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Factors Associated with Amputation of the Lower Arm, Hand and Fingers after Burn Injury - A National Burn Quality Platform Analysis
Elizabeth Blears, MD, MMS
1; Shiraz Mumtaz, MS
1; Brian Tinsley, MD
1; Sina Ramtin, MD
2; Asif M Ilyas, MD
31Tower Health, West Reading, PA; 2Rothman, Philadelphia, PA; 3Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
ABSTRACT
Introduction: The National Burn Quality Platform (NBQP) is the most comprehensive database of burn patients, collecting information from more than 100 burn centers and multiple countries. Burns of the hand and upper extremity are disproportionately common relative to other locations of burns. Despite their prevalence, evidence is lacking to define the characteristics and etiologies of hand burn injuries on a large scale. Additionally, risks for requiring amputations of the fingers, hand, wrist or forearm following burn injuries are also not well defined.
Materials & Methods: A cross-sectional analysis of the NBQP was performed to characterize the incidence, type, and etiologies of hand & upper extremity burn injuries. Burns of all mechanisms were included for analysis. Burns were stratified by anatomic location per Lund and Browder Charts (i.e. hand vs lower arm). Binomial logistic regression was performed to examine independent risk factors for requiring amputation distal to the elbow while adjusting for potential cofounding variables, such as total body surface area (TBSA) burned, age and presence of underlying co-morbidities.
Results: Of the total patients in the NBQP, 45.1% (129,113/ 286,478 patients) were documenting as having sustained a burn injury involving either the hand 31.6% (90,614/ 286,478), upper extremity 26.7% (76,536/ 286,478), or both 42.0% (119,699/ 286,478). The median hand & upper extremity TBSA size was 2% (Interquartile Range: 1-3.4%), whereas the overall body TBSA of those sustaining hand/lower arm burns was 5% (Interquartile Range: 2-12%). The most common mechanism involving lower arm / hand/ finger injuries was flame (51%). Cold or chemical burn mechanism, or presence of fracture, or tendon, vascular or nerve injury were independently associated with higher risk of sustaining amputation after burn injury (P<0.05).
Conclusions: Burn injuries to the hand & upper extremity are extremely common among all types of burns treated at burn centers and represent a large proportion of the overall TBSA affected. Statistically significant risk factors for amputation of the fingers, hand or forearm after burn included cold or chemical burn mechanism, or co-inciting presence of fracture, or tendon, vascular or nerve injury.
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