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)
Se. Wolf et al., 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), Annals of surgery, 225(5), 1997, pp. 554-565
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.