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Blears E, Kuo SCE, Tiongco RFP, Suresh R, Cooney CM, Caffrey J. Associations of urban versus rural patient residence on outcomes after burn: A national inpatient sample database study. Burns 2024; 50:1463-1474. [PMID: 38584006 DOI: 10.1016/j.burns.2024.03.021] [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: 08/02/2023] [Revised: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Burn patients in rural areas may encounter poorer outcomes associated with barriers to care; however, residence has not been studied in a large sample. The association between rural-versus-urban residence and outcomes after burn was examined using the National Inpatient Sample (NIS) database. METHODS Using the 2019 NIS database, patients over 18 years with a primary diagnosis of burn or corrosive injury were included. Level of urbanization was categorized into six groups. Outcomes after burn such as in-hospital mortality, multifactorial shock, prolonged mechanical ventilation, length of stay, and total costs were analyzed after adjusting for demographic factors and hospital characteristics. RESULTS We included 4671 records, which represented a weighted population of 23,085 patients. Rural residence was associated with higher percentage of prior transfer but not in-hospital mortality. Compared to the most urbanized counties, encounters from the most rural counties were associated with higher odds of shock (aOR:2.62, 99% CI: 1.04-6.56, p = 0.007). CONCLUSION Burn encounters from less urbanized counties did not experience differences in mortality, rates of skin grafting, prolonged mechanical ventilation, length of stay, or overall costs. However, odds of shock were higher among the least urbanized counties. Despite improved triage and transportation systems across the US, disparities and challenges exist for burn patients from rural residence.
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Affiliation(s)
- Elizabeth Blears
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Shih-Chiang Edward Kuo
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Rafael Felix P Tiongco
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rachana Suresh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Julie Caffrey
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hill DM, Rath AJ, Boam T, Fletchall S, Sabbatini S, Geib T, Krebs M, Funk D, Greer C, Mincey M, Wayne M, Dadireddy K, Liu X, Velamuri SR. A Regional Analysis of Potentially Preventable Injuries Sustained From Burning Garbage and Yard Waste. J Burn Care Res 2023; 44:1013-1016. [PMID: 37315006 DOI: 10.1093/jbcr/irad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 06/16/2023]
Abstract
Due to high prevalence in the south, understanding the injury pattern, healthcare burden, and cost of burn injuries associated with burning yard and trash debris are important for effective prevention. This 5-year retrospective, single-center study included patients sustaining an open flame burn injury due to burning brush or trash. Based on primary residence of the 136 patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment, and 18% did not have access. The median (Q1 and Q3) age and total body surface area (TBSA) burned was 50 (32, 66.5) years and 5% (2.5, 12), respectively, with 36% having some portion of full-thickness injury. One-third had some form of substance use. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 hospital days utilized (~6.6% of available bed-days per study period). Twenty-five percent were discharged with a paired functional status worse than pre-injury. Patients with some degree of pre-injury function limitations had a 3-fold higher length of stay (10 vs 3 days; P = .023). Patients with lower pre-injury functionality had almost four times higher mortality (23.7% vs 6.3%; P = .085). There were 9 (6.7%) deaths with an average (±SD) of 74.3 ± 13.1 years of age, median of 33% (31, 43) TBSA, and median full-thickness TBSA of 32% (21, 44). Total hospital charges exceeded $32.6 million with a median of $32,952.26 ($8,790.48, $103,113.95) per patient. Focusing future outreach efforts on education and resource availability may prevent future waste-burning injuries.
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Affiliation(s)
- David M Hill
- Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA
| | - Abigail J Rath
- College of Pharmacy, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tina Boam
- Department of Burn Administration, Regional One Health, Memphis, Tennessee, USA
| | - Sandra Fletchall
- Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA
| | - Sarah Sabbatini
- Department of Burn Rehabilitation, Regional One Health, Memphis, Tennessee, USA
| | - Teresa Geib
- Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA
| | - Mamie Krebs
- Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA
| | - David Funk
- Department of Burn Rehabilitation, Regional One Health, Memphis, Tennessee, USA
| | - Catherine Greer
- Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA
| | - Megan Mincey
- Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA
| | - Mary Wayne
- Department of Burn Rehabilitation, Regional One Health, Memphis, Tennessee, USA
| | - Kalyan Dadireddy
- Department of Surgery, Division of Plastic Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Xiangxia Liu
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sai R Velamuri
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Drago DA. Gasoline-related injuries and fatalities in the United States, 1995-2014. Int J Inj Contr Saf Promot 2018; 25:393-400. [PMID: 29431008 DOI: 10.1080/17457300.2018.1431947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This descriptive study examines twenty years of gasoline-related fatalities and emergency department treated injuries in the United States, based on data from the US Consumer Product Safety Commission. Thermal burns consistently accounted for the majority (56%) of gasoline-related injuries and for most (82%) gasoline-related deaths, and were commonly (57-71%) associated with the use of gasoline as an accelerant. Poisoning accounted for 13% of injuries and 17% of deaths. The primary poisoning injury pattern was ingestion; the primary fatality pattern was inhalation, with about half of those associated with deliberate abuse. The estimated number of ingestions decreased from 60 to 23% of poisoning-related injuries, while injuries associated with inhalation abuse increased from 6 to 23%. Chemical burns and dermatitis were less represented in the injury data and were primarily associated with gasoline spills or splashes. Gasoline cans reportedly ignited or exploded in about 5% of thermal burn injuries and fatalities. While mandatory requirements for child resistant closures on gasoline cans (a primary intervention) have potentially impacted poisonings, the use of flame mitigation devices to address thermal injuries, if successful, would be a secondary intervention, and could address only a small percentage (about 5%) of injuries and deaths.
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Duke J, Wood F, Semmens J, Edgar D, Spilsbury K, Rea S. An assessment of burn injury hospitalisations of adolescents and young adults in Western Australia, 1983–2008. Burns 2012; 38:128-35. [DOI: 10.1016/j.burns.2011.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/07/2011] [Accepted: 02/24/2011] [Indexed: 10/15/2022]
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