Concomitant Burn Research Articles

A Case-Controlled Retrospective Review of Fluid Resuscitation in Patients with Concomitant Burn and Trauma Injuries

A Case-Controlled Retrospective Review of Fluid Resuscitation in Patients with Concomitant Burn and Trauma Injuries

Outcomes of Geriatric Burn Patients Presenting to the Trauma Service: How Does Frailty Factor in?

IntroductionFrailty has been known to negatively affect the outcomes of geriatric trauma patients. However, there is a lack of data on the effect of frailty on the outcomes of geriatric trauma patients with concomitant burn injuries. The aim of our study was to compare the outcomes of frail versus nonfrail geriatric trauma patients with concomitant burn injuries. MethodsWe performed a retrospective analysis of American College of Surgeons Trauma Quality Improvement Program (2018). We included geriatric (≥65 y) trauma patients who sustained a concomitant burn injury with ≥10% Total Body Surface Area affected. Patients with body region-specific AIS ≥4 were excluded. Patients were stratified into Frail and Nonfrail, using 5-factor modified Frailty Index. Primary outcomes measured were mortality. Secondary outcomes measured were complications, and hospital and intensive care unit (ICU) length of stay (LOS). Multivariable logistic regression was performed to identify independent predictors of mortality. ResultsA total of 574 patients were identified, of which 172(30%) were Frail. Mean age was 74 ± 7 y and median [interquartile range] ISS was 3[1-10]. Overall, the rate of mortality was 23% and median hospital LOS was 14[3-31]. After controlling for potential confounding factors, frailty was not identified as an independent predictor of mortality (adjusted odds ratio:1.059, P = 0.93) and complications (adjusted odds ratio:1.10, P = 0.73). However, frail patients had longer hospital (β: 5.01, P = 0.002) and ICU LOS (β: 2.12, P < 0.001). ConclusionsAmong geriatric trauma patients with concomitant burn injuries, frailty is associated with longer hospital and ICU LOS, and higher rates of thrombotic complications, but not higher mortality or overall complications. Future research should investigate the impact of early assessment of frailty as well as tailored interventions on outcomes in this population.

289 The Timing of Pharmacologic Venous Thromboembolism Prophylaxis Initiation for Burn Patients with Concomitant Trauma

Abstract Introduction Hospitalized burn patients are at increased risk for venous thromboembolism (VTE). Clinical guidelines regarding thromboprophylaxis in burn patients with concomitant trauma are unclear. We aimed to compare the outcomes of early versus late thromboprophylaxis initiation for burn patients with concomitant trauma. Methods A 3-year analysis of 2017-2019 TQIP. We identified all adult burn patients with concomitant trauma who received thromboprophylaxis. We excluded patients that had severe TBI (Head AIS &amp;gt; 2), were transferred, those that died &amp;lt; 24 hours of admission and those that underwent hemorrhage control surgery. Patients were stratified based on the timing of initiation of postoperative thromboprophylaxis: Early (&amp;lt; 24 hours of admission) versus Late ( &amp;gt;24 hours). Multivariate regression analyses were performed. Outcome measures were odds of deep venous thrombosis (DVT), pulmonary embolism (PE), unplanned return to OR, unplanned ICU admission, post-prophylaxis PRBC transfusion and in-hospital mortality. Results 9,272 trauma patients with concomitant burns who received thromboprophylaxis were identified. Overall, mean age was 41.3 ± 13.4 years, 71.5% were male, and median ISS was 3 [1-8]. 53% had second degree burns, and 39% had more than 10% of total body surface area affected. Median time to thromboprophylaxis initiation was 11 [6-20.6] hours. On multivariate regression, patients who received thromboprophylaxis after 24 hours of admission had 1.8 times higher odds of developing DVT (aOR=1.8, 95% CI=1.04-3.11, p=0.03), 4.8 times higher odds of developing PE (aOR=4.8, 95% CI=1.9-11.9, p&amp;lt;.001), 2 times higher odds of unplanned ICU admission (aOR=2.1, 95% CI=1.4-3.1, p&amp;lt;0.001), and nonsignificant increase in the odds of unplanned return to OR (aOR=2, 95% CI=0.96-4.31, p=0.06). Further, early thromboprophylaxis was not associated with increased odds of post-prophylaxis PRBC transfusion (aOR=1.1, 95% CI=0.8-1.4, p=0.4), and in-hospital mortality (aOR=0.68, 95%CI=0.4-1.1, p=0.13) compared to patients who received late thromboprophylaxis. Conclusions Early VTE prophylaxis in burn patients is associated with decreased rates of DVT and PE, without increasing the risk of bleeding and mortality. VTE prophylaxis may be initiated within 24 hours of admission to reduce VTE in this high-risk patient population. Applicability of Research to Practice This work will guide the timing of initiation of venous thromboembolism prophylaxis in burn patients with concomitant trauma

51 Relationship of Early Dressing Change, Ambulation, and Early Discharge in Lower Extremity Grafted Burn Wounds

Abstract Introduction Split-thickness skin graft (STSG) healing follows the imbibition, inoculation, and revascularization healing model. The stage of imbibition takes approximately 48-72 hours and requires direct contact with the wound for success. Prior to revascularization the graft is at increased risk for damage from shear stress. Many of the protocols in place are based on pathophysiology of wound healing and few published data exist on the timing and logistics of mobilization after lower extremity STSG for burns. There is discordance in the Burn community as to when it is safe to start ambulation with patients after lower extremity skin grafting. The timing of the first dressing change may accelerate or delay ambulation and increase time to hospital discharge. Methods Retrospective chart review of burn patients regardless of age, admitted to burn service with grafted burns to lower extremities, whether they had other concomitant burns with/without grafting to determine if earlier first postoperative dressing changes (≤ 3 days) to grafted lower extremity burns lead to earlier ambulation and shorter hospital stays. Secondary endpoints will be evaluation of the ideal time to change the dressing after initial STSG grafting of the lower extremity without increasing graft failure rates. Results The groups were even in time from surgery to 1st dressing change (1st DC) (167 had a 1st DC in ≤3 days post-op, and 163 had a 1st DC &amp;gt;3 days post-op). Demographics and medical history were nearly identical between the two groups, indicating there may be no association between the demographics or medical history collected and earlier dressing change. Median time from surgery to the 1st DC was 3 days (IQR: 3-5) in the entire sample, and from surgery to staple removal was 5 days (IQR: 4-6). The median length of hospital stay in the entire sample was 10 days, and this slightly differed between groups: those with a 1st DC of ≤3 days had a shorter hospital stay (9 days [IQR: 6-13]) than those with a 1st DC of &amp;gt;3 days (11 days [IQR: 7-16]), this is exemplified in Figure 2. 80.3% of patients were discharged home in the sample, with a greater proportion of patients discharged to a facility when they had a 1st DC &amp;gt;3 days post-op (24.5%) than if they had a 1st DC ≤3 days post-op (15%). A greater proportion of patients were discharged walking (47.6% vs 32.7%) when they had an earlier 1st DC than those who did not. Graft failure was seen in 6 patients with 5 of them needing re-STSG. Four due to graft loss and two due to cellulitis. Conclusions Patients who had 1st DC ≤ 3 days after surgery saw an earlier hospital discharge by 2 days without risk of graft loss due to hematoma or seroma regardless of comorbidities. Applicability of Research to Practice The data gathered will be used to establish a clinical based approach to lower extremity dressing changes. We hope to delineate a timeline based on tailored patient factors that can be used as guideline to safely expedite ambulation and minimize hospital stays without increasing graft failure rates.

Thunder and lightning-areport on firework-associated acoustic trauma at New Year 2021/2022.

This cross-sectional study aimed to assess the frequency and type of firework-associated acoustic trauma occurring in Germany on New Year's Eve 2021, despite the ban on firework sales due to the COVID-19 pandemic. The survey period lasted 7days, from 28December 2021 to 03January 2022. Aquestionnaire inquired date, type and treatment of trauma, sex, and age of the patient, and whether the trauma occurred when lighting or watching fireworks. Hearing impairment was classified according to the World Health Organization (WHO grades0 to4), and concomitant tinnitus, vertigo, or other injuries were recorded. The questionnaire was sent to the otorhinolaryngology departments of 171hospitals in Germany. Of 37otorhinolaryngology departments, 16reported no and 21reported 50patients with firework-associated acoustic trauma. Mean age was 29 ± 16years and 41 of 50patients were males. Of these 50patients, 22presented without and 28with hearing loss, 32reported tinnitus and 3vertigo; 20patients were injured when lighting fireworks and 30when watching. Hearing impairment was classified as 14 × WHO grade0, 5 × WHO grade1, 4 × WHO grade2, 2 × WHO grade3, and 3 × WHO grade4. Inpatient treatment was received by 8patients and 11suffered from concomitant burn injuries. Despite the sales ban, some firework-associated acoustic traumas occurred at New Year 2021/2022 in Germany. Some instances led to hospitalization, but an even higher number of unreported cases can be assumed. This study can serve as abaseline for further annual surveys to raise the awareness of the danger of seemingly harmless fireworks for the individual.

Thunder and lightning-areport on firework-associated acoustic trauma at New Year 2021/2022 (German version)

This cross-sectional study aimed to assess the frequency and type of firework-associated acoustic trauma occurring in Germany on New Year's Eve 2021, despite the ban on firework sales due to the COVID-19 pandemic. The survey period lasted 7days, from 28December 2021 to 03January 2022. Aquestionnaire inquired date, type and treatment of trauma, sex, and age of the patient, and whether the trauma occurred when lighting or watching fireworks. Hearing impairment was classified according to the World Health Organization (WHO grades0 to4), and concomitant tinnitus, vertigo, or other injuries were recorded. The questionnaire was sent to the otorhinolaryngology departments of 171hospitals in Germany. Of 37otorhinolaryngology departments, 16reported no and 21reported 50patients with firework-associated acoustic trauma. Mean age was 29 ± 16years and 41 of 50patients were males. Of these 50patients, 22presented without and 28with hearing loss, 32reported tinnitus and 3vertigo; 20patients were injured when lighting fireworks and 30when watching. Hearing impairment was classified as 14 × WHO grade0, 5 × WHO grade1, 4 × WHO grade2, 2 × WHO grade3, and 3 × WHO grade4. Inpatient treatment was received by 8patients and 11suffered from concomitant burn injuries. Despite the sales ban, some firework-associated acoustic traumas occurred at New Year 2021/2022 in Germany. Some instances led to hospitalization, but an even higher number of unreported cases can be assumed. This study can serve as abaseline for further annual surveys to raise the awareness of the danger of seemingly harmless fireworks for the individual.

Inter-facility transfers for burn patients with concomitant traumatic injuries

Burn patients with concomitant traumatic injuries suffer increased morbidity and mortality. Complex care coordination is necessary for these patients, and the prevalence of resulting inter-facility transfers has not yet been quantified by literature. This study examined the outcomes for traumatically injured burn patients to identify the occurrence of trauma system transfers in this group. The National Trauma Data Bank was reviewed from the years 2007–2016 for 6,565,577 patients with traumatic, burn, and concomitant burn & traumatic injuries. There were 5068 patients with both traumatic and burn injuries, 145,890 patients with burn injuries, and 6,414,619 patients with traumatic injuries. Trauma/burn patients were more often admitted to the ICU from the ED at a rate of 35.5% compared to 27.1% for burn and 19.4% for trauma (P < 0.001). For disposition when discharged from the hospital, trauma/burn patients required more inter-facility transfers at a rate of 2.5% compared to 1.7% for burn and 1.3% for trauma (P < 0.001). For level I trauma centers, 5.5% of trauma/burn, 7.1% of burn, and 0.5% of trauma patients required inter-facility transfers. For level II trauma centers, 29.1% of trauma/burn, 47.0% of burn, and 2.8% of trauma patients required inter-facility transfers. Among level I and level II trauma centers, patients with only burns and burn patients with concomitant traumatic injuries required more inter-facility transfers, and level II trauma centers required more inter-facility transfers for all patients. Quantifying these findings is the first step toward improving triage decisions and allocation of health care resources while expediting appropriate care.

A Mini-review about Concomitant Burn and COVID-19

COVID-19 can cause different catastrophic events and mortalities. Therefore, burn hospitals strategies changed during regional peak of COVID-19 pandemic in the world. Some outpatient strategies were introduced to minimize the contact with infected patients. However, admission strategies were based on the severity of COVID-19 symptoms and also severity of burn injuries. The policy for admission to give inpatient care relates to history, symptoms and COVID-19 PCR results. If all the mentioned criteria were negative, the burn patient was admitted to GREEN area or ward. If the patient was suspected or positive for COVID-19, then would be admitted to RED area or ward. Given that some patients may be carriers without specific symptoms, considering a YELLOW area or ward seems logical for these groups. In GREEN areas one care giver for each adult and two care givers for each pediatric patient were allowed. For all care givers wearing medical masks were obligatory. All patients, care givers and staffs were under constant surveillance for fever and other symptoms. In RED areas no visitors were allowed and for each patient one nurse was assigned in BICU. All elective surgeries were stopped and other procedures were divided to emergency and semi-emergency. Strategies for facing COVID-19 surges especially new variants need to continuously evolve. Changing of infectivity rate, manifestations, resistance to different vaccine and duration of viral shedding necessitate modification of principles according to data collected from involving countries.

573 Interfacility Transfers for Burn Patients with Concomitant Traumatic Injuries

IntroductionBurn patients with concomitant traumatic injuries suffer increased morbidity and mortality. Complex care coordination for these patients often requires interfacility transfers. We sought to examine the outcomes for traumatically injured burn patients to identify the occurrence and associated reasons for trauma system transfers in this group.MethodsThe National Trauma Data Bank was examined from years 2007 to 2016 for 6,565,577 patients with traumatic, burn, and concomitant burn & traumatic injuries to evaluate demographic data, ED and hospital dispositions, length of ICU stay, ventilator days, mortality, and interfacility transfers. There were 5,068 patients with both traumatic and burn injuries, 145,890 patients with burn injuries, and 6,414,619 patients with traumatic injuries. Non-parametric Kruskal Wallis, analysis of variance, chi-square, Mann Whitney, and T-tests were utilized for comparisons.ResultsPatients were 69.1% male in the trauma/burn, 67.1% male in the burn, and 62.2% male in the trauma groups (P< 0.001). Trauma/burn patients were more often admitted to the ICU from the ED at 35.5% compared to 27.1% for burn and 19.4% for trauma (P< 0.001). ICU stay was longer for trauma/burn patients at 5.00 median days (IQR 2.00, 15.00) versus 3.00 (IQR 1.00, 10.00) for burn and 3.00 (IQR 1.00, 5.00) for trauma (P< 0.001). Trauma/burn patients had more ventilator days at 3.00 median days (IQR 1.00, 11.75) compared to 2.00 (IQR 1.00, 9.00) for burn and 2.00 (IQR 1.00, 7.00) for trauma (P< 0.001). Trauma/burn patients had increased mortality at 4.9% versus 2.5% for burn and 3.2% for trauma (P< 0.001). For hospital disposition, trauma/burn patients required more interfacility transfers 2.5% compared to 1.7% for burn and 1.3% for trauma (P< 0.001). For level 1 trauma centers, 5.5% of trauma/burn, 7.1% of burn, and 0.5% of trauma patients required interfacility transfers. For level 2 trauma centers, 29.1% of trauma/burn, 47.0% of burn, and 2.8% of trauma patients required interfacility transfers.ConclusionsAmong level 1 and level 2 trauma centers, patients with only burns and burn patients with concomitant traumatic injuries required more interfacility transfers, and level 2 trauma centers required more interfacility transfers for all patients.

Management of Hydrocarbon Burns: Considering Mental Health and Biochemical Abnormalities.

Volatile substance misuse, particularly the inhalation of hydrocarbons, is a growing issue globally. Consequences of volatile substance misuse, both acute and chronic cause cardiovascular, respiratory, renal, metabolic, and central nervous system damage. Whilst the effects of hydrocarbon abuse have been reported, the combination of intoxication with hydrocarbon and burns sustained has not yet been presented. A retrospective case series of patients who presented in the last 5 years to the Royal Adelaide Hospital with hydrocarbon-related burns in the context of illicit use was undertaken. Our aims are to present to the wider scientific community the high morbidity and mortality of hydrocarbon burn injuries and why this tertiary Burns Unit feel it most appropriate to medically stabilize these patients prior to definitive surgery for their burn. All patients that presented with acute hydrocarbon intoxication and sustained concomitant burns had significant psychiatric disorder and substance abuse history and three of five had either not eaten in several days resulting in acute malnourishment, refeeding syndrome or had evidence of chronic malnourishment with deranged electrolytes and hypoalbuminemia. Their definitive burns surgery was delayed where appropriate in order to facilitate medical stabilization as they were too high risk of cardiac membrane instability, electrolyte derangement, and/or respiratory compromise to undergo safe general anesthetic and burns debridement. We propose a multidisciplinary team approach, utilizing not only our Burns Unit care model of physiotherapists, psychologists, social work, and burns trained nurses and surgeons but also Intensive Care, Toxicology, Addiction medicine and General Medical physicians in the management of these patients.

Concomitant Pediatric Burns and Craniomaxillofacial Trauma.

This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing etiologies, presentations, facial fracture patterns, interventions, and outcomes between pediatric CMF trauma patients with versus without concomitant burns. In this retrospective cohort study of a tertiary care center between the years 1990 and 2010, concomitant burns were identified among pediatric patients presenting with CMF fractures. Patient charts were reviewed for demographics, presentation, burn characteristics (total body surface area %, location, and degree), imaging, interventions, involvement of child protective services, and long-term outcomes. Data were analyzed using two-tailed Student t tests and chi-square analysis. Of the identified 2966 pediatric CMF trauma patients (64.0% boys; age 7 ± 4.7 years), 10 (0.34%) patients presented with concomitant burns. Concomitant burn and CMF traumas were more likely to be due to penetrating injuries (P < 0.0001) and had longer hospital lengths of stay (13 ± 18.6 versus 4 ± 6.2 days, P < 0.0001). 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. All four child abuse patients presented in a delayed fashion; operative burn care was prioritized and 70% of the CMF fractures were managed nonoperatively. Concomitant burn and CMF trauma is a rare injury pattern in pediatrics and warrants skeletal surveys with suspicious injury patterns. Future research is necessary to develop practice guidelines.

602 Concomitant Pediatric Burns and Craniomaxillofacial Trauma: A Pediatric Burn Center’s Experience over 20 Years

Abstract Introduction Recent progress in pediatric burn care has reduced the mortality rate by 48.1% (Armstrong, 2020). Although it is well understood that mortality increases with increased number of systems involved, prior studies have not documented the effect of concomitant pediatric burn and craniomaxillofacial (CMF) trauma in pediatric patients. This retrospective cohort study is the first known to characterize presentation, management, and long-term outcomes of concomitant burns with CMF trauma in pediatric patients. Methods We performed a retrospective cohort study of all pediatrics patients who presented at a tertiary care center between the years 1990 to 2010 with CMF fractures and burns. Patient charts were reviewed for demographics, mechanism of injury, burn characteristics (TBSA %, location, and degree), imaging and interventions, involvement of child protective services, and long-term outcome. Data was analyzed using two-tailed Student’s t tests and chi square analysis. Results Of the 2,966 pediatric CMF trauma patients (64.0% boys; average age 7 ±4.7 years) that were identified, a total of 10 (0.34%) patients were identified to have concomitant burn injuries. Patients with concomitant burn and CMF injuries were less likely to have sustained blunt injuries (P &amp;lt; 0.0001) and had longer hospital lengths of stay (13 □ 18.6 vs 4 □ 6.2 days, P &amp;lt; 0.0001). Approximately 60% of CMF fractures were upper-third injuries. The CMF fractures of all 10 cases (100%) were managed non-operatively. 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. Of the four patients who presented due to child abuse, CMF trauma was incidentally found on imaging. One (13 months, female) child-abuse case was found to have 32% TBSA 2nd and 3rd degree burns to bilateral lower extremities after being submerged in hot bathwater and had concomitant orbit/skull fractures. Two other child abuse cases presented with hand burns and concomitant nasal/skull fractures. All four child abuse patients presented in a delayed fashion. Conclusions Concomitant burns and CMF trauma is rare injury pattern in pediatric populations and is associated with longer hospital lengths of stay. Child abuse and motor vehicle accidents caused 80% of the cases.

46 Increased Concomitant Burn and Trauma Injuries Follows an Increase in Overall Trauma Volume: A Descriptive Analysis

Abstract Introduction Concomitant traumatic injury in the burn patient complicates care coordination and increases morbidity and mortality. The incidence of concomitant injury, however, is uncommon and reported to range from 5–7%. In May 2020, our level 1 trauma center began seeing 40% more patients per month that the 12 months prior. We sought to determine the incidence of concomitant injury in burn patients during this time of increased trauma volume and to examine the associated traumatic injuries in this group. Methods The burn registry at a single ABA-verified burn center was examined from 5/20–9/20. Patients with concomitant burn and traumatic injury were examined with respect to: %TBSA burn, mechanism of injury, operative interventions, associated traumatic injuries, and length of hospital stay. Continuous data was presented as mean (standard deviation). Results Eighty-nine burn patients were admitted during this period, of whom 24 (26.9%) had concomitant traumatic injuries. The cohort was young and mostly male; the mean TBSA was 16% () (Table 1). The most common mechanism of injury was motor vehicle collision (12 or 50%), followed by fall after high voltage electrical injury (6 or 25%) and motorcycle collisions (5 or 21%). The most common associated injuries were: pulmonary contusions 29.1% (7/24); long bone fractures 25% (6/24); pelvic/acetabular fractures 20.8% (5/24); femur fractures 16.6% (4/24); and solid organ injury: 16.6% (4/24). Twenty patients (83.3%) required burn or trauma operative intervention during hospital stay. Of the 20 patients who required operative intervention, 85% underwent burn surgery and 55% underwent trauma surgery (solid organ or orthopedic). Forty percent of these patients required operation for both burn and traumatic injury. In looking specifically at the electric injury group, all six patients required operative intervention for burn injuries, and four required extremity fasciotomy. Patients with electrical injury had a significantly longer hospital stay relative to their TBSA (p&amp;lt; 0.04). Conclusions Concomitant trauma and burn injuries are infrequent yet present a major clinical challenge. Our recent increase in overall trauma volume was paralleled by an increase in patients with concomitant burn injuries. The associated traumatic injuries require a multi-disciplinary approach to minimize morbidity and restore function.

510 A Case-controlled Retrospective Review of Fluid Resuscitation in Patients with Concomitant Burn and Trauma Injuries

Abstract Introduction Aggressive fluid resuscitation with crystalloid has been a mainstay of therapy in burn injuries for over 50 years. However, in trauma populations there has been a shift away from crystalloid based resuscitation and the early administration of blood products has been recommended. The primary objective of this study was to evaluate if large-volume crystalloid resuscitation of patients presenting with both burn and trauma injuries is associated with higher mortality and complications. Methods This was a matched case-controlled retrospective chart review of patients treated over a 5-year period that suffered mixed burn and trauma injuries (MI). Patients that suffered burn only injuries (BO) were used as the control and were matched on TBSA, age, and gender. All patients were resuscitated using the standard burn center resuscitation protocol. Results A total of 4,416 patients were admitted to the burn center during the study period. Of those 18 had concomitant burn and trauma injuries requiring burn fluid resuscitation and were successfully matched to BO patients. There was no difference in age, gender, ethnicity, % TBSA burned, presence of inhalation injury, or Injury Severity Score (ISS). BO patients were more likely to have flame/flash as the etiology of burn injury (p=.0257). With fluid resuscitation, there was no difference in the total volume of fluid administered, or the amount of crystalloid or colloid administered. MI patients were more likely to have received blood products than BO patients (472 ml vs 19 ml, p=.0387). There was no difference in the following outcome measures: mortality, ICU days, ventilator days, number of surgeries, infections, or major complications. The only significant outcome difference was that the BO patients had a greater hospital length of stay (44 days) than the MI patients (24 days, p &amp;lt; 0.001). Conclusions Aggressive fluid resuscitation using existing burn resuscitation protocols did not result in greater complications in burn-trauma patients than in burn only patients. Crystalloid-based burn resuscitation is safe in patients with combined burn and trauma injuries.

Pediatric burn-trauma patients have increased length of stay compared to trauma-only patients: A propensity matched analysis

BackgroundTrauma is the leading cause of mortality in children. Burn injury involves intensive resources, especially in pediatric patients. We hypothesized that among pediatric trauma patients, combined burn-trauma (BT) patients have increased length of stay (LOS) and mortality compared to trauma-only (T) patients. MethodsThe Pediatric Trauma Quality Improvement Program (2014–2016) was queried and BT patients were 1:2 propensity-score-matched to T patients based on age, gender, hypotension on admission, injury type and severity. Results93 BT patients were matched to 186 T patients. There were no differences in matched characteristics. BT patients had a longer median LOS (4 vs 2 days, p<0.001) with no difference in mortality (1.1% vs 1.1%, p=1.00), intensive care unit (ICU) LOS (3 vs 3 days, p=0.55), or complications including decubitus ulcer (0% vs 1.1%, p=0.32), deep vein thrombosis (0% vs 0.5%, p=0.48), extremity compartment syndrome (1.1% vs 0%, p=0.16), and urinary tract infection (1.1% vs 1.1%, p=1.00). ConclusionPediatric BT patients had twice the LOS compared to a matched group of pediatric T patients. There was no difference between the cohorts in ICU LOS, complications or mortality rate. When evaluating risk-stratified quality metrics such as LOS, concomitant burn injury should be incorporated.

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

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.

Incidence of combined burns and major trauma in England and Wales

Introduction Within the United Kingdom’s major trauma networks, limited consideration is given to the management of concomitant burns and trauma injuries, prominently highlighted in the arrangement of specialist services for major trauma and burns care. The majority of the literature regarding this topic, based almost exclusively on North American studies, predicts between 5 and 7% of all patients admitted to burns centres will suffer from concomitant (non-thermal) trauma injuries, in addition to their burn injuries. The aim of this study is to understand the epidemiology and outcomes for patients sustaining burns and trauma injuries in England and Wales. Methods A retrospective review of patients sustaining concomitant burns and trauma injuries was made over a 71-month period from January 2010 to November 2016, using the national trauma registry for England and Wales, the Trauma Audit and Research Network database, identifying all patients with injury codes for burns and trauma (AIS &gt;3). Data collected comprised patient demographic information, burn injury percentages, details of trauma injuries, details of hospital stay, and patient outcome. Comparison of information was made against the total burns and total trauma cohort to form a base standard for burns and trauma injuries, respectively. Results Over the period analysed, 188 patients were found to have concomitant burns and trauma injuries. The patients were stratified according to age and the percentage of total body surface area burned. Hospital length of stay for concomitant burns and trauma patients was found to be higher than that of patients with isolated burns injuries. Mortality rates, although low overall, were found to be relatively higher for patients with concomitant burns and trauma injuries. Conclusions This study demonstrated the rarity of this combination of injury pattern, in particular the occurrence of severe burns in the presence of major trauma, in UK. Improvements in burns care and trauma care hopefully contributes to the higher level of survival in concomitantly injured patients against data from previous literature. However, the synergistic effect of burns and trauma injuries appears to impact on the course of such patients, although larger scale analysis is required to determine the true prognostic factors.

Severity of Inhalation Injury is Predictive of Alterations in Gas Exchange and Worsened Clinical Outcomes.

Inhalation injury (INH) is present in one third of large burn injuries and increases oxygenation and fluid resuscitation requirements, incidences of pulmonary complications, risk for multiple organ dysfunction syndrome (MODS), and overall mortality. Previous studies have demonstrated inconsistent correlation between bronchoscopic evaluation and clinical outcomes. The authors reviewed 161 patients admitted with a diagnosis of INH or underwent diagnostic bronchoscopy for suspected INH over a period of 8.5 years. One hundred one patients had concomitant burn injury and 60 had isolated INH. Seventeen patients had abbreviated injury score (AIS) 0, 81 patients had low-grade injury (AIS 1 and 2), and 63 patients had high-grade injury (AIS 3 and 4). Patients with high-grade INH had worse pulmonary dysfunction, worse oxygenation indices (P = 0.01) and plasma carboxyhemoglobin (COHgb; P < 0.01) on admission, increased fluid requirements (P < 0.01 at 24 hours; P = 0.04 at 48 hours), MODS (P = 0.04), pneumonia (P < 0.01), acute respiratory distress syndrome (P = 0.01 at 48 hours), fewer 28-day ventilator-free days (P < 0.01), greater ventilator dependence (P = 0.03), and longer length of stay (P < 0.01). Multivariate analyses demonstrated increased risk of MODS (P = 0.03), acute respiratory distress syndrome at 48 hours (P < 0.01), pneumonia (P = 0.01), prolonged ventilator dependence (P = 0.03), and a trend toward mortality (P = 0.08) with higher AIS groups. More severe INH correlates with early oxygenation impairments and is associated with more complicated hospitalization, fluid resuscitation requirements, and ventilation demands. Severe INH is associated with and predictive of increased morbidity and mortality.

Characterization of Skin Allograft Use in Thermal Injury

This study provides objective data on the practice of allograft usage in severely burned patients. Furthermore, gaps in our knowledge are identified, and areas for further research are delineated. Using an institutional review board-approved protocol, active duty military patients injured while deployed in support of overseas contingency operations and treated at our burn center between March 2003 and December 2010 were identified. Their electronic medical records were reviewed for allograft use, TBSA burned, injury severity score, anatomic distribution of burns, operative burden, length of stay, transfusions, and outcome. Among 844 patients, 112 (13.3%) received allograft and 732 (86.7%) did not. The amount of allograft used per patient varied and was not normally distributed (median, 23.5; interquartile range, 69.5). Patients received allograft skin an average of 12.75 times during their admission. Allografted patients sustained severe burns (μ, 53.8% TBSA); most were transfused (71.2%) and grafted frequently, averaging every 7.45 days. Most commonly, allograft was placed on the extremities (66.5%) followed by the trunk (44.2%); however, the vast majority of allografted patients also had concomitant burns of the head (91.1%) and hands (87.5%). All-cause mortality among the allografted patients was 19.1%. In conclusion, allograft is commonly used in the surgical treatment of severe burns. Although there are no anatomic limitations to allograft placement, there are distinct patterns of use. Given the role of allograft in the acute management of large burns, there is need for further investigation of its effect on mortality, morbidity, and antigenicity.

Endovascular Repair of a Thoracic Aortic Injury in a Burn Patient

Mortality in burn patients who sustain concomitant mechanical traumatic injuries at the time of thermal injury is greater than in patients who sustain isolated injuries. Invasive interventions to treat these mechanical traumatic injuries may be a source of added mortality and contribute to an injury-induced state of immunosuppression. Less-invasive interventions may minimize morbidity and mortality and allow for improved recovery from thermal injury. A case is presented of a patient who sustained 20% TBSA electrical burns and an acute thoracic aortic injury near the diaphragmatic hiatus. Abdominal aortic stent-graft components were used to successfully exclude the patient's thoracic aortic injury. The patient made a successful recovery from his burns and sustained no infectious complications. This case report highlights the potential advantages of endovascular therapy for the treatment of aortic trauma in patients who sustain concomitant burn injuries.