The Effect of Burn Center Volume on Mortality in a Pediatric Population

Abstract

The effect of burn center volume on mortality has been demonstrated in adults. The authors sought to evaluate whether such a relationship existed in burned children. The National Burn Repository, a voluntary registry sponsored by the American Burn Association, was queried for all data points on patients aged 18 years or less and treated from 2002 to 2011. Facilities were divided into quartiles based on average annual burn volume. Demographics and clinical characteristics were compared across groups, and univariate and multivariate logistic regressions were performed to evaluate relationships between facility volume, patient characteristics, and mortality. The authors analyzed 38,234 patients admitted to 88 unique facilities. Children under age 4 years or with larger burns were more likely to be managed at high-volume and very high–volume centers (57.12 and 53.41%, respectively). Overall mortality was low (0.85%). Comparing mortality across quartiles demonstrated improved unadjusted mortality rates at the low- and high-volume centers compared with the medium-volume and very high–volume centers although univariate logistic regression did not find a significant relationship. However, multivariate analysis identified burn center volume as a significant predictor of decreased mortality after controlling for patient characteristics including age, mechanism of injury, burn size, and presence of inhalation injury. Mortality among pediatric burn patients is low and was primarily related to patient and injury characteristics, such as burn size, inhalation injury, and burn cause. Average annual admission rate had a significant but small effect on mortality when injury characteristics were considered.

Characteristics and outcome of burned children admitted to a pediatric intensive care unit

“…( 1 , 4 , 7 ) Mortality among burned patients has decreased in previous decades, and recent studies have shown a correlation between mortality and BBS > 60%. ( 4 , 7 , 16 , 17 ) This same association was found in our study, as we observed more significant mortality in patients with a BBS > 50%.…”

Epidemiology and outcomes of pediatric burns over 35 years at Parkland Hospital

“…Similar to the findings of Morrow et al, we did find an increased risk of mortality among children under the age of 4 who sustained burn sizes between 30% and 60% TBSA [7]. Hodgman et al identified a similar trend in a recent analysis of the National Burn Repository [10]. However, this trend was not consistent for patients with small and large burns.…”

“…Over the 35 years of the study period, the mortality rate following a thermal injury among children admitted to Parkland was low at 2.5%; although this is higher than reported in several recent analyses of a pediatric subset of the National Burn Repository, which found rates of less than 1% [6,10]. However, we did see a significant decrease in mortality over time, with the rate approaching 1% in the last 5 years of analysis.…”

Creation of a decision aid for goal setting after geriatric burns

“…9,17 Estimations of the median lethal burn size (Lethal Area, 50%; LA50) LA 50 of a geriatric population range from 27.8% to 30.0% TBSA; this burn size would equate to a minimum Baux score of 92.8 to 95, which is quite similar to our cutoff point of 93 for increased risk of mortality. 7,18 However, among burn patients, there is a complex interplay between a patient's age and a decreased ability to adapt to stressors and the physiologic sequelae of the burn itself.…”

“…6 Unfortunately, the Baux score (or revised Baux score) has generally been studied using data sets that are dated, or inclusive of all age groups, effectively limiting their applicability to the geriatric subset. [7][8][9][10] Most importantly, despite the simplicity of the Baux score, its predictive ability has never been packaged as a simple and approachable decision aid.…”