Skin testing. A valuable predictor in thermal injury?

Area of Science:

• Immunology
• Trauma Surgery
• Critical Care Medicine

Background:

• Delayed hypersensitivity skin testing is a prognosticator for sepsis in severely injured patients.
• Its utility following thermal trauma (burns) has shown varied results.

Purpose of the Study:

• To evaluate the usefulness of delayed hypersensitivity skin testing in predicting sepsis and mortality in burn patients.
• To assess the correlation between skin test reactivity and sepsis outcomes in relation to burn severity.

Main Methods:

• 69 patients with >25% total body surface area (TBSA) burns and 42 controls with <25% TBSA burns underwent immediate and sequential skin testing with six recall antigens.
• Calorie intake was also recorded for all patients.

Main Results:

• In patients with >25% TBSA burns, 47 were anergic, 13 relatively anergic, and 9 normal.
• In controls (<25% TBSA burns), 13 were anergic, 16 relatively anergic, and 13 normal.
• Totally anergic patients were not more likely to die of sepsis or develop sepsis compared to normal or relatively anergic patients.

Conclusions:

• Delayed hypersensitivity skin testing results do not reliably predict sepsis-related mortality in burn patients.
• Burn severity does not significantly alter the prognostic value of skin testing for sepsis outcomes.
• Anergy following thermal trauma does not appear to be a negative prognostic indicator for sepsis.