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Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix.
- Source :
-
Burns : journal of the International Society for Burn Injuries [Burns] 2019 Aug; Vol. 45 (5), pp. 1057-1065. Date of Electronic Publication: 2019 Mar 02. - Publication Year :
- 2019
-
Abstract
- Purpose: Mortality in burn intensive care unit (ICU) has been decreasing and treatment appears to be changing. The aims of this study: (1) examine outcome in burn patients, (2) examine changes in ICU indication and (3) explore the influence of a changing case-mix.<br />Methods: Retrospective study in patients admitted to ICU (1987-2016). Four groups were specified: major burns (≥15% TBSA), inhalation injury with small injury (<15% TBSA, inhalation injury), watchful waiting (<15% TBSA, without inhalation injury), tender loving care (patients withheld from treatment). Logistic regression was performed to evaluate the relation between case-mix and outcome.<br />Results: Overall mortality decreased to 7%. Mortality of major burns decreased by 15%. The major burn group decreased by 36%. The inhalation injury and watchful waiting group increased by 9% and 21%. The percentage of ventilated patients increased by 14% in the major burn group. 40% of patients were ventilated in the watchful waiting group.<br />Conclusions: After correction for case-mix, survival improved, mainly in the major burn group. Case-mix shifted towards inhalation injury and watchful waiting. Growth of the watchful waiting group is not necessarily harmful. However, the increase of mechanical ventilation could be. We suggest raising awareness for risks and consequences of mechanical ventilation.<br /> (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Body Surface Area
Burn Units
Burns pathology
Burns therapy
Burns, Inhalation mortality
Burns, Inhalation therapy
Female
Humans
Length of Stay trends
Logistic Models
Male
Middle Aged
Netherlands
Palliative Care trends
Respiration, Artificial trends
Retrospective Studies
Risk Adjustment
Watchful Waiting trends
Withholding Treatment trends
Young Adult
Burns mortality
Critical Care trends
Diagnosis-Related Groups trends
Survival Rate trends
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1409
- Volume :
- 45
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Burns : journal of the International Society for Burn Injuries
- Publication Type :
- Academic Journal
- Accession number :
- 30837205
- Full Text :
- https://doi.org/10.1016/j.burns.2019.02.005