Aigner Annette, Schiefer Jennifer Lynn, Reinshagen Konrad, Najem Safiullah, Vasileiadis Vasileios, Königs Ingo
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Center for Stroke Research Berlin, Berlin, Germany.
Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany.
Burns. 2025 May;51(4):107397. doi: 10.1016/j.burns.2025.107397. Epub 2025 Jan 20.
Fluid resuscitation after a burn injury is one of the crucial aspects of acute therapy. The Parkland formula is a quick solution for determining the amount of fluid necessary in a specific situation, although it is not strictly followed or used in current practice. Therefore, we aimed to assess the association between a deviation from the Parkland formula and in-hospital mortality.
Based on data from 2235 burn patients recorded in the German Burn Registry from January 1st 2015 to December 31st 2022, we evaluate the relative deviation from the Parkland formula in either a positive or negative direction and its association with in-hospital mortality. We use mixed logistic regression models to assess this relationship and additionally evaluate its interaction with patient-level characteristics such as age, inhalation trauma (IHT), BMI, and percent of total body surface area (TBSA) affected.
Without taking patient-level characteristics into account, both positive and negative relative deviations from the Parkland formula were associated with a higher probability of in-hospital mortality. After adjusting for sex, age, BMI, IHT, a third-degree burn, and TBSA, only the positive deviation from Parkland remained a risk factor for the outcome. We found that this negative effect of deviating from Parkland could be further modified by patient-level characteristics such as IHT, TBSA, and BMI, but not by the patient's age.
The Parkland formula remains a useful tool for quick fluid calculations in the acute phase of severe burns. Deviations from the calculated amount are very common, with a higher incidence of over-infusion. Exceeding the Parkland formula increases mortality while under-infusion does not significantly affect mortality: 'Less seems to be better than more.'.
烧伤后的液体复苏是急性治疗的关键环节之一。帕克兰公式是确定特定情况下所需液体量的快速方法，尽管目前的实践中并未严格遵循或使用该公式。因此，我们旨在评估偏离帕克兰公式与住院死亡率之间的关联。
基于德国烧伤登记处2015年1月1日至2022年12月31日记录的2235例烧伤患者的数据，我们评估帕克兰公式在正负方向上的相对偏差及其与住院死亡率的关联。我们使用混合逻辑回归模型来评估这种关系，并额外评估其与患者层面特征（如年龄、吸入性损伤（IHT）、体重指数（BMI）和受影响的全身表面积（TBSA）百分比）的相互作用。
在不考虑患者层面特征的情况下，帕克兰公式的正负相对偏差均与较高的住院死亡率相关。在调整性别、年龄、BMI、IHT、三度烧伤和TBSA后，只有帕克兰公式的正偏差仍然是该结局的危险因素。我们发现，偏离帕克兰公式的这种负面影响可能会因IHT、TBSA和BMI等患者层面特征而进一步改变，但不受患者年龄的影响。
帕克兰公式仍然是严重烧伤急性期快速液体计算的有用工具。计算量的偏差非常常见，过量输注的发生率更高。超过帕克兰公式会增加死亡率，而输注不足不会显著影响死亡率：“少似乎比多更好”。
