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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.
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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
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Yeh CC, Lin YS, Chen CC, Liu CF. Implementing AI Models for Prognostic Predictions in High-Risk Burn Patients. Diagnostics (Basel) 2023; 13:2984. [PMID: 37761351 PMCID: PMC10528558 DOI: 10.3390/diagnostics13182984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Burn injuries range from minor medical issues to severe, life-threatening conditions. The severity and location of the burn dictate its treatment; while minor burns might be treatable at home, severe burns necessitate medical intervention, sometimes in specialized burn centers with extended follow-up care. This study aims to leverage artificial intelligence (AI)/machine learning (ML) to forecast potential adverse effects in burn patients. METHODS This retrospective analysis considered burn patients admitted to Chi Mei Medical Center from 2010 to 2019. The study employed 14 features, comprising supplementary information like prior comorbidities and laboratory results, for building models for predicting graft surgery, a prolonged hospital stay, and overall adverse effects. Overall, 70% of the data set trained the AI models, with the remaining 30% reserved for testing. Three ML algorithms of random forest, LightGBM, and logistic regression were employed with evaluation metrics of accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). RESULTS In this research, out of 224 patients assessed, the random forest model yielded the highest AUC for predictions related to prolonged hospital stays (>14 days) at 81.1%, followed by the XGBoost (79.9%) and LightGBM (79.5%) models. Besides, the random forest model of the need for a skin graft showed the highest AUC (78.8%), while the random forest model and XGBoost model of the occurrence of adverse complications both demonstrated the highest AUC (87.2%) as well. Based on the best models with the highest AUC values, an AI prediction system is designed and integrated into hospital information systems to assist physicians in the decision-making process. CONCLUSIONS AI techniques showcased exceptional capabilities for predicting a prolonged hospital stay, the need for a skin graft, and the occurrence of overall adverse complications for burn patients. The insights from our study fuel optimism for the inception of a novel predictive model that can seamlessly meld with hospital information systems, enhancing clinical decisions and bolstering physician-patient dialogues.
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Affiliation(s)
- Chin-Choon Yeh
- Department of Plastic Surgery, Chi Mei Medical Center, Tainan 711, Taiwan; (C.-C.Y.); (Y.-S.L.); (C.-C.C.)
| | - Yu-San Lin
- Department of Plastic Surgery, Chi Mei Medical Center, Tainan 711, Taiwan; (C.-C.Y.); (Y.-S.L.); (C.-C.C.)
| | - Chun-Chia Chen
- Department of Plastic Surgery, Chi Mei Medical Center, Tainan 711, Taiwan; (C.-C.Y.); (Y.-S.L.); (C.-C.C.)
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan 711, Taiwan
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Dang J, Goel P, Choi KJ, Massenzio E, Landau MJ, Pham CH, Huang S, Yenikomshian HA, Spellberg B, Gillenwater TJ. Mucormycosis following burn injuries: A systematic review. Burns 2023; 49:15-25. [PMID: 35842270 DOI: 10.1016/j.burns.2022.05.012] [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: 04/08/2021] [Revised: 09/16/2021] [Accepted: 05/09/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Mucormycosis is an opportunistic fungal infection with a high mortality rate. Though typically associated with diabetes and other conditions that affect innate immune function, infections can also be precipitated by conditions such as trauma and burns. Burn patients are particularly susceptible to fungal infections due to the immune dysfunction that often accompany their wounds. Indeed case series have described mucormycosis to occur in patients with burn injuries, however the factors contributing to mortality have not been well described. Thus, the purpose of our review was to identify factors contributing to morbidity and mortality in burn patients with Mucormycosis. METHODS A systematic review of the literature of mucormycosis infection in burn injury patients was performed on Pubmed and Google Scholar using the keywords: Mucor, Mucorales, Mucormycosis, Mucormycotina, Zygomycosis and burn or thermal injury. Clinical trials, observational studies, case reports, and case reviews were included if they provided information regarding mortality in adult and pediatric burn patients diagnosed with mucormycosis, review articles, non-English articles, and articles without patient information were excluded. No time limit was placed on our review. Individual patient data was stratified based on mortality. Statistical analysis was performed to investigate the relationship between patient risk factors and mortality, and the Oxford Level of Evidence was used to evaluate study quality. RESULTS 46 articles were included in our final review, encompassing 114 patients. On average, survivors had a total body surface area (TBSA)% of 46 (SD 19.8) while non-survivors had a TBSA of 65% (SD 16.4), and this difference was significant (p < .001). Patients with disseminated mucormycosis experienced an 80% mortality rate compared to 36% mortality rate in patients with localized disease (p < .001). We found no statistically significant difference in mean age (p > .05), diabetes (p > .05), mean delay in diagnosis (p > .05), time to antifungal therapy (p > .05), or type of therapy used (p > .05) between survivors and non-survivors. Our review was limited by the lack of prospective, controlled trials; thus, our review primarily consists of case reports. CONCLUSION Disseminated infections and higher TBSA both increased the risk of mortality in burn patients with mucormycosis, while diabetes did not increase mortality risk. The severity of the initial injury and infection locations must be taken into consideration to inform patient prognosis.
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Affiliation(s)
- Justin Dang
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Pedram Goel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Katherine J Choi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Erik Massenzio
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Mark J Landau
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Christopher H Pham
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Samantha Huang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, United States
| | - Brad Spellberg
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, United States; Division of Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, United States.
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Risk Models to Predict Mortality in Burn Patients: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open 2022; 10:e4694. [PMID: 36569241 PMCID: PMC9760622 DOI: 10.1097/gox.0000000000004694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/06/2022] [Indexed: 12/23/2022]
Abstract
The predictive capability of various risk assessment models (RAMs) in evaluating the risk of mortality in burn patients is not well established. It is also unclear which RAM provides the highest discriminative ability and presents the highest clinical utility. We pooled all available studies to establish this validity and compare the predictive capability of the various RAMs. Methods We reviewed PubMed, MEDLINE, and Embase from their inception up until December 2021 for studies evaluating risk of mortality in burn patients as stratified by RAMs. Data were pooled using random-effect models and presented as area under the receiver operating characteristic (AUROC) curve. Results Thirty-four studies, comprising of a total of 98,610 patients, were included in our analysis. Most studies were found to have a low risk of bias and a good measure of applicability. Nine RAMs were evaluated. We discovered that the classic Baux; the revised Baux; and the Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex (FLAMES) scores presented with the highest discriminative power with there being no significant difference between the results presented by them [AUROCs (95% CI), 0.92 (0.90-0.95), 0.92 (0.90-0.93), 0.94 (0.91-0.97), respectively, with P < 0.00001 for all]. Conclusions Many RAMs exist with no consensus on the optimal model to utilize and assess risk of mortality for burn patients. This study is the first systematic review and meta-analysis to compare the current RAMs' discriminative ability to predict mortality in patients with burn injuries. This meta-analysis demonstrated that RAMs designed for assessing mortality in individuals with burns have acceptable to great discriminative capacity, with the classic Baux, revised Baux, and FLAMES demonstrating superior discriminative performance in predicting death. FLAMES exhibited the highest discriminative ability among the RAMs studied.
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Lam NN, Hung NT, Duc NM. Prognosis value of revised Baux score among burn patients in developing country. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2021; 11:197-201. [PMID: 34336385 PMCID: PMC8310867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/06/2021] [Indexed: 06/13/2023]
Abstract
The aims of this study was to determine prognosis value of revised Baux score for burn patients in developing country. A retrospective study was conducted on all burn hospitalized patients at National Burn Hospital, Hanoi, Viet Nam during a period from 01/1/2015 to 31/12/2019. Collected criteria included age, burn extent, inhalation injury, death or survive, Baux and revised Baux score of each patients. AUC and SMR was compared between two scores. Prognosis value of revised Baux score was also classified according to age groups. The results showed that AUC of revided Baux score was significantly higher than that of Baux score (0.96 vs. 0.95; p=0.001). SMR of revised Baux score was closer to 1 than that of Baux score (1.03 vs. 1.14 respectively). For revised Baux score, AUC was highest in adult patients (0.98±0.01) followed by elderly and pediatric patients. In addition, SMR was 0.99 in adult group, 0.77 in elderly patient and was 4.36 in pediatric patients. In conclusion, the revised Baux score is more accurate than the Baux score but should only be recommended to apply in prognosis for adult and elderly burn patients in developing country.
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Affiliation(s)
- Nguyen N Lam
- National Burn HospitalHanoi, Viet Nam
- Medical Military UniversityHanoi, Viet Nam
| | | | - Ngo M Duc
- National Burn HospitalHanoi, Viet Nam
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Hu L, Wang B, Jiang Y, Zhu B, Wang C, Yu Q, Hou W, Xia Z, Wu G, Sun Y. Risk Factors for Transfusion-Related Acute Lung Injury. Respir Care 2021; 66:1029-1038. [PMID: 33774597 DOI: 10.4187/respcare.08829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Until now, transfusion-related acute lung injury (TRALI) has been considered the leading cause of blood transfusion-related diseases and death. In addition, there is no clinically effective treatment plan for TRALI. The aim of this study was to systematically summarize the literature on risk factors for TRALI in critical patients. METHODS Electronic searches (up to March 2020) were performed in the Cochrane Library, Web of Knowledge, Embase, and PubMed databases. We included studies reporting on the risk factors of TRALI for critical patients and extracted risk factors. A total of 13 studies met the inclusion criteria. RESULTS We summarized and analyzed the potential risk factors of TRALI for critical patients in 13 existing studies. Host-related factors were age (odds ratio [OR] 1.16 [95% CI 1.08-1.24]), female sex (OR 1.26 [95% CI 1.16-1.38]), tobacco use status (OR 3.82 [95% CI 1.91-7.65]), chronic alcohol abuse (OR 3.82 [95% CI 2.97-26.83]), positive fluid balance (OR 1.24 [95% CI 1.08-1.42]), shock before transfusion (OR 4.41 [95% CI 2.38-8.20]), and American Society of Anesthesiologists (ASA) score of the recipients (OR 2.72 [95% CI 1.43-5.16]). The transfusion-related factors were the number of transfusions (OR 1.40 [95% CI 1.14-1.72]) and units of fresh frozen plasma (OR 1.21 [95% CI 1.01-1.46]). The device-related factor was mechanical ventilation (OR 4.13 [95% CI 2.20-7.76]). CONCLUSIONS The risk factors that were positively correlated with TRALI in this study included number of transfusions and units of fresh frozen plasma. Age, female sex, tobacco use, chronic alcohol abuse, positive fluid balance, shock before transfusion, ASA score, and mechanical ventilation may be potential risk factors for TRALI. Our results suggest that host-related risk factors may play a more important role in the occurrence and development of TRALI than risk factors related to blood transfusions.
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Affiliation(s)
- Lunyang Hu
- Department of Burn Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Baoli Wang
- Department of Burn Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Yong Jiang
- Department of Burn Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Banghui Zhu
- Department of Burn Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Chen Wang
- Department of Burn Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Qing Yu
- Department of Burn Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Wenjia Hou
- Department of Burn Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Zhaofan Xia
- Burn and Trauma Center, Changhai Hospital, Shanghai, People's Republic of China.
| | - Guosheng Wu
- Burn and Trauma Center, Changhai Hospital, Shanghai, People's Republic of China
| | - Yu Sun
- Burn and Trauma Center, Changhai Hospital, Shanghai, People's Republic of China
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Fractional CO 2 laser treatment for burn scar improvement: A systematic review and meta-analysis. Burns 2020; 47:259-269. [PMID: 33288326 DOI: 10.1016/j.burns.2020.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022]
Abstract
Burn injury can cause abnormal healing and pathologic scar formation that significantly impairs patients' ability to return to baseline levels of functioning. Quality of life can be significantly diminished due to pain, stiffness, contracture, and the psychological burden of disfigurement. Traditional scar therapies such as silicone sheeting and compression garments are highly reliant on patient compliance, and have not demonstrated satisfactory efficacy. Even more invasive therapies such as intralesional medication delivery or surgical contracture release have high recurrence rates. Recently, fractional CO2 laser therapy has emerged as a promising treatment modality for burn scars, but there is a lack of recent studies that aggregates extant data to demonstrate outcomes after laser therapy. To address this, we conducted a systematic review and meta-analysis to determine the efficacy of fractional CO2 lasers in treating burn scars, and found that laser therapy alone yielded statistically significant improvements in scar profiles. There were very few reports of adverse effects, most treatments were provided as outpatient, and both patient and burn practitioners reported high satisfaction. By sharing our findings, we hope that more burn practitioners will consider adopting laser therapy as a safe and cost-effective first-line therapy for burn scar management.
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