Patients with burn injuries are a heterogenous patient group with respect to age, depth and extent of injury. A small, but deep burn of a hand or in the face may have substantial functional or cosmetic consequences. A deep burn that affects large areas of the body can be life-threatening and often requires several operations. In some cases, lack of available skin for transplants may prolong treatment for several months.
71 % of patients were men and 24 % were less than three years (fig 1). This is in accordance with fairly recent data from Swedish hospitals (1987 - 2004), where men accounted for 69 % of all stays caused by burns and 27 % of the patients were less than five years (5).
Extensive burns may be life-threatening for the patient; hospital mortality was 10.8 % in our material. For ten patients (0.8 %) for whom the extent of the injury, the age and premorbid condition gave them such a grave prognosis that there was not a realistic chance of survival transfer was arranged for palliative treatment closer to family and home. The real mortality from burn damage will therefore be somewhat higher than that deducted from solely status upon discharge.
Our material cannot easily be compared directly with burn material from other hospitals. Clinical burn injury material often varies substantially with respect to proportion of children, causes of injury, prevalence of inhalation injury and local practice for transfer of patients between hospitals. We find a survival which is approximately in line with results in a larger American material from 1991 to 93 (in the middle of our study period) (6).
For 52 (4 %) of our patients the burn injuries covered more than 60 % of the body surface. Taking into account the uncertainty contained in a limited number of extensive injuries, a patient with a burn of about 60 % of the body’s surface has approximately a 50 % chance of survival (all age groups assessed together), fig 4. This is in line with findings in an American material where the mortality was 47.5 % among 673 burn patients with injuries of about 60 - 69 % of the body’s surface (7).
The burn- injured patient’s problems are not solved when the wounds are healed upon discharge. For many patients with large burns, a long and demanding rehabilitation period awaits. In a follow-up of 999 patients discharged in 1984 - 1999 we found that among patients with previous burns the risk of sudden or violent death was ten times higher than in the adult population as a whole (8).
Inhalation injury secondary to inhalation of toxic combustion products increases the risk to die as a consequence of a burn. Among 1 665 patients treated at two Boston hospitals in 1990 - 94, three risk factors for death were found: age > 60 years, injured area > 40 % of the body surface and inhalation injury (9).
Several conditions cause the length of stay in the Burn Centre to be somewhat lower than the total hospital stay. With a large demand some patients with wounds in healing or small wounds have been treated in a plastic surgery ward. Total stay at Haukeland may therefore be somewhat longer than what has been recorded as stay in the Burn Centre. In an opposite direction points that after the patient hotel opened in 1998, some patients with healing wounds have been able to stay overnight there, but with daily wound treatment and assessment in the ward.
After skin grafting and with healing wounds, some patients have been returned to complete treatment in their home hospitals. We were not able to describe the duration of the burn treatment for patients who were moved back to their home hospitals because we could not couple databases from different hospitals. We were not able to describe the duration of the burn treatment for patients who were moved back to their home hospitals because we could not couple databases from different hospitals.
The same applies to patients (most often those with very extensive and deep injuries) that have been transferred to other hospitals (most often at Sunnaas hospital) for more specialised rehabilitation after having completed treatment with us.