Do standard burn mortality formulae work on a population of severely burned children and adults?

Détails

ID Serval
serval:BIB_7E4CE6AEE5A2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Do standard burn mortality formulae work on a population of severely burned children and adults?
Périodique
Burns
Auteur⸱e⸱s
Tsurumi A., Que Y.A., Yan S., Tompkins R.G., Rahme L.G., Ryan C.M.
ISSN
1879-1409 (Electronic)
ISSN-L
0305-4179
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
41
Numéro
5
Pages
935-945
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
Publication Status: ppublish
Résumé
Accurate prediction of mortality following burns is useful as an audit tool, and for providing treatment plan and resource allocation criteria. Common burn formulae (Ryan Score, Abbreviated Burn Severity Index (ABSI), classic and revised Baux) have not been compared with the standard Acute Physiology and Chronic Health Evaluation II (APACHEII) or re-validated in a severely (≥20% total burn surface area) burned population. Furthermore, the revised Baux (R-Baux) has been externally validated thoroughly only once and the pediatric Baux (P-Baux) has yet to be. Using 522 severely burned patients, we show that burn formulae (ABSI, Baux, revised Baux) outperform APACHEII among adults (AUROC increase p<0.001 adults; p>0.5 children). The Ryan Score performs well especially among the most at-risk populations (estimated mortality [90% CI] original versus current study: 33% [26-41%] versus 30.18% [24.25-36.86%] for Ryan Score 2; 87% [78-93%] versus 66.48% [51.31-78.87%] for Ryan Score 3). The R-Baux shows accurate discrimination (AUROC 0.908 [0.869-0.947]) and is well-calibrated. However, the ABSI and P-Baux, although showing high measures of discrimination (AUROC 0.826 [0.737-0.916] and 0.848 [0.758-0.938]) in children), exceedingly overestimates mortality, indicating poor calibration. We highlight challenges in designing and employing scores that are applicable to a wide range of populations.
Mots-clé
APACHE, Adolescent, Adult, Aged, Body Surface Area, Burns/mortality, Burns/pathology, Child, Child, Preschool, Critical Illness, Databases, Factual, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Risk Assessment/methods, Smoke Inhalation Injury/mortality, Trauma Severity Indices, Young Adult
Pubmed
Web of science
Création de la notice
01/08/2015 8:44
Dernière modification de la notice
20/08/2019 14:39
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