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Burn variables and intensive care mortality in severe burn patients

Introduction

The evaluation of probability of death from burn injuries would provide clinicians with an explicit basis for clinical decisions, help them understand the relative contributions of specific prognostic criteria and reduce reliance on clinical intuition [1]. The goal of this study is to estimate the mortality rate and the clinical variables for early assessment of outcome of a severe burn population.

Methods

We retrospectively reviewed the records of all patients with severe burn injuries admitted to a polyvalent intensive care unit (ICU) of a university teaching hospital from 1999 to 2001. Information collected included age, sex, percentage of body surface area (%TBSA) burned, SAPS II score and SOFA score on admission, Baux score (age + %TBSA), presence or absence of inhalation injury, need for intubation, time of first escharotomy, length of ICU stay (LOS), and ICU mortality. Data were analysed using SPSS for Windows.

Results

Nineteen severe burn patients were considered (13 male and six female). Their mean age was 53.5 ± 19.8 years; they had a mean %TBSA burned of 50.1 ± 25.7, of third degree. Ten patients (52.6%) died in the ICU; they had similar age to the survivors (56 ± 17 years vs 50.6 ± 23.2 years, P = NS), but their values of SAPS II and SOFA scores on admission were significantly greater (36.5 ± 10.5 vs 25.6 ± 12.5, P < 0.05 and 4.7 ± 2.4 vs 2.3 ± 2, P < 0.05); also the Baux score was statistically different (123.6 ± 10.9 vs 81.6 ± 24.4, P < 0.05). The patients who died had larger %TBSA burned than survivors (67.4 ± 21.5 vs31 ± 13.5, P < 0.05). All patients were intubated and ventilated. All dead patients and six survivors (66.6%) sustained inhalation injuries. The first escharotomy was performed 17.2 ± 7.4 days from the injury date in the patients who died and 8.2 ± 3.1 days in the others. Moreover, the mean of LOS was increased for those who died (34.4 ± 36.8 vs 19.5 ± 17.6, P < 0.05).

Conclusion

According to other studies [2], the mortality rate of severe burn patients remains high despite burn care having changed considerably. We report the severity of illness on admission to the ICU and the extent of burns as contributors to the mortality rate. Moreover, early excision of burns seems to be associated with better outcome.

References

  1. 1.

    Ryan CM, Schoenfeld DA, et al.: Objective estimates of the probability of death from burn injuries. N Engl J Med 1998, 5: 362-366. 10.1056/NEJM199802053380604

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Gianesello, L., Paparella, L., Pavoni, V. et al. Burn variables and intensive care mortality in severe burn patients. Crit Care 8, P138 (2004). https://doi.org/10.1186/cc2605

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Keywords

  • Intensive Care Unit
  • Body Surface Area
  • Intensive Care Unit Stay
  • Intensive Care Unit Mortality
  • Sofa Score