Corneal abrasions in burn admissions: severity and geographic access factors in a retrospective cohort

Background: Characterizing the incidence and determinants of corneal abrasions in burn patients and evaluating the roles of burn severity, comorbidities, and social determinants of health (SDOH) in shaping risk can inform screening and care. Methods: We conducted a retrospective cohort study of patients admitted to a regional burn center between January 1, 2019, and January 1, 2024. Eligible patients had documented burns and a complete ophthalmologic examination at admission. Demographics, burn severity, comorbidities, SDOH indices (Social Vulnerability Index [SVI], Area Deprivation Index [ADI]), geographic access, and outcomes were abstracted from the medical record. Group comparisons were performed using standard statistical tests. Results: Among 2023 patients, 90 (4.4%) had corneal abrasions. They had greater total body surface area burned (17.5% vs 6.2%, P < 0.001) and longer hospitalizations, intensive care unit stays, and ventilation durations (all P < 0.001). Abrasions were associated with inhalation injury (58% vs 19%, P < 0.001) and in-hospital mortality (18.9% vs 4.9%, P < 0.001). Patients with abrasions traveled farther (151 vs 121 miles, P = 0.02) and were more often from out of state (8.2% vs 3.6%). No significant differences were found in SVI, ADI, or most comorbidities, though diabetes was less common (7.8% vs 16.4%, P = 0.04). Conclusion: Corneal abrasions occur in about 1 in 20 burn admissions and are strongly associated with burn severity and critical illness. Geographic distance and incomplete race documentation were additional risk factors, while SDOH indices and diabetes were not. These findings identify corneal abrasions as markers of systemic severity and health system disparities, supporting standardized eye-care protocols for high-risk burn patients.