121 The Opioid Dependence Paradox in Among Patients with Burn Injury

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S81-S81
Author(s):  
Heather Peluso ◽  
Marc S Georgi ◽  
Julie Caffrey
Keyword(s):  
Length Of Stay ◽  
Resource Utilization ◽  
Opioid Dependence ◽  
Burn Injury ◽  
Multivariate Regression Analysis ◽  
Burn Injuries ◽  
Hospital Charges ◽  
P Value ◽  
Readmission Rates ◽  
Icd 10

Abstract Introduction The opioid epidemic has contributed significantly to the healthcare economic burden nationwide. Methods Using the 2016 National Readmission Database, patients were included if they had a principal diagnosis of burn injury. Opioid dependence was identified using appropriate ICD-10 CM codes. The primary outcome was 30-day all-cause readmission. Secondary outcomes were in-hospital and calendar-year mortality, resource utilization, and most common reasons for admission and readmission. Confounders were adjusted for using multivariate regression analysis. Results 22,348 patients were included, 597 of whom were opioid dependent. Opioid dependent patients were more likely to be older (43 years, range: 38.6–47.2 years) and male (70.8%) compared with patients without opioid dependence. Opioid dependence was associated with higher 30-day readmission rates (adjusted odds ratio (aOR): 1.93, 95% confidence interval (CI):1.39–2.68, p-value: < 0.01), longer mean length of stay (adjusted mean difference (aMD): 5.46 days, CI:2.63–8.29, p-value: < 0.01). and higher total hospitalization charges (aMD: $50,050, CI:$5,941-$94,960, p-value: 0.03) and costs (aMD: $14,889, CI:$3,658-$26,119, p-value: 0.01). However, opioid dependence was associated with lower in-hospital (aOR: 0.23, CI:0.06–0.85, p-value: 0.03) and calendar-year (aOR: 0.47, CI:0.22–0.99, p-value: 0.04) mortality. The most common reasons for both initial admission and readmission are presented in Table 1. Conclusions Opioid dependence is associated with lower in-hospital and calendar-year mortality, but higher rates of readmission, longer mean length of stay and higher hospital charges among patients with burn injuries. Applicability of Research to Practice Despite increased resource utilization for patients with opioid dependence, mortality was decreased in this population. Further research is needed to elucidate this paradox.

102 Wildfire Burns: Implications for Burn Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S67-S67
Author(s):  
Tina L Palmieri ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh
Keyword(s):  
Length Of Stay ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ventilatory Support ◽  
Mass Casualty ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Injury Incidence ◽  
Burn Centers ◽  
Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

Readmission after robotic Ivor Lewis esophagectomy: Earlier discharge, increased readmissions?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 149-149
Author(s):  
Ahmed I. Salem ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
Khaldoun Almhanna ◽  
Kenneth Meredith
Keyword(s):  
Length Of Stay ◽  
Neoadjuvant Therapy ◽  
Statistical Tests ◽  
P Value ◽  
Readmission Rates ◽  
Historical Cohort ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy ◽  
The Impact

149 Background: Readmissions after esophagectomy are costly and incidence can be as high as 25%. The robotic assisted approach has potential benefits of earlier discharge compared to conventional techniques, however it is unclear what impact an earlier discharge will have on readmission rates. We sought to examine the impact of early discharge on readmission rates with robotic approaches. Methods: A retrospective review of all patients undergoing robotic assisted Ivor Lewis esophagectomy (RAIL) from 2009-2015 was conducted. Clinicopathologic factors and surgical outcomes were recorded and compared. We then compared outcomes to a historical cohort from the Surveillance, Epidemiology, and End Results-Medicare data (2002 to 2009). Length of stay, 30-day and 90-day readmissions, and mortality were determined. All statistical tests were two-sided and a p-value < 0.05 was considered statistically significant. Results: We identified 147 patients who underwent RAIL. There were 78.9% (116) male with an average age 66 ±10 years. Adenocarcinoma was the predominant histology in 86% (126) patients, 9.52% (14) patients had squamous cell histology, and 4.76% (7) patients had other histology. Neoadjuvant therapy was administered to 77.6% (114) patients. In the SEER database 1,744 patients with esophageal cancer underwent esophagectomy: 80% of patients (1,390) were male, with a mean age of 73 years; 71.8% of tumors (1,251) were adenocarcinomas, and 38% of patients (667) received neoadjuvant therapy. Median length of stay was 13 days, 30-day mortality was 8.8% (158 patients), and 90 day mortality was 17.9% (302) compared to median LOH of 9 days, 30-day mortality of 0.6% (1) and 90-day mortality of 1.4% (2)% in the robotic cohort, p < 0.0001, p = 0.007, and p < 0.0001. Readmission rates at 30 and 90 days were 18.6% (212) and 31.3% (356) in the SEER patients, and 3.4% (5) and 5.4% (8) in the robotic cohort p = 0.001 and p < 0.001. Conclusions: RAIL is a safe surgical technique that provides an alternative to conventional approaches to esophageal resection. Patients undergoing RAIL had lower mortality rates and LOH. Despite the lower LOH, RAIL was associated with lower 30 and 90-day readmissions.

scholarly journals The Effect of Early Tangential Excision and Split Thickness Skin Graft in Reducing Length of Stay in Burns Patients in Jakarta Islamic Hospital Cempaka Putih

2021 ◽  
Vol 8 (1) ◽  
pp. 15-20
Author(s):  
Gammaditya Adhibarata Winarno ◽  
Aditya Wardhana ◽  
Sanjaya Faisal Tanjunga ◽  
A. S Augiani ◽  
An’umillah Arini Zidna
Keyword(s):  
Length Of Stay ◽  
Skin Graft ◽  
Burn Injury ◽  
Study Groups ◽  
Cross Sectional Study ◽  
Burn Injuries ◽  
Split Thickness Skin Graft ◽  
Burn Patients ◽  
Cross Sectional ◽  
Thickness Skin

Introduction: Early tangential excision (TE) and split-thickness skin graft (STSG) have increased the outcome in burn patients treated at specialized burn centers. This study was conducted to compare the length of stay (LOS) in burn patients undergoing early TE & STSG and delayed TE & STSG. Method: This is a retrospective cross-sectional study including 42 patients with varied burn degrees, and TBSA admitted to Jakarta Islamic Hospital Cempaka Putih (JIHCP) Burn Unit. Patients were assigned to two study groups, the early TE & STSG group including 32 patients and the delayed TE & STSG group including 10 patients. All data were collected from the medical record and compared between two study groups. Result: The mean of LOS in a group with early TE & STSG was shorter (9.81±6.41 days) than LOS in the delayed TE & STSG group (15.80±5.67 days). The data of LOS between these groups were compared using an independent T-test. The LOS in the early TE & STSG group was significantly shorter than the delayed TE & STSG group (p=0.012). Conclusion: In patients with burn injuries, early TE & STSG is associated with a shorter length of stay than the delayed TE & STSG. Our study indicates that early excision within five days after burn injury is optimal to reduce the length of stay in burn patients.

Enterocutaneous Fistula Complicating Trauma Laparotomy: A Major Resource Burden

2009 ◽  
Vol 75 (1) ◽  
pp. 30-32 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Kenji Inaba ◽  
Joseph Dubose ◽  
Ali Salim ◽  
Carlos Brown ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity Score ◽  
Resource Utilization ◽  
Severity Score ◽  
Injury Severity ◽  
Enterocutaneous Fistula ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Hollow Viscus

Enterocutaneous fistula (ECF) is an uncommon and poorly studied postoperative complication. The objective of this study was to analyze the incidence and resource utilization of patients who developed an ECF after trauma laparotomy. All patients with an ECF occurring after trauma laparotomy at a Level I trauma center were identified through a review of both the Trauma Registry and the Morbidity and Mortality reports for a 9-year period ending in December 2006. Each ECF case was matched with a control (non-ECF) that did not develop this complication after laparotomy. The matching criteria were: age, gender, mechanism of injury, Injury Severity Score, Abbreviated Injury Score, and damage control laparotomy requiring an open abdomen. Outcomes analyzed were intensive care unit (ICU) and hospital length of stay, mortality, and total hospital charges. During the 9-year period, of 2373 acute trauma laparotomies performed, 36 (1.5%) patients developed an enterocutaneous fistula, and were matched to 36 controls. Patients with an ECF were 31 ± 12 years of age, were 97 per cent male, had a mean Injury Severity Score of 21 ± 10, and 75 per cent were penetrating. Eighty-nine per cent of the ECF patients had a hollow viscus injury. The most common was colon (69%), followed by small bowel (53%), duodenum (36%), and stomach (19%). Fifty-six per cent of the ECF patients had multiple hollow viscus injuries. The development of an ECF was associated with significantly increased ICU length of stay (28.5 ± 30.5 vs 7.6 ± 9.3 days, P = 0.004), hospital length of stay (82.1 ± 100.8 vs 16.2 ± 17.3 days, P < 0.001), and hospital charges ($539,309 vs $126,996, P < 0.001). In conclusion, the development of an enterocutaneous fistula after laparotomy for trauma resulted in a significant impact on resource utilization including longer ICU and hospital length of stay and higher hospital charges. Further investigation into the prevention and treatment of this costly complication is warranted.

Abstract 16989: Clinical Outcomes of Atrial Fibrillation With Hyperthyroidism

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
MUHAMMAD ZUBAIR Z KHAN ◽  
Kirtenkumar Patel ◽  
Ashwani Gupta ◽  
Jordesha Hodge ◽  
Krunalkumar Patel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Multivariate Regression Analysis ◽  
International Classification Of Diseases ◽  
P Value ◽  
All Cause Mortality ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Cardiac Manifestation

Introduction: Atrial fibrillation (Afib) is a common cardiac manifestation of hyperthyroidism. The data regarding outcomes of A fib with and without hyperthyroidism are lacking. Hypothesis: We hypothesized that patients with Afib and hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism. Methods: We queried National Inpatient Sample database for years 2015 - 2017 using Validated International Classification of Diseases and Clinical Modification (ICD-10-CM) codes for atrial fibrillation and hyperthyroidism. Patients were separated into 2 groups- A fib with hyperthyroidism and A fib without hyperthyroidism. Results: Study was conducted on 68,095,278 pateints. A total of 9,727,295 Afib patients were identified, out of which 90,635(0.9%) had hyperthyroidism. The prevalence of hyperthyroidism was higher in patients with Afib (0.9% vs 0.4%, p value <0.001), compared with patients without A fib. Using multivariate regression analysis after adjusting for various confounding factors, the odds ratio of Afib with hyperthyroidism was 2.08 (CI 2.07 - 2.10 P<.0001). Afib patients with hyperthyroidism were younger, (70.9 vs75.1 years, p<0.0001) and more likely to be female (63.9% vs 47% p<0.0001) as compared with Afib patients without hyperthyroidism. Afib patients with hyperthyroidism had lower prevalence of CAD (36.4% vs 43.8%,p<0.0001), cardiomyopathy(24.1% vs 25.9%,p<0.0001), valvular disease (6.9% vs 7.4%,p<0.0001), hypertension(60.7% vs 64.4%,p<0.0001) , and diabetes mellitus (28.9% vs 31.8%,p<0.0001). Afib with hyperthyroidism group had lower all-cause mortality (3.3% vs 4.8%, p<0.0001), shorter mean length of stay (5.7 ±6.6 vs 5.9±6.6 days,p<0.0001) and hospitalization cost ($14968±21871 vs $15955±22233, p<0.0001). The disposition to home was higher in Afib with hyperthyroidism patients (50.6% vs 41.8 p<0.0001). Conclusions: Presence of hyperthyroidism is associated with Afib in both univariate and multivariate analysis. Afib patients with hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism.

In Patients with Lower Extremity Burns and Osteomyelitis, Diabetes Mellitus Increases Amputation Rate

2021 ◽  
Author(s):  
Kathleen A Iles ◽  
Stephen Heisler ◽  
Lori Chrisco ◽  
Booker King ◽  
Felicia N Williams ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Lower Extremity ◽  
Healthcare Utilization ◽  
Burn Injury ◽  
Average Length ◽  
Amputation Rate ◽  
P Value ◽  
Diabetic Patients ◽  
The Impact

Abstract In this retrospective analysis, we investigated the rate of radiologically confirmed osteomyelitis, extremity amputation and healthcare utilization in both the diabetic and non-diabetic lower extremity burn populations to determine the impact of diabetes mellitus on these outcomes. The burn registry was used to identify all patients admitted to our tertiary burn center from 2014 to 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Statistical analysis was performed using Student’s t test, chi-squared test, and Fischer’s exact test. Of the 315 patients identified, 103 had a known diagnosis of diabetes mellitus and 212 did not. Seventeen patients were found to have osteomyelitis within three months of the burn injury. Fifteen of these patients had a history of diabetes. Notably, when non-diabetics were diagnosed with osteomyelitis, significant differences were observed in both length of stay and cost in comparison to their counterparts without osteomyelitis (36 vs 9 days; p=0.0003; $226,289 vs $48,818, p=0.0001). Eleven patients required an amputation and 10 (90.9%) of these patients had comorbid diabetes and documented diabetic neuropathy. Compared to non-diabetics, the diabetic cohort demonstrated both a higher average length of stay (13.7 vs 9.2 days, p-value=0.0016) and hospitalization cost ($72,883 vs $50,500, p-value=0.0058). Our findings highlight that diabetic patients with lower extremity burns are more likely to develop osteomyelitis than their non-diabetic counterparts and when osteomyelitis is present, diabetic patients have an increased amputation rate. Further study is required to develop protocols to treat this population, with the specific goal of minimizing patient morbidity and optimizing healthcare utilization.

scholarly journals 3517 Cancer-Related Pain is a Predictor of In-hospital Opioid Overdose among Postoperative patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 36-36
Author(s):  
Nnaemeka E Onyeakusi ◽  
Fahad Mukhtar ◽  
Adebamike Oshunbade ◽  
Semiu Gbadamosi ◽  
Adeyinka Adejumo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Charges ◽  
P Value ◽  
Opioid Overdose ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Patients With Cancer ◽  
Cancer Management ◽  
Cancer Pathogenesis ◽  
Diagnosis Of Cancer

OBJECTIVES/SPECIFIC AIMS: Our study’s primary aim is to determine if there is an association between cancer-related pain among patients who underwent major elective procedures and postoperative opioid overdose. In addition, the relationship between cancer-related pain in this population and inpatient mortality, total hospital charge and length of stay was assessed. METHODS/STUDY POPULATION: Our study sample consisted of adults 18 years and older who had at least one of eight elective procedures. Data was obtained from the National Inpatient Sample (NIS). Variables were identified using ICD-9 codes. Our primary predictor was cancer-related pain while our primary outcome was opioid overdose. Secondary outcomes were inpatient mortality, length of stay and total charge. Propensity-matched regression models were employed in assessing the association between cancer-related pain and outcomes of interest. RESULTS/ANTICIPATED RESULTS: Among 4,085,355 selected patients, 0.8% (n = 2,665) had cancer-related pain while 99.92% (n = 4,082,690) had no diagnosis of cancer-related pain. All subjects with cancer-related pain (n = 2,665) were successfully matched to subjects with no diagnosis of cancer-related pain in a 1:5 ratio yielding 13,325 controls. Patients with cancer-related pain had significantly higher odds of opioid overdose (aOR 4.82 [95% CI [2.68-8.67]; p-value <0.0001) and inpatient mortality (aOR 1.39[1.11-1.74]; p-value 0.0043). Patients with cancer-related pain were also likely to stay significantly longer in the hospital (12.76 days vs. 7.88 days) with significantly higher total hospital charges ($140,220 vs. $88,316). DISCUSSION/SIGNIFICANCE OF IMPACT: Pain is a common complication of cancer pathogenesis, diagnosis or treatment. Though a rare outcome, opioid overdose could lead to undesirable outcomes. Cancer patients undergo invasive diagnostic and therapeutic procedures as part of their cancer management or for conditions not related to their primary cancer diagnosis. Safety measures including alternatives to opioids are recommended to prevent the poor clinical outcomes and higher healthcare utilization indices associated with opioid overdose in this population.

Comparative inpatient resource utilization for patients undergoing endoscopic or microscopic transsphenoidal surgery for pituitary lesions

2014 ◽  
Vol 121 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Andrew S. Little ◽  
Kristina Chapple ◽  
Heidi Jahnke ◽  
William L. White
Keyword(s):  
Health Care ◽  
Surgical Technique ◽  
Length Of Stay ◽  
Resource Utilization ◽  
Endoscopic Surgery ◽  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Surgical Techniques ◽  
Cushing's Disease ◽  
Hospital Charges

Object An increasingly important measure in the health care field is utilization of hospital resources, particularly in the context of emerging surgical techniques. Despite the recent widespread adoption of the endoscopic transsphenoidal approach for pituitary lesion surgery, the health care resources utilized with this approach have not been compared with those utilized with the traditional microscopic approach. The purpose of this study was to determine the drivers of resource utilization by comparing hospital charges for patients with pituitary tumors who had undergone either endoscopic or microscopic transsphenoidal surgery. Methods A complete accounting of all hospital charges for 166 patients prospectively enrolled in a surgical quality-of-life study at a single pituitary center during October 2011–June 2013 was undertaken. Patients were assigned to surgical technique group according to surgeon preference and then managed according to a standard postoperative institutional set of orders. Individual line-item charges were assigned to categories (such as pharmacy, imaging, surgical, laboratory, room, pathology, and recovery unit), and univariate and multivariate statistical analyses were conducted. Results Of the 166 patients, 99 underwent microscopic surgery and 67 underwent endoscopic surgery. Baseline demographic descriptors and tumor characteristics did not differ significantly. Mean total hospital charges were $74,703 ± $15,142 and $72,311 ± $16,576 for microscopic and endoscopic surgery patients, respectively (p = 0.33). Furthermore, other than for pathology, charge categories did not differ significantly between groups. A 2-step multivariate regression model revealed that length of stay was the most influential variable, followed by a diagnosis of Cushing's disease, and then by endoscopic surgical technique. The model accounts for 42% of the variance in hospital charges. Conclusions Study findings suggest that adoption of the endoscopic transsphenoidal technique for pituitary lesions does not adversely affect utilization of resources for inpatients. The primary drivers of hospital charges, in order of importance, were length of stay, a diagnosis of Cushing's disease, and, to a lesser extent, use of the endoscopic technique. This study also highlights the influence of individual surgeon practice patterns on resource utilization.

scholarly journals Morphine versus Hydromorphone: Does Choice of Opioid Influence Outcomes?

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Padma Gulur ◽  
Katharine Koury ◽  
Paul Arnstein ◽  
Hang Lee ◽  
Patricia McCarthy ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
Observational Study ◽  
Health Systems ◽  
Resource Utilization ◽  
Population Based ◽  
First Line ◽  
Readmission Rates ◽  
Hospital Population ◽  
The University

Morphine has traditionally been considered the first line agent for analgesia in hospitals; however, in the last few years there has been a shift towards the use of hydromorphone as a first line agent. We conducted a hospital population based observational study to evaluate the increasing use of hydromorphone over morphine in both medical and surgical populations. Additionally, we assessed the effect of this trend on three key outcomes, including adverse events, length of stay, and readmission rates. We evaluated data from the University Health Systems Consortium. Data from 38 hospitals from October 2010 to September 2013 was analyzed for patients treated with either hydromorphone or morphine. The use of morphine steadily decreased while use of hydromorphone increased in both medical and surgical groups. Rescue drugs were used more frequently in patients treated with hydromorphone in comparison to patients treated with morphine (p<0.01). Patients receiving morphine tended to stay in the hospital for almost one day longer than patients receiving hydromorphone. However, 30-day all cause readmission rates were significantly higher in patients treated with hydromorphone (p<0.01). Our study highlights that the choice of hydromorphone versus morphine may influence outcomes. There are implications related to resource utilization and these outcomes.

518 Massive Burn Injury Outcomes in Children

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S106-S106
Author(s):  
Sally A Martens ◽  
Kathleen S Romanowski ◽  
Tina L Palmieri ◽  
David G Greenhalgh ◽  
Soman Sen
Keyword(s):  
Pediatric Patients ◽  
Burn Injury ◽  
The United States ◽  
American Samoa ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
P Value ◽  
Significant Independent Predictor ◽  
Mean Values ◽  
Institutional Review

Abstract Introduction Advances in the care of burn injured pediatric patients has improved mortality over the last 20 years. However, massive burn injuries in pediatric patients, while overall rare, have a significant morbidity and mortality. The primary aim for this study is to analyze outcomes in massive pediatric burn injuries. Methods After institutional review board approval, a retrospective study of children with burn injuries 50% TBSA or greater who were admitted to our pediatric burn center from 2009 to 2019 was conducted. Data collected include age, gender, ethnicity, race, country of residence, % TBSA, degree of burn, presence of inhalation injury, hospital duration, intensive care duration, presence of tracheostomy, number and types of surgeries performed and discharge outcomes. All mean values are mean±standard deviation, all median values are median (interquartile range), and p-value &lt; 0.05 were considered significant. Results This study included 84 patients (60.7% male) with a mean age of 8±6 years old. The median time from injury to admission was 2(1–4) days. 56% of patients were from Mexico, 43% were from the United States and 1 patient was from American Samoa. 21% of the patients died. There was no difference in the extent of burn injury between patients who died (68±14% TBSA) versus those who lived (66±12% TBSA). The median length of stay was significantly shorter in the patients who died (19(5–44) vs. 74(35–138) days p=0.0001). Patients who died also suffered more inhalation injury (61% vs. 21%, p=0.01). After adjusting for age and TBSA, inhalation was a significant independent predictor of death (OR- 4.3, (1.4-13 95% CI), p=0.01). Conclusions Over the past decade, nearly 80% of children with massive burn injuries survived. The children who died as a result of their massive burn injury, died within the first month of admission. Inhalation injury significantly and independently increases the risk of dying in pediatric patients with a massive burn injury.

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