Establishing a treatment protocol for concomitant major burn and trauma patients: a tropical Asian hospital’s experience

Dear Editor, Burns and trauma represent two of the most severe injuries that both developing and developed countries face today. Concomitant burn and traumatic injuries are significant in terms of disease burden and cost of treatment due to associated high morbidity and mortality. Existing literature for burn and traumatic injuries encompass injuries derived from terrorism, warfare, natural disasters [1], and accidents. The most significant to date is the large-scale study by Kalson et al. on burn and traumatic injuries in England and Wales [2]. However, literature and outcomes regarding the multidisciplinary management and approach to concomitant burns and trauma in a developed Asian center are limited. The Singapore General Hospital (SGH) Burns Centre is the only adult burn center in Singapore and is the regional referral center in Southeast Asia. Our center receives 93% of all burn patients in Singapore including mass casualties from the region [3]. We conducted a retrospective case-control “trauma/ burns” study of 11 patients with concomitant major burn and traumatic injuries at SGH from 1998 to 2012 obtained from the SGH Burns Registry. Inclusion criteria were trauma with multiple injuries requiring activation of the trauma team (e.g., intracranial injuries, long bone fractures, abdominal injuries, inhalational injuries) and major burns of more than 15% total body surface area (TBSA). Exclusion criteria were patients who were dead on arrival or repatriation cases. We compared this group to a control group of 11 major burn (>15% TBSA) patients without traumatic injuries admitted during the same time period. Controls were randomly matched for TBSA and age. Both groups had similar demographics and burn characteristics for comparison. The median age is 37 and 39 years in the trauma/burns group and the control group, respectively. Majority of the patients are males (90.9% (n = 10) in trauma/burns, 81.8% (n = 9) in control). The median TBSA is 32% for both groups (16–90% and 15–88% for the trauma/burns group and control group, respectively) and of deep dermal depth. Occupational burns (e.g., electric and flash explosions, generator and gas cylinder explosions) is the majority in both study and control groups (73% (n = 8) of patients from both groups). This highlights the importance of workplace safety such as protective equipment, regular preventive maintenance and job-specific hazard analysis implementation. In our study, the severity and high mortality (36.4%) of patients with concomitant burn and traumatic injuries highlights the focus on managing these critically ill patients well. In contrast, the mortality for control group is 9.1% (n = 1) and the international average mortality rate is lower for burn injuries alone (3.1–18%) [4, 5]. Burn intensive care unit (BICU) admission rate was 90.9% (n = 10) in trauma/burn patients (due to their severe injuries) and 45.5% (n = 5) in the control burns only group. Patients in the trauma/burns group mostly belonged to Clavien Dindo Classification terminal grades of 4A (n = 7) and 5 (n = 4) compared to patients in the control group who were mainly grades of 3B (n = 6) and 3Bd (n = 4). * Correspondence: [email protected] Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Level 5, Academia, Singapore 169865, Singapore Full list of author information is available at the end of the article