An Australian study of long-term hospital admissions and costs comparing patients with unintentional burns and uninjured people

Ultrasound-based evaluation of loss of lean mass in patients with burns: A prospective longitudinal study

OBJECTIVES

To evaluate the loss of lean mass in patients with burns using ultrasonography of the quadriceps muscle of the thigh.

METHODS

A prospective longitudinal study was conducted using ultrasound of the quadriceps muscle of the thigh to assess the change in thickness in millimeters on days 1, 3 and 7 after study enrollment in 45 patients with burns who were admitted to a burn center (BTC) of a university hospital between April 2020 and September 2021. Patients burns on the thighs, which made it difficult to undertake examinations, were excluded. Depending on where they were admitted, patients were divided into ward and intensive care unit (ICU) patients. ICU patients were considered to have more severe injuries. The general data collected included age, sex, weight, height, area of body surface burn, burn degree and etiology, and airway injury. The data collected for all patients during hospitalization at the BTC were as follows: existence of chronic illness, requirement for mechanical ventilation, Simplified Acute Physiology Score 3 (SAPS 3) and Sequential Organ Failure Assessment (SOFA) on the first day of hospitalization in an intensive care bed in the burn treatment unit (BTU), health-related infection, feeding route, length of hospital stay, and time spent in the BTU.

RESULTS

Loss of muscle thickness was observed in all patients between days 1 and 7. The median thickness for all patients on day 1 was 24.50 mm (ITQ 21.22-30.85) and on day 7 it was 18.80 (ITQ 16.07-23.62), with P = 0.0001. The variation in thigh quadricep muscle thickness between day 1 and day 3, a median of - 2.80 mm (ITQ - 3.52-2.02) was obtained for patients on the ward and - 2.50 mm (ITQ - 3.92 to - 1.47) for ICU patients. Between day 3 and day 7, the variation was - 2.55 mm (ITQ - 4.55 to - 1.25) for ward patients and - 2.10 mm (ITQ - 3.12 to - 1.15) for ICU patients. The median thickness variation assessed between day 1 and day 7 was - 4.95 mm (ITQ - 8.25 to - 3.70) for patients on the ward and - 4.40 mm (ITQ - 7, 35 to - 2.90) for ICU patients. A correlation was observed between the variation in muscle thickness in the interval between day 1 to day 3 and age (P = 0.035).

CONCLUSIONS

Muscle loss occurred early and rapidly within the first seven days of hospitalization, reflecting the impact of burn injury on nutritional risk. An association was observed between muscle thickness loss and age, but no association was observed with the extent of burn, length of hospital stay, occurrence of health-related infections or mortality. These findings suggest the importance of monitoring muscle loss in these patients in planning nutritional therapy, early mobilization, and prevention of complications.

Long-Term Health Care Costs for Service Members Injured in Iraq and Afghanistan

INTRODUCTION

Over the last two decades, the conflicts in Iraq and Afghanistan have cost the United States significantly in terms of lives lost, disabling injuries, and budgetary expenditures. This manuscript calculates the differences in costs between veterans with combat injuries vs veterans without combat injuries. This work could be used to project future costs in subsequent studies.

MATERIALS AND METHODS

In this retrospective cohort study, we randomly selected 7,984 combat-injured veterans between February 1, 2002, and June 14, 2016, from Veterans Affairs Health System administrative data. We matched injured veterans 1:1 to noninjured veterans on year of birth (± 1 year), sex, and first service branch. We observed patients for a maximum of 10 years. This research protocol was reviewed and approved by the David Grant USAF Medical Center institutional review board (IRB), the University of Utah IRB, and the Research Review Committee of the VA Salt Lake City Health Care System in accordance with all applicable Federal regulations.

RESULTS

Patients were primarily male (98.1% in both groups) and White (76.4% for injured patients, 72.3% for noninjured patients), with a mean (SD) age of 26.8 (6.6) years for the injured group and 27.7 (7.0) years for noninjured subjects. Average total costs for combat-injured service members were higher for each year studied. The difference was highest in the first year ($16,050 compared to $4,135 for noninjured). These differences remained significant after adjustment. Although this difference was greatest in the first year (marginal effect $12,386, 95% confidence interval $9,736-$15,036; P < 0.001), total costs continued to be elevated in years 2-10, with marginal effects ranging from $1,766 to $2,597 (P < 0.001 for all years). More severe injuries tended to increase costs in all categories.

CONCLUSIONS

Combat injured patients have significantly higher long-term health care costs compared to their noninjured counterparts. If this random sample is extrapolated to the 53,251 total of combat wounded service members, it implies a total excess cost of $1.6 billion to date after adjustment for covariates and a median follow-up time of 10 years. These costs are likely to increase as injured veterans age and develop additional chronic conditions.

Risk factors for nosocomial infections and/or sepsis in adult burns patients: An integrative review

BACKGROUND

In comparison to general trauma patients, loss of skin barrier amongst the burns cohort predisposes them to a higher risk of nosocomial infections and sepsis, and this often leads to unfavourable morbidity and mortality outcomes.

PURPOSE

This integrative review aimed to explore existing literature to identify risk factors related to nosocomial infections and/or sepsis in adult burns patients following hospital admission.

METHODS

Electronic searches for journals published between 2007 and 2021 were performed in CINAHL, Scopus and Medline, and key journals were hand-searched. Inclusion criteria was: (1) peer-reviewed, primary studies; (2) qualitative, quantitative or mixed-methods studies; (3) study participants had sustained burns-related injury and developed nosocomial infections and/or sepsis during the course of hospitalisation. Studies were appraised using the Critical Appraisal Skill Program checklists.

RESULTS

15 studies ranging from 'poor' to 'fair' to 'moderate' quality were included in the final review. Patient factors that contributed to the development of nosocomial infections and/ or sepsis included: (1) Full thickness burns; (2) age; (3) % Total Burns Surface Area; and (4) Herpes Simplex Virus activation. Several provider-system risk factors were identified by 'poor' quality studies and further research is required to substantiate those findings.

DISCUSSION

Findings remained inconclusive due to the lack of 'good' quality studies however, there was an overemphasis on patient-related risk factors instead of healthcare workers or the system. Future research may focus on activation of the latest infection prevention strategies and early enforcement of care bundles. Through identification of related risk factors, it may reduce the incidence of nosocomial infection and/or sepsis post-burns.