Benchmarking Outcomes in the Critically Injured Burn Patient

Abstract

Objective To determine and compare outcomes with accepted benchmarks in burn care at six academic burn centers. Background Since the 1960s, U.S. morbidity and mortality rates have declined tremendously for burn patients, likely related to improvements in surgical and critical care treatment. We describe the baseline patient characteristics and well-defined outcomes for major burn injuries. Methods We followed 300 adults and 241 children from 2003–2009 through hospitalization using standard operating procedures developed at study onset. We created an extensive database on patient and injury characteristics, anatomic and physiological derangement, clinical treatment, and outcomes. These data were compared with existing benchmarks in burn care. Results Study patients were critically injured as demonstrated by mean %TBSA (41.2±18.3 for adults and 57.8±18.2 for children) and presence of inhalation injury in 38% of the adults and 54.8% of the children. Mortality in adults was 14.1% for those less than 55 years old and 38.5% for those age ≥55 years. Mortality in patients less than 17 years old was 7.9%. Overall, the multiple organ failure rate was 27%. When controlling for age and %TBSA, presence of inhalation injury was not significant. Conclusions This study provides the current benchmark for major burn patients. Mortality rates, notwithstanding significant % TBSA and presence of inhalation injury, have significantly declined compared to previous benchmarks. Modern day surgical and medically intensive management has markedly improved to the point where we can expect patients less than 55 years old with severe burn injuries and inhalation injury to survive these devastating conditions.

Effect and mechanism of hydrocortisone on organ function in patients with severe burns

“…19 Variables used to calculate the DenverMOF scores included use and dosage of catecholamines, heart rate, fraction of expired oxygen, renal creatinine, and hepatic total bilirubin and were extracted on admission and every day at 6.00 a.m. These variables were also used to calculate SOFA score.…”

“…19 They showed the important improvements in burn care that have been achieved during the last decades but also a plateauing in survival rates, necessitating new treatment paradigms. Large volumes of fluid resuscitation have been shown to induce organ failure and mechanisms that reduce these volumes might have better outcomes.…”

Manifestations respiratoires précoces d’un patient brûlé grave

“…Plus récemment, Klein et al ont réalisé une étude de cohorte, où l'inhalation de fumée d'incendie restait un facteur déterminant associé au pronostic, après ajustement sur l'âge et la surface cutanée brûlée [4].…”

Individualizing Optimal Fluid Resuscitation in Patients with Major Burns: Emerging Role for Hydrocortisone, Proteinuria and Brain Natriuretic Peptide

“…These formulae also do not take into account interventions that cause the inflammatory response and consequent capillary leakage to subside. Frequently, resuscitation volumes exceed the fluid amounts based on these formulae [1]. With hydrocortisone therapy administered fluids can be lowered more rapidly [31].…”

“…During the last decades tremendous progress has been made in the acute resuscitation of patients with major burns [1,2]. The recognition that large amounts of fluids should be infused during the first hours to days, due to capillary leakage which is the pathologic hallmark of a burn injury [3,4], is one of the most important reasons for the improved survival in these patients.…”