Predicting mortality in burns: a new scoring system

Authors

  • Ajay Lunawat Department of Surgery, SAMC, PGI, Indore, MP, India
  • Rishi Kant Vashistha Department of Surgery, SAMC, PGI, Indore, MP, India
  • Vishad Patel Department of Surgery, SAMC, PGI, Indore, MP, India
  • Ravindra Chhabra Department of Genetics, SAMC, PGI, Indore, MP, India
  • Venkatesh Kolla Department of Surgery, SAMC, PGI, Indore, MP, India

DOI:

https://doi.org/10.18203/2349-2902.isj20160241

Keywords:

SIRS, TLC, Platelet, Inhalation injury, TBSA

Abstract

Background: An analysis of various prognostic factors in burn patients was done which included age, sex, TBSA, onset of SIRS, septicemia, TLC, platelet count and grade of inhalational injury which could help in estimating the prognosis and probability of death of patients. On basis of these parameters a scoring system is designed, values of which will help in early assessment of prognosis and mortality.

Methods: This is cross sectional retrospective study and was carried out on 60 patients. Two groups were made one of survivors and other of non survivors with 30 patients in each group. Comparison of above mentioned parameters was done between two groups and a scoring system was designed on basis of six most significant parameters which are age, TLC, platelet count, grade of inhalational injury, TBSA and presence or absence of SIRS. Each parameter is scored according to its weightage. Scoring system has a maximum score of 420 and minimum of 60. Higher score corresponds to higher mortality.

Results: There was a significant difference in mean age of survivors and non-survivor. TBSA >45% showed high mortality. SIRS and sepsis was present in all non survivors. In 72% of non survivors blood culture was positive, inhalational injury was present 33.3% survivors and 53.3% non survivors and prolonged hospital stay was seen in survivors with inhalational injury. Non survivors showed leucocytosis or leucopenia; where gram negative sepsis accounted for fall in leucocytes. Survivor group did not show any persistent thrombocytopenia whereas persistent thrombocytopenia was present in non survivors. A death probability scoring system is designed which shows if score is more than 200 chance of mortality is 94%.

Conclusions: High mortality and poor prognosis was seen in patients of higher age group, TBSA more than 45%, presence of early SIRS.  A non cumbersome death probability scoring system was developed which does not requires sophisticated techniques, equipment and investigations; can help clinicians to foresee the course of prognosis in burn patients.    

References

Kasten KR, Makley AT. Update on critical care management of severe burns. J Intensive care Med. 2011;26(4):223-36.

Merrel SW, Saffle JR. The declining incidence of fatal sepsis following thermal injury. J Trauma. 1989;29:1362-6.

Rani M, Schwacha MG. Aging and the pathogenic response to burn. Aging Dis. 2012;3(2):171-80.

Munster AM. Immunologic response of trauma and burns: an overview. Am J Med. 1984;76(3A):142-5.

Ninneman JL. Immunological defenses against infection: alterations following thermal injuries. J Burn Care Rehabil. 1982;3:355-66.

Deitch EA, Berg R. Bacterial translocation from the gut: a mechanism of infection. J Burn Care Rehabil. 1987;8:475-82.

Belba M. Complications in severely burned patients and their development according to periods of the disease. J Annals of burns and fire disaster. 2002;15(1).

Dries, Endorf. Inhalation injury: epidemiology, pathology, treatment strategies. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2013;21:31.

Ryan CM, David S. Objective estimates of the probability of death from burn injuries. The New England Journal of Medicine. 1988;338,(6):362-7.

Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. crit. Care Med. 1992;20:864-75.

Dalal R, Sharma CA, Chakravarty BB. A study of prognostic factors for prediction of complications and outcomes in burn patients. Indian J Burns. 2014;22:56-61.

Wolf SE, Rose JK. Mortality Determinants in Massive Pediatric Burns. J Annals of Surgery. 1997;225(5):554-69.

Osler T, Glance LG, Hosmer DW. Simplified estimates of the probability of death after burn injuries: Extending and updating the baux score. The Journal of trauma. 2010;68(3):690-7.

Osler T, Glance LG, Hosmer DW. Simplified estimates of the probability of death after burn injuries: extending and updating the baux score. J Trauma. 2010;68(3):690-7.

Park JO, Shin SD. Association between socioeconomic status and burn injury severity. Burns. 2009;35(4):482-90.

Forjuoh SN. Burns in low- and middle-income countries: a review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns. 2006;32:529.

Brown A. Studies of Burns and Scalds. MRC Special Report. 1945;249:480.

Stuart R, Pollack M. Pseudomonas aeruginosa Exotoxin A Inhibits Proliferation of Human Bone Marrow Progenitor Cells In Vitro. Infection and Immunity. 1982;206-11.

Brain AN, Frame JD. Early lymphopenia in burned children with and without the toxic shock syndrome. Burns. 1988;14(2):120-4.

Dellinger RP, Levy MM, Carlet JM. Surviving sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Crit Care Med. 2008;36(1):296-327.

Downloads

Published

2016-12-13

Issue

Section

Original Research Articles