# The Impact of Concomitant Traumatic Brain Injuries on the Surgical Treatment of Burns: A Long-Term, Monocentric Retrospective Study

## TL;DR

Burn patients with traumatic brain injuries face higher risks, delays in surgery, and more complications, requiring careful interdisciplinary care.

## Contribution

This study identifies burns with TBI as a high-risk subgroup with unique clinical challenges and outcomes.

## Key findings

- Burn patients with TBI had the highest mortality rate (22.2%) compared to other groups.
- Surgical delays occurred only in TBI patients, leading to more interventions and longer operations.
- TBI patients experienced higher rates of wound infections and graft loss.

## Abstract

Burn injuries significantly impact morbidity and mortality, with early surgical intervention crucial for improving outcomes. However, concomitant traumatic brain injury (TBI) frequently complicates burn management, potentially delaying timely surgical treatment due to neurological concerns. Optimal timing of burn surgery in patients with concurrent TBI remains uncertain, necessitating clearer insights into their clinical outcomes. This retrospective study reviewed burned adults admitted to a Swiss Burn Center between 2014 and 2023. Patients were grouped as burns with TBI, burns alone, burns with other trauma, or electrical burns. Demographics, injury characteristics, timing of surgery, complications, and outcomes were analyzed. Generalized linear models and logistic regression were applied. Among 602 patients, 27 (4.5%) had a TBI. Mortality was highest in this group (22.2%) compared to isolated burns (3.7%), burns with other trauma (7.4%), and electrical burns (4.8%). Surgical delays (>72 h) occurred only in burn patients with TBI (22.2%), mainly due to hemodynamic instability, intracranial pressure monitoring, or additional trauma. Delayed surgery correlated with more surgical interventions (P = .018) and longer operative times (P = .048). Complications were more frequent: wound infections (48.1%) and graft loss (22.2%) were significantly higher in the TBI group. In conclusion, burns with concomitant TBI define a distinct, high-risk subgroup with increased surgical delays, complications, and mortality. Management requires an interdisciplinary approach, balancing early surgical intervention with neuroprotective strategies to optimize patient outcomes.