Mortality Associated With Injuries Sustained By Aircraft Accident Burn Survivors

Abstract

INTRODUCTION: Air travel is one of the most popular and efficient means of transportation available today. Although infrequent, disasters involving aircraft are an unfortunate reality. The medical profession is still learning how to best care for air crash survivors. The purpose of this paper is to identify the survivability of aircraft accidents as well as characterize morbidity and mortality of associated injuries sustained by aircraft accident burn survivors admitted to a major burn center over a 40-year period.METHODS: We performed a retrospective chart review of all aircraft accident patients admitted to our institution from January 1955 through July 1997. Data collected included age, gender, total body surface area burned (TBSA), full thickness burn, inhalation injury and associated injuries sustained at time of mishap. As major advances in burn care were achieved after 1975, patients injured prior to January 1975 were placed in group A (N=363); the remainder was placed in group B (N=143). Mortality was reviewed between the two different time periods for full thickness burns using Logistic Regression and Chisquared method of analysis.RESULTS: During the study period there were 30,718 aircraft accidents tracked by the NTSB. Of these, 19.33% (N=5,939) involved at least one fatality. Of 9175 patients admitted to the U. S. Army Burn center between January 1955 and July 1997, 506 (5.5%) were involved in aircraft crashes. The patient population was 92.3% male (N=467) and 7.7% female (N=23). The average age was 28.7 years. The overall mean TBSA was 32.5% and the full thickness burn was 19.05%. Associated injuries were seen in 77.0% of admissions. Fractures occurred in 39.72% of admissions, while closed head injuries were sustained by 8.1%. Inhalation injury was observed in 25.4% of patients; eye injuries in 7.5%. Hemo/pneumothorax, spleen, and liver injuries were seen in less than 3%. There was a dramatic improvement in mortality (p 40% between the two periods. In patients with less than 40% TBSAA, however, associated closed head injuries and fractures were associated with a 350% higher mortality (p<.001). CONCLUSIONS: Less than 20% of aircraft accidents involve a fatality. Most thermally injured survivors of aircraft crashes, 77.0%, are associated with significant blunt injury. Despite a statistically significant decrease in overall mortality of burn patients, closed head injuries and fractures are associated with increased mortality when compared to similarly burned patients without these injuries. A multi-disciplinary, well-coordinated team approach is necessary to optimize the treatment to this sub group of patients. RESEARCH CONDUCTED AT THE EXTREMITY TRAUMA BRANCH U. S. ARMY INSTITUTE OF SURGICAL RESEARCH, FORT SAM HOUSTON, TEXAS, 78234 “The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.”