MORTALITY DETERMINANTS IN MASSIVE PEDIATRIC BURNS - AN ANALYSIS OF 103 CHILDREN WITH GREATER-THAN-OR-EQUAL-TO-80-PERCENT TBSA BURNS (GREATER-THAN-OR-EQUAL-TO-70-PERCENT FULL-THICKNESS)

Objective Survivors and nonsurvivors among 103 consecutive pediatric p atients with massive burns were compared in an effort to define the pr edictors of mortality in massively burned children. Summary Background Data Predictors of mortality in burns that are used commonly are age, burn size, and inhalation injury. In the past, burns over 80% of the body surface area that are mostly full-thickness often were considered fatal, especially in children and in the elderly. In the past 15 year s, advances in burn treatment have increased rates of survival in thos e patients treated at specialized burn centers. The purpose of this st udy was to document the extent of improvement and to define the curren t predictors of mortality to further focus burn care. Methods Beginnin g in 1982, 103 children ages 6 months to 17 years with burns covering at least 80% of the body surface (70% full-thickness), were treated in the authors' institution by early excision and grafting and have been observed to determine outcome. The authors divided collected independ ent variables from the time of injury into temporally related groups a nd analyzed the data sequentially and cumulatively through univariate statistics and through pooled, cross-sectional multivariate logistic r egression to determine which variables predict the probability of mort ality. Results The mortality rate for this series of massively burned children was 33%. Lower age, larger burn size, presence of inhalation injury, delayed intravenous access, lower admission hematocrit, lower base deficit on admission, higher serum osmolarity at arrival to the a uthors' hospital, sepsis, inotropic support requirement, platelet coun t <20,000, and ventilator dependency during the hospital course signif icantly predict increased mortality. Conclusions The authors conclude that mortality has decreased in massively burned children to the exten t that nearly all patients should be considered as candidates for surv ival, regardless of age, burn size, presence of inhalation injury, del ay in resuscitation, or laboratory values on initial presentation. Dur ing the course of hospitalization, the development of sepsis and multi organ failure is a harbinger of poor outcome, but the authors have enc ountered futile cases only rarely. The authors found that those patien ts who are most apt to die are the very young, those with limited dono r sites, those who have inhalation injury, those with delays in resusc itation, and whose with burn-associated sepsis or multiorgan failure.