Objective estimates of the probability of death in acute burn injury: a proposed Taiwan burn score.

BACKGROUND: This study aimed to develop an objective model for predicting mortality after burn injury in Taiwan. METHODS: From 1997 to 2010, 23,147 patients with acute burn injury in 44 hospitals were retrospectively reviewed. Variables examined were age, sex, depth and extent of burn, inhalation injury, flushing time, hospital admission and referral status, intensive care unit admission, and mortality. Logistic regression analyses were used to evaluate risk factors. Model performance and calibration was evaluated by measures of discrimination and goodness-of-fit statistic, respectively. A nomogram of four major risk factors was used to calculate the probability of mortality. RESULTS: Only 22,665 patients (mean [SD] age, 31.05 [22.67] years; mean second-degree and third-degree burn sizes, 8.67% [10.64%] and 3.25% [10.91%], respectively) survived until discharge, for a mortality rate of 2.08%. CONCLUSION: Burn depth is an important predictive factor for mortality. An objective model can help estimate the probability of death in acute burn injury. LEVEL OF EVIDENCE: Prognostic study, level II.

The optimal time for early burn wound excision to reduce pro-inflammatory cytokine production in a murine burn injury model.

BACKGROUND: A potential solution to prevent post-burn deleterious inflammatory responses is early burn wound excision. However, the most beneficial time point remains controversial. This animal study investigated the optimal time point for burn wound excision to reduce pro-inflammatory cytokines production after burn. METHODS: Forty-eight male Sprague-Dawley rats received scald burns with third-degree burns of 30% body surface area, and were then divided into eight groups by day of operation for excision. Group 1 (n=6) received burn eschar excision on post-burn day (PBD) 1. Group 2 received excision on PBD2 (n=6) and so on, while group 8 was the control group (n=6) that did not undergo excision. The skin defect after excision was covered with a bovine-derived collagen dressing. Interleukin-1 (IL-1), IL-6, IL-10 and tumour necrosis factor-α were serially analysed by enzyme-linked immunosorbent assay (ELISA). RESULTS: We found that levels of all pro-inflammatory cytokines appeared to be lower after excision of full-thickness burns, but as the excision time was delayed from group 1 to group 7, the differences showed progressive decline. CONCLUSIONS: We believe that the earlier the excision is performed, the more the level of pro-inflammatory cytokines can be lowered, and the better the post-burn inflammatory process can be modulated.