Multi-Institutional Analysis of Risk Factors for Mortality in Burn Injuries
Dmitry Zavlin, M.D.1, Vishwanath Chegireddy, M.D.1, Ludwik K. Branski, M.D.2, Stefanos Boukovalas, M.D.2, Jeffrey D. Friedman, M.D.1, Anthony Echo, M.D.1.
1Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA, 2The University of Texas Medical Branch, Galveston, TX, USA.
PURPOSE: Previous reports individually identified factors, such as age, total body surface area, and gender, as related to death after burn injuries. The authors have employed the multi-centered American Burn Association's (ABA) National Burn Repository (NBR) to elucidate which parameters have the highest negative impact on burn mortality. METHODS: We audited data from the NBR, version 8, for the years 2002 through 2011 and included 137,061 patients in our study. The cases were stratified into two cohorts based on the primary outcome death/survival and then evaluated demographic data, intraoperative details, and their morbidity after admission. A broad multivariate regression analysis aimed to identify independent risk factors associated with mortality. RESULTS:A total of 96.7% of patients in this analysis survived their burn injuries while 3.3% did not. Deceased patients were significantly older (56.5 vs. 30.5 years, p < 0.001), more likely female (35.3% vs. 30.7%, p < 0.001), and had more comorbidities (26.2% vs. 14.5%, p < 0.001). Burned TBSA (43.2% vs. 8.0%), presence of inhalation injury (37.2% vs. 4.4%), hospitalization time (18.0 vs. 9.4 days), and occurrence of complications (31.9% vs. 13.7%) were higher compared to survivors (p < 0.001). The majority of patients (52.0%) deceased within 7 days after admission. Lack of insurance (OR: 1.84), any type of complication (OR: 4.09), inhalation injury (OR: 3.84), and the need for operative procedures (OR: 2.60) were the strongest independent contributors to mortality after burns (p < 0.001). Age and TBSA were significant on a continuous scale (p < 0.001) while comorbidities were not a statistical risk factor.
CONCLUSION: In this study, uninsured status, inhalation injury, in-hospital complications, and operative procedures were linked to increased mortality after burns. Knowing that most fatal outcomes occur within the first few days after injury, our findings may help guide risk assessment and optimal treatment protocols upon admission to a burn center.
Back to 2018 Program