A study of survival rates at the St Andrew’s Centre for Plastic Surgery and Burns in Chelmsford has shown big improvements in the last few decades. The burns unit saves as many lives as American burns units that are better equipped.
In the 1980’s children had 50% survival rate after severe burns but now medical treatment results in close to 100% survival rate.
One of the medical changes is that doctors are more aggressive with the removal of burnt skin. By removing burnt and dead skin earlier there are fewer complications during the recovery process.
The British Burn Association agree that this news is very exciting. It shows how improving medical procedures can sometimes be as important as investing in the latest technologies.
Chelmsford Burns Unit
The Chelmsford burns unit, St Andrew’s Centre for Plastic Surgery and Burns, treats around 75% of all serious burns victims in the South East and London.
The director of the Chelmsford burns unit, Peter Dziewulski F.R.C.S., worked with burns specialises in Texas where he learned the new skin removal procedures. He is on the Executive Committee on the British Burn Association and is on the Editorial Committee of the Burns Journal.
In 2009 St. Andrews won an award for its breast cancer reconstruction services.
The study was published in the Journal of Trauma.
Reference
“The Baux score is dead. Long live the Baux score: A 27-year retrospective cohort study of mortality at a regional burns service” by Roberts, Geoffrey MA, BM BCh, MRCS; Lloyd, Mark MRCS; Parker, Mike MSc; Martin, Rebecca FRCA; Philp, Bruce FRCS; Shelley, Odhran FRCSI; Dziewulski, Peter FRCS. Journal of Trauma and Acute Care Surgery: January 2012 – Volume 72 – Issue 1 – p 251–256 doi: 10.1097/TA.0b013e31824052bb
Abstract
Background: To assess trends in mortality after burn injuries treated in a regional specialist burns service between 1982 and 2008.
Methods: Patient and burn-specific information and mortality were collated from written admission ledgers and the hospital coding department for 11,109 patients. The data set was divided into age cohorts (0–14, 15–44, 45–64, and >65 years) and time cohorts (1982–1991, 1992–2000, and 2000–2008). Lethal area 50 (LA50) was calculated by logistic regression and probit analysis. Mortality was related to the Baux score (age + total % burned surface area) by logistic regression.
Results: In the time period 2000 to 2008, the LA50 values with approximate 95% confidence intervals (CIs) were 100% (CI, 85.5–100%) in the 0 to 14 cohort (LA10, 78.3%; CI, 64.1–92.5%), 76.4% (CI, 69.1–83.8%) in the 15 to 44 cohort, 58.6% (CI, 50.8–66.5%) in the 45 to 64 cohort, and 30.8% (CI, 24.7–36.9%) in the >65 cohort. The point of futility (the Baux Score at which predicted mortality is 100%) was 160 and the Baux50 (the Baux score at which predicted mortality is 50%) was 109.6 (CI, 105.9–113.4) in the 2000 to 2008 cohort.
Conclusions: Mortality is markedly improved over earlier data from this study and other historical series and compares favorably with outcomes published from the US National Burn Repository. The Baux Score continues to provide an indication of the risk of mortality. Survival after major burn injury is increasingly common, and decisions by nonspecialist about initial triage, management, and futility of care should be made after consultation with a specialist burn service.
