Systematic review of complications and outcomes of diabetic patients with burn trauma.
OBJECTIVE
We aimed to understand the effect diabetes plays on the extent of complications and patient outcomes in burn trauma.


METHODS
We searched MEDLINE, Science Direct and the Cochrane Review Database for 571 articles. Through our selection criteria, 12 articles were selected for systematic review and meta-analysis. Data was analysed via Review Manager 5.3, using Mantel-Haenszel statistics and random effect models.


RESULTS
The odds of a diabetic patient sustaining a wound or local infection was 2.55 times higher (95%CI: 1.21-5.36, Z=2.47; p=0.01), with a low heterogeneity (Tau2=0.00; I2=0%). Diabetics also had a higher odds of urinary tract infections (OR=3.32 (95% CI: 1.92-5.73; Z=4.31, p<0.001), low heterogeneity (Tau2=0.00; I2=0%)). In terms of length of hospital stay, the mean difference between diabetic and non-diabetic patients was 3.94 (95% CI: -2.69 to 10.6; I2=98%; p=0.24). For mortality rates, the odds ratio between diabetic and non-diabetic patients was 2.22 (95% CI: 0.45-10.9; I2=93%; p=0.32). Through our systematic review, we also found that diabetic patients are also more prone to nosocomial wound infections (OR=2.26; 95% CI=1.10-4.64), cellulitis (OR=2.69; 95% CI=1.85-3.91), bacteraemia (OR=2.91; 95% CI=1.48-5.73), sepsis (OR=4.36; 95% CI=2.20-8.64), a higher number of burn related operations (OR=3.94; 95% CI=1.94-7.90), longer period of wound closure (MD=26.8; 95% CI=8.52-45.1), respiratory complications (OR=2.91; 95% CI=1.35-6.28) and a higher number of days on ventilator (MD=8.70; 95% CI=3.51-13.89).


CONCLUSIONS
Diabetic patients have a higher odds of sustaining wound infections, local infections and urinary tract infection. However, diabetic patients did not have a higher odds of longer hospital stay or mortality.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: asayampa@gmail.com.
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Sayampanathan
D016470:Bacteremia / Q000453:epidemiology*; D002056:Burns / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D002481:Cellulitis / Q000453:epidemiology*; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D018805:Sepsis / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology*; D014946:Wound Infection / Q000453:epidemiology*
Burns; Complications; Diabetes; Outcomes; Review; Trauma