Background: During the past 13 years, mortality from acute renal failu
re in burned children has been on the decline. Objective: To determine
which new burn therapies contributed to the decrease in mortality. De
sign: The medical records of burned children admitted from February 19
66 to January 1997 were reviewed, and the outcome of changes in the tr
eatment of burned children were compared. Patients and Methods: Sixty
children with acute renal failure were identified. These children were
divided into those admitted from 1966 to 1983 (n = 24) and those admi
tted from 1984 to 1997 (n=36). They were compared with matched control
subjects from the same period without renal failure. Values are prese
nted as means +/- SEMs. Statistical analysis was by the Student t test
or chi(2) analysis. Results: Mortality rates in burned children with
acute renal failure decreased from 100% before 1983 to 56% after 1984
(P<.001). The time between a burn injury and the initiation of intrave
nous fluid resuscitation was 8.6+/-1.7 hours before 1983 compared with
3.0+/-0.5 hours after 1984 (P<.005). The time between a burn injury a
nd complete early wound excision decreased from 228 +/- 37 hours befor
e 1983 to 40 +/- 7 hours after 1984 (P<.001). The incidence of sepsis
decreased from 71% to 44% in these periods (P<.05). After 1984, surviv
ors had a shorter time delay for fluid resuscitation than nonsurvivors
(1.7 +/- 0.5 hours vs 4.8 +/- 0.9 hours; P<.005) and a lower incidenc
e of sepsis (19% vs 60%; P<.05). From 1984 to 1997, burned children wi
th acute renal failure who did not require dialysis had significantly
shorter delays for fluid resuscitation (2.2 +/- 0.5 hours vs 4.4 +/- 0
.9 hours) and complete wound excision (29 +/- 6 hours vs 49 +/- 7 hour
s) compared with those requiring dialysis (P<.05 for both). Conclusion
: Early adequate fluid resuscitation, early wound excision, and better
infection control may reduce mortality in burned children with acute
renal failure.