Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Figures & data

Table 1. Patient and injury characteristics of cases included in each of the burns centres, in Study I for paediatric cases at the Red Cross Hospital (n = 1165) and in Study II for adult cases at Tygerberg Hospital (n = 372).

	Paediatric		Adults
	n	%	n	%
Patient Characteristics
Gender
Men	649	55.7	250	67.2
Women	516	44.3	122	32.8
Age group (in years)
<2	604	51.9	N/A
2–3	312	26.8	N/A
4–5	106	9.1	N/A
6–12	143	12.3	N/A
13–20	N/A		50	13.4
21–40	N/A		214	57.5
41–60	N/A		95	25.5
61–90	N/A		13	3.5
Injury Characteristics
Mechanism
Hot liquid	953	81.8	72	19.4
Hot object	78	6.7	5	1.3
Fire/Flame	108	9.3	263	70.7
Electrical or Chemical	23	2.0	28	7.5
Unknown	3	0.3	4	1.1
Anatomical site^a
Head, face and neck	594	51.0	259	69.6
Arms and/or hands	714	61.3	319	85.8
Trunk	605	51.9	250	67.2
Genitalia/Perineum	112	9.6	31	8.3
Legs and/or feet	446	38.3	183	49.2
Burn size (TBSA, in %)
≤5	473	40.6	42	11.3
6–10	372	31.9	52	14.0
11–15	183	15.7	42	11.3
16–30	107	9.2	122	32.8
>30	21	1.8	114	30.6
Unknown	9	0.8	0	0.0
Burn depth^b
Superficial-partial	1021	87.6	24	6.5
Mid-partial/Indeterminate	15	1.3	106	28.5
Deep-partial	N/A	N/A	53	14.3
Full	102	8.8	152	40.9
Unknown	27	2.3	37	10.0
Inhalation injury
No	1132	97.2	197	53.0
Yes	33	2.8	175	47.0
Intent
Unintentional	1139	97.8	274	73.7
Intentional	22	1.9	94	25.3
Unknown	4	0.3	4	1.1

Table 2. Association between adherence to referral criteria and intensive patient care.

Criteria	Children <2 years old		Chidren ≥2 years old
	Odds Ratios	95% CI	Odds Ratios	95% CI
Age	N/A	-	1.8	1.4–2.2
Anatomical site	1.4	0.8–2.3	1.2	0.7–1.8
Severity	19.4	8.6–43.9	11.6	5.6–23.8
Inhalation injury	2.2	0.7–6.9	5.5	1.8–16.6
Mechanism of injury	2.7	0.7–10.3	1.1	0.6–2.2
Existing comorbidity	1.8	0.7–4.5	0.5	0.2–1.4

Table 3. Univariate and multivariate associations between patient, injury and admission-related characteristics with in-hospital mortality for flame burn patients admitted at Tygerberg Hospital burns centre in 2015 and 2016 (n = 263).

			Mortality		Crude		Adjusted
			n	%	Odds Ratios	95% CI	Odds Ratios	95% CI
Patient characteristics
Gender
	Men (n = 175)		39	22.3	Ref		Ref
	Women (n = 88)		34	38.6	2.2	1.3–3.8	3.77	1.7–8.5
Injury characteristics
Burn depth
	Superficial or Mid Partial (n = 73)		7	9.6	Ref		Ref
	Deep Partial or Full thickness (n = 164)		59	36.0	5.3	2.3–12.3	1.6	0.6–4.2
	No information (n = 26)		7	26.9	3.5	1.1–11.2	1.8	0.4–7.7
Burn size
	By percentage increase TBSA (n = 263)		73	27.7	1.1	1.07–1.13	1.1	1.08–1.14
Inhalational injury
	No (n = 99)		12	12.1	Ref		Ref
	Yes (n = 164)		61	37.2	4.3	2.2–8.5	1.2	0.5–3.1
Admission-related characteristics
Referral status
	Referred (n = 223)		53	23.8	Ref		Ref
	Not referred (n = 40)		20	50.0	3.2	1.6–6.4	2.8	1.1–7.4

Figure 1. Diagnostic accuracy of size and depth assessments made on handheld devices by case and participant group.

For size, 6 missing values, analysis performed on 1320 cases; for depth, 27 missing values, analysis performed on 1299 cases.

Figure 2. Wound classification algorithm performances results for the complete validation set as well as by skin type. Adapted from [108].

National Aeronautics and Space Administration. Anthropometry and Biomecanics. In: Document NASA-STD-3000: Man-Systems Integration Standards [Internet]. 1995 [cited 2019 Jan 29]. Available from: https://msis.jsc.nasa.gov/sections/section03.htm.

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