Setting the Standard: Using the ABA Burn Registry to Benchmark Risk Adjusted Mortality.

Reports of single center experience and studies of larger databases have identified several predictors of burn center mortality, including age, burn size, and inhalation injury. None of these analyses has been broad enough to allow benchmarking across burn centers. The purpose of this study was to derive a reliable, risk-adjusted, statistical model of mortality based on real-life experience at many burn centers in the U.

Using a National Burn Registry to Develop a Model for Risk-Adjusted Length of Stay Benchmarking.

Length of stay (LOS) is a frequently reported outcome after a burn injury. LOS benchmarking will benefit individual burn centers as a way to measure their performance and set expectations for patients. We sought to create a nationwide, risk-adjusted model to allow for LOS benchmarking based on the data from a national burn registry.

Specific patterns of vital sign fluctuations predict infection and enable sepsis diagnosis in pediatric burn patients.

Early recognition of the clinical signs of bloodstream infection in pediatric burn patients is key to improving survival rates in the burn unit. The objective of this study was to propose a simple scoring criteria that used readily available temperature, heart rate (HR) and mean arterial pressure (MAP) data to accurately predict bloodstream infection in pediatric burn patients. A retrospective chart review included 100 patients admitted to the pediatric burn unit for >20% total body surface area (TBSA) burn injuries.

Specific Patterns of Postoperative Temperature Elevations Predict Blood Infection in Pediatric Burn Patients.

Using readily available temperature data, we seek to propose a scoring criteria that can facilitate accurate and immediate prediction of blood infection. The standard in diagnosing blood infection is a positive blood culture result that may take up to 3 days to process, requiring providers to make a prediction about which febrile patient is actually bacteremic. This prediction is difficult in burned children as systemic inflammation can cause fever in the absence of infection.

The safety and efficacy of parenteral nutrition among pediatric patients with burn injuries.

Objective: Although enteral nutrition is the ideal mode of nutritional support following burn injury, it is often interrupted during episodes of severe sepsis and hemodynamic instability, leading to significant energy and protein deficits. Parenteral nutrition is not commonly used in burn centers due to concerns that it will lead to hyperglycemia, infection, and increased mortality. However, parenteral nutrition is often utilized in our burn unit when goal rate enteral nutrition is not feasible.

Selection of appropriate empiric gram-negative coverage in a multinational pediatric burn hospital.

The choice of appropriate empiric antimicrobial therapy for burn patients with suspected multidrug-resistant organisms remains a challenge. Burn patients transferred from outside the United States seem to be at particularly high risk. Given this perceived risk of multidrug resistance among our international patient population, we set out to determine which empiric antimicrobial therapy should be used at admission.

A survey of invasive catheter practices in U.S. burn centers.

Burn-specific guidelines for optimal catheter rotation, catheter type, insertion methods, and catheter site care do not exist, and practices vary widely from one burn unit to another. The purpose of this study was to define current practices and identify areas of practice variation for future clinical investigation. An online survey was sent to the directors of 123 U.

Incidence of catheter-associated bloodstream infection after introduction of minocycline and rifampin antimicrobial-coated catheters in a pediatric burn population.

The Centers for Disease Control and Prevention guidelines for prevention of intravascular catheter-related infections suggest that antimicrobial-coated catheters can decrease the risk of developing catheter-related bloodstream infection in a variety of adult patient populations. There are limited data on their efficacy in the pediatric population, particularly among children with burn injuries. A study was conducted at Shriners Hospitals for Children®, Boston, to determine whether minocycline/rifampin (MR)-coated catheters could decrease the incidence of catheter-associated bloodstream infection (CABSI) in a pediatric burn population.

The selenium status of pediatric patients with burn injuries.

Background: Dietary selenium (Se) requirements during critical illness are not well known. The objective of this study was to assess the longitudinal Se status of pediatric patients with burns.

Methods: Twenty patients admitted to our hospital with burns exceeding 10% of their total body surface area were studied longitudinally during the first 8 weeks of admission or until 95% wound closure was achieved.

Malnutrition among pediatric burn patients: A consequence of delayed admissions.

Early definitive burn treatment is assumed to improve prognosis, in part because open wounds rapidly stimulate muscle catabolism and systemic inflammation. This study describes the incidence and management of injury associated malnutrition among pediatric burn patients transferred for definitive care 21-166 days following burn injury. Medical records of patients admitted to our hospital between January 2003 and January 2009, at least 3 weeks after burn injury, were retrospectively reviewed.

Intravenous colistin for the treatment of multi-drug resistant, gram-negative infection in the pediatric burn population.

The rising incidence of multi-drug resistant (MDR) gram-negative infections in the intensive care unit (ICU) continues to challenge clinicians and has resulted in reemergence of the glycopeptide antibiotic colistin. Over the past 11 years, 14 patients at a tertiary pediatric burn center were treated with colistin for gram-negative infections resistant to all tested antibiotics. This study reviews the safety of such treatment and the outcome for this cohort of patients.

Mechanical and infectious complications of central venous cannulation in children: lessons learned from a 10-year experience placing more than 1000 catheters.

We sought to better describe the expected incidence of mechanical and infectious complications associated with central venous cannulation of critically ill children. We undertook a retrospective analysis of a prospective data collection of 1056 consecutive percutaneous central venous catheters inserted under the supervision of an experienced surgeon. There were 245 (23%) subclavian (SC), 118 (11%) internal jugular (IJ), and 693 (66%) femoral (F) catheters placed in 289 children with an average age of 6.

Computer equipment used in patient care within a multihospital system: recommendations for cleaning and disinfection.

Computer hardware has been implicated as a potential reservoir for infectious agents. Leaders of a 22-hospital system, which spans North America and serves pediatric patients with orthopedic or severe burns, sought to develop recommendations for the cleaning and disinfection of computer hardware within its myriad patient care venues. A task force comprising representatives from infection control, medical affairs, information services, and outcomes management departments was formed.

Young age is not a predictor of mortality in burns.

OBJECTIVE: Conventional wisdom and recently published reports suggest that children <48 months of age have a higher mortality rate after burns than older children and adolescents with similar injuries and that young age is a predictor of mortality. This study was done to validate or refute this impression. DESIGN: Retrospective review.

Effectiveness of bacteria-controlled nursing units in preventing cross-colonization with resistant bacteria in severely burned children.

Bacteria-controlled nursing units (BCNUs) are laminar air-flow patient isolation units. The rate of cross-colonization with resistant organisms in 66 critically ill pediatric burn patients with massive open wounds and ventilators housed in BCNUs during 5 years was examined and found to be extremely low (3.2 cases per 1,000 patient-days).