OUTCOMES IN PEDIATRIC BURN PATIENTS WITH ADDITIONAL TRAUMA-RELATED INJURIES

Objectives: The addition of trauma to burn injuries can have a synergistic effect, which may result in higher morbidity and mortality. In terms of treatment, the combined burn-trauma patient may present major challenges. The initial management consists of stabilization and airway maintenance, as well as hypothermia management and fluid resuscitation. The purpose of this study was to determine the outcomes of pediatric patients who have a combination of burn injuries and other trauma.

Methods: This was a single-site, retrospective review using our institutional Burn Center and Trauma registries. All pediatric burn, trauma, and combined burn-trauma patients (age < 18 years) admitted between July 1, 2011 and June 30, 2020 were included. Demographics, total body surface area (TBSA), length of stay (LOS), intensive care unit (ICU) days, ventilator days, and mortality were evaluated. We also assessed odds ratios for various patient characteristics and mortality via multivariate generalized linear models using inverse probability of treatment weighted (IPTW) data. Statistical significance was accepted at p < 0.05.

Results: There were a total of 3,931 Burn only (B), 3,045 Trauma only (T), and 28 combined Burn-Trauma (BT) patients. Mean LOS for the B group was 4.76 days and 3.54 days for the T group, while mean LOS for the BT group was 17.75 days. Mean number of ICU days was highest for the BT group with 19.25 days, compared to 6.38 and 4.26 days for the B and T groups, respectively. Mean number of ventilator days was also highest for the BT group with 25.0 days, compared to 15.23 and 4.59 days for the B and T groups, respectively. When comparing mortality between BT and T groups, the odds of mortality were 22 times higher for the BT group (OR 22.19, 95% CI 1.11, 443.43, p < 0.0426). When evaluating mortality between BT and B groups, the odds of mortality were 1.89 times higher for the BT group; however, these findings were not statistically significant (OR 1.89, 95% CI 0.00, 752.48, p < 0.8354).

Conclusion: The association of burn injuries with additional traumatic injuries is uncommon; however, it may lead to increased morbidity and mortality in many cases. In this study, the addition of trauma to burn injuries did contribute to a higher number of ICU and ventilator days, which ultimately resulted in prolonged LOS. These findings highlight the continued need for future collaborative research, which can help identify best practices and improve outcomes.