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Significant reductions in mortality for children with burn injuries through the use of prompt eschar excision
R G Tompkins1, J P Remensnyder, J F Burke
1Shriners Burns Institute, Boston, Massachusetts.
Insights
Pediatric burn injury mortality at Shriners Burns Institute (SBI) significantly decreased due to improved burn care, not patient age or burn size. Survival rates improved dramatically, especially for severe burns.
Area of Science:
- Pediatric Burn Care and Outcomes
- Burn Injury Epidemiology
- Medical Treatment Advancements
Background:
- Burn injuries pose a significant mortality risk, particularly in pediatric populations.
- Historical data from the Shriners Burns Institute (SBI) indicated a 9% mortality rate for pediatric burn admissions between 1968-1970.
Purpose of the Study:
- To analyze the significant decline in pediatric burn mortality observed at the Boston Unit of the Shriners Burns Institute (SBI) over a 19-year period.
- To determine if changes in patient demographics (age, burn size) or improvements in burn care contributed to the observed mortality reduction.
Main Methods:
- A detailed statistical analysis using logistic regression was employed.
- Patient characteristics including age (11 days to 19 years) and burn size (% of total body surface area) were evaluated.
- Mortality rates were compared across different time periods (1968-1970 vs. 1981-1986) and patient subgroups.
Main Results:
- Pediatric burn mortality at SBI decreased from 9% (1968-1970) to 1% (1981-1986).
- This decline was not attributable to changes in patient age or burn size; improvements in burn care are the likely cause.
- Survival rates showed dramatic improvement, especially for patients with burns exceeding 50% of body surface area. Since 1979, mortality is nearly eliminated for burns <70% TBSA, with 78% survival for burns >=80% TBSA (1979-1986).
Conclusions:
- Significant advancements in burn care have led to a marked reduction in pediatric burn mortality.
- Age is not a significant factor in survival for pediatric burn patients (11 days-19 years).
- Improved survival outcomes are evident even for patients with extensive burn injuries (>=50% TBSA).
Abstract:
During the past 19 years, mortality due to burn injuries has markedly declined for children at the Boston Unit of the Shriners Burns Institute (SBI), dropping from an average of 9% of SBI admissions during 1968-1970 to an average of 1% during 1981-1986. Detailed statistical analysis using logistic regression was necessary for determining whether this decline in mortality was explained by changes in patient characteristics, such as age or burn size, which are known to strongly influence the outcome of burn injuries. This dramatic decline in mortality during the past 19 years was not the result of change in the age of the patients or their burn sizes; rather, it may be attributed to improvements in burn care. Results of this statistical analysis indicated that, for burn injury patients whose ages ranged from 11 days to 19 years, age had no demonstrable effect on survival from a burn injury. Children survived burn injuries at least as well if not better than the young adult (20-29 years of age). Also, infants (less than 1 year old) survived as well as other children (2-19 years old). Dramatic improvement in survival occurred in patients with burns covering more than 50% of the body surface area. Since 1979, mortality has been essentially eliminated for patients with burn sizes less than 70% of the total body surface area (of 296 patients with burns covering 15-69% of the total body surface area, only two patients died). During the period 1979-1986, 29 of 37 patients (78%) survived an 80% or greater total body surface area thermal injury.