SURVIVAL ANALYSIS IN THE CHILDREN WITH SEVERE THERMAL INJURY TRANSFERRED TO THE HOSPITAL WITHIN THE FIRST 72 HOURS AFTER THE INJURY
https://doi.org/10.21292/2078-5658-2018-15-5-30-38
Abstract
The tragic statistics reflecting lethality and survival in children with burns have significantly changed over the last 70 years. A retrospective, non-randomized trial was performed aimed to detect factors providing an impact on survival in a pediatric burns center (1382 children at the age from 0 to 18 years were enrolled in the trial). The inclusion criteria were thermal injuries with hot liquid or flame of more than 20% of the total body surface area, and the area of 10-20% including eyes, ears, face and extremities. The patients were admitted to the intensive care wards of Speransky Children Municipal Clinical Hospital no.9, during the first 72 hours after thermal injury for the period from January 1, 2009 to December 31, 2017.
The survival was analyzed using the log-rank test, Kaplan – Meier curves, and Cox regression analysis, and the results demonstrated the significance of the number of factors: early transfer of pediatric patients to a special unit, thermal inhalation injuries, ≥ 12 scores as per ABSI scale, and female gender. The tender age is not one of the factors providing the impact on the survival of such patients.
About the Authors
A. U. Lekmanov
Research Institute of Children's Surgery by N. I. Pirogov Russian Research Institute Medical University; Speransky Children Municipal Clinical Hospital no.9.
Russian Federation
Russian Federation
Andrey U. Lekmanov - Doctor of Medical Sciences, Professor.
29, Bd. 5, Shmitovsky Rd., Moscow, 123317.
D. K. Azovskiy
Speransky Children Municipal Clinical Hospital no.9.
Russian Federation
Russian Federation
Dmitry K. Azovskiy - Candidate of Medical Sciences, Anesthesiologist and Emergency Physician.
29, Bd. 5, Shmitovsky Rd., Moscow, 123317.
S. F. Pilyutik
Speransky Children Municipal Clinical Hospital no.9.
Russian Federation
Russian Federation
Sergey F. Pilyutik - Head of Intensive Care Department.
29, Bd. 5, Shmitovsky Rd., Moscow, 123317.
References
1. Аleksandrova G.А., Polikarpov А.V., Golubev N.А. Sotsialno znachimye zabolevaniya naseleniya Rossii v 2014 g. [Socially significant diseases in the population of Russia in 2014]. Moscow, 2015.
2. Аlekseev А.А., Tyurnikov Yu.I. Analysis of activities of burns centers in the Russian Federation in 2016. (Epub.) Kombustiologiya, 2017, no. 59-60 (In Russ.), available at: http://combustiolog.ru/journal/sbonik-nauchny-h-rabot-chast-pervaya/ (Accessed as of: 10.12.2017).
3. Аlekseev А.А., Tyurnikov Yu.I. Main statistic rates of the burn hospitals in the Russian Federation in 2015. (Epub.) Kombustiologiya, 2015, no. 56-57 (In Russ.), available at: http://combustiolog.ru/journal/tezisy-konferentsii/ (Accessed: 10.09.2016).
4. Andreeva T.M. Traumatism in the Russian Federation as per statistic data. (Epub.) Socialnye Aspekty Zdorovya Naseleniya, 2010 (In Russ.), Available at: http://vestnik.mednet.ru/content/view/234/30/ (Accessed as of: 07.12.2010).
5. Bagin V.А., Rudnov V.А., Savitskiy А.А. Risk factors for sepsis development and prediction in the patients with burns. Vestn. Anesteziologii I Reanimatologii, 2013, no. 5, pp. 21-26. (In Russ.)
6. Degtyareva S.А., Shmelev E.I., Smirnov S.V.et al. Stages of treatment of patients with isolated thermal inhalation injuries. Vrach, 2013, no. 2, pp. 63-66. (In Russ.)
7. Ivanov V.V., Sakharov S.P., Polyakov А.P. Thermal injuries in children as a social economic problem. Med. Nauka i Obrazovanie Urala, 2010, no. 2, pp. 32-33. (In Russ.)
8. Lekmanov А.U., Аzovskiy D.K., Pilyutik S.F. et al. Intensive care of children with massive burns during the first 24 hours after the injury - results of the interactive survey. Vestn. Anesteziologii I Reanimatologii, 2018, no. 1, pp. 18-26. (In Russ.)
9. Lekmanov А.U., Аzovskiy D.K., Pilyutik S.F. Comparison of Doppler ultrasonography and transpulmonary thermodilution when analyzing hemodynamic rates in the children with severe thermal injury. Vestn. Anesteziologii I Reanimatologii, 2017, no. 1, pp. 42-50. (In Russ.)
10. Mukhametzyanov А.M. Medical and social aspects of thermal injuries in the Republic of Bashkortostan. Vestn. RUDN, Seriya Meditsina, 2009, no. 4, pp. 80-83. (In Russ.)
11. Nansalmaa Sh., Erdenechimeg E. Current problems of burns in children under 5 year old in Ulan-Bator. Sibirskiy Med. Journal, 2015, no. 4, pp. 73-76. (In Russ.)
12. Pavlenko T.N., Golovka O.V. Medical and social aspects of thermal injuries in children in the city of Orenburg. Zdorovye Naseleniya i Sreda Obitaniya, 2008, no. 265 (4), pp. 35-38. (In Russ.)
13. Sakharov S.P., Ivanov V.V., Zoroastrov O.M. et al. Analysis of lethal outcomes in children with burn disease. Vestn. Eksperimentalnoy i Klinicheskoy Khirurgii, 2010, no. 3 (3), pp. 256-259. (In Russ.)
14. Shatovkin K.А., Shlyk I.V. Optimization of infusion therapy in those suffering from severe thermal injury, complicated by acute pulmonary lesion syndrome. Vestn. Anesteziologii I Reanimatologii, 2011. no. 2 (8), pp. 8-15. (In Russ.)
15. Shlyk I.V., Polushin Yu.S., Krylov K.M. et al. Burn sepsis: specific features of development and early diagnostics. Vestn. Anesteziologii I Reanimatologii, 2009, no. 5, pp. 16-24. (In Russ.)
16. American College of Surgeons Resources for Optimal Care of the Injured Patient. American College of Surgeons, Chicago, 2014, 2015 p.
17. Balseven-Odabaşi A., Tümer A.R., Keten A. et al. Burn injuries among children aged up to seven years. Turkish J. Pediatrics, no. 4 (51), pp. 328-335.
18. Berndtson A.E., Sen S., Greenhalgh D.G. et al. Estimating severity of burn in children: Pediatric Risk of Mortality (PRISM) score versus Abbreviated Burn Severity Index (ABSI). Burns, 2013, no. 6 (39), pp. 1048-1053.
19. Bull J.P., Squire J.R. A study of mortality in a burns unit: standards for the evaluation of alternative methods of treatment. Ann. Surgery, 1949, no. 2 (130), pp. 160-173.
20. Burd A., Yuen C. A global study of hospitalized paediatric burn patients. Burns, 2005, no. 4 (31), pp. 432-438.
21. Cassidy T.J., Edgar D.W., Phillips M. et al. Transfer time to a specialist burn service and influence on burn mortality in Australia and New Zealand: A multi-centre, hospital based retrospective cohort study. Burns, 2015, no. 4 (41), pp. 735-741.
22. Deutsch C.J., Tan A., Smailes S. et al. The diagnosis and management of inhalation injury: An evidence based approach. Burns, 2018, no. 5 (44), pp. 1040-1051.
23. Ehrl D., Heidekrueger P.I., Ninkovic M. et al. Effect of primary admission to burn centers on the outcomes of severely burned patients. Burns, 2018, no. 3 (44), pp. 524-530.
24. Frank G. The «prognostic index» in burns for a more exact characterization of their degree of severity and a more reliable statistical evaluation. Zentralblatt fur Chirurgie, 1960, vol. 85, pp. 272-277.
25. Fukunishi K., Takahashi H., Kitagishi H. et al. Epidemiology of childhood burns in the critical care medical center of Kinki University Hospital in Osaka, Japan. Burns J. Intern. Society Burn Injuries, 2000, no. 5 (26), pp. 465-469.
26. Herndon D.N., Gore D., Cole M. et al. Determinants of mortality in pediatric patients with greater than 70% full-thickness total body surface area thermal injury treated by early total excision and grafting. J. Trauma, 1987, no. 2 (27), pp. 208-212.
27. Kobayashi K., Ikeda H., Higuchi R. et al. Epidemiological and outcome characteristics of major burns in Tokyo. Burns, 2005, no. 1 (31), pp. S3–S11.
28. Kraft R., Herndon D.N., Al-Mousawi A.M. et al. Burn size and survival probability in paediatric patients in modern burn care: A prospective observational cohort study. Lancet, 2012, no. 9820 (379), pp. 1013-1021.
29. Maghsoudi H., Samnia N. Etiology and outcome of pediatric burns in Tabriz, Iran. Burns, 2005, no. 6 (31), pp. 721-725.
30. Morrow S.E., Smith D.L., Cairns B.A. et al. Etiology and outcome of pediatric burns. J. Pediatrics Surgery, 1996, no. 3 (31), pp. 329-333.
31. Palmieri T.L., Taylor S., Lawless M. et al. Burn Center Volume Makes a Difference for Burned Children. Pediatr. Crit. Care Med., 2015, no. 4 (16), pp. 319-324.
32. Peden M., Oyegbite K.,Ozanne-Smith J. et al. World report on child injury prevention. Geneva, 2008.
33. Serour F., Gorenstein A., Boaz M. Characteristics of thermal burns in children admitted to an Israeli pediatric surgical ward. Isr. Med. Assoc. J., 2008, no. 4 (10), pp. 282-286.
34. Sheridan R.L., Remensnyder J.P., Schnitzer J.J. et al. Current Expectations for Survival in Pediatric Burns. Archiv. Pediatr. Adolesc. Med., 2000, no. 3 (154), pp. 245.
35. Sheridan R.L.,Weber J.M., Schnitzer J.J. et al. Young age is not a predictor of mortality in burns. Pediatr. Crit. Care Med., 2001, no. 3 (2), pp. 223-224.
36. Shirani K.Z., Pruitt B.A.Jr., Mason A.D. Jr. The influence of inhalation injury and pneumonia on burn mortality. Ann. Surgery, 1987, no. 1 (205), pp. 82-87.
37. Taylor S.L., Lawless M., Curri T. et al. Predicting mortality from burns: The need for age–group specific models. Burns, 2014, no. 6 (40), pp. 1106-1115.
38. Tobiasen J., Hiebert J.M., Edlich R.F. The abbreviated burn severity index. Ann. Emerg. Med., 1982, no. 5 (11), pp. 260-262.
39. Tyson A.F., Boschini L.P., Kiser M.M. et al. Survival after burn in a sub-Saharan burn unit: Challenges and opportunities. Burns, 2013, no. 8 (39), pp. 1619-1625.
40. Walker P.F., Buehner M.F., Wood L.A. et al. Diagnosis and management of inhalation injury: an updated review. Crit. Care, 2015, no. 1 (19), pp. 351.
41. Wolf S.E., Rose J.K., Desai M.H. et al. Mortality determinants in massive pediatric burns. An analysis of 103 children with > 80% TBSA burns (> 70% full-thickness). Ann. Surgery, 1997, no. 5 (225), pp. 554-565.
42. World Health Organization Burns – fact sheet [Electronic resource]. Available at: http://www.who.int/news-room/fact-sheets/detail/burns (Accessed: 06.03.2018).
Review
For citations:
Lekmanov A.U., Azovskiy D.K., Pilyutik S.F. SURVIVAL ANALYSIS IN THE CHILDREN WITH SEVERE THERMAL INJURY TRANSFERRED TO THE HOSPITAL WITHIN THE FIRST 72 HOURS AFTER THE INJURY. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2018;15(5):30-38. (In Russ.) https://doi.org/10.21292/2078-5658-2018-15-5-30-38
Email this article 