Heterogeneity in Intensive Care. The admissions and management of burns patients in a Quaternary Unit between 2015 – 2019.

Dr Juliette Mewton1, Dr William  Scalia2, Dr John  Gowardman1, Dr  Jason  Miller1

1Royal Brisbane And Women’s Hospital, Herston, Australia, 2The Prince Charles Hospital , Chermside , Australia

Abstract:

Introduction. A retrospective review of the admissions and management of patients during a four-year period. Results demonstrate significant patient demographics, mortality predictors and variable treatment regimens.

Methods. After ethical approval a retrospective audit with appropriate statistical analysis was completed on patients admitted with a primary diagnosis of a burn.

Results. One Hundred and sixty-three patients were admitted with a median age of forty-two years. Seventy six percent were male and thirty-nine percent female. Yearly admission rates reduced to 2018 (p= <0.001). An accidental cause was recorded for one Hundred and sixteen (71%) whilst forty-seven (29%) resulted from self-harm. Twenty-four patients died (12.8%) twelve despite active treatment. Mortality was associated with an act of self-harm (56%) P = 0.0013, a parkland calculation greater than twenty litres p= <0.05, a low pH (100%) and hypothermia (96%) on admission.

Parklands calculation documentation fell from 66% in 2015 to 38% in 2018 p=0.00133. Sixty-six percent of patients received more fluid than the calculation in 2015 rising to 93% in 2018 p=0.00005. Twenty-one different sedative/analgesic regimens were commenced on admission. Eighty-two percent had a benzodiazepine infusion on admission (2015) which fell to 70% in 2018 p=0.025.  Discharge prescribing of benzodiazepines increased from 13.8% (2015) to 44% (2018) p=0.00003.  During second surgical debridement procedures patients received 8 times greater analgesic doses than for the first (p=0.0085). Discharge analgesic and anti-psychotic medication varied significantly.

Conclusions.  Patients admitted with self-harmed, acidaemia or hypothermia have higher mortality. Significant variation in medical care is demonstrated within the unit.


Biography:

I qualified from Bristol University in 2003 and completed surgical training with a strong emphasis on the surgical and intensive care management of Burns. I transitioned into Intensive Care training in Australia and have maintained a keen interest in Burns care. I was keen to review the delivery of care to these patients in our unit.

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