The effect of transfer delays on illness severity scores and mortality in major burns in New Zealand

Samuel Hale 1, Alex Kazemi 2,

1 Middlemore Hospital Intensive Care Unit, Auckland, New Zealand,
2 Middlemore Hospital Intensive Care Unit, Auckland, New Zealand,
3 [Click here and enter an Organisation, Postal Address, State, Postcode, Email Address for Author 3]

Registry data may be used for benchmarking care of major burns across Australasia. Both ANZBA and ANZICS have produced mortality prediction models that allow comparison of individual units with the cohort of tertiary units. However outlier analysis can be confounded by regional disparities in systems of care that are not accounted for in a generalised mortality prediction model.

Observational data suggest significant differences in rates of direct admissions to Burns Units between New Zealand and Australia. This may impact standardised mortality through an increase in mortality secondary to delayed admission to expert care. Alternatively an apparent alteration in illness severity scoring at admission to final destination may confound accurate mortality prediction. The association of longer transfer times with mortality might be due to safe transfer being precluded by high illness severity at the regional intensive care unit. The APACHE illness severity score is designed to look at the first 24 hours of intensive care admission. This may mean that transfer delays impact the validity of the APACHE score when applied to the tertiary Burns intensive care after resuscitation has occurred at a regional centre.

The authors will examine a sample of admissions to the New Zealand National Burns Centre for transfer times and illness severity scores in the first 72 hours post burn to determine whether there is any effect of delay in admission to the Burns Centre on mortality and illness severity.

Key Words
Mortality Prediction, Transfer, Major Burns, Critical Care, Illness Severity.

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