Harborview burns -- 1974 to 2009
Year, Volume, Issue, Page(s):
2012, vol. 7, issue 7, pp e40086
Article reviews changes in burn care at the Harborview Burn Center in Seattle, WA, from 1974 to 2009. It reports results and include observations on changes in numbers of standard and short-stay admissions, age distribution, transport patterns, percent of total body surface area burned, race/ethnicity, payer status, fluid creep, burn surgery, length of stay, mortality, trajectory to death, and unprecedented survival. A total of 14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Changes that are highlighted include: (1) the large increase in numbers of total and short-stay admissions, (2) the decline in numbers of large burn injuries, (3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, (4) that race/ethnicity and payer status disparity exists, and (5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation, and opioids may be involved.
Engrav LH, Heimbach DM, Rivara FP, Kerr KF, Osler T, Pham TN, Sharar SR, Esselman PC, Bulger EM, Carrougher GJ, Honari S, Gibran NS
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