Nomogram based on burn characteristics and the National Early Warning Score to predict survival in severely burned patients

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2025-02-01 DOI:10.1016/j.burns.2024.10.006

Ying Chen , Yu Duan , Qingshan Liu , Yindi Li , Mingyu Liu , Hao Yan , Yu Sun , Bing Ma , Guosheng Wu

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引用次数: 0

Abstract

Background

Extensive burns are associated with a high mortality rate. Early prediction and action can reduce mortality. The National Early Warning Score (NEWS) is considered the best early warning score for predicting mortality. However, there has been no assessment conducted on the clinical prognostic significance of NEWS in individuals suffering from severe burns. The objective of this research was to establish a nomogram based on burn characteristics and the NEWS to predict survival in severely burned patients.

Methods

A retrospective analysis was performed on 335 patients diagnosed with extensive burns from 2005 to 2021 in the Department of Burn Surgery of Changhai Hospital, the First Affiliated Hospital of Naval Medical University. Univariate and multivariate analyses were used to determine independent prognostic factors. A nomogram was developed using these prognostic factors and its internal validity was assessed through bootstrap resampling.

Results

The results of multivariate analysis showed that the independent factors affecting the prognosis of severe burn patients were age, full-thickness burn, creatinine, inhalation tracheotomy, and the NEWS, all of which were identified to create the nomogram. The Akaike Information Criterion and Bayesian Information Criterion values of the nomogram demonstrated superior goodness-of-fit in predicting severe burns compared to NEWS, with lower scores (195.21 vs. 201.24; 221.91 vs. 224.12, respectively). The bootstrap-adjusted concordance index (C-index) of the nomogram yielded a higher value of 0.923(95 % CI 0.892–0.953), compared to NEWS which had a C-index of 0.699 (95 % CI 0.628–0.770). The calibration curves demonstrated excellent agreement between predicted probabilities and observed outcomes in the nomogram analysis. Furthermore, decision curve analysis indicated promising clinical utility for the proposed nomogram model. By applying an appropriate cutoff value derived from receiver operating characteristics curve analysis, it was observed that the high-risk group identified by the nomogram exhibited a significantly higher mortality rate than the low-risk group.

Conclusion

This study introduces an innovative nomogram that predicts the survival rate of individuals with severe burn injuries by combining clinical attributes and laboratory examinations, demonstrating superior efficacy compared to conventional NEWS systems.

查看原文本刊更多论文

基于烧伤特征和国家早期预警评分预测严重烧伤患者生存的Nomogram。

背景：大面积烧伤与高死亡率相关。早期预测和行动可以降低死亡率。国家早期预警评分（NEWS）被认为是预测死亡率的最佳早期预警评分。然而，目前还没有对NEWS在严重烧伤患者的临床预后意义进行评估。本研究的目的是建立一个基于烧伤特征和NEWS的nomogram来预测严重烧伤患者的生存。方法：回顾性分析海军医科大学第一附属长海医院烧伤外科2005 ~ 2021年诊断为大面积烧伤的335例患者。采用单因素和多因素分析确定独立预后因素。利用这些预后因素建立了一个nomogram，并通过bootstrap重采样来评估其内部有效性。结果：多因素分析结果显示，影响严重烧伤患者预后的独立因素为年龄、全层烧伤、肌酐、吸入性气管切开术、NEWS，这些因素均被识别并形成了nomogram。与NEWS相比，nomogram Akaike信息准则值和Bayesian信息准则值在预测严重烧伤方面的拟合优度更高，但评分较低(195.21比201.24；221.91 vs. 224.12)。与NEWS的C-index为0.699 （95% CI 0.628-0.770）相比，nomogram经bootstrap-adjusted consistency index （C-index）为0.923（95% CI 0.892-0.953）。校准曲线显示了在模态分析中预测概率和观察结果之间的良好一致性。此外，决策曲线分析表明，所提出的nomogram模型具有良好的临床应用前景。通过应用由受试者工作特征曲线分析得出的适当截止值，观察到nomogram高危组的死亡率明显高于低危组。结论：本研究引入了一种创新的nomogram，通过结合临床属性和实验室检查来预测严重烧伤患者的生存率，与传统的NEWS系统相比，显示出优越的疗效。

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.