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Specialized burn centre care essential for major burns

Dr. Marc Jeschke, Medical Director of the Ross Tilley Burn Centre at Sunnybrook Health Sciences Centre, and colleagues. Dr. Jeschke is seated.

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New research published by The Lancet shows that children with burn injuries are much more likely to suffer severe complications or die when the burns cover 60% or more of their total body surface area (TBSA). As a result, the authors recommend that all children with this level of injury should immediately be transferred to specialist burns units and treated with increased vigilance and improved therapies. The article is by Dr. Marc Jeschke, Medical Director of the Ross Tilley Burn Centre at Sunnybrook Health Sciences Centre, and colleagues.

Previous research in the 1990s suggested that a critical threshold of burns covering 40% or more TBSA resulted in increased risk of complications and death. However, during the past 10 years, additional improvements in care have further reduced morbidity and improved survival rates and outcomes after extensive burn injuries. Novel drug treatments, new grafting techniques and materials, and life-support systems combined with improved sensitivity of monitoring methods have all led to improved care after severe burn injuries.

In this study, the authors assessed 952 paediatric burn patients treated at the Shriners Hospitals for Children in Galveston, Texas between 1998 and 2008. The patients had burn size of at least 30% TBSA and were stratified into 10% increments, ranging from 30% to 100% TBSA. Two thirds of all patients were boys, a proportion that rose to 82% in the most severely burned group (90-100% TBSA).

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The authors were able to demonstrate that the presence and/or concentration of a wide variety of established and novel biomarkers for organ function, metabolism, and inflammation differs widely depending on whether children have burn size above or below this critical threshold. Vital signs such as liver and kidney function were monitored to help come to these conclusions.

“While Sunnybrook does not treat children, the research we conducted in Galveston does have some applicability to adult burn patients,” says Dr. Marc Jeschke, Medical Director of the Ross Tilley Burn Centre at Sunnybrook Health Sciences Centre

"First, this study demonstrated that we are able to determine cut-offs for all burn patients not only based on outcome data but also using biochemical markers. Second, determining cut-offs for burn patients enables burn surgeons to identify patients at high risk for poor outcomes and therefore allows patient focus care. Third, the study shows that modern burn care has dramatically improved burn outcomes for all patients. Lastly, we established some novel tools for burn surgeon allowing to validate and examine their outcome data."

The authors conclude: "We have established that, in a modern paediatric burn care setting, a burn size of roughly 60% TBSA is a crucial threshold for postburn morbidity and mortality. On the basis of these findings, we recommend that paediatric patients with greater than 60% TBSA burns be immediately transferred to a specialised burn centre. Furthermore, at the burn centre, patients should be treated with increased vigilance and improved therapies, recognising the increased risk for poor outcome associated with this burn size."

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