Early Fasciotomy in Electrically Injured Patients as a Marker for Injury Severity and Deep Venous Thrombosis Risk: An Analysis of the National Burn Repository

• Published in: Journal of burn care & research 2010-11, Vol.31 (6), p.882-887
• Main Authors: PANNUCCI, Christopher J, OSBORNE, Nicholas H, JABER, Reda M, CEDERNA, Paul S, WAHL, Wendy L
• Format: Article
• Language: English
• Subjects: Adult; Amputation, Surgical - statistics & numerical data; Biological and medical sciences; Blood and lymphatic vessels; Burns; Burns, Electric - complications; Burns, Electric - mortality; Burns, Electric - surgery; Cardiology. Vascular system; Dermatology; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Fascia - injuries; Fasciotomy; Female; Hospital Mortality; Humans; Injury Severity Score; Intensive Care Units - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Medical sciences; Registries; Risk Assessment; Risk Factors; Traumas. Diseases due to physical agents; Treatment Outcome; Venous Thrombosis - etiology
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1097/BCR.0b013e3181f93597

By using the National Burn Repository, the authors sought to identify markers for injury severity and deep venous thrombosis (DVT) risk after electrical injury. They identified adult patients in the National Burn Repository who were admitted with an electrical injury between 1995 and 2007 (n = 1469). Patients who died within 24 hours or were admitted for less than 1 day and hospitals reporting no complications were excluded. Independent variables included TBSA burned, duration of intensive care unit stay and hospital admission, duration of mechanical ventilation, the number of operative procedures, amputation, and early fasciotomy. Early fasciotomy was defined as fasciotomy performed on a patient's first trip to the operating room and was used as a proxy for severity of electrical injury. DVT and death were the dependent variables. Among electrically injured patients, 10.4% had early fasciotomy. Patients who had early fasciotomy had significantly prolonged intensive care unit stays (10.3 vs 4.8 days, P < .001), hospital days (36.7 vs 17.1 days, P < .001), amputations (49.0 vs 4.6%, P < .001), and a number of operative codes (17.6 vs 5.4, P < .001). DVT incidence was 0.9%. Electrically injured patients who had early fasciotomy were significantly more likely to have a DVT when compared with patients who did not have early fasciotomy (7.55 vs 0.95%, P = .002). Early fasciotomy after electrical injury is a marker for increased injury severity. Among patients who underwent early fasciotomy after electrical injury, 7.5% develop DVT, and 49% require amputation during their initial hospitalization.