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The use of alcohol and illicit substances has been associated with impaired judgment and health, but the effect on inpatient outcomes after burn injury remains unsettled. Our objective was to evaluate the effect of alcohol and illicit substance use on our inpatient burn outcomes. Adult patients admitted with burn injury—including inhalation injury only—between January 1, 2014 and June 30, 2019 were eligible for inclusion. Alcohol use and illicit drug use were identified on admission. Outcomes of interest included requiring mechanical ventilation, admission to the intensive care unit, length of stay, and inpatient mortality. Multivariable linear and logistic regression models were used to estimate the effects of use on inpatient outcomes. A total of 3476 patients were included in our analyses; 8% (n = 284) tested positive for alcohol, 10% (n = 364) tested positive for cocaine, and 27% (n = 930) tested positive for marijuana and at admission. Two hundred and eighty adults (18% of all positive patients) tested positive for at least two substances. Patients who tested positive for alcohol had longer lengths of stay and were more likely to be admitted to the intensive care unit. Patients who tested positive for cocaine had longer overall and intensive care unit lengths of stay. No differences in inpatient outcomes were seen among patients who tested positive for marijuana. Neither alcohol nor illicit substance use appears to affect inpatient mortality after burns. Alcohol and cocaine use significantly increased overall length of stay. Marijuana use had no impact on inpatient outcomes.

Burn injured patients are at high risk of thromboembolic complications. Morbid obesity further increases this risk. Our objective was to evaluate the efficacy of enoxaparin dosed 40 mg twice daily in achieving prophylactic plasma anti-Xa levels in obese burn patients. A retrospective chart review from November 2018 until September 2019 identified patients who were either ≥100 kg or had a body mass index ≥30 kg/m2 and initiated on enoxaparin 40 mg twice daily for venous thromboembolism prophylaxis. Patients were ≥18 yr of age and received ≥3 sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy. One hundred forty-eight patients were screened with 43 patients included for analysis. Forty-two percent of the patients did not reach target peak plasma anti-Xa levels (0.2–0.5 IU/ml) on enoxaparin 40 mg twice daily. Patients who did not meet prophylactic target levels were more likely to be male (P < 0.05) and have an increased mean body weight (129 ± 24 kg vs 110 ± 16 kg, P < 0.05). Thirteen out of 18 patients received dosage adjustments with subsequent anti-Xa levels available for follow-up assessment, of which an additional six patients required further dosage adjustment to meet prophylactic goals. Current utilization of a fixed 40 mg twice daily regimen of enoxaparin for venous thromboembolism (VTE) is inadequate to meet target prophylactic peak plasma anti-Xa levels in the obese burn patient population. Dose adjusting enoxaparin to target anti-Xa levels to reduce VTE rates in obese burn patients should be further evaluated.

The Rockwood Clinical Frailty Scale is a validated rapid assessment of frailty phenotype and predictor of mortality in the geriatric population. Using data from a large tertiary care burn center, we assessed the association between admission frailty in an elderly burn population and inpatient outcomes. This was a retrospective analysis of burn patients ≥65 years from 2015 to 2019. Patients were assigned to frailty subgroups based on comprehensive medical, social work, and therapy assessments. Cox proportional hazards regression was used to estimate associations between admission frailty and 30-day inpatient mortality. Our study included 644 patients (low frailty: 262, moderate frailty: 345, and high frailty: 37). Frailty was associated with higher median TBSA and age at admission. The 30-day cumulative incidence of mortality was 2.3%, 7.0%, and 24.3% among the low, moderate, and high frailty strata, respectively. After adjustment for age, TBSA, and inhalation injury, high frailty was associated with increased 30-day mortality, compared to low (hazard ratio 5.73; 95% confidence interval 1.86, 17.62). Moderate frailty also appeared to increase 30-day mortality, although estimates were imprecise (hazard ratio 2.19; 95% confidence interval 0.87–5.50). High frailty was associated with increased morbidity and healthcare utilization, including need for intensive care stay (68% vs 37% and 21%, P < .001) and rehab or care facility at discharge (41% vs 25% and 6%, P < .001), compared to moderate and low frailty subgroups. Our findings emphasize the need to consider preinjury physiological state and the increased risk of death and morbidity in the elderly burn population.

BACKGROUND: Among burn patients, research is conflicted, but may suggest that females are at increased risk of mortality, despite the opposite being true in non-burn trauma. Our objective was to determine if sex-based differences in burn mortality exist, and assess whether patient demographics, co-morbid conditions, and injury characteristics explain said differences. METHODS: Adult patients admitted with burn injury-including inhalation injury only-between 2004 and 2013 were included. Inverse-probability of treatment weights (IPTW) and inverse-probability of censor weights (IPCW) were calculated using admit year, patient demographics, co-morbid conditions, and injury characteristics to adjust for potential confounding and informative censoring. Standardized Kaplan-Meier survival curves, weighted by both IPTW and IPCW, were used to estimate the 30-day and 60day risk of inpatient mortality across sex. RESULTS: Females were older (median age 44 vs. 41 years old, p

In this retrospective analysis, we investigated the rate of radiologically confirmed osteomyelitis, extremity amputation, and healthcare utilization in both the diabetic and nondiabetic lower extremity burn populations to determine the impact of diabetes mellitus on these outcomes. The burn registry was used to identify all patients admitted to our tertiary burn center from 2014 to 2018. Only patients with lower extremity burns (foot and/or ankle) were included. Statistical analysis was performed using Student’s t-test, chi-squared test, and Fisher’s exact test. Of the 315 patients identified, 103 had a known diagnosis of diabetes mellitus, and 212 did not. Seventeen patients were found to have osteomyelitis within three months of the burn injury. Fifteen of these patients had a history of diabetes. Notably, when nondiabetics were diagnosed with osteomyelitis, significant differences were observed in both length of stay and cost in comparison to their counterparts without osteomyelitis (36 vs 9 days; P = .0003; $226,289 vs $48,818, P = .0001). Eleven patients required an amputation and 10 (90.9%) of these patients had comorbid diabetes and documented diabetic neuropathy. Compared to nondiabetics, the diabetic cohort demonstrated both a higher average length of stay (13.7 vs 9.2 days, P-value = .0016) and hospitalization cost ($72,883 vs $50,500, P-value = .0058). Our findings highlight that diabetic patients with lower extremity burns are more likely to develop osteomyelitis than their nondiabetic counterparts and when osteomyelitis is present, diabetic patients have an increased amputation rate. Further study is required to develop protocols to treat this population, with the specific goal of minimizing patient morbidity and optimizing healthcare utilization.

Highlights • Shelter-in-place mandate for COVID-19 led to an increase in pediatric burn admissions. • School-age children burn admissions increased 28% for our burn center. • Prevention strategies must target at-risk children if there is another shelter-in-place mandate., The ramifications from the 2019 severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic caused by the novel corona virus will be felt globally for years to come. Mandates to shelter-in-place were called in nearly every state to limit viral exposure. The impact of the mandate on acute burn admissions was unknown. Our objective was to assess the impact of a shelter-in-place order on acute burn admissions at our burn center. All patients admitted to the burn center with burn injuries– including inhalation injury only– and desquamating skin disorders between March 10th to May 22nd, 2020 were eligible for inclusion. We compared all burn center admissions to a month-matched historical cohort from 2019, and summertime admissions for the last five years. Statistical significance was accepted as p

The features of work-related burn (WRB) injuries are not well defined in the literature and they vary depending on geographical location. We wanted to describe these characteristics among patients treated in the UNC Burn Center to evaluate the potential impact of commonly accepted prevention efforts. Adults of working age, admitted between January 1, 2013, and December 31, 2018, were identified using our Burn Center Registry. Demographic data, characteristics of injury, course of treatment, and patients’ outcomes were described. Differences between work-related and non-work-related injuries were evaluated using the Chi-square test and Student t-test where appropriate. Three thousand five hundred and forty-five patients were included. WRB cases constituted 18% of the study population, and this proportion remained relatively stable during the study timeframe. Young white males were the majority of this group. When compared with non-WRB patients, they were characterized by fewer co-morbidities, decreased TBSA burns, decreased risk of inhalation injury, shorter time of intensive care treatment, shorter lengths of hospital stay, and lower treatment cost. In contrast to non-WRB, among which flame injuries were the main reason for admission, work-related patients most often suffered scald burns. They also had a dramatically increased proportion of chemical and electrical burns, making the latter the most common cause of death in that group. WRB are characterized by a characteristic patient profile, burn etiologies, and outcomes. Learning specific patterns at this group may contribute to optimize work safety regulations and medical interventions.

In patients with diabetes mellitus (DM), amputation rates exceed 30% when lower extremity osteomyelitis is present. We sought to determine the rate of osteomyelitis and any subsequent amputation in our patients with DM and lower extremity burns. We performed a single-site, retrospective review at our burn center using the institutional burn center registry, linked to clinical and administrative data. Adults (≥18 years old) with DM admitted from January 1, 2014 to December 31, 2018 for isolated lower extremity burns were eligible for inclusion. We evaluated demographics, burn characteristics, comorbidities, presence of radiologically confirmed osteomyelitis, length of stay (LOS), inpatient hospitalization costs, and amputation rate at 3 months and 12 months after injury. We identified 103 patients with DM and isolated lower extremity burns. Of these, 88 patients did not have osteomyelitis, while 15 patients had radiologically confirmed osteomyelitis within 3 months of the burn injury. Compared to patients without osteomyelitis, patients with osteomyelitis had significantly increased LOS (average LOS 22.7 days vs 12.1 days, P = .0042), inpatient hospitalization costs (average $135,345 vs $62,237, P = .0008), amputation rate within 3 months (66.7% vs 5.70%, P < .00001), and amputation rate within 12 months (66.7% vs 9.1%, P < .0001). The two groups were otherwise similar in demographics, burn injury characteristics, access to healthcare, and preexisting comorbidities. Patients with DM and lower extremity burns incurred increased LOS, higher inpatient hospitalization costs, and increased amputation rates if radiologically confirmed osteomyelitis was present within 3 months of the burn injury.

The art of pyrography, burning designs in wood, dates back to prehistory. Risks of traditional techniques included cutaneous burns and airway injury. Fractal wood burning is a niche technique using a high-voltage electrical source to burn branched designs into wood. While this technique has grown in popularity, the associated risks are not well understood. We describe a patient who presented to our burn center after sustaining high-voltage electrical injuries while making fractal wood art using an improvised a high-voltage transformer. During the wood-burning process, he contacted the electrodes and suffered full-thickness electrical burns to the neck, chest, and bilateral upper extremities. Bilateral upper extremity fasciotomies were performed on admission. Multiple subsequent operations culminated with autografting to most of the wounds and complex reconstruction of the left thumb. In evaluating online news reports, we found 25 unique individuals with death or injury attributed to fractal wood burning from July 2016 to January 2020. Five sustained substantial injuries, while 20 reportedly died. Ages ranged from 17 years old to the 60s. One death and one injury occurred in females, with the remainder of reports involving males. Of the survivors, four sustained significant upper extremity electrical injuries and three suffered cardiac arrest at the time of injury. Fractal wood burning is associated with devastating high-voltage electrical injuries and death. Prevention efforts should be focused on education about the potential for death and permanently disabling injuries from this art form.

Introduction Our state’s Strengthen Opioid Misuse Prevention (“STOP”) Act was enacted on January 1 st 2018 to reduce prescription opioid misuse. We sought to evaluate the impact of opioid-limiting legislation on readmission rates among burn patients to our tertiary care burn center related to uncontrolled pain. Methods Patients were identified using an institutional Burn Center registry and linked to clinical and administrative data. All patients admitted between July 1 st, 2014 to June 20 th, 2019 were eligible for inclusion. Injury mechanism categories and reasons for readmissions were evaluated. Statistical analysis was carried out using chi-squared test and significance was accepted as p< 0.05. Results Of the 7872 total admissions, 160 (2%) were readmissions. Mean number of readmissions for every year was 32. There was an increase in number of readmissions in 2018 observed but it was not statistically significant (2014 n=12, 2015 n=35, 2016 n=21, 2017 n=33, 2018 n=40, 2019 n=19). The reasons for readmission included wound progression, graft failure, infection, and pain. There was an increase in readmissions for infection, wound progression and graft failure after January 2018, p< 0.05. The percentage of patients readmitted for pain increased between 2014 to 2019 but it was not statistically significant. Conclusions The primary reasons for readmissions to our burn center were pain, infection, graft failure, and progression of disease. Despite the opioid-limiting law there was not an increase in readmissions related to pain. Applicability of Research to Practice This study demonstrates that our current discharge planning strategies are managing pain expectations for patients. Our focus should be shifted towards improving infection control and wound care.

Introduction In recent years, burn centers are managing more patients with exfoliative skin disorders including Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and SJS/TEN overlap. While it is well known that burn patients have higher rates of co-morbid psychiatric disorders than the general population, the incidence of pre-existing psychiatric disorders among patients who develop SJS, SJS/TEN overlap, and TEN is unknown. This study aimed to characterize a cohort of patients with pre-existing psychiatric disorders admitted to a tertiary burn center for treatment of SJS, SJS/TEN overlap, and TEN with specific focus on those who received the offending agent for a psychiatric indication. Methods A retrospective descriptive case series using an institutional burn center registry was performed. All patients admitted to a single verified burn center between January 1, 2009 and December 31, 2018 with biopsy-proven SJS, SJS/TEN overlap, or TEN and the presence of a co-morbid psychiatric disorder were identified. Demographic, hospital, and clinical information were extracted from the burn registry and verified through review of the electronic medical record. Results Among 168 patients with biopsy-proven SJS, SJS/TEN overlap, or TEN, 18% (30/168) had a pre-existing psychiatric disorder, with the offending agent being prescribed for a psychiatric indication in 30% (10/30) of patients. Lamotrigine was the offending agent in 80% of cases and prescribed 100% of the time for a psychiatric indication. Of those who received lamotrigine, patients were 100% female, 63% black, and had an average age of 38 years. The mean length of stay was 24 days and 88% received a psychiatric consultation. While 75% of patients were started on lamotrigine for a diagnosis of bipolar disorder, none of these patients met criteria for bipolar disorder. Conclusions Pre-existing psychiatric comorbidity is less common among patients that develop SJS, SJS/TEN overlap, and TEN than in burn-injured patients. For patients with pre-existing psychiatric disorders who develop these potentially fatal skin diseases from an offending agent that was prescribed for a psychiatric indication, early involvement of psychiatry colleagues is recommended to ensure proper psychiatric diagnosis and management moving forward. Applicability of Research to Practice This study highlights the importance of accurate assessment for and diagnosis of bipolar disorder prior to determining treatment approach. For the burn surgeon treating these patients, early involvement of psychiatric consultants is recommended and extremely important.

Introduction Stenotrophomonas maltophilia (SM) is a non-fermenting, gram-negative bacterium that is a challenge to treat in immunocompromised hosts. It is difficult to eradicate due to its natural resistance to multiple antibiotics and omni-presence. Our objective was to evaluate the clinical characteristics of burn patients diagnosed with SM infection in our Burn Unit. Methods A single-site, retrospective review using an institutional Burn Center registry and infection control data. All patients diagnosed with SM infection within our Burn Unit between June 1, 2012 and June 1, 2019 were included in this retrospective review. Demographics, burn characteristics, length of stay and mortality were evaluated. Patients were then compared to all admitted patients who were ventilated for greater than 4 days during the same time period. Significance was accepted at p< 0.05. Results Forty-seven patients were diagnosed with SM infection between 2012 to 2019. Among these patients 64% were male and 36% were female. Mean patient age was 51 years old +/- 16 years. The most common reason for admission was flame burns (64%), followed by Stevens Johnson/Toxic Epidermal Necrolysis (SJS/TEN) (17%). The average total body surface area (TBSA) involved was 29% +/- 18%. Mean time from admission to a positive SM culture was 34.5 days. One-hundred percent of the patients were intubated. Positive cultures for SM were obtained from bronchial alveolar lavage in 96% of positive cultures for SM. Mean length of stay in this group was 108 days +/- 86 days, ranging from 5 to 362 days. The mortality rate for patients diagnosed with a SM infection was 40%, compared to 27% in all patients admitted during this time who were ventilated for greater than 4 days. Conclusions SM is a highly virulent bacteria associated with increased morbidity and mortality in patients admitted to our burn unit. The patients with positive cultures were older, male, flame injured, mechanically ventilated, had large TBSA involvement, and had prolonged hospital courses. Applicability of Research to Practice This study demonstrates the virulence of SM in a high-volume burn center. Cultures positive for SM require aggressive source control and burn centers need to be hypervigilant in controlling environmental factors to mitigate risk.

Introduction Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is a rare, severe mucocutaneous eruption caused by medications and resulting in diffuse epidermal detachment. Patients are often referred to burn units for specialized care. This study assesses trends in precipitating medications over 10 years at our Burn Center. Methods We performed a single-site, retrospective review at our burn center using the institutional burn registry and patient charts. Patients admitted from January 1, 2009 to December 31, 2018 identified as having SJS/TEN were eligible for inclusion. Demographics, comorbidities, diagnosis, treatment, inciting agents, and severity-of-illness score for TEN (SCORTEN) were evaluated. Statistical analysis was performed using the Mann Whitney U test using SAS version 9.4 (SAS Inc., Cary, NC). Results Biopsy-proven SJS, SJS/TEN overlap, or TEN was confirmed in 168 patients. Of these, 103 had a single identified offending drug. Of these patients, 36% had been exposed to sulfamethoxazole-trimethoprim (SMX-TMP), 11% to allopurinol, and 10% to lamotrigine. Trends in culprit drug by year are shown in Figure 1. The majority of SMX-TMP and penicillin cases occurred early in the period of study; lamotrigine and pembrolizumab cases occurred more recently. Patients exposed to allopurinol presented with higher SCORTENs than patients exposed to SMX-TMP, 2.9 vs 1.9, respectively (p< 0.035). Conclusions SMX-TMP once accounted for a large portion of SJS and TEN cases at our center. In recent years, lamotrigine has become a more common offending drug, prescribed in our cohort for psychiatric indications. Also notable, in the past year we have treated three patients with TEN due to immunotherapy (pembrolizumab) for metastatic or unresectable cancer. Paralleling the increasing use of immunotherapy has been a rise of immune-related adverse events, including severe skin toxicities. Further study is warranted to determine what can be done to prevent SJS/TEN from occurring in patients treated with these drugs. Applicability of Research to Practice Understanding emerging trends in causative agents of SJS/TEN will allow the burn community to focus education efforts for providers who prescribe these medications frequently. The psychiatric and oncology communities may benefit from increased awareness of the risk of SJS/TEN in patients receiving lamotrigine and immunotherapy, respectively.

Supply and demand dictate resource allocation in large academic institutions. Classic teaching is that burns is a seasonal specialty with winter being the “busiest” time of year. Resident allocation during the winter and summer months, however, is traditionally low due to the holidays and travel peaks. Our objective was to evaluate our acuity—defined as patient complexity—based on seasons, in order to petition for appropriate mid-level provider allocation. We performed a retrospective review of all admissions to an accredited, large academic burn center. All patients admitted between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay, injury characteristics, and mortality were evaluated. Thirteen thousand four hundred fifty-eight patients were admitted during this study period. Most patients were admitted during the summer. Patients admitted to the intensive care unit were more likely to be admitted in the winter, although this was not statistically significant. Winter admissions had the longest lengths of stay, and the highest incidence of inhalation injury. Female and elderly patients were more likely admitted during the winter. There was a significant difference in mortality between summer and winter seasons. Acuity is seasonal in our large academic burn center and resource allocation should align with the needs of the patients. This data may help large centers petition their institutions for more consistent experienced mid-level providers, specifically during critical seasons.

Introduction Paraquat dichloride is a widely used, highly toxic chemical herbicide and a leading cause of fatal poisonings. Toxicity is thought to be related to lipid peroxidation. Hours after exposure, patients may experience signs and symptoms ranging from nausea to multi-system organ failure. To prevent pulmonary complications and death, it is recommended to give patients repeated pulse therapy with cyclophosphamide and methylprednisolone administered over a 72-hour period. Our objective is to report our center’s experience treating patients who had been exposed to paraquat over a two-day period. Methods Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. Demographics, length of stay, costs and mortality were evaluated. Results There were nine patients admitted from the exposure. All were male. All survived. Eight were undocumented migrant farmer workers. The average age was 36 years (range 25–59 years). The average length of stay was 3.3 days (range 2–5 days). Fifty-six percent had cutaneous injury, but only one required debridement and placement of a skin substitute. Thirty-three percent complained of continued shortness of breath after discharge. Average total hospital cost was $28,131 ($9,500–51,000). Conclusions Paraquat is a highly toxic herbicide and exposure can be fatal if not treated promptly. Immediate decontamination and repeated pulse therapy with cyclophosphamide and methylprednisolone may be lifesaving.

Introduction The shelter-in-place mandate to mitigate the effects from the 2019 severe acute respiratory syndrome coronavirus 2 was associated with an increase in admissions of school-aged children to our burn center but a decrease in adult admissions. It was unclear how many admissions were from suspected abuse. Our objective was to determine the social impact of the shelter-in-place mandate on the number of burn admissions secondary to suspected abuse during the COVID pandemic compared to previous years. Methods Patients were identified using Institutional Burn Center registry and linked to the clinical and administrative data. All patients admitted from January 1, 2016 to July 31, 2020 with suspected abuse were eligible for inclusion. Demographics, patient and burn characteristics were evaluated. Statistical analysis was performed with Students’ t-test, and chi-squared test. Results There were 7177 patients included in the study. Prior to 2020, each year the percentage of cases with suspected abuse decreased compared to previous years (19% decrease in 2017, 23% decrease in 2018, 30% decrease in 2019). Compared 2019, the number of patients admitted with suspected abuse during the COVID pandemic increased 257%, p=0.00046. There were no significant differences in race, ethnicity, sex, burn mechanism, or burn size in those admitted with abuse-related injuries. The average age of patients with abuse-related injuries in 2020 was 13 years old, compared to an average age of 28 years old for the period from 2016–2019 (p< 0.003). Conclusions There is a significant increase in number of patients admitted for suspected abuse. Shelter-in-place mandate limited viral transmission of COVID-19 but led to unfathomable increases in abuse cases at our institution.

Introduction Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are a spectrum of rare, life-threatening drug reactions characterized by diffuse skin detachment and mucositis. Our objective was to describe and analyze mortality trends at our institution for patients with biopsy-proven SJS and TEN over the last decade. Methods Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted with biopsy proven SJS, SJS/TEN overlap, and TEN between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test. Results One hundred sixty-eight patients had biopsy-proven SJS, SJS/TEN overlap, or TEN. The average age was 48 years. Sixty-one percent of patients were female. The average length of stay was 30 days. Fifty-six percent of patients were Black. Twenty-seven percent of patients died. Increased mortality risk was significantly associated with female gender, age, underrepresented minorities, Human Immunodeficiency Virus, and chronic obstructive pulmonary disease. The presence or absence of malignancy or chronic kidney disease was not evaluated. Conclusions Biopsy proven SJS, SJS/TEN overlap, and TEN are associated with increased mortality for females, underrepresented minority populations, and patients with comorbidities. Black patients represent 28% of our state’s population, but 56% of patients with biopsy proven SJS, SJS/TEN overlap, and TEN at our institution. Further study is warranted to investigate and mitigate these outcome disparities in these patient populations. Applicability of Research to Practice This study highlights the importance of acknowledging that these at-risk patient populations must be protected with higher vigilance during evaluation, assessment of the offending agent, and resuscitation.

Introduction Female gender is associated with poorer outcomes in burns, not necessarily related to co-morbid conditions. Our objective was to analyze the effect of gender in biopsy proven Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) spectrum disorders at our institution. Methods Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted with biopsy proven SJS, SJS/TEN overlap, and TEN between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay, and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test. Results One hundred and sixty-eight patients had biopsy proven SJS, SJS/TEN overlap, or TEN. Sixty-one percent of patients were female. The average age of female patients was 51 years while the average age of male patients was 44 years, p< 0.05. Fifty-sex percent of female patients were black. All American Indian patients were female. Female patients had significantly longer lengths of stay, 34 days versus 22 days, p< 0.05. Female patients had an average SCORTEN (a severity of illness score of TEN) compared to male patients. Thirty-three percent of female patients died compared to 18% of male patients, p< 0.05. Two out of three American Indian patients in this cohort died. Conclusions Female gender is associated with increased mortality in burn patients, as well as in our cohort of patients with SJS/TEN. Females represent 51% of our state’s population, but 61% of patients with biopsy proven SJS, SJS/TEN overlap, and TEN at our institution. Compared to male patients, female patients presented with more severe disease (higher SCORTEN at presentation). Genomic, and proteomic studies looking at sex-based differences may be helpful in elucidating the origin of these differences. Applicability of Research to Practice This study demonstrates sex-based differences related to skin desquamating disorders, and these outcomes, coupled with known disparities in burns, may indicate a need for hypervigilance in inpatient management for women, and a re-evaluation of prognostic scoring tools to include a variable for gender.