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2014

NATIONAL 
BURN 
REPOSITORY
REPORT OF DATA FROM 2004-2013

American Burn Association, National Burn Repository 2014. Version 10.0. All Rights Reserved Worldwide.
311 S. Wacker Drive Suite 4150 Chicago, IL 60606 312-642-9260 www.ameriburn.org

National Burn
Repository
2014 Report
Dataset Version 10.0

FIRE/FLAME INJURIES REPRESENT 43% OF THE CASES IN


THIS REPORT WITH A KNOWN ETIOLOGY

SCALD INJURIES REPRESENT 34% OF THE CASES IN THIS


REPORT WITH A KNOWN ETIOLOGY

CONTACT WITH HOT OBJECT INJURIES REPRESENT 9%


OF THE CASES IN THIS REPORT WITH A KNOWN ETIOLOGY

ELECTRICAL INJURIES REPRESENT 4% OF THE CASES IN THIS


REPORT WITH A KNOWN ETIOLOGY

CHEMICAL INJURIES REPRESENT 3% OF THE CASES IN THIS


REPORT WITH A KNOWN ETIOLOGY

American Burn Association, National Burn Repository 2014. Version 10.0. All Rights Reserved Worldwide.

National Burn Repository 2014 Report


American Burn Association NBR Advisory Committee
Christopher W. Lentz, MD, FACS, FCCM
NBR Committee Chair
Paul Silverstein Burn Center
INTEGRIS Baptist Medical Center
Oklahoma City, Oklahoma

Bruce M. Potenza, MD, FACS


UC San Diego Regional Burn Center
UC San Diego School of Medicine
San Diego, California
Cynthia L. Reigart, RN, BSN
The Nathan Speare Regional Burn Treatment Center
Crozer Chester Medical Center
Upland, Pennsylvania

Nicole Bernal, MD
University of California Irvine
UCI Regional Burn Center
Orange, California

Palmer Q. Bessey, MD, FACS, MS, Ad Hoc


Weill Cornell Medical College
New York Presbyterian Hospital
William Randolph Hearst Burn Center
New York, New York

Iris Faraklas, RN, BSN


University of Utah Hospital Burn Center
Salt Lake City, Utah
Steven A. Kahn, MD
Vanderbilt University Medical Center
Nashville, Tennessee

Margaret A. Finocchiaro, BA, Ad Hoc


The Nathan Speare Regional Burn Treatment Center
Crozer Chester Medical Center
Upland, Pennsylvania

M. Anwarul Huq Mian, MD, PhD, MPH


Southeast Pain Management
Augusta, Georgia

Matthew B. Klein, MD, MS, FACS, Ex Officio


Santa Clara Valley Medical Center
San Jose, California

Michael J. Mosier, MD, FACS


Loyola University Medical Center
Maywood, Illinois

Sidney F. Miller, MD, FACS, Ad Hoc


The Ohio State University Wexner Medical Center
Columbus, Ohio

John Myers, PhD


University of Louisville
Louisville, Kentucky

American Burn Association Staff


John A. Krichbaum, JD
CEO and Executive Director
Susan M. Browning, MPH
Deputy CEO and Chief Operating Officer
Maureen T. Kiley, BBA
ABA Director
Bart D. Phillips, MS, Senior Consultant
E-B Research, LLC
Minneapolis, MN

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American Burn Association, National Burn Repository 2014. Version 10.0. All Rights Reserved Worldwide.

Acknowledgements
The American Burn Association wishes to thank the members of the National Burn Repository Advisory Committee:
Christopher Lentz, Cynthia Reigart, Iris Faraklas, Michael Mosier, Bruce Potenza, Nicole Bernal, Margaret Finocchiaro,
Steven Kahn, M. Anwarul Huq Mian and John Myers, for their commitment, dedication and expedited review of
this years report. Their combined efforts compiled insightful analysis of these data allowing publication for the ABA
membership to receive this report for the 46th Annual Meeting in Boston, Massachusetts.
The ABA is also grateful for the work of Bart Phillips, Senior Consultant of E-B Research, and his dedicated staff.
Their compilation, organization and presentation of this data facilitates its utility into understanding the demographics
of thermal injury.
The NBR Advisory Committee would like to express its gratitude to the ABA Central Office which provides
the support and infrastructure to ensure that this resource is completed in a timely and effective fashion. We are also
thankful for the exceptional work of Maureen Kiley, ABA Director, who ensures fluid communication amongst all who
contribute to this report. We extend our gratitude to the previous Chairmen, Sidney Miller and Palmer Bessey, for their
vision and continued mentorship to this Committee.
Finally, the NBR Advisory Committee and the American Burn Association Board of Trustees would like to personally
thank the contributing American and International burn centers and registrars for maintaining an accurate registry and
submitting their data. Without you, this report would not exist.

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Table of Contents
American Burn Association National Burn Repository Advisory Committee...................................................ii
Acknowledgements.........................................................................................................................................iii
Table of Contents............................................................................................................................................iv
Introduction....................................................................................................................................................ix
Summary of Findings......................................................................................................................................x
1) Analysis of Contributing Hospitals..................................................................................................................1
Figure 1: States that have Submitted to the NBR, 2004 to 2013.......................................................................2
Table 1: Burn Center Location and Participation by Region............................................................................2
Figure 2: Contributing U.S. Hospitals by Geographic Region..........................................................................3
Figure 3: Arrival/Admission Year, Acute Burn Admissions.................................................................................3
Figure 4:Volume of Record Submission by Geographic Region......................................................................4
Figure 5: Contributing U.S. Hospitals by Hospital Ownership Type..................................................................4

2) Analysis of All U.S. Records Included in the Report........................................................................................7
Figure 6: Age Group by Gender.......................................................................................................................8
Table 2: Age Group by Gender........................................................................................................................8
Figure 7: Race/Ethnicity.................................................................................................................................9
Table 3: Race/Ethnicity...................................................................................................................................9
Figure 8: Age Group by White vs. Non-White.................................................................................................9
Figure 9: Burn Size Group (% TBSA)..............................................................................................................10
Table 4: Survived/Died by Burn Group Size (%TBSA)....................................................................................10
Figure 10: Etiology..........................................................................................................................................11
Table 5: Etiology.............................................................................................................................................11
Figure 11: Frequency of Contact with Hot Object, Electrical, Fire, and Fire by Age Group..............................11
Figure 12: Place of Occurrence E849 Code..................................................................................................12
Table 6: Place of Occurrence E849 Code......................................................................................................12
Figure 13: Circumstance of Injury...................................................................................................................12
Table 7: Circumstance of Injury.......................................................................................................................12
Figure 14: Hospital Disposition........................................................................................................................13
Table 8: Hospital Disposition...........................................................................................................................13
Figure 15: Average Hospital Length of Stay by Gender, 2004 to 2013...............................................................14
Figure 16: Mortality Rate by Gender, 2004 to 2013.........................................................................................14
Table 9: Mortality Rate by Age Group and Burn Size......................................................................................15
Figure 17: Complications: Frequency of Top Ten Clinically Relevant Complications........................................16
Figure 18: Complications: Frequency of Top Ten Clinically Relevant Complications by Days on the Ventilator...........16
Figure 19: Complication Rate for Age Categories by Days on Ventilator..........................................................17
Table 10: Complication Count for Age Categories by Days on Ventilator.........................................................17
Figure 20: Mortality Rate for BAUX Score Categories by Gender...................................................................18
Table 11: Number of Cases in BAUX Score Categories by Gender..................................................................18
Figure 21: Mortality Rate for BAUX Score Categories by Inhalation Injury....................................................19
Table 12: Number of Cases in BAUX Score Categories by Inhalation Injury...................................................19
Table 13: Mortality Rates for Matrix of Main Predictors..................................................................................20
Table 14: Primary Insurance Payor...................................................................................................................21
Figure 22: Percent of Patients Utilizing Selected Insurance Types Over Time....................................................22
Table 15: Case Count for Select Insurance Categories Over Time ...................................................................22
Table 16: Hospital Days: Lived/Died by Burn Size Group................................................................................23
Table 17: Hospital Charges: Lived/Died by Burn Size Group...........................................................................23
Table 18: Hospital Charges: Lived/Died by Top 20 MS-DRGs.........................................................................24
Table 19: Days per %TBSA and Charges per Day by Age Groups and Survival.................................................25
3) Analysis by Age Group....................................................................................................................................26
Age Group Birth to .9........................................................................................................... 28

Figure 23: Race/Ethnicity

Table 20: Race/Ethnicity

Figure 24: Etiology

Table 21: Etiology

Table 22: Hospital Days: Lived/Died by Inhalation Injury

Table 23: Top Ten Complications

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Age












Age












Age












Age












Age

Table 24: Top Ten Procedures


Table 25: Lived/Died by Burn Group Size (% TBSA)
Table 26: Hospital Days by Burn Group Size (% TBSA)
Table 27: Mean Charges for Top Five MS-DRGs
Figure 25: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 26: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 1-1.9 .................................................................................................................. 32
Figure 27: Race/Ethnicity
Table 28: Race/Ethnicity
Figure 28: Etiology
Table 29: Etiology
Table 30: Hospital Days: Lived/Died by Inhalation Injury
Table 31: Top Ten Complications
Table 32: Top Ten Procedures
Table 33: Lived/Died by Burn Group Size (% TBSA)
Table 34: Hospital Days by Burn Group Size (% TBSA)
Table 35: Mean Charges for Top Five MS-DRGs
Figure 29: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 30: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 2-4.9 .................................................................................................................. 36
Figure 31: Race/Ethnicity
Table 36: Race/Ethnicity
Figure 32: Etiology
Table 37: Etiology
Table 38: Hospital Days: Lived/Died by Inhalation Injury
Table 39: Top Ten Complications
Table 40: Top Ten Procedures
Table 41: Lived/Died by Burn Group Size (% TBSA)
Table 42: Hospital Days by Burn Group Size (% TBSA)
Table 43: Mean Charges for Top Five MS-DRGs
Figure 33: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 34: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 5-15.9 ................................................................................................................ 40
Figure 35: Race/Ethnicity
Table 44: Race/Ethnicity
Figure 36: Etiology
Table 45: Etiology
Table 46: Hospital Days: Lived/Died by Inhalation Injury
Table 47: Top Ten Complications
Table 48: Top Ten Procedures
Table 49: Lived/Died by Burn Group Size (% TBSA)
Table 50: Hospital Days by Burn Group Size (% TBSA)
Table 51: Mean Charges for Top Five MS-DRGs
Figure 37: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 38: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 16-19.9 .............................................................................................................. 44
Figure 39: Race/Ethnicity
Table 52: Race/Ethnicity
Figure 40: Etiology
Table 53: Etiology
Table 54: Hospital Days: Lived/Died by Inhalation Injury
Table 55: Top Ten Complications
Table 56: Top Ten Procedures
Table 57: Lived/Died by Burn Group Size (% TBSA)
Table 58: Hospital Days by Burn Group Size (% TBSA)
Table 59: Mean Charges for Top Five MS-DRGs
Figure 41: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 42: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 20-29.9 .............................................................................................................. 48
Figure 43: Race/Ethnicity

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Age












Age












Age












Age








Table 60: Race/Ethnicity


Figure 44: Etiology
Table 61: Etiology
Table 62: Hospital Days: Lived/Died by Inhalation Injury
Table 63: Top Ten Complications
Table 64: Top Ten Procedures
Table 65: Lived/Died by Burn Group Size (% TBSA)
Table 66: Hospital Days by Burn Group Size (% TBSA)
Table 67: Mean Charges for Top Five MS-DRGs
Figure 45: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 46: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 30-39.9 .............................................................................................................. 52
Figure 47: Race/Ethnicity
Table 68: Race/Ethnicity
Figure 48: Etiology
Table 69: Etiology
Table 70: Hospital Days: Lived/Died by Inhalation Injury
Table 71: Top Ten Complications
Table 72: Top Ten Procedures
Table 73: Lived/Died by Burn Group Size (% TBSA)
Table 74: Hospital Days by Burn Group Size (% TBSA)
Table 75: Mean Charges for Top Five MS-DRGs
Figure 49: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 50: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 40-49.9 .............................................................................................................. 56
Figure 51: Race/Ethnicity
Table 76: Race/Ethnicity
Figure 52: Etiology
Table 77: Etiology
Table 78: Hospital Days: Lived/Died by Inhalation Injury
Table 79: Top Ten Complications
Table 80: Top Ten Procedures
Table 81: Lived/Died by Burn Group Size (% TBSA)
Table 82: Hospital Days by Burn Group Size (% TBSA)
Table 83: Mean Charges for Top Five MS-DRGs
Figure 53: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 54: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 50-59.9 .............................................................................................................. 60
Figure 55: Race/Ethnicity
Table 84: Race/Ethnicity
Figure 56: Etiology
Table 85: Etiology
Table 86: Hospital Days: Lived/Died by Inhalation Injury
Table 87: Top Ten Complications
Table 88: Top Ten Procedures
Table 89: Lived/Died by Burn Group Size (% TBSA)
Table 90: Hospital Days by Burn Group Size (% TBSA)
Table 91: Mean Charges for Top Five MS-DRGs
Figure 57: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 58: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 60-69.9 .............................................................................................................. 64
Figure 59: Race/Ethnicity
Table 92: Race/Ethnicity
Figure 60: Etiology
Table 93: Etiology
Table 94: Hospital Days: Lived/Died by Inhalation Injury
Table 95: Top Ten Complications
Table 96: Top Ten Procedures
Table 97: Lived/Died by Burn Group Size (% TBSA)
Table 98: Hospital Days by Burn Group Size (% TBSA)

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Age












Age











Table 99: Mean Charges for Top Five MS-DRGs


Figure 61: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 62: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 70-79.9 .............................................................................................................. 68
Figure 63: Race/Ethnicity
Table 100: Race/Ethnicity
Figure 64: Etiology
Table 101: Etiology
Table 102: Hospital Days: Lived/Died by Inhalation Injury
Table 103: Top Ten Complications
Table 104: Top Ten Procedures
Table 105: Lived/Died by Burn Group Size (% TBSA)
Table 106: Hospital Days by Burn Group Size (% TBSA)
Table 107: Mean Charges for Top Five MS-DRGs
Figure 65: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 66: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases
Group 80 and Over ....................................................................................................... 72
Figure 67: Race/Ethnicity
Table 108: Race/Ethnicity
Figure 68: Etiology
Table 109: Etiology
Table 110: Hospital Days: Lived/Died by Inhalation Injury
Table 111: Top Ten Complications
Table 112: Top Ten Procedures
Table 113: Lived/Died by Burn Group Size (% TBSA)
Table 114: Hospital Days by Burn Group Size (% TBSA)
Table 115: Mean Charges for Top Five MS-DRGs
Figure 69: Mean Hospital Days for Fire/Flame, Contact with Hot Object, and Scald by Admission Year
Figure 70: Mean Charges for Etiology Categories with Greater than 100 Valid Charge Cases

4) Analysis by Etiology........................................................................................................................................77
Fire/Flame Injuries............................................................................................................... 78

Figure 71: Circumstance of Injury

Table 116: Circumstance of Injury

Figure 72: Place of Occurrence E849 Code

Table 117: Place of Occurrence E849 Code

Figure 73: Percent of Patient with Clinically Relevant Complications by Age Group

Table 118: Complication Rate by Age Group

Table 119: Top Ten Complications

Table 120: Top Ten Procedures

Table 121: Hospital Days: Lived/Died by Inhalation Injury

Table 122: Hospital Days: Lived/Died by Burn Size Group (%TBSA)

Table 123: Mortality Rate for Matrix of Main Predictors

Figure 74: Mortality Rate for BAUX Score Categories by Gender

Table 124: Number of Cases in BAUX Score Categories by Gender
Scald Injuries....................................................................................................................... 84

Figure 75: Circumstance of Injury

Table 125: Circumstance of Injury

Figure 76: Place of Occurrence E849 Code

Table 126: Place of Occurrence E849 Code

Figure 77: Percent of Patient with Clinically Relevant Complications by Age Group

Table 127: Complication Rate by Age Group

Table 128: Top Ten Complications

Table 129: Top Ten Procedures

Table 130: Hospital Days: Lived/Died by Burn Size Group (%TBSA)

Figure 78: Mortality Rate for BAUX Score Categories by Gender

Table 131: Number of Cases in BAUX Score Categories by Gender
Contact with Hot Object Injuries........................................................................................... 89

Figure 79: Circumstance of Injury

Table 132: Circumstance of Injury

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Table of Contents

Figure 80: Place of Occurrence E849 Code

Table 133: Place of Occurrence E849 Code

Figure 81: Percent of Patient with Clinically Relevant Complications by Age Group

Table 134: Complication Rate by Age Group

Table 135: Top Ten Complications

Table 136: Top Ten Procedures

Table 137: Hospital Days: Lived/Died by Burn Size Group (%TBSA)
Electrical Injuries................................................................................................................. 93

Figure 82: Circumstance of Injury

Table 138: Circumstance of Injury

Figure 83: Place of Occurrence E849 Code

Table 139: Place of Occurrence E849 Code

Figure 84: Percent of Patient with Clinically Relevant Complications by Age Group

Table 140: Complication Rate by Age Group

Table 141: Top Ten Complications

Table 142: Top Ten Procedures

Figure 85: Frequency of Records by Age Categories and Gender
Chemical Injuries................................................................................................................. 97

Figure 86: Circumstance of Injury

Table 143:Circumstance of Injury

Figure 87: Place of Occurrence E849 Code

Table 144: Place of Occurrence E849 Code

Figure 88 Percent of Patient with Clinically Relevant Complications by Age Group

Table 145:Complication Rate by Age Group

Table 146:TopTen Complications

Table 147:TopTen Procedures

Figure 89: Frequency of Records by Age Categories and Gender
5) Hospital Comparisons.....................................................................................................................................102
2010-2013 Fire/Flame Injuries................................................................................................ 103

Figure 90: 2010-2013 Fire/Flame Injuries Mortality Rate

Figure 91: 2010-2013 Fire/Flame Injuries Mean Charges

Figure 92: 2010-2013 Fire/Flame Injuries Mean Length of Stay

Figure 93: 2010-2013 Fire/Flame Injuries Complication Rate
6) Analysis of International Records....................................................................................................................109

Figure 94: Age Group by Gender

Table 148: Age Group by Gender

Figure 95: Etiology

Table 149: Etiology

Figure 96: Race/Ethnicity

Table 150: Race/Ethnicity

Figure 97: Place of Occurrence E849 Code

Table 151: Place of Occurrence E849 Code

Figure 98: Circumstance of Injury

Table 152: Circumstance of Injury

Table 153: Mortality Rate for BAUX Score Categories by Gender

Table 154: Lived/Died by Burn Group Size (% TBSA)
Appendix............................................................................................................................................................115
A. Minimum Data Set and Data Quality................................................................................. 116

Table 155: Data Completeness by Variable

Figure 99: Data Quality Expressed as Mean Percent of Missing Variables of the Minimum Data Set per

Record by Admission Year

Figure 100: Data Quality Expressed as Mean Percent of Missing Variables of the Minimum Data Set per

Record by Facility

Figure 101: Percent of Records with Number of MissingVariables Compared Between Data Submitted in 2013 and Before

Figure 102: Count of Records with Number of Missing Variables Compared Between 2013 and Before
B. List of Participating Hospitals............................................................................................ 122
C. Selected List of Peer-Reviewed Publications Utilizing NBR Data.......................................... 125

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Introduction
Data! Data! Data! he cried impatiently, I cannot make bricks
without clay.
Sherlock Holmes in The Adventure of the Copper Beeches
Sir Arthur Conan Doyle
This National Burn Repository (NBR) report represents
ten years of cumulative data from 96 United States Burn
Centers, four Canadian Burn Centers, and two Swedish
Burn Centers. The report contains over 190 thousand
entries. This report represents the largest resource on the
epidemiology of thermal injury, of patients admitted to
burn centers, in North America. It also is the single most
useful reference for determining benchmark standards for
outcomes such as mortality rate and hospital length of stay.
As we venture into the uncharted waters of medical quality
improvement, this report will be the foundation for our
specialty.
Although the report does not change much from year to
year, the results over time have changed. One striking finding
in this years report has been changes in overall length of
stay and burn mortality. Since 2004, the average hospital
length of stay has dropped from nine to eight days. Although
it represents only 11% reduction, this can have significant
impact on health care costs. Also during the 10 year period
from 2004 to 2013, the overall mortality has decreased from
3.4% to 2.7% for males and from 4.6% to 3.3% for females.
The clear message is that our burn care facilities are centers
of excellence that have a track record of improving the
efficiency and quality of burn care.
This next year, the NBR will have to evolve. The
implementation of the ICD-10 will bring granularity to the
burn diagnoses. Each ICD-10 burn code will specifically
delineate the exact location, depth and if appropriate, the

laterality of the injury. This will certainly improve queries


of the database. Also, the outcomes defined by the Burn
Quality Improvement Program (BQIP) Committee will be
incorporated into the NBR. This will elevate this repository to
a standard defined by the experts; the burn care professionals.
Its imperative that the NBR continues to serve as the
single best resource for health care planners within our
institutions and within our governments. With the shrinking
pool of health care dollars, resources still need to be allocated
to our centers registries and registrars. This data is the
foundation on how burn care quality will be measured. As
good as it has become, only 24% of the records are complete;
75% of the reports are missing one or more key variables.
The majority of the records added this year had zero deficits.
This represents approximately 75% of the new submissions.
Compared to the previous nine years, the majority of
the records were missing 2-5 key variables. Although the
accuracy has improved over the past decade, we still have
significant room for improvement.
The NBR Committee and the American Burn
Association still have a vision for making this registry a living
resource that permits continuous data entry in real time. We
also want to evolve with the changes in world technology to
make access to this data much suppler in this digital age of
information.Your data submission is the clay allowing the
NBR to become the bricks on which we will build our
towers as centers of excellence and our bridges to improve
our interoperability.
Christopher W. Lentz, MD, FACS, FCCM
Chair, ABA NBR Advisory Committee

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Summary of Findings
The 2014 National Burn Repository Annual Report reviewed the combined data set of acute burn admissions for the
time period between 2004 and 2013. Key findings included the following:
1. Ninety-six hospitals from 35 states, and the District of Columbia, contributed to this report, totaling 191,848
records. Seventy-seven hospitals contributed more than 500 cases. Data are not dominated by any single center and
appeared to represent a reasonable cross section of U.S. hospitals.
2. Nearly 69% of the burn patients were men. The mean age for all cases was 32 years old. Children under the age of 5
accounted for 19% of the cases, while patients age 60 or older represented 13% of the cases.
3. Seventy-four percent of the reported total burn sizes were less than 10%TBSA and these cases had a mortality rate
of .6%.The mortality rate for all cases was 3.3% and 5.9% for fire/flame injuries.
4. The two most common reported etiologies were fire/flame and scalds, and accounted for almost 8 out of 10
reported. Scald injuries were most prevalent in children under 5, while fire/flame injuries dominated the remaining age
categories. Nine percent of cases did not designate an etiology of injury.
5. Seventy-three percent of the burn injuries, with known places of occurrence, were reported to have occurred in the
home. Seventy-one percent of cases with known circumstances of injury were identified as accident, non-work related.
6. During the ten year period from 2004 and 2013, the average length of stay for both females and males declined from
roughly 9 days to 8 days. The mortality rate decreased from 3.4% to 2.7% for males and from 4.6% to 3.3% for females.
7. Deaths from burn injury increased with advancing age and burn size, and presence of inhalation injury. For patients
under age 60 and with a TBSA between .1 and 19.9, the presence of inhalation injury increased the likelihood of death
by 16 times.
8. Pneumonia was the most frequent clinically related complication and occurred in 5.8% of fire/flame injured
patients. The frequency of pneumonia and respiratory failure was much greater in patients with 4 days or more of
mechanical ventilation, than those with less than 4 days. The incidence of clinically related complications for patients
with 0 days of mechanical ventilation increased with age and topped out at 20% for age 80 and over.
9. For survivors, the average length of stay was slightly greater than approximately 1 day per percent TBSA burned.
For those who died, the total hospital days were roughly 3 weeks for burn patients with TBSA values below 70% and
decreased from 3 weeks to 1 week for the larger burn categories.
10. Overall, the charges per case for a death were over 3 times greater than those charges for a survivor ($285,225
vs. $86,146). Additionally, hospital charges per hospital day in patient deaths averaged roughly $14,000 more than
surviving patients.
All cases received from contributing hospitals (ABA burn registry and ABA non burn registry software) that met the data
structure requirements were initially accepted into the NBR. This report includes only cases with an admit year of 2004
2013, inclusive. Records were excluded from the analysis for this report if the Admit Type or Admit Status was:
Readmission
Admission for reconstruction/rehabilitation
Outpatient encounter
Same patient
Scheduled/elective admission
Acute admission, not burn injury related.
In addition, records were excluded from the analysis of this report if they contained missing values for the following
variables:
Gender
LOS < ICU days
Discharge disposition
Both Calculated Age and Manually entered Age
Both TBSA and Etiology

American Burn Association, National Burn Repository 2014. Version 10.0. All Rights Reserved Worldwide.

Summary of Findings
As was done last year, an algorithm was used to identify and remove potential duplicate records from the analysis.
Duplicate records can exist in the database if a facility submits the same record during two different calls for data. The
algorithm that was implemented identified records that contained identical information on the variables listed below.
The more recently submitted record was included in the analysis while the older record was eliminated as a duplicate.
Facility
AdmissionYear
Age
Gender
Race
AdmissionType
Discharge Date
ECODE
TBSA %
Lastly, the records received from our Canadian and International contributors are not included in the body of the
analysis, but are presented separately in Section 6.

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Analysis
of Contributing Hospitals

Analysis
of Contributing Hospitals
The first section of the National Burn Repository (NBR) report deals with an evaluation of the contributing
hospitals. Because the report reflects a rolling 10-year average and hospitals submit data, the mix of hospitals may vary
from year to year. This years NBR report contains data from thirty-five states in the U.S., four Canadian burn centers
and two Swedish centers. Sixty-four of the reporting centers are ABA verified. Seven states with Burn Centers have
not contributed data to the NBR report. The U.S. data comes from a representative sample of burn centers that appears
quite comparable to the actual distribution of Burn Centers in the U.S.
Figure
STATES THAT SUBMITTED TO THE NBR, 2004 TO 2013

1
2
3
4
5
6

3
2

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Have burn centers which have contributed to the NBR between 2004 to 2013

ANALYSIS
BY AGE
GROUP

Do not have burn centers


Canadian contributing burn centers are noted above and are located in:
(1) Edmonton, Alberta; (2) Hamilton, Ontario; (3) Toronto, Ontario; and (4) Montreal, Quebec.
International contributors not shown above include Uppsala, Sweden and Linkoping, Sweden.

Table

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

BURN CENTER LOCATION AND PARTICIPATION BY REGION

ANALYSIS
BY AGE
ETIOLOGY

Have burn centers that have not contributed data to the NBR

Region

U.S. Burn Care


Facilities*

U.S. Facilities in the


Annual Report

ABA Verified
Centers**

ABA Verified
Centers in the
Annual Report

East

34

23

14

14

North

39

28

22

22

South

29

23

14

14

West

26

22

14

14

Total

128

96

64

64

EAST DC, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, and Connecticut. NORTH Illinois,
Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin, and South Dakota. SOUTH Alabama,
Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Kentucky, Oklahoma, Virginia, West
Virginia, and Texas. WEST Arizona, California, Colorado, Nevada, New Mexico, Utah, and Washington
*ABA Burn Care Resource Directory, Edition March 2014
** ABA Verified Burn Centers, March 2014

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of Contributing Hospitals
24,591 records used for this report were submitted by 93 burn centers during this years Call for Data. This brings the
total number of records in this report to 191,848. The 2014 report contains roughly 15,000 more records than the 2013
report.
The north region, which has the largest number of burn centers, contributes the highest number of records.

Figure

VOLUME OF RECORD SUBMISSION BY GEOGRAPHIC REGION

Number of Cases

60,000
56,307
50,000
47,348

44,743

40,000

43,450

30,000
20,000

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

10,000

East

North

South

West

Figure

Record Submission

Before 2013

ARRIVAL/ADMISSION YEAR, ACUTE BURN ADMISSIONS

2013

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

25,000

Number of Cases

1
2
3
4
5
6

20,000

15,000

HOSPITAL
COMPARISONS

10,000

5,000

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Year of Admission
24,591 records were submitted in 2013 for this report
191,848 records are included in this report

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of Contributing Hospitals
Two groups of Burn Centers continue to contribute the largest number of records. Programs in hospitals with greater
than 500 beds lead the way. However, the next largest group continues to come from hospitals in the 200-299 bed range.
The majority of records submitted came from non-governmental, not-for-profit hospitals.

ANALYSIS OF
CONTRIBUTING
HOSPITALS

Figure

100,000

80,000

Number of Cases

1
2
3
4
5
6

CONTRIBUTING U.S. HOSPITALS BY HOSPITAL BED SIZE CATEGORY

60,000

40,000

20,000

ANALYSIS OF ALL
U.S. RECORDS

25-49
beds

50-99
beds

100-199
beds

200-299
beds

300-399
beds

400-499
beds

500 or
more beds

Hospital Bed Size

ANALYSIS
BY AGE
GROUP

Figure

CONTRIBUTING U.S. HOSPITALS BY HOSPITAL OWNERSHIP TYPE

ANALYSIS
BY AGE
ETIOLOGY

Number of Cases

HOSPITAL
COMPARISONS

100,000
80,000
60,000
40,000
20,000

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Army

Church
Operated

County

Hospital
District

Investor,
Corporation

Other Notfor-Profit

Ownership Type

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State

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

THIS PAGE INTENTIONALLY LEFT BLANK

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of All U.S. Records

21

Analysis
of All U.S. Records
Figure 6 and Table 2 show the number of cases in various age groups. Each column shows the total number of cases
and the gender distribution within a specific age category. Males outnumber females in all categories. Children less than
age 16 make up 29% of all patients. The most prevalent age groups remain ages 20 60, accounting for greater than 50%
of all patients.

Figure

ANALYSIS OF
CONTRIBUTING
HOSPITALS

Female
Male

30,000

Number of Cases

1
2
3
4
5
6

AGE GROUP BY GENDER

20,000

10,000

ANALYSIS OF ALL
U.S. RECORDS

0-.9

1-1.9

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories
Total N=191,848 (Excluding 0 Unknown/Missing)

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

2-4.9

AGE GROUP BY GENDER

Age Categories
0-.9
1-1.9
2-4.9
5-15.9
16-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80 and over
Subtotal
Missing
Total

Cases
10,360
14,380
12,609
18,068
10,027
28,516
24,411
27,042
22,056
12,319
7,150
4,910
191,848
0
191,848

Total
Column N %
5.4
7.5
6.6
9.4
5.2
14.9
12.7
14.1
11.5
6.4
3.7
2.6
100.0
0.0
100.0

Table

Gender
Female
Male
Cases
Column N %
Cases
Column N %
6.9
6,188
4.7
4,172
5,706
9.4
8,674
6.6
5,508
9.1
7,101
5.4
6,119
10.1
11,949
9.1
2,505
4.1
7,522
5.7
7,037
11.6
21,479
16.4
6,320
10.4
18,091
13.8
7,480
12.3
19,562
14.9
6,375
10.5
15,681
12.0
4,178
6.9
8,141
6.2
2,880
4.7
4,270
3.3
2,450
4.0
2,460
1.9
60,730
100.0
131,118
100.0
0
0.0
0
0.0
60,730
100.0
131,118
100.0

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of All U.S. Records
Figure 7 and Table 3 depict the distribution of cases in the NBR by race. The table shows that 4.1% of records did not
specify race. The figure is based on those records in which race was specified.
Figure 8 shows the number of cases of white and non-white patients in various age categories. Non-whites
predominate in children less than 5 admitted to burn centers. In all other age categories, however, there are more whites
than non-whites. This suggests that racial factors may influence the occurrence of burn injuries and/or admission to a
burn center differently as a function of age.

Figure

Table

RACE/ETHNICITY

RACE/ETHNICITY
Race

Cases

% of Valid

White

107,310

58.9%

Black

35,789

19.7%

Hispanic

25,557

14.0%

Other

7,491

4.1%

Asian

4,398

2.4%

Native
American

1,495

0.8%

Unknown

9808

Total

191,848

Race
White
Black
Hispanic
Other
Asian
Native American

Total N=182,040 (Excluding 9,808 Unknown/Missing)

Non-White
White

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
ETIOLOGY

15,000

Number of Cases

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS
BY AGE
GROUP

Figure

AGE GROUP BY WHITE VERSUS NON-WHITE

1
2
3
4
5
6

10,000

HOSPITAL
COMPARISONS

5,000

0-.9

1-1.9

2-4.9

5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories
Total N=182,040 (Excluding 9,808 Unknown/Missing)

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of All U.S. Records
Figure 9 shows the distribution of cases in the NBR by burn size. The proportion of records with no value for burn size
was 12.9%. These presumably included both patients who truly had no burn or skin loss, e.g. pure inhalation injury, and
those whose burn size was unknown or simply not recorded. For patient whom had a recorded burn size, 78% were less
than 20% total BSA. Patients with a total burn size of 40% BSA or more accounted for only 3.2% of cases.
Table 4 shows the proportion of patients in each category of total burn size who died, and the case fatality rate.This clearly
increased with burn size.The burn size associated with a 50% case fatality (LD-50) appears to be approximately 70% TBSA.
Figure

1
2
3
4
5
6

120,000

100,000

ANALYSIS OF
CONTRIBUTING
HOSPITALS

80,000

Number of Cases

ANALYSIS OF ALL
U.S. RECORDS

BURN SIZE GROUP (% TBSA)

60,000

40,000

20,000

ANALYSIS
BY AGE
GROUP

.1-9.9

10-19.9

20-29.9

30-39.9

40-49.9

50-59.9

60-69.9

70-79.9

80-89.9

90-100

% TBSA (Full+ Partial Thickness)


Total N=167,077 (Excluding 24,771 Missing or 0%)

{4

Table

ANALYSIS
BY AGE
ETIOLOGY

%TBSA
0.1 - 9.9
10 - 19.9
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
60 - 69.9
70 - 79.9
80 - 89.9
> 90
Subtotal
Missing or 0%
TOTAL

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

LIVED/DIED BY BURN GROUP SIZE (%TBSA)


Lived
Cases
123,097
24,940
7,116
3,059
1,501
782
527
273
197
105
161,597
23,877
185,474

Died
Cases
787
703
651
608
553
461
411
333
425
548
5,480
894
6,374

Mortality Rate
0.6
2.7
8.4
16.6
26.9
37.1
43.8
55.0
68.3
83.9
3.3
3.6
3.3

Total N=191,848

10

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Analysis
of All U.S. Records
Figure 10 and Table 5 depict the distribution of different burn etiologies amongst the cases in which one was
specified. The table documents that 8.5% of the records did not include an etiology. The figure is based only on those
cases with a specified etiology.
Figure 11 depicts the numbers of cases admitted to the participating hospitals that were caused by one of the four
most common burn etiologies or mechanisms in various age groups. Burns due to Fire/Flame predominated in all cases
5 years and older. Scalds and contact burns were more frequent than Fire/Flame in children less than age 5.
ETIOLOGY

10

Table

ETIOLOGY

Figure

Etiology

Cases

% of Valid

Fire/Flame

75,445

43.0%

Scald
Contact with Hot
Object
Electrical

59,099

33.7%

15,623

8.9%

6,546

3.7%

Chemical

5,839

3.3%

Burn, Unspecified

4,765

2.7%

Other, Non Burn

4,493

2.6%

Inhalation Only

2,814

1.6%

Radiation

470

0.3%

Skin Disease

390

0.2%

Unknown

16,364

Total

191,848

Categories of
Etiology
Fire/Flam e
Scald
Contact with Hot
Object
Electrical
Chemical
Burn,
Unspecified
Other, Non Burn
Inhalation Only
Radiation
Skin Disease

Total N=175,484 (Excluding 16,364 Unknown/Missing)

Figure

11

FREQUENCY OF CONTACT WITH HOT OBJECT,


ELECTRICAL, FIRE, AND SCALD BY AGE GROUP

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Fire/Flame
Scald
Contact with hot object
Electrical

12,000

ANALYSIS
BY AGE
ETIOLOGY

10,000

Number of Cases

1
2
3
4
5
6

8,000

HOSPITAL
COMPARISONS

6,000
4,000
2,000

0-.9

1-1.9

2-4.9

5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories
Total N=156,713 (Excluding 35,135 Cases)

11

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of All U.S. Records
Figure 12 and Table 6 depict the distribution of cases in the NBR by the place of occurrence.The table shows that 12.1 % of
records did not specify a place of occurrence.The figure is based on those records in which a place of occurrence was specified.
The home remains the most common place of occurrence, accounting for 72.8 % of burn injuries cared for in burn centers.
Figure 13 and Table 7 depict the distribution of cases in the NBR by the circumstances of the injury.The table shows that
9 % of records did not specify the circumstances in which the burn injury occurred.The figure is based on those records in
which these circumstances were specified.The vast majority of burns seen at burn centers were considered accidental, with only
14.1 % of these related to work, and only 3.6 % specified as non-accidental.

1
2
3
4
5
6

12

PLACE OF OCCURRENCE E849 CODE

Categories of
Place of
Occurrence
Home
Industrial
Other Specified
Place
Recreation and
Sport
Street/Highway
Public Building
Residential
Institution
Farm
Mine/Quarry

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Total N=168,604 (Excluding 23,244 Unknown/Missing)

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Circumstance
of Injury
Accident, NonWork Related
Accident, Work
Related
Accident,
Recreation
Accident,
Unspecified
Other
Suspected
Assault/Abuse
Suspected Child
Abuse
Suspected Self
Inflicted
Suspected
Arson

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=174,406 (Excluding 17,442 Unknown/Missing)

Home

122,731

72.8%

Industrial

14,005

8.3%

Other Specified Place

9,218

5.5%

Recreation and Sport

7,834

4.6%

Street/Highway

7,708

4.6%

Public Building

4,381

2.6%

Residential Institution

1,367

0.8%

Farm

1,185

0.7%

Mine/Quarry

175

0.1%

Unspecified

23,244

Total

191,848
Table

CIRCUMSTANCE OF INJURY

12

% of
Circumstance of Injury Cases
Valid
Accident, Non-Work
123,773 71.0%
Related
Accident, Work Related 24,666 14.1%
Accident, Recreation

7,464

4.3%

Accident, Unspecified

7,444

4.3%

Other

4,785

2.7%

Suspected Assault/Abuse 2,314

1.3%

Suspected Child Abuse

1,861

1.1%

Suspected Self Inflicted

1,816

1.0%

Suspected Arson

283

0.2%

Unknown

17,442

Total

191,848

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

% of Valid

13

CIRCUMSTANCE OF INJURY

Place of Occurrence Cases

Table

Figure

PLACE OF OCCURRENCE E849 CODE

Figure

Analysis
of All U.S. Records
Figure 14 depicts the proportion of patients in the NBR that died. Since outcome is a criterion for inclusion in the
NBR, there were no records in which the outcome was missing. The overall mortality rate from 2004 to 2013 is 3.3%.
Table 8 shows the numbers and proportions of various types of discharge disposition for all cases included in the
NBR. Seventy one percent of patients were discharged from the burn center to home.
Outcome
Lived
Died

HOSPITAL DISPOSITION

Figure

14

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=191,848

Table

HOSPITAL DISPOSITION

Discharge Disposition

Cases

Percent

Discharged Home, No Home Health

135,941

70.9

Discharged Home

19,599

10.2

Discharged Home, With Home Health

10,111

5.3

Death

6,374

3.3

Rehabilitation Facility

5,286

2.8

Nursing Home/Skilled Nursing Facility (SNF)

3,975

2.1

Transfer to Another Hospital

2,872

1.5

Other

1,187

0.6

Discharged to Extended Care Facility (ECF)

1,017

0.5

Transfer to Another Service

965

0.5

Discharged to Foster Care

941

0.5

Unable to Complete Treatment

858

0.4

Jail or Prison

773

0.4

Psychiatry, Inpatient

728

0.4

Discharged to Alternate Caregiver

646

0.3

Transfer to an Acute Burn Facility

381

0.2

Against Medical Advice

98

0.1

Transfer, Unspecified

96

0.1

Total

191,848

100.0

13

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of All U.S. Records
Figure 15 depicts the average total duration of hospitalization (Total Hospital Days, Length of Stay or LOS) for both
men and women by year. LOS decreased for both genders over the decade (13.6 % and 8.8 %). Although LOS was
substantially greater for women than men at the beginning of the decade depicted, in the last four years there has been a
trend for greater LOS in men.
Figure 16 depicts the proportion of patients in the NBR who died in the hospital (case fatality) by gender and year.
Case fatality decreased by 28 % for women and 20 % for men between 2004 and 2013. Case fatality is greater in women
than men through the decade, but that difference has narrowed over last four years.

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

15

Male

10.0
8.0
6.0
4.0
2.0

04

20

ANALYSIS
BY AGE
GROUP

05

20

06

20

07

20

08

20

09

20

10

20

Year of Admission

11

20

12

20

Admission
Year
2004

Female
Mean +/SEM
9.49+/-0.3

Male
Mean +/SEM
9.12+/-0.2

2005

9.61+/-0.1

9.19+/-0.1

2006

9.46+/-0.1

9.59+/-0.1

2007

9.8+/-0.1

9.4+/-0.1

2008

9.9+/-0.1

9.9+/-0.1

2009

9.5+/-0.1

9.0+/-0.1

2010

8.5+/-0.1

8.6+/-0.1

2011

8.5+/-0.1

8.8+/-0.1

2012

8.2+/-0.1

8.6+/-0.1

2013

8.2+/-0.1

8.4+/-0.1

13

20

Total N=191,848

Figure

16

MORTALITY RATE BY GENDER, 2004-2013

ANALYSIS
BY AGE
ETIOLOGY

Female
Male

6%

Mortality Rate

HOSPITAL
COMPARISONS

Figure

Female

Average Length of Stay

1
2
3
4
5
6

AVERAGE HOSPITAL LENGTH OF STAY


BY GENDER, 2004-2013

4%

2%

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

Year of Admission

12

20

13

20

Mortality Rate
Admission Year

Female

Male

2004

4.6

3.4

2005

4.5

3.2

2006

4.3

3.5

2007

4.3

3.5

2008

4.1

3.4

2009

3.9

3.0

2010

3.0

2.7

2011

3.3

2.9

2012

3.2

2.9

2013

3.3

2.7

Total N=191,848

14

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Analysis
of All U.S. Records
Table 9 depicts the case fatality for each decile of total burn size in each of several age categories. As age and/or burn
size increased, so did the case fatality. The numbers of cases used to determine these values (proportion of cases in each
group that died) are listed in the row beneath the case fatality values for each age group. The size of some of the groups
is small, so that the calculated case fatality value would have a high variance and standard error.

Table

MORTALITY RATE BY AGE GROUP AND BURN SIZE


(EXPRESSED AS THE NUMBER OF DEATHS OVER THE TOTAL NUMBER OF PATIENTS IN THAT GROUP)
Burn Size (% TBSA)

Age Group

0.1 - 9.9

10 - 19.9

> 90

Total

Birth - .9

0.1

1.0

3.8

7.7

21.0

20.5

56.3

41.4

52.2

85.0

1.3

Died/Total

7/7322

14/1471

13/346

13/169

13/62

8/39

18/32

12/29

12/23

17/20

127/9513

1 - 1.9

0.0

0.3

0.6

1.9

7.7

23.8

20.8

18.2

16.7

66.7

0.2

Died/Total

1/10833

6/1881

2/314

2/107

4/52

5/21

5/24

2/11

1/6

2/3

30/13252

2 - 4.9

0.1

0.2

0.8

4.3

7.5

16.4

16.0

18.2

51.5

61.9

0.8

Died/Total

10/8875

3/1599

3/386

8/187

8/106

12/73

8/50

4/22

17/33

13/21

86/11352

5 - 15.9

0.1

0.3

0.9

1.6

4.6

5.2

12.4

14.0

44.7

63.6

0.6

Died/Total

9/12331

6/2167

6/648

5/308

9/195

6/116

11/89

8/57

21/47

21/33

102/15991

16 - 19.9

0.1

0.3

1.3

3.3

4.3

6.0

18.4

20.7

53.1

72.2

1.0

Died/Total

7/6486

4/1299

5/400

6/183

5/116

4/67

9/49

6/29

17/32

26/36

89/8697

20 - 29.9

0.2

0.6

1.6

5.8

12.6

18.6

25.9

42.2

56.0

76.5

1.5

Died/Total

29/18369

22/3725

19/1182

30/520

35/277

31/167

35/135

35/83

51/91

75/98

362/24647

30 - 39.9

0.2

1.0

2.7

7.1

11.0

21.4

36.7

52.9

65.5

91.8

2.1

Died/Total

37/15037

32/3308

28/1040

37/519

31/281

34/159

51/139

46/87

57/87

90/98

443/20755

40 - 49.9

0.5

1.3

4.7

10.7

24.3

43.8

38.0

59.0

74.0

84.9

3.0

Died/Total

77/16672

48/3728

58/1229

63/588

79/325

89/203

54/142

46/78

77/104

101/119

692/23188

50 - 59.9

0.9

3.3

10.4

21.0

39.8

51.9

65.6

73.1

82.3

86.4

4.9

Died/Total

128/13596

97/2980

104/996

95/453

109/274

81/156

80/122

68/93

79/96

89/103

930/18869

60 - 69.9

2.0

6.4

18.6

40.0

57.4

67.5

88.4

87.0

94.3

92.7

7.9

Died/Total

151/7554

110/1731

107/576

110/275

89/155

77/114

61/69

47/54

33/35

51/55

836/10618

70 - 79.9

4.0

15.4

35.1

58.2

74.6

83.1

89.1

89.3

80.0

88.2

13.8

Died/Total

168/4160

154/1001

126/359

121/208

91/122

54/65

41/46

25/28

24/30

30/34

834/6053

80 or Greater

6.2

27.5

61.9

78.7

89.9

95.2

92.7

97.1

94.7

100.0

22.9

Died/Total

163/2649

207/753

180/291

118/150

80/89

60/63

38/41

34/35

36/38

33/33

949/4142

Total

0.6

2.7

8.4

16.6

26.9

37.1

43.8

55.0

68.3

83.9

3.3

Died/Total

20 - 29.9 30 - 39.9

40 - 49.9

50 - 59.9 60 - 69.9 70 - 79.9 80 - 89.9

787/123884 703/25643 651/7767 608/3667 553/2054 461/1243 411/938 333/606

425/622 548/653 5480/167077

Total N=167,077 (Excluding 24,771 Unknown/Missing)

15

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of All U.S. Records
Figure 17 depicts the number of several complications in all NBR case records. Pneumonia, cellulitis, and urinary tract
infections are the most prevalent complications recorded in burn center patients.
Figure 18 demonstrates the association of several complications with duration of mechanical ventilation. Except for cellulitis
and wound infections, the prevalence of complications increased with the number of days on mechanical ventilation.The
duration of mechanical ventilation might be considered a cause of some complications, e.g. the development of pneumonia.
In other cases, the duration of ventilation could be a marker of illness severity and correlate with other complications of the
critically ill, such as renal failure.

3,000
2,000
1,000

ANALYSIS OF ALL
U.S. RECORDS

mi

mi

th
rry

re
cte

Ba

ia
d/
re
re
on
ilu
ilu
loo ion
a
a
m
B
F
F
t
l
r
eu
ry
na
he fec
Pn
ato
Re
Ot ic In
r
i
sp
em
Re
yst

tis

uli

ll
Ce

mi

ce
pti

Se

ct
on
Tra ion
cti
e
y
f
r
t
n
ina fec nd I
Ur In
ou
W

Total N=176,796 (Excluding 15,052 cases from non ABA burn registry software centers)

ANALYSIS
BY AGE
GROUP

COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY


RELEVANT COMPLICATIONS BY DAYS ON THE VENTILATOR

0 Ventilator Days

Figure

18

1-3 Ventilator Days


4+ Ventilator Days

4,000

Number of Cases

ANALYSIS
BY AGE
ETIOLOGY

17

4,000

ANALYSIS OF
CONTRIBUTING
HOSPITALS

Figure

5,000

Number of Cases

1
2
3
4
5
6

COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY RELEVANT COMPLICATIONS

3,000

2,000

HOSPITAL
COMPARISONS

1,000

ia

hm

t
rry

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Ba

ia

em

r
cte

/
ia
re
re
od
on
ilu
ailu
Blo tion eum
F
Fa
l
r
y
na
he fec
Pn
tor
Re
Ot ic In
ira
p
s
m
Re
ste

tis

uli

ll
Ce

Sy

Se

ia

em

c
pti

n
ct
tio
Tra ion
ec
y
f
r
t
n
ina fec nd I
Ur In
ou
W

Total N=176,796 (Excluding 15,052 cases from non ABA burn registry software centers)

16

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of All U.S. Records
Figure 19 and Table 10 depict the association of occurrence of at least one complication with duration of mechanical
ventilation by categories of age. For patients who did not require mechanical ventilation, age had a strong, direct
association with the risk of developing a complication. For patients who required four or more days of mechanical
ventilation, however, the association between age and the risk of complications was much less pronounced. The total
complication rate increases with age category.
Figure

19

COMPLICATION RATE FOR AGE CATEGORIES BY DAYS ON VENTILATOR

0 Ventilator Days
1-3 Ventilator Days
4+ Ventilator Days

% of Patients with a Clinically


Related Complication

60%

40%

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

20%

0-.9

1-1.9

2-4.9

5-15.9

16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories
Total N=161,721 (Excluding 30,127 cases from non ABA burn registry software centers or unknown/missing age or ventilator days)

Table

10

COMPLICATION COUNT FOR AGE CATEGORIES BY DAYS ON VENTILATOR

Ventilator Days
0 Ventilator Days 1-3 Ventilator Days 4 or More Ventilator Days
Total
Complication
Complication
Complication
Complication
Age Categories
No
Yes
No
Yes
No
Yes
No
Yes
0-.9
6,672
326
91
31
102
96
6,865
453
1-1.9
12,194
429
92
32
138
132
12,424
593
2-4.9
10,313
449
153
59
241
183
10,707
691
5-15.9
13,818
654
436
110
404
414
14,658
1,178
16-19.9
6,836
407
342
94
179
251
7,357
752
20-29.9
19,346
1,356
1,144
261
527
871
21,017
2,488
30-39.9
16,127
1,307
1,032
264
627
1,002
17,786
2,573
40-49.9
17,334
1,739
1,220
366
760
1,244
19,314
3,349
50-59.9
13,540
1,599
1,107
385
750
1,332
15,397
3,316
60-69.9
7,105
972
745
295
524
917
8,374
2,184
70-79.9
3,730
646
515
187
362
626
4,607
1,459
80 and over
2,395
586
404
164
250
380
3,049
1,130
Subtotal
129,410 10,470
7,281
2,248
4,864
7,448
141,555 20,166
Missing
0
0
0
0
0
0
0
0
Total
129,410 10,470
7,281
2,248
4,864
7,448
141,555 20,166
Total N=161,721 (Excluding 30,127 cases from non ABA burn registry software centers or unknown/missing ventilator days)

17

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of All U.S. Records
The data table, in Table 9 on page 15, demonstrated the relationship between death, increasing age, and burn size.
Figure 20 depicts the data shown in Table 11 graphically and demonstrates a similar relationship. The proportion of
patients who died (case fatality) is plotted as a function of the sum of age and the total percentage of BSA burned, the so
called BAUX Score.
There is a strong association between this score and case fatality for both men and women. Overall, women had a higher
case fatality than men (3.9% vs 3.2%) but this difference is less pronounced. The sum of age and burn size (BAUX Score)
associated with a case fatality of 50% (P 50) was 100. There was no significant difference between genders.

ANALYSIS OF
CONTRIBUTING
HOSPITALS

20

100%

Female
Male

80%

% of Patients that Died

1
2
3
4
5
6

Figure

MORTALITY RATE FOR BAUX SCORE CATEGORIES BY GENDER

60%

40%

20%

ANALYSIS OF ALL
U.S. RECORDS

.1-9.9

1019.9

2029.9

3039.9

4049.9

5059.9

6069.9

7079.9

8089.9

9099.9

100- 110- 120- 130109.9 119.9 129.9 139.9

140+

BAUX Score (Age + TBSA)


Total N=181,777 (Excluding 10,071 Unknown/Missing)

ANALYSIS
BY AGE
GROUP

Table

11

NUMBER OF CASES IN BAUX SCORE CATEGORIES BY GENDER


Female

Male

BAUX Score (Age + TBSA)

Lived

Died

Lived

Died

0-9.9
10-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80-89.9
90-99.9
100-109.9
110-119.9
120-129.9
130-139.9
140 and Over
Total

12,198
6,952
6,184
5,876
6,245
6,292
4,623
3,127
2,173
1,075
305
102
46
18
26
55,242

24
23
34
38
71
103
160
188
259
285
303
203
162
115
188
2,156

17,558
11,958
17,284
16,842
16,897
16,077
11,205
6,471
3,667
1,571
590
231
94
38
44
120,527

29
29
56
74
143
188
282
365
413
494
434
411
337
248
349
3,852

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=181,777 (Excluding 10,071 Unknown/Missing)

18

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of All U.S. Records
In Figure 21 and Table 12, the relationship between the proportion of patients that died and the sum of age and burn
size (BAUX Score) is shown both for those with and those without inhalation injury. Patients with inhalation injury had
a higher case fatality for a given BAUX score than those with no inhalation injury, but the added risk was not constant.
For patients with an inhalation injury, the sum of age and burn size associated with case fatality of 50% was
approximately 100, compared with approximately 110 for those with no inhalation injury.
Inhalation Injury
Figure

21

MORTALITY RATE FOR BAUX SCORE CATEGORIES BY INHALATION INJURY

No
Yes

% of Patients that Died

100%

80%

60%

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

40%

20%

ANALYSIS OF ALL
U.S. RECORDS

.1-9.9

1019.9

2029.9

3039.9

4049.9

5059.9

6069.9

7079.9

8089.9

9099.9

100- 110- 120109.9 119.9 129.9

130- 140+
139.9

BAUX Score (Age + TBSA)


Total N=168,456 (Excluding 23,392 Unknown/Missing)

No Inhalation Injury

12

NUMBER OF CASES IN BAUX SCORE CATEGORIES BY INHALATION INJURY

ANALYSIS
BY AGE
GROUP

Table

Inhalation Injury

BAUX Score (Age + TBSA)

Lived

Died

Lived

Died

0-9.9
10-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80-89.9
90-99.9
100-109.9
110-119.9
120-129.9
130-139.9
140 and Over
Total

27,655
17,193
20,335
19,586
19,539
18,637
12,839
7,508
4,540
2,024
622
201
91
37
51
150,858

23
27
30
56
107
127
219
278
313
408
365
267
222
142
209
2,793

521
504
1,129
1,411
1,688
2,043
1,773
1,376
849
418
207
113
46
16
16
12,110

28
22
37
44
80
134
176
223
302
315
311
304
237
204
278
2,695

Total N=168,456 (Excluding 23,392 Unknown/Missing)

19

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of All U.S. Records
Major predictors of case fatality in burns include burn size, age, and the presence of inhalation injury. Table 13 shows
the case fatality for several combinations of these variables. There are four categories of burn size: 0.1-19.9%, 20-39.9%,
40-59.9%, and 60 % BSA and greater; two categories of age: under 60 and 60 and older; and two categories of presence
of inhalation injury: No and Yes.

{13
Table

1
2
3
4
5
6

MORTALITY RATES FOR MATRIX OF MAIN PREDICTORS

TBSA Category

Age

Inhalation Injury

Lived

Died

Mortality Rate

0.1-19.9

0-59.9

No

116,514

273

0.2

0.1-19.9

0-59.9

Yes

5,661

218

3.7

0.1-19.9

60 and Over

No

14,365

583

3.9

0.1-19.9

60 and Over

Yes

1,571

298

15.9

20-39.9

0-59.9

No

6,952

210

2.9

20-39.9

0-59.9

Yes

1,490

235

13.6

20-39.9

60 and Over

No

800

436

35.3

20-39.9

60 and Over

Yes

240

284

54.2

40-59.9

0-59.9

No

1,343

221

14.1

40-59.9

0-59.9

Yes

645

295

31.4

40-59.9

60 and Over

No

97

209

68.3

40-59.9

60 and Over

Yes

51

210

80.5

60 and Over

0-59.9

No

641

452

41.4

60 and Over

0-59.9

Yes

361

712

66.4

60 and Over

60 and Over

No

27

172

86.4

60 and Over

60 and Over

Yes

15

245

94.2

TOTAL

150,773

5,053

3.2

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=155,826 (Excluding 36,022 Unknown/Missing)

20

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of All U.S. Records
Table 14 lists the number and proportion of cases in the NBR that were covered by several forms of payment. Over
10% of the records did not include this information. Of those that did include this data, over one third (37.9%) were
covered by Medicaid or uninsured.

{14
Table

PRIMARY INSURANCE PAYOR

Insurance

Cases

Percent

Government-Medicaid

37,636

19.6

Government-Medicare

19,190

10.0

Other Government

6,763

3.5

Subtotal

63,589

33.1

Private/Commercial Insurance

43,377

22.6

Blue Cross/Blue Shield

13,064

6.8

Other Insurance-Not Named

269

0.1

Private-Foundation or Charity

3,696

1.9

Subtotal

60,406

31.5

Workers Compensation

17,303

9.0

Auto

1,205

0.6

Subtotal

18,508

9.6

No Insurance Information Provided

19,935

10.4

Uninsured, Including Self Pay

27,581

14.4

Subtotal

47,516

24.8

Unidentified Insurance Labels

1,829

1.0

TOTAL

191,848

100.0

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

21

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of All U.S. Records
Figure 22 and Table 15 show how the proportions of patients covered by Medicaid, Medicare, Workers Compensation,
and Self-pay categories have changed over the decade covered by this years NBR Report. The prevalence of patients
covered by Workers Compensation is still lower than a decade ago, but there has been a steady increase over the last four
years. All other categories have also continued to grow, and the percentage of patients with Medicaid has shown the
largest growth.

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

22

Medicare
Uninsured, including Self Pay
Workers Comp

25

% of Patients (Does not Sum to 100%)

1
2
3
4
5
6

PERCENT OF PATIENTS UTILIZING SELECT INSURANCE Figure


CATEGORIES OVER TIME

Medicaid

20

15

10

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Year of Admission

ANALYSIS
BY AGE
GROUP

Total N=101,710 (Excluding 90,138 Cases)

Table

CASE COUNT FOR SELECT INSURANCE CATEGORIES OVER TIME

15

Select Insurance Categories

ANALYSIS
BY AGE
ETIOLOGY

Medicaid

Medicare

Uninsured,
Including Self Pay

Workers
Compensation

Total

Year of Admission

Cases

Cases

Cases

Cases

Count

2004

1,948

13.2

1,182

8.0

1,585

10.7

1,461

9.9

14,786

2005

2,232

15.5

1,243

8.6

1,667

11.5

1,353

9.4

14,436

2006

2,754

14.5

1,667

8.8

3,044

16.0

1,886

9.9

19,011

2007

2,755

13.9

2,007

10.1

2,952

14.8

1,860

9.4

19,883

2008

3,390

17.7

1,995

10.4

2,573

13.4

1,858

9.7

19,152

2009

4,537

21.5

2,153

10.2

2,962

14.0

1,748

8.3

21,126

2010

5,640

23.1

2,520

10.3

3,762

15.4

1,923

7.9

24,448

2011

5,621

23.9

2,513

10.7

3,458

14.7

2,054

8.7

23,542

2012

5,656

24.3

2,503

10.7

3,647

15.6

2,064

8.9

23,317

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

2013

3,103

25.5

1,407

11.6

1,931

15.9

1,096

9.0

12,147

Total

37,636

19.6

19,190

10.0

27,581

14.4

17,303

9.0

191,848

22

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of All U.S. Records
Table 16 depicts the average length of hospital stay in days (LOS) for survivors and non-survivors in each decile of
burn size. Non-survivors with burns of 20 %TBSA and greater have shorter LOS compared with survivors. The LOS for
survivors in all categories of burn size was approximately 1 day for each percent BSA burn.
Only 29% of the cases reviewed in this years NBR report included data on hospital charges. Tables 17, 18, and 19 are
based on those records. Table 17 depicts hospital charges for survivors and non-survivors in each burn size decile.

Table

16

HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP


Total

Lived

%TBSA

Cases

Mean +/- SEM

Cases

0.1 - 9.9
10 - 19.9
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
60 - 69.9
70 - 79.9
80 - 89.9
> 90
Subtotal
Missing or 0%
TOTAL

123,884
25,643
7,767
3,667
2,054
1,243
938
606
622
653
167,077
24,771
191,848

5.6+/-0.0
12.8+/-0.0
22.9+/-0.2
34.1+/-0.5
42.1+/-0.8
45.4+/-1.2
49.2+/-1.7
43.9+/-2.3
28.5+/-2.0
13.6+/-1.6
9.4+/-0.0
7+/-0.0

123,097
24,940
7,116
3,059
1,501
782
527
273
197
105
161,597
23,877
185,474

Mean +/SEM
5.5+/-0.0
12.6+/-0.0
23.2+/-0.2
36.9+/-0.5
49.5+/-0.9
60.8+/-1.5
72.3+/-2.3
81.0+/-3.9
61.4+/-4.5
46.3+/-7.9
9.1+/-0.0
6.7+/-0.0

Died
Cases

Mean +/- SEM

787
703
651
608
553
461
411
333
425
548
5,480
894
6,374

16.6+/-0.9
19.6+/-0.9
19.6+/-0.9
20.4+/-1.1
22.1+/-1.6
19.4+/-1.7
19.7+/-1.7
13.5+/-1.5
13.3+/-1.5
7.4+/-1.1
17.4+/-0.4
12.5+/-0.8

Total N=191,848

Table

HOSPITAL CHARGES: LIVED/DIED BY BURN SIZE GROUP

17

%TBSA
Cases
0.1 - 9.9
47,749
10 - 19.9
10,262
20 - 29.9
3,091
30 - 39.9
1,400
40 - 49.9
749
50 - 59.9
446
60 - 69.9
333
70 - 79.9
246
80 - 89.9
229
> 90
253
Subtotal
64,758
Missing or 0% 9,520
TOTAL
74,278

Total
Mean +/- SEM
$42782+/-401
$122891+/-2107
$263076+/-6152
$449142+/-14694
$608572+/-25145
$686349+/-40415
$706449+/-45797
$643805+/-61836
$393205+/-45052
$160247+/-28542
$93147+/-963
$46221+/-1423
$87133+/-861

Cases
47,440
9,965
2,799
1,156
515
248
169
101
51
25
62,469
9,188
71,657

Lived
Mean +/- SEM Cases
$41859+/-385
309
$118739+/-2028
297
$260062+/-6343
292
$470098+/-16445
244
$700876+/-31771
234
$935338+/-59933
198
$1006194+/-66295 164
$1121252+/-115871 145
$977203+/-125218 178
$508344+/-155963 228
$86109+/-912
2,289
$42376+/-1325
332
$80501+/-815
2,621

Died
Mean +/- SEM
$184459+/-16465
$262206+/-24561
$291961+/-23279
$349859+/-31517
$405423+/-36588
$374485+/-42214
$397567+/-53412
$311238+/-51691
$225879+/-37206
$122079+/-25624
$285225+/-10285
$152640+/-16883
$268430+/-9273

Total N=74,278 (Excluding 117,570 cases with Unknown/Missing charge data)

23

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of All U.S. Records
Table 18 lists the twenty most frequently recorded MS-DRG codes and their associated hospital charges for both
survivors and deaths.
HOSPITAL CHARGES: LIVED/DIED BY TOP 20 MS-DRGS

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

18

Total
Lived
Died
Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM
31,966 $28481+369 31,825 $27933+351
141 $152246+24282

Top 20 MS-DRG Codes


935 Non-extensive burns
929 Full thickness burn w skin graft
6,833 $100487+1709
or inhal inj w/o CC/MCC

$98667+1665

64

$292999+41277

6,348 $183718+3321

234

$329227+31927

3,822

147

$70869+11505

2,533 $473849+11568 2,200 $454557+12107 333

$601305+35955

1,332 $102298+4723

$421846+158542

928 Full thickness burn w skin graft


6,582 $188891+3414
or inhal inj w CC/MCC
934 Full thickness burn w/o skin
grft or inhal inj
927 Extensive burns or full
thickness burns w MV 96+ hrs w
skin graft
507 Major shoulder or elbow joint
procedures w CC/MCC

3,969

$38951+1643

6,769

1,318

$37723+1644

$98904+4395

14

511 Shoulder,elbow or forearm


1,260 $19465+1031 1,259 $19381+1029
1
$124906+
proc,exc major joint proc w CC
933 Extensive burns or full
thickness burns w MV 96+ hrs w/o 883 $111082+8009
264 $177064+20416 619
$82940+7117
skin graft
506 Major thumb or joint
828 $147966+9193
803 $140486+8670 25 $388209+115250
procedures
3 ECMO or trach w MV 96+ hrs
or PDX exc face, mouth & neck w
721 $921564+31602 591 $930191+35232 130 $882343+71349
maj O.R.
923 Other injury, poisoning & toxic
379
$19531+1832
373
$18960+1769
6
$55001+36113
effect diag w/o MCC
918 Poisoning & toxic effects of
drugs w/o MCC
595 Major skin disorders w MCC
596 Major skin disorders w/o MCC
603 Cellulitis w/o MCC
577 Skin graft &/or debrid exc for
skin ulcer or cellulitis w CC
605 Trauma to the skin, subcut tiss
& breast w/o MCC
578 Skin graft &/or debrid exc for
skin ulcer or cellulitis w/o CC/MCC
483 Major joint & limb
reattachment proc of upper
extremity w CC/MCC
998 Principal diagnosis invalid as
discharge diagnosis
Subtotal
Other
Unmappable
Unknown
Total

251

$25832+3225

245

$25702+3256

$31130+25022

151
145
134

$103101+10420
$60278+7435
$31582+9835

112
140
134

$97956+11452
$59805+7689
$31582+9835

39
5
0

$117875+23485
$73509+11960

121

$67863+6246

121

$67863+6246

115

$38412+4219

115

$38412+4219

89

$97099+13760

89

$97099+13760

64

$184528+41443

61

$165999+41492

32

$5078+2087

32

$5078+2087

$561296+171882

58,388
56,621
1,767
4,263 $126477+4205 3,915 $113634+3903 348 $270957+25740
1,062 $141724+8327 1,000 $130222+8231 62 $327252+46522
10,565 $44076+1394 10,121 $38884+1287 444 $162426+14351
74,278
71,657
2,621

Total N=74,278 (Excluding 117,570 cases with Unknown/Missing charge data)

24

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
of All U.S. Records
Table 19 combines several parameters of resource utilization for survivors and non-survivors listed by age category.
These include mean LOS, mean LOS/Burn size (TBSA), mean total charges, and mean daily charges.

DAYS PER %TBSA AND CHARGES PER DAY BY AGE GROUPS AND SURVIVAL
Cases

Days

Age Groups

Lived

Died

Birth - 0.9

4,111

97

+/- SEM
1 - 1.9

4,742

10

+/- SEM
2 - 4.9

4,020

29

+/- SEM
5 - 15.9

5,142

35

+/- SEM
16 - 19.9

3,116

25

+/- SEM
20 - 29.9

9,717

142

+/- SEM
30 - 39.9

8,005

173

+/- SEM
40 - 49.9

8,922

281

+/- SEM
50 - 59.9

7,282

378

+/- SEM
60 - 69.9

3,923

351

+/- SEM
70 - 79.9

2,147

360

+/- SEM
80 or greater

1,297

408

+/- SEM
Total

62,424

+/- SEM

2,289

Lived Died

Hospital Days /
%TBSA
Lived
Died

Table

19

Hospital Charges
Lived

Died

Hospital Charges /
Hospital Days
Lived
Died

9.11

16.84

2.19

0.65

$43,736

$38,079

$4,814

$7,304

0.93

3.35

0.22

0.17

$2,129

$9,020

$93

$1,551

5.02

8.50

1.62

0.25

$36,747 $156,910 $6,460

$24,721

0.14

5.00

0.07

0.11

$1,364

$5,950

6.55

10.55

1.97

1.03

$48,416 $142,562 $6,648

$20,247

0.20

3.21

0.11

0.46

$1,910

$2,610

7.26

7.63

2.05

0.23

$63,051 $229,380 $6,925

$38,789

0.17

3.01

0.09

0.08

$2,567

$6,185

7.90

16.00

1.85

0.41

$70,454 $333,174 $6,729

$30,494

0.28

7.29

0.08

0.16

$3,762

$4,092

8.90

20.66

2.39

0.53

$80,730 $392,625 $7,219

$28,753

0.18

3.54

0.10

0.09

$2,353

$3,170

10.09 15.93

2.60

0.47

$94,818 $362,704 $7,588

$32,363

0.19

2.33

0.13

0.07

$2,806

$4,218

11.40 17.15

2.96

0.74

0.20

1.74

0.14

0.11

12.55 21.51

3.39

1.58

0.23

1.73

0.13

0.32

13.79 17.03

3.88

1.33

0.33

1.23

0.21

0.15

14.62 15.16

4.37

1.30

0.40

1.04

0.41

0.14

14.13 11.22

4.78

1.09

0.46

0.54

0.16

9.83 16.31

2.67

1.07

0.09

0.04

0.07

0.83

0.57

25

$65,440

$38,114

$84,753

$138,753

$55,498

$46,134

$112

$220

$134

$110

$80

$150

$106,788 $339,477 $7,791


$2,900

$30,697

$148

$116,949 $397,023 $8,052


$3,163

$32,462

$126

$125,024 $305,835 $8,047


$4,305

$24,452

$136

$131,591 $252,371 $8,085


$5,237

$21,241

$138

$126,665 $159,207 $8,098


$6,467

$13,100

$215

$86,146 $285,225 $7,244


$913

$10,286

$42

$23,845
$1,062
$23,302
$1,058
$22,739
$1,106
$18,018
$924
$16,836
$1,527
$21,926
$585

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

This year encompasses another decade of collected data ranging


from 2004 to 2013. Age of the burn patient continues to be an
important marker, having a dramatic effect on many of the attributes
found in the National Burn Repository. As we improve our collection
of data, it is interesting to note the stability of incidence of burns
in each ten year report. Data continues to be very useful when
contemplating prevention strategies, medical economics, and concerns
about public health.
The figures in this Age Analysis section provide detailed
information for each of the following age categories: Birth to 0.9, 1 to
1.9, 2 to 4.9, 5 to 15.9, 16 to 19.9, 20 to 29.9, 30 to 39.9, 40 to 49.9,
50 to 59.9, 60 to 69.9, 70 to 79.9, and 80-and-over.We have added
an additional section: 0-18.0 years old.These groupings were chosen
based on prior collective experience about the relationship of certain
ages to types of burn injury patterns, with an emphasis on accidental
injuries of the very young. Each age category has four pages of figures
and tables that summarize the data in the National Burn Repository.
Some highlights are abstracted below:
The race of burn victims continues to show a dramatic overrepresentation of minorities in children (age under 5 years) than
would be expected based on national demographics.The same
marked over-representation disappears in young adulthood.This has
continued to perpetuate for the past several years, these minority
communities might be at increased risk and in need of prevention
initiatives.
Furthermore, scald and contact burns are very prevalent in the early
age category when contemplating etiology. Fire/flame continues to
be the consistent, predominant etiology of burns in the adolescent and
adult age groups.There continues to be a large amount of unspecified
burns throughout all age groups, however this year non-burns have
seen a greater reporting value than in years past. Improvement of data
collection may impact these numbers bringing a better appreciation
of the total data set.
Inhalation injury is one of the most lethal characteristic of burn
victims, and somewhat surprisingly increases in incidence with age.
Even though children are exposed to smoke in structure fires and
even with the increase in fire/flame injuries in the lowest age group,
the preponderance of scald and contact injuries continues to crowd
out inhalation injuries in the young.
The most common complications are urinary tract infections
(UTI), pneumonia and cellulitis as the top three complications in
those patients under age 60.Those over age 60, show a shift in the

top three with respiratory failure over stepping cellulitis in the age
60-69.9 age group and arrhythmias in the over 70 population. UTI
was the most frequent infection among children. Pneumonia remains
a very frequent complication in all age groups. Cellulitis continues
to be a common thread in all age groups, while septicemia was less
common. Even with the emphasis on tracking hospital acquired
infections (HAI) and more stringent protocols geared to prevention,
urinary tract infections and pneumonia continue to be our top three
complications all age catagories.This stability with the larger data set
gives credence to our data and suggests that we need to begin looking
at ways to decrease our top three complications as they have been
consistently the same over the years.
As in previous years, the most frequently reported procedures
continue to be excisional debridement of wound, infection, or burn
(ICD-9-CM 86.22) and other skin graft to other site (ICD-9-CM
86.69).This is true of all age groups, and makes good intuitive
sense given that early excision and grafting of burns remains a
durable standard of care. Another absolutely expected finding is the
progression of mortality as a function of increasing age.

Analysis
by Age Group

Birth to .9

Figure

RACE/ETHNICITY

23

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=9,802 (Excluding 558 Unknown/Missing)

Cases

%Valid

White

4,128

42.1%

Black

2,234

22.8%

Hispanic

2,207

22.5%

Other

644

6.6%

Asian

413

4.2%

Native American

176

1.8%

Unknown

558

TOTAL

10,360

ETIOLOGY
Categories of
Etiology

ANALYSIS
BY AGE
ETIOLOGY

Scald
Contact with
Hot Object
Fire/Flam e
Burn,
Unspecified
Electrical
Chemical
Other, Non Burn
Inhalation Only
Skin Disease
Radiation

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=8,687 (Excluding 1,673 Unknown/Missing)

21

28

Etiology

Cases

% Valid

Scald

5,340

61.5%

Contact with Hot Object

2,046

23.6%

Fire/Flame

791

9.1%

Burn, Unspecified

186

2.1%

Electrical

89

1.0%

Chemical

83

1.0%

Other, Non Burn

58

0.7%

Inhalation Only

35

0.4%

Skin Disease

31

0.4%

Radiation

28

0.3%

Unknown

1,673

TOTAL

10,360

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ETIOLOGY

24

20

Race

ANALYSIS
BY AGE
GROUP

Figure

Table

RACE/ETHNICITY

Analysis
by Age Group
Table

22

Birth to .9

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

Inhalation Injury

Total
Mean +/Cases
SEM
9,002
6.31+0.15

No
Yes

322

Subtotal

9,324

Missing

1,036

TOTAL

10,360

Lived

Died

Cases

Mean +/- SEM

Cases

Mean +/- SEM

8,921

6.17+0.15

81

21.37+4.04

269

25+2.05

53

7.74+1.81

22.16+1.77

9,190
8.76+3.58

134

1,030

8.78+3.6

10,220

4.5+1.88

140

Total N=10,360

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

23

Top Ten Complications

Count

Urinary Tract Infection


Cellulitis
Pneumonia
Wound Infection
Respiratory Failure
Septicemia
Other Blood/Systemic Infection
Bacteremia
Catheter-Related Bloodstream Infection
Skin Graft Loss, Other
Total Complications

74
71
39
36
34
24
21
20
16
16
658

Percent of All
Complications
11.2
10.8
5.9
5.5
5.2
3.6
3.2
3.0
2.4
2.4

Percent of Patients
with Complication
0.9
0.9
0.5
0.5
0.4
0.3
0.3
0.3
0.2
0.2

Total N=7,807 (Excluding 2,553 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

2,806

17.3

86.69 Other skin graft to other sites

2,030

12.5

93.57 Application of other wound dressing

1,608

9.9

86.28 Nonexcisional debridement of wound, infection or burn

1,605

9.9

86.66 Homograft to skin

1,267

7.8

38.93 Venous catheterization, not elsewhere classified

806

5.0

86.67 Dermal regenerative graft

390

2.4

38.91 Arterial catheterization

357

2.2

86.65 Heterograft to skin

329

2.0

86.62 Other skin graft to hand

309

1.9

Total Procedures

16,252
Total N=10,360

29

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

24

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

25

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

26

Lived

Died

%TBSA

Cases

Cases

Mortality Rate

%TBSA

Cases

Mean +/- SEM

0.1 - 9.9

7,315

0.1

0.1 - 9.9

7,322

4.6+0.5

10 - 19.9

1,457

14

1.0

10 - 19.9

1,471

10.0+0.3

20 - 29.9

333

13

3.8

20 - 29.9

346

20.7+1.0

30 - 39.9

156

13

7.7

30 - 39.9

169

32.2+1.9

40 - 49.9

49

13

21.0

40 - 49.9

62

32.8+4.3

50 - 59.9

31

20.5

50 - 59.9

39

45.7+5.9

60 - 69.9

14

18

56.3

60 - 69.9

32

27+5.0

70 - 79.9

17

12

41.4

70 - 79.9

29

52.5+12.8

80 - 89.9

11

12

52.2

80 - 89.9

23

12.3+5.6

> 90

17

85.0

> 90

20

16.6+9.9

Subtotal

9,386

127

1.3

Subtotal

9,513

7.1+0.4

Missing or 0%

834

13

1.5

Missing or 0%

847

5.6+0.3

TOTAL

10,220

140

1.4

TOTAL

10,360

7.0+0.3

Total N=10,360

Table

27

Total N=10,360

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid


Charges

Mean +/- SEM

935 Non-extensive burns

4,991

2,281

24567+/-968

929 Full thickness burn w skin graft or inhal inj


w/o CC/MCC

589

234

84577+/-5944

934 Full thickness burn w/o skin grft or inhal


inj

346

212

30066+/-2581

928 Full thickness burn w skin graft or inhal inj


w CC/MCC

302

193

135691+/-13506

927 Extensive burns or full thickness burns w


MV 96+ hrs w skin graft

131

57

323201+/-37774

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

Birth to .9

Analysis
by Age Group

Total N=6,359

30

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
by Age Group
Figure

25

Birth to .9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Mean Hospital Days with 95% Cl

30

Fire/Flame
Scald
Contact with
Hot Object

20

ANALYSIS OF
CONTRIBUTING
HOSPITALS

10

2004

2005

2006

2007

2008

2009

2010

2011

2012

ANALYSIS OF ALL
U.S. RECORDS

2013

Admission Year
Total N=10,360

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

Estimated Mean Hospital Charges with 95% Cl

26

1
2
3
4
5
6

$140,000

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$120,000
$100,000
$80,000

HOSPITAL
COMPARISONS

$60,000
$40,000
$20,000

Scald
(N= 1,822)

Contact with Hot


Object (N= 653)

Fire/Flame
(N= 540)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=3,115

31

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

RACE/ETHNICITY

27

RACE/ETHNICITY

Table

28

Figure

1 - 1.9

Race

Cases

% Valid

White

5,234

38.0%

Black

3,474

25.3%

Hispanic

3,363

24.4%

Other

1,002

7.3%

Asian

579

4.2%

Native American

104

0.8%

Unknown

624

TOTAL

14,380

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=13,756 (Excluding 624 Unknown/Missing)

Figure

ETIOLOGY

28

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Scald
Contact with
Hot Object
Fire/Flam e
Burn,
Unspecified
Chemical
Electrical
Other, Non Burn
Inhalation Only
Radiation
Skin Disease

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=13,595 (Excluding 785 Unknown/Missing)

29

32

Etiology

Cases

% Valid

Scald

9,192

67.6%

Contact with Hot Object

2,936

21.6%

Fire/Flame

888

6.5%

Burn, Unspecified

208

1.5%

Chemical

169

1.2%

Electrical

109

0.8%

Other, Non Burn

56

0.4%

Inhalation Only

25

0.2%

Radiation

0.1%

Skin Disease

0.0%

Unknown

785

TOTAL

14,380

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

30

1 - 1.9

Inhalation Injury
No

Total
Mean +/Cases
SEM
13,587
4.9+/-0.0

Yes

200

Subtotal

13,787

Missing

593

TOTAL

14,380

Lived
Cases

Died

Mean +/- SEM

Cases

Mean +/- SEM

13,571

4.8+/-0.0

16

22.7+/-6.5

186

16.1+/-1.9

14

14+/-5.0

16.0+/-1.8

13,757
5.2+/-0.4

30

589

5.2+/-0.4

14,346

6.2+/-4.9

34

Total N=14,380

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

31

Top Ten Complications

Count

Cellulitis
Urinary Tract Infection
Pneumonia
Wound Infection
Respiratory Failure
Surgical Site Infection, Deep
Other Blood/Systemic Infection
Septicemia
Bacteremia
Fungal Sepsis
Total Complications

187
134
115
82
63
54
50
49
40
37
1,421

Percent of All
Complications
13.2
9.4
8.1
5.8
4.4
3.8
3.5
3.4
2.8
2.6

Percent of Patients
with Complication
1.3
1.0
0.8
0.6
0.5
0.4
0.4
0.4
0.3
0.3

Total N=13,917 (Excluding 463 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

4,723

16.5

93.57 Application of other wound dressing

4,336

15.1

86.28 Nonexcisional debridement of wound, infection or burn

3,933

13.7

86.69 Other skin graft to other sites

3,052

10.6

86.66 Homograft to skin

1,866

6.5

86.65 Heterograft to skin

1,006

3.5

86.67 Dermal regenerative graft

972

3.4

38.93 Venous catheterization, not elsewhere classified

890

3.1

86.62 Other skin graft to hand

549

1.9

99.04 Transfusion of packed cells

498

1.7

Total Procedures

28,660
Total N=14,380

33

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

32

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

{
ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

10,832

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

34

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

10,833

3.6+/-0.0

0.0

10 - 19.9

1,881

7.8+/-0.1

1,875

0.3

20 - 29.9

314

15.6+/-0.6

20 - 29.9

312

0.6

30 - 39.9

105

1.9

30 - 39.9

107

31.1+/-2.7

40 - 49.9

48

7.7

40 - 49.9

52

31.6+/-3.2

50 - 59.9

16

23.8

50 - 59.9

21

38.6+/-6.0

60 - 69.9

19

20.8

60 - 69.9

24

62.3+/-12.5

70 - 79.9

18.2

70 - 79.9

11

47.8+/-10.5

80 - 89.9

16.7

80 - 89.9

63.8+/-16.6

> 90

66.7

> 90

22+/-17.1

Subtotal

13,222

30

0.2

Subtotal

13,252

5.1+/-0.1

Missing or 0%

1,124

0.4

Missing or 0%

1,128

4.2+/-0.3

TOTAL

14,346

34

0.2

TOTAL

14,380

5.0+/-0.0

Total N=14,380

Table

35

Total N=14,380

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid


Charges

Mean +/- SEM

935 Non-extensive burns

7,954

3,072

$22027+/-748

929 Full thickness burn w skin graft or inhal


inj w/o CC/MCC

992

275

$88256+/-6007

934 Full thickness burn w/o skin grft or inhal


inj

481

221

$33853+/-2872

928 Full thickness burn w skin graft or inhal


inj w CC/MCC

359

158

$150878+/-10212

927 Extensive burns or full thickness burns w


MV 96+ hrs w skin graft

241

57

$977+/-142

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

33

1
2
3
4
5
6

1 - 1.9

Analysis
by Age Group

Total N=10,027

34

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
by Age Group
Figure

29

1 - 1.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR

25

Etiology

Mean Hospital Days with 95% Cl

Fire/Flame
Scald

20

Contact with
Hot Object
15

10

ANALYSIS OF
CONTRIBUTING
HOSPITALS

2004

2005

2006

2007

2008

2009

2010

2011

2012

ANALYSIS OF ALL
U.S. RECORDS

2013

Admission Year
Total N=14,380

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

30

$50,000

Estimated Mean Hospital Charges with 95% Cl

1
2
3
4
5
6

$40,000

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$30,000

$20,000

HOSPITAL
COMPARISONS

$10,000

Scald
(N= 3,339)

Contact with Hot


Object (N= 945)

Fire/Flame
(N= 432)

Burn, Unspecified
(N= 122)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=4,838

35

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

RACE/ETHNICITY

31

RACE/ETHNICITY

Table

36

Figure

2 - 4.9

Race

Cases

% Valid

White

5,268

43.4%

Black

3,069

25.3%

Hispanic

2,618

21.6%

Other

702

5.8%

Asian

360

3.0%

Native American

124

1.0%

Unknown

468

TOTAL

12,609

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=12,141 (Excluding 468 Unknown/Missing)

Figure

ETIOLOGY

32

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Scald
Fire/Flam e
Contact with
Hot Object
Electrical
Burn,
Unspecified
Chemical
Other, Non Burn
Inhalation Only
Radiation
Skin Disease

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=11,746 (Excluding 863 Unknown/Missing)

37

36

Etiology

Cases

% Valid

Scald

6,725

57.3%

Fire/Flame

2,137

18.2%

Contact with Hot Object

1,918

16.3%

Electrical

277

2.4%

Burn, Unspecified

275

2.3%

Chemical

143

1.2%

Other, Non Burn

128

1.1%

Inhalation Only

113

1.0%

Radiation

21

0.2%

Skin Disease

0.1%

Unknown

863

TOTAL

12,609

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

38

2 - 4.9

Inhalation Injury
No
Yes
Subtotal
Missing
TOTAL

Total
Mean +/Cases
SEM
11,553
6.0+/-0.1
424
23.0+/-1.7
11,977
632
7.3+/-0.7
12,609

Lived

Died

Cases

Mean +/- SEM

Cases

Mean +/- SEM

11,516
359
11,875
623
12,498

6.0+/-0.1
24.4+/-1.9

37
65
102
9
111

9.7+/-2.2
15.2+/-4.6

7.1+/-0.6

22.2+/-21.1

Total N=12,609

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

39

Top Ten Complications

Count

Urinary Tract Infection


Cellulitis
Pneumonia
Wound Infection
Septicemia
Respiratory Failure
Other Blood/Systemic Infection
Bacteremia
ARDS
Catheter-Related Bloodstream Infection
Total Complications

188
143
133
86
79
68
52
47
37
37
1,570

Percent of All
Complications
12.0
9.1
8.5
5.5
5.0
4.3
3.3
3.0
2.4
2.4

Percent of Patients
with Complication
1.5
1.2
1.1
0.7
0.6
0.6
0.4
0.4
0.3
0.3

Total N=12,154 (Excluding 455 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

6,084

17.2

86.69 Other skin graft to other sites

4,451

12.6

93.57 Application of other wound dressing

3,997

11.3

86.28 Nonexcisional debridement of wound, infection or burn

3,716

10.5

86.66 Homograft to skin

2,789

7.9

38.93 Venous catheterization, not elsewhere classified

1,297

3.7

86.65 Heterograft to skin

1,141

3.2

86.67 Dermal regenerative graft

1,036

2.9

99.04 Transfusion of packed cells

860

2.4

86.62 Other skin graft to hand

636

1.8

Total Procedures

35,325
Total N=12,609

37

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

40

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

41

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

8,865

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

42

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

8,875

4.0+/-0.0

10

0.1

10 - 19.9

1,599

9.8+/-0.3

1,596

0.2

20 - 29.9

386

18.8+/-0.8

20 - 29.9

383

0.8

30 - 39.9

179

4.3

30 - 39.9

187

29.1+/-1.6

40 - 49.9

98

7.5

40 - 49.9

106

42.3+/-3.4

50 - 59.9

61

12

16.4

50 - 59.9

73

40.9+/-3.6

60 - 69.9

42

16.0

60 - 69.9

50

55.5+/-6.1

70 - 79.9

18

18.2

70 - 79.9

22

74.0+/-13.6

80 - 89.9

16

17

51.5

80 - 89.9

33

38.7+/-8.7

> 90

13

61.9

> 90

21

33.8+/-14.3

Subtotal

11,266

86

0.8

Subtotal

11,352

6.8+/-0.1

Missing or 0%

1,232

25

2.0

Missing or 0%

1,257

5.1+/-0.3

TOTAL

12,498

111

0.9

TOTAL

12,609

6.7+/-0.1

Total N=12,609

Table

43

Total N=12,609

MEAN CHARGES FOR TOP FIVE MS-DRGS

DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

6,132

2,480

$23198+/-958

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

1,020

309

$90369+/4984

934 Full thickness burn w/o skin grft or inhal inj

470

226

$35446+/3393

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

405

197

$197642+/20522

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

373

78

$391803+/39376

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

2 - 4.9

Analysis
by Age Group

Total N=8,400

38

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
by Age Group
Figure

33

2 - 4.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Mean Hospital Days with 95% Cl

20

Fire/Flame
Scald
Contact with
Hot Object

15

10

ANALYSIS OF
CONTRIBUTING
HOSPITALS

2004

2005

2006

2007

2008

2009

2010

2011

2012

ANALYSIS OF ALL
U.S. RECORDS

2013

Admission Year
Total N=12,609

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

34

Estimated Mean Hospital Charges with 95% Cl

1
2
3
4
5
6

$120,000

$100,000

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$80,000

$60,000

HOSPITAL
COMPARISONS

$40,000

$20,000

Scald
(N= 2,498)

Fire/Flame
(N= 807)

Contact with Hot


Object (N= 595)

Burn, Unspecified
(N= 155)

Electrical
(N= 110)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=4,165

39

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

Table

44

RACE/ETHNICITY

35

RACE/ETHNICITY

Figure

5 - 15.9

Race

Cases

% Valid

White

9,216

53.2%

Black

4,160

24.0%

Hispanic

2,690

15.5%

Other

743

4.3%

Asian

356

2.1%

Native American

168

1.0%

Unknown

735

TOTAL

18,068

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=17,333 (Excluding 735 Unknown/Missing)

Figure

ETIOLOGY

36

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Contact with
Hot Object
Electrical
Burn,
Unspecified
Other, Non Burn
Chemical
Inhalation Only
Radiation
Skin Disease

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=16,598 (Excluding 1,470 Unknown/Missing)

45

40

Etiology

Cases

% Valid

Fire/Flame

7,330

44.2%

Scald

6,125

36.9%

Contact with Hot Object

1,461

8.8%

Electrical

430

2.6%

Burn, Unspecified

425

2.6%

Other, Non Burn

338

2.0%

Chemical

208

1.3%

Inhalation Only

187

1.1%

Radiation

72

0.4%

Skin Disease

22

0.1%

Unknown

1470

TOTAL

18,068

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

46

5 - 15.9

Inhalation Injury
No

Total
Mean +/Cases
SEM
16,074
6.7+/-0.1

Yes

885

Subtotal

16,959

Missing

1,109

TOTAL

18,068

Lived
Cases

Died

Mean +/- SEM

Cases

Mean +/- SEM

16,039

6.7+/-0.1

35

11.4+/-2.6

809

22.3+/-1.1

76

15.6+/-4.2

21.8+/-1.0

16,848
6.9+/-0.4

111

1,096

6.8+/-0.4

13

17,944

21.4+/-13.1

124

Total N=18,068

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

47

Top Ten Complications

Count

Urinary Tract Infection


Pneumonia
Cellulitis
Wound Infection
Septicemia
Catheter-Related Bloodstream Infection
Respiratory Failure
Bacteremia
Other Blood/Systemic Infection
Fungal Sepsis
Total Complications

296
283
256
209
165
112
112
80
72
61
2,781

Percent of All
Complications
10.6
10.2
9.2
7.5
5.9
4.0
4.0
2.9
2.6
2.2

Percent of Patients
with Complication
3.3
3.1
2.8
2.3
1.8
1.2
1.2
0.9
0.8
0.7

Total N=17,122 (Excluding 946 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

10,449

17.7

86.69 Other skin graft to other sites

8,344

14.1

93.57 Application of other wound dressing

5,108

8.6

86.28 Nonexcisional debridement of wound, infection or burn

5,061

8.6

86.66 Homograft to skin

4,379

7.4

38.93 Venous catheterization, not elsewhere classified

2,361

4.0

99.04 Transfusion of packed cells

2,256

3.8

86.67 Dermal regenerative graft

1,748

3.0

86.65 Heterograft to skin

1,737

2.9

86.62 Other skin graft to hand

1,061

1.8

Total Procedures

59,094
Total N=18,068

41

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

48

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

49

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

12,322

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

50

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

12,331

3.9+/-0.0

0.1

10 - 19.9

2,167

10.6+/-0.2

2,161

0.3

20 - 29.9

648

20.7+/-0.6

20 - 29.9

642

0.9

30 - 39.9

303

1.6

30 - 39.9

308

36.4+/-1.5

40 - 49.9

186

4.6

40 - 49.9

195

44.5+/-2.2

50 - 59.9

110

5.2

50 - 59.9

116

53.6+/-4.0

60 - 69.9

78

11

12.4

60 - 69.9

89

63.4+/-4.9

70 - 79.9

49

14.0

70 - 79.9

57

57.9+/-7.1

80 - 89.9

26

21

44.7

80 - 89.9

47

59.7+/-7.3

> 90

12

21

63.6

> 90

33

35.9+/-11.2

Subtotal

15,889

102

0.6

Subtotal

15,991

7.7+/-0.1

Missing or 0%

2,055

22

1.1

Missing or 0%

2,077

5.3+/-0.2

TOTAL

17,944

124

0.7

TOTAL

18,068

7.4+/-0.1

Total N=18,068

Table

51

Total N=18,068

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

7,378

2,829

$23410+/-758

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

1,995

649

$85380+/3704

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

740

307

$169695+/14624

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

693

154

$468469+/47209

934 Full thickness burn w/o skin grft or inhal inj

552

264

$31592+/4853

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

5 - 15.9

Analysis
by Age Group

Total N=11,358

42

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
by Age Group
Figure

37

5 - 15.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Mean Hospital Days with 95% Cl

12.5

Fire/Flame
Scald

10

Contact with
Hot Object

7.5

ANALYSIS OF
CONTRIBUTING
HOSPITALS

2.5

2004

2005

2006

2007

2008

2009

2010

2011

2012

ANALYSIS OF ALL
U.S. RECORDS

2013

Admission Year
Total N=18,068

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

Estimated Mean Hospital Charges with 95% Cl

38

1
2
3
4
5
6

$100,000
$90,000

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$80,000
$70,000
$60,000
$50,000

HOSPITAL
COMPARISONS

$40,000
$30,000
$20,000

Fire/Flame
(N= 2,493)

Scald
(N= 2,114)

Contact with Hot


Object (N= 423)

Burn, Unspecified
(N= 201)

Other, Non Burn


(N= 117)

Electrical
(N= 111)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=5,459

43

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

Table

52

RACE/ETHNICITY

39

RACE/ETHNICITY

Figure

16 - 19.9

Race

Cases

% Valid

White

6,275

66.1%

Black

1,515

16.0%

Hispanic

1,159

12.2%

Other

341

3.6%

Asian

125

1.3%

Native American

75

0.8%

Unknown

537

TOTAL

10,027

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=9,490 (Excluding 537 Unknown/Missing)

Figure

ETIOLOGY

40

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Contact with
Hot Object
Other, Non Burn
Burn,
Unspecified
Chemical
Electrical
Inhalation Only
Radiation
Skin Disease

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=9,110 (Excluding 917 Unknown/Missing)

53

44

Etiology

Cases

% Valid

Fire/Flame

4,928

54.1%

Scald

2,389

26.2%

Contact with Hot Object

532

5.8%

Other, Non Burn

322

3.5%

Burn, Unspecified

322

3.5%

Chemical

258

2.8%

Electrical

232

2.5%

Inhalation Only

79

0.9%

Radiation

29

0.3%

Skin Disease

19

0.2%

Unknown

917

TOTAL

10,027

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

54

16 - 19.9

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

Inhalation Injury

Total
Mean +/Cases
SEM
8,464
6.7+/-0.1

No
Yes

623

Subtotal

9,087

Missing

940

TOTAL

10,027

Lived

Died

Cases

Mean +/- SEM

Cases

Mean +/- SEM

8,424

6.6+/-0.1

40

17.5+/-6.1

566

19.2+/-1.2

57

9.2+/-2.3

18.3+/-1.1

8,990
7.6+/-0.5

97

925

7.7+/-0.6

15

9,915

3.6+/-1.4

112

Total N=10,027

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

55

Top Ten Complications

Count

Pneumonia
Cellulitis
Urinary Tract Infection
Wound Infection
Septicemia
Respiratory Failure
Other Blood/Systemic Infection
Other Hematologic
Catheter-Related Bloodstream Infection
Bacteremia
Total Complications

202
184
150
135
105
104
48
48
47
43
1,913

Percent of All
Complications
10.6
9.6
7.8
7.1
5.5
5.4
2.5
2.5
2.5
2.2

Percent of Patients
with Complication
2.2
2.0
1.7
1.5
1.2
1.1
0.5
0.5
0.5
0.5

Total N=9,065 (Excluding 962 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

5,172

17.7

86.69 Other skin graft to other sites

3,684

12.6

86.28 Nonexcisional debridement of wound, infection or burn

2,315

7.9

86.66 Homograft to skin

1,910

6.5

93.57 Application of other wound dressing

1,834

6.3

86.65 Heterograft to skin

1,102

3.8

38.93 Venous catheterization, not elsewhere classified

1,024

3.5

86.67 Dermal regenerative graft

823

2.8

99.04 Transfusion of packed cells

817

2.8

86.62 Other skin graft to hand

707

2.4

Total Procedures

29,225
Total N=10,027

45

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ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

56

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

57

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

5,691

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

58

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

6,486

4.2+/-0.1

0.1

10 - 19.9

1,299

9.4+/-0.2

1,208

0.4

20 - 29.9

400

20.1+/-0.9

20 - 29.9

377

1.0

30 - 39.9

183

28.5+/-1.5

30 - 39.9

153

3.8

40 - 49.9

112

4.3

40 - 49.9

116

43.2+/-2.9

50 - 59.9

55

11.3

50 - 59.9

67

58.4+/-5.9

60 - 69.9

34

17.1

60 - 69.9

49

68.4+/-9.5

70 - 79.9

23

17.9

70 - 79.9

29

59.7+/-9.3

80 - 89.9

12

15

55.6

80 - 89.9

32

38.4+/-9.3

> 90

10

25

71.4

> 90

36

28.8+/-8.8

Subtotal

7,675

87

1.1

Subtotal

8,697

7.9+/-0.1

Missing or 0%

1,179

19

1.6

Missing or 0%

1,330

4.9+/-0.2

TOTAL

8,854

106

1.2

TOTAL

10,027

7.5+/-0.1

Total N=10,027

Table

59

Total N=10,027

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

3,738

1,702

$24477+/3115

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

926

354

$84473+/6085

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

474

224

$150459+/13399

934 Full thickness burn w/o skin grft or inhal inj

350

208

$36430+/6903

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

280

104

$418147+/54099

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

16 - 19.9

Analysis
by Age Group

Total N=5,768

46

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
by Age Group
Figure

41

16 - 19.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Mean Hospital Days with 95% Cl

12.5

Fire/Flame
Scald
Contact with
Hot Object

10

7.5

ANALYSIS OF
CONTRIBUTING
HOSPITALS

2.5

2004

2005

2006

2007

2008

2009

2010

2011

2012

ANALYSIS OF ALL
U.S. RECORDS

2013

Admission Year
Total N=10,027

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

Estimated Mean Hospital Charges with 95% Cl

42

1
2
3
4
5
6

$140,000
$120,000

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$100,000
$80,000

HOSPITAL
COMPARISONS

$60,000
$40,000
$20,000
Fire/Flame
(N= 1,886)

Scald
(N= 914)

Contact with Hot Object


(N= 198)

Burn, Unspecified
(N= 129)

Burn, Unspecified
(N= 129)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=3,127

47

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

Table

60

RACE/ETHNICITY

43

RACE/ETHNICITY

Figure

20 - 29.9

Race

Cases

% Valid

White

16,713

62.2%

Black

4,332

16.1%

Hispanic

4,032

15.0%

Other

1,075

4.0%

Asian

503

1.9%

Native American

219

0.8%

Unknown

1,642

TOTAL

28,516

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=26,874 (Excluding 1,642 Unknown/Missing)

Figure

ETIOLOGY

44

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Contact with
Hot Object
Electrical
Chemical
Burn,
Unspecified
Other, Non Burn
Inhalation Only
Radiation
Skin Disease

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=26,101 (Excluding 2,415 Unknown/Missing)

61

48

Etiology

Cases

% Valid

Fire/Flame

12,778

49.0%

Scald

7,434

28.5%

Contact with Hot Object

1,363

5.2%

Electrical

1,341

5.1%

Chemical

1,051

4.0%

Burn, Unspecified

901

3.5%

Other, Non Burn

786

3.0%

Inhalation Only

336

1.3%

Radiation

76

0.3%

Skin Disease

35

0.1%

Unknown

2415

TOTAL

28,516

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

62

20 - 29.9

No

Total
Mean +/Cases
SEM
23,835
7.2+/-0.1

Yes

2,245

Subtotal

26,080

Missing

2,436

TOTAL

28,516

Inhalation Injury

Lived
Cases

20.1+/-0.7

Died

Mean +/- SEM

Cases

Mean +/- SEM

23,688

7.1+/-0.0

147

23.1+/-4.2

2,012

19.8+/-0.6

233

22.2+/-3.3

25,700
8.5+/-0.4

380

2,385

8.1+/-0.3

51

28,085

26.5+/-8.6

431

Total N=28,516

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

63

Top Ten Complications

Count

Cellulitis
Pneumonia
Urinary Tract Infection
Respiratory Failure
Wound Infection
Septicemia
Other Blood/Systemic Infection
Renal Failure
Catheter-Related Bloodstream Infection
Bacteremia
Total Complications

797
769
494
446
428
400
190
187
178
159
7,147

Percent of All
Complications
11.2
10.8
6.9
6.2
6.0
5.6
2.7
2.6
2.5
2.2

Percent of Patients
with Complication
3.1
3.0
1.9
1.7
1.6
1.5
0.7
0.7
0.7
0.6

Total N=25,976 (Excluding 2,540 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

15,852

18.5

86.69 Other skin graft to other sites

10,345

12.1

86.28 Nonexcisional debridement of wound, infection or burn

6,255

7.3

86.66 Homograft to skin

5,482

6.4

93.57 Application of other wound dressing

4,852

5.7

86.65 Heterograft to skin

3,677

4.3

38.93 Venous catheterization, not elsewhere classified

2,893

3.4

86.62 Other skin graft to hand

2,234

2.6

86.67 Dermal regenerative graft

2,118

2.5

86.6 Free skin graft

1,585

1.8

Total Procedures

85,772
Total N=28,516

49

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ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

64

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

65

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

18,340

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

66

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

18,369

4.7+/-0.0

29

0.2

10 - 19.9

3,725

10.9+/-0.2

3,703

22

0.6

20 - 29.9

1,182

19.0+/-0.4

20 - 29.9

1,163

19

1.6

30 - 39.9

520

33.3+/-1.3

30 - 39.9

490

30

5.8

40 - 49.9

242

35

12.6

40 - 49.9

277

49.1+/-3.0

50 - 59.9

136

31

18.6

50 - 59.9

167

60.5+/-4.2

60 - 69.9

100

35

25.9

60 - 69.9

135

56.5+/-4.2

70 - 79.9

48

35

42.2

70 - 79.9

83

66.2+/-7.4

80 - 89.9

40

51

56.0

80 - 89.9

91

56.2+/-7.3

> 90

23

75

76.5

> 90

98

30.2+/-7.2

Subtotal

24,285

362

1.5

Subtotal

24,647

8.6+/-0.1

Missing or 0%

3,800

69

1.8

Missing or 0%

3,869

6.2+/-0.2

TOTAL

28,085

431

1.5

TOTAL

28,516

8.3+/-0.1

Total N=28,516

Table

67

Total N=28,516

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

10,510

5,102

$23569+/-650

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

2,778

1,176

$96373+/3811

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

1,666

844

$181782+/11147

934 Full thickness burn w/o skin grft or inhal inj

1,071

652

$30377+/1883

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

816

409

$441328+/28666

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

20 - 29.9

Analysis
by Age Group

Total N=16,841

50

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Analysis
by Age Group
Figure

45

20 - 29.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR

Mean Hospital Days with 95% Cl

Etiology

Fire/Flame

20

Scald
Contact with
Hot Object
15

10

ANALYSIS OF
CONTRIBUTING
HOSPITALS

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Admission Year
Total N=28,516

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

46

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

$160,000

Estimated Mean Hospital Charges with 95% Cl

1
2
3
4
5
6

$140,000
$120,000

ANALYSIS
BY AGE
ETIOLOGY

$100,000
$80,000
$60,000

HOSPITAL
COMPARISONS

$40,000
$20,000

Fire/Flame
(N= 5,318)

Scald
(N= 3,080)

Electrical
(N= 632)

Contact with Hot


Object (N= 540)

Chemical
(N= 442)

Burn, Unspecified Other, Non Burn


(N= 400)
(N= 213)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=10,726

51

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

Table

68

RACE/ETHNICITY

47

RACE/ETHNICITY

Figure

30 - 39.9

Race

Cases

% Vslid

White

14,118

61.1%

Black

4,021

17.4%

Hispanic

3,426

14.8%

Other

842

3.6%

Asian

516

2.2%

Native American

166

0.7%

Unknown

1,322

TOTAL

24,411

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=23,089 (Excluding 1,322 Unknown/Missing)

Figure

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Electrical
Chemical
Contact with
Hot Object
Burn,
Unspecified
Other, Non Burn
Inhalation Only
Skin Disease
Radiation

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=22,425 (Excluding 1,986 Unknown/Missing)

69

52

Etiology

Cases

% Valid

Fire/Flame

10,960

48.9%

Scald

5,896

26.3%

Electrical

1,427

6.4%

Chemical

1,252

5.6%

Contact with Hot Object

1,215

5.4%

Other, Non Burn

562

2.5%

Burn, Unspecified

621

2.8%

Inhalation Only

399

1.8%

Skin Disease

50

0.2%

Radiation

43

0.2%

Unknown

1986

TOTAL

24,411

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ETIOLOGY

48

ETIOLOGY

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

70

30 - 39.9

No

Total
Mean +/Cases
SEM
20,088
7.7+/-0.1

Yes

2,186

Subtotal

22,274

Missing

2,137

TOTAL

24,411

Inhalation Injury

Lived
Cases

19.1+/-0.6

Died

Mean +/- SEM

Cases

Mean +/- SEM

19,901

7.7+/-0.1

187

18.2+/-3.0

1,921

20.0+/-0.6

265

12.4+/-1.2

21,822
9.5+/-0.4

452

2,076

9.2+/-0.4

61

23,898

20.4+/-5.4

513

Total N=24,411

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

71

Top Ten Complications

Count

Pneumonia
Cellulitis
Urinary Tract Infection
Respiratory Failure
Wound Infection
Septicemia
Bacteremia
Other Blood/Systemic Infection
Other Hematologic
Renal Failure
Total Complications

832
741
494
439
422
374
205
202
178
175
7,127

Percent of All
Complications
11.7
10.4
6.9
6.2
5.9
5.2
2.9
2.8
2.5
2.5

Percent of Patients
with Complication
3.7
3.3
2.2
2.0
1.9
1.7
0.9
0.9
0.8
0.8

Total N=22,498 (Excluding 1,913 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES

Top Ten Procedure Codes


86.22 Excisional debridement of wound, infection, or burn

Count
14,245

Percent of All Procedures


18.7

86.69 Other skin graft to other sites

9,374

12.3

86.28 Nonexcisional debridement of wound, infection or burn

5,295

6.9

86.66 Homograft to skin

4,964

6.5

93.57 Application of other wound dressing

3,784

5.0

86.65 Heterograft to skin

3,220

4.2

38.93 Venous catheterization, not elsewhere classified

2,813

3.7

86.62 Other skin graft to hand

1,957

2.6

86.67 Dermal regenerative graft

1,798

2.4

86.6 Free skin graft

1,435

1.9

Total Procedures

76,233
Total N=24,411

53

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

72

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

73

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

15,000

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

74

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

15,037

5.3+/-0.0

37

0.2

10 - 19.9

3,308

11.3+/-0.2

3,276

32

1.0

20 - 29.9

1,040

21+/-0.5

20 - 29.9

1,012

28

2.7

30 - 39.9

482

37

7.1

30 - 39.9

519

33.8+/-1.7

40 - 49.9

250

31

11.0

40 - 49.9

281

48.5+/-2.1

50 - 59.9

125

34

21.4

50 - 59.9

159

52.2+/-3.2

60 - 69.9

88

51

36.7

60 - 69.9

139

62.2+/-5.0

70 - 79.9

41

46

52.9

70 - 79.9

87

49.2+/-6.4

80 - 89.9

30

57

65.5

80 - 89.9

87

29.6+/-5.8

> 90

90

91.8

> 90

98

11.3+/-4.5

Subtotal

20,312

443

2.1

Subtotal

20,755

9.4+/-0.1

Missing or 0%

3,586

70

1.9

Missing or 0%

3,656

6.1+/-0.2

TOTAL

23,898

513

2.1

TOTAL

24,411

8.9+/-0.1

Total N=24,411

Table

75

Total N=24,411

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

8,536

4,051

$26423+/-830

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

2,404

983

$93478+/3893

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

1,684

880

$173486+/9234

934 Full thickness burn w/o skin grft or inhal inj

900

539

$37137+/3499

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

768

392

$457618+/25869

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

30 - 39.9

Analysis
by Age Group

Total N=14,292

54

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Analysis
by Age Group
Figure

49

30 - 39.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Mean Hospital Days with 95% Cl

14

Fire/Flame
Scald

12

Contact with
Hot Object
10
8

ANALYSIS OF
CONTRIBUTING
HOSPITALS

6
4
2

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Admission Year
Total N=24,411

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

50

$120,000

Estimated Mean Hospital Charges with 95% Cl

1
2
3
4
5
6

$100,000

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$80,000

$60,000

HOSPITAL
COMPARISONS

$40,000

$20,000

Fire/Flame
(N= 4,522)

Scald
(N= 2,406)

Electrical
(N= 626)

Chemical
(N= 502)

Contact with Hot Burn, Unspecified Other, Non Burn


Object (N= 494)
(N= 275)
(N= 150)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=8,976

55

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

Table

76

RACE/ETHNICITY

51

RACE/ETHNICITY

Figure

40 - 49.9

Race

Cases

% Valid

White

16,332

63.8%

Black

4,864

19.0%

Hispanic

2,867

11.2%

Other

843

3.3%

Asian

495

1.9%

Native American

212

0.8%

Unknown

1,429

TOTAL

27,042

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=25,613 (Excluding 1,429 Unknown/Missing)

Figure

ETIOLOGY

52

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Electrical
Contact with
Hot Object
Chemical
Other, Non Burn
Burn,
Unspecified
Inhalation Only
Radiation
Skin Disease

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=24,750 (Excluding 2,292 Unknown/Missing)

77

56

Etiology

Cases

% Valid

Fire/Flame

12,504

50.5%

Scald

6,164

24.9%

Electrical

1,445

5.8%

Contact with Hot Object

1,423

5.7%

Chemical

1,288

5.2%

Other, Non Burn

661

2.7%

Burn, Unspecified

659

2.7%

Inhalation Only

477

1.9%

Radiation

71

0.3%

Skin Disease

58

0.2%

Unknown

2292

TOTAL

27,042

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

78

40 - 49.9

No

Total
Mean +/Cases
SEM
22,000
8.9+/-0.1

Yes

2,722

Subtotal

24,722

Missing

2,320

TOTAL

27,042

Inhalation Injury

Lived
Cases

19.2+/-0.5

Died

Mean +/- SEM

Cases

Mean +/- SEM

21,675

8.7+/-0.1

325

21.7+/-1.8

2,322

19.9+/-0.6

400

15.3+/-1.3

23,997
10.0+/-0.4

725

2,236

9.7+/-0.4

84

26,233

17.6+/-2.9

809

Total N=27,042

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

79

Top Ten Complications

Count

Pneumonia
Cellulitis
Urinary Tract Infection
Respiratory Failure
Wound Infection
Septicemia
Renal Failure
Other Blood/Systemic Infection
Bacteremia
Other Hematologic
Total Complications

1066
978
672
652
521
520
355
254
242
227
9,874

Percent of All
Complications
10.8
9.9
6.8
6.6
5.3
5.3
3.6
2.6
2.5
2.3

Percent of Patients
with Complication
4.3
3.9
2.7
2.6
2.1
2.1
1.4
1.0
1.0
0.9

Total N=25,060 (Excluding 1,982 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

17,077

18.4

86.69 Other skin graft to other sites

11,549

12.5

86.28 Nonexcisional debridement of wound, infection or burn

5,763

6.2

86.66 Homograft to skin

5,742

6.2

93.57 Application of other wound dressing

4,485

4.8

38.93 Venous catheterization, not elsewhere classified

3,628

3.9

86.65 Heterograft to skin

3,507

3.8

86.62 Other skin graft to hand

2,305

2.5

86.67 Dermal regenerative graft

1,993

2.2

33.22 Fiber-optic bronchoscopy

1,779

1.9

Total Procedures

92,648
Total N=27,042

57

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ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

80

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

81

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

16,595

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

82

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

16,672

6.1+/-0.0

77

0.5

10 - 19.9

3,728

13.3+/-0.2

3,680

48

1.3

20 - 29.9

1,229

23.6+/-0.6

20 - 29.9

1,171

58

4.7

30 - 39.9

588

35.9+/-1.2

30 - 39.9

525

63

10.7

40 - 49.9

246

79

24.3

40 - 49.9

325

47.8+/-2.0

50 - 59.9

114

89

43.8

50 - 59.9

203

49.3+/-2.9

60 - 69.9

88

54

38.0

60 - 69.9

142

61.5+/-5.0

70 - 79.9

32

46

59.0

70 - 79.9

78

52.7+/-8.2

80 - 89.9

27

77

74.0

80 - 89.9

104

23.9+/-4.5

> 90

18

101

84.9

> 90

119

4.5+/-0.9

Subtotal

22,496

692

3.0

Subtotal

23,188

10.5+/-0.1

Missing or 0%

3,737

117

3.0

Missing or 0%

3,854

7.1+/-0.2

TOTAL

26,233

809

3.0

TOTAL

27,042

10.0+/-0.1

Total N=27,042

Table

83

Total N=27,042

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

8,982

4,221

$32019+/1102

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

2,678

1,085

$97781+/4318

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

2,334

1,186

$189161+/8790

934 Full thickness burn w/o skin grft or inhal inj

917

552

$36353+/2209

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

876

424

$527438+/30842

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

40 - 49.9

Analysis
by Age Group

Total N=15,787

58

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Analysis
by Age Group
Figure

53

40 - 49.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Fire/Flame

Mean Hospital Days with 95% Cl

15

Scald
12.5

Contact with
Hot Object

10
7.5

ANALYSIS OF
CONTRIBUTING
HOSPITALS

5
2

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Admission Year
Total N=27,042

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

54

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

$160,000
$140,000

Estimated Mean Hospital Charges with 95% Cl

1
2
3
4
5
6

$120,000

ANALYSIS
BY AGE
ETIOLOGY

$100,000

$80,000

HOSPITAL
COMPARISONS

$60,000

$40,000

Fire/Flame
(N= 5,116)

Scald
(N= 2,511)

Electrical
(N= 649)

Contact with Hot


Object (N= 583)

Chemical Burn, Unspecified Other, Non Burn


(N= 525)
(N= 337)
(N= 206)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=10,054

59

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

Table

84

RACE/ETHNICITY

55

RACE/ETHNICITY

Figure

50 - 59.9

Race

Cases

% Valid

White

13,763

65.8%

Black

4,169

19.9%

Hispanic

1,790

8.6%

Other

615

2.9%

Asian

450

2.2%

Native American

124

0.6%

Unknown

1,145

TOTAL

22,056

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=20,911 (Excluding 1,145 Unknown/Missing)

Figure

ETIOLOGY

56

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Contact with
Hot Object
Electrical
Chemical
Other, Non Burn
Burn,
Unspecified
Inhalation Only
Skin Disease
Radiation

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=20,232 (Excluding 1,824 Unknown/Missing)

85

60

Etiology

Cases

% Valid

Fire/Flame

10,575

52.3%

Scald

4,824

23.8%

Contact with Hot Object

1,266

6.3%

Electrical

882

4.4%

Chemical

881

4.4%

Other, Non Burn

636

3.1%

Burn, Unspecified

554

2.7%

Inhalation Only

488

2.4%

Skin Disease

68

0.3%

Radiation

58

0.3%

Unknown

1824

TOTAL

22,056

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Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

86

50 - 59.9

Cases

Mean +/- SEM

Cases

Mean +/- SEM

No

Total
Mean +/Cases
SEM
17,394
10.1+/-0.1

16,923

9.7+/-0.1

471

23.4+/-1.6

Yes

2,826

2,313

21+/-0.6

513

18.9+/-1.4

Subtotal

20,220

Missing

1,836

TOTAL

22,056

Inhalation Injury

Lived

20.6+/-0.5

Died

19,236
11.9+/-0.5

984

1,745

11.8+/-0.5

91

20,981

14.9+/-2.6

1,075

Total N=22,056

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

87

Top Ten Complications

Count

Pneumonia
Cellulitis
Urinary Tract Infection
Respiratory Failure
Wound Infection
Septicemia
Renal Failure
Arrythmia
Other Hematologic
Bacteremia
Total Complications

1057
774
716
635
538
449
369
264
244
222
9,744

Percent of All
Complications
10.8
7.9
7.3
6.5
5.5
4.6
3.8
2.7
2.5
2.3

Percent of Patients
with Complication
5.1
3.8
3.5
3.1
2.6
2.2
1.8
1.3
1.2
1.1

Total N=20,528 (Excluding 1,528 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

14,228

17.7

86.69 Other skin graft to other sites

9,797

12.2

86.66 Homograft to skin

5,004

6.2

86.28 Nonexcisional debridement of wound, infection or burn

4,442

5.5

93.57 Application of other wound dressing

3,536

4.4

38.93 Venous catheterization, not elsewhere classified

3,350

4.2

86.65 Heterograft to skin

2,592

3.2

86.62 Other skin graft to hand

1,820

2.3

38.91 Arterial catheterization

1,428

1.8

86.6 Free skin graft

1,405

1.8

Total Procedures

80,260
Total N=22,056

61

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ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

88

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

89

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

13,468

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

90

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

13,596

7.5+/-0.1

128

0.9

10 - 19.9

2,980

16.3+/-0.3

2,883

97

3.3

20 - 29.9

996

27.3+/-0.8

20 - 29.9

892

104

10.4

30 - 39.9

453

39.5+/-1.7

30 - 39.9

358

95

21.0

40 - 49.9

165

109

39.8

40 - 49.9

274

46.8+/-2.4

50 - 59.9

75

81

51.9

50 - 59.9

156

48.9+/-4.1

60 - 69.9

42

80

65.6

60 - 69.9

122

42.1+/-4.5

70 - 79.9

25

68

73.1

70 - 79.9

93

35.5+/-5.3

80 - 89.9

17

79

82.3

80 - 89.9

96

13.8+/-3.2

> 90

14

89

86.4

> 90

103

6.8+/-2.2

Subtotal

17,939

930

4.9

Subtotal

18,869

12.0+/-0.1

Missing or 0%

3,042

145

4.5

Missing or 0%

3,187

8.8+/-0.3

TOTAL

20,981

1,075

4.9

TOTAL

22,056

11.6+/-0.1

Total N=22,056

Table

91

Total N=22,056

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

6,787

3,288

$37681+/1426

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

2,283

904

$117272+/5298

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

2,282

1,130

$197866+/7747

934 Full thickness burn w/o skin grft or inhal inj

869

494

$45647+/4394

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

818

385

$535794+/36223

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

50 - 59.9

Analysis
by Age Group

Total N=13,039

62

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Analysis
by Age Group
Figure

57

50 - 59.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR

Mean Hospital Days with 95% Cl

Etiology

Fire/Flame

18

Scald
Contact with
Hot Object

16
14
12

ANALYSIS OF
CONTRIBUTING
HOSPITALS

10
8
6
2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Admission Year
Total N=22,056

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

58

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

$160,000

Estimated Mean Hospital Charges with 95% Cl

1
2
3
4
5
6

$140,000

ANALYSIS
BY AGE
ETIOLOGY

$120,000

$100,000

$80,000

HOSPITAL
COMPARISONS

$60,000

$40,000

Fire/Flame
(N= 4,446)

Scald
(N= 1,918)

Contact with Hot


Object (N= 533)

Electrical
(N= 393)

Chemical Burn, Unspecified Other, Non Burn


(N= 370)
(N= 304)
(N= 234)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=8,349

63

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

Table

92

RACE/ETHNICITY

59

RACE/ETHNICITY

Figure

60 - 69.9

Race

Cases

% Valid

White

7,990

68.7%

Black

2,125

18.3%

Hispanic

796

6.8%

Other

359

3.1%

Asian

288

2.5%

Native American

77

0.7%

Unknown

684

TOTAL

12,319

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=11,635 (Excluding 684 Unknown/Missing)

Figure

ETIOLOGY

60

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Contact with
Hot Object
Other, Non Burn
Chemical
Burn,
Unspecified
Inhalation Only
Electrical
Skin Disease
Radiation

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=11,216 (Excluding 1,103 Unknown/Missing)

93

64

Etiology

Cases

% Valid

Fire/Flame

6,278

56.0%

Scald

2,555

22.8%

Contact with Hot Object

709

6.3%

Other, Non Burn

404

3.6%

Chemical

334

3.0%

Burn, Unspecified

317

2.8%

Inhalation Only

300

2.7%

Electrical

239

2.1%

Skin Disease

45

0.4%

Radiation

35

0.3%

Unknown

1103

TOTAL

12,319

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

94

60 - 69.9

Cases

Mean +/- SEM

Cases

Mean +/- SEM

No

Total
Mean +/Cases
SEM
9,518
11.5+/-0.1

9,076

11.1+/-0.1

442

20.0+/-1.2

Yes

1,813

1,373

19.2+/-0.6

440

14.9+/-1.1

Subtotal

11,331

Missing

988

TOTAL

12,319

Inhalation Injury

Lived

18.2+/-0.5

Died

10,449
12.7+/-0.6

882

915

12.5+/-0.6

73

11,364

14.3+/-3.1

955

Total N=12,319

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

95

Top Ten Complications

Count

Pneumonia
Urinary Tract Infection
Respiratory Failure
Cellulitis
Renal Failure
Septicemia
Wound Infection
Arrythmia
Bacteremia
Other Blood/Systemic Infection
Total Complications

713
580
474
391
322
319
305
281
150
148
6,699

Percent of All
Complications
10.6
8.7
7.1
5.8
4.8
4.8
4.6
4.2
2.2
2.2

Percent of Patients
with Complication
6.2
5.1
4.1
3.4
2.8
2.8
2.7
2.5
1.3
1.3

Total N=11,449 (Excluding 870 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

7,901

16.4

86.69 Other skin graft to other sites

5,579

11.6

86.66 Homograft to skin

2,865

5.9

38.93 Venous catheterization, not elsewhere classified

2,375

4.9

86.28 Nonexcisional debridement of wound, infection or burn

2,245

4.7

93.57 Application of other wound dressing

1,919

4.0

86.65 Heterograft to skin

1,413

2.9

38.91 Arterial catheterization

1,096

2.3

33.22 Fiber-optic bronchoscopy

931

1.9

87.44 X-ray of chest

879

1.8

Total Procedures

48,189
Total N=12,319

65

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ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

96

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

97

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

7,403

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

98

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

7,554

8.5+/-0.1

151

2.0

10 - 19.9

1,731

18.8+/-0.4

1,621

110

6.4

20 - 29.9

576

32+/-1.1

20 - 29.9

469

107

18.6

30 - 39.9

165

110

40.0

30 - 39.9

275

43.1+/-2.2

40 - 49.9

66

89

57.4

40 - 49.9

155

35.2+/-3.0

50 - 59.9

37

77

67.5

50 - 59.9

114

32.6+/-3.9

60 - 69.9

61

88.4

60 - 69.9

69

17.5+/-3.1

70 - 79.9

47

87.0

70 - 79.9

54

11.2+/-2.8

80 - 89.9

33

94.3

80 - 89.9

35

4.4+/-1.6

> 90

51

92.7

> 90

55

2.7+/-0.6

Subtotal

9,782

836

7.9

Subtotal

10,618

13.1+/-0.1

Missing or 0%

1,582

119

7.0

Missing or 0%

1,701

9.6+/-0.4

TOTAL

11,364

955

7.8

TOTAL

12,319

12.6+/-0.1

Total N=12,319

Table

99

Total N=12,319

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

3,480

1,643

$42218+/2243

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

1,472

659

$218868+/12070

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

1,204

461

$130090+/11364

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

497

246

$468363+/34623

934 Full thickness burn w/o skin grft or inhal inj

457

253

$62274+/19499

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

60 - 69.9

Analysis
by Age Group

Total N=7,110

66

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Analysis
by Age Group
Figure

61

60 - 69.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Mean Hospital Days with 95% Cl

Fire/Flame
30

Scald
Contact with
Hot Object

25
20
15

ANALYSIS OF
CONTRIBUTING
HOSPITALS

10
5

2004

2005

2006

2007

2008

2009

2010

2011

2012

ANALYSIS OF ALL
U.S. RECORDS

2013

Admission Year
Total N=12,319

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

Estimated Mean Hospital Charges with 95% Cl

62

1
2
3
4
5
6

$300,000

$250,000

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$200,000

$150,000

HOSPITAL
COMPARISONS

$100,000

$50,000

Fire/Flame
(N= 2,657)

Scald
(N= 998)

Contact with Hot


Object (N= 281)

Burn, Unspecified
(N= 169)

Other, Non Burn


(N= 140)

Chemical
(N= 139)

Electrical
(N= 112)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=4,492

67

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

RACE/ETHNICITY

63

RACE/ETHNICITY

Table

100

Figure

70 - 79.9

Race

Cases

% Valid

White

4,859

71.8%

Black

1,105

16.3%

Hispanic

392

5.8%

Other

187

2.8%

Asian

182

2.7%

Native American

39

0.6%

Unknown

386

TOTAL

7,150

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=6,764 (Excluding 386 Unknown/Missing)

Figure

ETIOLOGY

64

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Contact with
Hot Object
Other, Non Burn
Inhalation Only
Burn,
Unspecified
Chemical
Electrical
Skin Disease
Radiation

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=6,506 (Excluding 644 Unknown/Missing)

101

68

Etiology

Cases

% Valid

Fire/Flame

3,867

59.4%

Scald

1,359

20.9%

Contact with Hot Object

395

6.1%

Other, Non Burn

305

4.7%

Burn, Unspecified

168

2.6%

Inhalation Only

198

3.0%

Chemical

108

1.7%

Electrical

52

0.8%

Skin Disease

32

0.5%

Radiation

22

0.3%

Unknown

644

TOTAL

7,150

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Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

102

70 - 79.9

No

Total
Mean +/Cases
SEM
5,404
13.5+/-0.2

Yes

1,133

Subtotal

6,537

Missing

613

TOTAL

7,150

Inhalation Injury

Lived

Died

Cases

Mean +/- SEM

Cases

Mean +/- SEM

4,895

12.8+/-0.2

509

19.8+/-1.1

763

17.2+/-0.7

370

11.1+/-0.9

15.2+/-0.6

5,658
13.9+/-1.0

879

511

13.5+/-0.9

102

6,169

16.1+/-4.1

981

Total N=7,150

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

103

Top Ten Complications

Count

Urinary Tract Infection


Pneumonia
Respiratory Failure
Arrythmia
Septicemia
Cellulitis
Renal Failure
Wound Infection
Cardiac arrest
Other Cardiovascular
Total Complications

506
505
383
272
227
215
214
175
127
122
4,991

Percent of All
Complications
10.1
10.1
7.7
5.4
4.5
4.3
4.3
3.5
2.5
2.4

Percent of Patients
with Complication
7.6
7.6
5.8
4.1
3.4
3.2
3.2
2.6
1.9
1.8

Total N=6,659 (Excluding 491 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES


Top Ten Procedure Codes

Count

Percent of All Procedures

86.22 Excisional debridement of wound, infection, or burn

4,657

16.1

86.69 Other skin graft to other sites

3,296

11.4

86.66 Homograft to skin

1,689

5.8

38.93 Venous catheterization, not elsewhere classified

1,451

5.0

86.28 Nonexcisional debridement of wound, infection or burn

1,245

4.3

93.57 Application of other wound dressing

1,009

3.5

86.65 Heterograft to skin

732

2.5

38.91 Arterial catheterization

648

2.2

96.04 Insertion of endotracheal tube

593

2.0

33.22 Fiber-optic bronchoscopy

590

2.0

Total Procedures

28,938
Total N=7,150

69

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ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

104

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

105

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

3,992

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

106

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

4,160

9.9+/-0.2

168

4.0

10 - 19.9

1,001

22.0+/-0.6

847

154

15.4

20 - 29.9

359

33.0+/-1.6

20 - 29.9

233

126

35.1

30 - 39.9

87

121

58.2

30 - 39.9

208

30.7+/-2.3

40 - 49.9

31

91

74.6

40 - 49.9

122

24.1+/-3.2

50 - 59.9

11

54

83.1

50 - 59.9

65

12.4+/-3.2

60 - 69.9

41

89.1

60 - 69.9

46

10.1+/-3.0

70 - 79.9

25

89.3

70 - 79.9

28

3.0+/-0.7

80 - 89.9

24

80.0

80 - 89.9

30

2.3+/-0.5

> 90

30

88.2

> 90

34

1.4+/-0.2

Subtotal

5,219

834

13.8

Subtotal

6,053

14.2+/-0.2

Missing or 0%

950

147

13.4

Missing or 0%

1,097

11.6+/-0.6

TOTAL

6,169

981

13.7

TOTAL

7,150

13.8+/-0.2

Total N=7,150

Table

107

Total N=7,150

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

1,713

802

$50103+/3100

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

976

484

$217712+/11212

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

666

255

$134485+/11202

934 Full thickness burn w/o skin grft or inhal inj

325

181

$48750+/5031

927 Extensive burns or full thickness burns w MV


96+ hrs w skin graft

283

139

$538615+/48848

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

70 - 79.9

Analysis
by Age Group

Total N=3,963

70

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Analysis
by Age Group
Figure

65

70 - 79.9

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Mean Hospital Days with 95% Cl

40

Fire/Flame
Scald
Contact with
Hot Object

30

20

ANALYSIS OF
CONTRIBUTING
HOSPITALS

10

2004

2005

2006

2007

2008

2009

2010

2011

2012

ANALYSIS OF ALL
U.S. RECORDS

2013

Admission Year
Total N=7,150

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

66

Estimated Mean Hospital Charges with 95% Cl

1
2
3
4
5
6

$160,000

$140,000

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$120,000

$100,000

HOSPITAL
COMPARISONS

$80,000

$60,000

Fire/Flame
(N= 1,669)

Scald
(N= 536)

Contact with Hot


Object (N= 186)

Other, Non Burn


(N= 100)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=2,391

71

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Age Group

Table

108

RACE/ETHNICITY

67

RACE/ETHNICITY

Figure

80 and over

Race

Cases

% Valid

White

3,414

73.7%

Black

721

15.6%

Hispanic

217

4.7%

Other

138

3.0%

Asian

131

2.8%

Native American

11

0.2%

Unknown

278

TOTAL

4,910

Race

1
2
3
4
5
6

White
Black
Hispanic
Other
Asian
Native American

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=4,632 (Excluding 278 Unknown/Missing)

Figure

ETIOLOGY

68

ETIOLOGY

ANALYSIS
BY AGE
ETIOLOGY

Categories of
Etiology
Fire/Flam e
Scald
Contact with
Hot Object
Other, Non Burn
Inhalation Only
Burn,
Unspecified
Chemical
Electrical
Skin Disease
Radiation

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=4,518 (Excluding 392 Unknown/Missing)

109

72

Etiology

Cases

% Valid

Fire/Flame

2,409

53.3%

Scald

1,096

24.3%

Contact with Hot Object

359

7.9%

Other, Non Burn

237

5.2%

Inhalation Only

177

3.9%

Burn, Unspecified

129

2.9%

Chemical

64

1.4%

Electrical

23

0.5%

Skin Disease

18

0.4%

Radiation

0.1%

Unknown

392

TOTAL

4,910

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Table

ANALYSIS
BY AGE
GROUP

Analysis
by Age Group
Table

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

110

80 and over

Inhalation Injury
No

Total
Mean +/Cases
SEM
3,746
13.9+/-0.4

Yes

730

Subtotal

4,476

Missing

434

TOTAL

4,910

Lived

Died

Cases

Mean +/- SEM

Cases

Mean +/- SEM

3,129

13.9+/-0.5

617

#VALUE

347

17.5+/-1.2

383

7.2+/-0.5

12.1+/-0.6

3,476
12.4+/-0.7

1,000

345

12.4+/-0.8

89

3,821

12.5+/-1.9

1,089

Total N=4,910

Table

ANALYSIS OF
CONTRIBUTING
HOSPITALS

TOP TEN COMPLICATIONS

111

Top Ten Complications

Count

Urinary Tract Infection


Pneumonia
Respiratory Failure
Cellulitis
Arrythmia
Septicemia
Renal Failure
Wound Infection
Cardiac arrest
Other Cardiovascular
Total Complications

420
304
271
174
171
151
138
113
103
93
3,371

Percent of All
Complications
12.5
9.0
8.0
5.2
5.1
4.5
4.1
3.4
3.1
2.8

Percent of Patients
with Complication
9.2
6.7
5.9
3.8
3.7
3.3
3.0
2.5
2.3
2.0

Total N=4,561 (Excluding 349 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES

Top Ten Procedure Codes


86.22 Excisional debridement of wound, infection, or burn

Count
3,121

Percent of All Procedures


16.1

86.69 Other skin graft to other sites

2,237

11.6

38.93 Venous catheterization, not elsewhere classified

1,000

5.2

86.66 Homograft to skin

996

5.1

86.28 Nonexcisional debridement of wound, infection or burn

796

4.1

93.57 Application of other wound dressing

710

3.7

99.04 Insertion of endotracheal tube

474

2.4

87.44 Routine chest x-ray, so described

443

2.3

86.65 Heterograft to skin

425

2.2

96.04 Insertion of endotracheal tube

421

2.2

Total Procedures

19,350
Total N=4,910

73

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ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

112

1
2
3
4
5
6
HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

113

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

%TBSA

Cases

Cases

0.1 - 9.9

2,486

10 - 19.9

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Table

114

%TBSA

Cases

Mean +/- SEM

Mortality Rate

0.1 - 9.9

2,649

11.5+/-0.6

163

6.2

10 - 19.9

753

23.1+/-0.7

546

207

27.5

20 - 29.9

291

22.4+/-1.3

20 - 29.9

111

180

61.9

30 - 39.9

32

118

78.7

30 - 39.9

150

16.6+/-1.9

40 - 49.9

80

89.9

40 - 49.9

89

8.6+/-1.6

50 - 59.9

60

95.2

50 - 59.9

63

3.7+/-0.9

60 - 69.9

38

92.7

60 - 69.9

41

4.6+/-2.5

70 - 79.9

34

97.1

70 - 79.9

35

1.2+/-0.1

80 - 89.9

36

94.7

80 - 89.9

38

1.1+/-0.0

> 90

33

100.0

> 90

33

1.7+/-0.5

Subtotal

3,193

949

22.9

Subtotal

4,142

14.1+/-0.4

Missing or 0%

628

140

18.2

Missing or 0%

768

10.5+/-0.6

TOTAL

3,821

1,089

22.2

TOTAL

4,910

13.5+/-0.3

Total N=4,910

Table

115

Total N=4,910

MEAN CHARGES FOR TOP FIVE MS-DRGS

MS-DRG Code

Cases

Cases with Valid Charges

Mean +/SEM

935 Non-extensive burns

1,029

495

$51342+/3604

928 Full thickness burn w skin graft or inhal inj w


CC/MCC

692

320

$202771+/12317

929 Full thickness burn w skin graft or inhal inj w/o


CC/MCC

453

148

$119831+/10596

934 Full thickness burn w/o skin grft or inhal inj

330

167

$58647+/5681

933 Extensive burns or full thickness burns w MV


96+ hrs w/o skin graft

285

145

$47261+/7770

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

HOSPITAL DAYS BY BURN GROUP SIZE


(% TBSA)

LIVED/DIED BY BURN GROUP SIZE


(% TBSA)

1
2
3
4
5
6

80 and over

Analysis
by Age Group

Total N=2,789

74

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Analysis
by Age Group
Figure

69

80 and over

MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,


AND SCALD BY ADMISSION YEAR
Etiology

Mean Hospital Days with 95% Cl

Fire/Flame
Scald
40

Contact with
Hot Object

30

ANALYSIS OF
CONTRIBUTING
HOSPITALS

20

10

2004

2005

2006

2007

2008

2009

2010

2011

2012

ANALYSIS OF ALL
U.S. RECORDS

2013

Admission Year
Total N=4,910

Figure

MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES

70

$160,000

Estimated Mean Hospital Charges with 95% Cl

1
2
3
4
5
6

$140,000

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

$120,000

$100,000

HOSPITAL
COMPARISONS

$80,000

$60,000

Fire/Flame
(N= 1,031)

Scald
(N= 446)

Contact with Hot


Object (N= 169)

Etiology Categories with Greater than 100 Valid Charge Cases


Total N=1,646

75

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

The etiology of thermal injury has a significant impact on the


morbidity and mortality of patients admitted to a burn center.
As you will observe in this section of the 2014 National Burn
Repository Report, different burns have different rates across the
varying categories of complications. Likely through differences
in size and severity of injury, the cause of the burn wound has an
impact on hospital length of stay. The demographics of the patients
suffering from burns from various etiologies is also different.
With different mechanisms of injury, there are differences in
the circumstances and environment in which the burn occurs.
Differences in gender also emerge when demographics are analyzed.
Understanding these patterns of different burn etiologies is a key
component in focusing burn prevention strategies.
The reader is reminded that the information in this section
pertains only to inpatient admissions for burns at burn centers.Valid
conclusions regarding the demographics of outpatient burns and
their etiologies cannot be drawn from this report. For example, the
most common surgical procedure performed on all these patients
is excision and skin grafting. This finding clearly suggests that these
patients had a burn severe enough to warrant admission to a burn
center, regardless of the etiology. Burns managed in the outpatient

setting are not currently reported with a central tracking mechanism


in the United States. The NBR report may eventually grow to
include the outpatient burn population in the future.

Analysis
by Etiology

Fire/Flame Injuries

Flame burns continue to be one of the most severe etiologies of thermal injury. They are typically associated with
the highest risk of death and complications compared to all other burn etiologies. The percentage of burn patients with
flame injuries admitted to burn centers in this ten year data set is 46.4%. The circumstances surrounding flame burns
are most commonly non-work related accidents (72.1%), followed by work related injuries (13.2%). Recreational flame
burns are the next most common circumstance occurring in 6.7% of instances (Figure 71, Table 116). Burns caused by
fire most commonly occur in the home (71.8%). The next most common places of occurrence are recreational events
(7.4%) and from industrial accidents (6.8%), depicted in Figure 72 and Table 117.

Accident, NonWork Related


Accident, Work
Related
Accident,
Recreation
Accident,
Unspecified
Suspected Self
Inflicted
Other
Suspected
Assault/Abuse
Suspected
Arson
Suspected Child
Abuse

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Total N=69,205 (Excluding 6,240 Unknown/Missing)

Figure

72

ANALYSIS
BY AGE
ETIOLOGY

PLACE OF OCCURRENCE E849 CODE


Categories of
Place of
Occurrence
Home
Recreation and
Sport
Industrial
Other Specified
Place
Street/Highway
Public Building
Residential
Institution
Farm
Mine/Quarry

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=65,934 (Excluding 9,511 Unknown/Missing)

78

Circumstance of Injury

Cases

Accident, Non-Work Related 49,921

% Valid
72.1%

Accident, Work Related

9,158

13.2%

Accident, Recreation

4,613

6.7%

Accident, Unspecified

2,012

2.9%

Suspected Self Inflicted

1,321

1.9%

Other

1,045

1.5%

Suspected Assault/Abuse

787

1.1%

Suspected Arson

210

0.3%

Suspected Child Abuse

138

0.2%

Unknown

6,240

Total

75,445

PLACE OF OCCURRENCE E849 CODE

Table

117

Place of Occurrence

Cases

% Valid

Home

47,330

71.8%

Recreation and Sport

4,898

7.4%

Industrial

4,474

6.8%

Other Specified Place

3,940

6.0%

Street/Highway

3,057

4.6%

Public Building

1,094

1.7%

Farm

670

1.0%

Residential Institution

414

0.6%

Mine/Quarry

57

0.1%

Unspecified

9,511

Total

75,445

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116

{
Categories of
Circumstance
of Injury

ANALYSIS OF
CONTRIBUTING
HOSPITALS

Table

CIRCUMSTANCE OF INJURY

71

CIRCUMSTANCE OF INJURY

1
2
3
4
5
6

Figure

Analysis
by Etiology

Fire/Flame Injuries

Burns caused by flames are typically associated with the highest rate of complications. The complication rate captured
in this report at participating burn centers over the past ten years is 17% (Table 118). As expected, with increasing age,
the rate of complications also increases (Figure 73). Although infants have a slightly higher rate of complications (13.4%),
children over age 1 and young adults under the age of 20 have a reported complication rate that ranges from 7.7-11.3%.
The rate of complications in patients above the age of 20 increases between each age group in a linear fashion (Figure
73). Patients older than 50 have the highest incidence of complications, ranging from 21 to 27.6% as the age groups
increase (Table 118).
Figure

% of Patients with a Clinically Related


Complication

73

PERCENT OF PATIENT WITH CLINICALLY RELEVANT COMPLICATIONS BY AGE GROUP


30%

20%

ANALYSIS OF
CONTRIBUTING
HOSPITALS

10%

ANALYSIS OF ALL
U.S. RECORDS

0-.9

1-1.9

2-4.9

5-15.9

16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories
Total N=71,423 (Excluding 4,022 cases from non ABA burn registry software centers or missing/unknown age)

Table

COMPLICATION RATE BY AGE GROUP

118

1
2
3
4
5
6

Age Category
0-.9
1-1.9
2-4.9
5-15.9
16-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80 and Over
Subtotal
Missing
Total

No Complication
# of Cases
376
791
1,848
6,288
4,109
10,409
8,769
9,729
7,967
4,576
2,731
1,666
59,259
0
59,259

Complication
# of Cases
58
66
213
791
523
1,590
1,640
2,142
2,112
1,433
960
636
12,164
0
12,164

Complication Rate
13.4
7.7
10.3
11.2
11.3
13.3
15.8
18.0
21.0
23.8
26.0
27.6
17.0
17.0

Total N=71,423 (Excluding 4,022 cases from non ABA burn registry software centers)

79

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ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

Fire/Flame Injuries

The most common complications reported in patients with flame burns are of an infectious nature. Pneumonia is
the most common infection, occurring at an incidence of 5.8% of all patients and represents approximately 12% of
total complications in this group (Table 119). The next most common complications are urinary tract infections (3.8%)
and cellulitis (3.2%). Catheter-related blood stream infections were reported in only 1.2% of the data set. Despite the
infectious complications, septicemia was only reported in 2.7% of the population.
The most commonly performed procedures on patients with flame burns are excision (17.3%) and grafting (12.1%).
The use of homograft is reported in 6.6% of the procedures. Heterografts make up 3.5% of procedures and dermal
regenerative templates comprise 2.2% of reported procedures. Skin grafts to the hand compose only 2.3% of the
population (Table 120).

119

Top Ten Complications

Count

Percent of All
Complications

Percent of Patients
with Complication

Pneumonia

4,128

11.8

5.8

Urinary Tract Infection

2,691

7.7

3.8

Respiratory Failure

2,420

6.9

3.4

Cellulitis

2,269

6.5

3.2

Septicemia

1,947

5.6

2.7

Wound Infection

1,685

4.8

2.4

Renal Failure

1,217

3.5

1.7

Arrythmia

989

2.8

1.4

Bacteremia

872

2.5

1.2

Catheter-Related Bloodstream Infection

862

2.5

1.2

Total Complications

35,049

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Total N=71,423 (Excluding 4,022 cases from non ABA burn registry software centers)

Table

120

TOP TEN PROCEDURES

ANALYSIS
BY AGE
ETIOLOGY

TOP TEN COMPLICATIONS

1
2
3
4
5
6

Table

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Top Ten Procedure Codes

Count

Percent of All
Procedures

86.22 Excisional debridement of wound, infection, or burn

59,365

17.2

86.69 Other skin graft to other sites

41,926

12.1

86.66 Homograft to skin

22,777

6.6

86.28 Nonexcisional debridement of wound, infection or burn

20,054

5.8

38.93 Venous catheterization, not elsewhere classified

16,060

4.6

93.57 Application of other wound dressing

15,507

4.5

86.65 Heterograft to skin

12,282

3.5

86.62 Other skin graft to hand

8,052

2.3

86.67 Dermal regenerative graft

7,508

2.2

99.04 Packed cell transfusion

7,265

2.1

Total Procedures

345,983
Total N=75,445

80

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Analysis
by Etiology

Fire/Flame Injuries

Smoke inhalation continues to have a significant impact on the morbidity and mortality of flame burns. Inhalation
injury is present in 16% of patients with flame burns (excluding patients with missing data field). The presence of
smoke inhalation is associated with an overall mortality rate of 22% over the past decade, while the mortality is 3% in
those patients without smoke inhalation. Patients with inhalation injury had almost a 2.2 times longer length of stay
compared to those without inhalation injury (24 days vs. 10 days). With a sub-group analysis of survivors, those with
smoke inhalation have an average length of stay of 24 days, while those without it have an average hospital stay of 10
days. Non-survivors with smoke inhalation injury have a length of stay of 15 days before succumbing to the injury.
Non-survivors of flame burns without inhalation injury have a length of stay of 20 days before death occurs (Table 121).
As expected, the length of hospital stay increases with burn size (%TBSA). The old adage, length of stay is
approximated by %TBSA only holds true in the current data set for all survivors with up to 40% TBSA. The ratio of
length of stay to burn size increases up to 1.3 in the group with 50-80% TBSA, and then evens out to a ratio of 1:1 in
patients with >80% TBSA. For non-survivors, the length of stay is approximately 2.5- 3 weeks those with flame burns
in the 10 -70% TBSA group. Non-survivors with flame burns <10% had a 13 day length of stay. Those who died with
burns > 70% TBSA had an average length of stay of less than two weeks (Table 122).

Table

121

ANALYSIS OF
CONTRIBUTING
HOSPITALS

HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY

Total

Lived

Died

Inhalation Injury

Cases

Mean +/- SEM

Cases

Mean +/- SEM

Cases

Mean +/- SEM

No

58,688

10.2+/-0.0

56,945

9.9+/-0.0

1,743

19.9+/-0.8

Yes

10,915

21.9+/-0.3

8,579

23.9+/-0.3

2,336

14.8+/-0.6

Subtotal

69,603

Missing

5,842

TOTAL

75,445

65,524
12.6+/-0.3

4,079

5,450

12.5+/-0.3

70,974

392

14.7+/-1.6

4,471

Total N=75,445

Table

HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP (%TBSA)

% TBSA
0.1 - 9.9
10 - 19.9
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
60 - 69.9
70 - 79.9
80 - 89.9
> 90
Subtotal
Missing or 0%
TOTAL

Cases
42,795
13,164
4,828
2,480
1,513
919
705
446
460
480
67,790
7,655
75,445

Total
Mean +/- SEM
6.0+/-0.0
14.5+/-0.1
25.3+/-0.3
36.1+/-0.6
45.8+/-1.0
48.5+/-1.5
52.3+/-2.0
42.1+/-2.7
28.6+/-2.2
14.1+/-2.1
12.5+/-0.0
7.9+/-0.2

Cases
42,381
12,689
4,339
2,015
1,071
552
362
166
111
38
63,724
7,250
70,974

Lived
Mean +/- SEM
5.9+/-0.0
14.3+/-0.1
25.9+/-0.3
39.6+/-0.7
55.1+/-1.1
67.9+/-1.8
82.1+/-2.8
91.6+/-4.7
82.5+/-6.2
96.9+/-18.0
12.3+/-0.0
7.6+/-0.1

Cases
414
475
489
465
442
367
343
280
349
442
4,066
405
4,471

Died
Mean +/- SEM
13.3+/-0.9
20.1+/-1.1
19.9+/-1.0
20.8+/-1.3
23.3+/-2.0
19.2+/-2.1
20.8+/-2.0
12.7+/-1.7
11.5+/-1.3
7.2+/-1.3
17.1+/-0.4
12.9+/-1.4

Total N=75,445

81

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ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

122

1
2
3
4
5
6
ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

ANALYSIS OF
CONTRIBUTING
HOSPITALS

In Table 123, the mortality of flame burn patients is stratified by age (less than 60 and greater than 60 years old) and
the presence of inhalation injury. For younger patients with burns <20 %TBSA, the presence of smoke inhalation is
associated with a 14 fold increase in mortality (Age < 60: 0.3% mortality without smoke inhalation, 4.1% with smoke
inhalation). For older patients (age > 60), the mortality increases from 4.1% without smoke inhalation to 16.9% with
smoke inhalation, a four-fold increase in mortality.
As burn size increases to 20-40 %TBSA, inhalation injury in the age < 60 years is associated with almost a five fold
increase in mortality (3 vs. 14%). In patients over the age of 60, flame burns are more lethal with an average mortality of
36%. If accompanied by inhalation, the mortality in this age group increases to 57%.
Mortality continues to increase with burn size in the 40 to 60 %TBSA group. In those under the age of 60, the
presence of smoke inhalation doubles the mortality (14.8 vs. 31.1%). In those over the age of 60, the prognosis is grave
with mortality rates of 72.2% without smoke inhalation and 82.5% with smoke inhalation.
As overall mortality rates increase in patients with >60% TBSA burns, the presence of smoke inhalation injury results
in less of a relative increase, as prognosis is worse irrespective of inhalation injury. In patients <60 years old, mortality
increase from 48.7% to 69.0% with inhalation injury. Patients with flame burns > 60% in the age > 60 category are
almost uniformly fatal despite the presence of inhalation injury.
Table

123

MORTALITY RATE FOR MATRIX OF MAIN PREDICTORS

1
2
3
4
5
6

Fire/Flame Injuries

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

TBSA Category

Age

Inhalation Injury

Lived

Died

Mortality Rate

0.1-19.9

0-59.9

No

39,049

112

0.3

0.1-19.9

0-59.9

Yes

3,897

165

4.1

0.1-19.9

60 and Over

No

6,861

297

4.1

0.1-19.9

60 and Over

Yes

1,187

242

16.9

20-39.9

0-59.9

No

3,948

118

2.9

20-39.9

0-59.9

Yes

1,236

198

13.8

20-39.9

60 and Over

No

549

312

36.2

20-39.9

60 and Over

Yes

185

249

57.4

40-59.9

0-59.9

No

858

149

14.8

40-59.9

0-59.9

Yes

552

249

31.1

40-59.9

60 and Over

No

62

161

72.2

40-59.9

60 and Over

Yes

39

184

82.5

60 and Over

0-59.9

No

349

331

48.7

60 and Over

0-59.9

Yes

278

619

69.0

60 and Over

60 and Over

No

136

95.8

60 and Over

60 and Over

Yes

211

97.7

TOTAL

59,061

3,733

5.9

Total N=62,794 (Excluding 12,651 Unknown/Missing)

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

82

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Analysis
by Etiology

Fire/Flame Injuries

The BAUX score (Age + %TBSA burned) has been a standard to estimate the mortality of burn patients for decades.
Figure 74 demonstrates that an increasing BAUX score is associated with a higher mortality. The effect of gender is also
depicted in this chart. Although there is no statistical analysis, in nearly every BAUX category, there is a higher mortality
in women compared to men. Analyzing Table 124, there is a nearly two fold higher mortality for women with flame
burns (8.8%) compared to men (5.0%). This difference is statistically significant (Chi-squared, p < 0.0001).
Traditionally, a BAUX score > 100 was associated with a mortality of > 50%. This holds true in this table, however, a
BAUX score of 100 to 110 in woman has a mortality rate of 58% vs. a mortality rate of 44.5% in men. This difference is
also statistically different (Chi-squared, p < 0.001). This finding has been previously reported, but the role of gender, sexhormones, and immune response have not been fully defined.
Although it appears that men have a survival advantage, men are more likely to be admitted with a flame-burn injury.
Men are responsible for 76.4% of burn center admissions for flame burns.
Female
Figure
MORTALITY RATE FOR BAUX SCORE CATEGORIES BY GENDER
Male

74

% of Patients that Died

100%
80%

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

60%
40%

ANALYSIS OF ALL
U.S. RECORDS

20%

.1-9.9

1019.9

2029.9

3039.9

4049.9

5059.9

6069.9

7079.9

8089.9

9099.9

100109.9

110- 120- 130119.9 129.9 139.9

140+

BAUX Score (Age + TBSA)


Total N=72,325 (Excluding 3,120 Unknown/Missing)

Table

124

NUMBER OF CASES IN BAUX SCORE CATEGORIES BY GENDER

ANALYSIS
BY AGE
GROUP

Female

Male

BAUX Score (Age + TBSA)

Lived

Died

Lived

Died

0-9.9
10-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80-89.9
90-99.9
100-109.9
110-119.9
120-129.9
130-139.9
140 and Over
Total

1,073
1,124
1,636
1,820
2,145
2,532
2,008
1,474
982
509
156
55
13
5
5
15,537

9
9
12
24
36
59
98
125
187
188
223
159
124
94
155
1,502

1,899
4,203
8,029
7,930
8,038
8,126
6,257
3,918
2,357
1,056
437
163
60
20
15
52,508

9
12
18
31
72
97
176
222
307
363
351
347
273
210
300
2,788

Total N=72,325 (Excluding 3,120 Unknown/Missing)

83

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ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

Scald Injuries

In Figure 75 and Table 125, the majority of scald burns occur as non-work related accidents (79%). The next most
common etiology is work related accidents (11%). The location of these injuries, as expected, occurs at home (84%) and
the workplace (6%). Approximately 2.4 % of scald admissions are suspect for child abuse and 1.5% is the result of an
assault (Figure 75, Table 125).

1
2
3
4
5
6

Categories of
Circumstance
of Injury
Accident, NonWork Related
Accident, Work
Related
Accident,
Unspecified
Suspected Child
Abuse
Other
Suspected
Assault/Abuse
Accident,
Recreation
Suspected Self
Inflicted
Suspected
Arson

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=54,779 (Excluding 4,320 Unknown/Missing)

ANALYSIS
BY AGE
GROUP

Figure

76

PLACE OF OCCURRENCE E849 CODE

Categories of
Place of
Occurrence

ANALYSIS
BY AGE
ETIOLOGY

Home
Industrial
Public Building
Other Specified
Place
Street/Highway
Residential
Institution
Recreation and
Sport
Farm
Mine/Quarry

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=54,353 (Excluding 4,746 Unknown/Missing)

84

Circumstance of Injury

125

Cases

Accident, Non-Work Related 43,502

% Valid
79.4%

Accident, Work Related

6,025

11.0%

Accident, Unspecified

1,759

3.2%

Suspected Child Abuse

1,301

2.4%

Other

927

1.7%

Suspected Assault/Abuse

814

1.5%

Accident, Recreation

385

0.7%

Suspected Self Inflicted

61

0.1%

Suspected Arson

0.0%

Unknown

4,320

Total

59,099

PLACE OF OCCURRENCE E849 CODE

Table

126

Place of Occurrence

Cases

% Valid

Home

45,545

83.8%

Industrial

3,286

6.0%

Public Building

1,989

3.7%

Other Specified Place

1,615

3.0%

Street/Highway

927

1.7%

Residential Institution

466

0.9%

Recreation and Sport

389

0.7%

Farm

105

0.2%

Mine/Quarry

31

0.1%

Unspecified

4,746

Total

59,099

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Table

CIRCUMSTANCE OF INJURY

75

CIRCUMSTANCE OF INJURY

Figure

Analysis
by Etiology

Scald Injuries

The overall complication rate of admitted scald burns (7.8%) is less than half of patients admitted with flame burns
(17%, Table 127 & 118). As with flame burns, the incidence of complications increases with age of the patient burned
(Figure 77). For patients admitted with scald burns under 30 years of age, the complication rate is approximately 5 to
6%. In patients with scald burns between 30 and 80 years of age, the incidence of complications is between 8 and 18%.
Patients with scalds over 80 %TBSA have a complication rate of 26% (Table 127).
Figure

% of Patients with a Clinically Related


Complication

77

PERCENT OF PATIENT WITH CLINICALLY RELEVANT COMPLICATIONS BY AGE GROUP


30%

20%

ANALYSIS OF
CONTRIBUTING
HOSPITALS

10%

ANALYSIS OF ALL
U.S. RECORDS

0-.9

1-1.9

2-4.9

5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories
Total N=56,956 (Excluding 2,143 cases from non ABA burn registry software centers or missing/unknown age)

Table

COMPLICATION RATE BY AGE GROUP

127

1
2
3
4
5
6

Age Category
0-.9
1-1.9
2-4.9
5-15.9
16-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80 and Over
Subtotal
Missing
Total

No Complication
# of Cases
4,466
8,552
6,211
5,697
2,149
6,699
5,252
5,377
4,105
2,111
1,089
801
52,509
0
52,509

Complication
# of Cases
325
436
366
228
128
462
459
592
574
368
235
274
4,447
0
4,447

Complication Rate
6.8
4.9
5.6
3.8
5.6
6.5
8.0
9.9
12.3
14.8
17.7
25.5
7.8
7.8

Total N=56,956 (Excluding 2,143 cases from non ABA burn registry software centers)

85

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ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

The top complications of scald burn admissions are also infections.The most common infection is cellulitis occurring at a
reported incidence of 2.6% and making up 18% of all scald complications.The next most common infection is urinary tract
infections occurring at a rate of 1.6%. Septicemia is a rare complication, occurring at a rate of 0.4%.
The most common surgical procedure performed on patients with scald injuries is still excision and skin grafting reported
in 20% and 14% of cases, respectively.This number is similar to the incidence of excision and grafting for flame burns
(18%, 13%,Table 120).This is not surprising, since these are scalds requiring admission to a burn center. Non-excisional
debridement of burn injuries and application of dressings is the third most common procedure performed on these patients,
reported approximately 12% of the time.The use of homograft in scald burns is reported at a rate of 6% (Table 129), which
is similar to the utilization in flame burn patients (6.5%,Table 120).The use of heterografts is reported in 4.7% of procedures
and dermal regenerative templates are reported in 2.9% of procedures on scald burn patients.This is higher than that of flame
burn patients (3.6% heterografts; 2.3% dermal templates,Table 120). Also, the use of skin grafts to the hand also is reported at
a rate of approximately 2.2%, which is similar to flame burn patients with a procedural rate of 2.3% (Table 120).
Table

128

TOP TEN COMPLICATIONS

1
2
3
4
5
6

Scald Injuries

Top Ten Complications

Count

Percent of All
Complications

Percent of Patients with


Complication

Cellulitis

1500

17.8

2.6

Urinary Tract Infection

927

11.0

1.6

Pneumonia

552

6.6

1.0

Wound Infection

523

6.2

0.9

Respiratory Failure

322

3.8

0.6

Septicemia

240

2.9

0.4

Arrythmia

224

2.7

0.4

Other Blood/Systemic Infection

217

2.6

0.4

Renal Failure

211

2.5

0.4

Bacteremia

191

2.3

0.3

Total Complications

8,413

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Total N=56,956 (Excluding 2,143 cases from non ABA burn registry software centers)

Table

TOP TEN PROCEDURES

129

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Top Ten Procedure Codes

Count

Percent of All
Procedures

86.22 Excisional debridement of wound, infection, or burn

25,441

19.4

86.69 Other skin graft to other sites

17,274

13.2

86.28 Nonexcisional debridement of wound, infection or burn

15,641

11.9

93.57 Application of other wound dressing

13,746

10.5

86.66 Homograft to skin

8,309

6.3

86.65 Heterograft to skin

6,115

4.7

86.67 Dermal regenerative graft

3,805

2.9

38.93 Venous catheterization, not elsewhere classified

3,784

2.9

86.62 Other skin graft to hand

2,846

2.2

86.6 Free skin graft

2,057

1.6

Total Procedures

131,109
Total N=59,099

86

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Analysis
by Etiology

Scald Injuries

The overall mortality of scald burn patients admitted to participating burn centers is 0.7%. This is significantly less
with flame burns with (31%) and without (3%) smoke inhalation injury (Table 121 & 122). As with flame burns, hospital
length of stay also increases with burn size. In patients that survive their injury, the rule of thumb of hospital stay equal
to the %TBSA burned does not apply for burn sizes > 10 %TBSA. For patients with scalds covering between 10 to 30
%TBSA, the length of stay is 0.6 days per %TBSA. For patients with scalds between 30 and 70 %TBSA, the length of
stay is approximately 0.8-0.9 days per %TBSA. There are too few patients with burn sizes greater than 70 %TBSA to
draw any conclusions about the relationship between burn size and LOS.
Non-survivors of scald injuries involving < 10 %TBSA have a length of stay of one month. The non-survivors of
scald injuries between 10 and 30 %TBSA survive approximately 3 weeks prior to succumbing to their injury. The length
of stay for non-survivors of scald burns from 30 to 60% TBSA ranges from one to two weeks. Interestingly, the length of
hospital stay for non-survivors of scald burns from 30 to 60 %TBSA is shorter than than the same size burn in patients
with flame burns.

Table

HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP (%TBSA)

130

Total

Lived

ANALYSIS OF
CONTRIBUTING
HOSPITALS

Died

% TBSA

Cases

Mean +/- SEM

Cases

Mean +/- SEM

Cases

Mean +/- SEM

0.1 - 9.9

44,275

4.9+/-0.0

44,193

4.9+/-0.0

82

28.9+/-4.4

10 - 19.9

7,882

9.8+/-0.1

7,793

9.6+/-0.1

89

21.2+/-2.2

20 - 29.9

1,579

17.2+/-0.3

1,527

17.1+/-0.3

52

21.2+/-3.3

30 - 39.9

502

28.6+/-1.0

458

30.0+/-1.1

44

14.1+/-2.9

40 - 49.9

180

32.3+/-2.0

147

35.7+/-2.2

33

17.1+/-3.2

50 - 59.9

76

35.3+/-3.2

59

40.0+/-3.7

17

19+/-5.4

60 - 69.9

52

50.6+/-7.1

42

58+/-8.1

10

19.9+/-10.1

70 - 79.9

26

48.4+/-12.2

17

66.3+/-16.8

14.5+/-7.4

80 - 89.9

31

15.2+/-6.3

22

9.3+/-3.1

29.7+/-20.3

> 90

20

12.1+/-5.6

13

17.5+/-8.4

2+/-0.5

Subtotal

54,623

6.4+/-0.0

54,271

6.3+/-0.0

352

21.3+/-1.5

Missing or 0%

4,476

4.5+/-0.1

4,452

4.4+/-0.1

24

16.1+/-4.0

TOTAL

59,099

58,723

1
2
3
4
5
6

376

Total N=59,099

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

87

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Analysis
by Etiology

Scald Injuries

In Figure 78, as with flame burns admissions, a higher BAUX score is associated with a higher mortality. Again, there
appears to be a higher mortality in women with BAUX scores > 100 that were admitted with scalds.
Scald injuries are much less lethal than flame burns. The overall mortality is 0.7%. When stratified by gender, again,
there is a survival advantage of men over women. The mortality for woman admitted with scald burns is 0.73% whereas
the observed mortality in men admitted with scalds is 0.56%. In scald injuries, a BAUX score of 100 to 110 is associated
with a similar mortality rate in both men and women (31.3% men vs. 33% women).
Interestingly, the gender ratio of scald burn admissions is different than flame burn admissions. The percentage of men
admitted with scald burns is 59%, while the percentage of women is 41%. This ratio is nearly one to one, where as it is
approximately three to one (male to female) for flame burns.

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

78

Male

MORTALITY RATE FOR BAUX SCORE CATEGORIES BY GENDER


80%

% of Patients that Died

1
2
3
4
5
6

Female

Figure

60%

40%

20%

0-9.9

1019.9-

20.29.9

3039.9

4049.9

5059.9

6069.9

7079.9

8089.9

9099.9

100109.9

BAUX Score (Age + TBSA)


Total N=57,326 (Excluding 1,773 Unknown/Missing)

ANALYSIS
BY AGE
GROUP

Table

131

NUMBER OF CASES IN BAUX SCORE CATEGORIES BY GENDER

ANALYSIS
BY AGE
ETIOLOGY

Female

Male

BAUX Score (Age + TBSA)

Lived

Died

Lived

Died

0-9.9
10-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80-89.9
90-99.9
100-109.9
110- and Over
Total

6,839
4,358
2,880
2,449
2,366
2,083
1,456
937
627
323
69
12
24,399

1
2
2
6
11
4
16
10
9
44
34
41
180

8,964
4,982
4,438
3,790
3,524
3,197
1,921
989
485
197
46
29
32,562

2
4
3
2
9
11
20
27
25
25
21
36
185

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=57,326 (Excluding 1,773 Unknown/Missing)

88

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110+

Analysis
by Etiology

Contact with Hot Object Injuries

Contact burns from touching a hot object are extremely common, but only make up 9% of all the data in the registry for this
decade of reporting burn centers.Again, this injury is typically managed as an outpatient, so the reader is reminded to keep that fact
in mind when interpreting the demographics of this patient population. Contact burns, as with flame and scald burns, are frequently
non-work related accidents (79%).The next most common circumstances of contact burns are work related accidents and accidents
involving recreational activities, each approximately 7% (Figure 79,Table 132).The majority of these injuries occur at home (75%,
Figure 80,Table 133) with the second most common frequency associated with sports and recreation (8%). Contact burns can be
commonly associated with motor vehicle and motor cycle accidents (6%) or occur in the workplace (4.6%).

Categories of
Circumstance
of Injury
Accident, NonWork Related
Accident,
Recreation
Accident, Work
Related
Other
Accident,
Unspecified
Suspected Child
Abuse
Suspected
Assault/Abuse
Suspected Self
Inflicted

Circumstance of Injury

80

Cases

Accident, Non-Work Related 11,401

Total N=14,446 (Excluding 1,177 Unknown/Missing)

Figure

Table

132

CIRCUMSTANCE OF INJURY

79

CIRCUMSTANCE OF INJURY

PLACE OF OCCURRENCE E849 CODE

Home
Recreation and
Sport
Street/Highway
Industrial
Other Specified
Place
Public Building
Residential
Institution
Farm
Mine/Quarry

Total N=14,107 (Excluding 1,516 Unknown/Missing)

89

78.9%

Accident, Recreation

1,012

7.0%

Accident, Work Related

976

6.8%

Other

354

2.5%

Accident, Unspecified

326

2.3%

Suspected Child Abuse

202

1.4%

Suspected Assault/Abuse

113

0.8%

Suspected Self Inflicted

62

0.4%

Unknown

1,177

Total

15,623

PLACE OF OCCURRENCE E849 CODE

Categories of
Place of
Occurrence

% Valid

Table

133

Figure

Place of Occurrence

Cases

% Valid

Home

10,521

74.6%

Recreation and Sport

1,118

7.9%

Street/Highway

819

5.8%

Industrial

650

4.6%

Other Specified Place

572

4.1%

Public Building

283

2.0%

Residential Institution

79

0.6%

Farm

57

0.4%

Mine/Quarry

0.1%

Unspecified

1,516

Total

15,623

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1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

Contact with Hot Object Injuries

As with both flame and scald injuries, the risk of complications increase as the patient gets older. The overall incidence
of complications in contact burn admissions is 7.4%. This is similar to the rate observed in scald burns (7.8%, Table
127). The incidence of complications is 3 to 4% in patients under the age of 16. From age 16 to 40, the incidence of
complications increases to 6 to 10%. The complication rate continues to increase exponentially from a rate of 12.7%
for contact burns in the 40 to 49 year old group up to a rate of 23% in patients over 80 years of age (Table 134). This
progression is very similar to that observed in patients with scald burns (Table 127).

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

81

PERCENT OF PATIENT WITH CLINICALLY RELEVANT COMPLICATIONS BY AGE GROUP

{
% of Patients with a Clinically Related
Complication

1
2
3
4
5
6

Figure

30%

20%

10%

0-.9

1-1.9

2-4.9

5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories

ANALYSIS
BY AGE
GROUP

Total N=14,848 (Excluding 775 cases from non ABA burn registry software centers or missing/unknown age)

Table

COMPLICATION RATE BY AGE GROUP

134

ANALYSIS
BY AGE
ETIOLOGY

Age Category
0-.9
1-1.9
2-4.9
5-15.9
16-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80 and Over
Subtotal
Missing
Total

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

No Complication
# of Cases
1,753
2,799
1,807
1,355
469
1,188
1,037
1,187
1,037
558
297
264
13,751
0
13,751

Complication
# of Cases
60
73
62
48
30
109
109
173
165
106
84
78
1,097
0
1,097

Complication Rate
3.3
2.5
3.3
3.4
6.0
8.4
9.5
12.7
13.7
16.0
22.0
22.8
7.4
7.4

Total N=14,848 (Excluding 775 cases from non ABA burn registry software centers)

90

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Analysis
by Etiology

Contact with Hot Object Injuries

The complications reported with contact burns are very similar to those of scald burns. The most frequent complication
is cellulitis with a reported incidence of 2.5% of admitted contact burns and represents 17.3% of all complications. The
next most common infection is a urinary tract infection with a reported incidence of 1.3% of contact burn patients. As
with scalds, sepsis is a rare complication occurring 0.4% of the time.
The most commonly reported procedure for contact burns, as with both flame burns and scalds, is excision and grafting
(20%, 13% respectively). Again, as in the previous two sections, homograft has a reported use of 6%, heterograft use of
2.5% and dermal templates have a procedural incidence of 3%. Skin grafts to the hand are, expectedly, more common
occurring at a rate of 2.3%. Of note, full thickness skin grafts make up approximately one-third of hand grafts reported.
Table

TOP TEN COMPLICATIONS

135

Top Ten Complications

Count

Percent of All
Complications

Percent of Patients
with Complication

Cellulitis

368

17.3

2.5

Urinary Tract Infection

197

9.2

1.3

Wound Infection

134

6.3

0.9

Pneumonia

118

5.5

0.8

Respiratory Failure

84

3.9

0.6

Skin Graft Loss, Other

69

3.2

0.5

Other Blood/Systemic Infection

68

3.2

0.5

Renal Failure

60

2.8

0.4

Septicemia

56

2.6

0.4

Surgical Site Infection, Deep

50

2.3

0.3

Total Complications

2,131

TOP TEN PROCEDURES

136

Top Ten Procedure Codes

Count

Percent of All
Procedures

86.22 Excisional debridement of wound, infection, or burn

7,514

20.2

86.69 Other skin graft to other sites

4,878

13.1

93.57 Application of other wound dressing

3,874

10.4

86.28 Nonexcisional debridement of wound, infection or burn

3,505

9.4

86.66 Homograft to skin

2,368

6.4

86.67 Dermal regenerative graft

1,034

2.8

86.65 Heterograft to skin

942

2.5

86.62 Other skin graft to hand

849

2.3

38.93 Venous catheterization, not elsewhere classified

833

2.2

86.6 Free skin graft

532

1.4

Total Procedures

37,250
Total N=15,623

91

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ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Total N=14,848 (Excluding 775 cases from non ABA burn registry software centers)

Table

1
2
3
4
5
6
ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

Although there are many similarities in the demographics of scald and contact burns, contact burns are significantly
smaller in size. The most frequent size reported is < 10%, compromising 96% of all contact burns. This is also the most
common size category of scald burns, but only 80% of the reported scald burns fall into the 0 to 10 %TBSA category. As
with scalds, the mortality rate of contact burns is extremely small, reported at 0.7%.
The estimated length of stay of contact burn survivors based on burn size approximates one day for each %TBSA burned
for burn sizes up to 30%. There are too few numbers to draw meaningful conclusions for contact burns greater than 30
%TBSA. Non-survivors with contact burns measuring < 10% spend approximately three weeks in the hospital. This is one
week shorter than the scald burn non-survivors and one week longer than the flame injury non-survivors. This difference
in length of stay for non survivors of flame, scald and contact burns with burn sizes less than 10 %TBSA merits further
investigation. Non-survivors of contact burns with a 10 to 40 %TBSA involvement survive an average of one to two weeks.
This is less than either flame or scald burn non-survivors.
Table

137

HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP (%TBSA)

1
2
3
4
5
6

Contact with Hot Object Injuries

Total

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Lived

Died

% TBSA

Cases

Mean +/- SEM

Cases

Mean +/- SEM

Cases

Mean +/- SEM

0.1 - 9.9

13,736

5.6+/-0.1

13,669

5.5+/-0.1

67

23.1+/-3.4

10 - 19.9

460

18.7+/-0.8

439

18.9+/-0.9

21

15.5+/-4.3

20 - 29.9

56

23.5+/-3.1

49

26.1+/-3.4

5+/-1.8

30 - 39.9

21

29+/-6.2

13

39+/-8.5

12.7+/-5.3

40 - 49.9

26.3+/-12.8

35.5+/-15.5

50 - 59.9

93+/-17

93+/-17

60 - 69.9

70 - 79.9

67+/-4

67+/-4

80 - 89.9

1.5+/-0.5

1.5+/-0.5

> 90

Subtotal

14,283

6.1+/-0.1

14,179

6.0+/-0.1

104

19.4+/-2.5

Missing or 0%

1,340

4.9+/-0.2

1,334

4.9+/-0.2

12.8+/-5.2

TOTAL

15,623

15,513

110

Total N=15,623

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

92

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Analysis
by Etiology

Electrical Injuries

Although one of the most devastating and debilitating injuries cared for in burn centers, electrical injuries only
compromise 4% of all the reported etiologies in this years review. Also, the reader is reminded that all types of electrical
injuries are pooled into this analysis making broad interpretation of these findings difficult. The low voltage contact
burn will obviously behave much differently than an electrical flash or electrical conduction burn. The majority of these
burns occur in industry (39.5%) with the second most common place of occurrence being the home (30.2%). Similar to
chemical burns, the majority of these injuries were reported under work-related circumstances (61%), with only 33%
of these accidents occurring in a non-work related scenario.

Accident, Work
Related
Accident, NonWork Related
Accident,
Unspecified
Accident,
Recreation
Other
Suspected Self
Inflicted
Suspected
Assault/Abuse
Suspected Child
Abuse

Total N=5,955 (Excluding 591 Unknown/Missing)

83

138

{
Circumstance of Injury

Categories of
Circumstance
of Injury

Figure

Table

CIRCUMSTANCE OF INJURY

82

CIRCUMSTANCE OF INJURY

PLACE OF OCCURRENCE E849 CODE

Cases % Valid

Accident, Work Related

3,638

61.1%

Accident, Non-Work Related

1,960

32.9%

Accident, Unspecified

163

2.7%

Accident, Recreation

106

1.8%

Other

66

1.1%

Suspected Self Inflicted

18

0.3%

Suspected Assault/Abuse

0.1%

Suspected Child Abuse

0.0%

Unknown

591

Total

6,546

PLACE OF OCCURRENCE E849 CODE

Categories of
Place of
Occurrence
Industrial
Home
Other Specified
Place
Street/Highway
Public Building
Recreation and
Sport
Farm
Residential
Institution
Mine/Quarry

Total N=5,474 (Excluding 1,072 Unknown/Missing)

93

Table

139

Figure

Place of Occurrence

Cases

% Valid

Industrial

2,160

39.5%

Home

1,652

30.2%

Other Specified Place

670

12.2%

Street/Highway

348

6.4%

Public Building

313

5.7%

Recreation and Sport

176

3.2%

Farm

81

1.5%

Residential Institution

53

1.0%

Mine/Quarry

21

0.4%

Unspecified

1,072

Total

6,546

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1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

Electrical Injuries

Unlike flame, scald, and contact burns (Figures 73, 77 & 81), there is no correlation between age and risk of
complication (Figure 84). The overall complication rate (10.6%) is higher in electrical burns than either scalds (7.8%,
Table 127) and contact burns (7.4%, Table 134), but less than flame burns (17%, Table 118). The complication rate in
patients over the age of 60 is approximately 12%. The lowest rates of complications are in 1 to two year olds (2%) and
2 to 5 year olds (1.9%). It is possible that the complications are lower in these children since they most likely represent
electrical contact burns and not electrical conduction burns. The electrical burn admissions in the 16 to 60 year old
group are more likely to have electrical conduction injuries since this age compromises the demographic of the work
force. Still, there is likely a great deal of variability in this population because electrical shocks, electrical contacts, and
electrical conduction injuries are all pooled in this section.

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

84

PERCENT OF PATIENT WITH CLINICALLY RELEVANT COMPLICATIONS BY AGE GROUP

{
% of Patients with a Clinically
Related Complication

1
2
3
4
5
6

Figure

15%

10%

0-.9

1-1.9

2-4.9

5-15.9

16-19.9

20-29.9

30-39.9

40-49.9

50-59.9

60+

Age Categories

ANALYSIS
BY AGE
GROUP

Total N=6,220 (Excluding 326 cases from non ABA burn registry software centers or missing/unknown age)

Table

140

COMPLICATION RATE BY AGE GROUP

ANALYSIS
BY AGE
ETIOLOGY

5%

Age Category
0-.9
1-1.9
2-4.9
5-15.9
16-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60 and Over
Subtotal
Missing
Total

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

No Complication
# of Cases
40
100
265
380
195
1,108
1,200
1,243
768
262
5,561
0
5,561

Complication
# of Cases
4
2
5
37
24
169
164
141
77
36
659
0
659

Complication Rate
9.1
2.0
1.9
8.9
11.0
13.2
12.0
10.2
9.1
12.1
10.6
10.6

Total N=6,220 (Excluding 326 cases from non ABA burn registry software centers)

94

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Analysis
by Etiology

Electrical Injuries

The most common complication reported in patients with electrical injuries is pneumonia (2.5%). This is followed
by cellulitis (1.8%) and wound infection (1.7%). Septicemia is less common in this burn etiology subset (1.5%) than in
flame burns (2.7%, Table 119), but more common than scald burns, and contact burns ( both 0.4%, Table 128 and 135).
Renal failure remains an infrequent complication in electrical burns (0.9%) but again, this may be due to the fact that
minor electrical injuries are included in this analysis.
As with all other burn etiologies, excisional debridement and skin grafting remain the most commonly performed
surgical procedure after electrical burn, encompassing 17% and 10% of all procedures, respectively. The use of homograft
is also similar to other burn types and is reported in 6.0% of procedures. The reported operative use of heterografts is
2.6% and dermal templates is 1.9%. Skin grafts to the hand represent 2.2% of procedures.
Table
TOP TEN COMPLICATIONS

141

Top Ten Complications

Count

Pneumonia
Cellulitis
Wound Infection
Septicemia
Respiratory Failure
Urinary Tract Infection
Renal Failure
Arrythmia
Catheter-Related Bloodstream Infection
ARDS
Total Complications

157
111
103
91
77
66
54
52
34
33
1,498

Percent of All
Complications

Percent of Patients with


Complication

10.5
7.4
6.9
6.1
5.1
4.4
3.6
3.5
2.3
2.2

2.5
1.8
1.7
1.5
1.2
1.1
0.9
0.8
0.5
0.5

Total N=6,220 (Excluding 326 cases from non ABA burn registry software centers)

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

Table

TOP TEN PROCEDURES

142

Top Ten Procedure Codes

Count

86.22 Excisional debridement of wound, infection, or burn

4,107

Percent of All
Procedures
16.7

86.69 Other skin graft to other sites

2,382

9.7

86.66 Homograft to skin

1,471

6.0

86.28 Nonexcisional debridement of wound, infection or burn

1,324

5.4

93.57 Application of other wound dressing

1,158

4.7

38.93 Venous catheterization, not elsewhere classified

849

3.5

86.65 Heterograft to skin

629

2.6

86.62 Other skin graft to hand

551

2.2

86.67 Dermal regenerative graft

473

1.9

99.04 - Transfusion of packed cells

402

1.6

Total Procedures

24,594
Total N=6,546

95

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ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

Electrical Injuries

Figure 85 is a graphical representation of the distribution of gender for each age category from electrical injuries
in this data set. It is clear that this injury is seen nearly exclusively in men in all age groups. The most common age
represented is from the ages 20 and 60. Again, this represents the work force demographic that will likely sustain and
electrical injury.

ANALYSIS OF
CONTRIBUTING
HOSPITALS

85

Male

1,250
1,000
750

Cases

ANALYSIS OF ALL
U.S. RECORDS

Female

Figure

1
2
3
4
5
6

FREQUENCY OF RECORDS BY AGE CATEGORIES AND GENDER

500
250

ANALYSIS
BY AGE
GROUP

0-.9

1-1.9

2-4.9

5-15.9

16-19.9

20-29.9

30-39.9

40-49.9

50-59.9

60-69.9

Age Categories
Total N=6,546

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

96

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70-79.9

80+

Analysis
by Etiology

Chemical Injuries

The chemical burn etiology section has only been included in the National Burn Repository Annual Report for a few
years.The demographics of these patients mirror those of electrical burns. This category also consists of pooled data of
varying types of chemical agents.The caustic injuries of acids are combined with the liquefaction destruction of alkali burns
as well as other different types of chemical irritants. Again the reader is reminded of this fact when reviewing this data.This
important injury represents 3.6% of the data set. Chemical injuries tend to most commonly occur at home (41.2%), while
37.3% of them are industrial. Injuries from chemical burns are work related accidents in 47.4% of reported instances and
non-work related in 43.4% of the data population.

Accident, Work
Related
Accident, NonWork Related
Suspected
Assault/Abuse
Accident,
Unspecified
Suspected Self
Inflicted
Other
Suspected Child
Abuse
Accident,
Recreation
Suspected
Arson

Total N=5,304 (Excluding 535 Unknown/Missing)

87

143

{
Circumstance of Injury

Categories of
Circumstance
of Injury

Figure

Table

CIRCUMSTANCE OF INJURY

86

CIRCUMSTANCE OF INJURY

PLACE OF OCCURRENCE E849 CODE

Cases % Valid

Accident, Work Related

2,516

47.4%

Accident, Non-Work Related

2,303

43.4%

Suspected Assault/Abuse

143

2.7%

Accident, Unspecified

92

1.7%

Suspected Self Inflicted

91

1.7%

Other

66

1.2%

Suspected Child Abuse

50

0.9%

Accident, Recreation

41

0.8%

Suspected Arson

0.0%

Unknown

535

Total

5,839

PLACE OF OCCURRENCE E849 CODE

Categories of
Place of
Occurrence
Home
Industrial
Other Specified
Place
Public Building
Street/Highway
Farm
Recreation and
Sport
Residential
Institution
Mine/Quarry

Total N=4,919 (Excluding 920 Unknown/Missing)

97

Table

144

Figure

Place of Occurrence

Cases

% Valid

Home

2,026

41.2%

Industrial

1,834

37.3%

Other Specified Place

347

7.1%

Public Building

261

5.3%

Street/Highway

198

4.0%

Farm

82

1.7%

Recreation and Sport

77

1.6%

Residential Institution

70

1.4%

Mine/Quarry

24

0.5%

Unspecified

920

Total

5,839

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1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

Chemical Injuries

As depicted in Figure 88, there is a predictable increase in the rate of reported complications in chemical burns with
increasing age. The complication rate in patients under the age of 20 ranges from 2.4-6.4%; between the age of 20 and
60, the range increases to 6.6-9.3%. Above the age of 60, the complication rate reported is 11.8 to 19.7%. Even though
the chemical burn category pools different types of chemical injuries, the population is likely more homogeneous
than the electrical burn category. A possible explanation is that the anatomic distribution, burn depth and medical care
required for different chemical injuries is relatively consistent when compared to the vast array of potential electrical
injury manifestations.
Figure

ANALYSIS OF
CONTRIBUTING
HOSPITALS

PERCENT OF PATIENT WITH CLINICALLY RELEVANT COMPLICATIONS BY AGE GROUP

20%

% of Patients with a Clinically


Related Complication

1
2
3
4
5
6

88

15%

10%

5%

ANALYSIS OF ALL
U.S. RECORDS

1-1.9

2-4.9

5-15.9 16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories
Total N=5,538 (Excluding 301 cases from non ABA burn registry software centers or missing/unknown age)

Table

145

COMPLICATION RATE BY AGE GROUP

ANALYSIS
BY AGE
GROUP

0-.9

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

No Complication

Complication

Age Category

# of Cases

# of Cases

Complication Rate

0-.9

74

5.1

1-1.9

160

2.4

2-4.9

129

5.1

5-15.9

191

13

6.4

16-19.9

231

14

5.7

20-29.9

930

66

6.6

30-39.9

1,091

86

7.3

40-49.9

1,125

94

7.7

50-59.9

758

78

9.3

60-69.9

283

38

11.8

70-79.9

86

15

14.9

80 and over

49

12

19.7

Subtotal

5,107

431

7.8

Missing

Total

5,107

431

Total N=5,538 (Excluding 301 cases from non ABA burn registry software centers)

98

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7.8

Analysis
by Etiology

Chemical Injuries

Cellulitis is the most common complication reported after a chemical burn, reported after 2.3% of injuries. This
rate of cellulitis is similar to those injuries seen with scalds (2.6%, Table 128). Pneumonia and wound infection are
the next two most common infectious complications, each occurring a rate of 1.1%. This rate has decreased for both
complications over the past several years. Sepsis is rare with after chemical burn, being reported at a rate of 0.8%.

Table

TOP TEN COMPLICATIONS

146

Top Ten Complications

Count

Cellulitis
Pneumonia
Wound Infection
Urinary Tract Infection
Respiratory Failure
Septicemia
Renal Failure
Arrythmia
Other Blood/Systemic Infection
Other Hematologic
Total Complications

125
60
59
57
51
43
25
22
22
22
820

Percent of All
Complications

Percent of Patients with


Complication

15.2
7.3
7.2
7.0
6.2
5.2
3.0
2.7
2.7
2.7

2.3
1.1
1.1
1.0
0.9
0.8
0.5
0.4
0.4
0.4

ANALYSIS
BY AGE
GROUP

TOP TEN PROCEDURES

147

Top Ten Procedure Codes

Count

Percent of All
Procedures

86.22 Excisional debridement of wound, infection, or burn

2,445

21.5

86.69 Other skin graft to other sites

1,772

15.6

86.28 Nonexcisional debridement of wound, infection or burn

1,072

9.4

93.57 Application of other wound dressing

952

8.4

86.66 Homograft to skin

791

7.0

86.65 Heterograft to skin

460

4.0

38.93 Venous catheterization, not elsewhere classified

428

3.8

86.67 Dermal regenerative graft

314

2.8

99.04 Transfusion of packed cells

197

1.7

33.22 fiberoptic bronchoscopy

194

1.7

Total Procedures

11,375
Total N=5,839

99

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ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=5,538 (Excluding 301 cases from non ABA burn registry software centers)

Table

1
2
3
4
5
6
ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
by Etiology

Chemical Injuries

In this gender stratified histogram, depicted in Figure 89, chemical burns occur predominantly in men. The peak
frequency is between the ages of 20 and 60. This also parallels what is observed in patients with electrical burns. It is also
the age demographic of the work force population. In children under the age of 16 and adults greater than 70, the male
to female ratio of chemical injuries is closer to 1:1.

ANALYSIS OF
CONTRIBUTING
HOSPITALS

89

Female
Male

1,000

800

600

Cases

1
2
3
4
5
6

Figure

FREQUENCY OF RECORDS BY AGE CATEGORIES AND GENDER

400

200

ANALYSIS OF ALL
U.S. RECORDS

0-.9

1-1.9

2-4.9

5-15.9

16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

Age Categories
Total N=5,839

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

100

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80+

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

THIS PAGE INTENTIONALLY LEFT BLANK

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

101

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Hospital
Comparisons

The analyses on the next three pages provide


comparisons for treatment of fire/flame injuries
in participating burn centers.The figures compare
unadjusted mortality, charges and length of stay across
participating centers.
The centers are grouped into three categories based
on the annual volume of submitted cases in 2010-2013.
Low volume centers reported an average of less than
100 initial admissions per year (n=15); medium volume
centers reported an average of 100-300 initial admissions
per year (n=50) and high volume centers reported
greater than 300 initial admissions per year (n=23).
Ninety-three hospitals are represented in total. All data
are de-identified to protect against direct comparison
between centers.The data are unadjusted, and thus, do
not take into consideration other patient characteristics
that have been widely accepted to impact outcomes.
Without risk adjustment, comparative analysis may have
limited value.
The nature of the registry is such that data is

not strictly standardized and the data entry is not


independently audited.This also limits the comparative
value of the data. However, this data suggests that
significant variability in practice, mortality and cost
of care may exist and should provide impetus to
investigators to explore the causes of such variability.
Much work remains to bring the collection of data
into a context where risk adjustment is possible and
definitions are standardized, to allow reliable comparisons
as well as benchmarking of the performance of
individual centers.These analyses are a beginning, and
they point the way to the delivery of more precise and
actionable information in the future.

Hospital
Comparisons
Figure 90 compares the raw mortality rates for fire/flame cases admitted from 2010-2013. Each blue bar
represents the mean percent TBSA for fire/flame burns from one burn center. The left y-axis depicts the percent
TBSA. The right y-axis provides depicts the percent mortality scale. The red dots represent the mortality rate for
each burn center. The red lines represent the 95% confidence interval for the mortality rate. Although the data is
not risk-adjusted, it suggests that while mean percent TBSA does not significantly differ between the thee groups
of hospitals (low, medium and high volume hospitals) a significant difference in mortality rates does exist. The
data suggests an inverse relationship, lower mortality rates are seen in hospitals with higher volume of admissions.
In addition, higher volume hospitals have less variability in mortality rates when compared to medium and low
volume hospitals.

0%

5%

10%

15%

20%

25%

30%

90

Figure

ANALYSIS
BY AGE
ETIOLOGY

10

20

30

40

50

60

70

80

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

90

100

LOW VOLUME

HOSPITAL
COMPARISONS

Mean Percent Total Burn Surface Area

104

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Total N=31,257

Facilities

ANALYSIS
BY AGE
GROUP

ANALYSIS OF ALL
U.S. RECORDS

MEDIUM VOLUME

2010-2013 FIRE/FLAME INJURIES -- MORTALITY RATE

ANALYSIS OF
CONTRIBUTING
HOSPITALS

HIGH VOLUME

Mean TBSA

Mortality Rate

1
2
3
4
5
6

Mortality Percentage with 95% Cl

Hospital
Comparisons
Figure 91 depicts hospital charges for fire/flame cases admitted from 2010-2013. Since some centers do not
report charge information a smaller size is present (i.e., fewer blue bars) . The left y-axis depicts the mean percent
TBSA scale. The right y-axis depicts total charges. Red dots represent the mean total charges per case. The red
lines depict the 95% confidence interval for mean charges. Outliers are not shown in this graph, but were used in
the calculation of estimated means for each center. Charges are not adjusted for mean burn size. The data suggests
that significant differences in charges may exist between hospital group (low, medium and high volume hospital);
and charges may be independent of mean percent TBSA.

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

Total N=13,571

MEDIUM VOLUME

Facilities

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

91

Figure

2010-2013 FIRE/FLAME INJURIES -- MEAN CHARGES

HIGH VOLUME

Mean TBSA

Mean Charges

Mean Hospital Charges with 95% Cl

10

20

30

40

50

60

70

80

90

100

LOW VOLUME

HOSPITAL
COMPARISONS

Mean Percent Total Burn Surface Area

105

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Hospital
Comparisons
Figure 92 depicts mean (hospital) length of stay (LOS) for fire/flame cases admitted between 2010-2013. The left
y-axis depicts mean percent TBSA. The right y-axis depicts LOS. Red dots represent mean LOS for each facility. Red
bars represent the 95% confidence interval for each mean LOS.
LOS varies significantly more amongst low volume burn centers when compared to medium and high volume burn
centers. Outliers may have significant impact on estimated mean LOS. The effect of outliers may be more pronounced
in centers with lower reported admission volumes. Outliers are not shown in this graph.

10

15

20

25

30

10

20

30

40

50

60

70

80

90

100

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Mean Percent Total Burn Surface Area

106

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Total N=31,257

Facilities

92

LOW VOLUME

HOSPITAL
COMPARISONS

Figure

ANALYSIS
BY AGE
ETIOLOGY

35

40

ANALYSIS
BY AGE
GROUP

ANALYSIS OF ALL
U.S. RECORDS

MEDIUM VOLUME

2010-2013 FIRE/FLAME INJURIES -- MEAN LENGTH OF STAY

ANALYSIS OF
CONTRIBUTING
HOSPITALS

HIGH VOLUME

Mean TBSA

Mean LOS

1
2
3
4
5
6

Mean Length of Stay with 95% Cl

Hospital
Comparisons

0%

10%

20%

30%

40%

50%

60%

1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

Total N=71,423

Facilities

MEDIUM VOLUME

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

93

Figure

HIGH VOLUME

Mean TBSA

Percent of Cases with a Complication

2010-2013 FIRE\FLAME INJURIES COMPLICATION RATE

Complication Rate

Figure 93 depicts complication rates for fire/flame cases submitted between 2010-2013. The left y-axis depicts
mean percent TBSA. The right y-axis depicts the complication rate. Red dots represent the complication rate
for each center. Red bars represent the 95% confidence interval for complication rates. Since the reporting
of complications is unaudited it may be the least valid and reliable reported data. Standard definitions of
complication and rigorous application of those definitions are warranted to ensure comparable data and broad
comparisons. In spite of these limitations, there appears to be significant variability in reported complication rates
that is largely independent of both mean burn size and admission volume.

10

20

30

40

50

60

70

80

90

100

LOW VOLUME

HOSPITAL
COMPARISONS

Mean Percent Total Burn Surface Area

107

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ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of International Records

61

This years NBR report includes 2,569 International records which represents the cumulative admissions
between 2004 and 2013 that met all ABA edit check criteria. This number of records is compared to 191,848
records from the United States.
Four Canadian and two Swedish centers have submitted data to the NBR. These International centers are
typically smaller than U.S. centers and have an average volume of 120 admissions annually. Additionally, not all
international burn centers have submitted on a yearly basis.
ABA has members throughout the world and the NBR encourages all participating burn centers to submit
their data to the registry.

Analysis
of International Records
Figure 94 and Table 148 show the number of admissions by age and gender. The male/female distribution is fairly
even in those younger than five or older than 80 years of age, however males outnumber females in all other age
categories (73% of all records are male).

ANALYSIS OF
CONTRIBUTING
HOSPITALS

Male

300

200

100

0-.9

ANALYSIS OF ALL
U.S. RECORDS

1-1.9

2-4.9

5-15.9

16-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9 70-79.9

80+

Age Categories
Total N=2,569 (Excluding 0 Unknown/Missing)

Table

148

AGE GROUP BY GENDER

ANALYSIS
BY AGE
GROUP

94

Female

400

Cases

1
2
3
4
5
6

Figure

AGE GROUP BY GENDER

Age Categories
0-.9
1-1.9
2-4.9
5-15.9
16-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80 and over
Subtotal
Missing
Total

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Count
72
105
63
135
139
422
360
418
356
242
157
100
2,569
0
2,569

Total
Column N %
2.8
4.1
2.5
5.3
5.4
16.4
14.0
16.3
13.9
9.4
6.1
3.9
100.0
0.0
100.0

Gender
Female
Count
Column N %
Count
31
4.5
41
42
6.0
63
34
4.9
29
40
5.7
95
25
3.6
114
85
12.2
337
73
10.5
287
106
15.2
312
92
13.2
264
71
10.2
171
49
7.0
108
48
6.9
52
696
100.0
1,873
0
0.0
0
696
100.0
1,873

Total N=2,569

110

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Male
Column N %
2.2
3.4
1.5
5.1
6.1
18.0
15.3
16.7
14.1
9.1
5.8
2.8
100.0
0.0
100.0

Analysis
of International Records
Etiology is similar to the United States as shown in Figure 95 and Table 149. Fire/flame is the cause of over half of all
burns, and scalds account for an additional 25%.
Figure 96 and Table 150 depict the distribution of known cases in the NBR by race. White patients are the
predominate group, this is similar to the United States population. There are a higher percentage of Native American
admissions in the Canadian/International group than in United States (4.0% vs. 0.8%).

95

ETIOLOGY

ETIOLOGY
Categories of
Etiology
Fire/Flam e
Scald
Electrical
Contact with Hot
Object
Chemical
Other, Non Burn
Burn,
Unspecified
Inhalation Only
Skin Disease
Radiation

Cases

% Valid

Fire/Flame

1378

55.2%

Scald

631

25.3%

Electrical

146

5.8%

Contact with Hot Object

116

4.6%

Chemical

89

3.6%

Other, Non Burn

60

2.4%

Burn, Unspecified

42

1.7%

Inhalation Only

18

0.7%

Skin Disease

14

0.6%

Radiation

0.1%

Unknown

72

TOTAL

2,569

Table

150

RACE/ETHNICITY

96

149

Etiology

Total N=2,497 (Excluding 72 Unknown/Missing)

Figure

Table

Figure

RACE/ETHNICITY
Race
White
Other
Native American
Asian
Black
Hispanic

Race

Cases

% of Valid

White

1,947

82.6%

Other

149

6.3%

Native American

95

4.0%

Asian

85

3.6%

Black

59

2.5%

Hispanic

22

0.9%

Unknown

212

Total

2,569

Total N=2,357 (Excluding 212 Unknown/Missing)

111

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1
2
3
4
5
6
ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Analysis
of International Records
Figure 97 and Table 151 show the distribution of cases by the place of occurrence. The table shows that 6% of records
did not specify a place of occurrence. The figure is based on those records in which a place of occurrence was specified.
The vast majority of injuries occurred in the home.
Figure 98 and Table 152 depict the distribution of cases by the circumstances surrounding the injury. Seventy cases
did not denote injury circumstance and were excluded.

97

1
2
3
4
5
6

PLACE OF OCCURRENCE
- E849 CODE
Categories of
Injury Site
Home
Industrial
Recreation and
Sport
Street/Highway
Other Specified
Place
Public Building
Farm
Residential
Institution
Mine/Quarry

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

Total N=2,406 (Excluding 163 Unknown/Missing)

ANALYSIS
BY AGE
GROUP

PLACE OF OCCURRENCE
- E849 CODE

Cases

% of Valid

Home

1,322

54.9%

Industrial

381

15.8%

Recreation and Sport

340

14.1%

Street/Highway

129

5.4%

Other Specified Place

119

4.9%

Public Building

48

2.0%

Farm

40

1.7%

Residential Institution

25

1.0%

Mine/Quarry

0.1%

Unspecified

163

Total

2,569

CIRCUMSTANCE OF INJURY
Categories of
Circumstance
of Injury

ANALYSIS
BY AGE
ETIOLOGY

Accident, NonWork Related


Accident, Work
Related
Accident,
Recreation
Other
Suspected Self
Inflicted
Suspected
Assault/Abuse
Accident,
Unspecified
Suspected
Arson
Suspected Child
Abuse

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Circumstance of Injury

112

152

Cases % of Valid

Accident, Non-Work Related 1,150

46.0%

Accident, Work Related

503

20.1%

Accident, Recreation

484

19.4%

Other

190

7.6%

Suspected Self Inflicted

95

3.8%

Suspected Assault/Abuse

40

1.6%

Accident, Unspecified

16

0.6%

Suspected Arson

11

0.4%

Suspected Child Abuse

10

0.4%

Unknown

70

Total

2,569

Total N=2,499 (Excluding 70 Unknown/Missing)

American Burn Association, National Burn Repository 2014.Version 10.0. All Rights Reserved Worldwide.

Table

98

151

Place of Occurrence

CIRCUMSTANCE OF INJURY
Figure

Table

Figure

Analysis
of International Records
Mortality rate by %TBSA is detailed in Table 154, the overall mortality was 4.8%. The BAUX score (Age + %TBSA
burned) has been a standard to estimate the mortality of burn patients for decades. Table 153 demonstrate that increasing
BAUX score is associated with a higher mortality. The effect of gender is also depicted in this table.

MORTALITY RATE FOR


BAUX SCORE CATEGORIES
BY GENDER

Table

153

Female

Male

BAUX Score
(Age + TBSA)

Lived

Died

Mortality Rate

Lived

Died

Mortality
Rate

0-9.9
10-19.9
20-29.9
30-39.9
40-49.9
50-59.9
60-69.9
70-79.9
80-89.9
90-99.9
100-109.9
110 and Over
Total

66
58
68
65
77
85
68
67
41
26
13
10
644

0
0
0
0
0
1
1
4
6
5
11
12
40

0.0
0.0
0.0
0.0
0.0
1.2
1.4
5.6
12.8
16.1
45.8
54.5
5.8

79
108
222
253
252
260
205
161
114
61
26
22
1,763

0
0
1
0
0
4
4
4
7
8
11
44
83

0.0
0.0
0.4
0.0
0.0
1.5
1.9
2.4
5.8
11.6
29.7
66.7
4.5

Total N=2530 (Excluding 39 Unknown/Missing)

Table

154

ANALYSIS OF
CONTRIBUTING
HOSPITALS

ANALYSIS OF ALL
U.S. RECORDS

ANALYSIS
BY AGE
GROUP

LIVED/DIED BY BURN
GROUP SIZE (%TBSA)
Lived

Died

%TBSA

Cases

Cases

Mortality Rate

0.1 - 9.9

1,393

10

0.7

10 - 19.9

459

15

3.2

20 - 29.9

174

17

8.9

30 - 39.9

103

17

14.2

40 - 49.9

50

14

21.9

50 - 59.9

41

14.6

60 - 69.9

26

23.5

70 - 79.9

11

45.0

80 - 89.9

12

85.7

> 90

90.0

Subtotal

2,260

118

5.0

Missing or 0%

185

3.1

TOTAL

2,445

124

4.8

ANALYSIS
BY AGE
ETIOLOGY

HOSPITAL
COMPARISONS

ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N=2,569

113

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1
2
3
4
5
6

Appendix

Appendix A

Minimum Data Set and Data Quality

Improving the data quality in the NBR has been a focal point for the past few years. The launch of ABA
burn registry software Version 5.0 and the subsequent v5.11 upgrade has done a great deal toward standardizing
the data submitted to the NBR. Furthermore, a Minimum Data Standard has been established that should
improve the completeness of the records submitted. The Minimum Data Standard requires the records included
in the NBR, must have known values for the variables listed below.
Reporting hospital number
Number of operating room visits
Number of procedures performed
Patient sex (gender)
Cause of death
State in which injury occurred
Patient age (for patients younger than 90 years)
Year of injury
Year of arrival at reporting hospital
Description of event (free text)
Site at which injury occurred (E 849 code)
Etiology of injury code (E-code)
Body areas injured (Lund and Browder 19 areas x 6 age categories)
Total burn size
Total deep burn
Inhalation injury
ICD-9 diagnosis codes
Total hospital days
Hospital discharge disposition
Primary payor source
MS-DRG code
Circumstances of injury
Discharge status (alive or dead)
Year of discharge or death
Total ICU days
Interhospital transfer to your hospital
The italicized variables were not included in the analysis of missing variables on cases used in this Annual
Report on the subsequent pages. Age, gender, hospital disposition and reporting hospital number are required
fields for a case to be included in the Annual Report. The remaining italicized variables were excluded from
analysis because they are not uniformly reported by non ABA burn registry software centers.

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Appendix A
This table represents the common data elements missing from submitted burn center records. The most common
missing information, in over 50% of cases, is the state where the patient was injured. Registrars cannot assume that
the answer to this inquiry is obvious since many burn centers care for patients outside of their own state. This data is
potentially important if the NBR is going to be used as a reference to determine future funding from state Medicaid
plans. Also, data is frequently missing from the total percent of deep burs, ICU days and cause of death. If the goal is to
use the NBR as a foundation for burn quality indicators, this information is crucial to have reliable information. Finally,
description of the burn as well as circumstances and site of injury are important in devising prevention strategies.

DATA COMPLETENESS BY VARIABLE

Table

155

Valid

Missing

Pct. Missing

Last Report Pct. Missing

Description of Event

105,055

86,793

45.2

51.2

Cause of Death

4,197

2,177

34.2

35.7

State in Which Injury Occurred

127,476

64,372

33.6

40.7

Total Deep Burn

133,746

58,102

30.3

34.1

MS-DRG Code

138,682

53,166

27.7

28.6

Interhospital Transfer to Hospital

154,404

37,444

19.5

22.2

Total ICU Days

165,183

26,665

13.9

15.8

Site at Which Injury Occurred (E 849 code)

168,604

23,244

12.1

12.8

Circustances of Injury

174,406

17,442

9.1

10.6

Primary Payor Source

176,039

15,809

8.2

10.1

Inahaltion Injury

176,774

15,074

7.9

8.1

Total Burn Size

177,202

14,646

7.6

8.5

Year of Injury

184,159

7,689

4.0

3.5

Year of Discharge or Death

185,280

6,568

3.4

3.2

Discharge Status (Alive or Dead)

186,687

5,161

2.7

1.7

Etiology of injury Code (E-code)

188,107

3,741

1.9

2.1

Total Hospital Days

190,506

1,342

0.7

0.6

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Appendix A
This is a graphic representation of the improvement of submitted data by year. This last call for data had the lowest
percentage (<2%) of missing data per record compared to previous years. It is possible that the emphasis on having more
accurate patient care data in the United States has driven this improvement in data. It would be interesting to determine
whether there has been an increase in medical center providing financial support for burn registrars.

DATA QUALITY EXPRESSED AS MEAN PERCENT OF MISSING VARIABLES Figure


FROM MINIMUM DATA SET PER RECORD BY ADMISSION YEAR

99

25

Percent of Missing Variables

20

15

10

2004

2005

2006

2007

2008

2009

2010

2011

2012

Admission Year
Total N=191,848

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2013

Appendix A

Facilities
0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Figure

100

Total N=191,848

0%

10%

20%

30%

40%

50%

60%

Percent Missing

DATA QUALITY EXPRESSED AS MEAN PERCENT OF MISSING VARIABLES OF THE MINIMUM


DATA STANDARD PER RECORD BY FACILITY

Case Volume

The graph depicts the individual burn centers submission volume and the percent of missing records. Over two thirds
of burn centers have less than 10% of key variables missing.Volume does not appear to have linear relationship with data
quality.

No. of Cases

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Appendix A
Although the actual percent of records with less than 5 percent of key variables missing is low as shown in Figure 99,
the absolute number of records that are incomplete is large from records submitted before 2013. The number of records
affected number greater than 100,000. Hopefully the trend in improving accuracy in completing the data elements will
continue over the next decade.
PERCENT OF RECORDS WITH NUMBER OF MISSING VARIABLES
COMPARED BETWEEN DATA SUBMITTED IN 2013 AND BEFORE

101}

Before 2013

Figure

2013

Percent

60.0%

40.0%

20.0%

.00

1.00 2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

11.00

12.00

Number of Missing Variables per Record


Total N=191,848

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13.00

14.00

Appendix A
Since there has been variation in the database software used by submitting burn centers, this year a comparison was
made between data completion and the version of software used.Version 5 of the ABA burn registry software is the most
commonly used software and therefore it will appear that it has the most incomplete data.

{102
Figure

Before 2013

COUNT OF RECORDS WITH NUMBER OF MISSING VARIABLES


COMPARED BETWEEN 2013 AND BEFORE

2013

Count

30,000

20,000

10,000

.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

11.00

12.00

13.00

Number of Missing Variables per Record


Total N=191,848

121

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14.00

Appendix B
The following list of hospitals have contributed to the NBR in any given year. We extend our thanks for their
contribution and ongoing support of this significant endeavor.
Alabama
Childrens Hospital, Birmingham
UAB Burn Center
University of South Alabama Regional Burn and Wound Center
Arizona
Arizona Burn Center at Maricopa Medical Center
Arkansas
The Burn Center at Arkansas Childrens Hospital
California
Bothin Burn Center, St. Francis Memorial Hospital
Community Regional Leon S. Peters Burn Center
Inland Counties Regional Burn Center at Arrowhead Regional Medical Center
Santa Clara Valley Medical Center Regional Burn Center
Shriners Hospital for Children-Northern California
Southern California Regional Burn Center at LAC & USC Medical Center
Torrance Memorial Burn Center
UC Davis Regional Burn Center
UCI Regional Burn Center
UCSD Regional Burn Center
The Grossman Burn Center at San Joaquin Community Hospital
The Grossman Burn Center - West Hills
Colorado
The Childrens Hospital Burn Center
University of Colorado Hospital Burn Center
Western States Burn Center
Connecticut
Connecticut Burn Center, Panettieri
District of Columbia
Childrens National Medical Center
The Burn Center at Medstar Washington Hospital Center
Florida
Orlando Regional Medical Center
Shands Burn Center at the University of Florida
Tampa General Hospital Regional Burn Center
University of Miami/Jackson Memorial Burn Center
Georgia
Grady Memorial Hospital Burn Center
The Joseph M. Still Burn Center at Doctors Hospital
Illinois
Loyola University Medical Center
Memorial Medical Center Regional Burn Center
Sumner L. Koch Burn Center, Stroger Hospital
University of Chicago Burn Center
Indiana
Indiana University
St. Josephs Burn Center
Wishard Health Services

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Appendix B
Iowa
University of Iowa Burn Center
Kansas
KUHA-Burnett Burn Center
Via Christi Regional Medical Center
Louisiana
Baton Rouge General Adult Burn Center Mid-City
Louisiana State University Health Sciences Center-Shreveport
Maryland
Johns Hopkins Bayview Medical Center Burn Center
Massachusetts
Brigham and Womens Hospital Burn Center
MGH Sumner Redstone Burn Center
Shriners Hospital for Children-Boston
University of Massachusetts Memorial
Michigan
Childrens Hospital of Michigan
Detroit Receiving Hospital Burn Center
Spectrum Health Regional Burn Center
University of Michigan Health Systems
Minnesota
Dwan Burn Center
Hennepin County Medical Center Burn Center
The Burn Center-Regions Hospital
Mississippi
Delta Regional Medical Center
Missouri
George David Peak Memorial Burn and Wound Center
Nebraska
St. Elizabeth Regional Burn Center
The Nebraska Medical Center
Nevada
Lions Burn Center
New Jersey
The Burn Center at St. Barnabas
New Mexico
New Mexico Regional Burn Center
New York
Clark Burn Center
Nassau University Medical Center Burn Center
Roger W. Seibel MD Burn Treatment Center
Kessler Burn Center, University of Rochester Medical Center
Westchester Medical Center Burn Center
William R. Hearst Burn Center, New York Presbyterian Hospital, Weill Cornell Medical Center
North Carolina
North Carolina Jaycee Burn Center
Wake Forest Baptist Medical Center Burn Center

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Appendix B
Ohio
Childrens Hospital Medical Center of Akron
MetroHealth Medical Center
Nationwide Childrens Hospital
Shriners Hospital for Children-Cincinnati
The Ohio State University Wexner Medical Center
The University Hospital Burn Center-Cincinnati
Oregon
Oregon Burn Center, Legacy Emmanuel Medical Center
Pennsylvania
Lehigh Valley Hospital Burn Center
St. Christophers Hospital for Children
Temple University Hospital Burn Center
The Nathan Speare Regional Burn Treatment Center, Crozer Chester Medical Center
The Western Pennsylvania Hospital Burn Center
UPMC Mercy
Rhode Island
Rhode Island Hospital Burn Center
South Carolina
Medical University of South Carolina Childrens Hospital
Tennessee
Erlanger Health Systems Burn Center
Firefighters Regional Burn Center
Vanderbilt Regional Burn Center
Texas
John S. Dunn, Sr. Burn Center
Parkland Memorial Hospital Regional Burn Center
Shriners Hospital for Children-Galveston
Timothy J. Harnar Burn Center
University of Texas Medical Branch
U.S. Army Institute of Surgical Research
Utah
University of Utah Hospital Burn Center
Virginia
VCU Evans-Haynes Burn Center
Washington
UW Medicine Regional Burn Center at Harborview Medical Center
Wisconsin
Columbia St. Marys Hospital Regional Burn Center
University of Wisconsin Hospitals and Clinics
International Contributors
Firefighters Burn Treatment Unit, Edmonton, Alberta, Canada
Hamilton Firefighters Burn Unit Hamilton Health Sciences, Hamilton, Ontario
Hospital for Sick Children, Toronto, Ontario
Hotel-Dieu du CHUM, Montreal, Quebec
Linkoping University Hospital, Linkoping, Sweden
Ross Tilley Burn Centre, Sunnybrook and Womens College Health Sciences Centre, Toronto, Ontario
Uppsala University Hospital, Uppsala, Sweden

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Appendix C
Selected List of Peer-Reviewed Publications Utilizing NBR Data
Blaisdell LL, Chace R, Hallagan LD, Clark DE. A half-century of burn epidemiology and burn care in a rural state. J Burn Care Res.
2012 May-Jun;33(3):347-53
Bloemsma GC, Dokter J, Boxma H, Oen IMMH. Mortality and causes of death in a burn centre. Burns. 2008 Dec; 34 (8): 1103-1107.
Burton KR, Sharma VK, Harrop R, Lindsay R. Burns. A population-based study of the epidemiology of acute adult burn injuries in the
Calgary Health Region and factors associated with mortality and hospital length of stay from 1995 to 2004. Burns. Jun 2009; 35 (4): 572-579.
Carpenter AM, Hollett LP, Jeng JC, Wu J, Turner DG, Jordan MH. How long a shadow does epidemic obesity cast in the burn unit?
A dietitians analysis of the strengths and weaknesses of the available data in the National Burn Repository. J Burn Care Res. 2008 JanFeb;29(1):97-101.
Carr JA, Phillips BD, Bowling WM. The Utility of Bronchoscopy After Inhalation Injury Complicated by Pneumonia in Burn Patients:
Results From the National Burn Repository. J Burn Care Res. 2009 Nov-Dec; 30(6):967-974.
Chung JY, Kowal-Vern A, Latenser BA, Lewis RW 2nd.Cement-related injuries: review of a series, the National Burn Repository, and
the prevailing literature. J Burn Care Res. 2007 Nov-Dec;28(6):827-34.Review.
Edelman LS, Cook L, Saffle JR. Using Probabilistic Linkage of Multiple Databases to Describe Burn Injuries in Utah. J Burn Care Res.
2009; 30: 983-992.
Engrav LH, Heimbach DM, Rivara FP, Kerr KF, Osler T, Pham TN, Sharar SR, Esselman PC, Bulger EM, Carrougher GJ, Honari S,
Gibran NS. Harborview burns--1974 to 2009. PLoS One. 2012;7(7):e40086.
Guagliardo MF, Jeng JC, Browning S, Bilodeau ME, Dimick A, HickersonW, Miller S, Peck M. Admissions across state lines: harnessing
the insight of the National Burn Repository for the healthcare accessibility, fiscal, and legislative concerns facing the American Burn
Association. J Burn Care Res. 2008 Jan-Feb;29(1):151-7.
Harpole BG, Wibbenmeyer LA, Erickson BA. Genital burns in the national burn repository: incidence, etiology, and impact on
morbidity and mortality. Urology. 2014 Feb; 83(2):298-303.
Holmes JH. Critical Issues in Burn Care. J Burn Care Res. 2008 Nov-Dec; 29(6):S180-S187.
Howard PA, Jeng JC, Miller SF. Is the glass really half empty? A closer look at the TBSA data in the National Burn Repository. J Burn
Care Res. 2007 Jul-Aug;28(4):542-3.
Hranjec T, Turrentine FE, Stukenborg G,Young JS, Sawyer RG, Calland JF. Burn-center quality improvement: are burn outcomes
dependent on admitting facilities and is there a volume-outcome sweet-spot? Am Surg. 2012 May;78(5):559-66.
Jaskille AD, Shupp JW, Pavlovich AR, Fidler P, Jordan MH, Jeng JC. Outcomes from Burn Injury-Should Decreasing Mortality
Continue to be Our Compass? Clinics in Plastic Surgery. 2009 Oct; 36 (4): 701.
Jeng JC; Advisory Committee to the National Burn Repository. Open for business! a primer on the scholarly use of the National Burn
Repository. J Burn Care Res. 2007 Jan-Feb;28(1):143-4.
Jeng JC. Patrimonie de Docteur BAUX--BAUX scores >> 100 gleaned from 170,791 admissions: a glimmer from the National Burn
Repository. J Burn Care Res. 2007 May-Jun;28(3):380-1.
Jeng JC. From qualitative contemplation to relational database: one approach to harnessing the National Burn Repository. J Burn Care
Res. 2008 Jan-Feb;29(1):267-8.
Jeng JC. Growth rings of a tree: progression of burn care charges abstracted from a decade of the National Burn Repository. J Burn Care
Res. 2007 Sep-Oct;28(5):659-60.
Jeng JC,Miller SF. From the burn units perspective, its lethal not being gainfully employed outside the home! A glimmer from the
National Burn Repository. J Burn Care Res. 2007 Jan-Feb;28(1):142.
Jeng JC,Miller SF. How patients enter the burn care system is changing: a glimmer from the National Burn Repository. J Burn Care Res.
2007 Mar-Apr;28(2):220-1.
Jeng JC, Parks J, Phillips BL. Warding Off Burn Injuries, Warding Off Database Fishing Expeditions: The ABA Burn Prevention
Committee Takes a Turn With a Glimmer From the National Burn Repository. J Burn Care Res. 2008 Apr.
Jeng JC, Phillips B. Improving on It Is What It Is: Stepping Up the Quality as a Consequence of New Version 5 Collection Software-A
Glimmer From the National Burn Repository. J Burn Care Res. 2008 Mar-Apr;29(2):291-292.
Jeng JC, Phillips B. Dead-Reckoning the Distance Between the National Burn Repository and a True Population-Based Registry: A
Challenge and an Opportunity. J Burn Care Res. 2009 Jan-Feb; 30(1):139-140.

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Appendix C
Jeng JC, Phillips B. Title: From Psychedelic Data Visualization to Hypothesis: All-At-Once Contemplation of Vast Amounts of
Information From the National Burn Repository. J Burn Care Res. 2008; 29 (6): 872-873.
Jeng JC, Shoham S. Leveraging the Unique Expertise of Our Clinical Colleagues: A Real-World Example for Collaborative Harnessing
of the National Burn Repository. J Burn Care Res. 2008 Sep-Oct; 29(5):704-705.
Jeng JC, Schurr MJ, Phillips B. The Noise Floor, Signal-to-Noise Ratio, and Demonstrating That Burn Care is Getting Better: A
Glimmer from the National Burn Repository. J Burn Care Res. 2008 July-Aug; 29(4):572-573.
Johnson LS, Shupp JW, Pavlovich AR, Pezzullo JC, Jeng JC, Jordan MH. Hospital length of stay--does 1% TBSA really equal 1 day? J
Burn Care Res. 2011 Jan-Feb;32(1):13-9.
Kagan RJ, Edelman L, Solem L, Saffle JR, Gamelli R.DRG 272: Does it Provide Adequate Burn Center
Reimbursement for the Care of Patients with Stevens. J Burn Care Res. 2007 Jul.
Kagan RJ, Edelman L, Solem L, Saffle JR, Gamelli R.DRG 272: does it provide adequate burn center reimbursement for the care of
patients with Stevens-Johnson syndrome and toxic epidermal necrolysis? J Burn Care Res. 2007 Sep-Oct;28(5):669-74.
Kagan RJ, Gamelli R, Kemalyan N, Saffle JR. Tracheostomy in thermally injured patients: does diagnosis-related group 483 adequately
estimate resource use and hospital costs? J Trauma. 2004 Oct;57(4):861-6.
Kagan RJ, Gamelli R, Saffle JR.DRG 504: the effect of 96 hours of mechanical ventilation on resource utilization. J Burn Care Res.
2007 Sep-Oct;28(5):664-8.
Kahn SA, Bell DE, Hutchins P, Lentz CW. Outpatient burn data: an untapped resource. Burns. 2013 Nov; 39(7):1351-4.
Kerby JD, McGwin G Jr, George RL, Cross JA, Chaudry IH, Rue LW 3rd. Sex differences in mortality after burn injury: results of
analysis of the National Burn Repository of the American Burn Association. J Burn Care Res. 2006 Jul-Aug;27(4):452-6.
Kramer B, Rivara F, Klein M.Variations in U.S. Pediatric Burn Injury Hospitalizations Using the National Burn Repository Data. J Burn
Care Res. 2010 Sept-Oct; (5): 734-9.
Krieger Y, Shoham Y, Levi A, Bogdanov-Beresovsky A, Silberstien E, Sagi A. Burn treatment framework in Israel. Ann Burns Fire
Disasters. 2011 Dec 31;24(4):199-202.
Latenser BA, Miller SF, Bessey PQ, Browning SM, Caruso DM, Gomez M, Jeng JC, Krichbaum JA, Lentz CW, Saffle JR, Schurr MJ,
Greenhalgh DG, Kagan RJ. National Burn Repository 2006 Report Dataset Version 3.0. J Burn Care Res. 2007 Jul.
Latenser BA, Miller SF, Bessey PQ, Browning SM, Caruso DM, Gomez M, Jeng JC, Krichbaum JA, Lentz CW, Saffle JR, Schurr MJ,
Greenhalgh DG, Kagan RJ. National Burn Repository 2006: a ten-year review. J Burn Care Res. 2007 Sep-Oct;28(5):635-58.
Lezotte DC, Hills RA, Heltshe SL, Holavanahalli RK, Fauerbach JA, Blakeney P, Klein MB, Engrav LH. Assets and liabilities of the Burn
Model System data model: a comparison with the National Burn Registry.Arch Phys Med Rehabil. 2007 Dec;88(12 Suppl 2):S7-17.
Light TD, Latenser BA, Heinle JA, Stolpen MS, Quinn KA, Ravindran V, Chacko J. Demographics of Pediatric Burns in Vellore, India. J
Burn Care Res. 2009 Jan-Feb; 30(1):50-54.
Light TD, Latenser BA, Kealey GP, Wibbenmeyer LA, Rosenthal GE, Sarrazin MV. The Effect of Burn Center and Burn Center Volume on
the Mortality of Burned Adults-An Analysis of the Data in the National Burn Repository. J Burn Care Res. 2009 Sept-Oct; 30(5):776-782.
Mason AD. Invited Critique: The 2007 NBR Report: A Synopsis of the 2007 Call for Data. J Burn Care Res. 2008 Nov-Dec; 29(6):871.
Mandell SP, Robinson EF, Cooper CL, Klein MB, Gibran NS. Patient safety measures in burn care: do National reporting systems
accurately reflect quality of burn care? J Burn Care Res. 2010 Jan-Feb;31(1):125-9.
Matt SE, Shupp JW, Carter EA, Shaw JD, Jordan, MH. Comparing a Single Institutions Experience with Electrical Injuries to the Data
Recorded in the National Burn Repository. J Burn Care Res. 2012 Sept-Oct; 33(5):606-611.
Matt SE, Shupp JW, Carter EA, Flanagan KE, Jordan MH. When a Hero Becomes a Patient:Firefighter Burn Injuries in the National
Burn Repository. J Burn Care Res. 2012 Jan-Feb; 33(1):147-151.
McKibben JBA, Bresnick MG, Wiechman A, Shelley A, Fauerbach JA. Acute Stress Disorder and Posttraumatic Stress Disorder: A Prospective
Study of Prevalence, Course, and Predictors in a Sample With Major Burn Injuries. J Burn Care Res. 2008 Jan-Feb; 29(1):22-35.
McGwin G Jr,George RL,Cross JM,Rue LW. Improving the ability to predict mortality among burn patients. Burns. 2008
May;34(3):320-327. Epub 2007 Sep 14.
Miller SF, Bessey PQ, Schurr MJ, Browning SM, Jeng JC,Caruso DM,Gomez M, Latenser BA, Lentz CW, Saffle JR, Kagan RJ, Purdue
GF, Krichbaum JA. National Burn Repository 2005: a ten-year review. J Burn Care Res. 2006 Jul-Aug;27(4):411-36.
Miller SF, Bessey P, Lentz CW, Jeng JC, Schurr M, Browning S. National Burn Repository 2007 Report: A Synopsis of the 2007 Call for
Data. J Burn Care Res. 2008 Nov-Dec; 29(6):862-870.
Moss LS. Outpatient management of the burn patient. Crit Care Nurs Clin North AM. 2004 Mar;16(1):109-17.Review.

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