*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.
Ann Surg. 2014 May;259(5):833-41. doi: 10.1097/SLA.0000000000000438.
To determine and compare outcomes with accepted benchmarks in burn care at 6 academic burn centers.
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.
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.
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.
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.
在 6 家学术烧伤中心确定并比较接受的烧伤护理基准结果。
自 20 世纪 60 年代以来，美国烧伤患者的发病率和死亡率大幅下降，这可能与外科和重症治疗的改进有关。我们描述了主要烧伤损伤的基线患者特征和明确的结果。
我们通过标准操作程序，对 2003 年至 2009 年期间的 300 名成人和 241 名儿童进行住院治疗，从患者和损伤特征、解剖和生理紊乱、临床治疗和结果方面建立了一个广泛的数据库。这些数据与现有的烧伤护理基准进行了比较。
研究患者受到严重伤害，成人平均总体表烧伤面积（TBSA）（41.2 ± 18.3）和儿童（57.8 ± 18.2）表明，38%的成人和 54.8%的儿童存在吸入性损伤。55 岁以下成人死亡率为 14.1%，55 岁及以上成人死亡率为 38.5%。17 岁以下患者死亡率为 7.9%。总体而言，多器官衰竭率为 27%。当控制年龄和 TBSA%时，吸入性损伤的存在仍然具有重要意义。
这项研究为主要烧伤患者提供了当前的基准。尽管 TBSA 百分比和吸入性损伤的存在显著，但与以前的基准相比，死亡率显著下降。现代外科和医学强化管理已经有了明显的改善，我们可以期望 55 岁以下的严重烧伤和吸入性损伤患者能够在这些毁灭性的条件下存活下来。
