Small burns need attention too: evaluating the 15% burn resuscitation threshold in adults

Abstract The American Burn Life Support (ABLS) course recommends fluid resuscitation of patients with total burned surface area (TBSA) ≥20% to prevent burn shock. Our center resuscitates patients with burns greater than 15% TBSA. Herein, we characterize that population. Patients with burns 15 to 19.9% TBSA admitted from 1/1/2019 to 3/31/2023 who received protocolized fluid resuscitation were included. Demographics, hospital course, and fluids received were reviewed. Fluid resuscitation was categorized as “below range” (Parkland formula PF 3 mL/kg/%TBSA), “within range” (PF = 3-5 mL/kg/%TBSA or “above range” (PF 5 mL/kg/%TBSA). Similarly, urine output (UOP) was expressed as “below range” (30 mL/h), “within range” (31-50 mL/h) or “above range” (50 mL/h). The resuscitation groups were compared. p.05 was considered significant. Thirty-three patients received resuscitation via Brooke (9.1%), PF (63.6%), or other formula (27.3%). Most were male (81.8%) with a median TBSA of 17%; median age was 57 years. Almost 20% of patients required vasopressors during resuscitation. Fifteen patients were within the predicated range of PF, 15 were under, and 3 were over. There was no difference between the groups with respect to demographics, burn injury variables, or complications. Notably, the average creatinine and lactate 24 h post-admission were 0.9 mg/dL and 2 mg/dL, respectively. Half of the study patients received greater than maintenance; all were in either the within burn resuscitation range or above range groups. This retrospective study suggests that patients with smaller burns may benefit from resuscitation as 50% received more than maintenance. Resuscitation of smaller burns requires more study.