Surviving Burns Does Early Wound Closure Help?

Abstract

Does early grafting of full-thickness (FT) burn wounds improve survival among severely burned? Wolfe and colleagues present, in this issue ofThe Journal(p 763), an elegant mathematical model as evidence that early grafting is associated with improved survival. They have collected information on 12,000 patients entered from 11 national burn treatment centers, reporting burned body surface area, treatment, and outcome for each case. Like mathematical architects, Wolfe and associates generate two bodies of data and then correlate them. Phase 1 explicates computation of standard mortality rate (SMR). From their burn registry data bank, authors formulate a multiple logistic regression model to predict mortality in burn patients by assigning probabilities to several variables—burn wound size, age, sex, presence of perineal burn, and year of treatment. The sum of these probabilities in patients treated at one burn center yields the expected number of deaths. The SMR compares