Outcome of burn care : the mortality perspective

Sammanfattning: Background: Despite the improvements in burn care during the last decades, burns remain catastrophic for the patients and a challenge for the care-givers.  The early outcome of burn care is to assess its quality and to improve it, but the crucial outcome is mortality, which is the main focus of this thesis. In particular, I address questions about mortality that have arisen from working with burned patients and that can have clinical consequences: the impact of pre- existing medical conditions; long-term survival; the causes of unexpected deaths; and the possible differences between sexes in the provision of resources.Patients with burns share the fact that the time of their injury is known, its severity can be quantified from the size of the burn, and the care is relatively standardised. The analysis of outcome among burned patients treated at a single burn centre may therefore be of general value to others who treat burns.Methods: We retrospectively analysed data that had been collected prospectively (the burn    unit database) from patients with burns admitted consecutively to a national burn centre in Sweden during the last 25 years.Results: Age and percentage of total body surface area burned (TBSA %) affected the in- hospital mortality, whereas pre-existing medical conditions did not influence the prediction of outcome (Paper I). After discharge, both age and the presence of full thickness burns reduced the long-term survival, whereas the extent of the burn (TBSA %) did not (Paper II). Most patients with moderate burns who die in hospital despite a good prognosis, die for reasons   other than the burn (Paper III). Previously, it has been shown that sex is not an independent factor for mortality during burn care; in this thesis we show that the sex of the patients did not affect the number of medical interventions given either (Paper IV).Conclusion: The addition of “coexisting condition” to a mortality model based on age and   size of burn does not improve its predictive value; rather, the factor “age” is sufficient to adjust for comorbidity in the assessment of a burn and its outcome (Paper I).If patients with burns survive, the long-term prognosis is good. The effect of age is the one that governs survival, whereas the effect of the extent of the burn ends when the patient is discharged (Paper II).The in-hospital mortality during burn care is low, but some patients die for reasons other than the actual burn (Paper III).In a centre where the mortality is independent of the sex of the patient, the provision of medical interventions is also equal between men and women (Paper IV).