Standard variables fail to identify patients who will not respond to fluid resuscitation following thermal injury: brief report.
Approximately 13% of thermally injured patients fail resuscitation, in that they die during the first 48 h postburn despite full resuscitative efforts. The purpose of this study was to characterize these patients, and to develop a predictor of resuscitation failure.


METHODS
Records of 3807 thermally injured patients admitted to this burn centre during 1980-1997 were reviewed. Patients were classified as surviving to hospital discharge ("NONFAIL/LIVE"), as surviving resuscitation but dying later ("NONFAIL/DIE"), or as failing resuscitation ("FAIL"). Ordinal logistic regression was used to develop a predictor of membership in each of these three groups.


RESULTS
With respect to total burn size, full-thickness burn size, and inhalation injury, the three groups represented a gradation in injury severity from least severe (NONFAIL/LIVE) to most severe (FAIL). The predictive model had an overall accuracy of 91.6%; however, it correctly classified NONFAIL/LIVE patients more often (97.7% accuracy) than it did NONFAIL/DIE patients (57.5%) or FAIL patients (16.1%).


CONCLUSIONS
Patients who failed resuscitation were more severely injured than those who survived resuscitation, but was not possible accurately to predict who will fail resuscitation using data available on admission.
Cancio
Leopoldo C
LC
U.S. Army Burn Center, U.S. Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, Fort Sam Houston, TX 78234-6315, USA. Lee.Cancio@us.army.mil.
Reifenberg
Lilane
L
Barillo
David J
DJ
Moreau
Aimee
A
Chavez
Saturnino
S
Bird
Patti
P
Goodwin
Cleon W
CW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000473:pathology / Q000628:therapy*; D002059:Burns, Inhalation / Q000628:therapy; D002648:Child; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D017211:Treatment Failure