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Working in a regional trauma center, the two types of injuries that make me cringe when I hear a patient is coming into the hospital are head injuries and burns. These injuries share many similarities in that they are both relatively common, are important causes of death, and many of the victims have lifelong morbidity.
There are approximately 4000 deaths each year in the US from fire and burns.1 A similar figure, proportional to population, is probably found in most developed countries. The problem of burns is even relatively greater in less industrialized countries where the absence of specialized burn care results in much greater morbidity, disability, and mortality for burn victims.2
The majority of fire deaths are due to smoke inhalation in residential fires, rather than from the burn itself. Smoke inhalation can increase the mortality rate 10-fold for the same size burn,3 and most of these deaths occur at the scene of the fire. Burn deaths include burns from residential fires, as well as scalds, clothing burns, industrial injuries, electrical injuries, and other sources of thermal energy. Medical care for burns has markedly improved survival. In 1940, 50% of patients with burns involving 30% or more of their total body surface area (TBSA) died. In contrast, a recent study reported no deaths for children with burns to 40% to 59% TBSA treated between 1991 and 1997. In fact, the death rate was only 14.3% for very large burns involving 60% or more TBSA.4 Another study from the same burn center reported a 3% mortality for individuals under 60 years of age admitted without smoke inhalation.3
This increased survival has come at a price, however, and that …