Risk of COVID-19 in pediatric population and the effects of COVID-19 vaccination: A retrospective cohort study

OBJECTIVE

Prior studies have demonstrated the adverse effects of upper respiratory infections on the pediatric population, such as increased risk for acute otitis media (AOM). Other studies have noted decreased otitis media complaints during the COVID-19 pandemic. This project aims to identify whether individuals who tested positive for COVID-19 at the Emergency Department (ED) visit had an increased risk of developing severe complications. Additionally, we will study whether vaccination helped decrease following COVID-19 complications.

METHODS

Utilizing the TriNetX database, we obtained de-identified electronic medical records for children under five and 6-10 years old from 2020-2023 in the United States. The study population was propensity-matched for gender, index age, and comorbidities. Complications within eight weeks of the ED visit were compared between COVID-19 vaccinated and unvaccinated children. Risk ratio was used to measure associations between our groups. A p-value less than or equal to 0.05 was considered significant.

RESULTS

After propensity matching, a total of 211,138 children were identified. Within eight weeks after the ED visit, unvaccinated children <5 years old who tested negative for COVID-19 had a 30 % relative risk reduction for AOM, 52 % for sinusitis, 76 % for multisystem inflammatory system (MIS), 17 % for acute respiratory failure, and 37 % for septic shock when compared to those with a positive COVID-19 result (p ≤ 0.05). Unvaccinated 6-10 years old children who tested negative for COVID-19 had an 18 % risk reduction for AOM, 44 % reduction for sinusitis, 63 % reduction for MIS, and 42 % for acute respiratory failure (p ≤ 0.05) compared to those that tested positive for COVID-19. Vaccinated children with positive COVID-19 results have no significant risk of AOM or acute respiratory failure. Additionally, children 6-10 years old with positive COVID-19 results did not have a substantial risk of sinusitis.

CONCLUSION

COVID-19's effects require continued investigation in children. This study showed that there are some increased risks of severe complications following this viral infection.

The Utilisation of INR to identify coagulopathy in burn patients

Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0-1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20-29% TBSA, p = .0005 at 30-39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399-5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.

Patterns of antibiotic administration in patients with burn injuries: A TriNetX study

BACKGROUND

In the advent of increasing antibiotic resistance, several studies sought to determine antibiotic prescription trends; however, no pattern has been firmly identified particularly for the burned population. We performed a query of burned patients in a large established database to understand differences in antibiotic use related to patient-specific factors.

METHODS

Burned patients with systemic antibiotics given within 7 days of injury were identified on the TriNetX database. The patient population was stratified by age, 1-year time intervals of antibiotic prescription from 2004 to 2019, time of antibiotic prescription in 1-day intervals after injury, and % TBSA burned in 10% intervals ranging from < 10% to > 90%. Data were analyzed using χ2 with p < 0.05 considered significant. Pearson coefficients (r2) values were used to correlate differences in antibiotic prescription between age groups and to changes over time.

RESULTS

Stratification by age revealed higher use of antibiotics in older burned patients compared to younger patients. Surprisingly, 87.6% of burn patients of those who received antibiotic therapy was on the day of injury. Penicillins and beta-lactam antimicrobials were used most often at a frequency of 64%. No statistically significant differences in rates of antibiotic therapy were observed in burned patients when stratified by %TBSA burned.

CONCLUSIONS

The study elucidates current patterns of antibiotic use in burn care in the United States, allowing for improved understanding of both past and present patterns of antibiotic prescription.

Early wound excision within three days decreases risks of wound infection and death in burned patients

INTRODUCTION

In lieu of limited studies on the timing of burn wound eschar excision for burns, a more comprehensive analysis is indicated to determine the effects of early wound excision following burns. This study aims to address the outcomes of early wound excision in burn patients.

METHODS

Data collection were from TriNetX research database. Three groups of burn patients were stratified by the number of days in which they received burn wound excision within 14 days of injury. Five outcomes were observed: death, wound infection, sepsis, myocardial contractile dysfunction, and blood transfusion. Risk and incidence of various health outcomes were compared between the groups after propensity-matching age, sex, ethnicity, race and burn size using a z-test with p < 0.05 considered significant.

RESULTS

We identified 6158 burn patients with wound excision within 14 days of injury, the majority of whom (60.1%) received burn wound excision between 0 and 3 days after burn. 72.5% of patients had burns covering less than 20% of total body surface area. After propensity matching, we found a significantly lower risk of mortality in those who received burn wound excision within the first three days (3.84%) as compared to 8-14 days after burn (6.09%) (p < 0.05). Moreover, we found a decreased risk of wound infection in patients with burn wound excision within 0-3 days (37.84%) compared to those 4-7 days (42.48%) (p < 0.05). No statistical difference was detected in propensity-matched groups for myocardial contractile dysfunction, blood transfusion, or sepsis. In addition, the risk of hypertrophic scaring significantly decreased when wound excision was performed within 0-3 days (22% within 0-3 days, 28% within 4-7 days, p < 0.05).

CONCLUSION

Burn wound excision within 3 days of injury is beneficial when comparing to later treatment between 4 and 14 days, which results in a significantly lowered risk of mortality and infection in burn patient.

Opioid prescription and opioid disorders in burns: A large database analysis from 1990 to 2019

BACKGROUND

Opioids remain crucial in the management of burn pain. A comprehensive analysis of opioid use in burns and their complications has not been investigated.

METHODS

Data were collected from TriNetX, a large multicenter database with de-identified patient information. The population included patients prescribed opioids on or following burn injury from January 1st, 1990, to December 31st, 2019. Opioid prescription use was analyzed after cohort stratification by decades: 1990-1999, 2000-2009, and 2010-2019. Outcomes for opioid-related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders from psychoactive substance use were investigated.

RESULTS

Hydrocodone was the most frequently prescribed opioid in 1990-1999 and 2000-2009, with oxycodone taking the lead in 2010-2019 (p < 0.0001). During 1990-1999, patients had a decreased risk of recorded opioid-related disorders (RR=0.52), opioid dependence (RR=0.46), opioid abuse (RR=0.55), mental and behavioral disorders (RR=0.88), and intentional self-harm (RR=0.37) when compared to 2000-2009. A comparison of the 2000-2009-2010-2019 cohorts showed an increased risk of recorded opioid-related disorders (RR= 1.91), opioid dependence (RR=1.56), opioid abuse (RR=1.67), mental and behavioral disorders (RR =1.73), and intentional self-harm (RR=2.02).

CONCLUSIONS

The risk of opioid-related disorders has nearly doubled since the year 2000 warranting precautions when prescribing pain medications to burn patients.

Higher risk of acute kidney injury and death with rhabdomyolysis in severely burned patients

BACKGROUND

Rhabdomyolysis is a severe condition responsible for up to 10% of acute kidney injury (AKI) cases. Severely burned patients are susceptible to developing both rhabdomyolysis and acute kidney injury, but whether burned patients with rhabdomyolysis are at greater risk of acute kidney injury compared to non-burned patients with rhabdomyolysis is unclear.

METHODS

TriNetX, a clinical research platform, was used to obtain electronic medical record information in 3 patient cohorts over the recent 20-year period. Cohort 1 included burn patients who developed rhabdomyolysis, cohort 2 were those who developed rhabdomyolysis due to non-burn causes, and cohort 3 included burn patients who did not develop rhabdomyolysis. Matching was performed to balance demographics and comorbidities for each cohort. Cohorts were then compared for the development of acute kidney injury and death.

RESULTS

We found 84 of 111 patients in cohort 1 (75.676%), 56 of 111 patients in cohort 2 (50.45%), and 18 of 111 patients in cohort 3 (16.216%) developed acute kidney injury within 5 days. The odds ratio for developing acute kidney injury for burned patients compared to non-burned patients with rhabdomyolysis was 3.056 with a 95% confidence interval of 1.726 to 5.41 (P < .05), and between burned patients with and without rhabdomyolysis was 16.074 with a 95% confidence interval of 8.263 to 31.268 (P < .05). The incidence of death within 1 year was also significantly higher in cohort 1 (48%) than the other cohorts (9% and 14%, respectively) (P < .05).

CONCLUSION

The risk of acute kidney injury and mortality in severely burned patients with rhabdomyolysis is significantly increased compared to matched non-burn patients with rhabdomyolysis or burned patients without rhabdomyolysis.

82 Early Skin Excision Decreased the Risk of Skin Infection, Sepsis and Mortality Among Burn Patients

Introduction

In lieu of outdated and limited patient studies on excision for severe burns, a more comprehensive analysis is indicated to determine the effects of early skin excision following burn. This study aims to address the outcomes of early excision.

Methods

Data collection and analysis was performed using TriNetX, a national research database. The study population included patients ranging from 0 to 90 years old who underwent excision for burns. Groups were stratified by the number of days after injury in which they received a skin excision treatment. Five outcomes were analyzed: death, cardiac stress, wound infection, blood transfusion, and sepsis. Risk and incidence of various health outcomes were compared between groups after matching for age, gender and race, using a z-test with p< 0.05 considered significant.

Results

We identified 2,522 patients who underwent excision between 0-3 days, 825 between 4-7 days, and 419 between 8-14 days following burn. We found a significant decrease in risk of skin infection and sepsis for skin excision 0-3 days after burn compared to 4-7 days (p< 0.05). Additionally, the frequency of blood transfusion significantly increased for those with excision 0-3 days after burn when compared to 4-7 days (p< 0.05). There was a significant increase in the risk of mortality for patients who received skin excision 8-14 days after injury as compared to both 0-3 days (p< 0.05) and 4-7 days (p< 0.05). However, we found no statistical difference in cardiac stress, skin infection, blood transfusion or sepsis between 0-3 and 8-14 days nor 4-7 and 8-14 days.

Conclusions

Skin excision 0-3 days after burn injury results in a significantly lowered risk of skin infection and sepsis as compared to skin excision 4-7 days and 8-14 days after burn. Skin excision within the first 7 days after burn decreased the risk of mortality as compared to excision 8-14 days after burn. The risk of blood transfusion increased with early excision, which may be explained by the severity of the injury.

12 The Influence of Female Sex Hormones on Outcomes After Burn Injury

Introduction

The pathophysiological response to major trauma has gender dimorphism in outcomes associated with sex hormones levels. However, little is known of the effects of female hormones on outcomes in burn patients. Previous studies demonstrated exogenous estrogen alleviates hyper-inflammation after burn. We thus posit that female patients have fewer comorbidities depending on female hormone levels. We had two objectives: to investigate the role of female hormones on outcomes after burn and to investigate potential protective properties of exogenous hormone treatment on burned post-menopausal women.

Methods

This study obtained data from the TriNetX research network with electronic medical records of de-identified patients. Both male and female patients who suffered burns were included from 2002-2020. The population was stratified to only include women over 45 on estrogen or progestin hormones taken within 6 months prior to injury and 1 month after injury to assure a menopausal state which occurs at age 45-55. Outcomes for mortality, sepsis, acute myocardial infarction, and acute kidney injury were measured within one day of injury to one month following injury. Odds ratios, risk difference, and risk ratios were calculated for outcome analysis after propensity-matched for race and ethnicity. A z-test for risk difference was performed. Statistical significance was defined at p &lt; 0.05.

Results

Compared to males, females grossly had a 28% risk reduction of 30-day mortality and a relative risk reduction for sepsis (26%), acute kidney failure (30), and myocardial infarction (29%) (p&lt; .05). Additionally, female burns younger than the age 45 had risk reductions for mortality 5.4-fold within 3 months, 2.9-fold lower for sepsis, 17.5-fold lower for myocardial infarction, and 7.7-fold lower for acute kidney injury (p&lt; .001). TriNetX identified 169,566 female burn patients, of which 2,683 were on estrogen and progestin and above 45 years old. Women over 45 on exogenous hormones had a 37% significant risk reduction in acute kidney failure when compared to the women over 45 not prescribed estrogen or progestin (p&lt; .05).

Conclusions

Female burn patients had better outcomes, while women over 45 had worse outcomes indicating the role of female sex hormone correlated to burn patient progress. The administration of estrogen and progestins for females above age 45 resulted in reduced risks for acute kidney failure after burn injury.

4 Risk Association Between Race and Complications Following Burn

Introduction

Racial minorities have been recognized to experience worse health outcomes for many medical conditions. However, it is not clear if these outcomes are associated with pre-existing conditions or the quality of care those patients receive. In burns, little information on the relationship between race and burn comorbidities is available. This study examines the risk association between race and burn complications, such as pneumonia, sepsis, and ARDS while controlling for common comorbidities that affect burn recovery such as diabetes and hypertension.

Methods

Burn patient cohorts were identified by ICD10 codes for burn injury using TriNetX, a federated network of real-world data. The cohorts were stratified by race and balanced in terms of age at index, gender, BMI, and pre-existing comorbidities such as diabetes and hypertension. The following post burn outcomes were selected for analysis: renal failure, cardiovascular disease, sepsis, ARDS, graft complication, pneumonia, ICU admit, respiratory failure, hypertrophic scarring (HTS), hyperglycemia, and mortality. A measure of association analysis was performed to compare risk outcomes in black vs. white burn patients. Statistical significance was set at p< 0.05. The same cohorts were analyzed for treatment pathways to compare critical care billing CPT codes for the amount of time seen by a physician: Critical Care and Evaluation, first 30-74 minutes, and Critical Care and Evaluation, each additional 30 minutes.

Results

The balanced patient cohorts comprised 78,974 patients per cohort. Black patients experience a positive relative risk ratio (RR) to renal failure (p < 0.0001, RR = 1.372, 95% CI: 1.314-1.435), cardiovascular disease (p < 0.0001, RR = 1.115, CI: 1.08-1.15), sepsis (p < 0.0071 RR = 1.081, CI: 1.021-1.144), and ARDS (p < 0.0010, RR = 1.287 CI: 1.107-1.496) following burn injury. However, black patients experience a negative risk ratio to mortality (p < 0.0006, RR = 0.935, CI: 0.89-0.982) and pneumonia (p < 0.0014, RR = 0.937, CI: 0.901-0.975). The risk ratio was not significant for outcomes between black and white burn patients for respiratory failure, HTS, hyperglycemia, and ICU admit. Analysis of treatment pathways did not show significant differences in Critical Care and Evaluation billing between the two races.

Conclusions

Black burn patients are more likely to experience renal failure, cardiovascular disease, sepsis, and ARDS compared to white burn patients despite controlling for common comorbidities. They are less likely to experience pneumonia and mortality.

6 Risk Factors and Comorbidities Associated with Post-burn Hypertension

Introduction

Hypertension (HTN) is a prevalent condition in the United States and leads to an increased risk of developing other comorbidities. However, the impact of hypertension following severe burns on patient outcomes is not known. We hypothesize that post-burn hypertension is associated with an increased risk of other comorbidities and mortality.

Methods

This study used data from TriNetX, a global federated health research network. Burned patients who were diagnosed with essential hypertension at least 1 day after injury were identified in the TriNetX database using specific ICD codes and were compared to those who did not develop essential hypertension; neither cohort was diagnosed with hypertension prior to injury. Each cohort was balanced for age, gender, race, and ethnicity. Occurrence of the following within 3 days of burn was compared between the two cohorts: acute kidney injury (AKI), hyperglycemia, heart failure, coronary artery disease, and death. These patient cohorts were then stratified by gender, percent total body surface area (TBSA) burned, and age. Statistical analysis for the measures of association used an odds ratio with a 95% confidence interval and a risk ratio with a z-test. Significance for the z-test was set at a p-value of < 0.05.

Results

The search identified 460,977 burn patients of whom 87,808 were diagnosed with hypertension at least 1 day after burn injury. Those diagnosed with hypertension were 7.25 times as likely to develop AKI, 5.45 times as likely to develop hyperglycemia, 7 times as likely to develop heart failure, 7.17 times as likely to develop coronary artery disease, and 1.78 times as likely to die. Men were at greater risk of experiencing AKI, heart failure, coronary artery disease, and death, however, women were 1.51 times as likely to develop hyperglycemia. Stratification based on % TBSA burned indicated an increased risk for all outcomes for patients with a high percentage of total body surface area burned (60% to > 90% TBSA burned was higher than < 10% to 50-59% groups). Subgroup analysis based on age indicated elevated risk of developing AKI, heart failure, coronary artery disease, or death with age. However, we found a spike in risk for all outcomes in the 0-9 age group. All data was significant at p < .0001.

Conclusions

A new hypertension diagnosis in severely burned patients is highly associated with other comorbidities including acute kidney injury, heart failure, coronary artery disease, and death. Overall, males, older patients, and those with a higher percent TBSA burned are at a higher risk of developing these comorbidities.

741 Burn Injury Elevates the Risk of Sepsis in Pregnant Women

Introduction

Pregnancy naturally strains a woman’s body, and is exacerbated by additional stressors, such as severe burn. This study seeks to establish a national incidence rate of burns during pregnancy, as well as categorize the patients epidemiologically and by percent total body surface area (%TBSA) burned. We posit that pregnancies complicated by burn injuries have worse outcomes in mortality and comorbidities in comparison to pregnancies not complicated by burns.

Methods

Using an electronic medical record database, TriNetX, a retrospective cohort study was performed to identify burned pregnant patients within the last 20 years. The burn cohort included all pregnant women aged 12-55 who experienced a burn injury on the same day as pregnancy or anytime within nine months after the first record of pregnancy. The non-burned cohort included women who did not experience a burn within nine months of the recorded pregnancy. Outcomes compared were sepsis, pregnancy with abortive outcome, ectopic pregnancy, spontaneous abortion, complications of labor and delivery, preterm labor, postpartum hemorrhage, maternal mortality, and acute respiratory distress syndrome (ARDS). After matching for age at pregnancy, each outcome was compared at one, three, and five years after pregnancy. Risk ratios (RR) with a 95% confidence interval (CI) were used to compare cohorts, and a p-value &lt; 0.05 was deemed significant.

Results

The TriNetX database contained 21,438,975 females between the ages of 12-55. Among these, pregnant women with burn injuries were found to have an incidence of 4.32% in the United States in the last 20 years (pregnant females with burn n = 4,721; females with burn n = 109,294). Of burns categorized by %TBSA burned, 84% were between 1-10%. Within one year of pregnancy, burned patients have a three-fold increase in risk of development of sepsis compared to non-burned women (RR = 3, 95% CI = 1.518, 5.929), but are less likely to experience pregnancy with abortive outcome (RR = 0.612, 95% CI = 0.509, 0.735), complications during labor and delivery (RR = 0.863, 95% CI = 0.803, 0.928) or spontaneous abortion (RR = 0.707, 95% CI = 0.556, 0.899).

Conclusions

Pregnancy complicated by burn injury has a lower national incidence rate than the generally accepted 7% of reproductively aged females. Burned patients were more likely to experience sepsis than their non-burned counterparts one year after pregnancy, however, risk of maternal mortality was the same between the burned and non-burned patients within one year after pregnancy with a curious decrease in miscarriage and labor and delivery complications.

118 Burn Injury Vandalizes Cancer Survival with Increased Risk of Complications

Introduction

Burn injuries place patients in a compromised state, especially those with pre-existing comorbidities. The presence of cancer complicates care and worsens outcomes for patients suffering from illnesses unrelated to burns, such as sepsis. Therefore, we posit the incidence of burn injury on patients with preexisting cancer diagnoses results in an increased risk of complications.

Methods

Burned patients were identified using the TriNetX database, a global federated health research network. Fifty-one thousand patients with a diagnosis of cancer prior to experiencing a burn injury were identified. Control groups included 1) patients who had a previous cancer diagnosis and no incidence of burn, and 2) patients who experienced a burn with no history of cancer. Outcomes analyzed included sepsis, nutritional deficiency, eating disorder, immunodeficiency, and depression within 5 years. Cancer diagnoses were categorized into 5 of the 13 most common cancer reported in the US. Data was analyzed using a chi-square analysis with p&lt; 0.05 considered significant, and presented odds ratio are with 95% confidence intervals.

Results

The majority of cancer survivors with burns were White (70%) and female (62%). Compared to cancer patients without burn injury, patients experiencing a burn after a diagnosis of cancer were more likely to develop sepsis (1.718, 1.612-1.83), nutritional deficiency (1.963, 1.593-2.418), immunodeficiency (1.265, 1.098-1.459), eating disorders (2.569, 2.077-3.177), and depression (1.538,1.468-1.611). When compared to burn patients with no history of cancer, burned patients with cancer diagnosis had increased odds of developing sepsis (3.806, 3.502-4.137), nutritional deficiency (3.529, 2.725-4.571), immunodeficiency (6.657, 5.126,8.645), eating disorder (2.184, 1.787-2.67), and depression (2.147, 2.041-2.259). Further, burned patients with a history of lung cancer experienced a uniquely high risk of sepsis. Additionally, burn patients with histories of either lung or breast cancers were also at increased risk ratios of experiencing depression (p&lt; 0.05).

Conclusions

Burned patients with a history of a cancer demonstrated considerable increases in complications when compared to those with only a burn injury. Categorization of the broad “neoplasm” label uncovers patterns or trends for specific cancer types to inform the current healthcare system more accurately.

123 Sleep Disorder Is Associated with Neuropsychological Disturbances in Burn Survivals

Introduction

Prior studies explored neuropsychological disorders in the context of burn severity; however, the relationship between occurrence after burn and sleep has not been investigated. This study aims to determine if patients that developed a first-time sleep disorder after burn injury are more likely to develop a psychological or nervous system disorder within 10 years after injury.

Methods

We identified burn patients on the TriNetX database, a federated research network of de-identified patient data. We formed two groups, those with first time sleep disorder diagnosis on or after the incidence of burn injury and those with no first-time sleep disorder diagnosis on or after burn. Groups were propensity matched to evaluate incidence of nervous system and mental disorders and characteristics, defined as bipolar disorder, epilepsy, neuropathy disorders, and 52 other neuropsychological disorders. Diagnoses of nervous system disorder and mental disorder were limited to after the burn injury and within the 10-year time frame. We analyzed data using a z-test with a p &lt; 0.05 considered significant.

Results

We found 7.83% of patients developed a first-time sleep disorder after burn injury. The population was older (43.9 ± 20.8 vs. 31.7 ± 22.4 yrs), female (51.13% vs. 46.10%), and White (70.02% vs 60.24%) when compared to those without sleep disorders (p&lt; 0.05). Those who experienced a first-time sleep disorder after burn presented a greater risk of developing the mental, central nervous system, and peripheral nervous system disorders when compared to those who did not. Eating disorders, persistent mood disorders, and obsessive-compulsive disorders were 4.54, 95% CI [3.65, 5.65]; 3.84, 95% CI [3.49, 4.22], and 3.94, 95% CI [3.13, 4.97] times higher, respectively, in patients who developed a first-time sleep disorder (p&lt; 0.05). Anxiety-related disorders were also more than 3 times more likely in those who developed a sleep disorder after burn (p&lt; 0.05).Central nervous system disorders were related to sleep disorder post burn. Extrapyramidal and movement disorders were more than 3 times more likely to occur in sleep disorder patients (Extrapyramidal and movement disorder, unspecified 95% CI [2.48, 4.63] and Other extrapyramidal and movement disorders 95% CI [3.17, 3.78]. In regard to peripheral nervous system disturbances, restless leg syndrome was more than 4 times more likely to occur in patients that developed a first time sleep disorder after burn injury 95% CI [3.70, 4.65]. Polyneuropathy was also 2.28 more times likely to occur 95% CI [2.12, 2.47].

Conclusions

Mental disorders and various central nervous system and peripheral nervous system disturbances are highly associated with identification of sleep disorders after burn. This finding suggests close monitoring for sleep in those who were burned to optimize outcomes.

95 Incidence of Hypertrophic Scar Diagnosis in Burn Patients Prescribed Glucocorticoids

Introduction

Despite advancements in burn care, the optimal treatment to prevent or treat hypertrophic scars is still elusive. Therefore, the objective of this study is to compare the efficacy of five glucocorticoid medications commonly used in the treatment of hypertrophic scarring in burned patients using a large patient database.

Methods

Patients diagnosed with hypertrophic scarring, hypertrophic disorders of the skin, or scar conditions and fibrosis of skin at least one day after burn injury were identified in the TriNetX database. Hydrocortisone, methylprednisolone, dexamethasone, triamcinolone, and prednisone were the glucocorticoids investigated. Those who received a glucocorticoid on the same day or any time after the incidence of burn injury were compared to those who did not take glucocorticoids in the previous five years. Patients were stratified into four groups based on percent total body surface area (TBSA) burned: 0-9%, 10-19%, 20-39%, and 40-100%. A total of 165,041 burned patients were found who did not receive glucocorticoids, and 66,652 burn patients who received glucocorticoids after injury. Statistical analysis for comparison included a risk ratio with a significance defined as a p-value < 0.05.

Results

In all burn patients identified, the risk of hypertrophic scarring diagnosis was reduced with methylprednisolone (RR=0.60, p< 0.001) and prednisone (RR=0.37, p< 0.001), while it was increased with dexamethasone (RR=2.48, p< 0.001). Stratification based on %TBSA burned showed that diagnosis of hypertrophic scarring was reduced in the < 10% TBSA group with methylprednisolone (RR=0.49, p< 0.001) and prednisone (RR=0.33, p< 0.001), while it was increased with dexamethasone (RR=3.6, p< 0.001). Similarly, in the 10-19% TBSA group, the risk was reduced with prednisone (RR=0.57, p=0.024) while increased with dexamethasone (RR=2.2, p< 0.001). No significant effect was observed with hydrocortisone or triamcinolone with any of the %TBSA groups examined. Patients treated with dexamethasone continued to show increased risk for hypertrophic scar diagnosis with 20-39% TBSA (RR=1.69, p< 0.001) and 40-100% TBSA (RR=1.87, p< 0.001).

Conclusions

While methylprednisolone and prednisone decreased the risk of hypertrophic scarring diagnosis among all burn patients identified, dexamethasone showed an increased risk of hypertrophic scarring diagnosis in all burn patients and in each %TBSA stratified group.

26 Opioid Prescription in Burns: A Large Database Analysis from 1990 to 2021

Introduction

The use of opioids in the medical field has contributed to the growing opioid epidemic. Nonetheless, opioids remain imperative in the treatment for pain management in burns. While some studies have addressed the use of opioids in surgery, a comprehensive analysis of the pattern of opioids use in burns has not been investigated. This study aims to identify trends of opioid use and investigate the risk of opioid related disorders in burn patients.

Methods

Data was obtained from TriNetX, a national research database that provides medical records of de-identified patients. The study population includes patients that were prescribed an opioid, ICD-10 code CN101, on or after any instance of burn between January 1^st, 1990 and September 19^th, 2021. Patient population was further stratified by the decade in which patients received opioids for pain following burn injury: 1990-1999, 2000-2009, 2010-2019, and 2020-September 19^th, 2021. Five outcomes were investigated: opioid related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders due to psychoactive substance use. Cohorts were matched for age at index, sex, and race. Statistical analysis used risk ratios with a 95% confidence interval, and p< 0.05 was considered significant.

Results

We identified 8,421 patients that were prescribed an opioid between 1990-1999, 30,846 patients from 2000-2009, 169,991 patients from 2010-2019, and 30,966 patients from 2020-present. When compared to the 2000s cohorts, the 1990s patients had a 47% decrease in risk of opioid related disorders, with a 53% decrease in risk of opioid dependence, 45% decrease in risk in opioid abuse, 11% decrease in risk of mental and behavioral disorders due to psychoactive substance use, and 63% reduced risk of intentional self-harm.

Comparison of the 2000-2009 to 2010-2019 cohorts showed increased risk of opioid related disorders (RR= 1.912), opioid dependence (RR=1.569), opioid abuse (RR=1.677), mental and behavioral disorders (RR =1.733), and intentional self-harm (RR=2.027). When compared to 2020-present, the 2010-2019 patient cohort had 10 times the risk of developing opioid-related disorders, with 3 times the risk for opioid dependence and behavioral disorders, and 5 times the risk for opioid abuse and intentional self-harm.

Conclusions

The risk of opioid related disorders in the 1990s was lower compared to the 2000s. Since 2000, the risk of opioid related disorders has significantly increased. Recognizing the risks of opioid prescriptions in burn patients is imperative when addressing the role of physicians in controlling the constantly growing opioid epidemic.

735 Early Treatment with NSAIDs Improves Blood Clotting Function in Severely Burned Patients

Introduction

The risk of coagulopathy is increased in severe burns. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in burn patients to relieve pain and reduce inflammation. This study investigates the impact of NSAIDs on burn induced coagulopathy in severely burned patients.

Methods

Severe burn patients (total body surface area [TBSA] >20%) were identified with TriNetX, a North American federated health research network from 51 health-care organizations (HCOs) and categorized for those receiving NSAIDs during the first week following injury; those with NSAID use prior to injury were excluded. NSAIDs included in this study were ibuprofen, oxaprozin, indomethacin, aspirin, diclofenac, celecoxib, and naproxen. Burn induced coagulopathy was defined as international normalized ratio (INR) levels ≥1.5. Statistical significance of the rate of burn-induced coagulopathy in the week following injury among the two groups was analyzed with measures of association using chi-squared tests.

Results

We identified 709 severely burned patients receiving NSAIDS during the week after burn and 1,032 severely burned patients without NSAID use. Among those receiving NSAIDs, ibuprofen and aspirin were the most prescribed at rates of 80% and 36%, respectively. After cohort matching, the risk of burn induced coagulopathy was significantly decreased in patients taking NSAIDs (17.7%) compared to patients not receiving NSAIDs (32.3%) (p< 0.0001). The protective nature of NSAIDs was greatest on the same day (p=0.0002) and first day following burn injury (p=0.0026). On average, those not taking NSAIDs had an elevated risk of developing coagulopathy compared to those who did as %TBSA increased in 10% intervals. This observation was confirmed in a linear regression analysis with slopes of 0.0453 and 0.0293, respectively. Furthermore, patients taking NSAIDs were less likely to develop sepsis (p=0.0046) and thrombocytopenia (p=0.0003) and die the first week following injury (p< 0.0001).

Conclusions

The early protective effects of NSAIDs at reducing the risk of coagulopathy occurs during the acute phase of burns, though selection bias cannot be excluded. The potential risk of burn induced coagulopathy increased more with %TBSA in patients without NASIDs.

Non-Survival Distributions in Paediatric Burn Patients; A Comparative Study of Two National Databases

A contemporary, age-specific model for the distribution of burn mortality in children has not been developed for over a decade. Using data from TriNetX, a global federated health research network, and the American Burn Association's Nation Burn Repository (NBR), we investigated non-survival distributions for paediatric burns in the United States. Paediatric burn patients ages 0-20 between 2010-2020 were identified in TriNetX from 41 Health Care Organizations using ICD-10 codes (T.20-T.30) and identified as lived/died. These were compared to the non-survival data from 90 certified burn centers in NBR database between 2016-2018. The patient population was stratified by age into subgroups of 0-4, 5-9, 10-14, 15-20 years. Overall, mortality rates for paediatric burn patients were found to be .62% in NBR and .52% in TrinetX. Boys had a higher incidence of mortality than girls in both databases (0.34% vs. 0.28% NBR, p = 0.13; 0.31% vs. 0.21% TriNetX, p = <0.001). Comparison of ethnic cohorts between 2010-2015 and 2016-2020 subgroups showed that non-survival rates of African American children increased relative to White children (TriNetX, p = <0.001), however, evidence was insufficient to conclude that African American children die more frequently than other ethnicities (NBR, p=0.054). When analyzing subgroups in TriNetX, burned children ages 5-9 had significantly increased frequency of non-survival, (p = <0.001). However, NBR data suggested that children 0-4 experience the highest frequency of mortality (p = <0.001). The non-survival distributions between these two large databases accurately reflects non-survival rates in burned children.