Patients With Combined Thermal and Intraabdominal Injuries: More Salvageable Than Not

Abstract This study aims to better characterize the course and outcome of the uncommon subset of trauma patients with combined thermal and intraabdominal organ injuries. The National Trauma Data Bank was queried for burn patients with intraabdominal injury treated in all U.S. trauma centers from July 1, 2011 to June 30, 2015. General demographics, Glasgow coma scale (GCS), shock index (SI), Abbreviated Injury Scale (AIS) for burn, Injury Severity Score (ISS), blood transfusions, and abdominal surgery were evaluated. During the 5-year study period, there were 334 burn patients with intraabdominal injury, 39 (13.2%) of which received abdominal surgery. Burn patients who underwent operations had more severe injuries reflected by higher SI, AIS, ISS, blood transfusion, and worse outcomes including higher mortality, longer hospital and ICU length of stay, and more ventilator days compared to patients who did not undergo an operation. Nonsurvivors also exhibited more severe injuries, and a higher proportion received abdominal operation compared to survivors. Multivariate logistic regression analysis revealed that GCS on arrival, SI, AIS, ISS, blood transfusion, and abdominal operation to be independent risk factors for mortality. Propensity score matching to control covariables (mean age, systolic blood pressure on arrival, GCS on arrival, SI, ISS, time to operation, blood transfusion, and comorbidities) showed that of trauma patients who received abdominal operation, those with concomitant burn injury exhibited a higher rate of complications but no significant difference in mortality compared to those without burns, suggesting that patients with concomitant burns are not less salvageable than nonburned trauma patients.

Download Full-text

Surviving Burn Injury: Drivers of Length of Hospital Stay

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020761 ◽

2021 ◽

Vol 18 (2) ◽

pp. 761

Author(s):

Chimdimma Noelyn Onah ◽

Richard Allmendinger ◽

Julia Handl ◽

Ken W. Dunn

Keyword(s):

Mental Status ◽

Burn Injury ◽

Length Of Hospital Stay ◽

Care Plan ◽

Burn Patients ◽

Emotional Needs ◽

Effective Care ◽

Significant Difference ◽

Unitary Model ◽

Hospital Resources

With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient’s LOS. However, few have investigated the association between LOS and a patient’s mental and socioeconomic status. There is anecdotal evidence for links between these factors; uncovering these will aid in better addressing the specific physical and emotional needs of burn patients and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model. Although we found no significant difference in the unitary model’s performance and the segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the socioeconomic segments’ models highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that in addition to ensuring that patients’ physical needs are met, management of their mental status is crucial for delivering an effective care plan.

Download Full-text

Surviving Burn Injury: Drivers of Length of Hospital Stay

10.20944/preprints202012.0518.v1 ◽

2020 ◽

Author(s):

Chimdimma Noelyn Onah ◽

Richard Allmendinger ◽

Julia Handl ◽

Ken W Dunn

Keyword(s):

Mental Status ◽

Burn Injury ◽

Adult Population ◽

Length Of Hospital Stay ◽

Care Plan ◽

Burn Patients ◽

Effective Care ◽

Significant Difference ◽

Unitary Model ◽

Hospital Resources

With a reduction in the mortality rate of burn patients, patient length of stay (LOS) is increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient's expected LOS. However, few have investigated the association between LOS and a patient's mental and socioeconomic status. There is anecdotal evidence for links between these factors and uncovering these will aid in better addressing the specific physical and emotional needs of burn patients, and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether a segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model derived for the full adult population of patients. Although we found no significant difference in the performance of the unitary model and segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the models for the socioeconomic segments highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that, in addition to ensuring that the physical needs of patients are met, management of their mental status is crucial for delivering an effective care plan.

Download Full-text

A Comparative Study between C-Reactive Protein and Procalcitonin in Iraqi Burn Patients

Al-Mustansiriyah Journal of Science ◽

10.23851/mjs.v28i1.310 ◽

2017 ◽

Vol 28 (1) ◽

pp. 41

Author(s):

Alia E. Al-Ubadi

Keyword(s):

Burn Injury ◽

Total Body Surface Area ◽

Latex Agglutination ◽

Burn Patients ◽

C Reactive Protein ◽

Reactive Protein ◽

Survivor Group ◽

Significant Difference ◽

The Mean ◽

Total Body

Association between Procalcitonin (PCT) and C-reactive protein (CRP) and burn injury was evaluated in 80 burned patients from Al-Kindy and Imam Ali hospitals in Baghdad-Iraq. Patients were divided into two groups, survivor group 56 (70%) and non-survivor group 24 (30%). PCT was estimated using (Human Procalcitonin ELISA kit) provided by RayBio/USA while CRP was performed using a latex agglutination kit from Chromatest (Spain). Our results declared that the mean of Total Body Surface Area (TBSA %) affected were 63.5% range (36%–95%) in non-survivor patients, while 26.5% range (10%–70%) in survivor patients. There is a significant difference between the two groups (P = 0.00), the higher mean percentage of TBSA has a significant association with mortality. Serum PCT and CRP were measured at the three times of sampling (within the first 48hr following admission, after 5thdays and after 10th days). The mean of PCT serum concentrations in non-survivor group (2638 ± 3013pg/ml) were higher than that of survivor group (588 ± 364pg/ml). Significantly high levels of CRP were found between the survivor and non-survivor groups especially in the 10th day of admission P=0.000, present study show that significant differences is found within the non-survivor group through the three times P= 0.01, while results were near to significant differences within survivor group through the three times (P= 0.05).

Download Full-text

87 Evaluating Endothelial Dysfunction in Thermally-injured Patients with syndecan-1, Tissue Factor Pathway Inhibitor, and Thrombomodulin as Predictors of Mortality

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.091 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S57-S58

Author(s):

John W Keyloun ◽

Saira Nisar ◽

Kathleen Brummel-Ziedins ◽

Maria Bravo ◽

Matthew Gissell ◽

...

Keyword(s):

Tissue Factor ◽

Tissue Factor Pathway Inhibitor ◽

Burn Injury ◽

Endothelial Damage ◽

Inhalation Injury ◽

Burn Patients ◽

Mixed Effect ◽

Significant Difference ◽

Tissue Factor Pathway ◽

Injured Patients

Abstract Introduction Endotheliopathy in burn patients is largely uncharacterized. Syndecan-1 (SDC-1), thrombomodulin (TM), and tissue factor pathway inhibitor (TFPI) are components of the vascular endothelial glycocalyx. Proteolytic cleavage of these moieties may yield biomarkers for endothelial damage. The aim of this study is to evaluate endotheliopathy after burn injury by monitoring plasma levels of these biomarkers over time to investigate potential relationship to mortality. Methods Burn injured patients presenting to a regional burn center from 2012 to 2017 were prospectively enrolled. Blood samples were collected at 0, 2, 4, 8, 12, 24, 36, 48, 60, and 72 hours from admission. Plasma SDC-1, TM, and TFPI levels were quantified by ELISA. Demographic data and injury characteristics were obtained from the medical chart. Patients with concomitant inhalation injury, trauma, or < 10% total body surface area (TBSA) burns were excluded. Statistical analysis was performed using mixed-effect models with Sidak’s correction for multiple comparisons. Significance was set at p =0.05. Data are presented as mean ± standard deviation. Results A cohort of 22 patients was identified with an average age of 45±14 years, TBSA of 30±15%, with 6 patients who died from their injuries. The deceased group was older (59±13 vs. 40±10 years, p = 0.01), and there was no significant difference in burn size. Mean SDC-1 levels were higher in the deceased group at all time points (p=0.0004) and this difference was significant at hour 12 (106±11 vs. 41±31 ng/mL, p = 0.0002), hour 24 (160±39 vs. 35±20 ng/mL, p = 0.04) and hour 72 (100±3 vs. 35±38 ng/mL, p = 0.01). Mean soluble TM levels were higher in the deceased group after hour 12 (p = 0.04) and there was a trend towards higher TFPI levels after hour 12 in the deceased group. Conclusions Biomarkers are elevated in patients following burn injury who die, when inhalation injury and trauma are excluded. Given equivalent TBSA, older patients appear more sensitive to thermally induced glycocalyx degradation. SDC-1 shows the greatest promise as a prognostic indicator as levels tend to be higher among deceased patients on admission and are significantly higher as early as hour 12. Applicability of Research to Practice Reliable assessment of the patient’s endothelial damage may hold predictive value for clinicians and could assist in clinical decision making. Further research must investigate endotheliopathy in burn patients.

Download Full-text

664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.280 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S177-S177

Author(s):

Kate Pape ◽

Sarah Zavala ◽

Rita Gayed ◽

Melissa Reger ◽

Kendrea Jones ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Pediatric Patients ◽

Burn Injury ◽

Total Body Surface Area ◽

Future Research ◽

Burn Patients ◽

Thermal Burn ◽

Increased Risk ◽

Significant Difference

Abstract Introduction Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy. Methods This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST. Results A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality. Conclusions Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis. Applicability of Research to Practice Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.

Download Full-text

Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18000274 ◽

2018 ◽

Vol 33 (3) ◽

pp. 230-236 ◽

Cited By ~ 6

Author(s):

Felicia M. Mix ◽

Martin D. Zielinski ◽

Lucas A. Myers ◽

Kathy S. Berns ◽

Anurahda Luke ◽

...

Keyword(s):

Blood Transfusion ◽

Patient Care ◽

Blood Product ◽

Life Support ◽

Descriptive Study ◽

Blood Product Transfusion ◽

Trauma Patients ◽

Blood Products ◽

Total Patient ◽

Significant Difference

AbstractIntroductionHemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).MethodsThis was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).ResultsA total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.ConclusionsIn this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital blood product administration opportunities in ground transport ALS EMS – a descriptive study. Prehosp Disaster Med. 2018;33(3):230–236.

Download Full-text

Early complementopathy predicts the outcomes of patients with trauma

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000217 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000217 ◽

Cited By ~ 1

Author(s):

Yansong Li ◽

Qingwei Zhao ◽

Bin Liu ◽

Alexander Dixon ◽

Leopoldo Cancio ◽

...

Keyword(s):

Complement System ◽

Complement Activation ◽

Injury Severity ◽

Burn Injury ◽

Blunt Injury ◽

Blood Levels ◽

Classical Pathway ◽

Trauma Patients ◽

Burn Patients ◽

Pathway Activation

BackgroundComplementopathy (rapid complement activation and consumption after trauma) has been reported in trauma patients, but the underlying mechanism of these phenomena and their clinical significance remain unclear. This study aimed to determine the complement/complement pathway activation and identify the association of complement activation with clinical outcomes in trauma patients.MethodsWe studied 33 trauma patients with mean Injury Severity Score of 25, and 25 healthy volunteers. Sera were collected on patients’ arrival at the emergency department, as well as 1, 2, 3, 5, and 7 days after trauma, to measure the levels of terminal complement activation product soluble C5b-9 (sC5b-9) by ELISA. In addition, the functional complement activation pathway was evaluated using a commercial complement system screening kit.ResultsSerum concentrations of sC5b-9 (complement terminal pathway activity) were significantly increased in trauma patients throughout the entire observation period except on day 1. Complement terminal activities were significantly higher in 27 of 33 patients with systemic inflammatory response syndrome (SIRS) than non-SIRS patients on day 2, day 5, and day 7. Increased serum levels of sC5b-9 positively correlated with SIRS. Functional complement analysis revealed that the classical pathway was the predominant pathway responsible for complement activation. Burn patients tended to have a greater and prolonged classical pathway activation than non-burn patients, and burn injury and blunt injury were associated with higher blood levels of sC5b-9 than penetrating injury.DiscussionEarly complement activation through the classical pathway after trauma is observed and positively correlated with the development of SIRS. Thus, monitoring of the complement system might be beneficial in the care of critically injured patients.Level of evidenceIII.Study typePrognostic.

Download Full-text

Sodium variability is associated with increased mortality in severe burn injury

Burns & Trauma ◽

10.1186/s41038-017-0098-4 ◽

2017 ◽

Vol 5 ◽

Cited By ~ 6

Author(s):

Soman Sen ◽

Nam Tran ◽

Brian Chan ◽

Tina L. Palmieri ◽

David G. Greenhalgh ◽

...

Keyword(s):

Serum Sodium ◽

Burn Injury ◽

Total Body Surface Area ◽

Multivariate Logistic Regression Analysis ◽

Median Number ◽

High Plasma ◽

Plasma Sodium ◽

Burn Patients ◽

Severe Burn ◽

Severe Burn Injury

Abstract Background Dysnatremias are associated with increased mortality in critically ill patients. Hypernatremia in burn patients is also associated with poor survival. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients. Methods We performed a retrospective review of adult burn patients with a burn injury of 15% total body surface area (TBSA) or greater from 2010 to 2014. All patients included in the study had at least three serum sodium levels checked during admission. We used multivariate logistic regression analysis to determine if hypernatremia, hyponatremia, or sodium variability independently increased the odds ratio (OR) for death. Results Two hundred twelve patients met entry criteria. Mean age and %TBSA for the study was 45 ± 18 years and 32 ± 19%. Twenty-nine patients died for a mortality rate of 14%. Serum sodium was measured 10,310 times overall. The median number of serum sodium measurements per patient was 22. Non-survivors were older (59 ± 19 vs. 42 ± 16 years) and suffered from a more severe burn injury (50 ± 25% vs. 29 ± 16%TBSA). While mean sodium was significantly higher for non-survivors (138 ± 3 milliequivalents/liter (meq/l)) than for survivors (135 ± 2 meq/l), mean sodium levels remained within the laboratory reference range (135 to 145 meq/l) for both groups. Non-survivors had a significantly higher median number of hypernatremic (> 145 meq/l) measurements (2 vs. 0). Coefficient of variation (CV) was significantly higher in non-survivors (2.85 ± 1.1) than survivors (2.0 ± 0.7). Adjusting for TBSA, age, ventilator days, and intensive care unit (ICU) stay, a higher CV of sodium measurements was associated with mortality (OR 5.8 (95% confidence interval (CI) 1.5 to 22)). Additionally, large variation in sodium ranges in the first 10 days of admission may be associated with increased mortality (OR 1.35 (95% CI 1.06 to1.7)). Conclusions Increased variability in plasma sodium may be associated with death in severely burned patients.

Download Full-text

Effects of Tranexamic Acid on Mortality and Blood Transfusion in Trauma Patients with Significant Hemorrhage: A Clinical Trial

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.17.05.04.04 ◽

2017 ◽

Vol 5 (4) ◽

pp. 24

Author(s):

Farzad Kakaei ◽

Peyman Virani ◽

Shahriar Hashemzadeh ◽

Sina Zarrintan ◽

Samad Beheshtirouy ◽

...

Keyword(s):

Blood Transfusion ◽

Tranexamic Acid ◽

Study Groups ◽

Control Group ◽

Case Group ◽

Trauma Patients ◽

Transfusion Rate ◽

Control Groups ◽

Significant Difference ◽

And Control

Extensive hemorrhage is a significant cause of mortality in trauma patients. Tranexamic acid has been used for controlling bleeding in cardiovascular surgeries and dental manipulations in patients with hemophilia. However, in traumatic patients with bleeding, its use dates back to more recent years. This study aims to examine the effects of this drug on reducing mortality and blood transfusion rate in trauma patients with significant hemorrhage. A total of 60 patients with significant trauma-related hemorrhage (systolic blood pressure < 90 mmHg/heart rate > 110/min) from the emergency department of Imam Reza Hospital (Tabriz, Iran), were randomized in two groups. The case group received intravenous Tranexamic acid (1 g in 10 min and then 1 g over 8 h). The control group received placebo. Rate of transfusion and rate of one-month mortality were compared between the study groups. The mean ICU stay and overall hospitalization times did not have significant difference between two groups (p<0.05). Transfusion of packed cells was 6.03±1.50 and 6.03±1.22 units in case and control groups respectively. Transfusion of fresh frozen plasma (FFP) was 2.50±1.36 and 3.03±0.96 units in case and control groups respectively (p=0.09). Transfusion of platelets was 0.40±0.20 1.33±0.31 units in case and control groups respectively (p=0.01). Three patients (10%) in the case group and 4 patients (13.3%) in the control group were expired (p=0.50). Tranexamic acid is safe and effective in reducing platelet transfusion rate in patients with trauma-related significant hemorrhage. However, transfusion need and mortality would not reduce by its use in trauma patients.

Download Full-text

In-Hospital Mortality Risk of Transcatheter Arterial Embolization for Patients with Severe Blunt Trauma: A Nationwide Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm9113485 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3485

Author(s):

Masayasu Gakumazawa ◽

Chiaki Toida ◽

Takashi Muguruma ◽

Mafumi Shinohara ◽

Takeru Abe ◽

...

Keyword(s):

Blood Transfusion ◽

Hospital Mortality ◽

Blunt Trauma ◽

Mortality Risk ◽

Transcatheter Arterial Embolization ◽

Injury Severity ◽

Multivariate Logistic Regression Analysis ◽

Arterial Embolization ◽

Trauma Patients ◽

Urgent Surgery

This study investigated the risk factors for in-hospital mortality of severe blunt trauma patients who underwent transcatheter arterial embolization (TAE). We analysed data from the Japan Trauma Data Bank from 2009 to 2018. Patients with severe blunt trauma and an Injury Severity Score (ISS) ≥ 16 who underwent TAE were enrolled. The primary analysis evaluated patient characteristics and outcomes, and variables with significant differences were included in the secondary multivariate logistic regression analysis. In total, 5800 patients (6.4%) with ISS ≥ 16 underwent TAE. There were significant differences in the proportion of male patients, transportation method, injury mechanism, injury region, Revised Trauma Score, survival probability values, and those who underwent urgent blood transfusion and additional urgent surgery. In multivariable regression analyses, higher age, urgent blood transfusion, and initial urgent surgery were significantly associated with higher in-hospital mortality risk [p < 0.001, odds ratio (OR), 95% confidence interval (CI): 1.01 (1.00–1.01); p < 0.001, 3.50 (2.55–4.79); and p = 0.001, 1.36 (1.13–1.63), respectively]. Inter-hospital transfer was significantly associated with lower in-hospital mortality risk (p < 0.001, OR = 0.56, 95% CI = 0.44–0.71). Treatment protocols for urgent intervention before and after TAE and a safe, rapid inter-hospital transport system are needed to improve mortality risks for severe blunt trauma patients.

Download Full-text