# Small Burns Need Attention Too: Evaluating the 15% Burn Resuscitation Threshold in Adults

## TL;DR

This study examines whether adults with 15-19.9% burns benefit from fluid resuscitation, finding that half received more than maintenance fluids.

## Contribution

The study challenges the 20% threshold for burn resuscitation by analyzing outcomes in patients with smaller burns.

## Key findings

- Half of patients with 15-19.9% burns received more than maintenance fluids.
- No significant differences in outcomes were found between resuscitation groups.
- 20% of patients required vasopressors during resuscitation.

## Abstract

The American Burn Life Support course recommends fluid resuscitation of patients with TBSA ≥20% to prevent burn shock. Our center resuscitates patients with burns greater than 15% TBSA. Herein, we characterize that population. Patients with burns 15% to 19.9% TBSA admitted from January 1, 2019 to March 31, 2023 who received protocolized fluid resuscitation were included. Demographics, hospital course, and fluids received were reviewed. Fluid resuscitation was categorized as “below range” (Parkland formula [PF] < 3 mL/kg/%TBSA), “within range” (PF = 3-5 mL/kg/%TBSA or “above range” (PF > 5 mL/kg/%TBSA). Similarly, urine output (UOP) was expressed as “below range” (<30 mL/h), “within range” (31-50 mL/h) or “above range” (>50 mL/h). The resuscitation groups were compared. P < .05 was considered significant. Thirty-three patients received resuscitation via Brooke (9.1%), PF (63.6%), or other formula (27.3%). Most were male (81.8%) with a median TBSA of 17%; median age was 57 years. Almost 20% of patients required vasopressors during resuscitation. Fifteen patients were within the predicated range of PF, 15 were under, and 3 were over. There was no difference between the groups with respect to demographics, burn injury variables, or complications. Notably, the average creatinine and lactate 24 h postadmission were 0.9 mg/dL and 2 mg/dL, respectively. Half of the study patients received greater than maintenance; all were in either the within burn resuscitation range or above range groups. This retrospective study suggests that patients with smaller burns may benefit from resuscitation as 50% received more than maintenance. Resuscitation of smaller burns requires more study.