Predictors of mortality and validation of burn mortality prognostic scores in a Malaysian burns intensive care unit

Abstract

BackgroundMajority burn mortality prognostic scores were developed and validated in western populations. The primary objective of this study was to evaluate and identify possible risk factors which may be used to predict burns mortality in a local Malaysian burns intensive care unit. The secondary objective was to validate the five well known burn prognostic scores (Baux score, Abbreviated Burn Severity Index (ABSI) score, Ryan score, Belgium Outcome Burn Injury (BOBI) score and revised Baux score) to predict burn mortality prediction.MethodsPatients that were treated at the Hospital Sultan Ismail’s Burns Intensive Care (BICU) unit for acute burn injuries between 1 January 2010 to 31 December 2017 were included. Risk factors to predict in-patient burn mortality were gender, age, mechanism of injury, total body surface area burn (TBSA), inhalational injury, mechanical ventilation, presence of tracheotomy, time from of burn injury to BICU admission and initial centre of first emergency treatment was administered. These variables were analysed using univariate and multivariate analysis for the outcomes of death. All patients were scored retrospectively using the five-burn mortality prognostic scores. Predictive ability for burn mortality was analysed using the area under receiver operating curve (AUROC).ResultsA total of 525 patients (372 males and 153 females) with mean age of 34.5 ± 14.6 years were included. There were 463 survivors and 62 deaths (11.8% mortality rate). The outcome of the primary objective showed that amongst the burn mortality risk factors that remained after multivariate analysis were older age (p = 0.004), wider TBSA burn (p < 0.001) and presence of mechanical ventilation (p < 0.001). Outcome of secondary objective showed good AUROC value for the prediction of burn death for all five burn prediction scores (Baux score; AUROC:0.9, ABSI score; AUROC:0.92, Ryan score; AUROC:0.87, BOBI score; AUROC:0.91 and revised Baux score; AUROC:0.94). The revised Baux score had the best AUROC value of 0.94 to predict burns mortality.ConclusionCurrent study evaluated and identified older age, total body surface area burns, and mechanical ventilation as significant predictors of burn mortality. In addition, the revised Baux score was the most accurate burn mortality risk score to predict mortality in a Malaysian burn’s population.

The analysis and accuracy of mortality prediction scores in burn patients admitted to the intensive care burn unit (ICBU)

“…Despite multiple articles reporting inhalational injury and the presence of comorbidities as a poor prognostic factor in burn patients [ 9 , 12 , 19 ], in our population those appeared to have no correlation. Meanwhile, factors such as the need for mechanical ventilation, presence of full thickness burns and higher TBSA% burns were associated with higher mortality rates.…”

“…The ICBU admission policy included paediatric patients with partial/full thickness burns >10% TBSA, adult patients with partial/full thickness burns >15% TBSA, electric burns, burns involving the face, any patient with suspected inhalational injury and patients with significant comorbidities [ 12 ].…”

Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia

“…Previous study conducted by Halgas et al [ 13 ] suggested that the revised Baux score was both accurate and easy to calculate, making it clinically useful. In addition, the revised Baux score was the most accurate burn mortality risk score to predict burn mortality in a Malaysian population [ 14 ]. In Indonesia, the majority of burn scoring systems used Rayan, Revised Baux Score, BOBI, ABSI.…”

Identification of important modules and biomarkers that related to immune cell in severe burns based on weighted gene co-expression network analysis(WGCNA)

“…7,8 Previous studies have explored the prognostic value of platelets, in ammatory factors, immune-related cytokines and scoring scales, however, the accuracy and clinical practicability need to be improved, and these prognostic factors cannot explain the disorder of homeostasis after severe burns, especially immunosuppression. [8][9][10] The change of gene expression pro le is the basis of disease, which can re ect the changes of homeostasis from the perspective of pathophysiology, explain the mechanism of its in uence on prognosis, and provide therapeutic targets for subsequent studies. 11,12 In addition, gene detection is convenient, economical and has strong stability in the application of prognosis.…”