Not all patients meet the 1 day per percent burn rule: A simple method for predicting hospital length of stay in patients with burn

Abstract

Traditional LOS estimates of 1day/%TBSA burn rule is biased, underestimating LOS, particularly for patients >40 years with inhalation injury. The following formulas applied at admission can accurately estimate hospital LOS, improve prediction over 1day/%TBSA, and provide results comparable to complicated models.

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

“…The most significant prognostic factor providing the highest discharge ratios in all children was %TBSA, similar to previous research (Dolp et al 2018;Möller et al 2017;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Matin et al 2015;Elrod et al 2019;Wang et al 2018;Hyland et al 2015;Meshulam-Derazon et al 2006). In Aboriginal and Torres Strait Islander children, greater %TBSA levels have been reported to increase LOS, however our ratios were greater than previous reports (Möller et al 2017).…”

“…Internationally there is a sound body of knowledge surrounding prognostic factors for hospital LOS in burn injuries (Dolp et al 2018;Moore et al 2015;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Sierra Zúñiga et al 2016;Matin et al 2015;Elrod et al 2019;Wang et al 2018). In adults, percentage total body surface area (%TBSA), full thickness burns, socioeconomic status (SES), age, inhalation injury, comorbidities, surgical interventions, and injury complications have been shown to be associated with a longer LOS (Dolp et al 2018;Moore et al 2015;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Sierra Zúñiga et al 2016). In children with a burn injury, large %TBSA (> 16%), burn cause (scald or flame compared to other types), full and partial thickness burns increase LOS, whereas younger age and early skin grafting decrease LOS (Matin et al 2015;Elrod et al 2019;Wang et al 2018).…”

Contributors to the length-of-stay trajectory in burn-injured patients

“…It has been shown that ARDS only effected LOS in the ICU and not inpatient units [30]. In our initial non-matched analysis, inhalation injury was an associated factor with increased LOS, a finding that parallels the recent large-scale record review of the American Burn Association (ABA) National Burn Repository [8]. However, in our matched analysis that association was lost as the presence of inhalation injury resulted in equal number of patients having expected-LOS and exceeding-LOS.…”

“…The LOS prediction solely based on the TBSA% has been under heavy critique for inaccuracy, and newer prediction models try to take into account the complexity of burn injury by incorporating variables of inhalation injury and age [8]. It has been postulated that a precise LOS prediction needs to include pre-existing medical conditions, demographics, and directly burn-related variables such as %TBSA and inhalation injury, but also complications that develop during hospitalization [8, 9]. However, it is still unclear to what extent medical conditions contribute to an increase in LOS in burn patients.…”

“…However, it is still unclear to what extent medical conditions contribute to an increase in LOS in burn patients. Identifying which modifiable factors cause an increased LOS will enable teams to appropriately target their care, evaluate its quality, identify areas of improvement, and to help calculate the needed medical resources [8, 10]. Additionally, identification of these factors will also aid in counseling patients and their families to anticipate an appropriate LOS.…”