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Clinical outcomes following burn injury across the continuum of chronic glycemic control.

Authors
  • Murphy, Claire V1
  • Zhelezny, Richard2
  • Porter, Kyle3
  • Zhang, Charles4
  • Coffey, Rebecca5
  • 1 Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, United States. , (United States)
  • 2 Department of Nursing, Burn and Post-Surgical Specialties, The Ohio State University Wexner Medical Center, Columbus, OH, United States. , (United States)
  • 3 Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States. , (United States)
  • 4 The Ohio State University College of Medicine, Columbus, OH, United States. , (United States)
  • 5 Department of Surgery, Division of Trauma, Critical Care, and Burn, The Ohio State University Wexner Medical Center, Columbus, OH, United States. Electronic address: [email protected] , (United States)
Type
Published Article
Journal
Burns : journal of the International Society for Burn Injuries
Publication Date
Nov 07, 2020
Identifiers
DOI: 10.1016/j.burns.2020.10.018
PMID: 33288330
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Diabetes has been associated with poor outcomes following burn injury. There is limited data related to prediabetes in burn injury, and no studies to date have compared clinical outcomes inpatients without diabetes, with prediabetes, and with diabetes. Therefore, this study aimed to compare clinical outcomes after burn injury across the continuum of pre-injury glucose control. A propensity score weighted cohort study of adult patients admitted for initial management of burn injury was performed. Patients were categorized as no diabetes, prediabetes or diabetes based on their admission hemoglobin A1c and past medical history. The primary outcome was length of stay per percent Total Body Surface Area (TBSA) burn. Secondary outcome measures included length of stay, all-cause hospital mortality, disposition at discharge, re-grafting of same site, and amputations. A total of 2450 patients were screened; 1137 patients were included for evaluation (236 diabetes, 191 prediabetes, 710 no diabetes). After inverse probability weighing to adjust for potentially confounding factors, patients in the diabetes group had longer length of stay/%TBSA burn than both the no diabetes group (ratio of geometric means (95% CI) = 1.65 (1.25, 2.18), p < 0.001) and the prediabetes group (ratio (95% CI) = 1.49 (1.10, 2.02), p = 0.01). No statistically significant differences in secondary outcomes were observed between groups other than a higher rate of amputations in the diabetes group (2.7%) compared to the no diabetes (0.7%, p = 0.047) and prediabetes (0%, p = 0.04) groups. Further studies are needed to delineate the differences across the continuum of pre-injury glucose control in order to identify mechanisms to optimize burn-related outcomes. Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.

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