Baux Score as a Predictor of Mortality at the CHBAH Adult Burns Unit

Christofides, C; Moore, Rachel; Nel, Marietha

doi:10.1016/j.jss.2020.01.018

Cited by 18 publications

(13 citation statements)

References 21 publications

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“…The mortality observed was in line with that seen across the African continent [ 111 ], and in another South African burns centre [ 112 ]. Regarding gender, more men were admitted to the burns centre, corroborating previous results that show men are more commonly transferred to higher levels of care in the country for a given severity [ 34 , 113 , 114 ]. Women were nonetheless more likely to succumb to their injury, confirming the presence of that variable in the ABSI score [ 50 ].…”

Section: Discussionsupporting

confidence: 85%

Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Boissin

2022

Global Health Action

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Background Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. Objectives The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. Methods Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts’ image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. Results Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. Conclusions Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.

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Section: Discussionsupporting

confidence: 85%

Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Boissin

2022

Global Health Action

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“…Structuring criteria has been strengthened; In order to assess neurological dysfunction in sedated patients within SOFA score determination [20], the Glasgow coma scale (GCS) value to consider should be either the last GCS value measured before sedating the patient, or current GCS value with correction for verbal response (V) in a no longer sedated patient who still has an endotracheal tube or cannula; For patients with chronic kidney disease, only glomerular filtration rate (G criterion) of the KDIGO classification [22] (see Appendix C) is considered, as it can readily be obtained from a simple blood sample, contrary to albuminuria (A criterion); Severe traumas have been removed, considering the lack of sufficiently simple and robust tools to assess probability of benefiting from critical care for trauma patients beforehand; Baux score (= age in years + total body surface area burned in %) has been chosen as burn severity criterion due to its simplicity and excellent prognostic value [23], way better than burned surface area alone. Smoke inhalation is not considered, as its diagnosis is impossible without fiberoptic bronchoscopy; Clinical frailty score (CFS, see Appendix D) is used to assess clinical autonomy [24], in line with French recommendations regarding treatment withholding/withdrawal procedures [4,6,8].…”

Section: Prioritisation Schemesmentioning

confidence: 99%

Prioritisation of ICU treatments for critically ill patients in a COVID-19 pandemic with scarce resources

Leclerc

Donat

et al. 2020

Anaesthesia Critical Care & Pain Medicine

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“… 7 , 28–30 Our data showed that in colistin-treated patients the overall mortality rate of 37.6% (50/133 patients) was related to older age, a higher percentage of third-degree burn areas, and severity of AKI, all well-known risk factors for death in the general burn population. 31 , 32 In the same way, by comparing colistin- and other antibiotic-treated groups, we found that a higher mortality rate and the severity of the burn were more frequently associated with MDRGN strains such as Acinetobacter baumannii , Pseudomonas aeruginosa and Klebsiella pneumoniae maintaining colistin as a unique sensitivity to antibiotics. In effect, the patients of the control group presented different types of MDRGN strains, and they were also treated with the new antibiotics specifically active against MDRGN when appropriate.…”

Section: Discussionmentioning

confidence: 59%

Colistin Therapy, Survival and Renal Replacement Therapy in Burn Patients: A 10-Year Single-Center Cohort Study

Mariano¹,

Malvasio²,

Risso³

et al. 2022

IJGM

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Purpose Colistin is still a therapeutic cornerstone against multidrug-resistant gram-negative bacteria (MDRGN), mostly when other antibiotics do not gain adequate activity on these strains. In the present study, we evaluated in a cohort of burn patients the relationship between colistin therapy, survival and requirement of renal replacement therapy (CRRT). Patients and Methods Retrospective study of 133 burn patients treated with iv colistimethate sodium (loading dose 9.0 × 10 6 IU, maintenance dose 4.5 × 10 6 IU BID) and 35 treated with other antibiotics for MDRGN infection including Acinetobacter baumannii , Pseudomonas aeruginosa , and Klebsiella pneumoniae between January 2008 and December 2017. Multivariate analysis with logistic regression was used to determine the effect of the predictors such as age, total body surface area (TBSA), third-degree burn areas, Revised Baux score, Charlson comorbidity score, length of stay, colistin dose and duration of treatment, mechanical ventilation, and need of CRRT on in-hospital mortality. To investigate the relationship between colistin and renal function, we focused on survivor patients as the completion of the therapeutic course of colistin represented the basic requirement to analyze its impact on the kidney. Results Out of 133 colistin- and 35 other antibiotics-treated patients, 83 (62.4%) and 31 (88.6%) survived, and 53 (39.8%) and 3 (9.7%) required CRRT, respectively. The severity of burns, as well as CRRT requirement and mortality, was significantly higher in colistin-treated patients than in other antibiotics-treated patients. Age and TBSA% were the significant predictors of mortality. Out of 83 colistin-treated survivors, 19 (22.9%) required CRRT (9 before and 10 after the start of colistin), and 64 (77.1%) had a normal renal function. No difference about the colistin dose and baseline characteristics, but the revised Baux score was found between the 9 patients requiring CRRT before the colistin course and the 10 patients after. Similarly, among the 64 patients not undergoing CRRT, no difference was found between the patients treated with the cumulative dose of colistin <99.0 × 10 6 IU (n = 33, median daily dose of 4.0 × 10 6 IU) and >99.0 × 10 6 IU (n = 31, median daily dose of 9.0 × 10 6 IU) about the baseline characteristics and the daily median plasma creatinine over 24 days of therapy. Conclusion Colistin therapy was associated with more severe burns, mortality, and CRRT requirement. A short course therapy, at appropriate cumulative dosage, can lead to clinical success without a significant association with severe renal impairment.

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Baux Score as a Predictor of Mortality at the CHBAH Adult Burns Unit

Cited by 18 publications

References 21 publications

Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Prioritisation of ICU treatments for critically ill patients in a COVID-19 pandemic with scarce resources

Colistin Therapy, Survival and Renal Replacement Therapy in Burn Patients: A 10-Year Single-Center Cohort Study

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