Variation in patient profile, management, and in-hospital outcomes for Australian adult burns patients

Dr Lincoln Tracy1, Anne Darton2, Professor Belinda Gabbe1,3, Kathryn Heath4, Rochelle Kurmis4, Dr Carl Lisec5,6, Mr Cheng Lo7,8, Yvonne Singer7, Professor Fiona Wood9,10, Associate Professor Heather Cleland7

1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 2Statewide Burn Injury Service, New South Wales Agency for Clinical Innovation, St Leonards, Australia, 3Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales, 4Adult Burns Service, Royal Adelaide Hospital, Adelaide, Australia, 5Faculty of Medicine, The University of Queensland, St Lucia, Australia, 6Professor Stuart Pegg Adult Burns Centre, The Royal Brisbane And Women’s Hospital, Herston, Australia, 7Victorian Adult Burns Service, The Alfred, Melbourne, Australia, 8Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia, 9State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia, 10Burn Injury Research Unit, University of Western Australia, Perth, Australia


Objective: To explore four years of data from the Burns Registry of Australia and New Zealand (BRANZ) to determine the extent of variation between participating Australian adult burn services with respect to treatment and specific in-hospital outcomes.
Methods: This registry-based cohort study used data from the BRANZ for patients admitted between July 1 2016 and June 30 2020. Rates of intensive care unit admission, burn wound management, in-hospital death, readmission to a specialist burn service within 28 days of discharge, and hospital length of stay were examined. Estimated probabilities, means, and corresponding 95% confidence intervals were calculated for each contributing service.
Results: During the four-year study period, 8365 admissions for adult patients were captured by the BRANZ. Variation between specialist Australian burn services in admission numbers (range: 242 to 1599) patient demographics, clinical management (skin grafting rates varied from 14% to 92% of patients), and in-hospital outcomes (intensive care admission rate range: 4% to 18%; median length of stay range: 2.3 to 7.6 days; and in-hospital mortality rate range: 0.3% to 1.4%) were observed. This variation remained after accounting for casemix factors.
Conclusions: A decade after its launch, BRANZ data displays variation between specialist burn services in Australia. Ongoing research has begun to explore the reasons underlying this variation and how the variation is associated with in-hospital outcomes. Further engagement with sites about models of care is required to enhance understanding of this variation and develop evidence-based guidelines for burn care in Australia and New Zealand.


Dr Lincoln Tracy is a Research Fellow within the Prehospital, Emergency and Trauma Group at the School of Public Health and Preventive Medicine, Monash University. Working primarily with data from the Burns Registry of Australia and New Zealand, he undertakes research identifying objective and verifiable data on treatment, outcomes, and quality of care to encourage higher standards of burn injury prevention and care.

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