Introduction

Survival or death following a burn is highly dependent on the age of the victim and the extent of the injury. Other factors play lesser though important roles, and ultimate survival depends on successful management of the patient both initially and through the course of a number of potential complications. As a measure of success, the mortality rate is the most important, the most easily quantified and the only unequivocal outcome parameter. Crude mortality figures, however, are of little value. They must be related to the factors that are known to influence prognosis. It is an examination of these severity factors and the weight which various authorities have assigned to them that occupies this chapter. Simple techniques and systems which enable one to estimate prognosis in the individual case or to compare performance within or between burn units will also be discussed.

Historical aspect

From the early years of the twentieth century it has been recognized that survival of a burn is related to the proportion of body surface burned and the age of the patient. However, a numerical definition of this relationship was not proposed until 1949 when Bull and Squire presented an approximate mortality probability grid, derived by probit analysis based on their experience of 794 burn patients. Bull revised this work in 1954, and again in 1971, including further experience and figures reflecting generally improved survival. Since Bull's first publication a number of workers have identified additional characteristics of burned patients which have significant bearing upon their survival.