The influence of burn injury timing on survival in patients with severe burns

Various factors can influence the survival of patients with severe burns. One of these factors could be the day or time of the burn injury. There are studies describing worse outcomes and higher mortality, as well as longer hospital stays, for emergency presentations at night and weekends for certain conditions. This study evaluates data from multiple burn centers, to analyse whether the day of the week, time of day or season of the year when a severe burn injury occurs has an impact on patient survival in a single patient cohort.

Only primary admitted adult patients with documented date and time of admission to hospital and existing Burn mortality prediction (BumP)-Score were eligible for this study. The BumP score is used to calculate mortality using the variables age, burn area, presence of full-thickness burns, presence of inhalation trauma, circumstances of the burn and presence of pre-existing conditions. In the analyzed period 6152 patients were included. For the following subgroups burn trauma frequencies and characteristics of patients were analysed: Time of day, weekdays versus weekends, month and season. For outcome analysis the standardised mortality ratio (SMR) was calculated.

The SMR calculation revealed no significant difference between daytime and nighttime (0.939 [95% CI 0.831 - 1.046] vs. 0.985 [95% CI 0.863 - 1.106], p = 0.556). There was also no difference in the SMR between weekdays and weekends (0.932 [95% CI 0.836-1.027] vs. 1.027 [95% CI 0.875-1.179], p = 0.375), nor between time of day (p = 0.873), or season (p = 0.197).

The timing of burn injury does not significantly affect overall patient survival in relation to the time of day and between weekends and weekdays, or season although temporal trends and variations in SMR suggest that structural or logistical factors may play a role. The quality of care is consistently high regardless of the time of the burn admission.