Significant Reductions in Mortality for Children With Burn Injuries Through the Use of Prompt Eschar Excision

Abstract

During the past 19 years, mortality due to burn injuries has markedly declined for children at the Boston Unit of the Shriners Burns Institute (SBI), dropping from an average of 9% of SBI admissions during 1968-1970 to an average of 1% during 1981-1986. Detailed statistical analysis using logistic regression was necessary for determining whether this decline in mortality was explained by changes in patient characteristics, such as age or burn size, which are known to strongly influence the outcome of burn injuries. This dramatic decline in mortality during the past 19 years was not the result of change in the age of the patients or their burn sizes; rather, it may be attributed to improvements in burn care. Results of this statistical analysis indicated that, for burn injury patients whose ages ranged from 11 days to 19 years, age had no demonstrable effect on survival from a burn injury. Children survived burn injuries at least as well if not better than the young adult (20-29 years of age). Also, infants (less than 1 year old) survived as well as other children (2-19 years old). Dramatic improvement in survival occurred in patients with burns covering more than 50% of the body surface area. Since 1979, mortality has been essentially eliminated for patients with burn sizes less than 70% of the total body surface area (of 296 patients with burns covering 15-69% of the total body surface area, only two patients died). During the period 1979-1986, 29 of 37 patients (78%) survived an 80% or greater total body surface area thermal injury.

Prior burn insult induces lethal acute lung injury in endotoxemic mice: effects of cytokine inhibition

“…This hypothesis is supported by the finding that early excision and grafting reduce TNF-␣ production in animal models (10,28) and improve the survival in clinical studies (30,31). The mechanisms of augmented cytokine production may also be related to the ischemia-reperfusion injury of the related area, and it is quite unlikely that cytokine synthesis inhibitors were directly associated with wound healing during the observation period in this study, since we did not find any differences in the burned area among treated and untreated groups.…”

“…Early complications during the first week postburn are mainly characterized by hypovolemic shock, shock-induced renal failure, and burn wound infection (20). Great advances in fluid management based on hemodynamic monitoring (2,33), widespread use of early excision, and the development of new wound care materials (30,31) over the last three decades have reduced mortality, especially during the first week. The late complications are mainly sepsis and the secondary multiple organ dysfunction syndrome (MODS), which remain the primary contributors to morbidity and mortality in burn patients (3).…”

Burn Wound Infections

“…The extent of excision at any one operation is limited by factors such as blood loss and temperature control. Usually no more than 20% of the burned area is excised during any single procedure (66,195,286,297,351,369,430). The open wound is usually covered with autograft, fresh allograft, or frozen allograft, in descending order of preference (297,369).…”

The use of human deceased donor skin allograft in burn care

“…This has implications in the surgical management of the burn wound. Early burn excision and autografting has been acknowledged as one of the major determinants in the decreasing mortality of extensively burned patients (Tompkins et al 1988). The seminal work of Janzekovic (1970) established tangential excision of deep burns and immediate grafting as the current method for acute burn wound management.…”