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BackgroundPrevious reports individually identified different factors that predict death after burns. The authors employed the multi-center American Burn Association’s (ABA) National Burn Repository (NBR) to elucidate which parameters have the highest negative impact on burn mortality.MethodsWe audited data from the NBR v8.0 for the years 2002–2011 and included 137,061 patients in our study. The cases were stratified into two cohorts based on the primary outcome of death/survival and then evaluated for demographic data, intraoperative details, and their morbidity after admission. A multivariable regression analysis aimed to identify independent risk factors associated with mortality.ResultsA total of 3.3% of patients in this analysis did not survive their burn injuries. Of those, 52.0% expired within 7 days after admission. Patients in the mortality cohort were of older age (p < 0.001), more frequently female (p < 0.001), and had more pre-existing comorbidities (p < 0.001). Total body surface area (TBSA), inhalation injury, hospitalization time, and occurrence of complications were higher compared to survivors (p < 0.001). Lack of insurance (odds ratio (OR) = 1.84, confidence interval (CI) 1.38–2.46), diabetes (OR = 1.24, CI 1.01–1.53), any complication (OR = 4.09, CI 3.27–5.12), inhalation injury (OR = 3.84, CI 3.38–4.36), and the need for operative procedures (OR = 2.60, CI 2.20–3.08) were the strongest independent contributors to mortality after burns (p < 0.001). Age (OR = 1.07, CI 1.06–1.07) and TBSA (OR = 1.09, CI 1.09–1.09) were significant on a continuous scale (p < 0.001) while overall comorbidities were not a statistical risk factor.ConclusionUninsured status, inhalation injury, in-hospital complications, and operative procedures were the strongest mortality predictors after burns. Since most fatal outcomes (52.0%) occur within 7 days after injury, physicians and medical staff need to be aware of these risk factors upon patient admission to a burn center.

The TEG is a useful adjunct for monitoring coagulation status in microsurgical breast reconstruction. When thrombosis at the anastomosis occurs, TEG correlates with a more rapid rebound from an intraoperative hypocoagulable state to a postoperative hypercoagulable state, when using the TEG. The TEG is a valuable tool for a more dynamic assessment of the patients' changing coagulation status.