Presence Of Inhalation Injury Research Articles

Characteristics and factors affecting the outcomes of massive burn paediatric patients

This study investigated characteristics and factors affecting the outcome of massive burns in children. A retrospective study was conducted on 288 pediatric burn patients (=<16 years old) with burn extent ≥ 30% of total burn surface area (TBSA) admitted to the Le Huu Trac National Burns Hospital from 1/1/2018 to 31/12/ 2022. Patients were divided into two groups of survival and death comparing demographic characteristics, burn features, and outcome. The results showed that most patients were under 6 years old (79.51%), boys (64.58%), due to scald (76.69%). Inhalation injury accounted for 6.25% and the overall mortality rate was 6.94%. There was no remarkable difference between survival and death groups in terms of age, gender, and admission time (p > 0.05). Meanwhile, the death group had significantly greater burn extent, deep burn area as well as the rate of inhalation injury than the survival group (p < 0.01). The most fatal causal agent was flame as compared to scald and other agents (18.75%; p < 0.01). Multivariate analysis showed that the increased deep burn area and the presence of inhalation injury were independent risk factors for mortality with AUC = 0.82; sensitivity: 80%; specificity: 91.42% in the case of combining both variates.

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.

747 Burn Mortality Prediction Model and Communication Tool for Healthcare Providers

Abstract Introduction Communication is a key competency – the effective exchange of information is essential to a physician’s role. Currently, our centre does not have a communication tool to help guide point of care discussions between healthcare providers and during family meetings. Prognostic relationship of the BAUX score and ABSI index should be determined. An objective communication tool that shows predicted mortality, length of stay (LOS), and number of operations, specifically in our hospital using BAUX index and ABSI score will allow patients and healthcare providers to better understand prognosis, course in hospital, and develop appropriate expectations for outcomes in our centre. Methods In this cross-sectional study, all burn patients admitted to our Centre from 2012 to June 2022 were retrospectively recruited. Our burn registry was used to extract complete data of patient information including age, gender, %TBSA, burn depth, presence of inhalational injury, need for ventilator support, intensive care unit (ICU) admission days, hospital LOS, BAUX score, rBAUX score, and ABSI index. Patients were divided into three cohorts: all patients without an inhalation injury, a subgroup of smokers with and without an inhalation injury, and all patients with an inhalation injury. For each cohort, a mean LOS in hospital and/or ICU, number of burn operations, and mortality rate per incremental BAUX score and ABSI index was computed. Results A total of 839 patients were included, 725 without and 114 (13.6%) with an inhalation injury. A subgroup of patients (n=286) smokers with and without inhalational injury were separately analyzed. With severity of burn and presence of inhalational injury, both BAUX score and ABSI index show an incremental increase in LOS in hospital, number of operations, and increased mortality. Smokers with rBAUX ≥110 had the longest LOS in hospital, 78.4 hospital days and 35 ICU days. Interestingly, all patients with ABSI 6-7 had the longest LOS/%TBSA and those patients who additionally had an inhalational injury had the highest LOS/%TBSA (5.1 days/%TBSA). Increase in BAUX and ABSI did not correlate with increase in LOS/%TBSA. For BAUX ≥ 90 and ABSI ≥ 8, number of operations and mortality exponentially increased. Conclusions Patients with BAUX ≥ 90 and ABSI ≥ 8 should be counselled on a complex course in hospital. Higher BAUX and ABSI correlate with increased mean LOS and number of operations but not LOS/%TBSA. Using our Centre’s burn registry, we can predict course in hospital and provide this to patients, family, and healthcare providers before tertiary centre transfer and admission. Applicability of Research to Practice An objective communication model showing the burn centre’s mean LOS, LOS/%TBSA, number of operations, and risk of mortality, can help guide physician-patient and physician-healthcare provider communication. This tool will provide realistic burn recovery expectations at admission, family meetings, and when discussing consent.

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 < 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 < 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.

706 Epidemiology, Therapeutic Complexity and Prognostic Challenges of Burns to the Perineum, Buttocks and Genitals

Abstract Introduction Burns that involve the perineum, buttocks and genitals (PBG) have been associated independently with more challenging therapeutic needs and worse clinical outcomes in case series and smaller patient collectives, while large scale epidemiology of this injury is lacking. We studied a cohort of 1024 patients admitted to our burn center to assess clinical outcomes based on the presence of PBG burns. Methods Medical records were screened for patients who did or did not sustain PBG burns and patients stratified accordingly (PBG vs. control (CTR)). Demographic baseline data, burn etiology, presence of inhalation injury (IHT), presence of full thickness burns (FT), number of operations (NOR), mortality, length of ICU treatment (LOS ICU) and hospitalization (LOS) were assessed to compare clinical characteristics and outcomes between the groups. Multivariate regression analyses adjusting for TBSA, sex and age were conducted for key clinical outcomes. Results Between 2014 and 2022, 1024 patients were included in the analysis (PBG: n=227; CTR: n=797). PBG burns were older (median (IQR) 54 (38) vs. 44, (31) years, p< 0.0001), more frequently female (35% vs. 23%, p=0.002) presented with larger TBSA burns overall (27 (37) vs. 10 (13) %, p< 0.0001) and sustained FT burns more frequently (69% vs. 26% p< 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p< 0.0001), PBG patients needed twice as many surgical procedures (2 (4) vs. 1 (1), p< 0.0001) as CTR. PBG patients remained longer in the ICU per per cent TBSA (0.9 (1.1) vs. 0.5 (0.8) days/%TBSA, p< 0.001). Mortality was higher in patients with PBG burns (33.1% vs. 7.8%, p< 0.0001). Multivariate logistic regression yielded significant effects of PBG burns on LOS ICU, LOS and NOR. Conclusions Burns to the perineum, buttocks and genitals are associated with more challenging baseline characteristics upon admission and substantially worse clinical outcomes than burns not involving PBG. Applicability of Research to Practice Expectable therapeutic challenges regarding prolonged intensive care, more frequent surgeries and increased risk for mortality should be taken into account and planned for when admitting patients with PBG burns.

782 The Effect of Medical Comorbidites on Mortality in Burn Patients

Abstract Introduction Age, percent total burn surface area (TBSA) burn, and presence of inhalation injury have been well accepted as prognostic factors associated with burn injury. However, there may be additional comorbidities that affect mortality to consider. Recently published data include comorbidities specifically in the elderly population or focus on a specific comorbidity. As such, this analysis sought to identify comorbidities with a more comprehensive approach while focusing on the adult population. Methods The National Inpatient Sample was queried for all patients with age 18-65 years with ICD-9 codes for total body surface area (TBSA) burn ≥ 20% and non-elective admissions. Years included were 2013- third quarter of 2015. Age, race, comorbidities and mortality were recorded. Cases with missing data for mortality were excluded. Statistical analysis was done with Chi-Square testing. Mortality was then used to perform a binary logistic regression using these variables. Results There were 5545 weighted cases. The median age was 41.0 years (IQR 29-52 years). Mortality was 14.7%. The presence of AIDS, chronic blood loss anemia, chronic pulmonary disease, congestive heart failure, peptic ulcer disease (excluding bleeding), peripheral vascular disease, renal failure, rheumatoid arthritis/collagen vascular disease, and solid tumor without metastasis were not found to be statistically significant. The significant variables were then entered into a binary regression model on mortality. For the regression analysis, age, gender and race were also included. Age and race were statistically significant (p < 0.001 for both), while gender was not (p=0.072). While significant on univariate analysis, alcohol abuse (p=0.059), diabetes with chronic complications (p=0.244), metastatic cancer (p=0.999), psychoses (p=0.053) and valvular disease (p=0.998) were no longer significant on multivariate analysis. The results of the significant comorbidities are listed in the table. In those who died, there were increased odds of having coagulopathy, uncomplicated diabetes, liver disease, paralysis, pulmonary circulation disorders and obesity. Conclusions Identification of these significant comorbidities potentially highlights the need for updated models to assist clinicians in determining risk of mortality in burn patients. Theses comorbidities also point to the importance of resources for primary care physicians to optimize these patient populations and potentially minimize the risk of complications should patients become injured. Applicability of Research to Practice

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< 0.001), burn surface area(P< 0.001), burn grade(P=0.016), use of inotropic agents(P< 0.001), initial endotracheal tube insertion(P< 0.001) and delayed burn-related acute kidney injury(P< 0.001), sepsis(P< 0.001) as well as pulmonary edema(P< 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.

501 The Role of a Tracheostomy in the Critically Ill Burn Patient

Abstract Introduction Tracheostomy is a commonly performed procedure in critically ill patients requiring prolonged mechanical ventilation. However, nationwide practice patterns for the role of a tracheostomy in critically ill burn patients have not been well described. Methods A 25-question Qualtrics online survey was distributed by the American Burn Association (ABA) to their physician members. Questions pertained to practitioner demographics, indications, type of tracheostomy performed, and timing of procedure. The questionnaire further ascertained how presence of inhalation injury and Total Body Surface Area (TBSA) influence timing of tracheostomy; if concurrent percutaneous endoscopic gastrostomy (PEG) tubes were performed, and whether enteral feeds were held prior to tracheostomy. Results Thirty-seven surgeons responded to the survey and worked primarily at ABA verified academic burn centers. Open tracheostomy was performed more frequently than percutaneous tracheostomy (73% vs 27%). Eighty-three percent of surgeons deferred concomitant PEG despite healthy overlying skin due to the belief that a patient would eventually pass a swallow evaluation (74%). Tube feeds were routinely held by 67% of surgeons, most commonly 6 or 8 hours prior. The most common indication for tracheostomy was prolonged mechanical ventilation. Fifty-four percent of surgeons routinely perform a tracheostomy through open uninfected 2nd degree neck burns. As for 3rd degree neck burns, 35% will perform a tracheostomy only after excision and grafting. For patients requiring prolonged mechanical ventilation 35% of surgeons had no standard time frame for tracheostomy regardless of TBSA. For mechanically ventilated patients with >20% TBSA burns (excluding neck burns), 40% performed early tracheostomy (0-7 days) and 24% performed delayed tracheostomy (8+days). For ventilated patients with inhalational injuries and TBSA < 20%, 35% had no standard time frame, 16% performed early tracheostomy and 49% performed delayed tracheostomy. Conclusions A national tendency toward open tracheostomy, deferring concomitant PEG, and holding tube feeds 6-8 hours prior to tracheostomy was identified. Patients with TBSA >20% seem to undergo earlier tracheostomy more frequently, whereas those with TBSA < 20% with inhalational injury more frequently undergo delayed tracheostomy. Although TBSA appears to impact timing of tracheostomy, evidence based guidelines are lacking to guide clinical practice and additional studies are needed. Applicability of Research to Practice Survey results infer practice patterns favoring consideration toward early tracheostomy for patients with >20% TBSA burns requiring prolonged mechanical ventilation.

Initial fluid resuscitation guided by the Parkland formula leads to high fluid volumes in the first 72 h, increasing mortality and the risk for kidney injury

BackgroundOur Burn center has used the Parkland formula (4 ml/kg/TBSA%) adjusted by physiological parameters to guide fluid resuscitation in burn patients. Our main objective was to examine fluid resuscitation in patients with major burn injury and its effect on mortality, need for renal replacement therapy (RRT) and the length of stay (LOS) in the Intensive Care Unit (ICU). Further aims were to determine which factors were associated with fluid resuscitation volumes during the first 24 h, and whether these fluid volumes had an association with the volumes infused during the next 48 h. MethodsThis retrospective observational study accrued patients (N = 46) admitted to the Helsinki Burn Center between 2016 and 2018 with burn injuries ≥ 20% TBSA. The national intensive care registry and the electronic patient record system provided data on fluid infusions, urine output, laboratory measurements, presence of inhalation injury, surgical procedures within 72 h from injury, patient demographics, need for renal replacement therapy and mortality. Patients were divided into groups based on infused fluid volumes and univariate regressions were performed to identify factors associated with fluid volumes. Results48% of the patients received fluids more than 6 ml/kg/TBSA% during the first 24 h. 35% of the patients received fluid volumes exceeding the Ivy index (250 ml/kg/d) and was associated with higher TBSA%, SOFA and SAPS scores as well as increased mortality and need for RRT. Higher lactate and lower base excess were associated with higher fluid volumes. Urine output had no association with the resuscitation volumes. Larger resuscitation volumes during the first 24 h were associated with larger fluid volumes given also during the next 48 h. Higher cumulative fluid volume in 0–72 h resulted in increased need of RRT and higher ICU mortality. ConclusionUsing the Parkland formula and adjusting the infusion based on physiological parameters leads to over resuscitation in many of the patients. It seems that the more fluids are given during the initial resuscitation phase, the more fluids are also administered during the subsequent phase. Higher cumulative fluid volumes are associated with RRT requirements and higher mortality. We postulate that starting fluid resuscitation with a lower infusion rate could be beneficial, as it may lead to smaller cumulative fluid volumes during the first 72 h, leading to reduced mortality and kidney injury.

Palliative Care Utilization in Burn Patients.

Background: Burn injuries are a common cause for hospitalization, and severe burns have an increased risk of death in patients with advanced age, inhalational injury, comorbid conditions. Very little is known about the utilization of palliative care consultation in burn patients. Objective: The aim of this study was to evaluate the factors influencing the utilization of inpatient palliative care consultation for patients with severe burn injuries. Methods: This was a retrospective chart review study at a single burn center. Results: Seventeen out of 191 patients (8.9%) received a palliative care consultation with the average time for consultation of 10.3 days. Factors that appear to impact consultation were age, presence of inhalational injury, and multiple comorbid conditions. Conclusion: Inpatient palliative care consultation was underutilized in patients with severe burn injurie. Further research into the outcomes of palliative care consultation could help further support the utility of early involvement in burn patients.

The predictive probability of mortality in the presence of full-thickness burns

IntroductionPrognostication of burn injury mortality is challenging. Recent mortality prognostication tools have incorporated the percent of full-thickness surface area (FTSA). We hypothesize that the presence of full-thickness burn injury independently increases in-hospital mortality. MethodsWe performed a retrospective review of the National Trauma Data Bank (NTDB) from 2007 to 2019 of adults (≥16 years old) with burn injuries. Variables evaluated included basic demographics, presence of inhalation injury, percent TBSA, and percent FTSA burned. The primary outcome was in-hospital mortality. We performed modified Poisson regression modeling adjusting for significant variables to estimate the relative mortality risk. Results75,816 patients met inclusion criteria. When controlling for TBSA, the presence of a full-thickness burn had a relative risk of in-hospital mortality of 1.42 (95% CI 1.09–1.85, p = 0.008). The predicted probability of mortality was 100% at 50% FTSA. ConclusionThe presence of full-thickness burns and the proportion of full-thickness burns independently and significantly increased in-hospital mortality. Therefore, clinicians should utilize prognostication models incorporating percent full-thickness burn area to predict mortality more accurately.

Factors Associated With Mechanical Ventilation Duration in Pediatric Burn Patients in a Regional Burn Center in the United States.

Among burned children who arrive at a burn center and require invasive mechanical ventilation (IMV), some may have prolonged IMV needs. This has implications for patient-centered outcomes as well as triage and resource allocation decisions. Our objective was to identify factors associated with the duration of mechanical ventilation in pediatric patients with acute burn injury in this setting. Single-center, retrospective cohort study. Registry data from a regional, pediatric burn center in the United States. Children less than or equal to 18 years old admitted with acute burn injury who received IMV between January 2005 and December 2020. None. Ventilator days were defined as any full or partial day having received IMV via an endotracheal tube or tracheostomy, not inclusive of time spent ventilated for procedures. Of 5,766 admissions for acute burn care, 4.3% ( n = 249) required IMV with a median duration of 10 days. A multivariable model for freedom from mechanical ventilation showed that the presence of inhalational injury (subhazard ratio [sHR], 0.62; 95% CI, 0.46-0.85) and burns to the head and neck region (sHR, 0.94; 95% CI, 0.90-0.98) were associated with increased risk of remaining mechanically ventilated at any time point. Older (sHR, 1.03; 95% CI, 1.01-1.04) and male children (sHR, 1.39; 95% CI, 1.05-1.84) were more likely to discontinue mechanical ventilation. A majority of children (94.8%) survived to hospital discharge. The presence of inhalational injury and burns to the head and neck region were associated with a longer duration of mechanical ventilation. Older age and male gender were associated with a shorter duration of mechanical ventilation. These factors should help clinicians better estimate a burned child's expected trajectory and resource-intensive needs upon arrival to a burn center.

The Impact of Body Mass Index in Patients with Severe Burn Injury

This study evaluated the association of body mass index (BMI) with mortality, length of stay in the intensive care unit (ICU), and length of hospital stay in major burn patients. It was a retrospective cohort study that was originally conducted from January 2017 to January 2020 and that used data from patients admitted to the intensive care unit for burns at a university hospital. The patients were divided into groups for the purposes of comparing relevant variables according to their BMI. We evaluated 288 patients: 52.8% were classified as eutrophic, 33.7% were classified as overweight, and 13.5% were classified as obese. The median length of stay in the ICU was 11 days for all patients, 9 days for eutrophic patients, 13 days for overweight patients, and 16 days for obese patients (p = 0.004). In the multivariate analysis, age (HR = 1.026; p < 0.001), total body surface area (HR = 1.047; p < 0.001), and the presence of inhalation injury (HR = 1.658; p = 0.026) were associated with mortality. Obesity was not associated with higher hospital mortality in this sample of burn patients. The length of stay in the ICU was longer among obese patients. Age, burned body surface, and the presence of inhalation injury were the major determinants of death in these patients.

Comparative Analysis of the Risk Factors among Survivors and Non-Survivors Burned Children

Background: Burn trauma in children results into high mortality and morbidity with lifelong consequences. Lack of health care facilities, equipped burn centers, illiteracy, poor infra structure and involvement of girls in cooking activities at early age are potentiating factors towards high mortality. Objectives: To determine key factors resulting into high mortality in children Study Design: Cross-sectional study Place and Duration of Study: Department of Paediatric Surgery Sahiwal Teaching Hospital & Sahiwal Medical College Sahiwal from 1st May 2019 to 28th February 2022. Methodology: One hundred and eighty four patients upto the age of 12 years with more than 10% partial thickness burn and less than 10% full thickness burn and any percent electric burn were included. Age, sex, presence of inhalation injury, total burn area, development of wound infection, sepsis, mode of burn, surgical intervention and length of hospitalization were all used to predict mortality. Resuscitation was done according to ATLS guide lines on admission. Topical treatment and intravenous antibiotics were given. Fasciotomy was done wherever needed. Wound swab was taken culture sensitivity on 5th day. Results: Overall mortality was 18.47%. Eighteen (53%) of non-survivors were 3-7 years. Mortality was high in females (61.67%). With regards to cause of burn, flame burns remained at the top in survivors (48%) while scalds in non-survivors (61.76%). 50% of patients presented with partial thickness burn (75/150) in survivors while 50% (17/34) with mixed burns in non-survivors. Mean total body surface area burn was 14.9% in survivors and 40.6% in non-survivors. Non-survivors presented late as compared to survivors. Hospital stay for survivors ranged from 1-28 days while non-survivors stayed 3-18 days before death (Mean 5.9 and 7.4 days) respectively. Conclusion: Age less than 7 years, females, scald burn, delayed presentation, full thickness or mixed burns with burn surface area more than 40% are significant risk factors for high mortality in burned children. Keywords: Burn, Children, Mortality, Sepsis, Scald

A Comprehensive, Retrospective Analysis of Variables for Potential Mortality Impact in Patients With Thermal or Inhalation Injury.

Age, percentage TBSA burned, and the presence of inhalation injury have been used historically in the prediction of mortality in thermally injured patients despite other factors being also associated with mortality. Recent literature has identified novel factors associated with increased length of stay (LOS) and may provide a better prediction model for mortality in burn patients. The study objective was to perform a subset analysis of a multitude of known and novel variables for potential association with mortality. Demographics and injury characteristics along with during stay variables were collected and analyzed. This study is a re-analysis of a retrospective study examining variables associated with increased LOS. Of the 629 patients screened, 396 were included in the analysis. After univariable analysis, 35 variables had significant associations with mortality, including age, house fire, acute kidney injury, heart failure, inhalation injury, and history of diabetes. After multivariable analysis, the best performing model included heart failure, acute kidney injury, admission Glasgow Coma Scale score, and revised Baux score. Quantile analysis of age revealed greater than 60 years was most predictive of mortality. The best multivariable model for patients greater than 60 years old included heart failure, vasopressor use, acute respiratory distress syndrome, and TBSA burned. Considering only variables present on admission, the best multivariable model for patients greater than 60 years old included heart failure, % TBSA burned, and inhalation injury. The addition of variables into current prediction models and databases may be warranted.

ASSESSMENT OF MICROALBUMINURIA AND BLOOD PLATELET COUNT AND ITS ASSOCIATION WITH THE SEVERITY OF BURNS AND OUTCOMES

Background: Burn injury causes a systemic inflammatory response, leads to reduced platelet count, and leakage of a significant amount of albumin in the interstitium and urine. Prognostic indicators play a critical role in patient management. There are not set prognostic factors indicating the outcome of a patient post burn injury. Objective: Correlate microalbuminuria and platelet count with clinical variables in the post-burn injury patients. It is carried out in an attempt to find a simple, cost-effective and at the same time reliable prognostic factor in burn patients. Methodology: This is a Prospective Cohort study conducted from May 2017 to December 2018. Any patient presenting with thermal burn injury fulfilling the inclusion criteria was included. Patients with a history of renal dysfunction or co-morbidities precipitating were excluded. Inhalational injury, Systemic inflammatory response, renal failure were assessed along with microalbuminuria and platelet count to outcome variable of survivors and non-survivors. A total of 49Results: patients were included. The presence of microalbuminuria showed a strong association with outcome variables but quantitative analysis of the same was not indicative more over microalbuminuria was strongly positive in presence of Inhalational injury and renal failure. Platelet count reached minimum value at 3 - 5 days from injury showing a strong correlation with outcomes. : Microalbuminuria and Platelet count are promising prognostic factors and canConclusion be used to direct the management of the patient with burn injury.

Nebulized heparin for burned patients with inhalation injury: a review

The presence of inhalation injury has a negative impact on the evolution of burned patients, being associated with increased mortality. It occurs as a direct consequence of thermal action, or secondary to the presence of respiratory irritants or absorption of toxins, and actual therapeutic management is mainly supportive. Several clinical findings are relevant to raising suspicion and guiding further examinations, fiberoptic bronchoscopy being the gold standard of diagnosis and staging. In burned patients with inhalation injuries, various reports showed that nebulized heparin (5,000 or 10,000 units) with a 4-hour administration regimen leads to improved outcome, reduces the days of mechanical ventilation and consequently the length of hospital stay, reduces pulmonary complications and improves lung function, having a safe profile, with fewer side effects.

61 A Burn Center’s Experience with COVID-19 Positive Burn Patients

IntroductionThe emergence of SARS-COV-2 and the COVID-19 pandemic has complicated the presentation, treatment, and prognosis of all types of patients. Further characterization and analysis of how concomitant COVID-19 infection impacts different patient populations is important for improving treatment strategies. Patients with burn injures often require ICU-level care, mechanical ventilation, and extensive surgical intervention. Concomitant COVID-19 infection in this population presents a new challenge to clinical teams. The purpose of this project is to compare COVID-19 positive burn patients treated at a regional burn center with those that are not.MethodsFollowing IRB approval, our institution’s burn registry was queried from March 2020-June 2021. Data on demographics, injury circumstances, COVID-19 status, and outcomes were collected. Continuous variables were nonparametric and\\compared using Mann-Whitney U test. Categorical variables were compared using Chi-squared with Fischer’s Exact test, where appropriate.ResultsOf the 622 patients admitted at our institution, 19 tested positive for COVID-19 during their hospitalization. Demographic and injury information is reported in Table 1. There were statistically significant differences between the COVID-19 positive and negative groups in regard to race and presence of inhalation injury (p=0.0002, p=0.0002). The TBSA burned was slightly higher in the COVID-19 positive group (9.1 vs 6.7%). COVID-19 positive patients spent more time ventilated (48±32.5 vs.12.2 ± 16.2 days, p=0.0035**) and had both longer ICU (42.71±37.41 vs 11.1±15.4 days, p=0.0175*) and hospital (26.32±32.14 vs 8.177±11.95 days, p< 0.0001***) lengths of stay (LOS). No COVID-19 positive patients died while 5% of the COVID-19 negative patients did. All outcomes were statistically significant.ConclusionsDespite similar TBSA injury burden and age breakdown, patients at our institution who tested positive for COVID-19 required more time on the ventilator and were hospitalized longer. People of color had a higher percentage of positive tests than their Caucasian counterparts. While mortality rates were higher in the COVID-19 negative cohort, morbidities associated with longer LOS must be considered.

546 Health Disparities Among Rural Burn Patients

IntroductionSocioeconomic status is a risk factor for sustaining a burn and for burn mortality. Patients from rural areas make up a minority of the population but are frequently more isolated from life-saving care and burn centers. Lower socioeconomic status patients may delay seeking treatment of their burns for concern over medical costs, time away from work, and overall distance from accredited burn centers. We aim to explore disparities in burn outcomes at our institution based on patient socioeconomic status.MethodsBetween January 2020 and January 2021, patients presenting for management of acute burns were reviewed. Patient demographics and outcomes were collected, including time to presentation, total body surface area burned, presence of inhalational injury, and mortality. Patient socioeconomic status and rural designations were assigned based on a validated metric derived from Census endpoints, with higher scores reflecting lower socioeconomic status.ResultsA total of 524 patients were identified. Overall, 30% of our patients were from areas defined as being small towns or rural by the Census. Racial demographics did not differ between rural and urban areas (p = 0.099), but Hispanic ethnicity was less common (16% vs. 29%, p = 0.002). Rates of alcohol, tobacco, and illicit drug use did not differ between groups. Compared to the urban/suburban cohort, rural patients were from less affluent areas (63.6 vs. 58.5, p = 0.001) and traveled farther to our center (112 miles vs. 70 miles, p = 0.029). Despite these distances, rural patients did not have a higher rate of delayed presentation (35.7% vs. 43.3%, p = 0.105), or longer average time to presentation (3.4 days vs 4.4 days, p = 0.222). Flame burns were the most common mechanism overall (44.3%) and were significantly more common in the rural population (59.2% vs. 37.8%, p < 0.001), Scalds, the second most common burn mechanism (25.9%), occurred less frequently in rural patients (18.5% vs. 29.2%, p = 0.011). Controlling for age, TBSA, inhalational injury, and ventilator requirement, patients from rural areas were at a significantly higher risk of mortality (OR 24, p = 0.024).ConclusionsRural burn patients face many challenges receiving appropriate care following a burn. They frequently come from less affluent backgrounds, limiting their ability to access care, and they must travel greater distances to a qualified burn surgeon. Despite these barriers, our rural patient population did not present any later following a burn compared to our more urban patients. Rural patients sustained more extensive burns but were not hospitalized at a greater rate. Even when controlling for numerous factors associated with burn mortality, rural patients were still at an increased risk. Burn prevention strategies targeting rural communities should address the unique challenges facing these areas.

Differences by age in the obesity paradox in severe burns

BackgroundMany studies show a “obesity paradox”, which seems to protect against death. Whether an obesity paradox space is present in severe burn patients remains a matter of great debate. Most research on the obesity paradox of burn injuries is classified by body mass index (BMI) rather than by age. ObjectiveTo investigate whether the obesity paradox exists in severe burn patients stratified by age. MethodsRetrospective analysis was performed on 490 patients with severe burns who were ≥ 18 years of age and were admitted to Fujian Medical University Union Hospital from January 2005 to December 2020. Demographic and clinical characteristics were collected, including age, BMI, total body surface area (TBSA), presence of inhalation injury, abbreviated burn severity index (ABSI) score, diabetes comorbidities, hypertension comorbidities, and in-hospital mortality. The patients were divided into the younger group (18 ≤ age<65 years) and the older group (age ≥ 65 years). The important variables of the two groups were compared. The predictive value of BMI stratified by age on in-hospital mortality was evaluated by binary logistic regression analysis and the Cochran’s and Mantel-Haenszel statistics. ResultsA total of 490 patients were selected for this study, and were divided into the younger group (413) and the elderly group (77) according to their ages. In the younger group, logistic regression analyses indicated that high BMI remained significantly and independently associated with decreased in-hospital mortality (P = 0.021). That is, in-hospital mortality decreased by 17.8% when BMI increased by 1 kg/m2. In the older group, BMI was not associated with in-hospital mortality (P = 0.808). In the younger group, the results of Pearson's chi-square test was less than 0.05, indicating a correlation between BMI and prognosis. In the older group, the conclusion was contrary with, no correlation between BMI and prognosis. If the confounding factors of age were not considered, this results in no correlation between BMI and prognosis. In the younger group, the survival/death ratio of patients with overweight and obesity was 2.078 times that of patients with normal weight. ConclusionIn this study of patients with severe burns, overweight and obesity had protective effect on burn injury in the younger group (18 ≤ age<65 years), but not in the older group (age ≥ 65 years). Investigating the obesity paradox in burn patients needs to consider age differences. However, multicentre clinical trials are needed to verify the results.