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Quantifying the effects of wound healing risk and potential on clinical measurements and outcomes of severely burned patients: A data-driven approach

Highlights•There is a shortage of granular, high-resolution data to track wound healing or progression in a large burn patient cohort.•Trends may be utilized to identify parameters relevant to the wound healing scenario using data-driven approaches.•A major implication of this study was that wound progression may be forecasted by many different measurements and outcomes.•Such variables may be incorporated into strategies to enhance wound care or into prediction models to stratify wound care.AbstractIntroductionGiven recent advances in computational power, the goal of this study was to quantify the effects of wound healing risk and potential on clinical measurements and outcomes of severely burned patients, with the hope of providing more insight on factors that affect wound healing.MethodsThis retrospective study involved patients who had at least 10% TBSA% “burned” and three burn mappings each. To model risk to wounds, we defined the variable θ, a hypothetical threshold for TBSA% “open wound” used to demarcate “low-risk” from “high-risk” patients. Low-risk patients denoted those patients whose actual TBSA% “open wound” ≤θ, whereas high-risk patients denoted those patients whose actual TBSA% “open wound” >θ. To consider all possibilities of risk, 100 sub analyses were performed by (1) varying θ from 100% to 1% in decrements of 1%, (2) grouping all patients as either “low-risk” or “high-risk” for each θ, and (3) comparing all means and deviations of variables and outcomes between the two groups for each θ. Hence, this study employed a data-driven approach to capture trends in clinical measurements and outcomes. Plots and tables were also obtained.ResultsFor 303 patients, median age and weight were 43 [29–59] years and 85 [72–99] kg, respectively. Mean TBSA% “burned” was 25 [17–39] %, with a full-thickness burn of 4 [0–15] %. Average crystalloid volumes were 4.25 ± 2.27 mL/kg/TBSA% “burned” in the first 24 h. Importantly, for high-risk patients, decreasing θ was matched by significant increases in PaO2-FiO2 ratio, platelet count, Glasgow coma score (GCS), and MAP. On the other hand, increasing their risk θ was also matched by significant increases in creatinine, bilirubin, lactate, blood, estimated blood loss, and 24-h and total fluid volumes. As expected, for low-risk patients, clinical measurements were more stable, despite decreasing or increasing θ. At a θ of 80%, statistical tests indicated much disparity between high-risk and low-risk patients for TBSA% “burned”, full thickness burn, bilirubin (1.66 ± 1.16 mg/dL versus 0.83 ± 0.65 mg/dL, p = 0.005), GCS (7 ± 2 versus 12 ± 3, p < 0.001), MAP (42 ± 22 mm Hg versus 59 ± 22 mm Hg, p = 0.004), 24-h blood, estimated blood loss, 24-h fluid, total fluid, and ICU length of stay (81 ± 113 days versus 24 ± 27 days, p = 0.002). These differences were all statistically significant and remained significant down to θ = 10%.ConclusionWound healing risk and potential may be forecasted by many different clinical measurements and outcomes and has many implications on multi-organ function. Future work will be needed to further explain and understand these effects, in order to facilitate development of new predictive models for wound healing.

بررسی اثرات خطر ترمیم زخم و پتانسیل در اندازه‌گیری بالینی و نتایج بیماران شدیدا سوخته: یک رویکرد مبتنی بر داده

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