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• W2831402893 abstract "Background Specialized burns centers should manage the most severe burn cases. They often cater for large geographical areas and in low-income settings must deal with patient volumes far larger than their capacity. In such context, understanding the most significant determinants of in-unit mortality and knowing how to best predict it is instrumental to priority settings. The objective of this study is two-fold: firstly to identify patient and wound characteristics that best predict in-hospital outcome, and secondly, to assess whether prediction mortality scores, such as the Burn Abbreviated Severity Index (ABSI), established in high-income settings, are suitable in other settings where resources are limited. Methods The study is set in the burns center at Tygerberg Hospital in the Western Cape Province of South Africa, the only burns center catering for adult patients. All patients there during two consecutive years 2015-2016 (n = 452) were identified of which palliative care patients (n = 7) were excluded. A case report form was then used to systematically collect data on the characteristics of the patient (sex, age, comorbidity and referral status), injury (mechanism, intent, body part, inhalation, burn depth and size), the treatment received and, if applicable, on in-hospital mortality (prior to discharge from the center). Associations between in-hospital mortality and individual patient and injury characteristics were measured using simple logistic regression, and expressed as odds ratios (OR). A stepwise multivariate logistic regression model was then used and odds ratios adjusted for all other variables were obtained. For all variables, the reference category was defined as the one with the smallest mortality rate. The sensitivity and specificity of the determined all cases aggregated using a cut-off point of 8 (equivalent to a mortality rate of 50%). Results Almost half (47.6%) of the patients had a TBSA > 20%, and almost as many (42.0%), full thickness burns. The overall mortality rate was 19.8%. In-hospital mortality was associated with age (OR = 1.03 per year increase), being a female (OR = 2.25 (1.58–3.97 compared to male) and having an inhalation burn (OR = 5.27 (3.14–8.84) compared to those with no inhalation burn). Patients with flame burns had 16.9 higher odds of dying compared to those with scaldings and deep/full thickness burns patients, 8.9 higher odds than those with superficial/partial burns. There was a graded association between burn surface and the odds of dying. Five variables remained associated with in-hospital mortality after adjusting for all others in a multivariate regression model: age, sex, inhalation, burn size and depth. The mean of the ABSI-scores was 6 but there is a steep increase in mortality rates between the two consecutive scores of 7 and 8 (12.1% and 39.5% respectively). The score's sensitivity was 68%, and its specificity 92%. It is of note that all 14 patients with scores higher than 11 died, whereas the published scores predict a chance of survival smaller than 10%. Conclusion At the center, the mortality rate was high, with age, sex, inhalation, mechanism of injury, depth and size all being individually associated with in-hospital mortality. Our adjusted model retained age, sex, inhalation, burn size and depth as predictors of in-hospital mortality. These 5 variables are the same as the ones used in ABSI, confirming both the potential to use that score and their importance in mortality predictions. The mixed results regarding the ABSI score suggest it would perform better to foresee in-unit mortality of severe burns rather than less severe ones at the center. Whether lowering down the cut-off value from 8 to 6 as an option remains to be determined." @default.
• W2831402893 created "2018-07-19" @default.
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• W2831402893 date "2018-07-01" @default.
• W2831402893 modified "2023-10-01" @default.
• W2831402893 title "Patient and injury characteristics associated with in-hospital mortality among adult acute burns patients. The case of a burns center in the Western Cape, South Africa" @default.
• W2831402893 doi "https://doi.org/10.1016/j.respe.2018.05.089" @default.
• W2831402893 hasPublicationYear "2018" @default.
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