Firearm injury survival is only the beginning: The impact of socioeconomic factors on unplanned readmission after injury.

Background: Firearm trauma remain a national crisis disproportionally impacting minority populations in the United States. Risk factors leading to unplanned readmission after firearm injury remain unclear. We hypothesized that socioeconomic factors have a major impact on unplanned readmission following assault-related firearm injury.

American Burn Association Clinical Practice Guidelines on the Treatment of Severe Frostbite.

This Clinical Practice Guideline addresses severe frostbite treatment. We defined severe frostbite as atmospheric cooling that results in a perfusion deficit to the extremities. We limited our review to adults and excluded cold contact or rapid freeze injuries that resulted in isolated devitalized tissue.

Bleeding Complications in Patients With Severe Frostbite Injury.

Frostbite is caused by exposure to cold temperatures and can lead to severe injury resulting in amputations. Tissue plasminogen activator (tPA) is a thrombolytic agent that has demonstrated efficacy preventing amputation in frostbite patients. The goal of frostbite management with tPA is to salvage tissue without causing clinically significant bleeding complication.

Palliative Care Utilization in Burn Patients.

Burn injuries are a common cause for hospitalization, and severe burns have an increased risk of death in patients with advanced age, inhalational injury, comorbid conditions. Very little is known about the utilization of palliative care consultation in burn patients. The aim of this study was to evaluate the factors influencing the utilization of inpatient palliative care consultation for patients with severe burn injuries.

Biopsychosocial factors associated with complications in patients with frostbite.

Cold weather injuries can be devastating and life changing. Biopsychosocial factors such as homelessness and mental illness (especially substance use disorders [SUDs]) are known risk factors for incurring frostbite. Based on clinical experience in an urban level 1 trauma center, we hypothesized that complications following frostbite injury would be influenced by homelessness, SUDs, and other forms of mental illness.

Revision Surgery Following Severe Frostbite Injury Compared to Similar Hand and Foot Burns.

Severe frostbite is associated with loss of digits or limbs and high levels of morbidity. The current practice is to salvage as much of the limb/digit as possible with the use of thrombolytic and adjuvant therapies. Sequelae from amputation can include severe nerve pain and poor wound healing requiring revision surgery.

Analysis of pediatric sternal fractures using the Kid's Inpatient Database (KID).

Purpose: This study aims to determine if sternal fracture is a predictor of discharge requiring additional care and mortality.

Methods: Blunt pediatric trauma admissions (<18 years) in the Kid's Inpatient Database (2016) were included in analysis. Weighted incidence of sternal fracture was calculated and adjusted for using survey weight, sampling clusters, and stratum.

The Effects of Rapid Rewarming on Tissue Salvage in Severe Frostbite Injury.

Frostbite is a high morbidity injury caused by soft tissue freezing, which can lead to digit necrosis requiring amputation. Rapid rewarming is a first-line treatment method that involves placing affected digits into a warm water bath. This study aims to assess the clinical practices for frostbite at facilities outside of dedicated burn centers, and any impact these practices have on tissue salvage.

Socioeconomic and Comorbid Factors Associated With Frostbite Injury in the United States.

Frostbite largely affects the extremities and often results in long-term disability due to amputation. More regions are experiencing extremes in temperature which increases the risk of frostbite injury. The aim of this study was to detail social and comorbid factors associated with frostbite injury compared to isolated hand or foot burns.

Social Determinants of Poor Outcomes Following Frostbite Injury: A Study of the National Inpatient Sample.

Severe frostbite injury can result in significant disability from amputation of limbs and digits which may be mitigated through prompt medical care. The reported rates of amputation vary widely between centers. Our aim was to describe the incidence and factors associated with amputation secondary to frostbite injury in the United States using a national sample of hospitalizations.

Hyperbaric Oxygen and Mortality in Burns With Inhalation Injury: A Study of the National Burn Repository.

Mortality in burn injury is primarily influenced by three factors: age, percent burn (%TBSA), and presence of inhalation injury. Numerous modalities have been tried in an attempt to treat those patients with burns and inhalation injury, including the use of hyperbaric oxygen (HBO). The aim of our study was to find the national prevalence of HBO for burns with inhalation injury, and whether HBO influenced mortality in these often severely injured patients.

High Cost and Resource Utilization of Frostbite Readmissions in the United States.

Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people.

An Institutional Protocol for the Treatment of Severe Frostbite Injury-A 6-Year Retrospective Analysis.

The treatment of severe frostbite injury has undergone rapid development in the past 30 years with many different diagnostic and treatment options now available. However, there is currently no consensus on the best method for management of this disease process. At our institution, we have designed a protocol for severe frostbite injury that includes diagnosis, medical treatment, wound cares, therapy, and surgery.

Severe Hypothermia and Frostbite Requiring ECMO and Four Limb Amputations.

Severe hypothermia and frostbite can result in significant morbidity and mortality. We present a case of a patient with severe hypothermia and frostbite due to cold exposure after a snowmobile crash. He presented in cardiac arrest with a core temperature of 19°C requiring prolonged cardiopulmonary resuscitation, active internal rewarming, venoarterial extracorporeal membrane oxygenation, and subsequently amputations of all four extremities.

Differences in Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis at Burn Centers and Nonburn Centers.

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and Stevens-Johnson/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at nonburn centers and then transferred to burn centers.

Incidence and Profile of Severe Cycling Injuries After Bikeway Infrastructure Changes.

The objective of this study was to evaluate whether bicycling infrastructure changes in the city of Minneapolis effectively reduced the incidence or severity of traumatic bicycling related injuries sustained by patients admitted to our Level 1 Trauma Center. Data for this retrospective cohort study was obtained from the trauma database at our institution and retrospective chart review. The total number of miles of bikeway in the city on a yearly basis was used to demonstrate the change in cycling infrastructure.

Effect of the Affordable Care Act on a Safety-Net Burn Center.

We hypothesized that the Patient Protection and Affordable Care Act (ACA) would have beneficial financial effects on our burn center at a safety-net hospital. We performed a retrospective chart review of all burn patients admitted to our center from 2008-2016. These were further divided into three time periods: 2008-2010 (pre-ACA), 2011-2013 (transitional), and 2014-2016 (post-ACA).

Nonmedical Factors Influencing Early Deaths in Burns: A Study of the National Burn Repository.

It is well-established that survival in burn injury is primarily dependent on three factors: age, percent total-body surface area burned (%TBSA), and inhalation injury. However, it is clear that in other (nonburn) conditions, nonmedical factors may influence mortality. Even in severe burns, patients undergoing resuscitation may survive for a period of time before succumbing to infection or other complications.

Microangiography: An Alternative Tool for Assessing Severe Frostbite Injury.

Assessment of frostbite injury typically relies on computed tomography, angiography, or nuclear medicine studies to detect perfusion deficits prior to thrombolytic therapy. The aim of this study was to evaluate the potential of a novel imaging method, microangiography, in the assessment of severe frostbite injury. Patients with severe frostbite were included if they received a post-thrombolytic Technetium 99 (Tc99) bone scan, a Tc99 bone scan without thrombolytic therapy, and/or post-thrombolytic microangiography (MA) study.

Stevens-Johnson syndrome and toxic epidermal necrolysis: retrospective review of 10-year experience.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous disorders. To date, relatively few studies have looked at institutional approaches to treatment of SJS/TEN, particularly with a focus on wound care.

Methods: A retrospective review was conducted on patients admitted to the Hennepin County Medical Center from 2007 to 2017 with a final diagnosis of SJS or TEN.

Influence of Insurance Status on Hospital Length of Stay and Discharge Location in Burn Patients.

Insurance status affects many aspects of healthcare in America, from access to delivery to outcomes. Our goal in this study was to determine whether different subtypes of insurance status affected hospital lengths of stay (LOS) and/or the location to which patients were discharged. The National Burn Repository was used to examine a total of 119,509 burn patients.

Frostbite in the United States: An Examination of the National Burn Repository and National Trauma Data Bank.

Frostbite is a form of thermal injury that can have devastating consequences for patients, including digit amputations and sometimes more proximal amputations. To the best of the authors' knowledge, no one has determined national characteristics of frostbite patients, nor the prevalence of these diagnostic and therapeutic modalities. This is the first look at nationwide trends in the treatment of frostbite in the United States.

Frostbite vs Burns: Increased Cost of Care and Use of Hospital Resources.

Numerous demographic, socioeconomic, and injury factors influence a burn patient's hospital course. Compared to the typical burn patient, frostbite injury frequently impacts those with high rates of mental illness, substance abuse, and those suffering homelessness. Our aim was to examine differences in the hospital course of frostbite patients compared to those with burns limited to the hands and feet.

Early Mobilization in Lower Extremity Frostbite Injury: Preliminary Experience at a Single Burn Center.

Cold exposure that leads to frostbite puts patients at high risk for extremity amputations. Recent treatment advances, such as thrombolytic administration, have decreased amputation rates. However, little is known about patient outcomes with early mobilization of affected limbs.