Prognosis in 51% Burns
A patient with 51% total body surface area (TBSA) burns has a poor prognosis with approximately 50% chance of survival, with high risk of systemic complications and mortality. 1
Mortality Risk Factors
- Age, TBSA burned, and presence of smoke inhalation are the main risk factors affecting mortality in severe burns 2
- Burns covering more than 50% TBSA are associated with mortality rates of approximately 84.6% according to recent retrospective studies 3
- Patients with a 78% TBSA burn have a 50% chance of survival, suggesting that at 51% TBSA, survival chances are somewhat better but still concerning 1
- The presence of inhalation injury significantly worsens prognosis and increases mortality risk 2
- Development of acute kidney failure during the first week increases mortality risk significantly (OR 5.47) 4
Expected Complications
Respiratory Complications
- Respiratory complications occur in approximately 95.6% of patients with >50% TBSA burns 3
- Patients with facial burns and inhalation injury should be closely monitored for glottis edema and respiratory distress 2
- Intubation should be considered if the patient has very extensive burns (TBSA >40%) along with deep circular neck burns or symptoms of airway obstruction 2
Cardiovascular Complications
- Cardiocirculatory complications occur in 93.4% of patients with >50% TBSA burns 3
- Hypovolemic shock is common and requires aggressive fluid resuscitation 2
- Fluid requirements are frequently underestimated; for adults with >50% TBSA burns, at least 2 liters of fluid are recommended in the first hour 5
Metabolic and Other Systemic Complications
- Metabolic complications occur in 84.6% of patients with >50% TBSA burns 3
- Hematological complications (74.7%), renal complications (64.8%), and hepatic complications (59.3%) are common 3
- Infectious complications occur in 38.4% of cases with >50% TBSA burns 3
- Fungal infections are a significant concern, with Aspergillus and Candida being the most common pathogens 6
Management Priorities to Improve Prognosis
Specialized Care
- Patients with >20% TBSA burns in adults should be referred to a specialized burn center immediately 2, 7
- Direct admission to a burn center is associated with better survival and decreased morbidity 2
- Telemedicine consultation with burn specialists should be utilized if immediate transfer is not possible 2
Fluid Resuscitation
- Proper fluid resuscitation is critical in the first 24-48 hours 2
- Balanced crystalloid solutions are recommended for initial fluid resuscitation 2
- For adults with >50% TBSA burns, at least 2 liters of fluid are recommended in the first hour 5
Respiratory Support
- Early intubation should be considered for patients with extensive burns (>40% TBSA) if they also have deep circular neck burns or symptoms of airway obstruction 2
- Mechanical ventilation parameters should be chosen to avoid barotrauma 5
Infection Prevention
- Systemic antibiotic prophylaxis in the first 4-14 days has been shown to reduce mortality by nearly half in burn patients 2
- Early surgical excision of necrotic tissue and wound coverage are essential to reduce infection risk 5
Exclusion Criteria for ICU Admission During Mass Casualty Events
- According to triage protocols, patients with severe burns meeting specific criteria may be excluded from ICU admission during mass casualty events 2
- These criteria include burns with >40% TBSA affected in patients >60 years of age, or burns with inhalation injury 2
- This information is relevant for disaster planning but should not affect standard care decisions outside of mass casualty scenarios 2
Long-term Considerations
- Survivors of extensive burns face significant functional limitations and may require prolonged rehabilitation 7
- Nutritional support is crucial as severe burn patients have very high metabolic demands 5
- Early surgical excision and skin grafting significantly reduce morbidity, mortality, and length of hospital stay 2