national burn repository 2017 update2017 update report of data from 2008-2017 american burn...

National Burn Repository

2017 UpdateREPORT OF DATA FROM 2008-2017

American Burn Association311 South Wacker Drive, Suite 4150Chicago, IL 60606(312) 642-9260www.ameriburn.org

National Burn Repository 2017 Report Dataset Version 13.0

FIRE/FLAME INJURIES REPRESENT 41% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

SCALD INJURIES REPRESENT 35% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

CONTACT WITH HOT OBJECT INJURIES REPRESENT 10% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

ELECTRICAL INJURIES REPRESENT 3% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

CHEMICAL INJURIES REPRESENT 3% OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

©American Burn Association, National Burn Repository® 2017. Version 13.0. All Rights Reserved Worldwide.

ii©American Burn Association, National Burn Repository® 2017. Version 13.0. All Rights Reserved Worldwide.

National Burn Repository 2017 Report

Michael J. Mosier, MD, FACS, FCCMNBR Committee Chair

Legacy EmmanuelOregon Burn Center

Portland, Oregon

Nicole Bernal, MDUniversity of California IrvineUCI Regional Burn Center

Orange, California

Iris H. Faraklas, RN, BSNPromise Hospital

Salt Lake City, Utah

Steven A. Kahn, MDArnold Luterman Regional Burn Center

University of South Alabama Medical CenterMobile, Alabama

Yvonne L. Karanas, MDSanta Clara Valley Medical Center

San Jose, California

Jong O. Lee, MD, FACSUniversity of Texas Medical Branch

Galveston, Texas

Lauren S. Nosanov, MDMedstar Washington Hospital Center

Washington, DC

Cynthia L. Reigart, RN, BSN, MSNThe Nathan Speare Regional Burn Treatment Center

Crozer Chester Medical CenterUpland, Pennsylvania

Colleen M. Ryan, MD, FACSMassachusetts General Hospital

Boston, Massachusetts

Joan M. Weber, RN, MSN, CICShriners Hospital for Children

Boston, Massachusetts

Palmer Q. Bessey, MD, FACS, MS, Ex OfficioWeill Cornell Medical CollegeNew York Presbyterian Hospital

William Randolph Hearst Burn CenterNew York, New York

Mary L. Patton, MD, FACS, Ex OfficioThe Nathan Speare Regional Burn Treatment Center

Crozer Chester Medical CenterUpland, Pennsylvania

American Burn Association NBR Advisory Committee

American Burn Association Staff

Kimberly A. Hoarle, MBA, CAEExecutive Director

Maureen T. Kiley, BSSenior Director

Bart D. Phillips, MS, Technology AdvisorBData, LLC

Minneapolis, MN

iii©American Burn Association, National Burn Repository® 2017. Version 13.0. 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 expedited 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® 2017. Version 13.0. 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, 2008 to 2017 ......................................................................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, 2008 to 2017 ..............................................................14Figure 16: Mortality Rate by Gender, 2008 to 2017 ........................................................................................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

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Table 24: Top Ten Procedures 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 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 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 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 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

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Table 60: Race/Ethnicity Figure 44: Etiology Table 61: Etiology Table 62: Hospital Days: Lived/Died by Inhalation Injury Table 63: Top Ten Complications Table 64: Top Ten 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 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 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 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 Procedures Table 97: Lived/Died by Burn Group Size (% TBSA) Table 98: Hospital Days by Burn Group Size (% TBSA)

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Table 99: Mean Charges for Top Five MS-DRGs 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 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 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 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 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

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Figure 80: Place of Occurrence – E849 Code Table 133: Place of Occurrence – E849 Code Figure 81: Percent of Patient with Clinically Relevant Complications by Age Group Table 134: Complication Rate by Age Group Table 135: Top Ten Complications Table 136: Top Ten Procedures Table 137: Hospital Days: Lived/Died by Burn Size Group (%TBSA)Electrical Injuries ................................................................................................................ 93 Figure 82: Circumstance of Injury Table 138: Circumstance of Injury Figure 83: Place of Occurrence – E849 Code Table 139: Place of Occurrence – E849 Code Figure 84: Percent of Patient with Clinically Relevant Complications by Age Group Table 140: Complication Rate by Age Group Table 141: Top Ten Complications Table 142: Top Ten Procedures Figure 85: Frequency of Records by Age Categories and GenderChemical Injuries ................................................................................................................ 97 Figure 86: Circumstance of Injury Table 143:Circumstance of Injury Figure 87: Place of Occurrence – E849 Code Table 144: Place of Occurrence – E849 Code Figure 88 Percent of Patient with Clinically Relevant Complications by Age Group Table 145:Complication Rate by Age Group Table 146:TopTen Complications Table 147:TopTen Procedures Figure 89: Frequency of Records by Age Categories and Gender

5) Hospital Comparisons ....................................................................................................................................1022011-2014 Fire/Flame Injuries ............................................................................................... 103 Figure 90: 2014-2017 Fire/Flame Injuries – Mortality Rate Figure 91: 2014-2017 Fire/Flame Injuries – Mean Charges Figure 92: 2014-2017 Fire/Flame Injuries – Mean Length of Stay Figure 93: 2014-2017 Fire/Flame Injuries – Complication Rate

6) Analysis of International Records ...................................................................................................................109 Figure 94: Age Group by Gender Table 148: Age Group by Gender Figure 95: Etiology Table 149: Etiology Figure 96: Race/Ethnicity Table 150: Race/Ethnicity Figure 97: Place of Occurrence – E849 Code Table 151: Place of Occurrence – E849 Code Figure 98: Circumstance of Injury Table 152: Circumstance of Injury Table 153: Mortality Rate for BAUX Score Categories by Gender Table 154: Lived/Died by Burn Group Size (% TBSA)

Appendix ...........................................................................................................................................................115A. Minimum Data Set and Data Quality ................................................................................ 116 Table 155: Data Completeness by Variable Figure 99: Data Quality Expressed as Mean Percent of Missing Variables of the Minimum Data Set per Record by Admission Year Figure 100: Data Quality Expressed as Mean Percent of Missing Variables of the Minimum Data Set per Record by FacilityB. List of Participating Hospitals ........................................................................................... 120C. Selected List of Peer-Reviewed Publications Utilizing NBR Data ......................................... 123

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This year’s National Burn Repository (NBR) report represents ten years of cumulative data from 101 United States Burn Centers, four Canadian Burn Centers, and two Swedish Burn Centers. The report contains over 212 thousand entries, with 42,402 new entries submitted by 81 U.S. burn centers for the 2016-2017 call for data, and over 3,700 international entries. This report represents the largest resource on epidemiology of thermal injury for patients admitted to burn centers in North America. It is also the single most useful reference for determining benchmark standards for outcomes such as mortality rate and hospital length of stay.

This year’s report also marks a transition from Version 5 to Version 6 of the burn registry software, which was released to burn centers in 2016/2017, after the release of the National Burn Data Standard (NBDS) in April of 2015. The evolution in data collection brought forward by Version 6 and the NBDS creates a number of reporting and research opportunities as well as the need for key decisions around how to incorporate the Version 6 data with the historical data, previously collected by the American Burn Association. The two biggest changes in the Version 6 software impacting reporting relate to complications and procedures. The number of complication choices dropped from 111 to 33, with a notable drop in reported complications from 10% to 5%, although the change was not uniform at the facility level. For procedures, the difference is that Version 6 allows for ICD-10 coding where Version 5 is strictly ICD-9.

This new data and changes to the Burn Registry Software continue to improve the quality of the NBR data and the ways that it can be used to understand the state of burn care in North America, how care has changed over time, and areas for continued improvement. These changes are good, but there is more to do. While accuracy and participation

continue to improve and, resultantly, the NBR continues to improve, the NBR only includes inpatient data, with limited data on isolated inhalation injury, skin diseases, and other conditions commonly treated in burn centers, as well as many records remaining incomplete.

To minimize the number of missing variables; better assess quality, through collection of BQIP quality indicators; and reflect the true scope of burn practice through future inclusion of outpatient data, we will need to have adequately supported burn registries. It is imperative that we support both the manpower to collect this data completely and continue to be thoughtful about the data that is collected if the NBR continues to serve as the single best resource for health care planners within our institutions and our governments. This commitment is labor and cost intensive, but highlights and demonstrates our ability to not only sustain life, but optimize quality of life following burn injury. 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.

Michael J. Mosier, MD, FACS, FCCMChair, ABA NBR Advisory Committee

Introduction

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The 2017 National Burn Repository Annual Report reviewed the combined data set of acute burn admissions for the time period between 2008 and 2017. Key findings included the following:

1. 101 hospitals from 37 states, and the District of Columbia, contributed to this report, totaling 212,820 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 comprising 23.5% of the total burns and the adult age group from ages 20 to 59 years, which makes up 55% of burns. Patients age 60 or older represented 15% of the cases.

3. More than 67% 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 3.1% and 5.6% for fire/flame injuries.

4. The two most common etiologies were fire/flame and scalds, accounting for 76% of cases reported. Scald injuries were most prevalent in children under 5, while fire/flame injuries dominated the remaining age categories. 5.4% percent of cases did not designate an etiology of injury.

5. Seventy four percent of the burn injuries with a known place of occurrence were reported to have occurred in the home. Nearly 95% of cases with known circumstances of injury were identified as accidents, with nearly 13% of these reported as work-related. Just over 2% of cases were suspected abuse and 1% was self-inflicted.

6. During the ten-year period from 2008 through 2017, the average length of stay for females declined from 9.4 days to 7.3 days, while that for males declined less significantly from 9.5 to 8.5 days. The mortality rate for females declined from 3.9% to 2.7% and 3.4% to 2.6% 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 4.7% of fire/flame-injured patients. The frequency of pneumonia and respiratory failure was much 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 10% TBSA, total charges for surviving patients averaged $269,523 and charges for non-survivors averaged $361,342.

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 2008-2017. 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 1Analysis of Contributing Hospitals

2©American Burn Association, National Burn Repository® 2017. Version 13.0. All Rights Reserved Worldwide.

Analysis of Contributing Hospitals

BURN CENTER LOCATION AND PARTICIPATION BY REGION

MIDWEST – Minnesota, North Dakota, South Dakota, Nebraska, Kansas, Wisconsin, Iowa, Illionois, Missouri. EASTERN GREAT LAKES – Michigan, Indiana, Ohio. SOUTHERN – Oklahoma, Texas, Arkansas, Louisiana, Kentucky , Tennessee, Mississippi, Alabama, West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida. NORTHEAST – Maine, New Hampshire, Vermont, New York, Massachusetts, Connecticut , Rhode Island, Pennsylvania, New Jersey, Delaware, Maryland. WESTERN – Montana, Wyoming, Colorado, New Mexico, Idaho, Utah, Arizona, Washington, Oregon, Nevada, California, Hawaii, Alaska.

*ABA Burn Care Resource Directory, Edition March 2018** ABA Verified Burn Centers, March 2018

3

2

1

Have burn centers which have contributed to the NBR between 2008 to 2017

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. Sixty-six of the reporting centers are ABA verified. 75% of burn centers in the U.S. submitted data. The south had the largest number of participating centers.

4

{

Figure

1

{

Table

1

6ANALYSIS OF

CANADIAN AND INTL. RECORDS

5HOSPITAL

COMPARISONS

4ANALYSIS BY AGE

ETIOLOGY

3ANALYSIS BY AGE GROUP

2ANALYSIS OF ALL

U.S. RECORDS

1ANALYSIS OF

CONTRIBUTING HOSPITALS

STATES THAT SUBMITTED TO THE NBR, 2008 TO 2017

Region U.S. Burn Care Facilities* U.S. Facilities in the

Annual ReportABA U.S.

Verified Centers**

ABA U.S. Verified Centers in the Annual Report

Northeast 30 21 14 14Midwest 22 17 11 11

Eastern Great Lakes 17 13 10 10Southern 38 28 16 16Western 27 22 15 15

Total 134 101 66 66


60,000


20,000

50,000

10,000

20,000

30,000

40,000

VOLUME OF RECORD SUBMISSION BY GEOGRAPHIC REGION{

Figure

2

Num

ber

of C

ases

5,000

10,000

15,000

25,000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Num

ber

of C

ases

ARRIVAL/ADMISSION YEAR, ACUTE BURN ADMISSIONS {

Figure

3 Before 20162016-2017

Year of Admission42,402 records were submitted in 2016-17 for this report

212,820 records are included in this report

Northeast

52,540

MIdwest

25,834

Southern

64,729

Eastern Great Lakes

23,066

Western

46,651

During the 2016-2017 calls for data, 42,402 records were submitted by 81 U.S. burn centers. The U.S. focused sections of the report contain 212,820 records.

In a change from the last report the South had the most NBR entries with a total of 64,729 up from 53,629. The East followed with 52,540. These data are not surprising as these regions have the largest number of burn centers by region.

Record Submission

6ANALYSIS OF


5HOSPITAL

COMPARISONS

4ANALYSIS BY AGE

ETIOLOGY


2ANALYSIS OF ALL

U.S. RECORDS

1ANALYSIS OF



120,000

100,000

80,000

80,000


100,000

60,000

40,000

20,000

300-399 beds

100-199 beds

400-499 beds

50-99 beds

Num

ber

of C

ases

Hospital Bed Size

CONTRIBUTING U.S. HOSPITALS BY HOSPITAL BED SIZE CATEGORY {

Figure

4

60,000

40,000

20,000

Army Church Operated

County Hospital District

Investor, Corporation

Other Not-for-Profit

State

Num

ber

of C

ases

CONTRIBUTING U.S. HOSPITALS BY HOSPITAL OWNERSHIP TYPE{

Figure

5

The majority of records submitted to the NBR report come from centers at “Other not for profit” hospitals, representing 52.5% of records. “State” (or government run) hospitals were the second most common group, at 16.9% 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 51.9% of total entries. Hospitals in the 400-499 bed range are second with 19.1% of entries.

Ownership Type

500 or more beds

6ANALYSIS OF


5HOSPITAL

COMPARISONS

4ANALYSIS BY AGE

ETIOLOGY


2ANALYSIS OF ALL

U.S. RECORDS

1ANALYSIS OF


200-299 beds

25-49 beds


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COMPARISONS

4ANALYSIS BY AGE

ETIOLOGY


2ANALYSIS OF ALL

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1ANALYSIS OF


12Analysis of All U.S. Records


Analysis of All U.S. Records

AGE GROUP BY GENDER {

Figure

6

10,000

5,000

20,000

25,000

15,000

30,000

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+

Num

ber

of C

ases

Female

Male

Age Categories

Total N=212,820 (Excluding 0 Unknown/Missing)

}AGE GROUP BY GENDER Table2

Figure 6 and Table 2 show the distribution of burn cases from 2008 to 2017 divided into age and gender distribution. With the exception of patients who are 80 years or older, men make up the majority of burns in each age group. There a bimodal distribution with a point of high prevalence within the adult and pediatric age groups. Within the pediatric age group 32% of the burns occur between ages 5 to 15.9. Within the adult age groups the age group with the highest prevalent is between 20 – 29.9 years. Over all the majority of burns occur between ages 20 to 60 years which constitute 50% of all reported burns.

6ANALYSIS OF


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ETIOLOGY


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GenderTotal Female Male

Age Categories Cases Column N % Cases Column N % Cases Column N %0-.9 4,507 2.1 1,811 2.6 2,696 1.9

1-1.9 14,109 6.6 5,666 8.1 8,443 5.92-4.9 14,779 6.9 6,562 9.4 8,217 5.8

5-15.9 21,379 10.0 8,176 11.7 13,203 9.216-19.9 10,466 4.9 2,973 4.2 7,493 5.220-29.9 32,758 15.4 8,781 12.5 23,977 16.830-39.9 27,766 13.0 7,812 11.2 19,954 14.040-49.9 28,283 13.3 8,229 11.8 20,054 14.050-59.9 27,414 12.9 8,146 11.6 19,268 13.560-69.9 16,878 7.9 5,731 8.2 11,147 7.870-79.9 8,792 4.1 3,416 4.9 5,376 3.8

80 and over 5,689 2.7 2,720 3.9 2,969 2.1Subtotal 212,820 100.0 70,023 100.0 142,797 100.0Missing 0 0.0 0 0.0 0 0.0Total 212,820 100.0 70,023 100.0 142,797 100.0


Analysis

5,000

Non-White

White

10,000

15,000

20,000

25,000

RACE/ETHNICITY {

Table

3

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+

Num

ber

of C

ases

Age Categories

Total N=205,068 (Excluding 7,752 Unknown/Missing)

RACE/ETHNICITY{

Figure

7


Figure 7 and table 3 depict the distribution of patients admitted to burns centers by race based on what is documented in the patient’s chart. The category of unknown was used when no race was identified in the chart. This is 3.6% of total cases which is a decrease of 1% from the prior reporting period.

Figure 8 compares the number of cases of white verses non-white patients in various age categories. In the pediatric population, age 16 and younger, the number of non-white patients is higher than white in each age group range. There has been an increase in the non-white patients compared to white group in the 5 – 16 age group, compared to the last reporting period. 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.

of All U.S. Records

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ETIOLOGY


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Race Cases % of Valid

White 121,475 59.2%

Black 42,474 20.7%

Hispanic 21,997 10.7%

Other 11,966 5.8%

Asian 5,224 2.5%

Native American 1,932 0.9%

Unknown 7,752

Total 212,820

AGE GROUP BY WHITE VERSUS NON-WHITE {

Figure

8


100,000

120,000

140,000

80,000

60,000

40,000

20,000

.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) {

Figure

9

Num

ber

of C

ases

% TBSA (Full+ Partial Thickness)


LIVED/DIED BY BURN GROUP SIZE (%TBSA){Table4


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. 12% of reported patient were either a pure inhalation injury, did not have a burn, or did not have a TBSA recorded. Of the patients with an injury to the skin reported, 77% of the total 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.


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Lived Died%TBSA Cases Cases Mortality Rate0.1 - 9.9 143,396 840 0.610 - 19.9 25,002 673 2.620 - 29.9 6,861 615 8.230 - 39.9 2,864 569 16.640 - 49.9 1,499 576 27.850 - 59.9 780 473 37.760 - 69.9 458 431 48.570 - 79.9 251 343 57.780 - 89.9 123 418 77.3

> 90 79 535 87.1Subtotal 181,313 5,473 2.9

Missing or 0% 25,176 858 3.3TOTAL 206,489 6,331 3.0


2,000

6,000

10,000

12,000

14,000

8,000

4,000

Num

ber

of C

ases

Fire/Flame

Scald

Age CategoriesTotal N=178,492 (Excluding 34,328 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{

Figure

10 ETIOLOGY {

Table

5


Figure 10 and Table 5 show the distribution of burns by etiology. The figure shows only cases that had a reported etiology. As shown in the table, only 5% of records did not include an etiology. The two most common causes of burns, fire/flame and scald, make up 78% of burn etiologies.

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. The increase number of scald burns in the 5- 16 years groups is new 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


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ETIOLOGY


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Etiology No. of Cases % of Valid

Fire/Flame 83,279 41.4%

Scald 69,792 34.7%Contact with Hot

Object 19,122 9.5%

Burn, Unspecified 8,419 4.2%

Chemical 6,873 3.4%

Electrical 6,299 3.1%

Other, Non Burn 4,374 2.2%

Inhalation Only 2,037 1.0%

Skin Disease 627 0.3%

Radiation 431 0.2%

Unknown 11,567

Total 212,820

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

Figure

11


PLACE OF OCCURRENCE - E849 CODE{

Figure

12 PLACE OF OCCURRENCE - E849 CODE {

Table

6


CIRCUMSTANCE OF INJURY{

Figure

13 CIRCUMSTANCE OF INJURY {

Table

7


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 74.1% of burn injuries cared for in reporting burn centers. The table shows that 12% 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 =6.3%), the majority of burns (96%) admitted to burn centers were considered accidental. Non-accidental burns which result from arson, assault, abuse or self-inflicted injuries only constitute 3.2% of burns. The figure does not include the burns listed as unknown in the table.


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Place of Occurrence Cases % of Valid

Home 138,547 74.1%

Industrial 13,053 7.0%

Other Specified Place 8,907 4.8%

Recreation and Sport 8,785 4.7%

Street/Highway 8,728 4.7%

Public Building 5,815 3.1%

Residential Institution 1,673 0.9%

Farm 1,315 0.7%

Mine/Quarry 112 0.1%

Unspecified 25,885

Total 212,820

Circumstance of Injury Cases % of ValidAccident, Non-Work

Related 151,623 74.2%

Accident, Work Related 25,581 12.5%

Accident, Recreation 9,649 4.7%

Accident, Unspecified 5,515 2.7%

Other 4,852 2.4%

Suspected Assault/Abuse 2,731 1.3%

Suspected Self Inflicted 2,164 1.1%

Suspected Child Abuse 1,809 0.9%

Suspected Arson 293 0.1%

Unknown 8,603

Total 212,820


Total N=212,820

}HOSPITAL DISPOSITION Figure14

HOSPITAL DISPOSITION{

Table

8

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. The overall mortality rate from 2008 to 2017 is 2.9% for patients cared for in a verified reporting burn centers.

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 (87.2%) were discharged to home. Only 6.3% of cases required discharge to an advanced care facility, like inpatient rehabilitation facility, skilled nursing facility, or extended care facility.


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Discharge Disposition Cases Percent

Discharged Home, No Home Health 170,623 80.2

Discharged Home, With Home Health 14,993 7.0

Death 6,331 3.0

Rehabilitation Facility 6,096 2.9

Nursing Home/Skilled Nursing Facility (Snf) 5,556 2.6

Discharged to Extended Care Facility (Ecf) 1,642 0.8

Transfer to Another Hospital 1,381 0.6

Transfer to Another Service 1,038 0.5

Psychiatry, Inpatient 1,006 0.5

Unable to Complete Treatment 879 0.4

Jail or Prison 878 0.4

Discharged to Alternate Caregiver 860 0.4

Discharged to Foster Care 651 0.3

Left Against Medical Device 351 0.2

Transfer to an Acute Burn Facility 311 0.1

Transferred to Hospice Care 127 0.1

Discharge to Street 97 0.0

Total 212,820 100.0


10.0

9.0

8.0

7.0

6.0

5.0

4.0

3.0

2.0

1.0

2008

AVERAGE HOSPITAL LENGTH OF STAY BY GENDER, 2008-2017 {

Figure

15

2009

2010

2011

2012

2013

2014

2015

2016

2017

Ave

rage

Len

gth

of S

tay

Year of AdmissionTotal N=212,820

Female

Male

2%

1.5%

1%

.5%

3%

2.5%

4%

3.5%

MORTALITY RATE BY GENDER, 2008-2017 {

Figure

16

Mor

talit

y R

ate

Year of AdmissionTotal N=212,820

Female

Male

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017


6ANALYSIS OF


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ETIOLOGY


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2ANALYSIS OF ALL

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Female Male

Admission Year Mean +/- SEMMean +/-

SEM2008 9.44+/-0.2 9.50+/-0.1

2009 9.30+/-0.1 8.55+/-0.1

2010 8.53+/-0.1 8.57+/-0.1

2011 8.5+/-0.1 8.8+/-0.1

2012 8.2+/-0.1 8.6+/-0.1

2013 8.0+/-0.1 8.8+/-0.1

2014 8.3+/-0.1 8.5+/-0.1

2015 7.8+/-0.2 9.0+/-0.2

2016 7.9+/-0.1 8.0+/-0.1

2017 7.3+/-0.5 8.5+/-0.5

Mortality Rate

Admission Year Female Male

2008 3.9 3.4

2009 4.0 3.0

2010 3.4 2.9

2011 3.4 2.9

2012 3.5 2.8

2013 3.0 2.6

2014 3.2 2.9

2015 2.5 2.7

2016 3.2 2.3

2017 2.7 2.6

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 seven years of the reporting period (2011 to 2017) there has been a shift to increased length of stay for men. In both men and women, there is a trend toward decreased length of stay over the ten year reporting period. The overall decrease is by 2 days for women and 1 day for men.

Figure 16 depicts the mortality rate (case fatality) in patients admitted to verified burn centers reported to the NBR by gender and year. Case fatality continues to be greater in women (3.3%) compared to men (2.8%) through the decade. Women have a higher mortality rate then men in every reporting year except 2015. The overall mortality rate has decreased for both men and women by 0.8% and 1.2% respectively.


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


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.


6ANALYSIS OF


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ETIOLOGY


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Burn Size (% TBSA)

Age Group 0.1 - 9.9 10 - 19.9 20 - 29.9 30 - 39.9 40 - 49.9 50 - 59.9 60 - 69.970 - 79.9

80 - 89.9 > 90 Total

Birth - .9 0.0 0.3 2.4 16.7 15.8 14.3 50.0 0.0 0.0 0.0 0.5

Died/Total 1/2775 1/379 2/85 6/36 3/19 1/7 1/2 0/3 0/1 0/0 15/3307

1 - 1.9 0.0 0.2 0.4 0.0 4.8 18.8 26.7 0.0 33.3 66.7 0.1

Died/Total 0/10932 3/1683 1/263 0/90 2/42 3/16 4/15 0/7 1/3 2/3 16/13054

2 - 4.9 0.1 0.4 0.8 3.6 6.5 13.3 27.3 20.0 52.9 64.7 0.6

Died/Total 13/10874 7/1627 3/384 7/196 7/107 8/60 12/44 3/15 9/17 11/17 80/13341

5 - 15.9 0.1 0.4 0.8 0.7 6.3 6.3 12.2 16.7 46.3 71.4 0.5

Died/Total 13/15409 9/2313 5/597 2/300 12/189 6/96 9/74 9/54 19/41 15/21 99/19094

16 - 19.9 0.2 0.3 1.4 2.7 3.4 14.8 17.6 26.3 53.3 68.4 0.9

Died/Total 12/7313 4/1235 5/358 4/149 3/88 9/61 6/34 5/19 8/15 26/38 82/9310

20 - 29.9 0.1 0.6 1.7 3.6 8.6 12.4 26.3 42.3 63.0 82.5 1.2

Died/Total 30/22379 24/4019 20/1204 18/500 25/291 19/153 35/133 44/104 51/81 85/103 351/28967

30 - 39.9 0.2 1.0 2.3 7.3 9.6 15.2 37.0 44.9 72.3 87.5 1.8

Died/Total 43/18270 33/3432 25/1099 37/509 28/291 25/164 50/135 40/89 60/83 91/104 432/24176

40 - 49.9 0.4 1.1 4.0 8.7 20.8 34.0 47.4 65.7 84.0 92.5 2.4

Died/Total 71/18496 40/3566 43/1088 44/507 60/289 65/191 63/133 44/67 79/94 86/93 595/24524

50 - 59.9 0.8 2.8 9.0 19.8 37.4 47.6 60.5 74.5 89.0 93.3 4.1

Died/Total 135/17959 96/3370 94/1046 93/469 120/321 100/210 75/124 79/106 81/91 97/104 970/23800

60 - 69.9 1.6 5.7 16.3 37.3 59.7 73.2 84.2 90.9 98.0 91.2 6.8

Died/Total 175/10955 121/2123 112/689 117/314 120/201 109/149 80/95 60/66 50/51 52/57 996/14700

70 - 79.9 3.0 12.1 33.2 59.0 80.7 81.8 98.2 85.7 88.9 92.7 11.6

Died/Total 164/5520 136/1128 127/383 128/217 113/140 63/77 56/57 24/28 32/36 38/41 881/762780 or

Greater 5.5 24.9 63.6 77.4 85.6 94.2 93.0 97.2 100.0 97.0 19.6

Died/Total 183/3354 199/800 178/280 113/146 83/97 65/69 40/43 35/36 28/28 32/33 956/4886

Total 0.6 2.6 8.2 16.6 27.8 37.7 48.5 57.7 77.3 87.1 2.9

Died/Total 840/144236 673/25675 615/7476 569/3433 576/2075 473/1253 431/889 343/594 418/541 535/614 5473/186786


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

Arryth

mia

Bacter

emia

Cardi

ac Arr

est

Cellul

itis

Pneum

onia

Renal F

ailure

Respir

atory

Failur

e

Septice

mia

Urina

ry Tra

ct

Infectio

n

Wound

Infect

ion

}COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY RELEVANT COMPLICATIONS Figure17

Num

ber

of C

ases

Total N=208,654 (Excluding 4,166 cases from non ABA burn registry software centers)

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

Figure

18

Num

ber

of C

ases

4+ Ventilator Days


0 Ventilator Days

1-3 Ventilator Days

Arryth

mia

Bacter

emia

Cardi

ac Arr

est

Cellul

itis

Pneum

onia

Renal F

ailure

Respir

atory

Failur

e

Septice

mia

Urina

ry Tra

ct

Infectio

n

Wound

Infect

ion

Figure 17 shows the reported complications from patients admitted to verified burn centers. Pneumonia continues to be the most prevalent complication. 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 several complications with duration of mechanical ventilation. Except for cellulitis, wound infections and urinary tract infection, the prevalence 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.


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20%

40%

COMPLICATION RATE FOR AGE CATEGORIES BY DAYS ON VENTILATOR {

Figure

19

60%

80%

% o

f Pat

ient

s w

ith

a C

linic

ally

R

elat

ed C

ompl

icat

ion

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 {Table

10


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. For patients who did not require mechanical ventilation, the overall complication rate is low (5.5%), 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 60%. There is no missing data for this reporting category.


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ETIOLOGY


1ANALYSIS OF


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U.S. RECORDS

Ventilator Days0 Ventilator Days 1-3 Ventilator Days 4 or More Ventilator Days Total

Complication Complication Complication ComplicationAge Categories No Yes No Yes No Yes No Yes

0-.9 4,031 166 77 41 49 119 4,157 3261-1.9 13,276 307 107 32 106 105 13,489 4442-4.9 13,683 374 154 56 207 166 14,044 596

5-15.9 19,403 461 447 107 399 362 20,249 93016-19.9 9,142 281 381 89 154 213 9,677 58320-29.9 27,506 1,201 1,497 267 618 878 29,621 2,34630-39.9 22,494 1,308 1,384 262 648 1,000 24,526 2,57040-49.9 22,249 1,660 1,462 336 799 1,152 24,510 3,14850-59.9 20,542 1,785 1,628 433 910 1,511 23,080 3,72960-69.9 11,878 1,237 1,201 363 701 1,120 13,780 2,72070-79.9 5,829 738 701 227 406 671 6,936 1,636

80 and over 3,500 735 460 201 243 418 4,203 1,354Subtotal 173,533 10,253 9,499 2,414 5,240 7,715 188,272 20,382Missing 0 0 0 0 0 0 0 0Total 173,533 10,253 9,499 2,414 5,240 7,715 188,272 20,382


20%

40%

60%

80%

100%

MORTALITY RATE FOR BAUX SCORE CATEGORIES BY GENDER {

Figure

20

% o

f Pat

ient

s th

at D

ied

BAUX Score (Age + TBSA)Total N=192,893 (Excluding 19,927 Unknown/Missing)

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 {Table

11


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 100. Demonstrating and equilateral relationship does not exist. There was no significant difference between genders.


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Female Male

BAUX Score (Age + TBSA) Lived Died Lived Died

0-9.9 11,917 24 16,429 3310-19.9 7,629 16 11,796 1720-29.9 7,169 22 17,775 3430-39.9 7,088 27 17,833 5040-49.9 6,808 57 16,966 8750-59.9 7,185 88 17,494 13560-69.9 5,668 130 13,188 23170-79.9 3,698 166 7,589 29480-89.9 2,361 211 4,124 37190-99.9 1,200 259 1,817 471

100-109.9 318 296 607 457110-119.9 106 233 243 423120-129.9 55 170 85 388130-139.9 19 119 33 269

140 and Over 18 184 20 393Total 61,239 2,002 125,999 3,653


20%

40%

60%

80%

100%

MORTALITY RATE FOR BAUX SCORE CATEGORIES BY INHALATION INJURY {

Figure

21

% o

f Pat

ient

s th

at D

ied

BAUX Score (Age + TBSA)Total N=183,820 (Excluding 29,000 Unknown/Missing)

No

Yes

NUMBER OF CASES IN BAUX SCORE CATEGORIES BY INHALATION INJURY {Table

12

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 of make up 7.5% 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 with no inhalation injury. For patients with an inhalation injury, a BAUX score between 95 and 100 was associated with case fatality of 50%, without an inhalation injury this rate occurred after the score was greater than 110. The overall mortality rate without an inhalation injury was 1.5% and with an inhalation injury the mortality rate increases to 19%.

.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


6ANALYSIS OF


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4ANALYSIS BY AGE

ETIOLOGY


1ANALYSIS OF


2ANALYSIS OF ALL

U.S. RECORDS

No Inhalation Injury Inhalation Injury

BAUX Score (Age + TBSA) Lived Died Lived Died

0-9.9 27,156 38 380 1810-19.9 18,116 12 435 2120-29.9 22,725 19 846 3030-39.9 22,451 45 1,178 2940-49.9 21,023 70 1,455 6350-59.9 21,505 98 1,965 11260-69.9 16,082 169 1,883 16570-79.9 9,395 236 1,369 20080-89.9 5,374 272 840 26790-99.9 2,456 382 427 307

100-109.9 662 376 216 340110-119.9 226 274 104 348120-129.9 101 216 34 319130-139.9 30 149 17 224

140 and Over 28 218 7 317Total 167,330 2,574 11,156 2,760


MORTALITY RATES FOR MATRIX OF MAIN PREDICTORS{Table13


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 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 increases at the level of 20% TBSA with inhalation injury and above as compared to


PRIMARY INSURANCE PAYOR{Table14

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 (41.5%) were covered by a government-based insurance which is increased from the previous reporting period. In addition, the percentage of uninsured decreased from 15% to 13.8%. Only 6% of the records did not include any insurance information, which decreased by 2% from the previous reporting period. Reporting of this financial data is consistently improving each year.


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Insurance Cases Percent

Government-Medicaid 53,971 25.4

Government-Medicare 25,509 12.0

Other Government 8,906 4.2

Subtotal 88,386 41.5

Private/Commercial Insurance 45,055 21.2

Blue Cross/Blue Shield 14,805 7.0

Private-Foundation or Charity 3,422 1.6


Workers Compensation 17,832 8.4

Auto 863 0.4

Subtotal 18,695 8.8

Uninsured, including Self Pay 29,430 13.8


Unknown 13,027 6.1

Total 212,820 100.0


10

15

5

20

25

30

35

}PERCENT OF PATIENTS UTILIZING SELECT INSURANCE CATEGORIES OVER TIME Figure22

CASE COUNT FOR SELECT INSURANCE CATEGORIES OVER TIME{

Table

15

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% o

f Pat

ient

s (D

oes

not

Sum

to

100%

)

Year of AdmissionTotal N=126,742 (Excluding 86,078 Cases)

Uninsured, including Self Pay Worker’s Comp

Medicaid Medicare

Figure 22 and Table 15 show how the proportions of patients covered by Medicaid, Medicare, Workers’ Compensation, and Self-pay categories have changed over the decade covered by this year’s NBR Report. The rates of each were steady for the first half of the reporting period. There is a new tread since 2013 of decreasing uninsured and increasing Medicare and Medicaid. This could be a indication of the affects of the Affordable Care Act, which was signed in 2010.


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Select Insurance Categories

Medicaid Medicare Uninsured, including self payWorkers

Compensation Total

Year of Admission Cases Row N % Cases Row N % Cases Row N % Cases Row N % Count

2008 3,366 18.9 1,746 9.8 2,483 13.9 1,773 10.0 17,801

2009 4,648 21.8 2,219 10.4 3,156 14.8 1,833 8.6 21,349

2010 5,510 22.7 2,568 10.6 3,808 15.7 1,937 8.0 24,256

2011 5,655 24.0 2,619 11.1 3,516 14.9 2,108 8.9 23,574

2012 5,719 24.3 2,625 11.1 3,689 15.7 2,041 8.7 23,563

2013 6,281 25.0 3,051 12.2 3,904 15.6 2,258 9.0 25,096

2014 6,550 27.7 3,229 13.7 3,032 12.8 2,084 8.8 23,644

2015 6,374 29.8 2,890 13.5 2,578 12.1 1,541 7.2 21,393

2016 6,701 30.7 3,037 13.9 2,336 10.7 1,523 7.0 21,856

2017 3,167 30.8 1,525 14.8 928 9.0 734 7.1 10,288

Total 53,971 25.4 25,509 12.0 29,430 13.8 17,832 8.4 212,820


HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP{

Table

16

Total N=212,820

HOSPITAL CHARGES: LIVED/DIED BY BURN SIZE GROUP{

Table

17

Total N=97,610 (Excluding 115,210 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 is around 1/3 of the cost of non-survivors, $102,092 verses $337,896.


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Total Lived Died

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

0.1 - 9.9 144,236 5.5+/-0.0 143,396 5.4+/-0.0 840 14.3+/-0.710 - 19.9 25,675 13.3+/-0.1 25,002 13.2+/-0.1 673 17.6+/-0.820 - 29.9 7,476 24.3+/-0.2 6,861 24.8+/-0.2 615 19.2+/-0.930 - 39.9 3,433 34.0+/-0.5 2,864 37.1+/-0.5 569 18.4+/-1.040 - 49.9 2,075 39.5+/-0.7 1,499 47.5+/-0.8 576 18.7+/-1.250 - 59.9 1,253 45.3+/-1.3 780 62.1+/-1.5 473 17.6+/-1.760 - 69.9 889 46.3+/-1.6 458 71.7+/-2.3 431 19.3+/-1.670 - 79.9 594 41.3+/-2.2 251 78.1+/-3.7 343 14.4+/-1.680 - 89.9 541 28.1+/-2.1 123 82.2+/-6.2 418 12.2+/-1.3

> 90 614 13.2+/-1.7 79 59.6+/-10.0 535 6.3+/-1.0Subtotal 186,786 8.9+/-0.0 181,313 8.7+/-0.0 5,473 15.9+/-0.3

Missing or 0% 26,034 6.1+/-0.1 25,176 5.9+/-0.1 858 10.7+/-0.6TOTAL 212,820 206,489 6,331

Total Lived Died%TBSA Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM0.1 - 9.9 65,711 $53923+/-471 65,294 $52951+/-462 417 $206162+/-1508410 - 19.9 12,999 $144933+/-2072 12,677 $140821+/-2031 322 $306826+/-2283120 - 29.9 3,815 $326153+/-7082 3,501 $320893+/-7197 314 $384805+/-3090030 - 39.9 1,714 $529199+/-15643 1,433 $552032+/-17236 281 $412756+/-3641640 - 49.9 1,028 $680027+/-23953 732 $769094+/-29606 296 $459766+/-3653150 - 59.9 594 $852681+/-40985 366 $1123300+/-55529 228 $418265+/-4608860 - 69.9 438 $828155+/-47071 220 $1198770+/-70867 218 $454140+/-5066470 - 79.9 311 $663402+/-54518 120 $1144082+/-110161 191 $361404+/-4332380 - 89.9 269 $480981+/-52753 65 $1004013+/-133840 204 $314328+/-49789

> 90 339 $213718+/-30215 50 $500960+/-130048 289 $164022+/-26474Subtotal 87,218 $109554+/-964 84,458 $102092+/-919 2,760 $337896+/-10848

Missing or 0% 10,392 $58741+/-1599 10,077 $57093+/-1612 315 $111445+/-10633TOTAL 97,610 $104145+/-879 94,535 $97296+/-840 3,075 $314698+/-9875


}HOSPITAL CHARGES: LIVED/DIED BY TOP 20 MS-DRGS Table18

Total N=97,610 (Excluding 115,210 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.


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Total Lived Died

Top 20 MS-DRG Codes No. of Cases Mean +/- SEMNo. of Cases Mean +/- SEM

No. of

CasesMean +/- SEM

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

maj O.R.979 $1072440+30169 796 $1103592+34022 183 $936938+63625

208 Respiratory system diagnosis w ventilator support


}DAYS PER %TBSA AND CHARGES PER DAY BY AGE GROUPS AND SURVIVAL Table19

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.


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Cases Days Hospital Days / %TBSA Hospital ChargesHospital Charges /

Hospital DaysAge Groups Lived Died Lived Died Lived Died Lived Died Lived Died

Birth - 0.9 1,206 2 5.21 10.50 1.69 0.35 $35,611 $151,928 $6,481 $14,610

+/- SEM 0.25 0.50 0.08 0.02 $2,057 $23,680 $164 $2,951

1 - 1.9 5,119 4 5.37 7.00 1.66 0.22 $37,438 $139,872 $7,263 $34,964

+/- SEM 0.72 3.11 0.15 0.15 $1,198 $52,769 $113 $15,585

2 - 4.9 5,223 34 6.31 11.97 1.71 1.08 $52,908 $217,679 $7,730 $33,015

+/- SEM 0.18 3.47 0.07 0.41 $1,855 $52,195 $180 $11,383

5 - 15.9 7,686 49 7.24 15.73 1.84 0.46 $71,517 $464,183 $8,982 $41,947

+/- SEM 0.16 4.83 0.08 0.13 $2,411 $126,473 $508 $4,431

16 - 19.9 4,190 33 7.12 14.18 1.78 0.38 $73,398 $416,766 $9,021 $36,792

+/- SEM 0.21 5.88 0.05 0.15 $3,281 $143,774 $252 $4,223

20 - 29.9 14,050 166 8.65 14.89 2.13 0.54 $98,962 $402,999 $9,754 $37,533

+/- SEM 0.14 1.97 0.05 0.10 $2,422 $54,547 $159 $3,387

30 - 39.9 11,753 237 9.75 15.91 2.51 0.43 $108,672 $440,368 $10,139 $39,136

+/- SEM 0.20 1.64 0.09 0.05 $2,686 $44,714 $280 $3,583

40 - 49.9 11,660 298 10.57 15.15 3.02 0.92 $116,057 $387,879 $10,279 $32,202

+/- SEM 0.16 1.61 0.13 0.16 $2,710 $36,107 $221 $2,246

50 - 59.9 11,348 477 11.94 19.47 3.36 1.66 $131,483 $432,827 $10,274 $28,364

+/- SEM 0.20 1.41 0.08 0.33 $2,890 $30,330 $379 $1,019

60 - 69.9 6,827 514 12.71 15.70 3.78 1.71 $142,222 $338,815 $10,261 $27,162

+/- SEM 0.22 1.00 0.11 0.48 $3,717 $23,060 $197 $1,028

70 - 79.9 3,402 466 14.34 13.27 3.90 1.23 $145,292 $270,039 $10,144 $23,261

+/- SEM 1.12 0.90 0.24 0.14 $4,885 $20,582 $162 $1,036

80 or greater 1,994 480 13.21 10.81 3.94 1.07 $138,540 $196,939 $10,267 $20,925

+/- SEM 0.33 0.65 0.20 0.14 $5,678 $16,474 $501 $1,450

Total 84,458 2,760 9.58 14.92 2.61 1.19 $102,093 $337,896 $9,590 $28,274

+/- SEM 0.09 0.46 0.03 0.11 $919 $10,848 $93 $630

Analysis by Age Group3

This year encompasses another decade of collected data ranging from 2008 to 2017. 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.

As in previous years, the most frequently reported procedures continue to be excisional debridement of wound, infection, or burn (ICD-9-CM 86.22) and other skin graft to other site (ICD-9-CM 86.69). This is true of all age groups, and makes good intuitive sense, given that early excision and grafting of burns remains a durable standard of care. Another absolutely expected finding is the progression of mortality as a function of increasing age.


Analysis by Age Group Birth to .9

RACE/ETHNICITY {

Table

20


ETIOLOGY {

Table

21


ETIOLOGY{

Figure

24

RACE/ETHNICITY{

Figure

23

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2ANALYSIS OF ALL

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Race Cases %Valid

White 1,675 42.9%

Black 1,025 26.3%

Hispanic 649 16.6%

Other 312 8.0%

Asian 195 5.0%

Native American 47 1.2%

Unknown 604

TOTAL 4,507

Etiology Cases % Valid

Scald 2,227 51.0%

Burn, Unspecified 1,012 23.2%

Contact with Hot Object 839 19.2%

Fire/Flame 159 3.6%

Chemical 46 1.1%

Electrical 16 0.4%

Inhalation Only 13 0.3%

Radiation 13 0.3%

Burn Subtotal 4,325 99.0%

Other, Non Burn 36 0.8%

Skin Disease 6 0.1%

Non-Burn Subtotal 42 1.0%

Unknown 140

TOTAL 4,507



HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY{Table

22

Total N=4,507

TOP TEN COMPLICATIONS{

Table

23

Total N=4,483 (Excluding 24 cases from non ABA burn registry software centers)

Total N=4,507

TOP TEN PROCEDURES{

Table

24

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4ANALYSIS BY AGE

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Total Lived Died

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

No 4,313 5.30+0.14 4,270 5.23+0.13 43 11.60+3.10

Yes 86 11.01+2.09 82 11.01+2.16 4 11.00+8.71

Subtotal 4,399 4,352 47

Missing 108 4.90+0.83 101 4.93+0.88 7 4.57+2.32

TOTAL 4,507 4,453 54

Top Ten Procedures Codes Count Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn 1,093 13.3

93.57 Application of other wound dressing 1,093 13.3

86.28 Nonexcisional debridement of wound, infection or burn 845 10.3

86.69 Other skin graft to other sites 473 5.8

38.93 Venous catheterization, not elsewhere classified 325 4.0

86.59 Closure of skin and subcutaneous tissue of other sites 275 3.3

86.66 Homograft to skin 261 3.2

86.65 Heterograft to skin 207 2.5

99.99 Other miscellaneous procedures 163 2.0

34.04 Insertion of intercostal catheter for drainage 140 1.7

Total Procedures 8225

Top Ten Complications Count Percent of All ComplicationsPercent of Patients with Complication

Pneumonia 65 8.6 1.4Urinary tract infection 61 8.0 1.4

Other hematologic 53 7.0 1.2Respiratory failure 52 6.8 1.2

ARDS 29 3.8 0.6Extubation, unintentional 28 3.7 0.6

Bacteremia 26 3.4 0.6Shock 26 3.4 0.6

Wound infection (non-surgical) 24 3.2 0.5Arrythmia 22 2.9 0.5

Total Complications 760


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

Table

25

Total N=4,507

Total N=2,468

HOSPITAL DAYS BY BURN GROUP SIZE (% TBSA) {

Table

26

Total N=4,507

MEAN CHARGES FOR TOP FIVE MS-DRGS{

Table

27


Lived Died

%TBSA Cases Cases Mortality Rate

0.1 - 9.9 2,774 1 0.0

10 - 19.9 378 1 0.3

20 - 29.9 83 2 2.4

30 - 39.9 30 6 16.7

40 - 49.9 16 3 15.8

50 - 59.9 6 1 14.3

60 - 69.9 1 1 50.0

70 - 79.9 3 0 0.0

80 - 89.9 1 0 0.0

> 90 0 0

Subtotal 3,292 15 0.5

Missing or 0% 1,161 39 3.3

TOTAL 4,453 54 1.2

%TBSA Cases Mean +/- SEM

0.1 - 9.9 2,775 3.7+0.0

10 - 19.9 379 10.1+0.5

20 - 29.9 85 19.5+1.8

30 - 39.9 36 25.7+4.6

40 - 49.9 19 26.9+6.8

50 - 59.9 7 64.1+22.0

60 - 69.9 2 15+14.0

70 - 79.9 3 22.6+2.6

80 - 89.9 1 2+0.0

> 90 0 0+0.0

Subtotal 3,307 5.3+0.1

Missing or 0% 1,200 5.4+0.2

TOTAL 4,507 5.4+0.1

MS-DRG Code Cases Cases with Valid Charges Mean +/- SEM

935 Non-extensive burns 2,028 859 32126+/-4501

934 Full thickness burn w/o skin grft or inhal inj 137 78 81977+/-8674

929 Full thickness burn w skin graft or inhal inj w/o CC/MCC 198 66 128057+/-16138

928 Full thickness burn w skin graft or inhal inj w CC/MCC 86 41 28936+/-7784

923 Other injury, poisoning & toxic effect diag w/o MCC 19 16 18678+/-4598

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Esti

mat

ed M

ean

Hos

pita

l Cha

rges

wit

h 95

% C

l

Etiology Categories with Greater than 100 Valid Charge Cases

Mea

n H

ospi

tal D

ays

wit

h 95

% C

l

Admission Year

Etiology

To

national burn repository 2017 update2017 update report of data from 2008-2017 american burn...

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