Inpatient Complications and Outcomes for Burn Patients Admitted with Opioid-Positive Drug Screens

Opioid use disorder complicates the management of burn injuries, particularly in achieving adequate pain control. While prior single-institution studies have evaluated associations between opioid use and burn outcomes, multi-institutional analyses of inpatient complications remain limited. Using the American Burn Association Noncommercial Burn Research Dataset, this study compares inpatient outcomes among patients with prehospital opioid-positive screening versus those with negative screening. Among 32 052 patients included, 50.5% screened positive for opioids at the time of presentation. These patients were more likely to be female (p < .0001), more likely to possess scald injuries (p < .0001), and less likely to be experiencing homelessness (p < .0001) or to be diagnosed with inhalation injury (p < .005). Opioid positivity was associated with increased odds of infectious complications, such as cellulitis (OR = 2.7, p < .0001) and sepsis (OR = 1.41, p < .001). Opioid negativity, conversely, had a higher prevalence of acute respiratory distress syndrome (p < .0001), acute kidney injury (p < .0001), respiratory failure (p < .05), and cardiac arrest (p < .05). The opioid-negative population also necessitated more frequent admission to the critical care unit (p < .05) and demonstrated higher overall mortality (p < .0001). These findings highlight the vulnerability of opioid-negative patients who may have delayed presentation and more severe injuries than originally anticipated. This work underscores the need for heightened vigilance and equitable, early care for these patients to mitigate risk in this group.