Clinical Fellow Vanderbilt University School of Medicine Nashville, Tennessee, United States
Background: Despite advances in care, sepsis after burn injury continues to significantly contribute to morbidity. Though burn-specific sepsis guidelines exist, they often fail to capture a new infection owing to the exaggerated and prolonged inflammatory response induced by the burn itself. Further, the altered immune state after burn injury can induce persistent-inflammatory-immunosuppressive and catabolism syndrome (PICS), characterized by an increased risk of recurrent infections, with significant declines in functional status. The clinical impact of this dysregulated immunophenotype in pediatric burns is unexplored. Objective: Determine prevalence of PICS and associated sepsis within pediatric burn-injuries at VUMC over the past 25 years. Design/Methods: We will perform a detailed retrospective analysis of pediatric burn injuries utilizing VUMC’s Synthetic Derivative database: a searchable, deidentified mirror image of the EHR stretching back to the mid-1990s. IRB approval obtained through VUMC’s IRB (#192203). Children, age 0-21, were identified by ICD or CPT codes. Data extraction included demographics, burn mechanism and size, presence of inhalational injury, as well as hospital-based metrics. Focus was placed on lab values consistent with PICS (ALC < 1x103 cells/uL, CRP>10 mg/L, and albumin < 3.0 g/dL) and their associations with positive cultures. The initial data extraction yielded 385 children with burn injuries of which 28% had a sepsis event. Logistic regression will evaluate the association between variables and the PICS phenotype. Univariable receiver operating characteristic curve analysis will evaluate performance of lab variables with an infectious event. We anticipate longer admissions and more frequent, severe infections in patients with lymphopenia. This study will allow us to determine the prevalence of PICS in pediatric burn patients and help delineate lab and clinical variables associated with PICS and burn related injuries.
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