptable at <13% for all scales. Marginal reliabilities of the CATs were credible. The PS-LIBRE1-5 Profile CAT contains 111 items, and is a comprehensive measure that captures physical, communication and language, psychological, and social functioning of preschool burn survivors.
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Affiliation(s)
- Khushbu F Patel
- Shriners Children's Boston, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA, USA
| | | | | | | | | | - Renata Fabia
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Carrie Tully
- Children's National Hospital, Washington, DC, USA
| | - Petra Warner
- Shriners Children's Ohio, Dayton, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - Kathleen S Romanowski
- Shriners Children's Northern California, Sacramento, CA, USA
- University of California-Davis, Davis, CA, USA
| | - Tina Palmieri
- Shriners Children's Northern California, Sacramento, CA, USA
- University of California-Davis, Davis, CA, USA
| | - Frederick J Stoddard
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey C Schneider
- Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Spaulding Rehabilitation Outcomes Center, Charlestown, MA, USA
| | - Lewis E Kazis
- Boston University School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Outcomes Center, Charlestown, MA, USA
| | - Colleen M Ryan
- Shriners Children's Boston, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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2
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Heard J, Sen S, Greenhalgh D, Palmieri T, Romanowski K. Use of Cultured Epithelial Autograft in Conjunction with Biodegradable Temporizing Matrix in Massive Burns: A Case Series. J Burn Care Res 2023; 44:1434-1439. [PMID: 37227867 DOI: 10.1093/jbcr/irad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 05/27/2023]
Abstract
Intensive care for massively burn patients has increased survival and highlights the need for a solution to the problem of insufficient donor sites for autologous skin coverage. In this case series, we present 10 patients with average burn size of 81% TBSA and mean age of 24 years old, who underwent burn excision followed by either immediate or delayed biodegradable temporizing matrix (BTM) placement. After an integration period, the BTM was delaminated either the day before or immediately prior to placement of cultured epithelial autografts over a widely meshed (4:1 or 6:1) split thickness skin graft. One patient had cultured epithelial autografts alone, without split thickness skin graft, placed on integrated BTM and had successful take. Seven patients survived to discharge and had average 95% wound closure at 135 ± 35 days. The patients had on average 10.4 total operations and 8.7 excision and grafting operations. Five patients had complications related to the BTM requiring removal or replacement including three fungal infections, one bacterial infection and one with bleeding and a large clot burden. In conclusion, this surgical strategy is a viable option for patients with massive burns and insufficient donor for autologous skin grafting.
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Affiliation(s)
- Jason Heard
- Burn Division, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Soman Sen
- Burn Division, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - David Greenhalgh
- Burn Division, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Tina Palmieri
- Burn Division, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Kathleen Romanowski
- Burn Division, Department of Surgery, University of California Davis, Sacramento, CA, USA
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Greenhalgh DG, Hill DM, Burmeister DM, Gus EI, Cleland H, Padiglione A, Holden D, Huss F, Chew MS, Kubasiak JC, Burrell A, Manzanares W, Gómez MC, Yoshimura Y, Sjöberg F, Xie WG, Egipto P, Lavrentieva A, Jain A, Miranda-Altamirano A, Raby E, Aramendi I, Sen S, Chung KK, Alvarez RJQ, Han C, Matsushima A, Elmasry M, Liu Y, Donoso CS, Bolgiani A, Johnson LS, Vana LPM, de Romero RVD, Allorto N, Abesamis G, Luna VN, Gragnani A, González CB, Basilico H, Wood F, Jeng J, Li A, Singer M, Luo G, Palmieri T, Kahn S, Joe V, Cartotto R. Surviving Sepsis After Burn Campaign. Burns 2023; 49:1487-1524. [PMID: 37839919 DOI: 10.1016/j.burns.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
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Affiliation(s)
- David G Greenhalgh
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA.
| | - David M Hill
- Department of Clinical Pharmacy & Translational Scre have been several studies that have evaluatedience, College of Pharmacy, University of Tennessee, Health Science Center; Memphis, TN, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eduardo I Gus
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Canada
| | - Heather Cleland
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Alex Padiglione
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Dane Holden
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University/Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, Monash University and Alfred Hospital, Intensive Care Research Center (ANZIC-RC), Melbourne, Australia
| | - William Manzanares
- Department of Critical Care Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - María Chacón Gómez
- Division of Intensive Care and Critical Medicine, Centro Nacional de Investigacion y Atencion de Quemados (CENIAQ), National Rehabilitation Institute, LGII, Mexico
| | - Yuya Yoshimura
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wei-Guo Xie
- Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Paula Egipto
- Centro Hospitalar e Universitário São João - Burn Unit, Porto, Portugal
| | | | | | | | - Ed Raby
- Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Soman Sen
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Chunmao Han
- Department of Burn and Wound Repair, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Asako Matsushima
- Department of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Moustafa Elmasry
- Department of Hand, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carlos Segovia Donoso
- Intensive Care Unit for Major Burns, Mutual Security Clinical Hospital, Santiago, Chile
| | - Alberto Bolgiani
- Department of Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Laura S Johnson
- Department of Surgery, Emory University School of Medicine and Grady Health System, Georgia
| | - Luiz Philipe Molina Vana
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Nikki Allorto
- Grey's Hospital Pietermaritzburg Metropolitan Burn Service, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Gerald Abesamis
- Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Virginia Nuñez Luna
- Unidad Michou y Mau Xochimilco for Burnt Children, Secretaria Salud Ciudad de México, Mexico
| | - Alfredo Gragnani
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina Bonilla González
- Department of Pediatrics and Intensive Care, Pediatric Burn Unit, Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo Basilico
- Intensive Care Area - Burn Unit - Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Fiona Wood
- Department of Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Jeng
- Department of Surgery, University of California, Irvine, CA, USA
| | - Andrew Li
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Mervyn Singer
- Department of Intensive Care Medicine, University College London, London, United Kingdom
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongqing, China
| | - Tina Palmieri
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven Kahn
- The South Carolina Burn Center, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victor Joe
- Department of Surgery, University of California, Irvine, CA, USA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
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Heard J, Cronin L, Romanowski K, Greenhalgh D, Palmieri T, Sen S. Massive Burn Injuries: Characteristics and Outcomes From a Single Institution. J Burn Care Res 2023; 44:925-930. [PMID: 36378582 DOI: 10.1093/jbcr/irac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Massive burn injuries are a unique patient population with unique treatment paradigms. Data from 155 adult patients, admitted from 2009 to 2019, with >50% total body surface area burns (TBSA) were collected and analyzed. Average burn size was 70% TBSA and 63% had a concomitant inhalation injury. Approximately 30% of patients (46/155) transitioned to comfort care-only measures within 24 hours of admission. Standard treatment patients were younger (37 ± 13 vs 60 ± 19 years; p < .00001), male (94% vs 28%; p = .001) and had smaller TBSA (66 ± 13 vs 80 ± 16; p < .00001). Of the standard treatment group, 72 (66%) survived to discharge. Survivors had smaller TBSA (64 ± 13 vs 71 ± 13; p = .003), less third-degree TBSA (48 ± 25 vs 71 ± 13; p = .003) and lower incidence of renal failure requiring dialysis (22% vs 73%, p < .00001). Multivariate regression analysis showed that age (OR 1.05; p = .025), total TBSA (OR 1.07; p = .005), and renal failure (OR 10.2; p = .00005) were independently associated with mortality. Inhalation injury was not significantly associated with mortality. About 23% (35/155) of patients had a psychiatric condition on admission and 19% (30/155) of patients were burned attempting suicide. Patients with psychiatric conditions spent more time in the hospital (62 vs 30 days; p = .004), more time on ventilator (31 vs 12 days; p = .046), underwent more surgery (4 vs 2 operations, p = .03), and were less likely to die (34% vs 59%; p = .02). In summary, age, burn size, and renal failure were independently associated with mortality, with renal failure being the strongest factor. Psychiatric conditions are prevalent pre-injury and tend to require more inpatient care.
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Affiliation(s)
- J Heard
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - Laura Cronin
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - K Romanowski
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - D Greenhalgh
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - T Palmieri
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - S Sen
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
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5
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Wallace D, Sloan K, Williams D, Heard J, Sen S, Palmieri T, Greenhalgh D, Romanowski K. Poverty and Frailty Are Not Related to Each Other with Regards to Outcomes in Middle Aged and Older Patients with Burn Injuries. J Burn Care Res 2023; 44:517-523. [PMID: 36881932 DOI: 10.1093/jbcr/irad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Indexed: 03/09/2023]
Abstract
The purpose of this study was to determine the relationship between frailty and poverty in burn patients >50 years-old, and their association with patient outcomes. This was a single-center retrospective chart review from 2009-2018 of patients >50 years old admitted with acute burn injuries. Frailty was assigned using the Canadian Study of Health and Aging Clinical Frailty Scale. Poverty was defined as a patient from a zip code that had >20% of people living in poverty. The relationship between frailty and poverty, as well as each variable independently on mortality, length of stay (LOS), and disposition location was examined. Of 953 patients, the median age was 61 years, 70.8% were male, and median total body surface area burn was 6.6%. Upon admission, 26.4% and 35.2% patients were frail and from impoverished neighborhoods, respectively. The mortality rate was 8.8%. Univariate analysis demonstrated that non-survivors had significantly higher chances of living in poverty (p=0.02) and were more likely to be frail compared to survivors. There was no significant correlation between poverty and frailty (p=0.08). Multivariate logistic regression confirmed the relationship between lack of poverty and mortality (OR 0.47 95% CI 0.25-0.89) and frailty and mortality OR 1.62 95%CI 1.24-2.12). Neither poverty (p=0.26) nor frailty (p=0.52) was associated with LOS. Both poverty and frailty were associated with a patient's discharge location (p=0.03; p<0.0001). Poverty and frailty each independently predict mortality and discharge destination in burn patients >50, but they are not associated with LOS nor each other.
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Affiliation(s)
- David Wallace
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA. 2315 Stockton Blvd, Sacramento, CA 95817, United States of America.,Shriners Children's Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, United States of America
| | - Keturah Sloan
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA. 2315 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Deborah Williams
- Shriners Children's Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, United States of America
| | - Jason Heard
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA. 2315 Stockton Blvd, Sacramento, CA 95817, United States of America.,Shriners Children's Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, United States of America
| | - Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA. 2315 Stockton Blvd, Sacramento, CA 95817, United States of America.,Shriners Children's Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, United States of America
| | - Tina Palmieri
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA. 2315 Stockton Blvd, Sacramento, CA 95817, United States of America.,Shriners Children's Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, United States of America
| | - David Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA. 2315 Stockton Blvd, Sacramento, CA 95817, United States of America.,Shriners Children's Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, United States of America
| | - Kathleen Romanowski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA. 2315 Stockton Blvd, Sacramento, CA 95817, United States of America.,Shriners Children's Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, United States of America
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Hauser N, Branch B, Palmieri T. 1378. Fungal infections in burn patients during Northern California wildfires. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Wildfires are an increasing human health concern. In 2020 there were nearly 10,000 fires in California including 5 of the 6 largest wildfires recorded in the state, burning 4.1million acres. In addition to the known risks of direct burn and inhalation injury, extreme heat exposure, and psychological stress, there are unrecognized infection risks associated with smoke exposure. Fungal elements travel great distances in the air, and smoke significantly alters the number and diversity of fungal particles in affected geographical regions. Aims: To analyze the incidence and contributing factors for mould infections in hospitalized burn patients in the fall of 2020, during the peak of wildfire season.
Methods
We reviewed the electronic medical records for all patients admitted with burns in the fall of 2020 and recorded demographics, treatment, and outcomes. Data was stored in a secure electronic database.
Results
Of the 10 patients admitted with wildfire related burns, 4 developed mould infections. Two additional cases were diagnosed in patients burned in a plane crash and one in a house fire. Five of the 7 patients (71%) were men; patients had a mean age of 37.7 years (range 24-56 years); mechanism in 4 of the 7 was direct wildfire exposure (57.1%); mean total body surface area (TBSA) burned was 69% (range 44-90%). Mould infection was identified on or after hospital day 14 in all patients. A total of 5 mould genera were isolated, with Aspergillus mould genus isolated from 6 patients (85.7%). All 7 patients (100%) were treated with at least 2 days of antibacterials before identification of mould infection; 4 (57.1%) of the patients died before leaving the hospital. Following this period, mould cases decreased to baseline low levels of < 10% for all burn sizes.
Conclusion
Wildfires in the western United States have had a devastating effect on the ecosystem and human health. We suspect that wildfires may increase the risk of invasive mold infections in burn patients with ambient wildfire smoke exposure. We observed a disproportionate number of invasive mould infections in hospitalized burn patients during large wildfires, which may have a significant impact on the seasonal treatment of burn patients. The relationship between wildfires and fungal infection warrants future investigation.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Naomi Hauser
- University of California Davis , Sacramento, California
| | | | - Tina Palmieri
- University of California Davis , Sacramento, California
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7
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Griffin B, Cabilan C, Ayoub B, Xu H(G, Palmieri T, Kimble R, Singer Y. The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: A systematic review and meta-analysis. Australas Emerg Care 2022; 25:367-376. [DOI: 10.1016/j.auec.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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Djärv T, Douma M, Palmieri T, Meyran D, Berry D, Kloeck D, Bendall J, Morrison LJ, Singletary EM, Zideman D. Duration of cooling with water for thermal burns as a first aid intervention: A systematic review. Burns 2022; 48:251-262. [PMID: 34916091 DOI: 10.1016/j.burns.2021.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cooling thermal burns with running water is a recommended first aid intervention. However, guidance on the ideal duration of cooling remains controversial and inconsistent across organisations. AIM To perform a systematic review of the evidence for the question; Among adults and children with thermal burn, does active cooling using running water as an immediate first aid intervention for 20 min or more, compared with active cooling using running water for any other duration, change the outcomes of burn size, burn depth, pain, adverse outcome (hypothermia) or complications? METHOD We searched Medline, Embase, Cochrane Database of Systematic Reviews and used ROBINS-I to assess for risk of bias. We used Grading of Recommendations, Assessment, Development and Evaluation methodology for determining the certainty of evidence. We included all studies that compared the selected outcomes of the duration of cooling of thermal burns with water in all patient ages. (PROSPERO registration number: CRD42021180665). From 560 screened references, we included four observational studies. In these studies, 48% of burns were cooled for 20 min or more. We found no benefit for a duration of 20 min or more of cooling when compared with less than 20 min of cooling for the outcomes of size and depth of burn, re-epithelialization, or skin grafting. The evidence is of very low certainty owing to limitations in study design, risk of bias and indirectness. CONCLUSION The optimal duration of cooling for thermal burns remains unknown and future prospective research is indicated to better define this treatment recommendation.
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Affiliation(s)
- Therese Djärv
- Department of Medicine Solna, Karolinska Institute and Division of Acute and Reparative Medicine, Karolinska University Hospital, Sweden.
| | - Matthew Douma
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Tina Palmieri
- Burn Division, University of California Davis and Shriners Hospital for Children Northern California, Sacramento, CA, USA.
| | - Daniel Meyran
- Bataillon de Marins Pompiers de Marseille, French Red Cross, France.
| | - David Berry
- Department of Kinesiology, Saginaw Valley State University, University Center, MI, USA.
| | - David Kloeck
- Department of Critical Care, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jason Bendall
- Department of Rural Health, University of Newcastle, Newcastle, Australia.
| | - Laurie J Morrison
- Emergency Department, St Michael´s Hospital, Division of Emergency Medicine, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Eunice M Singletary
- University of Virginia, Department of Emergency Medicine, Charlottesville, VA, USA.
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Martens S, Romanowksi K, Palmieri T, Greenhalgh D, Sen S. Massive Pediatric Burn Injury : A ten-year review. J Burn Care Res 2021; 44:670-674. [PMID: 34718611 DOI: 10.1093/jbcr/irab201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Indexed: 11/13/2022]
Abstract
Advances in the care of burn injured pediatric patients has improved mortality over the last 20 years. However, massive burn injuries (50% total body surface area or greater) in pediatric patients, while overall rare, have a significant morbidity and mortality. The primary aim for this study is to analyze treatment and outcomes in massive pediatric burn injuries. A retrospective study of children with burn injuries 50% TBSA or greater who were admitted to Shriners Hospital for Children Northern California, from May 1, 2009 to May 22, 2020 was conducted. Data was collected from the electronic health records through a comprehensive chart review that included: patient demographics, past medical history, treatment interventions and outcomes. This study included 69 patients (59.4% male) with a mean age of 8.7 ± 6 years old. The median time from injury to admission was 2 (1- 4) days. 63.8% of patients were from Mexico, 34.8% were from the United States and 1 patient was from American Samoa. The median time from injury to admission was 2 (1- 4) days. Mean TBSA was 66 ± 12 %. The median TBSA of second-degree burns was 0 (0- 6)%, and the mean TBSA of third-degree burns was 60 ± 16%. 40% of patients suffered an inhalation injury and 83% of patients received a tracheostomy. The median number of days requiring ventilator assistance was 26 (12-58) days. Mean length of hospitalization was 90 ± 60 days, with 61 ± 41 days spent in the ICU. The mean number surgical procedures were 6 ± 4. The time between surgical procedures was 12 ± 6 days. The median time from admission to the first surgical procedure was 1 (0-2) day. At the first procedure, a mean 42 ± 15% TBSA of the burn injury was excised. 62% of patients received autografting (22 ± 11% TBSA) and 52% of patients received allografting (27 ± 17% TBSA) during the first procedure. For survivors, the median number of inpatient occupational therapy encounters were 143.5 (83-215) and inpatient physical therapy encounters were 139.5 (81-215). 25% of the patients included in this study died as a result of their burn injury. Multivariate regression revealed that sustaining an inhalation injury was a significant and independent predictor of death (OR- 3.4, (1.05-11 95% CI), p=0.04). Massive burn injuries in children required a very high number of surgical procedures and hospital resources. Most children who died as a result of their massive burn injury, died within the first month of admission. Inhalation independently increases the risk of dying in pediatric patients with a massive burn injury.
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Affiliation(s)
- Sally Martens
- Department of Burn Surgery, Shriners Hospital for Children Northern California, Stockton Blvd, Sacramento, CA
| | - Kathleen Romanowksi
- Department of Burn Surgery, Shriners Hospital for Children Northern California, Stockton Blvd, Sacramento, CA
| | - Tina Palmieri
- Department of Burn Surgery, Shriners Hospital for Children Northern California, Stockton Blvd, Sacramento, CA
| | - David Greenhalgh
- Department of Burn Surgery, Shriners Hospital for Children Northern California, Stockton Blvd, Sacramento, CA
| | - Soman Sen
- Department of Burn Surgery, Shriners Hospital for Children Northern California, Stockton Blvd, Sacramento, CA
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10
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Sen S, Romanowski K, Miotke S, Palmieri T, Greenhalgh D. Burn Prevention in the Elderly: Identifying Age and Gender Differences in Consumer Products Associated With Burn Injuries. J Burn Care Res 2021; 42:14-17. [PMID: 33031521 DOI: 10.1093/jbcr/iraa175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Elderly suffer worse outcomes from burns; thus, it is important to identify the causes of burns in the elderly to develop burn prevention campaigns. We performed a 10-year review of burns that were registered in the NEISS database. We included patients at least 65 years old and analyzed the top five products that caused burn injury. In adults 65 to 74 years old, hot water was the most common cause of burns. Women suffered more burns by candles and cookware. Heaters/heating systems and gasoline were among the top five causes of burns in only men. For the age group 75 to 84 years old, the most common burn was from hot water in women and gasoline in men. For women, the top five included candles, nightwear, and cookware. Only men suffered gasoline burns. The majority of daywear, home/room fire, and ranges/ovens caused burns occurred in men. The majority of burns from hot water, ranges/ovens, electric heating pads, and bathtubs/showers occurred in women. For men, burns from gasoline, structural fires, and heaters are more prevalent. This data can be used to develop age- and gender-specific prevention campaigns to reduce the risk of burn injury.
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Affiliation(s)
- Soman Sen
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
| | - Kathleen Romanowski
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
| | - Sam Miotke
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
| | - Tina Palmieri
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
| | - David Greenhalgh
- Department of Surgery, University of California Davis, Sacramento.,Division of Burn Surgery, Shriners Hospital for Children Northern California, Sacramento
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11
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Glas GJ, Horn J, Hollmann MW, Preckel B, Colpaert K, Malbrain M, Neto AS, Asehnoune K, de Abreu MG, Martin-Loeches I, Pelosi P, Sjöberg F, Binnekade JM, Cleffken B, Juffermans NP, Knape P, Loef BG, Mackie DP, Enkhbaatar P, Depetris N, Perner A, Herrero E, Cachafeiro L, Jeschke M, Lipman J, Legrand M, Horter J, Lavrentieva A, Kazemi A, Guttormsen AB, Huss F, Kol M, Wong H, Starr T, De Crop L, de Oliveira Filho W, Manoel Silva Junior J, Grion CMC, Burnett M, Mondrup F, Ravat F, Fontaine M, Floch RL, Jeanne M, Bacus M, Chaussard M, Lehnhardt M, Mikhail BD, Gille J, Sharkey A, Trommel N, Reidinga AC, Vieleers N, Tilsley A, Onarheim H, Bouza MT, Agrifoglio A, Fredén F, Palmieri T, Painting LE, Schultz MJ. Ventilation practices in burn patients—an international prospective observational cohort study. Burns & Trauma 2021; 9:tkab034. [PMID: 34926707 PMCID: PMC8676707 DOI: 10.1093/burnst/tkab034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Background
It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28).
Methods
This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (VT) was defined as VT ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between VT and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma.
Results
A total of 160 patients from 28 ICUs in 16 countries were included. Low VT was used in 74% of patients, median VT size was 7.3 [interquartile range (IQR) 6.2–8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0–26), without a difference between ventilation with low or high VT (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O.
Conclusion
In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low VT was not associated with a reduction in VFD-28.
Trial registration
Clinicaltrials.gov NCT02312869. Date of registration: 9 December 2014.
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Affiliation(s)
- Gerie J Glas
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Janneke Horn
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Markus W Hollmann
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Benedikt Preckel
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Kirsten Colpaert
- Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1 – 20-059 Lublin – Poland
| | - Manu Malbrain
- AZ JAN PALFIJN GENT Watersportlaan 5 – 9000 Gent – Belgium
- Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1 – 20-059 Lublin – Poland
| | - Ary Serpa Neto
- ABC Medical School, São Paulo, Bangú, SP 5001, Brazil
- Australian and New Zealand Intensive Care Research Centre. Monash University, Melbourne, VIC 3004, Australia
- GH St-Louis- Lariboisière, APHP, Paris 75010, France
| | - Karim Asehnoune
- Service d'Anesthésie Réanimation Chirurgicale, Nantes 44093, France
| | | | | | | | - Folke Sjöberg
- Linköping University Hospital, Linköping 581 85, Sweden
| | - Jan M Binnekade
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | | | - Nicole P Juffermans
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Paul Knape
- Red Cross Hospital, Beverwijk, LE 1942, The Netherlands
| | - Bert G Loef
- Martini Hospital, Groningen, NT 9728, The Netherlands
| | | | | | | | | | - Eva Herrero
- La Paz University Hospital, Madrid 28046, Spain
| | | | - Marc Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Canada
| | - Jeffrey Lipman
- Royal Brisbane and Women’s Hospital, Queensland University, Herston, QLD 4029, Australia
| | - Matthieu Legrand
- GH St-Louis- Lariboisière, APHP, Paris 75010, France
- Hopital Roger Salengro, CHRU Lille, Lille 59037, France
| | | | | | - Alex Kazemi
- Middlemore Hospital, Otahuhu, Auckland 2025, New Zealand
| | | | | | - Mark Kol
- Concord Repatriation General Hospital NSW, University of Sydney, Concord 2139, Australia
| | - Helen Wong
- Concord Repatriation General Hospital NSW, University of Sydney, Concord 2139, Australia
| | - Therese Starr
- Royal Brisbane and Women’s Hospital, Queensland University, Herston, QLD 4029, Australia
| | - Luc De Crop
- Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1 – 20-059 Lublin – Poland
| | | | | | | | | | | | - Francois Ravat
- Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Canada
| | | | | | - Mathieu Jeanne
- CHU Nantes Service dánesthesie reanimation chirugicale, Nantes 44093, France
| | - Morgane Bacus
- CHU Nantes Service dánesthesie reanimation chirugicale, Nantes 44093, France
| | | | | | | | - Jochen Gille
- BG University Hospital Bergmannsheil, Bochum 44789, Germany
| | - Aidan Sharkey
- St James University Hospital, Dublin D08 NHY1, Ireland
| | | | | | | | - Anna Tilsley
- Middlemore Hospital, Otahuhu, Auckland 2025, New Zealand
| | | | | | | | - Filip Fredén
- Uppsala University Hospital, Uppsala 751 85, Sweden
| | | | | | - Marcus J Schultz
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
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Brown LM, Kratz A, Verba S, Tancredi D, Clauw DJ, Palmieri T, Williams D. Pain and Opioid Use After Thoracic Surgery: Where We Are and Where We Need To Go. Ann Thorac Surg 2020; 109:1638-1645. [DOI: 10.1016/j.athoracsur.2020.01.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
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13
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Abstract
There is a clinical trend toward "early mobilization" of patients with burn injury, however mobility is not well defined in burn care. Burn injuries result in various extents of injury, body areas affected, and types of skin graft surgeries needed-all of which may influence the type, timing, safety, and outcome of mobilization activities. This study surveyed burn clinicians to determine current mobility practices and the influence of skin graft surgery on clinical decisions to mobilize patients. A 32-question survey was electronically distributed to burn clinicians and included questions about postoperative range of motion (ROM) and out of bed (OOB) mobility practices for various skin graft types and locations. For all types of grafts on all body locations, the average time after skin graft surgery that patients resumed ROM activities was postoperative day (POD) 3.87 (±2.04) while OOB mobility resumed on POD 2.54 (±1.38). There was significantly greater variability for OOB mobility compared to ROM (coefficient of variation [CV] 0.71 ± 0.8 vs 0.5 ± 0.05). Time to postoperative ROM was significantly different depending on the type of skin graft placed with sheet skin grafts resuming ROM the earliest. Time to OOB mobility after surgery was significantly different for different body locations with grafts placed above the waist resuming OOB mobility earliest. This study provides a summary of current mobility practices and serves as a foundation for future studies investigating the optimal timing and practical application of mobility protocols that may influence safety and outcome of burn survivors.
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Affiliation(s)
- Ingrid Parry
- Shriners Hospital for Children, Northern California, Sacramento
| | - Soman Sen
- Shriners Hospital for Children, Northern California, Sacramento
| | - Tina Palmieri
- Shriners Hospital for Children, Northern California, Sacramento
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14
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Lin J, Falwell S, Greenhalgh D, Palmieri T, Sen S. High-Dose Ascorbic Acid for Burn Shock Resuscitation May Not Improve Outcomes. J Burn Care Res 2020; 39:708-712. [PMID: 29931212 DOI: 10.1093/jbcr/irx030] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
High dose ascorbic acid (HDAA) has been touted to ameliorate inflammation and reduce fluid requirements during burn shock resuscitation (BSR). Whether this leads to improved outcomes is not known. The authors' aim for this study was to compare ventilator days, ventilator-associated pneumonia, and mortality between patients who did and did not receive HDAA during BSR.The authors performed a retrospective case control study from 2012 to 2015. They identified 38 patients (HDAA) who received HDAA during BSR. Using age and %TBSA, the authors identified and matched 42 control patients (CTL) who did not receive HDAA for BSR during that same time period. The authors collected data for age, %TBSA, hospital days (LOS), ventilator days (VENT), inhalation injury (INH), ventilator-associated pneumonia (VAP), and mortality (MORT).There were no differences in age and %TBSA or %TBSA of third-degree burn injury between groups. There was no significant difference in the incidence of INH (HDAA-52% vs CTL-36%, P = .17) and the groups had similar LOS and VENT. Additionally, there was no significant difference in VAP incidence (HDAA-29% vs CTL-14%, P = .13) or mortality (HDAA-26% vs CTL-23%, P = .8). HDAA patients had a numerically higher incidence of acute renal failure requiring dialysis (23 vs 7%, P = .06) which was confirmed in a multivariate analysis (odds ratio 5.4; 95% confidence interval 1.1-26). HDAA, while potentially reducing inflammation and fluid requirements during BSR, may not improve any meaningful outcomes such as ventilator requirements, ventilator-associated pneumonia, and mortality.
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Affiliation(s)
- Jonathan Lin
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
| | - Stephanie Falwell
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
| | - David Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
| | - Tina Palmieri
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
| | - Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
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15
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Ryan CM, Lee A, Stoddard FJ, Li NC, Schneider JC, Shapiro GD, Griggs CL, Wang C, Palmieri T, Meyer WJ, Pidcock FS, Reilly D, Sheridan RL, Kazis LE, Tompkins RG. The Effect of Facial Burns on Long-Term Outcomes in Young Adults: A 5-Year Study. J Burn Care Res 2019; 39:497-506. [PMID: 29901795 DOI: 10.1093/jbcr/irx006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Long-term functional outcomes in young adults with facial burns remain poorly studied. This 5-year (2003-2008) prospective multicenter study includes burn survivors (age 19-30 years) who completed the Young Adult Burn Outcome Questionnaire (YABOQ) from 0 to 36 months after baseline survey administration. A composite canonical score was developed from 15 YABOQ domains using discriminant analysis, maximizing the difference at the baseline between burn-injured patients with face involved and not involved. A generalized linear model with the generalized estimation equation technique was used to track the changing pattern of the composite score over time. Individual domain scores with high correlation to the canonical score were used to evaluate recovery patterns in facial burns. A total of 153 burned (31% with face burns) and 112 nonburned subjects completed 620 questionnaires. Canonical analysis showed that early postburn, facial burns were associated with a difference in outcome, but this overall difference diminished over time. Regression analysis showed that for survivors with facial injury, Emotion and Sexual Function scores were persistently lower (worse), while Religion scores were persistently higher. Satisfaction with Role was initially better than the nonface burned group, but over time got worse, while Perceived Appearance was initially worse in the face burned group but this difference diminished over time. Social Function Limited by Appearance was initially similar between the groups, but over time the group with face burns scored lower. The overall difference in recovery between survivors with and without facial burns diminished over time while the individual domains had various patterns of recovery.
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Affiliation(s)
- Colleen M Ryan
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Shriners Hospitals for Children®, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Austin Lee
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,School of Insurance and Economics, University of International Business and Economics, Beijing, China
| | - Frederick J Stoddard
- Shriners Hospitals for Children®, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Nien Chen Li
- Department of Health Law, Policy, and Management, Boston University School of Public Health, MA, USA
| | - Jeffrey C Schneider
- Shriners Hospitals for Children®, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, USA
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Cornelia L Griggs
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | - Chao Wang
- Boston University Metropolitan College, MA, USA
| | - Tina Palmieri
- Shriners Hospital for Children Northern California, Sacramento.,Department of Surgery, University of California Davis, Sacramento, USA
| | - Walter J Meyer
- Shriners Hospital for Children, Galveston, TX, USA.,Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Frank S Pidcock
- Department of Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Debra Reilly
- Department of Surgery, University of Nebraska, Omaha, NE
| | - Robert L Sheridan
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Shriners Hospitals for Children®, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, MA, USA
| | - Ronald G Tompkins
- Surgical Services, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
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16
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Sen S, Barsun A, Romanowski K, Palmieri T, Greenhalgh D. Neuropathy May Be an Independent Risk Factor for Amputation After Lower-Extremity Burn in Adults With Diabetes. Clin Diabetes 2019; 37:352-356. [PMID: 31660008 PMCID: PMC6794228 DOI: 10.2337/cd18-0066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IN BRIEF Treatment of lower-extremity burn injuries in adults with diabetes can be complex, and some diabetes-related factors can lead to impaired healing of such wounds, putting patients at risk of amputation. In this retrospective review of adult patients with lower-extremity burns, patients with pre-injury neuropathy and higher A1C levels were more likely to require amputations after their burn injury. The authors conclude that lower-extremity burn injuries in patients with diabetes require close follow-up and possibly referral to a burn specialist for interventions and treatment strategies to offset more serious complications.
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Affiliation(s)
- Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California Davis, Sacramento, CA
| | - Alura Barsun
- Department of Surgery, Division of Burn Surgery, University of California Davis, Sacramento, CA
| | - Kathleen Romanowski
- Department of Surgery, Division of Burn Surgery, University of California Davis, Sacramento, CA
| | - Tina Palmieri
- Department of Surgery, Division of Burn Surgery, University of California Davis, Sacramento, CA
| | - David Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California Davis, Sacramento, CA
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17
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Romanowski K, Curtis E, Barsun A, Palmieri T, Greenhalgh D, Sen S. The frailty tipping point: Determining which patients are targets for intervention in a burn population. Burns 2019; 45:1051-1056. [DOI: 10.1016/j.burns.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 01/08/2023]
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18
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Giaccherini L, Ciammella P, Galaverni M, Manicone M, Renna I, Galeandro M, Timon G, Bellafiore F, Ramundo D, Vigo F, Rosca A, Palmieri T, Ruggieri M, Botti A, Sghedoni R, Cagni E, Orlandi M, Iori M, Russo M, Iotti C. EP-1650 Elderly glioblastoma patients:role of multidimensional assessment of frailty in predicting outcomes. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Manicone M, Galaverni M, Renna I, Ciammella P, Giaccherini L, Bellafiore F, Timon G, Vigo F, Rosca A, Ramundo D, Galeandro M, Ruggieri M, Palmieri T, Botti A, Sghedoni R, Cagni E, Orlandi M, Russo M, Bonelli C, Pagano M, Iotti C. EP-1248 Stereotactic radiotherapy for brain metastasis and systemic therapies: a safe combination? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Sen S, Hsei L, Tran N, Romanowski K, Palmieri T, Greenhalgh D, Cho K. Early clinical complete blood count changes in severe burn injuries. Burns 2019; 45:97-102. [DOI: 10.1016/j.burns.2018.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/23/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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22
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Nodoushani AY, Murphy JM, Wang SL, Stoddard FJ, Kazis L, Lydon M, Lee A, Warner P, Palmieri T, Herndon D, Sheridan RL. 269 Prevalence of Depressive Symptoms Over Time in Pediatric Burn Survivors. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Y Nodoushani
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - J M Murphy
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - S L Wang
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - F J Stoddard
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - L Kazis
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - M Lydon
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - A Lee
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - P Warner
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - T Palmieri
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - D Herndon
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - R L Sheridan
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
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Affiliation(s)
- A Gallardo
- Shriners Hospital for Children Northern California, Sacramento, CA; UC Davis Medical Center/ Shriners Hospital for Children Northern California, Sacramento, CA
| | - D Neal
- Shriners Hospital for Children Northern California, Sacramento, CA; UC Davis Medical Center/ Shriners Hospital for Children Northern California, Sacramento, CA
| | - T Palmieri
- Shriners Hospital for Children Northern California, Sacramento, CA; UC Davis Medical Center/ Shriners Hospital for Children Northern California, Sacramento, CA
| | - D G Greehalgh
- Shriners Hospital for Children Northern California, Sacramento, CA; UC Davis Medical Center/ Shriners Hospital for Children Northern California, Sacramento, CA
| | - S S Sen
- Shriners Hospital for Children Northern California, Sacramento, CA; UC Davis Medical Center/ Shriners Hospital for Children Northern California, Sacramento, CA
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Kazis LE, Lee AF, Rose M, Liang MH, Li NC, Ren XS, Sheridan R, Gilroy-Lewis J, Stoddard F, Hinson M, Warden G, Stubbs K, Blakeney P, Meyer W, McCauley R, Herndon D, Palmieri T, Mooney K, Wood D, Pidcock F, Reilly D, Cullen M, Calvert C, Ryan CM, Schneider JC, Soley-Bori M, Tompkins RG. Recovery Curves for Pediatric Burn Survivors: Advances in Patient-Oriented Outcomes. JAMA Pediatr 2016; 170:534-42. [PMID: 26953515 DOI: 10.1001/jamapediatrics.2015.4722] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patient-reported outcomes serving as benchmarks for recovery of pediatric burn survivors are lacking, and new approaches using longitudinal cohorts for monitoring their expected recovery based on statistical models are needed for patient management during the early years following the burn. OBJECTIVE To describe multidimensional patient-reported outcomes among pediatric burn survivors younger than 5 years to establish benchmarks using recovery curve methods. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of pediatric burn survivors younger than 5 years at 12 burn centers. Age-matched nonburned reference groups were studied to define expected results in normal growth and development. The Burn Outcomes Questionnaire for children aged 0 to 5 years (BOQ0-5) was administered to parents of children who had burns and were younger than 5 years. Mixed models were used to generate 48-month recovery curves for each of the 10 BOQ0-5 domains. The study was conducted between January 1999 and December 2008. MAIN OUTCOMES AND MEASURES The 10 BOQ0-5 domains including play, language, fine motor skills, gross motor skills, emotional behavior, family functioning, pain/itching, appearance, satisfaction with care, and worry/concern up to 48 months after burn injury. RESULTS A total of 336 pediatric burn survivors younger than 5 years (mean [SD] age, 2.0 [1.2] years; 58.4% male; 60.2% white, 18.6% black, and 12.0% Hispanic) and 285 age-matched nonburned controls (mean [SD] age, 2.4 [1.3] years; 51.1% male; 67.1% white, 8.9% black, and 15.0% Hispanic) completed the study. Predicted scores improved exponentially over time for 5 of the BOQ0-5 domains (predicted scores at 1 month vs 24 months: play, 48.6 vs 52.1 [P = .03]; language, 49.2 vs 54.4 [P < .001]; gross motor skills, 48.7 vs 53.0 [P = .002]; pain/itching, 15.8 vs 33.5 [P < .001]; and worry/concern, 31.6 vs 44.9 [P < .001]). Pediatric burn survivors had higher scores in language, emotional behavior, and family functioning domains compared with healthy children in later months. CONCLUSIONS AND RELEVANCE This study demonstrates significant deficits in multiple functional domains across pediatric burn survivors compared with controls. Recovery curves can be used to recognize deviation from the expected course and tailor care to patient needs.
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Affiliation(s)
- Lewis E Kazis
- Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts
| | - Austin F Lee
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts3School of Insurance and Economics, University of International Business and Economics, Beijing, China4Department of Surgery, Massachusetts General Hospital, Boston
| | - Mary Rose
- Shriners Hospitals for Children, Galveston, Texas
| | - Matthew H Liang
- Massachusetts Veterans Epidemiology Research and Information Center, Boston
| | - Nien-Chen Li
- Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts
| | - Xinhua S Ren
- Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts
| | | | | | - Fred Stoddard
- Shriners Hospitals for Children, Boston, Massachusetts
| | | | - Glenn Warden
- Shriners Hospitals for Children, Cincinnati, Ohio
| | - Kim Stubbs
- Shriners Hospitals for Children, Cincinnati, Ohio
| | | | - Walter Meyer
- Shriners Hospitals for Children, Galveston, Texas
| | | | | | - Tina Palmieri
- Shriners Hospitals for Children, Sacramento, California10Nebraska Medical Center, Omaha
| | - Kate Mooney
- Shriners Hospitals for Children, Sacramento, California
| | - David Wood
- Department of Pediatrics, College of Medicine-Jacksonville, University of Florida, Jacksonville
| | | | | | | | | | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Boston7Shriners Hospitals for Children, Boston, Massachusetts15Harvard Medical School, Boston, Massachusetts
| | - Jeffrey C Schneider
- Harvard Medical School, Boston, Massachusetts16Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Marina Soley-Bori
- Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, Boston, Massachusetts
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Godwin Z, Lima K, Greenhalgh D, Palmieri T, Sen S, Tran NK. A Retrospective Analysis of Clinical Laboratory Interferences Caused by Frequently Administered Medications in Burn Patients. J Burn Care Res 2016; 37:e10-7. [PMID: 26536541 PMCID: PMC4691365 DOI: 10.1097/bcr.0000000000000298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of this study is to quantify the number of medications administered to burn patients and identify potential drugs interfering with laboratory testing. The authors reviewed the medical records of 12 adult (age ≥ 18 years) burn patients with more than 20% TBSA burns from an existing glucose control database at our institution. Dose, interval, and route of medications administered from admission to discontinuation of intensive insulin therapy were recorded. Interfering drugs were identified based on established clinical chemistry literature. The retrospective cohort of adult burn patients exhibited a mean (SD) age of 37.9 (3.0) years. Mean TBSA burn was 51.3 (9.3)%. Disease severity determined by the average multiple organ dysfunction score was 5.4 (0.2). Mean and median medications administered per day were 42.1 (9.5) and 49 (with a daily range of 0-65), respectively. A total of 666 potential laboratory test interferences caused by medications were identified. There were 261 different effects (eg, increased glucose, decreased potassium). Multiple interferences, 71.0% (475/666), were caused by more than one medication. Investigation of the number of medications administered to a burn patient and delineation of potential laboratory test interferences has not been conducted in burn patients. Given the substantial number of medications administered to burn patients, physicians and laboratory personnel should work together to identify potential interferences and define appropriate countermeasures while enhancing the laboratorians understanding of this unique population. This synergistic partnership can lead to intelligent support tools and potentially autocorrecting instruments.
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Affiliation(s)
- Zachary Godwin
- From the *Department of Pathology and Laboratory Medicine, †Division of Burn Surgery, Department of Surgery, University of California, Davis, School of Medicine; and ‡Shriners Hospital for Children of Northern California, Sacramento
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Sen S, Godwin ZR, Palmieri T, Greenhalgh D, Steele AN, Tran NK. Whole blood neutrophil gelatinase-associated lipocalin predicts acute kidney injury in burn patients. J Surg Res 2015; 196:382-7. [PMID: 25890435 DOI: 10.1016/j.jss.2015.03.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/16/2015] [Accepted: 03/13/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early detection of acute kidney injury (AKI) in severely burn-injured patients can help alter treatment to prevent progression to acute failure and reduce the need for renal replacement therapy. We hypothesized that whole blood neutrophil gelatinase-associated lipocalin (NGAL) will be increased in severely burn-injured patients who develop AKI during acute resuscitation. MATERIALS AND METHODS We performed a prospective observation study of adult burn patients with a 20% total body surface area (TBSA) burned or greater burn injury. Two-hour serial measurements of NGAL, serum creatinine (Cr), and hourly urine output (UO) were collected for 48 h after admission. Our primary goal was to correlate the risk of AKI in the first week after burn injury with serial NGAL levels in the first 48 h after admission. Our secondary goal was to determine if NGAL was an earlier independent predictor of AKI compared with Cr and UO. RESULTS We enrolled 30 adult (age ≥ 18 y) burn patients with the mean ± standard deviation age of 40.9 ± 15.4 and mean TBSA of 46.4 ± 22.4. Fourteen patients developed AKI within the first 7 d after burn injury. There were no differences in age, TBSA, fluid administration, mean arterial pressure, UO, and Cr between AKI and no-AKI patients. NGAL was significantly increased as early as 4 h after injury (182.67 ± 83.3 versus 107.37 ± 46.15) in the AKI group. Controlling for age, TBSA, and inhalation injury, NGAL was a predictor of AKI at 4 h after injury (odds ratio, 1.02) and remained predictive of AKI for the period of more than the first 24 h after admission. UO and Cr were not predictive of AKI in the first 24 h after admission. CONCLUSIONS Whole blood NGAL is markedly increased in burn patients who develop AKI in the first week after injury. In addition, NGAL is an early independent predictor of AKI during acute resuscitation for severe burn injury. UO and Cr are not predictive of AKI during this time period.
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Affiliation(s)
- Soman Sen
- Division of Burn Surgery, Department of Surgery, University of California Davis, Sacramento, California.
| | - Zack R Godwin
- Department of Pathology, University of California Davis, Sacramento, California
| | - Tina Palmieri
- Division of Burn Surgery, Department of Surgery, University of California Davis, Sacramento, California
| | - David Greenhalgh
- Division of Burn Surgery, Department of Surgery, University of California Davis, Sacramento, California
| | - Amanda N Steele
- Department of Pathology, University of California Davis, Sacramento, California
| | - Nam K Tran
- Department of Pathology, University of California Davis, Sacramento, California
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Abstract
BACKGROUND Tracheostomy is often performed in the pediatric burn population to establish secure airways. Tracheostomy is safe in this population, but the duration of tracheostomy may be related to age and extent and severity of burn. We hypothesized that burn related factors and not age determine the time to removal of a tracheostomy in pediatric burn patients. METHODS A 5-year retrospective review was performed for pediatric burn patients (age ≤18 years) who underwent tracheostomy. Patients were divided into three groups by age (group 1: 0 to ≤2 years, group 2: >2 to ≤12 years, group 3: >12 to ≤18 years). Data collected included: age, total body surface area burn injured (TBSA), gender, mechanism of injury, diagnosis of inhalation injury, mortality, time from injury to admission, time from admission to placement of tracheostomy, time of injury to placement of tracheostomy, duration of tracheostomy, days of mechanical ventilation, and tracheostomy related complications. RESULTS 45 patients were reviewed. There were no differences in TBSA, length of ICU stay, length of hospital stay, and mortality between the three groups. Additionally, there were no differences in ventilator days and duration of tracheostomy. Multivariate linear regression analysis indicated that TBSA and not age independently increased the duration of tracheostomy. CONCLUSION Tracheostomy duration is dependent on the extent of burn in pediatric burn patients.
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Affiliation(s)
- Soman Sen
- Department of Surgery, Division of Burn Surgery, Shriners Hospital for Children Northern California, University of California Davis, Sacramento, CA, United States.
| | - Jonathan Heather
- Middlemore Hospital, Department of Plastic Surgery, Auckland, New Zealand
| | - Tina Palmieri
- Department of Surgery, Division of Burn Surgery, Shriners Hospital for Children Northern California, University of California Davis, Sacramento, CA, United States
| | - David Greenhalgh
- Department of Surgery, Division of Burn Surgery, Shriners Hospital for Children Northern California, University of California Davis, Sacramento, CA, United States
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Parry I, Carbullido C, Kawada J, Bagley A, Sen S, Greenhalgh D, Palmieri T. Keeping up with video game technology: objective analysis of Xbox Kinect™ and PlayStation 3 Move™ for use in burn rehabilitation. Burns 2013; 40:852-9. [PMID: 24296065 DOI: 10.1016/j.burns.2013.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/31/2013] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
Abstract
Commercially available interactive video games are commonly used in rehabilitation to aide in physical recovery from a variety of conditions and injuries, including burns. Most video games were not originally designed for rehabilitation purposes and although some games have shown therapeutic potential in burn rehabilitation, the physical demands of more recently released video games, such as Microsoft Xbox Kinect™ (Kinect) and Sony PlayStation 3 Move™ (PS Move), have not been objectively evaluated. Video game technology is constantly evolving and demonstrating different immersive qualities and interactive demands that may or may not have therapeutic potential for patients recovering from burns. This study analyzed the upper extremity motion demands of Kinect and PS Move using three-dimensional motion analysis to determine their applicability in burn rehabilitation. Thirty normal children played each video game while real-time movement of their upper extremities was measured to determine maximal excursion and amount of elevation time. Maximal shoulder flexion, shoulder abduction and elbow flexion range of motion were significantly greater while playing Kinect than the PS Move (p≤0.01). Elevation time of the arms above 120° was also significantly longer with Kinect (p<0.05). The physical demands for shoulder and elbow range of motion while playing the Kinect, and to a lesser extent PS Move, are comparable to functional motion needed for daily tasks such as eating with a utensil and hair combing. Therefore, these more recently released commercially available video games show therapeutic potential in burn rehabilitation. Objectively quantifying the physical demands of video games commonly used in rehabilitation aides clinicians in the integration of them into practice and lays the framework for further research on their efficacy.
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Affiliation(s)
- Ingrid Parry
- Shriners Hospital for Children, Northern California, 1832 Suffolk Way, Carmichael, CA 95608, United States.
| | | | - Jason Kawada
- Shriners Hospital for Children, Northern California, United States
| | - Anita Bagley
- Shriners Hospital for Children, Northern California, United States
| | - Soman Sen
- Shriners Hospital for Children, Northern California, University of California, Davis, United States
| | - David Greenhalgh
- Shriners Hospital for Children, Northern California, University of California, Davis, United States
| | - Tina Palmieri
- Shriners Hospital for Children, Northern California, University of California, Davis, United States
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Parry I, Hanley C, Niszczak J, Sen S, Palmieri T, Greenhalgh D. Harnessing the Transparent Face Orthosis for facial scar management: A comparison of methods. Burns 2013; 39:950-6. [DOI: 10.1016/j.burns.2012.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 11/29/2022]
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Donini E, Muraglia A, Ciammella P, D'Abbiero N, Galeandro M, Palmieri T, Ramundo D, Cagni E, Botti A, Paiusco M, Iotti C. 1161 poster FDG PET IN LOCALLY ADVANCED HEAD-AND-NECK CANCER: THE PREDICTION VALUE OF METABOLIC TUMOUR VOLUME. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lavrentieva A, Palmieri T. Determination of cardiovascular parameters in burn patients using arterial waveform analysis: A review. Burns 2011; 37:196-202. [DOI: 10.1016/j.burns.2010.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 09/09/2010] [Accepted: 09/28/2010] [Indexed: 11/16/2022]
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Palmieri T, Greenhalgh D, Lavrentieva A. Response to Letter to the Editor: ‘Acute kidney injury and the burned patient: Progression and outcomes’. Burns 2011. [DOI: 10.1016/j.burns.2010.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ciammella P, Iotti C, Donini E, Galeandro M, Muraglia A, Palmieri T, Ramundo D, Ruggieri M, Banzi M, Giunta A. Short-course Preoperative Radiotherapy Combined with Chemotherapy in Resectable Rectal Cancer: Local Control and Quality of Life. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Palmieri T, Lavrentieva A, Greenhalgh DG. Acute kidney injury in critically ill burn patients. Risk factors, progression and impact on mortality. Burns 2010; 36:205-11. [DOI: 10.1016/j.burns.2009.08.012] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 07/22/2009] [Accepted: 08/10/2009] [Indexed: 11/25/2022]
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Palmieri T, Lavrentieva A, Greenhalgh D. Acute kidney injury in critically ill burn patients. Risk factors, progression and impact on mortality. Burns 2009. [DOI: 10.1016/j.burns.2009.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Palmieri T, Lavrentieva A, Greenhalgh D. Assessment of acute kidney injury with modified RIFLE criteria in critically ill pediatric burn patients. Crit Care 2009. [PMCID: PMC4084151 DOI: 10.1186/cc7429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Iotti C, Versari A, Paiusco M, Iori M, Polico R, Palmieri T, D’Abbiero N, De Marco G, Romeo A, Armaroli L. 2383. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lyons JM, Davis C, Rieman MT, Kopcha R, Phan H, Greenhalgh D, Palmieri T, Kagan R. Prophylactic Intravenous Immune Globulin and Polymixin B Decrease the Incidence of Septic Episodes and Hospital Length of Stay in Severely Burned Children. J Burn Care Res 2006; 27:813-8. [PMID: 17091076 DOI: 10.1097/01.bcr.0000245421.54312.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After burn shock resuscitation, serum gamma globulin levels decrease well below normal before slowly recovering over the course of 1 to 2 months. During this period, patients are vulnerable to further insult as a result of this immunocompromise. We hypothesized that intravenous immune globulin and subtherapeutic polymixin B (IVIG-B) could decrease the incidence and/or severity of sepsis after major thermal injury. A retrospective chart review from 1997 through 2003 at two hospitals compared patients who received IVIG-B (Hospital A) with those who did not (Hospital B). Patients with burns 40% or greater TBSA were included, whereas patients with nonsurvivable injuries were excluded from data analysis. A total of 152 patients were included in the study. One hundred two patients received IVIG-B, and 50 did not. Total burn size was 63.4% TBSA at Hospital A and 63.1% TBSA at Hospital B, with full-thickness burns of 54.4 and 61.7% TBSA, respectively (P < .05). Patients treated at Hospital A had a 51.9% incidence of inhalation injury compared with 28% of the patients at Hospital B (P < .05). There was an average of 1.2 and 1.9 septic episodes for patients treated at Hospital A and Hospital B, respectively (P < .05). Length of hospital stay was 77.1 days at Hospital A compared with 103.8 days at Hospital B (P < .05). Mortality was 17.6% and 18% at Hospitals A and B, respectively, and was not significantly different. Our data suggest that prophylactic IVIG-B is associated with a reduction in the incidence of septic episodes and decreased hospital length of stay following major thermal injury.
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Affiliation(s)
- Jefferson M Lyons
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3095, USA
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Boyce ST, Kagan RJ, Greenhalgh DG, Warner P, Yakuboff KP, Palmieri T, Warden GD. Norepinephrine Modulates the Inflammatory and Proliferative Phases of Wound Healing. ACTA ACUST UNITED AC 2006; 60:821-9. [PMID: 16612303 DOI: 10.1097/01.ta.0000196802.91829.cc] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Injury results in the massive release of norepinephrine (NE) into the peripheral circulation. Recent investigations have demonstrated functional adrenoreceptors on the cellular mediators of cutaneous wound healing and NE-induced phenotypic alterations in immune cells have been demonstrated in vitro. Despite this, there is little description of how NE might alter the phases of wound healing in vivo. The purpose of this study was to compare cutaneous wound healing in norepinephrine-intact and norepinephrine-depleted mice. METHODS Norepinephrine-depleted (NED) mice were generated by chemical axotomy with 6-hydroxydopamine and compared with norepinephrine-intact (NEI) animals (n = 6-12 per group, per time point). Using an excisional wound model, neutrophil recruitment was measured by myeloperoxidase assay. Macrophage recruitment and angiogenesis were measured by immunohistochemistry and re-epithelialization was determined histologically. The development of incisional wound disruption strength was determined over time. Finally, macrophage scavenger function was assessed by an in vitro latex bead phagocytosis assay. RESULTS Wounds from NEI mice demonstrated greater neutrophil infiltration than NED wounds (24, 72 hours; p < 0.05). Wound macrophage recruitment was initially higher in NEI animals (24 hours, p < 0.05), but was eventually surpassed by that of NED animals (120 hours, p < 0.05). Angiogenesis was decreased while re-epithelialization was accelerated in NEI animals (p < 0.05). Wound disruption strength and macrophage scavenger function were unaltered between NED and NEI mice. CONCLUSIONS Norepinephrine modulates the inflammatory and proliferative phases of wound healing in a temporally defined, cell-specific manner. By increasing recruitment of innate immune cells and expediting wound closure, norepinephrine appears to play a protective role in defense against infection.
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Affiliation(s)
- Steven T Boyce
- Department of Surgery, University of Cincinnati, OH 45267, USA.
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Cho K, Adamson LK, Jeong J, Crivello SD, Vanhook TG, Palmieri T, Greenhalgh DG. CD14-dependent alterations in c-Jun expression in the liver after burn injury. J Surg Res 2004; 122:36-42. [PMID: 15522312 DOI: 10.1016/j.jss.2004.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Burn injury-triggered activation of lipopolysaccharide signaling via the CD14 pathway alters the expression of a variety of downstream genes contributing to pathogenic changes in distant organs. The regulation of CD14 and its role in the immediate-early response of c-Jun in the liver after burn injury were investigated in this study. MATERIALS AND METHODS An incidental identification of the differential induction of CD14 mRNA after an approximately 18% TBSA burn injury in mice was confirmed by RT-PCR and immunohistochemical analyses of CD14 expression. Subsequently, CD14's role in the immediate-early regulation of c-Jun expression in the liver after injury was examined by Western blot analysis using CD14 knockout (KO) mice. RESULTS RT-PCR analysis demonstrated a rapid and transient induction of CD14 mRNA in the liver and lungs of mice after injury. Immunohistochemical analysis revealed a peak induction of CD14 reactivity in cells appearing to be Kupffer cells at day 1 after injury. Furthermore, an augmented and delayed induction of c-Jun mRNA was observed in the liver of CD14 KO mice after injury compared to wild-type controls. The induction of phosphorylated (serine 63 or serine 73) forms of c-Jun after injury was lower in the livers of CD14 KO mice than that in WT controls. CONCLUSIONS This study provides evidence that injury elicits CD14 induction as well as hyperphosphorylation of the c-Jun N-terminus activation domain and that CD14 is involved in the modulation of c-Jun's transactivation potential via phosphorylation, which may be associated with hepatic pathogenesis after injury.
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Affiliation(s)
- Kiho Cho
- Burn Research, Shriners Hospitals for Children Northern California, Sacramento, California, USA
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Hurlin Foley K, Doyle B, Paradise P, Parry I, Palmieri T, Greenhalgh DG. Use of an improved Watusi collar to manage pediatric neck burn contractures. J Burn Care Rehabil 2002; 23:221-6. [PMID: 12032375 DOI: 10.1097/00004630-200205000-00014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Burns to the neck present a serious challenge to the pediatric burn team. Even when full neck range of motion is maintained, scarring may lead to banding and a loss of the neck's natural contour. Conventional thermoplastic neck conformers have been used to maintain neck position and provide pressure to maturing scars, but they are rigid and limit functional mobility. This is of particular concern in the pediatric population where limiting neck mobility can disrupt the development of sensory and motor patterns that are essential to normal developmental progression. The Multi-Ring Watusi collar is a flexible neck orthosis that allows mobility and provides circumferential pressure to the neck. We modified this collar to improve its comfort, cosmetic appearance and ease in donning/doffing. The improved Watusi collar is a flexible splint that supports neck position, provides circumferential pressure, and allows for functional neck mobility.
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Affiliation(s)
- K Hurlin Foley
- Shriners Hospital for Children-Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, USA
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Kazis LE, Liang MH, Lee A, Ren XS, Phillips CB, Hinson M, Calvert C, Cullen M, Daugherty MB, Goodwin CW, Jenkins M, McCauley RL, Meyer WJ, Palmieri T, Pidcock F, Reilly D, Warden G, Wood D, Tompkins R. The development, validation, and testing of a health outcomes burn questionnaire for infants and children 5 years of age and younger: American Burn Association/Shriners Hospitals for Children. J Burn Care Rehabil 2002; 23:196-207. [PMID: 12032370 DOI: 10.1097/00004630-200205000-00009] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 12-member American Burn Association/Shriners Hospitals for Children Outcomes Task Force was charged with developing a health outcomes questionnaire for use in children 5 years of age and younger that was clinically based and valid. A 55-item form was tested using a cross-sectional design on the basis of a range of 184 infants and children between 0 and 5 years of age at 8 burn centers, nationally. A total of 131 subjects completed a follow-up health outcomes questionnaire 6 months after the baseline assessment. A comparison group of 285 normal nonburn children was also obtained. Internal consistency reliability of the scales ranged from 0.74 to 0.94. Tests of clinical validity were significant in the hypothesized direction for the majority of scales for length of hospital stay, duration since the burn, percent of body surface area burned, overall clinician assessment of severity of burn injury, and number of comorbidities. The criterion validity of the instrument was supported using the Child Developmental Inventories for Burn Children in early childhood and preschool stages of development comparing normal vs abnormal children. The instrument was sensitive to changes over time following a clinical course observed by physicians in practice. The Health Outcomes Burn Questionnaire for Infants and Children 5 years of age and younger is a clinically based reliable and valid assessment tool that is sensitive to change over time for assessing burn outcomes in this age group.
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Affiliation(s)
- Lewis E Kazis
- Boston University School of Public Health, Boston, Massachusetts, USA
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Abstract
The timing and method of treatment of deep palm and finger burns varies widely. Our protocol involves performing full-thickness skin grafts (FTSG) in nonhealing palm burns. We reviewed the functional and cosmetic results after FTSG to the palm. From August 1997 to April 1999, 11 patients (12 palms) underwent excision and FTSG within 2 weeks of injury. A panel of medical and nonmedical professionals evaluated follow-up pictures of the grafts at 1, 2 to 4, and beyond 4 months. Parameters used for evaluation were color match with the unburned skin (1 = no difference to 4 = large difference), graft thickness (1 = flat to 4 = markedly raised), overall appearance (1 = poor to 100 = excellent), and time to maturity. Hand function, as assessed by occupational therapy notes, was also recorded. All 12 grafted palms had a 100% take and healed with minimal scarring. Mean color match scores were 2.4 at 1 month, 1.8 at 2 to 4 months, and 1.6 beyond 4 months. On the graft thickness scale, grafts were given scores of 2.6, 2.2, and 1.9 during the same intervals. The overall appearance was 71 at 1 month, 81 at 2 to 4 months, and 85 beyond 4 months. All grafts except 1 were judged to be mature at 2 to 4 months follow-up. Full passive range of motion was attained in all grafted hands within the period of 2 to 4 months after operation. Early excision and FTSG of deep pediatric palm burns can be performed in the outpatient setting. The grafts have an acceptable color match, are minimally raised, and achieve excellent cosmetic result. The grafts mature within a few months after surgery to allow for rapid return to normal range of motion. FTSG should be considered as a first choice for deep palm burns.
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Affiliation(s)
- T N Pham
- Shriners Hospital for Children Northern California, and University of California, Sacramento 95817, USA
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De Wing MD, Curry T, Stephenson E, Palmieri T, Greenhalgh DG. Cost-effective use of helicopters for the transportation of patients with burn injuries. J Burn Care Rehabil 2000; 21:535-40. [PMID: 11194808 DOI: 10.1097/00004630-200021060-00011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We performed a retrospective review to analyze the use of helicopters for the transportation of patients with burn injuries to determine whether a more cost-effective approach could be developed without impairing the quality or delivery of health care. Charts were reviewed for all patients with burn injuries who were transported by helicopter to our hospitals during a 2-year period. Patients with inhalation injuries, with burn injuries received more than 24 hours before admission or more than 200 miles from our burn center, with more than 30% total body surface area (TBSA) burned, or with associated trauma injuries were excluded. Control patients with burn injuries who were transported by ambulance were identified and matched to the patients with burn injuries transported by helicopter for the percentage of TBSA burned, the percentage of third-degree burns, transport mileage, and age. The outcome was evaluated by comparison of length of stay, days on ventilator, and mortality rate. Comparisons were performed with Student t test. The transportation charge was determined for the patients transported by helicopter who we believed were eligible for transport by ambulance. Forty-seven of 85 patients transported by helicopter matched the inclusion criteria and had survived. There was no statistically significant difference between the percentage of TBSA burned, the percentage of third-degree burns, length of stay, days on ventilator, age, or transport mileage. There was, however, a significant difference in the time from the injury to admission to the hospital, as well as in the charge for transportation. Patients who had less than 30% TBSA thermal cutaneous injuries without evidence of inhalation injury, and who are less than 200 miles from a burn center may be safely transported by ambulance. Ambulance transportation may take additional time; however, stricter protocols for helicopter transportation of patients with burn injuries will result in potentially substantial savings without affecting outcomes for patients.
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Affiliation(s)
- M D De Wing
- Shriners Hospital for Children, Northern California, Sacramento 95817, USA
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Bridges PE, Palmieri T, Greenhalgh DG. Torchiere-style halogen floor lamps: a need for fire safety awareness. J Burn Care Rehabil 2000; 21:447-9; discussion 446. [PMID: 11020053 DOI: 10.1097/00004630-200001001-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Torchiere-style halogen lamps pose a significant fire hazard. The 500-W halogen bulb in these lamps can generate temperatures as high as 1200 degrees F. Factors related to the design of the lamp also contribute to the fire risk. The Consumer Products Safety Commission has issued various warnings and recalls on these lamps because of a significant number of fire-related incidents and deaths. The impact of these recalls on a random sample of consumers was investigated. A survey of these participants revealed that 60% of lamp owners and nonowners were unaware of the recalls. The majority of respondents were also not aware of the risks of injury, the extreme bulb temperatures, or safety measures designed for these lamps. There is a need for increasing community awareness and education to reduce the fire hazards associated with this product.
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Affiliation(s)
- P E Bridges
- Shriners Hospital for Children, Northern California, Sacramento, USA
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Barbieri E, Putti C, Ammendolia I, Baldissera A, Chiaulon G, Mancini A, Palmieri T, Frezza G, Mercuri M, Babini L. 706Long term follow-up of localized Ewing's sarcoma. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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