Citation

Moore EC, Pilcher DV, Bailey MJ, Stephens H, Cleland H. J. Trauma Acute Care Surg. 2013; 75(2): 298-303.

Affiliation

From The Alfred Hospital (E.C.M., D.V.P., H.C.), Prahran, Melbourne; and Monash University (M.J.B., H.S.), Melbourne, Australia.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e318295409d

PMID

23887563

Abstract

BACKGROUND: An understanding of prognosis following burns is important. It alleviates patient and familial stress, provides a framework for better resource use, and facilitates benchmarking of performance between specialist centers. METHODS: Data were collected from eight tertiary referral burns centers in Australia and New Zealand. Our aim was to identify factors independently associated with mortality to develop a mortality prediction model, which accurately quantifies the risk of death among adults with burns who require intensive care. RESULTS: Between January 2005 and December 2011, 1,715 patients were admitted to intensive care unit with acute thermal burns. The mean (SD) age was 41.1 (18.0) years, and 20.3% (n = 348) were female. Median percentage of total body surface area was 17% (6-35%) and percent full-thickness surface area was 4% (0-20%). Inhalational injury was documented as present in 36.2%. Accidental injury was the most common etiology of burn (70.4%) and most frequently via a flame (68.3%). Overall hospital mortality was 10.9% (n = 187). Independent risk factors for death were age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.06-1.10; p < 0.001), percentage of full-thickness surface area (OR, 1.07; 95% CI 1.06-1.08; p < 0.001), and Acute Physiology and Chronic Health Evaluation II score excluding age (OR, 1.11; 95% CI, 1.07-1.15; p < 0.001) and female sex (OR, 3.35; 95% CI, 1.84-6.11; p = 0.001). There was no association between inhalational injury or deliberate self-harm and death, as well as etiology or type of burn. CONCLUSION: A highly discriminatory mortality prediction model was developed using logistic regression. Risk of death following major burns can be predicted from a combination of physiologic and burns specific parameters. Female sex is a highly significant risk factor. LEVEL OF EVIDENCE: Prognostic study, level III.

Language: en