Strassle Paula D, Williams Felicia N, Napravnik Sonia, van Duin David, Weber David J, Charles Anthony, Cairns Bruce A, Jones Samuel W
From the *Department of Epidemiology, University of North Carolina at Chapel Hill; †Department of Surgery, University of North Carolina at Chapel Hill, ‡North Carolina Jaycee Burn Center, Chapel Hill; and §Division of Infectious Diseases, University of North Carolina, Chapel Hill.
J Burn Care Res. 2017 May/Jun;38(3):187-193. doi: 10.1097/BCR.0000000000000456.
Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved.
烧伤死亡率的经典决定因素是年龄、烧伤面积和吸入性损伤的存在。我们的目的是描述患者和烧伤特征、住院死亡率的时间趋势，以及这些特征与住院死亡率随时间的关系。纳入了2004年至2013年间所有年龄在18岁及以上且因烧伤入院的患者，包括仅伴有吸入性损伤的患者。采用校正后的Cox比例风险回归模型来估计入院年份与住院死亡率之间的关系。2004年至2013年间共有5540名患者入院。在不同年份观察到性别、种族/民族、烧伤机制、总体表面积（TBSA）、吸入性损伤和住院死亡率存在显著差异。与2004年至2010年入院的患者相比，2011年至2013年入院的患者更可能为女性、非西班牙裔白人，烧伤面积较小，且发生吸入性损伤的可能性较小。在控制了患者人口统计学特征、烧伤机制和不同的住院时间后，未检测到住院死亡率的年份趋势。然而，在最近几年中，大面积烧伤（≥75% TBSA）患者的住院死亡率显著下降。在过去10年里，这家大型三级医疗转诊烧伤中心的烧伤患者住院死亡率一直保持在较低水平。虽然在此期间观察到的死亡率下降很大程度上归因于患者和烧伤特征的变化，但大面积烧伤患者的生存率有所提高。
