Clinical Outcomes and Incidence of Cellulitis in Lower Extremity Burns: A 6-Year Retrospective Analysis
Joseph Batac, MD, Catherine J. Sinnott, MD, Laurence T. Glickman, MD, Roger L. Simpson, MD, MBA.
Long Island Plastic Surgical Group, Garden City, NY, USA.
BACKGROUND: Patients with burn wounds of the lower extremities are at increased risk of developing cellulitis and may benefit from immediate hospitalization versus outpatient management. Diabetes causes immune dysfunction and vascular compromise and may increase the risk of developing lower extremity burn wound cellulitis. Other patient and wound characteristics may also be associated with an increased probability of developing burn wound cellulitis and may allow for identification of patients at risk for this complication. This study aims to identify factors which place patients at increased risk of developing lower extremity burn wound cellulitis.
METHODS: Retrospective data on 218 consecutive patients (>12 years old) admitted to a Burn Center with isolated lower extremity burns of any etiology between 2010 and 2016 was collected and analyzed. Patients who were managed initially as an outpatient were excluded. Age, gender, ethnicity, etiology of burn, % total body surface area (%TBSA), degree of burn, hospital length of stay, burn injury to admission interval, a medical history of diabetes and other comorbidities, the need for surgical intervention and the presence of cellulitis were reviewed. Patients were grouped as those with cellulitis and those without cellulitis.
RESULTS: Of the 218 admissions for lower extremity burns during the study period (2010-2016), 76 (35%) patients developed burn wound cellulitis and 142 (65%) did not. Risk factors for developing lower extremity burn wound cellulitis included male gender, an increased burn depth, as well as a delay in hospitalization. A medical history of diabetes or any other comorbidity was not associated with an increased incidence of burn wound cellulitis, nor was age, ethnicity, %TBSA or burn etiology. Clinical outcomes with regard to the need for surgical intervention or the length of hospitalization did not differ between patients with lower extremity burns and cellulitis as compared to those without cellulitis.
CONCLUSIONS: Patient risk factors associated with an increased risk of developing lower extremity burn wound cellulitis include male gender, increased burn depth and a delay in hospitalization. Identification of patients at risk for developing cellulitis is necessary to identify patients who will benefit from immediate hospitalization in order to prevent this complication and the morbidity and cost associated with it.
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