Comparison of mortality scores

Published Date: 10th August 2016

Publication Authors: Howarth O, Davenport K, , Raftery S

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Introduction

Burn injuries are amongst the most severe physical and psychological insults a patient can experience and morbidity is extensive with variable mortality. Studies have repeatedly confirmed factors associated with high mortality, which include increasing age, extent of burn and presence or absence of inhalational injury. Predicting mortality from burns is useful in identifying those that may benefit from treatment or those in whom initiation of treatment is futile and not in the best interests of the patient. The objective of this surveillance study was to evaluate and compare the predictive value of Baux, Modified Baux (m-Baux), and the Intensive Care National Audit and Research Centre (ICNARC) scores for overall outcome in our cohort of burns patients admitted to the ICU over the last 5 years.

Methods

A single centre, retrospective surveillance study was carried out on all patients with a total body surface area burn (TBSA) > =15 % admitted to the ICU between February 2011 and February 2015. The Baux, m-Baux, and ICNARC scoring systems were compared with data analysis performed using logistic regression models. The fitness of each model was assessed using the Hosmer-Lemeshow, the CoxSnell, and the Nagelkerke R2 statistics.

Results

45 patients were admitted to the ICU with burn injuries > =15 % TBSA, none were excluded from this study. 17 patients died resulting in a mortality rate of 37.7 %. On all three measurements, the Baux score had the highest R2 value (0.21, 0.25, 0.33). We found that the odds ratio for survival changes by 0.96 (95 % c.i. 0.92 to 0.98) for each increase in Baux score by one unit.

Conclusions

Our data suggests that the Baux score is most useful for predicting overall mortality in patients with Burns versus the m-Baux and ICNARC scoring systems but all tests utilised have good discrimination and calibration for mortality prediction.

Howarth, O; Davenport, K; Jeanrenaud, P; Raftery, S. (2016). A comparison of mortality scores in burns patients on the intensive care unit​ . Critical Care. 20 (Suppl 2), 147

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