Mortality In Burn Patients Research Articles

A tenyear review of candida sepsis and mortality in burn patients

A tenyear review of candida sepsis and mortality in burn patients

The influence of inhalation injury and pneumonia on burn mortality.

In order to assess the specific effects of inhalation injury and pneumonia on mortality in burn patients, the records of 1058 patients treated at a single institution over a five-year period, 1980-1984, were reviewed. Of these patients, 373 (35%) had inhalation injury diagnosed by bronchoscopy and/or ventilation perfusion lung scan. Of the 373 patients, 141 (38%) had subsequent pneumonia. Among the patients without inhalation injury, pneumonia occurred in 60 of 685 (8.8%). A multiple logistic equation was developed to estimate expected mortality at any age and burn size for patients without either inhalation injury or pneumonia, with either alone, or with both. Subtraction of the expected mortality without either inhalation injury or pneumonia from the expected mortality in the presence of either or both permitted the estimation of additional mortality attributable to these complications. Inhalation injury alone increased mortality by a maximum of 20% and pneumonia by a maximum of 40%, with a maximum increase of approximately 60% when both were present. The influence on mortality was maximal in the midrange of expected mortality without these complications for any age group. These data indicate that inhalation injury and pneumonia have significant, independent, additive effects on burn mortality and that these effects vary with age and burn size in a predictable manner.

Smoke inhalation injuries

Up to a third of all victims of major burns suffer smoke-related injury and may die as a result of inhalation injury. The management of the upper airway depends on a thorough understanding of the mechanisms of injury, including carbon monoxide toxicity, thermal injury, and smoke inhalation. Establishing and maintaining an airway for resuscitation requires a high index of suspicion, as early and severe upper airway swelling may preclude safe intubation under direct vision. Nasotracheal intubation is preferred in burn patients but is only indicated for patients in acute respiratory distress and a select group at high risk for developing progressive upper airway compromise and pulmonary injury. The use of the flexible bronchoscope and nasopharyngoscope is a safe and effective means of evaluating the respiratory tract and assisting in pulmonary therapy. Early tracheotomy is indicated only in rare cases because of increased morbidity and mortality in burn patients. The use of steroids is still controversial and is probably indicated only for refractory bronchospasm or secretions. Aggressive evaluation and management of inhalation burns will reduce the mortality rate of a frequently fatal injury.

Fluid retention during the first 48 hours as an indicator of burn survival.

The quantity of fluid retained during the first 48 hours of resuscitation has been suggested as an indicator of burn severity and mortality (13). In this study of 82 adult burned patients with more than 20% total body surface burns we found that the net fluid retention during the first 48 hours of resuscitation was a predictor of burn mortality and additionally 230 cc of retained fluid per kilogram of lean body mass in the initial 48 hours postburn was an excellent means for separating survivors from nonsurvivors. Fluid retention as an indicator of burn severity and mortality was compared to other methods of predicting burned patient mortality. Parameters evaluated included the per cent body surface area burned, per cent full thickness burn, presence or absence of inhalation injuries, sex, age, and ultimate outcome. The Abbreviated Burn Severity Index (ABSI) (14) was determined for each patient using these data. A comparison was made between fluid retention data, per cent body surface area burned, and the calculated Abbreviated Burn Severity Index and patient mortality. The power of each variable to predict mortality was evaluated by stepwise regression analysis. From this analysis net fluid retention during the first 48 hours of resuscitation was as accurate as the Abbreviated Burn Severity Index and was a better predictor of mortality than individual components of that Index.

Behavioural factors in burn mortality and length of stay in hospital.

Numerous studies have examined the effects of burn size and depth, age, concomitant injury, and illness upon burn patient mortality and duration of stay in hospital, and other studies have stressed the importance of psychosocial factors in the causation of burns. However, scant attention has been given to the effects of psychosocial factors on burn mortality and length of stay in hospital. Data on psychiatric diagnoses, substance abuse, and factors in severity of injury were abstracted from the charts of patients admitted to the San Diego Regional Burn Treatment Center. Mortality data were analysed using logistic regression. After adjusting for severity of the burn injury, statistically significant increases in mortality are associated with the diagnosis of character or personality disorder, schizophrenia, alcohol intoxication at the time of injury, and a variable indication a psychiatric diagnosis or severe undiagnosed problems. Comments on individual charts suggest that overtly self-destructive behaviour during treatment caused the increased mortality. Data on duration of stay in hospital among survivors were analysed using multiple linear regression. After adjusting for severity of injury, significantly longer stays are associated with suicidal intention, diagnosis of character or personality disorder, schizophrenia, senility and a variable indicating a psychiatric diagnosis or severe undiagnosed problems. Overtly self-destructive behaviour, treatment of psychiatric problems, and the inability of some patients to care for themselves may each contribute to the longer stay in hospital.

Surviving Burns Does Early Wound Closure Help?

Does early grafting of full-thickness (FT) burn wounds improve survival among severely burned? Wolfe and colleagues present, in this issue ofThe Journal(p 763), an elegant mathematical model as evidence that early grafting is associated with improved survival. They have collected information on 12,000 patients entered from 11 national burn treatment centers, reporting burned body surface area, treatment, and outcome for each case. Like mathematical architects, Wolfe and associates generate two bodies of data and then correlate them. Phase 1 explicates computation of standard mortality rate (SMR). From their burn registry data bank, authors formulate a multiple logistic regression model to predict mortality in burn patients by assigning probabilities to several variables—burn wound size, age, sex, presence of perineal burn, and year of treatment. The sum of these probabilities in patients treated at one burn center yields the expected number of deaths. The SMR compares

Mortality Differences and Speed of Wound Closure Among Specialized Burn Care Facilities

Burn patient mortality rates at 11 major American burn care units were investigated and were found to differ substantially after carefully adjusting for patient mix at each participating burn facility. The adjusted mortality rates differed by as much as a factor of two. Institution speed of full-thickness burn wound closure was found to be significantly associated with mortality experience, with lower mortality associated with quicker wound closure. The data analyzed were from the National Burn Information Exchange (12,000 cases).

The natural history of major burns with multiple subsystem failure.

Mortality in burned patients is related to the size and depth of the burn. However, the effects of subsequent physiologic subsystem failure on mortality have not been determined. One hundred sixty-eight patients with second- and third-degree burns involving 40% or greater body surface area were analyzed to determine the relationship of subsystem failure to mortality. Cardiovascular subsystem failure was defined as the need for catecholamines for blood pressure support, pulmonary failure defined as the requirement of mechanical ventilatory assistance, renal subsystem failure defined as the need for hemodialysis, and immunologic subsystem failure defined as the presence of sepsis (fever, tachycardia, hypotension, oliguria, disorientation) and/or bactcremia. The mean age of the group was 40 ± 17 years, with 50 (30%) females and 188 (70%) males. The mean BSA burn was 59% ± 15% with an overall mortality of 58% (97 patients). Sixty-seven (40%) patients developed cardiac subsystem failure, with 100% mortality. Eighty-nine (53%) patients developed pulmonary subsystem failure, with 92% mortality. Renal subsystem failure was noted in 14 (8%) patients, with 100% mortality, and immunologic subsystem failure occurred in 96 (57%) patients, with 73% mortality. The 81 patients with multiple subsystem failure (≥2) had a significantly higher mortality (98%) than those with zero or one subsystem failure (21%) (p < 0.001). This study shows patients who develop physiologic subsystem failure following a major burn injury have an extremely high mortality rate and that multiple subsystem failure is even more devastating.

An analysis of factors which predict mortality in hospitalized burn patients

Numerous studies have described the relationship between the size and depth of burn, age and burn patient mortality. Recent studies have examined the effect of other factors upon burn mortality and have proposed burn severity indexes based on statistical models. Data from 854 patients treated in the San Diego Burn Treatment Centre were analysed using multiple logistic regression. Many variables were associated with mortality, even when adjustments were made for burn size and depth. Several predictive models were constructed using those variables. The admission white blood count, admission serum osmolality, the involvement of inflammable liquid and the presence of pre-existing mental disorders, circulatory disease and digestive disease were found to have significant effects upon mortality when incorporated in a predictive model with age, size of partial-thickness burn and size of full-thickness burn. These results have implications for the construction and use of burn severity indexes.

Multifactorual probit analysis of mortality in burned patients

Multifactorual probit analysis of mortality in burned patients

Low mortality in burned patients in a pseudomonas vaccine trial

Low mortality in burned patients in a pseudomonas vaccine trial

Multifactorial probit analysis of mortality in burn patients

Multifactorial probit analysis of mortality in burn patients

Disinfection of immersion tanks (Hubbard) in a hospital burn unit.

Improved resuscitation methods, fluid and electrolyte control, and handling of burn shock have reduced mortality in burn patients, but latent infections have increased in importance. The full body immersion tank (Hubbard) used in the treatment of these patients is one potential source of exogenous bacteria. This investigation was designed to determine the effectiveness of cleaning procedures, specifically the disinfection step, of one immersion tank used in a hospital burn unit. Mechanical scrubbing with a detergent-disinfectant reduced surface and water contamination dramatically, whereas disinfection with residual chlorine following scrubbing did not significantly reduce microbial levels. Recommendations are made for cleaning and disinfection protocols.

Impact of burn unit routine on outcome: A 5-year experience

Background: The burn unit, like any high dependency, unit is awash with multi-antibiotic resistant microbes, and the clinician is in a constant battle to prevent such infections from becoming established. After the elimination of hypovolemic shock as a cause of death, infections constitute the leading cause of morbidity and mortality in burn patients. Aims and Objectives: This study aimed to determine the incidence of infection in our burn unit and to demonstrate how our burn unit routine leads to a low incidence of infection in our setting. Materials and Methods: This is a retrospective review of the records of patients attended to between 2009 and 2013 in the burn unit of Federal Teaching Hospital, Gombe, Nigeria. Details of the treatment and follow-up data were obtained from patients' case files using a predesigned pro forma. All patients were within 24 h of burn and had wounds cleaned under general anesthesia before admission to the unit. In addition, all patients with major burns received infusion of glucose, potassium, and insulin (GKI). Antibiotics use was strictly regulated and was guided by known antimicrobial and sensitivity patterns. Results: Thirty-three patients were admitted within the study period, of whom 27 patients had complete information and were analyzed. The mean age of the burn patients was 11 ± 16.7 (SD) years. There were 16 (59.3%) males and 11 (40.7%) females. Scalding and flame burns accounted for 20 (74.1%) and seven (25.9%) patients, respectively. Only four (14.8%) patients developed wound infection on admission (three were in the age range of 11 years and below, while one was 57 years old) and one patient had gastrointestinal tract (GIT) infection. One patient died from suspected thromboembolism within 24 h of burn, and 14 (51.8%) and 12 (44.4%) patients were discharged with and without residual burn wounds, respectively. The average burn surface area was 18.9%. The average length of stay (LOS) was 18.65 days and the average LOS per patient per percentage burn surface was 0.98 days. On follow-up at 2 weeks after discharge, four (14.8%) patients had delayed wound healing and seven (25.9%) patients developed hypertrophic scars.Conclusion: Our findings indicate a low incidence of infection related complications and it appears that our burn unit routine may play a significant role.

ACUTE PANCREATITIS. THE SIGNIFICANCE OF HEMOCONCENTRATION AT ADMISSION TO THE HOSPITAL.

Introduction PHILLIPS and Cope 1 recently suggested that the mortality of burn patients in the first few postburn days has diminished remarkably. One reason, certainly, is the effective use of colloid and salt solutions. The amounts of these solutions are calculated according to the ostensible extent of serious burn. In pancreatitis a burn-like injury exists in the retroperitoneal space the size of which is more difficult to calculate. The admission signs and symptoms of a case of acute pancreatitis that may end fatally may be less impressive than those of another case of acute pancreatitis that runs a short benign course with recovery and discharge on the third or fourth hospital day. The onset of shock may be insidious and surprise the unwary physician. The purpose of this article is to point to a useful sign in severe acute pancreatitis. Hemoconcentration is a forewarning that shock may ensue. Materials and

A comparison of methods of treatment of extensive burns at the San Francisco General Hospital

Because of the increasing mortality in burned patients, a revision of the method of treatment of burns has been instituted on the Surgical Service at the San Francisco General Hospital. The initial treatment for burn shock consists of electrolytes without the use of colloids. Oral saline solution is initiated as soon as the patient can tolerate it, which is usually on the first day. Blood is used only during the latent period if a drop in the packed cell volume becomes evident. The prophylactic use of antibiotics has been greatly curtailed. Homografts are used as an early burn dressing. This method of treatment is compared to the results obtained in the treatment of burns in which the Brooke formula, late autografting and prophylactic antibiotics are used.

Therapy of severely burned patients; eleven years' study at the University of Minnesota.

Death still claims a high percentage of seriously burned patients. Where 55% or more of the body surface is severely burned, the mortality rates are in the range of 85% in most clinics. Owing to a better understanding of fluid and electrolyte balances in patients with severe burns, these critically injured people often survive the initial shock period of the postburn state only to succumb with sepsis, hepatic failure, cardiac complications, or other types of medical emergencies in the later postburn period. We are immediately aware that further advances must be made in effecting earlier, more complete grafting of larger burned areas, with an over-all reduction of the chronic, or reconstructive, phase of the problem. In a recent report four American medical centers failed to show any improvement in mortality of burned patients in the 15%-35% body-surface burn group, and also in the 70%-100% body-surface burn group, when they compared