Tsurumi Amy, Que Yok-Ai, Yan Shuangchun, Tompkins Ronald G, Rahme Laurence G, Ryan Colleen M
Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
Department of Intensive Care Medicine, Lausanne University Hospital, BH 08-624, CH-1011 Lausanne, Switzerland.
Burns. 2015 Aug;41(5):935-45. doi: 10.1016/j.burns.2015.03.017. Epub 2015 Apr 25.
Accurate prediction of mortality following burns is useful as an audit tool, and for providing treatment plan and resource allocation criteria. Common burn formulae (Ryan Score, Abbreviated Burn Severity Index (ABSI), classic and revised Baux) have not been compared with the standard Acute Physiology and Chronic Health Evaluation II (APACHEII) or re-validated in a severely (≥20% total burn surface area) burned population. Furthermore, the revised Baux (R-Baux) has been externally validated thoroughly only once and the pediatric Baux (P-Baux) has yet to be. Using 522 severely burned patients, we show that burn formulae (ABSI, Baux, revised Baux) outperform APACHEII among adults (AUROC increase p<0.001 adults; p>0.5 children). The Ryan Score performs well especially among the most at-risk populations (estimated mortality [90% CI] original versus current study: 33% [26-41%] versus 30.18% [24.25-36.86%] for Ryan Score 2; 87% [78-93%] versus 66.48% [51.31-78.87%] for Ryan Score 3). The R-Baux shows accurate discrimination (AUROC 0.908 [0.869-0.947]) and is well-calibrated. However, the ABSI and P-Baux, although showing high measures of discrimination (AUROC 0.826 [0.737-0.916] and 0.848 [0.758-0.938]) in children), exceedingly overestimates mortality, indicating poor calibration. We highlight challenges in designing and employing scores that are applicable to a wide range of populations.
准确预测烧伤后的死亡率，作为一种审计工具，以及用于提供治疗方案和资源分配标准是很有用的。常见的烧伤公式（瑞安评分、简化烧伤严重程度指数（ABSI）、经典和修订后的博克斯评分）尚未与标准的急性生理与慢性健康状况评估II（APACHEII）进行比较，也未在严重烧伤（烧伤总面积≥20%）人群中重新验证。此外，修订后的博克斯评分（R - 博克斯）仅在外部进行过一次全面验证，而儿科博克斯评分（P - 博克斯）尚未得到验证。我们对522例严重烧伤患者进行研究，结果显示烧伤公式（ABSI、博克斯评分、修订后的博克斯评分）在成人中优于APACHEII（成人受试者工作特征曲线下面积增加，p<0.001；儿童中p>0.5）。瑞安评分表现良好，尤其是在风险最高的人群中（估计死亡率[90%置信区间]，原始研究与当前研究对比：瑞安评分2为33%[26 - 41%]对30.18%[24.25 - 36.86%]；瑞安评分3为87%[78 - 93%]对66.48%[51.31 - 78.87%]）。R - 博克斯评分显示出准确的区分能力（受试者工作特征曲线下面积为0.908[0.869 - 0.947]）且校准良好。然而，ABSI和P - 博克斯评分，尽管在儿童中显示出较高的区分度（受试者工作特征曲线下面积分别为0.826[0.737 - 0.916]和0.848[0.758 - 0.938]），但却过度高估了死亡率，表明校准不佳。我们强调了在设计和应用适用于广泛人群的评分系统时所面临的挑战。
