Objective estimates of the probability of death from burn injuries
Objective estimates of the probability of death from burn injuries
复制标题
DOI：
10.1056/nejm199802053380604
复制
发表时间：
1998-02-05
影响因子：
158.5
通讯作者：
Tompkins, RG
中科院分区：
文献类型：
--
作者：
Ryan, CM;Schoenfeld, DA;Tompkins, RG
背景在过去的20年里，在烧伤中心接受治疗的患者的生存率有了显著的提高。一个简单的，准确的系统，客观地估计死亡的概率将是有用的，在咨询病人和作出医疗decisions.Methods我们进行了回顾性分析，所有1665例急性烧伤入院于1990年至1994年的马萨诸塞州总医院和Shriners烧伤研究所在波士顿。使用逻辑回归分析，我们开发了基于最小定义变量集的死亡率预测概率估计。用此死亡率公式判断自1984年以来死亡率是否发生了变化，并对1995年或1996年收治的530例急性烧伤患者进行了前瞻性检验。（平均[+/-SD]年龄，21 ± 20岁;平均烧伤面积，体表面积的14 ± 20%），1598例（96%）存活出院。平均住院时间为21+/-29天。确定了三个死亡风险因素：年龄超过60岁，超过40%的体表面积烧伤和吸入性损伤。我们开发的死亡率公式预测了0.3%，3%，33%或大约90%的死亡率，这取决于是否存在零，一，两个或三个风险因素。该公式的前瞻性测试结果相似。选择不复苏的患者的比例大幅增加复杂的死亡率随时间的比较。结论烧伤后死亡的概率低，可以预测损伤后不久的基础上，简单，客观的临床标准。(C)1998年，马萨诸塞州医学会。
Background Over the past 20 years, there has been remarkable improvement in the chances of survival of patients treated in burn centers. A simple, accurate system for objectively estimating the probability of death would be useful in counseling patients and making medical decisions.Methods We conducted a retrospective review of all 1665 patients with acute burn injuries admitted from 1990 to 1994 to Massachusetts General Hospital and the Shriners Burns Institute in Boston. Using logistic-regression analysis, we developed probability estimates for the prediction of mortality based on a minimal set of well-defined variables. The resulting mortality formula was used to determine whether changes in mortality have occurred since 1984, and it was tested prospectively on all 530 patients with acute burn injuries admitted in 1995 or 1996.Results Of the 1665 patients (mean [+/-SD] age, 21+/-20 years; mean burn size, 14+/-20 percent of body-surface area), 1598 (96 percent) lived to discharge. The mean length of stay was 21+/-29 days. Three risk factors for death were identified: age greater than 60 years, more than 40 percent of body-surface area burned, and inhalation injury. The mortality formula we developed predicts 0.3 percent, 3 percent, 33 percent, or approximately 90 percent mortality, depending on whether zero, one, two, or three risk factors are present. The results of the prospective test of the formula were similar. A large increase in the proportion of patients who chose not to be resuscitated complicated comparisons of mortality over time.Conclusions The probability of death after burns is low and can be predicted soon after injury on the basis of simple, objective clinical criteria. (C) 1998, Massachusetts Medical Society.