Observed Patient Characteristics Research Articles

Weight maintenance in pediatric burned patients

Weight change, defined as the difference between the preadmission and discharge weights, has often been used as an indicator of the adequacy of nutrition support. Weight change has been found to be uninterpretable in burned patients because excision and grafting contribute to weight loss but do not reflect systemic physiology. Also, normal growth during hospitalization contributes to weight gain but is not included in traditional methods of assessing weight change of children. We examined weight change corrected for escharectomies and growth in 42 adult and pediatric burned patients. Thirty-five of the patients had weight loss within 10% of their premorbid weight. Moreover, weight loss was correlated with three observable patient characteristics: age, percent initial burn size, and preburn weight. It was concluded that the dietary regimen of providing twice the predicted basal metabolic rate in terms of calories, based on ideal body weight, was adequate to prevent significant weight loss in most patients but that further refinement is necessary to improve individual reliability. Furthermore, significant weight losses may not affect morbidity/mortality as previously thought.

Intravenous fluids in medical in‐patients.

1 Data from the Boston Collaborative Drug Surveillance Program were reviewed to determine the proportion of patients receiving intravenous fluids in the participating hospitals. 2 Wide differences between hospitals in the United States and four other countries were observed: i.v. fluids being given to 54% of patients in one American hospital and only 7% of patients in an Israeli one. A two-fold difference in the frequency of i.v. fluid use in two otherwise comparable Scottish teaching hospitals was observed. This difference was not due to observed patient characteristics, did not arise from selection bias or observational differences between the two hospitals and was unlikely to have arisen by chance. 3 It is concluded that the findings were due to different policies on the part of the attending physicians. Although the study could not be used to evaluate the beneficial effects of the administered fluids, adverse effects were common (15% of recipients) and in some instances potentially serious. Adverse effects were reported more frequently after infusion of 5% dextrose (13% of recipients) than after isotonic saline (7%) perhaps because of the low pH of the former solution.