Mortality determinants in massive pediatric burns

An analysis of 103 children with ≤80% TBSA burns (≤70% full-thickness)

Steven Wolf, J. Keith Rose, Manubhai H. Desai, Joan P. Mileski, Robert E. Barrow, David Herndon

Research output: Contribution to journalArticle

239 Citations (Scopus)

Abstract

Objective: Survivors and nonsurvivors among 103 consecutive pediatric patients with massive burns were compared in an effort to define the predictors 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 years, advances in burn treatment have increased rates of survival in those patients treated at specialized burn centers. The purpose of this study was to document the extent of improvement and to define the current predictors of mortality to further focus burn care. Methods: Beginning 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 independent variables from the time of injury into temporally related groups and analyzed the data sequentially and cumulatively through univariate statistics and through pooled, cross-sectional multivariate logistic regression to determine which variables predict the probability of mortality. 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 authors' hospital, sepsis, inotropic support requirement, platelet count <20,000, and ventilator dependency during the hospital course significantly predict increased mortality. Conclusions: The authors conclude that mortality has decreased in massively burned children to the extent that nearly all patients should be considered as candidates for survival, regardless of age, burn size, presence of inhalation injury, delay in resuscitation, or laboratory values on initial presentation. During the course of hospitalization, the development of sepsis and multiorgan failure is a harbinger of poor outcome, but the authors have encountered futile cases only rarely. The authors found that those patients who are most apt to die are the very young, those with limited donor sites, those who have inhalation injury, those with delays in resuscitation, and those with burn-associated sepsis or multiorgan failure.

Original languageEnglish (US)
Pages (from-to)554-569
Number of pages16
JournalAnnals of Surgery
Volume225
Issue number5
DOIs
StatePublished - 1997

Fingerprint

Burns
Pediatrics
Mortality
Inhalation
Wounds and Injuries
Sepsis
Resuscitation
Inhalation Burns
Burn Units
Body Surface Area
Mechanical Ventilators
Platelet Count
Hematocrit
Osmolar Concentration
Survivors
Hospitalization
Survival Rate
Logistic Models
Tissue Donors
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Mortality determinants in massive pediatric burns : An analysis of 103 children with ≤80% TBSA burns (≤70% full-thickness). / Wolf, Steven; Rose, J. Keith; Desai, Manubhai H.; Mileski, Joan P.; Barrow, Robert E.; Herndon, David.

In: Annals of Surgery, Vol. 225, No. 5, 1997, p. 554-569.

Research output: Contribution to journalArticle

Wolf, Steven ; Rose, J. Keith ; Desai, Manubhai H. ; Mileski, Joan P. ; Barrow, Robert E. ; Herndon, David. / Mortality determinants in massive pediatric burns : An analysis of 103 children with ≤80% TBSA burns (≤70% full-thickness). In: Annals of Surgery. 1997 ; Vol. 225, No. 5. pp. 554-569.
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abstract = "Objective: Survivors and nonsurvivors among 103 consecutive pediatric patients with massive burns were compared in an effort to define the predictors 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 years, advances in burn treatment have increased rates of survival in those patients treated at specialized burn centers. The purpose of this study was to document the extent of improvement and to define the current predictors of mortality to further focus burn care. Methods: Beginning 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 independent variables from the time of injury into temporally related groups and analyzed the data sequentially and cumulatively through univariate statistics and through pooled, cross-sectional multivariate logistic regression to determine which variables predict the probability of mortality. 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 authors' hospital, sepsis, inotropic support requirement, platelet count <20,000, and ventilator dependency during the hospital course significantly predict increased mortality. Conclusions: The authors conclude that mortality has decreased in massively burned children to the extent that nearly all patients should be considered as candidates for survival, regardless of age, burn size, presence of inhalation injury, delay in resuscitation, or laboratory values on initial presentation. During the course of hospitalization, the development of sepsis and multiorgan failure is a harbinger of poor outcome, but the authors have encountered futile cases only rarely. The authors found that those patients who are most apt to die are the very young, those with limited donor sites, those who have inhalation injury, those with delays in resuscitation, and those with burn-associated sepsis or multiorgan failure.",
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T1 - Mortality determinants in massive pediatric burns

T2 - An analysis of 103 children with ≤80% TBSA burns (≤70% full-thickness)

AU - Wolf, Steven

AU - Rose, J. Keith

AU - Desai, Manubhai H.

AU - Mileski, Joan P.

AU - Barrow, Robert E.

AU - Herndon, David

PY - 1997

Y1 - 1997

N2 - Objective: Survivors and nonsurvivors among 103 consecutive pediatric patients with massive burns were compared in an effort to define the predictors 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 years, advances in burn treatment have increased rates of survival in those patients treated at specialized burn centers. The purpose of this study was to document the extent of improvement and to define the current predictors of mortality to further focus burn care. Methods: Beginning 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 independent variables from the time of injury into temporally related groups and analyzed the data sequentially and cumulatively through univariate statistics and through pooled, cross-sectional multivariate logistic regression to determine which variables predict the probability of mortality. 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 authors' hospital, sepsis, inotropic support requirement, platelet count <20,000, and ventilator dependency during the hospital course significantly predict increased mortality. Conclusions: The authors conclude that mortality has decreased in massively burned children to the extent that nearly all patients should be considered as candidates for survival, regardless of age, burn size, presence of inhalation injury, delay in resuscitation, or laboratory values on initial presentation. During the course of hospitalization, the development of sepsis and multiorgan failure is a harbinger of poor outcome, but the authors have encountered futile cases only rarely. The authors found that those patients who are most apt to die are the very young, those with limited donor sites, those who have inhalation injury, those with delays in resuscitation, and those with burn-associated sepsis or multiorgan failure.

AB - Objective: Survivors and nonsurvivors among 103 consecutive pediatric patients with massive burns were compared in an effort to define the predictors 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 years, advances in burn treatment have increased rates of survival in those patients treated at specialized burn centers. The purpose of this study was to document the extent of improvement and to define the current predictors of mortality to further focus burn care. Methods: Beginning 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 independent variables from the time of injury into temporally related groups and analyzed the data sequentially and cumulatively through univariate statistics and through pooled, cross-sectional multivariate logistic regression to determine which variables predict the probability of mortality. 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 authors' hospital, sepsis, inotropic support requirement, platelet count <20,000, and ventilator dependency during the hospital course significantly predict increased mortality. Conclusions: The authors conclude that mortality has decreased in massively burned children to the extent that nearly all patients should be considered as candidates for survival, regardless of age, burn size, presence of inhalation injury, delay in resuscitation, or laboratory values on initial presentation. During the course of hospitalization, the development of sepsis and multiorgan failure is a harbinger of poor outcome, but the authors have encountered futile cases only rarely. The authors found that those patients who are most apt to die are the very young, those with limited donor sites, those who have inhalation injury, those with delays in resuscitation, and those with burn-associated sepsis or multiorgan failure.

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