Morbidity and Survival Probability in Burn Patients in Modern Burn Care*

Abstract

Objective Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn. Design and Patients Burn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0–99 years of age, admission within 96 hours after injury, and >20% total body surface area burns requiring at least one surgical intervention. Setting Six major burn centers in North America. Measurements and Main Results Burn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by ABA sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (DENVER2 score >3) for both children (<16 years) and adults (16–65 years). Five-hundred seventy-three patients were enrolled, of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children, the cutoff burn size for mortality, sepsis, infection, and multiple organ failure was approximately 60% total body surface area burned. In adults, the cutoff for these outcomes was lower, at approximately 40% total body surface area burned. Conclusions In the modern burn care setting, adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality, even in highly specialized centers.

Alternative Mechanism for White Adipose Tissue Lipolysis after Thermal Injury

“…Such stress responses are usually followed by wound infection, systemic inflammatory responses and sepsis that augment the severity of metabolic dysfunction and immunological impairment in the patient (3). Persisting catabolic hypermetabolism, including alternative Mechanism for White adipose Tissue Lipolysis after Thermal injury Li Diao, 1 David Patsouris, 1 Ali-Reza Sadri, 1 Xiaojing Dai, 1 Saeid Amini-Nik, 1,2 …”

Local Burn Injury Promotes Defects in the Epidermal Lipid and Antimicrobial Peptide Barriers in Human Autograft Skin and Burn Margin

“…We next evaluated whether burn margin or donor skin exhibits normal AMP activity against several skin pathogens and/or pathogens associated with the development of sepsis 1,35 . Both donor skin and burn margin exhibited a significant decrease in AMP activity against E.coli growth compared to peptides isolated from control skin ( p < 0.003) (Fig.…”

“…Furthermore, burn wound infection at both the donor site and burn site remain a frequent and serious complication of major burn injury, and are associated with over 50% of all deaths related to burn injury 1,35,38 . Despite this fact, no studies have examined potential mechanisms by which burn injury at a local site impacts epidermal barrier function at the donor site of human burn subjects.…”

Correlation Between Pao 2/Fio 2 and Peripheral Capillary Oxygenation/Fio 2 in Burned Children With Smoke Inhalation Injury

“…Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are frequent sequelae of SII (6, 7), occur in up to 34% of patients with SII, and are associated with a high mortality of up to 43% (8, 9). In 1994, the American European Consensus Conference (AECC) described ALI and ARDS using the ratio of the partial pressure of oxygen in arterial blood (PaO 2 ) to the fraction of inspired oxygen (FiO 2 ; P/F)(10).…”