Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study.
Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study.
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DOI：
10.1016/s0140-6736(11)61345-7
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发表时间：
2012-03-17
期刊：
影响因子：
168.9
通讯作者：
Jeschke, Marc G.
中科院分区：
文献类型：
--
作者：
Kraft, Robert;Herndon, David N.;Al-Mousawi, Ahmed M.;Williams, Felicia N.;Finnerty, Celeste C.;Jeschke, Marc G.
严重烧伤后患者的生存很大程度上取决于烧伤面积。烧伤护理的现代发展极大地改善了生存率和结果。然而，目前还没有对采用当前治疗方案的小儿烧伤患者的结局进行大型分析。本研究旨在确定目前与儿童烧伤患者发病率和死亡率显着增加相关的烧伤面积。单中心前瞻性观察队列研究利用 1998 年至 2009 年间收治的严重烧伤儿科患者的临床数据。这项研究包括 952 名烧伤面积至少占全身表面积 (TBSA) 30% 的严重烧伤儿科患者。根据烧伤面积以 10% 的增量对患者进行分层，范围从 30% 到 100%，并根据受试者工作特征 (ROC) 分析的结果进行二次分配。酌情使用Student’s t检验、χ2检验、逻辑回归和ROC分析进行统计分析，显着性设置为p<0.05。所有组的年龄均具有可比性（年龄：30–39：6.1±5.1、40–49：7.1±5.2、50–59：7.6±5.1、60–69：7.2±5.1、70–79：8.3±5.9、80–89：8.4±5.6、90–100： 9.6±5.4）和性别分布（男性：30-39：68％，40-49：64％，50-59：65％，60-69：59％，70-79：71％，80-89：62％，90-100：82％）。死亡率（30–39：3%、40–49：3%、50–59：7%、60–69：16%、70–79：22%、80–89：35%、90–100：55%）、多器官衰竭（30–39：6%、40–49：6%、 50–59：12%、60–69：27%、70–79：29%、80–89：44%、90–100：45%）和脓毒症（30–39：2%、40–49：5%、50–59：6%、60–69：15%、70–79： 13%、80–89: 22%、90–100: 26%），各组之间显着增加（p<0.001），阈值为 62% TBSA。烧伤面积大于 62% 的患者与烧伤面积较小的患者的比较显示，炎症（细胞因子）、急性期 (CRP) 和高代谢反应 (REE) 以及器官功能存在显着差异 (p<0.05)。我们确定，在现代儿科烧伤护理环境中，约 60% TBSA 的烧伤面积代表烧伤后发病率和死亡率的关键阈值。基于这些发现，我们建议 TBSA 烧伤超过 60% 的儿童烧伤患者应立即转移到专门的烧伤中心。此外，在烧伤中心，应对患者进行治疗时提高警惕并加强治疗，认识到与这种烧伤面积相关的不良结果风险增加。
Patient survival following severe burn injury is largely determined by burn size. Modern developments in burn care have tremendously improved survival and outcomes. However, no large analysis on outcomes in pediatric burn patients with current treatment regimen exists. This study was designed to identify the burn size presently associated with significant increases in morbidity and mortality in pediatric burn patients. Single center prospective observational cohort study utilizing the clinical data of severely burned pediatric patients admitted between 1998 and 2009. This study included 952 severely burned pediatric patients with burns over at least 30% of their total body surface area (TBSA). Patients were stratified by burn size in 10% increments, ranging from 30 to 100%, with a secondary assignment made according to the outcome of a receiver operating characteristic (ROC) analysis. Statistical analysis was performed using Student’s t-test, χ2 test, logistic regression and ROC analysis, as appropriate, with significance set at p<0.05. All groups were comparable in age (age in years: 30–39: 6.1±5.1, 40–49: 7.1±5.2, 50–59: 7.6±5.1, 60–69: 7.2±5.1, 70–79: 8.3±5.9, 80–89: 8.4±5.6, 90–100: 9.6±5.4), and gender distribution (male: 30–39: 68%, 40–49: 64%, 50–59: 65%, 60–69: 59%, 70–79: 71%, 80–89: 62%, 90–100: 82%). Mortality (30–39: 3%, 40–49: 3%, 50–59: 7%, 60–69: 16%, 70–79: 22%, 80–89: 35%, 90–100: 55%), multi-organ failure (30–39: 6%, 40–49: 6%, 50–59: 12%, 60–69: 27%, 70–79: 29%, 80–89: 44%, 90–100: 45%), and sepsis (30–39: 2%, 40–49: 5%, 50–59: 6%, 60–69: 15%, 70–79: 13%, 80–89: 22%, 90–100: 26%), increased significantly (p<0.001) among the groups and at a threshold of 62% TBSA. Comparison of patients with burns larger than 62% with those smaller showed significant differences in inflammatory (Cytokines), acute phase (CRP) and hypermetabolic responses (REE), as well as organ function (p<0.05). We established that in a modern pediatric burn care setting, a burn size of approximately 60% TBSA represents a crucial threshold for post-burn morbidity and mortality. Based on these findings, we recommend that pediatric burn patients over 60% TBSA burn should be immediately transferred to a specialized burn center. Furthermore, at the burn center patients should be treated with increased vigilance and enhanced therapies recognizing the increased risk for poor outcome associated with this burn size.