Specialized burn clinics care best for severely burned children

Children with burns covering 60% or more of their total body surface area (TBSA) are at increased risk for complications and death and should be transferred immediately to specialized burn units, according to a new study.

Research done in the 1990s identified burn size of 40% of TBSA as a critical threshold for increased risk of poor outcome. Since then, however, improvements in treatment have increased survival rates and outcomes after extensive burn injuries. In the current study, 952 severely burned pediatric patients in the burn unit of a major children’s hospital were stratified by burn size in 10% increments, ranging from 30% to 100% of TBSA, and treated according to established guidelines.

A total of 123 patients died. Mortality increased significantly as burn size increased, TBSA greater than 60% being the strongest predictor of death. The odds ratio of death was 10 times higher for patients with TBSA greater than 60% compared with those with less extensive burns. Inhalation injury increased the odds of death nearly 3-fold.

Children with larger burns had longer intensive-care unit stays, needed more operations, and required more time between surgeries. Increased burn size was also associated with multiorgan failure, sepsis, more minor infections, higher blood glucose and insulin levels, higher triglyceride levels, and higher metabolic rates. Liver, kidney, and pulmonary functions were worse in patients with larger burns, and levels of inflammatory markers were increased.

The findings establish that in a modern pediatric burn care center, a burn size of roughly 60% TBSA is a crucial threshold for morbidity and mortality, researchers conclude. They recommend that children with these severe burns be transferred to a specialized burn clinic immediately and treated with increased vigilance and novel therapies.

Go back to the current issue of the eConsult.