Boomtown: analysis of burn injuries from the Bakken Oil Industry [abstract #133]
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Introduction: Increased oil production in the Bakken shale formation has resulted in a large number of serious work-related burn injuries. The purpose of this study is to compare patient demographics, burn characteristics, and outcomes of patients employed by the oil industry (OIL) to those not oil related (NO) admitted to a regional burn center. Methods: This is a retrospective observational study of patients admitted to our ABA verified Burn Center between July 2007 and October 2013. To accommodate the statistical analysis plan, we selected control patients (NO) in a 5:1 ratio for comparison. Patient demographics, treatment characteristics, and patient outcomes were abstracted. All variables were summarized and compared between groups using unadjusted Student t-tests for continuous variables, Chi-squared test, Fisher’s Exact test, and Wilcoxon ranked-sum tests as appropriate for categorical variables. Results: A total of 184 patients (32 OIL, 148 NO) were included. OIL patients were significantly younger (38.0 ± 11.8 vs. 45.3 ± 18.4 years; p = 0.006), male (100% vs.75.4%; p < 0.001), burned due to an explosion (66% vs. 9%; p < 0.001), and had a higher median [IQR] %TBSA (22% [5%-24%] vs. 5% [3%-10%]; p = 0.006). A higher proportion of OIL patients underwent prehospital intubation (59% vs. 17%; p <0.001) and required continued burn center ventilation (41% vs. 18%; p = 0.004), but there was no difference in the median number of ventilator days (6 [2–11] vs. 2.5 [2–12]; p = 0.67). The OIL injured patients had a higher median [IQR] number of operations (1 [0–2] vs. 0 [0–1]; p = 0.02), and were more likely to experience at least one surgical complication (50% vs. 22%; p = 0.001) than the NO group. Both groups demonstrated a similar survival rate (OIL = 94%, NO = 97%; p = 0.61), but oil field patients had a much higher median hospital length of stay (13.5 [3–40] vs. 4 [1–13] days; p < 0.001). Conclusions: Injuries as the result of oil related activities have different demographic, treatment, and outcome characteristics compared to the general burn population. These patients are more severely burned, undergo more surgical procedures, require ventilatory support more often, use more intense in-hospital resources, and experience complications in greater numbers. Education and support for hospitals located near oil fields but hundreds of miles from definitive burn care is critical for initial resuscitation, and advanced planning to accommodate the small volume but resource intensive care required at regional burn centers should be considered. Applicability of Research to Practice: Detailing characteristics of this specific burn mechanism will allow for better prehospital stabilization and ultimate functional outcome for these patients.