Occurrence of multiorgan dysfunction in pediatric burn patients: incidence and clinical outcome.

Abstract

OBJECTIVE:

To examine the incidence of single or multiple organ failure postburn and its resultant clinical outcomes during acute hospitalization.

BACKGROUND:

Patient outcomes are inherently dependent on intact organ function; however, burn injury affects the structure and function of almost every organ, but especially lung, liver, kidney, and heart. Therefore, single-organ failure and/or multiorgan failure (MOF) are thought to contribute significantly to postburn morbidity and mortality, but to date no large trial examining the effects of MOF on postburn outcomes exists.

METHODS:

Incidence of MOF was monitored in 821 pediatric burn patients during acute hospitalization. Patients were divided into groups on the basis of the incidence of single-organ-specific failure, MOF, and non-MOF. The DENVER2 score was used to assess organ-specific scores for lung, liver, kidney, and heart. The patient's demographics, injury characteristics, and outcome parameters were recorded.

RESULTS:

Respiratory failure has the highest incidence in the early phase of postburn injury and decreases starting 5 days postburn. Cardiac failure was noted to have the highest incidence throughout hospital stay. Incidence of hepatic failure increases with the hospital length of stay and is associated with a high mortality during the late phase of the acute hospital stay. Renal failure has an unexpectedly low incidence but is associated with a high mortality during the first 3 weeks postburn injury. Three or more organ failure is associated with very high mortality.

CONCLUSIONS:

This is the first large study in burn patients to determine the incidence of organ-specific failure and outcome. The results of this study confirmed the expected chronologic incidence of organ-specific failure and yield the long-term mortality from liver and renal failure.

• Authors: Robert Kraft, David N Herndon, Celeste C Finnerty, Shahriar Shahrokhi, Marc G Jeschke
• Journal: Annals of surgery (Ann Surg) Vol. 259 Issue 2 Pg. 381-7 (Feb 2014) ISSN: 1528-1140 [Electronic] United States
• PMID: 23511841 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Burns (complications, mortality, therapy)
• Child
• Child, Preschool
• Combined Modality Therapy
• Critical Care
• Enteral Nutrition
• Female
• Fluid Therapy
• Health Status Indicators
• Hospitalization
• Humans
• Incidence
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Multiple Organ Failure (diagnosis, epidemiology, etiology, therapy)
• Prospective Studies
• Resuscitation (methods)
• Skin Transplantation
• Trauma Severity Indices
• Treatment Outcome