Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China.
Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
Burns. 2019 May;45(3):705-716. doi: 10.1016/j.burns.2018.08.008. Epub 2019 Mar 2.
Epidemiological features of massively burned patients in China remains unclear. This study was designed to investigate the epidemiological characteristics and evaluate the burn index (BI) and other risk factors associated with the prognosis of massively burned patients.
Data of patients with ≥30% total body surface area burned admitted in 2014 were retrieved from 106 burn centers in the mainland of China. Information of epidemiological features and the outcome were collected for retrospective analysis.
A total of 2483 massively burned patients were included in this study, with a male-to-female ratio of 2.29:1, the mean age of 49.23±16.67 years, mean TBSA of 55.53±21.39% and the mean BI of 39.75±21.59. Scald accounted for 81.07% of the injuries in children, while flame accounted for 66.89% and 74.31% of the injuries in adults and seniors. Approximately 17.76% of the patients were admitted to the local burn center after 6h of injury, and the wound areas of 1154 (46.48%) patients were covered with folk remedies. The mortality was 9.79%, and the area under the receiver operating characteristic (ROC) curve for BI was 0.941 (95% CI, 0.929-0.954). When the value of BI was above a threshold of 29 in the 0-14 years age group, 43.5 in the 15-59 years age group and 35.5 in the 60 years or older age group, the mortality increased significantly. Multivariate logistic regression analyses showed that the odds ratio (OR) of death increased 6% with an increase in the BI of 1.0. Patients older than 60 years, the admission time longer than 6h after-injury (adjusted OR, 1.797; 95% CI, 1.179-2.740; adjusted p<0.001), and patients with a combined inhalation injury (adjusted OR, 6.649; 95% CI, 4.517-9.789; adjusted p<0.000), were at higher risk of death.
There are etiological characteristics of the different age groups that should be considered for prevention. BI can be a reliable index of prognosis in severely burned patients. The results of the study showed that a large BI, elderly age, delayed admission after injury and combined inhalation injury are the main risk factors for extensively burned patients.
中国大面积烧伤患者的流行病学特征尚不清楚。本研究旨在调查流行病学特征，并评估与大面积烧伤患者预后相关的烧伤指数（BI）和其他危险因素。
从中国大陆 106 家烧伤中心检索了 2014 年入院时烧伤面积≥30%的患者数据。对流行病学特征和结局进行回顾性分析。
本研究共纳入 2483 例大面积烧伤患者，男女比例为 2.29:1，平均年龄 49.23±16.67 岁，平均 TBSA 为 55.53±21.39%，BI 为 39.75±21.59。儿童烧伤中 81.07%为烫伤，成人和老年人中 66.89%和 74.31%为火焰伤。约 17.76%的患者在受伤后 6 小时内被送往当地烧伤中心，1154 例（46.48%）患者的创面覆盖了民间偏方。死亡率为 9.79%，BI 的受试者工作特征（ROC）曲线下面积为 0.941（95%CI，0.929-0.954）。在 0-14 岁年龄组中，BI 值超过 29 时，在 15-59 岁年龄组中，BI 值超过 43.5，在 60 岁或以上年龄组中，BI 值超过 35.5 时，死亡率显著增加。多因素 logistic 回归分析显示，BI 每增加 1.0，死亡的比值比（OR）增加 6%。年龄大于 60 岁、受伤后入院时间大于 6 小时（调整 OR，1.797；95%CI，1.179-2.740；调整 p<0.001），以及合并吸入性损伤（调整 OR，6.649；95%CI，4.517-9.789；调整 p<0.000）的患者死亡风险更高。
不同年龄组有不同的病因特征，应考虑预防。BI 可以作为严重烧伤患者预后的可靠指标。研究结果表明，大 BI、高龄、伤后延迟入院和合并吸入性损伤是大面积烧伤患者的主要危险因素。
