Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn?

Abstract

Objective: Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns.

Interventions: None.

Measurements and main results: Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < .05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05).

Conclusion: The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.

Figure 1

Survival curve of the whole patient population (A) and patients with corresponding burn size (B).

Figure 2

Inflammatory parameters IL-6 and CRP.

Figure 3

Creatinin (A) and blood urea nitrogen (B) reflecting an impaired renal function in the flame burned group.

Figure 4

Assessment of the metabolic function utilizing daily average glucose levels (A) and administrated insulin (B). Resting energy expenditure (REE) increasing over the first half year with significant higher levels in the flame burned group (C).

Figure 5

A: flame burn B: scald burn. Micrograph showing an intense acute inflammatory infiltrate at the base of a zone of necrosis in an excision specimen from a scald burn wound. H&E, 40x magnification, scale bar 1.0 mm.