Predicting mortality from burns: The need for age-group specific models

Abstract

Traditional burn mortality models are derived using all age groups. We hypothesized that age variably impacts mortality after burn and that age-specific models for children, adults, and seniors will more accurately predict mortality than an all-ages model. We audited data from the American Burn Association (ABA) National Burn Repository (NBR) from 2000-2009 and used mixed effect logistic regression models to assess the influence of age, total body surface area (TBSA) burn, and inhalation injury on mortality. Mortality models were constructed for all ages and age-specific models: children (<18 years), adults (18-60 years), and seniors (>60 years). Model performance was assessed by area under the receiver operating curve (AUC). Main effect and two-way interactions were used to construct age-group specific mortality models. Each age-specific model was compared to the All Ages model. Of 286,293 records 100,051 had complete data. Overall mortality was 4% but varied by age (17% seniors, <1% children). Age, TBSA, and inhalation injury were significant mortality predictors for all models (p<0.05). Differences in predicted mortality between the All Ages model and the age-specific models occurred in children and seniors. In the age-specific pediatric model, predicted mortality decreased with age; inhalation injury had greater effect on mortality than in the All Ages model. In the senior model mortality increased with age. Seniors had greater increase in mortality per 1% increment in burn size and 1 year increase in age than other ages. The predicted mortality in seniors using the senior-specific model was higher than in the All Ages model. “One size fits all” models for predicting burn outcomes do not accurately reflect the outcomes for seniors and children. Age-specific models for children and seniors may be advisable.

Burn Center Volume Makes a Difference for Burned Children*

“…(16) Interestingly, the coefficient for the TBSA* Inhale interaction was negative indicating a lower rate of increase in mortality risk per percent TBSA increase in the presence of inhalation injury. This apparent anomaly likely stems from the differential effect of inhalation injury on mortality in conjunction with burn severity.…”

The blister fluid proteome of paediatric burns

“…Firstly, most children's burns are smaller in size and not life-threatening compared to adult burn injury [1,2]; and secondly, children's burns require frequent surgical operations until the child stops growing in order to remediate the scarring and contractures that form after severe burns [3][4][5]. Contractures arise from scar tissue that forms across joints.…”

Lower Serum Albumin Shortly After Admission Predicts Prolonged Hospital Stay in Younger Burn Patients

“…5,16,17,29 However, the need for further stratification by age groups as a primary independent determinant in predicting length of hospitalization has yet to be further studied in regards to correlation with a biochemical marker such as albumin. 30 Flora et al observations comment on age as the next most important predictor in LOS once adjusted for TBSA. 22,31 Studies performed by Johnson et al 2 notes on the linear correlation in LOS in accord with TBSA within each age group.…”