scholarly journals Surviving Burn Injury: Drivers of Length of Hospital Stay

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.

scholarly journals Surviving Burn Injury: Drivers of Length of Hospital Stay

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.

Malnutrition in Burns: A prospective, single center study

2021 ◽  
Author(s):  
Nancy Coutris ◽  
Justin Peter Gawaziuk ◽  
Saul Magnusson ◽  
Sarvesh Logsetty
Keyword(s):  
Burn Injury ◽  
Nutrition Intervention ◽  
Critically Ill Patient ◽  
Burn Patients ◽  
Significant Independent Predictor ◽  
Single Center Study ◽  
Multivariable Regression Model ◽  
Resource Requirements ◽  
Hospital Resources ◽  
Multivariable Regression

Abstract The hypermetabolic response from burn injury is the highest of the critically ill patient population. When coupled with the hypermetabolic response, preexisting malnutrition may increase the hospital resources used. The goal of this study was to evaluate the rate of malnutrition in burn patients and the associated hospital resource utilization.We collected prospective data on burn patients ≥ 18 years with a burn ≥ 10% TBSA admitted to a regional burn center. Demographics, %TBSA, co-morbidities, length of stay (LOS) and standardized LOS (LOS/%TBSA) were evaluated on 49 patients. A multivariable regression model was constructed. Nutrition assessment was completed within 24-48 hours of admission including an SGA (Subjective Global Assessment) classification. SGA A (well-nourished) was compared to SGA B and C (malnourished). Fourteen patients (28.6%) in this study were malnourished. Malnourished patients were not statistically different with respect to median age (50 versus 39; p = 0.08] and BMI (22.9 versus 26.5; p = 0.08) compared to the well-nourished group. However, malnourished patients had significantly longer median LOS (21.0 versus 11.0 days, p = 0.01) and LOS/%TBSA (1.69 versus 0.83, p = 0.001) than the well-nourished group. Being malnourished was a significant independent predictor of above median LOS/%TBSA (p=0.027) with an odds ratio (OR) of 5.61 (95% C.I. 1.215-25.890).The rate of malnutrition is important given the high metabolic demands of these patients. Malnutrition increased the resource requirements via higher standardized LOS. This underscores the importance of completing SGA on admission to identify malnutrition early on to optimize nutrition intervention during the patients’ hospital stay.

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

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).

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

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.

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

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.

826 Geographic Mapping to Target Adult Burn Prevention for an Urban Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S252-S252
Author(s):  
Mathangi A Chandramouli ◽  
Angela Rabbitts ◽  
Jamie Heffernan ◽  
Philip Chang
Keyword(s):  
Catchment Area ◽  
Burn Injury ◽  
Adult Population ◽  
Data Mapping ◽  
Burn Patients ◽  
Unequal Distribution ◽  
Burn Center ◽  
Burn Prevention ◽  
National Trends ◽  
Zip Code

Abstract Introduction Burn prevention is one of the core missions of burn centers. Geomapping has been instrumental for police departments to target resources for crime prevention. Similarly, geomapping could assist burn specialists in identifying “hotspots” of injury. The purpose of this study is to visually identify the incidence and location of adult burn injury within the catchment area of a single tertiary urban regional burn center. Data mapping can thus then be used to target burn outreach and prevention efforts. Methods Demographic and deidentified clinical data was collected from a single institution over a 3 year period. 1986 burn patients were admitted between 1/2016 and 12/2018. 1360 patients were 16 years of age or greater. Geriatric patients were defined as age 60 or greater to facilitate comparison with National Burn Repository data which breaks down age by decades. The patients were mapped by their home zip code. Results 1360 burn patients 16 years or older were admitted to this single tertiary burn center between 1/2016 and 12/2018 with an age range from 16–101. 393 patients were 60 years or older (28.9% of the adult population compared to 19.8% of the NBR population) 6 zip codes within the catchment area were identified as “hotspots” as having more than 30 inpatients listing that zip code as their home address (see figure). The results show an unequal distribution of patients over the burn center’s catchment area with hotspots (defined by > 30 burn admissions during the study period) in 6 zip codes. Conclusions The local demographics of this inpatient adult burn population follow national trends in etiology but differ with regards to age and race. The geomapping tool visualizes burn incidence by geography. Based on this analysis, outreach and prevention efforts should target elderly populations especially in the “hotspots.” Applicability of Research to Practice This research will inform targeted efforts towards burn prevention and education outreach.

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

2020 ◽  
Vol 41 (4) ◽  
pp. 835-840
Author(s):  
Jaimie Chang ◽  
Emily Hejna ◽  
Chih-Yuan Fu ◽  
Francesco Bajani ◽  
Leah Tatabe ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Abdominal Surgery ◽  
Burn Injury ◽  
Multivariate Logistic Regression Analysis ◽  
Trauma Patients ◽  
Burn Patients ◽  
Severe Injuries ◽  
Abdominal Operation ◽  
Significant Difference ◽  
Intraabdominal Injury

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.

scholarly journals BURN PATIENTS;

2013 ◽  
Vol 20 (06) ◽  
pp. 1042-1047
Author(s):  
FIRDOUS KHAN ◽  
ASIF SHAH ◽  
ABDUL AZIZ JANAN
Keyword(s):  
Hospital Stay ◽  
Plastic Surgery ◽  
Teaching Hospital ◽  
Burn Injury ◽  
Demographic Data ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Descriptive Study ◽  
Burn Patients ◽  
Key Factor

Aim: To determine major risk factors of mortality and causes of death in patients presented with burn injury. Study design:Prospective Descriptive Study. Setting and duration: Department of Burns and Plastic Surgery, Khyber Teaching Hospital, Peshawar,Pakistan from April 2008 and June 2012. Methodology: A prospective descriptive study was performed among the patients whoadmitted to the Department of Burns and Plastic Surgery, Khyber Teaching Hospital, Peshawar, Pakistan between April 2008 and June2012. All relative information was collected through a detailed proforma and patient’s treatment files. Patients of any age, any degree ofburns and burns exceeding 10% TBSA were included. Patients presenting after more than one week post burn or patients referred fromother hospitals were excluded. Within this period, demographic data, treatment, and outcomes of treatment were reviewed and analyzed.Survivors and non-survivors among burn patients were compared to define the predictive factors of mortality. Results: Between April2008 and June 2012, 1850 patients were admitted with burn injuries. There were 1150 male patients (62%) and 700 female patients(38%). Mean age was 36 years with range of 1-70 years. Inhalation injuries were present in 45 patients (2.40%). Causes were flameburns (65.0%), electrical burns (15%), scalds (13%) and chemical burns (7.0%). The total body surface area (TBSA) burn ranged from10- 100%, with a mean of 38% TBSA burn. Mean length of hospital stay was 12 days (ranging from 24 hours to 170 days). Mortality ratewas 11.2%. Higher age, larger burn area, wound infection, longer hospital stay and the presence of multi-system organ failuresignificantly predicted increased mortality. Conclusions: Prevention is a key factor in reducing the morbidity and mor tality associatedwith burn injury. A campaign to educate people that burns can be prevented will be important in our community. The prevention of multiorganfailure and septicemia are likely to be more effective than their treatment.

scholarly journals Epidemiology of Burn Injuries in Cipto Mangunkusumo Hospital from 2009 to 2010

1970 ◽  
Vol 1 (5) ◽  
Author(s):  
Pujisriyani Pujisriyani ◽  
Aditya Wardhana
Keyword(s):  
Burn Injury ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Burn Injuries ◽  
Burn Patients ◽  
Government Regulations ◽  
Female Ratio ◽  
Common Cause ◽  
The Mean ◽  
Male To Female

Background: Burns are one of the most devastating conditions encountered in medical world. It affects people of all ages, from the very young to the elderly, and represents an assault on all aspects of the patient, from the physical to the psychological.Method: The collection and analysis of burn patients admitted to Cipto Mangunkusumo Burn Centre between January 2009 and December 2010 were studied retrospectively in terms of admissions, age, sex, extent of burn, causes of burns, referral, length of hospital stay (LOS) and mortality. Result: A total of 303 burn patients were admitted with the male to female ratio is 2.26 : 1 and the mean age of admission is 25.7 years (15-54 yr). Most of the patient presented with 20-50% extent of burn (mean 45.87%). The most common cause of burn injury is LPG at 30.4 % followed by flame at 25.7% and by scald at 19.1%. The overall mean LOS and mortality are 13.72 days and 34%. Conclusion : LPG is the major cause of burn and the mortality are 42.4%. Because of level of the mortality, the prevention and management of LPG and the safety of the product of LPG should be given in terms of government regulations.

scholarly journals The Potential Association of Later Initiation of Oral/Enteral Nutrition on Euthyroid Sick Syndrome in Burn Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Joaquín Pérez-Guisado ◽  
Jesús M. de Haro-Padilla ◽  
Luis F. Rioja ◽  
Leo C. DeRosier ◽  
Jorge I. de la Torre
Keyword(s):  
Enteral Nutrition ◽  
Burn Injury ◽  
Length Of Hospital Stay ◽  
Early Initiation ◽  
Burn Patients ◽  
Sample Collection ◽  
Euthyroid Sick Syndrome ◽  
Injury Group ◽  
Group 3 ◽  
Group 2

Objective. The aim of this study was to determine if early initiation of oral/enteral nutrition in burn patients minimizes the drop in fT3 levels, reduces the potential for euthyroid sick syndrome (ESS), and shortens the length of hospital stay (LHS).Subjects and Methods. We retrospectively evaluated the statistical association of serum fT3, fT4, and TSH at the first (2nd–5th day) and second sample collection (9th–12th day) after the burn injury in 152 burn patients. Three groups were established depending on time of initiation of the oral/enteral nutrition: <24 h before the injury (Group 1), 24–48 h after the injury (Group 2), and >48 h after the injury (Group 3).Results. They were expressed as mean ± standard deviation. We found that LHS and the fT3 levels were statistically different in the 3 groups. The LHS (in days) was, respectively, in each group,16.77±4.56,21.98±4.86,and26.06±5.47. Despite the quantifiable drop in fT3, ESS was present only at the first sample collection (2.61±0.92days) in Group 3, but there was no group with ESS at the second sample collection (9.89±1.01days). Our data suggest that early initiation of nutritional supplementation decreases the length of hospitalization and is associated with decreasing fT3 serum concentration depression.Conclusion. Early initiation of oral/enteral nutrition counteracts ESS and improves the LHS in burn patients.

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