title: End of life decisions and care of the adult burn patient.
abstract: BACKGROUND
  Despite advancements in the provision of burn care, there is still a significant cohort of patients who fail to respond to therapy or for whom treatment is deemed futile. The decision to withdraw support from, or to implement a Do-Not-Resuscitate (DNAR) order in, such patients can be challenging. Our aims were to review the withdrawal of life-sustaining treatment, issuing of DNAR orders and end of life care in burn patient deaths.
  
  
  METHODS
  A retrospective case notes review was undertaken, for all burn in-patient deaths from 1st April 2001 to 31st December 2007.
  
  
  RESULTS
  Following exclusions, 63 patients were included in our study, with a median age of 56 years (21-94). End of life decisions in younger patients (under 65 years) were more often due to burn severity. In those over 65 years, reasons were due to co-morbidities, and these decisions were made late in the patient's admission. In 34% of patients, end of life care was not comprehensively documented.
  
  
  CONCLUSIONS
  A coherent, decisive approach should be adopted and adhered to by all members of the multi-disciplinary team, with clear, standardised documentation in place.
authors.affiliation: West Midlands Regional Burns Service, Queen Elizabeth Hospital, Birmingham B15 2WB, UK. amirismail@doctors.net.uk
authors.forename: A
authors.initials: A
authors.lastname: Ismail
authors.forename: J
authors.initials: J
authors.lastname: Long
authors.forename: N
authors.initials: N
authors.lastname: Moiemen
authors.forename: Y
authors.initials: Y
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care; D006113:United Kingdom; D028761:Withholding Treatment; D055815:Young Adult