Causes of Mortality by Autopsy Findings of Combat Casualties and Civilian Patients Admitted to a Burn Unit

BACKGROUND: Approximately 5% of combat-related injuries include burns. Previous studies have shown similar mortality rates between military and civilian burn casualties; but causes of death were not detailed. STUDY DESIGN: We retrospectively reviewed autopsy reports of patients with burns treated at the US Army Institute of Surgical Research Burn Center from 2004 to 2007. RESULTS: Of 1,255 admissions, 100 (8%) died, with autopsies performed on 74 (36 burned during military operations). Causes of death included infection (61%); disorders of the pulmonary (55%), cardiac (36%), renal (27%), gastrointestinal (27%), and central nervous (11%) systems; and multiorgan dysfunction (15%). Patients burned as a result of military operations were younger men with more associated inhalation injuries, greater severity of injury, and longer time from injury to admission and to death. They died more frequently of infection (notably fungus, Pseudomonas, and Klebsiella) and gastrointestinal complications; and those not burned in military operations had greater numbers of cardiac and renal causes of death. CONCLUSION: Casualties of military operations are clinically different and die from different causes than patients not burned during military operations. The differences are likely reflective of a younger population, with greater severity of illness and longer times from injury to admission. Therapeutic interventions should focus on prevention of infection and gastrointestinal catastrophes in military burn casualties, which are similar to younger burn patients in the US, and minimizing cardiac complications in civilian burn casualties, who are typically older patients and possibly reflective of patients with more comorbidities. (J Am Coll Surg 2009;208:348-354. (C) 2009 by the American College of Surgeons)