Do Trauma Scores Accurately Predict Outcomes for Patients with Burns?

Krob, Mary Jeanne; D’Amico, Filippo; Ross, Dolorosa Maria

doi:10.1097/00004630-199111000-00011

Cited by 34 publications

(10 citation statements)

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“…[44][45][46] These coarse scoring methods can be used for predicting patient outcome, for auditing, or as a triage system. In this study, the treatment of patients who eventually died was more than twice as expensive as the treatment of the survivors.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Patients With Severe Burns—Costs and Health-Related Quality of Life Outcome

Koljonen

Laitila

Rissanen

et al. 2013

Journal of Burn Care & Research

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To study the effectiveness of the treatment of patients with severe burns, the authors collected health-related quality of life (HRQoL) data with the 15D instrument, 17 to 29 months after treatment had commenced at the national burns unit. The costs of each patient's secondary care treatment were followed for a mean of 66 months. During the 1-year study period, 107 patients were treated at the burns unit, eight for scar surgery, the remainder for primary treatment of a burn injury; 19 had died or could not be located during the time of the HRQoL survey. Of the remaining 88 patients, 43 (49%; mean [SD] age 45.7 [14.8] years; 70% men) returned the questionnaire. Their mean (SD) HRQoL score (0.909[0.113]) was only slightly, and not significantly, lower than that of the age- and sex- standardized general population (0.928[0.080]). The mean (SD) secondary care cost of burn treatment of for all the 107 patients, over the 60- to 72-month observation time, was 42,838 USD (73,569 USD; range 1319-34,8741 USD). The largest portion of the total cost was because of inpatient treatment (61%) followed by operations (22%), and outpatient visits. In addition to the costs of burns treatment, the patients consumed other secondary care services to a value of nearly 12,229 USD. The HRQoL in patients treated for severe burns is good, thus the observed high-treatment costs can be considered acceptable.

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Section: Discussionmentioning

confidence: 99%

Treatment of Patients With Severe Burns—Costs and Health-Related Quality of Life Outcome

Koljonen

Laitila

Rissanen

et al. 2013

Journal of Burn Care & Research

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“…2, 40 The Baux score (defined as Age + % TBSA) has persisted for fifty years as one of the most consistent prognosticators of death from burn injury and has even been molded into a predictive scale that includes inhalation injury. 2, 25, 41, 42 Likewise, numerous studies indicate that inhalation injury severity, fluid resuscitation, COHb, PaO 2 /FiO 2 , pneumonia, and sepsis have utility in predicting death after burn injury. 2, 23, 43, 44 Specific to our study population of burn-injured patients with suspected inhalation injury we found that age, % TBSA, Baux score, and fluid resuscitation had significant associations with mortality.…”

Section: Discussionmentioning

confidence: 99%

Early Pulmonary Immune Hyporesponsiveness Is Associated With Mortality After Burn and Smoke Inhalation Injury

Davis

Albright

Carter

et al. 2012

Journal of Burn Care & Research

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Objective This prospective study aims to address mortality in the context of the early pulmonary immune response to burn and inhalation injury. Methods We collected bronchoalveolar lavage (BAL) fluid from 60 burn patients within 14 hours of their injury when smoke inhalation was suspected. Clinical and laboratory parameters and immune mediator profiles were compared to patient outcomes. Results Patients who succumbed to their injuries were older (p=0.005), had a larger % TBSA (total body surface area) burn (p<0.001), and required greater 24-hour resuscitative fluids (p=0.002). Non-survivors had lower BAL fluid concentrations of numerous immunomodulators, including C5a, IL-1β, IL-1RA, IL-8, IL-10, and IL-13 (p<0.05 for all). Comparing only those with the highest Baux scores to account for the effects of age and % TBSA burn on mortality, non-survivors also had reduced levels of IL-2, IL-4, G-CSF, IFN-γ, MIP-1β, and TNF-α (p<0.05 for all). The apparent pulmonary immune hyporesponsiveness in those who died was confirmed by in vitro culture, which revealed that pulmonary leukocytes from non-survivors had a blunted production of numerous immune mediators. Conclusions Our study demonstrates that the early pulmonary immune response to burn and smoke inhalation may be attenuated in patients who succumb to their injuries.

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“…Patients with burns, asphyxia or drowning and those with age <1 year (n = 86) were also excluded. These exclusions are habitual in studies on trauma mortality prediction modeling because severity indexes may perform differently with these injuries [15] and because the cut-offs of physiologic variables chosen for adults may not apply to infants. The final number of cases was 2488.…”

Section: Methodsmentioning

confidence: 99%

The counterintuitive effect of multiple injuries in severity scoring: a simple variable improves the predictive ability of NISS

Bartolomeo¹,

Ventura²,

Marino³

et al. 2011

Scand J Trauma Resusc Emerg Med

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BackgroundInjury scoring is important to formulate prognoses for trauma patients. Although scores based on empirical estimation allow for better prediction, those based on expert consensus, e.g. the New Injury Severity Score (NISS) are widely used. We describe how the addition of a variable quantifying the number of injuries improves the ability of NISS to predict mortality.MethodsWe analyzed 2488 injury cases included into the trauma registry of the Italian region Emilia-Romagna in 2006-2008 and assessed the ability of NISS alone, NISS plus number of injuries, and the maximum Abbreviated Injury Scale (AIS) to predict in-hospital mortality. Hierarchical logistic regression was used. We measured discrimination through the C statistics, and calibration through Hosmer-Lemeshow statistics, Akaike's information criterion (AIC) and calibration curves.ResultsThe best discrimination and calibration resulted from the model with NISS plus number of injuries, followed by NISS alone and then by the maximum AIS (C statistics 0.775, 0.755, and 0.729, respectively; AIC 1602, 1635, and 1712, respectively). The predictive ability of all the models improved after inclusion of age, gender, mechanism of injury, and the motor component of Glasgow Coma Scale (C statistics 0.889, 0.898, and 0.901; AIC 1234, 1174, and 1167). The model with NISS plus number of injuries still showed the best performances, this time with borderline statistical significance.ConclusionsIn NISS, the same weight is assigned to the three worst injuries, although the contribution of the second and third to the probability of death is smaller than that of the worst one. An improvement of the predictive ability of NISS can be obtained adjusting for the number of injuries.

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Do Trauma Scores Accurately Predict Outcomes for Patients with Burns?

Cited by 34 publications

References 0 publications

Treatment of Patients With Severe Burns—Costs and Health-Related Quality of Life Outcome

Treatment of Patients With Severe Burns—Costs and Health-Related Quality of Life Outcome

Early Pulmonary Immune Hyporesponsiveness Is Associated With Mortality After Burn and Smoke Inhalation Injury

The counterintuitive effect of multiple injuries in severity scoring: a simple variable improves the predictive ability of NISS

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