Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population

2021 ◽  
Author(s):  
Samantha Huang ◽  
Katherine J Choi ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
Justin M Dang ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Hospital Length ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Homeless Population ◽  
The Us ◽  
Upper And Lower Extremities ◽  
Total Body

Abstract Tent fires are a growing issue in regions with large homeless populations given the rise in homelessness within the US and existing data that suggest worse outcomes in this population. The aim of this study is to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. A retrospective review was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 2015 and December 2020. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes. Sixty-nine patients met the study inclusion criteria. The most common mechanisms of injury were by portable stove accident, assault, and tobacco or methamphetamine-related. Median percent total body surface area (%TBSA) burned was 6% (IQR 9%). Maximum depth of injury was partial thickness in 65% (n=45) and full thickness in 35% (n=24) of patients. Burns to the upper and lower extremities were present in 87% and 54% of patients, respectively. Median hospital Length-of-Stay (LOS) was 10 days (IQR=10.5) and median ICU LOS was 1 day (IQR=5). Inhalation injury was present in 14% (n=10) of patients. Surgical intervention was required in 43% (n=30) of patients, which included excision, debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 4% (n=3) of patients. Tent fire burns are severe enough to require inpatient and ICU level of care. A high proportion of injuries involved the extremities and pose significant barriers to functional recovery in this vulnerable population. Strategies to prevent these injuries are paramount.

596 Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S149-S150
Author(s):  
Samantha Huang ◽  
Katherine J Choi ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
Justin Dang ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Homeless Population ◽  
Health Crisis ◽  
Total Body ◽  
Injury Burden

Abstract Introduction Homelessness is a rising concern as insufficient housing and significant barriers to shelter has led to more individuals seeking shelter in tents. Within this demographic there has been an increased trend of burn injuries from tent fires in regions with large homeless populations. This represents a public health crisis given the long-term psychosocial and functional sequela of burn injuries and existing data that suggest worse outcomes in the homeless population. To our knowledge, homeless related tent fire burns have not previously been studied in the literature. The aim of this study is to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. Methods A retrospective cohort study was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 1, 2019 to July 31, 2020. Patients were identified as either domiciled or homeless based on medical records at the time of injury. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes. Results A total of 45 patients were identified. The most common mechanisms of injury were by portable stove accident (29%), assault (27%), bonfire (22%), and tobacco or methamphetamine paraphernalia-related (16%). Median percent total body surface area (%TBSA) burned was 5.5 (IQR 5.5). Maximum depth of injury was second degree in 62% (n=28) of patients and third degree in 38% (n=17) of patients. Burns to the upper extremities were present in 84% of patients and burns to the lower extremities were present in 53% of patients. Median hospital LOS was 9.5 days (IQR=10) and median ICU LOS was 2 days (IQR=4.8), with inhalation injury present in 16% (n=7) of patients. Surgical intervention was required in 40% (n=18) of patients, which included debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 5% (n=2) of patients. Conclusions Burn injuries from tent fires incur significant injury burden to an already vulnerable population, with risk factors that predispose them to poor burn outcomes. Injuries in our cohort were severe enough to require inpatient and ICU level of care. We saw a high proportion of injuries to the extremities, which pose functional and psychosocial challenges to the wellbeing of these patients. Further resources are needed to better prevent tent fires and care for this population.

scholarly journals Treatment of Anaemia in Patients with Acute Burn Injury: A Study of Blood Transfusion Practices

2021 ◽  
Vol 10 (3) ◽  
pp. 476
Author(s):  
Ioana Tichil ◽  
Samara Rosenblum ◽  
Eldho Paul ◽  
Heather Cleland
Keyword(s):  
Blood Transfusion ◽  
Surgical Management ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Perioperative Period ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Burn Care ◽  
Transfusion Requirements ◽  
Total Body

Objective: To determine blood transfusion practices, risk factors, and outcomes associated with the use of blood products in the setting of the acute management of burn patients at the Victorian Adult Burn Service. Background: Patients with burn injuries have variable transfusion requirements, based on a multitude of factors. We reviewed all acute admissions to the Victorian Adult Burns Service (VABS) between 2011 and 2017: 1636 patients in total, of whom 948 had surgery and were the focus of our analysis. Method and results: Patient demographics, surgical management, transfusion details, and outcome parameters were collected and analyzed. A total of 175 patients out of the 948 who had surgery also had a blood transfusion, while 52% of transfusions occurred in the perioperative period. The median trigger haemoglobin in perioperative was 80mg/dL (IQR = 76–84.9 mg/dL), and in the non-perioperative setting was 77 mg/dL (IQR = 71.61–80.84 mg/dL). Age, gender, % total body surface area (TBSA) burn, number of surgeries, and intensive care unit and hospital length of stay were associated with transfusion. Conclusions: The use of blood transfusions is an essential component of the surgical management of major burns. As observed in our study, half of these transfusions are related to surgical procedures and may be influenced by the employment of blood conserving strategies. Furthermore, transfusion trigger levels in stable patients may be amenable to review and reduction. Risk adjusted analysis can support the implementation of blood transfusion as a useful quality indicator in burn care.

Outcomes with the Use of Recombinant Human Erythropoietin in Critically Ill Burn Patients

2010 ◽  
Vol 76 (9) ◽  
pp. 951-956 ◽  
Author(s):  
Jonathan B. Lundy ◽  
Katherine Hetz ◽  
Kevin K. Chung ◽  
Evan M. Renz ◽  
Christopher E. White ◽  
...  
Keyword(s):  
Recombinant Human Erythropoietin ◽  
Total Body Surface Area ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Burn Patients ◽  
Human Erythropoietin ◽  
Transfusion Requirements ◽  
Total Body ◽  
Injured Patients

Recent data demonstrate a possible mortality benefit in traumatically injured patients when given subcutaneous recombinant human erythropoietin (rhEPO). The purpose of this report is to examine the effect of rhEPO on mortality and transfusion in burn patients. We conducted a review of burn patients (greater than 30% total body surface area, intensive care unit [ICU] days greater than 15) treated with 40,000u rhEPO over an 18-month period (January 2007 to July 2008). Matched historical controls were identified and a contemporaneous cohort of subjects not administered rhEPO was used for comparison (NrhEPO). Mortality, transfusions, ICU and hospital length of stay were assessed. A total of 105 patients were treated (25 rhEPO, 53 historical control group, 27 NrhEPO). Hospital transfusions (mean 13,704 ± mL vs 13,308 ± mL; P = 0.42) and mortality (29.6 vs 32.0%; P = 0.64) were similar. NrhEPO required more blood transfusions (13,308 ± mL vs 6,827 ± mL; P = 0.004). No difference in mortality for the rhEPO and NrhEPO (32.0 vs 22.2%; P = 0.43) was found. Thromboembolic complications were similar in all three groups. No effect was seen for rhEPO treatment on mortality or blood transfusion requirements in the severely burned.

714 IL-6 and Soluble IL-6 Receptor – Two Sides of the Same Coin

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Sarah Rehou ◽  
Abdikarim Abdullahi ◽  
Marc G Jeschke
Keyword(s):  
Immune Response ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Hospital Length ◽  
Inhalation Injury ◽  
High Ratio ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Anti Inflammatory ◽  
Poor Outcomes

Abstract Introduction Interleukin (IL)-6 is a multifunctional cytokine that has both a pro- and anti-inflammatory role. In many studies, IL-6 has been shown to increase rapidly after burn injury and is associated with poor outcomes. IL-6 can signal via its soluble IL-6 Receptor (sIL-6R) and is referred to as trans-signaling, which is regarded as the pro-inflammatory pathway. The role of sIL-6R post-burn injury has not yet been explored. We hypothesized that patients with a lower ratio of IL-6 to sIL-6R would have worse outcomes. Methods Patients admitted to our burn centre within 7 days of injury were included in this study. Patients were divided into two groups based on IL-6 and sIL-6R levels measured within the first 30 days post-burn injury. Patients were in the high ratio group if their IL-6:sIL-6R ratio was ≥ 0.185. Clinical outcomes included organ biomarkers, morbidities, and hospital length of stay. Groups were compared using Student’s t-test, Mann-Whitney U, and Fisher’s exact test as appropriate; a P value of < 0.05 was considered statistically significant. Results We studied 104 patients, mean age 51 ± 18 years and 24 ± 17% total body surface area (TBSA) burn. There were 49 patients categorized with a low IL-6:sIL-6R ratio and 55 patients with a high IL-6:sIL-6R ratio. Patients in the high IL-6:sIL-6R ratio group had a significantly greater TBSA burn and a significantly greater proportion of patients with inhalation injury (p< 0.05). Levels of sIL-6R were not significantly different among the low and high group (770 ± 264 pg/mL vs. 798 ± 268 pg/mL respectively; p=0.601). However, levels of IL-6 were significantly higher in patients with a high IL-6:sIL-6R ratio (37 IQR 19–97 pg/mL vs. 567 IQR 273–916 pg/mL; p< 0.0001). Mortality was significantly greater in the high IL-6:sIL-6R ratio group (2% vs. 27%; p< 0.001). Conclusions Interestingly, patients with a higher ratio of IL-6:sIL-6R had significantly greater mortality. Using sIL-6R as a marker for the proinflammatory immune response, we expected patients with a lower IL-6:sIL-6R ratio to have poor outcomes which are typically associated with a hyperinflammatory or exaggerated immune response. However, the absolute value of sIL-6R did not differ. This suggests that classic signaling of IL-6 via its membrane bound receptor, with an anti-inflammatory function, is an important factor. Applicability of Research to Practice The opposing pro- and anti-inflammatory function of IL-6 through trans- and classic signaling is contingent on the ratios expressed. The demonstrated increase in classic signaling highlights the importance of measuring both IL-6 and sIL-6R in future studies. Additionally, it lays the foundation for potential precision medicine approaches to selectively block specific signaling pathways.

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 < 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 < 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 < 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 < 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.

scholarly journals Restrictive Transfusion Strategy Is More Effective in Massive Burns: Results of the TRIBE Multicenter Prospective Randomized Trial

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 11-15 ◽  
Author(s):  
Tina L Palmieri ◽  
James H Holmes ◽  
Brett Arnoldo ◽  
Michael Peck ◽  
Amalia Cochran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Transfusion Strategy ◽  
Restrictive Transfusion ◽  
Blood Utilization ◽  
Outcome Differences ◽  
Total Body ◽  
Restrictive Transfusion Strategy

Abstract Objectives Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: compare outcomes between massive burn (≥60% total body surface area (TBSA) burn) and major (20–59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods Patients with burns ≥20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin <7 g/dL) or liberal (transfuse hemoglobin <10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 ± 47.63 vs. 77.16 ± 55.0, p < 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p < 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p < 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20–59%) group (p > 0.05). Conclusions: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.

scholarly journals The predisposing factors of AKI for prophylactic strategies in burn care

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9984
Author(s):  
Shin-Yi Tsai ◽  
Chon-Fu Lio ◽  
Shou-Chuan Shih ◽  
Cheng-Jui Lin ◽  
Yu-Tien Chen ◽  
...  
Keyword(s):  
Burn Injury ◽  
Laboratory Data ◽  
Total Body Surface Area ◽  
Kidney Injury ◽  
Inhalation Injury ◽  
Predisposing Factors ◽  
Dust Explosion ◽  
Burn Care ◽  
Hospital Patients ◽  
Total Body

Background Acute kidney injury (AKI) is one of the most severe complications of burn injury. AKI with severe burn injury causes high mortality. This study aims to investigate the incidence of and predisposing factors for AKI in burn patients. Methods This is a single-center, retrospective, descriptive criterion standard study conducted from June 27, 2015, to March 8, 2016. We used Kidney Disease Improving Global Outcomes criteria to define and select patients with AKI. The study was conducted by recruiting in hospital patients who suffered from the flammable cornstarch-based powder explosion and were treated under primary care procedures. A total of 49 patients who suffered from flammable dust explosion-related burn injury were enrolled and admitted on June 27, 2015. The patients with more than 20% total body surface area of burn were transferred to the intensive care unit. Patients received fluid resuscitation in the first 24 hours based on the Parkland formula. The primary measurements were the incidence of and predisposing factors for AKI in these patients. Demographic characteristics, laboratory data, and inpatient outcomes were also evaluated. The incidence of AKI in this cohort was 61.2% (n = 30). The mortality rate was 2.0% (n = 1) during a 59-day follow-up period. The multivariate analysis revealed inhalation injury (adjusted OR = 22.0; 95% CI [1.4–358.2]) and meeting ≥3 American Burn Association (ABA) sepsis criteria (adjusted OR = 13.7; 95% CI [1.7–110.5]) as independent risk factors for early advanced AKI. Conclusions The incidence rate of AKI was higher in this cohort than in previous studies, possibly due to the flammable dust explosion-related burn injury. However, the mortality was lower than that expected. In clinical practice, indicators of inflammation, including ABA sepsis criteria may help in predicting the risk of AKI in patients with burn injury.

Physical activity levels in hospitalised adults with burn injuries

2021 ◽  
Author(s):  
Anita Plaza ◽  
Julie Adsett ◽  
Angela Byrnes ◽  
Prue McRae
Keyword(s):  
Physical Activity ◽  
Total Body Surface Area ◽  
Physical Activity Behaviour ◽  
Cross Sectional Study ◽  
Hospital Length ◽  
Burn Injuries ◽  
Hospital Length Of Stay ◽  
Activity Levels ◽  
Cross Sectional ◽  
Activity Behaviour

Abstract Physical activity behaviour has not been previously described in hospitalised adults with burn injuries. This prospective, cross-sectional study used a standardised behavioural mapping protocol to observe patient behaviour related to physical activity over a 12-hour period on one weekday in a quaternary referral specialist burn centre. Structured observations were recorded for each of four domains: 1) patient location, 2) position, 3) activity performed and 4) the presence of others. Observations were summarised across all participants as median (IQR) proportion of time. Participants (n=17) were predominantly male (82%) with a mean age of 44.3 (SD 15.2) years, a mean burn size of 34.9% (SD 26.7) total body surface area and a median hospital length of stay of 18 (IQR 6-49) days at time of observation. Participants spent a median of 83% (IQR 73-93) of time in their bedroom, 92% (IQR 68-97) of time in or on their bed and a median of 5% (IQR 3-13) of time mobilising. Exercise accounted for 10% (IQR 8-17) of activity related observations. A median of 68% (IQR 39-83) of time was spent alone. Results suggest time spent engaging in physical activity is low. Further studies are required to investigate motivators and barriers to performing physical activity in this population. This will consequently inform the development and implementation of appropriate strategies to improve physical activity behaviour in this cohort.

A Prospective Look at the Current State of Open Abdomens

2008 ◽  
Vol 74 (10) ◽  
pp. 891-897 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Ali Salim ◽  
Kenji Inaba ◽  
Carlos Brown ◽  
Timothy Browder ◽  
...  
Keyword(s):  
Skin Grafting ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Fascial Closure ◽  
Stepwise Logistic Regression ◽  
Trauma Patients ◽  
Closure Rate ◽  
Abdominal Closure ◽  
Academic Level ◽  
Level I

The present study examines the current management, closure rate, and complications of open abdomens in trauma patients admitted to an Academic Level I trauma center between May 2004 and April 2007. Variables examined include mechanism, injuries, use of antibiotics and paralytics, type of abdominal closure, days to closure, complications, ICU and hospital length of stay, and mortality. Stepwise logistic regression was performed to identify independent predictors of failed abdominal closure. Of 900 laparotomies, 93 (10%) were left open. Eighty-five (91%) patients survived for closure opportunity. Definitive fascial closure was achieved in 72 (85%) at 3.9 ± 3.7 days (range 1–21 days). Of the remaining 13 patients, seven were closed with biologic material, five by skin grafting, and one had skin-only closure. Entero-atmospheric fistulas occurred in 14 (15%) patients. Two independent risk factors associated with failed abdominal closure were the presence of deep surgical site infection [odds ratio (OR) 17.4; 95% confidence interval (CI) 2.6–115.8, P = 0.003] and intra-abdominal abscess (OR 7.4; 95% CI 1.1–51.0, P = 0.04). In conclusion, open abdomens are commonly necessary after trauma laparotomies. Definitive fascial closure can be achieved in 85 per cent of cases. In conjunction with biologics, closure can be achieved in 93 per cent of cases. Failure to primarily close the abdomen is associated with a significantly higher risk for entero-atmospheric fistula occurrence.

Change in Total Body Water as a Metric for Predicting Need for Outpatient Intravenous Fluids in Postoperative Bariatric Patients

2020 ◽  
Vol 86 (9) ◽  
pp. 1169-1174
Author(s):  
Lauren E. Matevish ◽  
Alexander T. Hawkins ◽  
Alva J. Bethurum ◽  
Chetan V. Aher ◽  
Wayne J. English ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Composition ◽  
Length Of Stay ◽  
Total Body Water ◽  
Hospital Length ◽  
Body Water ◽  
Hospital Length Of Stay ◽  
Diabetes Diagnosis ◽  
Bariatric Patients ◽  
Total Body

Background Dehydration drives a significant proportion of readmissions following bariatric surgery. Routinely performed body composition testing and total body water (TBW) calculations may present a novel method for diagnosing dehydration for outpatient intervention. We sought to determine if a change in TBW from preoperative baseline could help identify bariatric patients requiring outpatient intravenous fluid (IVF) administration for dehydration. Methods The VUMC Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was retroactively queried for all patients undergoing bariatric surgery at an accredited bariatric surgery center from January 1, 2017 to May 31, 2018. Body composition test results presurgery and postsurgery were extracted from the electronic health record. Change in TBW was compared between patients requiring outpatient IVF and those who did not use multivariable logistic regression. Results 583 patients underwent surgery over the study period (388 laparoscopic Roux-en-Y gastric bypass, 195 sleeve). 62 (10.6%) required outpatient fluid administration for dehydration. After multivariable analysis, patients with an increased hospital length of stay at index operation were more likely to require outpatient IVF (odds ratio [OR] 1.65, 95% CI 1.22-2.2). Preexisting diabetes diagnosis was protective (OR 0.35, 95% CI 0.16-0.74). Neither 1-week nor 1-month change in TBW from preoperative baseline was significantly different between patients receiving outpatient IVF and those who did not. Conclusion Increased hospital length of stay predicts patients at risk of postoperative dehydration requiring IVF administration. Body composition testing and TBW were not useful in distinguishing between populations. Further research is needed to examine the efficacy of outpatient IVF in preventing hospital readmissions for dehydration.

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