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

Dmitry Zavlin; Vishwanath Chegireddy; Stefanos Boukovalas; Anna M Nia; Ludwik K Branski; Jeffrey D Friedman; Anthony Echo

doi:10.1186/s41038-018-0127-y

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

Burns Trauma. 2018 Aug 22:6:24. doi: 10.1186/s41038-018-0127-y. eCollection 2018.

Authors

Dmitry Zavlin¹, Vishwanath Chegireddy¹, Stefanos Boukovalas², Anna M Nia³, Ludwik K Branski², Jeffrey D Friedman¹, Anthony Echo¹

Affiliations

¹ 1Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX 77030 USA.
² 2Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX USA.
³ 3School of Medicine, The University of Texas Medical Branch, Galveston, TX USA.

Abstract

Background: Previous 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.

Methods: We 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.

Results: A 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.

Conclusion: Uninsured 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.

Keywords: Burns; Death; Mortality; Outcomes; Risks.