Dr Albert Kim1, Dr Pratik Rastogi1, Dr Edward Riordan1, Dr Jeon Cha1, Dr Robert Gates1
1Severe Burns Unit, Royal North Shore Hospital
Mortality predicting scores following burn injury can be valuable in guiding clinical decision-making and counselling families. The aim of this study is to identify burns mortality predictive scores and to demonstrate their usefulness on a retrospective cohort of burns patients that were admitted to the Severe Burns Unit at Royal North Shore Hospital.
A systematic review identified the revised Baux, Abbreviated Burn Severity Index (ABSI) and the Belgian Outcome in Burn Injury (BOBI) scores as suitable burns mortality predictive indices. This retrospective study included all patients admitted to RNSH from 2006 to 2017 with ≥50% total body surface area (TBSA) burns. There were no additional exclusion criteria. The accuracy of each scoring system was assessed using receiver-operator characteristics curve analysis.
During 2006-2017, 3002 patients were admitted to RNSH. 2% (n=56) had burns ≥50% TBSA burns. The mean age was 39yrs, mean TBSA burns was 71% and inhalation injury was present in 61% (n=34). The total mortality rate was 52%. In comparing burns survivors to mortality cases, significant differences were noted in mean age (35yrs vs. 44yrs, p=0.018), TBSA (63% vs. 78%, p<0.001) and Baux score (107 vs. 133, p<0.001). Survivors had a mean ABSI score of 11 (60-80% predicted mortality) and BOBI score of 5 (30% predicted mortality) vs. 13 (>90% predicted mortality) and 6 (50% predicted mortality) respectively in mortality cases (p<0.001, p=0.002).
The BOBI, ABSI and revised Baux sores may be used as clinical adjuncts to guide the management of severe burn patients.
Albert Kim is a Surgical SRMO at Royal North Shore Hospital with a special interest in severe burn injury.