Predicting the proportion of full thickness involvement for any given burn size based on burn resuscitation volumes.

INTRODUCTION: The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full thickness (FT) involvement impacted overall 24-hour burn resuscitation volumes.

METHODS: We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns who required resuscitation using our computerized decision support system for burn fluid resuscitation. We defined the degree of FT involvement as FT Index (FTI = percentage of FT injury/percentage of total body surface area burned [%FT/%TBSA]) and compared variables on actual 24-hour fluid resuscitation volumes overall as well as for any given burn size.

RESULTS: A total of 203 patients admitted to our burn center during the study period were included in the analysis. Mean age and weight were 47 ± 19 years and 87 ± 18 kg, respectively. Mean %TBSA was 41 ± 20 with a mean %FT of 18 ± 24. As %TBSA, %FT, and FTI increased, so did actual 24-hour fluid resuscitation volumes respectively (ml/kg). However, increase in FTI did not result in increased volume indexed to burn size (ml/kg/%TBSA). This was true even when patients with inhalation injury were excluded. Further investigation revealed that as %TBSA increased, %FT increased nonlinearly (quadratic polynomial) (R=0.994).

CONCLUSIONS: Total burn size as well as FT burn size were both highly correlated with increased 24-hour fluid resuscitation volumes. However, FTI did not correlate with a corresponding increase in resuscitation volumes for any given burn size, even when patients with inhalation injury were excluded. Thus, there is insufficient data to presume that those who receive more volume at any given burn size are likely to be mostly full thickness or vice versa. This was influenced by a relatively low sample size at each 10%TBSA increment and larger burn sizes disproportionately having more FT burns. A more robust sample size may elucidate this relationship better.

LEVEL OF EVIDENCE: Level IV Therapeutic/Care Management.

FUNDING: U.S. Army Combat Casualty Care Research Program.