Study shines more light on burn-associated morbidity, mortality in children

Galveston, Texas - A research team from Shriners Hospitals for Children here reports that burn-associated morbidity and mortality in children are driven by an increased hypermetabolic and inflammatory reaction and impaired cardiac function related to burn size, according to news source Medpagetoday.com.

The study, published online in Critical Care, suggests that as the surface area of the burn increased, so did the number of operations, incidence of infection and sepsis, and mortality.

The researchers reviewed data on 189 pediatric burn patients admitted to their hospital’s burn unit over nine years and who required at least one surgical intervention. Patients were resuscitated by means of a locally developed formula, and all patients underwent total burn-wound excision within 48 hours of admission. Skin grafting, followed by additional surgery, continued until all open wound areas were covered with autologous skin material. All patients received the same nutritional support.

The study found that patients with 80 percent or greater total body surface involvement had the highest resting-energy expenditure, followed by patients with 60 percent to 79 percent body surface burns.

Urine cortisol concentration increased with burn size and was associated with significant myocardial depression and change in liver size, the researchers found. Cytokine expression also differed according to burn size.

“Based on our findings, we suggest that a burn injury involving more than 80 percent of the total body surface causes marked and prolonged inflammation, marked increases in hypermetabolism, catabolism, cardiac dysfunction, and subsequently, higher incidences of infection, sepsis and death,” the authors conclude. “Treatment should focus on several aspects of the pathophysiologic events postburn, such as treatment of the inflammatory response, insulin resistance, hypermetabolism, catabolism and cardiac dysfunction.”

Past studies have shown that as burn size increases, so does mortality risk. Burn size also has been suggested as the key determinant of hypermetabolism. However, the principal contributor to the increased mortality risk - inflammation, hypermetabolism or other pathophysiologic factors - had not been determined.

The study population comprised 43 patients with involvement of less than 40 percent of total body surface area, 79 with 40 percent to 59 percent involvement, 46 with 60 percent to 79 percent, and 21 burns of 80 percent or more involvement.