Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX.
Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX; Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, TX.
J Am Coll Surg. 2018 Apr;226(4):453-463. doi: 10.1016/j.jamcollsurg.2017.12.045. Epub 2018 Mar 9.
The standard of burn treatment today reflects major advances. We sought to quantitate the impact of these advances on burn survival via age-stratified mortality ratios compared with other reported mortality analyses in burns.
Age, percent of the total body surface area (TBSA) burned, presence of inhalation injury, length of stay, and survival status were recorded at admission and at discharge for all new burn admissions between 1989 and 2017. The expected mortality probability was calculated using historical multiple regression techniques and compared with observed data. We developed a prediction model for our observed data.
Between 1989 and 2017, there were 10,384 consecutive new burn admissions, with 355 mortalities (median age, 13 years; median percent TBSA burn, 11%). We saw a significant decrease in our observed mortality data compared to historical predictions (p < 0.0001), and a 2% reduction per year in mortality during the 3 decades. The prediction model of mortality for the data is as follows: Pr(dying) = e/(1 + e) where x = -6.44 - 0.12 age + 0.0042 age - 0.0000283 age + 0.0499 TBSA + 1.21 Inhalation Injury + 0.015 third degree TBSA.
The reduction in mortality over time may be attributed to successful changes in standard of care protocols in the burn center that improved the outlook for burned individuals, including protocols for management of inhalation injury, nutrition, resuscitation, and early excision and grafting.
当今的烧伤治疗标准反映了重大进展。我们试图通过与烧伤报告的其他死亡率分析相比，按年龄分层死亡率比来量化这些进展对烧伤存活率的影响。
在 1989 年至 2017 年期间，对所有新入院的烧伤患者，记录入院时和出院时的年龄、总体表烧伤面积（TBSA）百分比、吸入性损伤的存在、住院时间和存活状况。使用历史多回归技术计算预期死亡率概率，并将其与观察数据进行比较。我们为观察数据开发了一个预测模型。
在 1989 年至 2017 年期间，共有 10384 例连续新入院的烧伤患者，其中 355 例死亡（中位数年龄为 13 岁；中位数 TBSA 烧伤百分比为 11%）。与历史预测相比，我们观察到死亡率数据显著下降（p<0.0001），在 30 年内死亡率每年降低 2%。该数据的死亡率预测模型如下：Pr（死亡）=e/（1+e），其中 x=-6.44-0.12 年龄+0.0042 年龄-0.0000283 年龄+0.0499 TBSA+1.21 吸入性损伤+0.015 三度 TBSA。
随着时间的推移，死亡率的降低可能归因于烧伤中心护理标准的成功改变，这些改变改善了烧伤患者的预后，包括吸入性损伤、营养、复苏、早期切除和植皮的管理方案。
