Hennepin County Medical Center, Minneapolis, MN.
J Burn Care Res. 2020 Jan 30;41(1):3-7. doi: 10.1093/jbcr/irz139.
It is well-established that survival in burn injury is primarily dependent on three factors: age, percent total-body surface area burned (%TBSA), and inhalation injury. However, it is clear that in other (nonburn) conditions, nonmedical factors may influence mortality. Even in severe burns, patients undergoing resuscitation may survive for a period of time before succumbing to infection or other complications. In some cases, though, families in conjunction with caregivers may choose to withdraw care and not resuscitate patients with large burns. We wanted to investigate whether any nonmedical socioeconomic factors influenced the rate of early deaths in burn patients. The National Burn Repository (NBR) was used to identify patients that died in the first 72 hours after injury and those that survived more than 72 hours. Both univariate and multivariate regression analyses were used to examine factors including age, gender, race, comorbidities, burn size, inhalation injury, and insurance type, and determine their influence on deaths within 72 hours. A total of 133,889 burn patients were identified, 1362 of which died in the first 72 hours. As expected, the Baux score (age plus burn size), and inhalation injury predicted early deaths. Interestingly, on multivariate analysis, patients with Medicare (p = .002), self-pay patients (p < .001), and those covered by automobile policies (p = .045) were significantly more likely to die early than those with commercial insurance. Medicaid patients were more likely to die early, but not significantly (p = .188). Worker's compensation patients were more likely to survive the first 72 hours compared with patients with commercial insurance (p < .001). Men were more likely to survive the early period than women (p = .043). On analysis by race, only Hispanic patients significantly differed from white patients, and Hispanics were more likely to survive the first 72 hours (p = .028). Traditional medical factors are major factors in early burn deaths. However, these results show that nonmedical socioeconomic factors including race, gender, and especially insurance status influence early burn deaths as well.
众所周知，烧伤患者的存活率主要取决于三个因素：年龄、总体表面积烧伤百分比（%TBSA）和吸入性损伤。然而，很明显，在其他（非烧伤）情况下，非医疗因素可能会影响死亡率。即使在严重烧伤的情况下，接受复苏的患者也可能在因感染或其他并发症而死亡之前存活一段时间。然而，在某些情况下，患者的家属和护理人员可能会选择停止治疗，不复苏大面积烧伤的患者。我们想调查是否有任何非医疗社会经济因素影响烧伤患者的早期死亡率。国家烧伤资料库（NBR）用于识别在受伤后 72 小时内死亡和存活超过 72 小时的患者。使用单变量和多变量回归分析检查了包括年龄、性别、种族、合并症、烧伤面积、吸入性损伤和保险类型在内的因素，并确定了它们对 72 小时内死亡的影响。共确定了 133889 例烧伤患者，其中 1362 例在头 72 小时内死亡。正如预期的那样，Baux 评分（年龄加烧伤面积）和吸入性损伤预测了早期死亡。有趣的是，在多变量分析中，医疗保险（p =.002）、自费患者（p <.001）和汽车保险覆盖的患者（p =.045）比商业保险患者更早死亡的可能性显著更高。医疗补助患者更早死亡的可能性更大，但不显著（p =.188）。与商业保险患者相比，工人补偿患者更有可能在头 72 小时内存活（p <.001）。男性比女性更有可能在早期存活（p =.043）。按种族分析，只有西班牙裔患者与白人患者有显著差异，西班牙裔患者更有可能在头 72 小时内存活（p =.028）。传统的医疗因素是早期烧伤死亡的主要因素。然而，这些结果表明，非医疗社会经济因素，包括种族、性别，尤其是保险状况，也会影响早期烧伤死亡。
