الفهرس 
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Abstract
SUMMARYUMMARYUMMARYUMMARYUMMARYUMMARY
Burn is a huge public health problem and remains one of the major causes of mortality and long term disability throughout the world especially in developing countries. Moreover, many patients are hospitalized with burn related trauma each year.
Over the past few decades, survival amongst patients with major burns has improved with advances in patient management and organization of burn centers. However, burn related mortality remains high and the burden of care is vast.
Accurate prediction of mortality in cases with burn is important for realistic family counseling, hospital resource allocation and appropriate interpretation of the variation in outcomes between different burn care units. Thus, study of the contributing factors to mortality has been an integral part of burns research.
In cases of death due to burn injury with allegations of medical negligence, it is of great medico-legal importance to determine if the death is caused by fatal burn injury or due to other factors related to treatment or other complications. Therefore, study of early predictors of mortality in cases with burn injuries may help to distinguish fatal burn injuries.
This study aimed to assess the relationship between the mortality in thermally injured patients and demographic
variables (age and gender), surface area of burns (both of total body surface area (TBSA) and full thickness surface area (FTSA) of burns) and APACHE III score. The study aimed also to investigate the association between mortality and presence of thermal inhalation injury and early requirement of mechanical ventilation.
This prospective cohort study included all cases with thermal burns admitted to Burn Unit, Ain Shams University Hospitals during a period of one year, started from 1/1/2011 to 31/12/2011. The study included both cases admitted to inpatient and intensive care unit (ICU). Cases with non-thermal burns or who died upon arrival to the hospital were excluded from the study.
The collected data included demographic data (age and sex), cause of thermal burn, (TBSA) and (FTSA) of the burns, delay time (in hours), distribution of burns on different body regions, clinical data necessary for calculation of APACHE III score, presence of inhalation injury, the need for early mechanical ventilation (in the first 72 hours after burn injury), duration of hospital admission (in days), outcome (either hospital discharge or death before discharge) and mechanism of death (in non survivors).
During the study period, a total of 1080 patients were presented to the Emergency Department of Burn Unit, Ain
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Shams University Hospitals, 17.8% of them (192 cases) were admitted to Burn Unit. This study was conducted on 152 cases (79.2% of admitted cases), who fulfilled the inclusion criteria.
The age of the included cases ranged from 2 to 69 years. The majority of patients were in the young adult group (86 cases, 56.6%). Males were predominant than females in the included cases. There was statistical significant difference of gender distribution between the age groups; the greatest proportion of males was found in middle age groups (87.5%) while the greatest proportion of females was in adolescents group (61.1%).
The majority of cases in this study were due to flame burns (77.6%), followed by scald burns (18.4%). By comparing causes of burn between age groups; scalds were found as the most frequent cause of thermal burns in children (87.5%) and elderly (81.3%) groups while flames were the most frequent cause in other age groups.
There was statistical significant increase in TBSA in cases with thermal burns due to explosions in comparison to flame and scald burns while there was non statistical significant difference in FTSA between different causes of burn.
Regarding distribution of burn injuries on body regions, the anterior trunk was the most frequent area affected in
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all causes of burn (89.3% in scalds, 75.4% in flames, 83.3% in explosions), followed by lower limbs in scald burns (78.8%) and upper limbs (72%) in flame burns while explosion burns showed equal distribution on other body regions.
Inhalation injury was evident in 19 cases (12.5% of the include cases). The highest incidence of inhalation injury was found in the cases of thermal burns due to explosions (50%), followed by flames (12.7%).
Early mechanical ventilation was indicated in 35 cases (23% of the included cases). Explosions were found as the most frequent cause of burns in these cases (66.7%), followed by flames (22.9%).
APACHE III score in the included cases ranged from (0 : 140). On comparison between age groups, middle age group showed statistical significant increase of APACHE III score.
Delay time in the included cases ranged from one to 72 hours. The majority of cases were admitted to the intensive care unit (ICU) (60.5%). Duration of hospital stay in the included cases ranged from 2 to 38 days, with a mean value 16.63 7.62 days.
Mortalities represented 20.4% of the included cases (31 cases). Multisystem organ failure (MOF) was the most frequent mechanism of death (61.3%), followed by sepsis
(22.7%) and respiratory tract illness (16%). MOF accounted for the greatest proportion of deaths in elderly group (80%), followed by middle age group (66.7%). Sepsis accounted for all deaths in children and adolescents groups (100%), and 25% of deaths in middle age group. Respiratory tract illness accounted for 25% of deaths in young adult, 20% of deaths in elderly and 8.3% of deaths in middle age group.
MOF accounted for the greatest proportion of deaths in all causes of burns. Proportion of deaths due to sepsis was greater in scald burns than other causes and proportion of deaths due to respiratory tract illness was greater in explosion burns than other causes.
On comparison between survivors and non survivors; there was statistical significant increase in the age in non survivors. There was no statistical significant difference of gender distribution between survivors and non survivors. Regarding the causes of burn, the greatest proportion of mortality was in cases with burns due to explosions (50%), followed by flames (19.5%).
There was statistical significant increase in TBSA of burns and APACHE III score in non survivors than that in survivors. There were none significant differences in FTSA of burns and delay time between survivors and non survivors.
Both of inhalation injury and indication of early
mechanical ventilation were associated with greater incidence
of mortality (47.4% in cases with inhalation injury vs. 16.5% in
other cases) and (54.3% in cases indicated early mechanical
ventilation vs. 10.3% in other cases).
Mortality was greater in cases required admission in ICU
(25% vs. 13.3% in other cases). Duration of hospital stay was
significantly prolonged in survivors when compared to that in
non survivors.
Binary logistic regression analysis showed that, TBSA
and APACHE III score were predictive for mortality. The
odds of mortality was found to increase by about 0.8 time with
each increase of TBSA by 1%, and by about 0.93 time with each
increase of APACHE III score by one unit. According to
equation of regression analysis:
Probability of death =
exp
1 exp
X
X
where X = 19.749 – (0.227× TBSA) – (0.07× APACHE III score).
Cases were classified as survivors and non survivors with
a cut off value 0.5 (cases with value <0.5 were classified as non
survivors, while cases with value > 0.5 were classified as
survivors). This model resulted in accurate classification of
95.9% of the cases.