Survival of children with burn injuries

Abstract

Excellent progress has been made in patients' survival after burn injury during the past five decades. Since the first study in 1949, 1 Bull JP Squire JR A study of mortality in a burns unit: standards for the evaluation of alternative methods of treatment. Ann Surg. 1949; 130: 160-173 Crossref PubMed Scopus (142) Google Scholar the likelihood of survival has improved substantially, with the last major analysis in 1998 2 Ryan CM Schoenfeld DA Thorpe WP et al. Objective estimates of the probability of death from burn injuries. N Engl J Med. 1998; 338: 362-366 Crossref PubMed Scopus (566) Google Scholar showing that the major determinants of mortality are age older than 60 years and, for all ages, burn size greater than 40% of total body surface area (TBSA) and presence of direct injury to the lung (eg, inhalation injury). The increase in likelihood of survival at all ages, but particularly in children, has largely resulted from early surgical excision of the burn then immediate closure of the wound with the patient's own skin or other biological materials. Improvements in modern critical care and anaesthesia management have further supported these advances in both children and adults. Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort studyWe established that, in a modern paediatric burn care setting, a burn size of roughly 60% TBSA is a crucial threshold for postburn morbidity and mortality. On the basis of these findings, we recommend that paediatric patients with greater than 60% TBSA burns be immediately transferred to a specialised burn centre. Furthermore, at the burn centre, patients should be treated with increased vigilance and improved therapies, in view of the increased risk of poor outcome associated with this burn size. Full-Text PDF