Pathologists Assessment of a Hospitalized Burn Victim

An autopsy not only helps determine a cause of death, but also uncovers findings unsuspected clinically. In one study at the University of Washington Burn Center from 1989 to 1994, 18% of 88 patients who were subject to an autopsy had clinical diagnostic errors. Premortem detection of the errors in four of these cases might have changed the clinical outcome (135).

The following items should be covered by the pathologist:

1. Review clinical history. Obtain information from other sources (e.g., police, fire investigator), depending on the circumstances of the death.

2. During external examination, record evidence of medical procedures. This includes fasciotomies/escharotomies (Fig. 27).

3. Document extent and appearance of burns (Fig. 28). Is there a pattern that suggests how the burn was caused? For example, scalding victims in hot tub water tend to have burns in the lower part of their bodies (91). Some of these cases show parts of the body spared injury, because of compression against the sides or bottom of a bathtub (136). Photographic documentation is necessary.

4. Rule out other trauma (137).

Table 1 footnote (Continued)

"Manifest as bleeding from sites of vascular puncture and from mucous membranes, extensive cutaneous ecchymoses, visceral hemorrhage including adrenal glands (130). nAssociated with DIC, septicemia, anticoagulant therapy, direct trauma. Also observed in the earlier post-burn period. Rarely, extensive retroperitoneal hemorrhage (124). (Adapted from ref. 3.)

Fig. 27. Burn victim. Escharotomies.

5. A complete autopsy, including microscopic examination of major organs, is required to address the multifactorial reasons for death (Table 1). Microscopy can include examination of the burns (Fig. 29).

6. Obtain appropriate samples (e.g., blood, lung, abscess tissue) for culture, if necessary, realizing that burn patients hospitalized for extended periods of time likely have had numerous microbiological studies and received various antibiotics.

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