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Comparing mortality outcomes of major burns and toxic epidermal necrolysis in a tertiary burns centre

Mahar, Patrick D., Wasiak, Jason, Paul, Eldho, Watters, David A., Kirby, Julia, Gin, Douglas, Marsh, Philip and Cleland, Heather 2014, Comparing mortality outcomes of major burns and toxic epidermal necrolysis in a tertiary burns centre, Burns, vol. 40, no. 8, pp. 1743-1747, doi: 10.1016/j.burns.2014.03.012.

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Title Comparing mortality outcomes of major burns and toxic epidermal necrolysis in a tertiary burns centre
Author(s) Mahar, Patrick D.
Wasiak, Jason
Paul, Eldho
Watters, David A.
Kirby, Julia
Gin, Douglas
Marsh, Philip
Cleland, Heather
Journal name Burns
Volume number 40
Issue number 8
Start page 1743
End page 1747
Total pages 5
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2014-12
ISSN 0305-4179
Keyword(s) Burns
Mortality
Palliative care
Toxic epidermal necrolysis
Summary  Introduction
Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage.

Methods
Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest.

Results
Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P = 0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P = 0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5 h; P = 0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality.

Conclusion
Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.
Language eng
DOI 10.1016/j.burns.2014.03.012
Field of Research 110323 Surgery
110304 Dermatology
Socio Economic Objective 920117 Skin and Related Disorders
HERDC Research category C1 Refereed article in a scholarly journal
Persistent URL http://hdl.handle.net/10536/DRO/DU:30066155

Document type: Journal Article
Collection: School of Medicine
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Created: Mon, 22 Sep 2014, 15:12:45 EST by Penny Andrews

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