Revised Baux Score Identifies a New Risk Factor for Mortality: History of Diabetes.

Introduction Mortality following burn injury is influenced by many objective factors. Over the past several decades, numerous predictive formulas have been developed to estimate the probability of death from burn injury. Despite the preponderance of models, there are relatively few widely accepted objective measures found to impact mortality in burn patients. These factors include sex, age, burn depth, TBSA, and presence of inhalation injury. In this study, we retrospectively analyzed mortality in the burn patients at our level one trauma center to identify prognostic factors. Methods A retrospective chart review was performed on all patients between 2015-2020 over the age of 18 that presented to our trauma center for burns. Significant risk factors for the prediction of mortality based on a set of objective variables were identified using a stepwise forward logistic-regression analysis. Results Of the 963 patients (mean [±SD] age, 47±17; mean TBSA, 9±13), 96% lived to discharge. The identified risk factors for death were increased age (OR 1.08, 95% CI 1.04-1.11, p< 0.001), increased TBSA (OR 1.10, 95% CI 1.06-1.13, p< 0.001), the presence of inhalation injury (OR 4.72, 95% CI 1.49-14.94, p=0.008), third degree burn depth (OR 6.09, 95% CI 1.15-32.00, p=0.033), and having diabetes (OR 3.61, 95% CI 1.17-11.08, p=0.025 (Table 1). The probability of death from patients who experience burns is described by the equation: probability=1/(1+e^(-log f ()it)) With logit equal too: logit = -9.584 + 0.072*(Age) + 0.090*(TBSA) + 1.804 (Presence Third Degree Burns) -2.231 (Presence Second & Third-Degree Burns) + 1.282 (Presence Diabetes) + 1.551 (Presence Inhalation Burns) Categorical values should be treated as 1 if they are present and 0 if they are absent. Conclusions Between 1990 and 2010 the number of people living with diabetes tripled, and the annual incidence doubled. Diabetic wound healing is characterized by excessive inflammation and reduced angiogenesis, resulting in increased risk for complications. Diabetes is an established comorbidity in burn patients, but has never been identified as a significant risk factor for mortality. Applicability of Research to Practice Analysis of burn patients at our level 1 trauma center identified history of diabetes as a significant risk factor for mortality and suggests that the inclusion of diabetic status in future mortality models would increase their prognostic value in comparable populations.

Objective The objective of this study was to assess serum albumin and base deficit as prognostic factors for mortality in major burn patients. Background Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Base deficit is routinely calculated on blood gas analysis, and it provides the best estimate of the degree of tissue anoxia and shock at the whole body level, particularly in hemorrhagic shock. A rising base deficit indicates increasing metabolic acidosis, and may stratify mortality in patients after major trauma. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin and base deficit can predict mortality in burn patients. Patients and methods This study included 42 patients. All patients were admitted to the burn ICU at Menoufia University Hospital. Serum albumin and base deficit were estimated in patients at admission, after 3 days, and after 1 week. Results The mean of serum albumin on admission was 3.33 ± 0.44 g/dl, after 3 days it was 2.85 ± 0.54 g/dl, and after 1 week it was 2.46 ± 0.67 g/dl, and the mean of base deficit was 5.75 ± 2.40, 5.24 ± 2.05, and 5.45 ± 2.76, respectively. These results were significant (P Conclusion Statistically, serum albumin and base deficit can be used as prognostic factors for mortality, and colloid therapy should be continued for the first week, not only for the first 3 days.

Burn injuries facilitate invasive infections and sepsis not only by destroying the continuity of the protective skin barrier but also through systemic effects. The burn wound, blood, and urine samples are frequently cultured to determine the pathogen agent. The aim of this study was to analyze pathogen growth in patients' cultures confirmed as "infection positive" by the hospital Infection Control Committee and to assess the clinical implications of these growths. Hospitalized patients included in the study were those with a total burned body surface area of >10% and "presence of infection" confirmed by the Infection Control Committee. The patients were evaluated with respect to age, gender, burn etiology, the total body surface area burned (TBSA), the presence of inhalation injury, sepsis, positive cultures, the microorganisms cultured in wound-blood-urine samples, and septic focus. Of the total 36 (10.3%) "infection-positive" patients, 26 (72.2%) were male; the mean age of patients was 44±21 years. The mean burned TBSA of the whole group was 45.58%±23.1%. Acinetobacter baumannii was the most isolated organism in the wound cultures. In patients with confirmed infection, there was a correlation between the pathogen isolated in urine cultures and mortality rates (p=0.023). Sepsis was diagnosed in 23 (63.9%) patients, of whom 21 had inhalation injuries. There was a significant correlation between inhalation injury and sepsis (p=0.015), and both the presence of sepsis or inhalation injury increased mortality (p=0.027 and p=0.009, respectively). According to the study data, the TBSA burned demonstrated a greater significance for mortality, although the presence of sepsis and/or urinary tract infection should also be noted as a cause of mortality in burned patients.

Mucormycosis following burn injuries: A systematic review

Background: Burns injury continues to be the greatest challenge to the trauma surgeon. A multitude of factors determine the mortality in burns patients. The present study aims at identifying those factors which have a significant impact on mortality in burns patients.Methods: A total 80 patients presenting with burns injury were studied prospectively. Various factors which included age, sex, aetiology, mode of injury, total body surface area which is burnt (BSA), duration of stay, time interval up to admission, pregnant state, inhalation injury, systemic complications, wound complications, and psychological impact were studied.Results: The mean age was 24.07 years. 59 were females, 21 were males. 19 (23.75%) cases were suicidal in aetiology whereas the remaining 61(76.25%) were accidental. Flame injury was the most common mode of injury in 65 patients (81.25%). The mean BSA in the study was 53.5% whereas the mean BSA in those patients who expired was 71.4%. Mean duration of stay in hospital was 6.55 days whereas mean time interval between burns injury and admission to hospital was 101.33 minutes. All 12 pregnant women had spontaneous miscarriages with a mortality in 11 patients. Inhalation injury was seen in 49 patients (61%) with mortality of 42 (83.7%) patients. Systemic complications seen in 60 patients mortality and BSA was high in patients who had infection. 31 patients in the study had severe depression with a mortality of 91.32%. 50 out of the 80 patients studied expired.Conclusions: Increased age, BSA, mode of injury, presence of inhalation injury, systemic complication, pregnant state, wound infection and depression had a significant impact on the mortality of burns patients.

BackgroundNone 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.MethodsA 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.ResultsA 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.ConclusionTBSA 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.

Inhalation injury is known to be an important factor in predicting mortality in burns patients. However, the diagnosis is complicated by the heterogeneous presentation and inability to determine the severity of inhalation injury. The purpose of this study was to identify clinical features of inhalation injury that affect mortality and the values that could predict the outcome more precisely in burns patients with inhalation injury. This retrospective observational study included 676 burns patients who were over 18 years of age and hospitalized in the Burns Intensive Care Unit between January 2012 and December 2015. We analyzed variables that are already known to be prognostic factors (age, percentage of total body surface area (%TBSA) burned, and inhalation injury) and factors associated with inhalation injury (carboxyhemoglobin and PaO2/FiO2 [PF] ratio) by univariate and multivariate logistic regression. Age group (odds ratio [OR] 1.069, p<0.001), %TBSA burned (OR 1.100, p<0.001), and mechanical ventilation (OR 3.774, p<0.001) were identified to be significant predictive factors. The findings for presence of inhalation injury, PF ratio, and carboxyhemoglobin were not statistically significant in multivariate logistic regression. Being in the upper inhalation group, the lower inhalation group, and having a PF ratio <100 were identified to be significant predictors only in univariate logistic regression analysis (OR 4.438, p<0.001; OR 2.379, p<0.001; and OR 2.765, p<0.001, respectively). History and physical findings are not appropriate for diagnosis of inhalation injury and do not predict mortality. Mechanical ventilation should be recognized as a risk factor for mortality in burns patients with inhalation injury.

Inhalation Injury is a risk factor for mortality in burn patients; the diagnosis is suspected by clinical history and findings. Aims: Determine if suspected inhalation injury is a risk factor for mortality in burn patients and if there are other risk factors. Retrospective cohort study that included 156 medical records in the HNAL between 2015-2016. Dependent variable was mortality and independent variables included suspected inhalation injury, sex, age, depth and extent of burn and place of origin. Relative risks were estimated. The HNAL “Thermic Registry” was used for data recollection.Descriptive analyzes performed with median and interquartile ranges and relative and absolute frequencies for categorical variables. Fisher, Chi square and U Mann Whitney tests were used in bivariate analysis. Poisson Regression was used in multivariate analysis. Overall mortality of 9%. 46% of patients had suspected inhalation injury. Percentage of deceased patients was higher in those exposed to suspected inhalation injury (16.7% vs. 2.38%), place of origin outside Lima (16.7% vs. 5.56%), third-degree burn (13.3% vs. 1.72%) and median extent of burn (56.3 vs. 10). Suspected inhalation injury [RR: 6.24 (IC95% 1.48-26.3) (p:0.013)], third degree burn [RR 6.86 (IC95% 1.17-40.2) (p:0.033)], burn extension greater than 11% [RR 6.12 (IC95% 1.77-21.1) (p:0.004)] and place of origin outside Lima [RR 3.69 (IC95% 1.54-8.86) (p:0.003)] were significant in multivariate analysis. Suspected inhalation injury, third degree burn, extension greater than 11% and place of origin outside Lima are risk factors for mortality in burn patients.

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

Introduction Burn injuries present significant health challenges with serious physical, psychological, and economic consequences. Clinical prediction tools like the Abbreviated Burn Severity Index (ABSI), Baux Score, and Ryan Score are widely used to predict outcomes such as mortality by analyzing variables like age, burn size, and depth. A recent study using a provincial burn registry identified the Baux score as the best predictor of mortality. This study aims to consolidate data on predictors of mortality in burn patients using the American Burn Association National Burn Repository and validate these findings against a provincial burn registry. A secondary goal is to develop enhanced models for mortality prediction to improve clinical decision-making. Methods This retrospective cohort study used data from burn patients recorded in the ABA-NBR (2009-2018) and a provincial burn registry (1973-2017). Inclusion criteria required complete data on age, gender, total body surface area (TBSA), burn depth, and inhalation injury. Using R statistical software, multivariate regression and machine learning models were developed to predict mortality and compared with Baux, Revised Baux, and ABSI scores. Results Analysis of over 280,000 ABA-NBR patients found age and TBSA to be the strongest individual predictors of mortality. The Baux score remained the most accurate mortality predictor, outperforming the Revised Baux and ABSI (p&amp;lt; 0.001) in this cohort. A machine-learning-based model using sex, age, total TBSA, burn etiology, and inhalational injury demonstrated better accuracy of 96.7% (AUC 0.950; sensitivity 0.700; specificity 0.970) than Baux score which had an accuracy of 94.9% (AUC 0.929; sensitivity 0.351, and specificity 0.997) in this cohort. Conclusions The Baux score is proven in this study continue to be a good and easy-to-use predictor of mortality in burn patients. While the new machine-learning model showed improved accuracy, its complexity may limit its use in clinical practice. Future work is aimed at expanding candidate variables using the ABA-NBR to determine if there are other key variables that may be important for prediction of mortality. Finally, a provincial burn registry will be used for final validation of this tool’s applicability in diverse populations. Applicability of Research to Practice The presented work provides further validation of the Baux score and encourages its ongoing application in the prediction of burn associated mortality. Funding for the Study Internal Educational Funding

Burn injuries are a critical public health issue globally, causing significant morbidity and mortality. This study investigates factors influencing mortality in burn patients. It also examines the effectiveness of total body surface area (TBSA) as a predictor of mortality, suggesting a new threshold to improve patient management and outcome predictions. A retrospective study was conducted at Lebanese Hospital Geitaoui - UMC from 2017 to 2023. The study included 474 patients with second-degree and third-degree burns. Statistical analyses were performed to identify factors significantly associated with mortality, and to assess the predictive power of TBSA. Of the 474 patients, 395 (83.3%) survived while 79 (16.7%) succumbed to their injuries. Patients with TBSA between 81% and 90% had a survival rate of 0%. The logistic regression analysis indicated that for each 1% increase in TBSA, the odds of mortality increased by 6% (p<0.001). Inhalation injuries were present in 70.9% of non-survivors (p<0.001). Patients requiring mechanical ventilation had markedly higher mortality (84.8% vs 15.2%) (p<0.001). Multi-site infections were notably more common among non-survivors (32.9%) substantially increasing mortality risk (p=0.001). The ROC curve analysis confirmed TBSA's strong predictive value. The optimal cutoff point identified was 42.5% TBSA, above which the mortality risk increases significantly. The study highlights the significant impact of demographic factors, burn severity and medical interventions on the survival of burn patients. TBSA emerged as a robust predictor of mortality, underscoring the need for targeted interventions and specialized care for patients with extensive burns.

Burn injuries are a major cause of death, and infections with antibiotic‑resistant Staphylococcus aureus further increase mortality in these patients. There is a need for accurate and interpretable tools to predict the risk of death in this high‑risk group. This retrospective study included 222 burn patients with confirmed antibiotic‑resistant Staphylococcus aureus infections admitted to Velayat center between 2021 and 2023. Clinical and demographic data (age, total body surface area burned, length of hospital stay, sex, ventilation, inhalation injury, underlying diseases, and outcome) were collected. Seven machine learning models (XGBoost, Random Forest, Naïve Bayes, Logistic Regression, SVM, KNN, and Decision Tree) were developed and tuned using 5‑fold cross‑validation, then evaluated in an independent validation set using AUC, accuracy, precision, recall, and F1‑score, with additional 10‑fold cross‑validation. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). The mean age of patients was 39.91 ± 14.39 years. Non‑survivors had larger burned areas and shorter hospital stays than survivors. Among the seven models, XGBoost achieved the best performance, with an AUC of 0.8704 and an accuracy of 0.8889 in the validation set. SHAP analysis identified total body surface area, inhalation injury, age, hospital stay, underlying disease, and ventilation as the main predictors of in‑hospital mortality and provided individualized explanations of predictions. This study introduces an interpretable XGBoost‑based model for predicting in‑hospital mortality in burn patients with antibiotic‑resistant Staphylococcus aureus infections in Northern Iran. The model’s strong performance and explainability suggest that it can complement traditional scoring systems and help clinicians make transparent, patient‑specific decisions in similar settings.

Introduction The revised Baux score (%TBSA + age + [17xR], R representing 1 or 0 based on the presence of inhalation injury), is a highly accurate predictor of mortality in burn patients, shown to be consistent across heterogeneous populations despite not accounting for individual patient characteristics. However, differences in outcomes on the basis of race, gender, and socioeconomic status among other variables suggests that the predictive value of models that do not account for these factors may have greater limitations than previously assessed. Further investigation reveals that variables not included in the Baux score calculation bear significant individual influence on prognosis and mortality for burn patients such as gender, race, mechanism of burn, socioeconomic status, and marginalized status. Therefore, we aim to assess the predictive accuracy of the revised Baux score among different racial/ethnic groups and, investigate whether racial differences among massive burn patients (&amp;gt;20% TBSA) are associated with in-hospital mortality differences after adjusting for confounding variables. Methods We analyzed data from 92 patients, comparing those who died during hospitalization (N=31) with those who were discharged alive (N=61). The characteristics of the two groups were assessed using Wilcoxon rank-sum and chi-squared tests. A logistic regression model was used to adjust for potential confounders. Receiver operating characteristic (ROC) curves were constructed to evaluate Baux score performance for different racial/ethnic groups. Results Patients who died were older (median age 59 years vs. 39 years, p&amp;lt; 0.001), had higher modified Baux scores (median 127 vs. 78, p&amp;lt; 0.001), greater total body surface area (TBSA) burns (median 60% vs. 29%, p&amp;lt; 0.001), and shorter hospital stays (median 3 days vs. 30 days, p&amp;lt; 0.001). Logistic regression identified a significant association between the modified Baux score (OR=1.06, 95% CI: 1.03-1.09, p&amp;lt; 0.001) and mortality, however racial/ethnic differences were not significant after adjustment (Black or Hispanic OR=0.41, 95% CI: 0.05-2.27, p=0.3; Asian OR=1.38, 95% CI: 0.22-7.99, p=0.7). ROC analysis showed that the overall area under the curve (AUC) for the model was 0.867: White patients had an AUC of 0.836, Black and Hispanic patients had an AUC of 0.922, and Asian patients had an AUC of 0.889. Conclusions After adjusting for confounding factors, there was no significant difference in the Baux score or odds of mortality between racial/ethnic groups. The modified Baux score demonstrated good overall predictive accuracy for mortality regardless of race, with particularly high performance for Black and Hispanic patients, suggesting that inclusion of race into score calculation is not required. Applicability of Research to Practice This work supports continued use of the Baux score as a predictive tool in the clinical setting when assessing mortality risk among increasingly diverse populations of adult burn patients. Funding for the Study N/A

Background:Burn injuries impose a considerable burden on healthcare systems in Iran. It is among the top ten causes of mortality and a main cause of disability.Objectives:This study aimed to examine factors influencing mortality in burn patients admitted to the main educational tertiary referral hospital in Kermanshah.Patients and Methods:All patients admitted to the Imam Khomeini Hospital (from March 2011 to March 2012), due to thermal burn injuries were included in the study. We applied multiple logistic regressions to identify risk and protective factors of mortality. Also we calculated lethal area fifty percent (LA50), as an aggregate index for hospital quality.Results:During the study period, 540 burn patients were admitted. Male to female ratio was 1.12:1. Twenty three percent of the patients were less than 15 years-old. Median of age was 25 years (Inter Quartile Range, 16 - 37). Overall, probability of death was 25.8%. Lethal area fifty percent (LA50) was 50.82 (CI 95%: 47.76 - 54.48). In the final model, after adjustment of sex, age, total body surface area (TBSA), cause of burn and it’s severity, female gender (P < 0.05), age ≥ 60 years (in comparison with age less than 15 years, P < 0.05) and larger burn size (P < 0.0001) were identified as the main risk factors of death in these patients.Conclusions:Findings showed that the main risk factors of death were female gender, burn size and old age. Directing more attention to these vulnerable patients is required to reduce mortality and improve patient survival.

BackgroundBurn patients are particularly vulnerable to infection. We assessed the incidence and outcomes of burn patients with common infections in acute care hospitals. We also investigated the risk factors for infection and the effect of infection on the mortality of burn patients.MethodsUsing the Nationwide Inpatient Sample database (2005–2014), we identified adult patients (≥18 years) with burn injury by ICD-9 codes. The infections of our interest included bacteremia, pneumonia, urinary tract infection (UTI), surgical infection, Clostridium difficile infection, skin and soft-tissue infection, cardiovascular infection, infection of throat, nose and ear. The infection rate, mortality, length of hospital stay (LOS) and hospital charge of burn patients were evaluated. The risk factors for infection and in-hospital death of burn patients were analyzed by logistic regression.Results125,957 burn cases were identified, and 10,301 (8.2%) had at least one infection. UTI and pneumonia were the most common infections of burn patients, and their incidences were 3.0 and 2.8%, respectively. Infection of burn patients was associated with 2.5 times increase in mortality (7.7% vs. 3.0%, P < 0.001), nearly five times prolonged LOS (median 19 days vs. 4 days, P < 0.001) and 6.5 times higher hospital charge (median $145,389 vs. $22,477, P < 0.001). In 10-year study period, the infection rate of burn patients increased from 5.1% in 2005 to 9.5% in 2008, then stayed around 9.0% until 2014 (Figure 1). The mortality of burn patients decreased from 3.7% in 2005 to 3.0% in 2014, while the mortality of the patients with infection varied by year (Figure 2). In multivariate analysis, pneumonia was the only infection type that increased the risk for in-hospital death (OR = 1.38, 95% CI 1.20–1.58). Age and total body surface area (TBSA) of burn were the major risk factors for infection and in-hospital death of burn patients. ConclusionThe incidence of infection in burn patients increased during 2005–2014. The age and TBSA of burn are the major risk factors for infection and mortality. Except for pneumonia, most infections were not associated with increased risk for in-hospital death of the burn patients.Disclosures All authors: No reported disclosures.