2014 nbr annual report

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American Burn Association, National Burn Repository 2014. Version 10.0. All Rights Reserved Worldwide.

311 S. Wacker Drive Suite 4150 Chicago, IL 60606 312-642-9260 www.ameriburn.org

2014NATIONALBURNREPOSITORYREPORT OF DATA FROM 2004-2013


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National BurnRepository

2014 ReportDataset Version 10.0

FIRE/FLAME INJURIES REPRESENT 43% OF THE CASES IN

THIS REPORT WITH A KNOWN ETIOLOGY

SCALD INJURIES REPRESENT 34% OF THE CASES IN THIS

REPORT WITH A KNOWN ETIOLOGY

CONTACT WITH HOT OBJECT INJURIES REPRESENT 9%

OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

ELECTRICAL INJURIES REPRESENT 4% OF THE CASES IN THIS


CHEMICAL INJURIES REPRESENT 3% OF THE CASES IN THIS


American Burn Association, National Burn Repository 2014. Version 10.0. All Rights Reserved Worldwide.


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National Burn Repository 2014 Report

Christopher W. Lentz, MD, FACS, FCCMNBR Committee Chair

Paul Silverstein Burn CenterINTEGRIS Baptist Medical Center

Oklahoma City, Oklahoma

Nicole Bernal, MDUniversity of California IrvineUCI Regional Burn Center

Orange, California

Iris Faraklas, RN, BSNUniversity of Utah Hospital Burn Center

Salt Lake City, Utah

Steven A. Kahn, MD

Vanderbilt University Medical CenterNashville, Tennessee

M. Anwarul Huq Mian, MD, PhD, MPHSoutheast Pain Management

Augusta, Georgia

Michael J. Mosier, MD, FACSLoyola University Medical Center

Maywood, Illinois

John Myers, PhDUniversity of Louisville

Louisville, Kentucky

Bruce M. Potenza, MD, FACSUC San Diego Regional Burn Center

UC San Diego School of MedicineSan Diego, California

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

Crozer Chester Medical CenterUpland, Pennsylvania

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

William Randolph Hearst Burn CenterNew York, New York

Margaret A. Finocchiaro, BA,Ad HocThe Nathan Speare Regional Burn Treatment Center

Crozer Chester Medical CenterUpland, Pennsylvania

Matthew B. Klein, MD, MS, FACS, Ex OfficioSanta Clara Valley Medical Center

San Jose, California

Sidney F. Miller, MD, FACS,Ad HocThe Ohio State University Wexner Medical Center

Columbus, Ohio

American Burn Association NBR Advisory Committee

American Burn Association Staff

John A. Krichbaum, JDCEO and Executive Director

Susan M. Browning, MPHDeputy CEO and Chief Operating Officer

Maureen T. Kiley, BBAABA Director

Bart D. Phillips, MS, Senior ConsultantE-B Research, LLCMinneapolis, MN


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The American Burn Association wishes to thank the members of the National Burn Repository Advisory Committee:Christopher Lentz, Cynthia Reigart, Iris Faraklas, Michael Mosier, Bruce Potenza, Nicole Bernal, Margaret Finocchiaro,Steven Kahn, M. Anwarul Huq Mian and John Myers, for their commitment, dedication and expedited review ofthis years report. Their combined efforts compiled insightful analysis of these data allowing publication for the ABAmembership to receive this report for the 46th Annual Meeting in Boston, Massachusetts.

The ABA is also grateful for the work of Bart Phillips, Senior Consultant of E-B Research, and his dedicated staff.Their compilation, organization and presentation of this data facilitates its utility into understanding the demographicsof thermal injury.

The NBR Advisory Committee would like to express its gratitude to the ABA Central Office which providesthe support and infrastructure to ensure that this resource is completed in a timely and effective fashion. We are alsothankful for the exceptional work of Maureen Kiley, ABA Director, who ensures fluid communication amongst all whocontribute to this report. We extend our gratitude to the previous Chairmen, Sidney Miller and Palmer Bessey, for theirvision and continued mentorship to this Committee.

Finally, the NBR Advisory Committee and the American Burn Association Board of Trustees would like to personallythank the contributing American and International burn centers and registrars for maintaining an accurate registry andsubmitting their data. Without you, this report would not exist.

Acknowledgements


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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, 2004 to 2013 ......................................................................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 ..................................................................................................................................9

Figure 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, 2004 to 2013 .............................................................. 14Figure 16: Mortality Rate by Gender, 2004 to 2013 ........................................................................................14

Table 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 ...............................................................................23

Table 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 ProceduresTable 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 Cases

Age 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 ....................................................................................................................................1022010-2013 Fire/Flame Injuries............................................................................................... 103 Figure 90: 2010-2013 Fire/Flame Injuries Mortality Rate Figure 91: 2010-2013 Fire/Flame Injuries Mean Charges Figure 92: 2010-2013 Fire/Flame Injuries Mean Length of Stay Figure 93: 2010-2013 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 ...........................................................................................................................................................115

A. 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 Facility Figure 101: Percent of Records with Number of Missing Variables Compared Between Data Submitted in 2013 and Before Figure 102: Count of Records with Number of Missing Variables Compared Between 2013 and BeforeB. List of Participating Hospitals ........................................................................................... 122C. Selected List of Peer-Reviewed Publications Utilizing NBR Data ......................................... 125

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Data! Data! Data! he cried impatiently, I cannot make brickswithout clay.

Sherlock Holmes in The Adventure of the Copper BeechesSir Arthur Conan Doyle

This National Burn Repository (NBR) report representsten years of cumulative data from 96 United States BurnCenters, four Canadian Burn Centers, and two SwedishBurn Centers. The report contains over 190 thousandentries. This report represents the largest resource on theepidemiology of thermal injury, of patients admitted toburn centers, in North America. It also is the single mostuseful reference for determining benchmark standards foroutcomes such as mortality rate and hospital length of stay.As we venture into the uncharted waters of medical qualityimprovement, this report will be the foundation for ourspecialty.

Although the report does not change much from year to

year, the results over time have changed. One striking findingin this years report has been changes in overall length ofstay and burn mortality. Since 2004, the average hospitallength of stay has dropped from nine to eight days. Althoughit represents only 11% reduction, this can have significantimpact on health care costs. Also during the 10 year periodfrom 2004 to 2013, the overall mortality has decreased from3.4% to 2.7% for males and from 4.6% to 3.3% for females.The clear message is that our burn care facilities are centersof excellence that have a track record of improving theefficiency and quality of burn care.

This next year, the NBR will have to evolve. Theimplementation of the ICD-10 will bring granularity to the

burn diagnoses. Each ICD-10 burn code will specificallydelineate the exact location, depth and if appropriate, the

laterality of the injury. This will certainly improve queriesof the database. Also, the outcomes defined by the BurnQuality Improvement Program (BQIP) Committee will beincorporated into the NBR. This will elevate this repository toa standard defined by the experts; the burn care professionals.

Its imperative that the NBR continues to serve as thesingle best resource for health care planners within ourinstitutions and within our governments. With the shrinkingpool of health care dollars, resources still need to be allocatedto our centers registries and registrars. This data is thefoundation on how burn care quality will be measured. Asgood as it has become, only 24% of the records are complete;75% of the reports are missing one or more key variables.The majority of the records added this year had zero deficits.This represents approximately 75% of the new submissions.Compared to the previous nine years, the majority ofthe records were missing 2-5 key variables. Although theaccuracy has improved over the past decade, we still have

significant room for improvement.

The NBR Committee and the American BurnAssociation still have a vision for making this registry a livingresource that permits continuous data entry in real time. Wealso want to evolve with the changes in world technology tomake access to this data much suppler in this digital age ofinformation. Your data submission is the clay allowing theNBR to become the bricks on which we will build ourtowers as centers of excellence and our bridges to improveour interoperability.

Christopher W. Lentz, MD, FACS, FCCM

Chair, ABA NBR Advisory Committee

Introduction


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The 2014 National Burn Repository Annual Report reviewed the combined data set of acute burn admissions for thetime period between 2004 and 2013. Key findings included the following:

1. Ninety-six hospitals from 35 states, and the District of Columbia, contributed to this report, totaling 191,848records. Seventy-seven hospitals contributed more than 500 cases. Data are not dominated by any single center and

appeared to represent a reasonable cross section of U.S. hospitals.

2. Nearly 69% of the burn patients were men. The mean age for all cases was 32 years old. Children under the age of 5accounted for 19% of the cases, while patients age 60 or older represented 13% of the cases.

3. Seventy-four percent of the reported total burn sizes were less than 10%TBSA and these cases had a mortality rateof .6%.The mortality rate for all cases was 3.3% and 5.9% for fire/flame injuries.

4. The two most common reported etiologies were fire/flame and scalds, and accounted for almost 8 out of 10reported. Scald injuries were most prevalent in children under 5, while fire/flame injuries dominated the remaining agecategories. Nine percent of cases did not designate an etiology of injury.

5. Seventy-three percent of the burn injuries, with known places of occurrence, were reported to have occurred in thehome. Seventy-one percent of cases with known circumstances of injury were identified as accident, non-work related.

6. During the ten year period from 2004 and 2013, the average length of stay for both females and males declined fromroughly 9 days to 8 days. The mortality rate decreased from 3.4% to 2.7% for males and from 4.6% to 3.3% for females.

7. Deaths from burn injury increased with advancing age and burn size, and presence of inhalation injury. For patientsunder age 60 and with a TBSA between .1 and 19.9, the presence of inhalation injury increased the likelihood of deathby 16 times.

8. Pneumonia was the most frequent clinically related complication and occurred in 5.8% of fire/flame injuredpatients. The frequency of pneumonia and respiratory failure was much greater in patients with 4 days or more ofmechanical ventilation, than those with less than 4 days. The incidence of clinically related complications for patientswith 0 days of mechanical ventilation increased with age and topped out at 20% for age 80 and over.

9. For survivors, the average length of stay was slightly greater than approximately 1 day per percent TBSA burned.

For those who died, the total hospital days were roughly 3 weeks for burn patients with TBSA values below 70% anddecreased from 3 weeks to 1 week for the larger burn categories.

10. Overall, the charges per case for a death were over 3 times greater than those charges for a survivor ($285,225vs. $86,146). Additionally, hospital charges per hospital day in patient deaths averaged roughly $14,000 more thansurviving patients.

All cases received from contributing hospitals (ABA burn registry and ABA non burn registry software) that met the datastructure requirements were initially accepted into the NBR. This report includes only cases with an admit year of 2004 2013, inclusive. 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 injury related.

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

GenderLOS < ICU daysDischarge dispositionBoth Calculated Age and Manually entered AgeBoth TBSA and Etiology

Summary of Findings


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As was done last year, 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. Thealgorithm 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.

FacilityAdmissionYearAgeGenderRaceAdmissionTypeDischarge DateECODETBSA %

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

Summary of Findings


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Analysisof Contributing Hospitals

BURN CENTER LOCATION AND PARTICIPATION BY REGION

EAST DC, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, and Connecticut. NORTH Illinois,Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin, and South Dakota. SOUTH Alabama,

Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Kentucky, Oklahoma, Virginia, WestVirginia, and Texas.WEST Arizona, California, Colorado, Nevada, New Mexico, Utah, and Washington

*ABA Burn Care Resource Directory, Edition March 2014** ABA Verified Burn Centers, March 2014

3

2

1

Have burn centers which have contributed to the NBR between 2004 to 2013

Have burn centers that have not contributed data to the NBR

Do not have burn centers

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, Sweden and Linkoping, Sweden.

The first section of the National Burn Repository (NBR) report deals with an evaluation of the contributinghospitals. Because the report reflects a rolling 10-year average and hospitals submit data, the mix of hospitals may varyfrom year to year. This years NBR report contains data from thirty-five states in the U.S., four Canadian burn centersand two Swedish centers. Sixty-four of the reporting centers are ABA verified. Seven states with Burn Centers havenot contributed data to the NBR report. The U.S. data comes from a representative sample of burn centers that appearsquite comparable to the actual distribution of Burn Centers in the U.S.

4

{

Figure1

{

Table

1

6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

2ALYSIS OF ALL.S. RECORDS

1ANALYSIS OF

ONTRIBUTING

HOSPITALS

STATES THAT SUBMITTED TO THE NBR, 2004 TO 2013

RegionU.S. Burn Care

Facilities*U.S. Facilities in the

Annual ReportABA Verified

Centers**

ABA VerifiedCenters in the

Annual Report

East 34 23 14 14

North 39 28 22 22

South 29 23 14 14

West 26 22 14 14

Total 128 96 64 64


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20,000

50,000

10,000

20,000

30,000

40,000

East North South West

VOLUME OF RECORD SUBMISSION BY GEOGRAPHIC REGION

{

Figure

2

Numb

erofCases

5,000

10,000

15,000

25,000

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Num

berofCases

ARRIVAL/ADMISSION YEAR, ACUTE BURN ADMISSIONS

{

Figure

3 Before 20132013

Year of Admission

24,591 records were submitted in 2013 for this report191,848 records are included in this report

44,743

56,307

47,34843,450

24,591 records used for this report were submitted by 93 burn centers during this years Call for Data. This brings thetotal number of records in this report to 191,848. The 2014 report contains roughly 15,000 more records than the 2013report.

The north region, which has the largest number of burn centers, contributes the highest number of records.

Record Submission

60,000

6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

2ANALYSISU.S. REC

1ANALYS

CONTRIB

HOSPI


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100,000

60,000

80,000


80,000

40,000

20,000

200-299beds

25-49beds

300-399beds

400-499beds

Num

berofCases

Hospital Bed Size

CONTRIBUTING U.S. HOSPITALS BY HOSPITAL BED SIZE CATEGORY

{

Figure

4

60,000

40,000

20,000

Army ChurchOperated

County HospitalDistrict

Investor,Corporation

Other Not-for-Profit

State

NumberofCases

CONTRIBUTING U.S. HOSPITALS BY HOSPITAL OWNERSHIP TYPE

{

Figure

5

Two groups of Burn Centers continue to contribute the largest number of records. Programs in hospitals with greaterthan 500 beds lead the way. However, the next largest group continues to come from hospitals in the 200-299 bed range.The majority of records submitted came from non-governmental, not-for-profit hospitals.

Ownership Type

500 ormore beds

100,000

6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP


1ANALYSIS OF

ONTRIBUTING

HOSPITALS

50-99beds

100-199beds


19/141


THIS PAGE INTENTIONALLY LEFT BLANK

6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

2ANALYSISU.S. REC

1ANALYS

CONTRIB

HOSPI


20/141


21/141

12Analysisof All U.S. Records


22/141


Analysisof All U.S. Records

AGE GROUP BY GENDER

{

Figure6

10,000

20,000

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+

Numb

erofCases

Female

Male

Age Categories

Total N=191,848 (Excluding 0 Unknown/Missing)

}AGE GROUP BY GENDERTable

2

Figure 6 and Table 2 show the number of cases in various age groups. Each column shows the total number of casesand the gender distribution within a specific age category. Males outnumber females in all categories. Children less thanage 16 make up 29% of all patients. The most prevalent age groups remain ages 20 60, accounting for greater than 50%of all patients.

6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS


Gender

Total Female Male

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

0-.9 10,360 5.4 4,172 6.9 6,188 4.7

1-1.9 14,380 7.5 5,706 9.4 8,674 6.6

2-4.9 12,609 6.6 5,508 9.1 7,101 5.4

5-15.9 18,068 9.4 6,119 10.1 11,949 9.1

16-19.9 10,027 5.2 2,505 4.1 7,522 5.7

20-29.9 28,516 14.9 7,037 11.6 21,479 16.4

30-39.9 24,411 12.7 6,320 10.4 18,091 13.8

40-49.9 27,042 14.1 7,480 12.3 19,562 14.9

50-59.9 22,056 11.5 6,375 10.5 15,681 12.0

60-69.9 12,319 6.4 4,178 6.9 8,141 6.2

70-79.9 7,150 3.7 2,880 4.7 4,270 3.3

80 and over 4,910 2.6 2,450 4.0 2,460 1.9

Subtotal 191,848 100.0 60,730 100.0 131,118 100.0

Missing 0 0.0 0 0.0 0 0.0

Total 191,848 100.0 60,730 100.0 131,118 100.0


23/141


Analysis

5,000

Non-White

White

10,000

15,000

RACE/ETHNICITY

{

Table

3

AGE GROUP BY WHITE VERSUS NON-WHITE

{

Figure

8

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+

NumberofCases

Age Categories

Total N=182,040 (Excluding 9,808 Unknown/Missing)

RACE/ETHNICITY

{

Figure

7


Figure 7 and Table 3 depict the distribution of cases in the NBR by race. The table shows that 4.1% of records did notspecify race. The figure is based on those records in which race was specified.

Figure 8 shows the number of cases of white and non-white patients in various age categories. Non-whitespredominate in children less than 5 admitted to burn centers. In all other age categories, however, there are more whitesthan non-whites. This suggests that racial factors may influence the occurrence of burn injuries and/or admission to aburn center differently as a function of age.

of All U.S. Records

Native American

AsianOther

HispanicBlack

White

Race

6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. REC

Race Cases % of Valid

White 107,310 58.9%

Black 35,789 19.7%

Hispanic 25,557 14.0%

Other 7,491 4.1%

Asian 4,398 2.4%

NativeAmerican

1,495 0.8%

Unknown 9808

Total 191,848


24/141


100,000

120,000

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

NumberofCase

s

% TBSA (Full+ Partial Thickness)

Total N=167,077 (Excluding 24,771 Missing or 0%)

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

4

Total N=191,848

Figure 9 shows the distribution of cases in the NBR by burn size. The proportion of records with no value for burn sizewas 12.9%. These presumably included both patients who truly had no burn or skin loss, e.g. pure inhalation injury, andthose whose burn size was unknown or simply not recorded. For patient whom had a recorded burn size, 78% were lessthan 20% total BSA. Patients with a total burn size of 40% BSA or more accounted for only 3.2% of cases.

Table 4 shows the proportion of patients in each category of total burn size who died, and the case fatality rate. This clearlyincreased with burn size. The burn size associated with a 50% case fatality (LD-50) appears to be approximately 70% TBSA.


6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS


Lived Died

%TBSA Cases Cases Mortality Rate

0.1 - 9.9 123,097 787 0.6

10 - 19.9 24,940 703 2.7

20 - 29.9 7,116 651 8.4

30 - 39.9 3,059 608 16.640 - 49.9 1,501 553 26.9

50 - 59.9 782 461 37.1

60 - 69.9 527 411 43.8

70 - 79.9 273 333 55.0

80 - 89.9 197 425 68.3

> 90 105 548 83.9

Subtotal 161,597 5,480 3.3

Missing or 0% 23,877 894 3.6

TOTAL 185,474 6,374 3.3


25/141


2,000

6,000

10,000

12,000

8,000

4,000Number

ofCases

Contact with hot object

Electrical

Age CategoriesTotal N=156,713 (Excluding 35,135 Cases)

Fire/Flame

Scald

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

Skin DiseaseRadiation

Inhalation Only

Other, Non Burn

Burn,Unspecified

Chemical

Electrical

Contact with HotObject

Scald

Fire/Flame

Categories ofEtiology

ETIOLOGY

{

Table5


Figure 10 and Table 5 depict the distribution of different burn etiologies amongst the cases in which one wasspecified. The table documents that 8.5% of the records did not include an etiology. The figure is based only on thosecases with a specified etiology.

Figure 11 depicts the numbers of cases admitted to the participating hospitals that were caused by one of the fourmost common burn etiologies or mechanisms in various age groups. Burns due to Fire/Flame predominated in all cases5 years and older. Scalds and contact burns were more frequent than Fire/Flame in children less than age 5.

0-.9


6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. REC

Etiology Cases % of Valid

Fire/Flame 75,445 43.0%

Scald 59,099 33.7%

Contact with HotObject

15,623 8.9%

Electrical 6,546 3.7%

Chemical 5,839 3.3%

Burn, Unspecified 4,765 2.7%

Other, Non Burn 4,493 2.6%

Inhalation Only 2,814 1.6%

Radiation 470 0.3%

Skin Disease 390 0.2%

Unknown 16,364

Total 191,848

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

{

Figure

11


26/141


PLACE OF OCCURRENCE -E849 CODE

{

Figure

12

Mine/Quarry

Farm

ResidentialInstitution

Public Building

Street/Highway

Recreation and

Sport

Other SpecifiedPlace

Industrial

Home

Categories ofPlace of

Occurrence

PLACE OF OCCURRENCE -E849 CODE

{

Table

6


CIRCUMSTANCE OF INJURY

{

Figure

13

SuspectedArson

Suspected SelfInflicted

Suspected ChildAbuse

SuspectedAssault/Abuse

Other

Accident,Unspecified

Accident,Recreation

Accident, WorkRelated

Accident, Non-Work Related

Categories ofCircumstance

of Injury

CIRCUMSTANCE OF INJURY

{

Table

7


Figure 12 and Table 6 depict the distribution of cases in the NBR by the place of occurrence. The table shows that 12.1 % ofrecords did not specify a place of occurrence. The figure is based on those records in which a place of occurrence was specified.The home remains the most common place of occurrence, accounting for 72.8 % of burn injuries cared for in burn centers.

Figure 13 and Table 7 depict the distribution of cases in the NBR by the circumstances of the injury. The table shows that9 % of records did not specify the circumstances in which the burn injury occurred. The figure is based on those records inwhich these circumstances were specified. The vast majority of burns seen at burn centers were considered accidental, with only14.1 % of these related to work, and only 3.6 % specified as non-accidental.


6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS


Place of Occurrence Cases % of Valid

Home 122,731 72.8%

Industrial 14,005 8.3%

Other Specified Place 9,218 5.5%

Recreation and Sport 7,834 4.6%

Street/Highway 7,708 4.6%

Public Building 4,381 2.6%

Residential Institution 1,367 0.8%

Farm 1,185 0.7%

Mine/Quarry 175 0.1%

Unspecified 23,244

Total 191,848

Circumstance of Injury Cases% of

ValidAccident, Non-Work

Related123,773 71.0%

Accident, Work Related 24,666 14.1%

Accident, Recreation 7,464 4.3%

Accident, Unspecified 7,444 4.3%Other 4,785 2.7%

Suspected Assault/Abuse 2,314 1.3%

Suspected Child Abuse 1,861 1.1%

Suspected Self Inflicted 1,816 1.0%

Suspected Arson 283 0.2%

Unknown 17,442

Total 191,848


27/141


Died

Lived

Outcome

Total N=191,848

}HOSPITAL DISPOSITIONFigure

14

HOSPITAL DISPOSITION

{

Table

8

Figure 14 depicts the proportion of patients in the NBR that died. Since outcome is a criterion for inclusion in theNBR, there were no records in which the outcome was missing. The overall mortality rate from 2004 to 2013 is 3.3%.

Table 8 shows the numbers and proportions of various types of discharge disposition for all cases included in theNBR. Seventy one percent of patients were discharged from the burn center to home.


6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. RECDischarge Disposition Cases Percent

Discharged Home, No Home Health 135,941 70.9

Discharged Home 19,599 10.2

Discharged Home, With Home Health 10,111 5.3

Death 6,374 3.3

Rehabilitation Facility 5,286 2.8

Nursing Home/Skilled Nursing Facility (SNF) 3,975 2.1

Transfer to Another Hospital 2,872 1.5

Other 1,187 0.6

Discharged to Extended Care Facility (ECF) 1,017 0.5

Transfer to Another Service 965 0.5

Discharged to Foster Care 941 0.5

Unable to Complete Treatment 858 0.4

Jail or Prison 773 0.4

Psychiatry, Inpatient 728 0.4

Discharged to Alternate Caregiver 646 0.3

Transfer to an Acute Burn Facility 381 0.2

Against Medical Advice 98 0.1

Transfer, Unspecified 96 0.1

Total 191,848 100.0


28/141


10.0

8.0

6.0

4.0

2.0

2004

AVERAGE HOSPITAL LENGTH OF STAYBY GENDER, 2004-2013

{

Figure

15

2005

2006

2007

2008

2009

2010

2011

2012

2013

AverageLengthofStay

Year of Admission

Total N=191,848

Female

Male

2%

4%

6%

MORTALITY RATE BY GENDER, 2004-2013

{

Figure

16

MortalityRate

Year of Admission

Total N=191,848

Female

Male

Figure 15 depicts the average total duration of hospitalization (Total Hospital Days, Length of Stay or LOS) for bothmen and women by year. LOS decreased for both genders over the decade (13.6 % and 8.8 %). Although LOS wassubstantially greater for women than men at the beginning of the decade depicted, in the last four years there has been atrend for greater LOS in men.

Figure 16 depicts the proportion of patients in the NBR who died in the hospital (case fatality) by gender and year.Case fatality decreased by 28 % for women and 20 % for men between 2004 and 2013. Case fatality is greater in womenthan men through the decade, but that difference has narrowed over last four years.

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013


6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS


Female Male

AdmissionYear

Mean +/-SEM

Mean +/-SEM

2004 9.49+/-0.3 9.12+/-0.2

2005 9.61+/-0.1 9.19+/-0.1

2006 9.46+/-0.1 9.59+/-0.1

2007 9.8+/-0.1 9.4+/-0.1

2008 9.9+/-0.1 9.9+/-0.1

2009 9.5+/-0.1 9.0+/-0.1

2010 8.5+/-0.1 8.6+/-0.1

2011 8.5+/-0.1 8.8+/-0.1

2012 8.2+/-0.1 8.6+/-0.1

2013 8.2+/-0.1 8.4+/-0.1

Mortality Rate

Admission Year Female Male

2004 4.6 3.4

2005 4.5 3.2

2006 4.3 3.5

2007 4.3 3.52008 4.1 3.4

2009 3.9 3.0

2010 3.0 2.7

2011 3.3 2.9

2012 3.2 2.9

2013 3.3 2.7


29/141


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 in each of several age categories. As age and/or burnsize increased, so did the case fatality. The numbers of cases used to determine these values (proportion of cases in eachgroup that died) are listed in the row beneath the case fatality values for each age group. The size of some of the groupsis small, so that the calculated case fatality value would have a high variance and standard error.


6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. REC

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 - 69.9 70 - 79.9 80 - 89.9 > 90 Total

Birth - .9 0.1 1.0 3.8 7.7 21.0 20.5 56.3 41.4 52.2 85.0 1.3

Died/Total 7/7322 14/1471 13/346 13/169 13/62 8/39 18/32 12/29 12/23 17/20 127/9513

1 - 1.9 0.0 0.3 0.6 1.9 7.7 23.8 20.8 18.2 16.7 66.7 0.2

Died/Total 1/10833 6/1881 2/314 2/107 4/52 5/21 5/24 2/11 1/6 2/3 30/13252

2 - 4.9 0.1 0.2 0.8 4.3 7.5 16.4 16.0 18.2 51.5 61.9 0.8

Died/Total 10/8875 3/1599 3/386 8/187 8/106 12/73 8/50 4/22 17/33 13/21 86/11352

5 - 15.9 0.1 0.3 0.9 1.6 4.6 5.2 12.4 14.0 44.7 63.6 0.6

Died/Total 9/12331 6/2167 6/648 5/308 9/195 6/116 11/89 8/57 21/47 21/33 102/15991

16 - 19.9 0.1 0.3 1.3 3.3 4.3 6.0 18.4 20.7 53.1 72.2 1.0

Died/Total 7/6486 4/1299 5/400 6/183 5/116 4/67 9/49 6/29 17/32 26/36 89/8697

20 - 29.9 0.2 0.6 1.6 5.8 12.6 18.6 25.9 42.2 56.0 76.5 1.5

Died/Total 29/18369 22/3725 19/1182 30/520 35/277 31/167 35/135 35/83 51/91 75/98 362/24647

30 - 39.9 0.2 1.0 2.7 7.1 11.0 21.4 36.7 52.9 65.5 91.8 2.1

Died/Total 37/15037 32/3308 28/1040 37/519 31/281 34/159 51/139 46/87 57/87 90/98 443/20755

40 - 49.9 0.5 1.3 4.7 10.7 24.3 43.8 38.0 59.0 74.0 84.9 3.0

Died/Total 77/16672 48/3728 58/1229 63/588 79/325 89/203 54/142 46/78 77/104 101/119 692/23188

50 - 59.9 0.9 3.3 10.4 21.0 39.8 51.9 65.6 73.1 82.3 86.4 4.9

Died/Total 128/13596 97/2980 104/996 95/453 109/274 81/156 80/122 68/93 79/96 89/103 930/18869

60 - 69.9 2.0 6.4 18.6 40.0 57.4 67.5 88.4 87.0 94.3 92.7 7.9

Died/Total 151/7554 110/1731 107/576 110/275 89/155 77/114 61/69 47/54 33/35 51/55 836/10618

70 - 79.9 4.0 15.4 35.1 58.2 74.6 83.1 89.1 89.3 80.0 88.2 13.8

Died/Total 168/4160 154/1001 126/359 121/208 91/122 54/65 41/46 25/28 24/30 30/34 834/6053

80 or Greater 6.2 27.5 61.9 78.7 89.9 95.2 92.7 97.1 94.7 100.0 22.9

Died/Total 163/2649 207/753 180/291 118/150 80/89 60/63 38/41 34/35 36/38 33/33 949/4142

Total 0.6 2.7 8.4 16.6 26.9 37.1 43.8 55.0 68.3 83.9 3.3

Died/Total 787/123884 703/25643 651/7767 608/3667 553/2054 461/1243 411/938 333/606 425/622 548/653 5480/167077


30/141


1,000

4,000

3,000

2,000

5,000

4,000

3,000

2,000

1,000

Arryth

mia

Bacter

emia

Cellul

itis

Other

Blood/

System

icInfe

ction

Pneum

onia

RenalF

ailure

Respira

toryF

ailure

Septice

mia

Urinar

yTrac

t

Infectio

n

Wound

Infect

ion

}COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY RELEVANT COMPLICATIONSFigure

17

NumberofCases

Total N=176,796 (Excluding 15,052 cases from non ABA burn registry software centers)

COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLYRELEVANT COMPLICATIONS BY DAYS ON THE VENTILATOR

{

Figure18

NumberofCases

4+ Ventilator Days


0 Ventilator Days

1-3 Ventilator Days

Arryth

mia

Bacter

emia

Cellul

itis

Other

Blood/

System

icInfe

ction

Pneum

onia

RenalF

ailure

Respira

toryF

ailure

Septice

mia

Urinar

yTrac

t

Infectio

n

Wound

Infect

ion

Figure 17 depicts the number of several complications in all NBR case records. Pneumonia, cellulitis, and urinary tractinfections are the most prevalent complications recorded in burn center patients.

Figure 18 demonstrates the association of several complications with duration of mechanical ventilation. Except for cellulitisand wound infections, the prevalence of complications increased with the number of days on mechanical ventilation. Theduration 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 thecritically ill, such as renal failure.


6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS



31/141


20%

40%

COMPLICATION RATE FOR AGE CATEGORIES BY DAYS ON VENTILATOR

{

Figure

19

60%

%o

fPatie

ntswithaClinically

Relate

dComplication

4+ Ventilator Days

Total N=161,721 (Excluding 30,127 cases from non ABA burn registry software centers or unknown/missing age or ventilator days)

0 Ventilator Days1-3 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

Total N=161,721 (Excluding 30,127 cases from non ABA burn registry software centers or unknown/missing ventilator days)

Figure 19 and Table 10 depict the association of occurrence of at least one complication with duration of mechanicalventilation by categories of age. For patients who did not require mechanical ventilation, age had a strong, directassociation with the risk of developing a complication. For patients who required four or more days of mechanicalventilation, however, the association between age and the risk of complications was much less pronounced. The totalcomplication rate increases with age category.


6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. REC

Ventilator Days

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

Complication Complication Complication Complication

Age Categories No Yes No Yes No Yes No Yes

0-.9 6,672 326 91 31 102 96 6,865 453

1-1.9 12,194 429 92 32 138 132 12,424 593

2-4.9 10,313 449 153 59 241 183 10,707 691

5-15.9 13,818 654 436 110 404 414 14,658 1,178

16-19.9 6,836 407 342 94 179 251 7,357 752

20-29.9 19,346 1,356 1,144 261 527 871 21,017 2,48830-39.9 16,127 1,307 1,032 264 627 1,002 17,786 2,573

40-49.9 17,334 1,739 1,220 366 760 1,244 19,314 3,349

50-59.9 13,540 1,599 1,107 385 750 1,332 15,397 3,316

60-69.9 7,105 972 745 295 524 917 8,374 2,184

70-79.9 3,730 646 515 187 362 626 4,607 1,459

80 and over 2,395 586 404 164 250 380 3,049 1,130

Subtotal 129,410 10,470 7,281 2,248 4,864 7,448 141,555 20,166

Missing 0 0 0 0 0 0 0 0

Total 129,410 10,470 7,281 2,248 4,864 7,448 141,555 20,166


32/141


20%

40%

60%

80%

100%

MORTALITY RATE FOR BAUX SCORE CATEGORIES BY GENDER

{

Figure

20

%o

fPat

ientsthatDied

BAUX Score (Age + TBSA)


Female

Male

.1-9.9 10-19.9

20-29.9

30-39.9

40-49.9

50-59.9

60-69.9

70-79.9

80-89.9

90-99.9

100-109.9

110-119.9

120-129.9

130-139.9

140+

NUMBER OF CASES IN BAUX SCORE CATEGORIES BY GENDER

{

Table

11


The data table, in Table 9 on page 15, demonstrated the relationship between death, increasing age, and burn size.Figure 20 depicts the data shown in Table 11 graphically and demonstrates a similar relationship. The proportion ofpatients who died (case fatality) is plotted as a function of the sum of age and the total percentage of BSA burned, the socalled BAUX Score.

There is a strong association between this score and case fatality for both men and women. Overall, women had a highercase fatality than men (3.9% vs 3.2%) but this difference is less pronounced. The sum of age and burn size (BAUX Score)associated with a case fatality of 50% (P 50) was 100. There was no significant difference between genders.


6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS


Female Male

BAUX Score (Age + TBSA) Lived Died Lived Died

0-9.9 12,198 24 17,558 29

10-19.9 6,952 23 11,958 29

20-29.9 6,184 34 17,284 56

30-39.9 5,876 38 16,842 74

40-49.9 6,245 71 16,897 143

50-59.9 6,292 103 16,077 188

60-69.9 4,623 160 11,205 28270-79.9 3,127 188 6,471 365

80-89.9 2,173 259 3,667 413

90-99.9 1,075 285 1,571 494

100-109.9 305 303 590 434

110-119.9 102 203 231 411

120-129.9 46 162 94 337

130-139.9 18 115 38 248

140 and Over 26 188 44 349

Total 55,242 2,156 120,527 3,852


33/141


34/141


MORTALITY RATES FOR MATRIX OF MAIN PREDICTORS

{Table

13


Major predictors of case fatality in burns include burn size, age, and the presence of inhalation injury. Table 13 showsthe 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: under 60 and 60 and older; and two categories of presenceof inhalation injury: No and Yes.


6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS


TBSA Category Age Inhalation Injury Lived Died Mortality Rate

0.1-19.9 0-59.9 No 116,514 273 0.2

0.1-19.9 0-59.9 Yes 5,661 218 3.7

0.1-19.9 60 and Over No 14,365 583 3.9

0.1-19.9 60 and Over Yes 1,571 298 15.9

20-39.9 0-59.9 No 6,952 210 2.9

20-39.9 0-59.9 Yes 1,490 235 13.6

20-39.9 60 and Over No 800 436 35.3

20-39.9 60 and Over Yes 240 284 54.2

40-59.9 0-59.9 No 1,343 221 14.1

40-59.9 0-59.9 Yes 645 295 31.4

40-59.9 60 and Over No 97 209 68.3

40-59.9 60 and Over Yes 51 210 80.5

60 and Over 0-59.9 No 641 452 41.4

60 and Over 0-59.9 Yes 361 712 66.4

60 and Over 60 and Over No 27 172 86.4

60 and Over 60 and Over Yes 15 245 94.2

TOTAL 150,773 5,053 3.2


35/141


PRIMARY INSURANCE PAYOR

{

Table

14

Table 14 lists the number and proportion of cases in the NBR that were covered by several forms of payment. Over10% of the records did not include this information. Of those that did include this data, over one third (37.9%) werecovered by Medicaid or uninsured.


6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. REC

Insurance Cases Percent

Government-Medicaid 37,636 19.6

Government-Medicare 19,190 10.0

Other Government 6,763 3.5

Subtotal 63,589 33.1

Private/Commercial Insurance 43,377 22.6Blue Cross/Blue Shield 13,064 6.8

Other Insurance-Not Named 269 0.1

Private-Foundation or Charity 3,696 1.9


Workers Compensation 17,303 9.0

Auto 1,205 0.6

Subtotal 18,508 9.6

No Insurance Information Provided 19,935 10.4

Uninsured, Including Self Pay 27,581 14.4


Unidentified Insurance Labels 1,829 1.0

TOTAL 191,848 100.0


36/141


10

15

5

20

25

}PERCENT OF PATIENTS UTILIZING SELECT INSURANCE

CATEGORIES OVER TIMEFigure22

CASE COUNT FOR SELECT INSURANCE CATEGORIES OVER TIME

{

Table

15

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

%o

fPatients(Does

notSumto100%)

Year of Admission

Total N=101,710 (Excluding 90,138 Cases)

Uninsured, including Self Pay

Workers Comp

Medicaid

Medicare

Figure 22 and Table 15 show how the proportions of patients covered by Medicaid, Medicare, Workers Compensationand Self-pay categories have changed over the decade covered by this years NBR Report. The prevalence of patientscovered by Workers Compensation is still lower than a decade ago, but there has been a steady increase over the last four

years. All other categories have also continued to grow, and the percentage of patients with Medicaid has shown thelargest growth.


6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS


Select Insurance Categories

Medicaid MedicareUninsured,

Including Self PayWorkers

CompensationTotal

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

2004 1,948 13.2 1,182 8.0 1,585 10.7 1,461 9.9 14,786

2005 2,232 15.5 1,243 8.6 1,667 11.5 1,353 9.4 14,436

2006 2,754 14.5 1,667 8.8 3,044 16.0 1,886 9.9 19,0112007 2,755 13.9 2,007 10.1 2,952 14.8 1,860 9.4 19,883

2008 3,390 17.7 1,995 10.4 2,573 13.4 1,858 9.7 19,152

2009 4,537 21.5 2,153 10.2 2,962 14.0 1,748 8.3 21,126

2010 5,640 23.1 2,520 10.3 3,762 15.4 1,923 7.9 24,448

2011 5,621 23.9 2,513 10.7 3,458 14.7 2,054 8.7 23,542

2012 5,656 24.3 2,503 10.7 3,647 15.6 2,064 8.9 23,317

2013 3,103 25.5 1,407 11.6 1,931 15.9 1,096 9.0 12,147

Total 37,636 19.6 19,190 10.0 27,581 14.4 17,303 9.0 191,848


37/141


HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP

{

Table

16

Total N=191,848

HOSPITAL CHARGES: LIVED/DIED BY BURN SIZE GROUP

{

Table

17

Total N=74,278 (Excluding 117,570 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 ofburn size. Non-survivors with burns of 20 %TBSA and greater have shorter LOS compared with survivors. The LOS forsurvivors in all categories of burn size was approximately 1 day for each percent BSA burn.

Only 29% of the cases reviewed in this years NBR report included data on hospital charges. Tables 17, 18, and 19 arebased on those records. Table 17 depicts hospital charges for survivors and non-survivors in each burn size decile.


6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. REC

Total Lived Died

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

SEMCases Mean +/- SEM

0.1 - 9.9 123,884 5.6+/-0.0 123,097 5.5+/-0.0 787 16.6+/-0.9

10 - 19.9 25,643 12.8+/-0.0 24,940 12.6+/-0.0 703 19.6+/-0.920 - 29.9 7,767 22.9+/-0.2 7,116 23.2+/-0.2 651 19.6+/-0.930 - 39.9 3,667 34.1+/-0.5 3,059 36.9+/-0.5 608 20.4+/-1.140 - 49.9 2,054 42.1+/-0.8 1,501 49.5+/-0.9 553 22.1+/-1.650 - 59.9 1,243 45.4+/-1.2 782 60.8+/-1.5 461 19.4+/-1.760 - 69.9 938 49.2+/-1.7 527 72.3+/-2.3 411 19.7+/-1.770 - 79.9 606 43.9+/-2.3 273 81.0+/-3.9 333 13.5+/-1.580 - 89.9 622 28.5+/-2.0 197 61.4+/-4.5 425 13.3+/-1.5

> 90 653 13.6+/-1.6 105 46.3+/-7.9 548 7.4+/-1.1Subtotal 167,077 9.4+/-0.0 161,597 9.1+/-0.0 5,480 17.4+/-0.4

Missing or 0% 24,771 7+/-0.0 23,877 6.7+/-0.0 894 12.5+/-0.8TOTAL 191,848 185,474 6,374

Total Lived Died

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

0.1 - 9.9 47,749 $42782+/-401 47,440 $41859+/-385 309 $184459+/-1646510 - 19.9 10,262 $122891+/-2107 9,965 $118739+/-2028 297 $262206+/-2456120 - 29.9 3,091 $263076+/-6152 2,799 $260062+/-6343 292 $291961+/-2327930 - 39.9 1,400 $449142+/-14694 1,156 $470098+/-16445 244 $349859+/-31517

40 - 49.9 749 $608572+/-25145 515 $700876+/-31771 234 $405423+/-3658850 - 59.9 446 $686349+/-40415 248 $935338+/-59933 198 $374485+/-4221460 - 69.9 333 $706449+/-45797 169 $1006194+/-66295 164 $397567+/-5341270 - 79.9 246 $643805+/-61836 101 $1121252+/-115871 145 $311238+/-5169180 - 89.9 229 $393205+/-45052 51 $977203+/-125218 178 $225879+/-37206

> 90 253 $160247+/-28542 25 $508344+/-155963 228 $122079+/-25624Subtotal 64,758 $93147+/-963 62,469 $86109+/-912 2,289 $285225+/-10285

Missing or 0% 9,520 $46221+/-1423 9,188 $42376+/-1325 332 $152640+/-16883TOTAL 74,278 $87133+/-861 71,657 $80501+/-815 2,621 $268430+/-9273


38/141


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

18

Total N=74,278 (Excluding 117,570 cases with Unknown/Missing charge data)

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


6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

3ANALYSIS

BY AGE

GROUP

1ANALYSIS OF

ONTRIBUTING

HOSPITALS


Total Lived Died

Top 20 MS-DRG Codes Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM

935 Non-extensive burns 31,966 $28481+369 31,825 $27933+351 141 $152246+24282

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

6,833 $100487+1709 6,769 $98667+1665 64 $292999+41277

928 Full thickness burn w skin graftor inhal inj w CC/MCC

6,582 $188891+3414 6,348 $183718+3321 234 $329227+31927

934 Full thickness burn w/o skingrft or inhal inj

3,969 $38951+1643 3,822 $37723+1644 147 $70869+11505

927 Extensive burns or fullthickness burns w MV 96+ hrs w

skin graft2,533 $473849+11568 2,200 $454557+12107 333 $601305+35955

507 Major shoulder or elbow joint

procedures w CC/MCC 1,332 $102298+4723 1,318 $98904+4395 14 $421846+158542

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

1,260 $19465+1031 1,259 $19381+1029 1 $124906+

933 Extensive burns or fullthickness burns w MV 96+ hrs w/o

skin graft883 $111082+8009 264 $177064+20416 619 $82940+7117

506 Major thumb or jointprocedures

828 $147966+9193 803 $140486+8670 25 $388209+115250

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

maj O.R.721 $921564+31602 591 $930191+35232 130 $882343+71349

923 Other injury, poisoning & toxiceffect diag w/o MCC

379 $19531+1832 373 $18960+1769 6 $55001+36113

918 Poisoning & toxic effects ofdrugs w/o MCC

251 $25832+3225 245 $25702+3256 6 $31130+25022

595 Major skin disorders w MCC 151 $103101+10420 112 $97956+11452 39 $117875+23485

596 Major skin disorders w/o MCC 145 $60278+7435 140 $59805+7689 5 $73509+11960

603 Cellulitis w/o MCC 134 $31582+9835 134 $31582+9835 0

577 Skin graft &/or debrid exc forskin ulcer or cellulitis w CC

121 $67863+6246 121 $67863+6246 0

605 Trauma to the skin, subcut tiss& breast w/o MCC

115 $38412+4219 115 $38412+4219 0

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

89 $97099+13760 89 $97099+13760 0

483 Major joint & limbreattachment proc of upper

extremity w CC/MCC64 $184528+41443 61 $165999+41492 3 $561296+171882

998 Principal diagnosis invalid asdischarge diagnosis

32 $5078+2087 32 $5078+2087 0

Subtotal 58,388 56,621 1,767

Other 4,263 $126477+4205 3,915 $113634+3903 348 $270957+25740

Unmappable 1,062 $141724+8327 1,000 $130222+8231 62 $327252+46522

Unknown 10,565 $44076+1394 10,121 $38884+1287 444 $162426+14351

Total 74,278 71,657 2,621


39/141


}DAYS PER %TBSA AND CHARGES PER DAY BY AGE GROUPS AND SURVIVALTable

19

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.


6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

3ANAL

BY A

GRO

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. REC

Cases Days Hospital Days /%TBSA

Hospital Charges Hospital Charges /Hospital Days

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

Birth - 0.9 4,111 97 9.11 16.84 2.19 0.65 $43,736 $38,079 $4,814 $7,304

+/- SEM 0.93 3.35 0.22 0.17 $2,129 $9,020 $93 $1,551

1 - 1.9 4,742 10 5.02 8.50 1.62 0.25 $36,747 $156,910 $6,460 $24,721

+/- SEM 0.14 5.00 0.07 0.11 $1,364 $65,440 $112 $5,950

2 - 4.9 4,020 29 6.55 10.55 1.97 1.03 $48,416 $142,562 $6,648 $20,247

+/- SEM 0.20 3.21 0.11 0.46 $1,910 $38,114 $220 $2,6105 - 15.9 5,142 35 7.26 7.63 2.05 0.23 $63,051 $229,380 $6,925 $38,789

+/- SEM 0.17 3.01 0.09 0.08 $2,567 $84,753 $134 $6,185

16 - 19.9 3,116 25 7.90 16.00 1.85 0.41 $70,454 $333,174 $6,729 $30,494

+/- SEM 0.28 7.29 0.08 0.16 $3,762 $138,753 $110 $4,092

20 - 29.9 9,717 142 8.90 20.66 2.39 0.53 $80,730 $392,625 $7,219 $28,753

+/- SEM 0.18 3.54 0.10 0.09 $2,353 $55,498 $80 $3,170

30 - 39.9 8,005 173 10.09 15.93 2.60 0.47 $94,818 $362,704 $7,588 $32,363

+/- SEM 0.19 2.33 0.13 0.07 $2,806 $46,134 $150 $4,218

40 - 49.9 8,922 281 11.40 17.15 2.96 0.74 $106,788 $339,477 $7,791 $23,845

+/- SEM 0.20 1.74 0.14 0.11 $2,900 $30,697 $148 $1,062

50 - 59.9 7,282 378 12.55 21.51 3.39 1.58 $116,949 $397,023 $8,052 $23,302

+/- SEM 0.23 1.73 0.13 0.32 $3,163 $32,462 $126 $1,058

60 - 69.9 3,923 351 13.79 17.03 3.88 1.33 $125,024 $305,835 $8,047 $22,739

+/- SEM 0.33 1.23 0.21 0.15 $4,305 $24,452 $136 $1,106

70 - 79.9 2,147 360 14.62 15.16 4.37 1.30 $131,591 $252,371 $8,085 $18,018

+/- SEM 0.40 1.04 0.41 0.14 $5,237 $21,241 $138 $924

80 or greater 1,297 408 14.13 11.22 4.78 1.09 $126,665 $159,207 $8,098 $16,836

+/- SEM 0.46 0.83 0.54 0.16 $6,467 $13,100 $215 $1,527

Total 62,424 2,289 9.83 16.31 2.67 1.07 $86,146 $285,225 $7,244 $21,926

+/- SEM 0.09 0.57 0.04 0.07 $913 $10,286 $42 $585


40/141

Analysisby Age Group3


41/141

This year encompasses another decade of collected data ranging

from 2004 to 2013. Age of the burn patient continues to be animportant marker, having a dramatic effect on many of the attributesfound in the National Burn Repository. As we improve our collectionof data, it is interesting to note the stability of incidence of burnsin each ten year report. Data continues to be very useful whencontemplating prevention strategies, medical economics, and concernsabout public health.

The figures in this Age Analysis section provide detailedinformation for each of the following age categories: Birth to 0.9, 1 to1.9, 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. We have addedan additional section: 0-18.0 years old. These groupings were chosenbased on prior collective experience about the relationship of certainages to types of burn injury patterns, with an emphasis on accidental

injuries of the very young. Each age category has four pages of figuresand tables that summarize the data in the National Burn Repository.Some highlights are abstracted below:

The race of burn victims continues to show a dramatic over-representation of minorities in children (age under 5 years) thanwould be expected based on national demographics. The samemarked over-representation disappears in young adulthood. This hascontinued to perpetuate for the past several years, these minoritycommunities might be at increased risk and in need of preventioninitiatives.

Furthermore, scald and contact burns are very prevalent in the earlyage category when contemplating etiology. Fire/flame continues tobe the consistent, predominant etiology of burns in the adolescent andadult age groups. There continues to be a large amount of unspecified

burns throughout all age groups, however this year non-burns haveseen a greater reporting value than in years past. Improvement of datacollection may impact these numbers bringing a better appreciationof the total data set.

Inhalation injury is one of the most lethal characteristic of burnvictims, and somewhat surprisingly increases in incidence with age.Even though children are exposed to smoke in structure fires andeven with the increase in fire/flame injuries in the lowest age group,the preponderance of scald and contact injuries continues to crowdout inhalation injuries in the young.

The most common complications are urinary tract infections(UTI), pneumonia and cellulitis as the top three complications inthose patients under age 60. Those over age 60, show a shift in the

top three with respiratory failure over stepping cellulitis in the age

60-69.9 age group and arrhythmias in the over 70 population. UTIwas the most frequent infection among children. Pneumonia remainsa very frequent complication in all age groups. Cellulitis continuesto be a common thread in all age groups, while septicemia was lesscommon. Even with the emphasis on tracking hospital acquiredinfections (HAI) and more stringent protocols geared to prevention,urinary tract infections and pneumonia continue to be our top threecomplications all age catagories. This stability with the larger data setgives credence to our data and suggests that we need to begin lookingat ways to decrease our top three complications as they have beenconsistently the same over the years.

As in previous years, the most frequently reported procedurescontinue 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 intuitivesense given that early excision and grafting of burns remains adurable standard of care. Another absolutely expected finding is theprogression of mortality as a function of increasing age.


42/141


Analysisby Age Group Birth to .9

Native American

Asian

OtherHispanic

Black

White

Race

RACE/ETHNICITY

{

Table

20

Total N=9,802 (Excluding 558 Unknown/Missing)

Radiation

Skin Disease

Inhalation OnlyOther, Non Burn

ChemicalElectrical

Burn,Unspecified

Fire/Flame

Contact withHot Object

Scald

Categories ofEtiology

ETIOLOGY

{

Table

21


ETIOLOGY

{

Figure

24

RACE/ETHNICITY

{

Figure

23

1ANALYSIS OF

ONTRIBUTING

HOSPITALS

6ANALYSIS OF

ANADIAN AND

TL. RECORDS

5HOSPITAL

OMPARISONS

4ANALYSIS

BY AGE

ETIOLOGY

2ALYSIS OF ALL.S. RECORDS3

ANALYSIS

BY AGE

GROUP

Race Cases %Valid

White 4,128 42.1%

Black 2,234 22.8%

Hispanic 2,207 22.5%

Other 644 6.6%

Asian 413 4.2%

Native American 176 1.8%

Unknown 558

TOTAL 10,360

Etiology Cases % Valid

Scald 5,340 61.5%

Contact with Hot Object 2,046 23.6%

Fire/Flame 791 9.1%

Burn, Unspecified 186 2.1%

Electrical 89 1.0%

Chemical 83 1.0%Other, Non Burn 58 0.7%

Inhalation Only 35 0.4%

Skin Disease 31 0.4%

Radiation 28 0.3%

Unknown 1,673

TOTAL 10,360


43/141


Analysisby Age Group Birth to .9

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

{

Table

22

Total N=10,360

TOP TEN COMPLICATIONS

{

Table

23


Total N=10,360

TOP TEN PROCEDURES

{

Table

24

6ANALYS

CANADIA

INTL. RE

5HOSP

COMPAR

4ANAL

BY A

ETIOL

1ANALYS

CONTRIB

HOSPI

2ANALYSISU.S. REC3

ANAL

BY A

GRO

Total Lived Died

Inhalation Injury CasesMean +/-

SEM Cases Mean +/- SEM Cases Mean +/- SEMNo 9,002 6.31+0.15 8,921 6.17+0.15 81 21.37+4.04

Yes 322 22.16+1.77 269 25+2.05 53 7.74+1.81

Subtotal 9,324 9,190 134

Missing 1,036 8.76+3.58 1,030 8.78+3.6 6 4.5+1.88

TOTAL 10,360 10,220 140

Top Ten Complications CountPercent of AllComplications

Percent of Patientswith Complication

Urinary Tract Infection 74 11.2 0.9

Cellulitis 71 10.8 0.9

Pneumonia 39 5.9 0.5

Wound Infection 36 5.5 0.5

Respiratory Failure 34 5.2 0.4

Septicemia 24 3.6 0.3

Other Blood/Systemic Infection 21 3.2 0.3

Bacteremia 20 3.0 0.3

Catheter-Related Bloodstream Infection 16 2.4 0.2

Skin Graft Loss, Other 16 2.4 0.2Total Complications 658

Top Ten Procedure Codes Count Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn 2,806 17.3

86.69 Other skin graft to other sites 2,030 12.5

93.57 Application of other wound dressing 1,608 9.9

86.28 Nonexcisional debridement of wound, infection or burn 1,605 9.9

86.66 Homograft to skin 1,267 7.8

38.93 Venous catheterization, not elsewhere classified 806 5.0

86.67 Dermal regenerative graft 390 2.4

38.91 Arterial catheterization 357 2.2

86.65 Heterograft to skin 329 2.0

86

2014 nbr annual report

Documents