title: Occurrence of multiorgan dysfunction in pediatric burn patients: incidence and clinical outcome.
abstract: OBJECTIVE
  To examine the incidence of single or multiple organ failure postburn and its resultant clinical outcomes during acute hospitalization.
  
  
  BACKGROUND
  Patient outcomes are inherently dependent on intact organ function; however, burn injury affects the structure and function of almost every organ, but especially lung, liver, kidney, and heart. Therefore, single-organ failure and/or multiorgan failure (MOF) are thought to contribute significantly to postburn morbidity and mortality, but to date no large trial examining the effects of MOF on postburn outcomes exists.
  
  
  METHODS
  Incidence of MOF was monitored in 821 pediatric burn patients during acute hospitalization. Patients were divided into groups on the basis of the incidence of single-organ-specific failure, MOF, and non-MOF. The DENVER2 score was used to assess organ-specific scores for lung, liver, kidney, and heart. The patient's demographics, injury characteristics, and outcome parameters were recorded.
  
  
  RESULTS
  Respiratory failure has the highest incidence in the early phase of postburn injury and decreases starting 5 days postburn. Cardiac failure was noted to have the highest incidence throughout hospital stay. Incidence of hepatic failure increases with the hospital length of stay and is associated with a high mortality during the late phase of the acute hospital stay. Renal failure has an unexpectedly low incidence but is associated with a high mortality during the first 3 weeks postburn injury. Three or more organ failure is associated with very high mortality.
  
  
  CONCLUSIONS
  This is the first large study in burn patients to determine the incidence of organ-specific failure and outcome. The results of this study confirmed the expected chronologic incidence of organ-specific failure and yield the long-term mortality from liver and renal failure.
authors.affiliation: *Shriners Hospitals for Children †Department of Surgery, University of Texas Medical Branch, Galveston, TX ‡Department of Surgery, Division of Plastic Surgery and Immunology, University of Toronto, Ontario, Canada §Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and ¶Sunnybrook Research Institute, Toronto, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Kraft
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: Celeste C
authors.initials: CC
authors.lastname: Finnerty
authors.forename: Shahriar
authors.initials: S
authors.lastname: Shahrokhi
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D000293:Adolescent; D002056:Burns / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003422:Critical Care; D004750:Enteral Nutrition; D005260:Female; D005440:Fluid Therapy; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D016038:Skin Transplantation; D015599:Trauma Severity Indices; D016896:Treatment Outcome