The lethal triad in patients with severe burns

The lethal triad of trauma (acidemia, coagulopathy, and hypothermia) is associated with substantial morbidity and mortality. Patients with severe burn injuries, defined as > 20 % total body surface area (TBSA), are one group of trauma patients at risk of developing this triad. However, there is currently limited evidence on how the lethal triad affects this cohort of patients.

To describe the prevalence of the lethal triad in patients with severe burns on arrival to an adult burns service hospital. The secondary aim was to investigate potential factors associated with presence of the lethal triad.

Adult patients (> 18 years of age) with severe burns (> 20 %TBSA) admitted to a Victorian Adult Burns Service (VABS) tertiary hospital between January 1, 2019 and 31 December, 2023, were included in the study.

From 158 patients identified through the VABS registry, 142 patients met inclusion criteria. Among 106 patients with available data, the lethal triad was present on arrival to hospital in 6 patients (5.7 %; 95 %CI: 2.1-11.9 %). Acidemia was present in 58 of 116 (50.0 %; 95 %CI: 40.6-59.4), coagulopathy in 18 of 125 (14.4 %; 95 %CI: 8.8-21.8) and hypothermia in 53 of 140 (37.9 %; 95 %CI: 29.8-46.4). Among patients with the lethal triad, all 6 patients (100 %) died, compared to 27 patients (27.0 %) without the lethal triad (odds ratio 21.0; 95 %CI: 2.91->99.9).

A small proportion of patients with severe burns presented to hospital with all three components of the lethal triad of trauma. Acidemia and hypothermia were more commonly observed when compared to coagulopathy. Recognition, prevention, and early management may result in improved outcomes.