Document Detail


Trajectories to death in patients with burn injury.
MedLine Citation:
PMID:  23271104     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: With unprecedented survival rates in modern burn care, there is increasing focus on optimizing long-term functional outcomes. However, 3% to 8% of patients admitted to burn centers still die of injury. Patterns in which these patients progress to death remain poorly characterized. We hypothesized that burn nonsurvivors will follow distinct temporal distributions and patterns of decline, parallel to the trimodality of deaths previously described for trauma.
METHODS: We retrospectively identified all adult deaths from 1995 to 2007 in the National Burn Repository database (n = 5,975) and at our regional burn center (n = 237). We stratified patients by age and analyzed injury and death characteristics. We used objective criteria to allocate nonsurvivors to one of four trajectories: early rapid decline, early organ failure, late sudden death, or late-onset decline.
RESULTS: The greatest concentration of deaths in both samples and age groups occurred within 72 hours of injury and decreased subsequently with no later mortality peak. Death was most often caused by burn shock within the first week of injury, cardiogenic shock or lung injury in Weeks 1 to 2, and sepsis/multiorgan failure after Week 2. In decreasing frequency, trajectories to death fit the pattern of early rapid decline (58%), early organ failure (20%), late-onset decline (16%), and late sudden death (6%).
CONCLUSION: Most burn deaths follow a pattern of early rapid decline or early organ failure manifested by death or critical illness within several days of the burn. These findings indicate that more than three quarters of burn deaths are attributable to failure or significant decompensation beginning in the resuscitation phase. Sporadic deaths later in hospitalization are uncommon. Despite significant advances in burn resuscitation, our data indicate that ongoing efforts to mitigate deaths in modern burn care should still focus on care improvements in the resuscitation phase.
LEVEL OF EVIDENCE: Epidemiologic study, level III.
Authors:
Jordan W Swanson; Andrew M Otto; Nicole S Gibran; Matthew B Klein; C Bradley Kramer; David M Heimbach; Tam N Pham
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  74     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-28     Completed Date:  2013-03-21     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  282-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Washington, Seattle, Washington 98104, USA. swanson2@uw.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Burn Units
Burns / mortality*
Cause of Death
Female
Hospital Mortality
Humans
Male
Middle Aged
Survival Rate
Young Adult
Grant Support
ID/Acronym/Agency:
KL2 TR000421/TR/NCATS NIH HHS; UL1 TR000423/TR/NCATS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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