Résumé du colloque
Massive burn injuries are difficult, stressful, and expensive and are therefore an ethically complex issue. Further, an acceptable quality of life is necessary in order to justify the personal and societal costs associated with burn resuscitation. We purpose to 1) examine the mortality and morbidity of major burn patients and to determine the changes over the past two decades; 2) assess the quality of life in survivors of massive burn injury and to identify factors associated with poor outcomes; 3) generate descriptive and normative data for quality of life outcomes after massive burn injuries. A retrospective review of burn patients treated from 1976 to 2001 was conducted using the computerized burn registry and individual chart review. 146 charts of patients with burns >70 % TBSA were reviewed for the following variables : age, sex, TBSA, inhalational injury, length of stay (LOS), facial burn, significant comorbid illnesses and compared between an early treatment era (Early) 1976-1987 and the more recent period 1988-2001(Recent). Massive burn patients who survived were surveyed by questionnaires including the SF-36 (Short Form - 36) and the BSHS (Burn Specific Health Scale). 60 patients in the Early group and 45 in the Recent period represent 4,3 % and 3,3 % (p<0.05) of the total burn population. They were similar in age (mean 30.0 vs 34.7 yr), but in the Recent period, there was a greater proportion of females injured (8,3 % vs 28,9 %), and a greater depth of injury (55,2 ± 3,9 vs 67,0 ± 3,3 % full thickness TBSA, p<0.05), requiring significantly more escharotomies. In the Recent period, there were higher rates of inhalation injury, more facial burns, intubation and tracheotomies. Although the frequency of work and oil field injuries declined in the Recent period, rates of assault and suicide increased. Recently, patients underwent slightly more operations, commencing earlier within the first week and were more likely to receive artificial skin substitutes in their operative management. Overall mortality was significantly reduced for all burn patients (4,3 vs 3,3 % p <0.05) and for the massive burn patients (92,7 % vs 58,3 p<0.01) in the recent era, despite higher rates of compassionate care (47,8 % vs 64,7 % of deaths in the first 48 hours post burn). Using logistical regression analysis there was a 5,95 fold greater chance of survival in the recent period, where % full thickness burn, age and inhalation injury were the greater predictors of mortality than TBSA. 50 % of massive burn injured patients responded to our survey. As compared to the general population, burn patients reported significantly poorer quality of life on scales of physical functioning, activities of daily living, bodily pain, general health perception and emotional functioning, but they did not differ significantly in areas of vitality, mental health, or social functioning. When compared to heart transplant recipients and general systems ICU patients, burn injured patients perceived themselves to have equal or better physical and mental functioning. Poorer quality of life following burn injury correlated significantly with injuries sustained at an older age and those with impaired hand function. Quality of life did not correlate with burn size. Despite lower frequency of massive burn injury, the severity of massive burn injury has increased and yet survival and length of stay have reduced, likely due to earlier surgery, reduced sepsis through control of nosocomial infections, and total burn care in one specialized unit with dedicated staff. As compared to other populations of patients requiring similar health care resources, survivors of massive burn injuries perceive an increased quality of life, which is nevertheless somewhat less than the normal population that is predictable not by the size of the injury, but by age and impairment in hand function.
Contexte
Hôte :
Université Laval
Colloque
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