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Redefining the Outcomes to Resources Ratio for Burn Patient Triage in a Mass Casualty

Taylor, Sandra PhD*; Jeng, James MD; Saffle, Jeffrey R. MD††; Sen, Soman MD§; Greenhalgh, David G. MD§; Palmieri, Tina L. MD§

doi: 10.1097/BCR.0000000000000034
2013 NBR Best Paper-Nonphysician

Recent disasters highlight the need for predisaster planning, including the need for accurate triage. Data-driven triage tables, such as that generated from the 2002 National Burn Repository, are vital to optimize resource use during a disaster. The study purpose was to generate a burn resource disaster triage table based on current burn-treatment outcomes. Data from the NBR after the year 2000 were audited. Records that missed age, burn size, or survival status were excluded from analysis. Duplicate records, readmissions, transfers, and nonburn injuries were eliminated. Resource use was divided into expectant (predicted mortality >90%), low (mortality 50–90%), medium (mortality 10–50%), high (mortality <10%, admission 14–21 days), very high (mortality <10%, admission <14 days), and outpatient. Tables were created for all patient admissions and with/without inhalation injury. Of the 286,293 records, 210,683 were from the year 2000 or later. Expectant status for those aged >70 years began at 50% burn; a 20- to 29-year-old never reached expectant status. Inhalation injury lowered the expectant category to a burn size of 40% in >70-year-olds, and at >90% in 20- to 29-year-olds. The 0- to 1.9-year old group without inhalation injury never reached expectant status; with inhalation injury, expectant status was reached at >80% burn. Changes in the triage tables suggest that burn care has changed in the past 10 years. Inhalation injury significantly alters triage in a burn disaster. Use of these updated tables for triage in a disaster may improve our ability to allocate resources.

From the *Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Sacramento; University of Maryland Department of Surgery, Baltimore; ††University of Utah Intermountain Burn Center, Salt Lake City; §University of California Davis Department of Surgery and Shriners Hospital for Children Northern California, Sacramento.

Address correspondence to Tina L. Palmieri MD, FACS, FCCM, 2425 Stockton Blvd, Suite 718, Sacramento, California 95817.

© 2014 The American Burn Association