1
|
Edgar MC, Bond SM, Jiang SH, Scharf IM, Bejarano G, Vrouwe SQ. The Revised Baux Score as a Predictor of Burn Mortality: A Systematic Review and Meta-Analysis. J Burn Care Res 2023; 44:1278-1288. [PMID: 37220881 DOI: 10.1093/jbcr/irad075] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 05/25/2023]
Abstract
Mortality following a severe burn is influenced by both patient- and injury-factors, and a number of predictive models have been developed or applied. As there is no consensus on the optimal formula to use, we aimed to investigate the predictive value of the revised Baux score in comparison to other models when determining mortality risk in patients with burn injuries. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The review yielded 21 relevant studies. The Prediction model Risk Of Bias ASsessment Tool quality appraisal checklist was used with many studies classified as "high" quality. All studies assessed the utility of the revised Baux score in comparison to other scoring systems such as the original Baux, Belgian Outcome in Burn Injury, Abbreviated Burn Severity Index, Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, Boston Group/Ryan scores, the Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex model, and the Prognostic Burn Index. There was a range of 48 to 15975 participants per study, with a mean age range of 16 to 52 years old. The area under the curve (AUC) values of the rBaux score ranged from 0.682 to 0.99, with a summary AUC of 0.93 for all included studies (CI 0.91-0.95). This summary value demonstrates that the rBaux equation is a reliable predictor for mortality risk in heterogeneous populations. However, this study also identified that the rBaux equation has a diminished ability to predict mortality risk when applied to patients at both extremes of age, highlighting an important area for future research. Overall, the rBaux equation offers a relatively easy means to quickly assess the mortality risk from burn injury in a broad range of patient populations.
Collapse
Affiliation(s)
- Michael C Edgar
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Stephanie M Bond
- Section of Plastic and Reconstructive Surgery, University of Chicago, Chicago, Illinois, USA
| | - Sam H Jiang
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Isabel M Scharf
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Geronimo Bejarano
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sebastian Q Vrouwe
- Section of Plastic and Reconstructive Surgery, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
2
|
Jiang M, Qian H, Li Q, Han Y, Hu K. Predictive value of lactate dehydrogenase combined with the abbreviated burn severity index for acute kidney injury and mortality in severe burn patients. Burns 2023; 49:1344-1355. [PMID: 36805837 DOI: 10.1016/j.burns.2023.01.012] [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] [Received: 07/13/2022] [Revised: 12/15/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extensive burns are devastating trauma. This study aimed to explore the predictive value of early lactate dehydrogenase (LDH) level, the abbreviated burn severity index (ABSI) and their combination on acute kidney injury (AKI) and mortality after severe burns. METHODS AND RESULTS 194 severe burn patients (TBSA ≥ 30%) were included. After multivariate analyses, early LDH value (first 24 h after admission) was an independent risk factor for early AKI (OR=1.095, CI,1.025-1.169,p = 0.007) and AKI (OR=1.452, CI,1.131-1.864, p = 0.003) in severe burn patients and was still a significant risk factor for mortality (OR=1.059, CI,1.006-1.115,p = 0.03). In ROC analysis, after combining LDH and ABSI, the AUC values were 0.925 for AKI, 0.926 for stage 3 AKI, and 0.904 for mortality. Based on cut-off values, patients were divided into different risk groups. The cumulative incidence of AKI (within 5 days, 30 days) and survival rate (within 60 days) were analyzed by the Kaplan-Meier method. The mortality, AKI incidence, and AKI staging showed a significant upward trend with the increasing risk level (P < 0.001). CONCLUSION Early LDH level is an independent risk factor for early AKI and AKI. LDH combined with ABSI can better predict mortality and AKI than single indicators.
Collapse
Affiliation(s)
- Ming Jiang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, People's Republic of China; Nantong University Medical School, Nantong, Jiangsu Province 226001, People's Republic of China.
| | - Hongyan Qian
- Cancer Research Centre Nantong, Tumor Hospital Affiliated to Nantong University, Nantong, Jiangsu Province 226300, People's Republic of China.
| | - Qiqi Li
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, People's Republic of China; Nantong University Medical School, Nantong, Jiangsu Province 226001, People's Republic of China.
| | - Yingying Han
- Nantong Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases Prevention and Control, Nantong, Jiangsu Province 226001, People's Republic of China.
| | - Kesu Hu
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, People's Republic of China.
| |
Collapse
|
3
|
Tsurumi A, Flaherty PJ, Que YA, Ryan CM, Banerjee A, Chakraborty A, Almpani M, Shankar M, Goverman J, Schulz JT, Sheridan RL, Friedstat J, Hickey SA, Tompkins RG, Rahme LG. A PREVENTIVE TOOL FOR PREDICTING BLOODSTREAM INFECTIONS IN CHILDREN WITH BURNS. Shock 2023; 59:393-399. [PMID: 36597771 PMCID: PMC9991965 DOI: 10.1097/shk.0000000000002075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT Introduction: Despite significant advances in pediatric burn care, bloodstream infections (BSIs) remain a compelling challenge during recovery. A personalized medicine approach for accurate prediction of BSIs before they occur would contribute to prevention efforts and improve patient outcomes. Methods: We analyzed the blood transcriptome of severely burned (total burn surface area [TBSA] ≥20%) patients in the multicenter Inflammation and Host Response to Injury ("Glue Grant") cohort. Our study included 82 pediatric (aged <16 years) patients, with blood samples at least 3 days before the observed BSI episode. We applied the least absolute shrinkage and selection operator (LASSO) machine-learning algorithm to select a panel of biomarkers predictive of BSI outcome. Results: We developed a panel of 10 probe sets corresponding to six annotated genes ( ARG2 [ arginase 2 ], CPT1A [ carnitine palmitoyltransferase 1A ], FYB [ FYN binding protein ], ITCH [ itchy E3 ubiquitin protein ligase ], MACF1 [ microtubule actin crosslinking factor 1 ], and SSH2 [ slingshot protein phosphatase 2 ]), two uncharacterized ( LOC101928635 , LOC101929599 ), and two unannotated regions. Our multibiomarker panel model yielded highly accurate prediction (area under the receiver operating characteristic curve, 0.938; 95% confidence interval [CI], 0.881-0.981) compared with models with TBSA (0.708; 95% CI, 0.588-0.824) or TBSA and inhalation injury status (0.792; 95% CI, 0.676-0.892). A model combining the multibiomarker panel with TBSA and inhalation injury status further improved prediction (0.978; 95% CI, 0.941-1.000). Conclusions: The multibiomarker panel model yielded a highly accurate prediction of BSIs before their onset. Knowing patients' risk profile early will guide clinicians to take rapid preventive measures for limiting infections, promote antibiotic stewardship that may aid in alleviating the current antibiotic resistance crisis, shorten hospital length of stay and burden on health care resources, reduce health care costs, and significantly improve patients' outcomes. In addition, the biomarkers' identity and molecular functions may contribute to developing novel preventive interventions.
Collapse
Affiliation(s)
- Amy Tsurumi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Patrick J. Flaherty
- Department of Mathematics and Statistics, University of Massachusetts at Amherst (Amherst, MA 01003, USA)
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland (3010 Bern, Switzerland)
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Ankita Banerjee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Arijit Chakraborty
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Marianna Almpani
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Malavika Shankar
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - John T. Schulz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Robert L. Sheridan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Jonathan Friedstat
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Sean A. Hickey
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| | - Ronald G. Tompkins
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
| | - Laurence G. Rahme
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA (50 Blossom St., Their 340, Boston, MA 02114, USA)
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA (77 Ave. Louis Pasteur, Boston, MA 02115, USA)
- Shriners Hospitals for Children-Boston, Boston, Massachusetts, USA (51 Blossom St., Boston, MA 02114, USA)
| |
Collapse
|
4
|
Sharma S, Tandon R. External Validation of Three Burn-Specific Mortality Prediction Models in Adult Burn Patients at a Tertiary Care Hospital in India. Indian J Plast Surg 2023; 56:39-43. [PMID: 36998930 PMCID: PMC10049816 DOI: 10.1055/s-0043-1760825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Abstract
Background Several burn-specific mortality prediction models have been formulated and validated in the developed countries. There is a dearth of studies validating these models in the Indian population. Our objective was to validate three such models in the Indian burn patients.
Methods A prospective observational study was performed after ethical clearance on consecutive eligible consenting burn patients. Patient demographics, vitals, and results of hematological workup were collected. Using these. the Abbreviated Burn Severity Index (ABSI), the revised Baux score (rBaux), and the Fatality by Longevity, APACHE II score, Measured extent of burn, and Sex score (FLAMES) were calculated. The discriminative ability of the ABSI, rBaux, and the FLAMES was tested using the receiver operating characteristic (ROC) curve at 30 days and the area under the ROC curve (AUROC) compared. A p-value ≤ 0.05 was considered significant. Probability of death was calculated using these models. Hosmer–Lemeshow goodness of fit test was run.
Results The ABSI (AUROC 0.7497, 95% CI 0.67796–0.82141), rBaux (AUROC 0.7456, 95% CI 0.67059–0.82068) and FLAMES (AUROC 0.7119, 95% CI 0.63209–0.79172), had fair discriminative ability. The Hosmer–Lemeshow test reported that ABSI and rBaux were a good fit for the Indian population, while FLAMES was not a good fit.
Conclusion The ABSI and rBaux had a fair discriminative ability and were a good fit for the adult patients with 30 to 60% thermal and scald burn patients. FLAMES despite having fair discriminative ability was not a good fit for the study population.
Collapse
Affiliation(s)
- Sneha Sharma
- Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College, New Delhi, India
| | - Raman Tandon
- Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College, New Delhi, India
| |
Collapse
|
5
|
Wang B, Hu L, Chen Y, Zhu B, Kong W, Zhu Z, Wang K, Yu Q, Zhang W, Wu G, Sun Y, Xia Z. Aspartate transaminase/alanine transaminase (De Ritis ratio) predicts survival in major burn patients. Burns 2022; 48:872-879. [PMID: 34456097 DOI: 10.1016/j.burns.2021.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although treatment of burn patients has significantly improved in recent decades, major burns remain fatal. Therefore, the evaluation of the death risk of the patients with extensive burns is very important. The ratio between the serum levels of aspartate transaminase and alanine transaminase (De Ritis ratio) was an independent predictor of poor outcomes in patients with acute ischemic stroke, cardiac surgery, non-metastatic renal cell carcinoma, and upper urinary tract urothelial carcinoma. Our aim was to determine whether the ratio between the serum levels of AST and ALT (De Ritis ratio) was useful to assess prognosis in extensively burned patients. METHODS We conducted a single-center cohort study at the Burns Department of Changhai Hospital. This retrospective observational analysis was performed based on the clinical data of major burn patients admitted between May 1, 2005 and April 30, 2018. Univariate and multivariate logistic regression analyses were performed on variables such as age, sex, total body surface area (TBSA), De Ritis ratio, and serum albumin level, which may affect mortality in major burn patients. We assessed their diagnostic value and found the cut-off value by receiver operative characteristic (ROC) curve analysis. We used the Kaplan-Meier curve to display the impact of the De Ritis ratio and serum albumin level on survival in burn patients. RESULTS A total of 351 patients with extensive burns were included in the study. The cohort predominantly consisted of males (74.64%), and most of the patients (78.35%) had been burned by a flame. Age, TBSA, inhalation, and the De Ritis ratio were found to be independent risk factors for the 30-days mortality of major burn patients, while age, TBSA, inhalation, and the De Ritis ratio were independent risk factors for 90-day mortality. Further, the De Ritis ratio was a better mortality predictor than serum albumin in severely burned patients, whose area under ROC for 30-day and 90-day mortality was 0.771 (95% confidence intervals [CI], 0.708-0.835) and 0.750 (95% CI, 0.683, 0.818). CONCLUSIONS The De Ritis ratio was useful as a prognostic indicator for major burn patients, which can be conveniently obtained through blood examination. Regardless of whether the prediction was for 30-day or 90-day mortality, the accuracy remained high. Moreover, compared to serum albumin level, the De Ritis ratio was superior in assessing the prognosis of extensively burned patients.
Collapse
Affiliation(s)
- Baoli Wang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China; Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai 200433, People's Republic of China; Department of Burns and Plastic Surgery, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan 430070, People's Republic of China.
| | - Lunyang Hu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China; Department of Critical Care Medicine, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, People's Republic of China.
| | - Yukun Chen
- Department of Medical Imaging, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, People's Republic of China.
| | - Banghui Zhu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.
| | - Weishi Kong
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.
| | - Zhe Zhu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.
| | - Kangan Wang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.
| | - Qing Yu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.
| | - Wei Zhang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.
| | - Guosheng Wu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China; Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai 200433, People's Republic of China.
| | - Yu Sun
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China; Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai 200433, People's Republic of China.
| | - Zhaofan Xia
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China; Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai 200433, People's Republic of China.
| |
Collapse
|
6
|
Discussion: A Systematic Review and Meta-Analysis of Extracorporeal Membrane Oxygenation in Patients with Burns. Plast Reconstr Surg 2022; 149:1191e-1192e. [PMID: 35613290 DOI: 10.1097/prs.0000000000009150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Chiu YJ, Huang YC, Chen TW, King YA, Ma H. A Systematic Review and Meta-Analysis of Extracorporeal Membrane Oxygenation in Patients with Burns. Plast Reconstr Surg 2022; 149:1181e-1190e. [PMID: 35426867 PMCID: PMC9150852 DOI: 10.1097/prs.0000000000009149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Severely burned patients are at high risk for cardiopulmonary failure. Promising studies have stimulated interest in using extracorporeal membrane oxygenation as a potential therapy for burn patients with refractory cardiac and/or respiratory failure. However, the findings from previous studies vary. METHODS In this study, the authors conducted a systematic review and meta-analysis using standardized mortality ratios to elucidate the benefits associated with the use of extracorporeal membrane oxygenation in patients with burn and/or inhalation injuries. A literature search was performed, and clinical outcomes in the selected studies were compared. RESULTS The meta-analysis found that the observed mortality was significantly higher than the predicted mortality in patients receiving extracorporeal membrane oxygenation (standardized mortality ratio, 2.07; 95 percent CI, 1.04 to 4.14). However, the subgroup of burn patients with inhalation injuries had lower mortality rates compared to their predicted mortality rates (standardized mortality ratio, 0.95; 95 percent CI, 0.52 to 1.73). Other subgroup analyses reported no benefits from extracorporeal membrane oxygenation; however, these results were not statistically significant. Interestingly, the pooled standardized mortality ratio values decreased as the selected patients' revised Baux scores increased (R = -0.92), indicating that the potential benefits from the treatment increased as the severity of patients with burns increased. CONCLUSIONS The authors' meta-analysis revealed that burn patients receiving extracorporeal membrane oxygenation treatment were at a higher risk of death. However, select patients, including those with inhalation injuries and those with revised Baux scores over 90, would benefit from the treatment. The authors suggest that burn patients with inhalation injuries or with revised Baux scores exceeding 90 should be considered for the treatment and early transfer to an extracorporeal membrane oxygenation center.
Collapse
Affiliation(s)
- Yu-Jen Chiu
- From the Divisions of Plastic and Reconstructive Surgery and Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, and Institute of Clinical Medicine, National Yang Ming Chiao Tung University; Department of Dermatology and Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, and Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University; Department of Dermatology, Taipei Medical University-Shuang Ho Hospital; and Department of Surgery, National Defense Medical Center
| | - Yu-Chen Huang
- From the Divisions of Plastic and Reconstructive Surgery and Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, and Institute of Clinical Medicine, National Yang Ming Chiao Tung University; Department of Dermatology and Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, and Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University; Department of Dermatology, Taipei Medical University-Shuang Ho Hospital; and Department of Surgery, National Defense Medical Center
| | - Tai-Wei Chen
- From the Divisions of Plastic and Reconstructive Surgery and Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, and Institute of Clinical Medicine, National Yang Ming Chiao Tung University; Department of Dermatology and Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, and Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University; Department of Dermatology, Taipei Medical University-Shuang Ho Hospital; and Department of Surgery, National Defense Medical Center
| | - Yih-An King
- From the Divisions of Plastic and Reconstructive Surgery and Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, and Institute of Clinical Medicine, National Yang Ming Chiao Tung University; Department of Dermatology and Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, and Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University; Department of Dermatology, Taipei Medical University-Shuang Ho Hospital; and Department of Surgery, National Defense Medical Center
| | - Hsu Ma
- From the Divisions of Plastic and Reconstructive Surgery and Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital; Department of Surgery, School of Medicine, and Institute of Clinical Medicine, National Yang Ming Chiao Tung University; Department of Dermatology and Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, and Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University; Department of Dermatology, Taipei Medical University-Shuang Ho Hospital; and Department of Surgery, National Defense Medical Center
| |
Collapse
|
8
|
Care of the Critically Injured Burn Patient. Ann Am Thorac Soc 2022; 19:880-889. [PMID: 35507538 DOI: 10.1513/annalsats.202110-1099cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Care of the critically injured burn patient presents unique challenges to the intensivist. Certified burn centers are rare and geographically sparse, necessitating that much of the initial management of patients with severe burn injuries must happen in the pre-burn center setting.1 Severe burn injuries often lead to a wide range of complications that extend beyond the loss of skin integrity and require specialized care. As such, medical intensivists are often called upon to stabilize these critically injured patients. This focused review outlines the clinical care of these medically complex patients, including airway management, post-burn complications, volume resuscitation, nutrition, and end-of-life care.
Collapse
|
9
|
Zhang JX, Ahmed SN, Pangli H, Papp A. Predicting and Estimating Burn Outcomes: An Institutional Analysis of 4622 cases. J Burn Care Res 2022; 43:1426-1433. [PMID: 35481479 DOI: 10.1093/jbcr/irac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Advances in burn care have improved patient outcomes, and independently validated indices and predictors of burn outcomes warrant re-evaluation. The purpose of this study is to consolidate predictors of burn outcomes and determine the factors that significantly contribute to length-of-stay (LOS) and mortality. A retrospective review was conducted of all burn patients (n=5778) admitted to a quaternary provincial burn unit from 1973 to 2017. Our inclusion criteria yielded 4622 independent cases. Multivariate linear and logistic regression models were generated, and area-under-receiver-operator-curve (AUROC) analysis was performed. Burn predictors included %TBSA, Baux (classic and revised) index, Abbreviated Burn Severity Index (ABSI), and Ryan score. Primary outcomes were mortality and LOS. Multivariate logistic regression for mortality showed the Baux index to be the best predictor for mortality (OR=1.11, p<0.001). The AUROC for Baux index was 0.95. With regards to LOS, ABSI was the best predictor for LOS (p<0.001). ICU stay, ventilator use, alcoholism, age, significantly associated with increased LOS. Interestingly, hypertension had a protective effect for LOS (p<0.01) and trended towards a protective effect in mortality. Lethal score 50% (LS50) improved over the study period. The regressions show that burn mortality and LOS are best predicted with the Baux index and ABSI, respectively. Hypertension may have a protective effect on burn outcomes and may be attributed to increased perfusion to the periphery. These predictive scores are useful in determining institutional outcomes in burn surgery. Objective benchmarking of improvement in burn care outcomes can be established using LS50 trends.
Collapse
Affiliation(s)
- Jacques X Zhang
- Division of Plastic Surgery, Department of Surgery, University of British Columbia
| | - S Nafeel Ahmed
- Faculty of Medicine, Department of Surgery, University of British Columbia
| | - Harpreet Pangli
- Division of Plastic Surgery, Department of Surgery, University of British Columbia
| | - Anthony Papp
- Division of Plastic Surgery, Department of Surgery, University of British Columbia
| |
Collapse
|
10
|
Lin JC, Wu GH, Zheng JJ, Chen ZH, Chen XD. Prognostic Values of Platelet Distribution Width and Platelet Distribution Width-to-Platelet Ratio in Severe Burns. Shock 2022; 57:494-500. [PMID: 34812187 PMCID: PMC8906250 DOI: 10.1097/shk.0000000000001890] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Platelet distribution width (PDW) and PDW-to-platelet ratio (PPR) have been proven to be good prognostic indicators for many diseases. However, their prognostic values in severe burns have not been reported. OBJECTIVE To investigate the early time course of PDW and PPR in severe burn patients and investigate their prognostic values. METHODS This is a 16-year, single-center retrospective study of 590 severe burn patients. The complete blood count parameters on day 1, day 3, and day 7 postburn, including PDW and PPR, were collected. Receiver operating characteristic curves (ROC) analysis, multiple logistic regression analysis and Kaplan-Meier survival analysis were performed to evaluate the prognostic values of PDW and PPR in severe burn patients. RESULTS According to 120-day follow-up records, 96 patients were nonsurvivors and 494 patients were survivors. ROC and area under the curve (AUC) analysis showed that, for predicting 120-day prognosis, the AUC of PDW (0.782) and PPR (0.816) on day 3 was the highest, followed by the AUC of PDW (0.764) and PPR (0.750) on day 7. The ROC-AUC of PPR (0.816) on day 3 was very close to that of the ABSI score (0.818). Multiple logistic regression analysis showed that the PDW (P = 0.033 and P = 0.009) and PPR (P = 0.052 and P = 0.046) on day 3 and day 7 were all significantly independently positively associated with 120-day mortality. Kaplan-Meier survival analysis showed that high PDW and PPR were both significantly associated with a high 120-day mortality rate on day 3 and day 7. CONCLUSION PDW and PPR on day 3 and day 7 were independent risk factors for 120-day mortality in severe burn patients. These objective and readily available prognostic indicators may be more clinically favored.
Collapse
Affiliation(s)
- Jian-Chang Lin
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
| | | | | | | | | |
Collapse
|
11
|
Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia. Afr J Emerg Med 2021; 11:331-334. [PMID: 34141527 PMCID: PMC8187157 DOI: 10.1016/j.afjem.2021.04.005] [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] [Received: 08/02/2020] [Revised: 03/14/2021] [Accepted: 04/20/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction The purpose of this study was to explore and compare the performance of four burn injury scoring systems in Indonesia. In a retrospective study, data of all burn patients admitted to the emergency centre (EC) were collected. The following clinical outcome and four burn injury scoring systems were used to assess each patient: Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, and revised Baux Score. Methods From April 2017 to April 2018, clinical outcome and burn injury score for every admitted patient were calculated to evaluate burn prognosis. Demographic information, ABSI score, full-thickness total body surface area (TBSA), overall TBSA, hospital stay, and inhalation injury were noted for analysis. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer–Lemeshow tests. Results We included 72 patients (mean age: 40.79 ± 16.30 years, average TBSA: 23.59% ± 24.84). Only 1 (1.4%) of them was diagnosed with inhalation injury. Mortality rate was 25%. Deceased patients had significantly higher mean age, %TBSA, and number of inhalation injuries. The ABSI model with sensitivity was 81.6, specificity was 92.5, accuracy was 87.3 and under the Receiver Operator Characteristics curve (AUC) was 0.93 (SE = 0.03). Conclusions The best estimation of predicted mortality was obtained with the ABSI model.
Collapse
|
12
|
Stefani K, Wagstaff MJD, Damkat I, Greenwood JE. Mortality data 2004-2019: an audit of the Royal Adelaide Hospital Adult Burn Service. ANZ J Surg 2020; 91:77-82. [PMID: 33135870 DOI: 10.1111/ans.16349] [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: 06/25/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Burns are complex, multifaceted injuries that can pose significant challenges to the treating team. The Royal Adelaide Hospital (RAH) Burns Service has undergone a major evolution over the past two decades, with perceived improvement in outcomes. We present here a longitudinal audit of the RAH Burns Service Mortality Data between 2004 and 2019. METHODS An audit was conducted of all index admissions to the RAH Burns Unit from 1 January 2004 to 31 December 2019. Age at admission, total body surface area, burn depth, presence of inhalation injury and outcome were recorded. Baux and revised Baux Scores were calculated. Lethal Area 50% for different time points and age groups, Baux50/100 and Revised Baux50/100 values were then calculated using logistical regression. RESULTS During 2004-2019, there were 5653 index admissions to the RAH Burns Unit. The mean total body surface area of burn injuries admitted was 5.1% and the survival rate was 99.17%. The Lethal Area 50% for the study period was 74%, with an improvement from 70% (2004-2011) to 80% (2012-2019). The Baux50 score for the time period was 120 and the Revised Baux50 was 129. CONCLUSION The RAH results are comparable with other high-income country Burn Services and demonstrated significant improvement across the study period. The data also highlight areas for ongoing focus such as the elderly burns patient.
Collapse
Affiliation(s)
- Kristian Stefani
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Marcus J D Wagstaff
- Adult Burn Service and Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ivo Damkat
- Strategic Analyst, Department of Education, SA Government, Adelaide, South Australia, Australia
| | - John E Greenwood
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
13
|
Bartels P, Thamm OC, Elrod J, Fuchs P, Reinshagen K, German Burn Registry, Koenigs I. The ABSI is dead, long live the ABSI - reliable prediction of survival in burns with a modified Abbreviated Burn Severity Index. Burns 2020; 46:1272-1279. [DOI: 10.1016/j.burns.2020.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/15/2020] [Accepted: 05/11/2020] [Indexed: 01/23/2023]
|
14
|
Wallace RG, Kenealy MR, Brady AJ, Twomey L, Duffy E, Degryse B, Caballero-Lima D, Moyna NM, Custaud MA, Meade-Murphy G, Morrin A, Murphy RP. Development of dynamic cell and organotypic skin models, for the investigation of a novel visco-elastic burns treatment using molecular and cellular approaches. Burns 2020; 46:1585-1602. [PMID: 32475797 DOI: 10.1016/j.burns.2020.04.036] [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: 02/05/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Burn injuries are a major cause of morbidity and mortality worldwide. Despite advances in therapeutic strategies for the management of patients with severe burns, the sequelae are pathophysiologically profound, up to the systemic and metabolic levels. Management of patients with a severe burn injury is a long-term, complex process, with treatment dependent on the degree and location of the burn and total body surface area (TBSA) affected. In adverse conditions with limited resources, efficient triage, stabilisation, and rapid transfer to a specialised intensive care burn centre is necessary to provide optimal outcomes. This initial lag time and the form of primary treatment initiated, from injury to specialist care, is crucial for the burn patient. This study aims to investigate the efficacy of a novel visco-elastic burn dressing with a proprietary bio-stimulatory marine mineral complex (MXC) as a primary care treatment to initiate a healthy healing process prior to specialist care. METHODS A new versatile emergency burn dressing saturated in a >90% translucent water-based, sterile, oil-free gel and carrying a unique bio-stimulatory marine mineral complex (MXC) was developed. This dressing was tested using LabSkin as a burn model platform. LabSkin a novel cellular 3D-dermal organotypic full thickness human skin equivalent, incorporating fully-differentiated dermal and epidermal components that functionally models skin. Cell and molecular analysis was carried out by in vitro Real-Time Cellular Analysis (RTCA), thermal analysis, and focused transcriptomic array profiling for quantitative gene expression analysis, interrogating both wound healing and fibrosis/scarring molecular pathways. In vivo analysis was also performed to assess the bio-mechanical and physiological effects of this novel dressing on human skin. RESULTS This hybrid emergency burn dressing (EBD) with MXC was hypoallergenic, and improved the barrier function of skin resulting in increased hydration up to 24 h. It was demonstrated to effectively initiate cooling upon application, limiting the continuous burn effect and preventing local tissue from damage and necrosis. xCELLigence RTCA® on primary human dermal cells (keratinocyte, fibroblast and micro-vascular endothelial) demonstrated improved cellular function with respect to tensegrity, migration, proliferation and cell-cell contact (barrier formation) [1]. Quantitative gene profiling supported the physiological and cellular function finding. A beneficial quid pro quo regulation of genes involved in wound healing and fibrosis formation was observed at 24 and 48 h time points. CONCLUSION Utilisation of this EBD + MXC as a primary treatment is an effective and easily applicable treatment in cases of burn injury, proving both a cooling and hydrating environment for the wound. It regulates inflammation and promotes healing in preparation for specialised secondary burn wound management. Moreover, it promotes a healthy remodelling phenotype that may potentially mitigate scarring. Based on our findings, this EBD + MXC is ideal for use in all pre-hospital, pre-surgical and resource limited settings.
Collapse
Affiliation(s)
- Robert G Wallace
- Center for Preventive Medicine, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland
| | - Mary-Rose Kenealy
- Center for Preventive Medicine, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland
| | - Aidan J Brady
- Center for Preventive Medicine, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland
| | - Laura Twomey
- Center for Preventive Medicine, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland; Technological University Dublin, Ireland
| | - Emer Duffy
- School of Chemical Sciences, Dublin City University, Dublin 9, Ireland
| | - Bernard Degryse
- Center for Preventive Medicine, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland; Integrative Cell & Molecular Physiology Group, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland
| | | | - Niall M Moyna
- Center for Preventive Medicine, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland
| | | | | | - Aoife Morrin
- School of Chemical Sciences, Dublin City University, Dublin 9, Ireland
| | - Ronan P Murphy
- Center for Preventive Medicine, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland; Integrative Cell & Molecular Physiology Group, School of Health & Human Performance, Dublin City University, Dublin 9, Ireland.
| |
Collapse
|
15
|
den Hollander D, Albertyn R, Amber J. Palliation, end-of-life care and burns; concepts, decision-making and communication - A narrative review. Afr J Emerg Med 2020; 10:95-98. [PMID: 32612916 PMCID: PMC7320205 DOI: 10.1016/j.afjem.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 12/03/2022] Open
Abstract
Palliative care is the turn from cure as the priority of care to symptom relief and comfort care. Although very little is published in the burn literature on palliative care, guidelines can be gleaned from the general literature on palliative care, particularly for acute surgical and critical care patients. Palliative care may be started because of futility, on request of the patient, or because of limited resources. The SPIKES acronym is a useful guide to avoid errors in communication with terminal patients and their relatives.
Collapse
Affiliation(s)
- Daan den Hollander
- Burns Unit Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Department of Surgery, University of KwaZulu Natal, South Africa
| | - Rene Albertyn
- Red Cross Memorial Children's Hospital, South Africa
| | - Julia Amber
- Palliative Care Practitioner, Department of Pediatrics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| |
Collapse
|
16
|
Ogura A, Tsurumi A, Que YA, Almpani M, Zheng H, Tompkins RG, Ryan CM, Rahme LG. Associations between clinical characteristics and the development of multiple organ failure after severe burns in adult patients. Burns 2019; 45:1775-1782. [PMID: 31690472 DOI: 10.1016/j.burns.2019.02.014] [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: 05/24/2018] [Revised: 01/07/2019] [Accepted: 02/14/2019] [Indexed: 11/24/2022]
Abstract
To determine the association between potential risk factors and multiple organ failure (MOF) in severe burn adult patients, we performed a secondary analysis of data from the "Inflammation and the Host Response to Injury" database, which included patients from six burn centers in the United States between 2003 and 2009. Three hundred twenty-two adult patients (aged ≥16 years) with severe burns (≥20.0% total body surface area [TBSA]) were included. MOF was defined according to the Denver score. Potential risk factors were analyzed for their association with MOF. Models were built using multivariable logistic regression analysis. Eighty-eight patients (27.3%) developed MOF during the study period. We found that TBSA, age, and inhalation injury were significant risk factors for MOF. This predictive model showed good performance, with the total area under the receiver operating characteristic curve being 0.823. Moreover, among patients who developed MOF, inhalation injury was significantly associated with the development of MOF in the acute phase (within three days of injury) (adjusted odds ratio 3.1; 95% confidence interval 1.1-8.3). TBSA, age, lactate, and Denver score within 24h were associated with the late phase development of MOF. Thus, we have identified key risk factors for the onset of MOF after severe burn injury. Our findings contribute to the understanding of individualized treatment and will potentially allow for efficient allocation of resources and a lower threshold for admission to an intensive care unit, which can prevent the development of MOF and eventually reduce mortality.
Collapse
Affiliation(s)
- Asako Ogura
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA
| | - Amy Tsurumi
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA; Shriners Hospitals for Children, 51 Blossom St., Boston, MA 02114, USA
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Marianna Almpani
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA; Shriners Hospitals for Children, 51 Blossom St., Boston, MA 02114, USA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, and Harvard Medical School, 50 Staniford St., Boston, MA 02114, USA
| | - Ronald G Tompkins
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA; Shriners Hospitals for Children, 51 Blossom St., Boston, MA 02114, USA
| | - Laurence G Rahme
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA; Shriners Hospitals for Children, 51 Blossom St., Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA 02114, USA.
| |
Collapse
|
17
|
Initiales klinisches Management des Brandverletzten. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Kim Y, Kym D, Hur J, Jeon J, Yoon J, Yim H, Cho YS, Chun W. Development of a risk prediction model (Hangang) and comparison with clinical severity scores in burn patients. PLoS One 2019; 14:e0211075. [PMID: 30726241 PMCID: PMC6364897 DOI: 10.1371/journal.pone.0211075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/05/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to develop a new prediction model to reflect the risk of mortality and severity of disease and to evaluate the ability of the developed model to predict mortality among adult burn patients. METHODS This study included 2009 patients aged more than 18 years who were admitted to the intensive care unit (ICU) within 24 hours after a burn. We divided the patients into two groups; those admitted from January 2007 to December 2013 were included in the derivation group and those admitted from January 2014 to September 2017 were included in the validation group. Shrinkage methods with 10-folds cross-validation were performed to identify variables and limit overfitting of the model. The discrimination was analyzed using the area under the curve (AUC) of the receiver operating characteristic curve. The Brier score, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were also calculated. The calibration was analyzed using the Hosmer-Lemeshow goodness-of-fit test (HL test). The clinical usefulness was evaluated using a decision-curve analysis. RESULTS The Hangang model showed good calibration with the HL test (χ2 = 8.785, p = 0.361); the highest AUC and the lowest Brier score were 0.943 and 0.068, respectively. The NRI and IDI were 0.124 (p-value = 0.003) and 0.079 (p-value <0.001) when compared with FLAMES, respectively. CONCLUSIONS This model reflects the current risk factors of mortality among adult burn patients. Furthermore, it was a highly discriminatory and well-calibrated model for the prediction of mortality in this cohort.
Collapse
Affiliation(s)
- Youngmin Kim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea
| | - Dohern Kym
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea
- * E-mail:
| | - Jun Hur
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea
| | - Jinwoo Jeon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea
| | - Jaechul Yoon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea
| | - Haejun Yim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea
| | - Yong Suk Cho
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea
| | - Wook Chun
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea
| |
Collapse
|
19
|
Botelho Filho FM, Marçal IM, Roa L, Marinho AG, Ruiz GZL, Lopes LMC, Brenck LF, Campos JL, Rabelo LMM, Chaves TV, Dias LSB, Santos APR, Tolentino LB, Alonso N. Análise da eficiência de uma rede de urgência para tratamento de múltiplos queimados. Rev Col Bras Cir 2019; 46:e2115. [DOI: 10.1590/0100-6991e-20192115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/27/2019] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: avaliar a eficácia da estratégia adotada e a qualidade do atendimento em trauma pediátrico na sobrevivência dos pacientes atendidos após desastre em uma cidade do interior de Minas Gerais, em comparação a resultados esperados por estudos sobre mortalidade infantil em grandes queimados. Métodos: análise retrospectiva observacional de dez pacientes que sofreram queimaduras e foram transferidos para um centro de referência de trauma. Utilizou-se o escore de R-Baux modificado para estimar a mortalidade esperada. Comparou-se a mortalidade esperada a partir do escore de R-Baux e a mortalidade real, a partir do teste de uma proporção. Comparou-se, também, tempo de admissão pós-trauma com mortalidade e grau de superfície corporal queimada com mortalidade. Resultados: o R-Baux médio foi de 75,2, o que significa uma mortalidade esperada para grandes queimados de 5%. No entanto, a mortalidade do grupo com grande área de superfície corporal queimada desse estudo foi de 60%, valor p=0,001. Observou-se neste caso uma mortalidade muito além da esperada pela literatura. Conclusão: apesar das inúmeras variáveis, aventa-se a hipótese de infraestrutura de atendimento em trauma pediátrico aquém da necessária no Estado. Este estudo sugere maior incentivo à políticas públicas para atendimento de trauma pediátrico, centro de referência preparado, acordos de transferência bem estabelecidos e otimização de planos de catástrofe para diminuição da morbimortalidade para os pacientes que sobrevivem à primeira hora após o trauma.
Collapse
|
20
|
Rakkolainen I, Lindbohm JV, Vuola J. Factors associated with acute kidney injury in the Helsinki Burn Centre in 2006-2015. Scand J Trauma Resusc Emerg Med 2018; 26:105. [PMID: 30545389 PMCID: PMC6293617 DOI: 10.1186/s13049-018-0573-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication in severe burns and can lead to significantly poorer outcomes. Although the prognosis has improved in recent decades, the mortality of AKI remains considerable. We investigated the factors that increase the risk of AKI and death after severe burn injury. METHODS Intensive care patients with ≥20% burned total body surface area (TBSA%) between January 2006 and December 2015 treated in Helsinki Burn Centre were enrolled retrospectively. Patients who arrived > 36 h after burn injury or died < 48 h from arrival were excluded. A total of 187 patients were included in the final analysis. Serum creatinine ≥120 μmol/l (1.4 mg/dl) was the criterion for AKI. RESULTS Fifty-one patients (27.3%) developed AKI during hospital stay and 21 (11.2%) required renal replacement therapy (RRT); 37 patients (19.8%) died during hospital stay. Mortality was significantly higher in the AKI group (52.9%) than in the AKI-negative group (7.4%). The Abbreviated Burn Severity Index (ABSI), Baux, and the modified Baux score were nearly equivalent in predicting mortality during ICU stay (AUC: 0.83-0.84). The risk of death and AKI were minimal with Baux scores < 80. LD50 was 112 for Baux score in all patients. In flame burns, the risk of death increased rapidly after Baux score > 80. Multivariate logistic regression model detected age, TBSA%, sepsis, and rhabdomyolysis as independent risk factors for AKI. Age (per 10 yrs. OR 1.99), TBSA% (per 10% OR 1.64), and AKI predicted mortality during hospital stay; AKI had an odds ratio of (OR) of 5.97 (95% confidence interval [CI] 2.2-16.2). CONCLUSIONS Age, TBSA%, and AKI were the strongest independent factors in predicting outcome in severe burns. Even a major burn (> 50% TBSA) has a relatively good prognosis without simultaneous AKI. Prognosis is poorer even in minor burns for patients with AKI.
Collapse
Affiliation(s)
- I Rakkolainen
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, PO. Box 800, FI-00029 HUS, Helsinki, Finland.
| | - J V Lindbohm
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Vuola
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, PO. Box 800, FI-00029 HUS, Helsinki, Finland
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Cato LD, Wearn CM, Bishop JR, Stone MJ, Harrison P, Moiemen N. Platelet count: A predictor of sepsis and mortality in severe burns. Burns 2018; 44:288-297. [DOI: 10.1016/j.burns.2017.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/20/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022]
|
23
|
Dhopte A, Bamal R, Tiwari VK. A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India. BURNS & TRAUMA 2017; 5:30. [PMID: 28944226 PMCID: PMC5606015 DOI: 10.1186/s41038-017-0095-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/23/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND None of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demographic and clinical risk factors for mortality in pediatric burns in an effort to decrease the mortality in these patients. METHODS A prospective analytical study was conducted in patients up to the age of 18 years admitted for burn injuries in a tertiary care burn center in India from January to December 2014. Clinical and demographic data was collected through questionnaire-interview and patient follow-up during their stay in the hospital. Univariate and multivariate firth logistic regression was used to identify various risk factors for mortality in pediatric burns. RESULTS A total of 475 patients were admitted during the study period. Overall mortality was 31.3% (n = 149) in this study. Mean age of the patients who died was 8.68 years. Of the 149 deaths, 74 were males and 75 were females (male to female ratio = 0.98). Mean total body surface area (TBSA) involved of the patients who expired was 62%. Inhalational injury was seen in 15.5% (n = 74) of pediatric burn admissions. Mortality was significantly higher (74.3%) in patients with inhalation injury. Mortality was highest in patients with isolates of Acinetobacter + Klebsiella (58.3%), followed by Pseudomonas + Klebsiella (53.3%), Acinetobacter (31.5%), and Pseudomonas (26.3%) (p < 0.0005). Factors found to be significant on univariate firth analysis were older age, female gender, suicidal burns, higher TBSA, presence of inhalation injury, increased depth of burn, and positive microbial cultures. On multivariate analysis, higher TBSA was identified as an independent risk factor for mortality. The adjusted odds ratios for TBSA involvement was 21.706 (25.1-50%), 136.195 (50.1-75%), and 1019.436 (75.1-100%), respectively. CONCLUSION TBSA is the most important factor predicting mortality in pediatric burns. The higher the TBSA, the higher is the risk of mortality. Other significant risk factors for mortality are female gender, deeper burns, positive wound cultures, and inhalation injury. Risk of mortality was significantly lower in children who belonged to urban areas, nuclear family, who sustained burn injury in the last quarter of the year, and who stayed in the hospital for longer period.
Collapse
Affiliation(s)
- Amol Dhopte
- Department of Plastic, Reconstructive and Maxillofacial surgery, Government Medical College and Hospital, Nagpur, 440003 India
| | - Rahul Bamal
- Department of Burns, Plastic and Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, India
| | - Vinay Kumar Tiwari
- Department of Burns and Plastic Surgery, PGIMER & RML Hospital, New Delhi, India
| |
Collapse
|
24
|
Tsurumi A, Que YA, Ryan CM, Tompkins RG, Rahme LG. TNF-α/IL-10 Ratio Correlates with Burn Severity and May Serve as a Risk Predictor of Increased Susceptibility to Infections. Front Public Health 2016; 4:216. [PMID: 27761434 PMCID: PMC5050217 DOI: 10.3389/fpubh.2016.00216] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/16/2016] [Indexed: 11/13/2022] Open
Abstract
Severe burn injury renders patients susceptible to multiple infection episodes; however, identifying specific patient groups at high risk remains challenging. Burn-induced inflammatory response dramatically modifies the levels of various cytokines. Whether these changes could predict susceptibility to infections remains unknown. The aim of this study was to determine the early changes in the pro- to anti-inflammatory cytokine ratio and investigate its ability to predict susceptibility to repeated infections after severe burn trauma. The patient population consisted of 34 adult patients having early (≤48 h since injury) blood draws following severe (≥20% total burn surface area (TBSA)) burn injury and suffering from a first infection episode at least 1 day after blood collection. Plasma TNF-α and IL-10 levels were measured to explore the association between the TNF-α/IL-10 ratio, hypersusceptibility to infections, burn size (TBSA), and common severity scores (Acute Physiology and Chronic Health Evaluation II (APACHEII), Baux, modified Baux (R-Baux), Ryan Score, and Abbreviated Burn Severity Index (ABSI)). TNF-α/IL10 plasma ratio measured shortly after burn trauma was inversely correlated with burn size and the injury severity scores investigated, and was predictive of repeated infections (≥3 infection episodes) outcome (AUROC [95%CI] of 0.80 [0.63-0.93]). Early measures of circulating TNF-α/IL10 ratio may be a previously unidentified biomarker associated with burn injury severity and predictive of the risk of hypersusceptibility to repeated infections.
Collapse
Affiliation(s)
- Amy Tsurumi
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Microbiology and Immunology, Harvard Medical School, Boston, MA, USA; Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Ronald G Tompkins
- Department of Surgery, Massachusetts General Hospital , Boston, MA , USA
| | - Laurence G Rahme
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Microbiology and Immunology, Harvard Medical School, Boston, MA, USA; Shriners Hospitals for Children-Boston®, Boston, MA, USA
| |
Collapse
|
25
|
Epidemiology and outcomes of pediatric burns over 35 years at Parkland Hospital. Burns 2016; 42:202-208. [DOI: 10.1016/j.burns.2015.10.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/27/2015] [Accepted: 10/07/2015] [Indexed: 11/21/2022]
|