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Neophytos Stylianou

Development and validation of a model for prediction of mortality in patients with acute burn injury. Neophytos Stylianou. Background. First thought that mortality must be related to Burn Surface Area (BSA) 1860 Mortality Prediction Models for Burn Injury exist since 1961 (BSA + Age)

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Neophytos Stylianou

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  1. Development and validation of a model for prediction of mortality in patients with acute burn injury Neophytos Stylianou

  2. Background • First thought that mortality must be related to Burn Surface Area (BSA) 1860 • Mortality Prediction Models for Burn Injury exist since 1961 (BSA + Age) • 1982 inhalation injury was incorporated in model (ABSI model) • More than 40 models exist now • In the UK only 3 were developed • Only 3 models used nationwide data world wide

  3. Prediction models • Predict the probability of an outcome for a condition given a specific amount of input data • Various types of models eg. ANN, Logistic regression • A model should be: • Based on objective criteria • Accurate and reliable • Easy to use • Should be dynamic

  4. Why mortality? • Burn lead to premature deaths • Reduction in mortality is good endpoint • Well defined • Good surveillance coverage • Easily measured • Change is easily detected • Other outcomes: • LOS • Functional status • Quality of Life

  5. Why do we need them? • Mortality in burn injuries has dropped significantly in the last decades • They can aid in clinical decision making • Quality control/performance indicator • Burn management is one of the most expensive conditions to treat • Resource allocation

  6. The paper • BOBI model • Refined Ryan model: TBSA, Age, Inhalation injury • Belgian nation wide data from 1999-2004, 6227 patients • 1999-2003 data was used to derive the model 5246 patients • Validation:2004 data of 981 patients • AUC:0.94 (CI: 0.90-0.97) • Calibration:0.452 not on the published model

  7. The BOBI model

  8. Limitations • Wide categorisation of BSA • Does not compare with continuous variables • Derivation of scoring system • Arbitrary scale-up/down of predicted probabilities • H-L test based on continuous model and not categorised • No logistic regression formula published

  9. BOBI applied on England and Wales data • Data from iBID 2003-2011 • Since no logistic equation the model published it had to be recreated

  10. BOBI applied on England and Wales data • AUC:0.96 (CI 0.95-0.96) • H-L(4) 4.88 P>x2 0.300

  11. Comparison to our model • Our model: Age+Age2+TBSA(categorised in 10%)+inhalation injury + number of existing disorders + type of burn injury • AUC 0.971 (CI 0.965-0.977) • HL(10) 7.02 P>x2 0.7235 • Comparing the two gave a x2 (1) of 31.4 thus the models are different

  12. Any questions?

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