540 A Systematic Review of Pressure Ulcers in Burn Patients: Risk Factors, Demographics, and Treatment Modalities

Abstract

Introduction

Pressure Ulcers can be a devastating sequelae of a hospital stay. Pressure ulcers increase patient morbidity, prolong hospital stay, and increase hospital costs. The estimated cost per patient is about $70,000 with anticipated continual increase each year. Although all patients are at risk, and burn patients do share some common risk factors with the general population, it is important to note burn patients suffer from unique, specific risk factors. Current research into the best prevention and management practices on burns-specific patients are limited and moribund, as such, this review is vital.

Methods

We performed a systematic review on PubMed and isolated relevant manuscripts. Isolated manuscripts and hospital cases met the predetermined inclusion criteria of pressure ulcers, which resulted from acute burns and were presented in the Intensive Care Unit. Chronic wounds, prior existing wounds, and Marjolin’s ulcers were excluded; whereas all ages, gender, total body surface area (TBSA) injury of >20 %, cause/mechanism of burn, length of stay (> 5 days), treatment(s) used and outcomes, and complications were highlighted in patient demographics as burns patients are more varied.

Results

In all studies, poor nutritional status, decreased tissue perfusion, immobility, edema, incontinence, moisture, and length of stay are amongst the identifying risk factors for pressure ulcer development in burns patients. These risk factors are present in most patients with significant burn injury. The incidence is higher in patients with any of the following characteristics: critically ill, terminally ill, elderly, geriatric/obese, amputees, recently fractured, or immobilized. Also many of the treatment modalities for burns including: large volume resuscitation, repeated operations, splinting, and immobilization further worsen the likelihood of developing a pressure ulcer. In our review of the literature, we are able to identify causative factors and deduce better prevention measures, but we also ascertain the need for further research to enhance the prevention and treatment of ulcers in burn patients.

Conclusions

Our review extensively describes risk/predisposing factors along with at-risk demographics. We reviewed approaches to prevention and management practices and recommended rigorous preventative strategies in at-risk patients. Pressure monitors and offloading techniques are certain nascent techniques recommended, which are worth exploring more in depth in burn-specific patients.

Applicability of Research to Practice

Identifying risk factors, incidence, and treatment of burn injury specific patients can lead to more research on preventative measures and better treatment modalities.