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Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort
Robert Kraft1, David N Herndon, Ahmed M Al-Mousawi
1Shriners Hospitals for Children, Galveston, TX, USA.
Insights
A burn size exceeding 60% of total body surface area (TBSA) significantly increases mortality and morbidity in pediatric patients. Early transfer to specialized burn centers is recommended for children with severe burns greater than 60% TBSA.
Area of Science:
- Pediatric Burn Care
- Trauma Surgery
- Critical Care Medicine
Background:
- Patient survival post-severe burn injury is strongly correlated with burn size.
- Advances in burn care have improved outcomes, yet large-scale analyses in pediatric populations are limited.
- This study aimed to identify critical burn size thresholds impacting pediatric patient morbidity and mortality.
Purpose of the Study:
- To determine the specific burn size associated with increased morbidity and mortality in pediatric burn patients.
- To establish a threshold for burn size that indicates a significantly higher risk of adverse outcomes.
- To inform treatment protocols and transfer decisions for severely burned children.
Main Methods:
- A single-center prospective observational cohort study included 952 pediatric patients with burns ≥30% TBSA.
- Patients were stratified by burn size in 10% increments (30-100% TBSA).
- Statistical analyses included Student's t test, chi-squared test, logistic regression, and ROC analysis (p<0.05 significance).
Main Results:
- Mortality increased significantly with burn size, from 3% (30-39% TBSA) to 55% (90-100% TBSA) (p<0.0001).
- Multiorgan failure (16%) and sepsis (9%) rates also escalated with larger burn sizes (p<0.0001).
- A burn size of 62% TBSA was identified as a critical threshold for mortality (OR 10.07, p<0.0001).
Conclusions:
- In modern pediatric burn care, approximately 60% TBSA burn size represents a critical threshold for increased morbidity and mortality.
- Pediatric patients with burns exceeding 60% TBSA should be transferred immediately to specialized burn centers.
- Increased vigilance and advanced therapies are crucial for patients with burns >60% TBSA due to elevated risks.
Background:
Patient survival after severe burn injury is largely determined by burn size. Modern developments in burn care have greatly improved survival and outcomes. However, no large analysis of outcomes in paediatric burn patients with present treatment regimens exists. This study was designed to identify the burn size associated with significant increases in morbidity and mortality in paediatric patients.
Methods:
We undertook a single-centre prospective observational cohort study using clinical data for paediatric patients with burns of at least 30% of their total body surface area (TBSA). Patients were stratified by burn size in 10% increments, ranging from 30% to 100% TBSA, with a secondary assignment made according to the outcome of a receiver operating characteristic (ROC) analysis. Statistical analysis was done with Student's t test, χ(2) test, logistic regression, and ROC analysis, as appropriate, with significance set at p<0·05.
Findings:
952 severely burned paediatric patients were admitted to the centre between 1998 and 2008. All groups were comparable in age (mean 7·3 [SD 5·3] years, ranging from 6·1 [5·1] years in the 30-39% TBSA group to 9·6 [5·4] years in the 90-100% TBSA group) and sex distribution (628 [66%] boys, ranging from 59% [73/123] in the 60-69% TBSA group to 82% [42/51] in the 90-100% TBSA group). 123 (13%) patients died (increasing from 3% [five of 180] in the 30-39% TBSA group to 55% [28/51] in the 90-100% TBSA group; p<0·0001), 154 (16%) developed multiorgan failure (increasing from 6% [ten] in the 30-39% TBSA group to 45% [23] in the 90-100% TBSA group; p<0·0001), and 89 (9%) had sepsis (increasing from 2% [three] in the 30-39% TBSA group to 26% [13] in the 90-100% TBSA group; p<0·0001). Burn size of 62% TBSA was a crucial threshold for mortality (odds ratio 10·07, 95% CI 5·56-18·22, p<0·0001).
Interpretation:
We 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.
Funding:
Shriners Hospitals for Children, US National Institutes of Health, US National Institute on Disability and Rehabilitation Research, Institute for Translational Sciences, CFI Leaders Opportunity Fund, Physicians' Services Incorporated Foundation.
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