Factors Associated With Mortality Following Burns Complicated by Necrotizing Skin and Soft Tissue Infections: A Systematic Review and Meta-Analysis of Individual Participant Data

Abstract

Abstract We reviewed studies with individual participant data of patients who sustained burn injury and subsequently developed necrotizing skin and soft tissue infections (NSTI). Characteristics and managements were compared between patients who lived and patients who died to determine factors associated with mortality. Six databases (PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and CINAHL) were searched. PRISMA-IPD guidelines were followed throughout the review. Eligible patients sustained a burn injury, treated in any setting, and diagnosed with a NSTI following burn injury. Comparisons were made between burned patients who lived “non-mortality” and burned patients who died “mortality” following NSTI using non-parametric univariate analyses. Fifty-eight studies with 78 patients were published from 1970 through 2019. Non-mortality resulted in 58 patients and mortality resulted in 20 patients. Patients with mortality had significantly greater median %TBSA burned (45%[IQR:44–64%] vs 35%[IQR:11–59%], P = .033), more intubations (79% vs 43%, P = .013), less debridements (83% vs 98%, P = .039), less skin excisions (83% vs 98%, P = .039), more complications (100% vs 50%, P < .001), management at a burn center (100% vs 71%, P = .008), underwent less flap surgeries (5% vs 35%, P = .014), less graft survival (25% vs 86%, P < .001), and less healed wounds (5% vs 95%, P < .001), compared to patients with non-mortality, respectively. Non-mortality patients had more debridements, skin excised, systemic antimicrobials, skin graft survival, flaps, improvement following surgery, and healed wounds compared to mortality patients. Mortality patients had greater %TBSA burned, intubations, management at a burn center and complications compared to non-mortality patients.