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Anaesthesiology Intensive Therapy
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1/2021
vol. 53
 
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Letter to the Editor

A comment on prognostic factors in burns

Ian Ewington
1, 2
,
Tomasz Torlinski
1
,
Randeep K. Mullhi
1

1.
Department of Anaesthetics and Critical Care, West Midlands Burns Centre, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
2.
Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom
Anaesthesiol Intensive Ther 2021; 53, 1: 89–90
Online publish date: 2021/02/11
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- A comment.pdf  [0.06 MB]
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Dear Editor,
We read the recent paper “Prognostic factors in patients with burns” [1] by Zielinski et al. with great interest. The article is very informative, in a concise and eloquent manner, allowing the reader to familiarise themselves with the plethora of prognostication models used worldwide in the assessment of burn patients. However, reading the paper we noticed that two aspects may require further consideration to provide the reader with a more comprehensive understanding of prognostication in burn patients.
The authors discussed in detail the impact of age and comorbidities but did not emphasise the impact of frailty on the outcome of burn injuries. In recent years, numerous studies have tried to address this issue, with prominent research coming from centres in the UK and US [2–4]. Ward et al. found The Frailty Score to be a much more sensitive predictor of one-year mortality than the modified Baux score. Their recommendation, based on the results from the UK, was to either incorporate frailty into the modified Baux score or use it independently to improve mortality predictions [2]. Northern American data presented by Romanowski et al. confirmed that patients with a higher frailty score not only had a lower chance of survival, but also had a significantly higher rate of discharge to specialised nursing facilities [3]. Those findings were confirmed by Maxwell et al., who concluded that frailty was more predictive of outcome when compared to age in patients with thermal injuries [4].
In addition, the authors discussed several general prognostication models, namely Apache II, MODS, and SOFA. We thought that for completeness the authors should have also discussed some other prognostic models, especially the Denver MOF score, because this is the main organ dysfunction score used in the Glue Grant benchmarking model – the biggest project to date designed to determine and compare outcomes of critically ill burn patients in leading academic centres in the USA [5]. It is also worth noting the research published by Yoon et al., which did not find Sepsis-3 to be particularly useful in the detection of complications such as sepsis in burn patients. The suggestion was that the SOFA score is more appropriate in such circumstances [6, 7].
In summary, we would like to congratulate the authors on an excellent and informative review, although we believe the points mentioned in our letter could have been discussed by the authors to allow a more comprehensive and complete picture.

Acknowledgements

1. Financial support and sponsorship: none.
2. Conflicts of interest: none.

References

1. Zieliński M, Wróblewski P, Kozielski J. Prognostic factors in patients with burns. Anaesthesiol Intensive Ther 2020; 52: 330-335. doi: 10.5114/ait.2020.97497.
2. Ward J, Phillips G, Radotra I, et al. Frailty: an independent predictor of burns mortality following in-patient admission. Burns 2018; 44: 1895-1902. doi: 10.1016/j.burns.2018.09.022.
3. Romanowski KS, Barsun A, Pamlieri TL, Greenhalgh DG, Sen S. Frailty score on admission predicts outcomes in elderly burn injury. J Burn Care Res 2015; 36: 1-6. doi: 10.1097/BCR.00000000000 00190.
4. Maxwell D, Rhee P, Drake M, Hodge J, Ingram W, Williams R. Development of the Burn Frailty Index: a prognostication index for elderly patients sustaining burn injuries. Am J Surg 2019; 218: 87-94. doi: 10.1016/j.amjsurg.2018.11.012.
5. Klein MB, Goverman J, Hayden DL, et al. Benchmarking outcomes in the critically injured burn patient. Ann Surg 2014; 259: 833-841. doi: 10.1097/SLA.0000000000000438.
6. Kym D. 3 Comparative usefulness of Sepsis-3, burn sepsis, and conventional sepsis criteria in patients with major burns. J Burn Care Res 2019; 40 (Suppl 1): S6. doi: https://doi.org/10.1093/jbcr/irz013.007.
7. Yoon J, Kym D, Hur J, et al. Comparative usefulness of Sepsis-3, burn sepsis, and conventional sepsis criteria in patients with major burns. Crit Care Med 2018; 46: e656-e662. doi: 10.1097/CCM. 0000000000003144.
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