Borgman Matthew A, Matos Renée I, Spinella Philip C
1Department of Pediatrics, San Antonio Military Medical Center, Fort Sam Houston, TX. 2Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
Pediatr Crit Care Med. 2015 Feb;16(2):e23-7. doi: 10.1097/PCC.0000000000000307.
To characterize the epidemiology of burn injury in pediatric patients and identify factors associated with mortality based on burn severity.
Retrospective cohort study.
U.S. military combat support hospitals and forward surgical hospitals in Iraq and Afghanistan.
Iraqi and Afghan children less than 18 years old admitted with isolated burn injury.
None.
Burn severity was classified as mild, moderate, and severe based on external Abbreviated Injury Scale score. Patient characteristics and outcomes were described according to burn severity. A multivariate logistic regression was performed on univariate associations with mortality. Of 4,743 pediatric patients, 549 (11.6%) had isolated burn injury. Overall mortality was 13%, median external Abbreviated Injury Scale was 3 (interquartile range, 2-4), and 67% were male. Variables included in the logistic regression were external Abbreviated Injury Scale score, abnormal heart rate for age, hypotension, mechanical ventilation, transfusion, Glasgow Coma Scale, international normalized ratio, base deficit, hematocrit, and platelet count. Factors independently associated with mortality were international normalized ratio (odds ratio, 2.6; 95% CI, 1.2-5.8; p = 0.021) and external Abbreviated Injury Scale (odds ratio, 2.5; 95% CI, 1.3-4.7; p = 0.004). Mortality increased with burn severity: mild 1.7%, moderate 7.2%, and severe 47% (p < 0.001).
This is the first in-depth study of pediatric burn injuries in combat. Children with severe burns (total body surface area > 39% or > 29% if < 5 yr) had a high mortality and required significant resources in a setting that is not primarily resourced for long-term care of severe pediatric burn injury. Extraordinary measures are therefore used for the long-term care of these burned children within the war zones of Iraq and Afghanistan.
描述儿科患者烧伤损伤的流行病学特征，并根据烧伤严重程度确定与死亡率相关的因素。
回顾性队列研究。
美国在伊拉克和阿富汗的军事战斗支援医院及前沿外科医院。
因单纯烧伤损伤入院的18岁以下伊拉克和阿富汗儿童。
无。
根据外部简明损伤量表评分将烧伤严重程度分为轻度、中度和重度。根据烧伤严重程度描述患者特征及预后。对与死亡率的单变量关联进行多变量逻辑回归分析。在4743名儿科患者中，549名（11.6%）有单纯烧伤损伤。总体死亡率为13%，外部简明损伤量表中位数为3（四分位间距，2 - 4），67%为男性。逻辑回归分析纳入的变量包括外部简明损伤量表评分、年龄异常心率、低血压、机械通气、输血、格拉斯哥昏迷量表、国际标准化比值、碱剩余、血细胞比容及血小板计数。与死亡率独立相关的因素为国际标准化比值（比值比，2.6；95%置信区间，1.2 - 5.8；p = 0.021）和外部简明损伤量表（比值比，2.5；95%置信区间，1.3 - 4.7；p = 0.004）。死亡率随烧伤严重程度增加：轻度为1.7%，中度为7.2%，重度为47%（p < 0.001）。
这是首次对战时儿科烧伤损伤进行的深入研究。重度烧伤儿童（如果年龄小于5岁，烧伤总面积>39%或>29%）死亡率高，且在一个并非主要为重度儿科烧伤损伤长期护理提供资源的环境中需要大量资源。因此，在伊拉克和阿富汗的战区，对这些烧伤儿童采取了特殊措施进行长期护理。
