L. T. Knowlin1, B. A. Cairns1, A. G. Charles1 1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA
Introduction: It is estimated 486,000 people sustained burn injuries last year in the United States.Despite advancements over the last three decades in burn care, the burden of burn injury morbidity and mortality is still high and the drivers are largely burn wound infections and sepsis. The challenge remains to prognosticate various burn injury outcomes as current burn prediction models do not account for specific comorbidities such as diabetes. We therefore sought to examine the impact of pre-existing diabetes on burn injury outcomes.
Methods: A retrospective analysis of patients admitted to a regional burn center from 2002-2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA (total body surface area), and pre-existing comorbidities. Bivariate analysis was performed and Poisson regression modeling was utilized to estimate the incidence of sepsis, graft complications, and in-hospital mortality.
Results: 7640 patients were included in this study. Overall survival rate was 96%. 8% (n=605) had a preexisting diabetes. Diabetic patients had a higher rate of sepsis (5% vs 2%), graft complications (2% vs 0.5%), and crude mortality rate (8% vs 4%) compared to those without diabetic disease (p < 0.001). The adjusted Poisson regression model to estimate the incidence risk of sepsis in patients with preexisting diabetic disease was 54% more compared to those without diabetic disease (IRR =1.54, 95% CI = 1.04-2.29). The risk of graft complication is two times higher (IRR= 2.17, 95% CI = 1.03-4.58) for patients with pre-existing diabetic disease compared to those without diabetic disease after controlling for patient demographics and injury characteristics. However, there was no significant impact of preexisting diabetic disease on in-hospital mortality.
Conclusion: Preexisting diabetes significantly increases the risk of developing sepsis and graft complication but has no significant effect on mortality in patients following burn injury. Our findings emphasizes the need for the inclusion of comorbidities in burn care outcomes in addition to prognosticate burn mortality.