82 results on '"Arnoldo BD"'
Search Results
2. Sustained impairments in cutaneous vasodilation and sweating in grafted skin following long-term recovery.
- Author
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Davis SL, Shibasaki M, Low DA, Cui J, Keller DM, Wingo JE, Purdue GF, Hunt JL, Arnoldo BD, Kowalske KJ, Crandall CG, Davis, Scott L, Shibasaki, Manabu, Low, David A, Cui, Jian, Keller, David M, Wingo, Jonathan E, Purdue, Gary F, Hunt, John L, and Arnoldo, Brett D
- Published
- 2009
- Full Text
- View/download PDF
3. Hydrofluoric acid burns: a 15-year experience.
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Stuke LE, Arnoldo BD, Hunt JL, Purdue GF, Stuke, Lance E, Arnoldo, Brett D, Hunt, John L, and Purdue, Gary F
- Published
- 2008
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- View/download PDF
4. The Parkland formula under fire: is the criticism justified?
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Blumetti J, Hunt JL, Arnoldo BD, Parks JK, Purdue GF, Blumetti, Jennifer, Hunt, John L, Arnoldo, Brett D, Parks, Jennifer K, and Purdue, Gary F
- Published
- 2008
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- View/download PDF
5. Epistatic interactions are critical to gene-association studies: PAI-1 and risk for mortality after burn injury.
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Barber RC, Chang LY, Lemaire SM, Burris A, Purdue GF, Hunt JL, Arnoldo BD, Horton JW, Barber, Robert C, Chang, Ling-Yu E, Lemaire, Susan M, Burris, Agnes, Purdue, Gary F, Hunt, John L, Arnoldo, Brett D, and Horton, Jureta W
- Published
- 2008
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- View/download PDF
6. Cutaneous vasoconstriction during whole-body and local cooling in grafted skin five to nine months postsurgery.
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Davis SL, Shibasaki M, Low DA, Cui J, Keller DM, Purdue GF, Hunt JL, Arnoldo BD, Kowalske KJ, Crandall CG, Davis, Scott L, Shibasaki, Manabu, Low, David A, Cui, Jian, Keller, David M, Purdue, Gary F, Hunt, John L, Arnoldo, Brett D, Kowalske, Karen J, and Crandall, Craig G
- Published
- 2008
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7. Abdominal compartment syndrome in the severely burned patient.
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Hershberger RC, Hunt JL, Arnoldo BD, Purdue GF, Hershberger, Richard C, Hunt, John L, Arnoldo, Brett D, and Purdue, Gary F
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- 2007
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8. Use of high-frequency percussive ventilation in inhalation injuries.
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Hall JJ, Hunt JL, Arnoldo BD, Purdue GF, Hall, Jason J, Hunt, John L, Arnoldo, Brett D, and Purdue, Gary F
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- 2007
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9. Skin grafting impairs postsynaptic cutaneous vasodilator and sweating responses.
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Davis SL, Shibaski M, Low DA, Cui J, Keller DM, Purdue GF, Hunt JL, Arnoldo BD, Kowalske KJ, Crandall CG, Davis, Scott L, Shibasaki, Manabu, Low, David A, Cui, Jian, Keller, David M, Purdue, Gary F, Hunt, John L, Arnoldo, Brett D, Kowalske, Karen J, and Crandall, Craig G
- Published
- 2007
- Full Text
- View/download PDF
10. Impaired cutaneous vasodilation and sweating in grafted skin during whole-body heating.
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Davis SL, Shibasaki M, Low DA, Cui J, Keller DM, Purdue GF, Hunt JL, Arnoldo BD, Kowalske KJ, Crandall cG, Davis, Scott L, Shibasaki, Manabu, Low, David A, Cui, Jian, Keller, David M, Purdue, Gary F, Hunt, John L, Arnoldo, T Brett D, Kowalske, Karen J, and Crandall, Craig G
- Published
- 2007
- Full Text
- View/download PDF
11. Self-esteem measurement before and after summer burn camp in pediatric burn patients.
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Arnoldo BD, Crump D, Burris AM, Hunt JL, Purdue GF, Arnoldo, Brett D, Crump, Donna, Burris, Agnes M, Hunt, John L, and Purdue, Gary F
- Published
- 2006
- Full Text
- View/download PDF
12. Heterotopic ossification revisited: a 21-year surgical experience.
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Hunt JL, Arnoldo BD, Kowalske K, Helm P, Purdue GF, Hunt, John L, Arnoldo, Brett D, Kowalske, Karen, Helm, Phala, and Purdue, Gary F
- Published
- 2006
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- View/download PDF
13. Acute cholecystitis in burn patients.
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Arnoldo BD, Hunt JL, Purdue GF, Arnoldo, Brett D, Hunt, John L, and Purdue, Gary F
- Published
- 2006
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14. Potential of hemoglobin-based oxygen carriers in trauma patients.
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Arnoldo BD, Minei JP, Arnoldo, B D, and Minei, J P
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- 2001
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15. Adult burn patients: the role of religion in recovery--should we be doing more?
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Arnoldo BD, Hunt JL, Burris A, Wilkerson L, Purdue GF, Arnoldo, Brett D, Hunt, John L, Burris, Agnes, Wilkerson, Linda, and Purdue, Gary F
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- 2006
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16. Microwave ovens: a hazardous convenience.
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Hastings TL, Arnoldo BD, Hunt JL, and Purdue GF
- Published
- 2008
17. Escharotomy - an underappreciated marker of burn severity.
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Purdue GF, Arnoldo BD, Burris AM, and Hunt JL
- Published
- 2008
18. Psychosocial services provided at burn centers in North America: results of a survey.
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Borman PD, Suris AM, Blakeney P, Smith MM, Holavanahalli RK, Arnoldo BD, Kowalske KJ, and Purdue GF
- Published
- 2008
19. Limb disarticulations performed at a burn center - review of a 24-year experience.
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Stuke LE, Lau LR, Arnoldo BD, Hunt JL, and Purdue GF
- Published
- 2008
20. Effect of gender on outcomes in severely burned patients.
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Endorf FW, Klein MB, Gamelli RL, Herndon DN, Jeschke MG, Silver GM, Arnoldo BD, and Gibran NS
- Published
- 2008
21. Delayed ectropion repair minimizes recurrence.
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Hall JJ, Arnoldo BD, Hunt JL, and Purdue GF
- Published
- 2007
22. A new look at a different problem: child abuse by burning.
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Purdue GF, Arnoldo BD, and Hunt JL
- Published
- 2007
23. Gene-gene and gene-environment interactions are critical to gene-association studies.
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Barber RC, Chang EL, Purdue GF, Hunt JL, Arnoldo BD, and Horton JW
- Published
- 2007
24. Is survival to discharge a suitable endpoint?: late burn death.
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Purdue GF, Arnoldo BD, Kowalske KJ, and Hunt JL
- Published
- 2007
25. BBQ burns: too much of a good thing.
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Purdue GF, Arnoldo BD, Burris AM, and Hunt JL
- Published
- 2007
26. Frostbite injured patients in the south: an under appreciated problem.
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Arnoldo BD, Hunt JL, and Purdue GF
- Published
- 2007
27. Micrografting allows complete coverage of patients with extensive, full-thickness thermal injury.
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Eastman AL, Arnoldo BD, Hunt JL, and Purdue GF
- Published
- 2007
28. Cutaneous vasoconstriction during whole-body and local colling is not altered in grafted skin 5-9 months post-surgery.
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Davis SL, Shibasaki M, Cui J, Low DA, Keller DM, Purdue GF, Hunt JL, Arnoldo BD, Kowalske KJ, and Crandall CG
- Published
- 2007
29. The Parkland formula under fire: is the criticism justified?
- Author
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Blumetti J, Hunt JL, Arnoldo BD, Parks J, and Purdue GF
- Published
- 2007
30. Muscle Homeostasis Is Disrupted in Burned Adults.
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Clark AT, Song J, Yao X, Carlson D, Huebinger RM, Mei Liu M, Madni TD, Imran JB, Taveras LR, Weis HB, Arnoldo BD, Phelan HA, and Wolf SE
- Subjects
- Adolescent, Adult, Age Factors, Burns complications, Caspase 3 metabolism, Female, Humans, Male, Muscle Proteins metabolism, Muscular Atrophy metabolism, Muscular Atrophy pathology, MyoD Protein metabolism, Myogenin metabolism, PAX7 Transcription Factor metabolism, Proliferating Cell Nuclear Antigen metabolism, Severity of Illness Index, Tripartite Motif Proteins metabolism, Ubiquitin-Protein Ligases metabolism, Young Adult, Burns metabolism, Burns pathology, Homeostasis physiology, Muscle, Skeletal metabolism, Muscle, Skeletal pathology, Muscular Atrophy etiology
- Abstract
Severe burn leads to substantial skeletal muscle wasting that is associated with adverse outcomes and protracted recovery. The purpose of our study was to investigate muscle tissue homeostasis in response to severe burn. Muscle biopsies from the right m. lateralis were obtained from 10 adult burn patients at the time of their first operation. Patients were grouped by burn size (total body surface area of <30% vs ≥30%). Muscle fiber size and factors of cell death and muscle regeneration were examined. Muscle cell cross-sectional area was significantly smaller in the large-burn group (2174.3 ± 183.8 µm2 vs 3687.0 ± 527.2 µm2, P = .04). The expression of ubiquitin E3 ligase MuRF1 and cell death downstream effector caspace 3 was increased in the large-burn group (P < .05). No significant difference was seen between groups in expression of the myogenic factors Pax7, MyoD, or myogenin. Interestingly, Pax7 and proliferating cell nuclear antigen (PCNA) expression in muscle tissue were significantly correlated to injury severity only in the smaller-burn group (P < .05). In conclusion, muscle atrophy after burn is driven by apoptotic activation without an equal response of satellite cell activation, differentiation, and fusion., (Published by Oxford University Press on behalf of the American Burn Association 2019.)
- Published
- 2020
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31. Prospective Analysis of Operating Room and Discharge Delays in a Burn Center.
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Madni TD, Nakonezny PA, Imran JB, Barrios E, Rizk P, Clark AT, Cunningham HB, Taveras L, Arnoldo BD, Cripps MW, Phelan HA, and Wolf SE
- Subjects
- Burn Units organization & administration, California, Databases, Factual, Female, Hospital Costs statistics & numerical data, Humans, Male, Organizational Innovation, Patient Discharge economics, Prospective Studies, Risk Assessment, Time Factors, Cost-Benefit Analysis, Length of Stay economics, Operating Rooms organization & administration, Patient Discharge statistics & numerical data, Time-to-Treatment economics
- Abstract
Delays to the operating room (OR) or discharge (DC) lead to longer lengths of stay and increased costs. Surprisingly, little work has been done to quantify the number and cost of delays for inpatients to the OR, and to DC to outpatient status. They reviewed their burn admissions to determine how often a patient experiences delays in healthcare delivery. Data for all burn admissions were prospectively collected from 2014 to 2016. A quality improvement filter was created to define acceptable parameters for patient throughput. Every hospital day was labeled as 1) No delay, 2) Operation, 3) Delay to the OR, or 4) Delay to DC. They had 1633 admissions: 432 ICU admissions (26%) and 1201 floor admissions (74%). Six hundred fifteen patients (37.7%) received an operation. Patients with delays included 331 with OR delays (20.3%) and 503 with DC delays (30.8%). Average delay days included (Mean ± SD): OR delay days = 4.7 ± 6.2 and DC delay days = 4.1 ± 4.4. Total number of hospital days was 13,009, divided into 1616 OR delay days (12%) and 2096 DC delay days (16%). Significant OR delays were due to patient unstable for OR (n = 387 [24%]), OR space availability (n = 662 [41%]), indeterminate wound depth (n = 437 [27%]), and donor site availability (n = 83 [5%]). Significant DC delays were due to medical goals not reached (n = 388 [19%]), pain control and wound care (n = 694 [33%]), PT/OT clearance (n = 168 [8.0%]), and DC placement delays (n = 754 [36%]). Costs for OR and DC delays ranged between US$1,000,000 and US$5,000,000. Costs of increasing OR capacity and/or additional social work ancillary staff can be justified through millions of dollars of savings annually., (© American Burn Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2019
- Full Text
- View/download PDF
32. Acute Kidney Injury After Burn: A Cohort Study From the Parkland Burn Intensive Care Unit.
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Clark AT, Li X, Kulangara R, Adams-Huet B, Huen SC, Madni TD, Imran JB, Phelan HA, Arnoldo BD, Moe OW, Wolf SE, and Neyra JA
- Subjects
- Acute Kidney Injury mortality, Acute Kidney Injury therapy, Adult, Burns mortality, Creatinine blood, Female, Hospital Mortality, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Renal Replacement Therapy, Respiration, Artificial statistics & numerical data, Retrospective Studies, Acute Kidney Injury etiology, Burns complications, Intensive Care Units
- Abstract
Acute kidney injury (AKI) is a common and morbid complication in patients with severe burn. The reported incidence of AKI and mortality in this population varies widely due to inconsistent and changing definitions. They aimed to examine the incidence, severity, and hospital mortality of patients with AKI after burn using consensus criteria. This is a retrospective cohort study of adults with thermal injury admitted to the Parkland burn intensive care unit (ICU) from 2008 to 2015. One thousand forty adult patients with burn were admitted to the burn ICU. AKI was defined by KDIGO serum creatinine criteria. Primary outcome includes hospital death and secondary outcome includes length of mechanical ventilation, ICU, and hospital stay. All available serum creatinine measurements were used to determine the occurrence of AKI during the hospitalization. All relevant clinical data were collected. The median total body surface area (TBSA) of burn was 16% (IQR: 6%-29%). AKI occurred in 601 patients (58%; AKI stage 1, 60%; stage 2, 19.8%; stage 3, 10.5%; and stage 3 requiring renal replacement therapy [3-RRT], 9.7%). Patients with AKI had larger TBSA burn (median 20.5% vs 11.0%; P < .001) and more mechanical ventilation and hospitalization days than patients without AKI. The hospital death rate was higher in those with AKI vs those without AKI (19.7% vs 3.9%; P < .001) and increased by each AKI severity stage (P trend < .001). AKI severity was independently associated with hospital mortality in the small burn group (for TBSA ≤ 10%: stage 1 adjusted OR 9.3; 95% CI, 2.6-33.0; stage 2-3 OR, 35.0; 95% CI, 9.0-136.8; stage 3-RRT OR, 30.7; 95% CI, 4.2-226.4) and medium burn group (TBSA 10%-40%: stage 2-3 OR, 6.5; 95% CI, 1.9-22.1; stage 3-RRT OR, 35.1; 95% CI, 8.2-150.3). AKI was not independently associated with hospital death in the large burn group (TBSA > 40%). Urine output data were unavailable. AKI occurs frequently in patients after burn. Presence of and increasing severity of AKI are associated with increased hospital mortality. AKI appears to be independently and strongly associated with mortality in patients with TBSA ≤ 40%. Further investigation to develop risk-stratification tools tailoring this susceptible population is direly needed.
- Published
- 2019
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33. Prospective Evaluation of Operating Room Inefficiency.
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Madni TD, Imran JB, Clark AT, Cunningham HB, Taveras L, Arnoldo BD, Phelan HA, and Wolf SE
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- Cost Savings, Humans, Operative Time, Prospective Studies, Quality Improvement, Video Recording, Burn Units statistics & numerical data, Burns surgery, Efficiency, Organizational statistics & numerical data, Operating Rooms statistics & numerical data
- Abstract
Previously, they identified that 60 per cent of their facility's total operative time is nonoperative. They performed a review of their operating room to determine where inefficiencies exist in nonoperative time. Live video of operations performed in a burn operating room from June 23, 2017 to August 16, 2017 was prospectively reviewed. Preparation (end of induction to procedure start) and turnover (patient out of room to next patient in room) were divided into the following activities: 1) Preparation: remove dressing, position patient, clean patient, drape patient, and 2) Turnover: clean operating room, scrub tray setup, anesthesia setup. Ideal preparation time was calculated as the sum of time needed to perform preparation activities consecutively. Ideal turnover time was calculated as the sum of time needed to clean the operating room and to set up either the scrub tray or anesthesia (the larger of the two times as these can be done in parallel). They reviewed 101 consecutive operations. An average of 2.4 ± 0.8 cases per day were performed. Ideal preparation and turnover time were 16.6 and 30.1 minutes, a 38.3 and 32.5 per cent reduction compared with actual times. Attending surgeon presence in the operating room within 10 minutes of a patient's arrival was found to significantly decrease time to incision by 33 per cent (52.7 ± 14.3 minutes down to 35.7 ± 20.4, P < .0001). A reduction in preparation and turnover time could save $1.02 million and generate $1.76 million in additional revenue annually. Reducing preparation and turnover to ideal times could increase caseload to 4 per day, leading to millions of dollars of savings annually.
- Published
- 2018
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34. Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study.
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Chung KK, Coates EC, Hickerson WL, Arnold-Ross AL, Caruso DM, Albrecht M, Arnoldo BD, Howard C, Johnson LS, McLawhorn MM, Friedman B, Sprague AM, Mosier MJ, Smith DJ Jr, Karlnoski RA, Aden JK, Mann-Salinas EA, and Wolf SE
- Subjects
- Female, Humans, Male, Middle Aged, United States, Acute Kidney Injury etiology, Acute Kidney Injury therapy, Burns complications, Renal Replacement Therapy
- Abstract
Acute kidney injury (AKI) after severe burns is historically associated with a high mortality. Over the past two decades, various modes of renal replacement therapy (RRT) have been used in this population. The purpose of this multicenter study was to evaluate demographic, treatment, and outcomes data among severe burn patients treated with RRT collectively at various burn centers around the United States. After institutional review board approval, a multicenter observational study was conducted. All adult patients aged 18 or older, admitted with severe burns who were placed on RRT for acute indications but not randomized into a concurrently enrolling interventional trial, were included. Across eight participating burn centers, 171 subjects were enrolled during a 4-year period. Complete data were available in 170 subjects with a mean age of 51 ± 17, percent total body surface area burn of 38 ± 26% and injury severity score of 27 ± 21. Eighty percent of subjects were male and 34% were diagnosed with smoke inhalation injury. The preferred mode of therapy was continuous venovenous hemofiltration at a mean delivered dose of 37 ± 19 (ml/kg/hour) and a treatment duration of 13 ± 24 days. Overall, in hospital, mortality was 50%. Among survivors, 21% required RRT on discharge from the hospital while 9% continued to require RRT 6 months after discharge. This is the first multicenter cohort of burn patients who underwent RRT reported to date. Overall mortality is comparable to other critically ill populations who undergo RRT. Most patients who survive to discharge eventually recover renal function.
- Published
- 2018
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35. Patient satisfaction after fractional ablation of burn scar with 2940nm wavelength Erbium-Yag laser.
- Author
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Madni TD, Nakonezny PA, Imran JB, Clark AT, Cunningham HB, Hoopman JE, Arnoldo BD, Wolf SE, Kenkel JM, and Phelan HA
- Subjects
- Adolescent, Adult, Burns complications, Cicatrix etiology, Female, Humans, Lasers, Solid-State, Male, Middle Aged, Pain, Paresthesia, Pruritus, Surveys and Questionnaires, Treatment Outcome, Young Adult, Cicatrix surgery, Laser Therapy, Patient Satisfaction
- Abstract
Objective: Fractional laser therapy is a new treatment with potential benefit in the treatment of burn scars. We sought to determine patient satisfaction after burn scar treatment with the Erbium-Yag laser., Methods: We performed a telephone survey of all patients who underwent fractional resurfacing of burn scars with the Erbium-Yag 2940 wavelength laser at Parkland Hospital from 01/01/2016 to 05/01/2017. Subjects were asked to rate their satisfaction with their scars' after treatment characteristics on a scale from 1 (completely unsatisfied) to 10 (completely satisfied). Subjects were also asked to assess their treatment response using the UNC 4P Scar Scale before and after treatment., Results: Sixty-four patients underwent 156 treatments. A survey response rate of 77% (49/64) was seen (age: 36.8+21 years; surface area treated=435+326cm
2 ; 35% of burn scars were >2 years old; mean scar age of 1.02+0.4 years). Overall, 46/49 (94%) of patients reported some degree of scar improvement after treatment. Patient satisfaction scores were 8.3+2.3. Number of laser treatments included: 1 (31%), 2 (33%), 3 (18%), 4(10%), >5 (8%). Treatment depth, scar age, and number of laser procedures were not significant predictors of satisfaction or UNC 4P Scar scores. The paired t-test showed a significant reduction on each of the UNC 4P Scar scale items (pain, pruritus, pliability, paresthesia). One subject reported that she felt that the laser treatment made her scar worse (2%)., Conclusion: Burn patients treated with the Erbium-Yag laser are highly satisfied with changes in their burn scars., (Copyright © 2018. Published by Elsevier Ltd.)- Published
- 2018
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36. The Relationship Between Frailty and the Subjective Decision to Conduct a Goals of Care Discussion With Burned Elders.
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Madni TD, Nakonezny PA, Wolf SE, Joseph B, Mohler MJ, Imran JB, Clark AT, Arnoldo BD, and Phelan HA
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- Aged, Female, Humans, Length of Stay, Logistic Models, Male, Patient Selection, Retrospective Studies, Burns complications, Burns therapy, Frailty complications, Patient Care Planning
- Abstract
Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our American Burn Association (ABA)-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition. One rater retrospectively assigned clinical frailty scores to patients using the Canadian Study of Health and Aging Criteria, which ranged from 1 (very fit) to 7 (severely frail). Ordinal logistic regression was performed. Demographics for the cohort of 126 subjects were (mean ± SD): age = 75.5 ± 7.7 years, %TBSA burned = 11.9% ± 7.2, revised Baux = 87.8 ± 10.2, hospital LOS (days) = 14.9 ± 13.7, Intensive Care Unit (ICU) LOS (days) = 6.2 ± 1.2, frailty score = 4.1 ± 1.1. Overall, 72% of geriatric survivors had a favorable discharge disposition. GoC discussions occurred in 25% of patients. GoC discussion (OR, 3.42; 95% CI, 1.54-7.60) and an unfavorable disposition (OR, 9.01; 95% CI, 3.91-20.78) were associated with greater predicted odds of receiving a higher ordered frailty score. Our results suggest that, even in the absence of a formal diagnosis, a frail appearance may influence a provider's decision to perform GoC discussions after severe thermal injury.
- Published
- 2018
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37. High-volume hemofiltration in adult burn patients with septic shock and acute kidney injury: a multicenter randomized controlled trial.
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Chung KK, Coates EC, Smith DJ Jr, Karlnoski RA, Hickerson WL, Arnold-Ross AL, Mosier MJ, Halerz M, Sprague AM, Mullins RF, Caruso DM, Albrecht M, Arnoldo BD, Burris AM, Taylor SL, and Wolf SE
- Subjects
- Adult, Female, Hemofiltration methods, Humans, Male, Middle Aged, Multiple Organ Failure prevention & control, Multiple Organ Failure therapy, Organ Dysfunction Scores, Prospective Studies, Renal Replacement Therapy methods, Renal Replacement Therapy standards, Acute Kidney Injury therapy, Burns therapy, Hemofiltration standards, Shock, Septic therapy
- Abstract
Background: Sepsis and septic shock occur commonly in severe burns. Acute kidney injury (AKI) is also common and often results as a consequence of sepsis. Mortality is unacceptably high in burn patients who develop AKI requiring renal replacement therapy and is presumed to be even higher when combined with septic shock. We hypothesized that high-volume hemofiltration (HVHF) as a blood purification technique would be beneficial in this population., Methods: We conducted a multicenter, prospective, randomized, controlled clinical trial to evaluate the impact of HVHF on the hemodynamic profile of burn patients with septic shock and AKI involving seven burn centers in the United States. Subjects randomized to the HVHF were prescribed a dose of 70 ml/kg/hour for 48 hours while control subjects were managed in standard fashion in accordance with local practices., Results: During a 4-year period, a total of nine subjects were enrolled for the intervention during the ramp-in phase and 28 subjects were randomized, 14 each into the control and HVHF arms respectively. The study was terminated due to slow enrollment. Ramp-in subjects were included along with those randomized in the final analysis. Our primary endpoint, the vasopressor dependency index, decreased significantly at 48 hours compared to baseline in the HVHF group (p = 0.007) while it remained no different in the control arm. At 14 days, the multiple organ dysfunction syndrome score decreased significantly in the HVHF group when compared to the day of treatment initiation (p = 0.02). No changes in inflammatory markers were detected during the 48-hour intervention period. No significant difference in survival was detected. No differences in adverse events were noted between the groups., Conclusions: HVHF was effective in reversing shock and improving organ function in burn patients with septic shock and AKI, and appears safe. Whether reversal of shock in these patients can improve survival is yet to be determined., Trial Registration: Clinicaltrials.gov NCT01213914 . Registered 30 September 2010.
- Published
- 2017
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38. Hospital-Onset Bloodstream Infection Rates After Discontinuing Active Surveillance Cultures for Methicillin-Resistant Staphylococcus aureus in a Regional Burn Center.
- Author
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Drum BE, Collinsworth K, Arnoldo BD, and Sreeramoju PV
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- Burn Units, Burns complications, Humans, Texas epidemiology, Bacteremia epidemiology, Cross Infection epidemiology, Methicillin-Resistant Staphylococcus aureus isolation & purification, Staphylococcal Infections epidemiology
- Published
- 2017
- Full Text
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39. The Effect of Illicit Drug Use on Outcomes Following Burn Injury.
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Hodgman EI, Subramanian M, Wolf SE, Arnoldo BD, Phelan HA, Cripps MW, and Abdel Fattah KR
- Subjects
- Adult, Age Factors, Alcoholism diagnosis, Alcoholism epidemiology, Burn Units statistics & numerical data, Burns diagnosis, Burns therapy, Cohort Studies, Comorbidity, Databases, Factual, Female, Follow-Up Studies, Hospitalization statistics & numerical data, Humans, Illicit Drugs adverse effects, Injury Severity Score, Male, Middle Aged, Propensity Score, Reference Values, Retrospective Studies, Risk Assessment, Sex Factors, Substance-Related Disorders diagnosis, Survival Analysis, Treatment Outcome, United States, Burns epidemiology, Cause of Death, Length of Stay, Substance Abuse Detection statistics & numerical data, Substance-Related Disorders epidemiology
- Abstract
Illicit drug use is common among patients admitted following burn injury. The authors sought to evaluate whether drug abuse results in worse outcomes. The National Burn Repository (NBR) was queried for data on all patients with drug testing results available. Outcomes included mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, and duration of ventilator support. Propensity score weighting was performed to control for age, alcohol use, burn size, gender, and etiology of burn. A total of 20,989 patients had drug screen data available; 11,642 (55.5%) tested positive for at least one drug of abuse. Illicit drug use was associated with a higher proportion of patients with flame burn (53.2 vs 48.4%) and larger average burn size (11.2 vs 9.5% TBSA, P < .001). Attempted suicide was more likely if the patient had used drugs (2.8 vs 1.7%, P < .001). Drug use resulted in longer hospital and ICU LOS (14.2 vs 11.4 and 8.5 vs 5.6 days, P < .001), but did not increase the risk of mortality (5.7 vs 5.2, P = .08). After propensity score weighting, drug use did not affect mortality, hospital LOS, or duration of ventilator support, but did increase the average ICU LOS by 1.2 days (P = .001). Drug use does not affect mortality, hospital LOS, or duration of ventilator support among burned patients. After controlling for burn size, age, mechanism of injury, and gender, patients with a positive drug screen had an average increase in ICU LOS by 1 day., Competing Interests: All authors have no conflicts of interest to report.
- Published
- 2017
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40. Characterizing End-of-Life Care after Geriatric Burns at a Verified Level I Burn Center.
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Partain NS, Subramanian M, Hodgman EI, Isbell CL, Wolf SE, Arnoldo BD, Kowalske KJ, and Phelan HA
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- Burn Units, Hospice Care, Humans, Palliative Care, Retrospective Studies, Terminal Care
- Abstract
Background: End-of-life (EoL) care after geriatric burns (geri-burns) is understudied., Objective: To examine the practices of burn surgeons for initiating EoL discussions and the impact of decisions made on the courses of geri-burn patients who died after injury., Methods: This retrospective cohort study examined all subjects ≥65 years who died on our Level I burn service from April 1, 2009, to December 31, 2014. Measurements obtained were timing of first EoL discussion (EARLY <24 hours post-admission; LATE ≥24 hours post-admission), decisions made, age, total body surface area burned, and calculated probability of death at admission., Results: The cohort consisted of 57 subjects, of whom 54 had at least one documented EoL care discussion between a burn physician and the patient/surrogate. No differences were seen between groups for the likelihood of an immediate decision for comfort care after the first discussion (p = 0.73) or the mean number of total discussions (p = 0.07). EARLY group subjects (n = 38) had significantly greater magnitudes of injury (p = 0.002), calculated probabilities of death at admission (p ≤ 0.001), shorter times to death (p ≤ 0.001), and fewer trips to the operating theater for burn excision and skin grafting (p ≤ 0.001) than LATE subjects (n = 16). LATE subjects' first discussion occurred at a mean of 9.3 ± 10.0 days., Discussion: The vast majority of geri-burn deaths on our burn service occur after a discussion about EoL care. The timing of these discussions is driven by magnitude of injury, and it does not lead to higher proportions of an immediate decision for comfort care. The presence and timing of EoL discussions bears further study as a quality metric for geri-burn EoL care.
- Published
- 2016
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41. Hold the Pendulum: Rates of Acute Kidney Injury are Increased in Patients Who Receive Resuscitation Volumes Less than Predicted by the Parkland Equation.
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Mason SA, Nathens AB, Finnerty CC, Gamelli RL, Gibran NS, Arnoldo BD, Tompkins RG, Herndon DN, and Jeschke MG
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- APACHE, Adult, Female, Humans, Male, Retrospective Studies, Risk Factors, Treatment Outcome, Acute Kidney Injury etiology, Burns complications, Burns therapy, Fluid Therapy adverse effects, Resuscitation methods
- Abstract
Objective: To determine whether restrictive fluid resuscitation results in increased rates of acute kidney injury (AKI) or infectious complications., Background: Studies demonstrate that patients often receive volumes in excess of those predicted by the Parkland equation, with potentially detrimental sequelae. However, the consequences of under-resuscitation are not well-studied., Methods: Data were collected from a multicenter prospective cohort study. Adults with greater than 20% total burned surface area injury were divided into 3 groups on the basis of the pattern of resuscitation in the first 24 hours: volumes less than (restrictive), equal to, or greater than (excessive) standard resuscitation (4 to 6 cc/kg/% total burned surface area). Multivariable regression analysis was employed to determine the effect of fluid group on AKI, burn wound infections (BWIs), and pneumonia., Results: Among 330 patients, 33% received restrictive volumes, 39% received standard resuscitation volumes, and 28% received excessive volumes. The standard and excessive groups had higher mean baseline APACHE scores (24.2 vs 16, P < 0.05 and 22.3 vs 16, P < 0.05) than the restrictive group, but were similar in other characteristics. After adjustment for confounders, restrictive resuscitation was associated with greater probability of AKI [odds ratio (OR) 3.25, 95% confidence interval (95% CI) 1.18-8.94]. No difference in the probability of BWI or pneumonia among groups was found (BWI: restrictive vs standard OR 0.74, 95% CI 0.39-1.40, excessive vs standard OR 1.40, 95% CI 0.75-2.60, pneumonia: restrictive vs standard, OR 0.52, 95% CI 0.26-1.05; excessive vs standard, OR 1.12, 95% CI 0.58-2.14)., Conclusions: Restrictive resuscitation is associated with increased AKI, without changes in infectious complications.
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- 2016
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42. Future Therapies in Burn Resuscitation.
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Hodgman EI, Subramanian M, Arnoldo BD, Phelan HA, and Wolf SE
- Subjects
- Burns physiopathology, Fluid Therapy trends, Humans, Monitoring, Physiologic, Resuscitation trends, Burns therapy, Fluid Therapy methods, Rehydration Solutions administration & dosage, Resuscitation methods
- Abstract
Since the 1940s, the resuscitation of burn patients has evolved with dramatic improvements in mortality. The most significant achievement remains the creation and adoption of formulae to calculate estimated fluid requirements to guide resuscitation. Modalities to attenuate the hypermetabolic phase of injury include pharmacologic agents, early enteral nutrition, and the aggressive approach of early excision of large injuries. Recent investigations into the genomic response to severe burns and the application of computer-based decision support tools will likely guide future resuscitation, with the goal of further reducing mortality and morbidity, and improving functional and quality of life outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2016
- Full Text
- View/download PDF
43. The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010.
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Hodgman EI, Pastorek RA, Saeman MR, Cripps MW, Bernstein IH, Wolf SE, Kowalske KJ, Arnoldo BD, and Phelan HA
- Subjects
- Age Distribution, Burn Units, Burns etiology, Burns mortality, Burns, Chemical, Child, Child Abuse mortality, Child, Preschool, Female, Hospitalization statistics & numerical data, Humans, Incidence, Infant, Logistic Models, Male, Retrospective Studies, Texas epidemiology, Burns epidemiology, Child Abuse statistics & numerical data
- Abstract
Introduction: Pediatric burns due to abuse are unfortunately relatively common, accounting for 5.8-8.8% of all cases of abuse annually. Our goal was to evaluate our 36-year experience in the evaluation and management of the victims of abuse in the North Texas area., Methods: A prospectively maintained database containing records on all admissions from 1974 through 2010 was queried for all patients aged less than 18 years. Patients admitted for management of a non-burn injury were excluded from the analysis., Results: Of 5,553 pediatric burn admissions, 297 (5.3%) were due to abuse. Children with non-accidental injuries tended to be younger (2.1 vs. 5.0 years, p<0.0001) and male (66.0 vs. 56.5%, p=0.0008). Scald was the most common mechanism of injury overall (44.8%), and was also the predominant cause of inflicted burns (89.6 vs. 42.3%, p<0.0001). Multivariate logistic regression identified age, gender, presence of a scald, contact, or chemical burn, and injury to the hands, bilateral feet, buttocks, back, and perineum to be significant predictors of abuse. Victims of abuse were also found to have worse outcomes, including mortality (5.4 vs. 2.3%, p=0.0005). After adjusting for age, mechanism of injury, and burn size, abuse remained a significant predictor of mortality (OR 3.3, 95% CI 1.5-7.2) CONCLUSIONS: Clinicians should approach all burn injuries in young children with a high index of suspicion, but in particular those with scalds, or injuries to the buttocks, perineum, or bilateral feet should provoke suspicion. Burns due to abuse are associated with worse outcomes, including length of stay and mortality., (Copyright © 2016. Published by Elsevier Ltd.)
- Published
- 2016
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44. Early leukocyte gene expression associated with age, burn size, and inhalation injury in severely burned adults.
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Sood RF, Gibran NS, Arnoldo BD, Gamelli RL, Herndon DN, and Tompkins RG
- Subjects
- Adult, Age Factors, Burns, Inhalation genetics, Female, Humans, Male, Middle Aged, Multiple Organ Failure etiology, Retrospective Studies, Risk Factors, Sepsis etiology, Burns, Inhalation mortality, Burns, Inhalation pathology, Leukocytes physiology, Transcriptome physiology
- Abstract
Background: In the patient with burn injury, older age, larger percentage of total body surface area (TBS) burned, and inhalation injury are established risk factors for death, which typically results from multisystem organ failure and sepsis, implicating burn-induced immune dysregulation as a contributory mechanism. We sought to identify early transcriptomic changes in circulating leukocytes underlying increased mortality associated with these three risk factors., Methods: We performed a retrospective analysis of the Glue Grant database. From 2003 to 2010, 324 adults with 20% or greater TBS burned were prospectively enrolled at five US burn centers, and 112 provided blood samples within 1 week after burn. RNA was extracted from pooled leukocytes for hybridization onto Affymetrix HU133 Plus 2.0 GeneChips. A multivariate regression model was constructed to determine risk factors for mortality. Testing for differential gene association associated with age, burn size, and inhalation injury was based on linear models using a fold change threshold of 1.5 and false discovery rate of 0.05., Results: After adjusting for potential confounders, age greater than 60 years (relative risk [RR], 4.53; 95% confidence interval [CI], 2.93-6.99), burn size greater than 40% TBS (RR, 4.24; 95% CI, 2.61-6.91), and inhalation injury (RR, 2.08; 95% CI, 1.35-3.21) were independently associated with mortality. No genes were differentially expressed in association with age greater than 60 years or inhalation injury. Fifty-one probe sets representing 39 unique genes were differentially expressed in leukocytes from patients with burn size greater than 40% TBS; these genes were associated with platelet activation and degranulation/exocytosis, and gene-set enrichment analysis suggested increased cellular proliferation and down-regulation of proinflammatory cytokines., Conclusion: Among adults with large burns, older age, increasing burn size, and inhalation injury have a modest effect on the leukocyte transcriptome in the context of the "genomic storm" induced by a 20% or greater than TBS burned. The 39-gene signature we identified may provide novel targets for the development of therapies to reduce morbidity and mortality associated with burns greater than 40% TBS., Level of Evidence: Epidemiologic study, level III.
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- 2016
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45. Epidemiology and outcomes of pediatric burns over 35 years at Parkland Hospital.
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Saeman MR, Hodgman EI, Burris A, Wolf SE, Arnoldo BD, Kowalske KJ, and Phelan HA
- Subjects
- Adolescent, Black or African American statistics & numerical data, Age Distribution, Body Surface Area, Burn Units, Burns mortality, Child, Child, Preschool, Female, Hispanic or Latino statistics & numerical data, Humans, Incidence, Infant, Infant, Newborn, Length of Stay, Male, Retrospective Studies, Sex Distribution, Texas epidemiology, Trauma Severity Indices, Burns epidemiology, Child Abuse statistics & numerical data, Hospitalization
- Abstract
Background: Since opening its doors in 1962, the Parkland Burn Center has played an important role in improving the care of burned children through basic and clinical research while also sponsoring community prevention programs. The aim of our study was to retrospectively analyze the characteristics and outcomes of pediatric burns at a single institution over 35 years., Study Design: The institutional burn database, which contains data from January 1974 until August 2010, was retrospectively reviewed. Patients older than 18 years of age were excluded. Patient age, cause of burn, total body surface area (TBSA), depth of burn, and patient outcomes were collected. Demographics were compared with regional census data., Results: Over 35 years, 5748 pediatric patients were admitted with a thermal injury. Males comprised roughly two-thirds (66.2%) of admissions. Although the annual admission rate has risen, the incidence of pediatric burn admissions, particularly among Hispanic and African American children has declined. The most common causes of admission were scald (42%), flame (29%), and contact burns (10%). Both the median length of hospitalization and burn size have decreased over time (r(2)=0.75 and 0.62, respectively). Mortality was significantly correlated with inhalation injury, size of burn, and history of abuse. It was negatively correlated with year of admission., Conclusions: Over 35 years in North Texas, the median burn size and incidence of pediatric burn admissions has decreased. Concomitantly, length of stay and mortality have also decreased., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)
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- 2016
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46. What's in a Name? Recent Key Projects of the Committee on Organization and Delivery of Burn Care.
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Hickerson WL, Ryan CM, Conlon KM, Harrington DT, Foster K, Schwartz S, Iyer N, Jeschke M, Haller HL, Faucher LD, Arnoldo BD, and Jeng JC
- Subjects
- Delivery of Health Care organization & administration, Disaster Planning, Female, Humans, Male, Organizational Innovation, Patient Care Team organization & administration, Societies, Medical organization & administration, United States, Burn Units organization & administration, Burns therapy, Congresses as Topic, Outcome Assessment, Health Care, Practice Guidelines as Topic
- Abstract
The Committee for the Organization and Delivery of Burn Care (ODBC) was charged by President Palmieri and the American Burn Association (ABA) Board of Directors with presenting a plenary session at the 45th Meeting of the ABA in Palm Springs, CA, in 2013. The objective of the plenary session was to inform the membership about the wide range of the activities performed by the ODBC committee. The hope was that this session would encourage active involvement within the ABA as a means to improve the delivery of future burn care. Selected current activities were summarized by key leaders of each project and highlighted in the plenary session. The history of the committee, current projects in disaster management, regionalization, best practice guidelines, federal partnerships, product development, new technologies, electronic medical records, and manpower issues in the burn workforce were summarized. The ODBC committee is a keystone committee of the ABA. It is tasked by the ABA leadership with addressing and leading progress in many areas that constitute current challenges in the delivery of burn care.
- Published
- 2015
- Full Text
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47. Morbidity and survival probability in burn patients in modern burn care.
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Jeschke MG, Pinto R, Kraft R, Nathens AB, Finnerty CC, Gamelli RL, Gibran NS, Klein MB, Arnoldo BD, Tompkins RG, and Herndon DN
- Subjects
- APACHE, Adolescent, Adult, Aged, Burn Units, Burns pathology, Burns therapy, Cohort Studies, Female, Humans, Male, Middle Aged, Multiple Organ Failure complications, Pneumonia complications, Probability, Prospective Studies, Respiratory Distress Syndrome complications, Sepsis complications, Young Adult, Burns mortality
- Abstract
Objective: Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn., Design and Patients: Burn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0-99 years old, admission within 96 hours after injury, and more than 20% total body surface area burns requiring at least one surgical intervention., Setting: Six major burn centers in North America., Measurements and Main Results: Burn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by American Burn Association sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (Denver 2 score>3) for both children (<16 yr) and adults (16-65 yr). Five hundred seventy-three patients were enrolled, of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children, the cutoff burn size for mortality, sepsis, infection, and multiple organ failure was approximately 60% total body surface area burned. In adults, the cutoff for these outcomes was lower, at approximately 40% total body surface area burned., Conclusions: In the modern burn care setting, adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality, even in highly specialized centers.
- Published
- 2015
- Full Text
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48. The year in burns 2013.
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Wolf SE, Phelan HA, and Arnoldo BD
- Subjects
- Biomedical Research, Burns complications, Burns epidemiology, Burns, Inhalation epidemiology, Burns, Inhalation therapy, Cicatrix etiology, Cicatrix prevention & control, Humans, Burns therapy, Cicatrix therapy, Critical Care methods, Plastic Surgery Procedures methods, Wound Infection therapy
- Abstract
Approximately 3415 research articles were published with burns in the title, abstract, and/or keyword in 2013. We have continued to see an increase in this number; the following reviews articles selected from these by the Editor of one of the major journals (Burns) and colleagues that in their opinion are most likely to have effects on burn care treatment and understanding. As we have done before, articles were found and divided into the following topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. The articles are mentioned briefly with notes from the authors; readers are referred to the full papers for details., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
49. The year in burns 2012.
- Author
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Wolf SE and Arnoldo BD
- Subjects
- Acute Disease, Humans, Pain Management, Pruritus therapy, Smoke Inhalation Injury therapy, Wound Infection therapy, Burns epidemiology, Burns prevention & control, Burns therapy
- Abstract
Approximately 2457 research articles were published with burns in the title, abstract, and/or keyword in 2012. This number continues to rise through the years; this article reviews those selected by the Editor of one of the major journals in the field (Burns) and his colleague that are most likely to have the greatest likelihood of affecting burn care treatment and understanding. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation, long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with comment from the authors; readers are referred to the full papers for further details., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
50. Mild obesity is protective after severe burn injury.
- Author
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Jeschke MG, Finnerty CC, Emdad F, Rivero HG, Kraft R, Williams FN, Gamelli RL, Gibran NS, Klein MB, Arnoldo BD, Tompkins RG, and Herndon DN
- Subjects
- Adult, Female, Humans, Injury Severity Score, Male, Prospective Studies, Severity of Illness Index, Burns complications, Burns mortality, Obesity
- Abstract
Objective: To assess the impact of obesity on morbidity and mortality in severely burned patients., Background: Despite the increasing number of people with obesity, little is known about the impact of obesity on postburn outcomes., Methods: A total of 405 patients were prospectively enrolled as part of the multicenter trial Inflammation and the Host Response to Injury Glue Grant with the following inclusion criteria: 0 to 89 years of age, admitted within 96 hours after injury, and more than 20% total body surface area burn requiring at least 1 surgical intervention. Body mass index was used in adult patients to stratify according to World Health Organization definitions: less than 18.5 (underweight), 18.5 to 29.9 (normal weight), 30 to 34.9 (obese I), 35 to 39.9 (obese II), and body mass index more than 40 (obese III). Pediatric patients (2 to ≤18 years of age) were stratified by using the Centers for Disease Control and Prevention and World Health Organization body mass index-for-age growth charts to obtain a percentile ranking and then grouped as underweight (<5th percentile), normal weight (5th percentile to <95th percentile), and obese (≥95th percentile). The primary outcome was mortality and secondary outcomes were clinical markers of patient recovery, for example, multiorgan function, infections, sepsis, and length of stay., Results: A total of 273 patients had normal weight, 116 were obese, and 16 were underweight; underweight patients were excluded from the analyses because of insufficient patient numbers. There were no differences in primary and secondary outcomes when normal weight patients were compared with obese patients. Further stratification in pediatric and adult patients showed similar results. However, when adult patients were stratified in obesity categories, log-rank analysis showed improved survival in the obese I group and higher mortality in the obese III group compared with obese I group (P < 0.05)., Conclusions: Overall, obesity was not associated with increased morbidity and mortality. Subgroup analysis revealed that patients with mild obesity have the best survival, whereas morbidly obese patients have the highest mortality. (NCT00257244).
- Published
- 2013
- Full Text
- View/download PDF
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