title: National trends in burn and inhalation injury in burn patients: results of analysis of the nationwide inpatient sample database.
abstract: The aim of this study was describe national trends in prevalence, demographics, hospital length of stay (LOS), hospital charges, and mortality for burn patients with and without inhalational injury and to compare to the National Burn Repository. Burns and inhalation injury cause considerable mortality and morbidity in the United States. There remains insufficient reporting of the demographics and outcomes surrounding such injuries. The National Inpatient Sample database, the nation's largest all-payer inpatient care data repository, was utilized to select 506,628 admissions for burns from 1988 to 2008 based on ICD-9-CM recording. The data were stratified based on the extent of injury (%TBSA) and presence or absence of inhalational injury. Inhalation injury was observed in only 2.2% of burns with <20% TBSA but 14% of burns with 80 to 99% TBSA. Burn patients with inhalation injury were more likely to expire in-hospital compared to those without (odds ratio, 3.6; 95% confidence interval, 2.7-5.0; P < .001). Other factors associated with higher mortality were African-American race, female sex, and urban practice setting. Patients treated at rural facilities and patients with hyperglycemia had lower mortality rates. Each increase in percent of TBSA of burns increased LOS by 2.5%. Patients with burns covering 50 to 59% of TBSA had the longest hospital stay at a median of 24 days (range, 17-55). The median in-hospital charge for a burn patient with inhalation injury was US$32,070, compared to US$17,600 for those without. Overall, patients who expired from burn injury accrued higher in-hospital charges (median, US$50,690 vs US$17,510). Geographically, California and New Jersey were the states with the highest charges, whereas Vermont and Maryland were states with the lowest charges. The study analysis provides a broad sampling of nationwide demographics, LOS, and in-hospital charges for patients with burns and inhalation injury.
authors.affiliation: From the Departments of *Neurosurgery and †Surgery, Stanford University School of Medicine, Palo Alto, California; ‡Department of Neurology and Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania; and §Department of Biostatistics, The Rothman Institute, Philadelphia, Pennsylvania.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.forename: Byung C
authors.initials: BC
authors.lastname: Yoon
authors.forename: Bowen
authors.initials: B
authors.lastname: Jiang
authors.forename: Carla M
authors.initials: CM
authors.lastname: Carvalho
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.forename: Jack
authors.initials: J
authors.lastname: Jallo
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002056:Burns / Q000145:classification / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012042:Registries; D015208:Smoke Inhalation Injury / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult