Manasyan Artur, Malkoff Nicolas, Cannata Brigette, Stanton Eloise W, Johnson Maxwell B, Yenikomshian Haig A, Gillenwater T Justin
Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Burns. 2024 Dec;50(9):107288. doi: 10.1016/j.burns.2024.107288. Epub 2024 Oct 10.
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.
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.
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±18.7 % vs. 8.2±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).
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.
及时入住烧伤科至关重要。理想的烧伤护理需要及时进行干预，如伤口和体温管理、感染控制及液体复苏，以预防烧伤进展和感染等并发症。在本研究中，我们确定了与延迟入住区域烧伤中心相关的特定因素和结果。
对2015年1月至2023年12月入住一家大型城市烧伤中心的患者进行回顾性查询，随后通过病历审查收集人口统计学和结果变量。进行了描述性统计、方差不等的韦尔奇t检验和卡方分析。进行多因素逻辑回归以探讨延迟入住与重症监护病房停留时间、呼吸机需求和死亡率之间的关联。
本研究共纳入3137例患者。约63.4%的患者在24小时内入院，而36.6%的患者在受伤后超过24小时才得到显著延迟的治疗。男性患者更有可能延迟入院（39.0%对31.8%，p<0.001）。两组患者的年龄无显著差异（38.6岁对39.7岁，p=0.199）。按种族背景划分的入院时间无显著差异（p=0.061）。延迟组和对照组的烧伤总面积（TBSA）有所不同（15.5±18.7%对8.2±12.9%，p<0.001）。单身患者（p<0.001）和独居患者（p=0.011）更有可能延迟入住烧伤科。无家可归（p<0.001）、药物滥用障碍（p<0.001）和未参保状态（p<0.001）也与延迟入院有关。在控制TBSA的回归分析中，护理延迟与重症监护病房停留时间更长（p<0.001）和机械通气需求更大（p=0.021）显著相关，但与死亡率增加无关（p=0.232）。
无家可归、缺乏社会支持和药物滥用等社会人口统计学变量与烧伤科延迟入院有关。了解这些因素可为未来的干预措施提供参考，以改善弱势患者的治疗结果，促进烧伤后更好的康复和长期预后。
