Objective: To determine blood transfusion practices, risk factors, and outcomes associated with the use of blood products in the setting of the acute management of burn patients at the Victorian Adult Burn Service. Background: Patients with burn injuries have variable transfusion requirements, based on a multitude of factors. We reviewed all acute admissions to the Victorian Adult Burns Service (VABS) between 2011 and 2017: 1636 patients in total, of whom 948 had surgery and were the focus of our analysis. Method and results: Patient demographics, surgical management, transfusion details, and outcome parameters were collected and analyzed. A total of 175 patients out of the 948 who had surgery also had a blood transfusion, while 52% of transfusions occurred in the perioperative period. The median trigger haemoglobin in perioperative was 80mg/dL (IQR = 76–84.9 mg/dL), and in the non-perioperative setting was 77 mg/dL (IQR = 71.61–80.84 mg/dL). Age, gender, % total body surface area (TBSA) burn, number of surgeries, and intensive care unit and hospital length of stay were associated with transfusion. Conclusions: The use of blood transfusions is an essential component of the surgical management of major burns. As observed in our study, half of these transfusions are related to surgical procedures and may be influenced by the employment of blood conserving strategies. Furthermore, transfusion trigger levels in stable patients may be amenable to review and reduction. Risk adjusted analysis can support the implementation of blood transfusion as a useful quality indicator in burn care.

Background: Use of intravascular warming catheters following major burns has been shown to be effective to maintain normothermia, but their use may be associated with complications. The aim of this study was to determine what proportion of patients with an intravascular warming catheter developed a potentially catheter-related venous thromboembolism (VTE) and to identify contributing risk factors. Methods: This was a retrospective cohort study of patients admitted to the Victorian Adult Burns Service January 2013 to July 2018 with major burns (TBSA > 20%) who had an ICY^TM intravascular warming catheter. Warming catheter insertion and other details were identified with a manual search of the patients’ medical records by a single author while incidence of VTE was determined by the coding department from a central database. Results: Forty patients had an intravascular warming catheter inserted during the study period. The number of patients in the catheter group that sustained a VTE was eight (20%), of which four (10%) could have been catheter-related due to the anatomical location. In the cases of the four potentially catheter-related VTE, other preventable VTE risk factors including suboptimal prophylactic anticoagulation (n = 2), prolonged catheter duration (n = 1) and prolonged haemoconcentration (n = 2) were identified. Conclusions: We found 20% of major burns patients with an intravascular warming device had significant VTE; however, only half of these may have been related to the catheter. A careful assessment for each patient that balances risks and benefits should be undertaken prior to using intravascular warming devices.

The lethal triad of trauma (acidemia, coagulopathy, and hypothermia) is associated with substantial morbidity and mortality. Patients with severe burn injuries, defined as > 20 % total body surface area (TBSA), are one group of trauma patients at risk of developing this triad. However, there is currently limited evidence on how the lethal triad affects this cohort of patients. To describe the prevalence of the lethal triad in patients with severe burns on arrival to an adult burns service hospital. The secondary aim was to investigate potential factors associated with presence of the lethal triad. Adult patients (> 18 years of age) with severe burns (> 20 %TBSA) admitted to a Victorian Adult Burns Service (VABS) tertiary hospital between January 1, 2019 and 31 December, 2023, were included in the study. From 158 patients identified through the VABS registry, 142 patients met inclusion criteria. Among 106 patients with available data, the lethal triad was present on arrival to hospital in 6 patients (5.7 %; 95 %CI: 2.1-11.9 %). Acidemia was present in 58 of 116 (50.0 %; 95 %CI: 40.6-59.4), coagulopathy in 18 of 125 (14.4 %; 95 %CI: 8.8-21.8) and hypothermia in 53 of 140 (37.9 %; 95 %CI: 29.8-46.4). Among patients with the lethal triad, all 6 patients (100 %) died, compared to 27 patients (27.0 %) without the lethal triad (odds ratio 21.0; 95 %CI: 2.91->99.9). A small proportion of patients with severe burns presented to hospital with all three components of the lethal triad of trauma. Acidemia and hypothermia were more commonly observed when compared to coagulopathy. Recognition, prevention, and early management may result in improved outcomes.