Ma H.Tung K.-Y.Tsai S.-L.Neil D.L.Ling Y.-Y.Yen H.-T.Lin K.-L.Cheng Y.-T.Kao S.-C.Lin M.-N.Dai N.-T.Perng C.-K.TYNG-GUEY WANGHAO-CHIH TAIChen L.-R.Tuan Y.-C.Lin C.-H.2020-06-172020-06-1720200305-4179https://www.scopus.com/inward/record.uri?eid=2-s2.0-85085663054&doi=10.1016%2fj.burns.2020.02.008&partnerID=40&md5=c3f7b13a4661d4cb04bcf3f6f3284e06https://scholars.lib.ntu.edu.tw/handle/123456789/502746Purpose: To study outcomes among survivors of the mass-casualty powder explosion on 27 June 2015, at Formosa Fun Coast Waterpark, New Taipei City, Taiwan. Methods: Using retrospective data on Taiwanese survivors, we analyzed prehospital management, burns assessment and prognosis, functional recovery, and medical costs, followed-up through 30 June 2017. We related outcomes to burn extent, categorized according to the percentages of total body surface area with second/third-degree burns (%TBSA) or autologous split-thickness skin grafts (%STSG), and an investigational scale: f{SASG} = (%TBSA + %STSG)/2, stratified by %STSG. Analyses included casualty dispersal, comparisons between %TBSA, %STSG and f{SASG}, and their relationships with length of hospitalization, times to rehabilitation and social/school re-entry, physical/mental disability, and medical costs. We also investigated how burn scars restricting joint mobility affected rehabilitation duration. Results: 445 hospitalized casualties (excluding 16 foreigners, 23 with 0% TBSA and 15 fatalities) aged 12–38 years, had mean TBSA of 41.1%. Hospitalization and functional recovery durations correlated with %TBSA, %STSG and f{SASG} – mean length of stay per %TBSA was 1.5 days; more numerous burn scar contractures prolonged rehabilitation. Females had worse burns than males, longer hospitalization and rehabilitation, and later school/social re-entry; at follow-up, 62.3% versus 37.7% had disabilities and 57.7% versus 42.3% suffered mental trauma (all p ≤ 0.001). Disabilities affecting 225/227 people were skin-related; 34 were severely disabled but 193 had mild/moderate impairments. The prevalence of stress-related and mood disorders increased with burn extent. Treatment costs (mean USD-equivalents ∼$48,977/patient, ∼$1192/%TBSA) increased with burn severity; however, the highest %TBSA, %STSG and f{SASG} categories accounted for <10% of total costs, whereas TBSA 41–80% accounted for 73.2%. Conclusions: Besides %TBSA, skin-graft requirements and burn scar contractures are complementary determinants of medium/long-term outcomes. We recommend further elucidation of factors that influence burn survivors’ recovery, long-term physical and mental well-being, and quality of life. © 2020 The Authors[SDGs]SDG3[SDGs]SDG11adolescent; adult; Article; body surface; burn; burn scar; burn survivor; child; cohort analysis; contracture; explosion; female; follow up; functional assessment; health care cost; human; joint mobility; length of stay; major clinical study; male; mass disaster; medical record review; mood disorder; observational study; outcome assessment; physical disability; prevalence; prognosis; psychological well-being; psychotrauma; quality of life; rehabilitation; retrospective study; second degree burn; split thickness skin graft; stress; Taiwan; body surface; burn; contracture; economics; explosion; health care cost; injury scale; mental health; pathology; pathophysiology; skin transplantation; survivor; Taiwan; young adult; Adolescent; Adult; Body Surface Area; Burns; Cohort Studies; Contracture; Explosions; Female; Health Care Costs; Humans; Length of Stay; Male; Mass Casualty Incidents; Mental Health; Psychological Trauma; Quality of Life; Retrospective Studies; Skin Transplantation; Survivors; Taiwan; Trauma Severity Indices; Young Adultjournal article10.1016/j.burns.2020.02.0082-s2.0-85085663054