1169: Characterization of Critical Pediatric Burn Injuries and Outcomes in the Icu From 2001-2022

Introduction: Burns remain a common and devastating injury in children. We aimed to characterize health resource use, complications, and mortality in the U.S. pediatric burn population from 2001-2022, hypothesizing that outcomes for critically ill burn patients improved over the study period. Methods: We used ICD 9/10-CM codes to identify admissions for burns in children < 18 years in the Healthcare Cost and Utilization Project’s State Inpatient Databases from 20 U.S. states over 6 sample years (2001, 2004, 2010, 2016, 2019, 2022). We used generalized linear regression to compare patients with and without burn injuries and changes over time in clinical outcomes. Results: Burn injuries encompassed 0.65% (n=17,196) of a total of 2,630,769 pediatric admissions from 2001-2022, with an ICU admission prevalence of 39.1% of burn hospitalizations. The prevalence of burn hospitalizations and ICU admissions remained similar over the study period. Children admitted for burns were more likely to be non-Hispanic Black (RR 1.36, 95% CI 1.32-1.39) and have public insurance (RR 1.22, 95% CI 1.21-1.24) than non-burn injured patients. The prevalence of mechanical ventilation for pediatric burn patients in the ICU increased from 5.7% in 2001 to 11.6% in 2022 (RR 2.05, 95% CI 1.50-2.79), and rates of organ failure nearly quadrupled from 7.3% to 27.9% (RR 3.81, 95% CI 3.00-4.84). The use of extracorporeal membrane oxygenation (ECMO) increased yearly from 2001-2022 from 0% to 1.0% of ICU burn patients, with 19 total patients placed on ECMO from 2001-2022 with 36.8% mortality. Pediatric ICU patients with burns had longer length of stay than patients without burns (RR 1.21, 95% CI 1.16-1.26). Mortality rose with higher total body surface area (TBSA) from 0.28% for TBSA < 20% to 48.3% for TBSA ≥80%, but mortality for patients with TBSA ≥50% decreased from 36.4% to 13.3% from 2001-2022. By burn location, mortality was highest for burns to the respiratory tract (11.2%). Conclusions: With advancements in pediatric burn care, critically injured pediatric burn patients have had improving mortality but increasingly high rates of mechanical ventilation and organ failure. More research is needed to better support patients who are surviving increasingly severe injuries during and after prolonged hospitalizations.