Assessment and determinants of global outcomes among 445 mass-casualty burn survivors: A 2-year retrospective cohort study in Taiwan

Burns. 2020 Sep;46(6):1444-1457. doi: 10.1016/j.burns.2020.02.008. Epub 2020 Jun 2.

Abstract

Purpose: To study outcomes among survivors of the mass-casualty powder explosion on 27 June 2015, at Formosa Fun Coast Waterpark, New Taipei City, Taiwan.

Methods: Using retrospective data on Taiwanese survivors, we analyzed prehospital management, burns assessment and prognosis, functional recovery, and medical costs, followed-up through 30 June 2017. We related outcomes to burn extent, categorized according to the percentages of total body surface area with second/third-degree burns (%TBSA) or autologous split-thickness skin grafts (%STSG), and an investigational scale: f{SASG} = (%TBSA + %STSG)/2, stratified by %STSG. Analyses included casualty dispersal, comparisons between %TBSA, %STSG and f{SASG}, and their relationships with length of hospitalization, times to rehabilitation and social/school re-entry, physical/mental disability, and medical costs. We also investigated how burn scars restricting joint mobility affected rehabilitation duration.

Results: 445 hospitalized casualties (excluding 16 foreigners, 23 with 0% TBSA and 15 fatalities) aged 12-38 years, had mean TBSA of 41.1%. Hospitalization and functional recovery durations correlated with %TBSA, %STSG and f{SASG} - mean length of stay per %TBSA was 1.5 days; more numerous burn scar contractures prolonged rehabilitation. Females had worse burns than males, longer hospitalization and rehabilitation, and later school/social re-entry; at follow-up, 62.3% versus 37.7% had disabilities and 57.7% versus 42.3% suffered mental trauma (all p ≤ 0.001). Disabilities affecting 225/227 people were skin-related; 34 were severely disabled but 193 had mild/moderate impairments. The prevalence of stress-related and mood disorders increased with burn extent. Treatment costs (mean USD-equivalents ∼$48,977/patient, ∼$1192/%TBSA) increased with burn severity; however, the highest %TBSA, %STSG and f{SASG} categories accounted for <10% of total costs, whereas TBSA 41-80% accounted for 73.2%.

Conclusions: Besides %TBSA, skin-graft requirements and burn scar contractures are complementary determinants of medium/long-term outcomes. We recommend further elucidation of factors that influence burn survivors' recovery, long-term physical and mental well-being, and quality of life.

Keywords: Burn injury assessment score/index; Length of stay (LOS); Long-term physical/mental health outcomes; Prognosis; Psychosocial rehabilitation; Treatment cost.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Body Surface Area*
  • Burns / economics
  • Burns / pathology
  • Burns / physiopathology*
  • Burns / therapy
  • Cohort Studies
  • Contracture / economics
  • Contracture / epidemiology
  • Contracture / physiopathology*
  • Explosions*
  • Female
  • Health Care Costs*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Mass Casualty Incidents*
  • Mental Health
  • Psychological Trauma / physiopathology
  • Quality of Life
  • Retrospective Studies
  • Skin Transplantation / statistics & numerical data*
  • Survivors*
  • Taiwan
  • Trauma Severity Indices
  • Young Adult