Thermomechanical Combination Injuries: A Rare But Life-Threatening Entity

Abstract

Thermomechanical combination injuries (TMCIs) are feared for their demanding preclinical and clinical management and bear the risk of high mortality compared to the single injury of a severe burn or multiple trauma. There remains a significant lack of standardized algorithms for diagnostics and therapy of this rare entity. The objective of the present study was to profile TMCI aiming at standardized procedures. In this study, TMCIs were extracted from our burn database of a level 1 burn and trauma center. From 2004 to 2017, all patients with TMCI were retrospectively analyzed. Further inclusion criteria were multiple trauma accompanied by burn with ≥10% TBSA. Patient and injury characteristics including injury severity score and outcome parameter were analyzed. A total of 45 patients matched the selective inclusion criteria of TMCI, comprising 4% of all burn injuries during the period. The average age was 38 years (range: 14-86), with a mean TBSA of 43% (range: 10-97%). The mean recorded temperature at admission was 34.8°C (range: 29.6-37.1) with 2215 ml volume of resuscitation fluids (range: 500-8000) administered preclinically in total. The mean injury severity score was 16. The overall mortality rate was 22%. TMCIs are rare and life-threatening events that require highly qualified management in combined level 1 trauma and burn centers to address both burn and trauma treatment. The multiple injury pattern is diverse, complicating standardized management in view of burn care-specific measures, as normothermia and restrictive volume management. The present study reveals further profiles and underlines the need for addressing TMCIs in ABLS®, ATLS®, and PHTLS® programs.