Analysis of factors impacting length of stay in thermal and inhalation injury

Autor: William L. Hickerson, Rebecca R. Smith, David M Hill, Sai R Velamuri
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Anemia
Body Surface Area
Population
Critical Care and Intensive Care Medicine
Infections
030207 dermatology & venereal diseases
03 medical and health sciences
Young Adult
0302 clinical medicine
Risk Factors
medicine
Humans
Vasoconstrictor Agents
education
Aged
Retrospective Studies
Aged
80 and over
education.field_of_study
business.industry
Medical record
Acute kidney injury
030208 emergency & critical care medicine
Burn center
Regression analysis
Retrospective cohort study
Bilirubin
General Medicine
Acute Kidney Injury
Blood Coagulation Disorders
Length of Stay
Middle Aged
Smoke Inhalation Injury
medicine.disease
C-Reactive Protein
Social Class
Creatinine
Emergency medicine
Emergency Medicine
Surgery
Blood Alcohol Content
Female
business
Burns
Total body surface area
Zdroj: Burns : journal of the International Society for Burn Injuries. 45(7)
ISSN: 1879-1409
Popis: Objectives Several studies have analyzed single or combinations of variables for impact on length of stay (LOS) in thermally-injured patients. The objective of this study was to evaluate a multitude of established variables and potentially identify novel variables associated with LOS in a single study. Methods This two-year, retrospective study included all patients admitted to the burn center between January 2015 and December 2016. Exclusions included death during admission, lack of thermal or inhalation injury, age less than 18 years, readmission(s), and if pregnant or incarcerated. Baseline demographics and pertinent data were collected using electronic medical records. Regression analysis was used to determine the most predictive variables. Results Six hundred twenty-nine patients were admitted during the inclusion period and 354 patients remained for analysis after exclusion. Univariable analysis revealed 32 variables significantly associated with LOS. Using multivariable regression, the best-fit baseline demographic model included: percent total body surface area (TBSA) injured, lower/middle socioeconomic status, clotting disorders, anemia, admission serum creatinine, and percent third degree injured (r2 = 0.557). The best-fit combined model (incorporating baseline demographics and early in-hospital variables) included: acute kidney injury, infection and received vasopressor(s), percent TBSA injured, admission serum ethanol level, maximum C-reactive protein, and maximum total bilirubin (r2 = 0.828). Conclusions There are multiple factors associated with the increased LOS seen in patients with thermal and inhalation injury. This study confirmed and identified novel factors not previously discussed in the literature that were significantly associated with LOS. Expansion of the data submitted to the National Burn Repository and the Burn Quality Improvement Program may be warranted. This study confirms claims from previous studies on inadequacy of current data submitted for benchmarking and under-reimbursement for the care of such a complex population.
Databáze: OpenAIRE
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