Assessment of adverse events in the demise of pediatric burn patients

Background: Given the contention that survival is to be expected from even the most severely burned child, then, intuitively, at least some pediatric burn victims die because of suboptimal care. The purpose of this study is to assess the impact of any adverse events that may have contributed to the death of burned children. Methods: Four surgeons with specialty training in pediatric burn care reviewed the clinical course and autopsy findings of 71 burned children who died after admission to a burn center during a 10-year interval. Reviewers were asked to determine the predominant factor or factors contributing to each child's demise and to assess the significance of any deviations from optimal care. Results: For the 10 years under review, overall mortality for all pediatric burns was 2.4%. Of these deaths, 25% had burns encompassing less than 50% body surface area. The reviewers identified lung damage as the most frequent cause of death, which was deemed largely unpreventable. Conversely, hypovolemia related to inadequate prehospital fluid resuscitation and failure to obtain and maintain a patent airway were considered the second and third most common factors in a child's death and deemed preventable under ideal circumstances. Conclusions: This review implies that deficiencies in health care contribute to the demise of many burned children. The most notable areas for improvement are in fluid resuscitation and airway control. This suggests that quality assurance and educational initiatives to improve these aspects of care may have the greatest impact on further improving survival of burned children.