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.
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