postburn mortality [multivariable OR 0.77 (95%CI 0.72- Abstract citation ID: irad045.006 0.81), p< 0.001]. Additionally, urban vs. rural patient C-155 residence was associated with decreased odds of postburn mor- Correlative V: Prevention/Epidemiology/Public tality [multivariable OR 0.36 (95%CI 0.16-0.85), p=0.015]. Conclusions: Our study shows that increasing FS score was Health associated with decreased odds of pediatric postburn mor- 32 Food Security as a Predictor of Global tality. Additionally, mortality and flame injuries were higher Pediatric Postburn Mortality in Moderate vs. Good FSE-grouped countries. International efforts to increase FS may improve survival in pediatric burn Rafael Felix Tiongco, BA, Ayman Ali, MD, patients. Joseph Puthumana, MD, C. Scott Hultman, MD, Applicability of Research to Practice: Improving food MBA, Julie Caffrey, DO, Richard Redett, MD, security is an actionable item that may improve pediatric Carisa Cooney, MPH postburn outcomes regardless of the country’s FSE-grouping. Johns Hopkins University School of Medicine, Baltimore, Maryland; Duke University School of Medicine, Durham, North Carolina; Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland Introduction: Food security (FS) is defined as access to suf- ficient and nutritious food. Children are disproportionately affected by low FS. Globally, burns contribute to over 50% of the disability-adjusted life years lost among 0-14 year-old children. Given the significance of nutrition in postburn outcomes, we hypothesized that high FS would be predictive of decreased global postburn mortality in pediatric patients. Methods: Publicly-available, deidentified datasets were obtained from the World Health Organization’s Global Burn Registry (GBR) and Corteva Agriculture’s Global FS Index (GFSI). The GFSI calculates a FS score annually from in- tergovernmental organization data reviewed by a panel of experts. FS score was reported on a scale from 0-100 with 100 indicating the highest FS. The GFSI also groups countries into “Good” (FS score ≥ 60) or “Moderate” (FS Score ≥ 40) FS environments (FSEs). Patients aged 0-19 years were in- cluded; after linking GBR and GFSI datasets, countries with < 100 patients were excluded. Descriptive statistics and non- parametric tests were performed on data stratified by FSE. Multiple logistic regression controlling for %TBSA was used to predict mortality with FS score. All statistical analyses were conducted in R version 4.1.2. Results: From 2016-2020, there were 2,246 cases over nine countries: Peru (n=839, 37.4%), Tanzania (n=290, 12.9%), India (n=225, 10.0%), Nigeria (n=195, 8.7%), Pakistan (n=181, 8.1%), Kenya (n=166, 7.4%), Nepal (n=145, 6.5%), South Africa (n=105, 4.7%), and Mexico (n=100, 4.5%). Median age was 3.0 [IQR 2.0, 7.0] years with 42.7% female. Median %TBSA was 15.0 [IQR 5.0, 25.0]%. Most injuries were by hot liquid, steam, or gas (n=1,457, 64.9%) followed by flame (n=560, 24.9%). There were 259 deaths (11.5%). Stratified by FSE, 939 cases occurred in “Good” and 1,307 in “Moderate” FSE countries. More flame injuries occurred in Moderate (n=373, 28.5%) vs. Good (187, 19.9%, p< 0.001) FSEs while more hot liquid, steam, or gas injuries occurred in Good (n=688, 73.3%) vs. Moderate (n=769, 58.8%, p< 0.001) FSEs. Mortality was higher in Moderate (n=245, 18.7%) vs. Good (n=14, 1.5%, p< 0.001) FSEs. Regression analysis controlling for %TBSA showed increased FS score was associated with decreased odds of pediatric May 15–19, 2023 S5 Abstract citation ID: irad045.007 Abstract citation ID: irad045.008 33 Targeting Vulnerability in the Homeless–A 34 Evaluation of Socioeconomic Status and National Analysis of Burn Injuries Presenting Burn Injuries: A Retrospective Review From a to the Emergency Department. Desert Burn Center Jennifer Shah, BA, BS, Farrah Liu, MD, Samuel Cohler, MS, Paul Chestovich, MD, FACS, Priscila Cevallos, BS, Uchechukwu Amakiri, BS, Syed Saquib, MD FACS, Kavita Batra, BDS, MPH, Thomas Johnstone, BS, Clifford Sheckter, MD, Ph.D., FRSPH Rahim Nazerali, MD, MHS, FACS Kirk Kerkorian School of Medicine at UNLV, Las Stanford University, New York, New York; Stanford Vegas, Nevada; ; Kirk Kerkorian School of Medicine University, Stanford, California; Stanford University, at UNLV, Las Vegas, Nevada; Kirk Kerkorian School Stanford, California; Icahn School of Medicine of Medicine at UNLV/UMC Lions Burn Care at Mount Sinai, New York, New York; Stanford Center, Las Vegas, Nevada; Kirk Kerkorian School of University, Stanford, California; Stanford University, Medicine at UNLV, Las Vegas, Nevada Palo Alto, California; Stanford University, Stanford, California Introduction: Incidence of burn injury rate appears to be af- fected by socioeconomic status (SES). Previous studies have Introduction: Burn management is complex and outcomes indicated that patients with low SES have an increased risk depend on injury severity, timing of presentation, and special- of unintentional burn injuries. However, this association has ized multidisciplinary care. Burn injuries among the homeless not been explored robustly in the Southwest United States. are an increasing problem in the United States (US) as record This study aims to investigate the relationship between SES numbers of people are unsheltered and using unsafe heating and burn injuries amongst patients in the Southwest United practices. This study aims to characterize mechanism, demo- States. graphic, and social factors related to burn injuries in homeless Methods: A retrospective registry review was performed on all persons. burn injury admissions to our ABA verified burn center from Methods: Burn encounters were extracted from the 2019 January 1, 2017 to December 31, 2021. Their zip code was Nationwide Emergency Department Sample (NEDS) da- then inputted into the Distressed Communities Index (DCI). tabase. Two cohorts were created comparing homeless and This is a national database that stratifies communities by zip non-homeless encounters. Burn characteristics (size, depth, code into quintiles, indicating overall distress. The DCI was location and mechanism), comorbidities, demographics, used as a measure of SES as it reflects employment status, ed- and ED treatments were compared with univariate testing. ucation level, poverty rate, median income, business growth, Multivariable regression evaluated the likelihood of admis- and housing vacancies. Patients who did not report an accu- sion. Discharge weights were used to yield national estimates. rate residential zip code or reported a zip code not included in Results: Of 316,334 ED visits meeting criteria for burn injuries the DCI were excluded. Many clinical variables were reviewed in 2019, 1,919 (0.6%) had a diagnosis code for homelessness. within each quintile including age, gender, total body surface Homelessness burn encounters were significantly older (mean area (TBSA), ICU days, hospital length of stay (LOS), venti- age 32.4 vs. 44.8), were more often male (71% vs. 52%), were lator days, surgical interventions, and discharge disposition. more often White (59% vs. 54%) or Black (24% vs. 21%), were Student’s t-test and Chi-squared tests were used to compare more often presenting to EDs in the Western region of the US groups, and statistical significance was defined at p < 0.05. (43% vs. 19%), and more often had Medicaid as primary payer Results: A total of 1,323 patients were identified in the (51% vs 33%). Burns in homeless encounters more commonly study period. The most distressed quintile accounted for 481 resulted from flame injury and more commonly involved the (36.4%) admissions. Flame and contact burns were the most lower extremity (p< 0.001). Among homeless encounters, burn common etiology overall (46.5%), as well as within each injuries were more often due to self-harm (12% vs. 2%) or as- quintile (Figure 1). The distribution of burn injury etiology sault (5% vs. 1%)(p< 0.001). In addition, homeless encounters was statistically significant by age, %TBSA, gender, race, and had significantly greater mental illness related to substance ethnicity (p < 0.001, Table 1); however, it was not significant abuse (69% vs 16%, p< 0.001) and had greater comorbidity by SES (p = 0.202). Burn severity, categorized as less than burden (38% vs. 6% had Elixhauser index scores of 3 or higher; or equal to second degree burns, or greater than or equal p< 0.001). Homeless encounters experienced higher rates of to third degree burns, showed significance when compared third degree burns and concomitant injuries (p≤0.003). 49% vs to age, LOS, ICU days, ventilator days, and total surgical 7% of homeless and non-homeless encounters, respectively, re- interventions performed (p < 0.001). However, the associa- quired admission, and homelessness was associated with higher tion between SES and burn severity was not found to be sig- odds of admission (adjusted OR 4.58; 95% CI 3.066–6.828; nificant (p = 0.886). p< 0.001). Conclusions: The two most distressed quintiles represented Conclusions: Burn injuries in the homeless affect a vulner- over half of the burn admissions. A lower SES did not con- able population who is older, has more comorbidities, and tribute to increased burn severity or utilization of healthcare has deeper burns. Mental illness is over 4 times more likely in resources. This study highlighted differences in burn injuries this population who is also at increased risk of getting burned between age, gender, race, and ethnicity. through assault. Applicability of Research to Practice: Identifying Applicability of Research to Practice: Burn injuries communities at increased risk for burn injuries can help with presenting to the ED should be screened for homelessness public health initiatives, focused on awareness and prevention given the associated risk factors. Legal, medical, and mental of these injuries. health resources can then be appropriately targeted. S6 American Burn Association 55th Annual Meeting