Predicting Resource Utilization in Burn Treatment

Taylor, Sandra L.; Curri, Terese; Lawless, Mary Beth; Sen, Soman; Greenhalgh, David G.; Palmieri, Tina L

doi:10.1097/bcr.0000000000000076

Cited by 15 publications

(13 citation statements)

References 16 publications

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“…17 Patients with TBSA 61%+ were removed from regression analyses to reduce a tail effect where outlier patients with high TBSA would skew results, as they commonly have exceptionally long LOS and intensive resource use. 7 , 17 We only included surviving patients to reduce confounding in our predictive analysis, as many of the same predictors of mortality (eg, TBSA and inhalation injury) overlap with important predictors of resource use such as LOS. 18 …”

Section: Methodsmentioning

confidence: 99%

“…Independent variables were informed by a review of the published burn literature, 7 , 8 interviews with burn surgeons and availability of variables in the NBR. These variables included patient characteristics such as age (in years), sex, selected comorbidities (diabetes status, hospital-acquired infection [HAI], other infection, and inhalation injury), burn TBSA, and whether the burn was superficial partial-thickness (SPT, defined as patients expected to heal in less than 14 to 21 days without an autograft procedure).…”

Section: Methodsmentioning

confidence: 99%

“…For example, one study assessed the relationship between burn patient characteristics and operating room visits, number of operations, mechanical ventilation use, and intensive care unit (ICU) days. 7 In this analysis, the authors included all patients regardless of survival status and injured TBSA and did not consider specific types of procedures. A systematic literature review of publications predicting LOS in thermal burns noted that age and percent TBSA of burn were the strongest predictors of LOS, with percent mixed depth/full-thickness burns, sex, inhalation injury, number of procedures, and depth of burn as additional significant variables.…”

mentioning

confidence: 99%

“… 8 However, many studies cited in the review focused on smaller TBSA ranges, typically less than 20%. 6 , 9–14 In addition, one publication did not differentiate between surviving patients and nonsurviving patients, 7 which may confound conclusions.…”

mentioning

confidence: 99%

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Relationship Between Patient Characteristics and Number of Procedures as well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository

Kruger

Kowal

Bilir

et al. 2020

Journal of Burn Care &Amp; Research

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This study establishes important, national benchmarks for burn centers to assess length of stay (LOS) and number of procedures across patient profiles. We examined the relationship between patient characteristics such as age and total body surface area (TBSA) burned and number of procedures and LOS in the United States, using the American Burn Association National Burn Repository (NBR) database version 8.0 (2002–2011). Among 21,175 surviving burn patients (TBSA > 10–60%), mean age was 33 years, and mean injury size was 19.9% TBSA. Outcomes included the number of debridement, excision, autograft procedures, and LOS. Independent variables considered were: age (linear, squared, and cubed to account for nonlinearity), TBSA, TBSAs of partial-thickness and mixed/full-thickness burns, sex, hospital-acquired infection, other infection, inhalation injury, and diabetes status. Regression methods included a mixed-effects model for LOS and ordinary least squares for number of procedures. A backward stepwise procedure (P <0.2) was used to select variables. Number of excision and autografting procedures increased with TBSA; however, this relationship did not hold for debridement. After adjusting for sex, age, and comorbidities, predicted LOS for adults (18+) was 12.1, 21.7, 32.2, 43.7, and 56.1 days for 10, 20, 30, 40, and 50% TBSA, respectively. Similarly, predicted LOS for pediatrics (age < 18) was 8.1, 18.8, 33.2, 47.6, and 56.1 days for the same TBSA groups, respectively. While average estimates for adults (1.12 days) and pediatrics (1.01) are close to the one day/TBSA rule-of-thumb, consideration of other important patient and burn features in the NBR can better refine predictions for LOS.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Relationship Between Patient Characteristics and Number of Procedures as well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository

Kruger

Kowal

Bilir

et al. 2020

Journal of Burn Care &Amp; Research

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“…15 Currently, the burn size associated with a 50% case fatality in high-income countries is between 60% and 70% total body surface area (TBSA). 17 In Nepal, burns between 20%À30% TBSA carried a 50% mortality rate, and no patient survived burns of more than 40% TBSA. 18 We hypothesize that treatments used in low-resource settings can be adapted to backcountry care of burn injuries.…”

Section: Introductionmentioning

confidence: 99%

Management of Burn Injuries in the Wilderness: Lessons from Low-Resource Settings

Bitter

Erickson

2016

Wilderness & Environmental Medicine

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Burns are a common source of injuries worldwide, with a high burden of disease in low- and middle-income countries. Burns also account for 2%-8% of wilderness injuries. Although many are minor, the potential for serious morbidity and mortality exists, and standard treatments used in high-resource settings are not readily available in the backcountry. A literature review was performed to find evidence from low-resource settings that supports alternative or improvised therapies that may be adapted to care of burns in the wilderness. There is good evidence for use of oral rehydration to support volume status in burn patients. There is moderate evidence to support cold therapy as first aid and adjunct for pain control. Some evidence supports use of alternative dressings such as boiled potato peel, banana leaf, aloe vera, honey, sugar paste, and papaya when standard therapies are not available.

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