Mortality prediction and outcomes among burns patients from Australian and New Zealand intensive care units.
BACKGROUND
Acute Physiology and Chronic Health Evaluation (APACHE) III scores have been shown to correlate with outcomes for patients with burn injuries. It is unknown whether they can be used to compare outcomes between intensive care units that admit patients with burns in Australia and New Zealand.


OBJECTIVE
To assess the APACHE III-j score as a predictor of mortality for burns patients and use it to compare riskadjusted outcomes between different ICUs.


METHODS
Retrospective cohort study of all patients listed in the Australian and New Zealand Intensive Care Society Adult Patient Database with a diagnosis of burns between 1 January 2001 and 30 June 2008. Logistic regression analysis was used to assess the relationship between APACHE III-j score and mortality, and to derive a predicted risk of death for each patient. Standardized mortality ratios for individual ICUs were calculated and outcome variation assessed.


RESULTS
Data on 1618 patients were included in the analysis (mean age, 40.6 years; mortality, 13.2%). Increasing APACHE III-j scores were significantly associated with increasing likelihood of death (odds ratio, 1.05 [95%CI, 1.04-1.06]). The largest ICU and two small ICUs had risk-adjusted outcomes that were significantly better than the rest. Over the study period there was a decline in observed mortality accompanied by a parallel reduction in predicted risk of death.


CONCLUSIONS
The APACHE III-j score is a good predictor of death among burns patients admitted to ICUs in Australia and New Zealand. It can be used to compare risk-adjusted outcomes between individual ICUs and over time.
Department of Anaesthesia, Royal Victoria Hospital, Belfast, Northern Ireland, UK. jamesjmcnamee@yahoo.co.uk.
James J
JJ
McNamee
David V
DV
Pilcher
Michael J
MJ
Bailey
Edwina C
EC
Moore
Heather J
HJ
Cleland
D018806:APACHE; D001315:Australia; D002056:Burns; D015331:Cohort Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D009520:New Zealand; D012189:Retrospective Studies