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Heard J, Cronin L, Romanowski K, Greenhalgh D, Palmieri T, Sen S. Massive Burn Injuries: Characteristics and Outcomes From a Single Institution. J Burn Care Res 2023; 44:925-930. [PMID: 36378582 DOI: 10.1093/jbcr/irac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Massive burn injuries are a unique patient population with unique treatment paradigms. Data from 155 adult patients, admitted from 2009 to 2019, with >50% total body surface area burns (TBSA) were collected and analyzed. Average burn size was 70% TBSA and 63% had a concomitant inhalation injury. Approximately 30% of patients (46/155) transitioned to comfort care-only measures within 24 hours of admission. Standard treatment patients were younger (37 ± 13 vs 60 ± 19 years; p < .00001), male (94% vs 28%; p = .001) and had smaller TBSA (66 ± 13 vs 80 ± 16; p < .00001). Of the standard treatment group, 72 (66%) survived to discharge. Survivors had smaller TBSA (64 ± 13 vs 71 ± 13; p = .003), less third-degree TBSA (48 ± 25 vs 71 ± 13; p = .003) and lower incidence of renal failure requiring dialysis (22% vs 73%, p < .00001). Multivariate regression analysis showed that age (OR 1.05; p = .025), total TBSA (OR 1.07; p = .005), and renal failure (OR 10.2; p = .00005) were independently associated with mortality. Inhalation injury was not significantly associated with mortality. About 23% (35/155) of patients had a psychiatric condition on admission and 19% (30/155) of patients were burned attempting suicide. Patients with psychiatric conditions spent more time in the hospital (62 vs 30 days; p = .004), more time on ventilator (31 vs 12 days; p = .046), underwent more surgery (4 vs 2 operations, p = .03), and were less likely to die (34% vs 59%; p = .02). In summary, age, burn size, and renal failure were independently associated with mortality, with renal failure being the strongest factor. Psychiatric conditions are prevalent pre-injury and tend to require more inpatient care.
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Affiliation(s)
- J Heard
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - Laura Cronin
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - K Romanowski
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - D Greenhalgh
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - T Palmieri
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - S Sen
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
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2
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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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Costescu Strachinaru DI, Gallez JL, François PM, Baekelandt D, Paridaens MS, Pirnay JP, De Vos D, Djebara S, Vanbrabant P, Strachinaru M, Soentjens P. Epidemiology and etiology of blood stream infections in a Belgian burn wound center. Acta Clin Belg 2022; 77:353-359. [PMID: 33432871 DOI: 10.1080/17843286.2021.1872309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infections are a major cause of morbidity in burn patients. We aimed to investigate the epidemiology and antibiotic susceptibility of blood stream infections in order to gain a better understanding of their role and burden in our Burn Wound Center. METHODS This retrospective epidemiological investigation analyzed data derived from medical files of patients admitted to our Burn Wound Center having had at least one positive blood culture between 1 January and 31 December 2018. We focused on the prevalence of causative agents in blood stream infections in function of the time after injury and on their drug sensitivity. RESULTS Among the 363 patients admitted to our Burn Wound Center during the study period, 29 had at least one episode of blood stream infection. Gram-negative organisms accounted for 56,36% of the pathogens in blood stream infections, Gram-positives for 38,17%, and yeasts for 5,45%. Pseudomonas aeruginosa was the most common bacterium (20%), followed by Staphylococcus epidermidis (16.36%), Escherichia coli and Klebsiella pneumoniae (9,09% each). A third of the Gram-negative isolates were multidrug resistant. Gram-positive cocci were isolated from blood cultures at a median of 9 days after the injury, earlier than Gram-negative rods (median 15 days). The main sources of blood stream infections were the burn wounds, followed by infected catheters. CONCLUSIONS Multidrug resistant bacteria must be considered when selecting empirical antibiotic therapy in septic burn patients. In our center, we need to update our antibiotic guidelines, to review the hospital infection control measures and to introduce routine typing technology.
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Affiliation(s)
| | - Jean-Luc Gallez
- Microbiology Laboratory, Queen Astrid Military Hospital, Brussels, Belgium
| | | | | | | | - Jean-Paul Pirnay
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
| | - Daniel De Vos
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Brussels, Belgium
| | - Sarah Djebara
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels, Belgium
| | - Peter Vanbrabant
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels, Belgium
- General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Mihai Strachinaru
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Patrick Soentjens
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Meuli JN, Pantet O, Berger MM, Waselle L, Raffoul W. Massive burns: retrospective analysis of changes in outcomes indicators across 18 years. J Burn Care Res 2021; 43:232-239. [PMID: 33886955 PMCID: PMC8737114 DOI: 10.1093/jbcr/irab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The treatment and management of massive burns, defined as burns affecting≥ 50% of total body surface area (TBSA) has considerably changed since the 90s. This study aimed at analyzing if the length of intensive care unit (ICU) stay, the success of skin grafting operations and the mortality changed in the last 18 years. METHODS Between 2000 and 2018, 77 patients were admitted for massive burns to the ICU of a university hospital. Transfers and early care withdrawal precluded inclusion for 38 patients, leaving 39 for analysis. Study variables were year of admission, demographics, burn characteristics, critical care treatment (fluid resuscitation, ventilation and nutrition) and surgical therapy. Association between outcomes and year of admission were assessed through correlation and logistic regression analysis. Potential confounders were assessed through stepwise linear regression. RESULTS Patients' characteristics were stable over time with a median age of 36[25.0, 48.0] years, burns 65% [55.0, 83.0] TBSA and deep burns 55% [50.0, 68.0] TBSA . Length of ICU stay remained stable at 0.97 [0.6, 1.5] days/%TBSA. Mortality was stable as well. Energy and carbohydrate delivery decreased in parallel with the number of infectious episodes per patient. Number of operations was stable but the take rate of skin grafts increased significantly. The multivariate analysis retained year of admission, weight, total number of infections, daily lipid intakes and fluid resuscitation as independent predicting variables. CONCLUSION Length of ICU stay and mortality did not change over time but skin grafts take rates improved significantly.
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Affiliation(s)
- Joachim N Meuli
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Switzerland
| | - Olivier Pantet
- Department of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Switzerland
| | - Mette M Berger
- Department of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Switzerland
| | - Laurent Waselle
- Cell Production Center, Lausanne University Hospital, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Switzerland
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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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Ellithy M, Mitwally H, Saad M, Mathias R, Shaukat A, Elzeer H, Hassan Koya S, Mahmood Z, Gazwi K. Mortality incidence among critically ill burn patients infected with multidrug-resistant organisms: A retrospective cohort study. Scars Burn Heal 2021; 7:20595131211015133. [PMID: 34104480 PMCID: PMC8155764 DOI: 10.1177/20595131211015133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Many risk factors have been reported to increase mortality among burn patients. Previously, a higher mortality incidence was reported in acute burn patients infected with multidrug-resistant organisms (MDROs) when compared to patients infected with non-MDROs. However, considering this as an independent risk factor for mortality in acute burn patients is not yet confirmed. METHODS We conducted an observational retrospective study in Qatar. We included adult patients admitted to the surgical intensive care unit (ICU) between January 2015 and December 2017 with burn injuries involving either at least 15% of the total body surface area (TBSA) or less than 15% with facial involvement. All patients developed infection with a positive culture of either MDRO or non-MDRO. The primary outcome was in-hospital mortality. Other outcomes included days of mechanical ventilation, ICU, length of stay in hospital, and requirement of vasoactive agents. RESULTS Fifty-eight patients were included in the final analysis: 33 patients in the MDRO group and 25 patients in the non-MDRO group. Six patients (18.2%) died in the MDRO group versus four patients (16%) in the non-MDRO group (P = 1). No significant difference was observed between the two groups with regard to the ICU length of stay. However, there was a trend towards increased median length of stay in hospital in the MDRO group: 62 days versus 45 days in the non-MDRO group (P = 0.057). No significant differences were observed in the other outcomes. CONCLUSION In severely burned patients, infection with MDRO was not associated with increased mortality. There was a trend towards increased hospitalisation in MDRO-infected patients. Further studies with a larger sample size are needed to confirm these results. LAY SUMMARY Many factors affect mortality in burn patients admitted to the intensive care unit, such as age, total body surface area involved in the injury, and others. In this retrospective study, we evaluated whether wound infection with a bacterial organism resistant to multiple classes of antibiotics (multidrug-resistant) is considered an independent risk factor for mortality in critically ill burn patients. We included 58 patients requiring intensive care admission with burn injuries involving 15% or more of the total body surface area or less than 15% but with facial involvement. A total of 33 patients were infected with multidrug-resistant organisms (MDROs) and 25 patients with non-MDROs. Six patients (18.2%) from the MDRO group died versus four (16%) in the non-MDRO group. The MDRO group required a longer stay in hospital and an average of one more day on a mechanical ventilator. We concluded that wound infection with MDROs might not increase mortality when compared to wound infection with non-MDROs, although other studies with a larger number of patients involved need to be conducted to validate these results.
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Affiliation(s)
- Moustafa Ellithy
- Department of Critical Care, Hazm
Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Mitwally
- Department of Pharmacy,
Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Saad
- Department of Pharmacy,
Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ranjan Mathias
- Department of Anesthesiology/Critical
Care, Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Adila Shaukat
- Department of Medicine-Infectious
Diseases, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hani Elzeer
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sunil Hassan Koya
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zia Mahmood
- Department of Anesthesiology/Critical
Care, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Gazwi
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
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Matsuo M, Muramatsu K, Matsuda S, Fushimi K, Kaizuka Y, Kamochi M. Age-dependent influence of premorbid underweight status on mortality in severe burn patients: An administrative database study. Burns 2020; 47:1314-1321. [PMID: 33358396 DOI: 10.1016/j.burns.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the associations between premorbid nutritional status and in-hospital mortality in severe burn patients according to age in Japan. METHODS We retrospectively extracted the data of 14,345 patients aged 18-84 years admitted for burns from April 1, 2014, to March 31, 2018, using the Japanese Diagnosis Procedure Combination database. The exclusion criteria were out-of-hospital cardiac arrest, death in the emergency room, readmission, and planned admission. We collected data on age, sex, height, weight, comorbidities, burn index, and mechanical ventilation use and performed age-stratified multilevel logistic regression analyses to estimate associations between premorbid body mass index (BMI) and in-hospital mortality. RESULTS We analyzed 2968 patients with a burn index ≥10, including 831 elderly aged 75-84 years. In patients aged 18-74 years, being underweight (BMI < 18.5) significantly decreased mortality (0.34 [0.15-0.77]; P = 0.010). In contrast, in patients aged 75-84 years, being underweight significantly increased mortality (2.11 [1.05-4.25]; P = 0.036). Being overweight (BMI >25) increased mortality in both age groups, but not significantly. CONCLUSIONS The results suggest that pre-morbidly underweight elderly patients aged 75-84 years with severe burns have high mortality risks. Further research is needed to identify optimal care strategies for this population.
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Affiliation(s)
- Mizue Matsuo
- Department of Intensive Care Medicine, University Hospital of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556, Japan.
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan.
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; Occupational Health Data Science Center, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Yasuo Kaizuka
- Department of Emergency and ICU, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu, Fukuoka 805-8508, Japan.
| | - Masayuki Kamochi
- Department of Intensive Care Medicine, University Hospital of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556, Japan.
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García-Díaz A, Durán-Romero AJ, PurificaciónGacto-Sánchez, Carbajal-Guerrero J, Gómez-Cía T, Pereyra-Rodríguez JJ. Trends in burn injury mortality in Spain (1979-2018): Sex-specific age-cohort-period effects. Burns 2020; 47:714-720. [PMID: 32878699 DOI: 10.1016/j.burns.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/08/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies about burns mortality are often exclusively based on hospital and burn centre data. National population-based reports on this topic are rather limited. The aim of this study was to analyse sex- and age-specific mortality rates of burns in Spain during the period 1979-2018. METHODS Age-standardised burns mortality rates were calculated from death records and mid-year population data were provided by the Spanish National Statistics Institute. Joinpoint regression analyses were used to identify significant points of change in trends over time and to compute average annual per cent change (AAPC). Age, period and cohort effects were also analysed. RESULTS Mortality due to burn injury decreased in both sexes between 1979 and 2018: from the first quinquennium of this period up to the last one age-adjusted mortality rates decreased from 1.37 to 0.49 per 100,000 in men and from 0.96 to 0.26 per 100,000 in women. CONCLUSIONS Burns mortality rates in Spain have been decreasing during the last decades. Promotion of primary prevention measures should continue.
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Affiliation(s)
- Antonio García-Díaz
- Plastic Surgery Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Tomás Gómez-Cía
- Plastic Surgery Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Modified abbreviated burn severity index as a predictor of in-hospital mortality in patients with inhalation injury: development and validation using independent cohorts. Surg Today 2020; 51:242-249. [PMID: 32691141 DOI: 10.1007/s00595-020-02085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The ability to accurately evaluate the severity of inhalation injury can help to optimize patient care. However, there is no accepted severity grading system, especially for inhalation injury. METHODS We screened a multicenter burn registry and included adult patients who required oxygen treatment or mechanical ventilation. After the patient data were divided into development and validation cohorts, missing values were replaced with multiple imputation. Twelve potential predictors were analyzed using multivariate logistic regression to identify prognostic variables for in-hospital mortality and scores were assigned to each predictor based on odds ratios to develop the Modified Abbreviated Burn Severity Index, mABSI. The mABSI was validated using c-statistics and calibration curves. RESULTS We randomly assigned 1377 and 919 patients to the development and validation cohorts, respectively. Age, self-inflicted injury, cutaneous burn area, and mechanical ventilation requirement were identified as independent predictors, and the mABSI (1-17 scale) was, thus, developed. The mABSI has a high discriminatory power (c-statistic = 0.94; 95% CI 0.92-0.97), and both estimated and observed in-hospital mortalities increased from 1% at score ≤ 5 to almost 100% at score ≥ 14 with linear calibration plots. CONCLUSIONS We developed and validated the mABSI which accurately predicts in-hospital mortality.
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10
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Bayuo J, Bristowe K, Harding R, Agyei FB, Agbeko AE, Agbenorku P, Baffour PK, Allotey G, Hoyte-Williams PE. The Role of Palliative Care in Burns: A Scoping Review. J Pain Symptom Manage 2020; 59:1089-1108. [PMID: 31733355 DOI: 10.1016/j.jpainsymman.2019.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Patients with severe burns may face distressing symptoms with a high risk of mortality as a result of their injury. The role of palliative care in burns management remains unclear. OBJECTIVE To appraise the literature on the role of palliative care in burns management. METHODS We used scoping review with searches in 12 databases from their inception to August 2019. The citation retrieval and retention are reported in a PRISMA statement. FINDINGS 39 papers comprising of 30 primary studies (26 from high-income and four from middle-income countries), four reviews, two editorials, two guidelines, and one expert board review document were retained in the review. Palliative care is used synonymously with comfort and end-of-life care in burns literature. Comfort care is mostly initiated when active treatment is withheld (early deaths) or withdrawn (late deaths), limiting its overall benefits to burn patients, their families, and health care professionals. Futility decisions are usually complex and challenging, particularly for patients in the late death category, and it is unclear if these decisions result in timely commencement of comfort care measures. Three comfort care pathways were identified, but it remained unclear how these pathways evaluated "good death" or supported the family which creates the need for the development of other evidence-based guidelines. CONCLUSION Palliative care is applicable in burns management, but its current role is mostly confined to the end-of-life period, suggesting that it is not been fully integrated in the management process. Evidence-based guidelines are needed to support the integration and delivery of palliative care in the burn patient population.
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Affiliation(s)
- Jonathan Bayuo
- Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College, Agogo, Ghana; School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, Kings College, London, United Kingdom
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, Kings College, London, United Kingdom
| | - Frank Bediako Agyei
- Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College, Agogo, Ghana
| | | | - Pius Agbenorku
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Plastics, Burns and Reconstructive Surgical Division, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Prince Kyei Baffour
- Burns Intensive Care Unit, Plastics and Reconstructive Surgical Unit, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Gabriel Allotey
- Burns Intensive Care Unit, Plastics and Reconstructive Surgical Unit, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Paa Ekow Hoyte-Williams
- Plastics, Burns and Reconstructive Surgical Division, Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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11
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Prevalence and prognostic impact of inhalation injury among burn patients: A systematic review and meta-analysis. J Trauma Acute Care Surg 2020; 88:330-344. [PMID: 31688831 DOI: 10.1097/ta.0000000000002523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of our study was to perform a systematic review and meta-analysis aimed at assessing the prevalence of inhalation injury in burn patients and its prognostic value in relation to in-hospital mortality. METHODS We searched the PubMed and EMBASE databases for noninterventional studies published between 1990 and 2018 investigating in-hospital mortality predictors among burn patients.The primary meta-analysis evaluated the association between inhalation injury and mortality. A secondary meta-analysis determined the global estimate of the prevalence of inhalation injury and the rate of mortality. Random effects models were used, and univariate meta-regressions were used to assess sources of heterogeneity. This study is registered in the PROSPERO database with code CRD42019127356. FINDINGS Fifty-four studies including a total of 408,157 patients were selected for the analysis. A pooled inhalation prevalence of 15.7% (95% confidence interval, 13.4%-18.3%) was calculated.The summarized odds ratio of in-hospital mortality secondary to an inhalation injury was 3.2 (95% confidence interval, 2.5-4.3). A significantly higher odd of mortality was found among the studies that included all hospitalized burn patients, those that included a lower proportion of male patients, those with a lower mean total body surface area, and those with a lower prevalence of inhalation injury. CONCLUSION Despite our study's limitations due to the high risk of bias and the interstudy heterogeneity of some of our analyses, our results revealed a wide range of prevalence rates of inhalation injury and a significant association between this entity and in-hospital mortality in burn patients. However, this association is not significant if adjusted for disease severity. LEVEL OF EVIDENCE Systematic review/meta-analysis, level III.
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Cheng RY, Eylert G, Gariepy JM, He S, Ahmad H, Gao Y, Priore S, Hakimi N, Jeschke MG, Günther A. Handheld instrument for wound-conformal delivery of skin precursor sheets improves healing in full-thickness burns. Biofabrication 2020; 12:025002. [PMID: 32015225 PMCID: PMC7042907 DOI: 10.1088/1758-5090/ab6413] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The current standard of care for patients with severe large-area burns consists of autologous skin grafting or acellular dermal substitutes. While emerging options to accelerate wound healing involve treatment with allogeneic or autologous cells, delivering cells to clinically relevant wound topologies, orientations, and sizes remains a challenge. Here, we report the one-step in situ formation of cell-containing biomaterial sheets using a handheld instrument that accommodates the topography of the wound. In an approach that maintained cell viability and proliferation, we demonstrated conformal delivery to surfaces that were inclined up to 45° with respect to the horizontal. In porcine pre-clinical models of full-thickness burn, we delivered mesenchymal stem/stromal cell-containing fibrin sheets directly to the wound bed, improving re-epithelialization, dermal cell repopulation, and neovascularization, indicating that this device could be introduced in a clinical setting improving dermal and epidermal regeneration.
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Affiliation(s)
- Richard Y. Cheng
- Institute of Biomaterials and Biomedical Engineering, University of Toronto 164 College Street, Toronto, Ontario M5S 3G9, Canada
| | - Gertraud Eylert
- Institute of Medical Science, University of Toronto 1 King’s College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada
| | - Jean-Michel Gariepy
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Sijin He
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Hasan Ahmad
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Yizhou Gao
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Stefania Priore
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Room D704, Toronto, Ontario M4N 3M5, Canada
| | - Navid Hakimi
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
| | - Marc G. Jeschke
- Institute of Medical Science, University of Toronto 1 King’s College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Room D704, Toronto, Ontario M4N 3M5, Canada
- Department of Surgery, Department of Immunology, Division of Plastic Surgery and General Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada
| | - Axel Günther
- Institute of Biomaterials and Biomedical Engineering, University of Toronto 164 College Street, Toronto, Ontario M5S 3G9, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto 5 King’s College Road, Toronto, Ontario M5S3G8, Canada
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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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Cachafeiro Fuciños L, Sánchez Sánchez M, García de Lorenzo Y Mateos A. Mechanical ventilation in critically ill burn patient with inhalation injury: Can we avoid it? Med Intensiva 2019; 44:54-56. [PMID: 30971340 DOI: 10.1016/j.medin.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Affiliation(s)
- L Cachafeiro Fuciños
- Grupo de trabajo Disfunción y fallo orgánico en la agresión, Servicio de Medicina Intensiva, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, España.
| | - M Sánchez Sánchez
- Grupo de trabajo Disfunción y fallo orgánico en la agresión, Servicio de Medicina Intensiva, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, España
| | - A García de Lorenzo Y Mateos
- Grupo de trabajo Disfunción y fallo orgánico en la agresión, Servicio de Medicina Intensiva, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, España
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Cheng W, Shen C, Zhao D, Zhang H, Tu J, Yuan Z, Song G, Liu M, Li D, Shang Y, Qin B. The epidemiology and prognosis of patients with massive burns: A multicenter study of 2483 cases. Burns 2019; 45:705-716. [PMID: 30837206 DOI: 10.1016/j.burns.2018.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/21/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Epidemiological features of massively burned patients in China remains unclear. This study was designed to investigate the epidemiological characteristics and evaluate the burn index (BI) and other risk factors associated with the prognosis of massively burned patients. METHODS Data of patients with ≥30% total body surface area burned admitted in 2014 were retrieved from 106 burn centers in the mainland of China. Information of epidemiological features and the outcome were collected for retrospective analysis. RESULTS A total of 2483 massively burned patients were included in this study, with a male-to-female ratio of 2.29:1, the mean age of 49.23±16.67 years, mean TBSA of 55.53±21.39% and the mean BI of 39.75±21.59. Scald accounted for 81.07% of the injuries in children, while flame accounted for 66.89% and 74.31% of the injuries in adults and seniors. Approximately 17.76% of the patients were admitted to the local burn center after 6h of injury, and the wound areas of 1154 (46.48%) patients were covered with folk remedies. The mortality was 9.79%, and the area under the receiver operating characteristic (ROC) curve for BI was 0.941 (95% CI, 0.929-0.954). When the value of BI was above a threshold of 29 in the 0-14 years age group, 43.5 in the 15-59 years age group and 35.5 in the 60 years or older age group, the mortality increased significantly. Multivariate logistic regression analyses showed that the odds ratio (OR) of death increased 6% with an increase in the BI of 1.0. Patients older than 60 years, the admission time longer than 6h after-injury (adjusted OR, 1.797; 95% CI, 1.179-2.740; adjusted p<0.001), and patients with a combined inhalation injury (adjusted OR, 6.649; 95% CI, 4.517-9.789; adjusted p<0.000), were at higher risk of death. CONCLUSIONS There are etiological characteristics of the different age groups that should be considered for prevention. BI can be a reliable index of prognosis in severely burned patients. The results of the study showed that a large BI, elderly age, delayed admission after injury and combined inhalation injury are the main risk factors for extensively burned patients.
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Affiliation(s)
- Wenfeng Cheng
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chuanan Shen
- Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Dongxu Zhao
- Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongyan Zhang
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiajin Tu
- Department of Burns, Ganzhou Municipal Hospital of Jiangxi Province, Ganzhou, China
| | - Zhiqiang Yuan
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Guodong Song
- Department of Burns, Affiliated Jinan Central Hospital, Shandong University, Jinan, China
| | - Miao Liu
- Department of Epidemiology, Institute of Geriatrics, PLA General Hospital, Beijing, China
| | - Dawei Li
- Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuru Shang
- Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Binyu Qin
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
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Cheung M, Cobb AN, Kuo PC. Predicting burn patient mortality with electronic medical records. Surgery 2018; 164:839-847. [PMID: 30174140 DOI: 10.1016/j.surg.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although there exists robust literature on mortality-associated factors in burn patients, it is not known how electronic medical records affect outcomes. Using burn injury as a surgical care model of information and communication, we hypothesized that functionality and interoperability of the electronic medical record could serve as determinants of outcome. METHODS We used the state inpatient databases for New York, Washington, California, and Florida for the years 2009 and 2010 for all states, with the additional years of 2012 and 2013 for New York (n = 6,002), and the respective data from the American Hospital Association Information Technology survey. Using International Classification of Diseases, Ninth Revision, codes, we included burn patients and characterized total body surface area burned. We summed the binary answers to questions 1 and 2 and question 3 from the American Hospital Association Information Technology survey to make continuous functionality and interoperability scores. Mortality was predicted using extreme gradient boosting in Python. RESULTS In each state in which our models had an accuracy and area under the curve of more than 0.90, electronic medical record functionality but not interoperability was a significant predictor in New York, California, and Florida. Important predictors in each state were, age, duration of stay, total body surface area burned/severity, and total charges. Electronic medical record functionality was more important than all comorbidities except for coagulopathies and electrolyte disorders. Higher functionality scores were associated with mortality (P < .01). CONCLUSION Our data support our hypothesis that electronic medical records may be associated with mortality in burn patients; however, electronic medical records are not having the intended impact on outcomes, and further research needs to elucidate exactly how electronic medical records are being used in clinical settings.
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Affiliation(s)
- Matthew Cheung
- Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, IL
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL
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Pompermaier L, Elmasry M, Abdelrahman I, Fredrikson M, Sjöberg F, Steinvall I. Are there any differences in the provided burn care between men and women? A retrospective study. BURNS & TRAUMA 2018; 6:22. [PMID: 30123802 PMCID: PMC6088398 DOI: 10.1186/s41038-018-0125-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/13/2018] [Indexed: 12/22/2022]
Abstract
Background Disparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes. Methods All patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality. Results A total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001). Conclusion We found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.
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Affiliation(s)
- Laura Pompermaier
- 1Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.,2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,5the Burn Centre, Linköping University Hospital, 58185 Linköping, Sweden
| | - Moustafa Elmasry
- 1Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.,2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Islam Abdelrahman
- 2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,3Department of Surgery, Plastic Surgery Unit, Suez Canal University, Ismailia, Egypt
| | - Mats Fredrikson
- 2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- 1Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.,2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,4Department of Anaesthesia and Intensive Care, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- 1Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.,2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Toft-Petersen AP, Ferrando-Vivas P, Harrison DA, Dunn K, Rowan KM. The organisation of critical care for burn patients in the UK: epidemiology and comparison of mortality prediction models. Anaesthesia 2018; 73:1131-1140. [PMID: 29762869 DOI: 10.1111/anae.14319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 12/23/2022]
Abstract
In the UK, a network of specialist centres has been set up to provide critical care for burn patients. However, some burn patients are admitted to general intensive care units. Little is known about the casemix of these patients and how it compares with patients in specialist burn centres. It is not known whether burn-specific or generic risk prediction models perform better when applied to patients managed in intensive care units. We examined admissions for burns in the Case Mix Programme Database from April 2010 to March 2016. The casemix, activity and outcome in general and specialist burn intensive care units were compared and the fit of two burn-specific risk prediction models (revised Baux and Belgian Outcome in Burn Injury models) and one generic model (Intensive Care National Audit and Research Centre model) were compared. Patients in burn intensive care units had more extensive injuries compared with patients in general intensive care units (median (IQR [range]) burn surface area 16 (7-32 [0-98])% vs. 8 (1-18 [0-100])%, respectively) but in-hospital mortality was similar (22.8% vs. 19.0%, respectively). The discrimination and calibration of the generic Intensive Care National Audit and Research Centre model was superior to the revised Baux and Belgian Outcome in Burn Injury burn-specific models for patients managed on both specialist burn and general intensive care units.
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Affiliation(s)
- A P Toft-Petersen
- Departments of Clinical Medicine and Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.,Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - P Ferrando-Vivas
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - D A Harrison
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - K Dunn
- Adult Burn Service, University Hospital of South Manchester, Manchester, UK
| | - K M Rowan
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
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Pompermaier L, Steinvall I, Elmasry M, Thorfinn J, Sjöberg F. Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study. Burns 2018; 44:280-287. [DOI: 10.1016/j.burns.2017.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/09/2017] [Accepted: 07/14/2017] [Indexed: 11/25/2022]
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Multiple-Drug Resistance in Burn Patients: A Retrospective Study on the Impact of Antibiotic Resistance on Survival and Length of Stay. J Burn Care Res 2018; 38:99-105. [PMID: 27984411 DOI: 10.1097/bcr.0000000000000479] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite improvements in early treatment, survival following burn injury remains challenged by sepsis and multiple organ dysfunction syndrome (MODS). Additionally, susceptibility to infections and growing antibiotic resistance places burn patients at increased risk for infections with multiple-drug resistant organisms (MDROs). We therefore aimed to evaluate the impact of MDRO infections on survival and hospital length of stay, as well as examine the role of these organisms in the development of complications, such as acute kidney injury, sepsis, and MODS. To study this, we included all burn patients with infections, admitted between January 1, 2012, and December 31, 2013. Patients were divided into two groups: patients with infections caused by MDROs and patients with infections caused by susceptible organisms. Data were collected on all available cultures, as well as demographic, injury, and treatment-related variables from the medical record. The number of operative procedures (median: 2 vs 1, P < .0001), ventilator days (21 vs 0 days, P < .0001), total antibiotic days (21 vs 7days, P < .0001), and length of hospitalization (39 vs 14 days, P < .0001) were significantly different in the MDRO group vs the nonresistant group. While MDRO infection was not associated with patient mortality, univariable logistic regression analyses demonstrated >20% TBSA (odds ratio [OR] = 4.30, 95% confidence interval [CI]: 1.14-16.29, P = .03), acute kidney injury (OR = 10.93, 95% CI: 2.74-43.57, P = .001), sepsis (OR = 19.20, 95% CI: 3.79-97.27, P < .001), and MODS (OR = 85.49, 95% CI: 12.97-563.28, P < .0001) significantly increased the odds of patient mortality. These findings suggest that infections with MDROs are associated with a greater number of surgical procedures, longer duration of mechanical ventilation, more antibiotic days, and longer hospitalization.
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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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Buja Z, Hoxha E. Burns in Kosovo: Epidemiological and therapeutic aspects of burns treated in University Clinical Center of Kosovo during the period 2003–2012. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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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Partain NS, Subramanian M, Hodgman EI, Isbell CL, Wolf SE, Arnoldo BD, Kowalske KJ, Phelan HA. Characterizing End-of-Life Care after Geriatric Burns at a Verified Level I Burn Center. J Palliat Med 2016; 19:1275-1280. [PMID: 27626364 DOI: 10.1089/jpm.2016.0152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND End-of-life (EoL) care after geriatric burns (geri-burns) is understudied. OBJECTIVE To examine the practices of burn surgeons for initiating EoL discussions and the impact of decisions made on the courses of geri-burn patients who died after injury. METHODS This retrospective cohort study examined all subjects ≥65 years who died on our Level I burn service from April 1, 2009, to December 31, 2014. Measurements obtained were timing of first EoL discussion (EARLY <24 hours post-admission; LATE ≥24 hours post-admission), decisions made, age, total body surface area burned, and calculated probability of death at admission. RESULTS The cohort consisted of 57 subjects, of whom 54 had at least one documented EoL care discussion between a burn physician and the patient/surrogate. No differences were seen between groups for the likelihood of an immediate decision for comfort care after the first discussion (p = 0.73) or the mean number of total discussions (p = 0.07). EARLY group subjects (n = 38) had significantly greater magnitudes of injury (p = 0.002), calculated probabilities of death at admission (p ≤ 0.001), shorter times to death (p ≤ 0.001), and fewer trips to the operating theater for burn excision and skin grafting (p ≤ 0.001) than LATE subjects (n = 16). LATE subjects' first discussion occurred at a mean of 9.3 ± 10.0 days. DISCUSSION The vast majority of geri-burn deaths on our burn service occur after a discussion about EoL care. The timing of these discussions is driven by magnitude of injury, and it does not lead to higher proportions of an immediate decision for comfort care. The presence and timing of EoL discussions bears further study as a quality metric for geri-burn EoL care.
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Affiliation(s)
- Natalia S Partain
- 1 Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas
| | - Madhu Subramanian
- 1 Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas
| | - Erica I Hodgman
- 1 Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas
| | - Claire L Isbell
- 2 Department of Surgery, Scott and White Hospital, Texas A&M Health Science Center , Temple, Texas
| | - Steve E Wolf
- 1 Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas.,3 Department of Surgery, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas
| | - Brett D Arnoldo
- 1 Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas.,3 Department of Surgery, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas
| | - Karen J Kowalske
- 4 Department of Physical Medicine and Rehabilitation, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas
| | - Herb A Phelan
- 1 Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas.,3 Department of Surgery, Parkland Memorial Hospital, University of Texas-Southwestern Medical Center , Dallas, Texas
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Long-term survival after burns in a Swedish population. Burns 2016; 43:157-161. [PMID: 27613474 DOI: 10.1016/j.burns.2016.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION As widely reported, the progress in burn care during recent decades has reduced the hospital mortality. The effect of the burns on long-term outcome has not received so much attention, and more study is indicated. The aim of this retrospective study was to investigate the long-time survival among patients who had been treated for burns. METHODS We studied 1487 patients who were discharged alive from the Linköping University Hospital Burn Centre during the period 1993 until the end of December 2012. We used Cox's regression analysis to study the effect of burns on long-term survival after adjustment for different factors. RESULTS Age and a full-thickness burn were significantly associated with mortality after discharge (p<0.001), whereas percentage of total body surface area burned (TBSA %), need for mechanical ventilation, and gender were not. Less than 1% of the patients with burns (13/1487) died within 30 days of discharge and a total of 176/1487 (12%) died during follow-up. CONCLUSION Age and full-thickness burns reduce the long-time survival after discharge from the Burn Centre, whereas the effect of TBSA% and need for artificial ventilation ends with discharge.
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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 Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, the University of Tokyo
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Severity of burn and its related factors: A study from the developing country Pakistan. Burns 2016; 42:901-5. [PMID: 26831723 DOI: 10.1016/j.burns.2016.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/19/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Burns are leading cause of fatal injuries and major cause of morbidity and mortality in developing countries. The major obstacle in controlling severity is factors related to burn. This study determines frequency of burns and the factors related to it in Karachi, Pakistan. METHODS A cross-sectional study was conducted and 384 hospitalized adult patients with burns were consecutively interviewed during August 2013 to February 2014. Information was collected on socio-demographic profile, intent of burn, severity of burn, health hazards, physical and psychological characteristics. TBSA burn of >15% was considered as higher severity of burn. RESULTS Higher severity of burns was found in 76.3% patients. Multivariate analysis showed that higher severity of burns were significantly associated with age less than 25 years (OR 2.7, 95% CI 1.5-4.9), never had been to school (OR 3.1, 95% CI 1.7-5.9) and intentional burn (OR 20.6, 95% CI 5.0-84.9). CONCLUSION Majority of patients had higher severity of burn. The intent of injury was intentional, age less than 25 years and no schooling were found significantly associated with higher severity of burns.
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Lorente JA, Amaya-Villar R. Update in the management of critically ill burned patients. Med Intensiva 2015; 40:46-8. [PMID: 26746126 DOI: 10.1016/j.medin.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
Abstract
The management of critically ill burn patients is challenging. These patients have to be managed in specialized centers, where the expertise of physicians and nursing personnel guarantees the best treatment. Mortality of burn patients has improved over the past decades due to a better understanding of burn shock pathophysiology, optimal surgical management, infection control and nutritional support. Indeed, a more aggressive resuscitation, early excision and grafting, the judicious use of topical antibiotics, and the provision of an adequate calorie and protein intake are key to attain best survival results. General advances in critical care have also to be implemented, including protective ventilation, glycemic control, selective decontamination of the digestive tract, and implementation of sedation protocols.
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Affiliation(s)
- J A Lorente
- Cuidados intensivos, Hospital Universitario de Getafe, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Universidad Europea, Madrid, Spain.
| | - R Amaya-Villar
- Cuidados intensivos, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Spain
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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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Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power. Burns 2015; 41:1868-1876. [PMID: 26507519 DOI: 10.1016/j.burns.2015.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/09/2015] [Accepted: 09/23/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Several models for predicting mortality have been developed for patients with burns, and the most commonly used are based on age and total body surface area (TBSA%). They often show good predictive precision as depicted by high values for area under the receiver operating characteristic curves (AUC). However the effect of coexisting morbidity on such prediction models has not to our knowledge been thoroughly examined. We hypothesised that adding it to a previously published model (based on age, TBSA%, full thickness burns, gender, and need for mechanical ventilation) would further improve its predictive power. METHODS We studied 772 patients admitted during the period 1997-2008 to the Linköping University Hospital, National Burn Centre with any type of burns. We defined coexisting morbidity as any of the medical conditions listed in the Charlson list, as well as psychiatric disorders or drug or alcohol misuse. We added coexisting medical conditions to the model for predicting mortality (age, TBSA%, and need for mechanical ventilation) to determine whether it improved the model as assessed by changes in deviances between the models. RESULTS Mean (SD) age and TBSA% was 35 (26) years and 13 (17) %, respectively. Among 725 patients who survived, 105 (14%) had one or more coexisting condition, compared with 28 (60%) among those 47 who died. The presence of coexisting conditions increased with age (p<0.001) among patients with burns. The AUC of the mortality prediction model in this study, based on the variables age, TBSA%, and need for mechanical ventilation was 0.980 (n=772); after inclusion of coexisting morbidity in the model, the AUC improved only marginally, to 0.986. The model was not significantly better either. CONCLUSION Adding coexisting morbidity to a model for prediction of mortality after a burn based on age, TBSA%, and the need for mechanical ventilation did not significantly improve its predictive value. This is probably because coexisting morbidity is automatically adjusted for by age in the original model.
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Ceniceros A, Pértega S, Galeiras R, Mourelo M, López E, Broullón J, Sousa D, Freire D. Predicting mortality in burn patients with bacteraemia. Infection 2015; 44:215-22. [DOI: 10.1007/s15010-015-0847-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
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Mourelo M, Galeiras R, Pértega S, Freire D, López E, Broullón J, Campos E. Tracheostomy in the management of patients with thermal injuries. Indian J Crit Care Med 2015; 19:449-55. [PMID: 26321803 PMCID: PMC4548413 DOI: 10.4103/0972-5229.162460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: To assess the use and clinical impact of tracheostomy in burn patients. Summary Background Data: The role of tracheostomy in the management of burn patients is controversial, with only a few recent studies conducted in this population. Methods: Retrospective study of all adult burn patients who underwent a tracheostomy in a Burns Unit between 1995 and 2013. These were compared with a control group (1:1) who underwent orotracheal intubation. Hospital records were reviewed to obtain demographic and clinical information, including those related to respiratory support and tracheostomy. The McNemar's Chi-square and Signed-Rank Tests were used to study differences in morbimortality between both groups. Results: A total of n = 20 patients underwent tracheostomy (0.9% of admissions, 56.0 ± 19.5 years, 60.0% women). The most common indication was long-term ventilation (75%), 24.6 ± 19.7 days after admission. Thirteen patients were successfully decannulated with a fatal complication observed in one case. Patients in the tracheostomy group were found to require longer-term mechanical ventilation (43.2 vs. 20.4 days; P = 0.004), with no differences in respiratory infection rates (30.0% vs. 31.6%; P = 0.687) or mortality (30.0% vs. 42.1%; P = 0.500). Ventilator weaning times (15.7 vs. 3.3 days; P = 0.001) and hospital stays (99.1 vs. 53.1 days; P = 0.030) were longer in the tracheostomy group, with no differences in duration of sedation. Conclusions: Tracheostomy may be a safe procedure in burn patients and is not associated with higher rates of mortality or respiratory infection. Tracheostomy patients showed longer mechanical ventilation times and higher morbidity, probably not attributable to tracheostomy.
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Affiliation(s)
- Mónica Mourelo
- Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain
| | - Rita Galeiras
- Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain
| | - Sonia Pértega
- Department of Clinical Epidemiology and Biostatistics, University Hospital of A Coruna, A Coruña, Spain
| | - David Freire
- Department of Critical Care, University Hospital of A Coruna, A Coruña, Spain
| | - Eugenia López
- Department of Plastic Surgery, Burn Unit, University Hospital of A Coruna, A Coruña, Spain
| | - Javier Broullón
- Department of Health Information Technology, University Hospital of A Coruna, A Coruña, Spain
| | - Eva Campos
- Department of Plastic Surgery, Burn Unit, University Hospital of A Coruna, A Coruña, Spain
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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: 49] [Impact Index Per Article: 5.4] [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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Clinical differences between major burns patients deemed survivable and non-survivable on admission. Injury 2015; 46:870-3. [PMID: 25707879 DOI: 10.1016/j.injury.2015.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/16/2014] [Accepted: 01/02/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite advances in burn care, there is still a group of patients with serious burn injury who fail to respond to therapies or for whom active treatments are unsuccessful. As the demographic and causative factors of burn related mortality may differ between treating units and countries, we aimed to investigate clinical aspects of patients that die whose injuries are considered either survivable or non-survivable on admission. METHODS A retrospective 11-year medical record review (2000-2011) of patients admitted to the Victorian Adult Burns Service (VABS), Melbourne, Australia, with a fatal burn injury was undertaken. Patient characteristics such as age, gender, total body surface area (TBSA%) burned, type and site of burn, hospital length of stay, receipt of burn care treatments and when withdrawal of care (WOC) took place were identified using hospital databases. For the purposes of categorization, two categories of patients were defined retrospectively. 'Early WOC' patients were those for whom a decision was made within the first 24h following admission that a patient injury was likely non-survivable, or that survival was incompatible with a meaningful quality of life. 'Late WOC' patients were those patients for whom a decision was made within the first 24h following admission that a patient injury was survivable and potentially compatible with a meaningful quality of life. RESULTS In a study analyzing 70 patients, the average TBSA% burned in the 'Early WOC' group (n=43) was significantly higher with the 'Late WOC' cohort (n=27) (85% vs. 45%; p=0.001) compared. A higher incidence of accelerant use (60% vs. 35%; p=0.07) and facial burns (74% vs. 44%; p=0.02) was found in the 'Early WOC' patients. In the 'Late WOC' group, 92.6% of patients required mechanical ventilation and 78.6% of patients underwent operative intervention (median surgical time 9.25h, inter-quartile range 6.5-18.5). CONCLUSION A number of clinical differences in major burn patients can be observed at admission between patients for whom a decision is made as to whether an injury is survivable or non-survivable. These differences may influence the degree of therapeutic aggression or conservatism as determined by the treating clinical team. As a matter of maintaining standards amongst the burns community, reporting mortality data such as this may also provide a benchmark by which other burns units can assess their own data regarding end-of-life decision-making.
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Tsurumi A, Que YA, Yan S, Tompkins RG, Rahme LG, Ryan CM. Do standard burn mortality formulae work on a population of severely burned children and adults? Burns 2015; 41:935-45. [PMID: 25922299 DOI: 10.1016/j.burns.2015.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/24/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
Accurate prediction of mortality following burns is useful as an audit tool, and for providing treatment plan and resource allocation criteria. Common burn formulae (Ryan Score, Abbreviated Burn Severity Index (ABSI), classic and revised Baux) have not been compared with the standard Acute Physiology and Chronic Health Evaluation II (APACHEII) or re-validated in a severely (≥20% total burn surface area) burned population. Furthermore, the revised Baux (R-Baux) has been externally validated thoroughly only once and the pediatric Baux (P-Baux) has yet to be. Using 522 severely burned patients, we show that burn formulae (ABSI, Baux, revised Baux) outperform APACHEII among adults (AUROC increase p<0.001 adults; p>0.5 children). The Ryan Score performs well especially among the most at-risk populations (estimated mortality [90% CI] original versus current study: 33% [26-41%] versus 30.18% [24.25-36.86%] for Ryan Score 2; 87% [78-93%] versus 66.48% [51.31-78.87%] for Ryan Score 3). The R-Baux shows accurate discrimination (AUROC 0.908 [0.869-0.947]) and is well-calibrated. However, the ABSI and P-Baux, although showing high measures of discrimination (AUROC 0.826 [0.737-0.916] and 0.848 [0.758-0.938]) in children), exceedingly overestimates mortality, indicating poor calibration. We highlight challenges in designing and employing scores that are applicable to a wide range of populations.
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Affiliation(s)
- Amy Tsurumi
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Lausanne University Hospital, BH 08-624, CH-1011 Lausanne, Switzerland.
| | - Shuangchun Yan
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
| | - Ronald G Tompkins
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA.
| | - Laurence G Rahme
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
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Indoor fire in a nursing home: evaluation of the medical response to a mass casualty incident based on a standardized protocol. Eur J Trauma Emerg Surg 2014; 41:167-78. [DOI: 10.1007/s00068-014-0446-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
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Characterization of critically ill adult burn patients admitted to a Brazilian intensive care unit. Burns 2014; 40:1770-9. [PMID: 24893761 DOI: 10.1016/j.burns.2014.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/05/2014] [Accepted: 03/30/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION To characterize the evolution of clinical and physiological variables in severe adult burn patients admitted to a Brazilian burn ICU, we hypothesized that characteristics of survivors are different from non-survivors after ICU admission. METHODS A five-year observational study was carried out. The clinical characteristics, physiological variables, and outcomes were collected during this period. RESULTS A total of 163 patients required ICU support and were analyzed. Median age was 34 [25,47] years. Total burn surface area (TBSA) was 29 [18,43]%, and hospital mortality rate was 42%. Lethal burn area at which fifty percent of patients died (LA50%) was 36.5%. Median SAPS3 was 41 [34,54]. Factors associated with hospital mortality were analyzed in three steps, the first incorporated ICU admission data, the second incorporated first day ICU data, and the third incorporated data from the first week of an ICU stay. We found a significant association between hospital mortality and SAPS3 [OR(95%CI)=1.114(1.062-1.168)], TBSA [OR(95%CI)=1.043(1.010-1.076)], suicide attempts [OR(95%CI)=8.126(2.284-28.907)], and cumulative fluid balance per liter within the first week [OR(95%CI)=1.090(1.030-1.154)]. Inhalation injury was present in 45% of patients, and it was not significantly associated with hospital mortality. CONCLUSIONS In this study of an ICU in a developing country, the mortality rate of critically ill burn patients was high and the TBSA was an independent risk factor for death. SAPS3 at admission and cumulative fluid balance in the first seven days, were also associated with unfavorable outcomes. The implementation of judicious fluid management after an acute resuscitation phase may help to improve outcomes in this scenario.
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Jiménez F, Sánchez G, Juárez JM. Multi-objective evolutionary algorithms for fuzzy classification in survival prediction. Artif Intell Med 2014; 60:197-219. [DOI: 10.1016/j.artmed.2013.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 12/10/2013] [Accepted: 12/22/2013] [Indexed: 11/26/2022]
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Ibarra Estrada MÁ, Chávez Peña Q, García Guardado DI, López Pulgarín JA, Aguirre Avalos G, Corona Jiménez F. A 10-year experience with major burns from a non-burn intensive care unit. Burns 2014; 40:1225-31. [PMID: 24560957 DOI: 10.1016/j.burns.2013.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 11/23/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to review clinical data and outcomes of patients with burns in a Mexican non-burn intensive care unit (ICU). METHODS We did a retrospective analysis of our single-centre database of burn patients admitted to the ICU in the Hospital Civil Fray Antonio Alcalde (University Hospital). The sample was divided for analysis into two groups according to the outcome 'death' or 'discharge' from ICU. RESULTS Overall mortality was 58.2%, without a decreasing trend in mortality rates through the years. We identified the presence of third-degree burns (odds ratio (OR) 1.5, p=0.003), and >49% total burned surface area (TBSA; OR 3.3, p≤0.001) was associated with mortality. Mean age was higher in deceased patients (38.2 years vs. 31.3 years, p=0.003) as was the TBSA (62.8% vs. 36.4%, p≤0.001). At multivariate analysis, inhalation injury was not associated with increased mortality, but it was with more mechanical ventilation days. Early surgical debridement/cleansing was performed in most patients; however, the mean of the procedures was 1.7 per patient in both groups. CONCLUSION We identified significant factors associated with mortality. These variables and prognosis from non-burn ICUs differ broadly compared with burn intensive care units (BICUs); thus, more structured, multidisciplinary and specialised treatment strategies are still needed.
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Affiliation(s)
- Miguel Ángel Ibarra Estrada
- Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico, Universidad de Guadalajara.
| | - Quetzalcóatl Chávez Peña
- Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico, Universidad de Guadalajara
| | - Dante Ismael García Guardado
- Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico, Universidad de Guadalajara
| | - José Arnulfo López Pulgarín
- Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico, Universidad de Guadalajara
| | - Guadalupe Aguirre Avalos
- Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico, Universidad de Guadalajara
| | - Federico Corona Jiménez
- Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, Mexico, Universidad de Guadalajara
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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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Unintentional domestic burns in Iran: Analysis of 125,000 cases from a national register. Burns 2013; 39:1304-10. [PMID: 23684319 DOI: 10.1016/j.burns.2013.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 02/11/2013] [Accepted: 02/25/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study was to map out some epidemiological aspects of unintentional burn injuries among Iranian victims using a national injury registry data. METHODS Injury data were taken from a national injury surveillance system over the period 2000-2002. The study population comprised 31.5% of Iran's population. Burn-injury cases were retrieved and analysed. RESULTS Of all the grossly 307,000 home injuries reported during the years 2000-2002 in Iran, about 125,000 cases (41%) were unintentional burn injuries. Women comprised 58% of the unintentional burn victims. The mean age among burn victims was 19.18±19 (standard deviation, SD) years. The age-adjusted incidence and mortality rates showed that children had a much higher incidence of domestic burns but the elderly suffered higher fatality in spite of lower incidence in this age group. Overall, 65.2% of the domestic burn injuries occurred in the living rooms or bedrooms followed by 27% in the kitchen. The hands and fingers were injured in 43.6% followed by the lower limbs in 37.6%. According to injury mechanism, scalds were the most common type of burn injuries comprising 77.7% of all burns. Of all the burn victims, 791 died, 48 victims became disabled and the remaining improved or were undergoing therapy when reported. CONCLUSION Burns form a major health problem in Iran. Due to high mortality rate, the elderly need specific attention regarding burn prevention and treatment in this age group. Moreover, in spite of lower fatality, any prevention programme should have a focus on childhood burns mainly due to the overwhelming distribution of burns in children and the young population of Iran.
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Brusselaers N, Agbenorku P, Hoyte-Williams PE. Assessment of mortality prediction models in a Ghanaian burn population. Burns 2012; 39:997-1003. [PMID: 23146574 DOI: 10.1016/j.burns.2012.10.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/30/2012] [Accepted: 10/24/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE Over 40 new or modified outcome prediction models have been developed for severe burns; with age, total burned surface area (TBSA) and inhalation area as major determinants of mortality. The objective of this study was to assess their applicability in a developing country. PROCEDURES Data were collected retrospectively of a consecutive series of 261 patients (2009-2011) admitted to a Burns Intensive Care. Five outcome prediction models based on admission criteria were evaluated: Bull grid, Abbreviated Burn Severity Index--ABSI, Ryan-model, Belgian Outcome in Burn Injury--BOBI and revised Baux. Discriminative power and goodness-of-fit were assessed by receiver operating characteristic analyses (area under the curve--AUC) and Hosmer-Lemeshow tests. FINDINGS Median age was 10.5 years (IQR: 2.5-27 years), median TBSA 21% (IQR: 11-34%); 55.2% were male, 28 patients died (10.7%). Only 2 patients were intubated (0.8%). The AUC were between 77 and 86%. The ABSI model showed the best calibration (28.7 expected deaths). Ryan, BOBI and rBaux significantly underestimated mortality, whereas Bull showed an overestimation. CONCLUSION This study on a young group of burn patients showed moderate to good discriminative power using all five prediction models. The expected number of deaths tended to be underestimated in the three most recent prediction models.
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Affiliation(s)
- N Brusselaers
- General Internal Medicine, Infectious Diseases and Psychosomatic Medicine, Ghent University Hospital, Ghent, Belgium; Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - P Agbenorku
- Reconstructive Plastic Surgery & Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - P E Hoyte-Williams
- Reconstructive Plastic Surgery & Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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A new algorithm to allow early prediction of mortality in elderly burn patients. Burns 2012; 38:1114-8. [PMID: 22999211 DOI: 10.1016/j.burns.2012.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/15/2012] [Accepted: 08/21/2012] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The elderly are the fastest growing population segment, and particularly susceptible to burns. Predicting outcomes for these patients remains difficult. Our objective was to identify early predictors of mortality in elderly burn patients. METHODS Our Burn Center's prospective database was reviewed for burn patients 60+ treated in the past 10 years. Predictor variables were identified by correlative analysis and subsequently entered into a multivariate logistic regression analysis examining survival to discharge. RESULTS 203 patients of 1343 (15%) were eligible for analysis. The average age was 72 ± 10 (range 60-102) and the average total body surface area (TBSA) burned was 23 ± 18% (range 1-95). Age, TBSA, base deficit, pO(2), respiratory rate, Glasgow Coma Score (GCS), and Revised Trauma Score (RTS, based on systolic blood pressure, respiratory rate, and GCS) all correlated with mortality (p ≤0 .05). Using multiple logistic regression analysis, a model with age, TBSA and RTS was calculated, demonstrating: In this model, β(0) is a constant that equals -8.32. CONCLUSIONS Predicting outcomes in elderly burn patients is difficult. A model using age, TBSA, and RTS can, immediately upon patient arrival, help identify patients with decreased chances of survival, further guiding end-of-life decisions.
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Engrav LH, Heimbach DM, Rivara FP, Kerr KF, Osler T, Pham TN, Sharar SR, Esselman PC, Bulger EM, Carrougher GJ, Honari S, Gibran NS. Harborview burns--1974 to 2009. PLoS One 2012; 7:e40086. [PMID: 22792216 PMCID: PMC3390332 DOI: 10.1371/journal.pone.0040086] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/31/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Burn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974-2009) at the Harborview Burn Center in Seattle, WA, USA. METHODS AND FINDINGS 14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved. CONCLUSIONS 1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate.
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Affiliation(s)
- Loren H Engrav
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, United States of America.
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Watterson D, Cleland H, Darton A, Edgar D, Fong J, Harvey J, Kavanagh S, Perrett T, Singer Y, Tonkin C, Cameron P. Developing clinical quality indicators for a Bi-National Burn Registry. Burns 2011; 37:1296-308. [DOI: 10.1016/j.burns.2011.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 08/10/2011] [Accepted: 08/11/2011] [Indexed: 11/29/2022]
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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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Maldonado AA, Sillero A, Küntscher M. Prediction of Mortality in Patients With Major Burns. Ann Plast Surg 2011; 67:226-31. [DOI: 10.1097/sap.0b013e3182259304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Gabbe BJ, Cleland HJ, Cameron PA. Profile, transport and outcomes of severe burns patients within an inclusive, regionalized trauma system. ANZ J Surg 2011; 81:725-30. [DOI: 10.1111/j.1445-2197.2010.05635.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Findlay JM, Shaw A. Emergency management of burns. Br J Hosp Med (Lond) 2010; 71:M162-6. [PMID: 21063246 DOI: 10.12968/hmed.2010.71.sup11.79670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John M Findlay
- Department of General Surgery, Royal Berkshire Hospital, Reading
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