• Runzhi Huang, Yuanan Li, Shuyuan Xian, Wei Zhang, Yifan Liu, Sujie Xie, Dayuan Xu, Yushu Zhu, Hanlin Sun, Jiale Yan, Xinya Guo, Yixu Li, Jianyu Lu, Xirui Tong, Yuntao Yao, Weijin Qian, Bingnan Lu, Jiaying Shi, Xiaoyi Ding, Junqiang Li, Shichu Xiao, and Shizhao Ji.
• Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai, China; Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai 200433, China.
• Burns. 2024 Nov 1; 50 (8): 197719901977-1990.

BackgroundSepsis is one of the major causes of morbidity and mortality in burn patients. However, the optimal timing of admission which can minimize the probability of sepsis is still unclear. This study aims to determine the optimal time period of admission for severely burned patients and find out the possible reasons for it.Method185 victims to the Kunshan factory aluminum dust explosion accident, which happened on August 2nd, 2014, were studied. The optimal cutpoint for continuous variables in survival models was determined by means of the maximally selected rank statistic. Univariate and multivariate analyses were further conducted to verify that admission time was not a risk factor for sepsis. Subgroup analyses were performed to find out possible contributing factors for the result.ResultThe cutoff point for admission time was determined as seven hours, which was supported by the survival curve (p < 0.001). Multivariate analysis showed that, in our study population, delayed admission time was not a risk factor for sepsis (HR = 0.610, 95 %CI = 0.415 - 0.896, p = 0.012). Subgroup analyses showed that "Tracheotomy before admission" (p = 0.002), "Whole blood transfusion" (p < 0.001), "Hemodynamic instability before admission" (p = 0.02), "Has a burn department in the hospital" (p = 0.009), "Has a burn ICU in the hospital" (p < 0.001), "Acute heart failure (AHF)" (p = 0.05), "acute respiratory distress syndrome (ARDS)" (p = 0.05) and "GI bleeding" (p = 0.04) were all statistically significant.ConclusionIn our study population, we found that delayed admission time was not a risk factor associated with a reduced incidence of sepsis among severely burned patients. This might be attributed to variations in prehospital treatments (whole blood transfusion and tracheotomy), whether the hospital had a burn department/ICU, and certain complications (AHF, ARDS and GI bleeding). It can be inferred that early prehospital care plays a crucial role in reducing sepsis risk among severe burn patients.Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.

39 keywords...

hide…