Survival from burns in the new millennium: 70 years' experience from a single institution

Abstract

Objective: This review explores the series of published analyses from Massachusetts General Hospital to better understand how changes in medical specialization of burn medicine likely enabled the most important increase in survival from burns in the past 70 years.

Background: Seventy years ago, survival from the most serious burn injuries was not possible even in the most advanced countries until critical advances were introduced. Insights into those few medical advances that actually impacted survival might be better understood from the consideration of a continuous series of survival analyses over 7 decades at Massachusetts General Hospital.

Methods: Mortality data from previously reported probit and logit analyses from thousands of patients treated at Massachusetts General Hospital were reviewed. A comparison of mortality from these prior mortality analyses from a more recent multicenter study and a national data set was performed.

Results: The only giant leap forward in survival occurred during the 1970s, with no improvement during either the preceding or subsequent 30-year intervals. Despite the many modern advances that have been added to the care of these patients since 1984, although these may have represented medical progress, these advances did not impact survival.

Conclusions: Survival rates from burn injury may have been maximized by current treatment approaches within medical centers of excellence in burn medicine. Further efforts to improve the quality of life of survivors of burn injury should ultimately have very favorable impact upon the long-term outcomes in these patients who now survive such devastating injuries.

Figure 1. Seventy-year mortality from burns at MGH

Average annual mortality rates or average mortality rates for an indicated time period from a series of published statistical analyses^– and improved survival rates from burn injury 2000–2007 (unpublished results) at the MGH over 70 years. The 30-year period prior to the 1970s was a combined mortality rate for both children and adults whereas the 30-year period after the early 1980s was segregated mortality rates for children and adults. a 1939–1943 vs. 1943–1954, χ²=2.82, 0.10 > p > 0.05 ; b 1939–1954 vs. 1955–1969, no difference ; c 1990–1994 vs. 1984, no difference ; d 1990–1994 vs. 2000–2007, no difference (unpublished results)

Figure 2. Mortality for Glue Grant versus NBR patients

Comparisons of mortality rates by TBSA quintile and age group (<50 years old versus ≥50 years old) for those patients in the Glue Grant with those in the NBR are shown. For young patient (<50 years), improved survival rates were seen for >35.5 TBSA injuries, whereas for older patients (≥50 years) improved survival rates were seen in 20–49.9% TBSA injuries. Manuscript in press at time of this manuscript submission: Reprinted from Annals of Surgery, day/month/year, volume #, issue #, pp #. Wolters Kluwer Health Lippincott Williams & Wilkins©