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Bingoel AS, Krezdorn N, Jokuszies A, Dastagir K, Vogt PM, Mett TR. Hot Bathtub, Cold Consequences-Misleading Wounds After Scald Injuries: A Retrospective Analysis. J Burn Care Res 2021; 42:390-397. [PMID: 32951030 DOI: 10.1093/jbcr/iraa157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Scalds in the elderly are frequently associated with the use of a bathtub and a disturbed consciousness. Therefore, the total burn surface area is often high. The initial clinical presentation displays a stark erythema of the skin, which frequently does not represent the true depth. The aim of this study was to characterize and assess medical features and outcome of scalds sustained in the bathtub. We conducted a retrospective study at a burn intensive care unit (BICU) between 2011 and 2018. Medical features as well as the treatment in these patients were statistically analyzed. We identified 16 patients and divided them into two groups regarding survival and lethality. The mean total burn surface area was 37.50 ± 19.47%. In 81.25% of the patients, we found a previous history of neurological or psychiatric disorders. Dementia and alcohol abuse were the most common triggers for the trauma. The statistical analysis showed a significant difference for the ABSI-score and the presence of multi organ failure (P-value .0462, respectively, .0004). Erythematous skin areas tended to progress into full thickness burns. We, therefore, coined the term "lobster redness" for these regions. Scalds sustained in the bathtub are devastating injuries. Initial assessment can be misleading and might delay early necrectomy. The wounds request even more attention, if the injuries occurred due to unconsciousness because of the longer exposure to heat. Early necrectomy should be considered. A biopsy with histological workup can be useful. Furthermore, we recommend special safety precautions for neurologically and psychiatrically affected patients.
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Affiliation(s)
- Alperen S Bingoel
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Andreas Jokuszies
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Peter Maria Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Tobias R Mett
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
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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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Yoshimura Y, Saitoh D, Yamada K, Nakamura T, Terayama T, Ikeuchi H, Sasaki J, Nemoto M. Comparison of prognostic models for burn patients: A retrospective nationwide registry study. Burns 2020; 46:1746-1755. [PMID: 33148486 DOI: 10.1016/j.burns.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognostic burn index (PBI) is a unique model utilized to predict mortality of burn patients in Japan. In contrast, other prediction models are rarely used in Japan, and their accuracy and predictive value are unknown. The present study aimed to compare commonly used burn prediction models and determine the appropriate model for mortality prediction in Japanese burn patients. METHODS Japanese burn patients registered in the nationwide burn registry of Japanese Society for Burn Injury between April 1, 2011 and March 31, 2019 were reviewed retrospectively. The prognostic performance of PBI was compared with Baux score, revised Baux score, abbreviated burn severity index (ABSI), Ryan score and Belgian outcome in burn injury score (BOBI). The primary outcome was in-hospital mortality. RESULTS The study included 7911 acute burn patients. The overall mortality rate was 10.7%, the median age was 52 (interquartile range, 26-72) years, and the median % total body surface area was 7% (interquartile range, 3%-17%). The areas under the receiver operating characteristic curve for PBI, Baux score, ABSI, revised Baux score, Ryan score, and BOBI were 0.940 (95% confidence interval [CI]: 0.931-0.948), 0.943 (95% CI: 0.934-0.951; p=0.002), 0.945 (95% CI: 0.937-0.953; p=0.058), 0.946 (95% CI: 0.937-0.953; p=0.002), 0.859 (95% CI: 0.846-0.870; p<0.001), and 0.896 (95% CI: 0.885-0.905; p<0.001), respectively. CONCLUSION Although the performance of PBI was good, it was not superior to the Baux score, revised Baux score, and ABSI. These three scores have a high prognostic accuracy. Hence, they are considered as alternative burn prognostic scores in Japan. The Baux score was an optimal prognostic model for patients with burns in Japan.
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Affiliation(s)
- Yuya Yoshimura
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Daizoh Saitoh
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Takahiro Nakamura
- Department of Mathematics, National Defense Medical College, Saitama, Japan
| | - Takero Terayama
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Hisashi Ikeuchi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Manabu Nemoto
- Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan
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Castanon L, Asmar S, Bible L, Chehab M, Ditillo M, Khurrum M, Hanna K, Douglas M, Joseph B. Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit? J Burn Care Res 2020; 41:986-991. [PMID: 32598455 DOI: 10.1093/jbcr/iraa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition in geriatric burn patients. This study aimed to assess the impact of early enteral nutrition on outcomes in this patient population. We performed a 1-year (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program and included all older adult (age ≥65 years) isolated thermal burn patients who were admitted for more than 24 hr and received enteral nutrition. Patients were stratified into two groups based on the timing of initiation of feeding: early (≤24 hr) vs late (>24 hr). Multivariate logistic regression was performed to control for potential confounding factors. Outcome measures were hospital and intensive care unit lengths of stay, in-hospital complications, and mortality. A total of 1,004,440 trauma patients were analyzed, of which 324 patients were included (early: 90 vs late: 234). The mean age was 73.9 years and mean TBSA burnt was 31%. Patients in the early enteral nutrition group had significantly lower rates of in-hospital complications and mortality (15.6% vs 26.1%; P = 0.044), and a shorter hospital length of stay (17 [11,23] days vs 20 [14,24] days; P = 0.042) and intensive care unit length of stay (13 [8,15] days vs 17 [9,21] days; P = 0.042). In our regression model of geriatric burn patients, early enteral nutrition was associated with improved outcomes. The cumulative benefits observed may warrant incorporating early enteral nutrition as part of intensive care protocols.
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Affiliation(s)
- Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Mohamad Chehab
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Kamil Hanna
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Molly Douglas
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
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Endo A, Shiraishi A, Otomo Y, Fushimi K, Murata K. Volume-outcome relationship on survival and cost benefits in severe burn injury: a retrospective analysis of a Japanese nationwide administrative database. J Intensive Care 2019; 7:7. [PMID: 30733868 PMCID: PMC6354429 DOI: 10.1186/s40560-019-0363-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although it has been reported that high hospital patient volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. Methods We conducted a retrospective observational study on severe burn patients, defined by a burn index ≥ 10, using 2010–2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between patient volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days). Generalized linear mixed-effect regression models (GLMMs) in which patient volume was incorporated as a continuous or categorical variable (≤ 5 or > 5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating patients who were directly transported, those with PBI ≤ 120 and those excluding patients who died within 2 days of admission, were also performed. Results We analyzed 5250 eligible severe burn patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in patient volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher volume hospitals. The GLMM model showed that patient volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)] = 1.14 [1.09–1.19]), high healthcare costs (adjusted difference [95% CI] = $4876 [4436–5316]), and few hospital-free days (adjusted difference [95% CI] = − 3.1 days [− 3.4 to − 2.8]). Similar trends were observed in the analyses in which patient volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results. Conclusions Analysis of Japanese nationwide administrative database demonstrated that high burn patient volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results. Electronic supplementary material The online version of this article (10.1186/s40560-019-0363-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akira Endo
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Atsushi Shiraishi
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.,2Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba Japan
| | - Yasuhiro Otomo
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Kiyohide Fushimi
- 3Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Murata
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.,The Shock Trauma and Emergency Medical Center, Matsudo City General Hospital, 933-1 Sendabori,, Matsudo, Chiba Japan
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Ward J, Phillips G, Radotra I, Smailes S, Dziewulski P, Zhang J, Martin N. Frailty: an independent predictor of burns mortality following in-patient admission. Burns 2018; 44:1895-1902. [DOI: 10.1016/j.burns.2018.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/11/2018] [Accepted: 09/13/2018] [Indexed: 01/26/2023]
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Tian H, Wang L, Xie W, Shen C, Guo G, Liu J, Han C, Ren L, Liang Y, Tang Y, Wang Y, Yin M, Zhang J, Huang Y. Epidemiologic and clinical characteristics of severe burn patients: results of a retrospective multicenter study in China, 2011-2015. BURNS & TRAUMA 2018; 6:14. [PMID: 29850643 PMCID: PMC5964711 DOI: 10.1186/s41038-018-0118-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/26/2018] [Indexed: 12/26/2022]
Abstract
Background Severe burns injury is a serious pathology, leading to teratogenicity and significant mortality, and it also has a long-term social impact. The aim of this article is to describe the hospitalized population with severe burns injuries in eight burn centers in China between 2011 and 2015 and to suggest future preventive strategies. Methods This 5-year retrospective review included all patients with severe burns in a database at eight institutions. The data collected included gender, age, month distribution, etiology, location, presence of inhalation injury, total burn surface area, depth of the burn, the length of hospitalization, and mortality. SPSS 19.0 software was used to analyze the data. Results A total of 1126 patients were included: 803 (71.3%) male patients and 323 (28.7%) female patients. Scalds were the most common cause of burns (476, 42.27%), followed by fire (457, 40.59%). The extremities were the most frequently affected areas, followed by the trunk. The median length of hospitalization was 30 (15, 52) days. The overall mortality rate was 14.21%. Conclusions Although medical centers have devoted intensive resources to improving the survival rates of burn patients, expenditures for prevention and education programs are minimal. Our findings suggest that more attention should be paid to the importance of prevention and the reduction of injury severity. This study may contribute to the establishment of a nationwide burn database and the elaboration of strategies to prevent severe burns injury.
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Affiliation(s)
- Hao Tian
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Liangxi Wang
- Institute of Burn and Plastic Surgery, the 97th Hospital of PLA, Xuzhou, , Jiangsu People's Republic of China
| | - Weiguo Xie
- 3Department of Burns, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, Hubei People's Republic of China
| | - Chuanan Shen
- 4The Department of Burns and Plastic Surgery, First Affiliated Hospital of People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Guanghua Guo
- 5The Department of Burns and Plastic Surgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006 People's Republic of China
| | - Jiaqi Liu
- Institute of Burn Research Center of PLA, Xijin Hospital, Forth Military Medical University, Xi'an, Shaanxi 710032 People's Republic of China
| | - Chunmao Han
- 7Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, Zhejiang, 310009 People's Republic of China
| | - Licheng Ren
- 8Department of Burn Reconstruction Surgery, Xiangya Hospital, Central South University, Changsha, Hunan People's Republic of China
| | - Yi Liang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Yong Tang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Yuan Wang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Meifang Yin
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Jiaping Zhang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Yuesheng Huang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
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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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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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Gaucher S, Grabar S, Fragny D, Lecam B, Stéphanazzi J, Wassermann D. Burns in older people. Epidemiology, surgical management and outcome in a university hospital referral burn unit, 1994–2004. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2011.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Albornoz CR, Villegas J, Sylvester M, Peña V, Bravo I. Burns are more aggressive in the elderly: Proportion of deep burn area/total burn area might have a role in mortality. Burns 2011; 37:1058-61. [DOI: 10.1016/j.burns.2011.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/31/2011] [Accepted: 03/12/2011] [Indexed: 11/29/2022]
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