Study Finds Children That Suffer Burns Over 60% TBSA Have Most Complications

A study published by The Lancet online last week concluded that children with burn injuries covering 60% or more of their total body surface area (TBSA) are at a much higher risk of experiencing severe complications or death. The authors urge the need for more attention to be given to such patients, with more vigilant and improved forms of therapy.

The study, was headed by Dr. Marc Jeschke of the Ross Tilley Burn Centre, University of Toronto, and Sunnybrook Research Institute in Ontario, Canada, and Dr. David N Herndon, Shriners Hospital for Children and University of Texas Medical Branch in Texas.  Their study involved assessing 952 paediatric burns patients aged 6 to 10 at the Shriners Hospital for Children Galveston, Texas over a period of 10 years. The study included patients with a variety of different burn sizes, including those with the severest burns (90-100% TBSA group) to those with less severe burns (30-39% TBSA group).

The researchers found that of the thirteen percent of children that died (123 of 952), those in the 30-39% TBSA group accounted for only 3% (5 of 180) of deaths, while those in the 90-100% TBSA group accounted for 55% (28 of 51). Sixteen percent of the children (154) experienced multiorgan failure, of those only 6% (10) were in the 30-39% TBSA group, compared to 45% (23) in the 90-100% TBSA group. Of the nine percent of the children with sepsis (89), only 2% (3) were in the 30-39% TBSA group compared to 26% (13) in the 90-100% TBSA group. Those with a burn size of 62% TBSA or above were 10 times more likely to die compared to those who had less severe burns, with the mortality rate being almost equal among those with burns below 60% TBSA. They also found that the presence and concentration of novel biomarkers for organ function, metabolism and inflammation depended greatly on whether or not the patient had burns above or below the 62% TBSA threshold.

Previous studies in the 1990s indicated that burn injuries covering 40% of TBSA, or more, were linked to increased risk of health complications and death. Since then, there have been many improvements in the care of patients with severe burns by using new grafting techniques, drug treatments and improved care methods. However work still needs to be done in order to address the high mortality rate of those with burns covering more than 60% of TBSA.

Dr. Jeschke and Dr. Herndon advise:

“We have established that, in a modern paediatric burn care setting, a burn size of roughly 60% TBSA is a crucial threshold for post-burn morbidity and mortality. On the basis of these findings, we recommend that paediatric patients with greater than 60% TBSA burns be immediately transferred to a specialised burn centre. Furthermore, at the burn centre, patients should be treated with increased vigilance and improved therapies, recognising the increased risk for poor outcome associated with this burn size.”

These statistics are heartening for parents who are forced to endure the pain and uncertain future that their children face after suffering catastrophic burn injuries.  Obviously, there are always exceptions to the statistics and many children who have suffered burns to well over 60% TBSA have both survived and flourished.


Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study
Robert Kraft MD, Prof David N Herndon MD, Ahmed M Al-Mousawi MD, Felicia N Williams MD Celeste C Finnerty PhD, and Dr Marc G Jeschke MD
The Lancet Jan 2012. doi:10.1016/S0140-6736(11)61345-7


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