TY - JOUR
T1 - Modified abbreviated burn severity index as a predictor of in-hospital mortality in patients with inhalation injury
T2 - development and validation using independent cohorts
AU - Yamamoto, Ryo
AU - Shibusawa, Takayuki
AU - Aikawa, Naoki
AU - Sasaki, Junichi
N1 - Publisher Copyright:
© 2020, Springer Nature Singapore Pte Ltd.
PY - 2021/2
Y1 - 2021/2
N2 - Purpose: The ability to accurately evaluate the severity of inhalation injury can help to optimize patient care. However, there is no accepted severity grading system, especially for inhalation injury. Methods: We screened a multicenter burn registry and included adult patients who required oxygen treatment or mechanical ventilation. After the patient data were divided into development and validation cohorts, missing values were replaced with multiple imputation. Twelve potential predictors were analyzed using multivariate logistic regression to identify prognostic variables for in-hospital mortality and scores were assigned to each predictor based on odds ratios to develop the Modified Abbreviated Burn Severity Index, mABSI. The mABSI was validated using c-statistics and calibration curves. Results: We randomly assigned 1377 and 919 patients to the development and validation cohorts, respectively. Age, self-inflicted injury, cutaneous burn area, and mechanical ventilation requirement were identified as independent predictors, and the mABSI (1–17 scale) was, thus, developed. The mABSI has a high discriminatory power (c-statistic = 0.94; 95% CI 0.92–0.97), and both estimated and observed in-hospital mortalities increased from 1% at score ≤ 5 to almost 100% at score ≥ 14 with linear calibration plots. Conclusions: We developed and validated the mABSI which accurately predicts in-hospital mortality.
AB - Purpose: The ability to accurately evaluate the severity of inhalation injury can help to optimize patient care. However, there is no accepted severity grading system, especially for inhalation injury. Methods: We screened a multicenter burn registry and included adult patients who required oxygen treatment or mechanical ventilation. After the patient data were divided into development and validation cohorts, missing values were replaced with multiple imputation. Twelve potential predictors were analyzed using multivariate logistic regression to identify prognostic variables for in-hospital mortality and scores were assigned to each predictor based on odds ratios to develop the Modified Abbreviated Burn Severity Index, mABSI. The mABSI was validated using c-statistics and calibration curves. Results: We randomly assigned 1377 and 919 patients to the development and validation cohorts, respectively. Age, self-inflicted injury, cutaneous burn area, and mechanical ventilation requirement were identified as independent predictors, and the mABSI (1–17 scale) was, thus, developed. The mABSI has a high discriminatory power (c-statistic = 0.94; 95% CI 0.92–0.97), and both estimated and observed in-hospital mortalities increased from 1% at score ≤ 5 to almost 100% at score ≥ 14 with linear calibration plots. Conclusions: We developed and validated the mABSI which accurately predicts in-hospital mortality.
KW - Inhalation injury
KW - Prognosis
KW - Scoring
KW - Severity
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U2 - 10.1007/s00595-020-02085-5
DO - 10.1007/s00595-020-02085-5
M3 - Article
C2 - 32691141
AN - SCOPUS:85088237468
VL - 51
SP - 242
EP - 249
JO - Surgery Today
JF - Surgery Today
SN - 0941-1291
IS - 2
ER -