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Factors Associated with Finger, Hand and/or Forearm Amputation after Burn Injury - A Burn Care Quality Platform Analysis
Elizabeth Blears, MD, MMS
1; Shiraz Mumtaz, MS
1,2; Brian Tinsley, MD
1,2,3; Asif M Ilyas, MD, MBA
2,41Tower Health, West Reading, PA; 2Drexel University College, Philadelphia, PA; 3Orthopaedic Associates of Reading, Wyomissing, PA; 4Rothman Institute at Thomas Jefferson University, Philadelphia, PA
Introduction: The Burn Care Quality Platform (BCQP) collects information from more than 100 burn centers in 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 BCQP was performed to characterize the incidence, type, and etiologies of hand 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: In the BCQP, 1.2% (3,439/ 286,478) of patients sustained burns to the finger(s), 12.4% (35,419/ 286,478) were to the hand, 10.4% (29,895/ 286,478) were to the forearm, and 21.1% (60,360/ 286,478) involved multiple sites at these areas. The median TBSA size was 2% (IQR: 1-3.4%), whereas the overall body TBSA of this cohort was 5% (IQR: 2-12%). The most common mechanism involving these 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 of the fingers, hand and/or forearm (P<0.05).
Conclusions: Burn injuries to fingers, hand and forearm are common 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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