scholarly journals Transfusion Requirement in Burn Care Evaluation (TRIBE)

2017 ◽  
Vol 266 (4) ◽  
pp. 595-602 ◽  
Author(s):  
Tina L. Palmieri ◽  
James H. Holmes ◽  
Brett Arnoldo ◽  
Michael Peck ◽  
Bruce Potenza ◽  
...  
Keyword(s):  
Transfusion Requirement ◽  
Burn Care ◽  
Care Evaluation

97 Major Psychiatric Illness and Substance Use Disorder Influence Mortality in Major Burn Injury: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation (TRIBE) Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S66-S67
Author(s):  
John A Andre ◽  
Soman Sen ◽  
David G Greenhalgh ◽  
Tina L Palmieri ◽  
Kathleen S Romanowski
Keyword(s):  
Psychiatric Illness ◽  
Transfusion Requirement ◽  
Total Body Surface Area ◽  
Secondary Analysis ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Burn Care ◽  
Major Burn ◽  
Total Body ◽  
Care Evaluation

Abstract Introduction Prior studies of burn patients with < 20% total body surface area (TBSA) burns have found that 15.4% of patients have major psychiatric illness (MPI) and 27.6% have Substance Use Disorder (SUD). In patients with small burns, SUD is associated with larger burn size and secondarily with longer length of stay while MPI is associated with longer lengths of stay while not increasing burn size. The purpose of this study was to determine whether MPI or SUD dependence affects outcomes such as mortality in patients with major burn injuries (≥20% TBSA). Methods A secondary analysis from the prospective, randomized, multicenter Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Patients with MPI and SUD were compared with patients without these disorders. Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables was conducted. Mortality between those with and without MPI and SUD were analyzed with a multivariable regression analysis. Results A total of 347 patients with a mean age of 43±17 years, 274 men and 73 women, were analyzed. The mean total body surface area burn (TBSA) was 38±18%, and 23% had inhalation injury. In this study population, 29.1% had SUD, 7.5% had MPI, and 2.3% had both. There was no difference with respect to age, gender, TBSA, frailty, or assignment to the liberal or restrictive transfusion strategy based on the presence of MPI, SUD, or both. Inhalation injury was more common in patients with MPI (27%) or SUD (35%) when compared with patients without these comorbidities (18%) or those who have both (11%) (p=0.006). Patients with MPI were more likely to die of their burn injuries (27%) when compared with those with SUD (17%), both (11%), or neither (8%) (p=0.014). On multivariate analysis for mortality controlling for TBSA and inhalation injury, MPI was found to be an independent predictor of death with an odds ratio of 5 (95% confidence interval 1.7–15, p=0.003). Conclusions In burns >20% TBSA, both MPI and SUD influence patient’s likelihood of sustaining inhalation injury. MPI is also independently associated with mortality in the study. Further work must be done to mitigate the effects of mental illness on burn outcomes.

54 Modified Frailty Index is an Independent Predictor of Death in the Burn Population: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation (TRIBE) Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S39-S39
Author(s):  
John A Andre ◽  
Kathleen S Romanowski ◽  
Justin A Mandell ◽  
David G Greenhalgh ◽  
Tina L Palmieri ◽  
...  
Keyword(s):  
Transfusion Requirement ◽  
Independent Predictor ◽  
Frailty Index ◽  
Secondary Analysis ◽  
Female Gender ◽  
P Value ◽  
Continuous Variables ◽  
Burn Care ◽  
Modified Frailty Index ◽  
Care Evaluation

Abstract Introduction Previous studies in the burn population have noted frailty as an independent predictor of inpatient and outpatient mortality. The Modified Frailty Index (MFI) uses comorbidities tracked by the American College of Surgeons National Surgical Quality Improvement Program to help to predict morbidity and mortality in patients. The purpose of this study was to determine whether or not the MFI-5 and MFI-11 would predict mortality in the burn population. Methods A secondary analysis of the prospective, randomized, multicenter Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables were conducted. Frailty was determined using the MFI-5 (functionally dependent, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, hypertension) and MFI-11 (using the aforementioned 5, as well as myocardial infarction, hypertension, delirium, transient ischemic attack/cerebrovascular accident (without deficits), cerebrovascular accident (with deficits), peripheral vascular disease) from comorbidities included in the Burn Registry. Patients were considered frail if they had an MFI > 1 on either scale. Multivariate regression was used to compare mortality between those who were and those were not considered frail based on this index. Results A total of 347 patients with a mean age of 43±17 years, 73 women and 274 men, were analyzed. Mean total body surface area burn (TBSA) was 38±18%, and 23% had inhalation injury. As continuous variables, MFI-5 (OR 1.86; 95% CI 1.11–3.11; p-value 0.02) and MFI-11 (OR 1.83; 95% CI 1.18–2.8; p-value 0.007) were independent predictors of mortality. In addition, TBSA total, age, and female gender were all independent predictors of mortality. Having a MFI-11 > 1 was considered an independent predictor of mortality (OR 2.91; 95% CI 1.1–7.7; p-value 0.03); whereas, having a MFI-5 > 1 was not considered an independent predictor of mortality (OR 2.6; 95% CI 0.95–7; p-value 0.06). Conclusions A MFI-11 > 1 in the burn population was an independent predictor of mortality, as were total TBSA, age, and female gender. Given these findings, further study on the predictive value of MFI-11 in major burn injury is warranted.

Inhalation Injury Does Not Influence the Amount of Blood Transfused to Major Burn Patients: A Secondary Analysis from the Transfusion Requirement in Burn Care Evaluation Study

2019 ◽  
Vol 40 (6) ◽  
pp. 757-762
Author(s):  
Robert Cartotto ◽  
Sandra L Taylor ◽  
James H Holmes ◽  
Brett Arnoldo ◽  
Michael Peck ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Blood Transfusion ◽  
Transfusion Requirement ◽  
Secondary Analysis ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Burn Care ◽  
Major Burn ◽  
Multivariable Regression ◽  
Care Evaluation

Abstract Patients with major burn injuries typically require numerous blood transfusions. It is not known if an inhalation injury (INHI) directly influences the need for blood transfusion. The purpose of this study was to determine whether INHI increases the amount of blood transfused to major burn patients. A secondary analysis from the Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Patients with INHI were compared with patients without INHI. The number of red blood cell (RBC) transfusions per day (RBC per day) between INHI and No INHI was analyzed with a multivariable regression. Patients with INHI (n = 78) had significantly larger burns (P = .0004), larger full-thickness burns (P = .0007), greater admission APACHE score (P < .0001), higher admission multiple organ dysfunction scores (P < .0001), and were transfused more RBC per day (P = .009) than No INHI patients (n = 267). In the multivariable regression analysis, RBC per day was significantly associated with the %TBSA burn (P < .0001), age of the patient (P = .004), the need for more than 1 day of mechanical ventilation (P < .0001), the occurrence of at least one blood stream infection (BSI; P = .044), and being assigned to the liberal transfusion arm of TRIBE (P < .001) but not the presence of INHI (P = .056). The null hypothesis that INHI exerts no influence on the amount of blood transfused could not be rejected. Larger burn size, advanced patient age, mechanical ventilation, and BSIs are important determinants of the blood transfusion rate in major burn patients.

Kenny Self-Care Evaluation

1965 ◽  
Author(s):  
Herbert A. Schoening ◽  
Lenore Anderegg ◽  
Doris Bergstrom ◽  
Mary Fonda ◽  
Norma Steinke ◽  
...  
Keyword(s):  
Self Care ◽  
Care Evaluation

Horizons in Burn Care

1986 ◽  
Vol 13 (1) ◽  
pp. 151-159 ◽  
Author(s):  
Irving Feller ◽  
Claudella A. Jones
Keyword(s):  
Burn Care

The Cost Of Burn Care And The Federal Government’S Response In The 1990S

1992 ◽  
Vol 19 (3) ◽  
pp. 561-568 ◽  
Author(s):  
Joseph M. Rees ◽  
Alan R. Dimick
Keyword(s):  
Burn Care ◽  
The Cost

Microporous Polysaccharide Hemosphere Absorbable Hemostat (AristaAH®) in Re-Operative Cardiac Surgical Procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 96-98
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe
Keyword(s):  
Patient Outcomes ◽  
Surgical Procedures ◽  
Systematic Approach ◽  
Surgical Intervention ◽  
Transfusion Requirement ◽  
Cardiac Surgical Procedures ◽  
Platelet Inhibitors ◽  
Hemostatic Agents ◽  
Surgical Field ◽  
Improve Patient

Patients undergoing re-operative cardiac surgical procedures present a great challenge with regard to obtaining hemostasis in the surgical field. Adhesions are ever-present and these patients are often on oral anti-coagulants and platelet inhibitors. As part of a well-planned surgical intervention, a systematic approach to hemostasis should be employed to decrease blood transfusion requirement and improve patient outcomes. Topical hemostatic agents can be a great help to the surgeon in achieving surgical field hemostasis and are increasingly being employed. Our approach, to these difficult patients, includes the systematic and planned use of AristaAH, which is a novel hemostatic agent whose use has proven safe and efficacious in our patient population.

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