Effects of Elevated Blood Alcohol Levels on Burn Patient Outcomes

Salomon Puyana, MD, MS; Samuel Ruiz, MD; Francisco Amador, MD; Elizabeth Young, MSN; Shaikh Hai, MD; Mark McKenney, MD, MBA; Rizal Lim, MD; Haaris Mir, MD

Disclosures

ePlasty. 2021;21(e8) 

In This Article

Abstract and Introduction

Abstract

Background: Alcohol use has been associated with poor wound healing in traumatic injuries as it impairs immune function and lowers leukocyte production. The aim of this study is to describe the association of alcohol use on the outcomes of patients with burn injuries. It is proposed that the use of alcohol can have a detrimental effect on burn patient outcomes.

Methods: A retrospective review of the American Burn Association Burn Registry from 2002 through 2011 was conducted. Patients were stratified into 2 groups: burn patients with a blood alcohol level above the legal limit of 0.08 mg/dl on admission (group 1) vs burn patients with a blood alcohol level below the legal limit of 0.08 mg/dl on admission (group 2). The outcome measures included in-hospital mortality rate, hospital length of stay (LOS), intensive care unit (ICU) LOS, and total days on a ventilator.

Results: A total of 11,286 burn patients met the inclusion criteria. There were a total of 1,544 patients in group 1 and a total of 9,742 patients in group 2. The percentage of total body surface area (TBSA) involvement of the burns was statistically similar in both groups, with an average of 2.08% in group 1 and 2.32% in group 2. There was a significantly higher ICU LOS at 5.91 days in group 1 compared to 3.66 in group 2. The days on a ventilator were significantly higher in group 1 at 5.67 days versus group 2 at 3.06 days. The in-hospital mortality was also significantly higher in group 1 at 4.86% compared to group 2 at 3.91%.

Conclusion: Burn patients who tested above the legal limit for alcohol on admission were associated with increased inpatient mortality, as well as increased ICU LOS and total days on a ventilator. An elevated admission blood alcohol level may be an independent predictor of worse outcomes in patients with burn injury, leading to an increase in resource needs and health care costs.

Introduction

The use of alcohol has been associated with increased morbidity and mortality in thermal injuries. Multiple reports in the literature have noted a detrimental association between alcohol use and burns.[1–8]

Burn patients with associated alcohol abuse have exposure to more injury from flames and had a greater proportion of bodily burns compared to patients with no alcohol history. Data from the Ontario fire reporting system reviewed the history of 264 fire death victims and demonstrated that 31% had evidence of alcoholic impairment.[9]

Acute and chronic alcohol use can alter immune function and leukocyte production, resulting in frequent infectious complications. It may also result in increased resource utilization, grafting requirements, and antibiotic use, as well as prolonged hospitalization.[1]

Many studies have shown that age, burn size, and inhalation injuries are important predictors of mortality and morbidity following an acute burn injury. The effects of preexisting comorbidities such as alcohol abuse, however, are not well understood.[10] The aim of this study is to describe the association of alcohol use on outcomes in a national compendium of patients with burn injury.

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