Smoke, Scars, and Survival: A Six-Year Analysis of Burn Mortality in a Resource-Limited Appalachian ICU

Abstract

Background: Despite recent advances in burn management, burn injuries remain a major global cause of morbidity and mortality, with rural and underserved populations, such as those in Appalachia, being disproportionately affected. Contributing factors include limited access to specialized care and a high prevalence of comorbidities. Understanding the prognostic factors associated with mortality in adult burn patients is critical for guiding clinical care and resource allocation, particularly in resource-limited settings.

Methods: This retrospective study analyzed data from adult burn patients aged 18 to 65 admitted to the only Burn Intensive Care Unit (BICU) in West Virginia, located at Cabell Huntington Hospital, between January 2017 and January 2023. A total of 748 patients were included. Variables analyzed included demographics, comorbidities (diabetes mellitus, chronic obstructive pulmonary disease (COPD), smoking history, home oxygen use), injury characteristics (inhalation injury, total body surface area burned (TBSA)), and clinical outcomes (total hospital duration (THD), total ventilation duration (TVD)). Categorical and continuous variables were compared between survivors and non-survivors using chi-square and t-tests, respectively. Multivariate logistic regression was used to identify independent predictors of mortality.

Results: The cohort consisted of 748 patients with a mortality rate of 3.6% (n = 27). Non-survivors were significantly older (mean age 56.1 vs. 40.2 years, p < 0.001), had higher mean TBSA (28.3% vs. 6.3%, p < 0.001), longer hospital stays (15.3 vs. 8.9 days, p = 0.012), and longer ventilation durations (18.5 vs. 6.7 days, p < 0.001). Inhalation injury was present in 66.7% of deceased patients compared to 14.1% of survivors (p < 0.001). Comorbidities such as diabetes (51.9% vs. 12.5%, p < 0.001), COPD (63.0% vs. 12.3%, p < 0.001), and home oxygen use (55.6% vs. 8.2%, p < 0.001) were significantly more prevalent in non-survivors. Smoking was also significantly associated with mortality (81.5% vs. 45.9%, p = 0.001). In the logistic regression analysis, independent predictors of mortality included TBSA (OR 1.15 per 1% increase, 95% CI: 1.10-1.21, p < 0.001), TVD (OR 1.08 per day, 95% CI: 1.02-1.14, p = 0.009), smoking history (OR 2.34, 95% CI: 1.15-4.78, p = 0.018), and inhalation injury (OR 6.82, 95% CI: 3.94-11.81, p < 0.001). THD was inversely associated with mortality (OR 0.93, 95% CI: 0.88-0.98, p = 0.008), possibly reflecting early deaths in more severe cases.

Conclusions: In this Appalachian cohort of adult burn patients, mortality was significantly associated with larger burn size, prolonged ventilation, inhalation injury, smoking, and comorbidities such as diabetes, COPD, and home oxygen use. These findings highlight the need for individualized, multidisciplinary care strategies in resource-limited rural settings. Efforts to standardize inhalation injury diagnostics and enhance access to burn care may improve outcomes. Future studies should focus on scalable interventions and policy changes to reduce disparities in burn care and improve survival in underserved populations.

Keywords: burn care; burn injuries; burn intensive care unit; clinical outcomes; resource-limited settings.

Figure 1. IRB approval letter