Clinical consideration of burns and it's mortalities
During past few decades, there have been some changes in the mortalities in the burned patients.
To properly assess the current cause of mortality in burned patients, it is necessary to review some of the changes in recent years in the factors producing mortalities and the changes in therapeutic regimes in attempts to control these factors.
Before World War-Two, 50 to 75 per cent of the death in burns were the result of "Shock".
With World War-Two came improvements in the management of shock and in the methods of obtaining, storing, and administering blood, blood substrates and fluid.
Shock has virtually disappeared now as a significant cause of early mortality in burns. Now, the largest single cause of death is invasive infection of the burn wound, followed by sepsis. A variety of topical agent has been introduced to attempt to control sepsis in burn wounds.
During the past 8 years and 3 months period from January, 1966 to March, 1974, 1068 cases of burns were treated at surgical department of Severance Hospital.
Among of these, 413 patients with old sequelae of burn for plastic reconstruction were excluded in the clinical observation and mortality analysis of the remained 655 patients with fresh burn cases was the basis of this report.
1. Males were affected more than females, the incidence being 385(58.8%) and 270 cases(412%).
2. The cause of burn were tubulated as follow: Scalding 319 cases(48.7%), Flame 250 cases(38.2%), Direct contact in the hot material 28 cases(4.3%), Chemical 26 cases (4.0%), and Electric 4 cases(1.7%), in this order.
3. Among 655 cases of burned patient, 258 cases(39.4%) were under 10% of burn surface area and 57 cases(8.7%) had over 50%. The majority cases were 2nd and 3rd degree burns combined.
4. Brooke's formula was employed for the fluid therapy and the predominant organisms isolated from the wounds were pseudomonas(35.5%), and staphylococci, aerobacter, E-coli, streptococci in order of decreasing frequency.
5. In most cases who required skin graft, the surface had been ready for graft after early removal of eschar.
6. The over-all mortality in this observation was 9.9%(65 cases). 23 patients succumped by septicemia, 8 cases were due to burn shock or hypovolemic shock and the remaining cases were due to air way obstruction or respiratory tract burn, Curling ulcer, aspiration pneumonia, acute renal failure, pulmonary edema, or head trauma etc.
7. In average survival periods of the deaths, 19 patients died within 48 hours after burn, 32 patients between 3rd to 7th days, 12 patients between 8th to 14 days, and thereafter mortality declined.
8. Under the 10% of burn surface, there was no mortality and above the 80% of burn surface(16 cases), there were 100% mortalities.
The mortality rates were higher in old age group than young age group.