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

Abstract

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. 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. 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. 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.’. • Negative deviations from Parkland are much more common than positive deviations in resuscitation of severe burns. • Positive deviation from Parkland was a risk factor for outcome. • Negative effect of excessive fluids on mortality is less pronounced in patients with IHT, obesity, higher TBSA, or younger age. • Models of specific patient groups may provide guidance for planning individualized fluid management in major burns.

Topics & Concepts