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Differences in mortality from thermal injury between pediatric and adult patients
E J Erickson1, S W Merrell, J R Saffle
1Department of Surgery, University of Utah Medical Center, Salt Lake City.
Insights
Young children, especially those under 48 months, face higher mortality from severe burns compared to adults. However, pediatric burn survival rates are improving across most age groups.
Area of Science:
- Pediatric critical care
- Burn injury outcomes
- Trauma research
Background:
- Children exhibit different responses to thermal injury than adults, with higher mortality rates for equivalent major injuries.
- Previous research has not clearly defined the age at which pediatric survival rates match those of young adults.
- Some studies suggest no difference in mortality between pediatric and adult burn patients.
Purpose of the Study:
- To evaluate age-related mortality in burn patients.
- To define the age at which pediatric survival rates approximate those of young adults.
- To compare mortality between pediatric and adult burn patients, particularly for large burns.
Main Methods:
- Retrospective analysis of 1,443 consecutive patients without inhalation injury treated between 1978 and 1988.
- Categorization of patients into three groups: children (≤12 years), adolescents (13-20 years), and young adults (21-40 years).
- Separate examination of mortality in patients with burns exceeding 30% total body surface area.
Main Results:
- No significant overall mortality differences were found between age groups in the total study sample.
- Children aged 0 to 48 months demonstrated higher mortality (31%) than comparably injured adults (12%) for large burns (P < .05).
- Survival improvements were observed in children aged 25 months to 8 years between the first and second halves of the study period.
Conclusions:
- Children 48 months of age and younger tolerate large thermal injuries less effectively than adults.
- Significant progress in improving pediatric burn survival has been achieved for most age groups.
- Further research is needed to understand and mitigate the increased risk in very young burn patients.
Abstract:
Children differ from adults in their responses to thermal injury, as reflected by higher reported mortality rates for equivalent major injuries. The age at which children's survival rates equal those of young adults has not been well defined, and some investigators have recently claimed that pediatric and adult burn mortality do not differ. We evaluated age-related mortality among 1,443 consecutive patients without inhalation injury treated from 1978 to 1988, inclusively. The sample consisted of 595 children aged 12 years or less, 243 children aged 13 to 20 years, and 605 young adults aged 21 to 40 years who served as a comparison group of patients with the best predicted survival. We separately examined mortality in patients with burns exceeding 30% total body surface area. There were no significant differences in mortality between age groups for the study sample as a whole, but among patients with large burns, children aged 0 to 48 months had higher mortality than comparably injured adults (31% v 12%, P less than .05 by analysis of covariance). Improvements in survival were also demonstrated between the first and second halves of the study period for children aged 25 months to 8 years. These data indicate that children 48 months of age and younger do not tolerate large thermal injuries as well as adults. Improvements in pediatric burn survival are being achieved in most age groups.