The leading causes of death after burn injury in a single pediatric burn center. Crit Care 13(6):R183

Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77555, USA.
Critical care (London, England) (Impact Factor: 4.48). 11/2009; 13(6):R183. DOI: 10.1186/cc8170
Source: PubMed


Severe thermal injury is characterized by profound morbidity and mortality. Advances in burn and critical care, including early excision and grafting, aggressive resuscitation and advances in antimicrobial therapy have made substantial contributions to decrease morbidity and mortality. Despite these advances, death still occurs. Our aim was to determine the predominant causes of death in burned pediatric patients in order to develop new treatment avenues and future trajectories associated with increased survival.
Primary causes of death were reviewed from 144 pediatric autopsy reports. Percentages of patients that died from anoxic brain injuries, sepsis, or multi-organ failure were calculated by comparing to the total number of deaths. Data was stratified by time (from 1989 to 1999, and 1999 to 2009), and gender. Statistical analysis was done by chi-squared, Student's t-test and Kaplan-Meier for survival where applicable. Significance was accepted as P < 0.05.
Five-thousand two-hundred-sixty patients were admitted after burn injury from July 1989 to June 2009, and of those, 145 patients died after burn injury. Of these patients, 144 patients had an autopsy. The leading causes of death over 20 years were sepsis (47%), respiratory failure (29%), anoxic brain injury (16%), and shock (8%). From 1989 to 1999, sepsis accounted for 35% of deaths but increased to 54% from 1999 to 2009, with a significant increase in the proportion due to antibiotic resistant organisms (P < 0.05).
Sepsis is the leading cause of death after burn injury. Multiple antibiotic resistant bacteria now account for the bulk of deaths due to sepsis. Further improvement in survival may require improved strategies to deal with this problem.

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Available from: Gabriela A Kulp, Dec 12, 2013
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    • "It is commonly accepted that due to the large wound areas, burn patients are vulnerable to local and systemic infections. Previously, Williams and colleagues concluded that sepsis is the leading cause of late death after burn [3]. Thermal injury alone induces alterations in multiple inflammatory parameters, leading to physiological changes such as tachycardia, tachypnea and a raise in body temperature [5] [6]. "
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    ABSTRACT: Background: Despite advances in surgery and critical care, candidemia remains a significant cause of morbidity and mortality in patients with extensive burns. Methods: A retrospective single-center cohort study was performed on 174 patients admitted to the Burn Intensive Care Unit of the General Hospital of Vienna (2007-2013). An AIC based model selection procedure for logistic regression models was utilized to identify factors associated with the presence of candidemia. Results: Twenty (11%) patients developed candidemia on median day 16 after ICU admission associated with an increased overall mortality (30% versus 10%). Statistical analysis identified the following factors associated with proven candidemia: younger age (years) odds ratio (OR):0.96, 95% confidence interval (95% CI):0.92-1.0, female gender (reference male) OR:5.03, 95% CI:1.25-24.9, gastrointestinal (GI) complications requiring surgery (reference no GI complication) OR:20.37, 95% CI:4.25-125.8, non-gastrointestinal thromboembolic complications (reference no thromboembolic complication) OR:17.3, 95% CI:2.57-170.4 and inhalation trauma (reference no inhalation trauma) OR:7.96, 95% CI:1.4-48.4. Conclusions: Above-mentioned patient groups are at considerably high risk for candidemia and might benefit from a prophylactic antifungal therapy. Younger age as associated risk factor is likely to be the result of the fact that older patients with a great extent of burn body surface have a lower chance of survival compared to younger patients with a comparable TBSA.
    Full-text · Article · Sep 2014 · Burns: journal of the International Society for Burn Injuries
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    • "Over the past years there has been a significant decrease in mortality and morbidity in patients suffering from severe burns due to improved burn wound management and approaches in critical care [2,3]. Survival is no longer the exception, but unfortunately death still occurs [2]. Hyperglycaemia is associated with adverse clinical outcomes; in particular, burned patients with poor glucose control had a significantly higher incidence of bacteraemia/fungaemia, exhibited enhanced catabolism, and demonstrated increased mortality rates [4]. "
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    ABSTRACT: Over the past years there has been a significant decrease in mortality and morbidity in patients suffering from severe burns due to improved burn wound management and approaches in critical care. Survival is no longer the exception, but unfortunately death still occurs. One of the key elements concerning state-of-the-art burn care is blood glucose control and insulin therapy; it is well known that burn-induced hyperglycaemia is associated with adverse clinical outcomes. However, controversy for insulin therapy and tight glycaemic control in critically ill and burn patients exists. The increased incidence of hypoglycaemia is the dominant argument against this treatment, because hypoglycaemia is also associated with an increased risk for death in critically ill patients. Taking all current data together, insulin therapy appears both a friend and a foe in the treatment of ICU patients. In order to overcome the limits of tight glycaemic control resulting from hypoglycaemic episodes, current efforts have been directed towards the development of protocols allowing for implementation of clinically feasible and safe guidelines. Among the strategies addressing this problem are closed loop techniques, which are supported by studies demonstrating their capability of exerting tight glycaemic control without the risk of developing hypoglycaemic episodes. Although closed loop techniques have become readily available, we require further evidence to ensure their safety in various ICU environments, notably in ICUs dealing with burn patients. Nonetheless, it is important to emphasise that glycaemic control and adequate insulin therapy are crucial factors for the final outcome (survival) and require our attention.
    Full-text · Article · Oct 2013 · Critical care (London, England)
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    • "Respiratory failure and sepsis are the leading causes of death in severely burned children, with acute lung injury and respiratory distress syndrome (ARDS) accounting for 40-50% of all deaths [53]. Multi-drug resistant organisms also increase death rates from patients with burn-related sepsis from 42% to 86% [53]. The reason for the higher mortality rate of burns in children may involve a lesser physiologic reserve, thinner skin, technical difficulties with vascular access, lesser margin for error in fluid management, or a greater reluctance to subject young children to stressful excisional burn operations [50] [55]. "
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    ABSTRACT: This study aimed at identifying risk factors related to pediatric burns mortality in a middle income country such as Ghana. The data for the three years retrospective study (May 2009 - April 2012) was obtained from the pediatric burn admissions records and patients' folders of the Reconstructive Plastic Surgery & Burns Unit (RPSBU), Komfo Anokye Teaching Hospital (KATH), Ghana. Data retrieved included: Demographic features, Total Burned Surface Area (TBSA) incurred; Aetiology of burns; Duration of the admission; Outcome of admission; Part of the body affected and Cost incurred. Ethical approval for this study was obtained from the KNUST-SMS/KATH Committee on Human Research, Publications and Ethics. Data analyses were performed with SPSS 17.0 version. Information on 197 patients was completely retrieved for the study. Burns mortality rate for the study was identified to be 21.3% (N=42). The mean age of the 42 dead patients was 3.7±0.3 years, ranging from 0-13 years, while, males (54.8%, N= 23) outnumbered females (45.2%, N=19). The TBSA burned interquartile range was 48%. In terms of etiology of burns Scald (73.8%, N=31) was the commonest cause of injury. Mortality risk factors identified were Age <6 years (P=0.028); Scald especially hot water and soup (P=0.016); TBSA >36% (P=0.028) and Inhalation injury (P=0.040). Age, scald, TBSA and Inhalation Injury were identified as pediatric burns mortality risk factors in a developing country such as Ghana's RPSBU. These identified factors will serve as a guideline for plastic surgeons and other health professionals practicing in countries such as Ghana.
    Full-text · Article · Jul 2013 · International Journal of Burns and Trauma
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