Correlation Between Burn Severity Index and Burn Wound Sepsis

Abstract

Background Burn injuries incur a significant cost to the healthcare system worldwide (1). Prolonged hospital stays and size of burn wound are among the strongest risk factors for the development of infection. Burns involving large body surface area and those that form eschars are associated with increased predisposition to sepsis (2). Burn severity is one of the risk factors for the development of burn wound sepsis and has been shown to be a predictor of mortality (3). There is lack of data on the correlation between burn severity parameters and burn wound sepsis among burns patients at the Kenyatta National Hospital and in Kenya. Objective of the Study To determine the correlation between burn severity index and burn wound sepsis among burn patients at the Kenyatta National Hospital. Study design and Setting This was a hospital based prospective cohort study among patients admitted in the burns unit and ward 4D at Kenyatta National Hospital, carried out over three months. Study Subjects All burns patients admitted in the burns unit and ward 4D who met the inclusion criteria were eligible to participate in the study. Methodology Patient with burns who were admitted to KNH over three months were recruited. Consecutive sampling procedure was used. Every burns patient admitted to the burns unit who fulfilled the inclusion criteria was included in the study in order to achieve the sample size of 84 patients. History and physical exam was undertaken and TBSA was determined by the Lund and Browder chart and recorded (4). Data was collected using guidelines as per the American Burn Association parameters for burn severity and patients classified into major, moderate and minor burn wound injuries. Patients progress was monitored for 28 days and those who demonstrated clinical characteristics of sepsis were further investigated as per the American burn sepsis score including pus wound swabs, blood and urine cultures to determine burn wound sepsis (5, 6). Correlation between burn severity and burn wound sepsis was established using multivariate analysis within 5% margin of error.

Results A total of 84 patients were recruited during the study duration. Most patients admitted had major burns (88.1%). The median age of patients recruited was 28 years with more males being admitted (57.1%) while the mean age of those with sepsis was 23.5 years. Burn wound sepsis was present in 11 patients and only in those with major burns. 3 out of the 11 patients with burn wound sepsis died, a further 19 not diagnosed to have sepsis (26.2%), died of other causes. Although Burn Wound Sepsis was present in patients with major burns it was not statistically significant. (P=0.73).