About

Tina L. Palmieri, M.D., F.A.C.S., is a faculty member at the UC Davis Department of Surgery. The provided page text does not include specific details about her research focus, background, or key contributions. Therefore, a detailed biography cannot be generated from the available information.

Research topics

• Medicine
• Emergency medicine
• Intensive care medicine
• Computer Science
• Internal medicine
• Medical emergency
• Machine Learning
• Artificial Intelligence
• Surgery
• Algorithm
• Composite material
• Anesthesia

Selected publications

• 801. Adherence to 20 Minutes of Cool Running Water for Acute Burns in Emergency Care

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

  articleOpen access

  Abstract Introduction Twenty minutes of cool running water (20CRW) is the recommended, evidence-based first-line treatment for acute thermal burn injuries in Australia, New Zealand, the United Kingdom, and across Europe. When delivered within the first three hours of a burn, this first aid treatment reduces burn depth progression and lowers the need for skin grafting. We assessed the implementation of 20CRW to the first 200 burn patient encounters in the emergency department (ED) of a major burn referral hospital from April 2024 – August 2025. Methods ED clinicians (comprised medical, nursing, and technician staff) completed online questionnaires for the first 200 burn patient encounters following the implementation of 20CRW as standard first aid management for acute thermal injuries. Questionnaires assessed whether 20CRW was applied, reasons for not providing it when eligible, and perceived barriers to consistent implementation. Eligibility for 20CRW was predefined, with exclusions including burns >30% total body surface area, Glasgow Coma Scale score < 15, airborne or contact precautions, cervical spine immobilization, lack of intravenous access, requirement for escharotomy, presentation >3 hours post-burn, hypothermia, inhalation injury, and burns involving the face. Free-text data were analyzed using inductive content analysis in NVivo. Results During the first 200 burn patient encounters, 95% (n = 190) were eligible for 20CRW provision. Among eligible patients, 80.5% (n = 153) received 20CRW within three hours of injury. Of these, 62.6% (n = 119) had 20CRW administered in the ED, and 17.9% (n = 34) in the prehospital setting prior to transport. An additional 4.7% (n = 9) received partial cooling (e.g., 5 – 15 minutes of cool running water). Of the 14.7% of eligible burn patients (n = 28) who did not receive first aid cooling, three chief reasons were identified: 1. Assorted barriers to 20CRW administration (n = 17; 8.9%): barriers such as limited access to showers, time constraints, staffing shortages, and high patient volumes. 2. Patient-related barriers (n = 5; 2.6%): combativeness, physical restraints, intoxication, age-related challenges, severe pain, and emotional distress. 3. Clinician-directed decisions (n = 6; 3.2%): four cases (2.1%) where emergency physicians advised against 20CRW; and two cases (1.1%) where burn surgeons recommended immediate alternative interventions (e.g., debridement). Conclusions The implementation of 20CRW as a first aid treatment was successfully integrated into the ED, with 80.5% of eligible burn patients receiving timely cooling within three hours of injury. Targeted strategies, combined with this evidence-based intervention, may drive higher adherence rates. Applicability of Research to Practice These findings highlight opportunities to improve adherence to first aid guidelines through targeted interventions addressing resource limitations, clinical decision-making, and patient compliance. Funding for the study This research received competitive grant funding, awarded to the Principal Investigator.

  PublisherDOI

• “Do as I say and not as I do: Surgical critical care program directors shape the future” authors’ response to the Letter to the Editor entitled: “Artificial intelligence literacy and infectious diseases competency: Essential considerations for future revisions of the surgical critical care curriculum”

  The Journal of Trauma: Injury, Infection, and Critical Care · 2026-04-28

  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

• Clathrin Heavy Chain-Linked Opioid Receptor Regulation in Burn Patients

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

  articleOpen accessSenior author

  Abstract Background/Objective Severe burn injury is associated with profound inflammatory, metabolic, and neuroimmune responses that contribute to persistent pain and reduced opioid responsiveness. Although dysregulation of μ-opioid receptor (MOR) signaling and opioid tolerance development are well-known in burn patients, the systemic molecular processes underlying these changes are unclear. Extracellular vesicles (EVs) carry protein cargo that reflects cellular signaling and trafficking pathways and provide a systemic window into receptor regulatory mechanisms. We hypothesized that EV proteomic profiling would identify changes in proteins mapping to opioid signaling pathways that reflect altered opioid receptor function regulation following burn injury. Methods Plasma EVs from 37 burn patients with >15% total body surface area burn and 21 nonburn controls were analyzed by quantitative proteomics. Differential protein abundance was integrated into pathway-level analysis using Ingenuity Pathway Analysis (IPA), with expression changes represented as log2 fold change (Expr Log Ratio). Proteins mapping to the opioid signaling pathway were examined to characterize patterns in receptor signaling and trafficking. Results Multiple proteins mapping to the opioid signaling pathway demonstrated coordinated differences in EV cargo. Notably, clathrin heavy chain (CLTC), a central component of clathrin-mediated endocytosis, was robustly enriched (~3-fold), while the adaptor protein AP2A2 demonstrated reduced representation. Small GTPases involved in membrane dynamics and vesicle trafficking, including RAC1, RALB, and RAP1B, demonstrated modest increases. Canonical G protein signaling components and calcium channel–associated proteins exhibited minimal directional changes. This pattern suggests that changes within opioid pathway–associated proteins are dominated by molecules involved in receptor internalization, membrane trafficking, and vesicle dynamics rather than uniform modulation of classical GPCR second-messenger signaling. Conclusions Clathrin-dependent trafficking and adaptor-mediated internalization are established regulators of MOR desensitization, recycling, and tolerance. Our EV proteomic results suggest prominent remodeling of receptor regulatory and trafficking pathways. Given that patients received opioids throughout hospitalization, these findings may reflect the combined effects of burn-induced systemic responses and opioid-driven adaptations in receptor regulatory mechanisms. Applicability of Research to Practice Together, these data provide new insight into molecular pathways linked to altered opioid responsiveness following burn injury and highlight receptor trafficking pathways as potential targets for improving analgesic strategies and reduction of tolerance. Funding for the study Academic and Department Seed Grants.

  PublisherDOI

• C-756-03. Development of a Comprehensive Pediatric Outcome Measure: The School-Aged Life Impact Burn Recovery Evaluation Instrument

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

  articleOpen access

  Abstract Introduction Assessing health-related quality of life in school-aged children is a continued challenge to the burn field. A new instrument, designed to monitor key aspects of a child’s life following burn injury, is needed to address this challenge. This instrument can support recovery and rehabilitation in children living with burns during this critical stage of growth. The objective of this study is to examine the psychometric properties of the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE) Profile Computer Adaptive Test (CAT), an innovative instrument developed to assess burn survivors 5 to 12 years of age based on parent responses. Methods Responses to the field-tested SA-LIBRE Profile (195 items) were recorded using frequency and ability response scales. Scores were coded from 0 to 4, with higher scores indicating better functioning. Factor analysis identified the unidimensional domains, or scales. Item Response Theory (IRT)-based analyses established item parameters and calibrated item banks for each scale. CAT simulations were conducted to estimate mean scores for each scale. The simulated CAT score and full item bank scores were compared based upon the score range, ceiling and floor effects, and marginal reliability. Results The sample included 416 parents of burn survivors. The mean age of the child was 8.5 ± 2.4 years (SD), and 54.3 % were male. The mean total body surface area burned was 8.7 %, with an average time since burn of 4.5 years. An eight-factor solution emerged: Functional Impact of Burn Symptoms (17 items), Upper Extremity (15 items), Lower Extremity (11 items), Psychosocial (22 items), Resilience (6 items), Body Image (13 items), Peer Support (10 items), and School (6 items). Upper and Lower Extremity functioning scales were analyzed separately for children with burns to the hands or arms (n = 288) and burns to the thigh, calf or feet (n = 171), respectively. CATs were developed for each scale, except for Resilience, Peer Support, and School, due to the small number of items in these item banks. Correlations between the CATs and full-item banks ranged from 0.94 to 0.99 (p<.05). Marginal reliabilities for the scales were credible after removing subjects performing at the floor and ceiling of the respective metrics and ranged from 0.61 to 0.87. Conclusions The School-Aged LIBRE, a psychometrically sound assessment for children 5 to 12 years of age, includes 8 scales that assess key aspects of recovery for children after a burn injury. Applicability of Research to Practice The eight scales of the School-Aged LIBRE will be made available for use in research and clinical practice. Funding for the study This work was supported by Foundation Funding (Grant# 79138, 79 136, and 79 145) and in part by the National Institute on Disability, Independent Living, and Rehabilitation Research (Grant# 90DPBU0008).

  PublisherDOI

• 671. MORE FUN: Progressive Mobility, Endurance, Strength, and Function for Burned Children

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

  articleOpen access

  Abstract Introduction Physical rehabilitation is a mainstay in the treatment of acutely injured burn patients. Despite the long-standing practice of implementing physical and occupational therapy in burn injury treatment, there are no standard therapy practices, prescribed daily duration, or timing that are established. The main aim of this investigation was to determine if a prescribed early physical rehabilitation program with less bedrest improves physical rehabilitation for acutely injured pediatric burn patients. Methods We performed a single center randomized control prospective study of pediatric patients (3-18 years of age) with an acute burn injury. To be included in the study patients needed to have a survivable burn injury of 5% of total body surface area (TBSA) or more and have an anticipated need for skin grafting. Patients were randomized to receive either active therapy (AT) or standard therapy (ST). The AT group received directed therapy of 45 to 60 minutes per day, with no pauses in the perioperative or postoperative period. ST group received usual therapy and care guided by the treating surgeon. Primary outcome was the 6-minute walk test (6MWT) distance at discharge. Secondary outcomes included Time-Up-and-Go, Patient Reported Outcome Measurement Information System scores, Canadian Occupational Performance Measure, and post discharge activity. Results 52 patients were enrolled in the study: 28 patients were randomized to the ST group and 24 patients were randomized to the AT group. Mean age (7.3 ± 4.7 vs. 8.3 ± 4.7 years), total burn TBSA (27 ± 21 vs. 21 ± 15%), and third degree burn TBSA (19 ± 16 vs. 16 ± 17%) did not differ between the groups (ST vs AT). While not reaching statistical significance (p=.141), the AT group walked longer distances (+41 meters) during the 6MWT at discharge and demonstrated more time in a “very active” activity zone during the 3 months after discharge (AT: 30%, ST; 20%, p<.001). There were no differences in skin graft loss or complications between the groups. Conclusions Intensive, prescribed, and daily physical therapy intervention can be safely administered for acutely burn-injured pediatric patients without complications. These interventions may help improve activity after discharge. Applicability of Research to Practice Pediatric burn patients can and should participate in aggressive daily physical therapy. Historically, concerns for graft loss and other perioperative wound healing complications have tended towards bedrest and limited mobility in this vulnerable population. However, this study demonstrates scheduled active therapy is not only safe but may benefit patients as well. Funding for the study Institutional research grant.

  PublisherDOI

• C-756-02. Communication and Language Outcomes After Pediatric Burn Injury: Impact of Age and Burn Location

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

  articleOpen access

  Abstract Introduction Burn injuries in early childhood may have lasting impacts that extend beyond physical recovery, yet their association with developmental outcomes such as communication and language is not well understood. Early childhood is a critical period for language development, and injuries involving functionally important or visible body areas may disrupt these processes. This study examines how age and burn location influence communication and language outcomes in young children, as measured by the communication and language domain of the Preschool Life Impact Burn Recovery Evaluation for children 1–5 years of age (PS-LIBRE1–5). Methods Data were obtained from parents/guardians of children 1 to 5 years of age with burn injuries. Responses to the calibration field-tested PS-LIBRE Profile (188 items) were measured on a scale of frequency or ability levels. Item responses were coded from 0 to 4, where higher scores reflected better functioning. Twenty items identified through confirmatory factor analysis loaded strongly onto the communication and language factor domain. Communication and language scores were generated from Rasch modeling and transformed into T-scores (mean = 50, SD = 10), where higher scores denote a higher level of functioning. Multivariable linear regression models were stratified by age group (< 48 months vs. ≥48 months) to evaluate associations between age at assessment, burns to one or more critical areas (hand, face, genitalia, or foot), and communication and language scores. Results The mean child age was 3.0 ± 1.5 years (n = 498), and 83% of respondents were mothers. The average total body surface area burned was 4.2% ± 7.8% (SD), and the mean time since injury was 1.1 ± 1.32 years. Burns to one or more critical areas were present in 70.3% of children. Communication and language scores demonstrated a positive association with age up to 48 months, after which the relationship plateaued (Fig. 1). In children aged ≥48 months, burns to critical areas were associated with significantly lower scores (–2.75 points, p=.017; Fig. 2), whereas age at survey completion was not significantly associated with outcomes (p=.24). In contrast, among children <48 months, each additional month of age was associated with a 0.65-point increase in scores (p<.001), and burns to critical areas were not significantly associated with communication and language outcomes (p=.89). Conclusions Communication and language development is strongly age-dependent in early childhood, but among older children, burns involving critical areas are linked to significantly poorer outcomes. Applicability of Research to Practice Assessing communication and language is important in pediatric burn rehabilitation, as these skills are likely significantly impacted by burn injury. The PS-LIBRE1–5 provides a standardized tool for evaluating communication and language outcomes, supporting targeted rehabilitation and treatment planning for young children with burn injuries. Funding for the study This work was supported by Foundation Funding (Grants #72000, #79136, and #79138), and in part by the National Institute on Disability, Independent Living, and Rehabilitation Research (Grant #90DPBU0008).

  PublisherDOI

• 860. Impact of Neurologic Complications on Burn Patient Outcomes

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

  articleOpen accessSenior author

  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

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

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

  articleOpen access

  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

• 816. Demographic Analysis of a Randomized Controlled Trial Comparing Outcomes of Dermal Matrices in Burn Injuries

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

  articleOpen access

  Abstract Introduction Severe burn injuries often require temporizing strategies before definitive wound closure. Advanced Dermal Matrices (ADMs) are designed to integrate into the wound bed and support subsequent split-thickness skin grafting (SSG). This pivotal, randomized, controlled trial (RCT) evaluates the safety and effectiveness of a novel, synthetic, biodegradable dermal matrix* compared to standard of care (SOC) treatments in patients with deep dermal and full-thickness thermal burns to determine the safety and efficacy of the novel ADM. Methods This multicenter, IDE, RCT was sponsored by BARDA and enrolled adult patients (18–75 years) with 3–60% TBSA burns. Subjects were randomized 2:1 to receive the novel, synthetic, biodegradable dermal matrix or SOC (e.g., an ADM containing cross-linked bovine collagen and chondroitin-6-sulfate or cadaveric allograft) before SSG. The primary effectiveness endpoint is the total percent wound closure calculated for each randomized subject based on an Independent Panel assessment of study lesions at 4 weeks after split-thickness skin grafting and serves as the dependent variable. The primary safety endpoint is a composite of device (BTM group)-/treatment (SOC group)-related mortality, skin graft loss requiring re-operation and device (BTM group)-/treatment (SOC group)-related AEs requiring re-operation. In this trial the subject served as the sampling unit for this composite endpoint; individual elements of this endpoint, such as skin graft loss, infection, and matrix removal, and is tabulated based on each treated burn site. Twenty-two sites in the USA and 3 in India participated. Results 127 subjects were enrolled and 120 randomized and treated with the first enrollment on 9-20-2021, and the final enrollment on 08-19-2024. Demographic Data is in the attached table. Conclusions The CP-003 study is among the largest RCT performed to date comparing the outcomes of dermal matrices in deep second- and third-degree burns. The demographic data demonstrate excellent randomization between the novel, synthetic, biodegradable dermal matrix and SOC. Efficacy and safety results are being finalized for submission to the FDA as part of a PMA submission package and will be shared once the PMA review is complete. Applicability of Research to Practice Safety and clinical efficacy of a novel, synthetic, biodegradable advanced dermal matrix that may promote faster healing and have improved cosmetic outcomes in severe burn injuries. Funding for the study The Biomedical Advanced Research & Development Agency (BARDA).

  PublisherDOI

Frequent coauthors

• David G. Greenhalgh

  UC Davis Health System

  624 shared

• Lewis E. Kazis

  Spaulding Rehabilitation Hospital

  604 shared

• Kathleen S Romanowski

  Shriners Hospitals for Children - Northern California

  534 shared

• Soman Sen

  University of California, Davis

  478 shared

• Colleen M. Ryan

  Harvard University

  417 shared

• Frederick J. Stoddard

  Spaulding Rehabilitation Hospital

  410 shared

• Robert L. Sheridan

  Harvard University

  346 shared

• Petra Warner

  University of Cincinnati

  328 shared

Awards & honors

• Harvey Stuart Allen Distinguished Service Award, American Bu…
• President, American Burn Association, 2012, 2013
• Dean's Award for Excellence in Clinical Care, UC Davis, 2009