Mortality After Burn Injury in Children: A 33-year Population-Based Study

Abstract

OBJECTIVE: To assess the impact of burn injury sustained during childhood on long-term mortality and to quantify any increased risk of death attributable to burn injury. METHODS: A population-based cohort study of children younger than 15 years hospitalized for burn injury in Western Australia (1980–2012) and a matched noninjured comparison group. Deidentified extraction of linked hospital morbidity and death records for the period 1980–2012 were provided by the Western Australian Data Linkage System. An inception cohort (1980–2012) of burn cases younger than 15 years of age when hospitalized for a first burn injury (n = 10 426) and a frequency matched noninjured comparison cohort (n = 40 818) were identified. Survival analysis was conducted by using the Kaplan-Meier method and Cox proportional hazards regression. Mortality rate ratios and attributable risk percent adjusted for sociodemographic and preexisting heath factors were generated. RESULTS: The median follow-up time for the pediatric burn cohort was 18.1 years after discharge. The adjusted all-cause mortality rate ratios for burn injury was 1.6 (95% confidence interval: 1.3–2.0); children with burn injury had a 1.6 times greater rate of mortality than those with no injury. The index burn injury was estimated to account for 38% (attributable risk percent) of all recorded deaths in the burn injury cohort during the study period. CONCLUSIONS: Burn injury sustained by children is associated with an increased risk of long-term all-cause mortality. Estimates of the total mortality burden based on in-hospital deaths alone underestimates the true burden from burn injury.