Pavement Burns Treated at a Desert Burn Center: Analysis of Mechanisms and Outcomes

Abstract

Burns from contact with hot pavement are a common mechanism treated at burn centers located in desert climates. Previous work has shown increased risk of pavement burns as ambient temperatures rise above 95 degrees. In direct sunlight, pavement absorbs radiant energy causing the temperature to rise high enough to cause second-degree burns in seconds. The goal of this study is to review the mechanisms and outcomes of patients suffering pavement burns and to compare patients who presented with hyperthermia to their normothermia counterparts. A retrospective chart review was performed on pavement burns at an ABA-verified Burn Center for 5 years from 2014 to 2018. A total of 195 patients were identified. It was found that 50.5% of admitted pavement burn patients required burn excision and 35.9% required split-thickness skin grafting. The leading causes of pavement burn admissions were found down by EMS and walking on pavement at 21.6% each, followed by mechanical falls at 15.1%. We found that patients with recorded hyperthermia had statistically significant increase in 30-day hospital mortality, intensive care unit days, surgical procedures, and %TBSA. Data provided from this study can be used for a public health initiative to help patients who may be at risk of acquiring pavement burns. The data may also be helpful for clinicians gaining information about the management, mechanism, and outcomes of pavement burn patients.

Pavement Burns in New Mexico: Our Experiences, Treatments, and Outcomes

“…On comparison with our study, our cohort presented with more extensive injury as the mean %TBSA burned was 9.82% vs 5.4%, and our patients required split-thickness autografting 100% of the time vs 35.9%. Operative intervention likely increased our average LOS which was 1.5 days longer than the patients reviewed by Eisenberg et al 10 A retrospective chart review of seven patients by Silver et al 8 evaluated the clinical course, outcomes, and financial costs associated with pavement burns. In that study, all patients required surgery with excision of all nonviable tissue including fascial excision to healthy tissue.…”

“…Harrington et al, Silver et al, and Eisenberg et al could not establish an explanation for this phenomenon. 1,7,8,10 Harrington et al 1 postulated that the extent of burn depth and devitalized tissue could not be fully appreciated at the time of initial assessment. Silver et al 7,8 hypothesized that since burns were located on the most dependent areas when recumbent, lying in hospital beds placed continued pressure on these areas and worsened injuries.…”

Management of Heat-Related Illness and Injury in the ICU: A Concise Definitive Review

“…The three leading causes of pavement burns are patients found lying on pavement-21.6% ("found down"), walking on pavement-21.6% (particularly diabetics, who have insensate feet), and mechanical falls-15.1% (64). Burns caused by contact with hot pavement/surfaces have an increased need for surgical excision, higher overall cost per percent burn, longer hospital stays and higher mortality than other types of burn injury (64). A single center study of 195 patients documented that 50.5% of those sustaining pavement burns required burn excision, and 35.9% required grafting (64).…”

“…Burns caused by contact with hot pavement/surfaces have an increased need for surgical excision, higher overall cost per percent burn, longer hospital stays and higher mortality than other types of burn injury (64). A single center study of 195 patients documented that 50.5% of those sustaining pavement burns required burn excision, and 35.9% required grafting (64).…”

“…Other prognostic indicators have been identified to predict which patients have the greatest risk of mortality (4,64,(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85). The most established include advanced age, maximum temperature, duration of hyperthermia, cooling rate, hypotension, and presence of organ dysfunction (68) (Fig.…”