Patrick D Mahar1, Jason Wasiak2, Eldho Paul3, David A Watters4, Julia Kirby5, Douglas Gin6, Philip Marsh7, Heather Cleland8. 1. Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Dermatology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, School of Medicine, Deakin University, VIC, Australia. Electronic address: dmahar@deakin.edu.au. 2. Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Epidemiology & Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, VIC, Australia. 3. Department of Epidemiology & Preventive Medicine, Monash University, The Alfred Hospital, Melbourne, VIC, Australia. 4. Department of Surgery, School of Medicine, Deakin University, VIC, Australia. 5. Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia. 6. Department of Dermatology, The Alfred Hospital, Melbourne, VIC, Australia. 7. Department of Medicine, Monash Health, Melbourne, VIC, Australia. 8. Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Central and Eastern Clinical School, Department of Surgery, Monash University, VIC, Australia.
Abstract
INTRODUCTION: Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage. METHODS: Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest. RESULTS: Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P=0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P=0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5h; P=0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality. CONCLUSION: Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.
INTRODUCTION: Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage. METHODS: Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest. RESULTS: Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P=0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P=0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5h; P=0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality. CONCLUSION: Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.
Authors: Alfonso Estrella-Alonso; José Antonio Aramburu; Mercedes Yolanda González-Ruiz; Lucía Cachafeiro; Manuel Sánchez Sánchez; José A Lorente Journal: Rev Bras Ter Intensiva Date: 2017 Oct-Dec