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Young age is not a predictor of mortality in burns
Robert L. Sheridan1, Joan M. Weber, Jay J. Schnitzer
1Shriners Burns Hospital (Drs. Sheridan, Schnitzer, Schulz, Ryan, and Tompkins and Ms. Weber), the Department of Surgical Services, Massachusetts General Hospital (Drs. Sheridan, Schnitzer, Schulz, Ryan, and Tompkins), and the Department of Surgery, Harvard Medical School (Drs. Sheridan, Schnitzer, Schulz, Ryan, and Tompkins), Boston, MA.
Insights
Young children under 48 months do not have a higher mortality rate from burns compared to older children. This study found that young age is not a predictor of mortality in pediatric burn patients.
Area of Science:
- Pediatric Burn Care
- Trauma Surgery
- Critical Care Medicine
Background:
- Conventional wisdom and prior reports suggest young children (<48 months) have higher burn mortality than older children.
- Young age is often considered a predictor of mortality in pediatric burn cases.
- This study aimed to validate or refute the impression that young age increases burn mortality risk.
Purpose of the Study:
- To determine if children under 48 months have a higher mortality rate after thermal burns compared to older children.
- To assess whether young age is a significant predictor of mortality in pediatric burn patients.
Main Methods:
- Retrospective review of 1223 pediatric patients with acute thermal burns managed over an 8-year period (1991-1998).
- Comparison of survival rates between children <48 months and children ≥48 months with burns ≥30% of body surface area.
- Analysis included burn size and need for mechanical ventilatory support.
Main Results:
- No deaths occurred in children with burns <30% body surface area, regardless of age.
- In children with burns ≥30% body surface area, mortality was 0% (0/47) in the <48 months group versus 10.9% (7/64) in the ≥48 months group (p=0.04).
- No significant differences were observed in burn size or need for mechanical ventilation between the age groups with severe burns.
Conclusions:
- Young age (<48 months) is not a predictor of mortality in pediatric patients with severe thermal burns.
- Mortality in severe burns is associated with large burn size and concurrent inhalation injury, not young age.
- Findings refute the conventional wisdom regarding young age as a mortality predictor in pediatric burn injuries.
Abstract:
OBJECTIVE: Conventional wisdom and recently published reports suggest that children <48 months of age have a higher mortality rate after burns than older children and adolescents with similar injuries and that young age is a predictor of mortality. This study was done to validate or refute this impression. DESIGN: Retrospective review. SETTING: Regional pediatric burn center. PATIENTS: All children (n = 1223) managed over a recent 8-yr interval (1991-1998) for acute thermal burns. INTERVENTIONS: The survival rate of children <48 months of age was compared with the survival rate of children >/=48 months of age. MEASUREMENTS AND MAIN RESULTS: Of the 1112 children with burns covering <30% of the body surface, 721 (65%) were <48 months of age. After exclusion of one child who was brain dead and became a solid organ donor, there were no deaths in this burn size group. There were 111 children admitted with burns covering >/=30% of the body surface: 47 (42%) with an average age of 2.0 yrs (range, 4 wks to 3 yrs and 11 months) were <48 months of age, and 64 (58%) with an average age of 10.9 yrs (range, 4 yrs to 17 yrs) were >/=48 months of age. There were no clinically important differences between the two groups in burn size (51.9% +/- 18.1% [range, 30%-90%] vs. 56.9% +/- 19.4% [range, 30%-97%]; p =.18) or need for mechanical ventilatory support (30/47 [63.8%] vs. 44/64 [68.8%]; p =.59). The mortality rate in the young group was 0% (0/47) and 10.9% (7/64) in the older group (p =.04). All children who died had large burns (average burn size, 82.9% +/- 11.5%) with concurrent inhalation injury. CONCLUSION: Young age is not a predictor of mortality in burns.