Factors associated with delayed admission to the burn unit: A major burn center’s experience

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2024-10-10 DOI:10.1016/j.burns.2024.107288

Artur Manasyan , Nicolas Malkoff , Brigette Cannata , Eloise W. Stanton , Maxwell B. Johnson , Haig A. Yenikomshian , T. Justin Gillenwater

{"title":"Factors associated with delayed admission to the burn unit: A major burn center’s experience","authors":"Artur Manasyan , Nicolas Malkoff , Brigette Cannata , Eloise W. Stanton , Maxwell B. Johnson , Haig A. Yenikomshian , T. Justin Gillenwater","doi":"10.1016/j.burns.2024.107288","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Timely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center.</div></div><div><h3>Methods</h3><div>Patients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch’s t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality.</div></div><div><h3>Results</h3><div>A total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.5<span><math><mo>±</mo></math></span>18.7 % vs. 8.2<span><math><mo>±</mo></math></span>12.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232).</div></div><div><h3>Conclusion</h3><div>Sociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107288"},"PeriodicalIF":3.2000,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Burns","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0305417924003255","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Timely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center.

Methods

Patients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch’s t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality.

Results

A total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.5

\pm

18.7 % vs. 8.2

\pm

12.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232).

Conclusion

Sociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury.

查看原文本刊更多论文

烧伤科延迟入院的相关因素：一家大型烧伤中心的经验。

背景：及时入住烧伤科至关重要。理想的烧伤护理需要及时干预，如伤口和体温管理、感染控制和液体复苏，以防止烧伤恶化和感染等并发症。在这项研究中，我们确定了与延迟入住地区烧伤中心相关的具体因素和结果：方法：我们对 2015 年 1 月至 2023 年 12 月期间入住一家大型城市烧伤中心的患者进行了回顾性查询，随后通过病历审查收集了人口统计学变量和结果变量。进行了描述性统计、韦尔奇不等式 t 检验和卡方分析。为了探讨延迟入院与重症监护室住院时间、呼吸机需求和死亡率之间的关系，还进行了多元逻辑回归：研究共纳入了 3137 名患者。约63.4%的患者在受伤后24小时内入院，36.6%的患者在受伤后超过24小时才入院。男性患者的入院时间更长（39.0% 对 31.8%，P 结论：男性患者的入院时间更长，而女性患者的入院时间更短：无家可归、缺乏社会支持和药物滥用等社会人口变量与烧伤科入院时间延迟有关。对这些因素的了解可以为未来的干预措施提供依据，从而改善弱势患者的治疗效果，促进烧伤后更好的康复和长期疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.