652 Burns and Incidence of Operative Treatment

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S183-S184
Author(s):  
Marc Schober ◽  
Taylor Hallman ◽  
Robert Africa ◽  
Kendall Wermine ◽  
Sunny Gotewal ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Large Scale ◽  
Age Groups ◽  
Total Body Surface Area ◽  
Research Network ◽  
Burn Patients ◽  
Healthcare Organizations ◽  
Chi Square ◽  
Burn Treatment ◽  
Burn Care

Abstract Introduction Over the past three decades, it has been repeatedly demonstrated that early surgical intervention is associated with improved outcomes in burns, however, large-scale studies regarding the incidence of operative treatment in burn patients are lacking. We conducted a retrospective study using the TriNetX database, a global, real-time electronic medical record driven index of patient populations, analyzing the incidence of grafting procedures in burned patients related to age and % total body surface area (TBSA) burned. Methods The population of burn patients and operative treatments were indexed using ICD-10 codes T31.0-T31.9 and 1013913, respectively. Queries were structured as sequential events allowing analysis of burn diagnosis to be followed by a subsequent operation. The patient population was partitioned by TBSA burned, and the number of grafting procedures were assessed. All patients were included and stratified by ages of 0–17, 18–34, 35–64, and 65–89. The data includes information collected between 2000–2020 from over 35 healthcare organizations comprising the Research network in TriNetX. Extracted data were analyzed using chi-square statistical analysis with p< 0.05 considered significant. Results Of 116,325 burn patients identified, 11.14% underwent at least one grafting procedure. Of surgeries performed, the majority occurred in the 35–64 years age group (45.3% p = < 0.001). Additionally, the incidence of grafting procedures was directly proportional to patient age: age groups of 0–17, 18–34, 35–64, and 65–89 years received grafting procedures in 6.5% (p = < 0.001), 9.8% (p = < 0.001), 12.9% (p = < 0.001), and 15.9% (p = < 0.001) of cases, respectively. When stratified by TBSA burned, those with 40–49% TBSA burns had the highest incidence of operations (50.7% p = < 0.001). Large TBSA burns correlated with increasing incidence of grafting procedures until 50–59% TBSA burned, where incidence begins to decrease, likely related to referral patterns which did not capture grafting procedures performed at specialized burn treatment centers or institution of palliative care. Conclusions This study reveals that the incidence of operational treatment increases with both age and percent TBSA burned. The data corroborate a referral pattern for burns that demonstrates a decline in operative treatments beginning with 50–59% TBSA, inconsistent with referral guidelines to specialized burn care centers published by the ABA.

Management of burns in the ICU

2016 ◽  
Author(s):  
Shahriar Shahrokhi ◽  
Marc G. Jeschke
Keyword(s):  
Total Body Surface Area ◽  
The Elderly ◽  
Similar Data ◽  
Burn Patients ◽  
Burn Care ◽  
Future Developments ◽  
Appropriate Treatment ◽  
Total Body ◽  
Critical Components ◽  
Current Standards

Outcomes of burn patients have significantly improved over the last two decades. A recent study in The Lancet showed that a burn size of over 60% total body surface area (TBSA) burned is now recognized as being associated with high risks; a decade ago similar risks resulted from a 40% TBSA burned. Similar data have been obtained in severely-burned adults and the elderly. This chapter discusses current standards, recent evidence, and future developments in burn care to improve outcomes of these patients. Critical components in the management of patients with burns are early adequate resuscitation, recognition and management of airway burns and appropriate treatment of the different stages of burn care—prehospital, early, and late management.

Timing of Flap Surgery in Acute Burn Patients Does Not Affect Complications

2020 ◽  
Vol 41 (5) ◽  
pp. 967-970
Author(s):  
David Perrault ◽  
Danielle Rochlin ◽  
Christopher Pham ◽  
Arash Momeni ◽  
Yvonne Karanas ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Multivariable Analysis ◽  
Total Body Surface Area ◽  
Free Flaps ◽  
Stepwise Logistic Regression ◽  
Electrical Injury ◽  
Burn Patients ◽  
Burn Wound ◽  
Burn Care ◽  
Flap Coverage

Abstract Pedicled and free flaps are occasionally necessary to reconstruct complex wounds in acute burn patients. Flap coverage has classically been delayed for concern of progressive tissue necrosis and flap failure. We aim to investigate flap complications in primary burn care leveraging national U.S. data. Acute burn patients with known % total body surface area(TBSA) were extracted from the Nationwide/National Inpatient Sample from 2002 to 2014 based on the International Classification of Disease (ICD) codes, ninth edition. Variables included age, sex, race, Elixhauser index, %TBSA, mechanism, inhalation injury, and location of burn. Flap complication was defined by ICD-9 procedure code 86.75, return to the operating room for flap revision. Multivariable analysis evaluated predictors of flap compromise using stepwise logistic regression with backward elimination. The weighted sample included 306,924 encounters of which 526 received a flap (0.17%). About 7.8% of flap encounters sustained electric injury compared to 2.7% of non-flap encounters (odds ratio [OR] 3.76, 95% confidence interval [CI] 1.95–7.24, P < .001). The mean hospital day of the flap procedure was 10.1 (SD 10.7) days. Flap complications occurred in 6.4% of cases. The timing of flap coverage was not associated with complications. The only independent predictor of flap complication was electrical injury (OR 40.49, 95% CI 2.98–550.64, P = .005). Electrical injury was an independent predictor of flap complications compared to other mechanisms. Flap timing was not associated with return to surgery for complications. This suggests that the use of flaps is safe in acute burn care to achieve burn wound closure with an understanding that electrical injuries may warrant particular consideration to avoid failure.

1 The Impact of No Next of Kin Decision Makers on End-of-life Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S4-S5
Author(s):  
Ryan K Ota ◽  
Maxwell B Johnson ◽  
Trevor A Pickering ◽  
Warren L Garner ◽  
Justin Gillenwater ◽  
...  
Keyword(s):  
Critically Ill ◽  
Decision Maker ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Next Of Kin ◽  
Medical Decisions ◽  
Comfort Care ◽  
Burn Care ◽  
The Impact

Abstract Introduction For critically ill burn patients without a next of kin (NOK), the medical team is tasked with becoming the surrogate decision maker. This poses difficult ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a NOK affects treatment in burn patients. This study is the first to evaluate this relationship. Methods A retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care from a single burn center from 2015 to 2019. Inclusion criteria were age ≥18 years and mortality within 4-weeks of admission. Exclusion criteria were death from dermatologic disease or trauma. Variables collected included age, gender, mechanism of injury, length of stay (LOS), total body surface area (TBSA), revised Baux score, and the presence of a NOK. Fisher’s Exact Test and Student’s t-test were used for analysis. Results In total, 67 patients met inclusion criteria. Of these patients, 14 (21%) did not have a NOK involved in medical decisions. Table 1 shows the means and odds ratio between the two groups. Patients without a NOK were younger (p < 0.05), more likely to be homeless (p < 0.01), had higher TBSA (p < 0.01), had shorter LOS (p < 0.01), and were 5 times less likely to receive comfort care (p < 0.05). Gender and ethnicity were not statistically significant. Conclusions Patients without a NOK present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care between the two groups demonstrates a need for a cultural shift in burn care to prevent suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present. Applicability of Research to Practice We report that the absence of a NOK has a significant impact leading to a decreased initiation of comfort care in critically ill burn patients. National protocols should be created to allow burn providers to act as a surrogate to prevent prolonged suffering.

90 Discrepancies in Mortality Metrics Between National Datasets

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S62-S63
Author(s):  
Deepak K Ozhathil ◽  
Garret Gutierrez ◽  
Sagar R Mulay ◽  
Adil Ahmed ◽  
Juquan Song ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Total Body Surface Area ◽  
Significant Degree ◽  
Large Datasets ◽  
Research Network ◽  
Global Health Research ◽  
Healthcare Organizations ◽  
Research Networks ◽  
All Cause Mortality ◽  
Different Populations

Abstract Introduction The National Burn Repository (NBR) is the recognized standard for data collection models within the academic burn community. Despite its robust capabilities, the NBR poses challenges to access and exploration that can be intimidating to some researchers. As a result, user-friendly alternative databases have grown in popularity. We compared the NBR to two commercially available large datasets using the well-recognized relationship between age and total body surface area (TBSA) on mortality as our metric to assess correlation. Methods We accessed the TriNetX Global Health Research Network and queried the Diamond network (medical clearinghouses) and Research network (41 healthcare organizations (HCO)) for all-cause mortality within 3 years following burn injuries that occurring between 2000 – 2020 using ICD-10 codes (T31-32). We explored the distribution of TBSA and age across these cohorts and compared the variance in the distribution to the 2008–2017 NBR report using one proportion z-tests for each age-TBSA matched sub-group. We also compared demographics and lethal area for 50% mortality (LA50). Results The Diamond network identified 336,965 entries with an all-cause mortality rate of 3.21% and an LA50 of < 10%. Demographics showed 50% male, 81% unknown race and a mean age of 39. In 2016 - 2017, 56,430 entries were reported. The Research network identified 114,778 entries with a mortality rate of 2.54% and an LA50 of < 10%. Demographics showed 61% male, 58% white, 24% unknown and 16% black with a mean age of 37. In 2016 - 2017, 14,164 entries were reported. In comparison, the NBR database reported 185,239 entries with a mortality rate of 2.96% and an LA50 of >70%. Demographics showed 67% male, 59% white and 3.6% unknown with a mean age between 20–29. In 2016 - 2017, 42,402 entries were reported. Comparison of mean mortality between age-TBSA matched subgroups in the Diamond and the Research networks relative to NBR showed correlation among pediatric populations but lacked significance. Conclusions The Diamond and Research networks are large datasets, which appear to be statistically different from the NBR dataset and are derived from different populations (insured patients, academic healthcare organization and accredited academic burn centers). The exact overlap between datasets is unknown, but demographics suggest that they are very different populations. The Figure depicts the relationship between age and TBSA on mortality for each database. Each database is large enough to achieve statistically significant conclusions, but caution should be used when contrasting conclusions between datasets due to the significant degree of divergence.

scholarly journals Surgical Management Evolution Between 2 Massive Burn Cases at 17-Year Interval: Contribution of Cell Therapies in Improving the Surgical Care

2020 ◽  
Vol 29 ◽  
pp. 096368972097364
Author(s):  
Sandra Monnier ◽  
Philippe Abdel-Sayed ◽  
Anthony de Buys Roessingh ◽  
Nathalie Hirt-Burri ◽  
Michèle Chemali ◽  
...  
Keyword(s):  
Intensive Care ◽  
Surgical Management ◽  
Total Body Surface Area ◽  
Young Patients ◽  
Surgical Care ◽  
The Body ◽  
Burn Patients ◽  
Cell Therapies ◽  
Burn Care ◽  
Technical Specifications

We report the cases of 2 patients admitted to our hospital at a 17-year interval, both with 90% total body surface area (TBSA) burns. These two young patients were in good health before their accident, but major differences in time of intensive care and hospitalization were observed: 162 versus 76 days in intensive care unit and 18 versus 9.5 months for hospitalization, respectively. We have analyzed the different parameters side-by-side during their medical care and we have identified that the overall improved outcomes are mainly due to a better adapted fluid reanimation in combination with the evolution of the surgical management to encompass allogenic cellular therapy (Biological Bandages). Indeed, autologous cell therapy using keratinocytes has been used for over 30 years in our hospital with the same technical specifications; however, we have integrated the Biological Bandages and routinely used them for burn patients to replace cadaver skin since the past 15 years. Thus, patient 1 versus patient 2 had, respectively, 83% versus 80% TBSA for autologous cells, and 0% versus 189% for allogenic cells. Notably, it was possible that patient 2 was able to recover ∼6% TBSA with the use of Biological Bandages, by stimulating intermediate burn zones toward a spontaneous healing without requiring further skin grafting (on abdomen and thighs). The body zones where Biological Bandages were not applied, such as the buttocks, progressed to deeper-stage burns. Despite inherent differences to patients at their admission and the complexity of severe burn care, the results of these two case reports suggest that integration of innovative allogenic cell therapies in the surgical care of burn patients could have major implications in the final outcome.

The Descriptive Epidemiology and Outcomes of Hospitalized Burn Patients in Southern Turkey: Age-specific Mortality Patterns

2020 ◽  
Author(s):  
Kayhan Gurbuz ◽  
Mete Demir
Keyword(s):  
Mortality Rate ◽  
Descriptive Analysis ◽  
Age Groups ◽  
Total Body Surface Area ◽  
Multivariate Regression Analysis ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Age Group ◽  
Specific Mortality ◽  
Fire Flame

Abstract The current descriptive analysis was designed to document the common epidemiologic characteristics and outcomes of burn injuries, and age-specific mortality patterns covering all age groups admitted for treatment to the Burn Center of Adana City Training and Research Hospital (ACTRH). Medical records were retrospectively analyzed. The patients were stratified into two age groups as pediatric and adults, and then into ten sub-age groups. Among the 946 patients of the study population, there were 24 mortalities with a mortality rate of 2.5%. Patients within the age range of 70-79 years had the highest mortality rate of 33.3%; followed by 60-69, 80+, 18-29, 10-17, and <5 sub-age groups, whose mortality rates were, 13.0%, 7.8%, 7.2%, 2.4%, 0.5%, respectively. In terms of multivariate regression analysis of factors predicting mortality among burn patients in all age groups, fire-flame related burns, age ≥18 years, total body surface area burned ≥20 percent (TBSA ≥20%), the existence of inhalation injury, deep partially/full-thickness burns were found to be significant prognostic factors of mortality. The strongest association was seen in TBSA ≥60% segment (p<0.0001), which had 25.9 times more death risk. As expected, a similar trend was detected when the age groups stratified into age groups, and the strongest association was in the 60+ sub-age group (p<0.0001), whose had 5.84 times more likely death; followed by 29-59, 18-29 sub-age groups, with the ORs of 2.12 (95%CI=1.25-3.61), 2.08 (95%CI=1.90-4.05), respectively. Oppose to these findings; the 0-17 sub-age group was not found to have a statistically significant effect in predicting mortality.

scholarly journals Guidelines for burn rehabilitation in China

2015 ◽  
Vol 3 ◽  
pp. 1-10 ◽  
Author(s):  
◽  
Ying Cen ◽  
Jiake Chai ◽  
Huade Chen ◽  
Jian Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Burn Injury ◽  
Medical Science ◽  
Current Medical ◽  
Team Work ◽  
Burn Patients ◽  
Burn Treatment ◽  
Burn Care ◽  
Chinese Association

Abstract Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.

scholarly journals Supporting the Regional Network for Children with Burn Injuries in a Pediatric Referral Hospital for COVID-19

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 551
Author(s):  
Gloria Pelizzo ◽  
Elettra Vestri ◽  
Giulia del Re ◽  
Claudia Filisetti ◽  
Monica Osti ◽  
...  
Keyword(s):  
Average Length ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Treatment Team ◽  
Pediatric Hospital ◽  
Regional Network ◽  
Burn Treatment ◽  
Burn Care ◽  
Management Protocol ◽  
Set Up

Considerable reorganization of the regional network for pediatric burn treatment during the pandemic was required to cope with severe burn injuries in small children. In support of the emergency network for burns during the COVID-19 pandemic, we referred to regional indications for centralization in our hospital for all children aged less than 5 years who presented with severe burns, >15% of total body surface area (TBSA), or who necessitated admittance to the pediatric intensive care unit (PICU). A new service with a dedicated management protocol was set up to treat pediatric burns in our SARS-CoV-2 pediatric hospital during the lockdown period. A multidisciplinary burn treatment team was set up to offer compassionate and comprehensive burn care. Patient’s clinical data, burn features, treatment and follow up were recorded. A higher number of admissions was recorded from February to December 2020 compared with the same period in 2019 (52 vs. 32 admissions). Eighteen patients were admitted to the COVID-19 Service (10 M/8 F; 3.10 ± 2.6 yrs); ten children (55.5%) were hospitalized in the ward and eight in the ICU (44.5%). Fifty percent of the cases presented with lesions extending over >15% TBSA; in one case, TBSA was 35%. All patients suffered 2nd-degree burns; while five patients also had 3rd degree lesions covering more than 15% TBSA. All of the injuries occurred at home. No major secondary infections were recorded. Successful treatment was achieved in 94.4% of cases. The average length of stay was 15.2 ± 12.6 days. A proactive, carefully planned service, involving a multidisciplinary team, was created to ensure appropriate care in a pediatric hospital during the COVID-19 period, despite the effective pandemic associated challenges. Better health promotion in pediatric burn cases should also include dedicated TBSA assessment and a database of children’s burn characteristics.

656 Autologous Skin Cell Suspension is Associated with Decreased Hospital Length of Stay and Limited Surgical Interventions

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Nicole M Kopari ◽  
Yazen Qumsiyeh
Keyword(s):  
Length Of Stay ◽  
Cell Suspension ◽  
Average Length ◽  
Total Body Surface Area ◽  
Hospital Length ◽  
Care Quality ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Burn Care ◽  
Skin Cell

Abstract Introduction Hospital length of stay is a measure of burn care quality and resource allocation. Traditionally, the average length of stay (LOS) for patients with burns is estimated at 1 day/% total body surface area (TBSA) although the 2016 American Burn Association National Burn Repository predicts closer to 3 days/%TBSA. Recent literature has shown that application of autologous skin cell suspension (ASCS) is associated with decreased hospital LOS and therefore is considered economically advantageous. Our study evaluated the LOS as it related to TBSA as well as the number of operations in patients treated with ASCS. Methods This is a single institution, retrospective review of burn patients at an American Burn Associated verified burn center admitted from August 2019 - August 2020 who underwent epidermal autografting. Patients were treated for partial thickness and full thickness burns either with epidermal grafting alone or in combination with widely meshed skin grafting. Demographics included age and sex of patient. The TBSA, LOS, number of operations, and re-admission rates were also collected. Results A total of 52 patients were included in the review. 73% were male with an average age of 42 years (range 15 months to 88 years. The patients were stratified into 4 different categories based on their burn TBSA: 0-10% (n=25), 11-20% (n=16), 21-30% (n=5), and >30% (n=6). The average number of operations increased with %TBSA (0-10%=1, 11-20%=1, 21-30%=2, >30%=4). The average LOS overall was 0.9 days/%TBSA (0-10%=1.0, 11-20%=0.7, 21-30%=0.9, >30%=0.8). Only one patient required re-admission after the first dressing takedown and underwent a second application of ASCS with subsequent healing. No patients required reconstructive surgery. Conclusions Burn patients treated with ASCS continue to demonstrate a decreased LOS/%TBSA and an overall decrease in the number of operations. The most significant impact may be noted as burn size increases.

53 Frailty is Not Only a Phenomenon of Elderly Burn Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S38-S39
Author(s):  
Kathleen S Romanowski ◽  
Melissa J Grigsby ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
David G Greenhalgh
Keyword(s):  
Chart Review ◽  
Burn Injury ◽  
Frailty Index ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Burn Patients ◽  
Chi Square ◽  
Frail Patients ◽  
Modified Frailty Index

Abstract Introduction Recent evidence indicates that increased frailty is associated with increased mortality in patients with burn injuries over the age of 50 years old. This work found that 35.7% of burn patients over 65 years old were frail at the time of their burn admission while 19.2% of burn patients 50 to 64 years old were frail. While frailty is associated with increased age the two are separate entities suggesting that frailty may be present in much younger patients who present with burn injuries. We hypothesize that frailty exists in all age groups of patients presenting with burn injury and the prevalence increases with age. Methods Following IRB approval, a 5-year (2014–2019) retrospective chart review was conducted of all burn patients admitted to the burn center. Data collected includes age, gender, and burn size (% TBSA). Frailty was determined using the Modified Frailty Index 11 (MFI 11) from co-morbidities included in the burn registry. Patients were considered frail if they have an MFI ³ 2 and pre-frail for an MFI³1 and < 2. Patients were assessed by decades for age. Statistical analysis included descriptive statistics, chi-square, and t-tests. Results A total of 2173 patients (mean age 46.1±17.3 years, 1584 males (72.8%), mean % TBSA 12.5±16.3%) were analyzed. All age groups included patients who were pre-frail (Table 1). In the under 20-year-old group, 8.5% were pre-frail. This increases with each age group to the 71-80-year-old group in which 41.7% of patients are pre-frail. The over 80-year-old group had slightly fewer pre-frail patients (35.9%). There were no frail patients in the under 20-year-old group. In the 21–30 there were 3 patients (0.7%) that had an MFI of 2 or more placing them in the frail group. Frailty was significantly different across the age groups (p< 0.001). As patients age, the proportion of female patients increases (from 17.6% to 37.5%. p< 0.0001). Frailty was also associated with gender with women having a higher percentage of frailty (p=0.0006). With respect to burn size, age category was not associated with burn size (p=0.12), but frail patients had smaller burns than non-frail or pre-frail patients (9.5% vs. 13.3% vs. 12.2%, p=0.0002). Conclusions Pre-frail patients were identified in all age groups. Frailty was present in all age groups except for those who are under 20 years of age. Frailty was associated with female sex and smaller burns. By not specifically looking for frailty in all burn patients admitted to the hospital we are potentially missing frail patients who may benefit from interventions to improve their outcomes.

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