Citation

Heard J, Cronin L, Romanowski K, Greenhalgh D, Palmieri T, Sen S. J. Burn Care Res. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/irac173

PMID

36378582

Abstract

Massive burn injuries are a unique patient population with unique treatment paradigms. Data from 155 adult patients, admitted from 2009-2019, with >50% total body surface area burns (TBSA) were collected and analyzed. Average burn size was 70% TBSA and 63% had a concomitant inhalation injury. Approximately 30% of patients (46/155) transitioned to comfort care only measures within 24 hours of admission. Standard treatment patients were younger (37±13 vs 60±19 years; p<0.00001), male (94% vs 28%; p=0.001) and had smaller TBSA (66±13 vs 80±16; p<0.00001). Of the standard treatment group, 72 (66%) survived to discharge. Survivors had smaller TBSA (64±13 vs 71±13; p=0.003), less third degree TBSA (48±25 vs 71±13; p=0.003) and lower incidence of renal failure requiring dialysis (22% vs 73%, p<0.00001). Multivariate regression analysis showed that age (OR 1.05; p=0.025), total TBSA (OR 1.07; p=0.005) and renal failure (OR 10.2; p=0.00005) were independently associated with mortality. Inhalation injury was not significantly associated with mortality. About 23% (35/155) of patients had a psychiatric condition on admission and 19% (30/155) of patients were burned attempting suicide. Patients with psychiatric conditions spent more time in the hospital (62 vs 30 days; p=0.004), more time on ventilator (31 vs 12 days; p=0.046), underwent more surgery (4 vs 2 operations, p=0.03), and were less likely to die (34% vs 59%; p=0.02). In summary, age, burn size and renal failure were independently associated with mortality, with renal failure being the strongest factor. Psychiatric conditions are prevalent pre-injury and tend to require more inpatient care.

Language: en

Keywords

Burn Mortality; Large Burn; Massive Burn; Psychiatric Burn; Severe Burn