Departments of Clinical Medicine and Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
Intensive Care National Audit and Research Centre (ICNARC), London, UK.
Anaesthesia. 2018 Sep;73(9):1131-1140. doi: 10.1111/anae.14319. Epub 2018 May 15.
In the UK, a network of specialist centres has been set up to provide critical care for burn patients. However, some burn patients are admitted to general intensive care units. Little is known about the casemix of these patients and how it compares with patients in specialist burn centres. It is not known whether burn-specific or generic risk prediction models perform better when applied to patients managed in intensive care units. We examined admissions for burns in the Case Mix Programme Database from April 2010 to March 2016. The casemix, activity and outcome in general and specialist burn intensive care units were compared and the fit of two burn-specific risk prediction models (revised Baux and Belgian Outcome in Burn Injury models) and one generic model (Intensive Care National Audit and Research Centre model) were compared. Patients in burn intensive care units had more extensive injuries compared with patients in general intensive care units (median (IQR [range]) burn surface area 16 (7-32 [0-98])% vs. 8 (1-18 [0-100])%, respectively) but in-hospital mortality was similar (22.8% vs. 19.0%, respectively). The discrimination and calibration of the generic Intensive Care National Audit and Research Centre model was superior to the revised Baux and Belgian Outcome in Burn Injury burn-specific models for patients managed on both specialist burn and general intensive care units.
在英国，已经建立了一个专门的中心网络，为烧伤患者提供重症监护。然而，一些烧伤患者被收入普通重症监护病房。人们对这些患者的病例组合及其与专科烧伤中心患者的比较知之甚少。也不知道当应用于重症监护病房的患者时，烧伤特异性或通用风险预测模型的表现是否更好。我们检查了 2010 年 4 月至 2016 年 3 月期间病例组合计划数据库中烧伤患者的入院情况。比较了普通和专科烧伤重症监护病房的病例组合、活动和结果，并比较了两种烧伤特异性风险预测模型（修订版 Baux 和比利时烧伤结局模型）和一种通用模型（重症监护国家审计和研究中心模型）的拟合情况。与普通重症监护病房的患者相比，烧伤重症监护病房的患者的损伤更为广泛（中位数（IQR[范围]）烧伤面积 16%（7-32%[0-98%]）比 8%（1-18%[0-100%]），但院内死亡率相似（分别为 22.8%和 19.0%）。对于在专科烧伤和普通重症监护病房接受治疗的患者，通用的重症监护国家审计和研究中心模型的判别力和校准均优于修订版 Baux 和比利时烧伤结局烧伤特异性模型。
