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Burns
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Brian Brisebois, Joyce McIntyre
The traditional Baux score formula, which tends to overpredict mortality and doesn't account for inhalation injury, has received an update. The formula retains ease of use, but accounts for inhalation injury and was recalibrated using patient data from the national burn registry to more accurately predict outcome (Osler). Hospitalization duration can be estimated at 1 day for every 1% TBSA, with longer stays required for larger burns (Greenhalgh).
Burns and burn surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The Modified Baux Score (age × TBSA + 17 for inhalation injury) is a convenient method to determine survival of burn patients as age, TBSA, inhalation injury, and pre-existing comorbidities are still the four main determinants of burn mortality. That said, mortality has decreased to such an extent that most children should be considered as candidates for survival, regardless of age, burn size, and delay in resuscitation or presence of inhalation injury on initial presentation. In a modern pediatric burn care setting, a burn size of approximately 60% TBSA is a crucial threshold for post-burn morbidity and mortality. However, with modern surgical techniques including micrografting techniques, a LD50 of 75–80% TBSA is possible, even in a resource-poor environment.
Relation between dynamic changes of platelet counts and 30-day mortality in severely burned patients
Published in Platelets, 2019
Xiaoqin Huang, Feng Guo, Zengding Zhou, Mengling Chang, Fei Wang, Yi Dou, Zhiyong Wang, Jingning Huan
Clinic scoring systems for severity of illness should take into account factors that reflect changes in clinical status during the hospital stay [42]. Change-sensitive parameters may contribute to prognostic assessment after patients have been in the ICU several days, thereby improving treatment decisions [43]. To optimize scoring systems, parameters must be readily available, independent from underlying diseases, and strongly associated with mortality [44]. The APACHE-Ⅱ score is composed of a series of indicators but lacks dynamic parameters reflecting the development of diseases. The APACHE II Score has been widely used to capture the initial physiological response in intensive care patients and has been found to be significantly associated with subsequent mortality in burn injuries [45]. The revised Baux score, a simple and accurate model for predicting mortality in patients with acute burn injuries in a burn center setting, is more likely to reflect marker of mortality risk [46]. Although dynamic changes in platelet counts should be considered as one of the many different prognostic markers, the goal of using multifactorial scoring systems is to improve the accuracy of the predictive tool, and we should not focus only on platelet count. However, the pathophysiologic mechanisms underlying the blunted increase in PCs in severely burned patients are complicated and should be elucidated. Platelet count assessments are inexpensive and easy to perform in routine practice. Thus, among patients with severe burns, platelet count could represent an early alert for the clinician.