scholarly journals Nonmedical Factors Influencing Early Deaths in Burns: A Study of the National Burn Repository

2019 ◽  
Author(s):  
Rachel M Nygaard ◽  
Frederick W Endorf
Keyword(s):  
Socioeconomic Factors ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Early Period ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Commercial Insurance ◽  
Severe Burns ◽  
Hispanic Patients ◽  
Major Factors

Abstract It is well-established that survival in burn injury is primarily dependent on three factors: age, percent total-body surface area burned (%TBSA), and inhalation injury. However, it is clear that in other (nonburn) conditions, nonmedical factors may influence mortality. Even in severe burns, patients undergoing resuscitation may survive for a period of time before succumbing to infection or other complications. In some cases, though, families in conjunction with caregivers may choose to withdraw care and not resuscitate patients with large burns. We wanted to investigate whether any nonmedical socioeconomic factors influenced the rate of early deaths in burn patients. The National Burn Repository (NBR) was used to identify patients that died in the first 72 hours after injury and those that survived more than 72 hours. Both univariate and multivariate regression analyses were used to examine factors including age, gender, race, comorbidities, burn size, inhalation injury, and insurance type, and determine their influence on deaths within 72 hours. A total of 133,889 burn patients were identified, 1362 of which died in the first 72 hours. As expected, the Baux score (age plus burn size), and inhalation injury predicted early deaths. Interestingly, on multivariate analysis, patients with Medicare (p = .002), self-pay patients (p < .001), and those covered by automobile policies (p = .045) were significantly more likely to die early than those with commercial insurance. Medicaid patients were more likely to die early, but not significantly (p = .188). Worker’s compensation patients were more likely to survive the first 72 hours compared with patients with commercial insurance (p < .001). Men were more likely to survive the early period than women (p = .043). On analysis by race, only Hispanic patients significantly differed from white patients, and Hispanics were more likely to survive the first 72 hours (p = .028). Traditional medical factors are major factors in early burn deaths. However, these results show that nonmedical socioeconomic factors including race, gender, and especially insurance status influence early burn deaths as well.

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

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

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

scholarly journals A prospective observation on nutrition support in adult patients with severe burns

2019 ◽  
Vol 121 (09) ◽  
pp. 974-981 ◽  
Author(s):  
Fengmei Guo ◽  
Hua Zhou ◽  
Jian Wu ◽  
Yingzi Huang ◽  
Guozhong Lv ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Burn Injury ◽  
Early Stage ◽  
Energy Requirement ◽  
Total Body Surface Area ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Burn Patients ◽  
Severe Burn ◽  
Severe Burns

AbstractNutrition therapy is considered an important treatment of burn patients. The aim of the study was to delineate the nutritional support in severe burn patients and to investigate association between nutritional practice and clinical outcomes. Severe burn patients were enrolled (n 100). In 90 % of the cases, the burn injury covered above 70 % of the total body surface area. Mean interval from injury to nutrition start was 2·4 (sd 1·1) d. Sixty-seven patients were initiated with enteral nutrition (EN) with a median time of 1 d from injury to first feed. Twenty-two patients began with parenteral nutrition (PN). During the study, thirty-two patients developed EN intolerance. Patients received an average of about 70 % of prescribed energy and protein. Patients with EN providing &lt;30 % energy had significantly higher 28- d and in-hospital mortality than patients with EN providing more than 30 % of energy. Mortality at 28 d was 11 % and in-hospital mortality was 45 %. Multiple regression analysis demonstrated that EN providing &lt;30 % energy and septic shock were independent risk factors for 28- d prognosis. EN could be initiated early in severe burn patients. Majority patients needed PN supplementation for energy requirement and EN feeding intolerance. Post-pyloric feeding is more efficient than gastric feeding in EN tolerance and energy supplement. It is difficult for severe burn patients to obtain enough feeding, especially in the early stage of the disease. More than 2 weeks of underfeeding is harmful to recovery.

scholarly journals Development of a Framework for Managing Severe Burns Through a 17-year Retrospective Analysis of Burn Epidemiology and Outcomes

2021 ◽  
Author(s):  
Ling Chen ◽  
Xiaochong He ◽  
Jishu Xian ◽  
Jianmei Liao ◽  
Xuanji Chen ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Burn Severity ◽  
Annual Number ◽  
Age Difference ◽  
Burn Patients ◽  
Severe Burns ◽  
High Level

Abstract Background Burns are one of the most common injuries in daily life for all ages of population. This study was to investigate the epidemiology and outcomes among burn patients in one of the largest burn centers in the southwest of China. Methods The study was performed at the Institute of Burn Research in the first affiliated with the Army Medical University (AMU). A total of 17939 burn patients were included in this retrospective study. Information regarding demographic, burn characteristics, and the burn severity of ABSI were collected, calculated and compared.Results The age ranged from 257 days to 95 years old. Scalding and flame were the two most common causes to burn injuries, comprising of 91.96% in total. Limbs, head/face/neck, and trunk were the most frequently occurred burn sites, with the number and the percent of 12324 (68.70%), 7989 (44.53%), and 7771 (43.32%), respectively. The average total body surface area (TBSA) was 13.64±16.83% (median 8%) with a range of 0.1~100%. A total of 874 (4.9%) patients had TBSA >50%. The presence of a burn with an inhalation injury was confirmed in 543 patients (3.03%). The average LOS was 32.11±65.72 days (median: 17days). Eventually, the retrospective analysis resulted in the development of a framework of burn management continuum used for developing strategies to prevent and manage severe burns.Conclusions The annual number of burn injuries has kept decreasing, which was partially attributed to the increased awareness and education of burn prevention and the improved burn-preventative circumstances. However, the burn severity and the economic burden were still in a high level. And the gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments.

scholarly journals Early treatment and intensive care of children with burn injury

2017 ◽  
Vol 64 (1) ◽  
pp. 39-42
Author(s):  
Ivana Petrov ◽  
Ivana Budic ◽  
Irena Simic ◽  
Dusica Simic
Keyword(s):  
Pediatric Patients ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Physiological Status ◽  
Hormonal Responses ◽  
Severe Burns ◽  
Immunological Profile ◽  
Major Burn ◽  
Total Body

Major burn injury remains a significant cause of morbidity and mortality in pediatric patients. The treatment of burned children differs substantially from that of adults not only because of the different body proportions but also because of the metabolic processes involved, hormonal responses, the immunological profile, the degree of psychological maturation and healing potential. After assessing the overall physiological status of the child, accurate assessment of the burn injury and appropriate fluid resuscitation are of great importance. The severity of burn injury is characterized by the depth of the burn, total body surface area (TBSA) that is involved, the location of burn injury and the presence or absence of inhalation injury. Early excision and grafting, adequate nutrition, alleviation of the hypermetabolic response, treatment of hyperglycaemia, and physical therapy improve survival and outcomes in children with severe burns.

scholarly journals Clinical Practice Variation in Acute Severe Burn Injury

2018 ◽  
Vol 46 (3) ◽  
pp. 321-325 ◽  
Author(s):  
T. L. Garside ◽  
R. P. Lee ◽  
A. Delaney ◽  
D. Milliss
Keyword(s):  
Intensive Care ◽  
Clinical Practice ◽  
Best Practice ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Practice Variation ◽  
Inhalation Injury ◽  
Severe Burns ◽  
Significant Difference ◽  
Inhalational Injury

The New South Wales (NSW) Statewide Burn Injury Service Database was reviewed to identify variations in clinical practice with respect to care of severely burn-injured patients in intensive care. We compared differences in practice relating to duration of endotracheal intubation and surgical grafting. In this retrospective observational study, we reviewed all intensive care unit (ICU) admissions to the two NSW adult burns centres, ICU A and ICU B, between January 2008 and December 2015. Data were analysed for association between duration of intubation and outcome. There were 855 admissions to adult ICU, with a significant difference in the percentage total body surface area (% TBSA) of burn and inhalation injury between patients in the two units. There was a significant difference in duration of intubation and ICU length of stay (LOS) between the units, which persisted when adjusted for age, % TBSA and inhalational injury. When analysing patients with more severe burns (>20% TBSA or intubated), the difference in duration of intubation remained significant (median of three days [interquartile range, IQR, 1–11 days] in A and 2 days [IQR 1–6 days] in B, P=0.003) as did ICU LOS (median 3 days [IQR 2–11 days] for A and 2 days [IQR 1–6 days] for B, P <0.0005). There was no significant difference in mortality between the two units for the severe or the more severe subgroup of burns when adjusted for age, % TBSA and inhalational injury (adjusted odds ratio, OR, for mortality 1.17 [95% confidence intervals 0.6 to 2.3, P=0.65]). There were significant differences in clinical practice, including duration of intubation, between the two ICUs. Longer intubation was associated with a longer ICU LOS, but was not associated with a difference in mortality. Large collaborative, prospective multicentre studies in severe burns are needed to identify best practice and variations in practice to determine if they are associated with increased mortality and/or cost.

631 Mobilization of Patient with Inhalation Burn Injury Requiring VV ECMO: A Case Study

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S159-S160
Author(s):  
Karina J Berenbaum ◽  
Lawrence Gottlieb ◽  
Annemarie O’Connor ◽  
Megan Teele ◽  
Cheryl Esbrook ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Inhalation Injury ◽  
Circulatory Support ◽  
Burn Patients ◽  
Inhalation Burn ◽  
Vv Ecmo

Abstract Introduction As extracorporeal membrane oxygenation (ECMO) becomes more popular, there is increasing evidence supporting the safety and feasibility of early physical and occupational therapy (PT, OT) and mobility with patients on ECMO. However, there is limited evidence to support mobilizing burn ECMO patients. This case discusses safety and feasibility and explains how to successfully mobilize a burn patient on ECMO. Methods The patient is a 56-year old male admitted after sustaining 16% total body surface area partial and full thickness burns to his face, neck, forearms, and hands following an explosion at work. He sustained an inhalational injury and was intubated upon admission. Progression of his inhalation injury led to respiratory failure despite maximal ventilatory support. To maintain appropriate oxygenation, he underwent placement of left femoral-left internal jugular veno-venous ECMO (VV-ECMO). The patient received PT and OT throughout his stay in the Burn ICU. After starting ECMO, the patient resumed therapy with a sitting restriction to &lt; 45 degrees of left hip flexion. The critical care, burn, OT, PT, and cardiothoracic surgery teams discussed factors impacting his ability to participate in therapy, e.g., managing sedation to maximize wakefulness and titrating medications due to hypertension. Modifications to therapy treatments were made based on medical changes and the patient’s ability to participate. The patient was seen daily for mobilization by a PT, OT, nurse, and ECMO specialist team. Clinicians had extensive training and experience working with patients with acute mechanical circulatory support. Safety considerations were followed during all therapy sessions, including careful monitoring of ECMO flows, vitals signs, and securement of medical devices. Results While on ECMO for 11 days, the patient was engaged in daily therapy consisting of active exercise, bed mobility, transfers and standing balance activities. ECMO flows were maintained and no adverse events occurred during mobilization. From the first session on ECMO to day of discharge, the patient exhibited a 14-point increase in his Boston University Activity Measure for Post-Acute Care functional outcome score and progressed to ambulating 300 feet. Conclusions Burn patients on VV-ECMO with femoral cannulation can safely and effectively engage in therapy and early mobilization, which yield positive functional outcomes. A well-coordinated inter-disciplinary team and highly skilled staff is essential to provide safe and effective intervention. Applicability of Research to Practice Early mobilization of burn patients on ECMO is feasible and can ameliorate the effects of immobility. Burn therapists are an integral part of the inter-disciplinary team and should be trained to be skilled at providing care for patients on mechanical circulatory support.

scholarly journals Development of a framework for managing severe burns through a 17-year retrospective analysis of burn epidemiology and outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ling Chen ◽  
Xiaochong He ◽  
Jishu Xian ◽  
Jianmei Liao ◽  
Xuanji Chen ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Annual Number ◽  
Age Difference ◽  
Burn Patients ◽  
Burn Prevention ◽  
Severe Burns ◽  
High Level

AbstractBurns are one of the most common injuries in daily life for all ages of population. This study was to investigate the epidemiology and outcomes among burn patients in one of the largest burn centers in the southwest of China. The study was performed at the Institute of Burn Research in the first affiliated with the Army Medical University (AMU). A total of 17,939 burn patients were included in this retrospective study. Information regarding burn epidemiology and outcomes in 17 years were collected, calculated and compared. The age ranged from 257 days to 95 years old. Scalding and flame were the two most common causes to burn injuries, comprising of 91.96% in total. Limbs, head/face/neck, and trunk were the most frequently occurred burn sites, with the number and the percent of 12,324 (68.70%), 7989 (44.53%), and 7771 (43.32%), respectively. The average total body surface area (TBSA) was 13.64 ± 16.83% (median 8%) with a range of 0.1–100%. A total of 874 (4.9%) patients had TBSA > 50%. The presence of a burn with an inhalation injury was confirmed in 543 patients (3.03%). The average LOS was 32.11 ± 65.72 days (median: 17 days). Eventually, the retrospective analysis resulted in the development of a burn management continuum used for developing strategies to prevent and manage severe burns. The annual number of burn injuries has kept decreasing, which was partially attributed to the increased awareness and education of burn prevention and the improved burn-preventative circumstances. However, the burn severity and the economic burden were still in a high level. And the gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments.

scholarly journals Activity Impairment, Work Status, and Work Productivity Loss in Adults 5–7 Years After Burn Injuries

2021 ◽  
Author(s):  
Inge Spronk ◽  
Nancy EE Van Loey ◽  
Cornelis H van der Vlies ◽  
Juanita A Haagsma ◽  
Suzanne Polinder ◽  
...  
Keyword(s):  
Productivity Loss ◽  
Total Body Surface Area ◽  
Work Productivity ◽  
Burn Injuries ◽  
Work Status ◽  
Burn Patients ◽  
Work Situation ◽  
Activity Impairment ◽  
Severe Burns ◽  
Specific Health

Abstract An important aspect of the rehabilitation of burn patients is social participation, including daily activities and work. Detailed information on long-term activity impairment and employment is scarce. Therefore, we investigated activity impairment, work status, and work productivity loss in adults 5–7 years following burn injuries, and investigated associations with burn-specific health-related quality of life (HRQL) domains. Adult participants completed the Work Productivity and Activity Impairment General Health questionnaire and the Burn Specific Health Scale-brief (BSHS-B) 5–7 years post-burn. Outcomes were compared between participants with mild/intermediate and severe burns (&gt;20% total body surface area burned). Seventy-six (36%) of the 213 participants experienced some degree of activity impairment due to burn-related problems 5–7 years post-burn. Seventy percent of the population was employed; 12% of them experienced work productivity loss due to burn-related problems. Nineteen percent reported changes in their work situation (partly) because of the burn injury. A higher proportion of participants with severe burns had activity impairments (56% vs 29%; P = .001) and work productivity loss (26% vs 8%; P &lt; .001) compared to participants with mild/intermediate burns. Activity impairment and work productivity loss were both associated with burn-related work problems and lower mood, measured with the BSHS-B. In conclusion, a substantial part of the study population experienced activity impairment and work productivity loss, was unemployed, and/or reported changes in their work situation due to their injury. Particularly patients with severe burns reported productivity loss and had lower employment rates. This subscribes the importance of addressing work-related functioning in the rehabilitation of burn patients.

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 &lt;7 g/dL) or liberal (transfuse hemoglobin &lt;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 &lt; 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p &lt; 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p &lt; 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 &gt; 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 Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro): protocol for a multicentre prospective observational study

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023709 ◽  
Author(s):  
Esther MM Van Lieshout ◽  
Daan T Van Yperen ◽  
Margriet E Van Baar ◽  
Suzanne Polinder ◽  
Doeke Boersma ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Burn Injury ◽  
Treatment Costs ◽  
Burn Patients ◽  
Severe Burns ◽  
Referral Criteria ◽  
Age Limit

IntroductionThe Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre. These data will subsequently be compared with data from patients with<10% total bodysurface area (TBSA) burned who are admitted (or secondarily referred) to a burn centre. If admissions were in agreement with the EMSB, referral criteria will also be determined.Methods and analysisIn this multicentre, prospective, observational study (cohort study), the following two groups of patients will be followed: 1) all patients (no age limit) admitted with burn-related injuries to a hospital without a dedicated burn centre in the Southwest Netherlands or Brabant Trauma Region and 2) all patients (no age limit) with<10% TBSA burned who are primarily admitted (or secondarily referred) to the burn centre of Maasstad Hospital. Data on the burn injury characteristics (primary outcome), EMSB compliance, treatment, treatment costs and outcome will be collected from the patients’ medical files. At 3 weeks and at 3, 6 and 12 months after trauma, patients will be asked to complete the quality of life questionnaire (EuroQoL-5D), and the patient-reported part of the Patient and Observer Scar Assessment Scale (POSAS). At those time visits, the coordinating investigator or research assistant will complete the observer-reported part of the POSAS.Ethics and disseminationThis study has been exempted by the medical research ethics committee Erasmus MC (Rotterdam, The Netherlands). Each participant will provide written consent to participate and remain encoded during the study. The results of the study are planned to be published in an international, peer-reviewed journal.Trial registration numberNTR6565.

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