504 Revised Baux Score Identifies a New Risk Factor for Mortality: History of Diabetes

TL;DR

This study found that a history of diabetes is a new risk factor for mortality in burn patients, adding it to existing models like the Baux Score.

Contribution

Identifying diabetes as a significant risk factor for mortality in burn patients, which has not been previously recognized in such models.

Findings

Diabetes was found to increase mortality risk in burn patients (OR 3.61, 95% CI 1.17-11.08, p=0.025).

The study developed a revised mortality prediction model incorporating diabetes as a risk factor.

The model includes age, TBSA, inhalation injury, burn depth, and diabetes as significant predictors of mortality.

Abstract

Mortality following burn injury is influenced by many objective factors. Over the past several decades, numerous predictive formulas have been developed to estimate the probability of death from burn injury. Despite the preponderance of models, there are relatively few widely accepted objective measures found to impact mortality in burn patients. These factors include sex, age, burn depth, TBSA, and presence of inhalation injury. In this study, we retrospectively analyzed mortality in the burn patients at our level one trauma center to identify prognostic factors.

A retrospective chart review was performed on all patients between 2015-2020 over the age of 18 that presented to our trauma center for burns. Significant risk factors for the prediction of mortality based on a set of objective variables were identified using a stepwise forward logistic-regression analysis.

Of the 963 patients (mean [±SD] age, 47±17; mean TBSA, 9±13), 96% lived to discharge. The identified risk factors for death were increased age (OR 1.08, 95% CI 1.04-1.11, p< 0.001), increased TBSA (OR 1.10, 95% CI 1.06-1.13, p< 0.001), the presence of inhalation injury (OR 4.72, 95% CI 1.49-14.94, p=0.008), third degree burn depth (OR 6.09, 95% CI 1.15-32.00, p=0.033), and having diabetes (OR 3.61, 95% CI 1.17-11.08, p=0.025 (Table 1). The probability of death from patients who experience burns is described by the equation:

probability=1/(1+e^(-log f ()it))

With logit equal too:

logit = -9.584 + 0.072*(Age) + 0.090*(TBSA) + 1.804 (Presence Third Degree Burns) -2.231 (Presence Second & Third-Degree Burns) + 1.282 (Presence Diabetes) + 1.551 (Presence Inhalation Burns)

Categorical values should be treated as 1 if they are present and 0 if they are absent.

Between 1990 and 2010 the number of people living with diabetes tripled, and the annual incidence doubled. Diabetic wound healing is characterized by excessive inflammation and reduced angiogenesis, resulting in increased risk for complications. Diabetes is an established comorbidity in burn patients, but has never been identified as a significant risk factor for mortality.

Analysis of burn patients at our level 1 trauma center identified history of diabetes as a significant risk factor for mortality and suggests that the inclusion of diabetic status in future mortality models would increase their prognostic value in comparable populations.

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