500 Anticoagulant Use Is Associated with Different Outcomes in Pediatric and Adult Burn Patients

Abstract Introduction Anticoagulation therapy in pediatric burn patients remains an under-researched area of burn medicine lacking guidelines or scores to establish standardized therapy. The aim of this study is to evaluate the use of anticoagulants in pediatric compared to adult burn patients and to identify the most frequently used drug classes. Methods A large database was searched to create two cohorts of burn patients with more than 10% TBSA. Pediatric patients (age 0-17) were compared to adult burn patients (18-100) after propensity score matching was carried out for gender, ethnicity, and race. Venous thromboembolic events (VTE), mortality, and bleeding events were defined as outcome variables. Data analysis was performed with the tools of descriptive statistics. Risk and odds ratios were presented with significance set at p< 0.05. We also examined and compared the number of cases in which burn victims were treated with anticoagulants and the frequency distribution of different anticoagulant classes. Anticoagulants were divided into 4 groups: heparins, factor Xa-inhibitors, vitamin K antagonists, and thrombin inhibitors. Results After propensity score matching, each of the cohorts included 5630 patients. 5.5% and therefore significantly (p< 0.001) more adult patients showed thromboembolic complications compared to 1.4% of pediatric patients, with RR 0.26 (95% CI 0.20-0.33) and OR 0.24 (95% CI 0.19-0.31). Bleeding events occurred in 4.9% of adult patients, which is more than twice as common as in pediatric patients (2.1%), with RR 0.42 (95% CI 0.34-0.52) and OR 0.41 (95% CI 0.33-0.51). With 5.8% vs. 1.5% deaths in adults compared to pediatrics, mortality was also significantly higher (p< 0.001) in the adult cohort, showing RR of 0.27 (95% CI 0.21-0.34) and OR of 0.26 (95% CI 0.20-0.32). While 33.4% of adult burn patients were treated with anticoagulants within the first week after burn, only 6.7% of the pediatric burn population were treated. Further, the most frequently used drug group in both adult and pediatric burn patients was heparins, given in over 90% of the cases. Other drug classes were used in less than 10% of cases. Conclusions Anticoagulant treatment within the first 7 days after burn is more likely administered to adults than to pediatric patients. However, in most cases, heparins were the drug of choice in both groups. Bleeding events, the occurrence of VTE, and mortality was significantly higher in adult burn patients. Applicability of Research to Practice The discrepancy in the use of anticoagulants between adults and pediatrics in burn care highlights the need for larger studies to develop standardized guidelines for the use of different anticoagulants in pediatric burn patients.

Introduction: Anticoagulation therapy in pediatric burn patients remains an under-researched area of burn medicine lacking guidelines or scores to establish standardized therapy.The aim of this study is to evaluate the use of anticoagulants in pediatric compared to adult burn patients and to identify the most frequently used drug classes.Methods: A large database was searched to create two cohorts of burn patients with more than 10% TBSA.Pediatric patients (age 0-17) were compared to adult burn patients (18-100) after propensity score matching was carried out for gender, ethnicity, and race.Venous thromboembolic events (VTE), mortality, and bleeding events were defined as outcome variables.Data analysis was performed with the tools of descriptive statistics.Risk and odds ratios were presented with significance set at p< 0.05.We also examined and compared the number of cases in which burn victims were treated with anticoagulants and the frequency distribution of different anticoagulant classes.Anticoagulants were divided into 4 groups: heparins, factor Xa-inhibitors, vitamin K antagonists, and thrombin inhibitors.
Results: After propensity score matching, each of the cohorts included 5630 patients.5.5% and therefore significantly (p< 0.001) more adult patients showed thromboembolic complications compared to 1.4% of pediatric patients, with RR 0.26 (95% CI 0.20-0.33)and OR 0.24 (95% CI 0.19-0.31).Bleeding events occurred in 4.9% of adult patients, which is more than twice as common as in pediatric patients (2.1%), with RR 0.42 (95% CI 0.34-0.52)and OR 0.41 (95% CI 0.33-0.51).With 5.8% vs. 1.5% deaths in adults compared to pediatrics, mortality was also significantly higher (p< 0.001) in the adult cohort, showing RR of 0.27 (95% CI 0.21-0.34)and OR of 0.26 (95% CI 0.20-0.32).While 33.4% of adult burn patients were treated with anticoagulants within the first week after burn, only 6.7% of the pediatric burn population were treated.Further, the most frequently used drug group in both adult and pediatric burn patients was heparins, given in over 90% of the cases.Other drug classes were used in less than 10% of cases.
Conclusions: Anticoagulant treatment within the first 7 days after burn is more likely administered to adults than to pediatric patients.However, in most cases, heparins were the drug of choice in both groups.Bleeding events, the occurrence of VTE, and mortality was significantly higher in adult burn patients.

Applicability of Research to Practice:
The discrepancy in the use of anticoagulants between adults and pediatrics in burn care highlights the need for larger studies to develop standardized guidelines for the use of different anticoagulants in pediatric burn patients.

501
The Effect of Renal Failure on Acute Burn

Mortality at a Tertiary Care Burn Center
Introduction: There is an increased incidence of renal failure in the expanding aging population.However, the effect of renal failure as a co-morbid condition on burn mortality remains overlooked in conventional predictive models.Our retrospective analysis of burn survivors and non-survivors aims to critically evaluate management of burn patients with pre-existing renal failure.Methods: We conducted a retrospective analysis utilizing data from the Institutional Burn Center registry, which was linked to clinical and administrative records.Our study included all adult patients admitted to the Burn Center between January 1, 2012, and December 31, 2022.We collected and analyzed various parameters, including patient demographics, length of hospital stay (LOS), comorbid conditions, and mortality outcomes.We evaluated the association between renal failure and burn mortality using logistic regression modeling.
Results: Over the ten-year study period, a total of 9,955 adult patients were admitted to the BICU.124 patients presented with a diagnosis of renal failure: 18 non-survivors, 106 survivors.Our analysis revealed that renal failure was associated with a nearly three-fold increase in the odds of mortality (OR 2.64, CI 1.33-5.01,p=0.004) when accounting for factors present in traditional predictive models such as burn size, age, and inhalational injury.Additionally, renal failure was identified as a co-morbidity in 6% of all deaths for this time frame and 14.5% of patients with this diagnosis on admission are deceased.These findings underscore the significant impact of renal failure on burn patient outcomes.Conclusions: As our population continues to age, burn providers will increasingly encounter the complex challenge of managing an acute burn with multiple comorbidities.Our study highlights the intuitive understanding that patients with pre-existing renal failure have a heightened mortality risk when suffering from an acute burn injury.In light of this, it is imperative to consider potential adjustments to burn resuscitation and care protocols for this at-risk population, with the ultimate goal of enhancing the chances of survival to hospital discharge.

Applicability of Research to Practice:
This study emphasizes the pressing need for further research into the effects of multiple comorbidities on mortality among burn patients.The insights gained from this research have practical implications for refining clinical approaches and optimizing care strategies for this vulnerable patient population.