Determinants of death following burn injury

Background: Burn care has changed considerably. Early surgery, nutritional support, improved resuscitation and novel skin replacement techniques are n ow well established. The aim of the study was to establish whether changes in management have improved survival following burn injury and to determine the contributory factors leading to non-survival. Methods: This was a retrospective outcome analysis of data collected from a consecutive series of 4094 patients with burns admitted to a tertiary refe rral, metropolitan teaching hospital between 1972 and 1996, Results: The overall mortality rate was 3.6 per cent. This decreased from 5 .3 per cent (1972-1980) to 3.4 per cent (1993-1996) (P = 0.076). The risk o f death was increased with increasing burn size (relative risk (RR) 95.90 ( 95 per cent confidence interval 12.60-729.47) if more than 35 per cent of t he total body surface area was burned; P < 0.001) increasing age (RR 7.32 ( 3.08-17.42) if aged more than 48 years; P < 0.001), inhalation injury (RR 3 .61 (2.39-5.47); P < 0.001) and female sex (RR 1.82 (1.23-2.69); P = 0.003) . Operative intervention (RR 0.11 (0.06-0.21); P < 0.001) and the presence of an upper limb burn (RR 0.53 (0.35-0.79); P = 0.002) decreased the risk. Conclusion: Modern burn care has decreased the mortality rate. Increasing b urn size, increasing age, inhalation injury and female sex increased, while operative intervention and an upper limb burn decreased, the risk of death .