scholarly journals Long-Term Risk of Mortality and Pulmonary Morbidity after Inhalation Injury among Burn Patients

2017 ◽  
Vol 225 (4) ◽  
pp. S56-S57 ◽  
Author(s):  
Cordelie E. Witt ◽  
Ali Rowhani-Rahbar ◽  
Frederick P. Rivara ◽  
Monica S. Vavilala ◽  
Tam N. Pham ◽  
...  
Keyword(s):  
Inhalation Injury ◽  
Burn Patients ◽  
Risk Of Mortality ◽  
Pulmonary Morbidity

17 Long-Term Pulmonary Sequelae After Inhalation Injury: A Retrospective Cohort Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S17-S17
Author(s):  
Julian Wier ◽  
Ian F Hulsebos ◽  
Haig A Yenikomshian ◽  
Justin Gillenwater
Keyword(s):  
Pulmonary Disease ◽  
Multinomial Logistic Regression ◽  
Smoking Status ◽  
Group Versus ◽  
Inhalation Injury ◽  
Primary Study ◽  
Burn Patients ◽  
Post Discharge ◽  
Ventilated Patients

Abstract Introduction Inhalation injury (INHI) has strong associations with increased rates of in-patient mortality and pneumonia. Data describing long-term health outcomes after inhalation injury are scarce and the true sequelae are largely unknown. The aim of the study is to review long-term pulmonary outcomes in inhalation injury patients. We hypothesize that INHI patients are at greater risk of developing long-term pulmonary sequelae. Methods We present a retrospective case-control of burn patients admitted to an ABA certified facility. We included burn patients with or without medically confirmed INHI who were admitted between 06/2016 to 11/2019 and were part of the regional Department of Health Services (DHS) system. The experimental group was patients with bronchoscopy confirmed INHI. The control groups were ventilated patients with confirmed non-inhalation injury (V) and non-ventilated patients with confirmed non-inhalation injury (NV). These were matched for age, TBSA, sex, previous comorbid pulmonary disease, and smoking status. Primary study outcomes were rates of post-discharge pulmonary sequelae, including ineffective airway clearance, infections, shortness of breath, and malignancy. Secondary outcomes included rates of post-discharge surgeries and readmission, post-discharge non-pulmonary sequelae, and post-discharge days to pulmonary/non-pulmonary sequelae. Results The study population included 33 INHI, 45 V, and 50 NV patients. There were no significant differences in age (P=.98), sex (P=.68), TBSA (P=.18), pulmonary comorbidity (P=.5), or smoking status (P=.92). Outpatient pulmonary sequelae were significantly higher for both INHI and V groups as compared to NV (21% and 17% vs 4%, P=.023, .043). The number of days from discharge to pulmonary sequelae was significantly shorter in the INHI group versus the V group (162±139 days vs 513±314 days, P=.024). Multinomial logistic regression for both INHI and V groups using the variables comorbid pulmonary disease, smoking status, and inpatient course and complications, indicated no effect on post-discharge pulmonary sequelae (all P >.05). All other measures were not significant when comparing INHI to V or NV (all P >.05). Conclusions Both INHI and V groups resulted in higher rates of outpatient pulmonary sequelae independent of inpatient course as compared to NV. While outpatient pulmonary sequelae were not significantly different between INHI and V, the INHI patients presented with complaints earlier. Thus one can conclude that ventilation alone is a significant contributing factor for the long-term pulmonary sequelae reported in this patient population.

Long-term pulmonary sequelae after inhalation injury: A retrospective case-control study

2021 ◽  
Author(s):  
Julian Wier ◽  
Ian Hulsebos ◽  
Leigh Spera ◽  
Haig Yenikomshian ◽  
T Justin Gillenwater
Keyword(s):  
Smoking Status ◽  
Group Versus ◽  
Inhalation Injury ◽  
Primary Study ◽  
Burn Patients ◽  
Post Discharge ◽  
Retrospective Case ◽  
Study Population ◽  
Ventilated Patients

Abstract Inhalation injury (INHI) has strong associations with increased rates of in-patient mortality and pneumonia. This study’s aim is to review long-term pulmonary outcomes in inhalation injury patients. We present a retrospective cohort of burn patients admitted to an ABA certified burn unit. Burn patients with or without medically confirmed INHI who were admitted were studied. The control groups were ventilated patients with (V) and non-ventilated patients (NV). Primary study outcomes were rates of post-discharge pulmonary sequelae, including ineffective airway clearance, infections, shortness of breath, and malignancy. Secondary outcomes included rates of post-discharge surgeries and readmission, post-discharge non-pulmonary sequelae, and post-discharge days to pulmonary/non-pulmonary sequelae. The study population included 33 INHI, 45 V, and 50 NV patients. There were no significant differences in age (P=.98), sex (P=.68), % TBSA (P=.18), pulmonary comorbidity (P=.5), or smoking status (P=.92). Outpatient pulmonary sequelae were significantly higher for both INHI and V groups as compared to NV (21% and 17% vs 4%, P=.023, .043). The number of days from discharge to pulmonary sequelae was significantly shorter in the INHI group versus the V group (162±139 days vs 513±314 days, P=.024). All other measures were not significant when comparing INHI to V or NV (P>.05). Both INHI and V groups resulted in higher rates of outpatient pulmonary sequelae independent of inpatient course as compared to NV. While outpatient pulmonary sequelae were not significantly different between INHI and V, the INHI patients presented with complaints earlier.

scholarly journals Epidemiologic and clinical characteristics of severe burn patients: results of a retrospective multicenter study in China, 2011–2015

2018 ◽  
Vol 6 ◽  
Author(s):  
Hao Tian ◽  
Liangxi Wang ◽  
Weiguo Xie ◽  
Chuanan Shen ◽  
Guanghua Guo ◽  
...  
Keyword(s):  
Social Impact ◽  
Injury Severity ◽  
Survival Rates ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Severe Burns ◽  
Medical Centers ◽  
Male Patients ◽  
Length Of Hospitalization

Abstract Background Severe burns injury is a serious pathology, leading to teratogenicity and significant mortality, and it also has a long-term social impact. The aim of this article is to describe the hospitalized population with severe burns injuries in eight burn centers in China between 2011 and 2015 and to suggest future preventive strategies. Methods This 5-year retrospective review included all patients with severe burns in a database at eight institutions. The data collected included gender, age, month distribution, etiology, location, presence of inhalation injury, total burn surface area, depth of the burn, the length of hospitalization, and mortality. SPSS 19.0 software was used to analyze the data. Results A total of 1126 patients were included: 803 (71.3%) male patients and 323 (28.7%) female patients. Scalds were the most common cause of burns (476, 42.27%), followed by fire (457, 40.59%). The extremities were the most frequently affected areas, followed by the trunk. The median length of hospitalization was 30 (15, 52) days. The overall mortality rate was 14.21%. Conclusions Although medical centers have devoted intensive resources to improving the survival rates of burn patients, expenditures for prevention and education programs are minimal. Our findings suggest that more attention should be paid to the importance of prevention and the reduction of injury severity. This study may contribute to the establishment of a nationwide burn database and the elaboration of strategies to prevent severe burns injury.

Burn-Center Quality Improvement: Are Burn Outcomes Dependent on Admitting Facilities and is There a Volume-Outcome “Sweet-Spot”?

2012 ◽  
Vol 78 (5) ◽  
pp. 559-566 ◽  
Author(s):  
Tjasa Hranjec ◽  
Florence E. Turrentine ◽  
George Stukenborg ◽  
Jeffrey S. Young ◽  
Robert G. Sawyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Body Surface Area ◽  
Significant Risk ◽  
Inhalation Injury ◽  
P Value ◽  
Burn Patients ◽  
Multivariable Logistic Regression Model ◽  
Risk Of Mortality ◽  
Volume Outcome ◽  
Total Body

Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD &lt; 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p &lt; 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p &lt; 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p &lt; 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Huang ◽  
C Liu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Funding Source ◽  
Preserved Ejection Fraction ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: &lt;120mmHg, ≥120mmHg and &lt;130mmHg, ≥130mmHg and &lt;140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of &lt;120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of &lt;120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

15 Use of Bioelectric Impedance Analysis in Burn Patients: A Pilot Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Ian F Hulsebos ◽  
Maxwell B Johnson ◽  
Leigh J Spera ◽  
Megan C Fobar ◽  
Zachary J Collier ◽  
...  
Keyword(s):  
Body Composition ◽  
High Risk ◽  
Phase Angle ◽  
Impedance Analysis ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Bioelectric Impedance Analysis ◽  
High Risk Patients ◽  
Severity Of Injury ◽  
Risk Patients

Abstract Introduction Bioelectric Impedance Analysis (BIA) is a rapid, non-invasive, and inexpensive technology based on electrical conductivity. BIA assesses body composition, fluid shifts, and phase angle, an electrical force vector where smaller values suggest cellular injury. Our objective was to use BIA to longitudinally track the clinical status of burn patients. We hypothesized that BIA would detect progressive decreases in muscle mass throughout the patient’s hospital course and that low phase angle values would correlate with severity of injury. Methods A cohort study of 10 patients from January 1, 2020 to March 13, 2020 was performed at an ABA-verified burn center. Patient and burn characteristics and laboratory data were collected. BIA measurements were performed daily for the first 10 days of admission and then twice weekly until discharge. The primary outcome was to detect changes in body composition. The secondary objectives were to detect differences between low and high-risk patients in terms of water composition and phase angle. Patients with APACHE II &gt; 15, measured at burn unit admission, were considered high risk for burn injury related morbidity and mortality. Results BIA detected a statistically significant negative correlation between time spent hospitalized and leg lean mass (LM) (r2=0.56, P&lt; 0.0001), right arm LM (r2=0.52, P&lt; 0.0001) and left leg LM (r2=0.57, P&lt; 0.0001), and positive correlation between body fat mass (BFM) and time spent hospitalized (r2=0.50, P=0.0004). Water composition (volume of extracellular water (ECW) per total body water (TBW)) negatively correlated with low-risk patients: right arm (r2=0.51, P&lt; 0.0001), left arm (0.71, P&lt; 0.001), thorax (0.66, P&lt; 0.0001), right leg (0.74, P&lt; 0.0001), left leg (0.35, P=0.002). Full body phase angle increased with low-risk patients over their hospital course (r2=0.62, P&lt; 0.0001), while phase angle decreased with high-risk patients (r2=0.71, P=0.0006). Full body phase angle differentiated high risk patients (P&lt; 0.0001), and phase angle of thorax differentiated between patients with and without inhalation injury (P=0.002). Conclusions Our study demonstrates that BIA measures changes in body composition and fluid shifts, identifies inhalation injury, and correlates with severity of injury in hospitalized burn patients. This pilot study included a limited number of participants with varying anatomic injuries presenting unique measurement challenges. Regardless, our preliminary data justifies a larger prospective study to confirm these results and correlate them with clinical outcomes.

scholarly journals Undifferentiated Embryonal Sarcoma of the Liver in Children Versus Adults: A National Cancer Database Analysis

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2918
Author(s):  
Ioannis A. Ziogas ◽  
Irving J. Zamora ◽  
Harold N. Lovvorn III ◽  
Christina E. Bailey ◽  
Sophoclis P. Alexopoulos
Keyword(s):  
Surgical Treatment ◽  
Cox Regression ◽  
Clinicopathological Characteristics ◽  
National Cancer Database ◽  
Term Survival ◽  
Long Term Survival ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Embryonal Sarcoma

This study evaluates the clinicopathological characteristics and outcomes of children vs. adults with undifferentiated embryonal sarcoma of the liver (UESL). A retrospective analysis of 82 children (<18 years) and 41 adults (≥18 years) with UESL registered in the National Cancer Database between 2004–2015 was conducted. No between-group differences were observed regarding tumor size, metastasis, surgical treatment, margin status, and radiation. Children received chemotherapy more often than adults (92.7% vs. 65.9%; p < 0.001). Children demonstrated superior overall survival vs. adults (log-rank, p < 0.001) with 5-year rates of 84.4% vs. 48.2%, respectively. In multivariable Cox regression for all patients, adults demonstrated an increased risk of mortality compared to children (p < 0.001), while metastasis was associated with an increased (p = 0.02) and surgical treatment with a decreased (p = 0.001) risk of mortality. In multivariable Cox regression for surgically-treated patients, adulthood (p = 0.004) and margin-positive resection (p = 0.03) were independently associated with an increased risk of mortality. Multimodal treatment including complete surgical resection and chemotherapy results in long-term survival in most children with UESL. However, adults with UESL have poorer long-term survival that may reflect differences in disease biology and an opportunity to further refine currently available treatment schemas.

523 Retrospective Outcomes Analysis of Tracheostomy in Paediatric Burn Population

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S108-S109
Author(s):  
Nicholas Iglesias ◽  
Anesh Prasai ◽  
George Golovko ◽  
Deepak K Ozhathil ◽  
Steven E Wolf
Keyword(s):  
Inhalation Injury ◽  
Smoke Inhalation ◽  
Research Network ◽  
Burn Patients ◽  
Pulmonary Injury ◽  
Smoke Inhalation Injury ◽  
Mortality And Morbidity ◽  
Laryngeal Injury ◽  
Icd 10 ◽  
Potential Benefits

Abstract Introduction For decades, controversy has raged regarding the placement of tracheostomy in severe paediatric burns. Numerous variables including extent of smoke inhalation injury, % TBSA burned, age of the patient, and co-morbidities among others complicate reaching consensus. Furthermore, paediatric patients are particularly susceptible to complications including inadvertent loss of airway and long-term swallowing and other anatomic issues. Additionally, previous analysis of the efficacy of tracheostomy in paediatric burn patients appears to be hindered by a lack of nationwide analysis. The aim of this study was to explore the efficacy of tracheostomy in the general paediatric burn patient population. Methods De-identified patient data was obtained from the TriNetX Research Network database. Two cohorts were identified: paediatric burn patients with tracheostomy (cohort A) and paediatric burn patients without tracheostomy (cohort B). Burn patients were identified using the ICD-10 codes T20-T25 & T30-T32. Tracheostomy was identified using the ICD-10 codes 1005887, 1014613, 31600, 31601, 31603, 31604, 31610, and Z93.0. A total of 132 patients were identified in cohort A in 23 HCOs and 83,117 patients were identified in cohort B in 38 HCOs. Infection, hypovolemia, pulmonary injury, laryngeal injury, pneumonia, and death were compared between the cohorts. Results Cohort A had a mean age of 11 (SD=5) and Cohort B had a mean age of 9 (SD=5). Paediatric burn patients with tracheostomy had a higher risk for death, infection, hypovolemia, pulmonary injury, laryngeal injury, and pneumonia when compared to their non-tracheostomy counterparts. The risk ratios for these outcomes were 62.452, 4.713, 9.267, 26.483, 116.163, and 18.154, respectively. Conclusions The analysis of the longitudinal outcomes of pediatric burn patients with tracheostomy as compared to those without tracheostomy demonstrated the tracheostomy cohort suffered much worse mortality and morbidity across several metrics. The potential benefits of tracheostomy placement in pediatric burn patients should be weighed against these outcomes.

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