title: Lethal triad in severe burns.
abstract: BACKGROUND
  Hypothermia, acidaemia and coagulopathy in trauma is associated with significant mortality. This study aimed to identify the incidence of the lethal triad in major burns, and describe demographics and outcomes.
  
  
  METHODS
  Patients admitted during a 71 month period with a total body surface area burn (TBSA)≥30% were identified. A structured review of a prospective database was conducted. The lethal triad was defined as a combination of coagulopathy (International normalised ratio>1.2), hypothermia (temperature≤35.5°C) and acidaemia (pH≤7.25).
  
  
  RESULTS
  Fifteen of 117 patients fulfilled the criteria for the lethal triad on admission. Lethal triad patients had a higher median (IQR) abbreviated burn severity index (ABSI) (12 (9-13) vs. 8.5 (6-10), p=0.001), mean (SD) TBSA burn (59.2% (18.7) vs. 47.9% (18.1), p=0.027), mean (SD) age (46 (22.6) vs. 33 (28.3) years, p=0.033), and had a higher incidence of inhalational injury (p<0.0001) and full-thickness burns (p=0.021). Both groups received similar volumes of fluid (p>0.05). The lethal triad was associated with increased mortality (66.7% vs. 13.7%, p<0.0001). With logistic regression analysis and adjustment for ABSI, the lethal triad was not shown to be a predictor of mortality (p>0.05).
  
  
  CONCLUSIONS
  Burn patients with the lethal triad have a high mortality rate which reflects the severity of the injury sustained.
authors.affiliation: Department of Anaesthesia and Intensive Care, The Royal London Hospital, London, UK. Electronic address: petersherren@gmail.com.
authors.forename: P B
authors.initials: PB
authors.lastname: Sherren
authors.affiliation: Department of Anaesthesia and Intensive Care, St. Andrew's Burn Centre, Chelmsford, UK. Electronic address: Joseph.Hussey@meht.nhs.uk.
authors.forename: J
authors.initials: J
authors.lastname: Hussey
authors.affiliation: Department of Anaesthesia and Intensive Care, St. Andrew's Burn Centre, Chelmsford, UK. Electronic address: Rebecca.Martin@meht.nhs.uk.
authors.forename: R
authors.initials: R
authors.lastname: Martin
authors.affiliation: Department of Anaesthesia and Intensive Care, The Royal London Hospital, London, UK. Electronic address: tapiwakundi@yahoo.co.uk.
authors.forename: T
authors.initials: T
authors.lastname: Kundishora
authors.affiliation: Medical Statistician, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK. Electronic address: michael.parker@anglia.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: Parker
authors.affiliation: Department of Anaesthesia and Intensive Care, St. Andrew's Burn Centre, Chelmsford, UK. Electronic address: Bruce.Emerson@meht.nhs.uk.
authors.forename: B
authors.initials: B
authors.lastname: Emerson
mesh_terms: D000138:Acidosis / Q000209:etiology / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000401:mortality*; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000401:mortality*; D002059:Burns, Inhalation / Q000150:complications / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000401:mortality*; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Abbreviated burn severity index (ABSI); Acidaemia; Burn; Coagulopathy; Hypothermia