Lethal triad in severe burns

Burns. 2014 Dec;40(8):1492-6. doi: 10.1016/j.burns.2014.04.011. Epub 2014 Jul 1.


Introduction: Hypothermia, acidaemia and coagulopathy in trauma is associated with significant mortality. This study aimed to identify the incidence of the lethal triad in major burns, and describe demographics and outcomes.

Methods: Patients admitted during a 71 month period with a total body surface area burn (TBSA)≥30% were identified. A structured review of a prospective database was conducted. The lethal triad was defined as a combination of coagulopathy (International normalised ratio>1.2), hypothermia (temperature≤35.5°C) and acidaemia (pH≤7.25).

Results: Fifteen of 117 patients fulfilled the criteria for the lethal triad on admission. Lethal triad patients had a higher median (IQR) abbreviated burn severity index (ABSI) (12 (9-13) vs. 8.5 (6-10), p=0.001), mean (SD) TBSA burn (59.2% (18.7) vs. 47.9% (18.1), p=0.027), mean (SD) age (46 (22.6) vs. 33 (28.3) years, p=0.033), and had a higher incidence of inhalational injury (p<0.0001) and full-thickness burns (p=0.021). Both groups received similar volumes of fluid (p>0.05). The lethal triad was associated with increased mortality (66.7% vs. 13.7%, p<0.0001). With logistic regression analysis and adjustment for ABSI, the lethal triad was not shown to be a predictor of mortality (p>0.05).

Conclusion: Burn patients with the lethal triad have a high mortality rate which reflects the severity of the injury sustained.

Keywords: Abbreviated burn severity index (ABSI); Acidaemia; Burn; Coagulopathy; Hypothermia.

MeSH terms

  • Acidosis / etiology
  • Acidosis / mortality*
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Disorders / mortality*
  • Body Surface Area
  • Burns / complications
  • Burns / mortality*
  • Burns, Inhalation / complications
  • Burns, Inhalation / mortality
  • Cohort Studies
  • Female
  • Humans
  • Hypothermia / etiology
  • Hypothermia / mortality*
  • International Normalized Ratio
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • Trauma Severity Indices
  • Young Adult