About

Kathleen Romanowski, M.D., F.A.C.S., is a faculty member at the UC Davis Department of Surgery. Her role involves contributing to the department's surgical education programs and clinical services. As a recognized surgeon with a focus on surgical practice and education, she is part of a team dedicated to advancing surgical care and training the next generation of surgeons. Her work supports the department's mission to provide comprehensive surgical services and to promote socially responsible surgery.

Research topics

• Surgery
• Medicine
• Emergency medicine
• Medical emergency
• Composite material
• Intensive care medicine
• Family medicine
• Internal medicine
• Anesthesia
• Physical therapy

Selected publications

• 570. Evaluating the Association of Frailty with Dermal Substitute Use in Older Adult Burn Patients

  Journal of Burn Care & Research · 2026-03-01

  articleOpen accessSenior author

  Abstract Introduction Frailty is established as a predictor of outcomes beyond chronological age and have been used as a measure of physiologic reserve to stratify risk, guide management, and anticipate complications. Older adult burn patients experience unique metabolic and surgical stressors specific to their injury. Dermal substitutes are sometimes used to ameliorate these stressors and delay or minimize definitive autografting. Despite this, literature examining the efficacy of dermal substitute use among frail and non-frail patients is limited. The aim of this study was to compare grafting and related outcomes among frail and non-frail older adult burn injured patients undergoing a dermal substitute surgical management strategy. Methods A multicenter trial examining burn injured patients admitted to 12 burn centers from January 2017 to December 2019 and who were 60 years and older were retrospectively reviewed. Demographics, injury characteristics, and clinical metrics were obtained. Frailty was assigned using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) seven point scoring system. Patients were categorized as fit (CFS score < 4), pre-frail (score = 4), and frail (score > 4). Outcomes evaluated included single stage dermal substitute placement vs subsequent autografting, graft loss, length of stay (LOS), in-hospital mortality, and disposition. Results Of 1632 older adult burn patients, 805 patients underwent dermal substitute placement. Of these, 386 patients were deemed fit, 203 as pre-frail, and 216 as frail. There was no significant association with the use of dermal substitute with frailty status (p=.140) or mortality (p=.165). Among institutions that reported, 49 patients underwent subsequent autografting, of which 15 experienced graft loss requiring regrafting. For patients without a dermal substitute, frail patients were more likely to be discharged to a higher level care facility compared to non-frail patients (p<.001). Older patients receiving dermal substitutes have significantly higher length of stay [37 (18, 55) vs 13 (6, 21) days, p<.001] and discharge to a higher level of care (p=.004). Additionally, twice as many frail patients were placed in a higher level care facility as opposed to going home. On multivariable regression, use of a dermal substitute was not associated with placement in a higher level of care facility after controlling for center, burn size, inhalation injury, and frailty (p=.511). Conclusions While frail patients are more likely to be placed in a higher level of care than return to home, there is not a significant association with use of dermal substitute after controlling for known disposition drivers. Applicability of Research to Practice Understanding the association of frailty with dermal substitute strategies in older adult burn patients may influence future management strategies and better anticipate expected outcomes. Funding for the study N/A.

  PublisherDOI

• 587. Exploring Occupational/physical Therapy Utilization, Frailty, and Discharge Disposition Within Older Patients Following Burn Injury

  Journal of Burn Care & Research · 2026-03-01

  articleOpen access

  Abstract Introduction Following burn injury, care is tailored to each patient’s specific injury and baseline functional capabilities. Even if not formally scored, we believe frailty is currently being utilized and may be a useful tool to guide care and disposition planning. Methods Following IRB approval, we conducted a retrospective multicenter cohort study of patients ≥60 years admitted to 12 burn centers (1/2017–12/2019). Demographics, injury characteristics, disposition, and many medical management specific variables were collected. Frailty was measured with the Canadian Study of Health and Aging Clinical Frailty Scale (1 – 7) and categorized as fit (< 4), prefrail (=4), or frail (>4). The number of occupational (OT) and physical therapy (PT) sessions totaled from individual 15-minute units. Discharge disposition was categorized 1 to 6 according to increasing necessary level of care. Death was removed and analyzed separately. There were three hypotheses explored in this analysis, focusing on the number of therapy sessions, frailty, and disposition. Univariate and multivariable analyses were performed utilizing chi-square test, Kruskal-Wallis test, and linear regression with p<.05 considered significant. The modified Baux score was considered, but was subsequently removed from modelling, as inhalation injury was not significantly associated with therapy sessions and age with either outcome in this older cohort. Results Data was collected on 1632 patients. Both the number of OT and PT sessions were negatively and independently associated with increasing admission frailty. (Figure 1) These hypotheses for OT (p<.001) and PT (p=.04) remained true after controlling for a possible center effect, percent total body surface area (TBSA) burned, length of stay, and presence of a hand injury (specific for OT sessions) and when categorically condensing frailty. Frail patients had nearly a seven times higher mortality than non-frail. Frailty was positively and independently associated with discharging to a higher level of care facility (p<.001) after controlling for center, TBSA, and presence of inhalation injury. In separate analyses controlling for center, injury characteristics, length of stay, and admission frailty, both the number of OT and PT sessions were positively and independently associated with being discharged to a higher care facility (p=.048 and p=.007, respectively). Conclusions Frailty scores can be utilized to plan the care of older patients admitted with burn injuries. Fit patients are more likely to return home with minimal assistance, while frail patients are more likely to be placed in a high level of care facility. Additionally, baseline frailty may be a meaningful measure to aid prognostic discussions. Applicability of Research to Practice Frailty assessment at admission provides prognostic and care planning value and should be integrated into burn care to support patient-centered care and family discussions. Funding for the study N/A.

  PublisherDOI

• C-753-05. Peripherally Inserted Central Line Catheters Are Safe to Use in Burn Patients

  Journal of Burn Care & Research · 2026-03-01

  articleOpen accessSenior author

  Abstract Introduction Peripherally inserted central catheters (PICCs) are increasingly used in burn care as an intermediate option between peripheral intravenous lines and central venous catheters. While central line–associated bloodstream infections (CLABSIs) in burn patients are well characterized, the specific risks associated with PICCs in this population remain poorly defined. Improved quantification of complication rates, identification of risk factors, and evidence-based protocols for PICC management are needed in burn care. Methods We performed a retrospective chart review of all burn patients at our ABA-verified regional burn center having a PICC order placed between January 2020 and December 2024. Data collected included demographics, injury characteristics, PICC related variables, and infection related information. We calculated infection rates per 1000 PICC days and performed both univariate and multivariate analyses to identify risk factors associated with PICC infection. Continuous variables are reported as median (interquartile range). Statistical significance was defined as p<.05. Results We identified 436 unique patients accounting for 525 PICC orders; of these, 419 PICCs were ultimately placed. Reasons for nonplacement included positive blood cultures (21, 4%), patient refusal (20, 3.8%), and presence of burn injury at insertion site (20,3.8%). Indications for PICC use included need for multilumen access (189, 36%), need for vasoactive medication (14, 2.7%), and inability to maintain peripheral IV access (129, 24.6%). The cumulative PICC infection rate was 4.7 infections per 1000 PICC-days. Patients who developed PICC infections had higher mean TBSA (30% vs 17.5%, p=.0006) and longer hospital stays (67 days vs 29 days, p<.0001). On univariate analysis, infected patients also had longer intervals from admission to PICC placement (19.5 days vs 8 days, p=.0002) and a higher prevalence of inhalation injury (43.3% vs 17.5%, p=.0006). There was no statistically significant increase in infection risk associated with burn injury of the upper extremity or burns on the same limb used for PICC insertion. In multivariate logistic regression, inhalation injury (odds ratio [OR] = 2.9) and placement for vasoactive medications (OR = 5.2) emerged as independent predictors of PICC infection. Conclusions In burn patients, PICC-associated infection rates appear lower than historically anticipated. However, certain subgroups, particularly those with inhalation injury and vasoactive medication requirements, are at markedly increased risk. These findings support the need for a risk stratification or scoring system to guide early PICC insertion in suitable candidates, close monitoring while in situ, and prompt removal when no longer needed. Applicability of Research to Practice PICC lines can safely be used in burn patients with care taken for patient selection and removal when the line is no longer required. Funding for the Study N/A.

  PublisherDOI

• Current Status of US Children’s Burn Care and Opportunities for Change

  Annals of Surgery Open · 2026-01-20

  articleOpen access

  Importance: The discipline of burn care has been challenged by a declining professional workforce, resulting from changes in general surgery residency training, simultaneous with a multidisciplinary but siloed approach to care. Secondary effects on children's burn care include decreased awareness of where children receive care outside of the American Burn Association (ABA)-verified burn centers, loss of bidirectional education and communication inherent to patient and family-centered care, and good outcome measures. These factors affect disaster planning. Observations: A system of care must be capable of addressing "everyday" pediatric burn care availability before the nation can manage multiple burn victims in a disaster. Pediatric burn care is delivered by a variety of clinicians with complementary skill levels, knowledge, and resources at several types of centers, including verified burn centers caring for children and adults or only children and nonverified children's or acute care hospitals providing pediatric burn care. The current ABA verification process is rigorous but not tiered, making it difficult for many children's hospitals to satisfy these standards. Conclusions: The current landscape of children's burn care has strengths and opportunities in terms of access to care, care delivery, workforce and training, education, data and quality, and research. A national pediatric burn system will: (1) improve the understanding of "everyday" and expert burn care for children, (2) define gaps in children's burn care, including preparedness of the emergency care system where children initially receive care, and (3) anticipate action and implementation strategies to address these gaps.

  PublisherDOI

• C-954-06. Comparing Outcomes Among Frail and Non-Frail Patients Following Non-Operative Management in Older Adult Burn Patients

  Journal of Burn Care & Research · 2026-03-01

  articleOpen access

  Abstract Introduction Frailty is increasingly recognized as a critical determinant of outcomes in older adult patients and is used to guide individualized care. Non-operative management (NOM) of older adult burn injured patients is often considered in the context of burn size, depth, and comorbidities. However, there is a paucity of literature examining outcomes using NOM, especially in the context of frailty. Herein, we compared outcomes of frail and non-frail older adult burn injured patients undergoing NOM. Methods This is a retrospective multicenter cohort study. Burn injured patients 60 years and older admitted to 12 burn centers from 2017 to 2019 were included. Demographics, injury characteristics, and clinical metrics were obtained. Frailty was scored using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS). Patients were grouped as fit (Score < 4), pre-frail (Score = 4), and frail (Score > 4). Length of stay (LOS), long-term mortality, and discharge disposition were evaluated. Univariate and multivariate analyses were performed to compare groups and identify predictors of poor outcomes. p<.05 was considered significant. Results Of 1528 older adult burn patients, 711 patients underwent NOM and had frailty scores. Of these, 255 patients were deemed fit, 160 were prefrail, and 296 were frail. There were no significant differences in sex, race, and ethnicity between the groups. Frail patients were significantly older than their prefrail and fit counterparts (69 [64-77] vs. 68 [62-76] vs. 66 [62-73], p<.001). Most patients suffered flame and flash burns (p=.008). No significant differences in median TBSA and inhalation injury were observed. The modified Baux score was highest among frail and prefrail patients (74.5 [67-85.9] vs. 75 [68-85.7] vs. 71.5 [65.6-81], p=.012). Frail patients had the highest LOS and LOS/%TBSA (p<.001). Long-term mortality rate was significantly higher in the frail group (27% vs. 3.8% vs. 2.7%, p<.001). Fit patients were more likely to be discharged home (86.9%), whereas frail patients were discharged to a skilled nursing facility (17.6%), inpatient rehabilitation (4.2%), and hospice care (5.7%) (p<.001). On multivariate analysis, modified Baux score and frailty status were associated with in-hospital mortality (OR = 1.13 [1.09-1.17] and 4.92 [1.09-22.11]) and hospice disposition (OR = 1.08 [1.02-1.14] and 19.68 [5.03-77]). Conclusions Burn injured patients who underwent NOM and were identified as either pre-frail or frail experienced higher mortality, LOS, and discharge disposition requiring higher level of care. Further study of this novel multicenter study on frailty and NOM will be necessary to better elucidate observed outcomes. Applicability of Research to Practice Understanding the effect of frailty on burn NOM strategies provides an important framework on understanding outcome variability and guiding individualized care. Funding for the study N/A.

  PublisherDOI

• 860. Impact of Neurologic Complications on Burn Patient Outcomes

  Journal of Burn Care & Research · 2026-03-01

  articleOpen access

  Abstract Introduction Although age, burn size, and inhalation injury are the primary drivers of outcomes after burn injury, other complications can also influence outcome. We hypothesized that patients with neurological complications would have worse outcomes in terms of survival, ventilator days, and length of stay (LOS). Methods This single center retrospective analysis of the National Burn Repository between 2015-2022 compared outcomes for patients with and without neurologic complications admitted to our facility. We collected demographic data (age, sex, race/ethnicity, marital status), injury characteristics (total burn surface area, inhalation injury), and outcomes (LOS, ventilator days, ICU stay, and survival. We used chi-square (mortality, sex, inhalation injury), T-test (age, race), and Wilcox Rank-Sum tests (burn size, length of stay) with p<.05 considered significant. Results A total of 710 patients were identified with 179 neurologic conditions (NC), and 2063 patients without neurologic conditions (control group-CG). CG patients were on average older than the NC group (47.6 ± 12 vs 45.0 ± 31.1 years old), had smaller burns (11.8 ± 4.9% vs. 12.4 ± 0.7%), and had a shorter ICU stay (10.4 ± 0.7 vs 11.5 ± 9.2 days, p<.05). There was no difference in mortality (5% in CG, 4.2% in NC), or hospital LOS (16.4 ± 3.5 days CG vs. 15.8 ± 24.7 days). Conclusions Patients who develop neurologic complications have longer ICU stays and consume more resources. Early identification and treatment of neurologic complications may mitigate these effects. Applicability of Research to Practice By better understanding the effects of neurologic complications, we can proactively intervene to identify and mitigate them. Funding for the study N/A.

  PublisherDOI

• Medical Response Framework for Catastrophic Burn and Radiation Mass Casualties after a Potential Ukraine Nuclear Event

  Burns · 2026-02-01

  article
  PublisherDOI

• 941. Improving Burn Care: Reducing Missed ED Consults Through Real-time Monitoring and Multidisciplinary Collaboration

  Journal of Burn Care & Research · 2026-03-01

  articleOpen access

  Abstract Introduction Timely evaluation by burn-trained specialists is critical to optimize outcomes for burn-injured patients. However, our institution identified a concerning pattern: patients presenting to the Emergency Department (ED) with burn injuries were often not being evaluated by the Burn Surgery team. As a result, these individuals were discharged without appropriate follow-up plans, placing them at risk for complications, delayed healing, and poor functional or cosmetic outcomes. Methods To address this care gap, a daily report was implemented to identify all ED patients presenting with burn injuries. Any case lacking notification to the burn team is escalated in real time to the Burn Center Director, Nurse Manager, and Burn Surgery team for evaluation and prioritization for outpatient follow-up. Missed consult opportunities are also communicated directly to our ED liaison team for immediate process improvement. Additionally, all identified cases are compiled and reviewed monthly, with comprehensive discussion at the Burn Center’s Quarterly QA/QI Meeting by the multidisciplinary team. Education was also provided to ED providers regarding the importance of consulting the Burn Surgery team when burn-injured patients present to the ED. Results As a result of these combined interventions, the percentage of missed ED consults decreased significantly, from 28.6% of burn-injured patients not being seen by the Burn Surgery team in calendar year (CY) 2020 to 9.9% in CY 2025. This demonstrates a measurable improvement in care coordination and specialty capture for burn patients. Conclusions This proactive, data-driven approach has enhanced the identification and management of burn-injured patients in the ED. It has also fostered accountability and communication between emergency and specialty teams, creating a more reliable pathway to ensure timely burn care. Applicability of Research to Practice Our experience highlights the critical role of real-time monitoring, provider education, and interdisciplinary escalation pathways in improving patient outcomes. This model is highly replicable and could be adapted by other institutions seeking to close gaps in specialty consults and improve continuity of care for vulnerable patient populations. Funding for the study N/A.

  PublisherDOI

• C-851-02. Assessing the Impact of Frailty on Surgical Decision-Making in Older Adults with Burn Injury

  Journal of Burn Care & Research · 2026-03-01

  articleOpen access

  Abstract Introduction Older adults make up a growing proportion of burn patients and present unique challenges requiring tailored approaches. Frailty, defined as decreased physiologic reserve and vulnerability to stressors, has emerged as an important predictor of outcomes in this population. In burn care, frailty may influence decisions about candidacy, timing, and extent of surgery, but its role remains unclear. We aimed to examine the association between frailty and operative decision-making in older adult burn patients. Methods Following IRB approval, we conducted a retrospective multicenter cohort study of patients ≥60 years admitted to 12 burn centers (1/2017–12/2019). Demographics, injury characteristics, and operative variables were collected. Frailty was measured with the Canadian Study of Health and Aging Clinical Frailty Scale and categorized as fit (< 4), prefrail (=4), or frail (>4). Univariate and multivariate analyses were performed to assess associations between frailty and operative decision-making. p<.05 was significant. Results Of 1478 patients with clinical frailty scores collected, 767 underwent surgery. Surgical patients were more often fit (371, 59.3%) than prefrail (190, 54.3%) or frail (206, 41%) (p<.0001). Among males, surgery was more common in the fit (274, 73.9%) and prefrail (138, 72.6%) groups than the frail (122, 59.2%). Frail patients were older (70 [64–79]) compared with prefrail (70 [64–76]) and fit (66 [62–74]) (p<.001). Injury type differed, with most patients sustaining flame or flash burns (p=.007), but TBSA and inhalation injury did not vary by frailty. Frail patients had more operations (1 [1–3]) than prefrail (1 [1–2]) and fit (1 [1–2]) (p=.005). Time from injury to surgery was longest in prefrail patients, followed by frail, and shortest in fit (5 [3–10.3] vs. 4 [2–9] vs. 4 [2–7], p=.004). Prefrail patients were most likely to undergo complete excision and grafting in one operation (50.5% vs. 49.6% vs. 39.8%, p=.04). Frail patients had greater allograft use (32%) compared with prefrail (30.5%) and fit (21.3%) (p=.007). Dermal substitute use and graft failure did not differ by frailty category. On multivariate analysis, allograft use was independently associated with TBSA (OR 1.03 [1.02–1.05]) and frailty (fit vs. frail OR 0.51 [0.34–0.76]). Treatment in a single operation was associated with TBSA (OR 0.95 [0.94–0.97]) and frailty (fit vs. frail OR 1.67 [1.16–2.38]; prefrail vs. frail OR 1.66 [1.10–2.52]). Conclusions Frailty influences operative care in older burn patients. Fit patients undergo surgery sooner and in fewer stages, while frail patients require more procedures and more often receive allograft. Applicability of Research to Practice Frailty assessment at admission provides prognostic and operative planning value and should be integrated into burn care to support surgical decision-making and patient-centered care. Funding for the Study N/A.

  PublisherOA PDFDOI

• 568. Nutrition Interventions in Older Adult Burn Patients

  Journal of Burn Care & Research · 2026-03-01

  articleOpen access

  Abstract Introduction Older adults are known to have a high risk of malnutrition at presentation, which is associated with increased morbidity and mortality. This study focuses on nutritional interventions and outcomes in older adult burn patients. Methods We utilized a multi-center database that specifically assessed the outcomes of older adult burn patients (60 years+). Patient demographics, hospitalization data, and clinical course were analyzed using a post hoc pairwise test with Bonferroni correction. A mixed effect generalized linear model was run specific to survival as an outcome measure. Patients who elected to go comfort care were excluded. Results The study group included 712 patients, nourished (admission albumin ≥3.0 g/dL, n = 442) and malnourished (admission albumin <3.0 g/dL, n = 270) with 57.9% of nourished and 73.7% of malnourished patients receiving supplemental nutrition. The malnourished group presented with increased total body surface area burns (p = < 0.001), higher revised Baux scores (p = < 0.001), and higher frailty score (p = < 0.001). The malnourished group had a statistically significant difference in need for supplemental nutrition (p=.001). However, the type of supplemental nutrition was not significant between groups. Mortality (p = < 0.001) showed the only statistically significant difference. When stratified by admission albumin, ARDS (p=.001) and catheter-associated blood stress infections (p=.001) were seen at higher rates in those with lower albumin levels. When comparing survivors to non-survivors, the differences between TBSA (p = < 0.001), modified Baux score (p = < 0.001), admission albumin (p = < 0.001), and length of ICU stay (p = < 0.001) were statistically significant. Non-survivors had higher rates of supplemental nutrition (81.8%), specifically in the form of tube feeds (93.7%) (p = < 0.001). Non-survivors had higher rates of ARDS (16.9%, p = < 0.001), cardiac arrest (13%, p = < 0.001) and abdominal compartment syndrome (7.8% p = < 0.001). A mixed effect generalized linear model for mortality revealed that for every one-point increase in admission albumin, the odds of death lowered by 54%. Conclusions This retrospective study demonstrates those older adults who presented with malnourishment had higher TBSA burns and increased rates of complications. Those burn patients who survived had higher rates of nutritional support than non-survivors with non-survivors. Admission albumin correlated strongly with risk of mortality should be utilized as an additional marker to help predict risk mortality in this population. Applicability of Research to Practice Our findings suggest that nutritional status prior to burn injury and in the post burn resuscitation is vital to improving survival in older adult patients. Funding for the study N/A.

  PublisherDOI

Frequent coauthors

• Tina L. Palmieri

  University of California, Davis

  534 shared

• Colleen M. Ryan

  Harvard University

  328 shared

• Soman Sen

  University of California, Davis

  313 shared

• David G. Greenhalgh

  UC Davis Health System

  244 shared

• John Schulz

  Spaulding Rehabilitation Hospital

  196 shared

• Lewis E. Kazis

  Spaulding Rehabilitation Hospital

  166 shared

• Victor Joe

  University of California, Irvine Medical Center

  143 shared

• Frederick J. Stoddard

  Spaulding Rehabilitation Hospital

  132 shared

Labs

• Burn SurgeryPI

Awards & honors

• Carl A. Moyer Resident Award - American Burn Association (20…
• First Place Resident Oral Presentation - Surgical Infection…
• Off-Service Teacher of the Year Nominee - The Iowa Emergency…