Hranjec Tjasa, Turrentine Florence E, Stukenborg George, Young Jeffrey S, Sawyer Robert G, Calland James F
Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
Am Surg. 2012 May;78(5):559-66.
Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.
烧伤患者死亡的风险因素，如吸入性损伤、患者年龄和烧伤总面积百分比（%TBSA），在以往的出版物中已有报道。然而，对于烧伤中心之间死亡率结果的差异，以及收治机构或机构规模是否可被视为死亡率的预测因素，我们却知之甚少。利用2003年至2007年期间从国家烧伤资料库获得的87665例急性烧伤观察的去识别数据，估计了一个多变量逻辑回归模型，该模型可参照收治烧伤机构/机构规模预测患者死亡率，并对年龄、吸入性损伤、%TBSA烧伤以及另一个因素——全层烧伤百分比（%FTB）的差异进行了调整。如先前报道，所有三个协变量（%TBSA烧伤、吸入性损伤和年龄）均被发现是烧伤患者死亡的高度统计学显著风险因素（P值<0.0001）。另一个变量%FTB也被发现是一个统计学显著的决定因素，尽管它并没有显著改善多变量模型。治疗/收治机构被发现是一个独立的死亡率预测因素，某些医院死亡几率增加，而其他医院则显示出保护作用（优势比降低）。烧伤量大的医院死亡率风险最高。具有相似风险因素（%TBSA烧伤、吸入性损伤、年龄和%FTB）的患者的死亡率结果受治疗机构及其收治规模的显著影响。
