title: Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn?
abstract: OBJECTIVE
  Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns.
  
  
  METHODS
  None.
  
  
  RESULTS
  Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < .05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05).
  
  
  CONCLUSIONS
  The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Kraft
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Kulp
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: Fatemah
authors.initials: F
authors.lastname: Emdad
authors.forename: Felicia N
authors.initials: FN
authors.lastname: Williams
authors.forename: Hal K
authors.initials: HK
authors.lastname: Hawkins
authors.forename: Katrina R
authors.initials: KR
authors.lastname: Leonard
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D000293:Adolescent; D002056:Burns / Q000145:classification / Q000378:metabolism* / Q000401:mortality / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood / Q000276:immunology; D004734:Energy Metabolism; D005260:Female; D005390:Fires; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D017063:Outcome Assessment, Health Care; D014867:Water / Q000009:adverse effects*
chemical_list: D016207:Cytokines; D014867:Water