Exploring clinicians’ decision-making processes about end-of-life care after burns: A qualitative interview study

Reeder, Sandra; Cleland, Heather; Gold, Michelle; Tracy, Lincoln M.

doi:10.1016/j.burns.2022.12.001

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…15 In another online survey, decisionmaking regarding end-of-life care was described as complex, layered, multifactorial and tailored. 17 Analyses of our data revealed no association between BMI and hospital LOS, ICU LOS, duration of ventilation support nor bacteraemia. This is consistent with several publications.…”

Section: Discussionmentioning

confidence: 52%

The obesity paradox in patients with major burn injuries: a single tertiary burn centre review

Pollock,

Paul,

2024

Australas J Plast Surg

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Introduction: The obesity paradox is a phenomenon described in medical literature where overweight and obese patients have improved survival and better health outcomes. The obesity paradox is of curiosity to many clinicians as the general consensus in medicine has been that a higher body mass index results in poorer health outcomes in both medical and surgical conditions. The aim of this study is to determine whether the obesity paradox exists in our patients with major burn injuries. To our knowledge, this has not been previously investigated in the Australian major burn population. Methods: This is a retrospective study involving patients with major burn injuries > 20 per cent total body surface area admitted to the Victorian Adult Burns Service (Melbourne, Australia) from 1 January 2016 to 31 December 2020 (five-year period). Information collected included patient demographics, weight and height, and nature of burn injuries. Primary outcome of interest was inpatient mortality, and secondary outcomes included hospital length of stay, intensive care unit length of stay, duration of ventilation support required and presence of bacteraemia. Results: A total of 1704 patients were admitted, of whom 165 patients met inclusion criteria for analysis. The vast majority of 31 patients (18.8%) who died during admission were palliated. The obesity paradox did not exist in this study population. Furthermore, although not statistically significant, higher levels of body mass index showed increased risk of mortality. There was no significant association between body mass index and hospital length of stay (p = 0.16), intensive care unit length of stay (p = 0.72), duration of ventilation support (p = 0.62) nor bacteraemia (p = 0.68). Conclusion: The emerging evidence regarding the obesity paradox in the burn surgery literature is inconsistent. We contend that differences in burn management, including palliation of patients with major burn injuries, contribute to these findings.

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Section: Discussionmentioning

confidence: 52%

The obesity paradox in patients with major burn injuries: a single tertiary burn centre review

Pollock,

Paul,

2024

Australas J Plast Surg

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Utilisation of palliative/ end-of-life care practice recommendations in the burn intensive care unit of a Ghanaian tertiary healthcare facility: An observational study

Bayuo,

Baffour

2024

Burns

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Primary and Specialty Palliative Care Utilization at a Regional Burn Center

Tao,

Hoffman,

Stecher

et al. 2024

Journal of Burn Care &Amp; Research

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There is little research informing appropriate specialty palliative care consultation over primary palliative care practice, or the ability of the burn surgeon to perform skills such as effective goals of care discussions. We sought to characterize patterns of palliative care utilization and hypothesized that greater modified Baux (mBaux) and systemic organ failure assessment (SOFA) scores would correlate with increased specialty palliative involvement but have no relationship with primary palliative involvement. A retrospective chart review was conducted at a regional burn center between 2020-2021 including patients admitted with burns or inhalation injury and a mBaux score over 60, detailing circumstances of palliative consultation and goals of care discussions. 163 patients met criteria. Odds of specialty palliative consultation increased by 3.9% for each additional mBaux score point and 23.3% for every SOFA score point. The odds of a goals of care discussion by a burn surgeon increased by 3.5% for each mBaux score point and 23.9% for each SOFA score point. Those receiving palliative consultation tended to have greater burn surface area, graft complications, code status changes, and more goals of care discussions by any provider at admission; there was no difference in symptom control or hospital length of stay. Higher mBaux and SOFA scores correlate with increased odds of both specialty and primary palliative involvement in our cohort. There is bias in diverting both primary and specialty palliative care resources toward acutely ill patients and those with less immediate projected mortality may need additional attention.

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Exploring clinicians’ decision-making processes about end-of-life care after burns: A qualitative interview study

Cited by 3 publications

References 38 publications

The obesity paradox in patients with major burn injuries: a single tertiary burn centre review

The obesity paradox in patients with major burn injuries: a single tertiary burn centre review

Utilisation of palliative/ end-of-life care practice recommendations in the burn intensive care unit of a Ghanaian tertiary healthcare facility: An observational study

Primary and Specialty Palliative Care Utilization at a Regional Burn Center

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