Average Total Body Surface Area Research Articles

Outpatient Follow Up and Reconstructive Surgery Rates in Massive Burn Survivors: Investigating the Social Determinants.

Burn care continues to improve and larger total body surface area (TBSA) burn survival is increasing. These survivors require more extensive care than smaller burns and are at higher risk for wound/scar related complications. Prior work has shown low rates of follow up for burn survivors linked to socioeconomic factors such as housing insecurity and substance use. There are limited studies that evaluate socioeconomic factors that contribute to follow up and reconstructive surgery rates in massively burned patients. Patients that survived to discharge with >50% TBSA burns and planned return to treating institution were included in the study. Univariate and multivariate analyses were performed on the data collected. Sixty-Five patients were included with an average TBSA of 63.1%. Fifty-three patients (81.5%) attended at least one follow up appointment with median of four follow-up appointments. Younger patients (33±9 vs 44±11; p=0.0006), patients with larger TBSA burns (65±13 vs 55±5%; p=0.02), those with private insurance and those without housing insecurity (1.8% vs 45.4%; p=0.003) were more likely to follow up. On multivariate regression analysis, patients with housing insecurity were independently associated with lack of follow up (OR: 0.009 CI: 0.00001-0.57). Thirty-five patients had at least one reconstructive surgery and 31 patients had reconstructive surgery after discharge. No patients with housing insecurity underwent reconstructive surgery. Follow up rates in massive burns were higher than reported for smaller TBSA burns and more than half received reconstructive surgery. Housing insecure patients should be targeted for improved follow up and access to reconstructive surgery.

The Frequency of Death Associated with Burn Injury in General Population of Peshawar City

Background: Burn injuries represent a significant public health issue worldwide, with a notably higher incidence and mortality rate in low and middle-income countries. These injuries are characterized by their devastating physical, psychological, and economic impacts on victims and their families. In Peshawar city, the lack of comprehensive data on burn-related deaths has hindered effective prevention and management strategies. Objective: This study aims to provide a demographic profile of burn-related deaths in Peshawar city, focusing on the factors influencing these fatalities and the manner of death, to inform better clinical practices and preventive measures. Methods: A retrospective study was conducted in the burn and trauma unit of Hayatabad Medical Complex, Peshawar, from May 1, 2021, to May 1, 2022. Data on 80 cases of death due to burns were collected and analyzed, categorizing by age, sex, cause of injury, nature and extent of burns, total body surface area (TBSA) affected, toxicological findings, location of the incident, duration of survival post-injury, and mechanism of death. The study adhered to the Declaration of Helsinki principles, with ethical approval obtained from the institutional review board. Results: The study found that out of 80 burn-related deaths, 70% (56 cases) were females and 30% (24 cases) were males. The highest number of fatalities was observed in individuals under 12 years, comprising 28.75% of the cases. Accidental burns were the leading cause of death, with more than 60% of incidents falling into this category. The average TBSA affected in fatal cases was significant, emphasizing the severity of injuries leading to mortality. Conclusion: Burn-related fatalities in Peshawar city predominantly affect females and young children, with accidental burns being the most common cause. This underscores the necessity for targeted preventive strategies, public awareness campaigns, and improvements in burn care facilities to address the high incidence and mortality rates of burn injuries in the region.

PEDIATRIC BURN MECHANISMS AND ITS PREVENTIONS: AN EPIDEMIOLOGICAL ANALYSISOF CHILDREN ADMITTED TO THE UHC MOHAMMED VI PLASTIC SURGERY DEPARTMENT IN MARRAKECH, MOROCCO

This study aims to describe the causes, mechanisms and characteristics of children burn injuries. It is a retrospective study that analyses the epidemiological particularities that are leading causes to burn injuries of a 100 cases of pediatric population and discuss different possible ways of its prevention. The pediatric cases of the UH Mohammed 6 plastic surgery department of Marrakech from January 2020 to December 2022 were retrospectively studied and the relative data were re-collected from the hospitalized patientsdigital medical records (i.e., etiology, age, gender, burn area and depth, length of stay (LOS), death). Children with burn injuries represent 40% of the admitted patients to our burn center, and this is an important percentage that should be studied and investigated in order to determine the elements that can contribute to brace prevention, which remains one of the only ways to ovecome this pathology. The average age is 3.82 years with a predilection for the age group under 5 years. Male involvement represents 62% of cases. The burn occurs at home and accidentally in more than 90% of cases. Thermal burns represent almost 92%which of scalding burns represents 68% of while Electric burns represent a relatively small proportion 6% of cases. The average total body surface area is 22.57%. The burn mainly concerns the trunk and the limbs.The average hospital admission time is 4 hours and the average length of hospital stay is 13.32%. The mortality rate is8%.

The use of NexoBrid™ enzymatic debridement and coagulation abnormalities

ObjectivesCurrent evidence on how the use of bromelain-based enzymatic debridement techniques (NexoBrid™) affect patient coagulation is limited. A single patient case report [1] suggests that a patient with 15% total body surface area (TBSA) burn developed decreased coagulation activity following debridement with NexoBrid™ enzymatic debridement (ED). Regional Burns Centres in the United Kingdom may be reluctant to use ED, particularly in larger burns, citing concerns regarding coagulation. At our centre we have routinely used ED on deep partial thickness burns since 2017 including on patients with burns over 15% TBSA. This study aims to investigate whether there is a significant disruption in coagulation in patients undergoing ED with burns > 15% TBSA or admitted to intensive care compared to the standard of care (SOC) which is surgical debridement in theatre. MethodsThis single-centre retrospective study includes all patients with a burn treated with ED at Pinderfields General Hospital Regional Burns Centre intensive care unit (ITU) from 2017 to 2020. Patients were matched to those treated with SOC at the same centre by age, % TBSA burn and presence of inhalational injury. These parameters correlate with the Baux score [9]. Percentage of burn debrided was matched as closely as possible, with coagulation profiles and platelet count taken the day before, the day of and three days following surgery. ResultsThirty-one patients were treated with ED in the intensive care unit between 2017 and 2020. Four patients were excluded due to insufficient records and one patient was anti-coagulated. Twenty-six patients were included and matched as described above. Average age of patients receiving ED was 44 years, the same in the matched group. Average TBSA burn is 35.5% (35.8% in matched group). No statistically significant difference in coagulation was seen between patients undergoing ED compared to SOC when considering prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count. Both groups slightly breached the upper limit of normal on day 2 post ED and SOC. There was a slight breach of the lower limit of the average platelet count on day 2 post-ED which was neither statistically nor clinically significant. ConclusionsLarge burns are associated with coagulation abnormalities, therefore isolating a single variable in this cohort is challenging. However, this study found no significant change following ED use when compared to SOC and therefore no convincing evidence that ED is associated with coagulation abnormalities. This study represents one of the largest focusing on coagulation abnormalities following the use of ED, as the current literature is limited. Our study suggests that concerns regarding coagulation abnormalities should not prevent patients with large, deep partial thickness burns or full thickness burns being treated with ED.

761 Albumin to Alkaline Phosphatase Ratio in Burn-Induced Liver Damage

Abstract Introduction Liver damage following burn injury is associated with a poor prognosis. Thus, prevention, and early identification, of burn-induced liver damage will improve the outcomes of burn patients. Aspartate-aminotransferase (AST) and alanine-aminotransferase (ALT) help detect liver injury in extensive burns >50% of Total body surface area (TBSA). However, their efficacy may be questionable in burns < 50% TBSA. Clinical reports describe albumin to alkaline phosphatase ratio (AAPR) to predict liver injury and dysfunction more accurately than AST and ALT in pathologies like non-alcoholic fatty liver disease and primary liver tumors. However, this ratio has never been tested in burn victims. Herein, we hypothesize that the AAPR may be more useful in detecting burn-induced liver damage. Given that liver biopsies are invasive methods with several complications, we correlated liver histological findings from a burn injury murine model Methods Livers and serum were collected from C57BL/6 8-12 weeks female mice, 1, 2, and 4 days after a 15% TBSA scald burn, n=5/group. Histological findings were scored by a pathologist blindly. Serum liver function tests were measured with a colorimetric method. We also conducted a pilot, prospective observational study on 58 burn patients admitted to the Burn Intensive Care Unit (ICU) to follow AST, ALT, and AAPR values. Furthermore, in an initial survival model, we correlated hospital days of stay with the AAPR values Results In our murine model of burn injury, liver damage worsens with time. Compared to postburn day 1 the histological damage score significantly increased by 75% at 4 days postburn. AST and ALT were elevated within the first day; however, their values normalized by day 3 postburn, failing to match the progression of liver injury showed by histology. Comparing postburn day 1 the AAPR significantly decreased by 40% on postburn day 4. The enrolled patients were mostly male (74%), with a median age of 50 and an average TBSA of 9.13%. While AST-ALT did not show significant changes in the first 2 weeks after burn, the AAPR on an initial run of a linear model of day predicting ratio decreased over time by -0.08/day (p=0.006). Moreover, our statistical model detected that the likelihood of discharge from ICU increases with the AAPR ratio (Hazard-Ratio 1.18/0.01 increase ratio p =0.003) Conclusions AAPR showed a better correlation of burn-induced liver injury in mice than AST and ALT. AAPR decreases in burn patients and may represent postburn liver alterations. AAPR increase raises the likelihood of ICU discharge Applicability of Research to Practice Identification and monitoring of liver injury and dysfunction with new modalities may improve the outcome of burn patients

99 Retrospective Review of Pediatric Fluid Resuscitation at a Large Burn Center

Abstract Introduction Foundational approaches to burn fluid resuscitation were largely developed with the adult patient in mind. Experience has shown, however, that physiologic nuances between adults and children necessitate an adjusted approach to resuscitation for pediatric patients. As practice has advanced to account for these differences, our burn center sought to evaluate efficacy of resuscitation for our pediatric patient population. The purpose of this study was to examine pediatric fluid resuscitation including trends and complications, and to establish a baseline for future quality improvement initiatives. Methods This was a retrospective review of pediatric patients <14 years of age treated with resuscitation in a burn center between 2017 and 2021. Descriptive statistics were calculated. Results Over a five-year period, 42 pediatric patients were admitted with a burn total body surface area (TBSA) >20%, of which 23 met inclusion/exclusion criteria. Average admission weight was 31.8 kg and average TBSA of 39%. Contributing mechanisms of injury were flame (61%), scald (35%) and chemical (4%). Concomitant inhalation injury was diagnosed in 17% of patients. Average hourly fluid resuscitation volume was 6.9 mL/kg/TBSA with a mean resuscitation duration of 25.7 hours. Total volume administered throughout resuscitation exceeded recommendations per the Parkland formula for 83% of the sample. Continuous albumin was administered for 74% of patients and was initiated on average at 10 hours post-injury. Boluses of lactated ringer’s and albumin were administered for 30% and 9% of patients, respectively. Urine output for the pediatric patients averaged 60 mL/hr with a mean low optimal urine output of 15.9mL/hr and high optimal output of 25.5 mL/hr. Adverse events occurring during fluid resuscitation included temperature < 36◦C (35%), vasopressor administration (9%), intra-abdominal pressure >12 (13%) and/or >19 (9%), and peripheral vascular pulses < +1 (61%). Prophylactic escharotomy was performed for 35%. Of note, none of the patients were diagnosed with compartment syndrome nor abdominal compartment syndrome and none required abdominal laparotomy. One patient (4%) was diagnosed with acute respiratory distress syndrome. Continuous renal replacement therapy (CRRT) was not utilized for any pediatric patients during or post-resuscitation, compared to 34% of adults resuscitated at the same center. No patients expired in the initial 48 hours post-burn. The overall survival rate for this population was 91.3%, with 87% discharged direct to home. Conclusions Resuscitation volumes for pediatric patients in a large burn center have exceeded historically accepted rates for resuscitation. Despite the divergence from traditional practice, associated complications remain low, and outcomes have been favorable. Applicability of Research to Practice Further research is needed to establish benchmarks for pediatric fluid resuscitation.

High incidence of adult respiratory distress syndrome associated with amphetamine use in the burn population: a retrospective cohort study.

A total of 188 patients age 18 and older with total body surface area (TBSA) between 20 and 60% were sampled over 5 years. To capture the moderate to severe burn population, a lower limit of 20% was chosen while 60% was used as the upper limit to exclude patients likely to die from the burns alone. Patients eligible to be include in the study had to meet the TBSA criteria. Demographic data was ascertained. Patients were placed into two cohorts: the amphetamine positive group (AmPOS), the amphetamine negative group (AmNEG). Key endpoints included hospital mortality, length of ICU stay, development of ARDS, and cardiac output parameters. Nonparametric data was evaluated with the Mann-Whitney test and categorical variables were compared using χ 2. Data from 49 patients with ARDS were collected retrospectively out of the 188 patients in this TBSA range. The incidence of amphetamine abuse in these burn patients is 14.9%. The average age of AmPOS and AmNEG patients was 36 and 34 and the average TBSA of burns in the AmPOS and AmNEG group was 51.8 and 45.2%. The mean onset of ARDS was 2.2 days for the AmPOS versus 3.3 days for the AmNEG (P=0.19). At admission, patients with amphetamine use exhibited less inhalational injury and a lower Acute Physiology and Chronic Health Evaluation II (APACHE II) score. In AmPOS, 64% developed ARDS compared to 19% in AmNEG (P<0.001). Mortality, time on a ventilator, ICU days, packed Red Blood Cell, Fresh Frozen Plasm, platelets transfused, and initial cardiac parameters all were not statistically significant. On the initial date of ARDS diagnosis, there was no statistically significant difference with PaO2/FiO2 and compliance (P=0.67), but positive end expiratory pressure requirements was higher in AmPOS (P=0.018). Amphetamine Use was associated with increased risk of developing ARDS in the burn population. This is despite having a better APACHE II and lower incidence of inhalational injury in the AmPOS group, supporting amphetamine as an independent risk factor for ARDS.

Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study.

Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China. Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records. A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome. We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.

Ocular-periocular burns in a tertiary hospital: Epidemiologic characteristics

Ocular burns are ophthalmic emergencies that can cause devastating injuries. This study aimed to analyze the epidemiology, complications, and management of ocular-periocular burns. A total of 193 patients with ocular-periocular burns were admitted to our tertiary hospital from January 2018 to December 2020. The demographic characteristics of the patients, injury variables, complications, and treatments were evaluated. There were 142 male (73.6%) and 51 female (26.4%) patients with a mean age of 32.53±17.75 years. The average total body surface area was 12% (range, 1-80%). Injuries were most common at work (52.3%) and home (36.3%). Thermal burns were the most common injuries (74.6%), followed by chemical (14.5%) and electrical burns (10.9%). Alkaline agents (75.0%), mainly sodium hydroxide and lime, were common in chemical burns. Superficial lid burns were significantly higher in the thermal group (p<0.001), and grade III-IV corneal burns were significantly higher in the chemical group (p<0.001). Various complications were developed in 50 (13%) eyes. Medical treatment only was performed in 318 (82.4%) eyes, and additional surgical treatment was performed in 64 (17.6%) eyes; however, 54 (14.0%) underwent more than one surgery. The most common complications were corneal scars (7.3%), limbal deficiency (4.1%), and ectropion (3.9%). The most frequent procedures performed were amniotic membrane transplantation (AMT) (11.9%) and tarsorrhaphy (6.7%). Chemical burns, limbal and conjunctival ischemia, and full-thickness eyelid defects had a poor prognosis. The degree of limbal deficiency and ınjury of intraocular structures were found to have a great influence on the outcome of their visual acuity.

520 Efficacy of high volume hemofiltration (HVHF) with step-down approach in critically ill burn patients

IntroductionContinuous renal replacement therapy (CRRT) is the standard of care for critically ill burn patients with acute kidney injury. Historical mortality rates for burn patients requiring CRRT is over 50%. High volume hemofiltration (HVHF) is a purification method that may have superior outcomes in the critically ill but has not been well studied in burn patients. We report results of utilizing HVHF with a step-down approach in our burn center.MethodsRetrospective review of all adult burn patients at a verified adult and pediatric burn center requiring continuous veno-venous hemodiafiltration (CVVHDF) from 2018 to 2021 when HVHF (50ml/kg/hr) for 18-24 hours with a step-down approach (25-30ml/kg/hr) was started. A normocarbia bicarbonate based dialysate was used with blood flow rates of 200ml/hr along with citrate anticoagulation. Demographics, indications and duration of CVVHDF, duration of vasopressor requirements, days on mechanical ventilation, length of stay, correction of acidosis and mortality were recorded.ResultsThirteen patients were identified, of which four were excluded as they had an exfoliative skin disease (two patients) or were treated with conventional CVVHDF (two patients). Of the remaining nine patients (six male and three female) the average age was 58.7 years (range: 42-75) and average total body surface area burn (%TBSA) was 46% (range: 20-92). All patients were diagnosed with AKI (Acute Kidney Injury Network [AKIN] Class III) with the indication for CRRT being diuretic resistant fluid overload in three patients and sepsis in the remaining six patients. Of the three patients with fluid overload, two developed sepsis while on CRRT. Acute respiratory distress syndrome (ARDS) as defined by the Berlin criteria was noted in six patients (66%). Three patients died (33% mortality) with the remaining six being eventually converted to intermittent hemodialysis and progressing to renal recovery. Amongst survivors, the duration of CRRT ranged between 7-33 days (average 13.8 days) and duration of vasopressor support from 1-30 (average 17 days). Metabolic acidosis resolved in all survivors within 48 hours. No hemorrhagic events were noted and all patients tolerated regional citrate anticoagulation well. Reduction in serum creatinine was noted to be significant.ConclusionsHigh volume hemofiltration resulted in improved mortality rates compared to what is reported in the literature. Further research and comparative studies are required to determine if HVHF with a step-down approach is superior.

76 A Retrospective Review of Factors Influencing Return to Work/school in Burn Patients

IntroductionTreatment and time to healing for burn injuries is largely dependent on the depth of the burn, location, and size. Treatment varies and can include any or several forms of dressings, surgery to remove eschar, allografting, autografting, depending on the depth of the burn. Hospitalization time ranges from days to months. Once discharged, patients continue to follow-up with burn specialists to ensure burns are healing properly. The time it takes a burn patient to return to work or school differ and can be dependent on many factors including personal choice. The objective of this study was to assess the time it took patients to return to work or school following burn injuries and help identify potential factors influencing their return time.MethodsA retrospective chart review of patients aged > 5 years, with TBSA > 10%, requiring hospitalization for > 7 days in a two-year span (2018-2019) was performed. Patients who did not report employment during admission and those who expired during hospitalization were excluded. IRB approval was obtained to contact patients via telephone who did not report a return to work or school date during their outpatient follow-up.ResultsThere were a total of 1579 burn admissions from 2018-2019, 93 of those patients met final protocol criteria. Seventy-four of those patients returned to work/school (RTW), and nineteen did not return to work/school (N-RTW) as of chart review date. The average total body surface area (% TBSA) for RTW was 18.30 vs. 33.08 for NRTW (p=0.0002). The average length of stay (LOS) for RTW was 23.55 vs. N-RTW 51.15 (p=0.0102). Exact return to work/school dates were obtained from 67 patients. The average length of days to return to work/school (n=67) was 102.19 post discharge, the minimum was 2 days, and the maximum was 785 days. There were 9 patients in the N-RTW group who filed for disability.ConclusionsResults suggest the average days per %TBSA it takes for burn patients to return to work or school is 5 days. Additionally, larger %TBSA burned and longer hospital LOS also adversely affected return to work. Additional studies are needed to identify additional factors influencing return to work and to identify methods to hopefully improve the ability to return to work.

733 Massive Burn Injuries: Characteristics, Treatment Strategies and Outcomes from a Single Institution

IntroductionAdvances in burn care have led to improved survival, with survival after a 50% total body surface area (TBSA) or larger burn being more common. Traditionally, age, TBSA burned, inhalation injury, delayed resuscitation and evidence of early organ dysfunction have been predictive of survival. The goal of this study was to describe a large series of massive burn injuries, treatment strategies and identify factors related to survival.MethodsFollowing IRB approval, a retrospective review of adult patients who sustained 50% TBSA or larger burn from 8/2009 to 7/2019 at an ABA verified burn center was conducted. Demographic, burn size/depth, mechanisms of injury, treatments, and outcome data were collected. Univariate and multivariate analyses were performed using R statistical software (R-project.org).Results155 patients were included which was 4.7% (155/3312) of all burn admissions during that time internal. Patients had an average age of 44±18 years, a male predominance (79%), and average TBSA burned of 70±15%. Overall mortality was 54% (83/155). One third of patients were transitioned to comfort care. The 103 treated patients were younger (37±12 vs 59±19 years; p=< 0.0001), more likely to be male (85 vs 65%; p=0.006), had smaller average TBSA (66±13 vs 78±16%; p< 0.0001) and more likely to have a psychiatric condition (31 vs 13%; p=0.02). Approximately 70% of treated patients survived to discharge. Survivors were more likely to have smaller TBSA (63±13 vs 73±13; p=0.001) and less third-degree burns (49±24 vs 61±24; p=0.01). One third of treated patients developed renal failure. One quarter of patients had a mental health condition, and these patients spent more time in the hospital (61 vs 31 days; p=0.009), more time on ventilator (29 vs 12 days; p=0.046), required more surgery (3 vs 2; p=0.048), and were less likely to die (36% vs 59%; p=0.02). On multivariate regression analysis of treated patients, psychiatric illness (OR 0.19; p=0.03) and burns related marijuana/hash oil production (OR 0.13; p=0.015) were protective against mortality.ConclusionsSurviving burns >50% TBSA is becoming more common as burn care continues to improve. Mortality in this study is lower than what would be predicted by an established revised Baux score regression model (predicted 61% overall mortality and 48% for treated). Care for these massive burn injuries is complex and requires an experienced multidisciplinary team. There is an established link between burn injuries and mental health conditions. Despite similar burn size/depth, patients with a mental health history spent significantly more time in the hospital, more time on the ventilator and required more surgery.

550 Considerations for Ophthalmologic Evaluation to Reduce Ocular Morbidity in Facial Burn Patients

IntroductionAdvances in burn management have led to significant improvement in survival rates, even in patients with high total body surface area (TBSA) affected. Ocular morbidity in facial burn patients remains high, partially attributable to the life-threatening nature of these injuries. Previous studies have shown that early ophthalmologic intervention leads to better outcomes, however, specific risk factors for short and longer term ophthalmologic outcomes have not been elucidated. This study aimed to identify risk factors for short- and long-term ophthalmologic complications in facial burn patients to prioritize patients that require urgent ophthalmologic evaluation.MethodsRetrospective review of facial burn patients presenting to an American Burn Association-verified regional burn center between June 2007 and May 2016 was conducted. Demographics, presentation, time to ophthalmologic consultation, and short- and long-term complications were recorded. Odds ratio and multivariate analyses were performed to assess for significant risk factors.ResultsA total of 1,126 facial burn patients were identified, of which 135 (12%) involved periorbital and orbital injury. Average TBSA burned was 9.68%, with an average facial surface area burned of 1.56%. The most common ocular injury was eyelid burn (65.9%). Ophthalmology was consulted for 118 (87.4%) patients. Short-term ophthalmologic complications were noted in 58 (43%) patients, most commonly chemosis (n = 34, 25.2%). Long-term complications were rare, occurring in only 7 (5.2%) patients.Odds ratio analysis revealed that inhalation injury significantly increased the likelihood of both short- and long-term complications (OR 3.16 and OR 9.81, respectively). Active smoking increased the likelihood of long-term complications (OR 14.76). Ophthalmologic intervention, including need for consult, and use of lubricant, antibiotics, or steroids were each associated with increased risk of short-term complications.On multivariate analysis, those with long-term complications tended to be older (p = 0.045). Those with corneal injury generally had worse outcomes, with higher likelihood of short- and long-term complications (p < 0.001, p = 0.057, respectively).Blindness did not occur in any patient, and no long-term complications occurred in those who did not receive ophthalmologic consult. Neither TBSA nor facial SA burned was associated with the development of short- or long-term complications.ConclusionsProviders should obtain early ophthalmologic evaluation and frequent follow-up exams for facial burn patients presenting with advanced age, active smoking status, corneal injury, or inhalation injury to reduce development of long-term complications.

Decrease in MRSA Bacteremia After Implementation of Intranasal Mupirocin Decolonization Protocol

Background: Methicillin-resistant Staphylococcus aureus (MRSA) remains a key pathogen in burn patients and is associated with increased morbidity and mortality. Disruption of skin barrier exposes these individuals to a myriad of infections. Various decolonization approaches, including chlorhexidine baths and intranasal mupirocin, have shown favorable outcomes in preventing MRSA infections in this cohort. Methods: In August 2020, a mupirocin decolonization protocol was implemented in Michigan’s largest trauma-level 1 burn intensive care unit. All patients admitted to the burn unit received daily intranasal mupirocin for the initial 5 days of hospitalization. We compared MRSA bacteremia rates per 1,000 patient days from January–July 2020 to those after August 2020. A hospital-acquired MRSA bacteremia infection was defined as a positive blood culture after hospital day 3. Patient characteristics and hospital course were collected through medical chart review. A 2-tailed t test was used for analysis. Results: We identified 5 cases of hospital-onset MRSA bacteremia and no cases of community-onset MRSA bacteremia. On average, there were 2.6 cases per 1,000 patient days before mupirocin implementation and 1.0 cases per 1,000 patient days after mupirocin implementation (P = .26) (Figure 1). In this patient cohort, the average total body surface area burned was 45.6% (range, 18%–90%), and 60% (n = 3) of patients had sputum culture positive for MRSA prior to developing bacteremia (Table 1). Also, 2 patients (40%) with MRSA bacteremia died. Notably, the patient in the postintervention cohort was admitted in July, prior to implementation. Conclusions: Implementation of a decolonization protocol with intranasal mupirocin in burn-surgery patients markedly decreased the incidence of MRSA bacteremia in this cohort. This is the first study to evaluate the use of mupirocin as a decolonizing agent in burn victims. Continued long-term surveillance is recommended, and this strategy has potential for application to other high-risk cohorts.Funding: NoDisclosures: None

Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia.

IntroductionThe purpose of this study was to explore and compare the performance of four burn injury scoring systems in Indonesia. In a retrospective study, data of all burn patients admitted to the emergency centre (EC) were collected. The following clinical outcome and four burn injury scoring systems were used to assess each patient: Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, and revised Baux Score.MethodsFrom April 2017 to April 2018, clinical outcome and burn injury score for every admitted patient were calculated to evaluate burn prognosis. Demographic information, ABSI score, full-thickness total body surface area (TBSA), overall TBSA, hospital stay, and inhalation injury were noted for analysis. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer–Lemeshow tests.ResultsWe included 72 patients (mean age: 40.79 ± 16.30 years, average TBSA: 23.59% ± 24.84). Only 1 (1.4%) of them was diagnosed with inhalation injury. Mortality rate was 25%. Deceased patients had significantly higher mean age, %TBSA, and number of inhalation injuries. The ABSI model with sensitivity was 81.6, specificity was 92.5, accuracy was 87.3 and under the Receiver Operator Characteristics curve (AUC) was 0.93 (SE = 0.03).ConclusionsThe best estimation of predicted mortality was obtained with the ABSI model.

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

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. 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.

76 Survival Outcomes from Burn Injury in Rural Africa

Abstract Introduction Burn injuries contribute a considerable burden of disease in variable-resource settings, often resulting in mortality. Despite contributing a substantial burden, outcomes from burn injuries in rural Africa are rarely described. The objective of this study was to examine factors associated with mortality from burn injury in rural Africa. Methods A retrospective chart review was conducted for all patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in eastern Africa. Bivariate analysis was used to compare patients who survived the hospital stay with those who did not. Using total body surface area (TBSA), the LD50 (Lethal Dose 50, burn size with a lethality of 50% of patients), and the modified-Baux score were calculated. Due to small sample size, lasso inference techniques for logistic regression were utilized to avoid overfitting a model and to determine relevant risk factors for mortality, by evaluating burn severity, age, sex, location of residence, payer status, time from injury to arrival, distance from hospital, presence of full thickness burns, inhalational injury, and referral status. Results A total 171 burn injury patients were reviewed for this study; two were excluded due to missing data. Among 169 patients, 14.8% (n=25) experienced mortality prior to hospital discharge. Fifty patients suffered an adverse event (29.6%) including: 17 wound infections, 10 urinary tract infections, 10 with sepsis, and 25 with respiratory complications. The LD50 for TBSA was 42%. The LD50 for the modified-Baux score was 81. Non-survivors had higher average TBSA (31.0±5.0% vs 11.5±0.8%; p&amp;lt; 0.01), more inhalational injury (44% vs 2.8%, p&amp;lt; 0.01), full-thickness burns (56.5% vs 23.9%, p&amp;lt; 0.01), and complications (88% vs 19.4%, p&amp;lt; 0.01). Odds of mortality increased 1.06 times for every percent increase in TBSA burn (95%CI: 1.02, 1.11; p&amp;lt; 0.01) and 13.9 times with inhalational injury (95%CI: 3.4, 56.4; p &amp;lt; 0.01). Conclusions Mortality from burn injury represents a substantial portion of patients at a hospital in rural Africa. Factors of larger TBSA and inhalational injury represent the greatest risk.

651 Inconspicuous Donor Sites- A Patient-Centered Approach to Donor Site Management with Autologous Skin Cell Suspension

Abstract Introduction Donor site morbidity (DSM) is a major patient dissatisfier due to pain and scarring leading to aesthetic and functional limitations acutely and over time. Many of the recent advancements in burn care such as autologous skin cell suspension (ASCS), cultured tissues, and engineered tissues are driven to reduce DSM. One of the most important advancements in reducing DSM has been the approval of ASCS. Our study assesses donor site (DS) location using real-world data after ASCS procedures with an inconspicuous surgical approach for DS. Methods An IRB approved, retrospective chart review of all burn patients undergoing ASCS at an American Burn Center verified burn center between January 2019 and August 2020 was completed. Patients were excluded who received ASCS in combination with widely meshed skin graft or who died during their hospitalization. Demographics were reported including age, gender, % total body surface area (TBSA), length of stay (LOS), ASCS size in cm2 and % TBSA, and location of burn. All DS were harvested at 0.004–0.008 inch after clysis of the prep site with injectable saline and 0.25% Marcaine with a dermatome or Weck knife. Photographs of the DS and burn wounds were uploaded to the EMR by the surgeon of record and assessed by two experienced burn nurses that were blinded to DS location and intraoperative procedures. Results 83 patients underwent ASCS with 25 patients meeting inclusion criteria. The average age was 33 years (range 15 months to 88 years). 68% of patients were male with an average TBSA of 11% (range 2.5–40). The mean LOS was 5.8 days (range 1–16). Burn locations included face/neck (n=9), torso (n=16), extremity (n=20), hand (n=10), and two patients had single site involvement. The adult patient average size of ASCS applied was 1700cm2 (range 250–6200) while pediatric patients had an average size of 13% TBSA (range 6–32). 21 of the 25 patients had DS adjacent to the burn. No significant difference was noted in healing time, infection rate, or hypertrophic scarring. None of the patients complained of DS pain that was distinguishable from the burn wound. Blinded observers were unable to discern the DS in 56% of the patients from the initial burn wound. Conclusions DSM is an iatrogenic insult to non-burn skin and a significant cause of morbidity. ASCS DS may be taken adjacent to the burn wound without risk of delayed re-epithelization, infection, or hypertrophic scarring. Placing ASCS DS adjacent to the burn wound is a more patient-centered approach with indistinguishable pain from the burn wound, a more pleasing cosmetic outcome, and potential greater patient satisfaction.

654 Successful Wound Closure in Patients with Large Total Body Surface Area Calciphylaxis with Aggressive Multi-modal Therapy Including Excision and Skin Grafting

Abstract Introduction Calcific Uremic Arteriolopathy (CUA), commonly known as Calciphylaxis, is a rare disorder characterized by ischemic necrosis of the skin and histologically by arteriolar calcification. CUA is most commonly seen in patients with end-stage renal disease (ESRD) but can be seen in other patients as well. CUA carries an extremely high mortality rate, with up to 80% in some studies, even in patients with limited disease. In light of this, many surgeons have adopted a “do-not-touch” practice with these patients. Over the past several years, our institution has seen an increase in referrals for the management of large total-body-surface-area (TBSA) CUA. Methods Retrospective review of all patients with biopsy-proven (by dermatopathology) large TBSA (&amp;gt;=5% TBSA) CUA admitted to a Verified Adult and Pediatric Burn Center from 2015 to present. Demographics, laboratory data, treatment modalities and outcomes including mortality and wound closure were recorded. Results A total of 8 patients with large TBSA CUA were admitted after being transferred from outside hospitals. Average TBSA affected was 13.76% (SD 7.27). 6 of these patients (75%) were noted to have non-uremic calciphylaxis. All patients had positive wound cultures on admission, and 1 patient (12.5%) developed a bacteremia in hospital. There were no central line associated bloodstream infections, catheter associated urinary tract infections or ventilator associated infections. All patients underwent surgical debridement (average 4.125, range 2–5), and 5 patients (62.5%) underwent grafting, (average 1.6, range 2–5) and subsequently proceeded to wound closure. In-hospital mortality was 25% and another patient was referred to a hospice facility after being readmitted with medical complications of her calciphylaxis. Secondary findings included 50% of the patients recently experienced significant weight loss (&amp;gt;100 lbs). On admission, 2 patients (25%) had abnormal serum calcium, 3 patients (37.5%) had abnormal serum PO4, and 4 (50%) patients had abnormal PTH levels. 2 patients (25%) had a recent exposure to warfarin (within 6 months). Conclusions Utilizing a multi-modal management strategy that includes surgical debridement and skin grafting, patients with calciphylaxis can progress to wound closure.

Firework and sparkler burns in paediatric patients

Background: While the consumer sale of fireworks is illegal in New South Wales, the sale of sparklers is legal—however, both still pose a significant risk of harm in the paediatric population. Anecdotally, burns services are aware that the misuse of sparklers can result in burns but there appears to be a paucity of studies examining this incidence in the paediatric population in Australia.Method: A retrospective review of all burns related to the use of fireworks or sparklers referred to the Children’s Hospital at Westmead (CHW) Burns Unit (BU) from January 2004 to December 2019. Results: 96 patients were referred to the CHW BU with a burn as a result of a firework or sparkler. Sparklers accounted for 69 (72%) of burns, compared with 27 (28%) from fireworks. The mean age of those injured by sparklers was five years compared with eight years in the firework group. Average total body surface area (TBSA) affected for both mechanisms was similar—for sparkler burns (2.0%) firework burns (2.4%), with a range of 0.1–15 per cent. Hands were the most common area burnt in both groups comprising 41 (59%) of sparkler burns and 13 (48%) of firework burns. Twenty patients required a total of 32 visits to the operating theatre for acute management of their burns.Conclusion: This study demonstrates the potential for significant injuries as a result of fireworks and sparklers. These findings can be used to raise awareness regarding their dangers, direct targeted educational campaigns and guide safety advice regarding their use.