Current expectations for survival in pediatric burns

Background: Conventional wisdom and published reports suggest that children, particularly those younger than 48 months, have higher mortality rates after burns than young adults. However, coincident with refinements in resuscitation, operative techniques, and critical care, survival rates for children with burns seem to have improved. To document this change and to define current expectations, a review of deaths during two 7-year intervals separated by a decade was done. Design: We examined the clinical course of children who died after admission for care of acute thermal burns during two 7-year intervals: calendar years 1974 to 1980 inclusive (group 1) and 1991 to 1997 inclusive (group 2). Dying children were stratified by total body surface area (TBSA) burned: small (0%-39%), midsize (40%-59%), and large (60%-100%) TBSA bums. Children who arrived with anoxic brain injury or in a moribund state with refractory shock were excluded from analysis (4 children in group 1 and 5 in group 2); 2 of these children in group 2 died and became solid organ donors. Setting: Regional pediatric burn center. Patients: Six hundred seventy-eight children in group 1 and 1150 children in group 2. Main Outcome Measure: Survival. Results: In children with 0% to 39% TBSA burns, mortality was 0.6% in group 1 and 0% in group 2 (Fisher exact test, P = .04; chi(2) test, P = .02). In children with 40% to 59% TBSA bums, mortality was 7.7% in group 1 and 0% in group 2 (Fisher exact test, P = .07; chi(2) test, P = .047). In children with 60% to 100% TBSA bums, mortality was 33.3% in group 1 and 14.3% in group 2 (Fisher exact test, P = .04; chi(2) test, P = .02). Although 59% of the children in group 2 were younger than 48 months, including 55% of those with 40% to 59% TBSA burns and 41% of those with 60% to 100% TBSA burns, there were no deaths in this age group. Conclusion: Survival rates after burns have improved significantly for children. At present, most children, even young children and children with large burns, should survive.