Current expectations for survival in pediatric burns

Background: Conventional wisdom and published reports suggest that children , particularly those younger than 48 months, have higher mortality rates af ter burns than young adults. However, coincident with refinements in resusc itation, operative techniques, and critical care, survival rates for childr en with burns seem to have improved. To document this change and to define current expectations, a review of deaths during two 7-year intervals separa ted by a decade was done. Design: We examined the clinical course of children who died after admissio n for care of acute thermal burns during two 7-year intervals: calendar yea rs 1974 to 1980 inclusive (group 1) and 1991 to 1997 inclusive (group 2). D ying children were stratified by total body surface area (TBSA) burned: sma ll (0%-39%), midsize (40%-59%), and large (60%-100%) TBSA bums. Children wh o arrived with anoxic brain injury or in a moribund state with refractory s hock were excluded from analysis (4 children in group 1 and 5 in group 2); 2 of these children in group 2 died and became solid organ donors. Setting: Regional pediatric burn center. Patients: Six hundred seventy-eight children in group 1 and 1150 children i n group 2. Main Outcome Measure: Survival. Results: In children with 0% to 39% TBSA burns, mortality was 0.6% in group 1 and 0% in group 2 (Fisher exact test, P = .04; chi(2) test, P = .02). In children with 40% to 59% TBSA bums, mortality was 7.7% in group 1 and 0% i n group 2 (Fisher exact test, P = .07; chi(2) test, P = .047). In children with 60% to 100% TBSA bums, mortality was 33.3% in group 1 and 14.3% in gro up 2 (Fisher exact test, P = .04; chi(2) test, P = .02). Although 59% of th e children in group 2 were younger than 48 months, including 55% of those w ith 40% to 59% TBSA burns and 41% of those with 60% to 100% TBSA burns, the re were no deaths in this age group. Conclusion: Survival rates after burns have improved significantly for chil dren. At present, most children, even young children and children with larg e burns, should survive.