Dr Lincoln Tracy1, Dr Michelle Gold2, Dr Sandy Braaf1,3, Associate Professor Heather Cleland4
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 2Palliative Care Service, The Alfred, Melbourne, Australia, 3Central Clinical School, Monash University, Melbourne, Australia, 4Victorian Adult Burns Service, The Alfred, Melbourne, Australia
Mortality following burn injury is rare in high-income countries. Compared to other trauma patients, burn patients (even those with non-survivable injuries) may be relatively stable in the initial stages after injury. Complications or patient comorbidities may make it clear later in the clinical trajectory that ongoing treatment is futile. This means that burn care clinicians are required to make decisions regarding the withholding or withdrawal of treatment in patients with non-survivable burn injury. There is yet to be a comprehensive investigation of palliative care practices following burn injury in specialist burn services across Australia and New Zealand.
Data for patients admitted to a specialist burn service between July 2009 and June 2020 were obtained from the Burns Registry of Australia and New Zealand. Patients were grouped according to treatment decision: palliative management, active treatment withdrawn, and active treatment until death. Predictors of treatment initiation and withholding or withdrawing treatment within 24 hours were assessed. Descriptive comparisons between treatment groups were made.
Of the 32,186 patients meeting study inclusion criteria, 327 (1.0%) died prior to discharge. Fifty-six patients were treated initially with palliative intent and 227 patients had active treatment initiated and later withdrawn. Increasing age, and %TBSA burned were associated with reduced odds of having active treatment initiated.
We demonstrate differences in demographic/injury severity characteristics and end-of-life decision-making timing between different treatment pathways pursued for patients who die in-hospital. Predictors of initiating active treatment were identified. Further research into the decision-making process from a clinician’s perspective is required.
Dr Lincoln Tracy is a Research Fellow within the Prehospital, Emergency and Trauma Group at the School of Public Health and Preventive Medicine, Monash University. Working primarily with data from the Burns Registry of Australia and New Zealand, he undertakes research identifying objective and verifiable data on treatment, outcomes, and quality of care to encourage higher standards of burn injury prevention and care.