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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
Linköping University, Department of Clinical and Experimental Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal University, Egypt.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
2016 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 42, no 1, 28-40 p.Article in journal (Refereed) PublishedText
Abstract [en]

Standardised Mortality Ratio (SMR) based on generic mortality predicting models is an established quality indicator in critical care. Burn-specific mortality models are preferred for the comparison among patients with burns as their predictive value is better. The aim was to assess whether the sum of age (years) and percentage total body surface area burned (which constitutes the Baux score) is acceptable in comparison to other more complex models, and to find out if data collected from a separate burn centre are sufficient for SMR based quality assessment. The predictive value of nine burn-specific models was tested by comparing values from the area under the receiver-operating characteristic curve (AUC) and a non-inferiority analysis using 1% as the limit (delta). SMR was analysed by comparing data from seven reference sources, including the North American National Burn Repository (NBR), with the observed mortality (years 1993-2012, n = 1613, 80 deaths). The AUC values ranged between 0.934 and 0.976. The AUC 0.970 (95% CI 0.96-0.98) for the Baux score was non-inferior to the other models. SMR was 0.52 (95% CI 0.28-0.88) for the most recent five-year period compared with NBR based data. The analysis suggests that SMR based on the Baux score is eligible as an indicator of quality for setting standards of mortality in burn care. More advanced modelling only marginally improves the predictive value. The SMR can detect mortality differences in data from a single centre. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD , 2016. Vol. 42, no 1, 28-40 p.
Keyword [en]
Burns; Mortality; Quality assurance benchmarking; Logistic models; Area under curve
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-125299DOI: 10.1016/j.burns.2015.10.032ISI: 000368840600005PubMedID: 26700877OAI: oai:DiVA.org:liu-125299DiVA: diva2:906390
Note

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

Available from: 2016-02-24 Created: 2016-02-19 Last updated: 2016-03-07

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Steinvall, IngridFredrikson, MatsSjöberg, Folke
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Department of Clinical and Experimental MedicineDepartment of Hand and Plastic SurgeryFaculty of Health SciencesDivision of Clinical SciencesFaculty of Medicine and Health SciencesDivision of Neuro and Inflammation Science
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Burns
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