Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn?

Robert Kraft, Gabriela A. Kulp, David Herndon, Fatemah Emdad, Felicia N. Williams, Hal K. Hawkins, Katrina R. Leonard, Marc G. Jeschke

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns. Interventions: None. Measurements and Main Results: Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < .05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05). Conclusion: The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.

Original languageEnglish (US)
JournalPediatric Critical Care Medicine
Volume12
Issue number6
DOIs
StatePublished - Nov 2011

Fingerprint

Burns
Inflammation
Acute-Phase Reaction
Mortality
Body Surface Area
Morbidity
Patient Advocacy
Propensity Score
Acute-Phase Proteins
Energy Metabolism
Sepsis
Analysis of Variance
Cohort Studies
Hot Temperature
Hormones
Pediatrics
Cytokines
Students
Wounds and Injuries
Population

Keywords

  • burn injury
  • burn type
  • cytokines
  • morbidity
  • mortality
  • pediatric

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn? / Kraft, Robert; Kulp, Gabriela A.; Herndon, David; Emdad, Fatemah; Williams, Felicia N.; Hawkins, Hal K.; Leonard, Katrina R.; Jeschke, Marc G.

In: Pediatric Critical Care Medicine, Vol. 12, No. 6, 11.2011.

Research output: Contribution to journalArticle

Kraft, R, Kulp, GA, Herndon, D, Emdad, F, Williams, FN, Hawkins, HK, Leonard, KR & Jeschke, MG 2011, 'Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn?', Pediatric Critical Care Medicine, vol. 12, no. 6. https://doi.org/10.1097/PCC.0b013e31820ac2c5
Kraft, Robert ; Kulp, Gabriela A. ; Herndon, David ; Emdad, Fatemah ; Williams, Felicia N. ; Hawkins, Hal K. ; Leonard, Katrina R. ; Jeschke, Marc G. / Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn?. In: Pediatric Critical Care Medicine. 2011 ; Vol. 12, No. 6.
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AU - Williams, Felicia N.

AU - Hawkins, Hal K.

AU - Leonard, Katrina R.

AU - Jeschke, Marc G.

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N2 - Objective: Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns. Interventions: None. Measurements and Main Results: Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < .05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05). Conclusion: The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.

AB - Objective: Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns. Interventions: None. Measurements and Main Results: Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < .05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05). Conclusion: The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.

KW - burn injury

KW - burn type

KW - cytokines

KW - morbidity

KW - mortality

KW - pediatric

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