The association between out of hours burn centre admission and in-hospital outcomes in patients with severe burns |
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| Affiliation: | 1. Victorian Adult Burn Service, The Alfred, Melbourne, Australia;2. Department of Epidemiology and Preventive Medicine, Monash University, Australia;3. Heath Data Research UK, Swansea University Medical School, Swansea University, United Kingdom;4. Emergency and Trauma Centre, The Alfred, Melbourne, Australia;1. Victorian Adult Burn Service, The Alfred, Melbourne, Australia;2. Department of Epidemiology and Preventive Medicine, Monash University, Australia;3. Heath Data Research UK, Swansea University Medical School, Swansea University, United Kingdom;4. Emergency and Trauma Centre, The Alfred, Melbourne, Australia;1. Plastic Surgery Department, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, United Kingdom;2. School of Medicine, The University of Nottingham, University Park, Nottingham, NG7 2UH, United Kingdom;1. Department of Burns, Plastic and Maxillofacial Surgery, Australia;2. New South Wales Agency for Clinical Innovation Statewide Burn Injury Service, Australia;3. Northern Clinical School, University of Sydney, Australia;1. School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa;2. Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa;3. Developing Research, Innovation, Localization and Leadership (DRILL), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa;4. Centre for Teaching & Research in Disaster Medicine and Traumatology (KMC), Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden;5. The Aga Khan University, Pakistan;6. School of Medicine, University of Sāo Paulo, Sāo Paulo, Brazil;7. Department of Surgery, Oregon Health and Science University, United States;8. Department of Surgery, Faculty of Health Sciences, University of Nairobi, Kenya;9. Department of Hand Surgery, Plastic Surgery and Burns in Linköping University, Sweden;10. Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden;1. The First School of Clinical Medicine, Southern Medical University, Guangzhou 510010, China;2. Department of Burn & Plastic Surgery, Guangzhou School of Clinical Medicine, Southern Medical University (General Hospital of Southern Theatre Command of PLA), Guangzhou 510010, China;3. Department of Burn and Plastic Surgery, Burns institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing 100048, China;4. Department of Plastic Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China;1. Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan;2. Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan;3. Division of Traumatology, Research Institute, National Defense Medical college, Saitama, Japan;4. Department of Psychiatry, National Defense Medical College, Saitama, Japan;5. Department of Mathematics, National Defense Medical College, Saitama, Japan |
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| Abstract: | IntroductionPatients with severe burns (≥20 % total body surface area [TBSA]) have specific and time sensitive needs on arrival to the burn centre. Burn care systems in Australia and New Zealand are organised differently during weekday business hours compared to overnight and weekends. The aims of this study were to compare the profile of adult patients with severe burns admitted during business hours with patients admitted out of hours and to quantify the association between time of admission and in-hospital outcomes in the Australian and New Zealand context.MethodsData were extracted from the Burns Registry of Australia and New Zealand for adults (≥18 years) with severe burns admitted to Australian or New Zealand burn centres between July 2016 and June 2020. Differences in patient profiles, clinical management, and in-hospital outcomes were investigated. Univariable and multivariable logistic and linear regression models were used to quantify associations between time of admission and in-hospital outcomes of interest.ResultsWe found 623 patients eligible for inclusion. Most patients were admitted out of hours (69.2 %), their median age was 42 years, and most were male (78 %). The median size burn was 30 % TBSA and 32 % of patients had an inhalation injury. A greater proportion of patients admitted out of hours had alcohol and/or drugs involved with injury compared to patients admitted during business hours. No other differences between groups were observed. Patients in both groups had similar odds of dying in hospital (Odds Ratio [OR], 95 % Confidence Interval [95 %CI] 1.49 [0.64, 3.48]), developing acute kidney injury within 72 h (OR, 95 %CI 0.58 [0.32, 1.07]), or sepsis (OR, 95 %CI 1.04 [0.46, 2.35]). No association was found between time of admission and hospital (%, 95 %CI 1.00 [0.82, 1.23]) nor intensive care length of stay (%, 95 %CI 0.97 [0.73, 1.27]).DiscussionIn this first Australian and/or New Zealand study to explore the association between time of admission and burn patient in-hospital outcomes, out of hours admission was not associated with patient outcomes of interest.ConclusionThese findings support current models of care in Australian and New Zealand burn centres, however further investigation is required. Nonetheless, given most severe burns patients arrive out of hours to burn the centre, it is plausible that out of hours availability of senior burn clinicians will improve patient care and safety resilience within burn care systems. |
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| Keywords: | Severe burns Out of hours admission Outcomes Mortality Acute kidney injury Registry Australia New Zealand |
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