• Marc G Jeschke, Ruxandra Pinto, Robert Kraft, Avery B Nathens, Celeste C Finnerty, Richard L Gamelli, Nicole S Gibran, Matthew B Klein, Brett D Arnoldo, Ronald G Tompkins, David N Herndon, and Inflammation and the Host Response to Injury Collaborative Research Program.
• 1Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. 2Programme in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 3Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 4Shriners Hospitals for Children, Galveston, TX. 5Department of Surgery, University of Texas Medical Branch, Galveston, TX. 6Sealy Center for Molecular Medicine and the Institute for Translational Science, University of Texas Medical Branch, Galveston, TX. 7Department of Surgery, Loyola University Stritch School of Medicine, Maywood, IL. 8Department of Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA. 9Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX. 10Department of Surgery, Massachusetts General Hospital, Shriners Hospital for Children, and Harvard Medical School, Boston, MA.
• Crit. Care Med. 2015 Apr 1; 43 (4): 808-15.

ObjectiveCharacterizing 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 benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn.Design And PatientsBurn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0-99 years old, admission within 96 hours after injury, and more than 20% total body surface area burns requiring at least one surgical intervention.SettingSix major burn centers in North America.Measurements And Main ResultsBurn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by American Burn Association sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (Denver 2 score>3) for both children (<16 yr) and adults (16-65 yr). 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.ConclusionsIn 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.

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