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Wound Healing Trajectories in Burn Patients and Their Impact on Mortality

Nitzschke, Stephanie L. MD*; Aden, James K. PhD*; Serio-Melvin, Maria L. RN, MSN*; Shingleton, Sarah K. RN, MS*; Chung, Kevin K. MD*†; Waters, J. A. MD*; King, Booker T. MD*; Burns, Christopher J. MD*‡; Lundy, Jonathan B. MD*; Salinas, José PhD*; Wolf, Steven E. MD; Cancio, Leopoldo C. MD

doi: 10.1097/BCR.0000000000000039
Original Articles

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).

From the *U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas; Uniformed Services University for the Health Sciences, Bethesda, Maryland; Naval Medical Research Unit-San Antonio, Fort Sam Houston, Texas; §University of Texas Health Science Center at San Antonio.

This study was funded in part by the Comprehensive ICU Research Task Area, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland.

Presented at the 44th Annual Meeting of the American Burn Association, Seattle, Washington, 24–27 April, 2012.

The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting the views of the Department of the Army or Department of Defense.

Address correspondence to: Leopoldo C. Cancio, MD, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, Texas 78234.

© 2014 The American Burn Association