Division of Plastic Surgery, Department of Surgery, University of British Columbia, Canada.
Faculty of Medicine, Department of Surgery, University of British Columbia, Canada.
J Burn Care Res. 2022 Nov 2;43(6):1426-1433. doi: 10.1093/jbcr/irac051.
Advances in burn care have improved patient outcomes, and independently validated indices and predictors of burn outcomes warrant re-evaluation. The purpose of this study is to consolidate predictors of burn outcomes and determine the factors that significantly contribute to length-of-stay (LOS) and mortality. A retrospective review was conducted of all burn patients (n = 5778) admitted to a quaternary provincial burn unit from 1973 to 2017. Our inclusion criteria yielded 4622 independent cases. Multivariate linear and logistic regression models were generated, and area-under-receiver-operator-curve (AUROC) analysis was performed. Burn predictors included %TBSA, Baux (classic and revised) index, Abbreviated Burn Severity Index (ABSI), and Ryan score. Primary outcomes were mortality and LOS. Multivariate logistic regression for mortality showed the Baux index to be the best predictor for mortality (OR = 1.11, P < 0.001). The AUROC for Baux index was 0.95. With regard to LOS, ABSI was the best predictor for LOS (P < 0.001). ICU stay, ventilator use, alcoholism, and age are significantly associated with increased LOS. Interestingly, hypertension had a protective effect for LOS (P < 0.01) and trended towards a protective effect in mortality. Lethal score 50% (LS50) improved over the study period. The regressions show that burn mortality and LOS are best predicted with the Baux index and ABSI, respectively. Hypertension may have a protective effect on burn outcomes and may be attributed to increased perfusion to the periphery. These predictive scores are useful in determining institutional outcomes in burn surgery. Objective benchmarking of improvement in burn care outcomes can be established using LS50 trends.
烧伤治疗的进展改善了患者的预后，独立验证的烧伤预后指标和预测因素需要重新评估。本研究旨在整合烧伤预后的预测因素，并确定对住院时间（ LOS ）和死亡率有显著影响的因素。对 1973 年至 2017 年期间在一家四级省级烧伤病房住院的所有烧伤患者（ n = 5778 ）进行了回顾性研究。我们的纳入标准产生了 4622 个独立病例。生成了多变量线性和逻辑回归模型，并进行了接收者操作特征曲线下面积（ AUROC ）分析。烧伤预测因素包括 %TBSA 、 Baux （经典和修订）指数、简化烧伤严重度指数（ ABSI ）和 Ryan 评分。主要结局是死亡率和 LOS 。多变量逻辑回归分析死亡率显示， Baux 指数是死亡率的最佳预测因素（ OR = 1.11 ， P < 0.001 ）。 Baux 指数的 AUROC 为 0.95 。关于 LOS ， ABSI 是 LOS 的最佳预测因素（ P < 0.001 ）。 ICU 住院时间、呼吸机使用、酗酒和年龄与 LOS 增加显著相关。有趣的是，高血压对 LOS 有保护作用（ P < 0.01 ），且对死亡率有保护作用的趋势。致死评分 50%（ LS50 ）在研究期间有所提高。回归分析表明，烧伤死亡率和 LOS 分别用 Baux 指数和 ABSI 预测最佳。高血压可能对烧伤结局有保护作用，这可能归因于外周灌注增加。这些预测评分可用于确定烧伤手术机构的结局。使用 LS50 趋势可以建立客观的烧伤治疗效果改善基准。
