Outcome predictors and quality of life of severe burn patients admitted to intensive care unit

Abstract

Background: Despite significant medical advances and improvement in overall mortality rate following burn injury, the treatment of patients with extensive burns remains a major challenge for intensivists. We present a study aimed to evaluate the short- and the long-term outcomes of severe burn patients (total body surface area, TBSA > 40%) treated in a polyvalent intensive care unit (ICU) and to assess the quality of life of survivors, one year after the injury using the EuroQol-5D (EQ-5D) questionnaire.

Methods: A prospective-observational study was performed in an ICU of a University-affiliated hospital. Logistic regression analysis was used to identify the factors predicting in-hospital mortality. The EQ-5D questionnaire was used to asses participant's long term self-reported general health.

Results: During a period of five years, 50 patients participated in the study. Their mean age was 53.8 +/- 19.8; they had a mean of %TBSA burned of 54.5 +/- 18.1. 44% and 10% of patients died in the ICU and in the ward after ICU discharge, respectively. Baux index, SAPS II and SOFA on admission to the ICU, infectious and respiratory complications, and time of first burn wound excision were found to have a significant predictive value for hospital mortality. The level of health of all survivors was worse than before the injury. Problems in the five dimensions studied were present as follows: mobility (moderate 68.5%; extreme 0%), self-care (moderate 21%; extreme 36.9%), usual activities (moderate 68.5%; extreme 21%), pain/discomfort (moderate 68.5%; extreme 10.5%), anxiety/depression (moderate 36.9%; extreme 42.1%).

Conclusions: In severe burn patients, Baux index, severity of illness on admission to the ICU, complications, and time of first burn wound excision were the major contributors to hospital mortality. Quality of life was influenced by consequences of injury both in psychological and physical health.

Figure 1

Outcome of 50 patients with severe burn after admission ICU between January 1,1999 and December 31, 2003; follow-up process was in December 2004.

Figure 2

Cumulative survival rate from ICU admission to one year after ICU discharge as plotted by Kaplan Meier compared to normal population.

Figure 3

Health related quality of life of burn patients using EuroQoL questionnaire one year after ICU discharge. Perceived current health status: VAS score (100% scale) 50. worse (%) 100. Work: retired patients (%) 36.8. un-employed patients (%) 63.2.