title: Revised Baux Score and updated Charlson comorbidity index are independently associated with mortality in burns intensive care patients.
abstract: OBJECTIVE
  The purpose of the current study was to utilise established scoring systems to analyse the association of (i) burn injury severity, (ii) comorbid status and (iii) associated systemic physiological disturbance with inpatient mortality in patients with severe burn injuries admitted to intensive care.
  
  
  METHODS
  Case notes of all patients with acute thermal injuries affecting ≥15% total body surface area (TBSA) admitted to the Burns Intensive Care Unit (BICU) at Chelsea and Westminster Hospital during a 10-year period were retrospectively reviewed. Revised Baux Score, Belgian Outcome in Burn Injury (BOBI) Score, Abbreviated Burn Severity Index (ABSI), APACHE II Score, Sequential Organ Failure Assessment (SOFA) Score and Updated Charlson Comorbidity Index (CCI) were computed for each patient and analysed for association with inpatient mortality.
  
  
  RESULTS
  Ninety mechanically ventilated patients (median age 45.7 years, median % TBSA burned 36.5%) were included. 72 patients had full thickness burns and 35 patients had inhalational injuries. Forty-four patients died in hospital while 46 survived to discharge. In a multivariate logistic regression model, only the Revised Baux Score (p<0.001) and updated CCI (p=0.014) were independently associated with mortality. This gave a ROC curve with area under the curve of 0.920. On multivariate cox regression survival analysis, only the Revised Baux Score (p<0.001) and the updated CCI (p=0.004) were independently associated with shorter time to death.
  
  
  CONCLUSIONS
  Our data suggest that the Revised Baux Score and the updated CCI are independently associated with inpatient mortality in patients admitted to intensive care with burn injuries affecting ≥15% TBSA. This emphasises the importance of comorbidities in the prognosis of patients with severe burn injuries.
authors.affiliation: Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom; Imperial College London Faculty of Medicine, London, United Kingdom.
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Heng
authors.affiliation: Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom; Imperial College London Faculty of Medicine, London, United Kingdom.
authors.forename: Olivia
authors.initials: O
authors.lastname: Clancy
authors.affiliation: Plastic Surgery and Burns Service, Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Atkins
authors.affiliation: Plastic Surgery and Burns Service, Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: Jorge
authors.initials: J
authors.lastname: Leon-Villapalos
authors.affiliation: Plastic Surgery and Burns Service, Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Williams
authors.affiliation: Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Keays
authors.affiliation: Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hayes
authors.affiliation: Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom; Imperial College London Faculty of Medicine, London, United Kingdom.
authors.forename: Masao
authors.initials: M
authors.lastname: Takata
authors.affiliation: Plastic Surgery and Burns Service, Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: Isabel
authors.initials: I
authors.lastname: Jones
authors.affiliation: Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London, United Kingdom; Imperial College London Faculty of Medicine, London, United Kingdom. Electronic address: m.vizcaychipi@imperial.ac.uk.
authors.forename: Marcela P
authors.initials: MP
authors.lastname: Vizcaychipi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001830:Body Surface Area; D002053:Burn Units / Q000706:statistics & numerical data; D002056:Burns / Q000401:mortality* / Q000473:pathology; D015897:Comorbidity; D003422:Critical Care; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Burn injury; Comorbidities; Intensive care; Prognostic score; Revised Baux Score; Updated Charlson Comorbidity Index