Outcome and changes over time in survival following severe burns from 1985 to 2004

Objective: To investigate outcome in severely burned patients over a 20-year period and to evaluate survival over time. Historical cohort in a six-bed burn unit of a 1060-bed university hospital. Paitents: 1385 patients admitted to the burn unit over a 20-year period. Measurements and results: Outcome was evaluated in relation to the presence of three major risk factors for death: age 60 years or over, total burned surface area 40% or more, and the presence of inhalation injury. Overall mortality was 7.1%. When zero, one, two, or three risk factors were present, mortality was respectively 0.5%, 9.9%, 48.0%, and 90.5%. Over the study period the average proportional total burned surface area decreased as did mortality. The survival benefit was significant among patient groups with one or two risk factors present. Multivariate regression analysis adjusting for risk factors for death confirmed that survival improved over time (odds ratio 0.73 per 5-year period). Conclusions: Global mortality following burns is low, and nearly all patients who die had at least one risk factor present. In the presence of three risk factors the prognosis following burns is particularly compromised. Taking into account that our patients over the past 20 years have been progressively less extensively burned and hence have a lesser at risk for death, survival following severe burns has continued to improve.