[Integration of preexisting diseases and risk factors in the Abbreviated Burn Severity Index (ABSI)]

There is no doubt that underlying medical problems such as concomitant diseases or risk factors play a role in increasing patient morbidity and mortality. These factors are already integrated in trauma scores but preexisting diseases have no impact on burn scores yet. This study was performed to examine the predictive value of the classical burn variables that are integrated in the Abbreviated Burn Severity Index (ABSI). The preexisting diseases and risk factors in burn patients within our burn center were evaluated, with the aim of incorporating these evaluations into a new burn score. This modified burn score was used to optimize the predictive value of burn mortality.

This study included 443 intensive care burn patients. Demographic, injury, age, total body surface area burned (TBSAB), full thickness burn (FTB), inhalation injury (IHT), sex, medical comorbidities, intensive care and outcome data were documented. Univariate analyses, stepwise logistic regression and the Receiver Operating Curve were used to generate values for the probability of death.

Univariate analyses identified the following risk factors for their relationship with mortality: TBSAB, age, IHT, FTB, sex and medical comorbidities (cardiovascular, pulmonary, renal and endocrinological). Logistic Regression showed that total body surface area burned and age correlated most significantly with the probability of poor outcome. There were weaker correlations between IHT and FTB. No main effect was registered for gender and preexisting medical problems. The greatest area under the ROC curve was registered for our modified ABSI when comorbidities and risk factors were integrated.

The results of this study show that the Abbreviated Burn Severity Index is an appropriate burn score for estimating the risk of mortality after burn trauma. However, in addition to the classical variables, preexisting diseases and risk factors have a significant influence on the outcome and therefore should be incorporated into a new burn score to predict mortality more accurately.