The Baux score is dead. Long live the Baux score: a 27-year retrospective cohort study of mortality at a regional burns service.
BACKGROUND
To assess trends in mortality after burn injuries treated in a regional specialist burns service between 1982 and 2008.


METHODS
Patient and burn-specific information and mortality were collated from written admission ledgers and the hospital coding department for 11,109 patients. The data set was divided into age cohorts (0-14, 15-44, 45-64, and >65 years) and time cohorts (1982-1991, 1992-2000, and 2000-2008). Lethal area 50 (LA50) was calculated by logistic regression and probit analysis. Mortality was related to the Baux score (age + total % burned surface area) by logistic regression.


RESULTS
In the time period 2000 to 2008, the LA50 values with approximate 95% confidence intervals (CIs) were 100% (CI, 85.5-100%) in the 0 to 14 cohort (LA10, 78.3%; CI, 64.1-92.5%), 76.4% (CI, 69.1-83.8%) in the 15 to 44 cohort, 58.6% (CI, 50.8-66.5%) in the 45 to 64 cohort, and 30.8% (CI, 24.7-36.9%) in the >65 cohort. The point of futility (the Baux Score at which predicted mortality is 100%) was 160 and the Baux50 (the Baux score at which predicted mortality is 50%) was 109.6 (CI, 105.9-113.4) in the 2000 to 2008 cohort.


CONCLUSIONS
Mortality is markedly improved over earlier data from this study and other historical series and compares favorably with outcomes published from the US National Burn Repository. The Baux Score continues to provide an indication of the risk of mortality. Survival after major burn injury is increasingly common, and decisions by nonspecialist about initial triage, management, and futility of care should be made after consultation with a specialist burn service.
St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, United Kingdom. geoffroberts@cantab.net
Geoffrey
G
Roberts
Mark
M
Lloyd
Mike
M
Parker
Rebecca
R
Martin
Bruce
B
Philp
Odhran
O
Shelley
Peter
P
Dziewulski
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002053:Burn Units / Q000706:statistics & numerical data; D002056:Burns / Q000175:diagnosis / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D016015:Logistic Models; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult