title: Comparing mortality outcomes of major burns and toxic epidermal necrolysis in a tertiary burns centre.
abstract: BACKGROUND
  Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage.
  
  
  METHODS
  Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest.
  
  
  RESULTS
  Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P=0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P=0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5h; P=0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality.
  
  
  CONCLUSIONS
  Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Dermatology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, School of Medicine, Deakin University, VIC, Australia. Electronic address: dmahar@deakin.edu.au.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Mahar
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Epidemiology & Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
authors.affiliation: Department of Epidemiology & Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.affiliation: Department of Surgery, School of Medicine, Deakin University, VIC, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Watters
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Kirby
authors.affiliation: Department of Dermatology, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Douglas
authors.initials: D
authors.lastname: Gin
authors.affiliation: Department of Medicine, Monash Health, Melbourne, VIC, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Marsh
authors.affiliation: Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Central and Eastern Clinical School, Department of Surgery, Monash University, VIC, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Cleland
mesh_terms: D000328:Adult; D000368:Aged; D002053:Burn Units; D002056:Burns / Q000401:mortality*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013262:Stevens-Johnson Syndrome / Q000401:mortality*; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: Burns; Mortality; Palliative care; Toxic epidermal necrolysis