Mortality in burned children with acute renal failure

Background: During the past 13 years, mortality from acute renal failure in burned children has been on the decline. Objective: To determine which new burn therapies contributed to the decrease in mortality. Design: The medical records of burned children admitted from February 1966 to January 1997 were reviewed, and the outcome of changes in the treatment of burned children were compared. Patients and Methods: Sixty children with acute renal failure were identified. These children were divided into those admitted from 1966 to 1983 (n = 24) and those admitted from 1984 to 1997 (n=36). They were compared with matched control subjects from the same period without renal failure. Values are presented as means +/- SEMs. Statistical analysis was by the Student t test or chi(2) analysis. Results: Mortality rates in burned children with acute renal failure decreased from 100% before 1983 to 56% after 1984 (P<.001). The time between a burn injury and the initiation of intravenous fluid resuscitation was 8.6+/-1.7 hours before 1983 compared with 3.0+/-0.5 hours after 1984 (P<.005). The time between a burn injury and complete early wound excision decreased from 228 +/- 37 hours before 1983 to 40 +/- 7 hours after 1984 (P<.001). The incidence of sepsis decreased from 71% to 44% in these periods (P<.05). After 1984, survivors had a shorter time delay for fluid resuscitation than nonsurvivors (1.7 +/- 0.5 hours vs 4.8 +/- 0.9 hours; P<.005) and a lower incidence of sepsis (19% vs 60%; P<.05). From 1984 to 1997, burned children with acute renal failure who did not require dialysis had significantly shorter delays for fluid resuscitation (2.2 +/- 0.5 hours vs 4.4 +/- 0.9 hours) and complete wound excision (29 +/- 6 hours vs 49 +/- 7 hours) compared with those requiring dialysis (P<.05 for both). Conclusion: Early adequate fluid resuscitation, early wound excision, and better infection control may reduce mortality in burned children with acute renal failure.