Critical appraisal of the “one-day-per-percent” rule - A register-based observational study

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2024-07-31 DOI:10.1016/j.burns.2024.07.033

RL Brekke , SK Almeland , KO Hufthammer , AB Guttormsen , E. Hansson , H. Onarheim

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引用次数: 0

Abstract

Background

The ”one-day-per-percent” rule states that for burn patients, one day of hospital stay can be expected for each percentage of burned body surface. This study aimed to test the rule's predictive value.

Methods

The study is a register-based observational study on all burns treated in the Norwegian National Burn Center 2000–22. All children and adults admitted and actively treated in this period were included (2269 patients). Patients receiving palliative care were not included (55). Age when injured, sex, year of admittance, LOS (length of stay), %TBSA (total body surface area), discharged alive/dead, and palliative care: yes/no were extracted from the registry. Quantile regression was used to estimate the quantiles of LOS/%TBSA as a function of %TBSA.

Results

For injuries < 15 %TBSA, the median LOS/%TBSA values were above 1.0, and the ratio increased as the injury size decreased. The median LOS/%TBSA values were close to 1.0 for patients with injuries ≥ 15 %TBSA (Table 2, Figure 2). The quantile regression analysis revealed a considerable spread in estimated values for both adults and children. Children had a lower median LOS/%TBSA than adults and a value below 1.0 for injuries 15–30 %TBSA. When survivors and non-survivors were compared, a higher median LOS/%TBSA was found for survivors with injuries > 60 %TBSA.

Discussion

The ”one-day-per-percent” rule does not seem applicable for injuries < 15 %TBSA. Even for more extensive injuries, the large spread in estimated values in different quantiles renders it poor at predicting length of hospital stay. There also seem to be many caveats when it is used to measure an institution's efficacy or when comparing different institutions.

Conclusion

The predictive value of the “one-day-per-percent” rule is deficient when considering individual patients. It does not fit for injuries < 15 %TBSA, and the significant variation for patients with injuries of a similar extent renders it not viable as a forecasting tool.

查看原文本刊更多论文

对 "一天-百分数 "规则的批判性评估--一项基于登记簿的观察研究。

背景：每烧伤一个百分点住院一天 "的规则认为，烧伤患者的烧伤面积每增加一个百分点，就需要住院一天。本研究旨在检验该规则的预测价值：本研究是一项以登记为基础的观察性研究，对象是 2000-22 年期间在挪威国家烧伤中心接受治疗的所有烧伤患者。在此期间入院并接受积极治疗的所有儿童和成人（2269名患者）均被纳入研究范围。接受姑息治疗的患者未包括在内（55例）。从登记表中提取了受伤时的年龄、性别、入院年份、LOS（住院时间）、%TBSA（总体表面积）、出院时存活/死亡以及姑息治疗：是/否。采用量值回归法估算出 LOS/%TBSA 与 %TBSA 的函数关系：对于 60%TBSA.Discussion：讨论："一天/百分比 "规则似乎不适用于受伤情况：在考虑个体患者时，"每百分比一天 "规则的预测价值存在缺陷。它不适用于损伤

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.