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Benchmarking Outcomes in the Critically Injured Burn Patient

Klein, Matthew B. MD*; Goverman, Jeremy MD; Hayden, Douglas L. PhD; Fagan, Shawn P. MD; McDonald-Smith, Grace P. MEd§; Alexander, Andrew K. BS§; Gamelli, Richard L. MD; Gibran, Nicole S. MD*; Finnerty, Celeste C. PhD; Jeschke, Marc G. MD, PhD**; Arnoldo, Brett MD††; Wispelwey, Bram MS; Mindrinos, Michael N. PhD‡‡; Xiao, Wenzhong PhD; Honari, Shari E. RN§§; Mason, Philip H. PhD§; Schoenfeld, David A. PhD¶¶; Herndon, David N. MD; Tompkins, Ronald G. MD, ScDthe Inflammation and Host Response to Injury, and Large-Scale Collaborative Research Program

doi: 10.1097/SLA.0000000000000438

Objective: To determine and compare outcomes with accepted benchmarks in burn care at 6 academic burn centers.

Background: Since the 1960s, US morbidity and mortality rates have declined tremendously for burn patients, likely related to improvements in surgical and critical care treatment. We describe the baseline patient characteristics and well-defined outcomes for major burn injuries.

Methods: We followed 300 adults and 241 children from 2003 to 2009 through hospitalization, using standard operating procedures developed at study onset. We created an extensive database on patient and injury characteristics, anatomic and physiological derangement, clinical treatment, and outcomes. These data were compared with existing benchmarks in burn care.

Results: Study patients were critically injured, as demonstrated by mean % total body surface area (TBSA) (41.2 ± 18.3 for adults and 57.8 ± 18.2 for children) and presence of inhalation injury in 38% of the adults and 54.8% of the children. Mortality in adults was 14.1% for those younger than 55 years and 38.5% for those aged 55 years and older. Mortality in patients younger than 17 years was 7.9%. Overall, the multiple organ failure rate was 27%. When controlling for age and % TBSA, presence of inhalation injury continues to be significant.

Conclusions: This study provides the current benchmark for major burn patients. Mortality rates, notwithstanding significant % TBSA and presence of inhalation injury, have significantly declined compared with previous benchmarks. Modern day surgical and medically intensive management has markedly improved to the point where we can expect patients younger than 55 years with severe burn injuries and inhalation injury to survive these devastating conditions.

Supplemental Digital Content is Available in the Text.In this study, we describe the baseline patient characteristics and well-defined outcomes of persons hospitalized in the United States for major burn injury. This study provides a current benchmark for patients with major burn injuries.

*Department of Surgery, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA

Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA

Department of Medicine, Massachusetts General Hospital, Boston, MA

§Department of Surgery, Massachusetts General Hospital, Boston, MA

Department of Surgery, Loyola University School of Medicine, Maywood, IL

Department of Surgery, University of Texas Medical Branch, Galveston, TX

**Department of Surgery and Plastic Surgery, University of Toronto, Canada

††Department of Surgery, Parkland Memorial Hospital, University of Texas, Southwestern Medical Center, Dallas TX

‡‡Stanford Genome Technology Center, Palo Alto, CA

§§Department of Surgery, Harborview Medical Center, Seattle, WA

¶¶Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA.

Reprints: Ronald G. Tompkins, MD, ScD, Harvard Medical School, and Massachusetts General Hospital, 55 Fruit St, GRB 1302, Boston, MA 02114. E-mail:

Disclosure: This study was supported by the Inflammation and the Host Response to Injury Large-Scale Collaborative Research Grant from the National Institute of General Medical Sciences, 5U54GM062119. The authors declare no conflicts of interest.

Trial Registration: Identifier NCT00257244.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2014 by Lippincott Williams & Wilkins.