FLAMES评分能准确预测烧伤患者的死亡风险。

The FLAMES score accurately predicts mortality risk in burn patients.

作者信息

Gomez Manuel, Wong David T, Stewart Thomas E, Redelmeier Donald A, Fish Joel S

机构信息

Tilley Burn Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite D718, Toronto, Ontario M4N3M5, Canada.

出版信息

J Trauma. 2008 Sep;65(3):636-45. doi: 10.1097/TA.0b013e3181840c6d.

DOI:10.1097/TA.0b013e3181840c6d

PMID:18784578

Abstract

BACKGROUND

The purposes of this study were to determine current mortality predictors in our thermally injured population, to develop and validate a new mortality predictive score, and to compare its predictive ability with those of the acute physiology and chronic health evaluation II (APACHE II) score, multiple organ dysfunction (MOD) score, and two burn-specific mortality predictive scores.

METHODS

A retrospective chart review of acute thermally injured (flame or scald) patients admitted during a 12-year period (1991-2003) to an adult regional burn center was performed. Patients admitted between January 1991 and February 1995 (derivation population) were included in the development of a mortality risk predictive score along with the patient's APACHE II score, MOD score, Smith's score, and the Age-Risk score. The new mortality risk predictive score was validated in a separate group of thermally injured patients (validation population) admitted to the same burn center between March 1995 and December 2003.

RESULTS

Of 1,439 acute thermally injured patients admitted between 1991 and 2003, 96 (7%) were excluded because they received comfort measures only. Of the remaining 1,343 patients, 378 (28%) were included in the mortality risk score derivation, and 965 (72%) in its validation. In the derivation group, there were 260 (69%) flame burns and 118 (31%) scald burns, and 35 (9%) patients died in hospital. Increased age, day 1 APACHE II score, percent partial-thickness burn, percent full-thickness burn, and sex were the strongest predictors of mortality. With these factors, we developed the FLAMES score (Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex), which had an area under the receiver operating characteristic curve of 0.97 that was better (p < 0.001) than those of the APACHE II score (0.91), MOD score (0.89), Smith's score (0.93), and the Age-Risk score (0.94). The FLAMES score was tested in the validation population and the area under the receiver operating characteristic curve = 0.93 was better (p < 0.001) than those of the APACHE II score (0.83), Smith's score (0.91), and the Age-Risk score (0.72).

CONCLUSION

The ability of the FLAMES score in predicting hospital mortality risk was validated in a regional burn center population.

摘要

背景

本研究的目的是确定我们热损伤患者群体当前的死亡预测因素，开发并验证一种新的死亡预测评分，并将其预测能力与急性生理学与慢性健康状况评价II（APACHE II）评分、多器官功能障碍（MOD）评分以及两种烧伤特异性死亡预测评分的预测能力进行比较。

方法

对一家成人区域烧伤中心12年期间（1991 - 2003年）收治的急性热损伤（火焰或烫伤）患者进行回顾性病历审查。1991年1月至1995年2月收治的患者（推导人群）连同患者的APACHE II评分、MOD评分、史密斯评分和年龄风险评分一起纳入死亡风险预测评分的开发。新的死亡风险预测评分在1995年3月至2003年12月期间收治于同一烧伤中心的另一组热损伤患者（验证人群）中进行验证。

结果

在1991年至2003年收治的1439例急性热损伤患者中，96例（7%）因仅接受了舒适护理措施而被排除。在其余1343例患者中，378例（28%）纳入死亡风险评分推导，965例（72%）纳入验证。在推导组中，有260例（69%）火焰烧伤和118例（31%）烫伤，35例（9%）患者在医院死亡。年龄增加、第1天的APACHE II评分、浅度烧伤百分比、深度烧伤百分比和性别是最强的死亡预测因素。基于这些因素，我们开发了FLAMES评分（由寿命、APACHE II评分、测量的烧伤范围和性别导致的死亡），其受试者工作特征曲线下面积为0.97，优于（p < 0.001）APACHE II评分（0.91）、MOD评分（0.89）、史密斯评分（0.93）和年龄风险评分（0.94）。FLAMES评分在验证人群中进行测试，受试者工作特征曲线下面积 = 0.93，优于（p < 0.001）APACHE II评分（0.83）、史密斯评分（0.91）和年龄风险评分（0.72）。