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Objective: Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20% or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality., Background: Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy. However, major burn injury is precluded from these studies. The optimal transfusion strategy in major burn injury is thus needed but remains unknown., Methods: This prospective randomized multicenter trial block randomized patients to a restrictive (hemoglobin 7-8 g/dL) or liberal (hemoglobin 10-11 g/dL) transfusion strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes., Results: Eighteen burn centers enrolled 345 patients with 20% or more TBSA burn similar in age, TBSA burn, and inhalation injury. A total of 7054 units blood were transfused. The restrictive group received fewer blood transfusions: mean 20.3 ± 32.7 units, median = 8 (interquartile range: 3, 24) versus mean 31.8 ± 44.3 units, median = 16 (interquartile range: 7, 40) in the liberal group (P < 0.0001, Wilcoxon rank sum). BSI incidence, organ dysfunction, ventilator days, and time to wound healing (P > 0.05) were similar. In addition, there was no 30-day mortality difference: 9.5% restrictive versus 8.5% liberal (P = 0.892, χ test)., Conclusions: A restrictive transfusion strategy halved blood product utilization. Although the restrictive strategy did not decrease BSI, mortality, or organ dysfunction in major burn injury, these outcomes were no worse than the liberal strategy (Clinicaltrials.gov identifier NCT01079247).

Background: This study compares burn and nonburn patients undergoing tracheostomy, all of whom were assigned to diagnosis-related group 483 to determine hospital reimbursement., Methods: We reviewed the records of all inpatients admitted to our hospital from January 2000 through December 2001 who underwent tracheostomy and who were assigned to diagnosis-related group 483. In addition, we compared our burn patient data with that from three other burn centers and the National Burn Repository., Results: We identified 357 inpatients who had tracheostomies during their hospitalization, only 12 of whom (3.4%) had acute burn injuries. The mean extent of burn in these patients was 43.4% total body surface area. The most frequent primary diagnoses for nonburn patients were injury and poisoning, and circulatory and respiratory disorders. Patients with burn injuries had 39.6 ventilator days, 40.7 intensive care unit days, and 49.2 hospital days compared with 19.8, 17.4, and 29.5 days, respectively, for nonburn patients (p <0.0001). Demographic, resource, and financial data for burn patients treated at the three other burn centers and those reported to the National Burn Repository were not significantly different from burn patients treated at our hospital. Total costs and charges for the care of burn patients were $186,830 and $343,904, respectively, compared with $82,176 and $160,498 for the nonburn patients (p <0.0005)., Conclusion: Burn patients requiring tracheostomies during their acute hospitalization consume significantly more resources than patients without burn injuries. More appropriate resource-based reimbursement for the care of these patients appears warranted.

Thirty-two primary desmoid tumors occurred in 29 patients. The median patient age was 32 years, and 55% of the patients were females. An antecedent history of trauma at the tumor site was elicited from 28% of patients. Thirty-one of 32 primary tumors were completely excised at initial presentation. Five tumors were treated with adjuvant radiotherapy. The overall recurrence rate for primary and recurrent lesions was 60%. The recurrence rate in children (88%) was more than twice that found in adults (38%). A single recurrence did not significantly increase the likelihood of a subsequent recurrence. Greater than 90% of all recurrences took place within 3 years of treatment. The rate of recurrence was not clearly influenced by the status of histologic margins, although this was examined in less than half the tumors. Desmoid tumors are aggressive neoplasms that exhibit a strong propensity for local recurrence. They should be treated as low-grade malignancies with documentation of histologic margins and close clinical follow-up within the framework of a tumor registry.