1
|
Al‐dolaimy F, Abdul‐Reda Hussein U, Hadi Kzar M, Saud A, Abed Jawad M, Yaseen Hasan S, Alhassan MS, Hussien Alawadi A, Alsaalamy A, Farzan R. Relationship between body mass index and mortality of burns patients: A systematic review and meta-analysis. Int Wound J 2024; 21:e14358. [PMID: 37654247 PMCID: PMC10781895 DOI: 10.1111/iwj.14358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
This systematic review and meta-analysis aimed to evaluate the relationship between body mass index (BMI) and mortality of burn patients. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Body mass index", "Burns" and "Mortality" from the earliest to the April 1, 2023. The quality of the studies included in this systematic review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). Finally, six articles were included in this systematic review and meta-analysis. A total of 16 154 burn patients participated in six studies. Their mean age was 46.32 (SD = 1.99). Of the participants, 71.7% were males. The mean length of hospitalization was 18.80 (SD = 8.08) days, and the average TBSA in burn patients was 38.32 (SD = 2.79) %. Also, the average BMI in burn patients was 27.10 (SD = 1.75). Results found mortality in patients with abnormal BMI (overweight to morbidity BMI) was 0.19 more than normal BMI (ES: 1.19, 95%CI: 0.76-1.87, Z = 0.75, I2 : 71.8%, p = 0.45). Results of linear dose-response showed each 5 kg/m2 increase in BMI was associated with a 5% increase in mortality that was marginally significant (ES: 1.05, 95%CI: 1.00-1.11, Z = 1.99, I2 : 22.2%, p = 0.047). There was a non-linear relationship between levels of BMI and mortality (Prob > χ2 = 0.02). There was an increase in mortality from percentile 10 to 50, although it was not significant (Correlational coefficient: 0.01, p = 0.85). Also, there was an increase in mortality rate from percentile 50 to 90 that was statistically significant (correlational coefficient: 0.06, p = 0.047). Finally, the results of the study indicated BMI can increase the chance of mortality by 0.19, although it was not significant. As a result, more studies are needed to better judge the relationship between BMI and mortality in burn victims.
Collapse
Affiliation(s)
| | | | - Mazin Hadi Kzar
- College of Physical Education and Sport SciencesAl‐Mustaqbal UniversityBabylonIraq
| | - Abdulnaser Saud
- Anesthesia Techniques DepartmentAl‐Hadi University CollegeBaghdadIraq
| | | | - Saif Yaseen Hasan
- College of Health and Medical TechnologyNational University of Science and TechnologyThi‐QarIraq
| | - Muataz S. Alhassan
- Division of advanced nano material technologies, Scientific Research CenterAl‐Ayen UniversityThi‐QarIraq
| | - Ahmed Hussien Alawadi
- College of Technical EngineeringThe Islamic UniversityNajafIraq
- College of Technical EngineeringThe Islamic University of Al DiwaniyahAl DiwaniyahIraq
- College of Technical EngineeringThe Islamic University of BabylonBabylonIraq
| | - Ali Alsaalamy
- College of Technical EngineeringImam Ja'afar Al‐Sadiq UniversityAl‐MuthannaIraq
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
| |
Collapse
|
2
|
Grossman H, Cole TJ, Shaw C, Dissanaike S, Dhanasekara CS. Baseline glucose levels moderate the association between burn-related mortality inpatients with obesity. Burns 2023; 49:1893-1899. [PMID: 37357062 DOI: 10.1016/j.burns.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Differing findings concerning outcomes for burn patients with obesity indicate additional factors at play. One possible explanation could lie in determining metabolically healthy versus unhealthy obesity, which necessitates further study. METHODS A retrospective study was conducted using the Cerner Health Facts® Database. Deidentified patient data from 2014 to 2018 with second or third-degree burn injuries were retrieved. A moderator analysis was conducted to determine if the association between increased body mass index (BMI) and mortality is moderated by baseline glucose level, a surrogate marker associated with metabolically unhealthy obesity. RESULTS The study included 4682 adult burn patients. BMI alone was not associated with higher mortality (β = 0.106, p = 0.331). Moderation analysis revealed that baseline glucose level significantly modulated the impact of BMI on burn-related obesity; patients with higher BMI and higher baseline blood glucose levels had higher mortality than those with lower baseline blood glucose levels (β = 0.277, p = 0.009). These results remained unchanged after adjusting for additional covariates (β = 0.285, p = 0.025) and inthe sensitivity analysis. CONCLUSIONS Increased baseline glucose levels indicate increased mortality in obese patients with burn injuries, emphasizing the differentiation between metabolically unhealthy versus healthy obesity.
Collapse
Affiliation(s)
- Holly Grossman
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Travis J Cole
- Clinical Research Data Warehouse, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Chip Shaw
- Clinical Research Data Warehouse, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX, USA
| | | |
Collapse
|
3
|
Kelly EJ, Reese AD, Carney BC, Keyloun JW, Palmieri TL, Moffatt LT, Shupp JW, Tejiram S. Examining Obesity and Its Association With Burn Injury: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation Study. J Surg Res 2023; 290:221-231. [PMID: 37285704 DOI: 10.1016/j.jss.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/04/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Literature examining the connection between obesity and burn injuries is limited. This study is a secondary analysis of a multicenter trial data set to investigate the association between burn outcomes and obesity following severe burn injury. MATERIALS AND METHODS Body mass index (BMI) was used to stratify patients as normal weight (NW; BMI 18.5-25), all obese (AO; any BMI>30), obese I (OI; BMI 30-34.9), obese II (OII; BMI 35-39.9), or obese III (OIII; BMI>40). The primary outcome examined was mortality. Secondary outcomes included hospital length of stay (LOS), number of transfusions, injury scores, infection occurrences, number of operations, ventilator days, intensive care unit LOS, and days to wound healing. RESULTS Of 335 patients included for study, 130 were obese. Median total body surface area (TBSA) was 31%, 77 patients (23%) had inhalation injury and 41 patients died. Inhalation injury was higher in OIII than NW (42.1% versus 20%, P = 0.03). Blood stream infections (BSI) were higher in OI versus NW (0.72 versus 0.33, P = 0.03). Total operations, ventilator days, days to wound healing, multiorgan dysfunction score, Acute Physiology and Chronic Health Evaluationscore, hospital LOS, and intensive care unit LOS were not significantly affected by BMI classification. Mortality was not significantly different between obesity groups. Kaplan-Meier survival curves did not significantly differ between the groups (χ2 = 0.025, P = 0.87). Multiple logistic regression identified age, TBSA, and full thickness burn as significant independent predictors (P < 0.05) of mortality; however, BMI classification itself was not predictive of mortality. CONCLUSIONS No significant association between obesity and mortality was seen after burn injury. Age, TBSA, and percent full- thickness burn were independent predictors of mortality after burn injury, while BMI classification was not.
Collapse
Affiliation(s)
- Edward J Kelly
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia
| | - Adam D Reese
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - John W Keyloun
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia
| | - Tina L Palmieri
- Department of Surgery, Burn Division, University of California, Sacramento, California
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Shawn Tejiram
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia.
| |
Collapse
|
4
|
Dhanasekara CS, Cole TJ, Bayouth J, Shaw C, Dissanaike S. Impact of elevated body mass index on burn injury-associated mortality in a representative US sample. Surgery 2023; 173:1508-1512. [PMID: 36959075 DOI: 10.1016/j.surg.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/04/2023] [Accepted: 02/11/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The impact of obesity on burn-related mortality is inconsistent and incongruent; despite being a risk factor for numerous comorbidities that would be expected to increase complications and worsen outcomes, there is evidence of a survival advantage for patients with high body mass index-the so-called obesity paradox. We used a national data set to explore further the relationship between body mass index and burn-related mortality. METHODS Deidentified data from patients with second and third-degree burns between 2014 and 2018 were obtained from the Cerner Health Facts Database. Univariate and multivariate regression models were created to identify potential factors related to burn-related mortality. A restricted cubic spline model was built to assess the nonlinear association between body mass index and burn-related mortality. All statistical analyses were conducted using R (R Foundation for Statistical Computing). RESULTS The study included 9,405 adult burn patients. Univariate and multivariate analyses revealed that age (odds ratio = 2.189 [1.771, 2.706], P < .001), total burn surface area (odds ratio = 1.824 [1.605, 2.074], P < .001), full-thickness burns (odds ratio = 1.992 [1.322, 3.001], P < .001), and comorbidities (odds ratio = 2.03 [1.367, 3.014], P < .001) were associated with increased mortality. Sensitivity analysis showed similar results. However, a restricted cubic spline indicated a U-shaped relation between body mass index and burn-related mortality. The nadir of body mass index was 28.92 kg/m2, with the lowest mortality. This association persisted even after controlling for age, total burn surface area, full-thickness burns, and comorbidities, which all remained significant. CONCLUSION This study confirms a U-shaped association between body mass index and burn-related mortality along with age, total burn surface area, full-thickness burns, and comorbidities as risk factors.
Collapse
Affiliation(s)
| | - Travis J Cole
- Clinical Research Data Warehouse, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Joseph Bayouth
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX
| | - Chip Shaw
- Clinical Research Data Warehouse, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX
| |
Collapse
|
5
|
Dhanasekara CS, Schrader K, Chandrahas S, Aickareth G, Dissanaike S, Griswold JA. Higher baseline copper levels are associated with worse outcome in burn patients with overweight and obesity. Burns 2022; 48:1246-1252. [PMID: 34629187 DOI: 10.1016/j.burns.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We examined the interactive effects of copper (Cu) and overweight (overweight) and obesity on outcomes of burn patients. We posited that higher baseline Cu among burn patients with overweight or obesity will be associated with poor clinical outcomes vs. patients with a normal weight. METHODS A retrospective review was conducted on patients with ≥20% total burn surface area (TBSA) with an initial measurement of Cu. Patients were grouped by body mass index (BMI). The interactions between baseline Cu and BMI groups on multiple burn patient outcomes were examined in a series of multiple regression models. RESULTS One-hundred-and-sixty patients met eligibility (age 43.9 ± 17.5, males 86.3%, normal weight:overweight:obesity = 53:38:69). BMI groups did not differ significantly on demographics, burn severity, or baseline biochemistry. Normal weight patients with higher baseline Cu had shorter ICU stay (ICUS), shorter length of stay (LOS), and had fewer operations (Ps < 0.05). In contrast, overweight and obese patients with higher baseline Cu had longer ICU stay (p = 0.001 and p = 0.034), LOS (p = 0.005 and p = 0.066), and increased operations (p = 0.001 and p = 0.067). CONCLUSIONS Higher baseline Cu seems associated with adverse outcomes in overweight and obese burn patients. Further research is needed to confirm this association and explore the direction of causality.
Collapse
Affiliation(s)
| | - Kaylee Schrader
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Sheila Chandrahas
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | | | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - John A Griswold
- Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA.
| |
Collapse
|
6
|
Rontoyanni VG, Kudlicki A, Palackic A, Gibran N, Stewart B, Schneider JC, Ryan CM, Murton AJ, Wolf SE, Kowalske K, Suman OE. Strength of association between body mass index and physical function scores in paediatric burn patients: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System study. Burns 2022; 48:824-832. [PMID: 35410694 PMCID: PMC9232948 DOI: 10.1016/j.burns.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Increased body weight has been associated with reduced muscle wasting in the early catabolic phase after a severe burn. Yet, overweight and obese non-burn children often exhibit impaired musculoskeletal function, which may lead to poor physical function (PF). We aimed to determine the association between body mass index (BMI) at discharge and self-reported PF and caregiver proxy-reported PF during recovery of burned children. MATERIALS AND METHODS This is a retrospective multisite longitudinal study in paediatric burn patients ((8-17 y old at time of burn). PF outcome measures were self-reported mobility, proxy-reported mobility, and upper extremity PF evaluated using PROMIS measures at 6-, 12-, and 24-months after injury. Primary exposure variable was BMI-for-age at discharge. RESULTS A total of 118 paediatric patients, aged 11.7 ± 3.3 y, with burns covering 37.6 ± 18.8% of their total body surface area (TBSA) and BMI-for-age of 23.1 ± 5.4 kg/m2 at discharge were analyzed. BMI at discharge was not significantly associated with self-reported mobility scores 6 months after burn (beta coefficient =-0.23, p = 0.31), had a positive effect on mobility at 12 months (beta = 0.46, p = 0.05), and no effect at 24 months after injury (beta=-0.10, p = 0.60), when adjusted for burn size. BMI did not have a significant effect on proxy-reported mobility or upper extremity PF. CONCLUSION A greater BMI at discharge was associated with improved self-reported PF at 12 months after burn but not at 6 months or 24 months, which suggests a faster recovery of PF in paediatric patients of larger body weight. Our data suggests that a larger body weight does not compromise the recovery of PF after burn.
Collapse
Affiliation(s)
| | - Andrew Kudlicki
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, Seattle, WA
| | - Barclay Stewart
- UW Medicine Regional Burn Center, Department of Surgery, University of Washington, Seattle, WA,Harborview Injury Prevention & Research Center, Seattle, WA, USA
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Hospital for Children-Boston, Boston, MA, USA
| | - Andrew J. Murton
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oscar E. Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA,Corresponding author: Oscar E. Suman, PhD, Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0737; Office: 409.772.3889; Fax: 409.747.0966;
| |
Collapse
|
7
|
Peluso H, Mujadzic H, Abougergi MS, Mujadzic T, Azefor TB, Caffrey J. Opioid dependence and treatment outcomes among patients with burn injury. Burns 2022; 48:774-784. [PMID: 34922783 DOI: 10.1016/j.burns.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/24/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with burn injuries cause significant healthcare economic burden, often utilising extra-hospital resources, caregiving, and specialized care. METHODS We present a retrospective cohort analysis of the hospitalized patients in the USA with a primary diagnosis of burn injury. Opioid dependence was identified using ICD-10 CM codes. The 30-day all-cause readmission rate was the main outcome while secondary outcomes were inhospital mortality rate, resource utilization which included hospital length of stay, total hospitalization costs and charges and surgical procedures for burn injury treatment as well as the most important five principal diagnoses for admission and readmission. RESULTS Out of 22,348 patients included in the study, 597 had opioid dependence. Older patients (43 years, range: 38.6-47.2 years) as well as males (70.8%) were more likely to be opioid dependent. Opioid dependence was associated with higher 30-day readmission rates (aOR: 1.83, 95% confidence interval (CI): 1.30-2.57, p-value: <0.01), higher total hospitalization costs (aMD: $14,981, CI: $3820-$26,142, p-value: 0.01), total hospitalization charges (aMD: $47,078, CI: -$5093 to $89,063, p-value: 0.03), and a shorter mean length of stay (aMD: 5.13 days, CI: 2.60-7.66, p-value: <0.01). However, patients with and without opioid dependence had similar in-hospital mortality rates (aOR: 0.27, CI: 0.06-1.28, p-value: 0.10). CONCLUSION We are the first to our knowledge to report the association of treatment outcomes and opioid dependence in patients hospitalized at the national level with a burn injury. We show that there were higher 30-day all-cause readmission rates and in-hospital resource utilization among patients with opioid-dependence.
Collapse
Affiliation(s)
- Heather Peluso
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Temple University Hospital and Lewis Katz School of Medicine, Philadelphia, PA, USA; Catalyst Medical Consulting, 722 Elmbrook Drive, Simpsonville, SC 29681, USA.
| | - Hata Mujadzic
- Department of Internal Medicine, Prisma Health Midlands, 5 Medical Park Road, Columbia, SC 29203, USA.
| | - Marwan S Abougergi
- Catalyst Medical Consulting, 722 Elmbrook Drive, Simpsonville, SC 29681, USA; Division of Gastroenterology, Department of Internal Medicine, Prisma Health Midlands, 5 Medical Park Road, Columbia, SC 29203, USA.
| | - Tariq Mujadzic
- Department of Surgery, Division of Plastic Surgery, Prisma Health Midlands, 5 Medical Park Road, Columbia, SC 29203, USA.
| | - Tangwan B Azefor
- Department of Anesthesia & Critical Care Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224, USA.
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University Medical Center, Burn Unit, Bayview Campus, 4940 Eastern Ave, Baltimore, MD 21224, USA.
| |
Collapse
|
8
|
Tolley PD, McClellan JM, Butler D, Stewart BT, Pham TN, Sheckter CC. Burn Outcomes at Extremes of Body Mass Index- Underweight is as problematic as Morbid Obesity. J Burn Care Res 2022; 43:1180-1185. [PMID: 35106572 DOI: 10.1093/jbcr/irac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Limited evidence suggests that obesity adversely affects burn outcomes. However, the impacts of body mass index (BMI) across the continuum has not been fully characterized. Therefore, we aimed to characterize outcomes after burn injury across the BMI continuum. We hypothesized that 'normal' BMI (18.5-24.9) would have the lowest mortality and complication rates. The US National Trauma Data Bank (NTDB) was queried for adult burn-injured patients from 2007-2015. Admission BMI was calculated and grouped according to World Health Organization (WHO) classification. The primary outcome was in-hospital mortality. Secondary outcomes of time to wound closure, length of stay (LOS), and inpatient complications were similarly assessed. Of the 116,008 burn patient encounters that were identified, 7,243 underwent at least one operation for wound closure. Mortality was lowest in the overweight (p=0.039) and obese I cohorts (BMI 25-29.9, 30.0-34.9) at 2.9% and increased in both directions of the BMI continuum to 4.1% in the underweight (p=0.032) and 5.1% in the morbidly obese (class III) group (p=0.042). Time to final wound closure was longest in the two BMI extremes. BMI >40 was associated with increased ICU days, ventilator days, renal and cardiac complications. BMI <18.5 had increased hospital days and rates of sepsis. Aberrations in metabolism associated with both increases and decreases of body weight may cause pathophysiologic changes that lead to worsened outcomes in burn-injured patients. In addition to morbidly obese patients, underweight patients also experience increased burn-related death and complications. In contrast, overweight BMI patients may have greater physiologic reserves without the burden of obesity or sarcopenia.
Collapse
Affiliation(s)
- Philip D Tolley
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington.,Division of Plastic and Reconstructive Surgery, University of Washington
| | - John M McClellan
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington
| | - Demsie Butler
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington
| | - Barclay T Stewart
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington.,Harborview Injury Prevention and Research Center
| | - Tam N Pham
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington.,Harborview Injury Prevention and Research Center
| | - Clifford C Sheckter
- Department of Surgery, Stanford University.,Northern California Regional Burn Center, Santa Clara Valley Medical Center
| |
Collapse
|
9
|
Abstract
ABSTRACT In the last few decades, obesity became one of the world's greatest health challenges reaching a size of global epidemic in virtually all socioeconomic statuses and all age groups. Obesity is a risk factor for many health problems and as its prevalence gradually increases is becoming a significant economic and health burden. In this manuscript we describe how normal respiratory and cardiovascular physiology is altered by obesity. We review past and current literature to describe how obesity affects outcomes of patients facing critical illnesses and discuss some controversies related to this topic.
Collapse
Affiliation(s)
- Itay Ayalon
- Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Department of Pediatric Critical Care, Tel-Aviv, Israel
| | - Lauren Bodilly
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Kaplan
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
10
|
Nie C, Yu H, Wang X, Li X, Wei Z, Shi X. Pro-inflammatory effect of obesity on rats with burn wounds. PeerJ 2020; 8:e10499. [PMID: 33354433 PMCID: PMC7731656 DOI: 10.7717/peerj.10499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/15/2020] [Indexed: 12/12/2022] Open
Abstract
Objective A burn is an inflammatory injury to the skin or other tissue due to contact with thermal, radioactive, electric, or chemical agents. Burn injury is an important cause of disability and death worldwide. Obesity is a significant public health problem, often causing underlying systemic inflammation. Studying the combined impact of burn injuries on obese patients has become critical to the successful treatment of these patients. The aim of this paper is to highlight the effect of inflammation associated with burn injuries on several body weight group in a rat study. Materials and methods Different degrees of obesity and burns were established in rats and divided into a normal weight group, overweight group, obese group, second-degree burn group, third-degree burn group, over-weight second-degree burn group, over-weight third-degree burn group, obese second-degree burn group, and obese third-degree burn group (20 rats per group). Changes in inflammatory factors and growth factor were measured on the 1st, 3rd, 7th and 14th days after burns were inflicted. Results The ELISA test showed that in the unburned control group, MCP-1, IL-1β and TNF-α protein expressions in the obese and over-weight groups were higher than the normal-weight group (P < 0.05). RT-PCR test showed that the expressions of MCP-1, IL-1β and TNF-α genes in the obese group were higher compared to the overweight and normal weight groups (P < 0.05). Three and 7 days after burns were inflicted, the level of VEGF in the normal weight group was higher than the obese group (P < 0.05), however increased VEGF was not observed on days 1 and 14. Conclusion Burn injury and obesity have a mutually synergistic effect on the body’s inflammatory response.
Collapse
Affiliation(s)
- Chan Nie
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China.,Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, China
| | - Huiting Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xue Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiahong Li
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Zairong Wei
- Burns & Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| |
Collapse
|
11
|
Tapking C, Houschyar KS, Rontoyanni VG, Hundeshagen G, Kowalewski KF, Hirche C, Popp D, Wolf SE, Herndon DN, Branski LK. The Influence of Obesity on Treatment and Outcome of Severely Burned Patients. J Burn Care Res 2020; 40:996-1008. [PMID: 31294797 DOI: 10.1093/jbcr/irz115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obesity and the related medical, social, and economic impacts are relevant multifactorial and chronic conditions that also have a meaningful impact on outcomes following a severe injury, including burns. In addition to burn-specific difficulties, such as adequate hypermetabolic response, fluid resuscitation, and early wound coverage, obese patients also present with common comorbidities, such as arterial hypertension, diabetes mellitus, or nonalcoholic fatty liver disease. In addition, the pathophysiologic response to severe burns can be enhanced. Besides the increased morbidity and mortality compared to burn patients with normal weight, obese patients present a challenge in fluid resuscitation, perioperative management, and difficulties in wound healing. The present work is an in-depth review of the current understanding of the influence of obesity on the management and outcome of severe burns.
Collapse
Affiliation(s)
- Christian Tapking
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Khosrow S Houschyar
- Department of Plastic Surgery, Hand Surgery, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany
| | - Victoria G Rontoyanni
- Department of Surgery, University of Texas Medical Branch, Galveston.,Metabolism Unit, Shriners Hospitals for Children, Galveston, Texas
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | | | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Daniel Popp
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Department of Urology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch, Galveston.,Shriners Hospitals for Children, Galveston, Texas.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| |
Collapse
|
12
|
Saadat GH, Toor R, Mazhar F, Bajani F, Tatebe L, Schlanser V, Kaminsky M, Messer T, Starr F, Dennis A, Poulakidas S, Bokhari F. Severe burn injury: Body Mass Index and the Baux score. Burns 2020; 47:72-77. [PMID: 33234365 DOI: 10.1016/j.burns.2020.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The revised Baux score (age total body surface area (TBSA) burned and inhalation injury)) is predictive of mortality in burn patients. Our study objective was to assess whether the addition of body mass index (BMI) to the revised Baux score would be of value. We posited that increasing BMI follows a pattern similar to age and TBSA in the revised Baux score after severe burn injury. METHODS Patient data from the burn registry was queried for patients admitted between 1/1/2013 to 8/31/2019. Patients 12 years or older with a TBSA of 20% or greater burn were included. Inpatient outcomes were analyzed based on BMI. RESULTS 56 of 1365 patients met inclusion criteria. Mean age of the study population was 48.25 years and 64.3% of patients were male. Median BMI was 25.8 and median TBSA was 26.5. Inhalation injury was present in 44.6% (25/56) of patients. Median hospital length of stay (LOS) and ICU LOS were 21.5 and 17 days respectively. On bivariate analysis, non-survivors had higher TBSA (41.5% vs 25.5%, p = 0.034), more inhalation injury (83.3%, 10/12 vs 34.8%, 15/43 p = 0.003) and higher complication rates (91.6%, 11/12 vs 59.1 %, 25/43, p = 0.043). Survivors also had higher BMI (28.2 vs 23, p = 0.003) and increased hospital LOS (24 vs 5.5, p = 0.003). Automatic model fit in binary logistic regression showed a negative relationship between BMI and mortality. CONCLUSION We found a negative relationship between BMI and mortality. Pre-obesity appears to have a protective role, but BMI was not found to be a useful addition to the revised Baux score. Larger sample sizes may be of benefit a for a for a more definitive understanding of the role of BMI with regards to burn survival.
Collapse
Affiliation(s)
- Ghulam H Saadat
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Rubinder Toor
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Faizan Mazhar
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy.
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Leah Tatebe
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Frederic Starr
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| |
Collapse
|
13
|
Bagheri M, Fuchs PC, Lefering R, Grigutsch D, Busche MN, Niederstätter I, The German Burn Registry, Schiefer JL. Effect of comorbidities on clinical outcome of patients with burn injury - An analysis of the German Burn Registry. Burns 2020; 47:1053-1058. [PMID: 34092418 DOI: 10.1016/j.burns.2020.04.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Severe burn injuries are associated with high morbidity and mortality. Well-implemented scoring systems for patients with major burns exist in the literature. A major disadvantage of these scores is the partial non-consideration of patient-related comorbidities. Published data on this matter is limited to small study cohorts and/or single center studies. Further, the effect of comorbidities on clinical outcome of patients with severe burn injuries has not yet been examined nationwide in a large cohort in Germany. Hence, the aim of this study was to examine the influence of comorbidities on clinical outcome of these patients based on data from the national registry. METHODS Anonymized data from a total of 3455 patients with documented burns of 1% or more Total Burn Surface Area (TBSA) and over 16 years of age included in the German Burn Registry between 2017 and 2018 were analyzed retrospectively. Data included burn extent, body weight, age, burn depth, inhalation injury, comorbidities, mortality, number of operations and length of hospital stay (LOS). RESULTS In the logistic regression analysis age (OR 1.07 [1.06-1.09], p < 0.001), TBSA (OR 1.09 [1.08-1.11], p < 0.001), IHT (OR 2.15 [1.44-3.20], p < 0001), third degree burn (OR 2.08 [1.39-3.11], p < 0.001), Chronic Obstructive Pulmonary Disease (COPD) (OR 2.45 [1.38-4.35], p = 0.002) and renal insufficiency (OR 2.02 [1.13-3.59], p = 0.017) influenced mortality significantly. If a patient had more than one comorbidity, mortality was higher and in-hospital length of stay (LOS) longer. Renal insufficiency was significantly (p < 0.001) associated with the most prolonged LOS by 11.44 days. TBSA (p < 0.001), Abbreviated Burn Severity Index (ABSI) > 3 (p < 0.001) and IHT (p = 0.001) correlated with the amount of required surgeries and significantly predicted the need for intubation. Patients with arrhythmia significantly required more surgeries (p = 0.041), whereas patients with COPD required significantly less surgical interventions (p = 0.013). CONCLUSION Preexisting comorbidities have a significant impact on the clinical outcome of patients with severe burn injuries. Further investigation is warranted in order to supplement existing prognostic scores with new mortality-associated parameters.
Collapse
Affiliation(s)
- Mahsa Bagheri
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Daniel Grigutsch
- Clinic of Anesthesiology at the University Hospital Bonn, Germany
| | - Marc Nicolai Busche
- Department of Plastic and Aesthetic Surgery, Burn Surgery, Leverkusen Hospital, Leverkusen, Germany; Hannover Medical School, Hannover, Germany
| | - Ines Niederstätter
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | | | - Jennifer Lynn Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany.
| |
Collapse
|
14
|
Pauzenberger R, Radtke C, Ederer IA, Hacker S, Waldmann A, Sternat N, Franke I, Thury A, Harpain L, Stievano S. Does obesity impact the outcome of severely burned patients? Int Wound J 2020; 17:380-386. [PMID: 31898396 PMCID: PMC7064920 DOI: 10.1111/iwj.13282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/19/2019] [Indexed: 12/02/2022] Open
Abstract
Although obesity appears to be an important predictor of mortality and morbidity, little data about the impact of body mass index (BMI) on the outcome of severely burned patients are available. Patients admitted to the General Hospital Vienna between 1994 and 2014, who underwent surgery because of burn injuries, were enrolled in this study. BMI was used to divide patients into five groups: BMI 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and > 40. The groups were compared in terms of difference of mortality and morbidity. Of 460 patients, 34.3% (n = 158) died. Mortality rates were the lowest in patients with obesity class III and the highest in patients with BMI 35 to 39.9 (BMI 18.5‐24.9: 30.5%, BMI 25‐29.9: 31.5%, BMI 30‐34.9: 41.3%, BMI 35‐39.9: 55.5%, BMI > 40: 30%; P = .031). BMI was not found to be an independent risk factor when corrected with age, percent total body surface area burned, full‐thickness burns, and inhalation injury. No significant differences in length of stay, inhalation trauma, pneumonia, wound infection, sepsis, and invasive ventilation were observed. BMI as an independent risk factor for severely burned patients could not be confirmed via multivariate analysis.
Collapse
Affiliation(s)
- Reinhard Pauzenberger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christine Radtke
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ines A Ederer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Stefan Hacker
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Facial Plastic Surgery, Marienhospital Stuttgart, Stuttgart, Germany
| | - Anna Waldmann
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Sternat
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Isabella Franke
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Thury
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Lucie Harpain
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Simona Stievano
- Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
15
|
Peluso H, Abougergi MS, Caffrey J. Impact of primary payer status on outcomes among patients with burn injury: A nationwide analysis. Burns 2018; 44:1973-1981. [PMID: 30005990 DOI: 10.1016/j.burns.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/24/2018] [Accepted: 06/15/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the relationship between insurance provider and important outcomes among patients with burn injury. METHODS Adults with burn injury were selected from the National Inpatient Sample. The primary outcome was inpatient mortality. Secondary outcomes were morbidity (septic shock and prolonged mechanical ventilation (PMV)), treatment metrics (time to surgery and parenteral or enteral nutrition (P/E-nutrition)) and resource utilization (length of stay (LOS) and total hospitalization costs and charges). Confounders were adjusted for using multivariate regression analysis. RESULTS Insurance did not affect in-hospital mortality rate. Compared with private insurance, Medicaid was associated with higher septic shock rate (aOR: 2.14 (1.04-4.39), longer LOS (adjusted mean difference (aMD): 2.79 (0.50-5.08) days) and higher costs (aMD: $16,161 ($4789-$27,534) while uninsured patients has shorter LOS (aMD: -2.57 (-4.59--0.55) days), lower charges (aMD: $-37,792 $(-65,550-$-10,034) and costs (aMD: $-8563 ($15,581-$-1544)). Insurance did not affect PMV rates or time to surgery or P/E-nutrition. CONCLUSIONS Primary payer does not affect in-hospital mortality or treatment metrics among patients admitted for burn injury. However, compared with private insurance, Medicaid was associated with both higher morbidity and resource utilization, whereas uninsured patients had lower resource utilization.
Collapse
Affiliation(s)
- Heather Peluso
- Department of surgery, University of South Carolina, Greenville Health System, 701 Grove Road, Greenville, SC, 29605, USA.
| | - Marwan S Abougergi
- Catalyst Medical Consulting, 722 Elmbrook Drive, Simpsonville, SC, 29681, USA; Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, 5 Medical Park Road, Columbia, SC, 29203, USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University Medical Center, Johns Hopkins Adult Burn Unit, Johns Hopkins Bayview Medical Center, 4900 Eastern Avenue, Baltimore, MD, 21224, USA
| |
Collapse
|
16
|
Toft-Petersen AP, Ferrando-Vivas P, Harrison DA, Dunn K, Rowan KM. The organisation of critical care for burn patients in the UK: epidemiology and comparison of mortality prediction models. Anaesthesia 2018; 73:1131-1140. [PMID: 29762869 DOI: 10.1111/anae.14319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 12/23/2022]
Abstract
In the UK, a network of specialist centres has been set up to provide critical care for burn patients. However, some burn patients are admitted to general intensive care units. Little is known about the casemix of these patients and how it compares with patients in specialist burn centres. It is not known whether burn-specific or generic risk prediction models perform better when applied to patients managed in intensive care units. We examined admissions for burns in the Case Mix Programme Database from April 2010 to March 2016. The casemix, activity and outcome in general and specialist burn intensive care units were compared and the fit of two burn-specific risk prediction models (revised Baux and Belgian Outcome in Burn Injury models) and one generic model (Intensive Care National Audit and Research Centre model) were compared. Patients in burn intensive care units had more extensive injuries compared with patients in general intensive care units (median (IQR [range]) burn surface area 16 (7-32 [0-98])% vs. 8 (1-18 [0-100])%, respectively) but in-hospital mortality was similar (22.8% vs. 19.0%, respectively). The discrimination and calibration of the generic Intensive Care National Audit and Research Centre model was superior to the revised Baux and Belgian Outcome in Burn Injury burn-specific models for patients managed on both specialist burn and general intensive care units.
Collapse
Affiliation(s)
- A P Toft-Petersen
- Departments of Clinical Medicine and Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.,Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - P Ferrando-Vivas
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - D A Harrison
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - K Dunn
- Adult Burn Service, University Hospital of South Manchester, Manchester, UK
| | - K M Rowan
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| |
Collapse
|
17
|
Impact of weekend admission on mortality and other outcomes among patients with burn injury: A nationwide analysis. Burns 2017; 43:1654-1661. [DOI: 10.1016/j.burns.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022]
|
18
|
Acute Kidney Injury in Burn Patients: Clinically Significant Over the Initial Hospitalization and 1 Year After Injury: An Original Retrospective Cohort Study. Ann Surg 2017; 266:376-382. [PMID: 27611620 DOI: 10.1097/sla.0000000000001979] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine the development of acute kidney injury (AKI) after burn injury as an independent risk factor for increased morbidity and mortality over initial hospitalization and 1-year follow-up. BACKGROUND Variability in fluid resuscitation and difficulty recognizing early sepsis are major barriers to preventing AKI after burn injury. Expanding our understanding of the burden AKI has on the clinical course of burn patients would highlight the need for standardized protocols. METHODS We queried the Healthcare Cost and Utilization Project State Inpatient Databases in the states of Florida and New York during the years 2009 to 2013 for patients over age 18 hospitalized with a primary diagnosis of burn injury using ICD-9 codes. We identified and grouped 18,155 patients, including 1476 with burns >20% total body surface area, by presence of AKI. Outcomes were compared in these cohorts via univariate analysis and multivariate logistic regression models. RESULTS During initial hospitalization, AKI was associated with increased pulmonary failure, mechanical ventilation, pneumonia, myocardial infarction, length of stay, cost, and mortality, and also a lower likelihood of being discharged home. One year after injury, AKI was associated with development of chronic kidney disease, conversion to chronic dialysis, hospital readmission, and long-term mortality. CONCLUSIONS AKI is associated with a profound and severe increase in morbidity and mortality in burn patients during initial hospitalization and up to 1 year after injury. Consensus protocols for initial burn resuscitation and early sepsis recognition and treatment are crucial to avoid the consequences of AKI after burn injury.
Collapse
|
19
|
Borhani-Khomani K, Partoft S, Holmgaard R. Assessment of burn size in obese adults; a literature review. J Plast Surg Hand Surg 2017; 51:375-380. [PMID: 28417654 DOI: 10.1080/2000656x.2017.1310732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Obesity causes changes in the total body surface area as well as the distribution of skin surfaces. In burn management, three methods are commonly used to determine the surface area burned: the patient's palm, the rule of nines, and the Lund-Browder chart. These methods rely on the distribution of skin surface, although none of these methods consider differences in body mass. This study investigates the relationship between body surfaces and body mass in the assessment of burn size to determine the validity of the conventional methods when applied to obese individuals. METHODS The current literature was reviewed using relevant electronic databases. The initial search yielded 247 results. Relevant articles were then reviewed. A total of seven publications fulfilled the inclusion criteria. RESULTS The palmar surface area ranged between 0.59%-1.22%, depending on BMI, gender, and ethnicity, compared to 1% according to conventional methods. The palmar surface area of obese individuals approximated 0.7% of the total body surface area in Caucasians. The surface areas comprised 5%-7.5% of the total body surface area for each arm, 15%-20% for each leg, and 40%-52% for the trunk in obese or morbidly obese individuals, compared to 9%, 18%, and 36%, respectively, for normal-weight adults. CONCLUSIONS The commonly used methods for assessment of burns should be used with caution when applied to obese burn patients, and the clinical parameters observed even more systematically.
Collapse
Affiliation(s)
- Kaveh Borhani-Khomani
- a Faculty of Health and Medical Sciences, University of Copenhagen , København N , Denmark
| | - Søren Partoft
- b Department of Plastic Surgery, Breast Surgery and Burns Treatment , Rigshospitalet , København Ø , Denmark
| | - Rikke Holmgaard
- b Department of Plastic Surgery, Breast Surgery and Burns Treatment , Rigshospitalet , København Ø , Denmark
| |
Collapse
|
20
|
|