How long a shadow does epidemic obesity cast in the burn unit? A dietitian's analysis of the strengths and weaknesses of the available data in the National Burn Repository.

To demonstrate the research potential of the National Burn Repository, we examined outcomes affecting the obese burn population, specifically length of stay and mortality. This retrospective analysis evaluates burn patients from the repository coded as "obese." We queried admissions from burn units between the years 2000 to 2006 (n = 101,450). We initially intended to associate and stratify obesity with several complications and outcomes using multivariate analysis. However, because of the lack of standardized data fields, a surrogate yard stick (length of stay > or =7 days) was a straightforward and sensible outcome measurement. Mortality was used as a second outcome measurement. Two statistical approaches were used: logistic regression and the Cochran-Mantel-Haenszel test. Obese patients were 4.1 times more likely to have a length of stay > or =7 days (P < .0001) and were 2.6 times more likely to die (P < .0001) than patients not described as obese. The results not only highlighted obesity as a major challenge in burn care, but also identified means of improving the National Burn Repository to facilitate future nutrition research. The repository has vast potential to be a useful research tool for the dietitian. With standardization of the data dictionary and the addition of nutrition-related fields, such as height and weight, future research will be greatly enhanced.

The Pentagon attack of September 11, 2001: a burn center's experience.

On September 11, 2001, an airplane flown by terrorists crashed into the Pentagon, causing a mass casualty incident with 189 deaths and 106 persons treated for injuries in local hospitals. Nine burn victims and one victim with an inhalation injury only were transported to the burn center hospital. The Burn Center at Washington Hospital Center admitted and treated the acute burn patients while continuing its mission as the regional burn center for the Washington DC region. Eight of the nine burn patients survived. Lessons learned include 1) A large-volume burn center hospital can absorb nine acute burns and maintain burn center and hospital operations, but the decision to keep or transfer burn patients must be tempered with the reality that several large burns can double or triple the work load for 2 to 3 months. 2) Transfer decisions should have high priority and be timely to ensure optimum care for the patients without need for movement of medical personnel from one burn center to another. 3) The reserve capacity of burn beds in the United States is limited, and the burn centers and the American Burn Association must continue to seek recognition and support from Congress and the federal agencies for optimal preparedness.