Treatment of white phosphorus and other chemical burn injuries at one burn center over a 51-year period.

UNLABELLED: Chemical burn injury meets the criteria of the American Burn Association for treatment at a specialized burn facility. Over a 51-year period, we have treated 276 patients with chemical burn injury including 146 white phosphorus injuries. In this study, we compare incidence, cause and outcome of chemical burn injury over time and review the management of white phosphorus injuries.

METHODS: Data for the period 1986-2000 was obtained by retrospective chart review. Data for the period 1950-1985 was obtained from previous studies and from retrospective chart review.

RESULTS: Chemical burn injury comprised 2.1% of all admissions between 1969 and 1985, and 2.07% between 1986 and 2000. The mean body surface area involved was 19.5% in the first 19 years of the study compared with 8.6% over the last 15 years. Mortality increased from 5.4% between 1950 and 1968 to 13.8% between 1969 and 1985. Mortality from 1986 to 2000 was 0%. Hospital length of stay decreased from a mean of 90 days in the first 19 years of the study to a mean of 15 days in the most recent 15-year period. The chemical responsible for injury was white phosphorus in 146 cases.

CONCLUSIONS: Over time, the proportion of burn center admissions caused by chemical injury is constant, while the average total burn size, full thickness burn size, length of stay and mortality have decreased. During peacetime, the chemicals responsible are similar to those seen in civilian burn centers. The experience of this center with burns caused by white phosphorus is unique and needs to be maintained for future conflicts.