The leading causes of death after burn injury in a single pediatric burn center

Abstract

Introduction: Severe thermal injury is characterized by profound morbidity and mortality. Advances in burn and critical care, including early excision and grafting, aggressive resuscitation and advances in antimicrobial therapy have made substantial contributions to decrease morbidity and mortality. Despite these advances, death still occurs. Our aim was to determine the predominant causes of death in burned pediatric patients in order to develop new treatment avenues and future trajectories associated with increased survival.

Methods: Primary causes of death were reviewed from 144 pediatric autopsy reports. Percentages of patients that died from anoxic brain injuries, sepsis, or multi-organ failure were calculated by comparing to the total number of deaths. Data was stratified by time (from 1989 to 1999, and 1999 to 2009), and gender. Statistical analysis was done by chi-squared, Student's t-test and Kaplan-Meier for survival where applicable. Significance was accepted as P < 0.05.

Results: Five-thousand two-hundred-sixty patients were admitted after burn injury from July 1989 to June 2009, and of those, 145 patients died after burn injury. Of these patients, 144 patients had an autopsy. The leading causes of death over 20 years were sepsis (47%), respiratory failure (29%), anoxic brain injury (16%), and shock (8%). From 1989 to 1999, sepsis accounted for 35% of deaths but increased to 54% from 1999 to 2009, with a significant increase in the proportion due to antibiotic resistant organisms (P < 0.05).

Conclusions: Sepsis is the leading cause of death after burn injury. Multiple antibiotic resistant bacteria now account for the bulk of deaths due to sepsis. Further improvement in survival may require improved strategies to deal with this problem.

Figure 1

Cause of death stratified by decade and gender. More patients died of respiratory failure from July 1989 to June 1999, while more patients died from sepsis from July 1999 to June 2009. More male patients from all time points died of sepsis compared with females, while more female patients from all time points died of respiratory failure compared with males (*P < 0.05 compared with females).

Figure 2

Cause of death from sepsis stratified by organisms. * P < 0.05 compared with other organisms. More septic patients died of drug-resistant organisms.

Figure 3

Percent of patients remaining for the different causes of death. * P < 0.05. Patients that died of sepsis lived longer until death compared with patients that died of shock, brain death, or respiratory failure.