Multi-institutional analysis of independent predictors for burn mortality in the United States

BACKGROUND: Previous reports individually identified different factors that predict death after burns. The authors employed the multi-center American Burn Association’s (ABA) National Burn Repository (NBR) to elucidate which parameters have the highest negative impact on burn mortality. METHODS: We audited data from the NBR v8.0 for the years 2002–2011 and included 137,061 patients in our study. The cases were stratified into two cohorts based on the primary outcome of death/survival and then evaluated for demographic data, intraoperative details, and their morbidity after admission. A multivariable regression analysis aimed to identify independent risk factors associated with mortality. RESULTS: A total of 3.3% of patients in this analysis did not survive their burn injuries. Of those, 52.0% expired within 7 days after admission. Patients in the mortality cohort were of older age (p < 0.001), more frequently female (p < 0.001), and had more pre-existing comorbidities (p < 0.001). Total body surface area (TBSA), inhalation injury, hospitalization time, and occurrence of complications were higher compared to survivors (p < 0.001). Lack of insurance (odds ratio (OR) = 1.84, confidence interval (CI) 1.38–2.46), diabetes (OR = 1.24, CI 1.01–1.53), any complication (OR = 4.09, CI 3.27–5.12), inhalation injury (OR = 3.84, CI 3.38–4.36), and the need for operative procedures (OR = 2.60, CI 2.20–3.08) were the strongest independent contributors to mortality after burns (p < 0.001). Age (OR = 1.07, CI 1.06–1.07) and TBSA (OR = 1.09, CI 1.09–1.09) were significant on a continuous scale (p < 0.001) while overall comorbidities were not a statistical risk factor. CONCLUSION: Uninsured status, inhalation injury, in-hospital complications, and operative procedures were the strongest mortality predictors after burns. Since most fatal outcomes (52.0%) occur within 7 days after injury, physicians and medical staff need to be aware of these risk factors upon patient admission to a burn center.