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Mortality After Thermal Injury: No Sex-Related Difference
Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns.
Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
2011 (English)In: JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, ISSN 0022-5282, Vol. 70, no 4, 959-964 p.Article in journal (Refereed) Published
Abstract [en]

Background: Young women have been reported to be more likely to survive than men after severe trauma. Girls also have less inflammation and hypermetabolism after major burns. Yet burned women have been found to have a twofold greater risk of death than men. Our aim was to find out if there is a sex-related difference in mortality after thermal injury, particularly in the age group between 16 years and 49 years, when hormonal differences would be most influential. Methods: All patients admitted to the Linkoping University Hospital Burn Unit with thermal injuries during the years 1993-2008 were included and the variables percentage burned total body surface area (TBSA%), age, type of burn, mechanical ventilation, and year were included in a multiple regression (Poisson log) model. Results: Of 1,119 patients with thermal injury, 792 (71%) were men. Crude mortality was 5% among men, and 8% among women (p = 0.04). After adjustment for age and TBSA%, there was no correlation between mortality and sex, in any age group. Eight men and four women died in the group of young adults (16-49 years) in which TBSA% correlated with mortality (p andlt; 0.01) but age did not. Mortality was 14% (32 of 221) among the men and 23% (23 of 102) of women in the group of older adults (50 years and older), and both age and TBSA% correlated with mortality (p andlt; 0.001). Conclusions: There is no relevant sex-related difference in survival after thermal injury. The conclusion is, however, tempered by the few deaths, particularly among younger adults.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS and WILKINS, 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA , 2011. Vol. 70, no 4, 959-964 p.
Keyword [en]
Burns, Outcome, Dimorphism, Age, Total body surface area
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-67966DOI: 10.1097/TA.0b013e3181e59dbeISI: 000289558700039OAI: oai:DiVA.org:liu-67966DiVA: diva2:414736
Available from: 2011-05-04 Created: 2011-05-04 Last updated: 2012-03-25
In thesis
1. Organ dysfunction among patients with major burns
Open this publication in new window or tab >>Organ dysfunction among patients with major burns
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The number of patients who are admitted for in-hospital care in Sweden because of burns is about 12/100,000, and only a small proportion of these have larger burns. Among them, and particularly among those who die in hospital, a condition referred to as “organ dysfunction” is common and an important factor in morbidity and mortality. The fact that the time of the initial event is known, and the magnitude of the insult is quantifiable, makes the burned patient ideal to be studied. In this doctoral thesis organ dysfunction and mortality were studied in a descriptive, prospective, exploratory study (no interventions or control groups) in patients admitted consecutively to a national burn centre in Sweden.

The respiratory dysfunction that is seen after burns was found to be equally often the result of acute respiratory distress syndrome and inhalation injury. We found little support for the idea that this early dysfunction is caused by pneumonia, ventilator-induced lung injury, or sepsis. Acute kidney injury (AKI) was also common, and mortality was associated with severity. Importantly, renal dysfunction recovered among the patients who survived. Pulmonary dysfunction and systemic inflammatory response syndrome developed before the onset of AKI. Sepsis was a possible aggravating factor for AKI in 48% of 31 patients; but we could find no support for the idea that late AKI was mainly associated with sepsis. We found that older age (over 60 years), greater TBSA%, and respiratory dysfunction were associated with increased mortality, but there was no association between the overall mortality and sex. We also found that early transient liver dysfunction was common, and recorded early hepatic “hyper”- function among many young adults. Persistent low values indicating severe liver dysfunction were found among patients who eventually died.

We conclude from this investigation that overall organ dysfunction is an early and common phenomenon among patients with severe burns. Our data suggest that the prognosis of organ dysfunction among these patients is good, and function recovers among most survivors. Multiple organ failure was, however, the main cause of death. The findings of the early onset in respiratory dysfunction and a delay in signs of sepsis are congruous with the gutlymphatic hypothesis for the development of organ dysfunction, and the idea of the lung as an inflammatory engine for its progression. We think that the early onset favours a syndrome in which organ dysfunction is induced by an inflammatory process mediated by the effect of the burn rather than being secondary to sepsis.

Our data further suggest that clinical strategies to improve burn care further should be focused on early interventions, interesting examples of which include: selective decontamination of the gastrointestinal tract to prevent translocation of gut-derived toxic and inflammatory factors; optimisation of fluid replacement during the first 8 hours after injury by goal-directed resuscitation; and possible improvement in the fluid treatment given before admission.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1248
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70061 (URN)978-91-7393-155-7 (ISBN)
Public defence
2011-09-08, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-08-17 Created: 2011-08-17 Last updated: 2012-03-13Bibliographically approved

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Steinvall, IngridFredrikson, MatsBak, ZoltanSjöberg, Folke

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Faculty of Health SciencesDepartment of Plastic Surgery, Hand surgery UHLPlastic Surgery, Hand Surgery and BurnsOccupational and Environmental MedicineAnesthesiologyDepartment of Surgery in ÖstergötlandDepartment of Anaesthesiology and Surgery UHLBurn Center
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