A56-19 Impact Of Fluid Resuscitation Deviations From The Parkland Formula On Clinical Outcomes In Burn Patients: A Systematic Review And Meta-analysis

Abstract Rationale Fluid resuscitation remains a cornerstone in the management of severe burn injuries. The Parkland formula, although widely accepted, has been criticized for potentially leading to over- or under-resuscitation, which may influence clinical outcomes such as mortality, renal function, and length of stay. Objective To evaluate the impact of deviations from the Parkland formula—specifically over-resuscitation and infra-resuscitation—on mortality, urinary output (UOP), and length of stay (LOS) in adult burn patients. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024602563). Searches were performed in MEDLINE, EMBASE, and the Cochrane Library through September 2023 using terms related to “burns,” “fluid resuscitation,” and “Parkland formula.” Observational studies comparing outcomes in patients receiving volumes above or below Parkland estimates with those receiving guideline-based resuscitation were included. Risk of bias was assessed using the ROBINS-I tool, and the certainty of evidence was graded with GRADE methodology. Pooled analyses were performed using a random-effects model to estimate relative risks (RR) and mean differences (MD) with 95% confidence intervals (CI). Results Of 490 records identified, nine studies met inclusion criteria, comprising 176 patients with infra-resuscitation, 654 with over-resuscitation, and 340 managed according to the Parkland formula. Over-resuscitation was not significantly associated with increased mortality (RR 1.14 95% CI 0.87-1.48, I² = 0%), nor was infra-resuscitation (RR 1.07 95% CI 0.74-1.54, I² = 0%). Over-resuscitated patients showed a higher mean UOP (MD 40.14 mL 95% CI 3.78-77.10, I² = 66%), indicating increased renal clearance without a corresponding clinical benefit. LOS tended to be longer in over-resuscitated patients (MD 19.91 days 95% CI − 0.14-39.67, I² = 85%), although this difference was not statistically significant. No publication bias was observed. According to GRADE, evidence certainty was rated as moderate for mortality, low for UOP, and high for LOS in the over-resuscitation subgroup. Conclusions Deviations from the Parkland formula—either over- or infra-resuscitation—did not significantly affect mortality or length of stay compared with standard resuscitation volumes. However, over-resuscitation was associated with higher urine output, suggesting potential fluid overload without improved outcomes. These findings highlight the need for individualized, physiology-based fluid management strategies and standardized outcome reporting in future studies. This abstract is funded by: None