The results of a national survey regarding nutritional care of obese burn patients.

Little is known about the nutritional needs of obese burn patients. Given the impact of obesity on the morbidity and mortality of these patients, a uniform understanding of perceptions and practices is needed. To elucidate current practices of clinicians working with the obese burn population, the authors constructed a multidisciplinary survey designed to collect this information from practitioners in United States burn centers. An electronic approach was implemented to allow for ease of distribution and completion. A portable document format (pdf) letter was e-mailed to the members of the American Burn Association and then mailed separately to additional registered dietitians identified as working in burn centers. This letter contained a link to a 29-question survey on the SurveyMonkey.com server. Questions took the form of multiple choice and free text entry. Responses were received from physicians, mid-level practitioners, registered dietitians, and nurses. Seventy-five percent of respondents defined obesity as body mass index >30. The Harris-Benedict equation was identified as the most frequently used equation to calculate the caloric needs of burn patients (32%). Fifty-eight percent indicated that they alter their calculations for the obese patient by using adjusted body weight. Calculations for estimated protein needs varied among centers. The majority did not use hypocaloric formulas for obese patients (79%). Enteral nutrition was initiated within the first 24 hours for both obese and nonobese patients at most centers. Sixty-three percent suspend enteral nutrition during operative procedures for all patients. Oral feeding of obese patients was the most preferred route, with total parenteral nutrition being the least preferred. Longer length of stay, poor wound healing, poor graft take, and prolonged intubation were outcomes perceived to occur more in the obese burn population. In the absence of supporting research, clinicians are making adjustments to the nutritional care of obese burn patients. This indicates the need for further research to determine consistent best practices.

How long a shadow does epidemic obesity cast in the burn unit? A dietitian's analysis of the strengths and weaknesses of the available data in the National Burn Repository.

To demonstrate the research potential of the National Burn Repository, we examined outcomes affecting the obese burn population, specifically length of stay and mortality. This retrospective analysis evaluates burn patients from the repository coded as "obese." We queried admissions from burn units between the years 2000 to 2006 (n = 101,450). We initially intended to associate and stratify obesity with several complications and outcomes using multivariate analysis. However, because of the lack of standardized data fields, a surrogate yard stick (length of stay > or =7 days) was a straightforward and sensible outcome measurement. Mortality was used as a second outcome measurement. Two statistical approaches were used: logistic regression and the Cochran-Mantel-Haenszel test. Obese patients were 4.1 times more likely to have a length of stay > or =7 days (P < .0001) and were 2.6 times more likely to die (P < .0001) than patients not described as obese. The results not only highlighted obesity as a major challenge in burn care, but also identified means of improving the National Burn Repository to facilitate future nutrition research. The repository has vast potential to be a useful research tool for the dietitian. With standardization of the data dictionary and the addition of nutrition-related fields, such as height and weight, future research will be greatly enhanced.