Improved Survival of Patients With Extensive Burns: Trends in Patient Characteristics and Mortality Among Burn Patients in a Tertiary Care Burn Facility, 2004-2013

Abstract

Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved.

Figure 1

a. Unadjusted mortality rate per 100 patients and 95% confidence interval across admit year. b. 30-day cumulative incidence of inpatient mortality during 2004–2007 (solid line), 2008–2010 (dashed line), and 2011–2013 (long-dashed line).

Figure 1

a. Unadjusted mortality rate per 100 patients and 95% confidence interval across admit year. b. 30-day cumulative incidence of inpatient mortality during 2004–2007 (solid line), 2008–2010 (dashed line), and 2011–2013 (long-dashed line).

Figure 2

Predicted 30-day inpatient mortality rate (%) and 95% confidence interval in 2004–2007 (solid line), 2008–2010 (dashed line), and 2011–2013 (long-dashed line), across total burn surface area and stratified by inhalational injury status.