The impact of burn injuries on life long trajectory

Fiona Wood

Burns Service of Western Australia, Fiona Stanley Hospital and Princess Margaret Hospital, Perth.

From the analysis of linked data of 30 000 patient’s admitted to hospital for burn injury since 1988 in Western Australia, we have gained the understanding that burn injury is a chronic disease with a lifelong impact. When considering the paediatric population having sustained a burn injury there is an associated statistically significant increased mortality from a range of causes including other injuries, malignancy and infection; in the cohort, 96 percent of the children have sustained burn injuries less than 20 % total body surface area (TBSA).  In the adult population we have found a measurable increase in mortality and morbidity reducing life expectancy: in the cohort 84 percent of the patients have burn injuries less than 20%TBSA.

The mechanism underlying the long-term impact has been explored using an animal model of a full thickness burn injury of 4%TBSA. In the model we see reduction in bone density, nerve density in the skin and hypertrophy in the heart. The inflammatory response comparing a burn to an excisional wound demonstrates profound differences which are seen even in burns as small as 4 % TBSA.

We know the scar is abnormal it is architecture, chemistry and phenotype. The question of tolerance of the immune system   tolerance of the scar and the impact on immune surveillance may give insight into the mechanism. Alternatively, is the stress of the burn injury unmaking the diseases of aging?

The potential mechanism of life long impact of burn injury and the therapeutic opportunities will be discussed.

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