Increased prehospital mortality in patients with combined burns and trauma in Canada: Analysis of a provincial trauma registry database.
Burns · 2024-12-26 · Registry study
Abstract
INTRODUCTION: The combination of burns and non-thermal trauma may have a synergistic effect on mortality. Our objective was to determine if burn patients with concomitant trauma are at increased risk of mortality in both the prehospital and in-hospital settings. METHODS: Data were collected from a population-based provincial trauma registry (2001-2019). Characteristics and outcomes of patients with trauma/burns were compared to isolated burn patients using t-tests, chi-square analysis and Fisher's exact tests. Risk ratios (RRs) were calculated to evaluate the impact of concomitant trauma on mortality, stratified by % total body surface area (TBSA) and injury severity score (ISS). Firth's penalized maximum likelihood estimation (PMLE) approach was used to fit multivariable logistic regression models to the outcomes of prehospital mortality and in-hospital mortality. RESULTS: Of 436 burn patients, 29.8 % (130/436) had combined trauma/burns. Prehospital mortality in the trauma/burns group was 57.7 % (75/130) versus 43.1 % (132/306) in isolated burn patients. Prehospital mortality risk was highest in trauma/burn patients with % TBSA ≥ 70 (RR 3.87, 95 % CI 2.99-4.99) or ISS ≥ 25 (RR 2.49, 95 % CI 1.84-3.36). Concomitant trauma was associated with increased odds of prehospital mortality (OR 2.42, 95 % CI 1.27-4.69), but had no impact on in-hospital mortality. CONCLUSIONS: Prehospital mortality was increased in patients with combined burns and trauma.