RESUMEN
BACKGROUND: Geospatial analysis is useful for identifying hot spots for preventable injuries and for informing prevention efforts. We hypothesize that specific populations of children in South Florida are at increased risk of burn injury. METHODS: We used a regional burn center registry to geocode burn cases treated from July 2013 to December 2022 for patients <18 years. Spatial analysis was utilized to identify high-density areas and potential spatial clusters of patients living in Palm Beach, Broward, and Miami-Dade Counties. Sociodemographic factors, burn etiology, and physiologic characteristics were analyzed using geospatial and statistical analyses. RESULTS: 689 patients (58% male, median age 2 [1-8] years) were identified. The annual incidence of burns was 5.5 per 100,000 children. There was no seasonal variation in injury patterns. Most patients were Black (51%) and non-Hispanic (73%). Scald burns (72%) represented the most common etiology, followed by flame (10%) and contact with hot objects (9%). Most patients (58%) required inpatient admission. Scald and contact burns occurred in younger patients compared to other mechanisms (median [IQR] age: 2 [1-6] vs. 8 [4-12] years, p < 0.001). Race, ethnicity, and insurance status were not associated with inpatient admission (all p > 0.05). Overall, there was a higher rate of pediatric burn injuries affecting Black residents, with a paucity of injuries in predominately high-income areas. CONCLUSIONS: A disproportionate amount of pediatric burn injuries occur in low-income and predominantly Black neighborhoods. Additionally, scald and contact burns are a target for injury prevention in South Florida. These data may inform public health implementation to reduce morbidity in vulnerable populations. LEVEL OF EVIDENCE: Level III. TYPE OF STUDY: Retrospective comparative study.
RESUMEN
BACKGROUND: Combat casualties receiving damage-control laparotomy at forward deployed, resource-constrained US military Role 2 (R2) surgical units require multiple evacuations, but the added risk of venous thromboembolism (VTE) in this population has not been defined. To fill this gap, we retrospectively analyzed 20 years of Department of Defense Trauma Registry data to define the VTE rate in this population. METHODS: Department of Defense Trauma Registry from 2002 to 2023 was queried for US military combat casualties requiring damage-control laparotomy at R2. All deaths were excluded in subsequent analysis. Rates of VTE were assessed, and subgroup analysis was performed on patients requiring massive transfusion. RESULTS: Department of Defense Trauma Registry (n = 288) patients were young (mean age, 25 years) and predominantly male (98%) with severe (mean Injury Severity Score, 26), mostly penetrating injury (76%) and high mortality. Venous thromboembolism rate was high: 15.8% (DVT, 10.3%; pulmonary embolism, 7.1%). In the massively transfused population, the VTE rate was even higher (26.7% vs. 10.2%, p < 0.001). CONCLUSION: This is the first report that combat casualties requiring damage-control laparotomy at R2 have such high VTE rates. Therefore, for military casualties, we propose screening ultrasound upon arrival to each subsequent capable echelon of care and low threshold for initiating thromboprophylaxis. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.