Minority pediatric burn survivors undergo more burn operations: A single center's five-year experience

Burn injuries remain a significant source of trauma in the United States and disproportionately affect racial and ethnic minorities. Although disparities are well documented in adults, less is known regarding those in pediatric populations. To address this gap in literature, we aim to better characterize burn injuries, inpatient treatments, and post-discharge outcomes in minority pediatric burn patients. We hypothesize minority patients undergo more surgery and re-admissions than non-minority patients for burn care. This is a single institution retrospective chart review of pediatric patient admissions with burn injuries from July 1st, 2016 to July 1st, 2021. Demographics, details of injury, inpatient surgical and non-surgical care, and post-discharge outcomes were collected. Patients identifying as Hispanic/Latino, Black, and Asian were coded as minority patients. Univariate analysis was utilized. A total of 332 patients with average age of 4.9 years (SD: 4.4) and average total burn surface area (TBSA) of 8.5% (SD: 10.0) were collected. Minority patients were significantly more likely to experience accidental burn injury (p < 0.01), inhalational injury (p < 0.01), surgical management (p < 0.01), and to undergo skin graft (p < 0.01) than White patients. Minority patients were significantly more likely to undergo laser treatment after discharge (p < 0.01) than White patients. Our study shows minority pediatric patients are at risk for non-intentional burn injuries that undergo surgical management such as skin grafting and longitudinal reconstructive procedures including laser therapy more often. Short-term goals should include facilitating improved physical and psychosocial outcomes in this often-underserved patient population.

Surgical Management of Diabetic Foot Burns is Associated with Poor Outcomes: A Systematic Review and Meta-Analysis

There is no consensus for the optimal management of diabetic foot burn injuries. Here, we systematically identify studies reporting on diabetic foot burns and evaluate outcomes among patients managed operatively versus non-operatively. PubMed, Embase, and Web of Science were searched. Screening was performed by independent reviewers. Primary research studies with English full texts published between 1980 to 2023 that discussed outcomes of foot burns in adults with diabetes were included and critically appraised using validated tools. Results are presented using descriptive statistics of aggregated data. The search yielded 2,402 non-duplicate papers, of which 35 met inclusion criteria. Nine papers were included for meta-analysis, including seven retrospective comparative analyses, one cross-sectional study, and one retrospective chart review. There were 1798 diabetic foot burn patients. Mean age was 58.2 years (SD 4.12) and 73.1% (n = 1,314) were male. A total of 15.7% (n = 283) of patients were surgically managed, including debridement (3.7%, n = 66), grafting (8.2%, n = 147), flap (0.2%, n = 3), and primary amputation (7.1%, n = 127). Secondary amputation rate, defined as amputation following initial surgery, was 4.9%, (n = 14). The overall amputation rate was 7.8% (n = 141). Other complications included infection (4.0%, n = 72), osteomyelitis (1.9%, n = 34), and graft failure (8.2%, n = 12). One study reported functional status at last visit. Diabetic foot burns are highly morbid. The surgical management of these complex injuries is high risk, as amputation results in poorer quality of life and functional outcomes.

Social Distancing or Socially Dividing? A Greater Proportion of Vulnerable Patients Admitted to a Metropolitan Burn Center During the COVID-19 Pandemic

Due to stay-at-home mandates and social distancing, we hypothesized the coronavirus disease 2019 global pandemic altered the epidemiology of burn injuries that presented to a single-institution, metropolitan burn center. A retrospective review of adult and pediatric patients admitted to the center during a three-year period: 3/20/19-3/19/20 (Pre-Pandemic Year), 3/20/20-3/19/21 (Pandemic Year 1), and 3/20/21-3/19/22 (Pandemic Year 2). Variables included patient demographics, burn injury, and hospitalization characteristics. A greater proportion of males compared to females were admitted during the Pre-Pandemic Year with a significant increase in this difference during Pandemic Year 1 (p<0.05). There was a significant increase in the proportion of undomiciled patients admitted between the Pre-Pandemic Year and Pandemic Year 2 (p<0.01). There were significant increases in the proportion of admitted patients who were uninsured, had a history of mental illness and/or substance abuse between Pandemic Years 1 and 2 (p<0.001, p<0.05, p<0.01) and between the Pre-Pandemic Year and Pandemic Year 2 (p<0.001, p<0.01, p<0.001). There were significant differences in deepest burn depth and burn etiology between individual years. The proportion of burn patients treated purely non-operatively significantly increased during Pandemic Year 1 (p<0.05). Greater changes in the demographics of burn patients admitted after the onset of the pandemic were reported compared to the characteristics and management of their burn injuries. Overall, this study demonstrated that a greater proportion of vulnerable patients were admitted during the pandemic, providing a better understanding of existing health disparities and the differential impact of the pandemic on lower socioeconomic populations.

Evaluation of YouTube As A Source For Graves' Disease Information: Is High-Quality Guideline-Based Information Available?

Objective

To understand the quality of informational Graves' disease (GD) videos on YouTube for treatment decision-making quality and inclusion of American Thyroid Association (ATA) treatment guidelines.

Study Design

Cross-sectional cohort.

Setting

Informational YouTube videos with subject matter "Graves' Disease treatment."

Method

The top 50 videos based on our query were assessed using the DISCERN instrument. This validated algorithm discretely rates treatment-related information from excellent (≥4.5) to very poor (<1.9). Videos were also screened for ATA guideline inclusion. Descriptive statistics were used for cohort characterization. Univariate and multivariate linear regressions characterized factors associated with DISCERN scores. Significance was set at P < .05.

Results

The videos featured 57,513.43 views (SD = 162,579.25), 1054.70 likes (SD = 2329.77), and 168.80 comments (SD = 292.97). Most were patient education (52%) or patient experience (24%). A minority (40%) were made by thyroid specialists (endocrinologists, endocrine surgeons, or otolaryngologists). Under half did not mention all 3 treatment modalities (44%), and 54% did not mention any ATA recommendations. Overall, videos displayed poor reliability (mean = 2.26, SD = 0.67), treatment information quality (mean = 2.29, SD = 0.75), and overall video quality (mean = 2.47, SD = 1.07). Physician videos were associated with lower likes, views, and comments (P < .001) but higher DISCERN reliability (P = .015) and overall score (P = .019). Longer videos (P = .015), patient accounts (P = .013), and patient experience (P = .002) were associated with lower scores.

Conclusion

The most available GD treatment content on YouTube varies significantly in the quality of medical information. This may contribute to suboptimal disease understanding, especially for patients highly engaged with online health information sources.

A Comparison of Otolaryngology Residency Applicants Over Time and to Other Surgical Applicants

Objective

Understand how otolaryngology residency applicant characteristics have changed over time and compare them to those of other surgical subspecialties.

Study Design

Retrospective analysis of academic, extracurricular, and application data in the Texas Seeking Transparency in Application to Residency databases.

Setting

Applicants to otolaryngology, neurological surgery, ophthalmology, plastic surgery, urology, and orthopedic surgery applicants from 2019 to 2023.

Methods

Kruskal-Wallis, Wilcoxon rank sum, Fischer's exact, and Mann-Whitney U tests were used to compare temporal, match-based, and subspecialty differences in applicant characteristics.

Results

Across 4 match cycles and 541 otolaryngology applicants, significant differences were found in the average number of honored clerkships per applicant (P = 0.044), the percentage of matched applicants (P = 0.017), and the average number of research experiences (P < 0.001), peer-revied publications (P = 0.002), applied programs (P < 0.001), and interviews received (P = 0.041). Relative to their unmatched counterparts, matched applicants frequently received more interviews, belonged to higher academic quartiles, and were more likely to belong to academic honor societies (all P < 0.05). Matched applicants exhibited significant differences in the number of research experiences (P = 0.002), peer-reviewed publications (P = 0.004), and applied programs across cycles (P < 0.001). Relative to applicants from other surgical subspecialties, otolaryngology applicants exhibited high amounts of extracurricular involvement, were on par in terms of research output, and received a low proportion of interviews despite applying to a high number of programs.

Conclusion

Matching into otolaryngology has become increasingly competitive and is as competitive as peer surgical subspecialties. Strong academic performance, judicious program signaling, increased research involvement, and holistic factors like letters of recommendation may help applicants successfully match.

Grill-Related Burn Injuries: A Matched Cohort Study

Barbequing can result in devastating burn injuries with unsafe practices. This study aims to characterize the demographics, injury characteristics, and outcomes of grill-related burns and identify ways of burn prevention. A retrospective review of patients admitted to a single-institution, metropolitan burn center from 1/1/17 - 7/1/23. Data included demographics, burn injury characteristics, and outcomes. Each Grill Cohort patient was matched to three non-grill controls by mBaux score and burn location. Out of 2,355 patients, 69 (2.9%) met Grill Cohort inclusion criteria. The Grill Cohort had 55 (79.7%) males and an average age of 41.7 ±17.5 years old. In the Grill Cohort, 25 (36.2%) patients had positive blood alcohol, 8 (11.6%) tested positive for amphetamines and 5 (7.2%) for cocaine at the time of admission. A total of 61 (88.4%) Grill Cohort burns involved the upper extremity, 43 (62.3%) the head/neck, 34 (49.3%) the lower extremity, and 30 (43.5%) the trunk. Compared to the Control Cohort, the Grill Cohort had smaller proportions of patients who were undomiciled (p<0.01) or had a history of mental illness (p<0.001). Grill-related burns had a greater proportion of flash/flame burns (p<0.001). This study suggests that middle-aged, domiciled males without psychiatric comorbidities are more likely to make preventable grilling errors resulting in burn injuries. Prevention strategies targeting this demographic should underscore the risks of grilling while intoxicated, proper handling of propane tanks and lighter fluid, and the use of flash/flame-resistant gear protecting the upper extremities and head/neck.

Blood glucose control in the burn intensive care unit: A narrative review of literature

Burn survivors undergoing complex glycemic derangements in the acute period after burn are at significantly increased risk of worse outcomes. Although most critical care investigations recommend intensive glycemic control to prevent morbidity and mortality, conflicting recommendations exist. To date, no literature review has studied outcomes associated with intensive glucose control in the burn intensive care unit (ICU) population. This review addresses this gap to improve practice guidelines and support further research regarding glycemic control. This is a narrative review of literature utilizing PubMed for articles published at any time. Inclusion criteria were English studies describing glucose management in ICU adult burn patients. Studies involving pediatric patients, non-human subjects, care non-ICU care, case reports, editorials, and position pieces were excluded. Our literature search identified 2154 articles. Full text review of 61 articles identified eight meeting inclusion criteria. Two studies reported mortality benefit of intensive glucose control ( mg/dL) compared to controls ( mg/dL), while two studies showed no mortality differences. Three studies reported reduced infectious complications such as pneumonia, urinary tract infection, sepsis, and bacteremia. A majority of the studies (6/8) reported higher risk for hypoglycemia with tight glucose control, but few reported instances of adverse sequela associated with hypoglycemia. Intensive glucose control may provide benefit to burn patients, but complications associated with hypoglycemia must be considered. This review recommends an individualized patient-centered approach factoring comorbidities, burn injury characteristics, and risk factors when determining whether to employ intensive glucose control.

Cancel cancer: The immunotherapeutic potential of CD200/CD200R blockade

Immune checkpoint molecules function to inhibit and regulate immune response pathways to prevent hyperactive immune activity from damaging healthy tissues. In cancer patients, targeting these key molecules may serve as a valuable therapeutic mechanism to bolster immune function and restore the body's natural defenses against tumors. CD200, an immune checkpoint molecule, is a surface glycoprotein that is widely but not ubiquitously expressed throughout the body. By interacting with its inhibitory receptor CD200R, CD200 suppresses immune cell activity within the tumor microenvironment, creating conditions that foster tumor growth. Targeting the CD200/CD200R pathway, either through the use of monoclonal antibodies or peptide inhibitors, has shown to be effective in boosting anti-tumor immune activity. This review will explore CD200 and the protein's expression and role within the tumor microenvironment, blood endothelial cells, and lymph nodes. This paper will also discuss the advantages and challenges of current strategies used to target CD200 and briefly summarize relevant preclinical/clinical studies investigating the immunotherapeutic efficacy of CD200/CD200R blockade.

O 089 - A soft robotic exosuit assisting the paretic ankle in patients post-stroke: Effect on muscle activation during overground walking

This study compared overground walking with and without exosuit assistance in post-stroke patients. Exosuit-assisted walking was found to improve paretic propulsion and ground clearance during swing, two common gait deviations in stroke patients. No changes in leg muscle activity was found, motivating further study of the exosuit as a tool for gait training during stroke rehabilitation.

18F-FDG uptake on positron emission tomography in gefitinib-treated non-small cell lung cancer patients

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Background: This study evaluated the clinical significance of 18F-fluoro-2-deoxy-glucose (FDG) uptake on positron emission tomography (PET) in gefitinib-treated non-small-cell lung cancer (NSCLC) patients. Method: We retrospectively analyzed PET scans of 66 NSCLC patients with stage IIIB-IV and its association with gefitinib responsiveness. Response rate and time-to- progression (TTP) were analyzed according to the maximum standardized uptake value (SUV) at presentation. Cut-off vale of SUV was obtained from receiver operating characteristic analysis. Univariate and multivariate analyses were performed. Results: According to smoking history and pathology, different response rates were observed (P = 0.012 and 0.048, respectively). Thirteen patients were categorized into low SUV group. Patients with low SUV showed higher RR compared with those with high SUV (46% vs 13%, P = 0.007). In univariate analysis, prolonged TTP was observed in never-smoker (P = 0.007). Low SUV was associated with prolonged TTP (P = 0.010). Multivariate analysis confirmed that low SUV and never-smoker remained favorable prognostic factors (P = 0.046 and 0.043, respectively). Conclusion: These results suggest that FDG uptake may be predictive of outcome in gefitinib-treated non-small-cell lung cancer patients.

No significant financial relationships to disclose.

Defining a role for endoscopic ultrasound in staging periampullary tumors

BACKGROUND

The goal of the preoperative workup in patients with suspected periampullary carcinoma is to establish the diagnosis with a high degree of certainty. In this study we compared endoscopic ultrasonography (EUS) and computed tomography (CT) scans for the detection of tumor, lymph node metastasis, and vascular invasion in patients with suspected periampullary carcinoma in order to define a role for EUS in the preoperative staging of these patients.

METHODS

Thirty-seven consecutive patients received EUS and CT scanning followed by operation for presumed periampullary carcinoma during a 30-month period. Both imaging modalities were reviewed in a blinded fashion and the results compared with pathology and operative reports on all patients.

RESULTS

Sensitivity, specificity, positive predictive value, and negative predictive value for tumor detection by EUS were 97%, 33%, 94%, and 50%, respectively, compared with 82%, 66%, 97%, and 25% for CT scan. For lymph nodes the values were 21%, 80%, 57%, and 44%, respectively, for EUS compared with 42%, 73%, 67%, and 50% for CT. For vascular invasion, the values were 20%, 100%, 100%, and 89%, respectively, for EUS, compared with 80%, 87%, 44%, and 96% for CT.

CONCLUSIONS

CT is the initial study of choice in patients with suspected periampullary tumors. EUS is superior for detecting tumor and for predicting vascular invasion. Therefore, EUS should be used for patients in whom CT does not detect a mass and for those with an identifiable mass on CT in whom vascular invasion cannot be ruled out.