Mason Stephanie A, Nathens Avery B, Byrne James P, Gonzalez Alejandro, Fowler Rob, Karanicolas Paul J, Moineddin Rahim, Jeschke Marc G
From the Sunnybrook Research Institute (S.A.M., A.B.N., J.P.B., R.F., P.J.K., M.G.J.), Sunnybrook Health Sciences Centre; Division of General Surgery (S.A.M., A.B.N., J.P.B., P.J.K.), Institute for Health Policy, Management, and Evaluation (S.A.M., A.B.N., J.P.B., R.F., P.K.), University of Toronto; Institute for Clinical Evaluative Sciences (A.B.N., A.G., R.M.); Interdepartmental Division of Critical Care (R.F.), Department of Family and Community Medicine (R.M.), University of Toronto; Ross Tilley Burn Centre (M.G.J.), Sunnybrook Health Sciences Centre; Division of Plastic Surgery (M.G.J.), and Institute for Medical Sciences (M.G.J.), University of Toronto, Toronto, Canada.
J Trauma Acute Care Surg. 2017 Nov;83(5):867-874. doi: 10.1097/TA.0000000000001586.
Burn-related mortality has decreased significantly over the past several decades. Although often attributed in part to regionalization of burn care, this has not been evaluated at the population level.
We conducted a retrospective, population-based cohort study of all patients with 20% or higher total body surface area burn injury in Ontario, Canada. Adult (≥16 years) patients injured between 2003 and 2013 were included. Deaths in the emergency department were excluded. Logistic generalized estimating equations were used to estimate risk-adjusted 30-day mortality. Mortality trends were compared at burn and nonburn centers.
Seven hundred seventy-two patients were identified at 84 centers (2 burn, 82 nonburn). Patients were 74% (n = 570) male, of median age 46 (interquartile range [IQR], 35-60) years and median total body surface area 35% (IQR, 25-45). Mortality at 30 days was 19% (n = 149). The proportion of patients treated at a burn center increased from 57% to 71% between 2003 and 2013 (p = 0.07). Average risk-adjusted 30-day mortality rates decreased over time; there were significantly reduced odds of death in 2010 to 2013 compared with 2003 to 2006 (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.25-0.61). Burn centers exhibited significantly reduced mortality from 2003-2006 to 2010-2013 (OR, 0.36; 95% CI, 0.34-0.38) compared with nonburn centers (OR, 0.41; 95% CI, 0.13-1.24).
Mortality rates have decreased over time; significant improvements have occurred at burn centers, whereas mortality rates at nonburn centers vary widely. A high proportion of patients continue to receive care outside of burn centers. These data suggest that there are further opportunities to regionalize burn care and in so doing, potentially lower burn-related mortality.
Epidemiological study, level III; Therapy, level IV.
在过去几十年中，烧伤相关死亡率显著下降。尽管部分原因常被认为是烧伤护理的区域化，但尚未在人群层面进行评估。
我们对加拿大安大略省所有全身表面积烧伤达20%或更高的患者进行了一项基于人群的回顾性队列研究。纳入2003年至2013年间受伤的成年（≥16岁）患者。排除在急诊科死亡的患者。使用逻辑广义估计方程来估计风险调整后的30天死亡率。比较烧伤中心和非烧伤中心的死亡率趋势。
在84个中心（2个烧伤中心，82个非烧伤中心）共识别出772例患者。患者中74%（n = 570）为男性，年龄中位数为46岁（四分位间距[IQR]，35 - 60岁），全身表面积中位数为35%（IQR，25 - 45）。30天死亡率为19%（n = 149）。2003年至2013年间，在烧伤中心接受治疗的患者比例从57%增至71%（p = 0.07）。随着时间推移，平均风险调整后的30天死亡率下降；与2003年至2006年相比，2010年至2013年死亡几率显著降低（优势比[OR]，0.39；95%置信区间[CI]，0.25 - 0.61）。与非烧伤中心相比，烧伤中心从2003 - 2006年至2010 - 2013年死亡率显著降低（OR，0.36；95% CI，0.34 - 0.38），而非烧伤中心（OR，0.41；95% CI，0.13 - 1.24）。
死亡率随时间下降；烧伤中心有显著改善，而非烧伤中心死亡率差异很大。仍有很大比例的患者在烧伤中心以外接受治疗。这些数据表明，进一步推进烧伤护理区域化仍有机会，这样做可能会降低烧伤相关死亡率。
流行病学研究，III级；治疗，IV级。
