Higher health risks for children with serious burn injuries

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A study published by The Lancet has found that health complications or even death are risked by children with serious burn injuries covering 60% or more of their total body surface area (TBSA).

The study, led by Dr Marc Jeschke and Dr David N Herndon of the Universities of Toronto and Texas respectively, called for greater awareness of such children and for types and methods of burn injury therapy to be improved.

From 1998 to 2008, 952 patients aged between 6 and 10 years, all with varying sizes of serious burn injuries, were assessed at the Shriners Hospital for Children in Texas.

Researchers discovered that children whose burn size was 62% TBSA or more were 10 times more likely to die compared to those whose burn injuries were less severe.

The study also found that the presence and concentration of novel biomarkers for organ function, metabolism and inflammation depended on whether the patient's burn injuries were above or below 62% TBSA.

Since the 1990s, when similar research linked 40% TBSA burn injuries or more to greater risk of poor health and potential death, patient care has much improved.

However, despite new drug treatments and grafting techniques, the high mortality rate of those with serious burn injuries covering more than 60% of TBSA means there is still work to be done.

The research established that a burn size of roughly 60% TBSA is a vital threshold for post-burn 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."

Dr Ronald G Tompkins, of Massachusetts General Hospital and Harvard Medical School, believes it is important to consider the quality of life for all survivors of serious injury.

"Clinicians have traditionally assigned their own values to the quality of a burn patient's survival," said Dr Tompkins. "However, the patient and their family should be allowed to contribute their views of how the injury has affected their lives."

"Recent articles have validated burn-specific outcomes instruments to measure quality of life after burn injury from the patient's and family's perspectives. In future, use of such post-burn injury questionnaires should be broadened to drive future strategies not only to ensure survival, but also to improve quality of life for those who do survive."




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