Belgian Outcome Research Articles

Burn Mortality in an Appalachian Referral Center: An Examination of Mortality Prediction Scores in a 13-Year Retrospective Study.

Introduction Burn injuries have profound implications, prompting the use of various mortality scoring systems. This study aimed to evaluate their effectiveness within our Appalachian burn referral center, which serves as the sole burn center in the state of West Virginia. Given this unique status, understanding the efficacy of mortality scoring systems within our center is crucial for resource allocation and optimizing patient outcomes in our region. Methods A retrospective analysis of patients admitted to Cabell Huntington Hospital Burn Intensive Care Unit (BICU) from January 2010 to June 2023 was conducted, assessing Baux (B), revised Baux (rB), Belgian Outcome in Burn Injury (BOBI), and Abbreviated Burn Severity Index (ABSI) scores. Logistic regression and receiver operating characteristic analysis were employed to examine survival status and determine optimal cut points. Results Among 1,104 patients, 57 died (5% mortality rate). Deceased patients had significantly higher B/rB/BOBI scores (mean: 98/98/92) than survivors (45/46/4.19) (p < 0.001), with ABSI showing no significance (p = 0.079). Each one-point increase in B/rB/BOBI scores correlated with a 1.09/1.09/2.34 times higher mortality risk (p < 0.001). The AUC for B score in predicting mortality was 0.926 (95% CI: 0.890, 0.962), with sensitivity and specificity values of 0.789 and 0.92, respectively, and an optimal cutoff point of 79. The AUC for the rB score was 0.927 (95% CI: 0.892, 0.962), with sensitivity and specificity values of 0.789 and 0.926, respectively, and an optimal cutoff point of 80. The AUC for the BOBI score was 0.901 (95% CI: 0.865, 0.937), with sensitivity and specificity values of 0.895 and 0.775, respectively, and an optimal cutoff point of 2. For patients with B scores above 79, their odds of mortality were 42.6 times higher than those with B scores of 79 or lower (95% CI: 22.6, 85.6, p < 0.001). Similarly, for patients with rB scores exceeding 80, their odds of mortality were 42.9 times higher than those with rB scores of 80 or lower (95% CI: 22.9, 84.8, p < 0.001). Finally, for patients with BOBI scores greater than 2, their odds of mortality were 17.8 times higher than those with BOBI scores of 2 or lower (95% CI: 9.88, 33.4, p < 0.001). Conclusion Our study underscores the vital role of mortality scoring systems in guiding clinical decision-making and resource allocation for burn patients, particularly within the Appalachian region served by the Cabell Huntington Hospital BICU. By leveraging tools such as the Baux, revised Baux, and BOBI scores, healthcare providers can identify high-risk patients early in their treatment course, facilitating personalized interventions and improving overall patient outcomes. Moreover, our findings highlight the significance of age and total body surface area burned as key determinants of mortality risk, emphasizing the need for tailored approaches to care for elderly patients and those with extensive burns. Continued research and refinement of mortality scoring systems are essential to further enhance their effectiveness and ensure optimal patient care in the challenging field of burn management.

A comparative study of the predictive value of four models for death in patients with severe burns

ObjectiveTo assess the prognostic value of the Ryan score, Belgian Outcome of Burn Injury (BOBI) score,revised Baux (rBaux) score, and a new model (a Logit(P)-based scoring method created in 2020) for predicting mortality risk in patients with extremely severe burns and to conduct a comparative analysis. MethodsA retrospective analysis was conducted on 599 burn patients who met the inclusion criteria and were admitted to the burn unit of the First Affiliated Hospital of Nanchang University from 2017 to 2022. Relevant information was collected, and receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were plotted for each of the four models in assessing mortality in these burn patients using both age-stratified and unstratified forms. The ROC curve section was further compared with the area under the curve (AUC), optimal cutoff value, as well as its sensitivity and specificity. Additionally, the quality of the AUC was assessed using the Delong test. ResultAmong the patients who met the inclusion criteria, 532 were in the survival group and 67 in the death group. Irrespective of age stratification, the novel model exhibited superior performance with an AUC of 0.868 (95% CI: 0.838–0.894) among all four models predicting mortality risk in included patients, and also demonstrated better AUC quality than other models; the calibration curves showed that the accuracy of all four models was good; the DCA curves showed that the clinical utility of the novel model and rBuax score were better. In the comparison of four scoring models across different age groups, the new model demonstrated the largest AUC in both 0–19 years (0.954, 95% CI 0.914–0.979) and 20–59 years groups (0.838, 95% CI 0.793–0.877), while rBuax score exhibited the highest AUC in ≥ 60 years group (0.708, 95% CI of 0.602–0.800). The calibration curves showed that the four models exhibited greater accuracy within the age range of 20–59 years, while the DCA curves indicated that both the novel model and rBuax score scale displayed better prediction in both the 20–59 and ≥ 60 years groups. ConclusionsAll four models demonstrate accurate and effective prognostication for patients with severe burns. Both the novel model and rBaux score exhibit enhanced prediction utility. In terms of the model itself alone, the new model is not simpler than, for example, the rBaux score, and whether it can be applied clinicallyinvolves further study.

503 The Accuracy of the Revised Baux Score in Predicting Burn Mortality: A Systematic Review

Abstract Introduction Osler et al. revised the Baux score in 2010 to include inhalation injury, attempting to improve upon the original 1961 model given the significant advances in modern burn care. Other predictive models of burn mortality have similarly been developed using use an assortment of other variables, however there is no consensus on the preferred formula to use. This systematic review aims to investigate the accuracy of the revised Baux (rBaux) score in comparison to other models when determining mortality risk in patients with burn injuries. Methods A systematic review was performed by two independent reviewers using electronic databases (PubMed, EMBASE, Scopus) from March 1, 2010 to May 22, 2022. The majority of studies were classified as “high” quality and no studies were excluded due to risk of bias. Articles were included if they were published in English and assessed risk of mortality from burns using the rBaux model and an alternative model. The PRISMA statement was followed, and all the PROBAST quality appraisal checklist was used during data extraction. Results The search identified 79 non-duplicate citations, of which 33 underwent full-text review, and 21 met inclusion criteria. They assessed the predictive ability of the rBaux score in comparison to the original Baux score, Belgian Outcome for Burn Injury, Abbreviated Burn Severity Index, APACHE II, Sequential Organ Failure Assessment score, Boston Group/Ryan scores, the FLAMES model, the Prognostic Burn Index, and several other equations that have not been externally validated. The accuracy of mortality prediction (area under ROC curves) for the rBaux score ranged from 0.68 to 0.99 and 14 studies found a value greater than 0.90. These ROC values were found to be lowest in the two studies with subgroupings for age, demonstrating an ROC of 0.01 in children, and 0.68 and 0.92 in the elderly. Eleven studies described sensitivity, specificity, or both, with sensitivity ranging from 12% to 96%, and specificity ranging from 80% to 100%. Conclusions The rBaux score offers a relatively easy method to rapidly assess the mortality risk from burn injury in a broad range of patient populations based on age, percent total body surface area burned, and presence/absence of an inhalation injury. This tool remains valid despite the exclusion of patient comorbidities and other injury-related factors. However, this study also identified the rBaux’s ability to predict mortality risk was limited when applied to patients at the extremes of age, highlighting an important area for future research. At present, given its relative simplicity and generalizability, the rBaux score remains a useful clinical tool for predicting mortality. Applicability of Research to Practice The rBaux score remains a simple yet powerful predictor of mortality in burn patients, which can be applied at the bedside on initial presentation across diverse patient populations.

Epidemiology and risk prediction of patients with severe burns admitted to a burn intensive care unit in a burn center in beijing: A 5-year retrospective study

ObjectiveThis study was performed to describe the epidemiology of patients with severe burns hospitalized in a burn intensive care unit (BICU), explore the risk factors associated with the patients’ outcomes and evaluate the ability of prognostic scoring systems as risk prediction of mortality. MethodsThe data for this study were derived from patients with severe burns in the BICU of Beijing Jishuitan Hospital from 2015 to 2019. The following epidemiological information and outcomes were collected for retrospective analysis: sex, age, date of injury, etiology of burn, admission time after injury, extent of burn, inhalation injury, length of stay, and outcome. Abbreviated Burn Severity Index (ABSI), prognostic burn index (PBI), the burn index (BI), Belgian Outcome in Burn Injury (BOBI) scores and the revised Baux (rBaux) scores were calculated. ResultsOf the 243 patients included in this study, the median age was 41.00 (22.00) years and the male: female ratio was 4.28:1.00. Most of the burns had occurred from March to July. Flame was the main cause of the burns (77.37%), followed by electricity (14.40%). In total, 78.19% of all patients sustained third-degree burns, and the median burn area and third-degree burn area of patients were 40% (53%) and 15.0% (43.0%) of the total body surface area, respectively. The incidence of inhalation injury was 69.14%. Tracheotomy was performed in 53.89% of the patients with inhalation injuries, and the rate of tracheostomy showing a rising trend. The median length of stay was 37 (40) days, and the case fatality rate was 8.64%. Multivariable logistic regression model indicated that age and third-degree burn area were risk factors for death, and the area under the receiver operating characteristic curve for the full prediction model was 0.921 (95% CI = 0.874–0.967). ConclusionsThe majority of severe burns are flame-related accidents in middle-aged men. Risk prediction model combining age and third-degree burn area has better mortality predictive value.

COMPARISON OF ASSESSMENT OF ABBREVIATED BURN SEVERITY INDEX (ABSI) AND BELGIAN OUTCOME OF BURN INJURY (BOBI) AT H. ADAM MALIK GENERAL HOSPITAL

Background: Assessment of length of stay and mortality in patients with burn injuries is essential to support clinicians in making clinical decisions. In Indonesia, there are several scoring systems used by hospital centers to assess the mortality of burn patients, such as the Belgian Outcome of Burn Injury (BOBI) and the Abbreviated Burn Severity Index (ABSI). However, different results were obtained in studies that examined the comparison of the results of the scoring system.&#x0D; Method: The type of research used in this research is unpaired comparative analysis research using a cross-sectional design. The data to be used is secondary data taken from medical records.&#x0D; Results: Respondents with death status were found in the serious, severe, and maximum ABSI categories, p=0.001 (p&lt;0.05) and the BOBI 50% category as many as three people and 85% as many as one person, p=0.0001 (0&lt;0.05). Length of stay based on the ABSI score for the length of stay was 23 days with an ABSI score of 12-13 (maximum), and based on the BOBI Score, the majority was 28 days with a BOBI score of 8 (85%). ABSI in this study had a sensitivity of 100% and a specificity of 86.4%, while the use of BOBI in this study had a sensitivity of 100% and a specificity of 88.1%.&#x0D; Discussion: The BOBI scoring system is more accurate than the ABSI. This difference may occur due to differences in demographics and quality of service in each region. Therefore, the analysis of the validity of the scoring model before the research is carried out in a new population is considered crucial to be carried out.

Comparison of prognostic models for severe burn patients in an Indonesian tertiary hospital: retrospective study

Background: Despite the high burn-related mortality rate, few studies investigate the discriminating power of various mortality prognostic models for burn patients in the Indonesian setting. Thus, the objective of our study is to describe and compare the discriminating power of several prognostic models for burn patients, including the Prognostic Burn Index (PBI), Belgian Outcome of Burn In-jury (BOBI), Revised Baux Score (rBaux), and Abbreviated Burn Severity Index (ABSI). Patients and methods: We conducted a retrospective study using medical records data with analysis including patients with severe burn (&gt;20% Total Body Surface Area (TBSA), &gt;10% for children and elderly), excluding those with known chronic conditions. Statistical analyses were performed on IBM SPSS 23.0 and included ROC curve and diagnostic values calculation, including sensitivity, specificity, positive, and negative predictive values with 95%CI. Results: Final analysis included 117 subjects with a 38.9% mortality rate. All prognostic models were statistically significant discriminating power with Area Under the Curve (AUC) values of 0.817, 0.849, 0.929, and 0.859, respectively. Comparing diagnostic values identified rBaux to have the strongest discriminating power with the highest specificity, PPV, and NPV. PBI score was identified with the highest sensitivity score. Conclusion: Discrepancy of results between our study and another Indonesian study with a similar design pointed to the need for a multi-centered study with a larger sample size to improve generalizability and statistical power of analysis.

Comparison between ABSI and BOBI Score for Burns Mortality Prediction in Indonesia’s National Referral Burn Center: A 5-year study

ObjectivesThe aim of this study is to test the validity of each burn mortality prediction model and to compare the accuracy between Abbreviated Burn Severity Index (ABSI) and Belgian Outcome for Burn Injury (BOBI) for mortality prediction in our burn unit. MethodsA retrospective cohort study was conducted enrolling burn patients during the period of 2016 to 2020 in burn unit of dr. Cipto Mangunkusumo Hospital. We specified our inclusion criteria to acute burn (≤48 h) within the age range of 17 to 58 years, and percentage of burned total body surface area (TBSA) 10–60%. Age, burn depth, gender, total TBSA and inhalation injury were variables accountable to ABSI and BOBI, thus were further analyzed statistically. ResultsA total of 220 patients were enrolled (133 males and 87 females) with mean age of 37.5 years and mean percentage of burned TBSA was 33.2%. The overall rate of mortality in this study was 25.9%. Full-thickness burn was observed in 133 subjects (60.45%) and inhalation trauma was experienced by 29 subjects (13.18%). Univariate and multivariate analysis were done on each variables. Full-thickness burn (p = 0.039), inhalation injury (p = 0.041), and 35.75% TBSA (p < 0.001) remained as significant variables for mortality prediction. Goodness-of-fit statistics done using the Hosmer-Lemeshow (HL) test for ABSI and BOBI showed p = 0.718 and p = 0.001. Performance discrimination for both ABSI and BOBI were analyzed by area under curve (AUC) of 0.84 (CI 95%; 0.785–0.896) and 0,79 (CI 95%; 0.731–0.859), respectively. DiscussionFull-thickness burn, inhalation injury, and %TBSA were identified as significant mortality predictors. Further analysis showed that ABSI score model fit well to actual outcomes observed in our unit. Furthermore, ABSI had better AUC value when compared with BOBI score in predicting burn mortality. ConclusionABSI score is valid for predicting mortality in our burn unit and can be used as clinical adjuncts to escalate the quality of burn patients management. In addition, ABSI was more accurate than BOBI in predicting burn mortality in our burn unit.

Comparative study of three scores in predicting the death risk of severe burn patients

Objective: To explore the predictive values of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score on the death risk of severe burn patients. Methods: A retrospective case series study was conducted. From February 2018 to November 2019, 260 severe burn patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University, including 158 males and 102 females, aged 36 (3, 53) years. According to the final outcome, the patients were divided into survival group (n=229) and death group (n=31). Data of patients were compared and statistically analyzed with chi-square test or Mann-Whitney U test between the two groups, including the gender, age, cause of burn, site of burn, total burn area, depth of burn, combined inhalation injury, and combined underlying diseases on admission, and the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score calculated based on part of the aforementioned data. The Kendall tau-b coefficient method was used to analyze the consistency of the above-mentioned three scores in 260 severe burn patients. The receiver operating characteristic (ROC) curves of the above-mentioned three scores predicting the death risk of 260 severe burn patients were drawn, and the area under the curve (AUC), the optimal threshold, and the sensitivity and specificity under the optimal threshold were calculated. The quality of AUC of the above-mentioned three scores was compared by Delong test. Results: The gender, site of burn, and depth of burn of patients between the two groups were all similar (P>0.05). The age, total burn area, proportion of flame burn, proportion of combined inhalation injury, and proportion of combined underlying diseases of patients in death group were significantly higher than those in survival group (with Z values of 5.53 and 17.78, respectively, χ2 values of 16.23, 15.89, and 17.78, respectively, P<0.01); the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score of patients in death group were 142 (115, 155), 7 (5, 7), 2 (2, 3), all significantly higher than 64 (27, 87), 1 (0, 3), 0 (0, 1) in survival group (with Z values of 7.91, 7.64, and 7.61, respectively, P<0.01). In 260 severe burn patients, the results between the modified Baux score and Ryan score, modified Baux score and Belgian Outcome in Burn Injury score, Ryan score and Belgian Outcome in Burn Injury score were significantly consistent (with Kendall tau-b coefficients of 0.75, 0.71, and 0.86, respectively, P<0.01). The AUCs of ROC curves of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score for predicting the death risk of 260 severe burn patients were 0.92, 0.89, and 0.85, respectively (with 95% confidence intervals of 0.86-0.98, 0.83-0.95, and 0.78-0.93, respectively, P<0.01); the optimal thresholds were 106.5, 4.5, and 1.5 points, respectively; the sensitivity under the optimal threshold were 88.5%, 76.9%, and 73.1%, respectively, and the specificity under the optimal threshold were 88.5%, 87.2%, and 86.3%, respectively. The modified Baux score was similar to Belgian Outcome in Burn Injury score in the AUC quality (z=1.25, P>0.05), which were both significantly better than the AUC quality of Ryan score (with z values of 2.35 and 2.11, respectively, P<0.05). Conclusions: The modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score have good ability in predicting the death risk of severe burn patients. From the perspective of clinical practice, the modified Baux score is more suitable as a predictive tool for the prognosis of severe burn patients.

Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia.

IntroductionThe purpose of this study was to explore and compare the performance of four burn injury scoring systems in Indonesia. In a retrospective study, data of all burn patients admitted to the emergency centre (EC) were collected. The following clinical outcome and four burn injury scoring systems were used to assess each patient: Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, and revised Baux Score.MethodsFrom April 2017 to April 2018, clinical outcome and burn injury score for every admitted patient were calculated to evaluate burn prognosis. Demographic information, ABSI score, full-thickness total body surface area (TBSA), overall TBSA, hospital stay, and inhalation injury were noted for analysis. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer–Lemeshow tests.ResultsWe included 72 patients (mean age: 40.79 ± 16.30 years, average TBSA: 23.59% ± 24.84). Only 1 (1.4%) of them was diagnosed with inhalation injury. Mortality rate was 25%. Deceased patients had significantly higher mean age, %TBSA, and number of inhalation injuries. The ABSI model with sensitivity was 81.6, specificity was 92.5, accuracy was 87.3 and under the Receiver Operator Characteristics curve (AUC) was 0.93 (SE = 0.03).ConclusionsThe best estimation of predicted mortality was obtained with the ABSI model.

Mortality prediction models for severe burn patients: Which one is the best?

For prediction of mortality and clinical course, various scoring systems had been developed. We choose four well known burn specific scoring systems and a general scoring system that using in Intensive Care Units. The primary outcome of this study was evaluate the predictive performances of this models and define the optimal one for our patient population. Variables analyzed were age, gender, burn type, total burned surface area (TBSA), total partial thickness burn area, total full thickness burn area, inhalation injuries, mechanical ventilation supports, blood products usage, total scores of Abbreviated Burn Severity Index (ABSI), revised Baux, Belgian Outcome in Burn Injury, Fatality by Longevity, Acute Physiology and Chronic Health Eval-uation II (APACHE II) score, Measured Extent of burn and Sex (FLAMES) and APACHE II, and their relations with mortality. In our study, a statistically significant relationship was found with mortality between age, TBSA, full thickness burn percent-age, inhalation injury, burn type, and it was similar to literature. Female gender was found to be a significant risk factor for mortality. We compared several burn mortality scoring systems and their predictional mortality rates. ABSI scores of patients for estimated mortality rates were similar to our mortality rate. Consequently, it was thought that ABSI was included all mortality-re-lated parameters.

Comparison of prognostic models for burn patients: A retrospective nationwide registry study

BackgroundPrognostic 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. MethodsJapanese 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. ResultsThe 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. ConclusionAlthough 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.

Validation of four burn-specific prognostic models in a cohort of 9625 cases, and a novel model for prediction of mortality in burn patients

BackgroundSurvival after burn injury has steadily improved in recent decades. The models for assessing the severity of burn injury and predicting burn-associated mortality have been used for over 20 years. The predictive accuracy of these models should be reconsidered now. MethodIn this retrospective study on all burn patients (n = 9625) admitted to the Burn Department, Southwest Hospital between 2008 and 2017, we compared the predictive performance of the four burn-severity models (Abbreviated Burn Severity Index, Ryan score, revised Baux score and Belgian Outcome of Burn Injury) by area under the receiver operating curve (AUC) and Hosmer–Lemeshow test. We developed a new model with the data from 2008 to 2012 (5006 patients) by logistic regression, data from 2013 to 2017 (4619 patients) were used for validation. ResultThe overall mortality rate of the burn patients was 1.14%. The four previously validated burn models showed good discrimination power of death risk (AUC > 0.890) but poor fitness to the observed mortality rate (p < 0.001). Risk factors associated with mortality included sex, age, total burn area, full thickness burn area, and inhalation injury. The new logistic model was devised with high sensitivity and specificity (0.913 and 0.806, respectively) and an AUC of 0.940. The new model also had good fitness to the observed mortality of burn patients (p = 0.588). ConclusionThe four widely used burn models have poor accuracy in predicting burn-associated mortality, and an accurate new model was developed based on simple and objective clinical characteristics of burn patients at admission.

The Predictive Capacity of American Society of Anesthesiologists Physical Status (ASA PS) Score in Burn Patients.

Advances in burn care continues to improve survival rates and patient outcomes. There are several burn prognostic tools used to predict mortality and outcomes; however, none include patient comorbidities. We used the American Society of Anesthesiologists physical status score as a surrogate measure for comorbidities, and evaluated its role in predicting mortality and outcomes in adult burn patients undergoing surgery. A retrospective analysis was performed on data collected from a single burn center in the United States, which was comprised of 183 patients. We evaluated the American Society of Anesthesiologists physical status score as an independent predictor of mortality and outcomes, including intensive care unit (ICU) length of stay (LOS), hospital LOS, mechanical ventilator (MV) days, and complications. We compared the American Society of Anesthesiologists physical status score to other prognostic models which included the revised Baux score, Belgian Outcome in Burn Injury, and the Abbreviated Burn Severity Index. Our results demonstrated that the revised Baux and American Society of Anesthesiologists physical status scores could be used to determine the mortality risk in adult burn patients. The revised Baux was the best predictor of mortality, ICU LOS, and MV days, while the Abbreviated Burn Severity Index was the best predictor of total LOS.

5 The Predictive Capacity of ASA PS in Burn Patients

Abstract Introduction The four main prognostic models used to determine risk of burn mortality are the revised Baux (rBaux), Belgian Outcome in Burn Injury (BOBI), Abbreviated Burn Severity Index (ABSI), and quick Sequential Organ Failure Assessment (qSOFA). These models fail to factor in medical comorbidities. The ASA PS (American Society of Anesthesiologists Physical Status) is a simple scale incorporating severity of traumatic injury with comorbidities, which strongly predicts mortality in surgical patients. The purpose of this study is to determine whether the ASA PS is an adequate adjunct to measure burn severity. Methods All adults admitted to an ABA verified burn center from January 2016 to April 2019 with TBSA ≥10% who underwent surgery were reviewed. Demographics (age, gender, TBSA, race, ASA PS), vital signs (GCS, blood pressure, respiratory rate), and outcome variables (length of stay [LOS], mechanical ventilation [MV] days, and complications) were evaluated. rBaux, BOBI, ABSI, and qSOFA scores were calculated. The primary outcome was in-hospital mortality. After descriptive statistical analysis, mortality associations of the models were assessed by determining odds ratios. Firth’s logistic regression and area under the receiver operator curves determined the predictive utility of the prognostic scores. Results Of the 183 patients who fit inclusion criteria, median age was 44 years (30–57), and the majority (70%) were male. Median TBSA was 20%, 65% (n=118) had full thickness burns, 14% (n=25) had inhalation injury, and mortality was 9% (n=17). rBaux score was the best predictor of mortality (AUC=.84), ICU LOS (R2=.04), and MV days (R2=.06). For every 10-point increase in rBaux score, there was a 1.7 times increase in mortality (OR=1.7, CI 1.4–2.3, p&amp;lt; .00). The predicted ICU LOS increases from 2.8 to 31.4 days for the lowest and highest rBaux score quartiles. Compared to rBaux scores of 30–53, patients with scores of 54–70 had 4 times more MV days (CI 1.5–11, p&amp;lt; .00). The ASA PS was slightly inferior to rBaux in predicting mortality (AUC=.72), although not statistically significant (p=0.1). As ASA PS score went from I/II to III, III to IV, and IV to V/VI; mortality increased by 2.8 (OR=2.8, CI 1.5–5.5, p&amp;lt; .00). Conclusions rBaux is the best predictor of mortality, ICU LOS, and MV days although ASA PS also predicts mortality. Future studies should determine the combined predictive ability of ASA PS and rBaux. Applicability of Research to Practice rBaux and ASA PS scores can be used to determine risk of mortality in burn patients.

The organisation of critical care for burn patients in the UK: epidemiology and comparison of mortality prediction models

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.

External Validation of Belgian Outcome of Burn Injury Score on Burned Patient In Burn Unit Cipto Mangunkusumo General Hospital

Introduction . The scoring system in burns is a merit in predicting mortality. To date, there’s no scoring system used as a standard prognostic tool at Cipto Mangunkusumo General Hospital’s Burn Unit. Belgian Outcome of Burn Injury (BOBI) Score, one of the best scoring system in accordance to systematic review in 2013 was validated externally in a study. Method . A retrospective cohort study was conducted enrolling all burn patients managed during period of 2012 to 2013 in burn unit of Cipto Mangunkusumo General Hospital. The prediction model of BOBI score (age, total burned surface area, and inhalation injury) were variables to be analyzed statistically. ROC and AUC was analyzed to find out its accurate level of prediction. The strong AUC is found with the value of >80–90%. Results . Out of 304 subjects enrolled, the mean age was 28 years, mean TBSA was 29%, inhalation injury was 15.7%, and overall mortality was 17.7%. The model gave an accurate prediction of mortality. The receiver operating characteristic analysis demonstrated an area under the curve of 0.96 (95% confidence interval: 0.94-0.99). Conclusion . The mortality prediction model (BOBI score) demonstrated a good accuracy. This model provide a good prediction tool and could be implemented in our burn management. Keywords : Mortality, prognostic, burn

Modified first world mortality scores can be used in a regional South African burn service with resource limitations

IntroductionSurvival following a major burn is highly dependent on the availability of scare and expensive resources such as critical care services, modern dressings and access to operating theatres. Scoring systems, which predict mortality have been developed and can be used to identify patients in whom the outlay of these resources is futile. The aim of this study was to analyse the mortality at a regional South African burn service and to see if these scoring models developed in a resource rich environment were applicable to our setting. MethodsConsecutive admissions to the Edendale burn service, South Africa were collected from patient records over a 2-year period from July 2013 to June 2015. Demographic, burn details and final outcome (lived or died) were captured for statistical analysis. Each patient was scored using the Modified Baux, Coste et al., Belgian Outcome of Burn Injury (BOBI) and Abbreviated Burn Severity Index (ABSI) scores. Validation of models and inferential statistics were done to determine new breakpoints more applicable to our sample. ResultsA total of 748 patients were included in the sample, with a mortality rate of 7.1%. The mean Modified Baux score was 27 (range 1–134), with the new breakpoint of 40 predicting 74% of the mortalities compared to the 42% predicted by the old breakpoint of 75. The mean ABSI score was 4 (range 2–15), with a lower break point of 6 predicting 75% of deaths compared to 42% with the old breakpoint of 8.The mean Coste score for the sample was 12 (range 0–100). With a suggested break point of 85 (predicting 50% mortality), only 6% of mortalities were predicted. The new break point of 17 predicted 91% of deaths. The original break point for the BOBI score was 6 (range 0–7). This included 42% of deaths. With a new breakpoint of 1, 74% of deaths were predicted. DiscussionOur data has shown that in our environment a significant number of fatalities occur in patients with potentially salvageable burns, and the breakpoints for the mortality prediction scores such as, the Modified Baux score, Coste et al. score, BOBI and ABSI scores are much lower than high-income countries.However these mortality predictive scores can be used in a resource scarce South African setting to triage patients into risk categories by lowering the breakpoints. This may facilitate early and more aggressive management of high-risk burn patients, improving survival rates, as well as efficient and judicious use of critical care and other resources.

Predicting Mortality in Severe Burns-What Is the Score?: Evaluation and Comparison of 4 Mortality Prediction Scores in an Irish Population.

Severe burns present a significant clinical challenge and are resource intensive. Predicting mortality at admission for burn patients is useful in determining the likely outcomes of interventions and in stratifying levels of care. In addition, it can provide benchmarks for audit and research. More than 45 composite models exist for the prediction of mortality in thermal injury, of which only a handful have been developed with methodological rigor.1 The 4 most routinely used are the Revised Baux score,2 the Belgian Outcome in Burn Injury score,3 Boston score,4 and Abbreviated Burn Severity Index (ABSI).5 Our aim was to validate and compare the utility of these scoring systems in an Irish population.

An analysis of surgical and anaesthetic factors affecting skin graft viability in patients admitted to a Burns Intensive Care Unit.

Objectives:Skin graft failure is a recognised complication in the treatment of major burns. Little research to date has analysed the impact of the complex physiological management of burns patients on the success of skin grafting. We analysed surgical and anaesthetic variables to identify factors contributing to graft failure.Methods:Inclusion criteria were admission to our Burns Intensive Care Unit (BICU) between January 2009 and October 2013 with a major burn. After exclusion for death before hospital discharge or prior skin graft at a different hospital, 35 patients remained and were divided into those with successful autografts (n=16) and those with a failed autograft (n=19). For the purposes of this study, we defined poor autograft viability as requiring at least one additional skin graft to the same site. Logistic regression of variables was performed using SPSS (Version 22.0 IBMTM).Results:Age, Sex, %Total Burn Surface Area or Belgian Outcome Burns Injury score did not significantly differ between groups. No differences were found in any surgical factor at logistic regression (graft site, harvest site, infection etc.). When all operations were analysed, the use of colloids was found to be significantly associated with graft failure (p=0.035, CI 95%) and this remained significant when only split thickness skin grafts (STSGs) and debridement operations were included (p=0.034, CI 95%). No differences were found in crystalloid use, intraoperative temperature, pre-operative haemoglobin and blood products or vasopressor use.Conclusions:This analysis highlights an independent association between colloids and graft failure which has not been previously documented.

Revised Baux Score and updated Charlson comorbidity index are independently associated with mortality in burns intensive care patients

PurposeThe purpose of the current study was to utilise established scoring systems to analyse the association of (i) burn injury severity, (ii) comorbid status and (iii) associated systemic physiological disturbance with inpatient mortality in patients with severe burn injuries admitted to intensive care. MethodsCase notes of all patients with acute thermal injuries affecting ≥15% total body surface area (TBSA) admitted to the Burns Intensive Care Unit (BICU) at Chelsea and Westminster Hospital during a 10-year period were retrospectively reviewed. Revised Baux Score, Belgian Outcome in Burn Injury (BOBI) Score, Abbreviated Burn Severity Index (ABSI), APACHE II Score, Sequential Organ Failure Assessment (SOFA) Score and Updated Charlson Comorbidity Index (CCI) were computed for each patient and analysed for association with inpatient mortality. ResultsNinety mechanically ventilated patients (median age 45.7 years, median % TBSA burned 36.5%) were included. 72 patients had full thickness burns and 35 patients had inhalational injuries. Forty-four patients died in hospital while 46 survived to discharge. In a multivariate logistic regression model, only the Revised Baux Score (p<0.001) and updated CCI (p=0.014) were independently associated with mortality. This gave a ROC curve with area under the curve of 0.920. On multivariate cox regression survival analysis, only the Revised Baux Score (p<0.001) and the updated CCI (p=0.004) were independently associated with shorter time to death. ConclusionOur data suggest that the Revised Baux Score and the updated CCI are independently associated with inpatient mortality in patients admitted to intensive care with burn injuries affecting ≥15% TBSA. This emphasises the importance of comorbidities in the prognosis of patients with severe burn injuries.