(150) Characterizing device and treatment of patients with deep dermal or full thickness thermal burns in the National Burn Registry between 2021-2023

Background: Burn injuries account for more than 600,000 emergency room visits in the US annually. The most severe burns are deep dermal or full thickness, which extend into the subcutaneous tissue. Treatment options are specific to the burn and patient’s condition, but generally include skin debridement followed by one or two-stage treatment options. One-stage treatment refers to permanent wound closure through autografting or other coverage, while two-stage treatment includes a temporary wound coverage followed by permanent wound closure.

Objectives: To describe treatment and device utilization patterns of patients admitted to a burn center with a deep dermal or full thickness burn in the US.

Methods: This is a retrospective observational cohort study using the National Burn Registry (NBR) among patients admitted to a participating burn treatment facility between January 1, 2021 through June 30, 2023. Patients were required to have a 3rd degree burn covering ≥3% total body surface area (TBSA). Patient demographic, comorbid, and injury characteristics as well as one and two-stage device treatment patterns were described using summary statistics overall and by subgroups of age and categorical TBSA. One-stage treatment included autograft or keratinocyte coverage, while two-stage treatment included use of NovoSorb biodegradable temporizing matrix (BTM), synthetic and biosynthetic membranes, human biologic grafts, non-human biologic grafts, and dermal substitutes.

Results: There were 26,138 patients included in the NBR, for which 3,128 met inclusion criteria. The median (interquartile range (IQR)) for age was 47 (30, 63) years, 68.9% were male, 62.6% white, and the median (IQR) for total TBSA burned was 10% (5%, 22%) upon admission. Thermal burns were the most common etiology (91.8%). The median (IQR) length of stay was 16 (7, 30) days. There were 2,326 (74.4%) patients with a one-stage treatment, of which 2,251 (96.8%) were treated with autograft and 647 (27.8%) were treated with keratinocyte coverage. Two-stage treatments were observed among 1,621 (51.8%) of the cohort. Of the patients with a two-stage treatment component, the most common type was human biologic grafts (N= 1,186, 73.2%). Among 420 patients with 3rd degree burn of 20-60% TBSA, the length of stay (median 33 (IQR 1, 67)) was longer compared to 2,141 patients with 3rd degree <10% TBSA burned (median 14 (IQR 7, 23)).

Conclusions: Findings from this analysis characterize a population of severe burn patients in a national burn registry and their treatment patterns wherein autografting and human biologic grafts were most commonly observed, but may not always be appropriate treatment, especially for patients with greater TBSA who require additional care.