A study published Online First by The Lancet has found that children with burn injuries covering 60% or more of their total body surface area (TBSA) are at a much higher risk of experiencing severe complications or death. The authors urge the need for more attention to be given to such patients, with more vigilant and improved forms of therapy.
The study, led by by Dr Marc Jeschke, Ross Tilley Burn Centre, University of Toronto, Sunnybrook Research Institute, ON, Canada, and Dr David N Herndon, Shriners Hospital for Children and University of Texas Medical Branch, TX, USA colleagues, involved assessing 952 paediatric burns patients aged 6 to 10 at the Shriners Hospital for Children Galveston, TX, USA between 1998 and 2008. The study included patients with a variety of different burn sizes, including those with the severest burns (90-100% TBSA group) to those with less severe burns (30-39% TBSA group).
The researchers found that of the thirteen percent of children that died (123 of 952), those in the 30-39% TBSA group accounted for only 3% (5 of 180) of deaths, while those in the 90-100% TBSA group accounted for 55% (28 of 51). Sixteen percent of the children (154) experienced multiorgan failure, of those only 6% (10) were in the 30-39% TBSA group, compared to 45% (23) in the 90-100% TBSA group. Of the nine percent of the children with sepsis (89), only 2% (3) were in the 30-39% TBSA group compared to 26% (13) in the 90-100% TBSA group. Those with a burn size of 62% TBSA or above were 10 times more likely to die compared to those who had less severe burns, with the mortality rate being almost equal among those with burns below 60% TBSA. They also found that the presence and concentration of novel biomarkers for organ function, metabolism and inflammation depended greatly on whether or not the patient had burns above or below the 62% TBSA threshold.
Previous studies in the 1990s indicated that burn injuries covering 40% of TBSA, or more, were linked to increased risk of health complications and death. Since then, there have been many improvements in the care of patients with severe burns by using new grafting techniques, drug treatments and improved care methods. However work still needs to be done in order to address the high mortality rate of those with burns covering more than 60% of TBSA.
The authors conclude
"We have established that, in a modern paediatric burn care setting, a burn size of roughly 60% TBSA is a crucial threshold for post-burn morbidity and mortality. On the basis of these findings, we recommend that paediatric patients with greater than 60% TBSA burns be immediately transferred to a specialised burn centre. Furthermore, at the burn centre, patients should be treated with increased vigilance and improved therapies, recognising the increased risk for poor outcome associated with this burn size."
Dr Ronald G Tompkins, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA, says
"It is time to think beyond survival to survivors' quality of life. Clinicians have traditionally assigned their own values to the quality of a burn patient's survival; however, the patient and their family should be allowed to contribute their views of how the injury has affected their lives. Recent articles have validated burn-specific outcomes instruments to measure quality of life after burn injury from the patient's and family's perspectives. In future, use of such post-burn injury questionnaires should be broadened to drive future strategies not only to ensure survival, but also to improve quality of life for those who do survive."
Written by Joseph Nordqvist