Benchmarking outcomes in the critically injured burn patient.
OBJECTIVE
To determine and compare outcomes with accepted benchmarks in burn care at 6 academic burn centers.


BACKGROUND
Since the 1960s, US morbidity and mortality rates have declined tremendously for burn patients, likely related to improvements in surgical and critical care treatment. We describe the baseline patient characteristics and well-defined outcomes for major burn injuries.


METHODS
We followed 300 adults and 241 children from 2003 to 2009 through hospitalization, using standard operating procedures developed at study onset. We created an extensive database on patient and injury characteristics, anatomic and physiological derangement, clinical treatment, and outcomes. These data were compared with existing benchmarks in burn care.


RESULTS
Study patients were critically injured, as demonstrated by mean % total body surface area (TBSA) (41.2 ± 18.3 for adults and 57.8 ± 18.2 for children) and presence of inhalation injury in 38% of the adults and 54.8% of the children. Mortality in adults was 14.1% for those younger than 55 years and 38.5% for those aged 55 years and older. Mortality in patients younger than 17 years was 7.9%. Overall, the multiple organ failure rate was 27%. When controlling for age and % TBSA, presence of inhalation injury continues to be significant.


CONCLUSIONS
This study provides the current benchmark for major burn patients. Mortality rates, notwithstanding significant % TBSA and presence of inhalation injury, have significantly declined compared with previous benchmarks. Modern day surgical and medically intensive management has markedly improved to the point where we can expect patients younger than 55 years with severe burn injuries and inhalation injury to survive these devastating conditions.
*Department of Surgery, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA †Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA ‡Department of Medicine, Massachusetts General Hospital, Boston, MA §Department of Surgery, Massachusetts General Hospital, Boston, MA ¶Department of Surgery, Loyola University School of Medicine, Maywood, IL ‖Department of Surgery, University of Texas Medical Branch, Galveston, TX **Department of Surgery and Plastic Surgery, University of Toronto, Canada ††Department of Surgery, Parkland Memorial Hospital, University of Texas, Southwestern Medical Center, Dallas TX ‡‡Stanford Genome Technology Center, Palo Alto, CA §§Department of Surgery, Harborview Medical Center, Seattle, WA ¶¶Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA.
Matthew B
MB
Klein
Jeremy
J
Goverman
Douglas L
DL
Hayden
Shawn P
SP
Fagan
Grace P
GP
McDonald-Smith
Andrew K
AK
Alexander
Richard L
RL
Gamelli
Nicole S
NS
Gibran
Celeste C
CC
Finnerty
Marc G
MG
Jeschke
Brett
B
Arnoldo
Bram
B
Wispelwey
Michael N
MN
Mindrinos
Wenzhong
W
Xiao
Shari E
SE
Honari
Philip H
PH
Mason
David A
DA
Schoenfeld
David N
DN
Herndon
Ronald G
RG
Tompkins
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D019985:Benchmarking; D002056:Burns / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D055815:Young Adult