Multiple organ failure in patients with thermal injury.

OBJECTIVE: To assess the frequency and significance of multiple organ failure in patients with burn injuries.
DESIGN: Retrospective review and prospective assessment of patients with acute burns.
SETTING: University hospital burn center. PATIENTS AND METHODS: We reviewed 529 patients admitted for acute burn treatment whose lengths of stay exceeded 72 hrs. A new scoring system, the Thermal Injury Organ Failure Score, was used to assign scores from 0 (normal) to 6 (severe dysfunction) to each of 6 organ systems, which were then totaled to compile the overall score. This system was also used for prospective assessment of 83 adult burn patients, and compared with the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system during the first week of treatment.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: For 496 survivors, mean organ failure score was 3.28, compared with 23.1 in 33 nonsurvivors (p < .0001). All nonsurvivors but one had scores of > or = 15, indicating dysfunction of at least three organs. Scores and mortality rate increased with age and burn size. Pulmonary dysfunction was the most frequent form of organ failure seen, but correlated less with outcome than did cardiovascular or neurologic scores. Sepsis was present in 22 of 33 patients who died. In the prospective study, organ failure scores correlated with outcome more closely than did APACHE II scores. Weekly evaluation of these patients demonstrated progressive divergence in scores between survivors and nonsurvivors.
CONCLUSIONS: Multiple organ failure was almost invariably present in burn patients who died > 72 hrs after injury. Burn victims, who have been excluded from reviews of multiple organ failure, appear to manifest organ failure in a manner similar to that of other surgical populations. The scoring system reported here may prove useful in evaluating organ failure in thermally injured patients.