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Citation
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Mason SA, Nathens AB, Byrne J, González A, Fowler R, Karanicolas P, Moineddin R, Jeschke MG. J. Trauma Acute Care Surg. 2017; 83(5): 867-874. |
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Affiliation
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aSunnybrook Research Institute, Sunnybrook Health Sciences Centre and Division of General Surgery, University of Toronto, Toronto, Canada bInstitute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada cInstitute for Clinical Evaluative Sciences, Toronto, Canada dInterdepartmental Division of Critical Care, University of Toronto eDepartment of Family and Community Medicine, University of Toronto fRoss Tilley Burn Centre, Sunnybrook Health Sciences Centre and Division of Plastic Surgery, University of Toronto, Toronto, Canada gInstitute for Medical Sciences, University of Toronto, Toronto, Canada .ca. |
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Abstract
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BACKGROUND: Burn-related mortality has decreased significantly over the past several decades. While 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% total burned surface area (TBSA) burn injury in Ontario, Canada. Adult (>16y) patients injured between 2003-2013 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 non-burn centers.
RESULTS: 772 patients were identified at 84 centers (2 burn, 82 non-burn). Patients were 74% (n=570) male, of median age 46 (IQR 35-60) years and median TBSA 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 2003-2013 (p=0.07). Average risk-adjusted 30-day mortality rates decreased over time; there were significantly reduced odds of death in 2010-2013 compared to 2003-2006 (OR 0.39, 95% 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 to non-designated centers (OR 0.41, 95% CI 0.13-1.24).
CONCLUSIONS: Mortality rates have decreased over time; significant improvements have occurred at burn centers while mortality rates at non-designated centers vary widely. A high proportion of patients continue to receive care outside of burn centers. These data suggest there are further opportunities to regionalize burn care and in so doing, potentially lower burn-related mortality. LEVEL OF EVIDENCE: Level III epidemiological study.
Language: en |