Surface Area Burn Research Articles

Nonsevere Burn Induces a Prolonged Systemic Metabolic Phenotype Indicative of a Persistent Inflammatory Response Postinjury.

Globally, burns are a significant cause of injury that can cause substantial acute trauma as well as lead to increased incidence of chronic comorbidity and disease. To date, research has primarily focused on the systemic response to severe injury, with little in the literature reported on the impact of nonsevere injuries (<15% total burn surface area; TBSA). To elucidate the metabolic consequences of a nonsevere burn injury, longitudinal plasma was collected from adults (n = 35) who presented at hospital with a nonsevere burn injury at admission, and at 6 week follow up. A cross-sectional baseline sample was also collected from nonburn control participants (n = 14). Samples underwent multiplatform metabolic phenotyping using 1H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry to quantify 112 lipoprotein and glycoprotein signatures and 852 lipid species from across 20 subclasses. Multivariate data modeling (orthogonal projections to latent structures-discriminate analysis; OPLS-DA) revealed alterations in lipoprotein and lipid metabolism when comparing the baseline control to hospital admission samples, with the phenotypic signature found to be sustained at follow up. Univariate (Mann-Whitney U) testing and OPLS-DA indicated specific increases in GlycB (p-value < 1.0e-4), low density lipoprotein-2 subfractions (variable importance in projection score; VIP > 6.83e-1) and monoacyglyceride (20:4) (p-value < 1.0e-4) and decreases in circulating anti-inflammatory high-density lipoprotein-4 subfractions (VIP > 7.75e-1), phosphatidylcholines, phosphatidylglycerols, phosphatidylinositols, and phosphatidylserines. The results indicate a persistent systemic metabolic phenotype that occurs even in cases of a nonsevere burn injury. The phenotype is indicative of an acute inflammatory profile that continues to be sustained postinjury, suggesting an impact on systems health beyond the site of injury. The phenotypes contained metabolic signatures consistent with chronic inflammatory states reported to have an elevated incidence postburn injury. Such phenotypic signatures may provide patient stratification opportunities, to identify individual responses to injury, personalize intervention strategies, and improve acute care, reducing the risk of chronic comorbidity.

Minority pediatric burn survivors undergo more burn operations: A single center’s five-year experience

Burn injuries remain a significant source of trauma in the United States and disproportionately affect racial and ethnic minorities. Although disparities are well documented in adults, less is known regarding those in pediatric populations. To address this gap in literature, we aim to better characterize burn injuries, inpatient treatments, and post-discharge outcomes in minority pediatric burn patients. We hypothesize minority patients undergo more surgery and re-admissions than non-minority patients for burn care. This is a single institution retrospective chart review of pediatric patient admissions with burn injuries from July 1st, 2016 to July 1st, 2021. Demographics, details of injury, inpatient surgical and non-surgical care, and post-discharge outcomes were collected. Patients identifying as Hispanic/Latino, Black, and Asian were coded as minority patients. Univariate analysis was utilized. A total of 332 patients with average age of 4.9 years (SD: 4.4) and average total burn surface area (TBSA) of 8.5% (SD: 10.0) were collected. Minority patients were significantly more likely to experience accidental burn injury (p < 0.01), inhalational injury (p < 0.01), surgical management (p < 0.01), and to undergo skin graft (p < 0.01) than White patients. Minority patients were significantly more likely to undergo laser treatment after discharge (p < 0.01) than White patients. Our study shows minority pediatric patients are at risk for non-intentional burn injuries that undergo surgical management such as skin grafting and longitudinal reconstructive procedures including laser therapy more often. Short-term goals should include facilitating improved physical and psychosocial outcomes in this often-underserved patient population.

Fragmentation of Care After Admissions for Burn: An Analysis of the National Readmissions Database

IntroductionBurn patients require complex longitudinal care guided by a team with specific clinical expertise. Burn patients are at increased need for readmission, which may result in Fragmentation of care (readmission to hospitals other than the index hospital), that can lead to increases in mortality, length of stay, and financial burden. In the already-complex burn patient, negative effects of care fragmentation may be magnified. We hypothesized that specific patient and demographic factors would be associated with burn readmissions and fragmentation of care. MethodsUtilizing the Nationwide Readmissions database, we identified patients admitted between January and September 2017 with a principal diagnosis of burn readmitted to any hospital within 90 d of index discharge. Demographics, total burn surface area, Elixhauser comorbidities, and index discharge disposition were collected. Primary outcome was readmission to the same hospital as the index admission. Penalized multivariable logistic regression assessed factors associated with index hospital readmission. ResultsOf 9987 burn patients who survived an index burn admission, 1082 (10.8%) were readmitted. Approximately half (51.6%, n = 558) of readmissions occurred at the index hospital. Factors associated with readmission to the same hospital were disposition to home with home health care (odds ratio: 1.42 [1.02-1.96], P = 0.037), private insurance (odds ratio: 1.63 [1.07-2.49], P = 0.022), and ZIP code income quartile >$74,000 (OR 1.87 [1.26-2.78], P = 0.002). ConclusionsDisposition home with home health care, private insurance, and a ZIP code income quartile greater than $74,000 were associated with a lower odds of having fragmentated care. Our data suggest that fragmentation of care may be potentiating a disparity for lower-income burn patients.

The Timing of Operative Intervention for Pediatric Burn Patients in Malawi.

Defining the optimal timing of operative intervention for pediatric burn patients in a resource-limited environment is challenging. We sought to characterize the association between mortality and the timing of operative intervention at a burn center in Lilongwe, Malawi. This is a retrospective analysis of burn patients (<18years old) presenting to Kamuzu Central Hospital from 2011 to 2022. We compared patients who underwent excision and/or burn grafting based on the timing of the operation. We used logistic regression modeling to estimate the adjusted odds ratio of death based on the timing of surgery. We included 2502 patients with a median age of 3years (IQR 1-5) and a male preponderance (56.8%). 411 patients (16.4%) had surgery with a median time to surgery of 18days (IQR 8-34). The crude mortality rate among all patients was 17.0% and 9.1% among the operative cohort. The odds ratio of mortality for patients undergoing surgery within 3days from presentation was 5.00 (95% CI 2.19, 11.44) after adjusting for age, sex, % total burn surface area (TBSA), and flame burn. The risk was highest for the youngest patients. Children who underwent burn excision and/or grafting in the first 3days of hospitalization had a much higher risk of death than patients undergoing surgical intervention later. Delaying operative intervention till >72h for pediatric patients, especially those under 5years old, may confer a survival advantage. More investment is needed in early resuscitation and monitoring for this patient population.

Current Trend in the Epidemiology of Thermal Burn Injury at a Tertiary Hospital in South Western Nigeria.

Worldwide, thermal burn is the leading etiological type of burn injury accounting for 86% of burn injuries requiring admissions. Flame, Scald, and contact burn are the leading causes of thermal burn. Changes in the sociodemographic characteristics of societies have led to alterations in the epidemiology of burn. An understanding of such changes in the epidemiology of burn is essential in formulating and executing adequate burn prevention programs. We sought to establish the current trend in the etiology, gender distribution, age, occurrence of inhalation injury, burn surface area, burn depth, and mortality rate of thermal burns at Ibadan. This was a retrospective study carried out between January 2013 and December 2022. Thermal burns constitute 92% of burn injuries. The male-to-female ratio was 1.4:1. There were 265 (45%) patients in the pediatric age group and 323 adults (55% of the patients). The proportion of flame, scald, and contact burns were 378 (58%), 203 (32%), and 14 (2%), respectively. Flame burns resulting from liquified petroleum gas (LPG) explosion show a rising trend, with a decline in flame burns from kerosene (P < .001). One hundred and ninety (32%) patients had inhalation injury. The overall mortality was 19% (N = 114). Kerosene flame, 38% (17 of 45 patients), and LPG, 32% (41 of 130 patients), were the most lethal causes of flame injuries (P < .043). The study shows the increasing contribution of LPG to the etiology of thermal burn injuries. Burn prevention programs should target safe use of LPG stoves and cylinders.

Improvement of Predictive Scores in Burn Medicine through Different Machine Learning Approaches.

The mortality of severely burned patients can be predicted by multiple scores which have been created over the last decades. As the treatment of burn injuries and intensive care management have improved immensely over the last years, former prediction scores seem to be losing accuracy in predicting survival. Therefore, various modifications of existing scores have been established and innovative scores have been introduced. In this study, we used data from the German Burn Registry and analyzed them regarding patient mortality using different methods of machine learning. We used Classification and Regression Trees (CARTs), random forests, XGBoost, and logistic regression regarding predictive features for patient mortality. Analyzing the data of 1401 patients via machine learning, the factors of full-thickness burns, patient's age, and total burned surface area could be identified as the most important features regarding the prediction of patient mortality following burn trauma. Although the different methods identified similar aspects, application of machine learning shows that more data are necessary for a valid analysis. In the future, the usage of machine learning can contribute to the development of an innovative and precise predictive score in burn medicine and even to further interpretations of relevant data regarding different forms of outcome from the German Burn registry.

Burn surgery

Burn injuries represent a special type of injury that requires special expertise. Both in adequate wound treatment and in intensive medical care, there are various special features that must be considered and due to which treatment by experienced medical personnel is necessary. In the clinical, but also in the preclinical course, the most important points in the treatment of the burn injury should be known to be able to guarantee adequate treatment. In this context, in addition to the knowledge of the different degrees of burns, the estimation of the burned body surface area (VKOF) is essential. Intensive medical treatment as well as surgical therapy of deep burn wounds should then be performed in a burn center. The article provides an overview of the classifications of burn injuries, the management of wound care, the various therapeutic options, both conservative and surgical, and the special features of burn disease.

Application of Cervical Epidural Anesthesia and Analgesia to the Patient with 90% Burnt Surface Area.

Patients with an extremely large, burnt surface area have a high mortality rate. The follow-up, treatment and intraoperative anesthesia practices of these patients in the ICU pose serious challenges. In this case, the experience of anesthesia and analgesia using cervical epidural anesthesia, which is not frequently used in anesthesia routine, applied to a patient with a 90% burnt surface area is shared. It was aimed to evaluate the contribution of effective non-opioid analgesia, early mobilization and nutrition applied to the patient's recovery.

Main Pathogens Causing Infections and Antibiotic Resistance Profile in Major Burns in Brazil Comparing Two Periods: 2015/2016 and 2019/2020.

Sepsis is the main cause of death in major burns. In this retrospective study conducted in a reference hospital in Brazil, the main agents causing infection and the resistance profile to antibiotics were identified. In addition, the epidemiological profile, length of hospital stay, type of burn, and total body surface area (TBSA) in major burns were collected from medical records, comparing the years 2015/2016 and 2019/2020. In both time periods, there was a predominance of males with a mean age of 43 years. Burns with less than 30% of TBSA predominated. There was a significant increase in positive cultures (P = .00026), from 58.7% to 80%, and an increase in skin punch culture collection from 25.6% to 43.9% in the years 2019/2020. The predominant etiological agent was Pseudomonas aeruginosa, followed by Acinetobacter baumannii resistant to carbapenems, and Staphylococcus aureus in both evaluated periods. The percentage of deaths was higher in 2019/2020 (26.2% vs. 14.6%; P = .026). The length of hospital stay was shorter in the latter period (P = .0081). Sepsis was the cause of death in 81.2% of cases in 2015/2020 and 78.3% in 2019/2020. Among the deaths, P. aeruginosa was the main agent identified. There was no change in the main pathogens and bacterial antibiotic resistance between the 2 time periods.

Do pre-burn center management algorithms work? Evaluation of pre-admission diagnosis and treatment adequacy of burn patients referred to a burn center.

Interventions for burn management until the patient is transferred to a burn center affect mortality and morbidity. Therefore, adherence to the developed algorithms is an important issue. This study aimed to determine deficiencies in different aspects of the implementation of these algorithms during the pre-admission diagnosis and treatment processes of patients referred to our burn center. This study involved a 4-year review of patients referred to our burn center. One hundred and seventy burn cases admitted by referral were enrolled in the study. Adequacy of resuscitation within the first 24 hours, adherence to guidelines, and mortality were investigated. Resuscitation performed within the first 24 hours was found to be inadequate in 88 patients (51.8%). When the burned surface area percentages were evaluated all percentages were calculated higher before arrival. There were 78 major burn cases (45.9%), and the frequency of inhalation burns, intubation requirements and renal failure were more common in this group compared to the minor burn group (P < .001). The frequency of intubation without accurate indications was found to be 70.58%. Inadequate escharotomy was detected at a rate of 52.9%, and inadequate fasciotomy at a rate of 66.6%. The mortality rate was 22.4% among all patients. Interventions undertaken during the period until the patients' referral to these centers affect mortality and morbidity. In this study, it was found that the pre-hospital applications generated were insufficient, and it was proposed that burn patient care algorithms be developed with in-service training throughout the country.

The Angiopoietin-2/Angiopoietin-1 ratio increases early in burn patients and predicts mortality

BackgroundAngiopoietin-2 (Angpt-2) is involved in the pathogenesis of the capillary leak syndrome in sepsis and has been shown to be associated with worse outcomes in diverse critical illnesses. It is however unclear whether Angpt-2 plays a similar role in severely burned patients during the early phase characterized by massive capillary leakage. Our aim was to analyze the Angiopoietin-2/Angiopoietin-1 ratio (Angpt-2/Angpt-1 ratio) over the first two days in critically ill burn patients and examine its association with survival and further clinical parameters. MethodsAdult burn patients with a total burn surface area (TBSA) ≥ 20% treated in the burn intensive care unit (ICU) of the University Hospital of Zurich, Switzerland, were included. Serum samples were collected prospectively and serum Angpt-1 and Angpt-2 were measured by enzyme-linked immunosorbent assay (ELISA) over the first two days after burn insult and stratified according to survival status, TBSA and the abbreviated burn severity index (ABSI). Due to hemodilution in the initial resuscitation phase, the Angpt-2/Angpt-1 ratio was normalized to albumin. ResultsFifty-six patients were included with a median age of 51.5 years. Overall mortality was 14.3% (8/56 patients). The total amount of infused crystalloids was 12́902 ml (IQR 9́362–16́770 ml) at 24 h and 18́461 ml (IQR 13́024–23́766 ml) at 48 h. The amount of substituted albumin was 20 g (IQR 10–50 g) at 24 h and 50 g (IQR 20–60 g) at 48 h.The albumin-corrected Angpt-2/Angpt-1 ratios increased over the first 48 h after the burn insult (d0: 0.5 pg*l/ml*g [IQR 0.24 – 0.80 pg*l/ml*g]; d1: 0.83 pg*l/ml*g [IQR 0.29 – 1.98 pg*l/ml*g]; d2: 1.76 pg*l/ml*g [IQR 0.70 – 3.23 pg*l/ml*g]; p < 0.001) and were significantly higher in eventual ICU non-survivors (p = 0.005), in patients with a higher TBSA (p = 0.001) and in patients with a higher ABSI (p = 0.001). ConclusionsIn analogy to the pathological host response in sepsis, the Angpt-2/Angpt-1 ratio steadily increases in the first two days in critically ill burn patients, suggesting a putative involvement in the pathogenesis of capillary leakage in burns. A higher Angpt-2/Angpt-1 ratio is associated with mortality, total burn surface area and burn scores.

#6505 POST-BURNS PERSISTENT INFLAMMATION LEADS TO KIDNEY PROGRAMMED CELL DEATH THROUGH ACTIVATION OF THE CASPASES SIGNALING PATHWAY

Abstract Background and Aims The underlying mechanism for the increased incidence of chronic kidney disease (CKD) in burn patients discharged from hospital remains unclear. Recent studies have shown that burn patients are discharged from the hospital with chronic inflammation despite normalization of all physiological parameters. We hypothesized that severe burns accelerate the onset and progression of CKD by activating persistent inflammation. This study aimed to investigate the long-term effects of severe burns on kidney and its possible mechanisms. Method The study was divided into three parts. First, to understand the effect of burns on the general population and the CKD population, 4-month-old C57BL/6 mice were divided into a blank control group (Blank) and an adenine-induced CKD group. Some mice were established by burns in a 10% total body burn surface area model at 5-month-old. Experiments were terminated at 7-month-old. The function, morphology, inflammatory response and oxidative stress of the kidney were assayed. Second, the effect of activated macrophages on podocytes was studied by in vitro experiments. Results In the Blank group, burns did not cause kidney function and weight alterations, but caused a small amount of organic lesions, glomerular atrophy, apoptosis, and macrophage infiltration. In the CKD group, burns not only significantly reduced kidney function, but also caused kidney atrophy, organic lesions, glomerular atrophy, apoptosis and macrophage infiltration. In addition, burns significantly increased Caspase-1 and -3 pathway expression in all mice. Electron microscopy showed that burns significantly aggravated glomerular injury in the CKD group, including podocyte injury, cell membrane blubbing and rupture. In vitro studies showed that polarized M1 macrophages increased MPC5 podocytes death. Conclusion Severe burns cause programmed cell death through activation of inflammation-induced Caspase-dependent pathways leading to kidney injury in mice. This phenomenon has a small effect on normal populations and a larger effect on CKD populations. This study has important implications for determining the prognosis of kidney function in burn patients and provides a promising therapeutic strategy.

Enteral glutamine supplements for patients with severe burns: A systematic review and meta-analysis

PurposeOur previous study in 2009 concluded that glutamine may shorten the length of hospital stay (LOS) in patients with severe burns. Recent large-scale studies have suggested a decline in the effectiveness of glutamine in treating patients with severe burns over the last decade. Therefore, we conducted this systematic review and meta-analysis to update the status of glutamine uses in patients with severe burns. MethodsWe retrieved related literature prior to December 2022 from the PubMed, Web of Science, Cochrane Library, Embase, SinoMed, Wanfang, and CNKI databases. Terms such as glutamine, enteral and burn were linked for searching. Adults patients with severe burns were included and non-randomized controlled trials were excluded. Data from studies that compared enteral glutamine for severe burns with a control group were extracted. The primary outcomes of mortality and infectious morbidities were pooled and analyzed. The modified Jadad scale and Cochrane collaboration's tool were used to assess the risk of bias in RCTs, and the Review Manager 5.4 was used to pool and analyze the data. ResultsSix randomized controlled trials involving 1398 patients were included in the analysis. There were no significant differences in overall mortality (risk ratio (RR) = 0.37; 95% confidence interval (CI): 0.06 − 2.37; p = 0.300) or infectious morbidities (RR = 0.73; 95% CI: 0.41 − 1.31; p = 0.290). The incidence of multiple organ dysfunction syndrome was similar between the 2 groups (RR = 0.27; 95% CI: 0.03 − 2.24; p = 0.220). The LOS (mean difference (MD) = −8.97; 95% CI: −15.22 to −2.71; p = 0.005) and LOS/total burn surface area (MD = −0.27; 95% CI: −0.54 to 0.00; p = 0.050) decreased in the enteral glutamine group. The incidence of wound infection was significantly reduced (RR = 0.42; 95% CI: 0.16 − 1.06; p = 0.070). ConclusionCompared to the control group, enteral glutamine administration may not improve the mortality, although it may be associated with a shorter LOS, a lower LOS/total burn surface area ratio, and may reduce the risk of wound infection in patients with severe burns.

Simulation of Solid Propellant Regression with Cracks Based on Level-Set Method

Traditional methods are difficult to deal with solid propellant regression in complex geometry, especially for a finocyl grain with cracks. In this work, the Level-Set method is adapted to solid propellant regression. The advantage of this method is the implicit representation of interface and no restriction on geometrical configuration. Therefore, tiny cracks can be easily captured by the Level-Set method without any complex grids. A three-dimensional solid propellant regression evolution process of a finocyl grain is presented. A one-dimensional unsteady internal ballistics numerical method is applied to obtain pressure and thrust time histories, coupled with the three-dimensional grain burnback model. The mass and energy injection in the governing equations can be computed from the Level-Set formulation. And the propellant burning rate can be computed from the local pressure. The results show that a crack increases the head-end pressure and thrust at early stage, because of the increment of the burning surface area. It can be seen from the evolution of propellant regression that the crack gradually expands.

63 Adjunctive Ketamine Reduces the Risk of Developing Chronic Opioid Use in Burn Patients

Abstract Introduction Opioid use for perioperative pain management in burn patients is associated with a high risk of developing chronic opioid use. Ketamine is commonly used as an analgesic adjunct due to its opioid-sparing effects. The purpose of this study is to determine whether analgesia with adjunctive ketamine reduces the risk of developing chronic opioid use in burn patients. Methods Burn patients who underwent burn-related surgeries were identified using relevant ICD-10 Codes. Data were collected using the TriNetX Research Network, a national research database providing de-identified patient medical records. Burn patients undergoing surgical procedures were identified based on their use of opioids alone or in combination with ketamine as adjunctive analgesia. Both groups excluded patients with a prior history of opioid-related and psychiatric disorders to control for potential pre-existing conditions affecting the study outcomes. Outcome analysis included continued opioid use and related psychiatric disorders, including nicotine dependence and anxiety, up to one year after burn injury. Risk ratios for each outcome were then generated using a measure of association analysis through TriNetX. Results We identified 107,270 patients across 51 health care organizations who underwent burn-related surgeries within one month after burn injury. Excluded from the study were 3,296 (3.07%) patients who had a prior history of opioid-related and psychiatric disorders. The remaining 103,974 patients were sorted into respective groups that received opioids with ketamine (n = 8,328) and without ketamine (n = 51,413). The two cohorts were balanced using (1:1) propensity score matching for age, sex, race, ethnicity, and burn surface area. Patients without ketamine had a higher risk of continuing opioid use (risk ratio [RR], 1.14, p &amp;lt; 0.001), developing nicotine dependence ([RR], 1.32, p &amp;lt; 0.001), and developing anxiety disorders ([RR], 1.21, p = 0.007) at least one year after burn injury. Conclusions Burn patients whose pain management included adjunctive ketamine ceased opioid use sooner and demonstrated a lesser risk of developing various psychiatric disorders associated with chronic opioid use. Applicability of Research to Practice This study supports the use of adjunctive ketamine as part of a multimodal approach to pain management in burn patients in order to minimize the risk of chronic opioid use.

291 Hypernatremia Is Associated with Acute Renal Dysfunction in Severe Burn Patients

Abstract Introduction Hypernatremia often occurs concurrently with acute kidney disease and is associated with increased mortality. It is a common electrolyte disorder presenting in severe burn patients, who are additionally at high risk for acute kidney disease. The purpose of this study is to determine if burn patients presenting with hypernatremia are at greater risk of developing acute kidney disease and related complications. Methods Patients diagnosed with severe burns (20% or more of total body surface area) were identified using the TriNetX Research Network and the relevant ICD-10 Codes. TriNetX is a national research database that provides real-time access to de-identified medical records. Burn patients were stratified into hypernatremic (serum sodium ≥ 145 mmol/L) and eunatremic (serum sodium between 135 and 145 mmol/L) groups. Both groups excluded patients with a prior diagnosis of diabetes or hypothyroidism, as both may render patients more susceptible to electrolyte dysregulation. Patients with a personal history of diseases involving the circulatory, urinary, and respiratory systems were also excluded to control for pre-existing conditions that may affect the outcomes of this study. We analyzed acute kidney disease, mortality, pulmonary edema, and respiratory failure one month after the onset of hypernatremia; these latter two complications are often associated with kidney injury. Statistical analysis was performed within TriNetX to generate the risk ratios and risk differences for each outcome. Results A total of 10,352 patients across 53 healthcare organizations were identified. Excluded from the study were 1,039 (10.04%) patients who were diagnosed with comorbidities. The remaining 9,313 patients were sorted respectively into the hypernatremic (n = 1,116) and eunatremic (n = 6,656) groups. The two cohorts were balanced using (1:1) propensity score matching for age, race, sex, ethnicity, and burn surface area. The hypernatremic group showed a greater risk of developing acute kidney disease (risk ratio [RR], 4.343, p &amp;lt; 0.001) and associated complications. Severe burn patients with hypernatremia had a 1.987 times greater risk of developing pulmonary edema (p &amp;lt; 0.001), a 2.896 times greater risk of developing respiratory failure (p &amp;lt; 0.001), and a 2.873 times greater 30-day mortality rate (p &amp;lt; 0.001). Conclusions Hypernatremia in severe burn patients is associated with an increased risk of developing acute kidney injury, mortality, and related pulmonary complications. Applicability of Research to Practice This study indicates that hypernatremia is a potential marker for the development of renal and pulmonary complications.

711 Analysis of the Risk Factors for Mortality in Elderly Burn Patients

Abstract Introduction The elderly experience higher mortality rates compared to younger burn patients with similar burn injuries. The aim of this retrospective study was to analyze the clinical factors affecting mortality in elderly burn patients admitted to single burn center. Methods Data were collected on all elderly burn patients admitted to Mackay memorial hospital burn center between 2010 to 2020, focused on the population over 60 years old. The demographic data, burn profiles, hospital length of stay, use of mechanical ventilation and inotropic agents, delayed burn-related complication and hospital mortality were studied retrospectively. Both univariate and multivariate analysis were used to identify the risk factors for mortality. Results 61 elderly burn patients were evaluated and flame was the most common cause of burns(57.4%). All of the burns involved more than 20% of total body surface area. Sixteen patients(26.2%) expired during hospitalization. Univariate analysis showed that the mortality among elderly burn patients was associated with age(P&amp;lt; 0.001), burn surface area(P&amp;lt; 0.001), burn grade(P=0.016), use of inotropic agents(P&amp;lt; 0.001), initial endotracheal tube insertion(P&amp;lt; 0.001) and delayed burn-related acute kidney injury(P&amp;lt; 0.001), sepsis(P&amp;lt; 0.001) as well as pulmonary edema(P&amp;lt; 0.001). We stratified the above risk factors into two subgroups: Initial presenting patient profile(Age, TBSA, Burn grade) and delayed burn-related complication(Acute kidney injury, Sepsis, Pulmonary edema). Multivariate logistic regression was used to analyze the two subgroups. We found that in the initial presenting patient profile subgroup, age(P=0.014) and TBSA(P=0.004) were positively correlated to patient mortality. Conversely, among the burn-related complications subgroup, only sepsis(P=0.002) was the only significant independent factor related to patient mortality. Conclusions This study identified key factors that affect mortality among elderly burn patients. Attention should be paid to those elderly burn patients with older age, increased TBSA, or delayed burn-related sepsis due to significantly increased mortality risk. Applicability of Research to Practice Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury (Revised Baux score). Several studies revealed that in-hospital complications was one of the strongest mortality predictors after burns. Understanding that sepsis is a major factor for mortality in elderly burn patient, we may improve our quality of care to decrease the mortality rate.

770 Outcome Results of the Prospective CEA Registry

Abstract Introduction Cultured epidermal autograft (CEA) is a permanent skin replacement indicated for use in adult and pediatric patients with deep dermal or full thickness burns comprising a total body surface area (TBSA) ≥ 30%. CEA may be used in conjunction with split-thickness autografts or alone, in patients for whom split-thickness autografts may not be an option due to the severity and extent of their burns. CEA was approved for use in adults in the United States in 2007 as a Humanitarian Use Device (HUD) under a Humanitarian Device Exemption (HDE) and was approved for pediatric use in 2016. Methods The objective of the CEA Registry is to allow prospective collection and analysis of demographic, treatment, and outcome data for the real-world use of CEA. Prior to initiation of the Registry, a central Institutional Review Board reviewed and approved written procedures and informed consent from each participating burn center. As of the date of this analysis, 5 centers were enrolling patients in the Registry. The data are collected and stored in a 21 Code of Federal Regulations (CFR) Part 11 and Health Insurance Portability and Accountability Act (HIPAA) compliant environment. First patient enrollment in the Registry was 13 June 2019 and data cutoff for this analysis was 28 July 2022. Results Sixtyeight patients (50 adults and 18 children) had completed data in the registry, up through hospital discharge, for this analysis. Except for age and revised Baux score, demographics and burn characteristics were similar between the adult and pediatric populations. The majority of patients were male in both the adult (76%) and pediatric (67%) groups, with burn caused by flame the most common etiology (86% and 78%, respectively). The total body surface area (TBSA) of burn was 58% in adults and 56% in pediatric patients (range 30% to 96%), and almost half had inhalation injury in each group. Approximately 74% of adults and 67% of pediatric patients had TBSA ≥50%. Median age in the adult group was 42 years, and in the pediatric group was 15 years. Since age is a component of the calculation of Baux score, pediatric patients had lower mean revised Baux scores (75) compared to adults (107.5). Overall, 59 of the 68 patients (87%) survived until hospital discharge. The mean % graft take (engraftment) in both adult (81%) and pediatric (84%) groups is notable when compared to mean final graft take in 453 Epiceltreated patients reported in the HDE database (67% in adults and 70% in pediatric). By age group, adults had 84% survival rate and pediatric patients had 94% survival. Conclusions Outcomes from this prospective collection of data in severely burned patients treated with CEA demonstrate favorable engraftment and survival rates and are in general agreement with recent literature. Applicability of Research to Practice Reported outcomes from the CEA Registry can be used as a benchmark by centers using CEA for treatment of burns.

59 Predictors and Impact of Pneumonia on Adverse Outcomes in Inhalation Injury Patients

Abstract Introduction Next to age and burn size, the presence of inhalation injury (II) is the third mortality prognostic factor for burn injury. II can lead to pulmonary complications such as pneumonia, acute respiratory distress syndrome (ARDS), and acute lung injury (ALI), all of which have been hypothesized to increase mortality in II. Herein, we aimed to identify variables associated with the risk of developing pneumonia and to determine the impact of pneumonia on selected outcomes. Methods De-identified data from the Prospective Inhalation study (ISIS) were used. II was confirmed by fiberoptic bronchoscopy. Baseline demographics, injury data, burn size, laboratory data, radiographic results, treatment, and hospital course were recorded. Ventilator use, complications, including pneumonia, ARDS, ALI, and death, were tracked daily for seven days and then weekly until discharge. Univariate and multivariate analysis were performed. Variables included in multivariate analysis had a p value of 0.1 or less. A p value of &amp;lt; 0.05 was considered significant. Results Of the 108 ISIS study group, 106 had complete data and were included in the analysis. Median age was 48.5 y, 59.4% of the subjects were male, 76.4% White and 9.4% Black. Regarding complications, 46.2% of the subjects developed pneumonia, 11.3% ARDS, 9.4% ALI, and 17% died. On univariate analysis, subjects who developed pneumonia were more likely to be white (87.8% vs. 66.7%, p = 0.006), to present with higher total burn surface area (24.70 [8.00-49.50] vs. 2.85 [0.00-25.38], p = 0.002), and full thickness burn (55.1% vs. 31.6%, p = 0.018). On multivariate analysis, being white (p = 0.033) and receiving colloids in the first 24 h of admission (OR = 3.582 [1.157-11.087], p = 0.027) were associated with increased risk of pneumonia while higher level of MMP-9 in the plasma (OR = 0.999 [0.998-1], p = 0.041) lowered the risk. Admission radiographs, FB score, clinical examination findings, and other demographic factors were not related to developing pneumonia. Pneumonia was independently associated with increased risk of developing ARDS (OR = 8.496 [1.322-54.61], p = 0.024) but not with ALI or mortality. Pneumonia was also associated with a longer hospital length of stay (B = 15.2 [2.4-28], p = 0.020) and higher number of days on a ventilator (B = 15.6 [8.2-23], p &amp;lt; 0.001). Conclusions Pneumonia is associated with increased LOS and ventilator days but not mortality. Those who received colloids were 3.5 times more likely to develop pneumonia. The relationship between colloid and pneumonia requires more research, however, the search for other intervenable clinical variables to prevent pneumonia remains elusive. Applicability of Research to Practice As colloids may affect the glycocalyx and contribute to inflammation, their role in developing pneumonia needs to be elucidated.

T5 Temperature Derangement on Admission Predicts Mortality in Burn Patients—a Nationwide Analysis and Opportunity for Improvement

Abstract Introduction While single-institution studies have described the relationship between hypothermia, burn severity, and complications, there are no national estimates on how temperature on admission impacts hospital mortality. This study aims to evaluate the relationship between admission temperature and complications on a national scale to expose opportunities for improved outcomes. Methods The US National Trauma Data Bank (NTDB) was analyzed between 2007-2018. Mortality was modeled using multivariable logistic regression including burn severity variables (% total burn surface area (TBSA), inhalation injury, emergency department (ED) temperature), demographics, and facility variables. Temperature was parsed into three categories: hypothermia ( &amp;lt; 36.0°C), euthermia (36.0-37.9°C), and hyperthermia (≥38.0°C). Results 116,796 burn encounters were included of which 77.9% were euthermic, 20.6% were hypothermic and 1.45% were hyperthermic on admission. For every 1.0C drop in body temperature from 36.0°C, mortality increased by 5%. Both hypothermia and hyperthermia were independently associated with increased odds of mortality when controlling for age, gender, inhalation injury, number of comorbidities, and %TBSA (p &amp;lt; .001). All temperatures below 36.0°C were significantly associated with increased odds of mortality. Patients with ED temperatures between 32.5-33.5°C had the highest odds of mortality across the cohort (22.0, 95% CI 15.6-31.0, p&amp;lt; .001). Conclusions ED hypothermia and hyperthermia are independently associated with mortality even when controlling for known covariates associated with inpatient death. These findings underscore the importance of early warming interventions both at the prehospital stage and upon ED arrival. ED temperature could become a quality metric in benchmarking burn centers to improve mortality. Applicability of Research to Practice This study provides national-scale data on the important relationship between ED temperature and mortality that can substantially impact both prehospital and hospital policies and practice and subsequently improve patient care.