ORIGINAL ARTICLE: 2014 ABA PAPER
Acute Pavement Burns: A Unique Subset of Burn Injuries: A Five-Year Review of Resource Use and Cost Impact Andrew G. Silver, MD, Gerrit M. Dunford, MS, William A. Zamboni, MD, Richard C. Baynosa, MD
This study focuses on the hospital care of a rare subset of burn injuries caused by contact with environmentally heated pavement, to further understand the required use of resources. This article aims to show that pavement burns are typically more severe than their flame/ scald counterparts. A retrospective review of patients admitted to the burn center with injuries suffered from contact with hot pavement was performed. Patients were stratified on the presence or absence of altered mental status (AMS) and additional inciting factors. A representative sample of similarly sized flame and scald wounds treated in the same time period was compiled for comparison. Those with pavement burns had a significantly greater requirement for operative intervention, repetitive debridements, overall cost/ percent burned, and lengthier hospital stays than those with flame/scald burns. Pavement burn victims with AMS were significantly more likely to require an operation, a greater cost/percent burned, and longer hospital stays than those without AMS. Pavement burns are significantly worse than similarly sized scald/flame burns with regards to length of stay and total hospital costs, and the necessity of initial and repetitive operative intervention. These discrepancies are even greater in patients with AMS as a concomitant inciting factor. It is apparent that these wounds often continue to deepen during a patient’s stay, likely because of continued pressure on the wounds while recumbent. As such, this article highly recommends pressure off-loading beds and more aggressive debridement in the treatment of these unique injuries. (J Burn Care Res 2015;36:e7–e11)
Acute burns secondary to contact with thermally heated pavement are uncommon in the majority of burn units in the United States. The previously described circumstances surrounding this type of burn have included motor vehicle accidents, seizure disorders, assault, police restraint, drug use, diabetic neuropathy, syncope, toddlers ambulating without shoes, and even child abuse.1–5 In addition, essentially any situation involving prolonged contact with hot pavement can and will cause such injuries. The scarce published literature on this specific mechanism of injury is limited to the inciting circumstances From the Division of Plastics Surgery, University of Nevada School of Medicine, Las Vegas; and Lions Burn Care Unit, University Medical Center, Las Vegas, Nevada. Address correspondence to Andrew G. Silver, MD, Department of Surgery, Division of Plastic Surgery, University of Nevada School of Medicine, 2040 West Charleston Blvd, Suite 301, Las Vegas, Nevada 89102. Copyright © 2014 by the American Burn Association 1559-047X/2015 DOI: 10.1097/BCR.0000000000000162
without attention to the hospitalization and impact on the health care system. This study focuses on the subsequent hospital care of this unique subset of burn injuries to further understand the required use of resources, and to draw conclusions from which to improve the quality of care provided by those who treat such injuries. We aim to show that pavement burns can be viewed as a unique subset of burn injuries, which are typically more severe than their flame/scald counterparts. Further, we hypothesize that these unique injuries can be further stratified by the presence or absence of altered mental status (AMS) as a concomitant inciting factor, with more significant injuries consistently encountered in the population with AMS.
METHODS Using data from the burn repository at the authors’ medical center, all patients who suffered burns through “contact with a hot item” and required e7
Journal of Burn Care & Research January/February 2015
e8 Silver et al
admission to the burn center were identified from May 2008 to September 2012. Individual patient charts were then selected specifically for contact with pavement or street surface as the hot item, and these patients’ charts were reviewed. Exclusion criteria included the following: significant traumatic injuries that necessitated activation of the trauma team, insufficient information on mechanism of injury, burns that were likely chemical in nature secondary to contact with a wet concrete mixture, those whose primary injury was road rash, and patients who presented to the hospital late with infectious complications of their wounds. Data points included but were not limited to the following: patient demographics (age, sex, comorbidities), injury characteristics (inciting circumstances, total body surface area burned, wound location, associated injuries), treatment information (operations required, operative modalities, hospital bed selection), and hospitalization details (length of stay, hospital costs, discharge disposition). A representative sample of patients with
Acute Pavement Burns: A Unique Subset of Burn Injuries: A Five-Year Review of Resource Use and Cost Impact Andrew G. Silver, MD, Gerrit M. Dunford, MS, William A. Zamboni, MD, Richard C. Baynosa, MD
This study focuses on the hospital care of a rare subset of burn injuries caused by contact with environmentally heated pavement, to further understand the required use of resources. This article aims to show that pavement burns are typically more severe than their flame/ scald counterparts. A retrospective review of patients admitted to the burn center with injuries suffered from contact with hot pavement was performed. Patients were stratified on the presence or absence of altered mental status (AMS) and additional inciting factors. A representative sample of similarly sized flame and scald wounds treated in the same time period was compiled for comparison. Those with pavement burns had a significantly greater requirement for operative intervention, repetitive debridements, overall cost/ percent burned, and lengthier hospital stays than those with flame/scald burns. Pavement burn victims with AMS were significantly more likely to require an operation, a greater cost/percent burned, and longer hospital stays than those without AMS. Pavement burns are significantly worse than similarly sized scald/flame burns with regards to length of stay and total hospital costs, and the necessity of initial and repetitive operative intervention. These discrepancies are even greater in patients with AMS as a concomitant inciting factor. It is apparent that these wounds often continue to deepen during a patient’s stay, likely because of continued pressure on the wounds while recumbent. As such, this article highly recommends pressure off-loading beds and more aggressive debridement in the treatment of these unique injuries. (J Burn Care Res 2015;36:e7–e11)
Acute burns secondary to contact with thermally heated pavement are uncommon in the majority of burn units in the United States. The previously described circumstances surrounding this type of burn have included motor vehicle accidents, seizure disorders, assault, police restraint, drug use, diabetic neuropathy, syncope, toddlers ambulating without shoes, and even child abuse.1–5 In addition, essentially any situation involving prolonged contact with hot pavement can and will cause such injuries. The scarce published literature on this specific mechanism of injury is limited to the inciting circumstances From the Division of Plastics Surgery, University of Nevada School of Medicine, Las Vegas; and Lions Burn Care Unit, University Medical Center, Las Vegas, Nevada. Address correspondence to Andrew G. Silver, MD, Department of Surgery, Division of Plastic Surgery, University of Nevada School of Medicine, 2040 West Charleston Blvd, Suite 301, Las Vegas, Nevada 89102. Copyright © 2014 by the American Burn Association 1559-047X/2015 DOI: 10.1097/BCR.0000000000000162
without attention to the hospitalization and impact on the health care system. This study focuses on the subsequent hospital care of this unique subset of burn injuries to further understand the required use of resources, and to draw conclusions from which to improve the quality of care provided by those who treat such injuries. We aim to show that pavement burns can be viewed as a unique subset of burn injuries, which are typically more severe than their flame/scald counterparts. Further, we hypothesize that these unique injuries can be further stratified by the presence or absence of altered mental status (AMS) as a concomitant inciting factor, with more significant injuries consistently encountered in the population with AMS.
METHODS Using data from the burn repository at the authors’ medical center, all patients who suffered burns through “contact with a hot item” and required e7
Journal of Burn Care & Research January/February 2015
e8 Silver et al
admission to the burn center were identified from May 2008 to September 2012. Individual patient charts were then selected specifically for contact with pavement or street surface as the hot item, and these patients’ charts were reviewed. Exclusion criteria included the following: significant traumatic injuries that necessitated activation of the trauma team, insufficient information on mechanism of injury, burns that were likely chemical in nature secondary to contact with a wet concrete mixture, those whose primary injury was road rash, and patients who presented to the hospital late with infectious complications of their wounds. Data points included but were not limited to the following: patient demographics (age, sex, comorbidities), injury characteristics (inciting circumstances, total body surface area burned, wound location, associated injuries), treatment information (operations required, operative modalities, hospital bed selection), and hospitalization details (length of stay, hospital costs, discharge disposition). A representative sample of patients with
