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Bagheri M, Fuchs PC, Lefering R, Daniels M, Schulz A, The German Burn Registry, Schiefer JL. The BUrn Mortality Prediction (BUMP) Score - An improved mortality prediction score based on data of the German burn registry. Burns 2023; 49:110-119. [PMID: 35210139 DOI: 10.1016/j.burns.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Burn injuries constitute the fourth most common injuries globally. Patient outcomes must be currently assessed to provide appropriate patient care with high quality standards. However, existing mortality prediction scoring methods have been shown to lack accuracy in current burn patient populations. Therefore, this study aimed to validate existing scores using current patient data and assess whether new prediction parameters can provide better accuracy. METHODS A retrospective analysis of the patient data from the German Burn Registry between 2016 and 2019 was performed to evaluate all Abbreviated Burn Severity Index (ABSI) score parameters. All patients over 16 years of age who received intensive care were included. Descriptive statistics and logistic regression analysis were used to identify novel prediction parameters based on the parameters documented at admission and establish a new prediction score, the BUrn Mortality Prediction (BUMP) score. The quality of the new score was subsequently compared to that of the original ABSI, modified ABSI, Galeiras, Revised Baux score and TIMM. The new prediction score was then validated using patient data collected in the German Burn Registry in 2020. RESULTS In total, 7276 patients were included. Age; the presence of at least two comorbidities; burn injuries caused by work-related accidents, traffic accidents and suicide attempts; total burn surface area; inhalation trauma and full-thickness burns were identified as independent significant predictors of mortality (p < 0.001). Additionally, we evaluated new age groups to improve prediction accuracy. The number of comorbidities (p < 0.001) and the aetiology (burns occurring at work [p = 0.028], burns caused by traffic accidents [p < 0.001] or burns due to attempted suicide [p < 0.001]) had a significant influence on mortality. The BUMP score, which was developed based on these parameters, showed the best fitness and showed more accurate mortality prediction than all the above-mentioned scores (area under the receiver operating characteristic curve: 0.947 [0.939-0.954] compared to 0.926 [0.915-0.936], 0.928 [0.918-0.939], 0.937 [0.928-0.947], 0.939 [0.930-0.948], 0.940 [0.932-0.949] respectively). CONCLUSIONS A novel score (BUMP score) was developed for the purpose of external quality assessment of burn centres participating in the German burn registry, where observed and expected outcomes are compared on a hospital level, and for scientifically applications. The clinical impact of this score and its generalisability to other patient populations needs to be evaluated.
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Affiliation(s)
- M Bagheri
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - P C Fuchs
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Cologne, Germany
| | - M Daniels
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - A Schulz
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - The German Burn Registry
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - J L Schiefer
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany.
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Wang C, Dou Z, Qin F, Chen H, Shen Y, Zhang GA. Epidemiology and risk prediction of patients with severe burns admitted to a burn intensive care unit in a burn center in beijing: A 5-year retrospective study. Heliyon 2022; 8:e12572. [PMID: 36619436 PMCID: PMC9813702 DOI: 10.1016/j.heliyon.2022.e12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 12/26/2022] Open
Abstract
Objective This study was performed to describe the epidemiology of patients with severe burns hospitalized in a burn intensive care unit (BICU), explore the risk factors associated with the patients' outcomes and evaluate the ability of prognostic scoring systems as risk prediction of mortality. Methods The data for this study were derived from patients with severe burns in the BICU of Beijing Jishuitan Hospital from 2015 to 2019. The following epidemiological information and outcomes were collected for retrospective analysis: sex, age, date of injury, etiology of burn, admission time after injury, extent of burn, inhalation injury, length of stay, and outcome. Abbreviated Burn Severity Index (ABSI), prognostic burn index (PBI), the burn index (BI), Belgian Outcome in Burn Injury (BOBI) scores and the revised Baux (rBaux) scores were calculated. Results Of the 243 patients included in this study, the median age was 41.00 (22.00) years and the male: female ratio was 4.28:1.00. Most of the burns had occurred from March to July. Flame was the main cause of the burns (77.37%), followed by electricity (14.40%). In total, 78.19% of all patients sustained third-degree burns, and the median burn area and third-degree burn area of patients were 40% (53%) and 15.0% (43.0%) of the total body surface area, respectively. The incidence of inhalation injury was 69.14%. Tracheotomy was performed in 53.89% of the patients with inhalation injuries, and the rate of tracheostomy showing a rising trend. The median length of stay was 37 (40) days, and the case fatality rate was 8.64%. Multivariable logistic regression model indicated that age and third-degree burn area were risk factors for death, and the area under the receiver operating characteristic curve for the full prediction model was 0.921 (95% CI = 0.874-0.967). Conclusions The majority of severe burns are flame-related accidents in middle-aged men. Risk prediction model combining age and third-degree burn area has better mortality predictive value.
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Affiliation(s)
- Cheng Wang
- Department of Burns, Beijing Jishuitan Hospital, 100035 PR China,Corresponding author.
| | - Zhe Dou
- Peking University Fourth School of Clinical Medicine, 100035 PR China
| | - Fengjun Qin
- Department of Burns, Beijing Jishuitan Hospital, 100035 PR China
| | - Hui Chen
- Department of Burns, Beijing Jishuitan Hospital, 100035 PR China
| | - Yuming Shen
- Department of Burns, Beijing Jishuitan Hospital, 100035 PR China
| | - Guo-An Zhang
- Department of Burns, Beijing Jishuitan Hospital, 100035 PR China
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Accuracy of SCORTEN in predicting mortality in toxic epidermal necrolysis. BMC Med Inform Decis Mak 2022; 22:273. [PMID: 36261833 PMCID: PMC9583545 DOI: 10.1186/s12911-022-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Toxic epidermal necrolysis (TEN) patients require multi-directional and multi-disciplinary treatment. In most cases, they are hospitalised at intensive care units and require multi-directional, burn-complication preventive care. Choosing the most appropriate treatment option might be troublesome even when predicting scores are used. SCORTEN is the most renowned prognostic score for TEN patients, however, there are some data indicating that the accuracy of this test may be limited. The credibility of not just the predicted mortality risk, but also componential laboratory results and clinical features subject to debate. The aim of this study was to evaluate the efficacy and credibility of SCORTEN in clinical practice, on proprietary material. METHODS A retrospective analysis of 35 patients with diagnosed in histopathology TEN was performed. The inclusion criteria were as follows: day of submission before 5th day from the onset of the symptoms, full protocol of plasmaphereses and IVIGs according to our scheme. Our protocol includes cycle of plasmapheresis with frozen fresh plasma twice daily for the first 2 days following admission, and once daily for the subsequent 5 to 7 days. IVIGs were administered after the first two sessions of plasmapheresis, for 4 to 7 days. The dosage was calculated according to body weight, at 0.4 to 0.5 g/kg per dose. RESULTS The sensitivity of SCORTEN for the analysed cohort was 100%, with a specificity of 24%. The estimated death was 41,9%, while the actual death rates were 12,5%. Our protocol improved the survival, OR = 26,57, RR = 6,34, p = 0,022. Decrease in mortality was caused by a combined treatment protocol we use- plasmaphereses with IVIGs. No independent risk factor was significant in death evaluation. CONCLUSION Our data suggest that the scoring system for predicting death among TEN patients are reliable when they are high. New prognostic factors should be found to improve the evaluation of patients with low SCORTEN.
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Choi KJ, Pham CH, Collier ZJ, Mert M, Ota RK, Li R, Yenikomshian HA, Singh M, Gillenwater TJ, Kuza CM. The Predictive Capacity of American Society of Anesthesiologists Physical Status (ASA PS) Score in Burn Patients. J Burn Care Res 2021; 41:803-808. [PMID: 32285103 DOI: 10.1093/jbcr/iraa060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Advances in burn care continues to improve survival rates and patient outcomes. There are several burn prognostic tools used to predict mortality and outcomes; however, none include patient comorbidities. We used the American Society of Anesthesiologists physical status score as a surrogate measure for comorbidities, and evaluated its role in predicting mortality and outcomes in adult burn patients undergoing surgery. A retrospective analysis was performed on data collected from a single burn center in the United States, which was comprised of 183 patients. We evaluated the American Society of Anesthesiologists physical status score as an independent predictor of mortality and outcomes, including intensive care unit (ICU) length of stay (LOS), hospital LOS, mechanical ventilator (MV) days, and complications. We compared the American Society of Anesthesiologists physical status score to other prognostic models which included the revised Baux score, Belgian Outcome in Burn Injury, and the Abbreviated Burn Severity Index. Our results demonstrated that the revised Baux and American Society of Anesthesiologists physical status scores could be used to determine the mortality risk in adult burn patients. The revised Baux was the best predictor of mortality, ICU LOS, and MV days, while the Abbreviated Burn Severity Index was the best predictor of total LOS.
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Affiliation(s)
- Katherine J Choi
- Division of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles.,Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles.,Keck School of Medicine, University of Southern California, Los Angeles
| | - Christopher H Pham
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Zachary J Collier
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Melissa Mert
- Southern California Clinical and Translational Science Institute, Los Angeles
| | - Ryan K Ota
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Ruibei Li
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Mandeep Singh
- Division of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Catherine M Kuza
- Division of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles
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Sharma S, Tandon R. Predicting Burn Mortality Using a Simple Novel Prediction Model. Indian J Plast Surg 2021; 54:46-52. [PMID: 33814741 PMCID: PMC8012794 DOI: 10.1055/s-0040-1721867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background
Prediction of outcome for burn patients allows appropriate allocation of resources and prognostication. There is a paucity of simple to use burn-specific mortality prediction models which consider both endogenous and exogenous factors. Our objective was to create such a model.
Methods
A prospective observational study was performed on consecutive eligible consenting burns patients. Demographic data, total burn surface area (TBSA), results of complete blood count, kidney function test, and arterial blood gas analysis were collected. The quantitative variables were compared using the unpaired student
t
-test/nonparametric Mann Whitney U-test. Qualitative variables were compared using the ⊠2-test/Fischer exact test. Binary logistic regression analysis was done and a logit score was derived and simplified. The discrimination of these models was tested using the receiver operating characteristic curve; calibration was checked using the Hosmer—Lemeshow goodness of fit statistic, and the probability of death calculated. Validation was done using the bootstrapping technique in 5,000 samples. A
p
-value of <0.05 was considered significant.
Results
On univariate analysis TBSA (
p
<0.001) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (
p
= 0.004) were found to be independent predictors of mortality. TBSA (odds ratio [OR] 1.094, 95% confidence interval [CI] 1.037–1.155,
p
= 0.001) and APACHE II (OR 1.166, 95% CI 1.034–1.313,
p
= 0.012) retained significance on binary logistic regression analysis. The prediction model devised performed well (area under the receiver operating characteristic 0.778, 95% CI 0.681–0.875).
Conclusion
The prediction of mortality can be done accurately at the bedside using TBSA and APACHE II score.
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Affiliation(s)
- Sneha Sharma
- Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Raman Tandon
- Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Yoshimura Y, Saitoh D, Yamada K, Nakamura T, Terayama T, Ikeuchi H, Sasaki J, Nemoto M. Comparison of prognostic models for burn patients: A retrospective nationwide registry study. Burns 2020; 46:1746-1755. [PMID: 33148486 DOI: 10.1016/j.burns.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognostic burn index (PBI) is a unique model utilized to predict mortality of burn patients in Japan. In contrast, other prediction models are rarely used in Japan, and their accuracy and predictive value are unknown. The present study aimed to compare commonly used burn prediction models and determine the appropriate model for mortality prediction in Japanese burn patients. METHODS Japanese burn patients registered in the nationwide burn registry of Japanese Society for Burn Injury between April 1, 2011 and March 31, 2019 were reviewed retrospectively. The prognostic performance of PBI was compared with Baux score, revised Baux score, abbreviated burn severity index (ABSI), Ryan score and Belgian outcome in burn injury score (BOBI). The primary outcome was in-hospital mortality. RESULTS The study included 7911 acute burn patients. The overall mortality rate was 10.7%, the median age was 52 (interquartile range, 26-72) years, and the median % total body surface area was 7% (interquartile range, 3%-17%). The areas under the receiver operating characteristic curve for PBI, Baux score, ABSI, revised Baux score, Ryan score, and BOBI were 0.940 (95% confidence interval [CI]: 0.931-0.948), 0.943 (95% CI: 0.934-0.951; p=0.002), 0.945 (95% CI: 0.937-0.953; p=0.058), 0.946 (95% CI: 0.937-0.953; p=0.002), 0.859 (95% CI: 0.846-0.870; p<0.001), and 0.896 (95% CI: 0.885-0.905; p<0.001), respectively. CONCLUSION Although the performance of PBI was good, it was not superior to the Baux score, revised Baux score, and ABSI. These three scores have a high prognostic accuracy. Hence, they are considered as alternative burn prognostic scores in Japan. The Baux score was an optimal prognostic model for patients with burns in Japan.
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Affiliation(s)
- Yuya Yoshimura
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Daizoh Saitoh
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Takahiro Nakamura
- Department of Mathematics, National Defense Medical College, Saitama, Japan
| | - Takero Terayama
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Hisashi Ikeuchi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Manabu Nemoto
- Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan
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Shalaby SA, Fouad Y, Azab SMS, Nabil DM, Abd El-Aziz YA. Predictors of mortality in cases of thermal burns admitted to Burn Unit, Ain Shams University Hospitals, Cairo. J Forensic Leg Med 2019; 67:19-23. [PMID: 31376649 DOI: 10.1016/j.jflm.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/02/2019] [Accepted: 07/28/2019] [Indexed: 11/28/2022]
Abstract
In cases of death due to burn injury, it may be of great medico-legal importance to determine if the death is caused by fatal burn injury or due to other factors related to treatment. Therefore, this study aimed to investigate early predictors of mortality in patients with thermal burns admitted to Burn Unit, Ain Shams University Hospitals during a period of one year (2011). The study included 152 cases, mortalities represented 20.4% of the included cases (31 cases). Binary logistic regression analysis showed that, total body surface area (TBSA) of the burns and APACHE III score were significant predictors of mortality. This model resulted in accurate classification of 95.9% of the cases. Further multi-centric studies on larger sample sizes are recommended to validate the results of this study. Also, it is important to study the effect of co-morbidities as confounding factors on the prediction of mortality in patients with thermal burns.
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Affiliation(s)
- Sawsan A Shalaby
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yasser Fouad
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sonya M S Azab
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Dalia M Nabil
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yasser A Abd El-Aziz
- Plastic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kuo G, Lee CC, Yang SY, Hsiao YC, Chuang SS, Chang SW, Tu KH, Fan PC, Tian YC, Chen YC, Chang CH. Hyperphosphatemia is associated with high mortality in severe burns. PLoS One 2018; 13:e0190978. [PMID: 29315336 PMCID: PMC5760089 DOI: 10.1371/journal.pone.0190978] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/23/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction Phosphate level is often deranged during acute illness, regardless of the presence of kidney injury or not. A few studies described that hypophosphatemia may associated with outcome in patients admitted to the burn unit, but the literatures for hyperphosphatemia is limited. Our study aims to evaluate if hyperphosphatemia, one of the sign of severe tissue damage or kidney injury, will associate with mortality of patients with severe burns. Materials and methods The study was a post hoc analysis of prospectively collected data from patients admitted to the burn unit between September 2006 and December 2011. Patients were stratified into normophosphatemic or hyperphosphatemic group by baseline plasma phosphate level. The primary endpoint is 90-day mortality. Results Total 301 patients were included (hyperphosphatemia: n = 52; normophosphatemia: n = 249). The hyperphosphatemic group had lower Glasgow Coma Scale, mean arterial blood pressure, hemoglobin level, albumin, and higher TBSA of burns, APACHE II score, ABSI score, Acute kidney injury (AKI), and creatinine. The 90-day mortality was higher in the hyperphosphatemic group than in the normal group (53.8% vs 18.1%, P < .001) and this difference was still significant when adjusting for several confounding factors (hazard ratio, 2.05; 95% CI, 1.17–3.59). Multivariable Cox analysis showed risk factors of mortality included TBSA of burns, hyperphosphatemia, reduced urine output, and APACHE II score. Conclusions Our study found in addition to TBSA of burns and inhalation injury, baseline hyperphosphatemia in patients with severe burns is also associated with higher mortality.
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Affiliation(s)
- George Kuo
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Shih-Yi Yang
- Linkou Burn Center, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yen-Chang Hsiao
- Linkou Burn Center, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shiow-Shuh Chuang
- Linkou Burn Center, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail: ,
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Kuo G, Yang SY, Chuang SS, Fan PC, Chang CH, Hsiao YC, Chen YC. Using acute kidney injury severity and scoring systems to predict outcome in patients with burn injury. J Formos Med Assoc 2016; 115:1046-1052. [PMID: 27923537 DOI: 10.1016/j.jfma.2016.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/16/2016] [Accepted: 10/28/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE Acute kidney injury (AKI) is a frequent complication of severe burn injury and is associated with mortality. The definition of AKI was modified by the Kidney Disease Improving Global Outcomes Group in 2012. So far, no study has compared the outcome accuracy of the new AKI staging guidelines with that of the complex score system. Hence, we compared the accuracy of these approaches in predicting mortality. METHODS This was a post hoc analysis of prospectively collected data from an intensive care burn unit in a tertiary care university hospital. Patients admitted to this unit from July 2004 to December 2006 were enrolled. Demographic, clinical, and laboratory data and prognostic risk scores were used as predictors of mortality. RESULTS A total of 145 adult patients with a mean age of 41.9 years were studied. Thirty-five patients (24.1%) died during the hospital course. Among the prognostic risk models, the Acute Physiology and Chronic Health Evaluation III system exhibited the strongest discriminative power and the AKI staging system also predicted mortality well (areas under the receiver operating characteristic curve: 0.889 vs. 0.835). Multivariate logistic regression analysis identified total burn surface area, ventilator use, AKI, and toxic epidermal necrolysis as independent risk factors for mortality. CONCLUSION Our results revealed that AKI stage has considerable discriminative power for predicting mortality. Compared with other prognostic models, AKI stage is easier to use to assess outcome in patients with severe burn injury.
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Affiliation(s)
- George Kuo
- Department of Nephrology, Kidney Research Center, Taoyuan City, Taiwan
| | - Shih-Yi Yang
- Department of Plastic Surgery, Linkou Burn Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shiow-Shuh Chuang
- Department of Plastic Surgery, Linkou Burn Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Pei-Chun Fan
- Department of Nephrology, Kidney Research Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic Surgery, Linkou Burn Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yung-Chang Chen
- Department of Nephrology, Kidney Research Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Queiroz LFT, Anami EHT, Zampar EF, Tanita MT, Cardoso LTQ, Grion CMC. Epidemiology and outcome analysis of burn patients admitted to an Intensive Care Unit in a University Hospital. Burns 2016; 42:655-62. [PMID: 26762620 DOI: 10.1016/j.burns.2015.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/01/2015] [Accepted: 08/06/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the epidemiologic aspects of burn victims who were hospitalized in the Intensive Care Unit (ICU) at the Burn Center in the University Hospital of the State University of Londrina (UEL). METHODS A longitudinal retrospective study was conducted, involving patients admitted to the Intensive Care Unit of the Burn Center from January 2010 to December 2012. Demographic and diagnostic data including the diagnosis of the extent and causes of the burns, complications resulting from the burns and the need for specific surgical interventions were collected, together with data for the calculation of the Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Therapeutic Intervention Scoring System (TISS-28) and Abbreviated Burn Severity Index (ABSI). Data were collected at admission and daily until discharge from the burn Intensive Care Unit. Risk factors for death and the prognostic performance of scores to predict mortality were analyzed. The level of significance was set at 5%. RESULTS Two hundred ninety-three patients were analyzed in the study; 68.30% were men, with a median age of 38 years (interquartile range: 28-52). The mean total body surface area burned was 26.60±18.05%. Home incidents were the most frequent cause, occurring in 53.90% of the cases. Fire was the most common cause, found in 77.10% of patients. Liquid alcohol was the most common agent and was associated with 51.50% of the cases. The ABSI presented a median of 7, and the area under the ROC curve was 0.890. In multivariate analysis, age (p<0.001), female gender (p=0.02), total body surface area burned (p<0.001), mechanical ventilation (p<0.001) and acute renal failure (p<0.001) were all associated with mortality. ICU mortality was 32.80%, and hospital mortality was 34.10%. CONCLUSION Burns most often occurred in young adult men in our study. The most common cause was a direct flame. Liquid alcohol was the most frequent accelerating agent. Patients were considered to be severely burned. Most of the samples had a high mean total body surface area burned. The ABSI score showed the best performance in discriminating non-survivors. Hospital mortality rate was high.
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Affiliation(s)
- Luiz Fernando Tibery Queiroz
- Londrina State University, Hospital Universitário - Universidade Estadual de Londrina, Rua Robert Koch 60, Vila Operária, Londrina, Paraná 86038-440, Brazil
| | - Elza H T Anami
- Londrina State University, Hospital Universitário - Universidade Estadual de Londrina, Rua Robert Koch 60, Vila Operária, Londrina, Paraná 86038-440, Brazil
| | - Elisangela F Zampar
- Londrina State University, Hospital Universitário - Universidade Estadual de Londrina, Rua Robert Koch 60, Vila Operária, Londrina, Paraná 86038-440, Brazil
| | - Marcos T Tanita
- Londrina State University, Hospital Universitário - Universidade Estadual de Londrina, Rua Robert Koch 60, Vila Operária, Londrina, Paraná 86038-440, Brazil
| | - Lucienne T Q Cardoso
- Department of Internal Medicine, Londrina State University, Hospital Universitário - Universidade Estadual de Londrina, Rua Robert Koch 60, Vila Operária, Londrina, Paraná 86038-440, Brazil
| | - Cintia Magalhaes C Grion
- Department of Internal Medicine, Londrina State University, Hospital Universitário - Universidade Estadual de Londrina, Rua Robert Koch 60, Vila Operária, Londrina, Paraná 86038-440, Brazil.
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Steinvall I, Elmasry M, Fredrikson M, Sjoberg F. Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: An exploratory review. Burns 2015; 42:28-40. [PMID: 26700877 DOI: 10.1016/j.burns.2015.10.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/27/2022]
Abstract
Standardised Mortality Ratio (SMR) based on generic mortality predicting models is an established quality indicator in critical care. Burn-specific mortality models are preferred for the comparison among patients with burns as their predictive value is better. The aim was to assess whether the sum of age (years) and percentage total body surface area burned (which constitutes the Baux score) is acceptable in comparison to other more complex models, and to find out if data collected from a separate burn centre are sufficient for SMR based quality assessment. The predictive value of nine burn-specific models was tested by comparing values from the area under the receiver-operating characteristic curve (AUC) and a non-inferiority analysis using 1% as the limit (delta). SMR was analysed by comparing data from seven reference sources, including the North American National Burn Repository (NBR), with the observed mortality (years 1993-2012, n=1613, 80 deaths). The AUC values ranged between 0.934 and 0.976. The AUC 0.970 (95% CI 0.96-0.98) for the Baux score was non-inferior to the other models. SMR was 0.52 (95% CI 0.28-0.88) for the most recent five-year period compared with NBR based data. The analysis suggests that SMR based on the Baux score is eligible as an indicator of quality for setting standards of mortality in burn care. More advanced modelling only marginally improves the predictive value. The SMR can detect mortality differences in data from a single centre.
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Affiliation(s)
- Ingrid Steinvall
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Moustafa Elmasry
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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12
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Alonso IJ, Maestro OC, Gómez NF, Mateos RS, Quinto AM, Molero FC, Municio AM, Pulido JC, Segurola CL, Romero CJ. Mind the model for end-stage liver disease: model for end-stage liver disease score as an indicator of hemoderivate transfusion and survival in liver transplantation. Transplant Proc 2015; 47:97-9. [PMID: 25645781 DOI: 10.1016/j.transproceed.2014.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The scarcity of liver donors has increased the necessity to closely select recipients to improve liver transplantation outcomes. If we were able to recognize those recipients with the best outcomes, then this could result in a better and more accurate selection of our donors. Hemoderivate transfusion is one of the main important factors to analyse. We reviewed the data of all of our liver transplant recipients from May 1998 to December 2013 and selected 888 patients with complete records. We divided these patients into 5 groups to get a better selection. We found differences between these groups with respect to the following: recipient age at the time of transplantation, percentage of patients with hepatocarcinoma, and those with hepatitis C virus (HCV)-related etiology. Also, intensive care unit (ICU) time and the need for retransplantation were distinctive factors with observable differences between our groups. With respect to model for end-stage liver disease (MELD) score, the groups were clearly defined by their mean MELD score, finding significant statistical differences between these groups with respect to this score. We also found a significant relationship between MELD scores and survival in the different groups. This is also the first review in which the MELD score and intraoperative transfusion requirements are well associated with patient and graft survival.
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Affiliation(s)
- I J Alonso
- "12 de Octubre" University Hospital, Madrid, Spain.
| | - O C Maestro
- "12 de Octubre" University Hospital, Madrid, Spain
| | - N F Gómez
- "12 de Octubre" University Hospital, Madrid, Spain
| | - R S Mateos
- "12 de Octubre" University Hospital, Madrid, Spain
| | - A M Quinto
- "12 de Octubre" University Hospital, Madrid, Spain
| | - F C Molero
- "12 de Octubre" University Hospital, Madrid, Spain
| | - A M Municio
- "12 de Octubre" University Hospital, Madrid, Spain
| | - J C Pulido
- "12 de Octubre" University Hospital, Madrid, Spain
| | - C L Segurola
- "12 de Octubre" University Hospital, Madrid, Spain
| | - C J Romero
- "12 de Octubre" University Hospital, Madrid, Spain
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Heng JS, Clancy O, Atkins J, Leon-Villapalos J, Williams AJ, Keays R, Hayes M, Takata M, Jones I, Vizcaychipi MP. Revised Baux Score and updated Charlson comorbidity index are independently associated with mortality in burns intensive care patients. Burns 2015; 41:1420-7. [PMID: 26187055 DOI: 10.1016/j.burns.2015.06.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of the current study was to utilise established scoring systems to analyse the association of (i) burn injury severity, (ii) comorbid status and (iii) associated systemic physiological disturbance with inpatient mortality in patients with severe burn injuries admitted to intensive care. METHODS Case notes of all patients with acute thermal injuries affecting ≥15% total body surface area (TBSA) admitted to the Burns Intensive Care Unit (BICU) at Chelsea and Westminster Hospital during a 10-year period were retrospectively reviewed. Revised Baux Score, Belgian Outcome in Burn Injury (BOBI) Score, Abbreviated Burn Severity Index (ABSI), APACHE II Score, Sequential Organ Failure Assessment (SOFA) Score and Updated Charlson Comorbidity Index (CCI) were computed for each patient and analysed for association with inpatient mortality. RESULTS Ninety mechanically ventilated patients (median age 45.7 years, median % TBSA burned 36.5%) were included. 72 patients had full thickness burns and 35 patients had inhalational injuries. Forty-four patients died in hospital while 46 survived to discharge. In a multivariate logistic regression model, only the Revised Baux Score (p<0.001) and updated CCI (p=0.014) were independently associated with mortality. This gave a ROC curve with area under the curve of 0.920. On multivariate cox regression survival analysis, only the Revised Baux Score (p<0.001) and the updated CCI (p=0.004) were independently associated with shorter time to death. CONCLUSION Our data suggest that the Revised Baux Score and the updated CCI are independently associated with inpatient mortality in patients admitted to intensive care with burn injuries affecting ≥15% TBSA. This emphasises the importance of comorbidities in the prognosis of patients with severe burn injuries.
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Affiliation(s)
- Jacob S Heng
- Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom; Imperial College London Faculty of Medicine, London, United Kingdom
| | - Olivia Clancy
- Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom; Imperial College London Faculty of Medicine, London, United Kingdom
| | - Joanne Atkins
- Plastic Surgery and Burns Service, Chelsea and Westminster Hospital, London, United Kingdom
| | - Jorge Leon-Villapalos
- Plastic Surgery and Burns Service, Chelsea and Westminster Hospital, London, United Kingdom
| | - Andrew J Williams
- Plastic Surgery and Burns Service, Chelsea and Westminster Hospital, London, United Kingdom
| | - Richard Keays
- Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom
| | - Michelle Hayes
- Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom
| | - Masao Takata
- Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom; Imperial College London Faculty of Medicine, London, United Kingdom
| | - Isabel Jones
- Plastic Surgery and Burns Service, Chelsea and Westminster Hospital, London, United Kingdom
| | - Marcela P Vizcaychipi
- Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom; Imperial College London Faculty of Medicine, London, United Kingdom.
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Tagami T, Matsui H, Fushimi K, Yasunaga H. Validation of the prognostic burn index: a nationwide retrospective study. Burns 2015; 41:1169-75. [PMID: 26120088 DOI: 10.1016/j.burns.2015.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The burn index (BI=full thickness total burn surface area [TBSA]+1/2 partial thickness TBSA) and prognostic burn index (PBI=BI+age) are clinically used particularly in Japan. However, few studies evaluated the validation of PBI with large sample size. We retrospectively investigated the relationships between PBI and mortality among burn patients using data from a nationwide database. METHODS Data of all burn patients with burn index ≥1 were extracted from the Japanese Diagnosis Procedure Combination (DPC) inpatient database from 1 July 2010 to 31 March 2013 (17,185 patients in 1044 hospitals). The primary endpoint was all-cause in-hospital mortality. RESULTS Overall in-hospital mortality was 5.9% (1011/17,185). Mortality increased significantly as the PBI increased (Mantel-Haenszel trend test, P<0.001). The area under the receiver operating characteristic curve for PBI was 0.90 (95%CI, 0.90-0.91), and a PBI above a threshold of 85 showed the highest association with in-hospital mortality. Logistic regression analysis showed that PBI≥85 (odds ratio (OR), 14.6; 95%CI, 12.1-17.6), inhalation injury with mechanical ventilation (OR, 13.0; 95%CI, 10.8-15.7), Charlson Comorbidity Index≥2 (OR, 1.8; 95%CI, 1.5-2.3), and male gender (OR, 1.5; 95%CI, 1.3-1.8) were significant independent risk factors for death. CONCLUSIONS Our study suggested that a PBI above a threshold of 85 was significantly associated with mortality. The PBI and mechanical ventilation were the most significant factors predicting in-hospital mortality, after adjustment for inhalation injury, comorbidity, and gender.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 1130033, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo 1138603, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 1130033, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo 1138519, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 1130033, Japan
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Emara S. Prognostic indicators in acute burned patients–a review. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(15)30014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Douglas HE, Ratcliffe A, Sandhu R, Anwar U. Comparison of mortality prediction models in burns ICU patients in Pinderfields Hospital over 3 years. Burns 2014; 41:49-52. [PMID: 24986595 DOI: 10.1016/j.burns.2014.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/10/2014] [Accepted: 05/15/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many different burns mortality prediction models exist; however most agree that important factors that can be weighted include the age of the patient, the total percentage of body surface area burned and the presence or absence of smoke inhalation. METHODS A retrospective review of all burns primarily admitted to Pinderfields Burns ICU under joint care of burns surgeons and intensivists for the past 3 years was completed. Predicted mortality was calculated using the revised Baux score (2010), the Belgian Outcome in Burn Injury score (2009) and the Boston group score by Ryan et al. (1998). Additionally 28 of the 48 patients had APACHE II scores recorded on admission and the predicted and actual mortality of this group were compared. RESULTS The Belgian score had the highest sensitivity and negative predictive value (72%/85%); followed by the Boston score (66%/78%) and then the revised Baux score (53%/70%). APACHE II scores had higher sensitivity (81%) and NPV (92%) than any of the burns scores. DISCUSSION In our group of burns ICU patients the Belgian model was the most sensitive and specific predictor of mortality. In our subgroup of patients with APACHE II data, this score more accurately predicted survival and mortality.
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Affiliation(s)
- Helen E Douglas
- Pinderfields Hospital, Aberford Road, Wakefield WF1 4DG, England, United Kingdom.
| | - Andrew Ratcliffe
- Pinderfields Hospital, Aberford Road, Wakefield WF1 4DG, England, United Kingdom
| | - Rajdeep Sandhu
- Pinderfields Hospital, Aberford Road, Wakefield WF1 4DG, England, United Kingdom
| | - Umair Anwar
- Pinderfields Hospital, Aberford Road, Wakefield WF1 4DG, England, United Kingdom
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The impact of Model for End-Stage Liver Disease-Na in predicting morbidity and mortality following elective colon cancer surgery irrespective of underlying liver disease. Am J Surg 2014; 207:520-6. [DOI: 10.1016/j.amjsurg.2013.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/01/2013] [Accepted: 06/01/2013] [Indexed: 12/28/2022]
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The Burns Evaluation and Mortality Study (BEAMS): predicting deaths in Australian and New Zealand burn patients admitted to intensive care with burns. J Trauma Acute Care Surg 2013; 75:298-303. [PMID: 23887563 DOI: 10.1097/ta.0b013e318295409d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND An understanding of prognosis following burns is important. It alleviates patient and familial stress, provides a framework for better resource use, and facilitates benchmarking of performance between specialist centers. METHODS Data were collected from eight tertiary referral burns centers in Australia and New Zealand. Our aim was to identify factors independently associated with mortality to develop a mortality prediction model, which accurately quantifies the risk of death among adults with burns who require intensive care. RESULTS Between January 2005 and December 2011, 1,715 patients were admitted to intensive care unit with acute thermal burns. The mean (SD) age was 41.1 (18.0) years, and 20.3% (n = 348) were female. Median percentage of total body surface area was 17% (6-35%) and percent full-thickness surface area was 4% (0-20%). Inhalational injury was documented as present in 36.2%. Accidental injury was the most common etiology of burn (70.4%) and most frequently via a flame (68.3%). Overall hospital mortality was 10.9% (n = 187). Independent risk factors for death were age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.06-1.10; p < 0.001), percentage of full-thickness surface area (OR, 1.07; 95% CI 1.06-1.08; p < 0.001), and Acute Physiology and Chronic Health Evaluation II score excluding age (OR, 1.11; 95% CI, 1.07-1.15; p < 0.001) and female sex (OR, 3.35; 95% CI, 1.84-6.11; p = 0.001). There was no association between inhalational injury or deliberate self-harm and death, as well as etiology or type of burn. CONCLUSION A highly discriminatory mortality prediction model was developed using logistic regression. Risk of death following major burns can be predicted from a combination of physiologic and burns specific parameters. Female sex is a highly significant risk factor.
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Hussain A, Choukairi F, Dunn K. Predicting survival in thermal injury: A systematic review of methodology of composite prediction models. Burns 2013; 39:835-50. [DOI: 10.1016/j.burns.2012.12.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 11/13/2012] [Accepted: 12/06/2012] [Indexed: 12/26/2022]
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Abstract
BACKGROUND Chromogranin A (CgA) in plasma (P-CgA), a neuroendocrine marker of sympathetic stress, has been shown to predict mortality in medical intensive care. We hypothesized that the magnitude of CgA release would reflect stress load, and thereby injury severity in burn intensive care patients. METHODS Fifty-one consecutive patients with a burn area exceeding 10% were included. P-CgA was measured twice daily for seven days after injury. The point value at 24h, the mean and maximum values and the AUC at days 1-7, were tested as possible predictors. Injury severity in the form of organ dysfunction was measured as SOFA score at day 7. RESULTS P-CgA could be classified into two types with respect to variability over time. Patients with high variability had more deep injuries and were older than those with low variability. All measures of CgA correlated with SOFA score at day 7, but not with total burn size. Univariate regressions showed that age, burn size and three of four measures of P-CgA predicted organ dysfunction. Multiple regressions showed that age, burn size, and either P-CgA at 24h, the mean value up to day 7, or the maximum value up to day 7, were independent predictors for organ dysfunction. Significant organ dysfunction was best predicted by age, burn area and the CgA point value at 24h with an AUC value of 0.91 in a ROC-analysis. CONCLUSIONS The extent of neuroendocrine activation assessed as P-CgA after a major burn injury is independently related to organ dysfunction.
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Affiliation(s)
- Andreas E Lindahl
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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21
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Medical futility and the burns patient. Burns 2013; 39:851-5. [PMID: 23523220 DOI: 10.1016/j.burns.2013.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/19/2012] [Accepted: 02/06/2013] [Indexed: 11/21/2022]
Abstract
Since its inception in the 1980s 'futility' has been a controversial concept. The history of this concept, its definition and application to burns care are discussed from the perspective of a burn surgeon. Although introduced as an objective (value-free) criterion, futility proves impossible to objectivate and judgements about the value of human life always play a role. The roles of the patient, the doctor, the 'politician' and society at large in futility-decisions are discussed.
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Application of split-thickness dermal grafts in deep partial- and full-thickness burns: a new source of auto-skin grafting. J Burn Care Res 2012; 33:e94-e100. [PMID: 22079912 DOI: 10.1097/bcr.0b013e31823499e9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early tangential excision of nonviable burn tissue, followed by immediate skin grafting with autograft or allograft, has resulted in the improvement of burn patient survival. The aim of this study was to add split-thickness dermal grafts (STDGs) as a new source of auto-skin grafting tool to our reconstructive armamentarium in deep partial- and full-thickness burns and soft tissue defects. The authors successfully applied STDGs along with split-thickness skin grafts as a new source of auto-skin grafting in 11 deep partial- and full-thickness burns over a period of 1 year without any significant donor site morbidity. Dermal graft take was complete in all but one patient. There was no donor site healing problem, and donor site epithelization was completed generally 1 week later than split-thickness skin graft by semi-open technique. Autologous split-thickness skin grafting still remains the standard therapy for burn wound closure but may be in limited availability in severe burns. The authors conclude that STDGs may be a new source of auto-skin grafting tool in extensive deep partial- and full-thickness burns.
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Sheppard NN, Hemington-Gorse S, Shelley OP, Philp B, Dziewulski P. Prognostic scoring systems in burns: a review. Burns 2011; 37:1288-95. [PMID: 21940104 DOI: 10.1016/j.burns.2011.07.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/20/2011] [Accepted: 07/19/2011] [Indexed: 12/16/2022]
Abstract
Survival after burn has steadily improved over the last few decades. Patient mortality is, however, still the primary outcome measure for burn care. Scoring systems aim to use the most predictive premorbid and injury factors to yield an expected likelihood of death for a given patient. Age, burn surface area and inhalational injury remain the mainstays of burn prognostication, but their relative weighting varies between scoring systems. Biochemical markers may hold the key to predicting outcomes in burns. Alternatively, the incorporation of global scales such as those used in the general intensive care unit may have relevance in burn patients. Outcomes other than mortality are increasingly relevant, especially as mortality after burns continues to improve. The evolution of prognostic scoring in burns is reviewed with specific reference to the more widely regarded measures. Alternative approaches to burn prognostication are reviewed along with evidence for the use of outcomes other than mortality. The purpose and utility of prognostic scoring in general is discussed with relevance to its potential uses in audit, research and at the bedside.
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Affiliation(s)
- N N Sheppard
- St. Andrew's Centre for Burns and Reconstructive Surgery, Broomfield, Chelmsford, United Kingdom.
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Moore EC, Pilcher DV, Bailey MJ, Cleland H, McNamee J. A simple tool for mortality prediction in burns patients: APACHE III score and FTSA. Burns 2010; 36:1086-91. [PMID: 20494521 DOI: 10.1016/j.burns.2010.03.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 03/20/2010] [Accepted: 03/26/2010] [Indexed: 11/30/2022]
Abstract
Prediction of outcome for patients with major thermal injury is important to inform clinical decision making, alleviate individual suffering and improve hospital resource allocation. Age and burn size are widely accepted as the two largest contributors of mortality amongst burns patients. The APACHE (Acute Physiology and Chronic Health Evaluation) III-j score, which incorporates patient age, is also useful for mortality prediction, of intensive care populations. Validation for the burns specific cohort is unclear. A retrospective cohort study was performed on patients admitted to the Intensive Care Unit (ICU) via the Victorian Adult Burns Service (VABS), to compare observed mortality with burns specific markers of illness severity and APACHE III-j score. Our primary aim was to develop a mortality prediction tool for the burns population. Between January 1, 2002 and December 31, 2008, 228 patients were admitted to the ICU at The Alfred with acute burns. The mean age was 45.6 years and 81% (n=184) were male. Patients had severe injuries: the average percent TBSA (total body surface area) was 28% (IQR 10-40) and percent FTSA (full thickness surface area) was 18% (IQR 10-25). 86% (n=197) had airway involvement. Overall mortality in the 7-year period was 12% (n=27). Non-survivors were older, had larger and deeper burns, a higher incidence of deliberate self-harm, higher APACHE III-j scores and spent less time in hospital (but similar time in ICU), compared with survivors. Independent risk factors for death were percent FTSA (OR 1.03, 95% CI 1.01-1.05, p=0.01) and APACHE III-j score (OR 1.04, 95% CI 1.02-1.07, p<0.001). Mortality prediction based on both of these variables in combination was more specific than either individual variable alone (AUROC 0.85, 95% CI 0.79-0.92). Likelihood of death for patients with severe thermal injury can be predicted with accuracy from APACHE III-j score and percent FTSA. Prospective validation of our model on different burn populations is necessary.
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Affiliation(s)
- E C Moore
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Rd, Prahran, 3181, Melbourne, Australia.
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Abstract
A cursory evaluation of the Acute Physiology and Chronic Health Evaluation, commonly known as the APACHE scoring system, validates its relevancy as the most widely used method for assessing severity and prognosis in intensive care unit patients. The APACHE system works and the evolution from APACHE I to APACHE IV reveal that each version has its positives and negatives. It would behoove critical care nurses to know differences and how each could be best utilized.
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Galeiras R, Lorente JA, Pértega S, Vallejo A, Tomicic V, de la Cal MA, Pita S, Cerdá E, Esteban A. A model for predicting mortality among critically ill burn victims. Burns 2008; 35:201-9. [PMID: 19019556 DOI: 10.1016/j.burns.2008.07.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 07/07/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a model for predicting mortality among burn victims. METHODS All casualties admitted to our intensive care burn unit (ICBU) with a diagnosis of thermal or inhalation injury were studied. Age, total and full-thickness body surface area (BSA) burned, presence of inhalation injury, gender, mechanism of injury, delay to ICBU admission and mechanical ventilation during the first 72 h were recorded. The 851 participants were randomly divided into derivation (671) and validation (180) sets. From univariate and multivariate logistic regression analyses a mortality predictive equation was derived. RESULTS Mortality was 17.6%. In univariate analysis, all variables were significantly associated with mortality except mechanism of injury and delay to ICBU admission. In multivariate analysis, age, total and full-thickness BSA burned, female gender and early mechanical ventilation were independently associated with mortality. CONCLUSIONS We propose a mortality predictive equation for burned victims. In this model, MV and not inhalation injury is a mortality risk factor.
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Abstract
In the year 2007, approximately 1000 original burn research articles were published in scientific journals using the English language. This article reviews approximately 90 of these which were deemed by the author to be the most important in terms of clinical burn care. Relevant topics include epidemiology, wound characterisation, critical care physiology, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain management, rehabilitation, and burn reconstruction. Each selected article is mentioned briefly with editorial comment.
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Affiliation(s)
- Steven E Wolf
- Department of Surgery, University of Texas Health Science Center, San Antonio and the United States Army Institute of Surgical Research, San Antonio 7703 Floyd Curl, TX 78229-3600, USA.
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Yang YL, Tang GJ, Wu YL, Yien HW, Lee TS, Kou YR. Exacerbation of wood smoke-induced acute lung injury by mechanical ventilation using moderately high tidal volume in mice. Respir Physiol Neurobiol 2007; 160:99-108. [PMID: 17964866 DOI: 10.1016/j.resp.2007.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 09/03/2007] [Accepted: 09/10/2007] [Indexed: 11/27/2022]
Abstract
We investigated the effects of mechanical ventilation with a moderately high tidal volume (VT) on acute lung injury (ALI) induced by wood smoke inhalation in anesthetized mice. Animals received challenges of air, 30 breaths of smoke (30SM) or 60 breaths of smoke (60SM) and were then ventilated with a VT of 10 ml/kg (10VT) or 16 ml/kg (16VT). After 4-h mechanical ventilation, the bronchoalveolar-capillary permeability, pulmonary infiltration of inflammatory cells, total lung injury score and pulmonary expressions of interleukin-1beta and macrophage inflammatory protein-2 mRNA and proteins in the 30SM+16VT and 60SM+16VT groups were greater than those in the 30SM+10VT and 60SM+10VT groups, respectively. Additionally, the wet/dry weight ratio of lung tissues and lung epithelial cell apoptosis in the 60SM+16VT group were greater than those in the 60SM+10VT group. These differences between the 16VT and 10VT groups were not seen in animals with air challenge. Thus, mechanical ventilation with a moderately high VT in mice exacerbates ALI induced by wood smoke inhalation.
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Affiliation(s)
- You-Lan Yang
- Department of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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