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Introduction: Burn injuries are the fifth most common cause of non-fatal injuries among children worldwide. Pediatric burn patients require complex management due to their distinct physiology compared to adults. The purpose of this study is to investigate demographic and clinical factors contributing to a prolonged total hospital duration among pediatric burn patients in a rural, Level 2 Trauma Center and Burn Intensive Care Unit (BICU) located in the Appalachian region., Methods: Data were collected from 2017 to 2023 and included all patients 18 years and younger who were admitted to the Cabell Huntington Hospital BICU. Patient demographics were analyzed using descriptive statistics. One-way ANOVA assessed the differences between gender and length of stay (LOS) and source of burn and LOS. A chi-square test analyzed the effect of an inhalation injury on LOS. Pearson correlation was used to assess the relationship between BMI and LOS and between total ventilation days (TVD) and LOS., Results: A total of 232 patients were included in this study, consisting of 102 (44%) females and 130 (56%) males. The average patient age was 6.9 years (SD ± 6.2). The mean LOS was 3.1 (SD ± 4.4) among this cohort. The most common sources of burn injuries within this cohort were flame (43%), scald (35%), and other (chemical/electric/radiation) comprising 22%. Flame burns were found to have a significant impact on LOS (p = 0.039), requiring longer hospital stays compared to other burn sources. Age was a significant predictor, with each additional year of age associated with an increase of 0.15 days in LOS (95% CI: 0.05 to 0.25, p < 0.001). Similarly, the total body surface area (TBSA) showed a significant positive association, with larger burn areas strongly predicting longer hospital stays (p < 0.001). The median TBSA was 5.5% (SD ± 6.7). For every 1% increase in TBSA burns, the hospital stay increased by approximately 0.13 days (95% CI: 0.05 to 0.22, p < 0.05). However, variables such as inhalation injury (p = 0.748) and BMI (p = 0.058) did not significantly predict hospital duration., Conclusion: The results of this study demonstrated that age, burn severity, and the source of the burn are significant predictors of prolonged hospital stay in pediatric burn patients. Recognizing these key predictors of LOS will allow providers to identify high-risk patients early and initiate prompt stabilization, management, and timely referral to tertiary centers when necessary. Further, the results of this study may serve as the framework for the development of preventative efforts and regional care guidelines for rural, underserved healthcare providers., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Marshall University Institutional Review Board issued approval 2063568-1. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Rahimpour et al.)

Background Despite advances in burn care, morbidity and mortality remain high. There is a large gap in research focusing on resource-limited Appalachian burn victims. Appalachia is unique in many different ways. The region is well known nationally for poor healthcare outcomes, household income below the national average, ranking high in addiction and drug use crisis, and characterized with a high prevalence of comorbidities such as chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), coronary artery disease, and obesity. To complicate this devastating imbalance, Cabell Huntington Hospital is the sole burn intensive care unit in the state of West Virginia, with only six beds available. It is crucial to understand the factors that prolong the length of stay (LOS), as LOS is a key indicator for healthcare resource utilization, especially in this resource-limited population. This study aims to identify factors that influence LOS among burn patients in Appalachia, focusing on demographic and clinical variables. Methodology A retrospective analysis was conducted among 748 patients between January 1, 2017, and January 1, 2023. Demographic and clinical variables, including age, gender, COPD, DM, smoking history, inhalational injury, burn source, body mass index (BMI), total burn surface area (TBSA), and total ventilation duration (TVD), were collected. Multiple linear regression was used to identify predictors of LOS. Statistical significance was set at p-values <0.05. Results Significant predictors of prolonged LOS included TVD (β = 1.25, p < 0.001), TBSA (β = 0.60, p < 0.001), inhalational injury (β = 6.02, p < 0.001), and burn source (thermal contact with metal: β = 10.68, p = 0.003). Discharge status (dead) was associated with shorter LOS (β = -17.09, p < 0.001). For every additional day of ventilation, LOS increased by approximately 1.25 days. Each percentage increase in TBSA contributed to a 0.6-day increase in LOS. Patients who died had a hospital stay approximately 17 days shorter than those who survived. The presence of inhalational injury extended the LOS by an average of six days. Age, gender, COPD, DM, BMI, and smoking history were not significantly associated with LOS. Conclusions Newer predictor models should be used to combine TBSA with other demographics, comorbidities, and burn factors, such as inhalation injury and TVD, to provide a more accurate LOS for patients, their loved ones, and caregivers. The rule that for every 1% TBSA burned LOS increases with one day does not hold in our population. These findings provide valuable insights for optimizing burn care in resource-limited settings., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Marshall University Institutional Review Board #1 issued approval 2063568-1. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Rahimpour et al.)

Background Burn injuries are among the top 10 causes of trauma and premature death globally. While burns are more prevalent in low-income countries, geriatric burns are disproportionately observed in developed nations, where longer life expectancies result in a larger elderly population. Geriatric burn patients face unique challenges, including slower healing, higher risk of complications, and increased hospital length of stay (LOS), which may be further exacerbated in resource-limited regions such as Appalachia. This study investigates factors influencing hospital LOS in geriatric burn patients aged 65 and older in a resource-constrained region of Appalachia. Variables analyzed include patient demographics, comorbidities, burn-specific characteristics, and the regional healthcare context. Methodology This retrospective cohort study analyzed 209 patients admitted to Cabell Huntington Hospital's Burn Intensive Care Unit between 2017 and 2023. Variables included age, gender, burn severity, total burn surface area (TBSA), inhalation injuries, burn source, comorbidities (chronic obstructive pulmonary disease (COPD), diabetes), smoking history, body mass index, home oxygen use, and discharge status. Statistical analyses included t-tests, analysis of variance, and multivariate regression to identify predictors of LOS. Results The mean LOS was 11.7 ± 10.3 days. Factors significantly associated with longer LOS included inhalation injuries (+8.3 days, p = 0.001) and full-thickness burns (+7.9 days, p < 0.001). Patients who died had significantly longer hospital stays (+5.6 days, p = 0.021). Surprisingly, home oxygen use was associated with shorter LOS (-5.1 days, p = 0.011). Furthermore, discharge status was significant. Patients who expired in the hospital had a longer LOS (+5.6 days, p = 0.021). Age, gender, and comorbidities (COPD, diabetes, smoking) did not significantly impact LOS in this cohort. Higher TBSA was associated with longer LOS (p < 0.001). For every 1% increase in TBSA, LOS increased by an average of 0.445 days. Conclusions Inhalation injuries, burn severity, and burn source are significant predictors of LOS in geriatric burn patients in Appalachia, while regional resource limitations may uniquely influence care outcomes. Identifying factors affecting LOS can guide tailored interventions to improve recovery and reduce hospital stays in resource-constrained settings. Further research is warranted to explore regional disparities in burn care., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Marshall University Institutional Review Board issued approval 2063568-1. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Rahimpour et al.)