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. 2017 Nov;83(5):867-874.
doi: 10.1097/TA.0000000000001586.

Trends in the epidemiology of major burn injury among hospitalized patients: A population-based analysis

Stephanie A Mason  1 , Avery B Nathens, James P Byrne, Alejandro Gonzalez, Rob Fowler, Paul J Karanicolas, Rahim Moineddin, Marc G Jeschke
Affiliations

Trends in the epidemiology of major burn injury among hospitalized patients: A population-based analysis

Stephanie A Mason et al. J Trauma Acute Care Surg. 2017 Nov.

Abstract

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.

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Conflict of interest statement

Conflicts of interest: None reported

Figures

Figure 1
Figure 1
Trends in incidence by gender. Rates were directly age-standardized to the 2015 Canadian general population.
Figure 2
Figure 2
Trends in incidence by age group. Rates were directly sex-standardized to the 2015 Canadian general population.
Figure 3
Figure 3
Trends in adjusted 30-day mortality by burn center status. Yearly mean adjusted rates derived from multivariable hierarchical logistic regression model adjusted for patient and injury characteristics. Error bars represent 95% confidence intervals. Annual admission volumes are reported in the table. BC, burn center; NBC, non-burn center; N, total yearly admissions.
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