Regional Burn Review: Neither Parkland Nor Brooke Formulas Reach 85% Accuracy Mark for Burn Resuscitation

Abstract

Prolonged resuscitation can result in burn wound conversion and other complications. Our team switched from using Parkland (PF) to modified Brooke formula (BF) in January 2020. Secondary to difficult resuscitations using BF, we sought to review our data to identify factors associated with resuscitation requiring greater than predicted resuscitation with either formula, defined as 25% or more of predicted, hereafter referred to as over-resuscitation. Patients admitted to the burn unit between 1/1/2019 and 8/29/2021 for a burn injury with a percentage of total body surface area (%TBSA) ≥15% were included. Subjects <18 years, or weighing <30 kg, and those who died or had care withdrawn within 24 h of admission were excluded. Demographics, injury information, and resuscitation information were collected. Univariate and multivariate analyses were performed to identify factors associated with over-resuscitation by either formula. P < 0.05 was considered significant. Sixty-four patients were included; 27 were resuscitated using BF and 37 using PF. No significant differences were observed in demographics and burn injury between the groups. Patients required a median 3.59 mL/kg/%TBSA for BF and 3.99 mL/kg/%TBSA for PF to reach maintenance (p = 0.32). Over-resuscitation was more likely to occur when using BF compared to PF (59.3% vs. 32.4%, p = 0.043). Over-resuscitation was associated with longer time to reach maintenance (OR = 1.179 [1.042-1.333], p = 0.009) and arrival via ground transportation (OR = 10.523 [1.171-94.597], p = 0.036). Future studies are warranted to identify populations in which BF underperforms and sequelae associated with prolonged resuscitation.