Severe burn injury in europe: a systematic review of the incidence, etiology, morbidity, and mortality. Critical Care 14:R188

Department of General Internal Medicine, Infectious Diseases and Psychosomatic Medicine, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium.
Critical care (London, England) (Impact Factor: 4.48). 10/2010; 14(5):R188. DOI: 10.1186/cc9300
Source: PubMed


Burn injury is a serious pathology, potentially leading to severe morbidity and significant mortality, but it also has a considerable health-economic impact. The aim of this study was to describe the European hospitalized population with severe burn injury, including the incidence, etiology, risk factors, mortality, and causes of death.
The systematic literature search (1985 to 2009) involved PubMed, the Web of Science, and the search engine Google. The reference lists and the Science Citation Index were used for hand searching (snowballing). Only studies dealing with epidemiologic issues (for example, incidence and outcome) as their major topic, on hospitalized populations with severe burn injury (in secondary and tertiary care) in Europe were included. Language restrictions were set on English, French, and Dutch.
The search led to 76 eligible studies, including more than 186,500 patients in total. The annual incidence of severe burns was 0.2 to 2.9/10,000 inhabitants with a decreasing trend in time. Almost 50% of patients were younger than 16 years, and ~60% were male patients. Flames, scalds, and contact burns were the most prevalent causes in the total population, but in children, scalds clearly dominated. Mortality was usually between 1.4% and 18% and is decreasing in time. Major risk factors for death were older age and a higher total percentage of burned surface area, as well as chronic diseases. (Multi) organ failure and sepsis were the most frequently reported causes of death. The main causes of early death (< 48 hours) were burn shock and inhalation injury.
Despite the lack of a large-scale European registration of burn injury, more epidemiologic information is available about the hospitalized population with severe burn injury than is generally presumed. National and international registration systems nevertheless remain necessary to allow better targeting of prevention campaigns and further improvement of cost-effectiveness in total burn care.

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Available from: Eric Hoste, Sep 29, 2015
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    • "Clinically significant inhalational injuries often do not manifest for three to four days after the exposure [16]. Complications of inhalational injury are not uncommon in patients with burns, coma, or other severe unexplained clinical symptoms [3] [17] [18]. There are many cases that are easily missed due to inhalation injury that can occur irrespective of burn injuries severity. "
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    ABSTRACT: Smoke-inhalation injury (SII) is an unfavorable prognostic sign and a major cause of mortality in burn patients. Subsequently, it is important to diagnose early, determine accurately the injuries severity and to intervene early in these patients.
    03/2015; 16. DOI:10.1016/j.ejcdt.2015.03.015
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    • "Both conditions have been studied extensively in the context of mortality, and a number of overlapping features have been shown to be associated with mortality relevant to both clinical conditions. These features include patient factors such as age and total body surface area (TBSA) involvement (in the context of burns, TBSA% burned and in the context of TEN, TBSA% detached) [4] [5] [6] [7] [8] [9] [10] [11]. This notwithstanding that a number of predictors of mortality for major burns have been identified, such as % full thickness burns area and inhalation injury, that are not clinically relevant to the TEN population [12] [13] [14]. "
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    ABSTRACT: Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage. Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest. Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P=0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P=0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5h; P=0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality. Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.
    Burns: journal of the International Society for Burn Injuries 05/2014; 40(8). DOI:10.1016/j.burns.2014.03.012 · 1.88 Impact Factor
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    • "Recently, Brusselaers et al. [12] and Peck [13] reviewed the epidemiology of burns in Europe and worldwide. Both reviewers conclude there is a decline in burn incidence and in burn severity in high-income countries. "
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    ABSTRACT: The aim of this study was to characterize the epidemiology of severe burns in the Netherlands, including trends in burn centre admissions, non burn centre admissions and differences by age. Patients with burn-related primary admission in a Dutch centre from 1995 to 2011 were included. Nationwide prospectively collected data were used from three separate historical databases and the uniform Dutch Burn Repository R3 (2009 onwards). General hospital data were derived from the National Hospital Discharge Register. Age and gender-adjusted rates were calculated by direct standardization, using the 2005 population as the reference standard. The annual number of admitted patients increased from 430 in 1995 to 747 in 2011, incidence rates increased from 2.72 to 4.66 per 100,000. Incidence rates were high in young children, aged 0-4 years and doubled from 10.26 to 22.96 per 100,000. Incidence rates in persons from 5 up to 59 increased as well, in older adults (60 years and older) admission rates were stable. Overall burn centre mortality rate was 4.1%, and significantly decreased over time. There was a trend towards admissions of less extensive burns, median total burned surface area (TBSA) decreased from 8% to 4%. Length of stay and length of stay per percent TBSA decreased over time as well. Data on 9031 patients admitted in a 17-year period showed an increasing incidence rate of burn-related burn centre admissions, with a decreasing TBSA and decreasing in-burn centre mortality. These data are important for prevention and establishment of required burn care capacity.
    Burns: journal of the International Society for Burn Injuries 04/2014; 40(7). DOI:10.1016/j.burns.2014.03.003 · 1.88 Impact Factor
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