Background: Factors contributing to mortality in burned children with acute
renal failure have been identified; however, they have not been identified
in thermally injured adults.
Methods: The records of 1,404 acutely burned adults admitted to the Blocker
Burn Unit were reviewed. Seventy-six patients with acute renal dysfunction
and burns covering more than 30% of their total body surface area with a f
ull-thickness component greater than 10% total body surface area were ident
ified. These patients were divided into those admitted from 1981 through 19
89 (n = 35) and those admitted from 1990 to 1998 (n = 41),
Results: No significant differences could be shown in the incidence of acut
e renal dysfunction (5.4 vs, 5.1%) or mortality (88 vs, 87%) for the two ti
me periods, respectively. Sixty-seven percent of the survivors were younger
than 40 years of age, compared with only 25% of nonsurvivors (p < 0.02); s
epsis was identified in 44 and 96% of survivors and nonsurvivors, respectiv
ely (p < 0.001). Fluid resuscitation was delayed in survivors by 1.7 +/- 1.
0 hours compared with 4.4 +/- 2.1 hours in nonsurvivors (p < 0.001).
Conclusion: Early fluid resuscitation and the prevention of sepsis may redu
ce the incidence of acute renal dysfunction and mortality in burned adults.