Clinical and demographic features of burn patients at Arizona Burn Center Emergency Department

Abstract

Background: Burns are a common cause of injury worldwide that can lead to death, physical disability, psychological trauma and financial burden. Incidence of burn injuries, mortality and emergency department admission rates vary by race, age, gender and socioeconomic status. In addition to patient demographic characteristics, clinical features of their burns influence patient outcomes and management strategies. In addition, clinical features of burns influence patient outcomes and management strategies. Despite having a nationally verified adult and pediatric tertiary burn center, Arizona-specific data regarding clinical features and patient demographics for non-fatal burns is not available in the literature. With this study, we aim to provide state-specific clinical and demographic characteristics of burn patients over a 3-month period. Additionally, we aim to identify differences in burn etiology between adult and pediatric patients. Methods: A retrospective chart review of all adult and pediatric patients who presented to the Arizona Burn Center emergency department at Valleywise Health from June through August of 2016 was performed. Demographic and clinical characteristics were reported as means and standard deviation for continuous variables, while frequencies and percentages were used for categorical variables. The Wilcoxon Rank Sum was used to compared continuous variables while Chi-Squared/Fisher’s Exact test was used to compare categorical variables. Multivariate logistic regression was used to associate variables and all regression models were controlled for age, gender, race, income, total body surface area (TBSA), and the total number of comorbidities. Exploratory descriptive analysis was used to ascertain frequencies and percentages of burn type and mechanism of burn in pediatric and adult groups. The one sample Z-test of proportions was used to assess percentage differences between each mechanism of burn and burn type respectively. Results: Of 651 patients, 240 (36.9%) were female, ages ranged between 0-93 years and the average of age was 31.3 ± 22.3 years. Adults accounted for 69.4% and the 18-29 years old group was affected more than other ages (19.1%). Children under 5 were affected more frequently (55.3%) within the pediatric population. White/Caucasian patients were affected more frequently (533, 81.9%), and 221 patients (33.9%) identified as Hispanic. Medicaid/other government insurance was the most common payment method (204, 31.3%) without including Medicare, followed by self pay/uninsured (154, 23.7%). Most common body part affected was upper extremities (372, 57.1%) and mean TBSA burned was 3.67 ± 8.31%. Admission was required in 163 (25%) of patients, and their LOS averaged 14.7 ± 22.2 days. Tobacco use was seen at higher frequency (20.9%). Most common burn type among all patients was scalding (253, 38.9%) and most burn injuries occurred at home (279, 42.9%). Scalding (41.2%) and contact burn (38.2%) affected children more often than adults, but there was no difference in incidence between these two etiologies among children (p=0.38). Adults were affected by flame burn more often than children (13.3% vs 5.53%, p=0.02). Within the adult group, scalding (37.8 %) was the most common cause of burn (p <0.001). Tar/asphalt was the most common mechanism of contact burns (61.5%, p<0.001) in adults. Conclusions: Demographic and clinical features vary among burn patients seen at the Arizona Burn Center ED. Scalding is the most common cause of burn in adults while scalding and contact equally affect children. Tar/asphalt is the most common cause of contact burns. The sample period was during the summer, so contact burns from hot asphalt are likely overrepresented, while burns from fires (fireplaces, furnaces, and heaters) are likely under-represented compared to an analysis of an entire year.