The impact of concomitant traumatic brain injuries on the surgical treatment of burns: a long-term, monocentric retrospective study

Burn injuries significantly impact morbidity and mortality, with early surgical intervention crucial for improving outcomes. However, concomitant traumatic brain injury frequently complicates burn management, potentially delaying timely surgical treatment due to neurological concerns. Optimal timing of burn surgery in patients with concurrent traumatic brain injury remains uncertain, necessitating clearer insights into their clinical outcomes. This retrospective study reviewed burned adults admitted to a Swiss Burn Center between 2014 and 2023. Patients were grouped as burns with traumatic brain injury, burns alone, burns with other trauma, or electrical burns. Demographics, injury characteristics, timing of surgery, complications, and outcomes were analyzed. Generalized linear models and logistic regression were applied. Among 602 patients, 27 (4.5 %) had a traumatic brain injury. Mortality was highest in this group (22.2 %) compared to isolated burns (3.7 %), burns with other trauma (7.4 %), and electrical burns (4.8 %). Surgical delays (>72 h) occurred only in burn patients with traumatic brain injury (22.2 %), mainly due to hemodynamic instability, intracranial pressure monitoring, or additional trauma. Delayed surgery correlated with more surgical interventions (p=.018) and longer operative times (p=.048). Complications were more frequent: wound infections (48.1 %) and graft loss (22.2 %) were significantly higher in the traumatic brain injury group. In conclusion, burns with concomitant traumatic brain injury define a distinct, high-risk subgroup with increased surgical delays, complications, and mortality. Management requires an interdisciplinary approach, balancing early surgical intervention with neuroprotective strategies to optimize patient outcomes.