Hospital Complications - Supplemental Information

Question: A patient, went to the operating room (OR) several times and had grafting done. Graft loss was identified in the first outpatient follow up clinic visit and the patient was readmitted to have a regraft of the area. Where would this graft loss complication be recorded?

Answer: Enter the graft loss in the complications field of the initial admission under the date the graft loss was identified in the Outpatient Department.

Question: Is there a percentage of graft loss needed to pick up the complication for "graft loss requiring regraft" (i.e 10% loss) or is it for any percentage of loss?

Answer: For a graft loss to be considered a complication, it must require regrafting, regardless of the percentage of graft loss that occurs.
GRAFT OR FLAP LOSS REQUIRING REPEAT PROCEDURE: Skin grafts or flap loss requiring return to the operating room for re-graft or flap repair.

Arrhythmia

Question: If a patient that had sinus bradycardia and a junctional rhythm is being logged into the registry as an arrhythmia and the only options to select were atrial fibrillation/flutter, Supraventricular tachycardia (SVT), Ventricular tachycardia, Ventricular fibrillation, would there be an ability to add another free text box for this?

Answer: This will be discussed with the Data Definitions Workgroup and will answer this as soon as possible.

Question: If a patient that has a pre-existing condition of AFib and has an episode of AFib RVR during their hospital stay, would this not be counted as a complication because it is a pre-existing condition?

Answer: No, a rapid heart rate in someone with a known history of atrial fibrillation is NOT a complication, because it is a pre-existing condition that is not likely due to the burn injury. However, if the atrial fibrillation/flutter is a new complication, in a patient with no past history of this, it should be documented.

Compartment Syndrome, Extremity

Question: In the definition of compartment syndrome, it indicates not present on admission. Is there a recommended time from for this or is there a guideline?  In coding standards there is a Present On Admission (POA) flag but not sure if this is what most registrars use?

Answer: Compartment syndrome of the extremity is a complication that the registry collects and should be recorded if the compartment syndrome develops after the admission to your burn unit OR if it was present but missed on admission and threatened limb viability and required later intervention. (see definition in Data Dictionary). 

Burn Infection

Question: Are positive cultures of the blood or wound required to meet the definition of a burn wound infection like cellulitis?

Answer: To meet the CDC definition of Burn Infection, which is used by the Burn Registry, a positive culture must be obtained. In the supplementary variable you can then identify the infection as Invasive or Non-Invasive Burn Infection using the definitions provided.

Question: Should cellulitis in a burn area with antibiotic treatment (without any tissue cultures) be captured as a "Burn Infection," per the registry definition? This differs from the CDC definition which requires a positive culture.

Answer: Yes, cellulitis would be captured as a burn infection if it meets the definition below.  Use the definition in the supplemental Burn Infection data variable which was approved by the Data Definition Workgroup and the Quality and Burn Registry Committee: Non-invasive burn wound infection:

Burn wounds that have a purulent exudate that is culture positive (if performed), requires a change in treatment (which may include a change or addition to antimicrobial therapy, the removal of wound covering, or an increase in the frequency of dressing changes); and at least one of the following:

·         Loss of synthetic or biologic covering of the wound;

·         Changes in wound appearance, such as hyperemia;

·         Erythema in the uninjured skin surrounding the wound;

·         Systemic signs, such as hyperthermia or leukocytosis."

Deep Venous Thrombosis (DVT)

Question: DVT Prophylaxis on the Outcome page (Discharge info tab) in BCQP referred to on Page 134 in the 2023 Burn data dictionary says it is "used to indicate whether a patient was receiving prophylaxis when diagnosed with a VTE (hospital complication)". Does the field in BCQP relate to the first prophylaxis given or only when a DVT complication arises?

Answer: The Venous thrombosis prophylaxis start date and type on the Outcomes section/Discharge Information is for anyone receiving Venous thrombosis prophylaxis and the 2024 Data Dictionary v4.1 defines these on pages 131 and 132. Unfortunately, these 2 definitions should be in the Outcomes section and were mistakenly put in the Outcome Complications - Supplementary Variables section.

The Deep Venous Thrombosis (DVT) complication that is in the Outcomes Complications section has a dropdown box, if the complication is selected, which asks if the patient was Receiving prophylaxis when Deep vein thrombosis (DVT) was diagnosed. The 2024 Data Dictionary v4.1 defines this on page 130 in the Hospital Complications – Supplemental Variables section.

These are 2 separate data points. The Venous thrombosis prophylaxis start date and type data point is to be completed for all patients with >/= to 10% TBSA burns, any patient with an inhalation injury, surgery or who died. The DVT complication supplementary data point is only completed for patients who had a DVT.

Screen for Major Depression

Question: For screening for Major depression, should this be a required reporting element for infants/toddlers that have a TBSA of 10% or greater, since children of younger ages can’t reliably display/tell you they are depressed?

Answer: The definition states that the screening should be done by a psychologist, social worker or other health care professional for major depression. It does not rely on the patient telling you they are depressed, and the professionals can make that determination.