A retrospective review of two years of intensive care admissions with a primary diagnosis of burns in a quaternary burns centre

Dr Juliette Mewton1, Dr  John  Gowardman1

1Royal Brisbane and Women’s Hospital , Herston , Australia


Introduction. Ninety-one patients were admitted to the Intensive Care Unit during 2015-2017. Admission characteristics, primary treatment, analgesia management and antimicrobial screening, infections and treatment were reviewed.

Methods. A retrospective chart review of ninety-one patients admitted to the Intensive Care Unit with a primary diagnosis of Burns.

Results. Of ninety-one admissions sixty-four were male and twenty-seven female. Median age at presentation was forty-three years (range fifteen- eighty-five). Cause of burn was deliberate self-harm in twenty-six patients (28.5%), accidental causes sixty-four (70%) and one forensic (1.5%). The mechanism of burn was electrocution four patients, accelerant thirty-three, MVA 2, House fire/blast fourteen, camp fire eight, or other causes five patients. Twenty-eight (31%) were direct admissions, fifty-nine transitioned through one facility, four via two centres and four from overseas.
The Total Body Surface Area range was eight-ninety-eight percent. The ICU length of stay was a median twenty-two days (range one – seventy-six days). Ten were palliated within twenty-four hours of admission seventeen patients died during admission (18.68%). On presentation only fifty-three (58%) were normothermic. Fifty-one had a lacticaemia (maximum 10.2 mmol/l). Forty-one had a haemoglobin below eighty or above one hundred and fifty-five grams per litre. Sixty- seven (73.6%) had more fluid resuscitation than their parkland calculation and that was despite forty-one patients having no pre-ICU fluids recorded. Forty required vasopressors and three patients required multiple agents. During their Intensive care stay fifty-seven had positive sputum microscopy, twenty-three positive blood and/or urine and twenty positive donor sites. Twelve had positive MRO screens.

Conclusions. There is still significant clinical variation in management and review of primary resuscitation. Inter-hospital transfer and geography can complicate the primary resuscitation. Early debridement is essential. A review of microbiology and multiple resistant organism screening may reduce costs and streamline care.


Currently working as a Fellow in the Royal Brisbane and Womens Hospital, having had a significant interest in Burns management during my training in the UK as a Surgeon and in Australia as an Intensivist.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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