Ryan C M, Schoenfeld D A, Thorpe W P, Sheridan R L, Cassem E H, Tompkins R G
Shriners Burns Institute and the Sumner Redstone Burn Center, Boston, MA, USA.
N Engl J Med. 1998 Feb 5;338(6):362-6. doi: 10.1056/NEJM199802053380604.
Over the past 20 years, there has been remarkable improvement in the chances of survival of patients treated in burn centers. A simple, accurate system for objectively estimating the probability of death would be useful in counseling patients and making medical decisions.
We conducted a retrospective review of all 1665 patients with acute burn injuries admitted from 1990 to 1994 to Massachusetts General Hospital and the Shriners Burns Institute in Boston. Using logistic-regression analysis, we developed probability estimates for the prediction of mortality based on a minimal set of well-defined variables. The resulting mortality formula was used to determine whether changes in mortality have occurred since 1984, and it was tested prospectively on all 530 patients with acute burn injuries admitted in 1995 or 1996.
Of the 1665 patients (mean [+/-SD] age, 21+/-20 years; mean burn size, 14+/-20 percent of body-surface area), 1598 (96 percent) lived to discharge. The mean length of stay was 21+/-29 days. Three risk factors for death were identified: age greater than 60 years, more than 40 percent of body-surface area burned, and inhalation injury. The mortality formula we developed predicts 0.3 percent, 3 percent, 33 percent, or approximately 90 percent mortality, depending on whether zero, one, two, or three risk factors are present. The results of the prospective test of the formula were similar. A large increase in the proportion of patients who chose not to be resuscitated complicated comparisons of mortality over time.
The probability of mortality after burns is low and can be predicted soon after injury on the basis of simple, objective clinical criteria.
在过去20年中，烧伤中心治疗的患者的存活几率有了显著提高。一个简单、准确的客观评估死亡概率的系统，对于为患者提供咨询和做出医疗决策将是有用的。
我们对1990年至1994年收治于马萨诸塞州总医院和波士顿施赖纳斯烧伤研究所的1665例急性烧伤患者进行了回顾性研究。我们使用逻辑回归分析，基于一组明确的最少变量，制定了预测死亡率的概率估计。所得的死亡率公式用于确定自1984年以来死亡率是否发生了变化，并对1995年或1996年收治的所有530例急性烧伤患者进行了前瞻性测试。
1665例患者（平均[±标准差]年龄为21±20岁；平均烧伤面积为体表面积的14±20%）中，1598例（96%）存活至出院。平均住院时间为21±29天。确定了三个死亡风险因素：年龄大于60岁、烧伤体表面积超过40%和吸入性损伤。我们制定的死亡率公式根据是否存在零个、一个、两个或三个风险因素，预测死亡率分别为0.3%、3%、33%或约90%。该公式前瞻性测试的结果相似。随着时间推移，选择不进行心肺复苏的患者比例大幅增加，这使得死亡率比较变得复杂。
烧伤后的死亡概率较低，并且可以在受伤后不久根据简单、客观的临床标准进行预测。
