O'Keefe G E, Hunt J L, Purdue G F
Department of Surgery, University of Texas Southwestern Medical Center Dallas 75235, USA.
J Am Coll Surg. 2001 Feb;192(2):153-60. doi: 10.1016/s1072-7515(00)00785-7.
The primary objective of this study was to determine an objective method for estimating the risk of mortality after burn trauma, and secondarily, to evaluate the relationship between gender and mortality, in the setting of a quantifiable inflammatory stimulus. Previously reported estimates of mortality risk after burn trauma may no longer be applicable, given the overall reduction in case-fatality rates after burn trauma. We expect that future advances in burn trauma research will require careful and ongoing quantification of mortality risk factors to measure the importance of newly identified factors and to determine the impact of new therapies. Conflicting clinical reports regarding the impact of gender on survival after sepsis and critical illness may in part, be from different study designs, patient samples, or failure to adequately control for additional factors contributing to the development ofsepsis and mortality.
Data from the prospectively maintained burn registry for patients admitted to the Parkland Memorial Hospital burn unit between January 1, 1989 and December 31, 1998 were analyzed. Logistic regression was used to generate estimates of the probability of death in half of the study sample, and this model was validated on the second half of the sample. Risk factors evaluated for their relationship with mortality were: age, inhalation injury, burn size, body mass (weight), preexisting medical conditions, nonburn injuries, and gender.
Of 4,927 patients, 5.3% died. The best model for estimating mortality included the percent of total body surface area burned; the percent of full-thickness burn size; the presence of an inhalation injury; age categories of: < 30 years, 30 to 59 years, > or = 60 years; and gender. The risk of death was approximately two-fold higher in women aged 30 to 59 years compared with men of the same age.
We have provided a detailed method for estimating the risk of mortality after burn trauma, based on a large, contemporary cohort of patients. These estimates were validated on a second sample and proved to predict mortality accurately. We have identified an increased mortality risk in women of 30 to 59 years of age.
本研究的主要目的是确定一种客观方法来评估烧伤创伤后的死亡风险，其次是在可量化炎症刺激的背景下，评估性别与死亡率之间的关系。鉴于烧伤创伤后总体病死率有所下降，先前报道的烧伤创伤后死亡风险估计可能不再适用。我们预计，烧伤创伤研究的未来进展将需要仔细且持续地对死亡风险因素进行量化，以衡量新发现因素的重要性，并确定新疗法的影响。关于性别对脓毒症和危重病患者生存影响的临床报告相互矛盾，部分原因可能在于不同的研究设计、患者样本，或者未能充分控制导致脓毒症和死亡的其他因素。
分析了1989年1月1日至1998年12月31日期间入住帕克兰纪念医院烧伤科患者的前瞻性烧伤登记数据。使用逻辑回归生成研究样本一半的死亡概率估计值，并在样本的另一半上对该模型进行验证。评估与死亡率关系的风险因素包括：年龄、吸入性损伤、烧伤面积、体重、既往病史、非烧伤损伤和性别。
4927例患者中，5.3%死亡。估计死亡率的最佳模型包括：烧伤总面积百分比；全层烧伤面积百分比；是否存在吸入性损伤；年龄类别：<30岁、30至59岁、≥60岁；以及性别。30至59岁女性的死亡风险比同年龄男性高约两倍。
我们基于大量当代患者队列，提供了一种详细的评估烧伤创伤后死亡风险的方法。这些估计值在第二个样本上得到验证，并被证明能准确预测死亡率。我们发现30至59岁女性的死亡风险增加。
