The unique clinical and laboratory derangements associated with burn injury have prompted the American Burn Association (ABA) to advise against the routine use of systemic inflammatory response syndrome criteria in evaluation of the burn patient.

In addition, a recent study found that elevated temperature, changes in WBC count and neutrophil percentage are not predictive of bacteremia in burn patients ( 36). These changes render the definition of systemic inflammatory response syndrome far too inclusive to be useful for predicting the presence of infection or impending sepsis in burn patients ( 21). The alterations in metabolism and physiology that accompany burn injury result in increased temperature, heart rate, respiratory rate and blood pressure. Although the precept of systemic inflammatory response syndrome has been widely accepted and applied by the critical care community, it is of limited utility in the burn population because the majority of these patients easily meet systemic inflammatory response syndrome criteria on a daily basis. The presence of systemic inflammatory response syndrome is defined by the finding of two or more markers of inflammation which include 1) temperature above 38☌ or below 36☌, 2) heart rate > 90 bpm, 3) respiratory rate > 20 min or PaCO2 > 32 mmHG and 4) WBC count of >12,000/mm3, or 10% bands. The concept of a systemic inflammatory response syndrome (SIRS) was devised as a way to identify patients with a pro-inflammatory state due to infectious or non-infectious causes ( 8). Historically, fever has been considered a reliable marker of infection though it may occur as a result of inflammatory states induced by a variety of infectious and non-infectious insults. Despite this, the presence of infection can be difficult to diagnose as many of the typical signs of infection, such as fever and tachycardia, overlap with those of the pro-inflammatory state common to all burn injuries. Following adequate control of the initial burn related shock, infection emerges as the most common cause of death in these patients. Fortunately, advances in burn shock resuscitation have led to a marked reduction in mortality within the first 48 hours after injury. Multiple organ failure syndrome typically occurs as a result of inadequate fluid resuscitation ( 26). The most frequent complication in the first 24-48 hours post-burn is multiple organ failure syndrome. The remainder later succumb to complications of burn injury. Nearly 75% of these deaths occur before the victim reaches medical care. It is estimated that 4,000 people die in the U.S. Over 60% of those hospitalized require care in a specialized burn center. Approximately 40,000 of those injured require hospitalization. The vast majority of these injuries (88%) are a result of residential fires. According to the American Burn Association (ABA), there are 500,000 burn injuries that require medical attention in the US every year ( 3).

Infected 2nd degree burn