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      Severe burn injury in europe: a systematic review of the incidence, etiology, morbidity, and mortality

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          Abstract

          Introduction

          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.

          Methods

          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.

          Results

          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.

          Conclusions

          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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          Objective estimates of the probability of death from burn injuries.

          E H Cassem, R. Sheridan, Douglas R Tompkins … (1998)
          Over the past 20 years, there has been remarkable improvement in the chances of survival of patients treated in burn centers. A simple, accurate system for objectively estimating the probability of death would be useful in counseling patients and making medical decisions. We conducted a retrospective review of all 1665 patients with acute burn injuries admitted from 1990 to 1994 to Massachusetts General Hospital and the Shriners Burns Institute in Boston. Using logistic-regression analysis, we developed probability estimates for the prediction of mortality based on a minimal set of well-defined variables. The resulting mortality formula was used to determine whether changes in mortality have occurred since 1984, and it was tested prospectively on all 530 patients with acute burn injuries admitted in 1995 or 1996. Of the 1665 patients (mean [+/-SD] age, 21+/-20 years; mean burn size, 14+/-20 percent of body-surface area), 1598 (96 percent) lived to discharge. The mean length of stay was 21+/-29 days. Three risk factors for death were identified: age greater than 60 years, more than 40 percent of body-surface area burned, and inhalation injury. The mortality formula we developed predicts 0.3 percent, 3 percent, 33 percent, or approximately 90 percent mortality, depending on whether zero, one, two, or three risk factors are present. The results of the prospective test of the formula were similar. A large increase in the proportion of patients who chose not to be resuscitated complicated comparisons of mortality over time. The probability of mortality after burns is low and can be predicted soon after injury on the basis of simple, objective clinical criteria.
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            Mortality and causes of death in a burn centre.

            H Boxma, J Dokter, G Bloemsma … (2008)
            Mortality rates are important outcome parameters after burn, and can serve as objective end points for quality control. Causes of death after severe burn have changed over time; in the international literature, multisystem organ failure is seen as the most important cause, but the exact distribution of causes of death remains unknown. Insight into underlying agents of mortality can be directive in research and prevention programmes. This comparison between results from the Rotterdam Burn Centre (RBC) and the American National Burn Repository (NBR) examines the most important predictive parameters for fatal outcome, i.e. age, total body surface area involved and presence of inhalation injury. Causes of death were attributed for all fatal outcomes treated in the RBC from 1996 to 2006. The mortality rate at the RBC was 6.9% and at the NBR was 5.6%, with almost no differences in age or total body surface area involved. The discrepancy in mortality rate might have been due to the high incidence of inhalation injury among the RBC population. However, the mortality rate at the RBC after admission with intention to treat decreased to 4.9%. The most frequent cause of death appeared to be multisystem organ failure, in 64.9% of cases; 93% of these had systemic inflammatory response syndrome at time of death and, in 45.9%, infection was deemed responsible for the fatal clinical deterioration (in 21.3% sepsis was proved and in 24.6% was highly suspected). To compare mortality rates between different burn centres and periods of time, uniform classifications are needed, particularly for presence of inhalation injury and for causes of death. Prevention of multisystem organ failure, by better management of infection and systemic inflammatory response syndrome, might do most to decrease mortality after burn.
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              Development and validation of a model for prediction of mortality in patients with acute burn injury.

              (2008)
              The objective was to develop a user-friendly model to predict the probability of death from acute burns soon after injury, based on burned surface area, age and presence of inhalation injury. This population-based cohort study included all burned patients admitted to one of the six Belgian burn centres. Data from 1999 to 2003 (5246 patients) were used to develop a mortality prediction model, and data from 2004 (981 patients) were used for validation. Mortality in the derivation cohort was 4.6 per cent. A mortality score (0-10 points) was devised: 0-4 points according to the percentage of burned surface area (less than 20, 20-39, 40-59, 60-79 or at least 80 per cent), 0-3 points according to age (under 50, 50-64, 65-79 or at least 80 years) and 3 points for the presence of an inhalation injury. Mortality in the validation cohort was 4.3 per cent. The model predicted 40 deaths, and 42 deaths were observed (P = 0.950). Receiver-operator characteristic curve analysis of the model for prediction of mortality demonstrated an area under the curve of 0.94 (95 per cent confidence interval 0.90 to 0.97). An accurate model was developed to predict the probability of death from acute burn injury based on simple and objective clinical criteria. Copyright (c) 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
              Article 0 comments Cited 42 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Crit Care
                Title: Critical Care
                Publisher: BioMed Central
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Print): 2010
                Publication date (Electronic): 19 October 2010
                Volume: 14
                Issue: 5
                Page: R188
                Affiliations
                [1 ]Department of General Internal Medicine, Infectious Diseases and Psychosomatic Medicine, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium
                [2 ]Department of Plastic Surgery and Burn Unit, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium
                [3 ]Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent 9000, Belgium
                [4 ]Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium
                [5 ]Department of Healthcare, University College Ghent, Keramiekstraat 80, Ghent 9000, Belgium
                Article
                Publisher ID: cc9300
                DOI: 10.1186/cc9300
                PMC ID: 3219295
                PubMed ID: 20958968
                SO-VID: c684fb4a-86c6-4a55-b998-dadda2fa3306
                Copyright © Copyright ©2010 Brusselaers et al.; licensee BioMed Central Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

                History
                Date received : 22 February 2010
                Date revision received : 21 April 2010
                Date accepted : 19 October 2010
                Categories
                Subject: Research

                ScienceOpen disciplines: Emergency medicine & Trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma

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