Assessment of mortality prediction models in a Ghanaian burn population

Abstract Purpose Over 40 new or modified outcome prediction models have been developed for severe burns; with age, total burned surface area (TBSA) and inhalation area as major determinants of mortality. The objective of this study was to assess their applicability in a developing country. Procedure...

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Bibliographic Details
Published in:Burns 2013-08, Vol.39 (5), p.997-1003
Main Authors: Brusselaers, N, Agbenorku, P, Hoyte-Williams, P.E
Format: Article
Language:English
Subjects:
Abbreviated Burn Severity Index (ABSI)
Adolescent
Adult
Age Factors
Aged
Assessment
Belgian Outcome in Burn Injury (BOBI)
Body Surface Area
Burn Units - statistics & numerical data
Burns - mortality
Child
Child, Preschool
Critical Care
Determinants of mortality
Female
Ghana
Ghana - epidemiology
Humans
Infant
Injury Severity Score
Male
Medicin och hälsovetenskap
Middle Aged
Models, Statistical
Mortality prediction models
Predictive Value of Tests
Regression Analysis
Retrospective Studies
Risk Factors
ROC Curve
Severity of Illness Index
Young Adult
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Summary:Abstract Purpose Over 40 new or modified outcome prediction models have been developed for severe burns; with age, total burned surface area (TBSA) and inhalation area as major determinants of mortality. The objective of this study was to assess their applicability in a developing country. Procedures Data were collected retrospectively of a consecutive series of 261 patients (2009–2011) admitted to a Burns Intensive Care. Five outcome prediction models based on admission criteria were evaluated: Bull grid, Abbreviated Burn Severity Index – ABSI, Ryan-model, Belgian Outcome in Burn Injury – BOBI and revised Baux. Discriminative power and goodness-of-fit were assessed by receiver operating characteristic analyses (area under the curve – AUC) and Hosmer–Lemeshow tests. Findings Median age was 10.5 years (IQR: 2.5–27 years), median TBSA 21% (IQR: 11–34%); 55.2% were male, 28 patients died (10.7%). Only 2 patients were intubated (0.8%). The AUC were between 77 and 86%. The ABSI model showed the best calibration (28.7 expected deaths). Ryan, BOBI and rBaux significantly underestimated mortality, whereas Bull showed an overestimation. Conclusion This study on a young group of burn patients showed moderate to good discriminative power using all five prediction models. The expected number of deaths tended to be underestimated in the three most recent prediction models.
ISSN:0305-4179
1879-1409
1879-1409
DOI:10.1016/j.burns.2012.10.023