Brain injury in patients admitted to the burn ICU is a recognized phenomenon but has not been well described.  Patients with severe thermal injury undergo complex metabolic, hemodynamic, and inflammatory changes and require aggressive fluid resuscitation, which may have significant effects on the types and degree of brain injury in this population.

To evaluate the nature of intracranial injuries in patients admitted to a burn ICU over a 14 year period with respect to the volume of resuscitation fluids administered.

We performed a retrospective analysis of all patients admitted to the Burn ICU at a single facility between January 2003 and June 2017. Patients were included if they were admitted within 24 hours of burn injury and received a head CT in the first 96 hours of hospitalization.

Of the 5176 patients admitted, 439 met the inclusion criteria. An acute intracranial process was identified in 41 patients. 27 received <150 cc/kg of IV fluids, while 11 received >200 cc/kg during the first 24 hours. The most common injuries in the former were hemorrhage (subarachnoid, intraparenchymal) and edema (7/27 for each), while ischemia (4/11) was the most frequent in the latter group. Follow up imaging was more likely to be worse in the >200 group (5/11) than in the <150 group (2/27) (Fisher’s Exact p=0.0139).

Of Burn ICU patients who received a head CT within 96 hours of injury, an acute intracranial abnormality was found in 8% of patients. The most common diagnosis was hemorrhage and ischemia in those receiving <150cc/kg and >200cc/kg, respectively. An association between higher resuscitation volume and severity of brain injury on CT was observed, and follow-up imaging in the higher volume group was more likely to show worsening.  These findings warrant further investigation into the relationship between intravenous fluid resuscitation and brain injury severity in burn patients.