Optimizing mass casualty burns intensive care organization and treatment using evidence-based outcome predictors. Issue 5 (August 2018)

• Record Type: Journal Article
• Authors: Kao, Huang-Kai; Loh, Charles Yuen Yung; Kou, Hao-Wei; Kao, Kuo-Chin; Hu, Han-Chung; Chang, Chia-Ming; Lee, Chia-Hui; Hsu, Hsiang-Hao
• Is Part Of: Burns. Volume 44:Issue 5(2018)
• Page Start: 1077
• Page End: 1082
• Publication Date: 2018-08
• Subjects: Burns -- Dust explosion -- Resource management -- Intensive care -- Mass casualty -- Massive burns injury; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2018.02.025
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Maximizing the value of critical care services for burns victims in mass casualty events requires understanding the relationship between utilization, clinical outcomes, and costs. There is a paucity of literature focusing on strategizing the use of intensive care units (ICU) in available in hospitals for mass casualty incidents (MCI) especially with regards to MBI. We present a detailed analysis of the in-hospital reorganization of critical care resources as well as clinical and non-clinical factors which led to an overall successful outcome of a MCI. Abstract: Background: Majority of current research focuses on pre-hospital care in mass casualty incidents (MCI) whereas this study is the first to examine multifactorial aspects of intensive care unit (ICU) resource management during a surge in massive burn injury (MBI) patients whilst identifying key outcome predictors that resulted in successful disaster managements. Methods: Both critical care, surgical parameters and cost-effectiveness are investigated in patients admitted with severe burns resulting from the explosion. A fully integrated trauma response and expansion of critical care resources in Linkou Chang Gung Memorial Hospital (CGMH) in this incident is analyzed. Results: 52 burn patients were treated in CGMH and 27 patients (51.9%) had TBSA greater than 45% with the mean TBSA of 44.6 ± 20.3%. ICU based management of MBI including early debridement and resource strategizing. The overall mortality rate was 2/52 (3.85%). Patients had an average of 14.8 days on mechanical ventilation and 43 days as an inpatient in total. Operative treatment wise, 44.2% of patients received escharotomies and each patient received an average of 2 skin grafting procedures. The initial TBSA was a significant predictor for burn wound infection (OR 1.107, 95% CI 1.023–1.298; p = 0.011). Each patient cost an average of USD 1035 per TBSA% with an average total cost of USD 50415. Conclusion: With ever increasing chances of terrorist activity in urban areas, hospitals can hopefully increase their preparedness using outcome-predictors presented in this study.