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Trends in the epidemiology of major burn injury among hospitalized patients

A population-based analysis

Mason, Stephanie A. MD; Nathens, Avery B. MD, PhD; Byrne, James P. MD; Gonzalez, Alejandro MSc; Fowler, Rob MD, MS (Epi); Karanicolas, Paul J. MD, PhD; Moineddin, Rahim PhD; Jeschke, Marc G. MD, PhD

Journal of Trauma and Acute Care Surgery: November 2017 - Volume 83 - Issue 5 - p 867–874
doi: 10.1097/TA.0000000000001586
Original Articles

BACKGROUND Burn-related mortality has decreased significantly over the past several decades. Although often attributed in part to regionalization of burn care, this has not been evaluated at the population level.

METHODS We conducted a retrospective, population-based cohort study of all patients with 20% or higher total body surface area burn injury in Ontario, Canada. Adult (≥16 years) patients injured between 2003 and 2013 were included. Deaths in the emergency department were excluded. Logistic generalized estimating equations were used to estimate risk-adjusted 30-day mortality. Mortality trends were compared at burn and nonburn centers.

RESULTS Seven hundred seventy-two patients were identified at 84 centers (2 burn, 82 nonburn). Patients were 74% (n = 570) male, of median age 46 (interquartile range [IQR], 35–60) years and median total body surface area 35% (IQR, 25–45). Mortality at 30 days was 19% (n = 149). The proportion of patients treated at a burn center increased from 57% to 71% between 2003 and 2013 (p = 0.07). Average risk-adjusted 30-day mortality rates decreased over time; there were significantly reduced odds of death in 2010 to 2013 compared with 2003 to 2006 (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.25–0.61). Burn centers exhibited significantly reduced mortality from 2003–2006 to 2010–2013 (OR, 0.36; 95% CI, 0.34–0.38) compared with nonburn centers (OR, 0.41; 95% CI, 0.13–1.24).

CONCLUSION Mortality rates have decreased over time; significant improvements have occurred at burn centers, whereas mortality rates at nonburn centers vary widely. A high proportion of patients continue to receive care outside of burn centers. These data suggest that there are further opportunities to regionalize burn care and in so doing, potentially lower burn-related mortality.

LEVEL OF EVIDENCE Epidemiological study, level III; Therapy, level IV.

From the Sunnybrook Research Institute (S.A.M., A.B.N., J.P.B., R.F., P.J.K., M.G.J.), Sunnybrook Health Sciences Centre; Division of General Surgery (S.A.M., A.B.N., J.P.B., P.J.K.), Institute for Health Policy, Management, and Evaluation (S.A.M., A.B.N., J.P.B., R.F., P.K.), University of Toronto; Institute for Clinical Evaluative Sciences (A.B.N., A.G., R.M.); Interdepartmental Division of Critical Care (R.F.), Department of Family and Community Medicine (R.M.), University of Toronto; Ross Tilley Burn Centre (M.G.J.), Sunnybrook Health Sciences Centre; Division of Plastic Surgery (M.G.J.), and Institute for Medical Sciences (M.G.J.), University of Toronto, Toronto, Canada.

Submitted: August 15, 2016, Revised: April 3, 2017, Accepted: April 14, 2017, Published online: May 22, 2017.

Address for reprints: Marc G. Jeschke, MD, PhD, D704-2075 Bayview Avenue Toronto, ON, Canada M4N3M5.

© 2017 Lippincott Williams & Wilkins, Inc.