Prediction of mortality from catastrophic burns in children

• Published in: The Lancet (British edition) 2003-03, Vol.361 (9362), p.989-994
• Main Authors: Spies, Marcus, Herndon, David N, Rosenblatt, Judah I, Sanford, Arthur P, Wolf, Steven E
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Burn patients; Burn Units; Burns; Burns - mortality; Burns - physiopathology; Burns - therapy; Burns, Inhalation - mortality; Cell size; Child; Child mortality; Children; Clinical outcomes; Creatinine; Data collection; Demographic variables; Demographics; Dependence; Emergency and intensive care: burns; Female; Health risks; Humans; Inhalation; Injuries; Intensive care medicine; Investigations; Male; Mathematical models; Medical sciences; Model accuracy; Mortality; Mortality risk; Osmolarity; Patients; Pediatrics; Prediction models; Predictions; Predictive Value of Tests; Prospective Studies; Respiration; Resuscitation; Sepsis; Statistical analysis; Survival Analysis; Ventilators
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(03)12824-3

We previously developed a model to predict survival in massive paediatric burns (>80% total body surface area [TBSA]). This model included not only demographic variables, but also variables obtained throughout the hospital course. We aimed to prospectively validate our model for accuracy of outcome prediction. We admitted 33 paediatric burn patients with burns greater than 80% TBSA. We recorded age, burn size, inhalation injury, resuscitation, packed-cell volume at admission, base deficit, serum osmolarity, sepsis, inotropic support, platelet count, creatinine, and ventilator dependency. We entered these data into our previous models. 20 male and 13 female children with mean age 7·6 (SD 1) years with TBSA burns of 88% (SD 1; full thickness 86% [SD 1]) were admitted. Mortality was 39·4% (13 of 30). When all variables were integrated into our final model, we predicted outcome with 97% accuracy. When we used a model based only on demographic characteristics of age, burn size, and presence of inhalation injury, outcome was correctly predicted in only 51% of patients. We show prospectively that mortality in severely burned children can be reliably estimated at a burn centre, and that outcome cannot be reliably predicted on the basis of demographic and injury characteristics alone. These data suggest that all severely burned children should be given a course of treatment before consideration of treatment futility.