Standard variables fail to identify patients who will not respond to fluid resuscitation following thermal injury: brief report

Approximately 13% of thermally injured patients fail resuscitation, in that they die during the first 48 h postburn despite full resuscitative efforts. The purpose of this study was to characterize these patients, and to develop a predictor of resuscitation failure. Methods: Records of 3807 thermally injured patients admitted to this burn centre during 1980-1997 were reviewed. Patients were classified as Surviving to hospital discharge ("NONFAIL/LIVE"), as surviving resuscitation but dying later ("NONFAIL/DIE"), or as failing resuscitation ("FAIL"). Ordinal logistic regression was used to develop a predictor of membership in each of these three groups. Results: With respect to total burn size, full-thickness burn size, and inhalation injury. the three groups represented a gradation in injury severity from least severe (NONFAIL/LIVE) to most severe (FAIL). The predictive model had an overall accuracy of 91.6%: however, it correctly classified NONFAIL/LIVE patients more often (97.7% accuracy) than it did NONFAIL/DIE patients (57.5%) or FAIL patients (16.1%). Conclusion: Patients who failed resuscitation were more severely injured than those who survived resuscitation, but was not possible accurately to predict who will fail resuscitation using data available on admission. (c) 2004 Elsevier Ltd and ISBI. All rights reserved.