Thomas Leclerc1, Tom Potokar2, Amy Hughes3, Ian Norton4, Calin Alexandru5, Josef Haik6, Naiem Moiemen7, Stian Kreken Almeland8. 1. Burn Centre, Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France. Electronic address: thomas.leclerc@m4x.org. 2. Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK; Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK. Electronic address: tom.potokar@interburns.org. 3. Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK; The Humanitarian and Conflict Response Institute (HCRI), The University of Manchester, UK; Cambridge University Hospital NHS Foundation Trust, Addenbrookes (PICU), UK. Electronic address: amy.hughes@manchester.ac.uk. 4. Respond Global, Australia; Previously World Health Organization, Geneva, Switzerland. Electronic address: ian.norton@respondglobal.com. 5. Department for Emergency Situations, Ministry of Internal Affairs, Bucharest, Romania. Electronic address: calin.alexandru@mai.gov.ro. 6. Division of Plastic and Reconstructive Surgery & National Burn Center, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel; Institute for Health Research, University of Notre Dame, Western Australia, Australia; College of Health and Medicine, University of Tasmania, Australia. Electronic address: Josef.Haik@sheba.health.gov.il. 7. University Hospitals Birmingham Foundation Trust, Birmingham, UK; University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK. Electronic address: nmoiemen@aol.com. 8. Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Bergen, Norway; Faculty of Medicine, University of Bergen, Norway. Electronic address: stian.almeland@uib.no.
Abstract
BACKGROUND: Burn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. METHODS: The TWGB formula was numerically compared with 2-4 mL/kg/%TBSA for adults and the Galveston formula for children. RESULTS: In adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20-25% and the 50-60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups. CONCLUSION: The TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.
BACKGROUND: Burn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. METHODS: The TWGB formula was numerically compared with 2-4 mL/kg/%TBSA for adults and the Galveston formula for children. RESULTS: In adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20-25% and the 50-60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups. CONCLUSION: The TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.