Wound Care

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Burn Size and Survival Probability in Pediatric Patients in Modern Burn Care

 

While patient survival after severe burn injury is largely determined by burn size, modern developments in burn care have greatly improved survival and outcomes. However, no large analysis of outcomes in pediatric burn patients with present treatment regimens exists. As a result, a study published in The Lancet, (2012;379:1013-1021), was designed to identify the burn size associated with significant increases in morbidity and mortality in pediatric patients.

 

The investigation was a single-center prospective observational cohort study using clinical data for pediatric patients with burns of at least 30% of their total body surface area (TBSA). Patients were stratified by burn size in 10% increments, ranging from 30% to 100% TBSA, with a secondary assignment made according to the outcome of a receiver operating characteristic (ROC) analysis.

 

Between 1998 and 2008, 952 severely burned pediatric patients were admitted to the center. All groups were comparable in age (mean 7.3 years, ranging from 6.1 years in the 30-39% TBSA group to 9.6 years in the 90-100% TBSA group). Gender distribution was 66% boys, ranging from 59% in the 60-69% TBSA group to 82% in the 90-100% TBSA group.

 

Results showed that burn size of 62% TBSA was a crucial threshold for mortality (odds ratio 10.07; p<0.00001).

 

According to the authors, in a modern pediatric burn care setting, a burn size of roughly 60% TBSA is a crucial threshold for postburn morbidity and mortality and that on the basis of these findings, it is recommended that pediatric patients with greater than 60% TBSA burns be immediately transferred to a specialized burn center. The authors added that at the burn center, patients should be treated with increased vigilance and improved therapies, in view of the increased risk of poor outcome associated with this burn size.

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