Initial Results of the American Burn Association Observational Multicenter Evaluation on the Effectiveness of the Burn Navigator

The objective of this multicenter observational study was to evaluate resuscitation volumes and outcomes of patients who underwent fluid resuscitation utilizing the Burn Navigator (BN), a resuscitation clinical decision support tool. Two analyses were performed: examination of the first 24 hours of resuscitation and the first 24 hours postburn regardless of when the resuscitation began, to account for patients who presented in a delayed fashion. Patients were classified as having followed the BN (FBN) if all hourly fluid rates were within +/- 20 ml of BN recommendations for that hour at least 83% of the time; otherwise, they were classified as not having followed BN (NFBN). Analysis of resuscitation volumes for FBN patients in the first 24 hours resulted in average volumes for primary crystalloid and total fluids administered of 4.07 +/- 1.76 ml/kg/TBSA (151.48 +/- 77.46 ml/kg) and 4.68 +/- 2.06 ml/kg/TBSA (175.01 +/- 92.22 ml/kg), respectively. Patients who presented in a delayed fashion revealed average volumes for primary and total fluids of 5.28 +/- 2.54 ml/kg/TBSA (201.11 +/- 106.53 ml/kg) and 6.35 +/- 2.95 ml/kg/TBSA (244.08 +/- 133.5 ml/kg), respectively. There was a significant decrease in the incidence of burn shock in the FBN group (P < .05). This study shows that the BN provides comparable resuscitation volumes of primary crystalloid fluid to the Parkland formula, recommends total fluid infusion less than the Ivy index, and was associated with a decreased incidence of burn shock. Early initiation of the BN device resulted in lower overall fluid volumes.