National Burn Repository 2019 Update · 2020. 5. 29. · national burn repository 2019 report dataset version 14.0 fire/flame injuries represent 40.6% of the cases in this report

National Burn Repository

2019 UpdateREPORT OF DATA

FROM 2009-2018

American Burn Association

311 South Wacker Drive, Suite 4150

Chicago, IL 60606

(312) 642-9260

www.ameriburn.org

National Burn Repository 2019 Report Dataset Version 14.0

FIRE/FLAME INJURIES REPRESENT 40.6% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

SCALD INJURIES REPRESENT 31.4% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

CONTACT WITH HOT OBJECT INJURIES REPRESENT 9.1% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

ELECTRICAL INJURIES REPRESENT 3.6% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

CHEMICAL INJURIES REPRESENT 3.5% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

ii©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

National Burn Repository 2019 Report

Anthony Papp, MD, PhD, FRCSCNBR Committee Chair

B. C. Professional Firefighters’ Burn and PlasticVancouver, British Columbia, Canada

Thereasa E. Abrams, PhD, LCSWUniversity of TennesseeCollege of Social Work

Nashville, Tennessee

Nicole P. Bernal, MD, FACSUniversity of California Irvine Medical Center

UCI Regional Burn CenterOrange, California

Damien W. Carter, MDMaine Medical Center

Portland, Maine

Steven A. Kahn, MDUniversity of South Alabama Medical Center

Mobile, Alabama

Yvonne L. Karanas, MDSanta Clara Valley Medical Center

San Jose, California

Jong O. Lee, MD, FACSShriners Hospitals for Children

Galveston, Texas

Lauren A. Nosanov, MD Medstar Washington Hospital Center

Washington, DC

Jennifer Rosenthal, RNMedical City Plano Burn and Reconstructive Clinic

Plano, Texas

Joan M. Weber, RN, MSNShriners Hospitals for Children

Boston, Massachusetts

Palmer Q. Bessey, MD, FACS, MS, Ad HocWeill Cornell Medical CollegeNew York Presbyterian Hospital

William Randolph Hearst Burn CenterNew York, New York

Matthew B. Klein, MD, FACS, MS, Ad HocSanta Clara Valley Medical Center

San Jose, California

American Burn Association NBR Advisory Committee

American Burn Association Staff

Kimberly A. Hoarle, MBA, CAE Executive Director

Maureen T. Kiley, BBASenior Program Director

Bart D. Phillips, MSTechnology Advisor

BData, LLC, Minneapolis, MN

Sarah K. Neumeier, MS Technology Advisor

BData, LLC, Minneapolis, MN

iii©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

On behalf of the American Burn Association, and the National Burn Repository Committee, we would like to acknowledge the dedication of the burn center registrars that commit to providing accurate data to the NBR. Without their work, there would be no report to provide to the membership and efforts at quality improvement would be greatly limited. We would also like to recognize the work performed by the nurses, therapists, dieticians, social workers, chaplains, surgical teams, volunteers, and medical providers whose commitment to excellent care provides meaning for each of these records. More than data points, they are human lives touched and affected through our efforts. The hours dedicated to the recovery of these patients by each team member are impossible to quantify in this report.

The American Burn Association would also like to thank the members of the National Burn Repository Committee for their commitment, dedication, and review of this year’s report. Their thoughtful analysis of the data guides the membership in their reading of the report and influences future interests and investigations.

The ABA is also grateful for the work of Bart Phillips, Technology Advisor of BData, and his dedicated staff. Their compilation, organization and presentation of this data facilitate its utility into understanding the demographics of burn injury.

Last but not least, the NBR Advisory Committee would like to express their gratitude to the ABA Central Office who provides support and infrastructure to ensure that this resource is completed in a timely fashion. We are also thankful for the tremendous work of Maureen Kiley, ABA Senior Program Director, and Kim Hoarle, Executive Director, who have provided good communication amongst all shareholders of this report and have advocated for continued growth and improvement in the NBR.

Acknowledgements

iv©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

American Burn Association National Burn Repository Advisory Committee ..................................................iiAcknowledgements ........................................................................................................................................iiiTable of Contents ...........................................................................................................................................ivIntroduction ...................................................................................................................................................ixSummary of Findings .....................................................................................................................................x

1) Analysis of Contributing Hospitals .................................................................................................................1Figure 1: States that have Submitted to the NBR, 2009 to 2018 ......................................................................2Table 1: Burn Center Location and Participation by Region ...........................................................................2Figure 2: Contributing U.S. Hospitals by Geographic Region .........................................................................3Figure 3: Arrival/Admission Year, Acute Burn Admissions ................................................................................3Figure 4: Volume of Record Submission by Geographic Region .....................................................................4Figure 5: Contributing U.S. Hospitals by Hospital Ownership Type .................................................................4

2) Analysis of All U.S. Records Included in the Report .......................................................................................7Figure 6: Age Group by Gender ......................................................................................................................8Table 2: Age Group by Gender .......................................................................................................................8Figure 7: Race/Ethnicity ................................................................................................................................9Table 3: Race/Ethnicity ..................................................................................................................................9Figure 8: Age Group by White vs. Non-White ................................................................................................9Figure 9: Burn Size Group (% TBSA) .............................................................................................................10Table 4: Survived/Died by Burn Group Size (%TBSA) ...................................................................................10Figure 10: Etiology .........................................................................................................................................11Table 5: Etiology ............................................................................................................................................11Figure 11: Frequency of Contact with Hot Object, Electrical, Fire, and Fire by Age Group .............................11Figure 12: Place of Occurrence – E849 Code .................................................................................................12Table 6: Place of Occurrence – E849 Code .....................................................................................................12Figure 13: Circumstance of Injury ..................................................................................................................12Table 7: Circumstance of Injury ......................................................................................................................12Figure 14: Hospital Disposition .......................................................................................................................13Table 8: Hospital Disposition ..........................................................................................................................13Figure 15: Average Hospital Length of Stay by Gender, 2009 to 2018 ..............................................................14Figure 16: Mortality Rate by Gender, 2009 to 2018 ........................................................................................14Table 9: Mortality Rate by Age Group and Burn Size .....................................................................................15Figure 17: Complications: Frequency of Top Ten Clinically Relevant Complications .......................................16Figure 18: Complications: Frequency of Top Ten Clinically Relevant Complications by Days on the Ventilator ..........16Figure 19: Complication Rate for Age Categories by Days on Ventilator .........................................................17Table 10: Complication Count for Age Categories by Days on Ventilator ........................................................17Figure 20: Mortality Rate for BAUX Score Categories by Gender ..................................................................18Table 11: Number of Cases in BAUX Score Categories by Gender .................................................................18Figure 21: Mortality Rate for BAUX Score Categories by Inhalation Injury ...................................................19Table 12: Number of Cases in BAUX Score Categories by Inhalation Injury...................................................19Table 13: Mortality Rates for Matrix of Main Predictors .................................................................................20Table 14: Primary Insurance Payor ..................................................................................................................21Figure 22: Percent of Patients Utilizing Selected Insurance Types Over Time ...................................................22Table 15: Case Count for Select Insurance Categories Over Time ..................................................................22Table 16: Hospital Days: Lived/Died by Burn Size Group ...............................................................................23Table 17: Hospital Charges: Lived/Died by Burn Size Group ..........................................................................23Table 18: Hospital Charges: Lived/Died by Top 20 MS-DRGs ........................................................................24Table 19: Days per %TBSA and Charges per Day by Age Groups and Survival ................................................25

3) Analysis by Age Group ...................................................................................................................................26Age Group Birth to .9 .......................................................................................................... 28 Figure 23: Race/Ethnicity Table 20: Race/Ethnicity Figure 24: Etiology Table 21: Etiology Table 22: Hospital Days: Lived/Died by Inhalation Injury Table 23: Top Ten Complications Table 24: Top Ten ICD-10 Procedures

Table of Contents

v©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

Table 25: Lived/Died by Burn Group Size (% TBSA) Table 26: Hospital Days by Burn Group Size (% TBSA) Table 27: Mean Charges for Top Five MS-DRGs Figure 25: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 26: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 1-1.9 ................................................................................................................. 32 Figure 27: Race/Ethnicity Table 28: Race/Ethnicity Figure 28: Etiology Table 29: Etiology Table 30: Hospital Days: Lived/Died by Inhalation Injury Table 31: Top Ten Complications Table 32: Top Ten ICD-10 Procedures Table 33: Lived/Died by Burn Group Size (% TBSA) Table 34: Hospital Days by Burn Group Size (% TBSA) Table 35: Mean Charges for Top Five MS-DRGs Figure 29: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 30: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 2-4.9 ................................................................................................................. 36 Figure 31: Race/Ethnicity Table 36: Race/Ethnicity Figure 32: Etiology Table 37: Etiology Table 38: Hospital Days: Lived/Died by Inhalation Injury Table 39: Top Ten Complications Table 40: Top Ten ICD-10 Procedures Table 41: Lived/Died by Burn Group Size (% TBSA) Table 42: Hospital Days by Burn Group Size (% TBSA) Table 43: Mean Charges for Top Five MS-DRGs Figure 33: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 34: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 5-15.9 ............................................................................................................... 40 Figure 35: Race/Ethnicity Table 44: Race/Ethnicity Figure 36: Etiology Table 45: Etiology Table 46: Hospital Days: Lived/Died by Inhalation Injury Table 47: Top Ten Complications Table 48: Top Ten ICD-10 Procedures Table 49: Lived/Died by Burn Group Size (% TBSA) Table 50: Hospital Days by Burn Group Size (% TBSA) Table 51: Mean Charges for Top Five MS-DRGs Figure 37: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 38: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 16-19.9 ............................................................................................................. 44 Figure 39: Race/Ethnicity Table 52: Race/Ethnicity Figure 40: Etiology Table 53: Etiology Table 54: Hospital Days: Lived/Died by Inhalation Injury Table 55: Top Ten Complications Table 56: Top Ten ICD-10 Procedures Table 57: Lived/Died by Burn Group Size (% TBSA) Table 58: Hospital Days by Burn Group Size (% TBSA) Table 59: Mean Charges for Top Five MS-DRGs Figure 41: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 42: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 20-29.9 ............................................................................................................. 48 Figure 43: Race/Ethnicity Table 60: Race/Ethnicity

Table of Contents

vi©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

Figure 44: Etiology Table 61: Etiology Table 62: Hospital Days: Lived/Died by Inhalation Injury Table 63: Top Ten Complications Table 64: Top Ten ICD-10 Procedures Table 65: Lived/Died by Burn Group Size (% TBSA) Table 66: Hospital Days by Burn Group Size (% TBSA) Table 67: Mean Charges for Top Five MS-DRGs Figure 45: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 46: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 30-39.9 ............................................................................................................. 52 Figure 47: Race/Ethnicity Table 68: Race/Ethnicity Figure 48: Etiology Table 69: Etiology Table 70: Hospital Days: Lived/Died by Inhalation Injury Table 71: Top Ten Complications Table 72: Top Ten ICD-10 Procedures Table 73: Lived/Died by Burn Group Size (% TBSA) Table 74: Hospital Days by Burn Group Size (% TBSA) Table 75: Mean Charges for Top Five MS-DRGs Figure 49: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 50: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 40-49.9 ............................................................................................................. 56 Figure 51: Race/Ethnicity Table 76: Race/Ethnicity Figure 52: Etiology Table 77: Etiology Table 78: Hospital Days: Lived/Died by Inhalation Injury Table 79: Top Ten Complications Table 80: Top Ten ICD-10 Procedures Table 81: Lived/Died by Burn Group Size (% TBSA) Table 82: Hospital Days by Burn Group Size (% TBSA) Table 83: Mean Charges for Top Five MS-DRGs Figure 53: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 54: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 50-59.9 ............................................................................................................. 60 Figure 55: Race/Ethnicity Table 84: Race/Ethnicity Figure 56: Etiology Table 85: Etiology Table 86: Hospital Days: Lived/Died by Inhalation Injury Table 87: Top Ten Complications Table 88: Top Ten ICD-10 Procedures Table 89: Lived/Died by Burn Group Size (% TBSA) Table 90: Hospital Days by Burn Group Size (% TBSA) Table 91: Mean Charges for Top Five MS-DRGs Figure 57: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 58: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 60-69.9 ............................................................................................................. 64 Figure 59: Race/Ethnicity Table 92: Race/Ethnicity Figure 60: Etiology Table 93: Etiology Table 94: Hospital Days: Lived/Died by Inhalation Injury Table 95: Top Ten Complications Table 96: Top Ten ICD-10 Procedures Table 97: Lived/Died by Burn Group Size (% TBSA) Table 98: Hospital Days by Burn Group Size (% TBSA) Table 99: Mean Charges for Top Five MS-DRGs

Table of Contents

vii©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

Figure 61: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 62: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 70-79.9 ............................................................................................................. 68 Figure 63: Race/Ethnicity Table 100: Race/Ethnicity Figure 64: Etiology Table 101: Etiology Table 102: Hospital Days: Lived/Died by Inhalation Injury Table 103: Top Ten Complications Table 104: Top Ten ICD-10 Procedures Table 105: Lived/Died by Burn Group Size (% TBSA) Table 106: Hospital Days by Burn Group Size (% TBSA) Table 107: Mean Charges for Top Five MS-DRGs Figure 65: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 66: Mean Charges for Etiology Categories with Greater than 100 Valid Charge CasesAge Group 80 and Over ...................................................................................................... 72 Figure 67: Race/Ethnicity Table 108: Race/Ethnicity Figure 68: Etiology Table 109: Etiology Table 110: Hospital Days: Lived/Died by Inhalation Injury Table 111: Top Ten Complications Table 112: Top Ten ICD-10 Procedures Table 113: Lived/Died by Burn Group Size (% TBSA) Table 114: Hospital Days by Burn Group Size (% TBSA) Table 115: Mean Charges for Top Five MS-DRGs Figure 69: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year Figure 70: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases

4) Analysis by Etiology .......................................................................................................................................77Fire/Flame Injuries .............................................................................................................. 78 Figure 71: Circumstance of Injury Table 116: Circumstance of Injury Figure 72: Place of Occurrence – E849 Code Table 117: Place of Occurrence – E849 Code Figure 73: Percent of Patient with Clinically Relevant Complications by Age Group Table 118: Complication Rate by Age Group Table 119: Top Ten Complications Table 120: Top Ten ICD-10 Procedures Table 121: Hospital Days: Lived/Died by Inhalation Injury Table 122: Hospital Days: Lived/Died by Burn Size Group (%TBSA) Table 123: Mortality Rate for Matrix of Main Predictors Figure 74: Mortality Rate for BAUX Score Categories by Gender Table 124: Number of Cases in BAUX Score Categories by GenderScald Injuries ...................................................................................................................... 84 Figure 75: Circumstance of Injury Table 125: Circumstance of Injury Figure 76: Place of Occurrence – E849 Code Table 126: Place of Occurrence – E849 Code Figure 77: Percent of Patient with Clinically Relevant Complications by Age Group Table 127: Complication Rate by Age Group Table 128: Top Ten Complications Table 129: Top Ten ICD-10 Procedures Table 130: Hospital Days: Lived/Died by Burn Size Group (%TBSA) Figure 78: Mortality Rate for BAUX Score Categories by Gender Table 131: Number of Cases in BAUX Score Categories by GenderContact with Hot Object Injuries .......................................................................................... 89 Figure 79: Circumstance of Injury Table 132: Circumstance of Injury Figure 80: Place of Occurrence – E849 Code

Table of Contents

viii©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

Table 133: Place of Occurrence – E849 CodeFigure 81: Percent of Patient with Clinically Relevant Complications by Age GroupTable 134: Complication Rate by Age GroupTable 135: Top Ten ComplicationsTable 136: Top Ten ICD-10 ProceduresTable 137: Hospital Days: Lived/Died by Burn Size Group (%TBSA)

Electrical Injuries ................................................................................................................ 93Figure 82: Circumstance of Injury Table 138: Circumstance of InjuryFigure 83: Place of Occurrence – E849 CodeTable 139: Place of Occurrence – E849 CodeFigure 84: Percent of Patient with Clinically Relevant Complications by Age GroupTable 140: Complication Rate by Age GroupTable 141: Top Ten ComplicationsTable 142: Top Ten ICD-10 ProceduresFigure 85: Frequency of Records by Age Categories and Gender

Chemical Injuries ................................................................................................................ 97Figure 86: Circumstance of InjuryTable 143:Circumstance of InjuryFigure 87: Place of Occurrence – E849 CodeTable 144: Place of Occurrence – E849 CodeFigure 88 Percent of Patient with Clinically Relevant Complications by Age GroupTable 145:Complication Rate by Age GroupTable 146:TopTen ComplicationsTable 147:Top Ten ICD-10 ProceduresFigure 89: Frequency of Records by Age Categories and Gender

5) Hospital Comparisons ....................................................................................................................................1022015-2018 Fire/Flame Injuries ............................................................................................... 103

Figure 90: 2015-2018 Fire/Flame Injuries – Mortality RateFigure 91: 2015-2018 Fire/Flame Injuries – Mean ChargesFigure 92: 2015-2018 Fire/Flame Injuries – Mean Length of StayFigure 93: 2015-2018 Fire/Flame Injuries – Complication Rate

6) Analysis of International Records ...................................................................................................................109Figure 94: Age Group by GenderTable 148: Age Group by GenderFigure 95: EtiologyTable 149: EtiologyFigure 96: Race/EthnicityTable 150: Race/EthnicityFigure 97: Place of Occurrence – E849 Code Table 151: Place of Occurrence – E849 CodeFigure 98: Circumstance of InjuryTable 152: Circumstance of InjuryTable 153: Mortality Rate for BAUX Score Categories by GenderTable 154: Lived/Died by Burn Group Size (% TBSA)

Appendix ...........................................................................................................................................................115A. Minimum Data Set and Data Quality ................................................................................ 116

Table 155: Data Completeness by VariableFigure 99: Data Quality Expressed as Mean Percent of Missing Variables of the Minimum Data Set per Record by Admission YearFigure 100: Data Quality Expressed as Mean Percent of Missing Variables of the Minimum Data Set per Record by Facility

B. List of Participating Hospitals ........................................................................................... 120C. Selected List of Peer-Reviewed Publications Utilizing NBR Data ......................................... 123

Table of Contents

ix©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

This newest National Burn Repository (NBR) report represents 10 years, 2009-2018, of cumulative data from 101 US burn centers, including all 69 ABA verified burn centers, four Canadian, 2 Swedish and 1 Swiss burn center. The report contains 221,519 entries, up about 10,000 entries from previous report, and 3,458 International entries, down from 3,712 last year. This report represents the largest single resource of thermal injury epidemiology in North America. It also serves as a useful reference for burn treatment outcomes, such as mortality, complications and length of stay in the hospital.

After moving from Version 5 to Version 6 of the ABA Burn Registry software, this report marks the first-time reporting procedures using ICD-10 codes. ICD-10 codes were implemented as required by Centers for Medicare and Medicaid Services (CMS) in 2015 and have considerably more granularity than the ICD-9 codes. The increased detail of the ICD-10 codes will lead to increased significantly improved future reporting, specifically the reporting of procedures.

Ten years ago, the complication rate was roughly 15% while the current 2017-2018 rate hovers around 5.5%. This probably has as much to do with the data definition refinements and collection practices around complications as improvements in the actual quality of care. Given the report is a 10-year rolling time period as we drop older years in exchange for newer data the overall complication rates seen across etiology and age groups decreases from what has been previously reported.

Burn registry personnel play a pivotal role in the consistency of data entered, therefore it is imperative to train and support them adequately in order to see improvement in

the quality and volume of data collected. The number of data points in Version 6 was increased over Version 5, as a result we heard that data collection for many records is somewhat more laborious and time consuming. Even with the increase in data elements, data quality continued to improve over the last three years with a particularly strong uptick in the reporting of charge information and MS-DRGs. It is worth noting there are still large numbers of missing values, namely race/ethnicity, burn etiology and place of occurrence, these absences could be due to a variety of factors and workflows. Accurate and comprehensive data collection and submission is key to our ability to deliver the single best resource of burn data for our institutions, researchers, health care planners and governments. Data collection and interpretation is the foundation of clinical information support which drives the development of burn specific clinical care pathways, improved patient care and ultimately improved patient outcomes and better quality of life for our patients. We plan to continuously improve our data quality, analysis and burn care quality programs through expanding the data elements collected; including but not limited to frostbite and outpatient burn care.

Thank you to all members of the American Burn Association for your continued support of and belief in the NBR. I hope that you find this report informative and useful.

Anthony Papp, MD, PhD, FRCSCChair, ABA NBR Advisory Committee

Introduction

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The 2019 National Burn Repository Annual Report reviewed the combined data set of acute burn admissions for the time period between 2009 and 2018. Key findings included the following:

1.101 hospitals from 37 states, and the District of Columbia, contributed to this report, totaling 221,519 records. The majority of patients came from hospitals with 500 or more beds, with the next largest group coming from hospitals with 200-299 beds. Data are not dominated by any single center and appeared to represent a reasonable cross section of U.S. hospitals.

2. In all age categories, except age greater than 80 years old, there are considerably more men than women. There is a bimodal distribution of with greatest prevalence in the pediatric age range from 1 to 15.9 comprising 22.5% of the total burns and the adult age group from ages 20 to 59.9 years, which makes up 56% of burns. Patients age 60 or older represented 16.9% of the cases.

3. About 63% of the reported total burn sizes were less than 10% TBSA and these cases had a mortality rate of 0.6%. The mortality rate for all cases was 3.0% and 5.4% for fire/flame injuries.

4. The two most common etiologies were fire/flame and scalds, accounting for 72% of cases reported. Scald injuries were most prevalent in children under 16, while fire/flame injuries dominated the remaining age categories. In 8.4% percent of cases the etiology of injury was unknown.

5. 72.5% of the burn injuries with a known place of occurrence were reported to have occurred in the home. Nearly 98% of cases with known circumstances of injury were identified as accidents, with 12.2% of these reported as work-related. Just over 2% of cases were suspected abuse.

6. During the ten-year period from 2009 through 2018, the average length of stay has remained at just under 10 days for both men and women. It is noted in 2017 and 2018 the average length of stay increased for both men and women. The overall trend is for the length of stay, independent of sex, has been between 8.5 and 10 for each of the years in this reporting period. The mortality rate for females declined from 4.1% to 3.1% and increased from 3.0% to 3.4% for males.’

7. Deaths from burn injury increased with advancing age and burn size, as well as presence of inhalation injury.

8. Pneumonia was the most frequent clinically related complication and occurred in 4.1% of fire/flame-injured patients. The frequency of pneumonia, respiratory failure, renal failure, septicemia and bacteremia was greater in patients with 4 days or greater of mechanical ventilation. As expected, with increasing age, the rate of complications increases (with the exception of infants, who have a higher rate than other children).

9. For survivors, the average length of stay was slightly greater than 1 day per %TBSA burned. For those who died, the total hospital days was typically between 2-3 weeks in patients with %TBSA <80%. Eighty seven percent of patients were discharged home and 3.1% were transferred to rehabilitation facilities.

10. Overall, the charges for patients who died were over 3 times greater than those who survived; however, this was greatly affected by the large number of patients with burns < 10% TBSA. For burns >10% TBSA, total charges for surviving patients averaged $268,435 and charges for non-survivors averaged $354,560. All cases received from contributing hospitals (both ABA Burn Registry and non-burn registry users) that met the data structure requirements were initially accepted into the NBR. This report includes only cases with an admit year of 2009-2018. Records were excluded from the analysis for this report if the “Admit type” or “Admit status” was:

• Readmission • Admission for reconstruction/rehabilitation • Outpatient encounter • Same patient • Scheduled/elective admission • Acute admission, not burn-related

Summary of Findings

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In addition, records were excluded from analysis of this report if they contained missing values for the following:

• Gender • LOS < ICU days • Discharge disposition • Both calculated age and manually entered age • Both TBSA and etiology

As was done previously, an algorithm was used to identify and remove potential duplicate records from the analysis. Duplicate records can exist in the database if a facility submits the same record during two different calls for data. The algorithm that was implemented identified records that contained identical information on the variables listed below. The more recently submitted record was included in the analysis, while the older record was eliminated as a duplicate.

• Facility • Admission year • Age • Gender • Race • Admission type • Discharge date • E Code • %TBSA

Lastly, the records received from our Canadian and International contributors are not included in the body of the analysis but are presented separately in Section 6.

Summary of Findings

1Analysis of Contributing Hospitals 1

2©American Burn Association, National Burn Repository® 2019. Version 14.0. All Rights Reserved Worldwide.

Analysis of Contributing Hospitals

BURN CENTER LOCATION AND PARTICIPATION BY REGION

EAST: Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island NORTH CENTRAL: Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, Wisconsin NORTH LAKES: Indiana, Michigan, Ohio SOUTH: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia WEST: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming

3

2

1

Have burn centers which have contributed to the NBR between 2009 to 2018

Have burn centers that have not contributed data to the NBR (Hawaii, Kentucky, Maine, Oklahoma, South Dakota, Vermont, and, West Virginia)

Do not have burn centers (Alaska, Delaware, Idaho, Montana, New Hampshire, North Dakota, and, Wyoming)

Canadian contributing burn centers are noted above and are located in: (1) Edmonton, Alberta; (2) Hamilton, Ontario; (3) Toronto, Ontario; and (4) Montreal, Quebec. International contributors not shown above include Uppsala and Linkoping, Sweden and Switzerland.

The first section of the National Burn Repository (NBR) reports on the evaluation of the contributing hospitals. Because the report reflects a rolling 10-year average the mix of hospitals may vary from year to year. This year’s NBR report contains data from 37 states in the U.S. Seventy of the reporting centers are ABA verified. 77% of burn centers in the U.S. submitted data. The south had the largest number of participating centers.

4

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

2ANALYSIS OF ALL

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1ANALYSIS OF

CONTRIBUTING

HOSPITALS

STATES THAT SUBMITTED TO THE NBR, 2009 TO 2018

Region US Burn Care FacilitiesUS Facilities in the

Annual ReportABA Verified Centers

South 37 28 18

North Central 21 17 11

West 23 22 16

East 33 21 16

North Lakes 18 13 9

Total 132 101 70

Figure

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60,000


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2018

Year of Admission

24,090 records were submitted in 2016 - 2018 for this report221,519 records are included in this report

55,545

East

30,297

North Central

63,047

South

21,378

North Lakes

51,252

West

During the 2018 call for data, 37,691 records were submitted by 93 U.S. burn centers with 24,090 records meeting inclusion criteria for the report. The U.S. focused sections of the report contain 221,519 records.

Burn centers from the South region have submitted the most cases with a total of 63,047. The East region has the second highest case volume with 55,545. These data are not surprising as these regions have the largest number of burn centers.

Record Submission

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

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2ANALYSIS OF ALL

U.S. RECORDS

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

Figure

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CONTRIBUTING U.S. HOSPITALS BY HOSPITAL BED SIZE CATEGORY

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County Hospital District

Investor, Corporation

Other Not-for-Profit

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Case

s

CONTRIBUTING U.S. HOSPITALS BY HOSPITAL OWNERSHIP TYPE

The majority of records submitted to the NBR report come from centers at “Other not for profit” hospitals, representing 51.2% of records. “State” (or government run) hospitals were the second most common group, at 17% of entries. These numbers are similar to the prior report.

Burn centers in the largest hospitals (500 beds or more) contribute most of the NBR records, at 52.8% of total entries. Hospitals in the 200-299 bed range are second with 15.4% of entries.

Ownership Type

500 or more beds

200-299 beds

25-49 beds

Figure

4

Figure

5

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

2ANALYSIS OF ALL

U.S. RECORDS

1ANALYSIS OF

CONTRIBUTING

HOSPITALS


THIS PAGE INTENTIONALLY LEFT BLANK

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

2ANALYSIS OF ALL

U.S. RECORDS

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

12Analysis of All U.S. Records


Analysis of All U.S. Records

AGE GROUP BY GENDER

10,000

30,000

40,000

20,000

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+

Nu

mb

er

of

Case

s

Female

Male

Age Categories

Total N=221,519 (Excluding 0 Unknown/Missing)

AGE GROUP BY GENDER

Figure 6 and Table 2 show the distribution of burn cases from 2009 to 2018 divided into age and gender distribution. Men make up the majority of burns in each age categories, except 80 and over, in which there is an even distribution between men and women. Men make up 62% of the total number of cases treated at US burn centers. There a bimodal distribution with a point of high prevalence within the adult (ages 16 and older) and pediatric (ages 0 – 15.9) age groups. Within the pediatric age group 42% of the burns occur between ages 5 to 15.9. Within the adult age groups the age group with the highest prevalent is consistently between 20 – 29.9 years. The majority of burns occur between ages 20 to 60 years which constitute 56% of all reported burns. The total number of US burns submitted increased by over 8,000 for this reporting period.

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

Gender

Total Female Male

Age Categories Cases Column N % Cases Column N % Cases Column N %

0-.9 2,973 1.3 1,409 1.7 1,564 1.1

1-1.9 11,848 5.3 5,175 6.2 6,673 4.9

2-4.9 14,325 6.5 6,628 7.9 7,697 5.6

5-15.9 20,915 9.4 8,550 10.2 12,365 9.0

16-19.9 9,873 4.5 3,338 4.0 6,535 4.8

20-29.9 32,749 14.8 10,904 13.0 21,845 15.9

30-39.9 29,476 13.3 10,155 12.1 19,321 14.0

40-49.9 30,583 13.8 10,515 12.5 20,068 14.6

50-59.9 31,245 14.1 11,218 13.4 20,027 14.6

60-69.9 20,188 9.1 8,083 9.6 12,105 8.8

70-79.9 10,513 4.7 4,606 5.5 5,907 4.3

80 and over 6,831 3.1 3,417 4.1 3,414 2.5

Subtotal 221,519 100.0 83,998 100.0 137,521 100.0

Missing 0 0.0 0 0.0 0 0.0

Total 221,519 100.0 83,998 100.0 137,521 100.0

Figure

6

Table

2


Analysis

5,000

Non-White

White

10,000

15,000

20,000

RACE/ETHNICITY

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+

Nu

mb

er

of

Case

s

Age Categories

Total N=213,811 (Excluding 7,708 Unknown/Missing)

RACE/ETHNICITY


Figure 7 and Table 3 depict the distribution of patients admitted to burn centers by race, based on what is reported by the patient and documented in the medical record. The category of “unknown” was used when no race was documented in the chart, and is only 3.5% of total cases reported.

Figure 8 compares the number of cases of white compared to non-white patients in various age categories. Patients identified as white make up 60% of the patient population. In the pediatric population, age 4.9 and younger, the number of non-white patients is higher than white patients in each age group range. This suggests that racial factors may influence the occurrence of burn injuries and/or admission to a burn center differently as a function of age. The exception is the pediatric group ages 5 – 15.9 which for the last few reporting periods has similar number of white and non-white patients.

of All U.S. Records

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

Race Cases % of Valid

White 128,855 60.3%

Black 43,953 20.6%

Hispanic 20,265 9.5%

Other 12,787 6.0%

Asian 5,826 2.7%

Native American

2,125 1.0%

Unknown 7,708

Total 221,519

AGE GROUP BY WHITE VERSUS NON-WHITE

Table

3Figure

7

Figure

8


125,000

100,000

75,000

50,000

25,000

.1-9.9 10-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80-89.9 90-100

BURN SIZE GROUP (% TBSA)

Nu

mb

er

of

Case

s

% TBSA (Full+ Partial Thickness)


LIVED/DIED BY BURN GROUP SIZE (%TBSA)


Figure 9 is the distribution of burns based on total TBSA (total body surface area) which is a combination of 2nd and 3rd degree burns. No TBSA was recorded for 17% of reported patients which is either a pure inhalation injury, did not have a burn, or did not have a TBSA recorded. This is a 5% increase from the prior reporting period. Of the patients with a reported TBSA, 78% sustained less than 10% TBSA burn.

Table 4 provides the total number of patients and mortality rates for admitted patients purely based on total body surface area burned. The mortality rate increases with the size of the burn. Mortality rates increase to 30% once a burn has affected greater than 40% of the body surface area. The burn size associated with a 50% case fatality (LD-50) occurs once burns are greater than 70% TBSA.


Lived Died

%TBSA Cases Cases Mortality Rate

0.1 - 9.9 139,084 876 0.6

10 - 19.9 23,931 670 2.7

20 - 29.9 7,076 592 7.7

30 - 39.9 3,327 561 14.4

40 - 49.9 1,801 573 24.1

50 - 59.9 1,074 456 29.8

60 - 69.9 712 407 36.4

70 - 79.9 431 359 45.4

80 - 89.9 242 392 61.8

> 90 159 533 77.0

Subtotal 177,837 5,419 3.0

Missing or 0% 36,928 1,335 3.5

TOTAL 214,765 6,754 3.0

Figure

9

Table

4

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


2,500

5,000

10,000

12,500

7,500

Nu

mb

er

of

Case

s

Fire/Flame

Scald

Age CategoriesTotal N=171,778 (Excluding 49,741 Cases)

Contact with hot object

Electrical

1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+

ETIOLOGY

Categories

of Etiology

ETIOLOGY


Figure 10 and Table 5 show the distribution of burns by etiology. The figure shows only cases that had a reported etiology, which was 92% of patient records. The two most common causes of burns, fire/flame and scald, make up 66% of burn etiologies. There is an overall decrease in the fire/flame and scald totals with a comparison increase in the other, non-burn category.

Figure 11 depicts the number of cases in each of the 4 most common burn etiologies divided into age groups. Scald and contact burns are the most common etiology for children younger than age 16. There is a decrease the total number of scald burns from ages 1 to 16 years for this reporting period. Electrical injuries have a relatively low prevalence, but occur mainly in patients of working age, as shown in age categories between 20 to 60 years.

0-.9


Etiology Cases % of Valid

Fire/Flame 82,404 40.6%

Scald 63,780 31.4%

Contact with Hot Object

18,376 9.1%

Other, Non Burn 11,355 5.6%

Electrical 7,218 3.6%

Chemical 7,164 3.5%

Burn, Unspecified 6,964 3.4%

Inhalation Only 3,838 1.9%

Skin Disease 1,263 0.6%

Radiation 445 0.2%

Unknown 18,712

Total 221,519

FREQUENCY OF CONTACT WITH HOT OBJECT, ELECTRICAL, FIRE, AND SCALD BY AGE GROUP

Table

5Figure

10

Figure

11

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


PLACE OF OCCURRENCE - E849 CODE



CIRCUMSTANCE OF INJURY CIRCUMSTANCE OF INJURY


Figure 12 and Table 6 shows the distribution of cases based on the location were the injury occurred. The home remains the most common location for a burn injury to occur, accounting for 72.5% of burn injuries cared for in reporting burn centers. The table shows that 11% of records did not specify a place of occurrence. The figure is based only on those records in which a place of occurrence was specified.

Figure 13 and Table 7 represents the distribution of cases in the NBR by the circumstances of the injury. Of the burns with reported circumstance (excluding other and unknown =10%), the majority of burns (97.6%) admitted to burn centers were considered accidental. Non-accidental burns which result from arson, assault, abuse or self-inflicted injuries only constitute 2.4% of burns. The figure does not include the burns listed as unknown in the table.


Place of Occurrence Cases % of Valid

Home 142,464 72.5%

Industrial 13,066 6.6%

Other Specified Place 10,795 5.5%

Street/Highway 10,740 5.5%

Recreation and Sport 8,868 4.5%

Public Building 6,824 3.5%

Residential Institution 2,194 1.1%

Farm 1,420 0.7%

Mine/Quarry 148 0.1%

Unspecified 25,000

Total 221,519

Circumstance of Injury Cases% of Valid

Accident, Non-Work Related

154,116 73.2%

Accident, Work Related 25,623 12.2%

Other 11,690 5.6%

Accident, Recreation 10,288 4.9%

Accident, Unspecified 3,997 1.9%

Suspected Assault/Abuse 2,223 1.1%

Suspected Child Abuse 2,192 1.0%

Suspected Arson 314 0.1%

Unknown 11,076

Total 221,519

Figure

12Table

6

Table

7Figure

13

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


Total N=221,519

}HOSPITAL DISPOSITIONFigure

14

HOSPITAL DISPOSITION

Figure 14 depicts the proportion of patients in the NBR that died during their admission (case fatality rate). Since outcome is a criterion for inclusion in the NBR, all records have a reported outcome.

Table 8 displays the number and percentage of cases to various discharge dispositions for all reported cases in the 10- year reporting period. The majority of patients (78%) were discharged to home. Only 7.4% of cases required discharge to an advanced care facility, like inpatient rehabilitation facility, skilled nursing facility, or extended care facility.


Discharge Disposition Cases Percent

Discharge Home, No Home Health 172,606 77.9

Discharged Home, With Home Health 17,201 7.8

Discharged/Transferred to SNF 7,338 3.3

Transferred to Inpatient Rehabilitiation Facility 6,777 3.1

Death 6,754 3.0

Discharged/Transferred to LTC 2,235 1.0

Transferred as Inpatient to Another Hospital 1,553 0.7

Transfer to Another Service 1,259 0.6

Transferred to Inpatient Psychiatry Unit 1,160 0.5

Discharged to Alternate Caregiver 929 0.4

Discharged to Jail or Prison 880 0.4

Unable to Complete Treatment 859 0.4

Left Against Medical Advice or Discontinued Care 607 0.3

Discharged to Foster Care 600 0.3

Transferred as Inpatient to Another Acute Burn Facility 351 0.2

Transferred to Hospice Care 213 0.1

Discharged to Street 197 0.1

Total 221,519 100.0

Table

8

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


10.0

8.0

6.0

4.0

2.0

2009

AVERAGE HOSPITAL LENGTH OF STAY BY GENDER, 2008-2017

20102011

20122013

20142015

20162017

2018

Ave

rage L

en

gth

of

Sta

y

Year of Admission

Total N=221,519

Female

Male

2%

1%

3%

4%

MORTALITY RATE BY GENDER, 2008-2017

Mo

rtality

Rate

Year of Admission

Total N=221,519

Female

Male

20092010

20112012

20132014

20152016

20172018


Female Male

Admission YearMean +/-

SEMMean +/-

SEM

2009 9.89+/-0.5 9.03+/-0.1

2010 8.89+/-0.1 8.87+/-0.1

2011 8.70+/-0.1 8.97+/-0.1

2012 8.6+/-0.1 8.9+/-0.1

2013 8.4+/-0.1 9.0+/-0.1

2014 8.5+/-0.1 8.9+/-0.1

2015 8.9+/-0.2 9.5+/-0.2

2016 8.5+/-0.1 8.7+/-0.1

2017 9.6+/-0.3 9.4+/-0.3

2018 9.8+/-0.3 9.4+/-0.3

Mortality Rate

Admission Year Female Male

2009 4.1 3.0

2010 3.4 2.8

2011 3.6 2.9

2012 3.5 2.8

2013 3.2 2.7

2014 3.5 2.9

2015 2.7 2.9

2016 3.5 2.7

2017 3.1 3.0

2018 3.1 3.4

Figure 15 depicts the average duration of hospitalization (Total Hospital Days, Length of Stay or LOS) for both men and women by year. In the last two years, both men and women, demonstrated an increase in average length of stay. The overall trend is for the length of stay, independent of sex, has been between 8.5 and 10 for each of the years in this reporting period.

Figure 16 depicts the mortality rate (case fatality) in patients admitted to US burn centers reported to the NBR by gender and year. Case fatality continues to be greater in women compared to men in each reporting year except the most recent, 2018. The overall mortality rate has decreased for women by 1% from 2009 compare to 2018. The mortality rate in men has increased for the first time in 10 years and is highest at 3.4% for this reporting period (2018).

Figure

15

Figure

16

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


MORTALITY RATE BY AGE GROUP AND BURN SIZE (EXPRESSED AS THE NUMBER OF DEATHS OVER THE TOTAL NUMBER OF PATIENTS IN THAT GROUP)


Table 9 depicts the case fatality for each decile of total burn size for each decade of age group. As age and/or burn size increased, so did the case fatality. The numbers of cases used to determine these values (proportion of cases in each group that died/total cases) are listed in the row beneath the case fatality values for each age group. The size of some of the groups is small, so that the calculated case fatality value would have a high variance and standard error. This grouping does not account for inhalation injury or the portion of burn that is full thickness (3rd degree) as a factor of mortality.


Burn Size (% TBSA)

Age Group 0.1 - 9.9 10 - 19.9 20 - 29.9 30 - 39.9 40 - 49.9 50 - 59.960 - 69.9

70 - 79.9

80 - 89.9

> 90 Total

Birth - .9 0.0 0.6 1.4 7.1 20.0 0.0 0.0 0.0 0.0 50.0 0.3

Died/Total 1/2269 2/315 1/71 2/28 2/10 0/5 0/2 0/1 0/0 1/2 9/2703

1 - 1.9 0.0 0.4 0.0 0.0 3.9 11.1 16.7 22.2 33.3 66.7 0.2

Died/Total 1/8791 5/1424 0/248 0/87 2/51 2/18 3/18 2/9 1/3 2/3 18/10652

2 - 4.9 0.1 0.4 0.2 2.5 4.0 8.1 15.7 13.6 55.0 63.2 0.6

Died/Total 13/9926 6/1534 1/405 6/237 6/149 7/86 11/70 3/22 11/20 12/19 76/12468

5 - 15.9 0.1 0.4 0.7 0.4 3.1 3.0 7.1 9.5 21.4 50.0 0.6

Died/Total 15/13352 10/2250 5/758 2/517 9/287 5/167 10/140 10/105 21/98 13/26 100/17700

16 - 19.9 0.2 0.4 1.1 1.6 3.3 5.8 10.5 17.1 21.7 54.5 0.9

Died/Total 12/6359 4/1088 4/373 3/190 4/120 5/86 6/57 7/41 5/23 24/44 74/8381

20 - 29.9 0.2 0.5 1.0 3.1 7.4 10.7 16.1 34.5 48.4 69.8 1.2

Died/Total 32/21143 20/3695 12/1159 16/511 23/312 21/196 33/205 40/116 45/93 81/116 323/27546

30 - 39.9 0.2 1.0 1.7 6.8 11.0 13.3 32.0 36.9 62.4 78.2 1.7

Died/Total 45/18252 32/3355 19/1104 36/528 34/309 25/188 47/147 38/103 53/85 86/110 415/24181

40 - 49.9 0.4 1.0 3.9 7.4 16.4 27.0 38.0 52.2 77.5 82.9 2.2

Died/Total 75/18774 35/3358 42/1086 41/554 52/317 60/222 54/142 48/92 62/80 87/105 556/24730

50 - 59.9 0.7 2.9 9.3 19.2 33.5 40.6 54.4 56.3 78.3 81.9 3.9

Died/Total 141/19057 97/3298 99/1063 95/496 113/337 89/219 74/136 80/142 83/106 95/116 966/24970

60 - 69.9 1.4 5.6 15.7 31.5 56.7 61.3 78.2 83.3 85.7 87.7 6.3

Died/Total 170/12121 125/2235 110/702 107/340 131/231 114/186 79/101 65/78 48/56 64/73 1013/16123

70 - 79.9 2.9 10.9 30.7 56.2 77.4 79.0 93.2 74.4 87.5 83.7 10.7

Died/Total 179/6117 133/1220 123/401 131/233 113/146 64/81 55/59 29/39 35/40 36/43 898/8379

80 or Greater

5.1 24.2 59.1 73.1 80.0 84.2 83.3 88.1 93.3 91.4 17.9

Died/Total 192/3799 201/829 176/298 122/167 84/105 64/76 35/42 37/42 28/30 32/35 971/5423

Total 0.6 2.7 7.7 14.4 24.1 29.8 36.4 45.4 61.8 77.0 3.0

Died/Total 876/139960 670/24601 592/7668 561/3888 573/2374 456/1530 407/1119 359/790 392/634 533/692 5419/183256

Table

9

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


1,000

500

4,000

3,500

3,000

2,500

2,000

1,500

5,000

4,000

3,000

2,000

1,000

Arrythmia

Bactere

mia

Cardiac

Arre

st

Celluliti

s

Pneumonia

Renal Failu

re

Respira

tory

Failure

Septic

emia

Urinary

Trac

t

Infection

Wound In

fection

COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY RELEVANT COMPLICATIONS

Nu

mb

er

of

Case

s

Total N=219,505 (Excluding 2,014 cases from non ABA burn registry software centers)

COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY RELEVANT COMPLICATIONS BY DAYS ON THE VENTILATOR

Nu

mb

er

of

Case

s

4+ Ventilator Days


0 Ventilator Days

1-3 Ventilator Days

Arrythmia

Bactere

mia

Cardiac

Arre

st

Celluliti

s

Pneumonia

Renal Failu

re

Respira

tory

Failure

Septic

emia

Urinary

Trac

t

Infection

Wound In

fection

Figure 17 shows the frequency of the ten most clinically relevant complications in patients admitted to reporting US burn centers. Of the ten complications listed, pneumonia continues to be the complication with the highest frequency. Urinary tract infection and cellulitis total second and third, respectfully. Respiratory failure and wound infection round out the top five which is consistent with last reporting period. Figure 18 demonstrates the association of the ten clinically relevant complications with duration of mechanical ventilation. Except for cellulitis, wound infections and urinary tract infections, the frequency of complications increased with the number of days on mechanical ventilation. The duration of mechanical ventilation might be considered a cause of some complications, e.g. the development of pneumonia. In other cases, the duration of ventilation could be a marker of illness severity and correlate with other complications of the critically ill, such as renal failure and respiratory failure.


Figure

17

Figure

18

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


20%

40%

COMPLICATION RATE FOR AGE CATEGORIES BY DAYS ON VENTILATOR

60%

% o

f P

ati

en

ts w

ith

a C

lin

ically

Rela

ted

Co

mp

lica

tio

n

4+ Ventilator Days


0 Ventilator Days

1-3 Ventilator Days

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+

Age Categories

COMPLICATION COUNT FOR AGE CATEGORIES BY DAYS ON VENTILATOR


Figure 19 and Table 10 demonstrates the association of the occurrence of at least one complication with duration of mechanical ventilation by categories of age. The overall complication rate for this reporting period was 9.8%. For patients who did not require mechanical ventilation, the overall complication rate is low (5.8%), and the incidence of complications increases with age. The addition of mechanical ventilation results in a steady rate of complications with the number of ventilator days resulting in a higher complications rate regardless of age. For patients requiring 1-3 days of ventilation the average complication rate is 20%. If greater than 4 days of ventilation required, the average rate of complications is 57%.


Ventilator Days

0 Ventilator Days 1-3 Ventilator Days 4 or More Ventilator Days Total

Complication Complication Complication Complication

Age Categories No Yes No Yes No Yes No Yes

0-.9 2,788 68 24 13 36 32 2,848 113

1-1.9 11,119 253 106 29 99 103 11,324 385

2-4.9 13,246 393 177 56 189 150 13,612 599

5-15.9 18,923 526 446 105 419 341 19,788 972

16-19.9 8,639 318 366 77 181 209 9,186 604

20-29.9 27,878 1,272 1,472 273 667 872 30,017 2,417

30-39.9 24,377 1,372 1,429 292 728 985 26,534 2,649

40-49.9 24,619 1,754 1,554 349 859 1,167 27,032 3,270

50-59.9 23,971 2,072 1,754 479 1,092 1,594 26,817 4,145

60-69.9 14,764 1,431 1,353 395 875 1,200 16,992 3,026

70-79.9 7,281 846 780 251 477 765 8,538 1,862

80 and over 4,463 834 513 218 277 467 5,253 1,519

Subtotal 182,068 11,139 9,974 2,537 5,899 7,885 197,941 21,561

Missing 0 0 0 0 0 0 0 0

Total 182,068 11,139 9,974 2,537 5,899 7,885 197,941 21,561

Figure

19

Table

10

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


20%

40%

60%

80%

100%

MORTALITY RATE FOR BAUX SCORE CATEGORIES BY GENDER

% o

f P

ati

en

ts t

hat

Die

d

BAUX Score (Age + TBSA)


Female

Male

.1-9.9 10-19.9

20-29.9

30-39.9

40-49.9

50-59.9

60-69.9

70-79.9

80-89.9

90-99.9

100-109.9

110-119.9

120-129.9

130-139.9

140+

NUMBER OF CASES IN BAUX SCORE CATEGORIES BY GENDER


Figure 20 and Table 11 examines the relationship with gender separation of case fatality with BAUX score (the sum of age and the total percentage of BSA burned). There is a strong association between this score and case fatality for both men and women. It was once thought the BAUX score gave an estimation of mortality rate. This shows that the proportion of patients who died (case fatality) does not cross 50% (LD - 50) until the BAUX score is well above 110. Demonstrating that an equilateral relationship does not exist. In the three highest BAUX score groupings the male mortality rate is higher.


Female Male

BAUX Score (Age + TBSA) Lived Died Lived Died

0-9.9 10,655 14 12,789 10

10-19.9 7,294 17 9,725 18

20-29.9 7,977 20 14,946 25

30-39.9 8,466 33 15,726 52

40-49.9 8,199 52 15,674 71

50-59.9 8,897 96 16,435 105

60-69.9 7,320 158 12,793 198

70-79.9 4,646 189 7,577 282

80-89.9 2,971 253 4,174 340

90-99.9 1,455 299 1,980 427

100-109.9 425 301 677 416

110-119.9 168 271 278 382

120-129.9 86 192 138 347

130-139.9 48 139 63 256

140 and Over 70 218 62 367

Total 68,677 2,252 113,037 3,296

Table

11

Figure

20

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


20%

40%

60%

80%

100%

MORTALITY RATE FOR BAUX SCORE CATEGORIES BY INHALATION INJURY

% o

f P

ati

en

ts t

hat

Die

d



No

Yes

NUMBER OF CASES IN BAUX SCORE CATEGORIES BY INHALATION INJURY

Inhalation Injury


In Figure 21 and Table 12, the relationship between the proportion of patients that died (case fatality) and the sum of age and burn size (BAUX Score) is shown both for those with and those without inhalation injury. Patients with an inhalation injury make-up 8.6% of patients with reported data but have a higher case fatality rate. Patients with inhalation injury had a higher case fatality for a given BAUX score than those without an inhalation injury. For patients with an inhalation injury and a BAUX score greater than 90, the inhalation injury increased the mortality rate for each grouping by approximately 25%. The overall mortality rate without an inhalation injury was 1.7% and with an inhalation injury the mortality rate increases to 16.6%.

.1-9.9 10-19.9

20-29.9

30-39.9

40-49.9

50-59.9

60-69.9

70-79.9

80-89.9

90-99.9

100-109.9

120-129.9

130-139.9

140+110-119.9


No Inhalation Injury Inhalation Injury


0-9.9 22,326 7 292 17

10-19.9 15,918 12 380 22

20-29.9 21,022 13 768 27

30-39.9 21,902 42 1,136 39

40-49.9 21,202 54 1,412 64

50-59.9 22,176 92 1,883 101

60-69.9 17,216 183 1,917 158

70-79.9 10,195 238 1,440 214

80-89.9 5,881 301 932 258

90-99.9 2,797 388 491 301

100-109.9 794 363 263 319

110-119.9 301 290 126 332

120-129.9 160 218 61 297

130-139.9 85 158 21 221

140 and Over 107 242 21 302

Total 162,082 2,601 11,143 2,672

Table

12

Figure

21

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


MORTALITY RATES FOR MATRIX OF MAIN PREDICTORS


Major predictors of case fatality in burns include burn size, age, and the presence of inhalation injury. Table 13 shows the case fatality for several combinations of these variables. There are four categories of burn size: 0.1-19.9%, 20-39.9%, 40-59.9%, and 60% BSA and greater; two categories of age: <60 and >60 years; and two categories of the presence of inhalation injury: No and Yes. As age and burn size together reach 60 and over, the presence or absence of inhalation injury is equally significant.

Additionally, in the age groups of >60 years of age, case fatality greatly increase above 50% with a TBSA of 20% or greater. A mortality rate greater than 50% does not occur until after a TBSA of 60% or greater for patients without an inhalation injury and age less than 60 years.


TBSA Category Age Inhalation Injury Lived Died Mortality Rate

0.1-19.9 0-59.9 No 125,725 276 0.2

0.1-19.9 0-59.9 Yes 5,463 245 4.3

0.1-19.9 60 and Over No 22,146 643 2.8

0.1-19.9 60 and Over Yes 1,855 307 14.2

20-39.9 0-59.9 No 7,067 155 2.1

20-39.9 0-59.9 Yes 1,628 209 11.4

20-39.9 60 and Over No 1,055 429 28.9

20-39.9 60 and Over Yes 264 302 53.4

40-59.9 0-59.9 No 1,742 179 9.3

40-59.9 0-59.9 Yes 802 253 24.0

40-59.9 60 and Over No 177 260 59.5

40-59.9 60 and Over Yes 69 287 80.6

60 and Over 0-59.9 No 880 400 31.3

60 and Over 0-59.9 Yes 534 691 56.4

60 and Over 60 and Over No 80 216 73.0

60 and Over 60 and Over Yes 10 296 96.7

TOTAL 169,497 5,148 2.9

Table

13

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


PRIMARY INSURANCE PAYOR

Table 14 divides up the number and proportion of cases in the NBR based on payment type. Of those that did include this data, over one third (43.3%) were covered by a government-based insurance which is increased from the previous reporting period. In addition, the percentage of uninsured decreased from 13.8% to 13%. Only 6% of the records did not include any insurance information.


Insurance Cases Percent

Government-Medicaid 55,514 25.1

Government-Medicare 31,166 14.1

Other Government 9,203 4.2

Subtotal 95,883 43.3

Private/Commercial Insurance 47,432 21.4

Blue Cross/Blue Shield 14,070 6.4

Private-Foundation or Charity 3,740 1.7


Workers Compensation 18,205 8.2

Auto 956 0.4

Subtotal 19,161 8.6

Uninsured, including self pay 28,809 13.0


Unknown 12,424 5.6

TOTAL 221,519 100.0

Table

14

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


10

15

5

20

25

30

PERCENT OF PATIENTS UTILIZING SELECT INSURANCE CATEGORIES OVER TIME

CASE COUNT FOR SELECT INSURANCE CATEGORIES OVER TIME

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

% o

f P

ati

en

ts (

Do

es

no

t S

um

to

100%

)

Year of AdmissionTotal N=131,564 (Excluding 89,955 Cases)

Uninsured, including Self Pay Worker’s Comp

Medicaid Medicare

Figure 22 and Table 15 shows the trend of patients covered by Medicaid, Medicare, Workers’ Compensation, and Uninsured/Self-pay categories and a percent of the total. There is a change in trends from 2013 and later. The percentage of patients covered by Medicaid continues to increase at a rate greater than the change in other categories. The number of patients that have Medicare or are uninsured remains equal, and both show a modest increase in last 5 years. The number of Workmans’ Compensation cases decreased after 2013 and has been level for the last 5 years.


Select Insurance Categories

Medicaid MedicareUninsured,

including self payWorkers

CompensationTotal

Year of Admission Cases % Cases % Cases % Cases % Count

2009 4,768 20.7 2,894 12.6 1,585 10.7 1,461 9.9 28,259

2010 5,635 22.3 3,180 12.6 1,667 11.5 1,353 9.4 30,102

2011 5,702 22.5 3,227 12.7 3,044 16.0 1,886 9.9 32,830

2012 5,683 23.2 3,304 13.5 2,952 14.8 1,860 9.4 32,101

2013 5,951 23.4 3,546 14.0 2,573 13.4 1,858 9.7 31,918

2014 6,072 26.3 3,407 14.8 2,962 14.0 1,748 8.3 29,481

2015 5,652 28.3 2,997 15.0 3,762 15.4 1,923 7.9 27,336

2016 5,856 28.4 3,198 15.5 3,458 14.7 2,054 8.7 26,957

2017 6,660 29.2 3,537 15.5 3,647 15.6 2,064 8.9 28,712

2018 3,535 30.8 1,876 16.3 1,931 15.9 1,096 9.0 14,516

Total 55,514 25.1 31,166 14.1 27,581 14.4 17,303 9.0 282,212

Table

15

Figure

22

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP

Total N=221,519

HOSPITAL CHARGES: LIVED/DIED BY BURN SIZE GROUP

Total N=118,416 (Excluding 103,103 cases with Unknown/Missing charge data)

Table 16 depicts the average length of hospital stay in days (LOS) for survivors and non-survivors in each decile of burn size. Non-survivors with burns of 20 %TBSA and greater have shorter LOS compared with survivors. The length of stay in non-survivors remains steady between 14% and 19% until the burn size exceeds 80%. The LOS for survivors in all categories of burn size was slightly greater than 1 day/%TBSA burn until the burn exceeds 80%.

Table 17 depicts hospital charges for survivors and non-survivors in each burn size decile. The average charges for survivors with a known %TBSA are around 1/3 of the cost of non-survivors, $98,000 verses $310,000.


Total Lived Died

%TBSA Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM

0.1 - 9.9 139,960 6.0+/-0.0 139,084 6.0+/-0.0 876 13.9+/-0.610 - 19.9 24,601 13.6+/-0.1 23,931 13.5+/-0.1 670 18.3+/-0.920 - 29.9 7,668 23.1+/-0.2 7,076 23.3+/-0.2 592 20.1+/-1.430 - 39.9 3,888 29.2+/-0.5 3,327 31.3+/-0.5 561 16.5+/-0.940 - 49.9 2,374 34.5+/-0.7 1,801 39.3+/-0.8 573 19.3+/-1.350 - 59.9 1,530 37.5+/-1.0 1,074 46.7+/-1.3 456 15.7+/-1.260 - 69.9 1,119 34.5+/-1.3 712 44.7+/-1.8 407 16.7+/-1.370 - 79.9 790 32.6+/-1.8 431 47.5+/-2.7 359 14.7+/-1.780 - 89.9 634 24.0+/-1.8 242 44.1+/-3.8 392 11.5+/-1.3

> 90 692 13.8+/-1.4 159 38.5+/-5.1 533 6.5+/-0.9Subtotal 183,256 9.3+/-0.0 177,837 9.1+/-0.0 5,419 15.5+/-0.3

Missing or 0% 38,263 7.8+/-0.1 36,928 7.6+/-0.1 1,335 13.7+/-0.6TOTAL 221,519 214,765 6,754

Total Lived Died

%TBSA Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM

0.1 - 9.9 75,932 $54195+/-457 75,413 $53202+/-448 519 $198436+/-1404110 - 19.9 14,044 $148228+/-2142 13,691 $143649+/-2090 353 $325850+/-2455120 - 29.9 4,223 $328258+/-7068 3,878 $324695+/-7252 345 $368308+/-2895430 - 39.9 2,074 $478872+/-14166 1,754 $494553+/-15487 320 $392920+/-3464940 - 49.9 1,249 $632559+/-22633 905 $692745+/-27558 344 $474224+/-3742350 - 59.9 794 $757373+/-35264 538 $916744+/-45942 256 $422446+/-4476960 - 69.9 538 $707102+/-41747 309 $934007+/-60706 229 $400930+/-4701670 - 79.9 435 $521539+/-40983 207 $724293+/-72530 228 $337459+/-3845480 - 89.9 351 $403604+/-41313 132 $606566+/-81508 219 $281271+/-42462

> 90 409 $237455+/-28211 93 $442723+/-81989 316 $177044+/-26560Subtotal 100,049 $108085+/-912 96,920 $100963+/-872 3,129 $328664+/-10225

Missing or 0% 18,367 $87395+/-1713 17,681 $82159+/-1626 686 $222343+/-17927TOTAL 118,416 $104876+/-815 114,601 $98062+/-779 3,815 $309546+/-9008

Table

16

Table

17

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


HOSPITAL CHARGES: LIVED/DIED BY TOP 20 MS-DRGS

Total N=118,416 (Excluding 103,103 cases with Unknown/Missing charge data)

Table 18 lists the twenty most frequently recorded MS-DRG codes and their associated hospital charges for both survivors and deaths.


Total Lived Died

Top 20 MS-DRG Codes Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM208 Respiratory system diagnosis w

ventilator support <96 hours707 $60843+2750 612 $60714+2934 95 $61673+7890

3 ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj

O.R.1,335 $1071185+26775 1,082 $1097699+29844 253 $957790+60185

507 Major shoulder or elbow joint procedures w CC/MCC

513 $97801+6727 510 $96686+6707 3 $287480+128419

511 Shoulder,elbow or forearm proc,exc major joint proc w CC

852 $22807+1263 852 $22807+1263 0

578 Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC

691 $73539+3938 690 $72196+3707 1 $0

595 Major skin disorders w MCC 592 $231698+16397 447 $209288+16195 145 $300781+44238

596 Major skin disorders w/o MCC 863 $83731+5007 857 $83247+5007 6 $152814+87539

603 Cellulitis w/o MCC 537 $31297+3771 537 $31297+3771 0

607 Minor skin disorders w/o MCC 588 $27654+2267 586 $27380+2264 2 $107888+44868853 Infectious & parasitic diseases w

O.R. procedure w MCC489 $360166+19587 432 $347425+18959 57 $456729+86756

904 Skin grafts for injuries w CC/MCC 406 $135310+11283 404 $132974+11183 2 $607128+251558

918 Poisoning & toxic effects of drugs w/o MCC

566 $28968+2197 555 $27373+1996 11 $109457+47269

923 Other injury, poisoning & toxic effect diag w/o MCC

1,145 $33637+2258 1,138 $33510+2264 7 $54221+30698

927 Extensive burns or full thickness burns w MV 96+ hrs w skin graft

4,183 $563046+10210 3,618 $546317+10753 565 $670170+30826

928 Full thickness burn w skin graft or inhal inj w CC/MCC

12,809 $195151+2672 12,446 $192274+2650 363 $293807+24702

929 Full thickness burn w skin graft or inhal inj w/o CC/MCC

12,597 $98249+1655 12,527 $96839+1600 70 $350541+76911

933 Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft

1,292 $134296+8481 405 $219358+22380 887 $95456+6553

934 Full thickness burn w/o skin grft or inhal inj

6,436 $41852+1469 6,234 $40800+1493 202 $74324+7830

935 Non-extensive burns 46,093 $34399+398 45,938 $33834+387 155 $201930+26202

998 Principal diagnosis invalid as discharge diagnosis

1,027 $895+151 1,021 $900+152 6 $0

Subtotal 93,721 90,891 2,830

Other Values 11,632 $144448+2589 11,014 $138809+2544 618 $244948+17387

Unknown 13,063 $37884+1239 12,696 $33851+1121 367 $177392+19713

Total 118,416 114,601 3,815

Table

18

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS


DAYS PER %TBSA AND CHARGES PER DAY BY AGE GROUPS AND SURVIVAL

Table 19 combines several parameters of resource utilization for survivors and non-survivors, listed by age category. These include mean LOS, mean LOS/Burn size (TBSA), mean total charges, and mean daily charges.


Cases DaysHospital Days /

%TBSAHospital Charges

Hospital Charges / Hospital Days

Age Groups Lived Died Lived Died Lived Died Lived Died Lived Died

Birth - 0.9 1,422 2 5.82 3.50 2.59 2.60 $32,816 $132,612 $6,427 $39,147

+/- SEM 0.41 1.50 0.43 2.40 $2,332 $48,448 $265 $2,935

1 - 1.9 5,254 9 5.87 20.78 1.91 1.31 $40,160 $152,057 $8,010 $40,968

+/- SEM 0.72 16.56 0.20 1.12 $1,610 $30,437 $304 $8,029

2 - 4.9 5,882 38 6.74 9.76 2.24 1.03 $51,234 $218,933 $7,579 $34,150

+/- SEM 0.42 2.70 0.38 0.41 $1,893 $54,316 $171 $10,144

5 - 15.9 7,864 54 7.94 18.80 2.03 0.59 $71,741 $450,049 $8,812 $40,555

+/- SEM 0.20 4.93 0.08 0.15 $2,469 $115,510 $554 $4,208

16 - 19.9 4,175 37 7.59 9.41 2.12 0.29 $78,172 $321,295 $9,175 $33,493

+/- SEM 0.25 3.05 0.10 0.11 $3,614 $120,623 $262 $4,255

20 - 29.9 15,342 176 8.84 18.58 2.38 0.59 $98,757 $420,311 $9,648 $35,873

+/- SEM 0.14 2.64 0.06 0.10 $2,362 $55,509 $121 $2,528

30 - 39.9 13,717 248 9.70 14.89 2.83 1.24 $106,336 $423,291 $10,130 $39,551

+/- SEM 0.19 1.60 0.10 0.77 $2,498 $42,971 $250 $3,353

40 - 49.9 13,483 325 10.54 15.46 3.37 1.07 $112,502 $406,667 $10,195 $33,152

+/- SEM 0.17 1.63 0.12 0.24 $2,517 $37,163 $199 $1,642

50 - 59.9 13,794 544 11.73 18.08 3.91 1.55 $125,395 $404,355 $10,164 $28,652

+/- SEM 0.18 1.24 0.09 0.26 $2,582 $27,693 $317 $1,199

60 - 69.9 8,784 593 12.78 16.60 4.57 1.56 $134,039 $335,765 $10,101 $28,589

+/- SEM 0.22 1.40 0.22 0.21 $3,228 $22,964 $176 $1,279

70 - 79.9 4,359 541 14.26 14.07 4.35 1.96 $137,442 $259,176 $9,742 $23,712

+/- SEM 0.90 1.08 0.22 0.59 $4,432 $18,202 $150 $1,035

80 or greater 2,571 558 12.83 10.65 4.11 1.24 $131,750 $200,396 $9,974 $21,324

+/- SEM 0.34 0.58 0.17 0.14 $5,122 $15,754 $401 $1,361

Total 96,647 3,125 9.86 15.09 3.06 1.40 $101,246 $329,080 $9,570 $28,588

+/- SEM 0.08 0.49 0.04 0.14 $875 $10,237 $86 $588

Table

19

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

Analysis by Age Group3

This year encompasses another decade of collected data ranging from 2009 to 2018. Age of the burn patient continues to be an important marker, having a dramatic effect on many of the attributes found in the National Burn Repository (NBR). As we improve our collection of data, it is interesting to note the stability of incidence of burns in each ten-year report. Data continues to be very useful when contemplating prevention strategies, medical economics, and concerns about public health.

The figures in this Age Analysis Section provide detailed information for each of the following age categories: Birth to 0.9, 1 to 1.9, 2 to 4.9, 5 to 15.9, 16 to 19.9, 20 to 29.9, 30 to 39.9, 40 to 49.9, 50 to 59.9, 60 to 69.9, 70 to 79.9, and 80-and-over. These categories were chosen based on prior collective experience about the relationship of certain ages to types of burn injury patterns, with an emphasis on accidental injuries of the very young. Each age category has six pages with four figures and eight tables that summarize the data in the NBR. Some highlights are abstracted below.

The race of burn patients continues to show a dramatic over-representation of minorities in children (age under 5 years) than would be expected based on national demographics. The same marked over-representation disappears in young adulthood. This has continued to perpetuate for the past several years, these minority communities might be at increased risk and in need of prevention initiatives.

Furthermore, scald and contact burns are very prevalent in the early age category when contemplating etiology. Fire/flame

continues to be the consistent, predominant etiology of burns in the adolescent and adult age groups. There continues to be a large amount of unspecified burns in the 0 – 0.9 year age group, but there have been improvements in capturing this data in the remainder of the groups. Non-burns have seen a greater reporting value than in years past, especially in young adults. Improvement of data collection may impact these numbers, bringing a better appreciation of the total data set.

Inhalation injury is one of the most lethal characteristics of burn patients, and somewhat surprisingly, increases in incidence with age. Even though children are exposed to smoke in structural fires and even with, the increase in fire/flame injuries in the lowest age group, the preponderance of scald and contact injuries continues to crowd out inhalation injuries in the young.

As a non-mandatory field, complication rates may be lacking. The most common complications are urinary tract infections (UTI), pneumonia and cellulitis as the top three complications in those patients under age 60. The number of complications observed increased with the increase of age.

Another absolutely expected finding is the progression of mortality as a function of increasing age.


Analysis by Age Group Birth to .9

Race

RACE/ETHNICITY

{

Table

20


ETIOLOGY

{

Table

21


ETIOLOGY

{

Figure

24

RACE/ETHNICITY

{

Figure

23

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

Race Cases %Valid

White 1,107 39.2%

Black 821 29.1%

Hispanic 411 14.6%

Other 288 10.2%

Asian 153 5.4%

Native American 44 1.6%

Unknown 149

TOTAL 2,973

Etiology Cases % Valid

Scald 1,838 65.4%

Contact with Hot Object 680 24.2%

Fire/Flame 120 4.3%

Chemical 46 1.6%

Burn, Unspecified 44 1.6%

Electrical 20 0.7%

Radiation 8 0.3%

Inhalation Only 7 0.2%

Burn Subtotal 2,763 98.3%

Other, Non Burn 44 1.6%

Skin Disease 4 0.1%

Non-Burn Subtotal 48 1.7%

Unknown 162

TOTAL 2,973



HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

{Table

22

Total N=2,973

TOP TEN COMPLICATIONS

{

Table

23

Total N=2,961 (Excluding 12 cases from non ABA burn registry software centers)

Total N=2,973

TOP TEN ICD-10 PROCEDURES

{

Table

24

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

Total Lived Died

Inhalation Injury Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM

No 2,798 5.45+0.23 2,786 5.40+0.23 12 17.00+8.06

Yes 69 9.59+1.84 68 9.66+1.87 1 5.00

Subtotal 2,867 2,854 13

Missing 106 4.58+0.71 105 4.61+0.71 1 1.00

TOTAL 2,973 2,959 14

Top Ten ICD-10 Procedure Codes CountPercent of All ICD-10

Procedures0HD7XZZ Extraction of Abdomen Skin, External Approach 55 2.3

0HDHXZZ Extraction of Right Upper Leg Skin, External Approach 55 2.3

0HDJXZZ Extraction of Left Upper Leg Skin, External Approach 53 2.2

0HD5XZZ Extraction of Chest Skin, External Approach 48 2.0

2W23X4Z Dressing of Abdominal Wall using Bandage 45 1.9

2W2PX4Z Dressing of Left Upper Leg using Bandage 44 1.8

2W2FX4Z Dressing of Left Hand using Bandage 42 1.7

0HD1XZZ Extraction of Face Skin, External Approach 40 1.6

2W24X4Z Dressing of Chest Wall using Bandage 39 1.6

0HDGXZZ Extraction of Left Hand Skin, External Approach 38 1.6

Total Procedures 2,431

Top Ten Complications CountPercent of All Complications

Percent of Patients with Complication

Urinary Tract Infection 22 16.3 0.7

Bacteremia 12 8.9 0.4

Respiratory Failure 11 8.1 0.4

Wound Infection 9 6.7 0.3

Pneumonia 8 5.9 0.3

Cellulitis 7 5.2 0.2

Septicemia 7 5.2 0.2

Thrombosis 7 5.2 0.2

Other Airway 6 4.4 0.2

Compartmental Syndrome 5 3.7 0.2

Total Complications 135


LIVED/DIED BY BURN GROUP SIZE (% TBSA){

Table

25

Total N=2,973

Total N=2,166

HOSPITAL DAYS BY BURN GROUP SIZE (% TBSA) {

Table

26

Total N=2,973

MEAN CHARGES FOR TOP FIVE MS-DRGS

{

Table

27


Lived Died


0.1 - 9.9 2,268 1 0.0

10 - 19.9 313 2 0.6

20 - 29.9 70 1 1.4

30 - 39.9 26 2 7.1

40 - 49.9 8 2 20.0

50 - 59.9 5 0 0.0

60 - 69.9 2 0 0.0

70 - 79.9 1 0 0.0

80 - 89.9 0 0 0.0

> 90 1 1 50.0

Subtotal 2,694 9 0.3

Missing or 0% 265 5 1.9

TOTAL 2,959 14 0.5

%TBSA Cases Mean +/- SEM

0.1 - 9.9 2,269 4.1+0.2

10 - 19.9 315 9.1+0.5

20 - 29.9 71 17.8+2.0

30 - 39.9 28 24.5+3.5

40 - 49.9 10 19.5+3.6

50 - 59.9 5 47+26.8

60 - 69.9 2 28.5+0.5

70 - 79.9 1 28+0.0

80 - 89.9 0

> 90 2 43.5+40.5

Subtotal 2,703 5.4+0.2

Missing or 0% 270 5.7+0.6

TOTAL 2,973 5.5+0.2

MS-DRG Code CasesCases with Valid

ChargesMean +/- SEM

935 Non-extensive burns 1,744 994 20122+/-1176


184 96 48826+/-5864


134 84 20970+/-3221


65 41 172709+/-42854


39 23 335814+/-62425

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Est

imate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl

Etiology Categories with Greater than 100 Valid Charge Cases

Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year

Etiology

Total N=2,973

Total N=1,334

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

{

Figure

26

$20,000

$15,000

$30,000

$25,000

$40,000

$35,000

Scald (N= 1,011)

-100

0

-50

100

50


Fire/Flame

Scald

Contact with Hot Object (N= 323)

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018


MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT, AND SCALD BY ADMISSION YEAR{

Figure

25

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis by Age Group 1 - 1.9

RACE/ETHNICITY

{

Figure

27 RACE/ETHNICITY

{

Table

28


ETIOLOGY

{

Figure

28

ETIOLOGY

{

Table

29


Race Cases % Valid

White 4,491 39.9%

Black 2,899 25.8%


Other 1,243 11.1%

Asian 695 6.2%


Unknown 600

TOTAL 11,848


Scald 7,232 65.2%

Contact with Hot Object 2,501 22.5%

Fire/Flame 620 5.6%


Chemical 206 1.9%

Electrical 126 1.1%


Radiation 12 0.1%



Skin Disease 14 0.1%


Unknown 756

TOTAL 11,848

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

30

Total N=11,848


{

Table

31


Total N=11,848


{

Table

32

Total Lived Died


No 11,187 4.9+/-0.1 11,176 4.9+/-0.1 11 21.4+/-13.3

Yes 208 10.9+/-1.2 193 11.1+/-1.3 15 8.9+/-4.0

Subtotal 11,395 11,369 26

Missing 453 12.6+/-8.1 452 12.6+/-8.1 1 11.0+/-0.0

TOTAL 11,848 11,821 27




Pneumonia 42 3.0 0.4






Extubation Unintentional 19 1.3 0.2

Adult Respiratory Distress Syndrome (Ards) 14 1.0 0.1

Deep Vein Thrombosis (Dvt) 14 1.0 0.1



Procedures2W24X4Z Dressing of Chest Wall using Bandage 270 2.7



2W21X4Z Dressing of Face using Bandage 192 1.9

2W2EX4Z Dressing of Right Hand using Bandage 168 1.7

0HDBXZZ Extraction of Right Upper Arm Skin, External Approach 162 1.6

2W2AX4Z Dressing of Right Upper Arm using Bandage 157 1.6

0HDFXZZ Extraction of Right Hand Skin, External Approach 150 1.5

0HR5XK4 Replacement of Chest Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

140 1.4

0HDCXZZ Extraction of Left Upper Arm Skin, External Approach 124 1.2


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

33

Total N=11,848

Total N=8,720


Table

34

Total N=11,848


{

Table

35

Lived Died


0.1 - 9.9 8,790 1 0.0

10 - 19.9 1,419 5 0.4

20 - 29.9 248 0 0.0

30 - 39.9 87 0 0.0

40 - 49.9 49 2 3.9

50 - 59.9 16 2 11.1

60 - 69.9 15 3 16.7

70 - 79.9 7 2 22.2

80 - 89.9 2 1 33.3

> 90 1 2 66.7

Subtotal 10,634 18 0.2

Missing or 0% 1,187 9 0.8

TOTAL 11,821 27 0.2


0.1 - 9.9 8,791 4.2+/-0.4

10 - 19.9 1,424 8.4+/-0.3

20 - 29.9 248 16.4+/-0.9

30 - 39.9 87 30.7+/-3.1

40 - 49.9 51 26.8+/-3.8

50 - 59.9 18 44.0+/-8.7

60 - 69.9 18 34.7+/-7.9

70 - 79.9 9 23.8+/-10.0

80 - 89.9 3 15+/-12.0

> 90 3 22.3+/-16.9

Subtotal 10,652 5.5+/-0.3

Missing or 0% 1,196 3.6+/-0.2

TOTAL 11,848 5.3+/-0.3

MS-DRG Code CasesCases with Valid

ChargesMean +/- SEM

935 Non-extensive burns 1,744 994 20122+/-1176


184 96 48826+/-5864


134 84 20970+/-3221


65 41 172709+/-42854


39 23 335814+/-62425

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Est

imate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl


Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year



Figure

29

Total N=5,355


{

Figure

30

$20,000

$10,000

$30,000

$40,000

$50,000

$60,000

Scald (N= 3,590)

Total N=11,848

Contact with Hot Object (N= 1,168)

Fire/Flame (N= 345)

Burn, Unspecified (N= 147)

Chemical (N= 105)

Etiology

0

10

5

15

20 Contact with Hot Object

Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

31 RACE/ETHNICITY

{

Table

36


ETIOLOGY

{

Figure

32

ETIOLOGY

{

Table

37


Race Cases % Valid

White 5,936 43.1%

Black 3,614 26.3%


Other 1,241 9.0%

Asian 490 3.6%


Unknown 567

TOTAL 14,325


Scald 7,380 56.1%


Fire/Flame 2,112 16.1%


Electrical 350 2.7%

Chemical 220 1.7%


Radiation 22 0.2%





Unknown 1168

TOTAL 14,325

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

38

Total N=14,325


{

Table

39


Total N=14,325


{

Table

40

Total Lived Died


No 13,215 5.9+/-0.2 13,184 5.9+/-0.2 31 12.1+/-2.9

Yes 476 16.7+/-1.3 412 17.3+/-1.4 64 12.2+/-4.5

Subtotal 13,691 13,596 95

Missing 634 6.1+/-0.8 633 6.1+/-0.8 1 1.0+/-0.0

TOTAL 14,325 14,229 96










Cardiac Arrest 29 3.9 0.2





Procedures2W24X4Z Dressing of Chest Wall using Bandage 235 1.6

0HBHXZZ Excision of Right Upper Leg Skin, External Approach 205 1.4



0HBJXZZ Excision of Left Upper Leg Skin, External Approach 181 1.3

2W2EX4Z Dressing of Right Hand using Bandage 174 1.2

2W2FX4Z Dressing of Left Hand using Bandage 168 1.2


2W25X4Z Dressing of Back using Bandage 164 1.1



6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

41

Total N=14,325

Total N=9,493


Table

42

Total N=14,325


{

Table

43

Lived Died


0.1 - 9.9 8,865 10 0.1

10 - 19.9 1,596 3 0.2

20 - 29.9 383 3 0.8

30 - 39.9 179 8 4.3

40 - 49.9 98 8 7.5

50 - 59.9 61 12 16.4

60 - 69.9 42 8 16.0

70 - 79.9 18 4 18.2

80 - 89.9 16 17 51.5

> 90 8 13 61.9

Subtotal 11,266 86 0.8

Missing or 0% 1,232 25 2.0

TOTAL 12,498 111 0.9


0.1 - 9.9 9,926 4.3+/-0.2

10 - 19.9 1,534 9.6+/-0.4

20 - 29.9 405 16.8+/-0.7

30 - 39.9 237 23.9+/-1.2

40 - 49.9 149 29.9+/-2.8

50 - 59.9 86 30.2+/-3.2

60 - 69.9 70 22.7+/-4.4

70 - 79.9 22 47+/-8.4

80 - 89.9 20 29.6+/-7.5

> 90 19 34+/-16.0

Subtotal 12,468 6.5+/-0.2

Missing or 0% 1,857 4.7+/-0.2

TOTAL 14,325 6.3+/-0.1

MS-DRG Code Cases Cases with Valid ChargesMean +/-

SEM

935 Non-extensive burns 6,825 3,722 $25123+/-895


1,248 527$90161+/-

5916

934 Full thickness burn w/o skin grft or inhal inj 563 335$33706+/-

2946


463 274$195483+/-

16208


394 161$406695+/-

36969

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Est

imate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl


Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year



Figure

33

Total N=6,086


{

Figure

34

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

Scald (N= 3,650)


Fire/Flame (N= 931)

Total N=14,325


Electrical (N= 171)

Chemical (N= 107)

Etiology

15

5

10

25

20


Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

0

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

35 RACE/ETHNICITY

{

Table

44


ETIOLOGY

{

Figure

36

ETIOLOGY

{

Table

45


Race Cases % Valid

White 10,138 50.1%

Black 5,210 25.8%


Other 1,324 6.5%

Asian 533 2.6%


Unknown 699

TOTAL 20,915


Scald 7,531 39.3%




Electrical 489 2.5%


Chemical 251 1.3%

Radiation 59 0.3%





Unknown 1733

TOTAL 20,915

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

46

Total N=20,915


{

Table

47


Total N=20,915


{

Table

48

Total Lived Died


No 18,705 6.6+/-0.1 18,664 6.6+/-0.1 41 13.2+/-4.4

Yes 1,231 16.9+/-0.8 1,140 17.0+/-0.8 91 15.0+/-3.1

Subtotal 19,936 19,804 132

Missing 979 5.2+/-0.5 974 5.1+/-0.5 5 15.6+/-12.0

TOTAL 20,915 20,778 137













Total Complications 1,145


ProceduresExcision of Right Upper Leg Skin, External Approach 572 1.9

Excision of Left Upper Leg Skin, External Approach 522 1.8

Excision of Right Lower Leg Skin, External Approach 339 1.2

Excision of Back Skin, External Approach 320 1.1

Excision of Abdomen Skin, External Approach 316 1.1

Excision of Right Upper Arm Skin, External Approach 310 1.1

Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous Approach

292 1.0

Excision of Left Lower Leg Skin, External Approach 291 1.0

Replacement of Right Upper Arm Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

267 0.9

Excision of Chest Skin, External Approach 263 0.9


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

49

Total N=20,915

Total N=12,680


Table

50

Total N=20,915


{

Table

51

Lived Died


0.1 - 9.9 13,337 15 0.1

10 - 19.9 2,240 10 0.4

20 - 29.9 753 5 0.7

30 - 39.9 515 2 0.4

40 - 49.9 278 9 3.1

50 - 59.9 162 5 3.0

60 - 69.9 130 10 7.1

70 - 79.9 95 10 9.5

80 - 89.9 77 21 21.4

> 90 13 13 50.0

Subtotal 17,600 100 0.6

Missing or 0% 3,178 37 1.2

TOTAL 20,778 137 0.7


0.1 - 9.9 13,352 4.1+/-0.0

10 - 19.9 2,250 11.3+/-0.2

20 - 29.9 758 18.6+/-0.6

30 - 39.9 517 20.8+/-1.1

40 - 49.9 287 26.8+/-1.7

50 - 59.9 167 31.3+/-3.1

60 - 69.9 140 33.6+/-3.6

70 - 79.9 105 40.5+/-4.9

80 - 89.9 98 30.8+/-5.4

> 90 26 22.8+/-7.3

Subtotal 17,700 7.4+/-0.1

Missing or 0% 3,215 5.7+/-0.8

TOTAL 20,915 7.1+/-0.1


SEM

935 Non-extensive burns 8,155 4,277$26074+/-

1147


2,229 1,058$90696+/-

5794


956 558$179891+/-

13487


711 326$457039+/-

30937


2983

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis E

stim

ate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl


Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year

by Age Group 5 - 15.9

Total N=8,418


{

Figure

38

$20,000

$10,000

$40,000

$30,000

$60,000

$50,000

$80,000

$70,000

$100,000

$90,000

Scald (N= 3,519)

Total N=20,915

Fire/Flame (N= 3,252)

Other, Non Burn (N= 235)

Electrical (N= 202)




Figure

37

Etiology

5

15

10

20Contact with Hot Object

Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

0

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

39 RACE/ETHNICITY

{

Table

52


ETIOLOGY

{

Figure

40

ETIOLOGY

{

Table

53


Race Cases % Valid

White 6,051 63.4%

Black 1,654 17.3%


Other 542 5.7%

Asian 191 2.0%


Unknown 330

TOTAL 9,873



Scald 2,469 27.3%



Electrical 288 3.2%

Chemical 269 3.0%


Radiation 20 0.2%





Unknown 831

TOTAL 9,873

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

54

Total N=9,873


{

Table

55


Total N=9,873


{

Table

56

Total Lived Died


No 8,703 6.4+/-0.2 8,680 6.4+/-0.2 23 7.3+/-4.2

Yes 623 16.5+/-1.1 556 17.2+/-1.2 67 10.5+/-3.3

Subtotal 9,326 9,236 90

Missing 547 5.6+/-0.6 541 5.6+/-0.6 6 1.1+/-0.3

TOTAL 9,873 9,777 96











Other Hematologic 28 3.2 0.3




Procedures



0HBLXZZ Excision of Left Lower Leg Skin, External Approach 149 1.3


0HBKXZZ Excision of Right Lower Leg Skin, External Approach 137 1.2

0HBFXZZ Excision of Right Hand Skin, External Approach 135 1.2


0HBGXZZ Excision of Left Hand Skin, External Approach 116 1.0

0HBDXZZ Excision of Right Lower Arm Skin, External Approach 111 1.0

0HRFX74 Replacement of Right Hand Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

111 1.0


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

57

Total N=9,873

Total N=6,057


Table

58

Total N=9,873


{

Table

59

Lived Died


0.1 - 9.9 5,691 8 0.1

10 - 19.9 1,208 5 0.4

20 - 29.9 377 4 1.0

30 - 39.9 153 6 3.8

40 - 49.9 112 5 4.3

50 - 59.9 55 7 11.3

60 - 69.9 34 7 17.1

70 - 79.9 23 5 17.9

80 - 89.9 12 15 55.6

> 90 10 25 71.4

Subtotal 7,675 87 1.1

Missing or 0% 1,179 19 1.6

TOTAL 8,854 106 1.2


0.1 - 9.9 6,359 4.4+/-0.2

10 - 19.9 1,088 9.5+/-0.3

20 - 29.9 373 17.9+/-0.9

30 - 39.9 190 23.9+/-1.9

40 - 49.9 120 27.3+/-2.3

50 - 59.9 86 40.3+/-5.0

60 - 69.9 57 33+/-5.8

70 - 79.9 41 27.2+/-6.7

80 - 89.9 23 34.7+/-9.9

> 90 44 30.5+/-7.4

Subtotal 8,381 7.3+/-0.2

Missing or 0% 1,492 5.4+/-0.4

TOTAL 9,873 7.0+/-0.1


SEM


1590


1,027 547$85232+/-

9725


551 345$172017+/-

12259


3220


281 151$565937+/-

56378

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis E

stim

ate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl


Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year



Figure

41

Total N=4,461


{

Figure

42

Total N=9,873

$20,000

$60,000

$40,000

$100,000

$80,000

$140,000

$120,000


Scald (N= 1,247)




Etiology

7.5

2.5

5

12.5

10


Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

43 RACE/ETHNICITY

{

Table

60


ETIOLOGY

{

Figure

44

ETIOLOGY

{

Table

61


Race Cases % Valid

White 19,596 61.9%

Black 5,802 18.3%


Other 1,967 6.2%

Asian 738 2.3%


Unknown 1,108

TOTAL 32,749


Fire/Flame 13,321 44.0%

Scald 8,716 28.8%



Burn, Unspecified 1,337 4.4%

Chemical 1,324 4.4%


Radiation 66 0.2%




Non-Burn Subtotal 1,590 5.3%

Unknown 2505

TOTAL 32,749

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

62

Total N=32,749


{

Table

63


Total N=32,749


{

Table

64

Total Lived Died


No 28,746 7.1+/-0.0 28,600 7.1+/-0.0 146 16.9+/-2.5

Yes 2,215 18.7+/-0.6 2,003 18.9+/-0.7 212 17.4+/-2.6

Subtotal 30,961 30,603 358

Missing 1,788 5.6+/-0.3 1,763 5.5+/-0.3 25 13.6+/-5.4

TOTAL 32,749 32,366 383










Renal Failure 139 3.8 0.4





Procedures

0HBHXZZ Excision of Right Upper Leg Skin, External Approach 1,118 2.6

0HBJXZZ Excision of Left Upper Leg Skin, External Approach 1,040 2.5





485 1.1


0HBBXZZ Excision of Right Upper Arm Skin, External Approach 441 1.0

0HRDX74 Replacement of Right Lower Arm Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

432 1.0

0HBGXZZ Excision of Left Hand Skin, External Approach 428 1.0


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

65

Total N=32,749

Total N=21,231


Table

66

Total N=32,749


{

Table

67

Lived Died


0.1 - 9.9 21,111 32 0.2

10 - 19.9 3,675 20 0.5

20 - 29.9 1,147 12 1.0

30 - 39.9 495 16 3.1

40 - 49.9 289 23 7.4

50 - 59.9 175 21 10.7

60 - 69.9 172 33 16.1

70 - 79.9 76 40 34.5

80 - 89.9 48 45 48.4

> 90 35 81 69.8

Subtotal 27,223 323 1.2

Missing or 0% 5,143 60 1.2

TOTAL 32,366 383 1.2


0.1 - 9.9 21,143 4.8+/-0.0

10 - 19.9 3,695 11.4+/-0.2

20 - 29.9 1,159 20.2+/-0.6

30 - 39.9 511 29.7+/-1.4

40 - 49.9 312 38.1+/-1.8

50 - 59.9 196 50.9+/-3.3

60 - 69.9 205 39.3+/-3.3

70 - 79.9 116 49.7+/-6.0

80 - 89.9 93 38.1+/-5.6

> 90 116 17.2+/-4.0

Subtotal 27,546 8.2+/-0.1

Missing or 0% 5,203 6.1+/-0.1

TOTAL 32,749 7.8+/-0.0


SEM



3,903 2,151$91182+/-

3499


2,550 1,670$203011+/-

9748

934 Full thickness burn w/o skin grft or inhal inj 1,494 1,035$35146+/-

4100


952 627$559222+/-

27238

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis E

stim

ate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl




Figure

45

Total N=16,771


{

Figure

46

$20,000

$40,000

$60,000

$80,000

$100,000


Total N=32,749

Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year

Scald (N= 4,695)


Electrical (N= 830)

Other, Non Burn

(N= 809)


Chemical (N= 711)

$120,000

Etiology

5

2.5

10

7.5

12.5 Contact with Hot Object

Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

47 RACE/ETHNICITY

{

Table

68


ETIOLOGY

{

Figure

48

ETIOLOGY

{

Table

69


Race Cases % Vslid

White 17,325 60.9%

Black 5,481 19.3%


Other 1,797 6.3%

Asian 660 2.3%


Unknown 1,009

TOTAL 29,476


Fire/Flame 11,951 44.0%

Scald 7,255 26.7%



Chemical 1,370 5.0%



Radiation 43 0.2%





Unknown 2310

TOTAL 29,476

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

70

Total N=29,476


{

Table

71


Total N=29,476


{

Table

72

Total Lived Died


No 25,338 7.8+/-0.1 25,124 7.7+/-0.1 214 17.5+/-1.8

Yes 2,361 18.6+/-0.6 2,085 19.4+/-0.6 276 12.0+/-1.1

Subtotal 27,699 27,209 490

Missing 1,777 6.3+/-0.3 1,745 6.2+/-0.3 32 13.0+/-4.4

TOTAL 29,476 28,954 522















Procedures








454 1.1

0HRKX74 Replacement of Right Lower Leg Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

436 1.1

0HRLX74 Replacement of Left Lower Leg Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

432 1.1

0HRDX74 Replacement of Right Lower Arm Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

422 1.0


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

73

Total N=29,476

Total N=19,219


Table

74

Total N=29,476


{

Table

75

Lived Died


0.1 - 9.9 18,207 45 0.2

10 - 19.9 3,323 32 1.0

20 - 29.9 1,085 19 1.7

30 - 39.9 492 36 6.8

40 - 49.9 275 34 11.0

50 - 59.9 163 25 13.3

60 - 69.9 100 47 32.0

70 - 79.9 65 38 36.9

80 - 89.9 32 53 62.4

> 90 24 86 78.2

Subtotal 23,766 415 1.7

Missing or 0% 5,188 107 2.0

TOTAL 28,954 522 1.8


0.1 - 9.9 18,252 5.6+/-0.1

10 - 19.9 3,355 11.5+/-0.2

20 - 29.9 1,104 20.9+/-0.5

30 - 39.9 528 29.5+/-1.3

40 - 49.9 309 41.0+/-1.9

50 - 59.9 188 49.1+/-3.0

60 - 69.9 147 46.8+/-3.8

70 - 79.9 103 44.3+/-5.3

80 - 89.9 85 44.3+/-7.2

> 90 110 20.5+/-5.7

Subtotal 24,181 9.0+/-0.1

Missing or 0% 5,295 6.6+/-0.1

TOTAL 29,476 8.6+/-0.1

MS-DRG Code No. of Cases Cases with Valid ChargesMean +/-

SEM



3,624 2,008$99620+/-

4368


2,684 1,781$185706+/-

7562

934 Full thickness burn w/o skin grft or inhal inj 1,344 937$37986+/-

2848


1,004 665$536147+/-

24199

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis E

stim

ate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl


Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year



Figure

49

Total N=15,296


{

Figure

50

Total N=29,476

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000


Scald (N= 3,997)


Electrical (N= 957)

Other, Non Burn

(N= 872)

Chemical (N= 747)a


Inhalation Only (N= 192)

Etiology

5

2.5

10

7.5

12.5


Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

51 RACE/ETHNICITY

{

Table

76


ETIOLOGY

{

Figure

52

ETIOLOGY

{

Table

77


Race Cases % Valid

White 18,771 63.4%

Black 5,759 19.5%

Hispanic 2,506 8.5%

Other 1,564 5.3%

Asian 681 2.3%


Unknown 995

TOTAL 30,583


Fire/Flame 12,350 44.4%

Scald 7,019 25.2%



Chemical 1,411 5.1%



Radiation 72 0.3%





Unknown 2764

TOTAL 30,583

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

78

Total N=30,583


{

Table

79


Total N=30,583


{

Table

80

Total Lived Died


No 25,922 8.8+/-0.1 25,616 8.6+/-0.0 306 19.2+/-1.7

Yes 2,777 17.6+/-0.5 2,429 18.3+/-0.5 348 13.0+/-1.3

Subtotal 28,699 28,045 654

Missing 1,884 7.6+/-0.4 1,839 7.2+/-0.4 45 27.8+/-6.7

TOTAL 30,583 29,884 699















Procedures0HBHXZZ Excision of Right Upper Leg Skin, External Approach 1,019 2.6




0HBEXZZ Excision of Left Lower Arm Skin, External Approach 440 1.1

BW03ZZZ Plain Radiography of Chest 440 1.1



0HBCXZZ Excision of Left Upper Arm Skin, External Approach 426 1.1

0HB6XZZ Excision of Back Skin, External Approach 420 1.1


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

81

Total N=30,583

Total N=19,367


Table

82

Total N=30,583


{

Table

83

Lived Died


0.1 - 9.9 18,699 75 0.4

10 - 19.9 3,323 35 1.0

20 - 29.9 1,044 42 3.9

30 - 39.9 513 41 7.4

40 - 49.9 265 52 16.4

50 - 59.9 162 60 27.0

60 - 69.9 88 54 38.0

70 - 79.9 44 48 52.2

80 - 89.9 18 62 77.5

> 90 18 87 82.9

Subtotal 24,174 556 2.2

Missing or 0% 5,710 143 2.4

TOTAL 29,884 699 2.3


0.1 - 9.9 18,774 6.3+/-0.0

10 - 19.9 3,358 13.5+/-0.2

20 - 29.9 1,086 24.0+/-0.6

30 - 39.9 554 36.0+/-1.8

40 - 49.9 317 44.6+/-2.3

50 - 59.9 222 40.2+/-2.7

60 - 69.9 142 46.7+/-4.5

70 - 79.9 92 33.3+/-5.3

80 - 89.9 80 20.7+/-4.0

> 90 105 8.2+/-2.6

Subtotal 24,730 9.9+/-0.1

Missing or 0% 5,853 7.8+/-0.2

TOTAL 30,583 9.5+/-0.1


SEM


1109


3,625 1,921$92365+/-

3900


3,229 2,071$183305+/-

6127


1900


1,047 613$622735+/-

29738

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis E

stim

ate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl


Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year



Figure

53

Total N=15,034


{

Figure

54

Total N=30,583

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000


Scald (N= 3,772)


Other, Non Burn

(N= 967)

Electrical (N= 896)

Chemical (N= 756)


Inhalation Only

(N= 219)

Etiology

7.5

5

12.5

10

15


Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

55 RACE/ETHNICITY

{

Table

84


ETIOLOGY

{

Figure

56

ETIOLOGY

{

Table

85


Race Cases % Valid

White 19,988 66.0%

Black 6,169 20.4%

Hispanic 1,857 6.1%

Other 1,344 4.4%

Asian 658 2.2%


Unknown 973

TOTAL 31,245


Fire/Flame 13,115 46.2%

Scald 6,706 23.6%


Chemical 1,250 4.4%




Radiation 72 0.3%





Unknown 2831

TOTAL 31,245

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

86

Total N=31,245


{

Table

87


Total N=31,245


{

Table

88

Total Lived Died


No 25,998 10.3+/-0.1 25,428 10.1+/-0.1 570 21.6+/-1.2

Yes 3,439 18.1+/-0.4 2,869 18.7+/-0.5 570 15.0+/-1.1

Subtotal 29,437 28,297 1,140

Missing 1,808 9.2+/-0.4 1,746 9.0+/-0.4 62 15.4+/-3.1

TOTAL 31,245 30,043 1,202















Procedures


0HBJXZZ Excision of Left Upper Leg Skin, External Approach 1,131 2.5





491 1.1



454 1.0



Total Procedures 44,898 100.0

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

89

Total N=31,245

Total N=19,494


Table

90

Total N=31,245


{

Table

91

Lived Died


0.1 - 9.9 18,916 141 0.7

10 - 19.9 3,201 97 2.9

20 - 29.9 964 99 9.3

30 - 39.9 401 95 19.2

40 - 49.9 224 113 33.5

50 - 59.9 130 89 40.6

60 - 69.9 62 74 54.4

70 - 79.9 62 80 56.3

80 - 89.9 23 83 78.3

> 90 21 95 81.9

Subtotal 24,004 966 3.9

Missing or 0% 6,039 236 3.8

TOTAL 30,043 1,202 3.8


0.1 - 9.9 19,057 7.6+/-0.1

10 - 19.9 3,298 16.8+/-0.3

20 - 29.9 1,063 27.9+/-0.9

30 - 39.9 496 34.2+/-1.2

40 - 49.9 337 41.3+/-2.1

50 - 59.9 219 47.7+/-3.2

60 - 69.9 136 36.7+/-3.8

70 - 79.9 142 31.7+/-4.4

80 - 89.9 106 11.9+/-2.4

> 90 116 8.8+/-2.0

Subtotal 24,970 11.4+/-0.1

Missing or 0% 6,275 10.2+/-0.2

TOTAL 31,245 11.1+/-0.1


SEM


1471


3,798 2,463$203275+/-

6305


3,466 1,841$107874+/-

4898


5099


1,112 682$614162+/-

26508

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

Analysis


Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl



Figure

57

Total N=15,806


{

Figure

58

Total N=31,245

Admission Year

Est

imate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl


Other, Non Burn (N= 1,308)


Chemical (N= 665)

Electrical (N= 640)



Scald (N= 3,622)

Etiology

8

6

12

10


Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

59 RACE/ETHNICITY

{

Table

92


ETIOLOGY

{

Figure

60

ETIOLOGY

{

Table

93


Race Cases % Valid

White 13,373 68.5%

Black 3,787 19.4%

Hispanic 882 4.5%

Other 830 4.3%

Asian 498 2.6%


Unknown 676

TOTAL 20,188



Scald 4,126 22.6%



Chemical 527 2.9%


Electrical 362 2.0%

Radiation 42 0.2%





Unknown 1893

TOTAL 20,188

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

94

Total N=20,188


{

Table

95


Total N=20,188


{

Table

96

Total Lived Died


No 16,589 11.6+/-0.1 15,934 11.1+/-0.1 655 22.0+/-1.4

Yes 2,458 16.0+/-0.4 1,891 17.1+/-0.5 567 12.0+/-0.8

Subtotal 19,047 17,825 1,222

Missing 1,141 9.5+/-0.5 1,087 9.4+/-0.5 54 11.0+/-2.5

TOTAL 20,188 18,912 1,276















Procedures






0BJ08ZZ Inspection of Tracheobronchial Tree, Via Natural or Artificial Opening Endoscopic

324 1.0


315 1.0


314 1.0

0HRBX74 Replacement of Right Upper Arm Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

308 0.9

0HB7XZZ Excision of Abdomen Skin, External Approach 290 0.9


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

97

Total N=20,188

Total N=12,305


Table

98

Total N=20,188


{

Table

99

Lived Died


0.1 - 9.9 11,951 170 1.4

10 - 19.9 2,110 125 5.6

20 - 29.9 592 110 15.7

30 - 39.9 233 107 31.5

40 - 49.9 100 131 56.7

50 - 59.9 72 114 61.3

60 - 69.9 22 79 78.2

70 - 79.9 13 65 83.3

80 - 89.9 8 48 85.7

> 90 9 64 87.7

Subtotal 15,110 1,013 6.3

Missing or 0% 3,802 263 6.5

TOTAL 18,912 1,276 6.3


0.1 - 9.9 12,121 8.6+/-0.1

10 - 19.9 2,235 18.8+/-0.4

20 - 29.9 702 32.2+/-1.3

30 - 39.9 340 35.0+/-1.8

40 - 49.9 231 34.1+/-2.8

50 - 59.9 186 26.9+/-2.7

60 - 69.9 101 23.8+/-3.5

70 - 79.9 78 11.4+/-3.0

80 - 89.9 56 6+/-1.7

> 90 73 5.0+/-0.9

Subtotal 16,123 12.3+/-0.1

Missing or 0% 4,065 10.7+/-0.2

TOTAL 20,188 12.0+/-0.1


SEM


1733


2,680 1,719$204543+/-

6392


2,157 1,133$113477+/-

6342


8963


738 457$623588+/-

33883

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis

Admission Year



Figure

61

Total N=10,296


{

Figure

62

Total N=20,188

Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Est

imate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl





Chemical (N= 290)

Scald (N= 2,298)


Electrical (N= 228)

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

Etiology

10

5

20

15

25

30


Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP



RACE/ETHNICITY

{

Figure

63 RACE/ETHNICITY

{

Table

100


ETIOLOGY

{

Figure

64

ETIOLOGY

{

Table

101


Race Cases % Valid

White 7,213 71.0%

Black 1,783 17.5%

Hispanic 392 3.9%

Other 404 4.0%

Asian 300 3.0%


Unknown 350

TOTAL 10,513



Scald 1,980 21.0%




Chemical 182 1.9%

Electrical 68 0.7%

Radiation 20 0.2%





Unknown 1083

TOTAL 10,513

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

102

Total N=10,513


{

Table

103


Total N=10,513


{

Table

104

Total Lived Died


No 8,535 12.8+/-0.4 7,932 12.4+/-0.5 603 18.0+/-1.1

Yes 1,379 14.2+/-0.6 919 16.9+/-0.8 460 8.8+/-0.6

Subtotal 9,914 8,851 1,063

Missing 599 10.2+/-0.7 542 10.0+/-0.7 57 11.9+/-2.5

TOTAL 10,513 9,393 1,120















Procedures





207 1.2

0HB6XZZ Excision of Back Skin, External Approach 203 1.2


0HRHXK3 Replacement of Right Upper Leg Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

179 1.0

0HRHX74 Replacement of Right Upper Leg Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

169 1.0

0BH17EZ Insertion of Endotracheal Airway into Trachea, Via Natural or Artificial Opening

167 1.0


Total Procedures 17,156 100.0

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

105

Total N=10,513

Total N=6,335


Table

106

Total N=10,513


{

Table

107

Lived Died


0.1 - 9.9 5,938 179 2.9

10 - 19.9 1,087 133 10.9

20 - 29.9 278 123 30.7

30 - 39.9 102 131 56.2

40 - 49.9 33 113 77.4

50 - 59.9 17 64 79.0

60 - 69.9 4 55 93.2

70 - 79.9 10 29 74.4

80 - 89.9 5 35 87.5

> 90 7 36 83.7

Subtotal 7,481 898 10.7

Missing or 0% 1,912 222 10.4

TOTAL 9,393 1,120 10.7


0.1 - 9.9 6,117 9.5+/-0.2

10 - 19.9 1,220 23.2+/-3.0

20 - 29.9 401 33.6+/-1.9

30 - 39.9 233 27.4+/-1.9

40 - 49.9 146 24.1+/-3.5

50 - 59.9 81 11.9+/-2.3

60 - 69.9 59 8.4+/-2.4

70 - 79.9 39 4.4+/-0.8

80 - 89.9 40 3.7+/-1.5

> 90 43 5.4+/-1.2

Subtotal 8,379 13.4+/-0.4

Missing or 0% 2,134 10.8+/-0.3

TOTAL 10,513 12.8+/-0.3


SEM


2382


1,572 989$197830+/-

7501


1,098 572$110793+/-

8030


7272


415 259$576321+/-

33403

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis M

ean

Ho

spit

al D

ays

wit

h 9

5%

Cl



Figure

65

Total N=5,111


{

Figure

66

Total N=10,513

Admission Year

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

Est

imate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl




Chemical (N= 99)

Other, Non Burn (N=417)


Scald (N= 1,098)


Etiology

10

0

30

20


Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP


Analysis by Age Group 80 and over

RACE/ETHNICITY

{

Figure

67 RACE/ETHNICITY

{

Table

108


ETIOLOGY

{

Figure

68

ETIOLOGY

{

Table

109


Race Cases % Valid

White 4,866 74.0%

Black 974 14.8%

Other 243 3.7%

Hispanic 239 3.6%

Asian 229 3.5%


Unknown 252

TOTAL 6,831



Scald 1,528 24.8%




Chemical 108 1.8%

Electrical 23 0.4%

Radiation 9 0.1%





Unknown 676

TOTAL 6,831

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




{Table

110

Total N=6,831


{

Table

111


Total N=6,831

TOP TEN PROCEDURES

{

Table

112

Total Lived Died


No 5,596 12.1+/-0.2 4,881 11.9+/-0.2 715 13.1+/-0.5

Yes 829 11.7+/-0.6 438 15.9+/-1.1 391 7.0+/-0.6

Subtotal 6,425 5,319 1,106

Missing 406 10.3+/-0.6 330 10.5+/-0.7 76 9.5+/-1.7

TOTAL 6,831 5,649 1,182










Other Cardiovascular 103 2.4 1.5





Procedures0HBHXZZ Excision of Right Upper Leg Skin, External Approach 292 1.8



0HBKXZZ Excision of Right Lower Leg Skin, External Approach 104 0.60HRLX74 Replacement of Left Lower Leg Skin with Autologous

Tissue Substitute, Partial Thickness, External Approach98 0.6


95 0.6

0HRBX74 Replacement of Right Upper Arm Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

93 0.6

0HRJX74 Replacement of Left Upper Leg Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

93 0.6

0HBLXZZ Excision of Left Lower Leg Skin, External Approach 92 0.60HR6X74 Replacement of Back Skin with Autologous Tissue

Substitute, Partial Thickness, External Approach89 0.5


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Table

113

Total N=6,831

Total N=4,105


Table

114

Total N=6,831


{

Table

115

Lived Died


0.1 - 9.9 3,607 192 5.1

10 - 19.9 628 201 24.2

20 - 29.9 122 176 59.1

30 - 39.9 45 122 73.1

40 - 49.9 21 84 80.0

50 - 59.9 12 64 84.2

60 - 69.9 7 35 83.3

70 - 79.9 5 37 88.1

80 - 89.9 2 28 93.3

> 90 3 32 91.4

Subtotal 4,452 971 17.9

Missing or 0% 1,197 211 15.0

TOTAL 5,649 1,182 17.3


0.1 - 9.9 3,799 10.4+/-0.2

10 - 19.9 829 21.1+/-0.7

20 - 29.9 298 19.5+/-1.2

30 - 39.9 167 18.2+/-1.9

40 - 49.9 105 7.6+/-1.2

50 - 59.9 76 5.8+/-1.0

60 - 69.9 42 7.3+/-2.6

70 - 79.9 42 2.9+/-0.8

80 - 89.9 30 1.8+/-0.6

> 90 35 2.8+/-1.0

Subtotal 5,423 12.5+/-0.2

Missing or 0% 1,408 9.8+/-0.4

TOTAL 6,831 11.9+/-0.1


SEM

935 Non-extensive burns 1,549 897$58792+/-

5862


1,073 695$215058+/-

9467


678 327$124714+/-

8576


4806

933 Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft

292 179$64433+/-

8863

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP




Figure

69

Total N=3,194


{

Figure

70

Total N=6,831

Mean

Ho

spit

al D

ays

wit

h 9

5%

Cl

Admission Year

$40,000

$20,000

$60,000

$80,000

$100,000

$120,000

$140,000

Est

imate

d M

ean

Ho

spit

al C

harg

es

wit

h 9

5%

Cl






Scald (N= 829)

Etiology

5

0

15

10

20


Fire/Flame

Scald

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS

BY

ETIOLOGY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

Analysis by Etiology4

The etiology of thermal injury impacts both the morbidity and mortality of patients admitted to burn centers around North America. The reader should note that this database only contains extractions from inpatient admission records. Valid conclusions regarding the demographics of outpatient burns and their etiologies cannot be drawn from this report. In general, burns managed in the outpatient setting are less severe in nature but have not been characterized in large studies. Burns managed in the outpatient setting are not currently reported with a central tracking mechanism in the United States and may or may not be tracked closely by individual centers.

The 2018 National Burn Repository Report shows that flame burns are the most common form of injury, followed by scalds, contact burns, and chemical/electrical injuries. Complications vary across the different categories of injury.Likely through differences in size, severity of injury, and risk of inhalation injury, the cause of the burn wound has an impact on hospital length of stay. Demographics (age and gender) also differ between the various etiologies. As mechanisms of injury are varied, so are the circumstances and environment in which the burn occurs. Understanding these patterns of different burn etiologies is a key component in focusing burn prevention strategies.


Analysis by Etiology Fire/Flame Injuries

CIRCUMSTANCE OF INJURY

{Figure

71 CIRCUMSTANCE OF INJURY

{

Table

116


PLACE OF OCCURRENCE - E849 CODE{

Figure

72PLACE OF OCCURRENCE -

E849 CODE {

Table

117

Flame burns are the most common type of burn represented in the 2018 database. As in previous versions of this report, flame burns continue to cause some of the most severe thermal injury. Fire and flame burns are typically associated with the highest risk of death and complications compared to the other etiologies. The vast majority of these burns are accidental, and the majority occur in the home.

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY


Circumstance of Injury Cases % Valid

Accident, Non-Work Related 61,024 76.9%




Other 1,686 2.1%

Suspected Assault/Abuse 806 1.0%


Suspected Child Abuse 228 0.3%

Unknown 3,046

Total 82,404

Place of Occurrence Cases % Valid

Home 54,035 73.6%






Farm 710 1.0%

Residential Institution 493 0.7%

Mine/Quarry 68 0.1%

Unspecified 8,985

Total 82,404



PERCENT OF PATIENT WITH CLINICALLY RELEVANT COMPLICATIONS BY AGE GROUP

{

Figure

73

10%

20%

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+

% o

f P

ati

en

ts w

ith

a C

lin

ically

Rela

ted

C

om

plica

tio

n

Age Categories

Total N=81,916 (Excluding 488 cases from non ABA burn registry software users)

COMPLICATION RATE BY AGE GROUP

{

Table

118


Burns caused by flames are typically associated with the highest rate of complications. As expected, with increasing age, the rate of complications also increases (Figure 73), with the exception of infants, who have a rate higher than other young children (15%). In pediatrics (over age1) ranging up young adults under the age of 20, the complication rate that ranges from 7.7-8.1%. The rate of complications in patients above the age of 20 increases between each age group in a linear fashion (Figure 73) to a maximum of 25.5% in those over age 80 (Table 118). Advanced age is associated with worse outcome after injury.

30%

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY

No Complication Complication

Age Category Cases Cases Complication Rate

0-.9 102 18 15.0

1-1.9 564 51 8.3

2-4.9 1,934 170 8.1

5-15.9 6,732 567 7.8

16-19.9 4,058 340 7.7

20-29.9 11,953 1,286 9.7

30-39.9 10,458 1,414 11.9

40-49.9 10,562 1,704 13.9

50-59.9 10,890 2,143 16.4

60-69.9 7,463 1,587 17.5

70-79.9 4,022 1,014 20.1

80 and Over 2,150 734 25.5

Subtotal 70,888 11,028 13.5

Missing 0 0

Total 70,888 11,028 13.5




{Table

119



{

Table

120

Total N=25,055 cases record in software capable of collecting ICD-10

As with other forms of injury, complications of flame burns are predominantly infectious in nature. Pneumonia is the most common complication. The most common procedures performed for these patients involve burn excision and autologous skin graft placement.



Pneumonia 3,363 17.1 4.1

Urinary Tract Infection 1,960 10.0 2.4

Respiratory Failure 1,578 8.0 1.9

Cellulitis 1,376 7.0 1.7

Wound Infection 1,154 5.9 1.4

Renal Failure 1,098 5.6 1.3

Bacteremia 1,030 5.2 1.3





Top Ten ICD-10 Procedures Codes CountPercent of All ICD-

10 Procedures

Excision of Right Upper Leg Skin, External Approach 3,935 2.4

Excision of Left Upper Leg Skin, External Approach 3,731 2.3

Excision of Right Lower Leg Skin, External Approach 1,999 1.2

Excision of Left Lower Leg Skin, External Approach 1,958 1.2

Excision of Right Upper Arm Skin, External Approach 1,899 1.2


1,873 1.2

Excision of Back Skin, External Approach 1,846 1.1

Excision of Left Upper Arm Skin, External Approach 1,748 1.1

Plain Radiography of Chest 1,738 1.1

Replacement of Right Lower Leg Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

1,703 1.1


1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY




{

Table

121

Total N=82,404

HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP (%TBSA)

{

Table

122

Total N=82,404

Inhalation injury has a significant impact on the morbidity and mortality of flame burn patients. The presence of smoke inhalation is associated with an overall mortality rate of 20% over the past decade, while the mortality is only 2.9% in those patients without smoke inhalation (Table 121). Most patients with inhalation injury have a longer length of stay (Table 122).

Total Lived Died


No 66,505 9.9+/-0.0 64,877 9.7+/-0.0 1,628 18.6+/-0.8

Yes 12,874 19.6+/-0.2 10,312 21.4+/-0.3 2,562 12.3+/-0.4

Subtotal 79,379 75,189 4,190

Missing 3,025 9.9+/-0.4 2,813 9.7+/-0.4 212 11.5+/-1.6

TOTAL 82,404 78,002 4,402

Total Lived Died

% TBSA Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM

0.1 - 9.9 47,587 6.2+/-0.0 47,153 6.2+/-0.0 434 10.6+/-0.6

10 - 19.9 12,910 15.1+/-0.3 12,496 15.0+/-0.3 414 #VALUE

20 - 29.9 4,731 25.6+/-0.3 4,295 26.0+/-0.3 436 21.1+/-1.8

30 - 39.9 2,623 31.3+/-0.6 2,182 34.3+/-0.7 441 16.8+/-1.0

40 - 49.9 1,675 37.6+/-0.9 1,225 44.1+/-1.1 450 20.2+/-1.6

50 - 59.9 1,096 40.2+/-1.3 728 52.6+/-1.7 368 15.5+/-1.5

60 - 69.9 823 37.7+/-1.6 478 53.5+/-2.4 345 15.8+/-1.4

70 - 79.9 563 35.9+/-2.2 265 60.5+/-3.8 298 14.1+/-1.8

80 - 89.9 484 24.2+/-2.1 152 52.6+/-5.4 332 11.2+/-1.5

> 90 502 13.6+/-1.9 54 73.7+/-13.5 448 6.5+/-1.1

Subtotal 72,994 12.0+/-0.0 69,028 11.8+/-0.0 3,966 15.1+/-0.4

Missing or 0% 9,410 7.1+/-0.1 8,974 6.9+/-0.1 436 10.3+/-0.9

TOTAL 82,404 78,002 4,402

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY



MORTALITY RATE FOR MATRIX OF MAIN PREDICTORS

{

Table

123


Table 123 stratifies mortality rates according to age, burn size, and the presence/absence of inhalation injury. Large burns, advanced age, and inhalation injury are all associated with mortality.

TBSA Category Age Inhalation Injury Lived Died Mortality Rate

0.1-19.9 0-59.9 No 42,017 86 0.2

0.1-19.9 0-59.9 Yes 3,962 184 4.4

0.1-19.9 60 and Over No 10,053 286 2.8

0.1-19.9 60 and Over Yes 1,497 258 14.7

20-39.9 0-59.9 No 4,008 94 2.3

20-39.9 0-59.9 Yes 1,416 184 11.5

20-39.9 60 and Over No 647 288 30.8

20-39.9 60 and Over Yes 235 275 53.9

40-59.9 0-59.9 No 1,069 112 9.5

40-59.9 0-59.9 Yes 691 225 24.6

40-59.9 60 and Over No 80 188 70.1

40-59.9 60 and Over Yes 65 254 79.6

60 and Over 0-59.9 No 466 314 40.3

60 and Over 0-59.9 Yes 450 613 57.7

60 and Over 60 and Over No 12 149 92.5

60 and Over 60 and Over Yes 6 269 97.8

TOTAL 66,674 3,779 5.4

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY




% o

f P

ati

en

ts t

hat

Die

d


Female

MaleMORTALITY RATE FOR BAUX SCORE CATEGORIES BY GENDER

{

Figure

74


{

Table

124

Figure 74 and Table 124 demonstrate how the Baux score illustrates the impact of age and body surface area in predicting mortality. Mortality risk is very low with a score of less than 80.A Baux Score range of 100-109.9 will result in mortality in approximately 50% of patients. Males tend to have slightly better survival than females.

20%

40%

60%

80%

100%

.1-9.9 10-19.9

20-29.9

30-39.9

40-49.9

50-59.9

60-69.9

70-79.9

80-89.9

90-99.9

100-109.9

110-119.9

120-129.9

130-139.9

140+


Female Male


0-9.9 933 7 1,257 3

10-19.9 1,388 8 3,128 12

20-29.9 2,405 11 6,452 13

30-39.9 2,897 18 7,010 25

40-49.9 3,032 32 7,140 41

50-59.9 3,626 55 7,716 56

60-69.9 3,318 104 6,644 128

70-79.9 2,322 120 4,414 196

80-89.9 1,463 174 2,593 245

90-99.9 663 195 1,239 313

100-109.9 212 214 466 333

110-119.9 91 205 189 319

120-129.9 29 156 84 288

130-139.9 17 115 30 213

140 and Over 5 173 21 311

Total 22,401 1,587 48,383 2,496

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY


Analysis


{Figure


{

Table

125



Figure


E849 CODE {

Table

126


by Etiology Scald Injuries

Scald burns are the second most common etiology of burn injury captured in the National Burn Repository. Table 125 and 126 demonstrate that most scalds occur in the home and are accidental in nature.




Suspected Child Abuse 1,356 2.2%

Other 1,328 2.1%



Accident, Recreation 831 1.3%


Unknown 1,156

Total 63,780


Home 50,678 83.8%




Street/Highway 898 1.5%


Recreation and Sport 461 0.8%

Farm 150 0.2%

Mine/Quarry 11 0.0%

Unspecified 3,280

Total 63,780

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY


Analysis by Etiology Scald Injuries

% o

f P

ati

en

ts w

ith

a C

lin

ically

Rela

ted

C

om

plica

tio

n

Age Categories



{

Table

127


As with most other burn etiologies in the NBR, complication rates for scald injuries are rather low in younger patients and rise steadily with advancing age. Rates start out at approximately 4% in young children and increase to 18.5% for those over age 80.


{

Figure

77

10%

5%

20%

15%

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+



0-.9 1,750 79 4.3

1-1.9 6,916 259 3.6

2-4.9 7,052 291 4.0

5-15.9 7,345 157 2.1

16-19.9 2,366 89 3.6

20-29.9 8,321 359 4.1

30-39.9 6,857 367 5.1

40-49.9 6,509 483 6.9

50-59.9 6,094 590 8.8

60-69.9 3,674 436 10.6

70-79.9 1,736 234 11.9

80 and Over 1,241 282 18.5

Subtotal 59,861 3,626 5.7

Missing 0 0

Total 59,861 3,626 5.7

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY


Analysis Most complications are infectious in nature, although these and other complications are uncommon. Although the

overall rate of complication for scald burns was quite low, a substantial fraction of scald injuries reported in the National Burn Repository required excision and skin graft placement.


{Table

128

by Etiology Scald Injuries



{

Table

129















Top Ten ICD-10 Procedures Codes CountPercent of All ICD-10 Procedures

Excision of Right Upper Leg Skin, External Approach 1,718 2.6

Excision of Left Upper Leg Skin, External Approach 1,527 2.3

Replacement of Right Foot Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

837 1.3

Extraction of Chest Skin, External Approach 793 1.2

Replacement of Left Foot Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

757 1.2

Excision of Right Foot Skin, External Approach 739 1.1

Dressing of Chest Wall using Bandage 712 1.1

Extraction of Right Upper Leg Skin, External Approach 651 1.0

Excision of Left Foot Skin, External Approach 638 1.0



1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY




{

Table

130

Total N=63,780

Most scald burns are small in size and have a low risk of mortality. However, mortality becomes higher for large surface area scald burns (although these are very uncommon), and even rivals mortality rates after flame burn injury in the larger burn sizes.

Total Lived Died


0.1 - 9.9 49,030 5.2+/-0.1 48,930 5.2+/-0.1 100 17.9+/-2.0

10 - 19.9 7,179 10.4+/-0.1 7,100 10.3+/-0.1 79 20.7+/-2.6

20 - 29.9 1,445 17.7+/-0.5 1,402 17.6+/-0.5 43 21.1+/-4.3

30 - 39.9 498 24.2+/-1.0 469 25.0+/-1.0 29 10.3+/-1.9

40 - 49.9 213 26.6+/-1.8 189 28.2+/-1.9 24 13.6+/-3.8

50 - 59.9 84 30.9+/-3.3 67 33.7+/-3.8 17 20.1+/-6.9

60 - 69.9 76 25.6+/-3.9 67 26.2+/-4.3 9 #VALUE

70 - 79.9 32 29.5+/-6.1 24 33.6+/-7.6 8 17.1+/-8.3

80 - 89.9 10 17.8+/-9.2 3 46.0+/-25.9 7 5.7+/-2.8

> 90 11 19.7+/-10.3 7 26.1+/-15.8 4 8.5+/-6.5

Subtotal 58,578 6.5+/-0.0 58,258 6.4+/-0.0 320 17.8+/-1.2

Missing or 0% 5,202 5.0+/-0.5 5,184 5.0+/-0.5 18 16.8+/-5.1

TOTAL 63,780 63,442 338

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY




20%

40%

60%

80%

% o

f P

ati

en

ts t

hat

Die

d



Female

Male

0-9.9 10-19.9-

20.-29.9

30-39.9

40-49.9

50-59.9

60-69.9

70-79.9

80-89.9

90-99.9

100-109.9

110+


{

Figure

78


{Table

131

The Baux score illustrates the relationship between age and body surface area burn in mortality, as in the flame burn section. Mortality from scald burns is shifted to the right compared to flame burns and is of low risk with a Baux score <100 (compared to <80 in flame burns).

Female Male


0-9.9 5,825 0 6,674 2

10-19.9 4,406 2 4,451 2

20-29.9 3,390 1 4,423 2

30-39.9 3,208 1 4,019 4

40-49.9 2,871 5 3,669 8

50-59.9 2,862 7 3,780 8

60-69.9 2,213 11 2,578 10

70-79.9 1,287 12 1,350 19

80-89.9 824 13 616 24

90-99.9 418 43 276 33

100-109.9 81 25 53 18

110- and Over 17 49 23 23

Total 27,402 169 31,912 153

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY


Analysis by Etiology Contact with Hot Object Injuries


{Figure


{

Table

132



Figure


E849 CODE {Table

133


Contact burns from touching a hot object only make up 8.3% of all the data in the NBR. This injury is often managed in the outpatient setting, so these burns may be more common the data in this inpatient registry suggests. The majority of contact burns occur in the home and are non-work-related accidents (Figure 79, 80: Table 132, 133).





Other 395 2.2%

Accident, Unspecified 229 1.3%




Unknown 370

Total 18,376


Home 11,378 67.8%



Other Specified Place 909 5.4%

Industrial 783 4.7%

Public Building 421 2.5%


Farm 58 0.3%

Mine/Quarry 5 0.0%

Unspecified 1,591

Total 18,376

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

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ETIOLOGY


Analysis


{

Figure

81

by Etiology Contact with Hot Object Injuries

% o

f P

ati

en

ts w

ith

a C

lin

ically

Rela

ted

C

om

plica

tio

n

Age Categories




{

Table

134

As with many other burn etiologies, the rate of complications from contact burn rises steadily with advancing age. The range spans from 1.3% in infants to 18.3% in those 80 and over. Of note, mortality has slightly decreased from last year’s report in these age groups.

10%

5%

20%

15%

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+



0-.9 670 9 1.3

1-1.9 2,443 39 1.6

2-4.9 2,145 31 1.4

5-15.9 1,731 29 1.6

16-19.9 587 16 2.7

20-29.9 1,954 115 5.6

30-39.9 1,765 133 7.0

40-49.9 1,795 164 8.4

50-59.9 1,919 210 9.9

60-69.9 1,230 157 11.3

70-79.9 557 109 16.4

80 and Over 403 90 18.3

Subtotal 17,199 1,102 6.0

Missing 0 0

Total 17,199 1,102 6.0

1ANALYSIS OF

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HOSPITALS

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ETIOLOGY




{

Table

135



{

Table

136


The complications reported with contact burns are very similar to those of scald burns and are primarily infectious in nature. The most frequent complication is cellulitis with a reported incidence of 1.2% of all contact burns and represents 17.7% of all complications seen in this group (Table 135). The most commonly reported surgical procedure for contact burns, as with both flame burns and scalds, is excision and grafting (Table 136).














Top Ten ICD-10 Procedures Codes CountPercent of All ICD-10

Procedures

Excision of Right Upper Leg Skin, External Approach 652 2.6


Extraction of Right Hand Skin, External Approach 322 1.3


Extraction of Left Hand Skin, External Approach 288 1.1


274 1.1

Dressing of Left Hand using Bandage 271 1.1

Dressing of Right Hand using Bandage 262 1.0

Replacement of Left Lower Leg Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

237 0.9



6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

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{Table

137

Total N=18,376

Contact burns tend to be quite small and only rarely result in mortality. The mean LOS for all contact burns in the NBR is 6.1 days. The most frequent size reported is <10%TBSA, compromising 88% of all contact burn records.

Total Lived Died


0.1 - 9.9 15,974 6.3+/-0.1 15,897 6.2+/-0.1 77 19.3+/-2.9

10 - 19.9 609 18.6+/-0.8 582 18.3+/-0.8 27 24.2+/-5.6

20 - 29.9 98 23.8+/-2.4 82 26.6+/-2.8 16 9.5+/-1.8

30 - 39.9 29 37.1+/-6.0 24 37.2+/-5.6 5 36.8+/-24.7

40 - 49.9 5 35.6+/-12.4 4 42.2+/-13.6 1 9

50 - 59.9 8 50.2+/-14.4 6 63.3+/-15.7 2 11+/-10

60 - 69.9 3 50.3+/-12.3 1 75 2 38+/-1

70 - 79.9 9 23.8+/-10.8 8 26.7+/-11.8 1 1

80 - 89.9 1 65 1 65 0

> 90 1 4 0 1 4

Subtotal 16,737 7.0+/-0.1 16,605 6.9+/-0.1 132 19.6+/-2.2

Missing or 0% 1,639 5.7+/-0.2 1,629 5.6+/-0.2 10 19.7+/-6.2

TOTAL 18,376 18,234 142

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

6ANALYSIS OF

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COMPARISONS

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ETIOLOGY


Analysis by Etiology Electrical Injuries


{Figure


{

Table

138



Figure


E849 CODE {Table

139


Electrical injuries differ from other burn etiologies in that electrical burns are most commonly industrial, work related accidents. Scald, contact, flame, and chemical injuries are more likely to occur in the home.





Other 80 1.1%




Unknown 200

Total 7,218



Home 2,017 32.8%





Farm 115 1.9%


Mine/Quarry 27 0.4%

Unspecified 1,060

Total 7,218

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

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ETIOLOGY


Analysis


{Figure

84

by Etiology Electrical Injuries

% o

f P

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ts w

ith

a C

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ically

Rela

ted

Co

mp

lica

tio

n

Age Categories



{

Table

140


Electrical injuries occur mostly in adults as they tend to be the group that works in industrial settings and on home repairs. Overall complication rates are relatively low compared to flame burns; however, some of the most devastating complications seen after burn injury can occur in this group. The likelihood of complication generally increases with age, with the exception of ages 50-59 and 70-79 which have slightly fewer complications. (Table 140, Figure 84)



0-.9 19 1 5.0

1-1.9 124 2 1.6

2-4.9 348 2 0.6

5-15.9 464 22 4.5

16-19.9 266 21 7.3

20-29.9 1,240 114 8.4

30-39.9 1,443 143 9.0

40-49.9 1,374 132 8.8

50-59.9 959 69 6.7

60 and Over 408 43 9.5

Subtotal 6,645 549 7.6

Missing 0 0

Total 6,645 549 7.6

2.5%

5%

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60 and over

10%

12.5%

7.5%

1ANALYSIS OF

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HOSPITALS

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4ANALYSIS

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ETIOLOGY




{

Table

141



{

Table

142


The most common complication for patients with electrical injuries is pneumonia, followed by celulitis, then renal failure. As with other etiologies of burn injury, most procedures performed for electrical injury are involve excision and grafting of burn injury.












Compartmental Syndrome 36 4.5 0.5



10 Procedures



Excision of Right Hand Skin, External Approach 147 1.3

Excision of Left Hand Skin, External Approach 146 1.3

Replacement of Left Hand Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

132 1.1

Excision of Chest Skin, External Approach 125 1.1

Replacement of Right Hand Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

119 1.0

Replacement of Left Upper Arm Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

116 1.0


115 1.0

Excision of Back Skin, External Approach 114 1.0

Total Procedures 11,563 6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

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4ANALYSIS

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ETIOLOGY



250

500

750

1,000

Case

s

Age Categories

Total N=7,218

Female

Male

1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+

FREQUENCY OF RECORDS BY AGE CATEGORIES AND GENDER

{

Figure

85

Electrical injuries occur predominantly to adult males, as they comprise the majority of those who work in an industrial setting, where these injuries tend to occur.

1,250

0-.9

1ANALYSIS OF

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ETIOLOGY


Analysis by Etiology Chemical Injuries


{

Figure

86


{

Table

143



Figure


E849 CODE {Table

144


Chemical injuries comprise a very small fraction of burn injuries within the NBR database. When interpreting this data, the reader should keep in mind that this section contains injury from a wide range of chemicals, both acidic and basic of varying concentrations. These differing agents, which might behave in dramatically different clinical fashions, are not separated. Some chemicals, such as hydrofluoric acid, have unique pathophysiology and injury patterns. Chemical injuries occur most often in the home, followed by industrial settings, representing approximately ¾ of the chemical injuries in the NBR (Figure 86). The overwhelming majority of chemical burns are accidents that occur in the home and the workplace; while only a small percentage are intentional injuries from assault/abuse or self-inflicted (Figure 87).


Accident, Non-Work Related

3,295 47.6%


Other 223 3.2%






Unknown 241

Total 7,164


Home 2,797 45.1%





Farm 122 2.0%



Mine/Quarry 15 0.2%

Unspecified 956

Total 7,164

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

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ETIOLOGY


10%

20%


{

Figure

88


% o

f P

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ith

a C

lin

ically

Rela

ted

Co

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lica

tio

n

Age Categories



{

Table

145


In younger patients, complications associated with chemical burns are uncommon. Figure 88 and Table 145 demonstrates a overall trend for an increase in complications associated with chemical burns as age increases. The “working age” group (20-50) also represents the largest frequencies of chemical injury reported in the NBR, not surprising as almost half of these injuries occur in the work place. As decade of life increases, the curve shifts above the previously mentioned plateau to 8.1% for those age 50-59.9, increases to finally 20.5% in those over age 80.

5%

15%

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+



0-.9 46 0 0.0

1-1.9 200 4 2.0

2-4.9 216 4 1.8

5-15.9 237 14 5.6

16-19.9 260 8 3.0

20-29.9 1,259 56 4.3

30-39.9 1,287 67 4.9

40-49.9 1,337 61 4.4

50-59.9 1,138 105 8.4

60-69.9 486 36 6.9

70-79.9 162 19 10.5

80 and over 89 18 16.8

Subtotal 6,717 392 5.5

Missing 0 0

Total 6,717 392 5.5

1ANALYSIS OF

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HOSPITALS

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ETIOLOGY




{

Table

146



{

Table

147


Complications are relatively uncommon after chemical burn injury and have been on the decline in each NBR report over the past several years. Cellulitis is still the most common complication reported after a chemical burn, reported in 1.9% of injuries, down from 1.9% in last year’s report. Wound infection, UTI, and pneumonia, are the next most common infectious complications, each occurring a rate of 0.7%, a slight decrease from last year. Sepsis is rare with after chemical burn, being reported at a rate of 0.3%, down from 0.5% in 2017. Excision and grafting is the most commonly performed set of surgical procedures for this patient population.















10 Procedures




92 0.8

Plain Radiography of Chest 88 0.8


Replacement of Left Lower Leg Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

77 0.7


Examination of Musculoskeletal System 55 0.5

Replacement of Right Lower Arm Skin with Nonautologous Tissue Substitute, Partial Thickness, External Approach

55 0.5

Replacement of Right Lower Arm Skin with Autologous Tissue Substitute, Partial Thickness, External Approach

54 0.5


6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

5HOSPITAL

COMPARISONS

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BY AGE

GROUP

4ANALYSIS

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ETIOLOGY


200

400

600

800

1,000

1,200


Case

s

Age Categories

Total N=7,164

Female

Male

1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+

FREQUENCY OF RECORDS BY AGE CATEGORIES AND GENDER

{

Figure

89

Most chemical injuries are suffered by adults. As with most burns, this gender stratified histogram demonstrates that most chemical burns occur in the male population. Most occur between the ages of 20 and 60, also paralleling the demographic of the industrial workforce and adults who are using chemicals for projects around the home.

0-.9

1ANALYSIS OF

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THIS PAGE INTENTIONALLY LEFT BLANK

6ANALYSIS OF

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5 Hospital Comparisons

The analyses on the next four pages provide comparisons for treatment of fire/flame injuries in participating burn centers.The figures compare unadjusted mortality, charges and length of stay across participating centers. The centers are grouped into three categories based on the annual volume of submitted cases in 2015-2018. Low volume centers reported an average of less than 100 initial admissions per year (n=25), medium volume centers reported an average of 100-300 initial admissions per year (n=43), and high-volume centers reported greater than 300 initial admissions per year (n=27). Ninety-three hospitals are represented in total. All data are de-identified to protect against direct comparison between centers. The data are unadjusted, and do not take into consideration other patient characteristics which have been widely accepted to impact outcomes.

Without risk adjustment,comparative analysis may have limited value.

The nature of the registry is such that data are not strictly standardized, and data entry is not independently audited, additionally limiting the ability to draw comparisons. Regardless, the data suggest a potential variability in practice, mortality and cost of care, and should provide impetus to investigators to explore the causes of such variability. Much work remains to bring the data collection process into a context where risk adjustment is possible and definitions are more standardized, allowing for more reliable comparisons and ultimately benchmarking of the performance of individual centers. These analyses are a beginning and point the way to the delivery of more precise and actionable information in the future.


Hospital Comparisons

Figure 90 compares the raw mortality rates for fire/flame cases admitted between 2015-2018. The left y-axis denotes percent TBSA, and the right y-axis denotes percent mortality. Each blue bar represents the mean percent TBSA for fire/flame burns at each burn center, while the red diamonds represent the centers’ corresponding mortality rates. The red lines indicate the 95% confidence interval for mortality rates.

Although the data are not risk-adjusted, they demonstrate that while mean percent TBSA does not differ greatly between the three admission volume categories (low, medium and high), notable variability in mortality rates is observed. The data suggest a trend toward overall lower mortality rates in higher volume hospitals. Additionally, less variability in mortality rates appears to exist within the high volume category as compared to medium and low volume categories.

Mean Percent Total Burn Surface Area

Faci

liti

es

Mortality Percentage with 95% Cl

20

15

-20

18

FIR

E/F

LA

ME

IN

JUR

IES

-- M

OR

TA

LIT

Y R

AT

EM

ort

alit

y R

ate

Mea

n T

BSA

Tota

l N=

29

,11

3

1ANALYSIS OF

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4ANALYSIS

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5HOSPITAL

COMPARISONS

LOW

VO

LUM

E

M

ED

IUM

VO

LUM

E

HIG

H V

OLU

ME

0%5%10%

15%

20%

25%

30%

35%

40%

0102030405060708090100

Fig

ure

90



Figure 91 depicts hospital charges for fire/flame cases admitted between 2015-2018. As some centers do not report charge information, a smaller number of centers (fewer blue bars) are represented. The left y-axis denotes mean percent TBSA, and the right y-axis denotes total hospital charges in US dollars. Each blue bar represents the mean percent TBSA for fire/flame burns at each burn center, while the red diamonds represent the centers’ corresponding mean hospital charges per case. The red lines indicate the 95% confidence interval for mean charges. Outliers are not shown in this graph, but were incorporated into the calculation of estimated means for each center. Charges are not adjusted for mean burn size. The data show variability in hospital charges within and between volume categories, with a suggestion that charges may be independent of mean percent TBSA.


Faci

liti

es

Mean Hospital Charges with 95% Cl

20

15

-20

18

FIR

E/F

LA

ME

IN

JUR

IES

-- M

EA

N C

HA

RG

ES

Mea

n C

har

ges

Mea

n T

BSA

Tota

l N=

16

,33

1

6ANALYSIS OF

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5HOSPITAL

COMPARISONS

LOW

VO

LUM

E

M

ED

IUM

VO

LUM

E

H

IGH

VO

LUM

E

$0

$50,0

00

$100,0

00

$150,0

00

$200,0

00

$250,0

00

$300,0

00

$350,0

00

0

10

20

30

40

50

60

70

80

90

100

Fig

ure

91



Figure 92 depicts mean hospital stay durations for fire/flame cases admitted between 2015-2018. The left y-axis denotes mean percent TBSA, and the right y-axis denotes mean hospital length of stay in days. Each blue bar represents the mean percent TBSA for fire/flame burns at each burn center, while the red diamonds represent the centers’ corresponding mean hospital length of stay. The red lines indicate the 95% confidence interval for hospital length of stay. Outliers are not shown in this graph, but were incorporated into the calculation of means for each center.

It is worth noting that the length of stay data do not discriminate between patients who survived to discharge and those who did not, and that length of stay calculations may be influenced by the distribution of early and late mortalities at a given center. Considerable variability is noted for mean length of stay in all three volume categories, with a suggestion of independence from mean percent TBSA.


Faci

liti

es

Mean Length of Stay with 95% Cl

20

15

-20

18

FIR

E/F

LA

ME

IN

JUR

IES

-- M

EA

N L

EN

GT

H O

F S

TA

YM

ean L

OS

Mea

n T

BSA

Tota

l N=

29

,11

3

1ANALYSIS OF

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HOSPITALS

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ETIOLOGY

5HOSPITAL

COMPARISONS

LOW

VO

LUM

E

M

ED

IUM

VO

LUM

E

H

IGH

VO

LUM

E

-10

010

20

30

40

50

60

0

10

20

30

40

50

60

70

80

90

100

Fig

ure

92



Figure 93 depicts overall complication rates for fire/flame cases submitted between 2015-2018. The left y-axis denotes mean percent TBSA, and the right y-axis denotes mean complication rates. Each blue bar represents the mean percent TBSA for fire/flame burns at each burn center, while the red diamonds represent the centers’ corresponding mean complication rates. The red lines indicate the 95% confidence interval for mean complication rates. There is high variability in reported complication rates, which appears to be largely independent of both mean burn size and admission volume.

As the reporting of complications is not audited, these data may be less reliable and potentially less valid than other reported data. Standard definitions of complications and rigorous application of these definitions is warranted in order to ensure comparable data and the ability to make broad comparisons. Additionally, as the 2017 Annual Report is the first to include Version 6 data, which entails a different data collection structure, later complications data may or may not be directly comparable with earlier data. The impact of this will be separately addressed elsewhere in this report.


Faci

liti

es

Percent of Cases with a Complication

20

15

-20

18

FIR

E\F

LA

ME

IN

JUR

IES

– C

OM

PL

ICA

TIO

N R

AT

EC

om

plic

atio

n R

ate

Mea

n T

BSA

Tota

l N=

29

,11

3

6ANALYSIS OF

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LOW

VO

LUM

E

M

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IUM

VO

LUM

E

H

IGH

VO

LUM

E

0%10%

20%

30%

40%

50%

60%

70%

80%

90%

0102030405060708090100

Fig

ure

93

16Analysis of International Records

This year’s NBR report includes 3,458 International records, which represent the cumulative admissions between 2009 and 2018 that met all ABA edit check criteria. This year’s report includes 190 more records than the previous year’s report. Four Canadian, two Swedish centers, and one Swiss center have submitted data to the NBR between 2009 and 2018.These International centers are typically smaller than U.S. centers and have an average volume of 120 admissions annually. Additionally, not all International burn centers have submitted on a yearly basis. The ABA has members throughout the world and the NBR encourages all participating burn centers to submit their data to the registry


Analysis of International Records

100

200

300

Case

s

Total N=3,458

Female

Male

0-.9 1-1.9 2-4.9 5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9 80+

AGE GROUP BY GENDER

AGE GROUP BY GENDER

Total N=3,458

Figure 94 and Table 148 show the number of admissions by age and sex. Males outnumber females across the board (69% of all records are male). Twenty-five percent of the records account for individuals under the age of 20 years.

400

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY

5HOSPITAL

COMPARISONS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

Age Categories

Gender

Total Female Male

Age Categories Count Column N % Count Column N % Count Column N %

0-.9 100 2.9 46 3.9 54 2.4

1-1.9 301 8.7 113 9.6 188 8.2

2-4.9 160 4.6 76 6.5 84 3.7

5-15.9 176 5.1 76 6.5 100 4.4

16-19.9 131 3.8 39 3.3 92 4.0

20-29.9 508 14.7 132 11.3 376 16.4

30-39.9 406 11.7 118 10.1 288 12.6

40-49.9 467 13.5 143 12.2 324 14.2

50-59.9 469 13.6 154 13.1 315 13.8

60-69.9 355 10.3 124 10.6 231 10.1

70-79.9 239 6.9 89 7.6 150 6.6

80 and over 146 4.2 62 5.3 84 3.7

Subtotal 3,458 100.0 1,172 100.0 2,286 100.0

Missing 0 0.0 0 0.0 0 0.0

Total 3,458 100.0 1,172 100.0 2,286 100.0

Figure

94

Table

148



ETIOLOGY

RACE/ETHNICITY


Total N=3,458

Total N=3,458Total N=2,834 (Excluding 624 Unknown/Missing)

Etiology is similar to the United States as shown in Figure 95 and Table 149. Fire/flame is the cause of almost half of all burns, and scalds account for an additional 30.1%.

Electrical injuries are higher in the International group (4.6% vs. 5.1%). There are very few cases of isolated inhalation injuries or skin diseases reported.

More than 80% of reported burn patients were white which is more than reported in the US burn centers (60.3%).

ETIOLOGY

RACE/ETHNICITY

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY

5HOSPITAL

COMPARISONS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS


Fire/Flame 1449 48.5%

Scald 898 30.1%

Electrical 153 5.1%



Chemical 102 3.4%




Radiation 1 0.0%

Unknown 472

TOTAL 3,458

Race Cases % of Valid

White 2,301 81.2%

Other 219 7.7%

Asian 153 5.4%

Black 82 2.9%


Hispanic 24 0.8%

Unknown 624

Total 3,458

Figure

95

Figure

96

Table

150

Table

149



Figure 97 and Table 151 show the distribution of cases by the place of occurrence. The table shows that 13.4% of records did not specify a place of occurrence. Once again, the majority of events continue to occur at home.

Figure 98 and Table 152 depict the distribution of cases by the circumstances surrounding the injury. Four hundred and seven cases did not denote injury circumstances and they were excluded.




Total N=3,458

Total N=3,458Total N=3,051 (Excluding 407 Unknown/Missing)



Place of Occurrence Cases % of Valid

Home 1,873 62.5%


Industrial 318 10.6%




Farm 37 1.2%


Mine/Quarry 2 0.1%

Unspecified 463

Total 3,458

Circumstance of Injury Cases% of Valid


Accident, Work Related 484 15.9%


Other 254 8.3%





Unknown 407

Total 3,458

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY

5HOSPITAL

COMPARISONS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

Figure

97

Figure

98

Table

151

Table

152



The BAUX score (Age + %TBSA burned) has been a standard to estimate the mortality of burn patients for decades. Table 153 demonstrates that increasing BAUX score is associated with a higher mortality and LD50 around 110. The effect of gender is also noted in the table, females have a higher mortality rate in Baux scores 70-109.9 and males in Baux scores 40-69.9 and 110 and over.

LIVED/DIED BY BURN GROUP SIZE (%TBSA)

Lived Died


0.1 - 9.9 1,848 11 0.6

10 - 19.9 594 16 2.6

20 - 29.9 213 18 7.8

30 - 39.9 111 24 17.8

40 - 49.9 79 14 15.1

50 - 59.9 50 13 20.6

60 - 69.9 22 8 26.7

70 - 79.9 20 11 35.5

80 - 89.9 6 10 62.5

> 90 4 15 78.9

Subtotal 2,947 140 4.5

Missing or 0% 365 6 1.6

TOTAL 3,312 146 4.2



Total N=3,458

Female Male


Lived DiedMortality

RateLived Died

Mortality Rate

0-9.9 189 0 0.0 252 0 0.0

10-19.9 103 0 0.0 133 0 0.0

20-29.9 97 0 0.0 240 0 0.0

30-39.9 108 0 0.0 259 0 0.0

40-49.9 101 0 0.0 278 1 0.4

50-59.9 135 1 0.7 295 6 2.0

60-69.9 116 1 0.9 251 4 1.6

70-79.9 109 5 4.4 192 2 1.0

80-89.9 77 7 8.3 149 4 2.6

90-99.9 43 8 15.7 82 8 8.9

100-109.9 17 12 41.4 34 11 24.4

110 and Over 19 24 55.8 33 52 61.2

Total 1,114 58 4.9 2,198 88 3.8

1ANALYSIS OF

CONTRIBUTING

HOSPITALS

2ANALYSIS OF ALL

U.S. RECORDS

3ANALYSIS

BY AGE

GROUP

4ANALYSIS

BY

ETIOLOGY

5HOSPITAL

COMPARISONS

6ANALYSIS OF

CANADIAN AND

INTL. RECORDS

Table

153

Table

154

Appendix


Appendix A Minimum Data Set and Data Quality

Improving the data quality in the NBR has been a consistent focus over the past five years. In the Spring of 2015 the National Burn Data Standard Data Dictionary (NBDS) was released and incorporated into Version 6 of the Burn Registry Software, released by the American Burn Association. This Annual Report is the first time Version 6 data has been included in an Annual Report. In this section we highlight the data quality related to data elements that can be consistently evaluated across the different software platform used to collect and submit burn care data to the NBR.

The below list of data elements represents those fields previously highlighted as the Minimum Data Standard. The software versions 5 and 6 increasingly include edit checks at the front end of data collection to ensure those Minimum Required elements are collected and submitted. As such, the number of data elements that can be evaluated as a signal for data completeness and data quality is reduced to thirteen data elements (Colored Orange below). Given this change in methodology comparing data completeness metrics in this Annual Report to previous reports should be done with caution.

• Reporting hospital number• Number of operating room visits• Number of procedures performed• Patient sex (gender)• Cause of death• State in which injury occurred• Patient age (for patients younger than 90 years)• Year of injury• Year of arrival at reporting hospital• Description of event (free text)• Site at which injury occurred (E 849 code)• Etiology of injury code (E-code)• Body areas injured (Lund and Browder 19 areas x 6 age categories)• Total burn size• Total deep burn• Inhalation injury• ICD-9 diagnosis codes• Total hospital days• Hospital discharge disposition• Primary payor source• MS-DRG code• Circumstances of injury• Discharge status (alive or dead)• Year of discharge or death• Total ICU days• Interhospital transfer to your hospital

The italicized variables were not included in the analysis of missing variables on cases used in this Annual Report on the subsequent pages. Age, gender, hospital disposition and reporting hospital number are required fields for a case to be included in the Annual Report. The remaining italicized variables were excluded from analysis because they are not uniformly reported by non-ABA burn registry software centers or, by virtue of the release of Version 6 of the Burn Registry software, can not be consistently evaluated across software versions.


Appendix A This table represents the common data elements missing from submitted burn center records.

}DATA COMPLETENESS BY VARIABLETable

155

Valid Missing Pct. Missing

Total Burn Size 187,262 34,257 15%

MS-DRG Code 187,602 33,917 15%

Site at which Injury Occurred (E 849 code) 196,519 25,000 11%

State in which Injury Occurred 208,485 13,034 6%

Primary Payor Source 209,095 12,424 6%

Inhalation Injury 209,397 12,122 5%

Interhospital Transfer to Hospital 210,193 11,326 5%

Circumstances of Injury 210,443 11,076 5%

Etiology of Injury Code (E-code) 214,659 6,860 3%

Year of Injury 214,745 6,774 3%

Total ICU Days 220,079 1,440 1%


Appendix A

}DATA QUALITY EXPRESSED AS MEAN PERCENT OF MISSING VARIABLES FROM MINIMUM DATA SET PER RECORD BY ADMISSION YEAR

Figure

99

This is a graphic representation of the improvement of submitted data by year. It is possible that the emphasis on having more accurate patient care data in the United States has driven this improvement in data.

2

4

6

8

10

12

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Perc

en

t o

f M

issi

ng V

ari

ab

les

Admission Year

Total N=221,519


Appendix A This graph depicts the individual burn centers submission volume and the percent of missing records. Over 80% of

burn centers have less than 10% of key variables missing. Volume does not appear to have linear relationship with data quality.

DA

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EX

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AC

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Y

{

Fig

ure

100

Cas

e V

olu

me

Per

cent

Mis

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Faci

liti

es

Tota

l N=

22

1,5

19

No. of Cases

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0

2000

4000

6000

8000

10000

12000

14000

16000


Appendix B The following list of hospitals have contributed to the NBR in any given year. We extend our thanks for their

contribution and ongoing support of this significant endeavor.

AlabamaChildren’s Hospital, BirminghamUAB Burn Center University of South Alabama Regional Burn and Wound Center

ArizonaArizona Burn Center at Maricopa Medical Center

ArkansasThe Burn Center at Arkansas Children’s Hospital

CaliforniaBothin Burn Center, St. Francis Memorial Hospital, Dignity HealthCommunity Regional Leon S. Peters Burn Center Inland Counties Regional Burn Center at Arrowhead Regional Medical CenterOrange County Burn CenterSanta Clara Valley Medical Center Regional Burn CenterShriners Hospital for Children-Northern CaliforniaSouthern California Regional Burn Center at LAC & USC Medical CenterTorrance Memorial Burn CenterUC Davis Regional Burn CenterUCI Regional Burn CenterUCSD Regional Burn CenterThe Grossman Burn Center at San Joaquin Community HospitalThe Grossman Burn Center - West Hills

ColoradoThe Children’s Hospital Burn CenterUniversity of Colorado Hospital Burn Center, UC Health Western States Burn Center, Banner Health

ConnecticutConnecticut Burn Center, Panettieri, Bridgeport Hospital

District of ColumbiaChildren’s National Medical CenterThe Burn Center at Medstar Washington Hospital Center

FloridaOrlando Regional Medical Center Shands Burn Center at the University of FloridaTampa General Hospital Regional Burn CenterUniversity of Miami/Jackson Memorial Burn Center

GeorgiaGrady Memorial Hospital Burn CenterThe Joseph M. Still Burn Center at Doctors’ Hospital

IllinoisLoyola University Medical Center Memorial Medical Center Regional Burn CenterOSF Saint Anthony Hospital Sumner L. Koch Burn Center, Stroger Hospital University of Chicago Burn Center

IndianaIndiana University, Riley Hospital for ChildrenSt. Joseph’s Burn CenterEskenazi Health, Richard M. Fairbanks Burn Center

IowaUniversity of Iowa Burn Center


Appendix B KansasKUHA-Burnett Burn CenterVia Christi Regional Medical Center

LouisianaBaton Rouge General Adult Burn Center Mid-CityLouisiana State University Health Sciences Center-ShreveportOur Lady of Lourdes Regional Medical Center

MarylandJohns Hopkins Bayview Medical Center Burn CenterJohns Hopkins Pediatric Burn Center

MassachusettsBrigham and Women’s Hospital Burn CenterMGH Sumner Redstone Burn CenterShriners Hospital for Children-BostonUniversity of Massachusetts Memorial

MichiganChildren’s Hospital of MichiganDetroit Receiving Hospital Burn CenterSpectrum Health Regional Burn CenterUniversity of Michigan Health Systems

MinnesotaDwan Burn CenterHennepin County Medical Center Burn CenterThe Burn Center-Regions Hospital

MississippiDelta Regional Medical Center

MissouriGeorge David Peak Memorial Burn and Wound CenterMercy Hospital SpringfieldMercy Hospital St. Louis

NebraskaNebraska MedicineSt. Elizabeth Regional Burn Center

NevadaLion’s Burn Center

New JerseyThe Burn Center at Saint Barnabas

New MexicoNew Mexico Regional Burn Center

New YorkClark Burn CenterNassau University Medical Center Burn CenterRoger W. Seibel MD Burn Treatment CenterKessler Burn Center, University of Rochester Medical Center Westchester Medical Center Burn CenterWilliam R. Hearst Burn Center, New York Presbyterian Hospital, Weill Cornell Medical Center

North CarolinaNorth Carolina Jaycee Burn CenterWake Forest Baptist Medical Center Burn Center


Appendix B OhioChildren’s Hospital Medical Center of Akron MetroHealth Medical CenterNationwide Children’s HospitalShriners Hospital for Children-CincinnatiThe Ohio State University Wexner Medical CenterThe University Hospital Burn Center-Cincinnati

OregonOregon Burn Center, Legacy Emmanuel Medical Center

PennsylvaniaLehigh Valley Hospital Burn CenterStuart J. Hulnick Burn Center, St. Christopher’s Hospital for ChildrenTemple University Hospital Burn CenterThe Nathan Speare Regional Burn Treatment Center, Crozer Chester Medical CenterThe Western Pennsylvania Hospital Burn CenterUPMC Mercy Burn Center

Rhode IslandRhode Island Hospital Burn Center

South CarolinaMedical University of South Carolina Children’s Hospital

TennesseeErlanger Health Systems Burn CenterFirefighters Regional Burn Center, Regional One HealthVanderbilt Regional Burn Center

TexasJohn S. Dunn, Sr. Burn Center Parkland Health and Hospital System, Regional Burn Center Shriners Hospital for Children-Galveston The Medical Center of PlanoTimothy J. Harnar Burn Center University of Texas Medical Branch U.S. Army Institute of Surgical Research

UtahUniversity of Utah Hospital Burn Center

VirginiaVCU Evans-Haynes Burn Center

WashingtonUW Medicine Regional Burn Center at Harborview Medical Center

WisconsinColumbia St. Mary’s Hospital Regional Burn CenterUniversity of Wisconsin Hospitals and Clinics

International ContributorsFirefighters’ Burn Treatment Unit, Edmonton, Alberta, Canada Hamilton Firefighters Burn Unit Hamilton Health Sciences, Hamilton, Ontario Hospital for Sick Children, Toronto, OntarioHotel-Dieu du CHUM, Montreal, QuebecLassaine University Hospital, SwitzerlandLinkoping University Hospital, Linkoping, SwedenRoss Tilley Burn Centre, Sunnybrook and Women’s College Health Sciences Centre, Toronto, OntarioUppsala University Hospital, Uppsala, Sweden


Selected List of Peer-Reviewed Publications Utilizing NBR Data

Abdelrahman, I., M. Elmasry, P. Olofsson, I. Steinvall, M. Fredrikson and F. Sjoberg (2017). “Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.(Research Article)(Report).” PLoS ONE 12(3): e0174579.

Afshar, M., G. Netzer, M. J. Mosier, R. S. Cooper, W. Adams, E. L. Burnham, E. J. Kovacs, R. Durazo-Arvizu and S. Kliethermes (2017). “The Contributing Risk of Tobacco Use for ARDS Development in Burn-Injured Adults With Inhalation Injury.(Report).” Respiratory Care 62(11): 1456.

Ajami S, Lamoochi P. Comparative study on National Burn Registry in America, England, Australia and Iran. J Educ Health Promot. 2014 Nov 29;3:106

Amtmann, D., K. McMullen, A. Bamer, J. A. Fauerbach, N. S. Gibran, D. Herndon, J. C. Schneider, K. Kowalske, R. Holavanahalli and A. C. Miller (2017). “National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System: Review of Program and Database.” Archives of Physical Medicine and Rehabilitation.

Anami, E. H. T., E. F. Zampar, M. T. Tanita, L. T. Q. Cardoso, T. Matsuo and C. M. C. Grion (2017). “Treatment costs of burn victims in a university hospital.” Burns43(2): 350-356.

Assimacopoulos EM, Liao J, Heard JP, Kluesner KM, Wilson J, Wibbenmeyer LA. The national incidence and resource utilization of burn injuries sustained while smoking on home oxygen therapy. Journal of Burn Care & Research. 2016 Jan 1;37(1):25-31.

Baqui Z, Li W, Zakhary E, Buchanan P, Boakye EA, Jacobs D. Inferior Vena Cava Filter Utilization for Burn Patients in the United States: Analysis of the National Burn Repository. Journal of Vascular Surgery. 2015 Jan 6;61(6):103S-4S.

Bedri, S. H., S. K. Romanowski, S. J. Liao, S. G. Al-Ramahi, S. J. Heard, S. T. Granchi and S. L. Wibbenmeyer (2017). “A National Study of the Effect of Race, Socioeconomic Status, and Gender on Burn Outcomes.” Journal of Burn Care & Research 38(3): 161-168.

Bell C, Slim J, Flaten HK, Lindberg G, Arek W, Monte AA. Butane Hash Oil Burns Associated with Marijuana Liberalization in Colorado. J Med Toxicol. 2015 Dec;11(4):422-5.

Bessey PQ, Phillips BD, Lentz CW, Edelman LS, Faraklas I, Finocchiaro MA, Kemalyan NA, Klein MB, Miller SF, Mosier MJ, Potenza BM. Synopsis of the 2013 annual report of the national burn repository. Journal of Burn Care & Research. 2014 May 1;35:S218-34.

Blaisdell LL, Chace R, Hallagan LD, Clark DE. A half-century of burn epidemiology and burn care in a rural state. J Burn Care Res. 2012 May-Jun;33(3):347-53

Bloemsma GC, Dokter J, Boxma H, Oen IMMH. Mortality and causes of death in a burn centre. Burns. 2008 Dec; 34 (8): 1103-1107.

Boyce, T. S., S. P. Simpson, T. M. Rieman, M. P. Warner, P. K. Yakuboff, K. J. Bailey, K. J. Nelson, A. L. Fowler and J. R. Kagan (2017). “Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns.” Journal of Burn Care & Research 38(2): 61-70.

Brodzinska, B., G. Czaja-Bulsa, A. Marasz and B. Musial (2017). “Epidemiology of burns in hospitalized children from the Western Pomerania region in Poland in 1985-2010.(Report).” Progress in Health Sciences 7(1): 99.

Burton KR, Sharma VK, Harrop R, Lindsay R. Burns. A population-based study of the epidemiology of acute adult burn injuries in the Calgary Health Region and factors associated with mortality and hospital length of stay from 1995 to 2004. Burns. Jun 2009; 35 (4): 572-579.

Carpenter AM, Hollett LP, Jeng JC, Wu J, Turner DG, Jordan MH. How long a shadow does epidemic obesity cast in the burn unit? A dietitian’s analysis of the strengths and weaknesses of the available data in the National Burn Repository. J Burn Care Res. 2008 Jan-Feb;29(1):97-101.

Carr JA, Phillips BD, Bowling WM. The Utility of Bronchoscopy After Inhalation Injury Complicated by Pneumonia in Burn Patients: Results From the National Burn Repository. J Burn Care Res. 2009 Nov-Dec; 30(6):967-974.

Ching JA, Ching YH, Shivers SC, Karlnoski RA, Payne WG, Smith DJ Jr. An Analysis of Inhalation Injury Diagnostic Methods and Patient Outcomes. J Burn Care Res. 2016 Jan-Feb; 37(1):e27-32.

Chrisco, J. L., J. D. Travers and J. E. Grant (2017). “Evaluation of the New North Carolina Burn Registry.” Journal of Burn Care & Research 38(4): e765-e771.

Chung JY, Kowal-Vern A, Latenser BA, Lewis RW 2nd.Cement-related injuries: review of a series, the National Burn Repository, and the prevailing literature. J Burn Care Res. 2007 Nov-Dec;28(6):827-34.Review.

Clark, A., J. Imran, T. Madni and S. E. Wolf (2017). “Nutrition and metabolism in burn patients.” Burns & Trauma 5.

Clemens, M. S., J. C. Janak, J. A. Rizzo, J. C. Graybill, M. F. Buehner, S. J. Hudak, C. K. Thompson and K. K. Chung (2017). “Burns to the genitalia, perineum, and buttocks increase the risk of death among U.S. service members sustaining combat-related burns in Iraq and Afghanistan.” Burns 43(5): 1120-1128.

Cobb, A. N., W. Daungjaiboon, S. A. Brownlee, A. J. Baldea, A. P. Sanford, M. M. Mosier and P. C. Kuo (2018). “Seeing the forest beyond the trees: Predicting survival in burn patients with machine learning.” The American Journal of Surgery 215(3): 411-416.

Cornet, P. A., A. S. Niemeijer, G. D. Figaroa, M. A. van Daalen, T. W. Broersma, M. E. van Baar, G. I. J. M. Beerthuizen and M. K. Nieuwenhuis (2017). “Clinical outcome of patients with self-inflicted burns.” Burns 43(4): 789-795.

Dale, E. L. and C. S. Hultman (2017). “Patient Safety in Burn Care: Application of Evidence-based Medicine to Improve Outcomes: Application of Evidence-based Medicine to Improve Outcomes.” Clinics in Plastic Surgery 44(3): 611-618.

Edelman LS, Cook L, Saffle JR. Using Probabilistic Linkage of Multiple Databases to Describe Burn Injuries in Utah. J Burn Care Res. 2009; 30: 983-992.

Engrav LH, Heimbach DM, Rivara FP, Kerr KF, Osler T, Pham TN, Sharar SR, Esselman PC, Bulger EM, Carrougher GJ, Honari S, Gibran NS. Harborview burns--1974 to 2009. PLoS One. 2012;7(7):e40086.

Appendix C


Appendix C Farahati, F., S. Nystrom, D. R. Howell and R. Jaffe (2017). “Economic Spillovers From Public Investments in Medical Countermeasures:

A Case Study of a Burn Debridement Product.” Disaster medicine and public health preparedness 11(6): 711.

Frankel, J. H., D. M. Boe, J. M. Albright, amp, Apos, E. B. Halloran, S. R. Carter, C. S. Davis, L. Ramirez, E. L. Burnham, R. L. Gamelli, M. Afshar and E. J. Kovacs (2017). “Age-related immune responses after burn and inhalation injury are associated with altered clinical outcomes.” Experimental Gerontology.

Friedstat, J. S., C. M. Ryan and N. Gibran (2017). “Outcome Metrics After Burn Injury: From Patient-Reported Outcome Measures to Value-Based Health Care: From Patient-Reported Outcome Measures to Value-Based Health Care.” Clinics in Plastic Surgery 44(4): 911-915.

Friedstat, J., D. A. Brown and B. Levi (2017). “Chemical, Electrical, and Radiation Injuries.” Clinics in Plastic Surgery 44(3): 657-669.

Guagliardo MF, Jeng JC, Browning S, Bilodeau ME, Dimick A, HickersonW, Miller S, Peck M. Admissions across state lines: harnessing the insight of the National Burn Repository for the healthcare accessibility, fiscal, and legislative concerns facing the American Burn Association. J Burn Care Res. 2008 Jan-Feb;29(1):151-7.

Harpole BG, Wibbenmeyer LA, Erickson BA. Genital burns in the national burn repository: incidence, etiology, and impact on morbidity and mortality. Urology. 2014 Feb; 83(2):298-303.

Heard JP, McDonald KM, Xing Y, Kluesner KM, Liao J, Wibbenmeyer LA. Regional and National Review of Factors Associated With Burn Wound Cellulitis. Journal of Burn Care & Research. 2015 Jan 1;36(1):23-32.

Hodgman E, Joseph B, Mohler J, Wolf SE, Paulk ME, Rhodes RL, Nakonezny PA, Phelan HA. Creation of a decision aid for goal-setting after geriatric burns: A study from the prognostic assessment of life and limitations after trauma in the elderly [PALLIATE] consortium. The journal of trauma and acute care surgery. 2016 Feb.

Hodgman EI, Saeman MR, Subramanian M, Wolf SE. The effect of burn center volume on mortality in a pediatric population: an analysis of the National Burn Repository. Journal of Burn Care & Research. 2016 Jan;37(1):32.

Hodgman, I. E., E. M. Subramanian, D. S. Wolf, A. B. Arnoldo, W. H. Phelan, R. M. Cripps and R. K. Abdel Fattah (2017). “The Effect of Illicit Drug Use on Outcomes Following Burn Injury.” Journal of Burn Care & Research 38(1): e89-e94.

Holmes JH. Critical Issues in Burn Care. J Burn Care Res. 2008 Nov-Dec; 29(6):S180-S187.

Holmes, E. G., S. W. Jones and S. L. Laughon (2017). “A Retrospective Analysis of Neurocognitive Impairment in Older Patients With Burn Injuries.” Psychosomatics58(4): 386-394.

Howard PA, Jeng JC, Miller SF. Is the glass really half empty? A closer look at the TBSA data in the National Burn Repository. J Burn Care Res. 2007 Jul-Aug;28(4):542-3.

Hranjec T, Turrentine FE, Stukenborg G, Young JS, Sawyer RG, Calland JF. Burn-center quality improvement: are burn outcomes dependent on admitting facilities and is there a volume-outcome sweet-spot”?” Am Surg. 2012 May;78(5):559-66.

Hsu, P.-S., Y.-T. Tsai, C.-Y. Lin, S.-G. Chen, N.-T. Dai, C.-J. Chen, J.-L. Chen and C.-S. Tsai (2017). “Benefit of extracorporeal membrane oxygenation in major burns after stun grenade explosion: Experience from a single military medical center.” Burns 43(3): 674-680.

Huang, S. Z. and S. L. Friedman (2017). “Work-Related Burn Injuries Hospitalized in US Burn Centers: 2002 to 2011.” Journal of Occupational and Environmental Medicine 59(3): 282-288.

Hultman, C. S., D. van Duin, E. Sickbert-Bennett, L. M. Dibiase, S. W. Jones, B. A. Cairns and D. J. Weber (2017). “Systems-based Practice in Burn Care: Prevention, Management, and Economic Impact of Health Care–associated Infections: Prevention, Management, and Economic Impact of Health Care–associated Infections.” Clinics in Plastic Surgery 44(4): 935-942.

Jaskille AD, Shupp JW, Pavlovich AR, Fidler P, Jordan MH, Jeng JC. Outcomes from Burn Injury-Should Decreasing Mortality Continue to be Our Compass? Clinics in Plastic Surgery. 2009 Oct; 36 (4): 701.

Jehle CC Jr, Nazir N, Bhavsar D. The rapidly increasing trend of cannabis use in burn injury. J Burn Care Res. 2015 Jan-Feb;36(1):e12-7.

Jeng JC, Parks J, Phillips BL. Warding Off Burn Injuries, Warding Off Database Fishing Expeditions: The ABA Burn Prevention Committee Takes a Turn With a Glimmer From the National Burn Repository. J Burn Care Res. 2008 Apr.

Jeng JC, Phillips B. Dead-Reckoning the Distance Between the National Burn Repository and a True Population-Based Registry: A Challenge and an Opportunity. J Burn Care Res. 2009 Jan-Feb; 30(1):139-140.

Jeng JC, Phillips B. Improving on “It Is What It Is”: Stepping Up the Quality as a Consequence of New Version 5 Collection Software-A Glimmer From the National Burn Repository. J Burn Care Res. 2008 Mar-Apr;29(2):291-292.

Jeng JC, Phillips B. Title: From Psychedelic Data Visualization to Hypothesis: All-At-Once Contemplation of Vast Amounts of Information From the National Burn Repository. J Burn Care Res. 2008; 29 (6): 872-873.

Jeng JC, Schurr MJ, Phillips B. The Noise Floor, Signal-to-Noise Ratio, and Demonstrating That Burn Care is Getting Better: A Glimmer from the National Burn Repository. J Burn Care Res. 2008 July-Aug; 29(4):572-573.

Jeng JC, Shoham S. Leveraging the Unique Expertise of Our Clinical Colleagues: A Real-World Example for Collaborative Harnessing of the National Burn Repository. J Burn Care Res. 2008 Sep-Oct; 29(5):704-705.

Jeng JC,Miller SF. From the burn unit’s perspective, it’s lethal not being gainfully employed outside the home! A glimmer from the National Burn Repository. J Burn Care Res. 2007 Jan-Feb;28(1):142.

Jeng JC,Miller SF. How patients enter the burn care system is changing: a glimmer from the National Burn Repository. J Burn Care Res. 2007 Mar-Apr;28(2):220-1.

Jeng JC. From qualitative contemplation to relational database: one approach to harnessing the National Burn Repository. J Burn Care Res. 2008 Jan-Feb;29(1):267-8.

Jeng JC. Growth rings of a tree: progression of burn care charges abstracted from a decade of the National Burn Repository. J Burn Care Res. 2007 Sep-Oct;28(5):659-60.

Jeng JC. Patrimonie de Docteur BAUX--BAUX scores >> 100 gleaned from 170,791 admissions: a glimmer from the National Burn Repository. J Burn Care Res. 2007 May-Jun;28(3):380-1.


Jeng JC; Advisory Committee to the National Burn Repository. “Open for business!” a primer on the scholarly use of the National Burn Repository. J Burn Care Res. 2007 Jan-Feb;28(1):143-4.

Johnson LS, Shupp JW, Pavlovich AR, Pezzullo JC, Jeng JC, Jordan MH. Hospital length of stay--does 1% TBSA really equal 1 day? J Burn Care Res. 2011 Jan-Feb;32(1):13-9.

Kagan RJ, Edelman L, Solem L, Saffle JR, Gamelli R.DRG 272: Does it Provide Adequate Burn Center

Kagan RJ, Edelman L, Solem L, Saffle JR, Gamelli R.DRG 272: does it provide adequate burn center reimbursement for the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis? J Burn Care Res. 2007 Sep-Oct;28(5):669-74.

Kagan RJ, Gamelli R, Kemalyan N, Saffle JR. Tracheostomy in thermally injured patients: does diagnosis-related group 483 adequately estimate resource use and hospital costs? J Trauma. 2004 Oct;57(4):861-6.

Kagan RJ, Gamelli R, Saffle JR.DRG 504: the effect of 96 hours of mechanical ventilation on resource utilization. J Burn Care Res. 2007 Sep-Oct;28(5):664-8.

Kahn SA, Bell DE, Hutchins P, Lentz CW. Outpatient burn data: an untapped resource. Burns. 2013 Nov; 39(7):1351-4.

Kalina M, Malyutin G, Cooper ML. A comparison of burn related injuries following the natural disaster Super Storm Hurricane Sandy to the National Burn Repository of the American Burn Association. Burns & Trauma. 2016 Dec 1;4(1):1-4.

Karimi, K., I. Faraklas, G. Lewis, D. Ha, B. Walker, Y. Zhai, G. Graves and S. Dissanaike (2017). “Increased mortality in women: sex differences in burn outcomes.” Burns & Trauma 5.

Kennedy, J. D., W. Thayer, R. Beuno, K. Kohorst and A. B. Kumar (2017). “ECMO in major burn patients: feasibility and considerations when multiple modes of mechanical ventilation fail.” Burns & Trauma 5.

Kerby JD, McGwin G Jr, George RL, Cross JA, Chaudry IH, Rue LW 3rd. Sex differences in mortality after burn injury: results of analysis of the National Burn Repository of the American Burn Association. J Burn Care Res. 2006 Jul-Aug;27(4):452-6.

Knowlin, L. T., L. B. Stanford, B. A. Cairns and A. G. Charles (2017). “The effect of preexisting respiratory co-morbidities on burn outcomes.” Burns 43(2): 366-373.

Knowlin, L., P. D. Strassle, F. N. Williams, R. Thompson, S. Jones, D. J. Weber, D. van Duin, B. A. Cairns and A. Charles (2018). “Burn injury outcomes in patients with pre-existing diabetic mellitus: Risk of hospital-acquired infections and inpatient mortality.” Burns 44(2): 272-279.

Kok, Y. O., N. Sim, P. Tiwari, T. H. Wong and S. J. Chong (2017). “Establishing a treatment protocol for concomitant major burn and trauma patients: a tropical Asian hospital’s experience.” Burns & Trauma 5.

Kramer B, Rivara F, Klein M. Variations in U.S. Pediatric Burn Injury Hospitalizations Using the National Burn Repository Data. J Burn Care Res. 2010 Sept-Oct; (5): 734-9.

Krieger Y, Shoham Y, Levi A, Bogdanov-Beresovsky A, Silberstien E, Sagi A. Burn treatment framework in Israel. Ann Burns Fire Disasters. 2011 Dec 31;24(4):199-202.

Latenser BA, Miller SF, Bessey PQ, Browning SM, Caruso DM, Gomez M, Jeng JC, Krichbaum JA, Lentz CW, Saffle JR, Schurr MJ, Greenhalgh DG, Kagan RJ. National Burn Repository 2006 Report Dataset Version 3.0. J Burn Care Res. 2007 Jul.

Latenser BA, Miller SF, Bessey PQ, Browning SM, Caruso DM, Gomez M, Jeng JC, Krichbaum JA, Lentz CW, Saffle JR, Schurr MJ, Greenhalgh DG, Kagan RJ. National Burn Repository 2006: a ten-year review. J Burn Care Res. 2007 Sep-Oct;28(5):635-58.

Lezotte DC, Hills RA, Heltshe SL, Holavanahalli RK, Fauerbach JA, Blakeney P, Klein MB, Engrav LH. Assets and liabilities of the Burn Model System data model: a comparison with the National Burn Registry.Arch Phys Med Rehabil. 2007 Dec;88(12 Suppl 2):S7-17.

Light TD, Latenser BA, Heinle JA, Stolpen MS, Quinn KA, Ravindran V, Chacko J. Demographics of Pediatric Burns in Vellore, India. J Burn Care Res. 2009 Jan-Feb; 30(1):50-54.

Light TD, Latenser BA, Kealey GP, Wibbenmeyer LA, Rosenthal GE, Sarrazin MV. The Effect of Burn Center and Burn Center Volume on the Mortality of Burned Adults-An Analysis of the Data in the National Burn Repository. J Burn Care Res. 2009 Sept-Oct; 30(5):776-782.

Mandell SP, Robinson EF, Cooper CL, Klein MB, Gibran NS. Patient safety measures in burn care: do National reporting systems accurately reflect quality of burn care? J Burn Care Res. 2010 Jan-Feb;31(1):125-9.

Manzano-Nunez, R., H. A. Garcia-Perdomo, P. Ferrada, C. A. Ordoeez Delgado, D. A. Gomez and J. E. Foianini (2017). “Safety and effectiveness of propranolol in severely burned patients: systematic review and meta-analysis.(Report).” World Journal of Emergency Surgery 12(1).

Mason AD. Invited Critique: The 2007 NBR Report: A Synopsis of the 2007 Call for Data. J Burn Care Res. 2008 Nov-Dec; 29(6):871.

Mason, S. A., A. B. Nathens, J. P. Byrne, R. Fowler, A. Gonzalez, P. J. Karanicolas, R. Moineddin and M. G. Jeschke (2017). “The accuracy of burn diagnosis codes in health administrative data: A validation study.” Burns 43(2): 258-264.

Mathias, E., M. Srinivas Murthy and G. Litscher (2017). “Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects.” Medicines 4(4).

Matt SE, Shupp JW, Carter EA, Flanagan KE, Jordan MH. When a Hero Becomes a Patient: Firefighter Burn Injuries in the National Burn Repository. J Burn Care Res. 2012 Jan-Feb; 33(1):147-151.

Matt SE, Shupp JW, Carter EA, Shaw JD, Jordan, MH. Comparing a Single Institution’s Experience with Electrical Injuries to the Data Recorded in the National Burn Repository. J Burn Care Res. 2012 Sept-Oct; 33(5):606-611.

Appendix C


Appendix C McGwin G Jr,George RL,Cross JM,Rue LW. Improving the ability to predict mortality among burn patients. Burns. 2008

May;34(3):320-327. Epub 2007 Sep 14.

McKibben JBA, Bresnick MG, Wiechman A, Shelley A, Fauerbach JA. Acute Stress Disorder and Posttraumatic Stress Disorder: A Prospective Study of Prevalence, Course, and Predictors in a Sample With Major Burn Injuries. J Burn Care Res. 2008 Jan-Feb; 29(1):22-35.

Miller SF, Bessey P, Lentz CW, Jeng JC, Schurr M, Browning S. National Burn Repository 2007 Report: A Synopsis of the 2007 Call for Data. J Burn Care Res. 2008 Nov-Dec; 29(6):862-870.

Miller SF, Bessey PQ, Schurr MJ, Browning SM, Jeng JC,Caruso DM,Gomez M, Latenser BA, Lentz CW, Saffle JR, Kagan RJ, Purdue GF, Krichbaum JA. National Burn Repository 2005: a ten-year review. J Burn Care Res. 2006 Jul-Aug;27(4):411-36.

Modjarrad K,McGwin G Jr,Cross JM,Rue LW 3rd.The descriptive epidemiology of intentional burns in the United States: an analysis of the National Burn Repository. Burns. 2007 Nov;33(7):828-32. Epub 2007 May 24.

Moss LS. Outpatient management of the burn patient. Crit Care Nurs Clin North AM. 2004 Mar;16(1):109-17.Review.

Nisavic, M., S. Nejad and S. Beach (2017). “Intentional Self-inflicted Burn Injuries: Review of the Literature.” Psychosomatics.

Nosanov, L. B., M. M. McLawhorn, L. Hassan, T. E. Travis, S. Tejiram, L. S. Johnson, L. T. Moffatt and J. W. Shupp (2017). “Graft loss: Review of a single burn center’s experience and proposal of a graft loss grading scale.” Journal of Surgical Research 216: 185-190.

Nosanov, L. B., M. M. McLawhorn, M. Vigiola Cruz, J. H. Chen and J. W. Shupp (2017). “A National Perspective on ECMO Utilization in Patients with Burn Injury.” Journal of burn care & research : official publication of the American Burn Association 39(1).

Nosanov, L. B., R. R. Allely, R. T. Beyene, E. S. Walters and J. W. Shupp (2017). “Winner in the ring: Advantages of the Watusi collar in management of post-burn neck scar contractures.” Burns Open 1(1): 9-15.

Nosanov, Lauren B., Daniel Y. Jo, Pranay R. Randad, Lauren T. Moffatt, Bonnie C. Carney, Rachel T. Ortiz and Jeffrey W. Shupp (2017). “Effectiveness of a Glycylcycline Antibiotic for Reducing the Pathogenicity of Superantigen-Producing Methicillin-Resistant Staphylococcus aureus in Burn Wounds.” Eplasty 17.

Nygaard, R. M. and F. W. Endorf (2017). “Effects of demographic and socioeconomic factors on the use of skin substitutes in burn patients.” Burns Open.

Nygaard, R. M. and F. W. Endorf (2017). “Patterns of skin substitute use in isolated face and hand burns.” Burns Open 1(2): 63-66.

Osler T, Glance LG, Hosmer DW. Simplified estimates of the probability of death after burn injuries: extending and updating the BAUX score. J Trauma. 2010 Mar;68(3):690-7.

Palmieri TL, Taylor S, Lawless M, Curri T, Sen S, Greenhalgh DG. Burn center volume makes a difference for burned children*. Pediatric critical care medicine. 2015 May 1;16(4):319-24.

Pannucci C, Osborne N, Jaber R, Cederna P, Wahl Wendy. Early Fasciotomy in Electrically Injured Patients as a Marker for Injury Severity and Deep Venous Thrombosis Risk: An Analysis of the National Burn Repository. J Burn Care Res. 2010 Nov-Dec; (6): 882-7.

Pannucci CJ, Diaz JA, Wahl WL. Temporal changes in deep venous thrombosis risk after electrical injury. J Burn Care Res. 2011 May-Jun;32(3):442-6.

Pannucci CJ, Osborne NH, Wahl WL. Venous thromboembolism in thermally injured patients: analysis of the National Burn Repository. J Burn Care Res. 2011 Jan-Feb;32(1):6-12.

Pannucci, C. J., A. T. Obi, B. H. Timmins and A. L. Cochran (2017). “Venous Thromboembolism in Patients with Thermal Injury: A Review of Risk Assessment Tools and Current Knowledge on the Effectiveness and Risks of Mechanical and Chemical Prophylaxis: A Review of Risk Assessment Tools and Current Knowledge on the Effectiveness and Risks of Mechanical and Chemical Prophylaxis.” Clinics in Plastic Surgery 44(3): 573-581.

Pannucci, CJ, Osborne NH, Wahl WL. Creation and Validation of a Simple Venus Thromboembolism Risk Scoring Tool for Thermally Injured Patients: Analysis of the National Burn Repository. J Burn Care Res. 2012 Jan-Feb; 33(1):20-25.

Pavlovich AR, Shupp JW, Jeng JC. Is Length of Stay Linearly Related to Burn Size? A Glimmer From the National Burn Repository. J Burn Care Res. 2009 Mar-Apr; 30(2):229-230.

Pavlovich, AR, Shupp JW, Jeng JC. A Novel Approach to Discerning Burn Mortality: A Glimmer From the National Burn Repository. J Burn Care Res. 2009 Jul-Aug; 30(4):574-575.

Pham TN, Kramer CB, Wang J, Rivara FP, Heimbach DM, Gibran NS, Klein MB. Epidemiology and Outcomes of Older Adults With Burn Injury: An Analysis of the National Burn Repository. J Burn Care Res. 2009 Jan-Feb; 30(1):30-36.

Pompermaier, L., I. Steinvall, M. Elmasry, J. Thorfinn and F. Sjöberg (2018). “Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study.” Burns 44(2): 280-287.

Price LA,Thombs B,Chen CL,Milner SM. Liver disease in burn injury: evidence from a national sample of 31,338 adult patients. J BurnsWounds. 2007 Jun 12;7.

Rapolti, M., C. Wu, O. A. Schuth and C. S. Hultman (2017). “Under Pressure: Applying Practice-Based Learning and Improvement to the Treatment of Chronic Neuropathic Pain in Patients with Burns: Applying Practice-Based Learning and Improvement to the Treatment of Chronic Neuropathic Pain in Patients with Burns.” Clinics in Plastic Surgery 44(4): 925-934.

Reimbursement for the Care of Patients with Stevens. J Burn Care Res. 2007 Jul.

Roberts G, Lloyd M, Parker M, Martin R, Philp B, Shelley O, Dziewulski P. The BAUX score is dead. Long live the BAUX score: a 27-year retrospective cohort study of mortality at a regional burns service. J Trauma Acute Care Surg. 2012 Jan;72(1):251-6.

Saffle JR. Invited Critique: Burn Unit Size and Census: Too Much of a Good Thing? J Burn Care Res. 2009 Sept-Oct; 30(5):783-784.

Santaniello JM, Luchette FA, EspositoTJ, Gunawan H, Reed RL, Davis KA, Gamelli RL. Ten year experience of burn, trauma, and combined burn/trauma injuries comparing outcomes. J Trauma. 2004 Oct;57(4):696-700; discussion 700-1.

Sharma, K., M. Bichanich and A. M. Moore (2017). “A 3-Phase Approach for the Management of Upper Extremity Electrical Injuries.” Hand Clinics 33(2): 243-256.


Shupp J, Pavlovich A, Jeng J, Pezzullo J, Oetgen W, Jaskille A, Jordan M, Shoham S, Epidemiology of Bloodstream Infections in Burn-Injured Patients: A Review of the National Burn Repository. J Burn Care Res. 2010 Jul-Aug; (4):521-8.

Sikora, S. and A. Papp (2017). “Venous thromboembolism in burn patients is not prevented by chemoprophylaxis.” Burns 43(6): 1330-1334.

Soleimani T, Evans TA, Sood R, Hartman BC, Hadad I, Tholpady SS. Pediatric burns: Kids’ Inpatient Database vs the National Burn Repository. Journal of Surgical Research. 2015 Nov 26.

Steinvall I, Elmasry M, Fredrikson M, Sjoberg F. Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: An exploratory review. Burns. 2016 Feb;42(1):28-40.

Swanson JW, Otto AM, Gibran NS, Klein MB, Kramer CB, Heimbach DM, Pham TN. Trajectories to death in patients with burn injury. J Trauma Acute Care Surg. 2013 Jan;74(1):282-8.

Tang, C. Q., J. Q. Li, B. M. Shou, B. H. Pan, T. S. Chen, Y. Q. Xiao, X. P. Zheng, S. C. Xiao, Q. Tan and Z. F. Xia (2018). “Epidemiology and outcomes of bloodstream infections in 177 severe burn patients from an industrial disaster: a multicentre retrospective study.” Clinical Microbiology and Infection 24(2): 199.e191-199.e197.

Tanttula, K., K. Haikonen and J. Vuola (2017). “Hospitalized burns in Finland: 36 305 cases from 1980–2010.” Burns.

Taylor S, Jeng J, Saffle JR, Sen S, Greenhalgh DG, Palmieri TL. Redefining the outcomes to resources ratio for burn patient triage in a mass casualty. J Burn Care Res. 2014 Jan-Feb; 35(1):41-5.

Taylor SL, Lawless M, Curri T, Sen S, Greenhalgh DG, Palmieri TL. Predicting mortality from burns: the need for age-group specific models. Burns. 2014 Sep 30;40(6):1106-15.

Taylor SL, Lee D, Nagler T, Lawless MB, Curri T, Palmieri TL. A Validity Review of the National Burn Repository. J Burn Care Res. 2012 Nov.

Taylor SL, Lee D, Nagler T, Lawless MB, Curri T, Palmieri TL. A validity review of the National Burn Repository. J Burn Care Res. 2013 Mar-Apr; 34(2):274-80.

Taylor SL, Sen S, Greenhalgh DG, Lawless M, Curri T, Palmieri TL. A competing risk analysis for hospital length of stay in patients with burns. JAMA Surg. 2015 May;150(5):450-6.

Taylor, S. L., S. Sen, D. G. Greenhalgh, M. Lawless, T. Curri and T. L. Palmieri (2017). “Not all patients meet the 1 day per percent burn rule: A simple method for predicting hospital length of stay in patients with burn.” Burns 43(2): 282-289.

Thombs BD, Bresnick MG, Magyar-Russell G. Who attempts suicide by burning? An analysis of age patterns of mortality by self-inflicted burning in the United States. Gen Hosp Psychiatry. 2007 May-Jun;29(3):244-50.

Thombs BD, Bresnick MG. Mortality risk and length of stay associated with self-inflicted burn injury: evidence from a national sample of 30,382 adult patients. Crit Care Med. 2008 Jan;36(1):118-25.

Thombs BD, SinghVA, Halonen J,Diallo A,Milner SM.The effects of preexisting medical comorbidities on mortality and length of hospital stay in acute burn injury: evidence from a national sample of 31,338 adult patients. Ann Surg. 2007 Apr;245(4):629-34.

Thombs BD. Patient and injury characteristics, mortality risk, and length of stay related to child abuse by burning: evidence from a national sample of 15,802 pediatric admissions. Ann Surg. 2008 Mar;247(3):519-23.

Travis TE, Johnson LS, Moffatt LT, Subramanian RM, Jordan MH, Shupp JW. Organ donation from burn-injured patients--a national perspective. J Surg Res. 2014 Jul;190(1):289-99.

Verma, P., S. Bhoi, U. Baitha, T. Sinha and P. Mishra (2017). “Gender-based assessment of survival in trauma-hemorrhagic shock: A retrospective analysis of Indian population.(Research Article)(Clinical report).” Indian Journal of Critical Care Medicine 21(4): 218.

Villaveces A, Peck M, Faraklas I, Hsu-Chang N, Joe V, Wibbenmeyer L. Process evaluation of software using the international classification of external causes of injuries for collecting burn injury data at burn centers in the United States. J Burn Care Res. 2014 Jan-Feb; 35(1):28-40.

Walsh, D. M., S. D. McCullough, S. Yourstone, S. W. Jones, B. A. Cairns, C. D. Jones, I. Jaspers and D. Diaz-Sanchez (2017). “Alterations in airway microbiota in patients with PaO.sub.2/FiO.sub.2 ratio [less than or equal to] 300 after burn and inhalation injury.(Research Article).” PLoS ONE 12(3): e0173848.

Wiechman, S., M. A. Hoyt and D. R. Patterson (2017). “Using a Biopsychosocial Model to Understand Long-term Outcomes in Persons with Burn Injuries.” Archives of Physical Medicine and Rehabilitation.

(2017). “Data on Burn Care Research Reported by S.L. Taylor and Colleagues (Not all patients meet the 1day per percent burn rule: A simple method for predicting hospital length of stay in patients with burn).(Medical condition overview)(Report).” Health & Medicine Week: 3366.

(2017). “Findings on Burn Care Detailed by Investigators at University of Texas Southwestern (The Effect of Illicit Drug Use on Outcomes Following Burn Injury).(Medical condition overview).” Medical Devices & Surgical Technology Week: 132.

(2017). “Researchers from University of Iowa Detail New Studies and Findings in the Area of Sepsis (A National Study of the Effect of Race, Socioeconomic Status, and Gender on Burn Outcomes).(Report).” Medical Devices & Surgical Technology Week: 701.

(2017). “Studies Conducted at University of North Carolina on Burn Care Research Recently Reported (Evaluation of the New North Carolina Burn Registry).(Medical condition overview).” Health & Medicine Week: 5413.

Appendix C

Documents

National Burn Repository 2019 Update · 2020. 5. 29. · national burn repository 2019 report dataset version 14.0 fire/flame injuries represent 40.6% of the cases in this report