Palilonis Mary A, Amanullah Siraj, Gjelsvik Annie, Schlichting Lauren E, Cioffi William G, Harrington David T, Vivier Patrick M
Hassenfeld Child Health Innovation Institute, Brown University, Providence.
Department of Surgery, Rhode Island Hospital, Brown University, Providence.
J Burn Care Res. 2019 Jun 21;40(4):392-397. doi: 10.1093/jbcr/irz052.
Flame injuries are the primary cause of burns in young adults. Although drug and alcohol intoxication has been associated with other types of trauma, its role in burn injury has not been well described in this population. The purpose of this study was to investigate the association of intoxication and flame burn injuries in young adults in the United States. The 2014 Nationwide Emergency Department Sample was queried for burn injury visits of young adult patients, 13-25 years old. This data is weighted to allow for national estimates. Burn mechanism and intoxication status were determined by International Classification of Diseases, Ninth Revision codes. Multivariable logistic regression analysis was used to assess the association of intoxication and emergency department (ED) visits due to flame burns, adjusting for patient age, gender, zip code median income, zip code rural-urban designation, timing of visit, and hospital region. Further analyses assessed the odds of admission or transfer, as a possible proxy of injury severity, in patients with flame or other burns, with and without intoxication adjusting for patient age, gender, primary insurance, and hospital trauma designation. There were 20,787 visits for patients 13-25 years old with burn injuries and 12.9% (n = 2678) had a codiagnosis of intoxication. There was an increasing proportion of intoxication by age (5.8% 13-17 years old, 25% 18-20 years old, 69% 21-25 years old, P < .001). ED visits for burns with a codiagnosis of intoxication had 1.34 times ([95% confidence interval (CI): 1.18, 1.52], P < .01) higher odds of having flame burns compared to other burn mechanisms. Those with flame burns and intoxication were most likely to be admitted or transferred when compared to nonflame, nonintoxication visits in the adjusted model (odds ratio [OR] 5.49, [95% CI: 4.29, 7.02], P < .01). Furthermore, the odds of admission or transfer in visits with the combined exposure of intoxication and flame mechanism were significantly higher than visits due to nonflame burns and intoxication (OR 2.75, [2.25, 3.36], P < .01) or flame burns without intoxication (OR 3.00, [95% CI: 2.61, 3.42], P < .01). This study identified a significant association between flame-burn-related ED visits and intoxication in the young adult population in the United States. In addition, the combination of flame mechanism and intoxication appears to result in more substantial injury compared with either exposure alone. The relationship seen between intoxication and flame burn injury underscores a major target for burn prevention efforts in the young adult population.
火焰伤是年轻成年人烧伤的主要原因。尽管药物和酒精中毒与其他类型的创伤有关，但其在烧伤中的作用在这一人群中尚未得到充分描述。本研究的目的是调查美国年轻成年人中毒与火焰烧伤之间的关联。查询了2014年全国急诊科样本中13至25岁年轻成年患者的烧伤就诊情况。该数据经过加权处理以得出全国估计数。烧伤机制和中毒状态由国际疾病分类第九版编码确定。采用多变量逻辑回归分析来评估中毒与因火焰烧伤导致的急诊科就诊之间的关联，并对患者年龄、性别、邮政编码中位数收入、邮政编码城乡划分、就诊时间和医院区域进行了调整。进一步的分析评估了有火焰或其他烧伤的患者，无论有无中毒，在调整了患者年龄、性别、主要保险和医院创伤指定情况后，入院或转院的几率，以此作为损伤严重程度的一个可能指标。13至25岁有烧伤的患者有20787次就诊，其中12.9%（n = 2678）同时诊断为中毒。中毒比例随年龄增加（13至17岁为5.8%，18至20岁为25%，21至25岁为69%，P <.001）。与其他烧伤机制相比，同时诊断为中毒的烧伤患者因火焰烧伤就诊的几率高出1.34倍（[95%置信区间（CI）：1.18，1.52]，P <.01）。在调整后的模型中，与非火焰、非中毒就诊相比，有火焰烧伤且中毒的患者最有可能入院或转院（优势比[OR] 5.49，[95% CI：4.29，7.02]，P <.01）。此外，中毒与火焰机制共同导致的就诊入院或转院几率显著高于非火焰烧伤且中毒的就诊（OR 2.75，[2.25，3.36]，P <.01）或有火焰烧伤但无中毒的就诊（OR 3.00，[95% CI：2.61，3.42]，P <.01）。本研究确定了在美国年轻成年人群中，与火焰烧伤相关的急诊科就诊与中毒之间存在显著关联。此外，与单独任何一种暴露相比，火焰机制和中毒的共同作用似乎会导致更严重的损伤。中毒与火焰烧伤损伤之间的这种关系凸显了年轻成年人群烧伤预防工作的一个主要目标。
