Objective Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest (-)-p-Bromotetramisole Oxalate benefit from individualized experimental or innovative therapies. criteria: 0-99 years of age admission within 96 hours after injury and >20% total body surface area burns requiring at least one surgical intervention. Setting Six major burn centers in North America. Measurements and Main Results Burn size cutoff values were determined for mortality burn wound infection (at least two infections) sepsis (as defined by ABA sepsis criteria) pneumonia acute respiratory distress syndrome and multiple organ failure (DENVER2 score >3) for both children (<16 years) and adults (16-65 years). Five-hundred seventy-three patients were enrolled of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children the cutoff burn size for mortality sepsis infection and multiple organ failure was approximately 60% total body surface area burned. In adults the cutoff for these outcomes was lower at approximately 40% total body surface area burned. Conclusions In the modern burn care setting adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality even in highly specialized centers. Keywords: burns survival cutoff morbidity outcomes INTRODUCTION Burn injury isunique in thatinjury severity can be quantified enabling the use of formulas to predict survival(1).Predicting survival is a key aspect guidingburn care choices(1-3).Baux’s score which was established in the mid-20th century has been used to determine burn outcomes. Later on during 1980-1990 various formulas based on burn size were developed to Rabbit Polyclonal to SIRT2. guide clinical treatment decisions(2 4 etal.(6)identified risks factors and developed a model for predicting poor outcomebased on a retrospective analysis of data from 1 665 burn patients treated between 1990 and 1996.Features of the injury along with initial treatment and biochemical markers atadmission and during (-)-p-Bromotetramisole Oxalate hospitalization were included in this model.Recently a review by Hussain and colleagues(1)revealed that of all prediction models only a few actually predict mortality reasonably well. While predicting survival is important a substantial difference exists between predicting mortality and the burn size predictive of morbidity(7).Cutoff values are burn sizes that at admission can discriminate whether a patient with a given burn size is at risk for significant complications(7). From a practical point of view this burn size threshold should identify patients requiring specific interventions (e.g. early initiation of antibiotics anabolic agents or anti-catabolic agents; more aggressive surgery or use of innovative therapies)(8).We have recently shown that in a large pediatric cohort the cutoff burn size linked to greater complications and death morbidity and mortality in a specialized burn center is approximately 60% total body surface area (TBSA) burned(7). This study was a single-center study and included only pediatric patients. Todate there are significant gaps in our knowledge of predictors of adverse outcomes after massive burns. This prospective cohort study was undertakenin six major US burn centers to determine the burn sizeassociated with increased risks of morbidity and mortality. PATIENTS AND METHODS Patients This study was part of the Inflammation and the Host Response (-)-p-Bromotetramisole Oxalate to Injury Glue Grant and was approved by Institutional Review Boards of the participating institutions (University of Texas Medical Branch Galveston TX; Loyola University Medical College Chicago IL; University of Texas Southwestern Dallas TX; University of Washington Seattle Seattle WA;Massachusetts General Hospital Boston (-)-p-Bromotetramisole Oxalate MA). Over an 8-year period 573 patients meeting all inclusion criteria were prospectively enrolled. Inclusion criteria were as follows:age of 0-99years admissionto a participating hospital no later than96 hours postburn >20% TBSA burns with the need for at least one surgical intervention. All hospitals followedstandard operating procedures set forth by the burn patient-oriented (-)-p-Bromotetramisole Oxalate research core(9 10 subject or a family member provided written informed consent before.