| Improved survival following thermal injury in adult patients treated at a regional burn center. | |
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MedLine Citation:
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PMID: 18182910 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Since January 1999, changes in the management of acute burn patients at a regional adult burn center included no hydrotherapy, blood sparing surgical techniques, a restrictive blood transfusion strategy, newer protective modes of mechanical ventilation, aggressive surgical wound excision, temporary wound closure with allograft skin, employment of advanced critical care trained nurses, and an increased number of dedicated full-time fellowship-trained burn surgeons. The purpose of this study was to determine the composite effect of these modifications on burn patients' survival. A retrospective hospital chart review was conducted among adult burn patients admitted during a 10-year period (1996-2005). Patients were stratified in two time periods: PAST (1996-1998) and RECENT (1999-2005). RECENT patients were selected by matching age, gender, total body surface area burn, full thickness burn, and presence of inhalation injury with PAST patients. All values are mean +/- SD. Student's t-test and chi2 analysis were performed accordingly with a P < .05 considered significant. Of 1569 acute burn patients admitted between 1996 and 2005, 96 (6%) were excluded because they received comfort measures only. Of the remaining 1473 patients, 684 patients (PAST = 342, RECENT = 342) were selected by the matching criteria. More RECENT patients required mechanical ventilation (25% vs 17%, P = .011), with a trend toward more prolonged duration (9 vs 11.5 days, P = .175), more escharotomies (9.6% vs 5.6%, P = .036), more operations (1.1 vs 0.8, P = .003), and more temporary allograft skin (10% vs 2%, P < .001) than did PAST patients. RECENT patients had lower mortality than did PAST patients (2.3% vs 5.6%, P = .048), specifically patients aged 60 or older (5.4% vs 25.5%, P = .004), patients with TBSA lower than 20% (1% vs 3.9%, P = .031), patients on mechanical ventilation (9.3% vs 27.6%, P = .006), and patients who had surgery (2.6% vs 7.3%, P = .032). The significant decrease in burn patient's mortality was likely due to the composite effects of improvements in clinical care between the two time periods. |
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Authors:
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Manuel Gomez; Robert Cartotto; Judy Knighton; Karen Smith; Joel S Fish |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of burn care & research : official publication of the American Burn Association Volume: 29 ISSN: 1559-047X ISO Abbreviation: - Publication Date: 2008 Jan-Feb |
Date Detail:
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Created Date: 2008-01-09 Completed Date: 2008-03-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101262774 Medline TA: J Burn Care Res Country: United States |
Other Details:
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Languages: eng Pagination: 130-7 Citation Subset: IM |
Affiliation:
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Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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APACHE Acute Disease Adult Age Factors Burn Units* Burns / mortality*, therapy Female Health Status Indicators Humans Male Retrospective Studies Severity of Illness Index Sickness Impact Profile Time Factors Treatment Outcome* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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