Clinical practice variation in acute severe burn injury

Area of Science:

• Critical Care Medicine
• Burn Surgery
• Trauma Management

Background:

• Severe burn injuries necessitate intensive care unit (ICU) management.
• Variations in clinical practice may influence patient outcomes in burn care.
• Understanding practice differences in endotracheal intubation and surgical grafting is crucial.

Purpose of the Study:

• To identify variations in clinical practice for severely burn-injured patients in intensive care.
• To compare differences in endotracheal intubation duration and surgical grafting between two adult burns centers.
• To analyze the association between duration of intubation and patient outcomes, including mortality.

Main Methods:

• Retrospective observational study of ICU admissions to two New South Wales adult burns centers (ICU A and ICU B) from January 2008 to December 2015.
• Data collected included percentage of total body surface area (% TBSA) burn, inhalation injury, duration of intubation, ICU length of stay (LOS), and mortality.
• Statistical analysis was performed to compare practices and outcomes, adjusting for age, % TBSA, and inhalational injury.

Main Results:

• Significant differences in clinical practice, including duration of endotracheal intubation and ICU LOS, were observed between ICU A and ICU B.
• Longer intubation duration (median 3 days in A vs. 2 days in B for severe burns) was associated with longer ICU LOS (median 3 days in A vs. 2 days in B).
• No significant difference in mortality was found between the units for severe burn subgroups after adjusting for confounding factors (adjusted OR 1.17, P=0.65).

Conclusions:

• Significant variations in clinical practice, particularly endotracheal intubation duration, exist between adult burns ICUs.
• Extended intubation is linked to increased ICU length of stay but not to higher mortality rates in severe burn patients.
• Prospective, multicenter studies are essential to establish best practices and evaluate the impact of practice variations on severe burn patient outcomes and costs.