Contemporary Burn Survival - 26/03/18

Doi : 10.1016/j.jamcollsurg.2017.12.045

Karel D. Capek, MD ^a,^b, Linda E. Sousse, PhD ^a,^b, Gabriel Hundeshagen, MD ^a,^b, Charles D. Voigt, MD ^a,^b, Oscar E. Suman, PhD ^a,^b, Celeste C. Finnerty, PhD ^a,^b,^c,^d, Kristofer Jennings, PhD ^e, David N. Herndon, MD, FACS ^a,^b,^c,^⁎
^a Department of Surgery, University of Texas Medical Branch, Galveston, TX
^b Shriners Hospitals for Children–Galveston, Galveston, TX
^c Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX
^d Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, TX
^e Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX

^∗Correspondence address: David N Herndon, MD, FACS, Shriners Hospitals for Children–Galveston, 815 Market St, Galveston, TX 77550.Shriners Hospitals for Children–Galveston815 Market StGalvestonTX77550

Abstract

Background

The standard of burn treatment today reflects major advances. We sought to quantitate the impact of these advances on burn survival via age-stratified mortality ratios compared with other reported mortality analyses in burns.

Study Design

Age, percent of the total body surface area (TBSA) burned, presence of inhalation injury, length of stay, and survival status were recorded at admission and at discharge for all new burn admissions between 1989 and 2017. The expected mortality probability was calculated using historical multiple regression techniques and compared with observed data. We developed a prediction model for our observed data.

Results

Between 1989 and 2017, there were 10,384 consecutive new burn admissions, with 355 mortalities (median age, 13 years; median percent TBSA burn, 11%). We saw a significant decrease in our observed mortality data compared to historical predictions (p < 0.0001), and a 2% reduction per year in mortality during the 3 decades. The prediction model of mortality for the data is as follows: Pr(dying) = e^x/(1 + e^x) where x = –6.44 – 0.12 age + 0.0042 age² – 0.0000283 age³ + 0.0499 TBSA + 1.21 Inhalation Injury + 0.015 third degree TBSA.

Conclusions

The reduction in mortality over time may be attributed to successful changes in standard of care protocols in the burn center that improved the outlook for burned individuals, including protocols for management of inhalation injury, nutrition, resuscitation, and early excision and grafting.

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Plan

Methods

Subject demographics and injury characteristics

Inhalation injury diagnosis

	Disclosure Information: Nothing to disclose.
	Disclosures outside the scope of this work: Dr Herndon receives royalties from Elsevier.
	Support: This work was supported by NIDILRR (90DP0043-02-01 [DNH]), NIH (P50GM060338, R01GM056687, T32GM008256 [DNH]; R01HD049471 [OES]; and R01GM112936 [CCF]), Shriners Hospitals for Children (84080, 80100, 71008, and 71000 [DNH]), the Department of Surgery at UTMB (2014-667 [LES]), and the Remembering the 15 Research Education Endowment Fund. This study was also conducted with the support of UTMB's Institute for Translational Sciences, supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences (NIH).
	Disclaimer: None of the funding sources had any role in the design of the study, in the writing of the manuscript, or in the collection, analysis, and/or interpretation of the data.