Burn is a serious public health problem and a leading cause of disability and disfigurement. The study of burn epidemiology is essential for adopting effective and individualized prevention approaches in the community and in the institution. Our study focuses on the characteristics and outcomes of burn patients admitted to a burn center in a large metropolitan area from 2019 to 2022. We selectively included only majorly burned patients based on the ABA Burn Injury Severity Grading [2].
This study's baseline data can form the basis of future evaluations of prevention and management strategies, to improve the outcomes of majorly burned patients in the underserved population of the northern manhattan area.
Based on the results obtained in our study (taking into consideration the small sample size), we compared it with the ABA National Burn Repository 2009-2015 period.
Flame and scald burns made up the majority of burns in our study as well as nationally (74% of cases vs 66.6% in our study). The majority of burns that were admitted to burn centers were accidental non-work-related (95% vs 85.1% in our study) with less related to work (13.6% vs 3.7% in our study). Most of the burns occurred in Black/African Americans in our study as compared to Whites in the National Burn Repository.
A systematic review evaluating studies in the United States on burn disparities showed that Black patients exhibited worse mortality and morbidity after burn injury. Despite Whites being the majority of patients in the studies, there was a disproportionate number of Blacks experiencing burn injuries compared to the general population. It also showed that Black and Hispanic (vs white) burn survivors exhibited poorer wound healing and worsened community integration and adjustment outside of the hospital setting after burn injury [3]. Minority populations (e.g Black and Hispanic) were more likely to have higher complication rates after burn injury such as urinary tract infections, contractures, increased length of stay. [3]
Various cultural and environmental exposures predispose certain ethnic groups to burn injuries, which if identified can be the target for culturally-tailored interventions aimed at raising awareness to reduce occurrences.
Bedri et al. highlight the fact that uninsured burn patients had higher mortality, longer LOS, higher hospital charges, and increased infections [4]. Another study by Murphy et al. showed that the racial disparities in outcomes still persisted even in patients who had private insurance [5,6]. Murphy et al. analyzed the National Burn Registry and showed that African American males with burn injury are at increased risk of mortality regardless of insurance coverage, and most females are at increased risk regardless of race [7]. These findings were also seen in our study where Black patients had a higher mortality rate as compared to the other races. Our study also demonstrated that females were more likely to suffer from non-accidental burn injuries.
Burn wound debridement/excision and coverage are generally recommended to be done between 24-72 hours after the injury. Rates of bacterial colonization and infectious complications are lower after early burn wound excision within 24 hours [8]. In this study the average time for burn excision and coverage was approximately 5 days. This is likely due to the overall hemodynamic status and comorbidities needing to be stabilized first. The results from this study indicated that patients who underwent > 1 burn excision/skin grafting procedure were more likely to stay in the hospital for greater than 30 days.
Overall mortality from a burn injury ranges from 3-55%, depending on various factors including age, sex, region, comorbidities, etc. The presence of inhalational injury is associated with increased mortality [9,10].
The overall mortality in our study for the 3-year period was 25.9%. Burn patients with inhalation injury were more likely to expire in-hospital compared to those without inhalation injury in our study. Patients that had to receive RRT had 100% mortality iin this study. The two non-RRT deaths occurred within 24 hours.
A retrospective study of 6325 patients from China by Li et al. showed that full-thickness burns, burns with a larger TBSA and older age were risk factors for mortality, and that a higher number of operations and flame burns were protective factors for mortality [9]. These protective factors seen in this study was not demonstrated in our study likely due to the small sample size or differing patient population.
Overall in the United States, Burn related mortality rates have decreased over time, due to numerous factors, including attempts at regionalizing burn care to designated burn centers [10].
The major limitation of this study is it being from a single institution and the small sample size. The generalization of the findings should be considered with caution. Also, it is a retrospective study relying upon the accuracy of the coder and individual data entry. There may be variations in the burn TBSA and depth estimation based on separate provider documentation. This assumes that there may be an overestimation (or underestimation), introducing a misclassification bias.