ABSTRACT
BACKGROUND: Morbidity and mortality from venous thromboembolism (VTE) remains a significant problem for hospitalized patients. Despite the ample prospective literature defining the prevalence of VTE in hospitalized patient populations, the prevalence of VTE in the thermally injured population remains largely unknown. METHODS: We prospectively studied 148 thermally injured patients with hospital stays of greater than 3 days with lower extremity duplex ultrasonograms obtained at admission and discharge. RESULTS: Nine patients experienced VTE (6.08%). Eight of the nine deep venous thromboses were proximal. One of the two pulmonary embolisms was fatal. Treatment risk factors that were associated with VTE were the presence of a central venous line (p = 0.020) and transfusion of more than 4 units of packed red blood cells (p = 0.023). These treatment factors were significantly related to each other (p < 0.0001), to body surface area burned, and to intervention. CONCLUSION: The prevalence of VTE in burn patients is similar to that of moderate- to high-risk general surgical patients for whom VTE prophylaxis is recommended. VTE prophylaxis of burn patients, especially those requiring central venous lines and more than 4 units of packed red blood cells, should be considered.
Subject(s)
Burns/complications , Postoperative Complications/diagnostic imaging , Postoperative Complications/epidemiology , Thromboembolism/diagnostic imaging , Thromboembolism/epidemiology , Ultrasonography, Doppler, Duplex , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Body Surface Area , Burns/surgery , Catheterization, Central Venous/adverse effects , Female , Humans , Iowa/epidemiology , Length of Stay/statistics & numerical data , Male , Mass Screening , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Prevalence , Prospective Studies , Risk Factors , Sex Distribution , Thromboembolism/etiology , Thromboembolism/prevention & control , Transfusion Reaction , Ultrasonography, Doppler, Duplex/methods , Venous Thrombosis/etiology , Venous Thrombosis/prevention & controlABSTRACT
The purpose of this study was to analyze the outcome of elderly burn victims and to determine an instrument to predict survival in this population. Charts of three hundred and eight burn patients > or =60 yr of age who were admitted to a university-based hospital between the years of 1977-1996 were retrospectively analyzed. The mean age of the population was 71.5+/-8.6, with a male predominance (1.8 to 1, P < 0.001). The majority of the burns were secondary to flame injuries (210, 68.6%). The median body surface area (BSAB) was 13.0% with an in-hospital mortality rate of 30.2%. We demonstrated improved survival in patients aged 60-74 yr as compared to 1965-1971 national burn survival data. A similar trend could not be shown in the very old (> 75 yr of age). Only age and BSAB were related to death by multiple stepwise forward linear regression. The Baux score, which adds age and BSAB, was predictive of outcome in 87.0% of our population. In conclusion, this study reinforces the high mortality associated with burn injuries in the elderly and the superior ability of the Baux score (age + percent burn) in predicting outcome in this population.
