Too much or too little? Fluid resuscitation in the first 24 h after severe burns: Evaluating the Parkland formula - A retrospective analysis of adult burn patients in Austria, Germany, and Switzerland 2015-2022.

BACKGROUND

Fluid resuscitation after a burn injury is one of the crucial aspects of acute therapy. The Parkland formula is a quick solution for determining the amount of fluid necessary in a specific situation, although it is not strictly followed or used in current practice. Therefore, we aimed to assess the association between a deviation from the Parkland formula and in-hospital mortality.

METHODS

Based on data from 2235 burn patients recorded in the German Burn Registry from January 1st 2015 to December 31st 2022, we evaluate the relative deviation from the Parkland formula in either a positive or negative direction and its association with in-hospital mortality. We use mixed logistic regression models to assess this relationship and additionally evaluate its interaction with patient-level characteristics such as age, inhalation trauma (IHT), BMI, and percent of total body surface area (TBSA) affected.

RESULTS

Without taking patient-level characteristics into account, both positive and negative relative deviations from the Parkland formula were associated with a higher probability of in-hospital mortality. After adjusting for sex, age, BMI, IHT, a third-degree burn, and TBSA, only the positive deviation from Parkland remained a risk factor for the outcome. We found that this negative effect of deviating from Parkland could be further modified by patient-level characteristics such as IHT, TBSA, and BMI, but not by the patient's age.

CONCLUSION

The Parkland formula remains a useful tool for quick fluid calculations in the acute phase of severe burns. Deviations from the calculated amount are very common, with a higher incidence of over-infusion. Exceeding the Parkland formula increases mortality while under-infusion does not significantly affect mortality: 'Less seems to be better than more.'.