Obesity and Outcomes Following Burns in the Pediatric Population
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PURPOSE: While obesity is associated with increased mortality and decreased functional outcomes in adult burn patients, the ramifications of larger than average body size in the pediatric burn population are less well understood. Building on the finding that obese pediatric burn patients have a significantly longer length of hospital stay than their lean counterparts, the present study sought to determine whether obesity was associated with poor outcomes following burn injuries. METHODS: Data on patients ≤ 18 years of age who were admitted to a large regional burn unit between the years of 2000 and 2010 and for whom height and weight data was available (n=540) was collected from the hospital's burn database. Using the definition of obesity as ≥ 95thpercentile of weight for height according to the World Health Organization growth charts (< 2 years of age) or BMI for age according to the Centers for Disease Control growth charts (2 to 18 years of age), outcomes were compared between thermally-injured children classified as obese (n=155) and those classified as non-obese (n=385). Outcome parameters examined were total body surface area injury (TBSA), % full thickness injury, days in the ICU, non-ICU hospital days, days requiring mechanical ventilation, incidence of sepsis, pneumonia, number of operations, and overall mortality. All data was collected in accordance with IRB (#STU 032012-032) regulations. RESULTS: Obese and non-obese thermally injured children did not differ significantly with respect to TBSA, percentage of full thickness burn, or overall mortality. However, these groups were significantly different with respect to age (obese=7.26±0.46 years, non-obese=9.36±0.32 years, p=0.00015) and days requiring mechanical ventilation (obese=4.86±1.28 days, non-obese=2.72±0.49 days, p=0.029). When considering only those thermally injured children admitted to the BICU without inhalation injury (n=177), the obese (n=46) and non-obese (n=131) groups did not differ significantly with respect to TBSA, percentage of full thickness burn, or overall mortality. However, significant differences between these groups were noted for number of days spent in the ICU (obese=18.59±5.12 days, non-obese=9.38±1.79 days, p=0.017) and number of days requiring mechanical ventilation (obese=11.65±3.87 days, non-obese=3.87±0.83 days, p=0.002). CONCLUSION: These data show thermally injured obese pediatric patients required longer and more intensive medical support in the form of BICU care and respiratory intervention. Counter to findings in adult populations, differences in mortality were not observed. Collectively, these findings suggest obesity as a risk factor for increased morbidity in the pediatric burn population.