Weight Changes and Weight Measurements in Hospitalized Burn Patients

INTRODUCTION: Burns are associated with significant changes in body weight due to resuscitation volumes leading to increased weight and a hypermetabolic state and prolonged bed rest resulting in wasting of lean body mass and weight loss. The actual weight changes and frequency of weight measurements throughout hospitalization have not been well described across time. The purpose of this study was to describe these in more detail. METHODS: A review was conducted of 232 thermally injured patients hospitalized in a large, ABA-verified burn center from February 2016 to September 2016. Patients were seen daily by a nutritionist and received tube or oral feeding as appropriate. Demographics, hospital length of stay, and all weight measurements were collected. RESULTS: Over 8 months, 232 burn patients were admitted. The mean (±SD) age was 33 ± 24 years, median TBSA was 7% (IQR 13-3) and men were 67.37% of the sample. Patients had a 4.92% ± 1.40% (mean ± SEM) increase in weight from baseline at hospital day 7(n=40). The mean weight changes of hospitalized patients were -1.57% ± 4.46% at 30 days (n=13), -6.66% ± 4.47% at 45 days (n=10), -13.83% ± 3.74% at 60 days (n=7), and -23.93% ± 12.26% at 130 days (n=2). The maximum length of stay was 205 days and this subject had a weight loss of 33.33% from baseline. Composite data of mean change of weight from baseline over time was plotted with an R2 value of 0.6 for both linear and third order regression. Patients with a length of stay between 7 to 14 days (n=49), 15 to 30 days (n=15), 31 to 60 days (n=9) and more than 60 days (n=9) had a daily weight recorded only 7.4%, 20.6%, 35.5% and 47% of their inpatient days, respectively. CONCLUSIONS: Burn patients demonstrate an increase in body weight within the first week of hospitalization likely related to resuscitation followed by a consistent decline. Patients with stays greater than one month have a decline in weight below their baseline and can lose as much as a third of their body mass even in the setting of nutritional support and rehabilitation efforts. Additionally, these data show that weight is measured more often as length of stay increases. Weight is often used as a marker of nutritional status, although this may not be appropriate in the setting of large fluid shifts and obesity. Additionally, patients might be losing muscle mass in favor of body fat. It is important to recognize long-term weight trends in the burn population, but further investigation is needed regarding the predictors of significant weight loss and associated outcomes.