Is Length of Stay Linearly Related to Burn Size? A Glimmer From the National Burn Repository

In academic medical circles, burns are often touted as the ideal injury to study because the physiologic insult seems readily quantified—in other words, the total body surface area (TBSA). This metric of injury severity is indeed much more accessible than other closely allied specialties we all are familiar with, such as trauma and the injury severity score methodology. To be a critical thinker, however, we should all be skeptical about this common wisdom and put it to the test. Any burn team member knows that there are a myriad of factors that modify how serious we think any given burn injury will prove to be beyond just the burn size. Inhalation injury, medical comorbidities, concomitant trauma, extremes of age, and so forth are factors we all recognize as prognostically important. The National Burn Repository (NBR) allows us to examine if the common wisdom about easy quantification of injury severity by burn size has a basis in fact. Let us use length of stay (LOS) as a meaningful surrogate for progressive consequences of increasing injury severity. Therefore, we can choose to ask if LOS is linearly related to %TBSA burn size.