A review of some of the latest low-resourcs emergency medicine evidence

A comparison of burns scoring systems

Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia


Risa HerlianitaEdi, PurwantoIndri, WahyuningsihIndah, Dwi Pratiwi

Aim

To compare 4 different burns scoring systems in predicting mortality.

Rationale

A vast majority of burns deaths occur in Low or Middle income countries. There is a need to accurately assess burns severity in the Emergency Department to direct patients to the correct treatment path, especially if there are limited treatment options. However, few evaluations of burn scoring systems have been conducted in low resource settings. 

Design

Retrospective review of notes, trained reviewers calculate the scores using the Ryan model, Revised Baux score, BOBI and ABSI. 

Setting

Large referral hospital in Malang, Indonesia. 

Population

111 patients aged >17 years with complete notes who attended the Emergency department with burns injuries.

Primary outcome

Mortality

Results

The ABSI score was the best at predicting mortality with sensitivity of 81.6 and a specificity of 92.5.

Author’s Discussion

The ABSI remains an accurate method for predicting outcome in burns patients. 

Strengths

Simple patient orientated outcome.

Focus on this outcome limited data drenching 

 

Weakness

Retrospective review of notes

Limited number of patients

Significant proportion(10%) with incomplete data

Low numbers of patients

Specialist reviewers calculating scores limit real world applicability. 

 

 My humble opinion

In low resource settings I would tend to use a score to determine if there is value in trying to transfer a patient to a burns certain or pallating. Therefore it is reassuring that the ABSI has very high sensitivity. I would use the ABSI scoring system to help inform a difficult decision that I do not have to undertake often.

 


Written by Daniel Roberts

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