liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
Pompermaier, Laura
Publications (4 of 4) Show all publications
Pompermaier, L., Elmasry, M., Abdelrahman, I., Fredrikson, M., Sjöberg, F. & Steinvall, I. (2018). Are there any differences in the provided burn care between men and women? A retrospective study. Burns & Trauma, 6, Article ID 22.
Open this publication in new window or tab >>Are there any differences in the provided burn care between men and women? A retrospective study
Show others...
2018 (English)In: Burns & Trauma, E-ISSN 2321-3876, Vol. 6, article id 22Article in journal (Refereed) Published
Abstract [en]


Disparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes.


All patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality.


A total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001).


We found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.

Place, publisher, year, edition, pages
BioMed Central, 2018
Burn care; Intervention score; Sex; Trauma model; Workload
National Category
urn:nbn:se:liu:diva-150365 (URN)10.1186/s41038-018-0125-0 (DOI)000442159400001 ()30123802 (PubMedID)
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2019-04-18Bibliographically approved
Pompermaier, L., Steinvall, I., Elmasry, M., Thorfinn, J. & Sjöberg, F. (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
Open this publication in new window or tab >>Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study
Show others...
2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 2, p. 280-287Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The Baux score - the sum of age and total body surface area burned (TBSA %) - is a good predictor of mortality has a high specificity but low sensitivity. Our aim was to examine the causes of death in patients who die with Baux scores of <100, which may explain the lower sensitivity and possibly affect the prediction of mortality.

METHODS: All patients admitted to our centre for burn care from 1993 to 2015 (n=1946) were included in this retrospective, descriptive, exploratory study. The study group comprised those patients who died with Baux scores of <100 (n=23), and their medical charts were examined for the cause of death and for coexisting diseases.

RESULTS: Crude mortality was 5% (93/1946) for the overall cohort, and a quarter of the patients who died (23/93) had Baux scores of less than 100 (range 64-99). In this latter group, flame burns were the most common (18/23), the median (10th-90th centile) age was 70 (46-86) years and for TBSA 21 (5.0-40.5) %, of which 7 (0-27.0) % of the area was full thickness. The main causes of death in 17 of the 23 were classified as "other than burn", being cerebral disease (n=9), cardiovascular disease (n=6), and respiratory failure (n=2). Among the remaining six (burn-related) deaths, multiple organ failure (predominantly renal failure) was responsible. When we excluded the cases in which the cause of death was not related to the burn, the Baux mortality prediction value improved (receiver operating characteristics area under the curve, AUC) from 0.9733 (95% CI 0.9633-0.9834) to 0.9888 (95% CI 0.9839-0.9936) and the sensitivity estimate increased from 45.2% to 53.9%.

CONCLUSION: Patients with burns who died with a Baux score <100 were a quarter of all the patients who died. An important finding is that most of these deaths were caused by reasons other than the burn, usually cerebrovascular disease. This may be the explanation why the sensitivity of the Baux score is low, as factors other than age and TBSA % explain the fatal outcome.

Place, publisher, year, edition, pages
Elsevier, 2018
Baux score, Burns, Cause of death, Mortality
National Category
Cardiac and Cardiovascular Systems
urn:nbn:se:liu:diva-142898 (URN)10.1016/j.burns.2017.07.014 (DOI)000427535000006 ()28830698 (PubMedID)2-s2.0-85027674409 (Scopus ID)

Funding agencies: Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Region Ostergotland; Linkoping University, Linkoping, Sweden

Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-04-12Bibliographically approved
Pompermaier, L. (2017). Outcome of burn care: the mortality perspective. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Outcome of burn care: the mortality perspective
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Despite the improvements in burn care during the last decades, burns remain catastrophic for the patients and a challenge for the care-givers.  The early outcome of burn care is to assess its quality and to improve it, but the crucial outcome is mortality, which is the main focus of this thesis. In particular, I address questions about mortality that have arisen from working with burned patients and that can have clinical consequences: the impact of pre- existing medical conditions; long-term survival; the causes of unexpected deaths; and the possible differences between sexes in the provision of resources.

Patients with burns share the fact that the time of their injury is known, its severity can be quantified from the size of the burn, and the care is relatively standardised. The analysis of outcome among burned patients treated at a single burn centre may therefore be of general value to others who treat burns.

Methods: We retrospectively analysed data that had been collected prospectively (the burn    unit database) from patients with burns admitted consecutively to a national burn centre in Sweden during the last 25 years.

Results: Age and percentage of total body surface area burned (TBSA %) affected the in- hospital mortality, whereas pre-existing medical conditions did not influence the prediction of outcome (Paper I). After discharge, both age and the presence of full thickness burns reduced the long-term survival, whereas the extent of the burn (TBSA %) did not (Paper II). Most patients with moderate burns who die in hospital despite a good prognosis, die for reasons   other than the burn (Paper III). Previously, it has been shown that sex is not an independent factor for mortality during burn care; in this thesis we show that the sex of the patients did not affect the number of medical interventions given either (Paper IV).

Conclusion: The addition of “coexisting condition” to a mortality model based on age and   size of burn does not improve its predictive value; rather, the factor “age” is sufficient to adjust for comorbidity in the assessment of a burn and its outcome (Paper I).

If patients with burns survive, the long-term prognosis is good. The effect of age is the one that governs survival, whereas the effect of the extent of the burn ends when the patient is discharged (Paper II).

The in-hospital mortality during burn care is low, but some patients die for reasons other than the actual burn (Paper III).

In a centre where the mortality is independent of the sex of the patient, the provision of medical interventions is also equal between men and women (Paper IV).

Abstract [it]

Questa tesi tratta del rischio di morte in seguito ad ustioni ed affronta, con approccio scientifico, alcune domande sollevate frequentemente da pazienti e da addetti ai lavori.

In particolare:

  1. a presenza di altre malattie a prescindere dall´ustione (diabete, nefropatie, alcolismo, etc.) peggiora la prognosi del paziente?
  2. L´essere sopravvissuto ad un´ustione riduce l´aspettativa di vita dopo la dimissione dall´ospedale?
  3. Qual è la causa di morte in quei (rari) pazienti che muoiono con ustioni di modesta entità?
  4. Il sesso del paziente influenza le cure prestate durante il ricovero ed, in tal caso, qual è l´effetto sulla prognosi?

Spesso avevamo risposto a questi interrogativi di interesse clinico basandoci sull´esperienza o su luoghi comuni accettati acriticamente. Con questa tesi abbiamo cercato con metodo scientifico delle risposte di valore generale, analizzando i dati raccolti durante l´ultimo ventennio sui pazienti ricoverati a causa di traumi termici al Centro Nazionale Grandi Ustioni dell´Università di Linköping.

In Svezia, come negli altri paesi a reddito medio-alto, il tasso di mortalità in seguito ad ustioni è diminuito notevolmente negli ultimi anni, tuttavia l´obbiettivo principale tra gli addetti ai lavori rimane quello di diminuire ulteriormente la mortalità. L´identificazione precoce di pazienti ad alto rischio di morte fornisce un mezzo utile per migliorarne la prognosi. A tale proposito sono stati sviluppati numerosi modelli matematici in grado di calcolare la probabilità di morte in seguito ad ustioni, basati principalmente sull`età del paziente e sull´ estensione dell´ustione. Infatti, è intuitivamente comprensibile che il rischio di morire aumenti con l´età del paziente e la gravità dell´ustione.

Nel nostro primo studio abbiamo aggiunto ad un modello prognostico basato su età e superficie corporea ustionata informazioni sulle malattie già presenti nel paziente prima dell`ustione. Contrariamente a quanto ipotizzato, la presenza di altre malattie negli ustionati non ne aumenta la probabilità di morte.  Nel nostro secondo studio abbiamo seguito i pazienti sopravvissuti all´ustione dopo la dimissione dal nostro Centro ed abbiano dimostrato che l´ustione in se´ non ne accorcia la vita ne´a breve termine (nei 30 giorni seguenti la dimissione), ne´a lungo termine.

È piuttosto inusuale che pazienti con ustioni di modesta gravitá muioiano durante il ricovero ospedaliero. Nel nostro terzo studio abbiamo dimostrato che la principale cause di morte tra questi pazienti non è correlata all´ustione in se´, ma ad altre patologie indipendenti dal trauma termico, quali l´ictus o l´infarto miocardico.

A livello internazionale è stato ampiamente documentato un impari impiego delle cure mediche tra i sessi, a discapito delle donne. Questa disparità riguarda principalmente la diversa allocazione delle risorse terapeutiche, ma ha conseguenze negative sul´esito finale della cura. Studi provenienti da diversi centri per la terapia delle grandi ustioni (USA, Australia, India) hanno dimostrato che il rischio di morte in ospedale è maggiore per le pazienti femmine. In contrasto con questo, una precedente ricerca svolta presso il nostro centro non ha mostrato alcuna differenza nella sopravvivenza tra uomini e donne. Anche tra i pazienti della terapia intensiva generale svedese la mortalità è simile per entrambi i sessi, nonostante gli uomini ricevano più trattamenti rispetto alle donne. Questa osservazione apre le porte ad un´ovvia domanda, e cioè: se le donne ricevessero le stesse attenzioni degli uomini morirebbero esse su scala minore? In linea con i risultati riguardanti la mortalità precedentemente pubblicati dal nostro centro, col nostro quarto studio abbiamo dimostrato che non esiste alcuna disparità tra i sessi nella distribuzione delle risorse.

In sintesi, con questa tesi abbiamo dimostrato che:

  1. i fattori che maggiormente influenzano la prognosi in caso di ustione sono l'età del paziente e l´area corporea ustionata; la presenza di altre patologie non aumenta significativamente il rischio di morte.
  2. L´essere sopravvissutto ad un´ustione non riduce l´aspettativa di vita dopo la dimissione dall´ospedale.
  3. Una percentuale non indifferente delle morti che si verificano durante il periodo di cura per ustioni di modesta gravità è causata da fattori indipendenti dall´ustione stessa.
  4. Uomini e donne nel nostro centro ricevono equo trattamento. La prognosi per donne e uomini ricoverati nel nostro centro è la stessa.

Riteniamo che i risultati presentati in questa tesi dovrebbero essere tenuti in considerazione nella terapia dei pazienti ustionati: il trattamento attivo dovrebbe essere offerto a chiunque abbia una ragionevole possibilità di sopravvivenza, calcolata sulla base dell´età e della gravità dell´ustione. Una volta guariti da un´ustione l´aspettativa di vita è buona. Non va scordato che, tra i pazienti che muoiono in seguito ad un´ustione, le cause di morte potrebbero essere dovute a patologie di altra natura. Non si evidenziano differenze nelle mortalitá, lí dove venga offerto uguale trattamento a uomini e donne.

Abstract [sv]

Dödligheten efter brännskador har minskat under de senaste årtiondena, likväl kvarstår målet att ytterligare minska risken att avlida.

Syftet med denna avhandling var att studera prognosen efter brännskador, och i synnerhet att analysera dödligheten ur olika perspektiv.

De modeller som brukar användas inom brännskadevård för att förutse dödlighet baseras framför allt på brännskadeyta och ålder. Det är emellertid oklart huruvida patientens samsjuklighet påverkar prognosen, och huruvida åldern kan ersätta uppgifter om samsjukligheten. I det första arbetet har detta undersökts genom analys av befintliga vårdregisterdata i Sverige. Att addera information om samsjukligheten till en modell baserat   på ålder och brännskadeyta gav inte säkrare förutsägelser.

En återkommande fråga inom brännskadevården har varit huruvida patienter som överlever tiden på sjukhus har förkortad långsiktig överlevnad. I det andra arbetet har detta undersökts genom en uppföljning av samtliga patienter som behandlats vid det nationella brännskadecentrat i Linköping. Resultaten visar att skadans svårighetsgrad (brännskadeytan) inte påverkar hur länge patienterna lever efter utskrivning, medan effekten av ålder är avgörande för överlevnaden på lång sikt.

Det är ovanligt att patienter som vårdas på sjukhus för brännskador avlider. En viktig observation som gjorts i detta sammanhang är att bland dem som dör under dessa omständigheter återfinns individer vars dödsorsak inte är relaterad till själva brännskadan. Detta gäller särskilt för dem som dör trots att skadeutbredningen är relativt sett liten. Fokus för det tredje arbetet var att undersöka vilka dödsorsaker som är relevanta för gruppen i fråga. Resultaten visar att en inte oväsentlig del av dödsfallen var orsakade av andra faktorer än de som är direkt kopplade till själva brännskadan, exempelvis hjärnblödning eller hjärtinfarkt.

Det är väl dokumenterat att ojämlikhet mellan könen ofta föreligger vid medicinsk vård med en diskriminering för kvinnor både avseende resursallokering och utfall (dödlighet). Detta finns visat inom olika sektorer, till exempel finns det visat att mortalitetsutfallet är lika mellan män och kvinnor inom allmän svensk intensivvård men att män får fler behandlingsinsatser än kvinnor. Studier från olika brännskadecentra (USA, Australien, Indien) har visat att risken att avlida på sjukhus efter en brännskada är högre för kvinnliga patienter. I motsats till detta finns resultat från en studie vid Brännskadecentrum i Linköping där ingen skillnad i överlevnad kunde påvisas efter justering för skadans storlek och patienternas ålder. I det fjärde arbetet har resursfördelning undersökts ur ett könsperspektiv. Validerade metoder för att mäta vårdinterventioner har använts. I linje med tidigare resultat, med lika överlevnad mellan könen, visade även denna studie att ingen skillnad i resursfördelning mellan könen kunde påvisas.

Sammanfattningsvis visar fynden i denna avhandling att risken av dö av brännskador ökar   med åldern och brännskadeytans storlek, och att addering av samsjuklighet inte ger säkrare förutsägelser därutöver. Vidare, att den långsiktiga prognosen är god för de brännskadepatienter som överlever vårdtiden på sjukhus. En inte oväsentlig del av dödsfallen som sker under vårdtiden är orsakade av andra faktorer än de som är direkt kopplade till själva brännskadan. Slutligen har vi visat att behandlingen av manliga och kvinnliga patienter vid ett nationellt brännskadecentrum är jämlik med avseende på resursfördelning och överlevnad.

Slutsatserna som presenteras i denna avhandling bör beaktas vid behandling av brännskadepatienter: data stödjer således ytterligare att aktiv behandling bör erbjudas alla som har en rimlig chans att överleva beräknat utifrån de prediktioner som kan göras med de prediktionsmodeller som presenterats. Denna konklusion är mycket viktig sett ur ett behandlingsperspektiv för denna patientgrupp.

Prognostiska modeller avseende mortalitetsprediktion optimeras om dödsfall med dödsorsaker som inte är relaterade till brännskadan tas bort vid analysen. Vid ett brännskadecentrum där könsjämlik behandling av brännskadepatienter tillämpas, påverkar patientens kön inte utfallet. Detta resultat är glädjande men samtidigt unikt, sett ur ett övergripande vårdperspektiv.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. p. 56
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1599
National Category
urn:nbn:se:liu:diva-142897 (URN)10.3384/diss.diva-142897 (DOI)9789176854143 (ISBN)
Public defence
2017-12-15, Berzeliussalen, Campus US, Linköping, 09:00 (English)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-10-28Bibliographically approved
Pompermaier, L., Steinvall, I., Fredrikson, M. & Sjöberg, F. (2015). Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power. Burns, 41(8), 1868-1876
Open this publication in new window or tab >>Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power
2015 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 41, no 8, p. 1868-1876Article in journal (Refereed) Published
Abstract [en]

Introduction: Several models for predicting mortality have been developed for patients with burns, and the most commonly used are based on age and total body surface area (TBSA%). They often show good predictive precision as depicted by high values for area under the receiver operating characteristic curves (AUC). However the effect of coexisting morbidity on such prediction models has not to our knowledge been thoroughly examined. We hypothesised that adding it to a previously published model (based on age, TBSA%, full thickness burns, gender, and need for mechanical ventilation) would further improve its predictive power. Methods: We studied 772 patients admitted during the period 1997-2008 to the Linkoping University Hospital, National Burn Centre with any type of burns. We defined coexisting morbidity as any of the medical conditions listed in the Charlson list, as well as psychiatric disorders or drug or alcohol misuse. We added coexisting medical conditions to the model for predicting mortality (age, TBSA%, and need for mechanical ventilation) to determine whether it improved the model as assessed by changes in deviances between the models. Results: Mean (SD) age and TBSA% was 35 (26) years and 13 (17) %, respectively. Among 725 patients who survived, 105 (14%) had one or more coexisting condition, compared with 28 (60%) among those 47 who died. The presence of coexisting conditions increased with age (p &lt; 0.001) among patients with burns. The AUC of the mortality prediction model in this study, based on the variables age, TBSA%, and need for mechanical ventilation was 0.980 (n = 772); after inclusion of coexisting morbidity in the model, the AUC improved only marginally, to 0.986. The model was not significantly better either. Conclusion: Adding coexisting morbidity to a model for prediction of mortality after a burn based on age, TBSA%, and the need for mechanical ventilation did not significantly improve its predictive value. This is probably because coexisting morbidity is automatically adjusted for by age in the original model. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.

Place, publisher, year, edition, pages
Burns; Comorbidity; Mortality; Prediction model
National Category
Clinical Medicine
urn:nbn:se:liu:diva-124131 (URN)10.1016/j.burns.2015.09.017 (DOI)000367127700031 ()26507519 (PubMedID)
Available from: 2016-01-22 Created: 2016-01-19 Last updated: 2017-11-30

Search in DiVA

Show all publications