Dr Lincoln Tracy1, Ms Yvonne Singer2, Professor Palmer Bessey3, Professor Michael Peck4,5, Mr Bart Phillips6, Dr Judy McInnes1, Miss Heather Cleland2, Professor Belinda Gabbe1,7
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 2Victorian Adult Burns Service, The Alfred, Melbourne, Australia, 3William Randolph Hearst Burn Center, Department of Surgery, Weill Cornell Medical College, New York, USA, 4Arizona Burn Center, Maricopa Medical Center, Phoenix, USA, 5University of Arizona College of Medicine, Tuscon, USA, 6BData, Minneapolis, USA, 7Farr Institute, Swansea University Medical School, Swansea University, Swansea, Wales
Introduction: Comparing registry data between countries may offer insights into improving patient care. Preliminary comparisons suggest that burns patients treated in the US are older, and have a higher crude inhalation injury and mortality rate than patients treated in Australia/New Zealand. This study aimed to explore these differences further.
Methods: Admission data between July 2015 and June 2017 were examined. Patients were categorized by age (paediatric <18 years, adult 18-65 years, and seniors ≥65 years) and %TBSA (0-9%, 10-19%, 20-49%, and ≥50%).
Results: There were 5,946 admissions in BRANZ, and 48,012 in the National Burn Repository (NBR). There were more paediatrics in BRANZ (33.0% vs 24.3%, p<0.01), but fewer adults (57.4% vs 64.0%, p<0.05) and seniors (9.6% vs 10.7%, p<0.05). A higher proportion of paediatrics (4.4% vs 2.9%, p<0.05) and adults (8.2% vs 5.6%, p<0.05) in BRANZ had a TBSA ≥20%, but there was no difference for seniors (7.2% vs 7.2%). Inhalation injury for paediatrics was similar (1.3% vs 1.9%), but lower for adults (5.7% vs 6.8%, p<0.05) and seniors 6.1% vs 10.7%, p<0.05) in BRANZ. Deaths for paediatrics were similar (0.2% vs 0.5%), but lower for adults (1.4% vs 2.4%, p<0.05) and seniors (6.1% vs 10.5%, p<0.05) in BRANZ.
Summary and conclusion: Comparing registry data between countries is feasible. More BRANZ patients have large burns than NBR patients, but they are younger. Higher proportions of inhalation injury in adults and seniors may account for higher crude burn mortality in the NBR. Further data harmonization and risk adjustment is required.
Dr Lincoln Tracy is a Research Fellow in the School of Public Health and Preventive Medicine at Monash University, where he currently works on the Burns Registry of Australia and New Zealand (BRANZ). He completed his PhD at Monash University in 2017, focusing on modulating the psychological and physiological aspects of pain experience.