The Effect of Burn Center Volume on Mortality in a Pediatric Population: An Analysis of the National Burn Repository.
The Effect of Burn Center Volume on Mortality in a Pediatric Population: An Analysis of the National Burn Repository.
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DOI：
10.1097/bcr.0000000000000274
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Wolf SE
中科院分区：
文献类型：
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作者：
Hodgman EI;Saeman MR;Subramanian M;Wolf SE
烧伤中心体积对死亡率的影响已在成人中得到证实。作者试图评估这种关系是否存在于烧伤儿童中。国家烧伤资料库是由美国烧伤协会赞助的一个自愿登记处，查询了2002年至2011年18岁或以下患者的所有数据点。根据平均年烧伤量将设施分为四分位数。比较各组的人口统计学和临床特征，并进行单变量和多变量logistic回归，以评估设施容量，患者特征和死亡率之间的关系。作者分析了88家独特机构收治的38，234名患者。4岁以下或烧伤面积较大的儿童更有可能在高容量和非常高容量的中心接受治疗（分别为57.12%和53.41%）。总体死亡率较低（0.85%）。比较四分位数的死亡率表明，与中等容量和非常高容量中心相比，低容量和高容量中心的未校正死亡率有所改善，尽管单变量logistic回归未发现显著相关性。然而，多变量分析确定烧伤中心体积是控制患者特征（包括年龄、损伤机制、烧伤面积和吸入性损伤）后死亡率降低的重要预测因素。小儿烧伤患者的死亡率较低，主要与患者和损伤特征有关，如烧伤面积、吸入性损伤和烧伤原因。当考虑损伤特征时，平均年入院率对死亡率有显著但较小的影响。
The effect of burn center volume on mortality has been demonstrated in adults. The authors sought to evaluate whether such a relationship existed in burned children. The National Burn Repository, a voluntary registry sponsored by the American Burn Association, was queried for all data points on patients aged 18 years or less and treated from 2002 to 2011. Facilities were divided into quartiles based on average annual burn volume. Demographics and clinical characteristics were compared across groups, and univariate and multivariate logistic regressions were performed to evaluate relationships between facility volume, patient characteristics, and mortality. The authors analyzed 38,234 patients admitted to 88 unique facilities. Children under age 4 years or with larger burns were more likely to be managed at high-volume and very high–volume centers (57.12 and 53.41%, respectively). Overall mortality was low (0.85%). Comparing mortality across quartiles demonstrated improved unadjusted mortality rates at the low- and high-volume centers compared with the medium-volume and very high–volume centers although univariate logistic regression did not find a significant relationship. However, multivariate analysis identified burn center volume as a significant predictor of decreased mortality after controlling for patient characteristics including age, mechanism of injury, burn size, and presence of inhalation injury. Mortality among pediatric burn patients is low and was primarily related to patient and injury characteristics, such as burn size, inhalation injury, and burn cause. Average annual admission rate had a significant but small effect on mortality when injury characteristics were considered.