title: Burn-center quality improvement: are burn outcomes dependent on admitting facilities and is there a volume-outcome "sweet-spot"?
abstract: Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether  the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict  patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and  age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting  facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar  risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
authors.forename: Tjasa
authors.initials: T
authors.lastname: Hranjec
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.forename: George
authors.initials: G
authors.lastname: Stukenborg
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Young
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
authors.forename: James F
authors.initials: JF
authors.lastname: Calland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002053:Burn Units / Q000592:standards*; D002056:Burns / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D055815:Young Adult