Massive Burns: Retrospective Analysis of Changes in Outcomes Indicators Across 18 Years

Abstract

The treatment and management of massive burns, defined as burns affecting at least 50% of total body surface area (TBSA), have considerably changed since the 1990s. This study aimed at analyzing if the length of intensive care unit (ICU) stay, the success of skin grafting operations, and the mortality changed in the past 18 years. Between 2000 and 2018, 77 patients were admitted for massive burns to the ICU of a university hospital. Transfers and early care withdrawal precluded inclusion for 38 patients, leaving 39 for analysis. Study variables were year of admission, demographics, burn characteristics, critical care treatment (fluid resuscitation, ventilation, and nutrition), and surgical therapy. Association between outcomes and year of admission was assessed through correlation and logistic regression analysis. Potential confounders were assessed through stepwise linear regression. Patients’ characteristics were stable over time with a median age of 36 (25.0–48.0) years, burns 65% (55.0–83.0) TBSA, and deep burns 55% (50.0–68.0) TBSA. Length of ICU stay remained stable at 0.97 (0.6–1.5) days/%TBSA. Mortality was stable as well. Energy and carbohydrate delivery decreased in parallel with the number of infectious episodes per patient. The number of operations was stable, but the take rate of skin grafts increased significantly. The multivariate analysis retained year of admission, weight, the total number of infections, daily lipid intakes, and fluid resuscitation as independent predicting variables.

Demographics to Define Pediatric Burn Patients at Risk of Adverse Outcomes

“…Generally, burns greater than 15% to 20% TBSA can lead to large inflammatory responses (14); however, there is no clear standardized TBSA burn percentage to define a severe burn across burn centers (15,16). Some clinicians have used the lower ranges (15%-25%) as massive burn cutoff points, whereas others use higher definitions (30%-60%), leaving the question of what threshold should be considered a severe burn (3,6,14,(17)(18)(19)(20).…”