Wound Healing Trajectories in Burn Patients and Their Impact on Mortality
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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The rate of wound healing and its effect on mortality has not been well described. The objective of this article is to report wound healing trajectories in burn patients and analyze their effects on in-hospital mortality. The authors used software WoundFlow to depict burn wounds, surgical results, and healing progression at multiple time points throughout admission. Data for all patients admitted to the intensive care unit with 20 TBSA burned were collected retrospectively. The open wound size OWS, which includes both unhealed burns and unhealed donor sites, was measured. We calculated the rate of wound closure healing rate, which we defined as the change in OWStime. We also determined the time delay DAYS from day of burn until day on which there was a reduction in OWS 10. Data are medians interquartile range. There were 38 patients with complete data 25 had documentation of successful healing H, and 13 did not NH. H differed from NH on age 38 years 32 57 vs 63 51 74, body mass index 27 21 28 vs 32 19 52, 24-hour fluid resuscitation 12 L 10 16 vs 18 15 20, pressors during first 48 hours 72 vs 100, use of renal replacement therapy 32 vs 92, and mortality 4 vs 100. Repeated measures analysis of covariance showed a significant difference between survivors and nonsurvivors on OWS as a function of time P.001. Patients with a positive healing rate 2day after postburn day 20 had 100 survival whereas those with a negative healing rate 2day had 100 mortality. For H patients, median DAYS was 41 28 54 median DAYSTBSA was 1.3 1.0 1.9. Survivors had a 0.62 drop in OWSday, or 4.3week. In this cohort of patients with 20 TBSA, there was a difference in mortality after postburn day 20, between patients with a positive healing rate 2day, 100 survival and those with a negative healing rate 2day, 100 mortality, P .05.
- Anatomy and Physiology
- Medicine and Medical Research