Assessment and determinants of global outcomes among 445 mass-casualty burn survivors: A 2-year retrospective cohort study in Taiwan.

Abstract

PURPOSE:

To study outcomes among survivors of the mass-casualty powder explosion on 27 June 2015, at Formosa Fun Coast Waterpark, New Taipei City, Taiwan.

METHODS:

Using retrospective data on Taiwanese survivors, we analyzed prehospital management, burns assessment and prognosis, functional recovery, and medical costs, followed-up through 30 June 2017. We related outcomes to burn extent, categorized according to the percentages of total body surface area with second/third-degree burns (%TBSA) or autologous split-thickness skin grafts (%STSG), and an investigational scale: f{SASG} = (%TBSA + %STSG)/2, stratified by %STSG. Analyses included casualty dispersal, comparisons between %TBSA, %STSG and f{SASG}, and their relationships with length of hospitalization, times to rehabilitation and social/school re-entry, physical/mental disability, and medical costs. We also investigated how burn scars restricting joint mobility affected rehabilitation duration.

RESULTS:

445 hospitalized casualties (excluding 16 foreigners, 23 with 0% TBSA and 15 fatalities) aged 12-38 years, had mean TBSA of 41.1%. Hospitalization and functional recovery durations correlated with %TBSA, %STSG and f{SASG} - mean length of stay per %TBSA was 1.5 days; more numerous burn scar contractures prolonged rehabilitation. Females had worse burns than males, longer hospitalization and rehabilitation, and later school/social re-entry; at follow-up, 62.3% versus 37.7% had disabilities and 57.7% versus 42.3% suffered mental trauma (all p ≤ 0.001). Disabilities affecting 225/227 people were skin-related; 34 were severely disabled but 193 had mild/moderate impairments. The prevalence of stress-related and mood disorders increased with burn extent. Treatment costs (mean USD-equivalents ∼$48,977/patient, ∼$1192/%TBSA) increased with burn severity; however, the highest %TBSA, %STSG and f{SASG} categories accounted for <10% of total costs, whereas TBSA 41-80% accounted for 73.2%.

CONCLUSIONS:

Besides %TBSA, skin-graft requirements and burn scar contractures are complementary determinants of medium/long-term outcomes. We recommend further elucidation of factors that influence burn survivors' recovery, long-term physical and mental well-being, and quality of life.

• Authors: Hsu Ma, Kwang-Yi Tung, Shu-Ling Tsai, David L Neil, Yun-Yi Lin, Hung-Tsang Yen, Kao-Li Lin, Yi-Ting Cheng, Shu-Chen Kao, Mei-Na Lin, Niann-Tzyy Dai, Cherng-Kang Perng, Tyng-Guey Wang, Hao-Chih Tai, Li-Ru Chen, Yung-Chang Tuan, Chi-Hung Lin
• Journal: Burns : journal of the International Society for Burn Injuries (Burns) Vol. 46 Issue 6 Pg. 1444-1457 (09 2020) ISSN: 1879-1409 [Electronic] Netherlands
• PMID: 32499049 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Topics

• Adolescent
• Adult
• Body Surface Area
• Burns (economics, pathology, physiopathology, therapy)
• Cohort Studies
• Contracture (economics, epidemiology, physiopathology)
• Explosions
• Female
• Health Care Costs
• Humans
• Length of Stay (statistics & numerical data)
• Male
• Mass Casualty Incidents
• Mental Health
• Psychological Trauma (physiopathology)
• Quality of Life
• Retrospective Studies
• Skin Transplantation (statistics & numerical data)
• Survivors
• Taiwan
• Trauma Severity Indices
• Young Adult