This Clinical Practice Guideline (CPG) addresses the topic of acute fluid resuscitation during the first 48 hours following a burn injury for adults with burns ≥20% of the total body surface area (%TBSA). The listed authors formed an investigation panel and developed clinically relevant PICO (Population, Intervention, Comparator, Outcome) questions. A systematic literature search returned 5978 titles related to this topic and after 3 levels of screening, 24 studies met criteria to address the PICO questions and were critically reviewed. We recommend that clinicians consider the use of human albumin solution, especially in patients with larger burns, to lower resuscitation volumes and improve urine output. We recommend initiating resuscitation based on providing 2 mL/kg/% TBSA burn in order to reduce resuscitation fluid volumes. We recommend selective monitoring of intra-abdominal and intraocular pressure during burn shock resuscitation. We make a weak recommendation for clinicians to consider the use of computer decision support software to guide fluid titration and lower resuscitation fluid volumes. We do not recommend the use of transpulmonary thermodilution-derived variables to guide burn shock resuscitation. We are unable to make any recommendations on the use of high-dose vitamin C (ascorbic acid), fresh frozen plasma (FFP), early continuous renal replacement therapy, or vasopressors as adjuncts during acute burn shock resuscitation. Mortality is an important outcome in burn shock resuscitation, but it was not formally included as a PICO outcome because the available scientific literature is missing studies of sufficient population size and quality to allow us to confidently make recommendations related to the outcome of survival at this time.

Background: Infection is the greatest cause of mortality in burn patients. As our population ages, the need to care for elderly burn patients will increase, and with it our understanding of how infection affects older patients with burn injuries. This article presents a review of the available literature on the effect of aging on the physiologic response to burns, of the known effects of infection in the elder population, and of the contribution of underlying medical comorbidities to the outcomes for the elderly burn patient. The potential for more serious outcomes from multi-drug resistance in the elder population is also discussed. Methods: This article is a review of the available literature on infection in elderly burn patients. A literature search was performed for key words: elderly; geriatric; burn; infection; comorbidity; multi-drug resistance; central line; urinary tract infection; and burn sepsis. Relevant findings were included in each section. Results: Pre-existing conditions are common in the elderly and contribute to a higher rate of development of pneumonia, cellulitis, urinary tract infection, central line infections, and burn wound infections. Specific data pertaining to infections in the elderly burn population are scarce or confined to single-center reports. Conclusions: Because of the inherent susceptibility of the elder population to infection because of pre-existing medical conditions, immunosenescence, and potential exposure via frequent interaction with the medical system, vigilance must be maintained for preventing and treating infection in elderly burn patients. More research is needed to define the risks and extent of this increasingly important issue.

Burn management has significantly advanced in the past 75 years, resulting in improved mortality rates. However, there are still over one million burn victims in the United States each year, with over 3,000 burn-related deaths annually. The impacts of individual patient, hospital, and regional demographics on length of stay (LOS) and total cost have yet to be fully explored in a large nationally representative cohort. Thus, this study aimed to examine various hospital and patient characteristics using a sample of over 20,000 patients. Inpatient data from the National Inpatient Sample from 2008 to 2015 were analyzed, and only patients with an ICD-9 code for second- or third-degree burns were included. In addition, a major operating room procedure must have been indicated on the discharge summary for patients to be included in the final dataset, ensuring that only severe burns requiring complex care were analyzed. Analysis of covariance models was used to evaluate the impact of various patient, hospital, and regional variables on both LOS and cost. The study found that skin grafts and fasciotomy significantly increased the cost of hospitalization. Having burns on the face, neck, and trunk significantly increased costs for patients with second-degree burns, while burns on the trunk resulted in the longest LOS for patients with third-degree burns. Infections in the hospital and additional procedures, such as flaps and skin grafts, also led to longer stays. The study also found that the prevalence of postoperative complications, such as electrolyte imbalance, was high among patients with burn surgery.

Burn injuries pose a significant source of patient morbidity/mortality and reconstructive challenges for burn surgeons, especially in vulnerable populations such as geriatric patients. Our study aims to provide new insights into burn epidemiology by analyzing the largest national, multicenter sample of geriatric patients to date. Using the National Electronic Injury and Surveillance System (NEISS) database (2004-2022), individuals with a “burn” diagnosis were extracted and divided into 2 comparison age groups of 18-64 and 65+. Variables including sex, race, affected body part, incident location, burn etiology, and clinical outcomes were assessed between the 2 groups using 2 proportion z-tests. About 60,581 adult patients who sustained burns were identified from the NEISS database with 6630 of those patients categorized as geriatric (65+). Geriatric patients had a significantly greater frequency of scald burns (36.9% vs 35.4%; P < .01), and third-degree/full-thickness burns (10.4% vs 5.5%, P < .01) relative to nongeriatric adult patients with most of these burns occurring at home (75.9% vs 67.4%; P < .01). The top 5 burn sites for geriatric patients were the hand, face, foot, lower arm, and lower leg and the top 5 burn injury sources were hot water, cookware, oven/ranges, home fires, and gasoline. Geriatric patients had over 2 times greater risk of hospital admission (odds ratio [OR]: 2.32, 95% CI: 2.17-2.49, P < .01) and over 5 times greater risk of emergency department mortality (OR: 6.22, 95% CI: 4.00-9.66, P < .01) after incurring burn injuries. These results highlight the need for stronger awareness of preventative measures for geriatric burn injuries.