Taylor Sandra L, Sen Soman, Greenhalgh David G, Lawless MaryBeth, Curri Terese, Palmieri Tina L
University of California, Davis Medical Center, Department of Public Health Sciences, Sacramento, CA, United States.
University of California, Davis Medical Center, Department of Surgery, Sacramento, CA, United States; Burn Department, Shriners Hospitals for Children Northern California, Sacramento, CA, United States.
Burns. 2017 Mar;43(2):282-289. doi: 10.1016/j.burns.2016.10.021. Epub 2016 Dec 29.
Hospital length of stay (LOS) is utilized to estimate resource utilization and quality of care. In burns the LOS estimation is 1day per percent total body surface area burn (1day/%TBSA). Our purpose was to evaluate the 1day/%TBSA burn rule and develop simple accurate formulas to predict LOS.
The American Burn Association National Burn Repository (NBR) from 2000 to 2013 was utilized to collate data on patients >18 years. We divided 106,543 records in half, utilizing one set to develop a model (training set) and the other to test the model (test set). We calculated the difference between observed and predicted LOS for all patients, and then examined the effect of inhalation injury and age using a linear regression model containing TBSA, age, inhalation injury and all two-way interactions. We compared predictive performance of the linear regression model to the 1day/%TBSA rule. Finally, we developed and validated three simple formulas to more accurately predict LOS than the 1day/% TBSA rule.
LOS was significantly associated with patient age, TBSA, inhalation injury, and all two-way interactions. For patients <40 years without inhalation injury the main effect of TBSA was 0.71. For each decade increase in age, LOS increased by 0.74days/TBSA burn; inhalation injury added 1.70days. LOS was highly variable among patients with similar burn size, age and inhalation injury due to concomitant trauma, complications, and comorbidities. We developed 3 formulas to estimate patient LOS: (1) inhalation injury present, regardless of age (2) no inhalation injury and ≥40 years old (3) no inhalation injury and <40 years old.
Traditional LOS estimates of 1day/%TBSA burn rule is biased, underestimating LOS, particularly for patients >40 years with inhalation injury. The following formulas applied at admission can accurately estimate hospital LOS, improve prediction over 1day/%TBSA, and provide results comparable to complicated models.
住院时间（LOS）用于评估资源利用情况和医疗质量。对于烧伤患者，住院时间的估计是每烧伤总体表面积的1%为1天（1天/%TBSA）。我们的目的是评估1天/%TBSA烧伤规则，并开发简单准确的公式来预测住院时间。
利用2000年至2013年美国烧伤协会国家烧伤资料库（NBR）收集18岁以上患者的数据。我们将106543条记录分成两半，用一组数据建立模型（训练集），另一组数据测试模型（测试集）。我们计算了所有患者观察到的和预测的住院时间之间的差异，然后使用包含TBSA、年龄、吸入性损伤以及所有双向交互作用的线性回归模型，研究吸入性损伤和年龄的影响。我们将线性回归模型的预测性能与1天/%TBSA规则进行比较。最后，我们开发并验证了三个简单的公式，以比1天/%TBSA规则更准确地预测住院时间。
住院时间与患者年龄、TBSA、吸入性损伤以及所有双向交互作用显著相关。对于年龄小于40岁且无吸入性损伤的患者，TBSA的主要影响为0.71。年龄每增加十岁，每%TBSA烧伤的住院时间增加0.74天；吸入性损伤增加1.70天。由于并发创伤、并发症和合并症，烧伤面积、年龄和吸入性损伤相似的患者住院时间差异很大。我们开发了3个公式来估计患者的住院时间：（1）存在吸入性损伤，无论年龄大小；（2）无吸入性损伤且年龄≥40岁；（3）无吸入性损伤且年龄<40岁。
传统的每%TBSA烧伤1天的住院时间估计存在偏差，低估了住院时间，特别是对于年龄大于40岁且有吸入性损伤的患者。入院时应用以下公式可以准确估计住院时间，比1天/%TBSA规则的预测性更好，并能提供与复杂模型相当的结果。
