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Current expectations for survival in pediatric burns
R L Sheridan1, J P Remensnyder, J J Schnitzer
1Boston Shriners Burns Hospital, and the Harvard Medical School, Department of Surgery, Boston, USA. sheridan.robert@mgh.harvard.edu
Insights
Pediatric burn survival has significantly improved, with most children, including those with extensive injuries, now expected to survive. Advances in critical care have dramatically reduced mortality rates for young burn patients.
Area of Science:
- Pediatric critical care medicine
- Burn management and outcomes
- Trauma surgery
Background:
- Historically, children under 48 months faced higher burn mortality than adults.
- Recent advancements in resuscitation, surgical techniques, and critical care have improved pediatric burn survival rates.
- This study aimed to quantify these improvements by comparing outcomes over two distinct periods.
Purpose of the Study:
- To evaluate the change in mortality rates for children treated for acute thermal burns over a decade.
- To establish current survival expectations for pediatric burn patients, including those with severe injuries.
- To analyze survival trends based on the percentage of total body surface area (TBSA) burned.
Main Methods:
- A retrospective review of pediatric deaths from acute thermal burns was conducted.
- Data were collected from two 7-year intervals: 1974-1980 (Group 1) and 1991-1997 (Group 2).
- Children were stratified by TBSA burned (0-39%, 40-59%, 60-100%); those with anoxic brain injury or refractory shock were excluded.
Main Results:
- Mortality decreased significantly across all TBSA categories between Group 1 and Group 2.
- For small burns (0-39% TBSA), mortality dropped from 0.6% to 0% (P=.02).
- For large burns (60-100% TBSA), mortality decreased from 33.3% to 14.3% (P=.02), with no deaths in children under 48 months in Group 2.
Conclusions:
- Pediatric burn survival rates have markedly improved.
- Current medical and critical care advancements mean most children, regardless of age or burn severity, should now survive.
- The study underscores the effectiveness of contemporary pediatric burn management strategies.
Background:
Conventional wisdom and published reports suggest that children, particularly those younger than 48 months, have higher mortality rates after burns than young adults. However, coincident with refinements in resuscitation, operative techniques, and critical care, survival rates for children with burns seem to have improved. To document this change and to define current expectations, a review of deaths during two 7-year intervals separated by a decade was done.
Design:
We examined the clinical course of children who died after admission for care of acute thermal burns during two 7-year intervals: calendar years 1974 to 1980 inclusive (group 1) and 1991 to 1997 inclusive (group 2). Dying children were stratified by total body surface area (TBSA) burned: small (0%-39%), midsize (40%-59%), and large (60%-100%) TBSA burns. Children who arrived with anoxic brain injury or in a moribund state with refractory shock were excluded from analysis (4 children in group 1 and 5 in group 2); 2 of these children in group 2 died and became solid organ donors.
Setting:
Regional pediatric burn center.
Patients:
Six hundred seventy-eight children in group 1 and 1150 children in group 2.
Main Outcome Measure:
Survival.
Results:
In children with 0% to 39% TBSA burns, mortality was 0.6% in group 1 and 0% in group 2 (Fisher exact test, P = .04; chi2 test, P = .02). In children with 40% to 59% TBSA burns, mortality was 7.7% in group 1 and 0% in group 2 (Fisher exact test, P = .07; chi2 test, P = .047). In children with 60% to 100% TBSA bums, mortality was 33.3% ingroup 1 and 14.3% in group 2 (Fisher exact test, P = .04; chi2 test, P = .02). Although 59% of the children in group 2 were younger than 48 months, including 55% of those with 40% to 59% TBSA burns and 41% of those with 60% to 100% TBSA burns, there were no deaths in this age group.
Conclusion:
Survival rates after burns have improved significantly for children. At present, most children, even young children and children with large burns, should survive.