Morbidity and survival probability in burn patients in modern burn care

Marc G. Jeschke, Ruxandra Pinto, Robert Kraft, Avery B. Nathens, Celeste C. Finnerty, Richard L. Gamelli, Nicole S. Gibran, Matthew B. Klein, Brett D. Arnoldo, Ronald G. Tompkins, David N. Herndon

Research output: Contribution to journalArticle

63 Citations (Scopus)

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 old, admission within 96 hours after injury, and more than 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 American Burn Association sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (Denver 2 score > 3) for both children (< 16 yr) and adults (16-65 yr). 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. ©

Original languageEnglish (US)
Pages (from-to)808-815
Number of pages8
JournalCritical Care Medicine
Volume43
Issue number4
DOIs
StatePublished - Apr 20 2015

Fingerprint

Body Surface Area
Morbidity
Survival
Mortality
Sepsis
Investigational Therapies
Multiple Organ Failure
Burn Units
Adult Respiratory Distress Syndrome
Wounds and Injuries
Wound Infection
North America
Infection
Burns
Adhesives
Pneumonia
Cohort Studies
Prospective Studies
Inflammation

Keywords

  • Burns
  • Cutoff
  • Morbidity
  • Outcomes
  • Survival

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Jeschke, M. G., Pinto, R., Kraft, R., Nathens, A. B., Finnerty, C. C., Gamelli, R. L., ... Herndon, D. N. (2015). Morbidity and survival probability in burn patients in modern burn care. Critical Care Medicine, 43(4), 808-815. https://doi.org/10.1097/CCM.0000000000000790

Morbidity and survival probability in burn patients in modern burn care. / Jeschke, Marc G.; Pinto, Ruxandra; Kraft, Robert; Nathens, Avery B.; Finnerty, Celeste C.; Gamelli, Richard L.; Gibran, Nicole S.; Klein, Matthew B.; Arnoldo, Brett D.; Tompkins, Ronald G.; Herndon, David N.

In: Critical Care Medicine, Vol. 43, No. 4, 20.04.2015, p. 808-815.

Research output: Contribution to journalArticle

Jeschke, MG, Pinto, R, Kraft, R, Nathens, AB, Finnerty, CC, Gamelli, RL, Gibran, NS, Klein, MB, Arnoldo, BD, Tompkins, RG & Herndon, DN 2015, 'Morbidity and survival probability in burn patients in modern burn care', Critical Care Medicine, vol. 43, no. 4, pp. 808-815. https://doi.org/10.1097/CCM.0000000000000790
Jeschke MG, Pinto R, Kraft R, Nathens AB, Finnerty CC, Gamelli RL et al. Morbidity and survival probability in burn patients in modern burn care. Critical Care Medicine. 2015 Apr 20;43(4):808-815. https://doi.org/10.1097/CCM.0000000000000790
Jeschke, Marc G. ; Pinto, Ruxandra ; Kraft, Robert ; Nathens, Avery B. ; Finnerty, Celeste C. ; Gamelli, Richard L. ; Gibran, Nicole S. ; Klein, Matthew B. ; Arnoldo, Brett D. ; Tompkins, Ronald G. ; Herndon, David N. / Morbidity and survival probability in burn patients in modern burn care. In: Critical Care Medicine. 2015 ; Vol. 43, No. 4. pp. 808-815.
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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 old, admission within 96 hours after injury, and more than 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 American Burn Association sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (Denver 2 score > 3) for both children (< 16 yr) and adults (16-65 yr). 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. {\circledC}",
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