OBJECTIVE ESTIMATES OF THE PROBABILITY OF DEATH FROM BURN INJURIES

Background Over the past 20 years, there has been remarkable improveme nt in the chances of survival of patients treated in burn centers. A s imple, accurate system for objectively estimating the probability of d eath would be useful in counseling patients and making medical decisio ns. Methods We conducted a retrospective review of all 1665 patients w ith acute burn injuries admitted from 1990 to 1994 to Massachusetts Ge neral Hospital and the Shriners Burns Institute in Boston. Using logis tic-regression analysis, we developed probability estimates for the pr ediction of mortality based on a minimal set of well-defined variables . The resulting mortality formula was used to determine whether change s in mortality have occurred since 1984, and it was tested prospective ly on all 530 patients with acute burn injuries admitted in 1995 or 19 96. Results Of the 1665 patients (mean [+/-SD] age, 21+/-20 years; mea n 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 ri sk factors for death were identified: age greater than 60 years, more than 40 percent of body-surface area burned, and inhalation injury. Th e mortality formula we developed predicts 0.3 percent, 3 percent, 33 p ercent, or approximately 90 percent mortality, depending on whether ze ro, one, two, or three risk factors are present. The results of the pr ospective test of the formula were similar. A large increase in the pr oportion of patients who chose not to be resuscitated complicated comp arisons of mortality over time. Conclusions The probability of death a fter burns is low and can be predicted soon after injury on the basis of simple, objective clinical criteria. (C) 1998, Massachusetts Medica l Society.