Massive Burns Versus Less Extensive Burns in Children: Clinical Outcomes and Independent Predictors of Mortality

Background/Objectives: Massive burns are associated with substantial morbidity and mortality in children. Data comparing pediatric burns of different severities and identifying mortality predictors remain limited. This study aimed to compare the clinical characteristics and outcomes of children with burns involving 20–49% and ≥50% total body surface area (TBSA) and to identify independent predictors of mortality. Methods: This retrospective cohort study included children with burns involving ≥20% TBSA treated at a national referral pediatric burn center. Patients were categorized as 20–49% TBSA or ≥50% TBSA. Demographic characteristics, burn etiology, inhalation injury, intubation, intensive care requirements, length of hospital stay, pBaux score, and mortality were analyzed. Multivariable logistic regression was used to identify mortality predictors. Results: Among 260 children, 206 had burns involving 20–49% TBSA and 54 had burns involving ≥50% TBSA. Scald burns predominated in the 20–49% TBSA group, whereas flame burns were more frequent in the ≥50% TBSA group. Inhalation injury and intubation were also more common in the ≥50% TBSA group. Mortality was significantly higher in patients with ≥50% TBSA burns (29.6% vs. 3.4%; p < 0.001). Burn extent ≥50% TBSA (OR 14.30) and intubation (OR 15.59) independently predicted mortality. Conclusions: Massive pediatric burns are associated with markedly worse outcomes. Burn extent ≥ 50% TBSA and intubation may help identify children at particularly high risk of mortality.