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Pompermaier L, Steinvall I, Elmasry M, Eladany MM, Abdelrahman I, Fredrikson M, Sjöberg F. Long-term mortality after self-inflicted burns. Burns 2024; 50:252-261. [PMID: 37805374 DOI: 10.1016/j.burns.2023.09.015] [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: 04/13/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Those with self-inflicted burns are a small but consistent group among burn patients, with large injuries and conflicting findings regarding their in-hospital mortality. Overall, burn survivors have a shorter life expectancy, as compared with national controls, but long-term mortality after self-inflicted burns is understudied. The aim of this retrospective study was to investigate possible differences in long-term mortality among survivors after self-inflicted and accidental burns. METHODS All adult patients with burns admitted at the Linköping Burn Centre and discharged alive between 2000 and 2017 were included, and end of follow up was April 26, 2021. Those with unknown survival status at that time were excluded. A Cox proportional hazards regression model, adjusted for age and sex, was used to analyse long term mortality. RESULTS Among the 930 patients included in this study, 37 had self-inflicted burns. Overall, median follow up period was 8.8 years and crude mortality was 24.7%. After adjustment for age and sex, self-inflicted burns were independently associated with long-term mortality, Hazard Ratio= 2.08 (95% CI 1.13-3.83). Post hoc analysis showed that the effect was most pronounced during the first years after discharge although it was noticeable over the whole study period. CONCLUSION Long-term risk of mortality after discharge from a burn centre was higher in patients with self-inflicted burns than in patients with accidental burns. The effect was noticeable over the whole study period although it was most pronounced during the first years after discharge.
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Affiliation(s)
- Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden.
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Mostafa M Eladany
- Department of Anesthesiology & Intensive Care, Faculty of Medicine, Suez Canal University, Egypt
| | - Islam Abdelrahman
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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2
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Bayuo J, Agbeko AE, Wong AKC, Wong FKY, Baafi EO, Baffour PK, Naw HE, Agbenorku P. Global epidemiology of geriatric burns, capacities of care, and injury outcomes: Perspectives from the World Health Organization global burn registry. Burns 2023; 49:1796-1807. [PMID: 37945508 DOI: 10.1016/j.burns.2023.09.020] [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: 07/03/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND An increasing aging population alongside a potentially increasing injury risk emphasizes a critical need for evidence-based burn care regarding preventive and therapeutic strategies tailored to the unique needs of older adults. However, we note a critical gap in understanding geriatric burn trends on a global scale and the care capacity across settings. Thus, this study sought to ascertain the global trend of geriatric burns with a focus on patient demographics, injury characteristics, capacities of care, and injury outcomes. METHODS A retrospective design focusing on older adults aged ≥ 60 years with burns recorded in the World Health Organization Global Burn Registry as of 31st May 2023 was employed. Descriptive statistics were employed to analyze the data. RESULTS Of the 9277 records obtained from the Global Burn Registry, 849 participants (9.2%) were aged ≥ 60 years with the majority of these reported from the Eastern Mediterranean (EMRO) and Southeast Asia (SEARO) regions. More females than males were involved in burn injuries with the most common aetiological factor being flame. Most burns occurred in the home/ domestic setting with a seasonal variation (more injuries occurred in December and January). In terms of burn care capacity, the data suggest the availability of specialized services in most settings albeit the AFRO and SEARO regions still lacked the resources to offer specialized burn care. While most injured older adults were discharged home with no physical impairment (395, 46.5%), a substantial number died (250, 29.4%) during hospitalization, particularly in the African (AFRO) region and 111 (11.1%) left the facility against medical advice with the majority from the SEARO region (88). CONCLUSION Burn injuries in older adults remain a public health issue. On the preventive aspect, the results demonstrate a need to intensify safety in the home or domestic setting, and during festive seasons. Therapeutically, the findings underscore a need to consider the inclusion of more specialist geriatric and palliative care services in the burn management process. Additionally, we identified a need to strengthen burn care capacity in the AFRO and SEARO regions.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong; Department of Nursing, Presbyterian University, Ghana.
| | | | | | | | | | | | - Hser Eh Naw
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Pius Agbenorku
- Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Ghana
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3
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Chen WH, Ye HF, Wu YX, Dai WT, Ling XW, Zhao S, Lin C. Association of creatinine-albumin ratio with 28-day mortality in major burned patients: A retrospective cohort study. Burns 2023; 49:1614-1620. [PMID: 37211475 DOI: 10.1016/j.burns.2023.04.002] [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: 09/26/2022] [Revised: 03/08/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Serum creatinine (Cr) and Albumin (Alb) have emerged as prognostic factors for mortality in many diseases including burned patients. However, few studies report the relationship between Cr/Alb ratio and major burned patients. The purpose of this study is to make evaluation of efficacy of Cr/Alb ratio in predicting 28-day mortality in major burned patients. METHOD Based on a local largest tertiary hospital in South of China, we retrospectively analyzed data of 174 patients with total burn area surface (TBSA) ≥ 30% from January 2010 to December 2022. Receiver operating characteristic curve (ROC), logistic analysis, and Kaplan-Meier analysis were performed to evaluate the association between Cr/Alb ratio and 28-day mortality. Integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were used to estimate the improvements in new model performance. RESULTS 28-day mortality rate was 13.2% (23/174) in burned patients. Cr/Alb on admission at level of 3.340μmol/g showed the best discrimination between survivors and non-survivors after admission at 28 days. The result of multivariate logistic analysis suggested that age (OR, 1.058 [95%CI 1.016-1.102]; p = 0.006), higher FTSA (OR, 1.036 [95%CI 1.010-1.062]; p = 0.006), and higher level of Cr/Alb ratio (OR, 6.923 [95CI% 1.743-27.498]; p = 0.006) were independently associated with 28 day-mortality. A regression model was constructed by logit(p) = 0.057 *Age + 0.035 *FTBA + 1.935 * Cr/Alb - 6.822. The model showed a better discrimination and risk reclassification compared with ABSI and rBaux score. CONCLUSIONS High Cr/Alb ratio at admission is a herald of poor outcome. The model generated from multivariate analysis could serve as an alternative prediction tool among major burned patients.
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Affiliation(s)
- Wei-Hao Chen
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Yu-Xuan Wu
- Wenzhou Medical University, Wenzhou, China
| | - Wen-Tong Dai
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang-Wei Ling
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sheng Zhao
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cai Lin
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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4
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Atkins K, Schneider A, Rodriguez C, Gallaher J, Charles A. The predictive probability of mortality in the presence of full-thickness burns. Am J Surg 2023; 225:793-799. [PMID: 36266136 DOI: 10.1016/j.amjsurg.2022.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Prognostication of burn injury mortality is challenging. Recent mortality prognostication tools have incorporated the percent of full-thickness surface area (FTSA). We hypothesize that the presence of full-thickness burn injury independently increases in-hospital mortality. METHODS We performed a retrospective review of the National Trauma Data Bank (NTDB) from 2007 to 2019 of adults (≥16 years old) with burn injuries. Variables evaluated included basic demographics, presence of inhalation injury, percent TBSA, and percent FTSA burned. The primary outcome was in-hospital mortality. We performed modified Poisson regression modeling adjusting for significant variables to estimate the relative mortality risk. RESULTS 75,816 patients met inclusion criteria. When controlling for TBSA, the presence of a full-thickness burn had a relative risk of in-hospital mortality of 1.42 (95% CI 1.09-1.85, p = 0.008). The predicted probability of mortality was 100% at 50% FTSA. CONCLUSION The presence of full-thickness burns and the proportion of full-thickness burns independently and significantly increased in-hospital mortality. Therefore, clinicians should utilize prognostication models incorporating percent full-thickness burn area to predict mortality more accurately.
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Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Christian Rodriguez
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, United States.
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Bagheri M, Fuchs PC, Lefering R, Daniels M, Schulz A, The German Burn Registry, Schiefer JL. The BUrn Mortality Prediction (BUMP) Score - An improved mortality prediction score based on data of the German burn registry. Burns 2023; 49:110-119. [PMID: 35210139 DOI: 10.1016/j.burns.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Burn injuries constitute the fourth most common injuries globally. Patient outcomes must be currently assessed to provide appropriate patient care with high quality standards. However, existing mortality prediction scoring methods have been shown to lack accuracy in current burn patient populations. Therefore, this study aimed to validate existing scores using current patient data and assess whether new prediction parameters can provide better accuracy. METHODS A retrospective analysis of the patient data from the German Burn Registry between 2016 and 2019 was performed to evaluate all Abbreviated Burn Severity Index (ABSI) score parameters. All patients over 16 years of age who received intensive care were included. Descriptive statistics and logistic regression analysis were used to identify novel prediction parameters based on the parameters documented at admission and establish a new prediction score, the BUrn Mortality Prediction (BUMP) score. The quality of the new score was subsequently compared to that of the original ABSI, modified ABSI, Galeiras, Revised Baux score and TIMM. The new prediction score was then validated using patient data collected in the German Burn Registry in 2020. RESULTS In total, 7276 patients were included. Age; the presence of at least two comorbidities; burn injuries caused by work-related accidents, traffic accidents and suicide attempts; total burn surface area; inhalation trauma and full-thickness burns were identified as independent significant predictors of mortality (p < 0.001). Additionally, we evaluated new age groups to improve prediction accuracy. The number of comorbidities (p < 0.001) and the aetiology (burns occurring at work [p = 0.028], burns caused by traffic accidents [p < 0.001] or burns due to attempted suicide [p < 0.001]) had a significant influence on mortality. The BUMP score, which was developed based on these parameters, showed the best fitness and showed more accurate mortality prediction than all the above-mentioned scores (area under the receiver operating characteristic curve: 0.947 [0.939-0.954] compared to 0.926 [0.915-0.936], 0.928 [0.918-0.939], 0.937 [0.928-0.947], 0.939 [0.930-0.948], 0.940 [0.932-0.949] respectively). CONCLUSIONS A novel score (BUMP score) was developed for the purpose of external quality assessment of burn centres participating in the German burn registry, where observed and expected outcomes are compared on a hospital level, and for scientifically applications. The clinical impact of this score and its generalisability to other patient populations needs to be evaluated.
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Affiliation(s)
- M Bagheri
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - P C Fuchs
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Cologne, Germany
| | - M Daniels
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - A Schulz
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - The German Burn Registry
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - J L Schiefer
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany.
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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.
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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
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7
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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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Tracy LM, Reeder S, Gold M, Cleland HJ. Burn Care Specialists' Views Toward End-of-Life Decision-Making in Patients With Severe Burn Injury: Findings From an Online Survey in Australia and New Zealand. J Burn Care Res 2022; 43:1322-1328. [PMID: 35255498 PMCID: PMC9629441 DOI: 10.1093/jbcr/irac030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn care clinicians are required to make critical decisions regarding the withholding and withdrawal of treatment in patients with severe and potentially non-survivable burn injuries. Little is known about how Australian and New Zealand burn care specialists approach decision-making for these patients. This study aimed to understand clinician beliefs, values, considerations, and difficulties regarding palliative and end-of-life (EoL) care discussions and decision-making following severe burn injury in Australian and New Zealand burn services. An online survey collected respondent and institutional demographic data as well as information about training and involvement in palliative care/EoL decision-making discussions from nurses, surgeons, and intensivists in Australian and New Zealand hospitals with specialist burn services. Twenty-nine burns nurses, 26 burns surgeons, and 15 intensivists completed the survey. Respondents were predominantly female (64%) and had a median of 15 years of experience in treating burn patients. All respondents received little training in EoL decision-making during their undergraduate education; intensivists reported receiving more on-the-job training. Specialist clinicians differed on who they felt should contribute to EoL discussions. Ninety percent of respondents reported injury severity as a key factor in their decision-making to withhold or withdraw treatment, but less than half reported considering age in their decision-making. Approximately two-thirds indicated a high probability of death or a poor predicted quality of life influenced their decision-making. The three cohorts of clinicians had similar views toward certain aspects of EoL decision-making. Qualitative research could provide detailed insights into the varying perspectives held by clinicians.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Michelle Gold
- Palliative Care Service, Alfred Health, Melbourne, VIC, Australia
| | - Heather J Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
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Lu P, Burrell A, Bailey M, Moore E, Pilcher D, Cleland H. Performance of BEAMS risk of death score for mortality prediction in Australian and New Zealand burns patients. J Burn Care Res 2022; 43:1434-1439. [PMID: 35460563 DOI: 10.1093/jbcr/irac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The BEAMS (Burns Evaluation And Mortality Study) risk of death score was developed in 2013 as a mortality prediction tool for burns patients admitted to an ICU (Intensive Care Unit) in Australia and New Zealand. While it previously performed well, identifying high risk groups and allowing benchmarking, over time such scores may lose calibration or be superseded by improved scoring systems. Our aim was to assess the performance of the BEAMS score in a modern cohort of burns patient. Data was sourced from the Burns Registry of Australia and New Zealand (BRANZ) and the Australia New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) databases. Data was linked using probabilistic methodology. BEAMS risk of death scores was calculated for all adult patients. Between 2009 and 2019, there were 2075 patients admitted to an Australian or New Zealand ICU with a burns related injury. Advanced age, female gender, higher %TBSA burns and inhalation injury were all associated with increased rate of mortality (p<0.05). Overall hospital mortality was 9.4% (n=195). The predicted risk of death from BEAMS was 8.7% and the score had an area under the receiver operating characteristic curve of 0.934. We found the BEAMS Risk of Death score continues to have excellent performance in a modern cohort of adult critically ill burns patients. It remains a valid tool for mortality prediction among adult burns patients admitted to ICU across Australia and New Zealand.
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Affiliation(s)
- Patrick Lu
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Aidan Burrell
- Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edwina Moore
- Department of Endocrine Surgery, Peninsula Private Hospital, Frankston, Victoria, Australia.,Department of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resources Evaluation, Camberwell, Victoria, Australia
| | - Heather Cleland
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia
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Mehta K, Arega H, Smith NL, Li K, Gause E, Lee J, Stewart B. Gender-based disparities in burn injuries, care and outcomes: A World Health Organization (WHO) Global Burn Registry cohort study. Am J Surg 2022; 223:157-163. [PMID: 34330521 PMCID: PMC8688305 DOI: 10.1016/j.amjsurg.2021.07.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/14/2021] [Accepted: 07/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to describe the gender-based disparities in burn injury patterns, care received, and mortality across national income levels. METHODS In the WHO Global Burn Registry (GBR), we compared patient demographics, injury characteristics, care and outcomes by sex using Chi-square statistics. Logistic regression was used to identify the associations of patient sex with surgical treatment and in-hospital mortality. RESULTS Among 6431 burn patients (38 % female; 62 % male), females less frequently received surgical treatment during index hospitalization (49 % vs 56 %, p < 0.001), and more frequently died in-hospital (26 % vs 16 %, p < 0.001) than males. Odds of in in-hospital death was 2.16 (95 % CI: 1.73-2.71) times higher among females compared to males in middle-income countries. CONCLUSIONS Across national income levels, there appears to be important gender-based disparities among burn injury epidemiology, treatment received and outcomes that require redress. Multinational registries can be utilized to track and to evaluate initiatives to reduce gender disparities at national, regional and global levels.
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Affiliation(s)
- Kajal Mehta
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Hana Arega
- School of Public Health, University of Washington, Seattle, WA, USA
| | | | - Kathleen Li
- Krieger School of Arts & Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Emma Gause
- Harborview Injury Prevention & Research Center, Seattle, WA, USA
| | - Joohee Lee
- Public Health Concern Trust-Nepal, Kathmandu, Nepal
| | - Barclay Stewart
- Harborview Injury Prevention & Research Center, Seattle, WA, USA; Department of Surgery, University of Washington, Seattle, WA, USA
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Robledo Cadavid JM, Salgado Flórez L, Garcés Echeverri JC, Ruiz Santacruz JE, Hernandez Ortiz OH. Characterization of severely burned patients and evaluation of factors associated to mortality. An observational retrospective cohort study in San Vicente Fundación Hospital. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211046464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Burns are common in developing countries and place a large burden on the medical and social care systems. However, information about management and outcomes from such countries is scarce. The purpose of this study was to analyze the epidemiology and main factors related to the mortality in severely burned patients at the Hospital Universitario San Vicente Fundación in Medellín, Colombia. Methods An observational retrospective cohort study was conducted. To establish prognostic factors associated with mortality, we analyzed variables such as age, sex, burned surface, and degree of burn, among others. Demographic, clinic, and management features as well as complications and factors associated with mortality were analyzed using logistic regression. Results 4516 clinical histories were reviewed, 225 were included in the study. 76.9% were men, with a median age of 35 years; 64.9% were fire burns. The median burned body surface area was 42%. There were inhalation injuries in 135 patients and ocular in 106 patients. The main complication was infection followed by rhabdomyolysis. The overall hospital stay was 27 days, and the median length of stay at the intensive care unit was 7 days with in-hospital mortality of 30.7%. The variables associated with mortality were age, burned body surface area, degree of burn, and kidney injury. Surgical intervention was protective. Conclusions Severely burned patients in our hospital have similar outcomes and, in some cases, better outcomes than those reported in the literature in countries with similar characteristics, and we have seen that in the last years, there has been a better experience in the management of these patients. Elderly, extension, and depth of burnt tissue are markers of poor outcomes. Early surgery and intubation have shown better outcomes, probably due to infection control and removal of necrotic tissue, airway management, and ventilatory support for metabolic and hemodynamic derangement.
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Sharma S, Tandon R. Predicting Burn Mortality Using a Simple Novel Prediction Model. Indian J Plast Surg 2021; 54:46-52. [PMID: 33814741 PMCID: PMC8012794 DOI: 10.1055/s-0040-1721867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background
Prediction of outcome for burn patients allows appropriate allocation of resources and prognostication. There is a paucity of simple to use burn-specific mortality prediction models which consider both endogenous and exogenous factors. Our objective was to create such a model.
Methods
A prospective observational study was performed on consecutive eligible consenting burns patients. Demographic data, total burn surface area (TBSA), results of complete blood count, kidney function test, and arterial blood gas analysis were collected. The quantitative variables were compared using the unpaired student
t
-test/nonparametric Mann Whitney U-test. Qualitative variables were compared using the ⊠2-test/Fischer exact test. Binary logistic regression analysis was done and a logit score was derived and simplified. The discrimination of these models was tested using the receiver operating characteristic curve; calibration was checked using the Hosmer—Lemeshow goodness of fit statistic, and the probability of death calculated. Validation was done using the bootstrapping technique in 5,000 samples. A
p
-value of <0.05 was considered significant.
Results
On univariate analysis TBSA (
p
<0.001) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (
p
= 0.004) were found to be independent predictors of mortality. TBSA (odds ratio [OR] 1.094, 95% confidence interval [CI] 1.037–1.155,
p
= 0.001) and APACHE II (OR 1.166, 95% CI 1.034–1.313,
p
= 0.012) retained significance on binary logistic regression analysis. The prediction model devised performed well (area under the receiver operating characteristic 0.778, 95% CI 0.681–0.875).
Conclusion
The prediction of mortality can be done accurately at the bedside using TBSA and APACHE II score.
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Affiliation(s)
- Sneha Sharma
- Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Raman Tandon
- Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Treatment of Anaemia in Patients with Acute Burn Injury: A Study of Blood Transfusion Practices. J Clin Med 2021; 10:jcm10030476. [PMID: 33514060 PMCID: PMC7865424 DOI: 10.3390/jcm10030476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: To determine blood transfusion practices, risk factors, and outcomes associated with the use of blood products in the setting of the acute management of burn patients at the Victorian Adult Burn Service. Background: Patients with burn injuries have variable transfusion requirements, based on a multitude of factors. We reviewed all acute admissions to the Victorian Adult Burns Service (VABS) between 2011 and 2017: 1636 patients in total, of whom 948 had surgery and were the focus of our analysis. Method and results: Patient demographics, surgical management, transfusion details, and outcome parameters were collected and analyzed. A total of 175 patients out of the 948 who had surgery also had a blood transfusion, while 52% of transfusions occurred in the perioperative period. The median trigger haemoglobin in perioperative was 80mg/dL (IQR = 76–84.9 mg/dL), and in the non-perioperative setting was 77 mg/dL (IQR = 71.61–80.84 mg/dL). Age, gender, % total body surface area (TBSA) burn, number of surgeries, and intensive care unit and hospital length of stay were associated with transfusion. Conclusions: The use of blood transfusions is an essential component of the surgical management of major burns. As observed in our study, half of these transfusions are related to surgical procedures and may be influenced by the employment of blood conserving strategies. Furthermore, transfusion trigger levels in stable patients may be amenable to review and reduction. Risk adjusted analysis can support the implementation of blood transfusion as a useful quality indicator in burn care.
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14
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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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15
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Holley A, Cohen J, Reade M, Laupland KB, Lipman J. New guidelines for the management of severe thermal burns in the acute phase in adults and children: Is it time for a global surviving burn injury campaign (SBIC)? Anaesth Crit Care Pain Med 2020; 39:195-196. [PMID: 32253125 DOI: 10.1016/j.accpm.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Anthony Holley
- Royal Brisbane and Women's Hospital, Butterfield street, QLD 4029 Herston, Australia; The University of Queensland, QLD 4072 Saint-Lucia, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, QLD 4029 Herston, Australia; Australian Defence Force, Canberra, Australia.
| | - Jeremy Cohen
- Royal Brisbane and Women's Hospital, Butterfield street, QLD 4029 Herston, Australia; The University of Queensland, QLD 4072 Saint-Lucia, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, QLD 4029 Herston, Australia
| | - Michael Reade
- Royal Brisbane and Women's Hospital, Butterfield street, QLD 4029 Herston, Australia; The University of Queensland, QLD 4072 Saint-Lucia, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, QLD 4029 Herston, Australia; Australian Defence Force, Canberra, Australia
| | - Kevin B Laupland
- Royal Brisbane and Women's Hospital, Butterfield street, QLD 4029 Herston, Australia; Queensland University of Technology, 2, George street, QLD 4000 Brisbane City, Australia
| | - Jeffrey Lipman
- Royal Brisbane and Women's Hospital, Butterfield street, QLD 4029 Herston, Australia; The University of Queensland, QLD 4072 Saint-Lucia, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, QLD 4029 Herston, Australia; Nîmes University Hospital, University of Montpellier, Nîmes, France
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16
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Prevalence and prognostic impact of inhalation injury among burn patients: A systematic review and meta-analysis. J Trauma Acute Care Surg 2020; 88:330-344. [PMID: 31688831 DOI: 10.1097/ta.0000000000002523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of our study was to perform a systematic review and meta-analysis aimed at assessing the prevalence of inhalation injury in burn patients and its prognostic value in relation to in-hospital mortality. METHODS We searched the PubMed and EMBASE databases for noninterventional studies published between 1990 and 2018 investigating in-hospital mortality predictors among burn patients.The primary meta-analysis evaluated the association between inhalation injury and mortality. A secondary meta-analysis determined the global estimate of the prevalence of inhalation injury and the rate of mortality. Random effects models were used, and univariate meta-regressions were used to assess sources of heterogeneity. This study is registered in the PROSPERO database with code CRD42019127356. FINDINGS Fifty-four studies including a total of 408,157 patients were selected for the analysis. A pooled inhalation prevalence of 15.7% (95% confidence interval, 13.4%-18.3%) was calculated.The summarized odds ratio of in-hospital mortality secondary to an inhalation injury was 3.2 (95% confidence interval, 2.5-4.3). A significantly higher odd of mortality was found among the studies that included all hospitalized burn patients, those that included a lower proportion of male patients, those with a lower mean total body surface area, and those with a lower prevalence of inhalation injury. CONCLUSION Despite our study's limitations due to the high risk of bias and the interstudy heterogeneity of some of our analyses, our results revealed a wide range of prevalence rates of inhalation injury and a significant association between this entity and in-hospital mortality in burn patients. However, this association is not significant if adjusted for disease severity. LEVEL OF EVIDENCE Systematic review/meta-analysis, level III.
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17
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Spronk I, Van Loey NEE, Sewalt C, Nieboer D, Renneberg B, Moi AL, Oster C, Orwelius L, van Baar ME, Polinder S. Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis. PLoS One 2020; 15:e0226653. [PMID: 31923272 PMCID: PMC6953837 DOI: 10.1371/journal.pone.0226653] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background A prominent outcome measure within burn care is health related quality of life (HRQL). Until now, no model for long-term recovery of HRQL exists for adult burn patients which requires large samples with repeated measurements. Re-use and the combination of existing data is a way to achieve larger data samples that enable the estimation of long-term recovery models. The aim of this secondary data analysis was to assess the recovery of HRQL after a burn injury over time. Methods and findings Data from ten European studies on generic HRQL assessed in adult burn patients (either with the EQ-5D or SF-36) from five different countries were merged into one dataset. SF-36 outcomes were transformed into EQ-5D outcomes. A 24-month recovery of HRQL (EQ-5D utility) was modeled using a linear mixed-effects model and adjusted for important patient and burn characteristics. Subgroups of patients with mild and intermediate burns (≤20% total body surface area (TBSA) burned) and with major burns (>20% TBSA burned) were compared. The combined database included 1687 patients with a mean age of 43 (SD 15) years and a median %TBSA burned of 9% (IQR 4–18). There was large improvement in HRQL up to six months after burns, and HRQL remained relatively stable afterwards (studied up to 24 months post burn). However, the estimated EQ-5D utility scores remained below the norm scores of the general population. In this large sample, females, patients with a long hospital stay and patients with major burns had a delayed and worse recovery. The proportion of patients that reported problems for the EQ-5D dimensions ranged from 100% (pain/discomfort at baseline in patients with major burns) to 10% (self-care ≥3 months after injury in patients with mild and intermediate burns). After 24 months, both subgroups of burn patients did not reach the level of the general population in the dimensions pain/discomfort and anxiety/depression, and patients with major burns in the dimension usual activities. A main limitation of the study includes that the variables in the model were limited to age, gender, %TBSA, LOS and time since burn as these were the only variables available in all datasets. Conclusions The 24-month recovery model can be used in clinical practice to inform patients on expected HRQL outcomes and provide clinicians insights into the expected recovery of HRQL. In this way, a delayed recovery can be recognized in an early stage and timely interventions can be started in order to improve patient outcomes. However, external validation of the developed model is needed before implementation into clinical practice. Furthermore, our study showed the benefit of secondary data usage within the field of burns.
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Affiliation(s)
- Inge Spronk
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, Netherlands
- * E-mail:
| | - Nancy E. E. Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands
- Utrecht University, Department Clinical Psychology, Utrecht, the Netherlands
| | - Charlie Sewalt
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Daan Nieboer
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Babette Renneberg
- Freie Universität Berlin, Department of Clinical Psychology and Psychotherapy, Berlin, Germany
| | - Asgjerd Litleré Moi
- Western Norway University of Applied Sciences, Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Bergen, Norway
- National Burn Centre, Haukeland University Hospital, Department of Plastic, Hand and Reconstructive Surgery, Bergen, Norway
| | - Caisa Oster
- Uppsala University, Department of Neuroscience, Psychiatry, Sweden
| | - Lotti Orwelius
- Linköping University, Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping, Sweden
| | - Margriet E. van Baar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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18
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Spronk I, Polinder S, van Loey NE, van der Vlies CH, Pijpe A, Haagsma JA, van Baar ME. Health related quality of life 5–7 years after minor and severe burn injuries: a multicentre cross-sectional study. Burns 2019; 45:1291-1299. [DOI: 10.1016/j.burns.2019.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
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19
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Gigengack RK, van Baar ME, Cleffken BI, Dokter J, van der Vlies CH. Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix. Burns 2019; 45:1057-1065. [PMID: 30837205 DOI: 10.1016/j.burns.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Mortality in burn intensive care unit (ICU) has been decreasing and treatment appears to be changing. The aims of this study: (1) examine outcome in burn patients, (2) examine changes in ICU indication and (3) explore the influence of a changing case-mix. METHODS Retrospective study in patients admitted to ICU (1987-2016). Four groups were specified: major burns (≥15% TBSA), inhalation injury with small injury (<15% TBSA, inhalation injury), watchful waiting (<15% TBSA, without inhalation injury), tender loving care (patients withheld from treatment). Logistic regression was performed to evaluate the relation between case-mix and outcome. RESULTS Overall mortality decreased to 7%. Mortality of major burns decreased by 15%. The major burn group decreased by 36%. The inhalation injury and watchful waiting group increased by 9% and 21%. The percentage of ventilated patients increased by 14% in the major burn group. 40% of patients were ventilated in the watchful waiting group. CONCLUSIONS After correction for case-mix, survival improved, mainly in the major burn group. Case-mix shifted towards inhalation injury and watchful waiting. Growth of the watchful waiting group is not necessarily harmful. However, the increase of mechanical ventilation could be. We suggest raising awareness for risks and consequences of mechanical ventilation.
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Affiliation(s)
- Rolf K Gigengack
- Department of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Department of Anesthesiology, Amsterdam UMC, Location VU Medical Center, Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Margriet E van Baar
- Association of Dutch Burn Centers, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Berry I Cleffken
- Department of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Department of Intensive Care Medicine, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands.
| | - Jan Dokter
- Department of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands.
| | - Cornelis H van der Vlies
- Department of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Association of Dutch Burn Centers, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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20
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Esechie A, Bhardwaj A, Masel T, Raji M. Neurocognitive sequela of burn injury in the elderly. J Clin Neurosci 2019; 59:1-5. [DOI: 10.1016/j.jocn.2018.10.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/24/2018] [Indexed: 11/25/2022]
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21
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Sadeghian F, Saeedi Moghaddam S, Saadat S, Niloofar P, Rezaei N, Amirzade-Iranaq MH, Mehdipour P, Abbaszadeh Kasbi A, Ghodsi Z, Mansouri A, Sharif-Alhoseini M, Jazayeri SB, Aryannejad A, Ehyaee V, Naghdi K, Derakhshan P, Moradi-Lakeh M, Mokdad AH, O'Reilly G, Rahimi-Movaghar V. The trend of burn mortality in Iran - A study of fire, heat and hot substance-related fatal injuries from 1990 to 2015. Burns 2018; 45:228-240. [PMID: 30274812 DOI: 10.1016/j.burns.2018.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/30/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Burn injuries are a major cause of preventable mortality worldwide. To implement preventive strategies, a detailed understanding of the rate and trend of fatal burn injuries is needed. The aim of this study was to determine the rate and trend of burn mortality at national and province level in Iran from 1990 to 2015. MATERIALS AND METHODS The data were retrieved from various sources: the Death Registration System, cemetery databases, the Demographic and Health Survey and three national population and housing censuses. ICD-10 codes were converted to Global Burden of Disease (GBD) codes for comparability. After addressing the incompleteness of death data, statistical methods such as spatio-temporal modelling and Gaussian Process Regression (GPR) were applied to estimate the levels and trend of death and cause specific mortality. RESULTS The number of deaths due to burning across Iran was 80,625, with a male to female ratio of 0.88, 0.94 and 1.14 in 1990, 1995 and 2015, respectively. The annual percentage change of age-standardized death rate from 1990 to 2015 was -5.42% and -4.22% in women and men, respectively. The burn-related age-standardized mortality rate decreased considerably from 5.97 in 1990 to 1.74 per 100,000 in 2015. The mortality rate due to burns was highest among those aged more than 85 years, especially in Ilam province. CONCLUSION This study showed a decline in burn mortality in Iran from 1990 to 2015. Continued efforts to reduce the burden of burns are needed to accelerate this progress and prevent injuries.
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Affiliation(s)
- Farideh Sadeghian
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastoo Niloofar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosein Amirzade-Iranaq
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anita Mansouri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behzad Jazayeri
- Department of Surgery, Kaiser Permanente, Fontana, CA, USA; Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Armin Aryannejad
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vida Ehyaee
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Derakhshan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, WA, USA
| | - Gerard O'Reilly
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Predictors of health-related quality of life after burn injuries: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:160. [PMID: 29898757 PMCID: PMC6000969 DOI: 10.1186/s13054-018-2071-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/17/2018] [Indexed: 01/08/2023]
Abstract
Background Identifying predictors of health-related quality of life (HRQL) following burns is essential for optimization of rehabilitation for burn survivors. This study aimed to systematically review predictors of HRQL in burn patients. Methods Medline, Embase, Web of Science, Cochrane, CINAHL, and Google Scholar were reviewed from inception to October 2016 for studies that investigated at least one predictor of HRQL after burns. The Quality in Prognostic Studies tool was used to assess risk of bias of included studies. Results Thirty-two studies were included. Severity of burns, postburn depression, post-traumatic stress symptoms, avoidance coping, less emotional or social support, higher levels of neuroticism, and unemployment postburn were found to predict a poorer HRQL after burns in multivariable analyses. In addition, weaker predictors included female gender, pain, and a postburn substance use disorder. Risk of bias was generally low in outcome measurement and high in study attrition and study confounding. Conclusions HRQL after burns is affected by the severity of burns and the psychological response to the trauma. Both constructs provide unique information and knowledge that are necessary for optimized rehabilitation. Therefore, both physical and psychological problems require attention months to years after the burn trauma. Electronic supplementary material The online version of this article (10.1186/s13054-018-2071-4) contains supplementary material, which is available to authorized users.
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23
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Toft-Petersen AP, Ferrando-Vivas P, Harrison DA, Dunn K, Rowan KM. The organisation of critical care for burn patients in the UK: epidemiology and comparison of mortality prediction models. Anaesthesia 2018; 73:1131-1140. [PMID: 29762869 DOI: 10.1111/anae.14319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 12/23/2022]
Abstract
In the UK, a network of specialist centres has been set up to provide critical care for burn patients. However, some burn patients are admitted to general intensive care units. Little is known about the casemix of these patients and how it compares with patients in specialist burn centres. It is not known whether burn-specific or generic risk prediction models perform better when applied to patients managed in intensive care units. We examined admissions for burns in the Case Mix Programme Database from April 2010 to March 2016. The casemix, activity and outcome in general and specialist burn intensive care units were compared and the fit of two burn-specific risk prediction models (revised Baux and Belgian Outcome in Burn Injury models) and one generic model (Intensive Care National Audit and Research Centre model) were compared. Patients in burn intensive care units had more extensive injuries compared with patients in general intensive care units (median (IQR [range]) burn surface area 16 (7-32 [0-98])% vs. 8 (1-18 [0-100])%, respectively) but in-hospital mortality was similar (22.8% vs. 19.0%, respectively). The discrimination and calibration of the generic Intensive Care National Audit and Research Centre model was superior to the revised Baux and Belgian Outcome in Burn Injury burn-specific models for patients managed on both specialist burn and general intensive care units.
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Affiliation(s)
- A P Toft-Petersen
- Departments of Clinical Medicine and Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.,Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - P Ferrando-Vivas
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - D A Harrison
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - K Dunn
- Adult Burn Service, University Hospital of South Manchester, Manchester, UK
| | - K M Rowan
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
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Aung MT, Garner D, Pacquola M, Rosenblum S, McClure J, Cleland H, Pilcher DV. The use of a simple three-level bronchoscopic assessment of inhalation injury to predict in-hospital mortality and duration of mechanical ventilation in patients with burns. Anaesth Intensive Care 2018; 46:67-73. [PMID: 29361258 DOI: 10.1177/0310057x1804600110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Major burn centres in Australia use bronchoscopy to assess severity of inhalation injuries despite limited evidence as to how best to classify severity of inhalational injury or its relationship to patient outcomes. All patients with burns who were admitted to the intensive care unit (ICU) at The Alfred Hospital between February 2010 and July 2014 and underwent bronchoscopy to assess inhalational injury, were reviewed. Age, total body surface area burnt, severity of illness indices and mechanisms of injury were extracted from medical histories and local ICU and burns registries. Inhalational injury was classified based on the Abbreviated Injury Score and then grouped into three categories (none/mild, moderate, or severe injury). Univariable and multivariable analyses were undertaken to examine the relationship between inhalational injury and outcomes (in-hospital mortality and duration of mechanical ventilation). One hundred and twenty-eight patients were classified as having none/mild inhalational injury, 81 moderate, and 13 severe inhalation injury. Mortality in each group was 2.3% (3/128), 7.4% (6/81) and 30.7% (4/13) respectively. Median (interquartile range) duration of mechanical ventilation in each group was 26 (11-82) hours, 84 (32-232) hours and 94 (21-146) hours respectively. After adjusting for age, total body surface area burnt and severity of illness, only the severe inhalation injury group was independently associated with increased mortality (odds ratio 20.4 [95% confidence intervals {CI} 1.74 to 239.4], <i>P</i>=0.016). Moderate inhalation injury was independently associated with increased duration of ventilation (odds ratio 2.25 [95% CI 1.53 to 3.31], <i>P</i> <0.001), but not increased mortality. This study suggests that stratification of bronchoscopically-assessed inhalational injury into three categories can provide useful prognostic information about duration of ventilation and mortality. Larger multicentre prospective studies are required to validate these findings.
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Affiliation(s)
| | | | | | | | | | - H Cleland
- Department of Surgery, Central and Eastern Clinical School, Monash University, Melbourne, Victoria
| | - D V Pilcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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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.
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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
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Clarey A, Trainor D. Critical care management of severe burns and inhalational injury. ANAESTHESIA & INTENSIVE CARE MEDICINE 2017. [DOI: 10.1016/j.mpaic.2017.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Epidemiology and Outcome of Patients With Burns Treated With Cerium Nitrate Silversulfadiazine. J Burn Care Res 2017; 38:e432-e442. [DOI: 10.1097/bcr.0000000000000448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gabbe BJ, Cleland H, Watterson D, Schrale R, McRae S, Taggart S, Darton A, Wood F, Edgar DW. Predictors of moderate to severe fatigue 12 months following admission to hospital for burn: Results from the Burns Registry of Australia and New Zealand (BRANZ) Long Term Outcomes project. Burns 2016; 42:1652-1661. [PMID: 28341091 DOI: 10.1016/j.burns.2016.08.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/23/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Fatigue has been identified as an outcome of concern following burn but is rarely captured in outcomes studies. We aimed to: (i) describe the prevalence, and predictors, of moderate to severe fatigue in the first 12 months following burn, and (ii) establish the association between fatigue and health-related quality of life and work outcomes. METHODS Adult burns patients, admitted >24h, were recruited from five BRANZ sites. Participants were followed-up at 1-, 6-, and 12-months after injury using the Brief Fatigue Inventory (BFI), 36-item Short Form Health Survey (SF-36) and the Sickness Impact Profile (SIP)-work scale. Moderate to severe fatigue was defined as a global BFI score of 4-10. Multivariable mixed effects regression modelling was used to identify demographic, socioeconomic, burn size and severity predictors of moderate/severe fatigue at follow-up. RESULTS The mean±SD age of the 328 participants was 42.1±16.7years, 70% were male, 47% were flame burns, and the mean±SD %TBSA was 8.7±11.2. The prevalence of moderate/severe fatigue decreased from 37% at 1-month, to 32% at 6-months and 26% at 12-months. The adjusted odds of moderate/severe fatigue were 2.62 (95% CI: 1.27, 5.42) times higher for women compared to men, and 2.64 (95% CI: 1.03, 6.79) times higher in patients with a %TBSA≥20. Compared to patients in major cities, the adjusted odds of reporting moderate/severe fatigue were 2.48 fold higher (95% CI: 1.17, 5.24) for patients residing in inner regional areas, and 3.60 fold (95% CI: 1.43, 9.05) higher for patients living in remote/very remote areas. At each time point, the physical and mental health summary scores, and each sub-scale score, of the SF-36 were significantly lower in patients reporting moderate/severe fatigue. Patients experiencing moderate to severe fatigue reported higher work-related disability on the SIP work scale at each time point after injury. DISCUSSION AND CONCLUSION More than a quarter of participants reported moderate to severe fatigue on the BFI at 12-months and fatigue was strongly associated with poorer health-related quality of life and greater work-related disability.
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Affiliation(s)
- Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Farr Institute, College of Medicine, Swansea University, Singleton Park, Swansea, Wales SA28PP, United Kingdom.
| | - Heather Cleland
- Victorian Adult Burns Service, The Alfred, Commercial Road, Melbourne 3004, Australia; Department of Surgery, Monash University, The Alfred Centre, Commercial Road, Melbourne 3004, Australia
| | - Dina Watterson
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Allied Health, Alfred Health, Commercial Road, Melbourne 3004, Australia
| | - Rebecca Schrale
- Tasmanian Burns Unit, Royal Hobart Hospital, Burns & Surgical Specialities Unit 5A, GPO Box 1061, Hobart 7001, Australia
| | - Sally McRae
- Burns Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Susan Taggart
- Burns Unit, Concord Repatriation General Hospital, Hospital Road, Concord 2139, Australia
| | - Anne Darton
- Statewide Burn Injury Service, Agency for Clinical Innovation, Royal North Shore Hospital, Reserve Road, St Leonards, 2065, Australia
| | - Fiona Wood
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150, Australia; Burn Injury Research Node, The University of Notre Dame, 19 Mouat Street, Fremantle 6959, Australia
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Witkowski W, Kawecki M, Surowiecka-Pastewka A, Klimm W, Szamotulska K, Niemczyk S. Early and Late Acute Kidney Injury in Severely Burned Patients. Med Sci Monit 2016; 22:3755-3763. [PMID: 27746455 PMCID: PMC5070618 DOI: 10.12659/msm.895875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background This study evaluated factors influencing early and late occurrence of AKI in severely burned patients and assessed the relationship between time of occurrence of AKI and mortality of AKI patients. Material/Methods Renal function was evaluated at 3 time points: at admission, at the critical point or middle point of hospitalization, and at the endpoint for which death or a discharge from the center was considered. AKI criteria were: decrease in GFR of less than 60 ml/min at admission, decrease in GFR of more than 75% compared to baseline, and decrease in the daily diuresis of less than 500 ml/24 h. Results At admission, 15.1% of the patients had eGFR <60 ml/min. AKI occurred in 38.5% of cases. The occurrence of AKI was associated with: elderly age (p<0.001), female sex (p=0.017), overweight and obesity (p=0.055); extent and depth of burns, respiratory failure, low protein concentration (for all p<0.001), low blood pressure (p=0.014), and high WBC (p=0.010). Early AKI was detected in 28% of patients. Mortality was 100% with the initial GFR ≥60, 100% with the initial GFR <60 and early deterioration of renal function, 80% with the initial GFR <60 and late worsening, and 60% with the initial GFR <60 and no worsening. Late AKI was observed in 10% of patients and mortality in this group was 79.2%. Mortality in the entire group with AKI was 88.0% versus 24.5%. Conclusions The frequent occurrence of AKI, especially early, worsens the prognosis for survival. Assessment of renal function should be included in the prognostic scales for burned patients.
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Affiliation(s)
- Wojciech Witkowski
- Department of Burns, Plastic and Reconstructive Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Marek Kawecki
- , Centre for the Treatment of Burns, Siemianowice Śląskie, Poland
| | | | - Wojciech Klimm
- Department of Internal Medicine, Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics , Institute of Mother and Child , Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Medicine, Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland
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Steinvall I, Elmasry M, Fredrikson M, Sjoberg F. Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: An exploratory review. Burns 2015; 42:28-40. [PMID: 26700877 DOI: 10.1016/j.burns.2015.10.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/27/2022]
Abstract
Standardised Mortality Ratio (SMR) based on generic mortality predicting models is an established quality indicator in critical care. Burn-specific mortality models are preferred for the comparison among patients with burns as their predictive value is better. The aim was to assess whether the sum of age (years) and percentage total body surface area burned (which constitutes the Baux score) is acceptable in comparison to other more complex models, and to find out if data collected from a separate burn centre are sufficient for SMR based quality assessment. The predictive value of nine burn-specific models was tested by comparing values from the area under the receiver-operating characteristic curve (AUC) and a non-inferiority analysis using 1% as the limit (delta). SMR was analysed by comparing data from seven reference sources, including the North American National Burn Repository (NBR), with the observed mortality (years 1993-2012, n=1613, 80 deaths). The AUC values ranged between 0.934 and 0.976. The AUC 0.970 (95% CI 0.96-0.98) for the Baux score was non-inferior to the other models. SMR was 0.52 (95% CI 0.28-0.88) for the most recent five-year period compared with NBR based data. The analysis suggests that SMR based on the Baux score is eligible as an indicator of quality for setting standards of mortality in burn care. More advanced modelling only marginally improves the predictive value. The SMR can detect mortality differences in data from a single centre.
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Affiliation(s)
- Ingrid Steinvall
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Moustafa Elmasry
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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Abstract
We report the use of a single dose of methylene blue in a patient with burn-induced vasoplegia refractory to fluids, vasopressors, and steroids. Administration of methylene blue allowed for cessation of epinephrine infusion within 2 hours of administration, and reduction in excessive fluid resuscitation. The patient's clinical course continued for 2 months and was complicated by severe acute respiratory distress syndrome, pneumonia, septic shock, poor skin graft adherence, renal failure requiring continuous renal replacement therapy, cutaneous mucormycosis, and ultimately, withdrawal of care and death. Despite the eventual outcome, this is the longest reported survival following methylene blue administration for vasoplegia secondary to burn injury.
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Czapran A, Headdon W, Deane AM, Lange K, Chapman MJ, Heyland DK. International observational study of nutritional support in mechanically ventilated patients following burn injury. Burns 2014; 41:510-8. [PMID: 25445003 DOI: 10.1016/j.burns.2014.09.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 09/12/2014] [Accepted: 09/13/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION It has been proposed that nutritional therapy in critically ill patients after major burn reduces mortality. However, the actual practice of nutrient delivery, and the effect on outcome, has not been described. STUDY OBJECTIVES To evaluate international practices related to nutritional support and outcomes in mechanically ventilated patients with burn injury. METHODS Data from the International Nutrition Surveys (2007-2011) for patients with a primary diagnosis of burn were extracted and analysed. RESULTS Eighty-eight of 90 patients (aged 16-84 years) received enteral nutrition. The median time for initiation of enteral feeding was 17 h [range 0-65]. Fifty patients (57%) had interruptions to nutrient delivery, most often these interruptions were fasting for operative procedures. There were substantive energy and protein deficits [943 (654) kcal/day and 49 (41) g/day, respectively; mean (SD)]. Nineteen (21%) patients died within 60 days of admission, and the energy and protein deficits were greater in those that died compared with survivors [died vs. survived, energy: 1251 (742) vs. 861 (607) kcal/d; p=0.02; and protein 67(42) vs. 44(39) g/d; p=0.03]. Energy and protein deficits were associated with increased mortality with the greater the deficit, the stronger the association with death (odds ratio for death: energy deficit/100 kcal 1.10 (1.01, 1.19); p=0.028 and protein/10 g 1.16 (1.01, 1.33); p=0.037). Results were similar and remained significant after adjusting for severity of illness. CONCLUSIONS Mechanically ventilated patients following burn develop substantial energy and protein deficits, with lesser deficits observed in survivors.
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Affiliation(s)
- Adam Czapran
- Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia.
| | - William Headdon
- Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia
| | - Adam M Deane
- Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia; Discipline of Acute Care Medicine, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Kylie Lange
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Marianne J Chapman
- Intensive Care Unit, Level 4, Emergency Services Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia; Discipline of Acute Care Medicine, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
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Taylor SL, Lawless M, Curri T, Sen S, Greenhalgh DG, Palmieri TL. Predicting mortality from burns: the need for age-group specific models. Burns 2014; 40:1106-15. [PMID: 24846014 DOI: 10.1016/j.burns.2014.03.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/07/2014] [Accepted: 03/08/2014] [Indexed: 11/25/2022]
Abstract
Traditional burn mortality models are derived using all age groups. We hypothesized that age variably impacts mortality after burn and that age-specific models for children, adults, and seniors will more accurately predict mortality than an all-ages model. We audited data from the American Burn Association (ABA) National Burn Repository (NBR) from 2000 to 2009 and used mixed effect logistic regression models to assess the influence of age, total body surface area (TBSA) burn, and inhalation injury on mortality. Mortality models were constructed for all ages and age-specific models: children (<18 years), adults (18-60 years), and seniors (>60 years). Model performance was assessed by area under the receiver operating curve (AUC). Main effect and two-way interactions were used to construct age-group specific mortality models. Each age-specific model was compared to the All Ages model. Of 286,293 records 100,051 had complete data. Overall mortality was 4% but varied by age (17% seniors, <1% children). Age, TBSA, and inhalation injury were significant mortality predictors for all models (p<0.05). Differences in predicted mortality between the All Ages model and the age-specific models occurred in children and seniors. In the age-specific pediatric model, predicted mortality decreased with age; inhalation injury had greater effect on mortality than in the All Ages model. In the senior model mortality increased with age. Seniors had greater increase in mortality per 1% increment in burn size and 1 year increase in age than other ages. The predicted mortality in seniors using the senior-specific model was higher than in the All Ages model. "One size fits all" models for predicting burn outcomes do not accurately reflect the outcomes for seniors and children. Age-specific models for children and seniors may be advisable.
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Affiliation(s)
- Sandra L Taylor
- University of California Davis, Sacramento, CA, United States
| | - MaryBeth Lawless
- University of California Davis, Sacramento, CA, United States; Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Terese Curri
- University of California Davis, Sacramento, CA, United States
| | - Soman Sen
- University of California Davis, Sacramento, CA, United States; Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - David G Greenhalgh
- University of California Davis, Sacramento, CA, United States; Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Tina L Palmieri
- University of California Davis, Sacramento, CA, United States; Shriners Hospitals for Children Northern California, Sacramento, CA, United States.
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