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The Utility of the Social Vulnerability Index on Burn Injury Outcomes
Meredith Hanrahan1, Daniel Wiese2, Kevin A Henry2
1Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
Introduction:
Clinical predictors of burn outcomes are well established, but the impact of social vulnerability remains unclear. This study evaluated the utility of the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) in predicting outcomes at an urban, academic burn center.
Methods:
We conducted a retrospective cohort study of patients (age ≥18) admitted to an American Burn Association-verified center (2020-2023). Subjects were categorized into high-risk (SVI ≥0.75) and low-risk (SVI <0.75) groups. Multivariate regression compared outcomes, controlling for age, sex, percentage of total body surface area, ethnicity, diabetes, inhalation injury, delayed presentation, insurance, and housing.
Results:
Among 699 burn patients, the median age was 52 y (interquartile range 38-65), 62.5% were male, and median percentage of total body surface area was 3% (interquartile range 1-7). Flame burns (47.2%) were most common, with 16.3% sustaining inhalation injury. 55.1% of subjects were high-risk and were more likely to be African American or Hispanic, have Medicaid insurance, be unemployed (all P < 0.01) and present >24 h postinjury (P = 0.009) compared to low-risk. Delayed presentation was associated with increased odds of unplanned readmission (odds ratio 1.94, 95% confidence interval 1.01-3.72, P = 0.047) and wound infection (odds ratio 2.99, 95% confidence interval 1.86-4.78, P < 0.001). However, in multivariate analysis controlling for covariates, overall SVI was not a significant predictor of discharge destination, unplanned readmission, follow-up, wound infection, or death.
Conclusions:
Although the overall SVI correlates with demographic disparities and delayed presentation, it did not independently predict clinical outcomes in this population after adjusting for individual risk factors. While SVI is valuable for identifying at-risk populations, its prognostic utility for specific clinical burn outcomes may be limited when individual patient data is considered.
