Multi-institutional analysis of independent predictors for burn mortality in the United States

Abstract

BackgroundPrevious reports individually identified different factors that predict death after burns. The authors employed the multi-center American Burn Association’s (ABA) National Burn Repository (NBR) to elucidate which parameters have the highest negative impact on burn mortality.MethodsWe audited data from the NBR v8.0 for the years 2002–2011 and included 137,061 patients in our study. The cases were stratified into two cohorts based on the primary outcome of death/survival and then evaluated for demographic data, intraoperative details, and their morbidity after admission. A multivariable regression analysis aimed to identify independent risk factors associated with mortality.ResultsA total of 3.3% of patients in this analysis did not survive their burn injuries. Of those, 52.0% expired within 7 days after admission. Patients in the mortality cohort were of older age (p < 0.001), more frequently female (p < 0.001), and had more pre-existing comorbidities (p < 0.001). Total body surface area (TBSA), inhalation injury, hospitalization time, and occurrence of complications were higher compared to survivors (p < 0.001). Lack of insurance (odds ratio (OR) = 1.84, confidence interval (CI) 1.38–2.46), diabetes (OR = 1.24, CI 1.01–1.53), any complication (OR = 4.09, CI 3.27–5.12), inhalation injury (OR = 3.84, CI 3.38–4.36), and the need for operative procedures (OR = 2.60, CI 2.20–3.08) were the strongest independent contributors to mortality after burns (p < 0.001). Age (OR = 1.07, CI 1.06–1.07) and TBSA (OR = 1.09, CI 1.09–1.09) were significant on a continuous scale (p < 0.001) while overall comorbidities were not a statistical risk factor.ConclusionUninsured status, inhalation injury, in-hospital complications, and operative procedures were the strongest mortality predictors after burns. Since most fatal outcomes (52.0%) occur within 7 days after injury, physicians and medical staff need to be aware of these risk factors upon patient admission to a burn center.

Epidemiological Investigation of Elderly Patients with Severe Burns at a Major Burn Center in Southwest China

“…The prevalence of pre-existing comorbidities is a unique feature of the elderly population and increases the vulnerability and mortality of burns in the elderly population [29][30][31]. In the present study, approximately half of the patients had at least one pre-existing comorbidity, which is less than the reported 69-82.4% rate in the literature [18,32,33].…”

Novel pharmacotherapy for burn wounds: what are the advancements

“…Furthermore, a complex cascade of biochemical events leads to a 'systemic apoptotic response' and the onset of both systemic and local immunosuppression that abrogates the normal self-defense mechanisms that would fight against infection [153]. The area of the body that is burned is the most important factor in deciding outcomes in patients, with burns over 50% of the body sometimes proving fatal [154]. The difficulties faced by systemically administered antibiotics in reaching the damaged tissue with its compromised circulation, has encouraged the use of topically applied antimicrobial products [155,156].…”

A Single Intravenous Infusion of Human Choriodecidual Mesenchymal Stem Cell Decreases Early Burn Mortality in a Rodent Model

“…Previous studies have mentioned that burns extending over 40 % of total body surface area can trigger a systemic in ammatory response syndrome (SIRS) in the rst few hours after injuries, affecting various functions of the systemic organs [1,2]. Although there has been a great advancement in modern burn care with early burn excision and grafting, aggressive uid resuscitation, metabolic and nutritional support, and infection control [3][4][5], mortality remains high even within specialized units, especially in the aged and in cases of truly extensive deep burns [6,7]. Pulmonary failure is the common cause of mortality.…”