316 Disparities Affecting Incarcerated Burn-Injured Patients: Insight From The National Burn Repository

Abstract

As incarcerated patients are categorized as a vulnerable population, little is known regarding injury patterns and outcomes following burn injury. This study aimed to examine a national database in order to further appreciate disparities in care which may affect this patient cohort. The National Burn Repository (NBR, Version 8.0) was queried for all patients 18 years and older discharged to jail or police custody. Demographics, comorbidities, mechanism, injury details and clinical outcomes were recorded. Patients discharged to jail were compared to those with other dispositions utilizing Chi square and Mann-Whitney U tests. Primary outcomes assessed were hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days and mortality. Between 2002–2011, 852 burn patients were discharged to jail, comprising 0.7% of adult patients in the dataset. 300 (35.2%) of these sustained injuries while in custody. Patients were predominantly male (86.5%) and Caucasian (51.9%), with a mean age of 37.7 ± 13.0 years. As compared to patients with non-custody disposition, patients discharged to jail were significantly younger and male, with higher rates of drug abuse and psychiatric illness (p<0.05). Incarcerated patients were injured primarily by scalds (31.5%), while non-incarcerated patients sustained primarily flame injuries (46.6%). As compared to patients not discharged into custody, the jail cohort had significantly smaller burns (5.6 ± 9.8 vs. 8.0 ± 13.2 % TBSA), underwent fewer surgical procedures, had fewer ventilator days and shorter ICU LOS (p<0.05). HLOS was not significantly different between the groups. There were no recorded deaths in the jailed population, as compared to a mortality rate of 4.7% in the non-jailed cohort (p<0.001). Although burn-injured patients discharged to jail sustain smaller scald injuries, receive fewer operations and are less acutely ill, they remain hospitalized for similar durations as patients with other dispositions. As these findings may represent challenges in arranging for ongoing outpatient management, there may be opportunities to improve the transition of care through education and outreach to receiving facilities and providers. Although burn-injured patients discharged to jail represent a small proportion of the population, providers should be cognizant of unique challenges which may be encountered.