Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77555, USA.
Crit Care. 2009;13(6):R183. doi: 10.1186/cc8170. Epub 2009 Nov 17.
Severe thermal injury is characterized by profound morbidity and mortality. Advances in burn and critical care, including early excision and grafting, aggressive resuscitation and advances in antimicrobial therapy have made substantial contributions to decrease morbidity and mortality. Despite these advances, death still occurs. Our aim was to determine the predominant causes of death in burned pediatric patients in order to develop new treatment avenues and future trajectories associated with increased survival.
Primary causes of death were reviewed from 144 pediatric autopsy reports. Percentages of patients that died from anoxic brain injuries, sepsis, or multi-organ failure were calculated by comparing to the total number of deaths. Data was stratified by time (from 1989 to 1999, and 1999 to 2009), and gender. Statistical analysis was done by chi-squared, Student's t-test and Kaplan-Meier for survival where applicable. Significance was accepted as P < 0.05.
Five-thousand two-hundred-sixty patients were admitted after burn injury from July 1989 to June 2009, and of those, 145 patients died after burn injury. Of these patients, 144 patients had an autopsy. The leading causes of death over 20 years were sepsis (47%), respiratory failure (29%), anoxic brain injury (16%), and shock (8%). From 1989 to 1999, sepsis accounted for 35% of deaths but increased to 54% from 1999 to 2009, with a significant increase in the proportion due to antibiotic resistant organisms (P < 0.05).
Sepsis is the leading cause of death after burn injury. Multiple antibiotic resistant bacteria now account for the bulk of deaths due to sepsis. Further improvement in survival may require improved strategies to deal with this problem.
严重的热损伤以高发病率和死亡率为特征。烧伤和重症监护方面的进步，包括早期切除和植皮、积极的复苏以及抗菌治疗的进步，都为降低发病率和死亡率做出了巨大贡献。尽管取得了这些进展，死亡仍在发生。我们的目的是确定烧伤儿科患者死亡的主要原因，以便制定新的治疗方案，并确定与生存率提高相关的未来发展轨迹。
从 144 份儿科尸检报告中回顾了主要死因。通过与总死亡人数相比，计算出因缺氧性脑损伤、败血症或多器官衰竭而死亡的患者比例。数据按时间（1989 年至 1999 年和 1999 年至 2009 年）和性别分层。适用时，通过卡方检验、学生 t 检验和 Kaplan-Meier 进行统计分析。接受 P<0.05 作为显著性标准。
1989 年 7 月至 2009 年 6 月期间，5260 名烧伤患者入院，其中 145 名烧伤患者死亡。在这些患者中，有 144 名患者进行了尸检。20 多年来，主要死亡原因是败血症（47%）、呼吸衰竭（29%）、缺氧性脑损伤（16%）和休克（8%）。1989 年至 1999 年，败血症占死亡人数的 35%，但从 1999 年至 2009 年增加到 54%，抗生素耐药菌导致的死亡比例显著增加（P<0.05）。
败血症是烧伤后死亡的主要原因。现在，多种抗生素耐药菌导致败血症死亡的比例最大。要进一步提高生存率，可能需要改进处理这一问题的策略。
