Victorian Adult Burn Service, The Alfred, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Australia; Heath Data Research UK, Swansea University Medical School, Swansea University, United Kingdom.
Burns. 2023 Aug;49(5):1062-1072. doi: 10.1016/j.burns.2022.08.002. Epub 2022 Aug 13.
Patients with severe burns (≥20 % total body surface area [TBSA]) have specific and time sensitive needs on arrival to the burn centre. Burn care systems in Australia and New Zealand are organised differently during weekday business hours compared to overnight and weekends. The aims of this study were to compare the profile of adult patients with severe burns admitted during business hours with patients admitted out of hours and to quantify the association between time of admission and in-hospital outcomes in the Australian and New Zealand context.
Data were extracted from the Burns Registry of Australia and New Zealand for adults (≥18 years) with severe burns admitted to Australian or New Zealand burn centres between July 2016 and June 2020. Differences in patient profiles, clinical management, and in-hospital outcomes were investigated. Univariable and multivariable logistic and linear regression models were used to quantify associations between time of admission and in-hospital outcomes of interest.
We found 623 patients eligible for inclusion. Most patients were admitted out of hours (69.2 %), their median age was 42 years, and most were male (78 %). The median size burn was 30 % TBSA and 32 % of patients had an inhalation injury. A greater proportion of patients admitted out of hours had alcohol and/or drugs involved with injury compared to patients admitted during business hours. No other differences between groups were observed. Patients in both groups had similar odds of dying in hospital (Odds Ratio [OR], 95 % Confidence Interval [95 %CI] 1.49 [0.64, 3.48]), developing acute kidney injury within 72 h (OR, 95 %CI 0.58 [0.32, 1.07]), or sepsis (OR, 95 %CI 1.04 [0.46, 2.35]). No association was found between time of admission and hospital (%, 95 %CI 1.00 [0.82, 1.23]) nor intensive care length of stay (%, 95 %CI 0.97 [0.73, 1.27]).
In this first Australian and/or New Zealand study to explore the association between time of admission and burn patient in-hospital outcomes, out of hours admission was not associated with patient outcomes of interest.
These findings support current models of care in Australian and New Zealand burn centres, however further investigation is required. Nonetheless, given most severe burns patients arrive out of hours to burn the centre, it is plausible that out of hours availability of senior burn clinicians will improve patient care and safety resilience within burn care systems.
严重烧伤（≥20%体表面积[TBSA]）患者在到达烧伤中心时具有特定且时间敏感的需求。与夜间和周末相比，澳大利亚和新西兰的烧伤护理系统在工作日营业时间内的组织方式有所不同。本研究的目的是比较日间和夜间成人严重烧伤患者的入院情况，并量化澳大利亚和新西兰背景下入院时间与住院结果之间的关联。
从澳大利亚和新西兰烧伤登记处提取 2016 年 7 月至 2020 年 6 月期间入住澳大利亚或新西兰烧伤中心的≥18 岁成人严重烧伤患者的数据。研究了患者特征、临床管理和住院结果方面的差异。使用单变量和多变量逻辑和线性回归模型来量化入院时间与感兴趣的住院结果之间的关联。
我们发现 623 名患者符合纳入标准。大多数患者在夜间入院（69.2%），中位年龄为 42 岁，大多数为男性（78%）。中位烧伤面积为 30%TBSA，32%的患者有吸入性损伤。与日间入院的患者相比，夜间入院的患者中更多的人有酒精和/或药物与损伤有关。两组之间没有观察到其他差异。两组患者住院期间死亡的几率相似（优势比[OR]，95%置信区间[95%CI]1.49[0.64, 3.48]），72 小时内发生急性肾损伤的几率（OR，95%CI0.58[0.32, 1.07]）或脓毒症（OR，95%CI1.04[0.46, 2.35]）。入院时间与住院时间（%，95%CI1.00[0.82, 1.23]）或重症监护病房住院时间（%，95%CI0.97[0.73, 1.27]）之间没有关联。
这是第一项在澳大利亚和/或新西兰探索入院时间与烧伤患者住院结果之间关联的研究，夜间入院与感兴趣的患者结果无关。
这些发现支持澳大利亚和新西兰烧伤中心当前的护理模式，但需要进一步调查。尽管如此，鉴于大多数严重烧伤患者夜间到达烧伤中心，夜间有高级烧伤临床医生的可用性将改善烧伤护理系统内的患者护理和安全弹性。
