Morbidity and survival probability in burn patients in modern burn care

Abstract

Objective: Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn.

Design and patients: Burn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0-99 years old, admission within 96 hours after injury, and more than 20% total body surface area burns requiring at least one surgical intervention.

Setting: Six major burn centers in North America.

Measurements and main results: Burn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by American Burn Association sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (Denver 2 score>3) for both children (<16 yr) and adults (16-65 yr). Five hundred seventy-three patients were enrolled, of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children, the cutoff burn size for mortality, sepsis, infection, and multiple organ failure was approximately 60% total body surface area burned. In adults, the cutoff for these outcomes was lower, at approximately 40% total body surface area burned.

Conclusions: In the modern burn care setting, adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality, even in highly specialized centers.

Figure 1

(A) Kaplan Meier survival curve in pediatric and adult patients.Survival probability was greatest in pediatric patients and progressively worse inadult and elderly patients.*Significant difference between pediatric and adult patients p<0.05. (B-E)Cutoff values for sepsis, burn wound infections, MOF and mortality, according to age. (B) The cutoffs for sepsis, burn wound infections, MOF and mortality are greatest in pediatric patientsand then decrease to about 40% TBSA burned in adults and 30% TBSA burned for elderly. (C-E) Incidence of patients with burns below or above the cutoff in the different age groups. *Significant difference between groups, p<0.05.