Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power

Abstract

Introduction: Several models for predicting mortality have been developed for patients with burns, and the most commonly used are based on age and total body surface area (TBSA%). They often show good predictive precision as depicted by high values for area under the receiver operating characteristic curves (AUC). However the effect of coexisting morbidity on such prediction models has not to our knowledge been thoroughly examined. We hypothesised that adding it to a previously published model (based on age, TBSA%, full thickness burns, gender, and need for mechanical ventilation) would further improve its predictive power. Methods: We studied 772 patients admitted during the period 1997-2008 to the Linkoping University Hospital, National Burn Centre with any type of burns. We defined coexisting morbidity as any of the medical conditions listed in the Charlson list, as well as psychiatric disorders or drug or alcohol misuse. We added coexisting medical conditions to the model for predicting mortality (age, TBSA%, and need for mechanical ventilation) to determine whether it improved the model as assessed by changes in deviances between the models. Results: Mean (SD) age and TBSA% was 35 (26) years and 13 (17) %, respectively. Among 725 patients who survived, 105 (14%) had one or more coexisting condition, compared with 28 (60%) among those 47 who died. The presence of coexisting conditions increased with age (p < 0.001) among patients with burns. The AUC of the mortality prediction model in this study, based on the variables age, TBSA%, and need for mechanical ventilation was 0.980 (n = 772); after inclusion of coexisting morbidity in the model, the AUC improved only marginally, to 0.986. The model was not significantly better either. Conclusion: Adding coexisting morbidity to a model for prediction of mortality after a burn based on age, TBSA%, and the need for mechanical ventilation did not significantly improve its predictive value. This is probably because coexisting morbidity is automatically adjusted for by age in the original model. (C) 2015 Elsevier Ltd and ISBI. All rights reserved

Outcome of burn care : the mortality perspective

“…34 As expected, these were more common among older patients, independent of their sex, and psychiatric diagnoses, and misuse of alcohol (and other substances) was overrepresented throughout.…”

“…34,47 This is a unique finding in this context, both as a method and in a national or international perspective. We have shown equality among sexes in delivery of therapeutic interventions and outcome, which is a pleasing conclusion that can lead to further speculation -particularly, if the difference in outcome between the sexes at other burn centres depends on the underlying severity of injury, or an unequal use of resources.…”

“…34,45,47,63,64 However, risk-adjusted mortality may or may not be another difference between the sexes in burn care. 34,[45][46][47]65 A recent Swedish study in general intensive care showed equal mortality between men and women, but a different allocation of resources for the benefit of the men. 66 A female disadvantage in the level of medical care provided for general trauma and critical care patients has also been reported previously.…”

“…34,35 One of the most measured outcomes is the duration of stay in hospital. 36 The size of the burn and the patient's age influence the duration of admission, and their effects change during the stay in hospital.…”

“…A further deduction is that the factor "age" already adjusts for coexisting conditions, in that none of the patients in the youngest groups (0 to 39 years old) had a severe pre-existing disorder, and there were no deaths in this group. 34 This made it difficult, however, to evaluate the impact of pre-existing disorders (however serious) on the mortality among younger patients. Our conclusions therefore need to be interpreted with caution.…”