Wound healing trajectories in burn patients and their impact on mortality

Stephanie L. Nitzschke, James K. Aden, Maria L. Serio-Melvin, Sarah K. Shingleton, Kevin K. Chung, J. A. Waters, Booker T. King, Christopher J. Burns, Jonathan B. Lundy, José Salinas, Steven Wolf, Leopoldo C. Cancio

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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 OWS/time. 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 (+2%/day) after postburn day 20 had 100% survival whereas those with a negative healing rate (-2%/day) had 100% mortality. For H patients, median DAYS was 41 (28-54); median DAYS/TBSA was 1.3 (1.0-1.9). Survivors had a 0.62% drop in OWS/day, or 4.3%/week. 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 (+2%/day, 100% survival) and those with a negative healing rate (-2%/day, 100% mortality, P < .05).

Original languageEnglish (US)
Pages (from-to)474-479
Number of pages6
JournalJournal of Burn Care and Research
Volume35
Issue number6
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Wound Healing
Mortality
Wounds and Injuries
Survivors
Renal Replacement Therapy
Survival
Hospital Mortality
Burns
Resuscitation
Documentation
Intensive Care Units
Body Mass Index
Software
Tissue Donors

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Rehabilitation

Cite this

Nitzschke, S. L., Aden, J. K., Serio-Melvin, M. L., Shingleton, S. K., Chung, K. K., Waters, J. A., ... Cancio, L. C. (2014). Wound healing trajectories in burn patients and their impact on mortality. Journal of Burn Care and Research, 35(6), 474-479. https://doi.org/10.1097/BCR.0000000000000039

Wound healing trajectories in burn patients and their impact on mortality. / Nitzschke, Stephanie L.; Aden, James K.; Serio-Melvin, Maria L.; Shingleton, Sarah K.; Chung, Kevin K.; Waters, J. A.; King, Booker T.; Burns, Christopher J.; Lundy, Jonathan B.; Salinas, José; Wolf, Steven; Cancio, Leopoldo C.

In: Journal of Burn Care and Research, Vol. 35, No. 6, 01.01.2014, p. 474-479.

Research output: Contribution to journalArticle

Nitzschke, SL, Aden, JK, Serio-Melvin, ML, Shingleton, SK, Chung, KK, Waters, JA, King, BT, Burns, CJ, Lundy, JB, Salinas, J, Wolf, S & Cancio, LC 2014, 'Wound healing trajectories in burn patients and their impact on mortality', Journal of Burn Care and Research, vol. 35, no. 6, pp. 474-479. https://doi.org/10.1097/BCR.0000000000000039
Nitzschke SL, Aden JK, Serio-Melvin ML, Shingleton SK, Chung KK, Waters JA et al. Wound healing trajectories in burn patients and their impact on mortality. Journal of Burn Care and Research. 2014 Jan 1;35(6):474-479. https://doi.org/10.1097/BCR.0000000000000039
Nitzschke, Stephanie L. ; Aden, James K. ; Serio-Melvin, Maria L. ; Shingleton, Sarah K. ; Chung, Kevin K. ; Waters, J. A. ; King, Booker T. ; Burns, Christopher J. ; Lundy, Jonathan B. ; Salinas, José ; Wolf, Steven ; Cancio, Leopoldo C. / Wound healing trajectories in burn patients and their impact on mortality. In: Journal of Burn Care and Research. 2014 ; Vol. 35, No. 6. pp. 474-479.
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