A three decade analysis of factors affecting burn mortality in the elderly

This study's objective was to identify variables that affect the mortality of elderly burn patients and to assess their changes over time. A retrospective review was conducted on all patients 75 or older (n = 201) admitted to a university-based burn center between 1972 and 2000. Variables examined were age, sex, TBSA, ABSI, inhalation injury, timing from burn to operative intervention, the number of surgical procedures, the number of pre-morbid conditions, and mortality. There were 95 fatalities. TBSA strongly correlated with mortality (p < 0.0001). Adjusting for TBSA and inhalation injury, mortality significantly decreased (p = 0.04, odds ratio = 0.58). Mortality significantly increased with inhalation injury (p < 0.01). Fatality risk increased by 400% with inhalation injury. Absence of inhalation injury was not significant with respect to mortality in the 1970s, however there was a significant decrease (p = 0.02) in mortality without an inhalation injury in the 1980s and 1990s. ABSI was strongly predictive of mortality (p < 0.0001). On average there was a 200% increase in mortality per unit increase of ABSI. The elderly are 58% less likely to die from burns now as compared to the 1970s. Although mortality rose with increasing TBSA equally in each decade, the absolute risk of mortality decreased over time. This data suggests major strides have been made in burn care, however similar success has not been achieved with inhalation injuries.     

Influence of demographics and inhalation injury on burn mortality in children

BACKGROUND: Pulmonary failure has emerged as one of the leading causes of mortality in burned children due, in part, to the success in reducing the incidence of sepsis, early surgery and fluid resuscitation, and new advances in nutritional support. To evaluate the effect of pulmonary injury, age, gender, race, and burn size on mortality, the records of 3179 burned children admitted to our burn center from 1985 to 2001 were reviewed. In this population, 1246 were admitted within 14 days of injury with burns greater than 20% of their total body surface area (TBSA). METHODS: Lethal burn areas (LAs) for a thermal injury only or burn plus inhalation injury were estimated from best fit probit curve within 95% confidence limits. Data analysis was by chi(2)-test, t-test, or Fisher's exact test where appropriate. RESULTS: The lethal burn area for a 10% mortality rate with and without concomitant inhalation injury was a 50 and 73% TBSA burn, respectively. Children up to the age of 3 with >/=20% TBSA burns had a higher rate of mortality (9.9%) compared to those 3-12 years of age (4.9%) and 13-18 years of age (4.2%). Children with 21-80% TBSA burns showed a significant difference in mortality (P<0.05) between those with burn plus inhalation injury (13.9%) and burn only (2.9%), while those with 81-100% TBSA burns showed no significant difference between burn only and burn plus inhalation injury. CONCLUSION: Inhalation injury remains one of the primary contributors to burn mortality. Children under the age of 3 years, however, are at a higher risk both with and without inhalation injury.     

The influence of inhalation injury and pneumonia on burn mortality.

In order to assess the specific effects of inhalation injury and pneumonia on mortality in burn patients, the records of 1058 patients treated at a single institution over a five-year period, 1980-1984, were reviewed. Of these patients, 373 (35%) had inhalation injury diagnosed by bronchoscopy and/or ventilation perfusion lung scan. Of the 373 patients, 141 (38%) had subsequent pneumonia. Among the patients without inhalation injury, pneumonia occurred in 60 of 685 (8.8%). A multiple logistic equation was developed to estimate expected mortality at any age and burn size for patients without either inhalation injury or pneumonia, with either alone, or with both. Subtraction of the expected mortality without either inhalation injury or pneumonia from the expected mortality in the presence of either or both permitted the estimation of additional mortality attributable to these complications. Inhalation injury alone increased mortality by a maximum of 20% and pneumonia by a maximum of 40%, with a maximum increase of approximately 60% when both were present. The influence on mortality was maximal in the midrange of expected mortality without these complications for any age group. These data indicate that inhalation injury and pneumonia have significant, independent, additive effects on burn mortality and that these effects vary with age and burn size in a predictable manner.     

Prognostic implications of inhalation injury in burn patients in Tokyo

Inhalation injury has recently emerged as the major cause of mortality in burn patients. However, the prognostic value of inhalation injury has not been thoroughly assessed in Japanese burn facilities. The aim of the present study was to evaluate the impact of inhalation injury on burn patients' mortality in Tokyo. Of 6416 patients admitted to 13 burn facilities of the Tokyo Burn Unit Association between 1984 and 2002; the 5560 eligible patients were included in this study (mean age, 40+/-20 years; male, 61.6%; mean partial- and full-thickness burn size, 10.7+/-13.0% and 9.6+/-20.5%). Of the 5560 patients, 1690 patients (30.4%) had experienced inhalation injury. The overall in-hospital mortality rate of the patients with inhalation injury was higher than that of those without inhalation injury (33.6% versus 8.1%, odds ratio, 5.72 [95% CI, 4.91-6.67]). The results of the multivariate analysis indicated that inhalation injury; full- and partial-thickness burn size, and age were independent predictors of outcome (relative risk, 2.58 [2.03-3.29], 1.10 [1.09-1.11], 1.06 [1.06-1.07], 1.05 [1.05-1.06], respectively). In conclusion, inhalation injury was the most important predictor of overall mortality among burned patients in Tokyo.     

Mortality following combined burn and traumatic brain injuries: An analysis of the national trauma data bank of the American College of Surgeons

BackgroundSevere burn and traumatic brain injuries (TBI) lead to significant mortality, and combined burn-TBI injuries may predispose towards even worse outcomes. The purpose of this study was to investigate the mortality of patients with burn, burn with non-TBI trauma, and combined burn/TBI to determine if combined injury portends a worse outcome.MethodsWe obtained the National Trauma Data Bank from 2007 to 2012, identifying 32,334 patients with burn related injuries, dividing this cohort into three injury types: BURN ONLY, BURN with TRAUMA/NO TBI, and BURN with TBI. For each patient, demographic data was obtained, including age, gender, presence of trauma, TBI, or inhalation injury, burn total body surface area (TBSA), Glasgow Coma Scale, Injury Severity Score, and mortality. Multivariable logistic regression was performed.ResultsAge, gender, and TBSA were similar across the three injury groups, but the incidence of inhalation injury was doubled in the BURN with TRAUMA/NO TBI (15.4 %) and BURN with TBI (15.3 %) groups when compared to the BURN ONLY (7.2 %) group. Mortality differed across injury categories after adjusting for age, TBSA, and inhalation injury. Increased mortality was seen in BURN with TRAUMA/NO TBI versus BURN ONLY (OR = 1.27 [1.06, 1.53]) and was higher when comparing BURN with TBI versus BURN ONLY (OR = 4.22 [2.85, 6.18]). BURN with TBI also had higher mortality when compared to BURN with TRAUMA/NO TBI (OR = 3.33 [2.30, 4.82]). The logs odds of mortality also increased with increasing age, TBSA and presence of inhalation injury.DiscussionThis analysis of the NTDB suggests that mortality following burn-related injuries may be higher when burn injury is combined with TBI when compared to burns with other trauma, even after correcting for age, TBSA, and inhalation injury. Further clinical and laboratory research is needed to validate these findings and better understand how to optimize combined TBI and burn injury treatment.     

Epidemiological and outcome characteristics of major burns in Tokyo

The Tokyo Burn Unit Association (TBUA) was established in 1983 funded by the Tokyo Metropolitan Government, and is organized by 13 burn units in Tokyo. TBUA covers more than 90% of severe burn patients occurring in Tokyo, and all of the cases are registered according to the burn injury registration format. The purpose of this study is to analyze the registered data and to elucidate epidemiological and outcome characteristics of major burn injuries in Tokyo. The total of 6988 hospitalized patients had data for epidemiological analysis, and 6401 patients had complete data for outcome analysis as well, and were included in this study. The characteristic profiles for the analysis included age, sex, cause of burns, inhalation injury, %BSA, burn index (BI), length of burn unit stay, and outcome, and were analyzed by age groups. The mean age of the patients was 40.4 years, and 63% of them were male. It was noteworthy that 25% of the total patients were elderly patients over 60 years of age. Flame was the most common cause making up 45.6% followed by scalding (32.0%). The overall mortality rate was 15.4%. Inhalation injury was accompanied in 27.3% of burn patients. The mortality rate was 34.6% with inhalation injury, and 8.2% without inhalation injury. Causes of death showed that multiple organ failure made up 36.9% of total mortality, followed by sepsis 25.2 and shock 19.0%. The burn size (%BSA and BI) and inhalation injury were the factors for high mortality rate in all age groups whereas age was a predictor for high mortality in the patients older than 16 years of age. Gender was not a factor for high mortality in any age group. The mortality rate showed mildly decreasing tendency since 1995 for which implementation of skin bank was thought to be responsible.     

烧伤患者吸入性损伤和肺部感染的发生特点及其对死亡的影响

为了评价吸入性损伤和肺部感染的发生特点及其对死亡的影响，总结了我科近１４年住院治疗的热力烧伤患者９４０例，其中吸入性损伤７５例，轻度１５例，全部治愈，中度２５例，死亡１３例，死亡率为５２．０％，重度３５例，死亡３１例，死亡率为８８．６％。统计分析表明，合并吸入性损伤者６９．３％在密闭空间发生，同时伴有面部烧伤者达９６．０％。随着烧伤面积的增加，吸入性损伤发生率和肺部感染的发生率相应增加。有吸入性损伤肺部感染较无吸入性损伤肺部感染率为高（Ｐ＜０．０１），发生时间早。两组同等烧伤面积、深度、年龄患者，有吸入性损伤组发生死亡的危险比无吸入性损伤组大１７．２倍（Ｐ＜０．００１）。烧伤面积、深度和年龄相近，合并肺部感染者明显增加了死亡的机会（Ｐ＜０．００１）。     

烧伤患者吸入性损伤和肺部感染的发生特点及其对死亡的影响

为了评价吸入性损伤和肺部感染的发生特点及其对死亡的影响,总结了我科近14年住院治疗的热力烧伤患者940例,其中吸入性损伤175例,轻度15例。全部治愈,中度25例,死亡13例,死亡率为52.0％,重度35例。死亡31例,死亡率为88.6％,统计分析表明,合并吸入性损伤者69.3％在密闭空间发生,同时伴有面部烧伤者达96.0％。随着烧伤面积的增加,吸入性损伤发生率和肺部感染的发生率相应增加,有吸入性损伤肺部感染较无吸入性损伤肺部感染率为高(P<0.01),发生时间早,两组同等烧伤面积、深度、年龄患者、有吸入性损伤组发生死亡的危险比无吸入性损份组大17.2倍(P<0.001)。烧伤面积、深度和年龄相近,合并肺部感染者明显增加了死亡的机会(P<0.001)。     

No influence of burn size on ventilator-associated pneumonia in burn patients with inhalation injury

Objective

Burn size and inhalation injury are important predictors of mortality following burn. The important factors for predicting ventilator-associated pneumonia (VAP) following burn remain unclear. The aim of our study was to investigate the effect of burn size on VAP in burn patients with inhalation injury.

Methods

We retrospectively studied 52 burn patients with inhalation injury requiring mechanical ventilation admitted to the Department of Acute Medicine, Kawasaki Medical School Hospital, Okayama, Japan, between June 2007 and October 2010.

Results

The overall mortality for all patients was 15%. Twenty-six patients (50%) developed VAP. Patients with VAP required longer ICU stay and mechanical ventilation than those without VAP. There was no difference in age, gender, mortality, and TBSA between burn patients with inhalation injury with and Without VAP. VAP rate had no difference with increasing TBSA in burn patients with inhalation injury.

Conclusions

Our data indicated that burn size had no relationship with the development of VAP in burn patients with inhalation injury.     

Burn-center quality improvement: are burn outcomes dependent on admitting facilities and is there a volume-outcome "sweet-spot"?

Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.     

Inhalation injury in southwest China—The evolution of care

Aim

This study aims to review the changes in management of inhalation injury and the associated reduction in mortality over the past 2 decades.

Methods

The records of burn patients with inhalation injury hospitalised in our institute from 1986 to 2005 were retrospectively analysed. The incidence of inhalation injury and the associated mortality were analysed. Meanwhile, the relationship of inhalation injury with age, total burn area, tracheostomy intubation and mechanical ventilation were studied.

Results

The incidence of inhalation injury was 8.01% in the total 10 608 hospitalised burn patients during the 20 years surveyed. Inhalation injury was always associated with large-sized burn and was more common in adults. The incidence of tracheostomy and mechanical ventilation increased from 39.46 and 30.28% in the period from 1986 to 1995 to 70.12 and 39.74% from 1996 to 2005, respectively. The overall mortality of inhalation-injured burn patients was 15.88% compared with 0.82% of the non-inhalation group. The mortality of the burn patients with inhalation injury dropped from 25.29% during the first 10 years to 11.71% during the second decade (p < 0.01). Mortality secondary to inhalation injury as the lead cause decreased from 14.56 to 6.29% (p < 0.01).

Conclusion

The care of inhalation injury has made significant progress over the past 2 decades. The early diagnosis of inhalation injury, early airway control and pulmonary function assistance with mechanical ventilation contribute to the reduction of mortality.     

气管切开术在严重烧伤患者中的应用体会

目的探讨颜面部烧伤合并吸人性损伤患者行气管切开术的适应证、手术时机和相关注意事项。方法对178例颜面部烧伤患者合并吸人性损伤行气管切开术的患者作回顾性总结。结果178例患者均于伤后0．5—49h内行气管切开术。重度吸人性损伤的病死率（38．2％）明显高于轻（8．3％）、中度（8．0％）组。早期开放气道可预防突发急性喉头水肿窒息,而且有利于气道分泌物的排出。结论对于颜面部烧伤合并吸人性损伤的患者,尽早行气管切开术,可防止呼吸道梗阻,减少并发症,降低死亡率。     

Fungal wound infection (not colonization) is independently associated with mortality in burn patients

OBJECTIVE: To analyze the occurrence of fungal wound infection (FWI) after thermal injury and its relationship to mortality. BACKGROUND: FWI is an uncommon but potentially lethal complication of severe thermal injury. METHODS: The records of patients with thermal burns admitted to a single burn center (1991-2002) were reviewed. Analyses accounted for total burn size (TBS, percentage body surface area), full-thickness burn size (FTBS, percentage body surface area), age, inhalation injury, sex, and fungal-status category. Fungal colonization and infection were determined histopathologically. RESULTS: Criteria for inclusion were met by 2651 patients. Each patient's fungal-status category was defined according to the deepest level of fungal involvement observed during the hospital course: no fungus (2476 patients), fungal wound colonization (FWC, 121 patients), or fungal wound infection (FWI, 54 patients). Median TBS (9%, 47%, 64%, respectively) and mortality (5%, 27%, 76%, respectively) varied significantly among fungal-status groups. Logistic regression was used to detect significant independent associations. FWI was associated with higher TBS. Mortality was associated with TBS, FTBS, inhalation injury, FWI, and age. Unlike FWI, FWC was not independently related to mortality, the greater observed mortality in FWC being explained by other variables such as TBS. The odds ratio for FWI (8.16) suggested about the same mortality impact as augmenting TBS by 33%. A midrange TBS of 30% to 60% was required for most of the detectable association of FWI with mortality. CONCLUSIONS: FWI accompanies larger burns and is associated with mortality in burn patients, particularly in those with TBS 30% to 60%. This association is independent of burn size, inhalation injury, and age.     

Predicting mortality from burns: The need for age-group specific models

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.     

Clinical factors affecting mortality in elderly burn patients admitted to a burns service

INTRODUCTION: The purpose of this retrospective study was to provide basic probabilistic predictors of mortality to assist in determining appropriate therapeutic aggression in elderly burns population. METHOD: Eighty patients over the age of 70 years were admitted to the Victorian Adult Burns Service in Melbourne, Australia, over a period of 4 years. Retrospective data was analysed, taking into account patient demographics, type, site, depth and area of burn, presence of inhalation injury, number of co-morbidities, survival time and the number of operations performed, withdrawal of care and implementation of comfort measures only. RESULTS: Comparing survivors and non-survivors, significant differences were found between age, percentage total burn surface area (TBSA%), percentage full thickness surface area (FTSA%), presence of inhalation injury, site of burn and number of operations. The number of co-morbidities and gender were not significant to outcome. FTSA%, presence of inhalation injury, site of burn, age and number of operations were all significantly related to survival time. When patients who obtained comfort care were excluded from analysis, age and the number of operations were not considered to be significantly related to mortality. CONCLUSION: This study indicates that TBSA%, FTSA%, inhalation injury and age are significant predictors of death in the elderly burns population, although only the first three remain significant when patients who receive comfort care measures only are excluded.     

Prophylactic antibiotic therapy after inhalation injury

ObjectiveInhalation injury is suspected in patients with facial and neck burn-injuries and in patients who suffered burns in an enclosed space. Inhalation injury is associated with a disappointingly high morbidity and mortality in spite of advances in diagnostics and therapy.Prophylactic antibiotic therapy in patients with diagnosed inhalation injury is still a controversial subject.The epidemiologic characteristics of the burn patients with diagnosed inhalation injury in our clinic receiving prophylactic antibiotic therapy and mortality of these patients will be referred in this study.MethodsPatients >16 years of age admitted to the burn unit between January 2008 and December 2012 and fulfilling the burn center referral criteria according the German Burn Association were enrolled in the study.Results58 patients (male:female 47:11) were diagnosed with an inhalation injury by their admission. The average length of hospital stay was 27.5 days, whereas of the patients with no inhalation injury was 16 days (p = 0.04). 56.9% of the patients underwent tracheostomy. An escalation of the antibiotic therapy was done in 39.7% of the patients with inhalation injury and in 20.3% of the patients without one. The mortality of inhalation injury patients was 12.1%.ConclusionsThe development of pneumonia is not influenced in a statistical significant way by the use of prophylactic antibiotics. We do recommend the administration of prophylactic antibiotic therapy to patients with diagnosed inhalation trauma, as the mortality of these patients was lower in comparison to other studies.     

Inhalation injury in burn patients: Establishing the link between diagnosis and prognosis

This study was to re-evaluate inhalation injury as a prognostic factor in burn patients and to determine the factors that should be considered when refining the definition of inhalation injury. A total of 192 burn patients (152 men, 40 women; mean age, 46.1 ± 13.8 years) who were suspected to have an inhalation injury and underwent bronchoscopy between January 2010 and June 2012 were included in this prospective observational study. All patients underwent bronchoscopy within 24 h of sustaining the burn. The bronchoscopic findings were classified as normal, mild, moderate, and severe. Mechanical ventilation was administered, when required. Age, percentage of TBSA burned, ABSI score, requirement of mechanical ventilation and PF ratio, but not inhalation injury, COHb level, and bronchoscopic grades, significantly differed between the survivors and non-survivors (p < 0.05). Mechanical ventilation (adjusted odds ratio [OR]: 9.787) and severe inhalation injury on bronchoscopy (adjusted OR: 45.357) were independent predictors of mortality on multivariate logistic regression analysis. Inhalation injury diagnosed through history does not predict mortality from burns. Other components such as severity of inhalation injury determined using bronchoscopy, and administration of mechanical ventilation might help predict the morbidity and mortality of burn patients with inhalation injury and all of the factors should be considered when the definition of inhalation injury is refined.     

Respiratory management of inhalation injury

Advances in the care of patients with major burns have led to a reduction in mortality and a change in the cause of their death. Burn shock, which accounted for almost 20 percent of burn deaths in the 1930s and 1940s, is now treated with early, vigorous fluid resuscitation and is only rarely a cause of death. Burn wound sepsis, which emerged as the primary cause of mortality once burn shock decreased in importance, has been brought under control with the use of topical antibiotics and aggressive surgical debridement. Inhalation injury has now become the most frequent cause of death in burn patients. Although mortality from smoke inhalation alone is low (0-11 percent), smoke inhalation in combination with cutaneous burns is fatal in 30 to 90 percent of patients. It has been recently reported that the presence of inhalation injury increases burn mortality by 20 percent and that inhalation injury predisposes to pneumonia. Pneumonia has been shown to independently increase burn mortality by 40 percent, and the combination of inhalation injury and pneumonia leads to a 60 percent increase in deaths. Children and the elderly are especially prone to pneumonia due to a limited physiologic reserve. It is imperative that a well organized, protocol driven approach to respiratory care of inhalation injury be utilized so that improvements can be made and the morbidity and mortality associated with inhalation injury be reduced.     

Mortality determinants in massive pediatric burns. An analysis of 103 children with > or = 80% TBSA burns (> or = 70% full-thickness).

OBJECTIVE: Survivors and nonsurvivors among 103 consecutive pediatric patients with massive burns were compared in an effort to define the predictors of mortality in massively burned children. SUMMARY BACKGROUND DATA: Predictors of mortality in burns that are used commonly are age, burn size, and inhalation injury. In the past, burns over 80% of the body surface area that are mostly full-thickness often were considered fatal, especially in children and in the elderly. In the past 15 years, advances in burn treatment have increased rates of survival in those patients treated at specialized burn centers. The purpose of this study was to document the extent of improvement and to define the current predictors of mortality to further focus burn care. METHODS: Beginning in 1982, 103 children ages 6 months to 17 years with burns covering at least 80% of the body surface (70% full-thickness), were treated in the authors' institution by early excision and grafting and have been observed to determine outcome. The authors divided collected independent variables from the time of injury into temporally related groups and analyzed the data sequentially and cumulatively through univariate statistics and through pooled, cross-sectional multivariate logistic regression to determine which variables predict the probability of mortality. RESULTS: The mortality rate for this series of massively burned children was 33%. Lower age, larger burn size, presence of inhalation injury, delayed intravenous access, lower admission hematocrit, lower base deficit on admission, higher serum osmolarity at arrival to the authors' hospital, sepsis, inotropic support requirement, platelet count < 20,000, and ventilator dependency during the hospital course significantly predict increased mortality. CONCLUSIONS: The authors conclude that mortality has decreased in massively burned children to the extent that nearly all patients should be considered as candidates for survival, regardless of age, burn size, presence of inhalation injury, delay in resuscitation, or laboratory values on initial presentation. During the course of hospitalization, the development of sepsis and multiorgan failure is a harbinger of poor outcome, but the authors have encountered futile cases only rarely. The authors found that those patients who are most apt to die are the very young, those with limited donor sites, those who have inhalation injury, those with delays in resuscitation, and those with burn-associated sepsis or multiorgan failure.     

Mortality prognostication scores do not predict long-term,health-related quality of life after burn: A burn model system national database study

ObjectiveDespite improved mortality rates after burn injury, many patients face significant long-term physical and psychosocial disabilities. We aimed to determine whether commonly used mortality prognostication scores predict long-term, health-related quality of life after burn injury. By doing so, we might add evidence to support goals of care discussions and facilitate shared decision-making efforts in the hours and days after a life-changing injury.MethodsWe used the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System database (1994–2019) to analyze SF-12 physical (PCS) and mental component (MCS) scores among survivors one year after major burn injury. Ninety percent of the observations were randomly assigned to a model development dataset. Multilevel, mixed-effects, linear regression models determined the relationship between revised Baux and Ryan Scores and SF-12 measures. Additionally, we tested a model with disaggregated independent and other covariates easily obtained around the time of index admission: age, sex, race, burn size, inhalation injury. Residuals from the remaining 10% of observations in the validation dataset were examined.ResultsThe analysis included 1606 respondents (median age 42 years, IQR 28–53 years; 70% male). Median burn size was 16% TBSA (IQR 6–30) and 13% of respondents sustained inhalation injury. Higher revised Baux and Ryan Scores and age, burn size, and inhalation injury were significantly correlated with lower PCS, but were not correlated with MCS. Female sex, black race, burn size, and inhalation injury correlated with lower MCS. All models poorly explained the variance in SF-12 scores (adjusted r² 0.01–0.12).ConclusionHigher revised Baux and Ryan Scores negatively correlated with long-term physical health, but not mental health, after burn injury. Regardless, the models poorly explained the variance in SF-12 scores one year after injury. More accurate models are needed to predict long-term, health-related quality of life and support shared decision-making during acute burn care.