Current Expectations for Survival in Pediatric Burns

Sheridan, Robert L.; Remensnyder, John P.; Schnitzer, Jay J.; Schulz, John; Ryan, Colleen M.; Tompkins, Ronald G.

doi:10.1001/archpedi.154.3.245

Cited by 82 publications

(26 citation statements)

References 37 publications

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“…However, no previous studies with large samples and more than 100 fatalities have examined this issue, and some recent studies have argued that young age is not a risk factor for mortality (8,9). This study provides strong evidence that when comparing children based on burn injuries of similar size and etiology, children younger than 4 years are at greater risk of death as compared with older children.…”

Section: Discussionmentioning

confidence: 67%

Children Under 4 Years Are at Greater Risk of Mortality Following Acute Burn Injury

Thombs¹,

Singh²,

Milner³

2006

Shock

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It is important to have an accurate understanding of mortality risk in children to make sound treatment decisions and to advise parents and families. Several studies have found that children younger than 4 years are at greater risk for mortality from burn injury than older children, although other studies have found no difference. All of these studies, however, have been limited by small sample sizes from single burn centers. The objective of this study was to assess age-related mortality risk in a sample of more than 12,000 children from a national burn registry who were admitted to 43 burn centers in the United States from 1992 to 2002. The study showed that, compared with older children, children younger than 4 years were significantly more likely to be admitted with scalds rather than flame burns, had smaller burn injuries, and were less likely to have an inhalation injury. Logistic regression analysis was used to assess age-related mortality risk. After adjusting for sex, burn size, inhalation injury, and type of burn (flame versus scald), the risk of mortality was substantially higher for children aged 0 to 1.9 years (odds ratio, 2.70; P<0.001) and for children aged 2.0 to 3.9 years (odds ratio, 2.00; P<0.01) as compared with children aged 4 years or older. This study provides strong evidence that when comparing children based on burn injuries of similar size and etiology, children younger than 4 years are at substantial risk for death as compared with older children.

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Section: Discussionmentioning

confidence: 67%

Children Under 4 Years Are at Greater Risk of Mortality Following Acute Burn Injury

Thombs¹,

Singh²,

Milner³

2006

Shock

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“…[1][2][3] Advancements in burn resuscitation, intensive care, trauma care, nutritional support, and infection control are thought to be the primary reasons for increased survival. 4 The practice of early excision of nonviable tissue followed by immediate skin grafting with autograft or allograft has resulted in a further improvement in survival.…”

mentioning

confidence: 99%

Cultured Epithelial Autografts for Coverage of Large Burn Wounds in Eighty-Eight Patients: The Indiana University Experience

Sood¹,

Roggy²,

Zieger³

et al. 2010

Journal of Burn Care & Research

129

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Since 1990, the authors have used a new technique for coverage of large burns, which begins with early tangential excision and coverage with cadaver allograft (A), followed by placement of cultured epithelial autograft (CEA) onto an allodermis base (CEA/A). They present their 18-year experience (1990-present) using CEA in 88 patients (20 children and 68 adults) with age range of 6 months to 73 years. A review of prospectively collected data was conducted on adult and pediatric patients grafted with CEA at the Indiana University Medical Center for definitive wound coverage (TBSA 28-98%). These patients were followed up for 3 to 90 months. Complications, take rates, and outpatient follow-ups were noted. The mean final take rate of CEA/A was 72.7%, and the overall patient survival rate was 91% (80 of 88 patients). Complications were classified as early and late, they included: (early) blistering and shearing (31%), pruritus and itching (4.7%), (late) CEA loss (2 patients, 2.3%), and wound contractures (66%). Contracture releases were performed on 32 patients (36%); of which, 18 were children (56%). Cultured keratinocytes provide an excellent alternative or adjunct to conventional split-thickness skin grafting in treating large burn wounds. A dedicated team of physicians, nurses, and therapists well rehearsed in CEA care are vital for success in keratinocyte grafting. The final graft take of 72.7% with a 91% overall survival rate gives much optimism for continuing to use CEA in critically burned patients.

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“…Several authors have researched predictors of pediatric mortality. Major determinants of death in this age group were related to age, size of burn, delayed resuscitation measures, and multiorgan failure [18,25]. Predicted mortality rates for elderly patients range between 21% and 63% [26].…”

Section: Changing Rates Of Burn Severity and Burn Survivalmentioning

confidence: 99%

“…Pediatric research in the years between 1981 and 1984 showed that children with burns covering more than 80% TBSA and inhalation injury had a mortality rate of approximately 75%. In 1997, data showed, for the same population, a mortality rate of 51% [18,25].…”

Section: Changing Rates Of Burn Severity and Burn Survivalmentioning

confidence: 99%

Burn epidemiology: the patient, the nation, the statistics, and the data resources

LaBorde

2004

Critical Care Nursing Clinics of North America

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Current Expectations for Survival in Pediatric Burns

Cited by 82 publications

References 37 publications

Children Under 4 Years Are at Greater Risk of Mortality Following Acute Burn Injury

Children Under 4 Years Are at Greater Risk of Mortality Following Acute Burn Injury

Cultured Epithelial Autografts for Coverage of Large Burn Wounds in Eighty-Eight Patients: The Indiana University Experience

Burn epidemiology: the patient, the nation, the statistics, and the data resources

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