Obesity and outcomes following burns in the pediatric population

Purpose While obesity is associated with increased mortality and decreased functional outcomes in adult burn patients, the ramifications of larger than average body size in the pediatric burn population are less well understood. The present study examines whether obesity was associated with poor outcomes following pediatric burn injuries. Methods Thermal injury data for patients ≤ 18 years of age admitted to a Level III burn center over ten years (n = 536) was analyzed. Obesity was defined as ≥ 95th percentile of weight for height according to the WHO growth charts (< 2 years of age) or BMI for age according to the CDC growth charts (2-18 years of age). Outcomes were compared between thermally injured obese (n = 154) and non-obese (n = 382) children. All data was collected in accordance with IRB regulations. Results Obese and non-obese thermally-injured children did not differ in TBSA, percentage of full thickness burn, or overall mortality. However, these groups were significantly different with respect to age (obese = 7.16 ± 0.46 years, non-obese = 9.38 ± 0.32 years, p < 0.001) and days requiring mechanical ventilation (obese = 4.89 ± 1.3 days, non-obese = 2.67 ± 0.49 days, p < 0.05). For thermally injured children admitted to the BICU without inhalation injury (n = 175); the obese (n = 46) and non-obese (n = 129) did not differ significantly with respect to age, TBSA, percentage of full thickness burn or other outcome measures. However, significant differences between these groups were noted for ICU LOS (obese = 18.59 ± 5.18 days, non-obese = 9.51 ± 1.82 days, p < 0.05) and number of days requiring mechanical ventilation (obese = 11.65 ± 3.91 days, non-obese = 3.92 ± 0.85 days, p < 0.05). Conclusion These data show thermally-injured obese pediatric patients required longer and more intensive medical support in the form of BICU care and respiratory intervention. Counter to findings in adult populations, differences in mortality were not observed. Collectively, these findings suggest obesity as a risk factor for increased morbidity in the pediatric burn population.