2009 NBRAnnual Report

NATIONAL BURN
REPOSITORY
REPORT OF DATA FROM 1999-2008
©
American Burn Association, National Burn Repository® 2009.Version 5.0.All Rights Reserved Worldwide.
National Burn
Repository
2009 Report
Dataset Version 5.0
FIRE/FLAME INJURIES REPRESENT 40% OF THE CASES IN

THIS REPORT WITH A KNOWN ETIOLOGY
SCALD INJURIES REPRESENT 30% 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

CHEMICAL INJURIES REPRESENT 3% OF THE CASES IN THIS

©
National Burn Repository 2009 Report
American Burn Association National Burn Repository Advisory Committee
Sidney F. Miller, MD, FACS, Chair Barbara A. Latenser, MD, FACS

The Ohio State University Burn Center University of Iowa Hospitals and Clinics
University Hospitals Iowa City, Iowa
Columbus, Ohio
Christopher W. Lentz, MD
James C. Jeng, MD, FACS, Co-Chair University of Rochester Medical Center
Washington Hospital Burn Center Rochester, New York
Washington, DC
Timothy D. Light, MD
Palmer Q. Bessey, MD, FACS,Vice Chair University of Iowa Hospitals and Clinics
New York Presbyterian Hospital Iowa City, Iowa
New York, New York
Jeffrey R. Saffle, MD, FACS
Daniel M. Caruso, MD, FACS University of Utah School of Medicine
Arizona Burn Center, Maricopa Medical Center Salt Lake City, Utah
Phoenix,Arizona
Michael J. Schurr, MD, FACS
Richard J. Kagan MD, FACS, ex officio University of Wisconsin Hospitals and Clinics
Shriner's Hospital for Children Madison,Wisconsin
Cincinnati, Ohio
American Burn Association Staff
John A. Krichbaum, JD
Executive Director
Susan M. Browning, MPH

Associate Executive Director
Bart Phillips, Senior Consultant

E-B Research, LLC
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ii
Acknowledgments
The American Burn Association wishes to thank Drs. Sidney F. Miller, Palmer Q. Bessey, Michael J. Schurr and James
C. Jeng for their invaluable assistance in the review and editing of this report. In addition, the Association is grateful to
the work provided by staff from E-B Research, LLC, particularly Bart Phillips, in the production of this report. The
NBR Advisory Committee wishes to thank the staff of the ABA who worked especially hard to make this report possi-
ble and particularly the guidance, prodding and support of Susan Browning and John Krichbaum.
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iii
Table of Contents
American Burn Association National Burn Repository Advisory Committee ..................................................ii

Acknowledgements .........................................................................................................................................iii
Table of Contents............................................................................................................................................iv
Introduction....................................................................................................................................................ix
Summary of Findings ......................................................................................................................................xi
1) Analysis of Contributing Hospitals ..................................................................................................................1

Figure 1: States That Have Submitted to the NBR,1999 to 2008 .....................................................................2
Table 1: Burn Center Location and Participation by Region............................................................................2
Figure 2: Contributing US Hospitals by Geographic Region ...........................................................................3
Figure 3:Arrival/Admission Year,Acute Burn Admissions ................................................................................3
Figure 4: Contributing US Hospitals by Hospital Bed Size Category ...............................................................4
Figure 5: Contributing US Hospitals by Hospital Ownership Type ..................................................................4
2) Analysis of All US 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 versus Non-White ...........................................................................................9
Figure 9: Burn Size Group (% TBSA) ..............................................................................................................10
Table 4: Lived/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 LOS by Gender, 1999-2008 .................................................................................14
Figure 16: Mortality Rate by Gender, 1999-2008 ............................................................................................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 theVentilator...........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 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 0-.9 ..............................................................................................................................................28
Figure 23: Race/Ethnicity
Table 20: Race/Ethnicity
Figure 24: Etiology
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iv
Table of Contents
Table 21: Etiology

Table 22: Hospital Days: Lived/Died by Inhalation Injury
Table 23:Top Ten Complications
Table 24:Top Ten Procedures
Table 25: Lived/Died by Burn Group Size (% TBSA)
Table 26: Hospital Days by Burns Group Size (% TBSA)
Table 27: Mean Charges for Top Five 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
Age Group 1-1.9 ...........................................................................................................................................32
Figure 28: Etiology
Table 29: Etiology
Age Group 2-4.9 ...........................................................................................................................................36
Figure 32: Etiology
Table 37: Etiology
Age Group 5-15.9 ..........................................................................................................................................40
Figure 36: Etiology
Table 45: Etiology
Age Group 16-19.9 ........................................................................................................................................44
Figure 40: Etiology
Table 53: Etiology
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v
Table of Contents

Age Group 20-29.9 ........................................................................................................................................48
Figure 44: Etiology
Table 61: Etiology
Age Group 30-39.9 ........................................................................................................................................52
Figure 48: Etiology
Table 69: Etiology
Age Group 40-49.9 ........................................................................................................................................56
Figure 52: Etiology
Table 77: Etiology
Age Group 50-59.9 ........................................................................................................................................60
Figure 56: Etiology
Table 85: Etiology
Age Group 60-69.9 ........................................................................................................................................64
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vi
Table of Contents
Figure 60: Etiology

Table 93: Etiology
Age Group 70-79.9 ........................................................................................................................................68
Figure 64: Etiology
Table 101: Etiology
Age Group 80 and Over ................................................................................................................................72
Figure 68: Etiology
Table 109: Etiology
4) Analysis by Etiology........................................................................................................................................77
Fire/Flame ......................................................................................................................................................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 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 ...............................................................................................................................................................84
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Table of Contents

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................................................................................................................................89
Electrical.........................................................................................................................................................93
Figure 85: Frequency of Records by Age Categories and Gender
5) Hospital Comparisons ....................................................................................................................................98

2005-2008 Fire/Flame Injuries........................................................................................................................99
Figure 86: 2005-2008 Fire/Flame Injuries – Mortality Rate
Figure 87: 2005-2008 Fire/Flame Injuries – Mean Charges
Figure 88: 2005-2008 Fire/Flame Injuries – Mean Length of Stay
6) Analysis of Canadian and International Records..............................................................................................105

Figure 89:Age Group by Gender
Table 143:Age Group by Gender
Figure 90: Etiology
Table 144: Etiology
Table 146: Lived/Died by Admission Year
Appendix ...........................................................................................................................................................109
A. Data Quality ...............................................................................................................................................110
Table 147: Data Completeness by Variable
Figure 91: Data Quality Expressed as Mean Percent of Missing Variables of the Minimum Data Standard per
Record by Facility
Figure 92: Data Quality Expressed as Mean Percent of Missing Variables of the Minimum Data Standard per
Record by Admission Year
B. List of Participating Hospitals ......................................................................................................................114
C. Glimmers Published in 2008.......................................................................................................................117
D. Selected List of Peer-reviewed Publications Utilizing NBR Data.................................................................131
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viii
Introduction
This year’s report represents many significant improvements.The 2008 call for data resulted in the registry now con-
taining data on over 220,000 burn patients treated by contributing hospitals. Two events highlighted the compilation of
this year’s report. The first was the release of v5 of the Burn TRACS software which contains a significant number of
pull down menus that replace many of the free text fields. This will allow for more consistent data and hopefully fewer
‘empty’ fields. Before the record is ready for transmission to the NBR, an error report is generated and those fields that
are illogical (hospital length of stay shorter then ICU length of stay) and empty fields will be identified for correction
before transmission to the NBR. Secondly, it has been identified that in some cases with dual users of the TRACS
trauma and burn software, both trauma and burn records were previously transmitted to the NBR. Although patients in
the trauma record may be identified as having burns, it remained unclear whether definitive care was provided by the
trauma center or not. Additionally, the data fields in the Trauma TRACS are less extensive and inclusion of some of
these records may have been the source of many ‘empty’ fields in the NBR. Because of this, the total number of records
in the NBR is less this year then last year with approximately 80,000 records being removed from the registry. This
problem has been addressed with the software source. The NBR Committee has also tightened the criteria for includ-
ing a record in the NBR. The NBR still represents the largest single collection of data on the care and management of
burned patients available today.
I want to thank all of the members of the NBR committee and ABA staff for contributing their time to meet regu-
larly during the past year and to continue to support the activities of the committee including the ‘Glimmers’, quality as-
surance of the NBR, marketing and this annual report. Bart Phillips and Susan Browning have done yeoman’s service to
the ABA to keep all of the committee members focused in order to produce this report in a timely fashion. Bart has
been our primary ‘data masseur’ who, in conjunction with Susan, developed the 2009 annual report framework. This
report represents data on burn patients through June 30, 2008. Committee members assisted in this data review and
provided timely commentary. Now for some particulars about this year’s NBR report.
This report, as was true for previous reports, should not be viewed as an in-depth statistical analysis of the data in the
NBR but represents as sampling of the data felt to be of most value to the ABA membership and the public. Many
members use the report to benchmark their own programs and for presentations to hospital, pre-hospital care givers and
the public. The report is divided into six sections with several appendices.
• Section 1 ‘Analysis of contributing Hospitals’
• Section 2 ‘Analysis of all records’
• Section 3 ‘Analysis by age groups’
• Section 4 ‘Analysis by etiology’
• Section 5 ‘Hospital comparisons’
• Section 6 ‘Analysis of Canadian and International Records’
Section 1 ‘Analysis of contributing Hospitals’ demonstrate the distribution of contributing hospitals in the United
States and also looks at the geographic distribution, bed capacity and type of ownership of these contributing hospitals.
Section 2 ‘Analysis of all records’ looks at the demographics of the patients’ information in the NBR. The demo-
graphics are age, gender, race and ethnicity, burn size, etiology of the burn injury, place the burn occurred and patient
disposition. Hospital length of stay and mortality are reviewed by gender and burn size. Clinically significant complica-
tions were selected from a long list of complication submitted in free text format are reviewed by frequency. The func-
tion of ICU days and number of days on the ventilator as a factor in complications is reviewed. A number of graphics
were produced to evaluate the hospital charges, DRG data and insurance grouping of patients in the NBR.
At the suggestion of many members, Section 3 ‘Analysis by age groups’ has seen the greatest change and expansion.
The age groups for review have been subclassified extensively to hopefully more closely reflect the actual clinical setting.
The committee felt that the age grouping should be under 1 year of age, toddlers age 1-2, pre-schoolers age 2-5, youths
age 5-16 (the age at which many state trauma systems make the divide between children and adults for triage purposes)
and then the ‘standard’ ten year cycles from age 20 up. The data in each age group reviewed similarly for race, etiology,
mortality, complications, procedures, and charges. Comparisons between age groups are not shown but as the actual data
are present in the reports, individuals can do group age comparisons for themselves.
Section 4 present an ‘Analysis by etiology’ and looks at the circumstances of the injuries, places of occurrence, clini-
cally relevant complications, procedures, burn size, and mortality rates by the different etiologies of flame, scald, contact
with hot objects, and electrical injuries.Again comparisons between etiology groups are not shown but as the actual data
is presented in the reports and individuals can do group age comparisons for themselves.
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ix
Introduction
Section 5 gives a very brief comparison of data contributed by hospitals to the NBR without in any way violating our
basic agreement with contributing hospitals to not disclose individual hospital information. The spread between the
varying hospitals contributing to the NBR is, however, interesting food for thought.
In the appendices are found some of the NBR QA data that suggest standardization of data entry through the pull
down menus found in v5 of the software and the data definitions in our new data dictionary will be beneficial to the
quality of the data in the NBR. The appendices also include a list of contributing hospitals and the ‘Glimmer from the
NBR’ published during the past year.
The entire NBR Advisory Committee hope you find this year’s report enlightening and valuable. We hope that it also
encourages investigators to make more in-depth evaluations of the NBR data set and that more and more burn centers
will be encourage to add their contributions to the NBR.
Sidney F. Miller MD
Chair,ABA NBR Advisory Committee
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x
Summary of Findings
This report of the National Burn Repository reviews the combined data set of acute burn admissions for the period
1999 – 2008. Key findings include the following:
1. Seventy-nine hospitals from 33 states plus the District of Columbia contributed to this report, totaling 127,016
records. Sixty-two hospitals contributed more than 500 cases. Data are not dominated by any single center and appear
to represent a reasonable cross section of US hospitals.
2. Nearly 71% of the burn patients were men. Mean age for all cases was 32 years old. Children under the age of 5
accounted for 17% of the cases while patients age 60 or older represented 12% of the cases.
3. Sixty-seven 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 is 4.0% and 7.3% for fire/flame injuries.
4.The two most common reported etiologies were fire/flame and scalds, accounting for almost 7 out of 10 reported.
Scald injuries are most prevalent in children under 5 while fire/flame injuries dominate the remaining age categories.
Twenty-one percent of cases did not designate an etiology of injury.
5. Sixty-five percent of the burn injuries with known places of occurrence were reported to have occurred in the
home. Sixty-five percent of cases with known circumstances of injury were identified as accident, non-work related.
6. During the ten year period from 1999 – 2008 the average length of stay for both females and males declined from
roughly 11 days to 9 days.The mortality rate stayed relatively constant for males (4%) but decreased from 6.4% in 1999
to 4.6% in 2008 for females.
7. Deaths from burn injury increased with advancing age and burn size, and presence of inhalation injury. For patients under
60 and with a TBSA between .1 and 19.9 the presence of inhalation injury increases the likelihood of death by 15 times.
8. Pneumonia was the most frequent clinically related complication and occurs in 4.5% of fire/flame injured patients.
The frequency of pneumonia and respiratory failure is much greater in patients with 4 days or more of mechanical ven-
tilation than those with less 4 days.The incidence of clinically related complications for patients with 0 days of mechani-
cal ventilation increases with age and tops out at 16% for those aged 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 die, the total hospital days were roughly three weeks for burn patients with TBSA values below 40% and de-
creased from 3 weeks to 1 week for the larger burn categories.
10. Overall, the charges per case for a death were over three times greater than those for a survivor.Additionally, hospi-
tal charges per hospital day in those that died averaged to be about $8000 more than in those that survived.
All cases received from contributing hospitals (TRACS burnware and non-TRACS burnware users) that met the data
structure requirements were initially accepted into the NBR. This report includes only cases with an admit year of 1999
– 2008, 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
As was done last year, an algorithm was used to identify and remove potential duplicate records from the analysis. Du-
plicate records can exist in the database if a facility submits the same record during two different calls for data.The algo-
rithm 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
• Admission Year
• Age
• Gender
• Race
• Admission Type
• 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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xi
Analysis
of Contributing Hospitals 1
Analysis
of Contributing Hospitals
The first section of the National Burn Repository (NBR) report deals with an evaluation of the contributing hos-
pitals. Because the report reflects a rolling 10 year average and hospitals submit data anonymously, the mix of hospitals
may very from year to year. The consistence of the contributions, however, appears to be relatively stable.
Figure
STATES THAT HAVE SUBMITTED TO THE NBR, 1999 TO 2008
1
{
1
1
4
3
2
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
ANALYSIS OF ALL US
RECORDS
3 ANALYSIS
BY AGE
Have burn centers which have contributed to the NBR between 1999 to 2008
Have burn centers that have not contributed data to the NBR
4
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.
ANALYSIS Table
BY AGE 1 BURN CENTER LOCATION AND PARTICIPATION BY REGION
5
{
ETIOLOGY
US Burn Care ABA Verified

US Burn Care ABA Verified
Region Facilities in the Centers in the
Facilities Centers
Annual Report Annual Report
East 29 17 14 12
HOSPITAL
COMPARISONS
North 39 24 21 19
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
South
West
Total
33
24
125
20
18
79
10
11
56
9
11
51
EAST – District of Columbia, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island, and Connecticut.
NORTH – Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, and Wisconsin. SOUTH – Alabama,
Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, Tennessee, and Texas. WEST – Arizona, California, Colorado,
Nevada, Oregon, Utah, and Washington.
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2
Analysis
26,897 records were submitted by 58 burn centers during this year’s call for data. This brings the total number of
records in this report to 127,016.Approximately 10,000 records submitted were for patient cared for in 2007 and ap-
proximately 8,000 were for patients treated in 2008. An additional 8,000 records were for patients cared for in the pre-
ceding 8 years but these records were fairly evenly distributed. Figure 3 graphically represents this data. With last year’s
inclusion of Pennsylvania data and the new requirement of the American Burn Association Verification Review Com-
mittee for participation in the NBR, there appeared to be more catch-up with a larger number of records being submit-
ted in the 2007 data call.The percentage of current data was about the same both years.
The geographic distribution of the contributors is more uniform this year then last with approximate equal numbers
of cases coming from the north and south, approximate 37,000 each, and equal numbers from the east and west of ap-
1
proximately 26,000 each.
Figure
2 CONTRIBUTING U.S. HOSPITALS BY GEOGRAPHIC REGION
{
Number of Cases
40,000 ANALYSIS OF
CONTRIBUTING
2
36,951 37,074 HOSPITALS
30,000
26,907 26,084
20,000
ANALYSIS OF ALL US
RECORDS
3
10,000
East North South West
Figure ANALYSIS
Record Submission
ARRIVAL/ADMISSION YEAR, ACUTE BURN ADMISSIONS
3 BY AGE
4
2008 GROUP
{
Before 2008
20,000
ANALYSIS
BY AGE
5
15,000 ETIOLOGY
Number of Cases
10,000
HOSPITAL
COMPARISONS
5,000
1999 2000 2001 2002 2003 2004
Year of Admission
2005 2006 2007 2008
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
26,897 records were submitted in 2008 for this report

127,016 records are included in this report
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3
Analysis
The majority of data came from hospitals with greater than 500 beds (53%). Hospitals of 200-299 beds (17.5%)
and 400-499 beds (15%) combined with the large hospitals (>500 beds) comprise 85% of the hospitals contributing to
the NBR. Over half the contributing hospitals were Not-for-profit (53%) and combined state and other local govern-
mental hospitals (33.5%) make up the majority of hospital ownership for those contributing to the NBR this year. The
geographical and ownership distributions are very similar to last year’s data.
Figure
CONTRIBUTING U.S. HOSPITALS BY HOSPITAL BED SIZE CATEGORY
4
{
1 60,000
Number of Cases
ANALYSIS OF
CONTRIBUTING 40,000
2
HOSPITALS
20,000
ANALYSIS OF ALL US
RECORDS
3 ANALYSIS
BY AGE
under 100
beds
100-199
beds
200-299
beds
Hospital Bed Size
300-399
beds
400-499
beds
500 or
more beds
4
GROUP Figure
5 CONTRIBUTING U.S. HOSPITALS BY HOSPITAL OWNERSHIP TYPE
{
ANALYSIS
BY AGE
5
ETIOLOGY
60,000
Number of Cases
HOSPITAL 40,000
COMPARISONS
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
20,000
Other not-
for-profit
State Investor,
Corporation
Hospital
district
County Army Church
operated
Ownership Type
©
4
Analysis
of All US Records 2
Analysis
of All US Records
This figure and table show the number of cases of various categories of age. Each column shows the total number
of cases and the gender distribution within a specific age category. Males outnumber females in almost all categories,
except in the oldest group (those 80 years and older) in which women predominate, accounting for 53% of the cases.
The ages with the highest prevalence of burns treated at participating Burn Centers are the early adult years, age 20 –
50. Of all records in the NBR, 1.8 % did not include the age of the patient.
Figure
AGE GROUP BY GENDER
6 Female
{
Male
1
20,000
15,000
Number of Cases
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
10,000
5,000
ANALYSIS OF ALL US
RECORDS
3 ANALYSIS
BY AGE
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= 124,776 (Excluding 2,240 Unknown/Missing)
80+
4 }
GROUP Table
AGE GROUP BY GENDER
2
Gender
Total Female Male
ANALYSIS
BY AGE
Age Categories Count Column N % Count Column N % Count Column N %
5
ETIOLOGY 0-.9 3,675 2.9 1,521 4.1 2,154 2.4
1-1.9 9,387 7.4 3,699 9.9 5,688 6.3
2-4.9 7,987 6.3 3,370 9.1 4,617 5.1
5-15.9 13,457 10.6 4,082 11 9,375 10.4
16-19.9 7,230 5.7 1,618 4.3 5,612 6.2
HOSPITAL
COMPARISONS
20-29.9 19,033 15 4,208 11.3 14,825 16.5
6
30-39.9 17,657 13.9 4,062 10.9 13,595 15.1
40-49.9 18,421 14.5 4,576 12.3 13,845 15.4
50-59.9 12,523 9.9 3,359 9 9,164 10.2
60-69.9 6,987 5.5 2,174 5.8 4,813 5.4
70-79.9 4,825 3.8 2,014 5.4 2,811 3.1
ANALYSIS OF 80 and over 3,594 2.8 1,919 5.2 1,675 1.9
CANADIAN AND
INTL. RECORDS Subtotal 124,776 98.2 36,602 98.3 88,174 98.2
Missing 2,240 1.8 618 1.7 1,622 1.8
Total 127,016 100 37,220 100 89,796 100
©
8
Analysis
of All US Records
Figure 7 and table 3 depict the distribution of cases in the NBR by race. The table shows that 4.6 % 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 predomi-
nate in young children, less that 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. Note that non-whites predominate in young children, less than 5. In all
other age categories, burn injury is substantially more prevalent in whites than in non-whites. This suggests that Racial
factors influence the occurrence of burn injury differently for young children and other age groups.
Table
Figure
7 RACE/ETHNICITY
RACE/ETHNICITY
3
{
{
Race No. of Cases

Race
White (63.0%)
Black (17.4%) White 76,263
Hispanic (13.0%) ANALYSIS OF
Other (3.7%)
CONTRIBUTING
2
Asian (2.2%)
Native American
Black 21,102 HOSPITALS
(0.8%)
Hispanic 15,694
Other 4,458
ANALYSIS OF ALL US
Asian 2,611 RECORDS

Native American
Unknown
Total
982
5,906
127,016
3 ANALYSIS
BY AGE
4
GROUP
Figure
AGE GROUP BY WHITE VERSUS NON-WHITE
8 Non White
{
White
12,000
ANALYSIS
BY AGE
5
10,000 ETIOLOGY
Number of Cases
8,000
6,000
HOSPITAL
COMPARISONS
6
4,000
2,000
ANALYSIS OF
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+ CANADIAN AND
INTL. RECORDS
Age Categories
©
9
Analysis
of All US 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 26.8%. These presumably include 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. Of those with a specified burn size, only a
small proportion had large burns. Patients with a total burn size of 40% BSA or more accounted for only 4.8 % of cases.
Table 4 shows the proportion of patients in each category of total burn size who died, case fatality. The fatality clearly
increases with burn size. The burn size associated with a 50% case fatality (LA-50) appears to be approximately 70 %
TBSA.
Figure
BURN SIZE GROUP (% TBSA)
9
{
1
60,000
50,000
ANALYSIS OF
Number of Cases
CONTRIBUTING 40,000
2
HOSPITALS
30,000
20,000
ANALYSIS OF ALL US
RECORDS
3 ANALYSIS
BY AGE
10,000
.1-9.9 10-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9
% TBSA - (Full+ Partial Thickness)

70-79.9 80-89.9 90-100
4
GROUP
Total 93,018 (Excluding 33,998 Unknown/Missing)
{4 Table
LIVED/DIED BY BURN GROUP SIZE (%TBSA)
ANALYSIS
BY AGE Lived Died
5
ETIOLOGY
%TBSA No. of Cases No. of Cases Mortality Rate
0.1 - 9.9 62,113 403 0.6
10 - 19.9 17,064 518 2.9
20 - 29.9 5,267 473 8.2
30 - 39.9 2,277 419 15.5
HOSPITAL
COMPARISONS 40 - 49.9 1,093 352 24.4
6
50 - 59.9 596 336 36.1
60 - 69.9 398 297 42.7
70 - 79.9 215 289 57.3
80 - 89.9 128 286 69.1
> 90 97 397 80.4
ANALYSIS OF Subtotal 89,248 3,770 4.1
CANADIAN AND Missing or 0% 32,737 1,261 3.7
INTL. RECORDS
TOTAL 121,985 5,031 4.0
Total N= 127,016
©
10
Analysis
of All US Records
Table 10 and figure 5 depict the distribution of different burn etiologies amongst the cases that specified one. The
table documents that 21% 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 due to one of the four most common burn etiologies for various age groups.
Burns due to Fire/Flame predominated in all cases 5 years and older. Scalds were most frequent in children under 1 to 5.
Table
Figure
10 ETIOLOGY
ETIOLOGY
5
{
{
1
No. of
Etiology
Cases
Categories of
Etiology Code Fire/Flame 41,906
Fire/Flame
(41.8%) Scald 30,153
Scald (30.1%)
Other, Non Burn Other, Non Burn 9,030 ANALYSIS OF
(9.0%) CONTRIBUTING
2
Contact with Contact with Hot Object 8,536 HOSPITALS
Hot Object
(8.5%)
Electrical (3.8%) Electrical 3,812
Chemical (2.9%)
Burn, Chemical 2,949
Unspecified
(2.4%) Burn, Unspecified 2,453
Skin Disease
(0.8%)
Radiation (0.3%) Skin Disease 774 ANALYSIS OF ALL US
Inhalation Only RECORDS
Radiation 289
3
(0.3%)
Inhalation Only 285

Unknown 26,829
Total N = 100,187 (Excluding 26,829 Unknown/Missing) Total 127,016
ANALYSIS
BY AGE
4
GROUP
Figure Contact with hot object
FREQUENCY OF CONTACT WITH HOT OBJECT,
ELECTRICAL, FIRE, AND SCALD BY AGE GROUP 11 Electrical
{
Fire/Flame
Scald
ANALYSIS
6,000 BY AGE
5
ETIOLOGY
Number of Cases
4,000
HOSPITAL
COMPARISONS
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
Age Categories
80+
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
Total N = 82,797 (Excluding 44,219 Cases)
©
11
Analysis
of All US Records
Figure 12 and table 6 depict the distribution of cases in the NBR by the place of occurrence. The table shows that
15.2% of records did not specify a place of occurrence. The figure is based on those records in which a place of occur-
rence was specified. Almost 66% of burn injuries cared for in burn centers occurred in the home.
Figure 13 and table 7 depict the distribution of cases in the NBR by the circumstances of the injury. The table shows
that 26.2% 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. Almost 90% of burns seen in burn centers were considered acci-
dental and most of these were not related to work.
Figure PLACE OF OCCURRENCE - PLACE OF OCCURRENCE - Table

{12 E849 CODE E849 CODE 6
{
1 ANALYSIS OF
CONTRIBUTING
Place of
Occurrence -
E849 Code
Home (65.5%)
Industrial
Home
Place of Occurrence
Street/Highway
No. of
Cases
70,624
7,737
2
HOSPITALS (11.1%)
Street/Highway Industrial 11,933
(7.2%)
Other Specified
Place (7.0%) Other Specified Place 7,592
Recreation and
Sport (4.5%) Recreation and Sport 4,822
Public Building
(2.6%) Public Building 2,824
ANALYSIS OF ALL US Residential
RECORDS Institution (1.1% )
Residential Institution 1,154
3
Farm (0.9%)
Mine/Quarry
(0.1%) Farm 994
Mine/Quarry 68
Unspecified 19,268
ANALYSIS Total 127,016
BY AGE
Total N = 107,748 (Excluding 19,268 Unknown/Missing)
4
GROUP
Figure Table
13 CIRCUMSTANCE OF INJURY CIRCUMSTANCE OF INJURY
7
{
{
ANALYSIS No. of
BY AGE Circumstance of Injury
Cases
5
ETIOLOGY
Categories of
Circumstance
of Injury Accident, Non-Work Related 60,882
Accident, Non-
Work Related Accident, Work Related 14,199
(65.0%)
Accident, Work
Related (15.2%) Other 6,214
Other (4.6%)
HOSPITAL Accident, Accident, Recreation 4,266
COMPARISONS Recreation
6
(4.6%) Accident, Unspecified 4,250
Accident,
Unspecified
(4.5%) Suspected Assualt/Abuse 1,502
Suspected
Assualt/Abuse Suspected Self Inflicted 1,115
(1.6%)
Suspected Self Suspected Child Abuse 1,078
Inflicted (1.2%)
ANALYSIS OF Suspected Child
CANADIAN AND Abuse (1.2%) Suspected Arson 184
INTL. RECORDS Suspected
Arson (0.2%) Unknown 33,326
©
12
Analysis
of All US Records
Figure 14 depicts the proportion of patients in the NBR that died. Since outcome is a criterion for inclusion in the
NBR this year, there were no records in which the outcome was missing.
Table 8 shows the numbers and proportions of various types of discharge dispsition for all cases included in the NBR.
Over 80% of cases were discharged from the Burn Center to home.
Outcome
Derived from
HOSPDISP
Lived (96.0%)
Died (4.0%)
HOSPITAL DISPOSITION
Figure
14 } 1 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
Total N = 127,016
ANALYSIS OF ALL US
RECORDS
Table
8 HOSPITAL DISPOSITION
3
{
Discharge Disposition No. of Cases Valid Pct.

Discharged Home 65,669 52.0 ANALYSIS
BY AGE
4
Discharged Home without Home Health 33,480 26.5 GROUP
Death 5,031 4.0

Discharged Home with Home Health 4,567 3.6
Other 4,149 3.3
Transfer to another hospital 3,949 3.1 ANALYSIS
BY AGE
5
Rehabilitation Facility 3,823 3.0 ETIOLOGY
Nursing home/skilled nursing facility 2,681 2.1
Discharged to extended care facility 615 0.5
Transfer to an acute burn facility 518 0.4
Jail or Prison 409 0.3 HOSPITAL
Discharged to foster care 399 0.3 COMPARISONS
Transfer, unspecified
Transfer to another service
Unable to Complete Treatment
Against Medical Advice
Psychiatry
Discharged to alternate caregiver
357
318
310
296
283
162
0.3
0.3
0.2
0.2
0.2
0.1
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
TOTAL 127,016
©
13
Analysis
of All US Records
Figure 15 depicts the average total duration of hospitalization (Total Hospital Days, Length of Stay, LOS) for both
men and women by year. LOS decreased by almost 25% between 1999 and 2005-2006, but then it began to increase. In
addition, LOS was generally greater for women than men during the early part of the decade depicted, but recently,
LOS has been essentially equivalent for the two genders.
Figure 16 depicts the proportion of patients in the NBR who died in the hospital (Case fatality) for both men and women
by year. Case fatality appeared to decrease by approximately one third for both women and men between 1999 and 2005.
Since then it has appeared to increase for both genders. Furthermore, case fatality appeared to be markedly greater for women
in the early part of the decade depicted, but in the recent years, the gender specific case fatality has been much less disaprate.
Figure
AVERAGE HOSPITAL LOS BY GENDER, 1999-2008
15
1
{
Female Male
12.0 Admission Mean +/- Mean +/-
Female Year SEM SEM
Male 1999 11.7+/-0.3 11+/-0.2
10.0
2000 10.4+/-0.4 9.9+/-0.2
ANALYSIS OF
Average Length of Stay
CONTRIBUTING 2001 10.7+/-0.4 10+/-0.2
2
HOSPITALS 8.0
2002 11.2+/-0.4 9.9+/-0.2
2003 9.9+/-0.3 9.1+/-0.2
6.0
2004 8.9+/-0.3 8.6+/-0.2
ANALYSIS OF ALL US
2005 8.9+/-0.4 8.4+/-0.2
4.0
RECORDS
2006 8.4+/-0.3 8.7+/-0.2
3 ANALYSIS
BY AGE
2.0
19
99
20
00
20
01
20
02
20
03
Year of Admission
20
04
20
05
20
06
20
07
20
08
2007
2008
9.0+/-0.2
9.3+/-0.3
9.2+/-0.2
9.5+/-0.2
4
GROUP Total N = 123,610 (Excluding 3,406 Unknown/Missing)
Figure
MORTALITY RATE BY GENDER, 1999-2008
16
{
Female Male
8% Admission Mortality Mortality
ANALYSIS
BY AGE Female Year Rate Rate
5
ETIOLOGY
Male 1999 6.4 4.3
6%
Mortality Rate
2000 5.9 4.3

2001 7.1 4.7
HOSPITAL
4% 2002 5.0 4.3
COMPARISONS
6
2003 5.3 3.4
2004 4.1 3.2
2%
2005 4.0 2.8
2006 3.9 3.4
ANALYSIS OF 2007 4.3 3.5
CANADIAN AND 99 00 01 02 03 04 05 06 07 08
INTL. RECORDS 19 20 20 20 20 20 20 20 20 20
2008 4.6 3.9
Year of Admission
Total N = 127,016
©
14
Analysis
of All US Records
The table on this page depicts the case fatality for each decile of total burn size in each of several age categories. As
age and/or burn size increases, so does the case fatality or risk of death. The numbers of cases used to determine the
case fatality values (proportion of cases in each group that died) are listed in the second table. 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
9
MORTALITY RATE BY AGE GROUP AND BURN SIZE
(EXPRESSED AS THE NUMBER OF DEATHS OVER THE TOTAL NUMBER OF PATIENTS IN THAT GROUP)
1
{
Burn Size (% TBSA)

Age ANALYSIS OF
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 Total CONTRIBUTING
Group
2
HOSPITALS
Birth - .9 0.1 0.2 3.2 5.2 5.0 0.0 62.5 50.0 75.0 50.0 0.7
Died/Total 2/2466 1/501 4/124 3/58 1/20 0/14 5/8 3/6 3/4 1/2 23/3203
1 - 1.9 0.0 0.3 1.2 3.8 5.1 14.3 25.0 18.2 57.1 50.0 0.4
Died/Total 3/6305 4/1417 3/250 4/104 2/39 2/14 4/16 2/11 4/7 2/4 30/8167
ANALYSIS OF ALL US
2 - 4.9 0.0 0.0 1.4 5.9 8.5 11.8 5.7 33.3 66.7 58.8 1.0 RECORDS
Died/Total
5 - 15.9
Died/Total
16 - 19.9
Died/Total
2/4789
0.1
5/7280
0.1
5/3586
0/1172
0.2
3/1796
0.4
4/922
5/349
1.2
7/586
2.4
7/289
9/153
2.0
6/297
3.3
4/122
7/82
3.8
6/157
7.6
7/92
6/51
4.4
5/113
6.8
3/44
2/35
11.1
8/72
17.6
6/34
10/30
8.0
4/50
33.3
7/21
18/27
41.9
18/43
45.8
11/24
10/17
41.9
13/31
66.7
20/30
69/6705
0.7
75/10425
1.4
74/5164
3 ANALYSIS
BY AGE
4
GROUP
20 - 29.9 0.1 0.8 2.1 6.2 9.8 19.4 27.0 44.8 57.9 80.3 1.9
Died/Total 11/8899 20/2594 17/819 24/389 19/193 26/134 30/111 26/58 33/57 53/66 259/13320
30 - 39.9 0.3 0.6 3.5 5.9 14.5 28.3 34.7 57.3 68.3 89.5 2.8
Died/Total 21/8006 14/2477 29/819 23/391 33/227 34/120 35/101 47/82 43/63 68/76 347/12362
ANALYSIS
40 - 49.9 0.4 1.6 4.8 12.7 23.8 39.5 44.4 57.7 74.2 83.6 4.0 BY AGE
5
Died/Total 35/8458 39/2493 43/889 56/442 54/227 58/147 52/117 41/71 46/62 92/110 516/13016 ETIOLOGY
50 - 59.9 0.9 3.8 9.6 21.6 36.6 55.7 68.3 86.7 80.0 87.3 6.6
Died/Total 52/5555 66/1717 60/628 64/296 56/153 68/122 56/82 52/60 44/55 55/63 573/8731
60 - 69.9 2.0 7.6 16.2 38.6 51.6 64.3 75.0 82.5 92.6 83.3 9.7
Died/Total 61/3022 75/988 64/394 68/176 47/91 36/56 27/36 33/40 25/27 35/42 471/4872 HOSPITAL
COMPARISONS
6
70 - 79.9 4.7 16.1 34.9 57.4 72.0 87.3 86.4 81.3 88.9 83.9 17.7
Died/Total 91/1922 113/703 95/272 70/122 59/82 48/55 38/44 26/32 16/18 26/31 582/3281
80 + 8.3 30.7 59.5 75.5 91.8 93.9 88.2 85.7 90.0 100.0 28.6
Died/Total 107/1296 174/566 128/215 83/110 56/61 46/49 30/34 30/35 18/20 15/15 687/2401
Total 0.6 3.0 8.2 15.6 24.4 36.1 42.5 56.7 68.6 80.1 4.0 ANALYSIS OF
CANADIAN AND
Died/Total 395/61584 513/17346 462/5634 414/2660 347/1424 332/919 293/690 281/496 279/407 390/487 3706/91647 INTL. RECORDS
©
15
Analysis
of All US Records
Figure 17 depicts the number of several complications in all case records in the NBR. Pneumonia, cellulitis, and uri-
nary tract infections are the most prevalent complications noted in burn center patients.
Figure 18 demonstrates the association of several complications and duration of mechanical ventilation. Except for
cellulitis, the prevalence of complications increases with the number of days on mechanical ventilation. In some cases,
the duration of mechanical ventilation might be considered as a cause of the complication, for example in the develop-
ment of pneumonia. In other cases, duration of ventilation could be a marker of severity of illness and correlate with
other complications of the critically ill, such as renal failure.
COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY RELEVANT COMPLICATIONS

Figure
17 }
1 3,000
Number of Cases
ANALYSIS OF
CONTRIBUTING 2,000
2
HOSPITALS
1,000
ANALYSIS OF ALL US
RECORDS
3 s/
nia t re on a re on ia on
liti rac ailu cti mi ailu cti thm ct i
mo llu jury ry T tion F fe tice F fe y fe
eu e
C c In ina fec or
y dI
n p na
l
rI
n rh eI
n
Pn Se Ar
ti Ur In pirat un Re he Lin
um
a
s W
o Ot
Tra Re
Total N = 96,912 (Excluding 23,771 cases from non TRACS centers)

ANALYSIS
BY AGE
4
GROUP Figure 0 Ventilator Days
COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY
RELEVANT COMPLICATIONS BY DAYS ON THE VENTILATOR 18 1-3 Ventilator Days
{
4+ Ventilator Days
ANALYSIS 2,500
BY AGE
Number of Cases
5
ETIOLOGY
2,000
1,500
HOSPITAL 1,000
COMPARISONS
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
500
Pn
e umo
nia
Tra
um
e
C c In
ati
liti
s/
rac
llu jury ry T tion
ina fec
Ur In pirat
Re
s
t
or
y F ailu
re
Se
ptice
mi
W
a
ou
nd
Infecti
on
O the
rI
nfecti
on
Re
na
l F ailu
re
Ar
r h y thm
ia
Lin
eI
nfect i
on
©
16
Analysis
of All US Records
Figure 19 and table 10 depict the association of occurrence of at least one complication with duration of mechani-
cal ventilation in several categories of age. For patients who do not require mechanical ventilation, age has a direct asso-
ciation with the risk of developing complications. For patients who require four or more days of mechanical ventilation,
age has much less of an effect.
Figure 0 Ventilator Days

COMPLICATION RATE FOR AGE CATEGORIES BY DAYS ON VENTILATOR
19 1-3 Ventilator Days
{
4+ Ventilator Days
60%
1
% of Patients with a Clinically Re-
50%
lated Complication
40%
ANALYSIS OF
CONTRIBUTING
2
30% HOSPITALS
20%
10%
ANALYSIS OF ALL US
RECORDS
3
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 = 81,764 (Excluding 45,252 cases from non TRACS centers or unknown/missing age or ventilator days)
Table ANALYSIS
COMPLICATION COUNT FOR AGE CATEGORIES BY DAYS ON VENTILATOR
10 BY AGE
4
GROUP
{
Ventilator Days
0 Ventilator Days 1-3 Ventilator Days 4 or More Ventalitor Days Total
Complication Complication Complication Complication
ANALYSIS
Age Categories No Yes No Yes No Yes No Yes BY AGE
5
0-.9 2,491 59 43 17 68 43 2,602 119 ETIOLOGY
1-1.9 6,126 152 58 15 128 86 6,312 253
2-4.9 4,880 145 113 30 185 136 5,178 311
5-15.9 7,832 269 300 59 334 305 8,466 633
16-19.9 3,824 195 202 62 138 115 4,164 372
20-29.9 9,583 631 577 150 419 456 10,579 1,237 HOSPITAL
30-39.9 9,029 674 622 142 475 555 10,126 1,371 COMPARISONS
40-49.9
50-59.9
60-69.9
70-79.9
80 and over
Subtotal
Missing
Total
9,060
5,770
2,940
1,825
1,215
64,575
146
64,721
763
575
364
284
229
4,340
20
4,360
648
518
321
300
276
3,978
108
4,086
171
162
119
84
67
1,078
4
1,082
619
530
393
315
218
3,822
161
3,983
724
595
416
318
222
3,971
3
3,974
10,327
6,818
3,654
2,440
1,709
72,375
415
72,790
1,658
1,332
899
686
518
9,389
27
9,416
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
©
17
Analysis
of All US Records
The data table in Table 9 (page 15) demonstrated the relationship between death, increasing age, and burn size. Fig-
ure 20 and table 11 show a similar relationship graphically. The proportion of patients who died (case fatality rate) 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 sum or score and case fatality for both men and women.A sum of age and burn size
(Baux Score) of 110 was associated with death in approximately 50% of cases.
Women appear to have a higher case fatality than men in several but not all of the categories (See Figure 16). Overall
the case fatality for women (4.93%) is slightly greater than that for men (3.70%).
Figure Female
MORTALITY RATE FOR BAUX SCORE CATEGORIES BY GENDER
20 Male
{
1
100%
80%
% of Patients that Died
ANALYSIS OF
CONTRIBUTING
60%
2
HOSPITALS
40%
20%
ANALYSIS OF ALL US
RECORDS
3 ANALYSIS
BY AGE
0-9.9 10-
19.9
20-
29.9
30-
39.9
40-
49.9
50-
59.9
60-
69.9
70-
79.9
BAUX Score (Age + TBSA)
80-
89.9
90-
99.9

100- 110- 120- 130-
109.9 119.9 129.9 139.9
Table
140
+
4 11
GROUP NUMBER OF CASES IN BAUX SCORE CATEGORIES BY GENDER
Female
{ Male
BAUX Score (Age + TBSA) Lived Died Lived Died
0-9.9 6,859 19 10,073 27
ANALYSIS
BY AGE 10-19.9 4,467 13 9,314 44
5
ETIOLOGY
20-29.9 3,868 32 12,575 94
30-39.9 3,656 42 11,992 95
40-49.9 3,984 77 12,393 158
50-59.9 3,402 71 10,150 178
60-69.9 2,365 113 6,593 209
HOSPITAL
COMPARISONS 70-79.9 1,906 169 3,991 304
6
80-89.9 1,574 211 2,299 301
90-99.9 729 202 1,022 360
100-109.9 195 199 417 323
110-119.9 77 152 156 282
120-129.9 41 102 54 231
ANALYSIS OF 130-139.9 16 81 27 194
CANADIAN AND
INTL. RECORDS 140 and Over 33 148 25 235
Total 33,172 1,631 81,081 3,035
©
18
Analysis
of All US Records
In figure 21 and table 12, the relationship between the proportion of patients that died and the sum of age and
burn size is shown both for those with and those without inhalation injury. Patients with inhalation injury generally had
a higher proportion of deaths for a given sum of age and burn size than those with no inhalation injury, but the added
risk was not constant. For patients with an inhalation injury, a sum of age and burn size (Baux Score) of 100 was associ-
ated with death in approximately 50% of cases, compared with 110 for those without.
Inhalation Injury
Figure No
MORTALITY RATE FOR BAUX SCORE CATEGORIES BY INHALATION INJURY
21 Yes
{
100%
80%
1
60% ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
40%
20%
ANALYSIS OF ALL US
RECORDS
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- 110- 120- 130-
109.9 119.9 129.9 139.9
Table
140
+
3 ANALYSIS
BY AGE
12
4
NUMBER OF CASES IN BAUX SCORE CATEGORIES BY INHALATION INJURY GROUP
{
No Inhalation Injury Inhalation Injury

0-9.9 15,159 30 145 12
ANALYSIS
10-19.9 11,762 40 213 10 BY AGE
5
20-29.9 13,584 76 512 29 ETIOLOGY
30-39.9 13,160 80 670 45

40-49.9 13,567 155 844 58
50-59.9 11,040 164 921 67
60-69.9 7,073 204 831 104
HOSPITAL
70-79.9 4,446 279 719 159 COMPARISONS
6
80-89.9 2,706 284 513 208
90-99.9 1,269 317 299 217
100-109.9 418 289 155 208
110-119.9 120 216 96 202
120-129.9 51 163 39 156
ANALYSIS OF
130-139.9 28 120 15 145 CANADIAN AND
140 and Over 40 175 15 183 INTL. RECORDS
Total 94,423 2,592 5,987 1,803

©
19
Analysis
of All US Records
The major predictors of mortality or case fatality in burns include burn size, age, and the presence of inhalation in-
jury. This table 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.
{13Table
MORTALITY RATES FOR MATRIX OF MAIN PREDICTORS
TBSA Category Age Inhalation Injury Lived Died Mortality Rate
1 ANALYSIS OF
CONTRIBUTING
0.1-19.9
0.1-19.9
0.1-19.9
0-59.9
0-59.9
60 and Over
No
Yes
No
62,942
2,221
6,710
164
109
428
0.3
4.7
6.0
2
HOSPITALS
0.1-19.9 60 and Over Yes 615 163 21.0
20-39.9 0-59.9 No 5,185 177 3.3

ANALYSIS OF ALL US
RECORDS
20-39.9 0-59.9 Yes 1,018 182 15.2
3 ANALYSIS
BY AGE
20-39.9
20-39.9
40-59.9
60 and Over
60 and Over
0-59.9
No
Yes
No
564
170
301
188
34.8
52.5
14.5
4
GROUP
986 167
40-59.9 0-59.9 Yes 494 208 29.6
40-59.9 60 and Over No 60 144 70.6

ANALYSIS
BY AGE
5
ETIOLOGY 40-59.9 60 and Over Yes 40 129 76.3
60 and Over 0-59.9 No 427 375 46.8
60 and Over 0-59.9 Yes 300 505 62.7

HOSPITAL
COMPARISONS
6
60 and Over 60 and Over No 39 152 79.6
60 and Over 60 and Over Yes 13 147 91.9
TOTAL 81,784 3,539 4.1

ANALYSIS OF
CANADIAN AND Total N = 85,323 (Excluding 41,693 Unknown/Missing)
INTL. RECORDS
©
20
Analysis
of All US Records
Table 14 lists the proportion of cases in the NBR covered by several forms of payment. Over one fourth (26.2%) of
the records did not include this information. Of those that did include this data, almost one third (32.3%) were covered
by Medicaid or uninsured.
{14 Table
PRIMARY INSURANCE PAYOR
Insurance No. of Cases Pct.
1
Government-Medicaid 14,676 11.6
Government-Medicare 10,565 8.3
Other Government 1,864 1.5
Subtotal 27,105 21.4

ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
Commercial 15,983 12.6
Blue Cross/Blue Shield 3,419 2.7
Other Named Insurance Plan 2,895 2.3

ANALYSIS OF ALL US
Other Insurance-Not Named 1,130 0.9 RECORDS
Private-Foundation or Charity
Subtotal
Worker's Compensation
1,543
24,970
11,140
1.2
19.7
8.8
3 ANALYSIS
BY AGE
4
GROUP
Managed Care 7,132 5.6
No Insurance Information Provided 33,215 26.2 ANALYSIS

BY AGE
5
Unisured, including self pay 15,604 12.3 ETIOLOGY
Subtotal 48,819 38.5
Auto 610 0.5

HOSPITAL
COMPARISONS
Unidentified Insurance Labels
TOTAL
7,240
127,016
5.7
100.0 6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
©
21
Analysis
of All US Records
Figure 22 and table 15 and table show how the proportions of patients covered by Medicaid, Medicare,Workers’
Compensation, and Self-pay categories have changed over the decade covered by this year’s NBR Report. The preva-
lence of patients covered by Workers’ Compensation has decreased. This could reflect improved safety in the work place.
It might also reflect changes in coverage eligibility.
Medicaid
PERCENT OF PATIENTS UTILIZING SELECT INSURANCE
CATEGORIES OVER TIME
Figure
22 } Medicare
Uninsured, including self pay
Worker’s Comp
1 18
% of Patients (Does not Sum to 100%)
16
14
ANALYSIS OF
CONTRIBUTING 12
2
HOSPITALS
10
6
ANALYSIS OF ALL US
RECORDS 4
3 ANALYSIS
BY AGE
2
1999 2000 2001 2002 2003 2004

Year of Admission
Total N = 51,985
2005 2006 2007 2008
4
GROUP
Table
15 CASES COUNT FOR SELECT INSURANCE CATEGORIES OVER TIME
{
Select Insurance Categories

ANALYSIS
BY AGE Uninsured, Workers
Medicaid Medicare Total
5
ETIOLOGY including self pay Compensation
Year of
Count Row N % Count Row N % Count Row N % Count Row N % Count
Admission
1999 1,062 12.9 725 8.8 870 10.6 1,072 13 8,219
2000 731 9.8 635 8.5 707 9.5 830 11.1 7,460
HOSPITAL 2001 911 11.7 624 8 791 10.2 729 9.4 7,764
COMPARISONS
6
2002 1,363 11 900 7.3 1,223 9.9 1,179 9.5 12,410
2003 1,394 10.2 953 7 1,485 10.9 1,224 8.9 13,681
2004 1,755 10.7 1,310 8 1,669 10.1 1,418 8.6 16,463
2005 2,044 12.6 1,254 7.7 1,909 11.8 1,216 7.5 16,182
ANALYSIS OF 2006 2,323 12.5 1,400 7.5 3,019 16.2 1,530 8.2 18,599
CANADIAN AND
INTL. RECORDS 2007 2,097 11.4 1,805 9.8 2,934 16 1,330 7.2 18,386
2008 996 12.7 959 12.2 997 12.7 612 7.8 7,857
Total 14,676 11.6 10,565 8.3 15,604 12.3 11,140 8.8 127,016
©
22
Analysis
of All US Records
Table 16 depicts the average length of hospital stay in days for survivors and non-survivors in each decile of burn
size. Non-survivors with burns of 20 % TBSA and greater have relatively short LOS compared with survivors. The
LOS for survivors in all categories of burn size was approximately 1 day for each percent BSA burn.
Approximately 40% of the cases reviewed in this year’s 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. Note that charge data was
provided in only 30% of all records.
Table
16 HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP
1
{
Total Lived Dead

ANALYSIS OF
%TBSA Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM CONTRIBUTING
2
0.1 - 9.9 62,516 5.4+/-0.04 62,113 5.4+/-0.04 403 16.6+/-1.14 HOSPITALS
10 - 19.9 17,582 12+/-0.1 17,064 11.7+/-0.1 518 21.8+/-1.12

20 - 29.9 5,740 21.5+/-0.28 5,267 21.7+/-0.28 473 19.7+/-1.17
30 - 39.9 2,696 32.6+/-0.54 2,277 34.8+/-0.57 419 20.6+/-1.47
40 - 49.9 1,445 40.4+/-0.94 1,093 47.7+/-1.07 352 18.1+/-1.39
50 - 59.9 932 42.5+/-1.34 596 56.7+/-1.63 336 17.3+/-1.59 ANALYSIS OF ALL US
RECORDS
60 - 69.9 695 45.1+/-1.86 398 66.5+/-2.51 297 16.7+/-1.7
70 - 79.9
80 - 89.9
> 90
Subtotal
Missing or 0%
TOTAL
504
414
494
93,018
33,998
127,016
39.5+/-2.45
35.3+/-3.05
19.5+/-2.44
10.1+/-0.06
7.2+/-0.1
215
128
97
89,248
32,737
121,985
75.8+/-4.27
88.9+/-7.45
65.6+/-10.07
9.8+/-0.06
7+/-0.1
289
286
397
3,770
1,261
5,031
12.7+/-1.52
11.5+/-1.42
8.6+/-1.37
16.8+/-0.44
12.6+/-0.72
3 ANALYSIS
BY AGE
4
GROUP
Total N = 127,016
Table
17 HOSPITAL CHARGES: LIVED/DIED BY BURN SIZE GROUP
{
ANALYSIS
Total Lived Dead BY AGE
5
ETIOLOGY
%TBSA Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM
0.1 - 9.9 25,084 $22089+/-329 24,907 $21538+/-320 177 $99511+/-25084
10 - 19.9 7,461 $67210+/-2215 7,218 $63959+/-2159 243 $163787+/-7461
20 - 29.9 2,501 $133144+/-5433 2,256 $130043+/-5725 245 $161694+/-2501
30 - 39.9 1,187 $235163+/-10034 1,000 $241459+/-11028 187 $201496+/-1187
HOSPITAL
40 - 49.9 611 $270182+/-15012 448 $295915+/-17996 163 $199457+/-611 COMPARISONS
6
50 - 59.9 402 $329154+/-26429 246 $447051+/-39549 156 $143241+/-402
60 - 69.9 265 $367045+/-42383 135 $494468+/-57787 130 $234722+/-265
70 - 79.9 228 $376897+/-55553 90 $741125+/-123539 138 $139358+/-228
80 - 89.9 173 $266813+/-44797 51 $549314+/-129034 122 $148718+/-173
> 90 219 $116588+/-29501 36 $235518+/-89068 183 $93191+/-219
Subtotal 38,131 $58219+/-998 36,387 $53465+/-956 1,744 $157402+/-38131 ANALYSIS OF
CANADIAN AND
Missing or 0% 14,249 $44168+/-1257 13,613 $39102+/-1168 636 $152597+/-14249 INTL. RECORDS
TOTAL 52,380 50,000 2,380
Total N = 52,380 (Excluding 74,636 cases with Unknown/Missing charge data)
©
23
Analysis
of All US Records
Table 18 lists the twenty most frequently recorded DRG codes and their associated hospital charges for both
survivors and deaths.
HOSPITAL CHARGES: LIVED/DIED BY TOP 20 DRGs

18 }
Table
Total Lived Died

No. of No. of No. of
Top 20 DRG Codes Mean +/- SEM Mean +/- SEM Mean +/- SEM
Cases Cases Cases
511 Non-extensive burns w/o cc or
12,940 $15532+/-645 12,900 $15297+/-638 40 $91476+/-33455
significant trauma
1 ANALYSIS OF
CONTRIBUTING
507 Full thickness burn w skin grft or
inhal inj w/o cc or sig trauma
510 Non-extensive burns w cc or
significant trauma
506 Full thickness burn w skin graft
or inhal inj w cc or sig trauma
504 Exten. burns or full thickness
3,396
3,338
3,168
$79466+/-3230
$48379+/-1541
$134674+/-3856
1,421 $272758+/-11462
3,356
3,239
3,005
1,237
$76830+/-3187
$45469+/-1444
$129888+/-3733
$257596+/-11767
40
99
163
184
$300664+/-50413
$143613+/-19483
$222910+/-28903
$374683+/-39006
2
HOSPITALS
burn w/mv 96+hrs w/skin gft
509 Full thickness burn w/o skin grft
1,197 $18028+/-1302 1,179 $16987+/-851 18 $86220+/-66145
or inh inj w/o cc or sig trauma
508 Full thickness burn w/o skin grft
619 $51172+/-8799 546 $41229+/-4643 73 $125539+/-65783
or inhal inj w cc or sig trauma
505 Exten. burns or full thickness
474 $67269+/-6782 113 $110433+/-20971 361 $53758+/-5864
burn w/mv 96+hrs w/o skin gft
ANALYSIS OF ALL US
RECORDS 541 Trach w mv 96+hrs or pdx exc
207 $762889+/-58444 176 $782213+/-64117 31 $653176+/-141386
3
face,mouth, & neck dx w/maj or
272 Major skin disorders w cc 195 $67681+/-5229 132 $64765+/-6517 63 $73792+/-8714
217 Wnd debrid & skn grft except
189 $107844+/-11921 182 $97429+/-7651 7 $378639+/-248215
hand,for muscskelet & conn tiss dis
475 Respiratory system diagnosis
171 $102434+/-28147 144 $102571+/-32894 27 $101701+/-32668
ANALYSIS with ventilator support
BY AGE 455 Other injury, poisoning & toxic
4
GROUP 167 $11411+/-1964 162 $9925+/-1483 5 $59565+/-43358
effect diag w/o cc
440 Wound debridements for
144 $51409+/-5554 143 $51769+/-5581 1 $0
injuries
441 Hand procedures for injuries 139 $33606+/-2194 139 $33606+/-2194 0
ANALYSIS 266 Skin graft &/or debrid except for

BY AGE 136 $24998+/-4472 136 $24998+/-4472 0
skin ulcer or cellulitis w/o cc
5
ETIOLOGY
449 Poisoning & toxic effects of
118 $28592+/-3267 109 $30000+/-3501 9 $11533+/-1841
drugs age >17 w cc
265 Skin graft &/or debrid except for
96 $46527+/-14374 91 $31302+/-5317 5 $323621+/-249771
skin ulcer or cellulitis w cc
HOSPITAL 450 Poisoning & toxic effects of

90 $11363+/-2691 89 $11460+/-2719 1 $2,779
COMPARISONS drugs age >17 w/o cc
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
281 Trauma to the skin, subcut tiss &
breast age >17 w/o cc
Subtotal
Other Valid DRG Codes
No Longer Valid DRG Codes
Missing DRG Codes
Total
79
3,192
5,700
15,204
52,380
$33227+/-4139
28,284 $62566+/-1155
$74201+/-4354
$85795+/-3340
$23270+/-740
79
27,157
3,055
5,251
14,537
50,000
$33227+/-4139
$57885+/-1101
$66800+/-3916
$74984+/-3308
$21183+/-717
0
1,127
137
449
667
2,380
$175349+/-28284
$239250+/-3192
$212228+/-5700
$68776+/-15204
Total N = 52,380 (Excluding 74,636 cases with Unknown/Missing charge data)
©
24
Analysis
of All US Records
This table combines several parameters of resource utilization for survivors and non-survivors in each of the burrn
size deciles. 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
Table
19 }
Hospital Days / Hospital Charges /
No. of Cases Days Hospital Charges
%TBSA Hospital Days
Age
Lived Died Lived Died Lived Died Lived Died Lived Died
Groups
Birth - 0.9 1,054
+/- SEM
1 - 1.9
+/- SEM
2,799
13
18
6.01
0.31
5.25
0.18
4.92
1.69
11.83
4.89
1.35
0.07
1.30
0.05
0.20
0.08
0.36
0.12
$25,468
$5,231
$18,504
$1,109
$32,876
$12,749
$41,908
$16,699
$3,075
$408
$2,988
$117
$9,280
$2,311
$10,729
$4,235
1 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
2 - 4.9 2,401 22 8.09 26 1.40 0.36 $27,131 $64,124 $2,863 $6,666
+/- SEM 0.31 7.22 0.04 0.09 $1,747 $36,491 $78 $2,044
5 - 15.9 3,754 23 9.39 24.43 1.45 0.38 $36,188 $85,258 $3,375 $15,794
+/- SEM 0.27 10.93 0.04 0.14 $2,529 $35,945 $298 $4,957 ANALYSIS OF ALL US
RECORDS
3
16 - 19.9 2,084 32 8.43 6.88 1.43 0.35 $52,073 $92,756 $4,266 $15,661
+/- SEM 0.35 2.62 0.05 0.17 $6,012 $40,624 $624 $3,551
20 - 29.9 5,623 121 9.53 17.52 1.74 0.36 $54,449 $242,344 $4,099 $17,007
+/- SEM 0.28 2.54 0.11 0.04 $2,638 $45,447 $112 $1,703
ANALYSIS
30 - 39.9 5,192 168 9.80 11.25 1.74 0.55 $55,244 $167,848 $4,134 $14,021 BY AGE
4
GROUP
+/- SEM 0.23 1.45 0.05 0.10 $2,470 $33,489 $91 $1,129
40 - 49.9 5,246 239 11.51 19.41 1.86 0.60 $70,166 $228,484 $4,502 $13,293
+/- SEM 0.26 2 0.04 0.07 $2,996 $33,703 $137 $1,186
50 - 59.9 3,244 251 12.98 18.19 2.28 0.75 $78,947 $182,417 $4,959 $14,331 ANALYSIS
BY AGE
5
+/- SEM 0.35 1.89 0.08 0.09 $3,708 $21,998 $227 $972 ETIOLOGY
60 - 69.9 1,733 217 15.22 18.82 2.71 1.30 $80,080 $177,506 $4,747 $10,247
+/- SEM 0.52 1.74 0.14 0.19 $4,442 $27,199 $260 $679
70 - 79.9 1,128 262 16.31 14.65 3.16 1.16 $88,573 $116,741 $4,850 $8,474
HOSPITAL
+/- SEM 0.60 1.25 0.24 0.17 $4,873 $12,673 $277 $498 COMPARISONS
80 +
+/- SEM
Total
+/- SEM
685
34,943 1,689
323 14.29
0.63
10.15
0.10
11.94
0.83
15.76
0.61
2.99
0.18
1.80
0.03
0.96
0.10
0.83
0.05
$74,105
$5,671
$97,428
$9,200
$54,225 $157,497 $4,033
$991 $8,759
$4,337
$189
$66
$8,725
$771
$11,709
$358
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
Note: Cases were selected if they had valid data for each category: hospital days, %TBSA, and hospital charges. This ratio (days/%TBSA)
has been used previously to indicate the efficiency of burn care; a ratio below 1.0 has been quoted as a goal for burn treatment.
©
25
3 Analysis
by Age Group
Intuitively, the age of the burn patient cohort has a dra- When examining most frequent complications, this year’s
matic effect on many of the attributes found in the Na- NBR dataset is demonstrating tangible differences from prior
tional Burn Repository. Some of these findings are surprising years. Urinary tract infection tops the list of complications in
while others are expected; all are very useful when contemplating both the very young and the very old. The primary reason for
prevention strategies, medical economics, and concerns about pub- this change is that the TRACS version 5 software does not sepa-
lic health. rate urinary tract infections into ‘early’ or ‘late’ categories as did
The figures in this Age Analysis section provide detailed infor- the earlier TRACS software versions. For purposes of reporting,
mation for each of the following age categories: Birth to 0.9, 1 to it was decided to group ‘early’ and ‘late’ urinary tract infections
1.9, 2 to 4.9, 5 to 15.9, 16 to 19.9, 20 to 29.9, 30 to 39.9, 40 to into one category. Pneumonia remains a very frequent complica-
49.9, 50 to 59.9, 60 to 69.9, 70 to 79.9, and 80-and-over. These tion in all age groups. In young adulthood, cellulitis and trau-
groupings were chosen based on prior collective experience about matic injury is also very common.
the relationship of certain ages to types of burn injury patterns, Most frequently reported procedures continue to be excisional
with an emphasis on accidental injuries of the very young. debridement of wound, infection or burn (ICD-9-CM 86.22) and
Each age category has four pages of figures and tables that sum- other skin graft to other site (ICD-9-CM 86.69). This is true of
marize the data in the National Burn Repository. Some highlights all age groups, and makes good intuitive sense given that early ex-
are abstracted below: cision and grafting of burns remains a durable standard of care.
Examining the race of burn victims shows a dramatic over-rep- Another absolutely expected finding is the progression of mor-
resentation of minorities in children (age under 5) than would be tality as a function of increasing age. In fact, age of the burn pa-
expected based on national demographics. The same marked tient seems to be more linearly correlated with mortality than total
over-representation disappears in young adulthood. Furthermore, body surface area.
scald and contact burns are very prevalent in this age category Finally, a significant amount of medical economic information
when contemplating etiology. Fire/flame is consistently the pre- resides within this Age Analysis section, including mean hospital
dominant etiology in adolescent and into adulthood. charges, mean hospital days, and charges and bed days broken
Inhalation injury is one of the most lethal characteristic of burn down even further by burn etiology, etc. By way of example,
victims, and somewhat surprisingly increases in incidence with age. length of stay tends to increase by one day for each percent TBSA
Even though children are exposed to smoke in structure fires, the burned, up to roughly 40-70% burns. After that, the relationship
preponderance of scald and contact injuries tends to crowd out in- tends to break down at different injury severities, based on the age
halation injuries in the young. of the burn patient.
Analysis
by Age Group Birth - .9
Table
RACE
20
{
Figure
23 RACE
{
Race No. of Cases
Race
White (44.6%)
White 1,550
Black (25.5%)
1
Hispanic (18.4%)
Other (6.4%) Black 884
Asian (4.6%)
Native American
(0.5%)
Hispanic 638
Other 224
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS Asian 160
Native American 17
Unknown 202
ANALYSIS OF ALL US
RECORDS TOTAL 3,675
3 ANALYSIS
BY AGE
Total N = 3,473 (Excluding 202 Unknown/Missing)
Table
4 21
GROUP ETIOLOGY
{
Figure
24 ETIOLOGY
{
Etiology No. of Cases

Categories of Scald 2,014
Etiology Code
ANALYSIS
BY AGE Scald (63.8%) Contact with Hot Object 807
5
Contact with Hot
ETIOLOGY Object (25.6%)
Fire/Flame (6.7%) Fire/Flame 212
Chemical (1.0%)
Other, Non Burn
(0.9%) Chemical 32
Radiation (0.6%)
Electrical (0.5%)
Burn, Unspecified Other, Non Burn 28
(0.5%)
Skin Disease (0.3%)
Inhalation Only Radiation 18
HOSPITAL (0.2%)
COMPARISONS Electrical 16
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS Total N = 3,158 (Excluding 517 Unknown/Missing)
Burn, Unspecified
Skin Disease
Inhalation Only
Unknown
TOTAL
15
10
517
3,675
©
28
American Burn Association, National Burn Repository® 2009.Version 5.0. All Rights Reserved Worldwide.
Analysis
Table
22 HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY
{
Total Lived Dead
Inhalation Injury No. of Cases Mean +/- SEM No. of Cases Mean +/- SEM No. of Cases Mean +/- SEM
No 3,344 5.78+0.20 3,325 5.76+0.20 19 8.78+3.56
Yes 58 25.46+4.19 48 28.10+4.79 10 12.8+7.00
Subtotal 3,402 3,373 29
Missing
TOTAL
Table
23
273
3,675
6.84+0.70 271
3,644
Total N = 3,675
6.75+0.70 2
31
20.00+1.00
1 ANALYSIS OF
CONTRIBUTING
2
TOP TEN COMPLICATIONS HOSPITALS
{
Top Ten Complications Count % of All Complications % of Patients with Complication

Urinary Tract Infection 30 13.3 0.9
Pneumonia 21 9.3 0.6
ANALYSIS OF ALL US
Septicemia 18 7.0 0.5 RECORDS
3
Cellulitis/traumatic Injury 15 6.6 0.4
Wound Infection 13 5.8 0.4
Other Infection 11 4.9 0.3
Respiratory Failure 8 3.5 0.2
Other Cardiovascular 7 3.1 0.2
ANALYSIS
Other Pulmonary 7 3.1 0.2 BY AGE
4
Acute Respiratory Distress Syndrome 6 2.7 0.2 GROUP
Total Complications 226
Total N = 3,415 (Excluding 260 records from non TRACS users due to inconsistencies in reporting complication information)
Table ANALYSIS
24 TOP TEN PROCEDURES BY AGE
5
{
ETIOLOGY
Top Ten Procedures Codes Count % of All Procedures

86.22 Excisional debridement of wound, infection, or burn 948 19.9
86.69 Other skin graft to other sites 702 14.7
86.28 Nonexcisional debridement of wound, infection or burn 455 9.5 HOSPITAL
COMPARISONS
6
93.57 Application of other wound dressing 448 9.4
86.66 Homograft to skin 377 7.9
86.67 Dermal regenerative graft 166 3.5
38.93 Venous catheterization, not elsewhere 160 3.4
86.62 Other skin graft to hand 102 2.1 ANALYSIS OF
99.04 Transfusion of packed cells 91 1.9 CANADIAN AND
INTL. RECORDS
84.01 Amputation and disarticulation of finger 69 1.4
Total N = 3,675
©
29
Analysis
Table LIVED/DIED BY BURN GROUP SIZE HOSPITAL DAYS BY BURN GROUP SIZE Table
25 (% TBSA) (% TBSA) 26
{
{ Lived Died No. of Cases Mean +/- SEM
%TBSA Cases Cases Mortality Rate %TBSA
0.1 - 9.9 2,464 2 0.1 0.1 - 9.9 2,466 3.74+/-0.15
10 - 19.9 500 1 0.2 10 - 19.9 501 9.11+/-0.48
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
120
55
19
14
4
3
1
0
3.2
5.2
5.0
0.0
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
124
58
20
14
20.88+/-2.43
32.75+/-3.30
37.2+/-9.99
36.71+/-7.75
2
HOSPITALS 60 - 69.9 3 5 62.5 60 - 69.9 8 27.12+/-8.57
70 - 79.9 3 3 50.0 70 - 79.9 6 42.83+/-14.98
80 - 89.9 1 3 75.0 80 - 89.9 4 24.5+/-23.5
> 90 1 1 50.0 > 90 2 1.5+/-0.5
ANALYSIS OF ALL US
RECORDS Subtotal 3,180 23 0.7 Subtotal 3,203 6.28+/-0.22
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
464
3,644
8
31
Total N = 3,675
1.7
0.8
Missing or 0%
TOTAL
472
3,675
Total N = 3,675
5.40+/-0.43
6.17+/-0.20
4
GROUP Table
27 MEAN CHARGES FOR TOP FIVE DRGs
{
No. of Cases with Valid

DRG Code No. of Cases Mean +/- SEM
ANALYSIS Charges
BY AGE
5
ETIOLOGY
511 Non-extensive burns
1,330 446 $10287+/-756
w/o cc or significant trauma

230 91 $111168+/-51654
with cc or significant trauma
HOSPITAL
COMPARISONS
510 Full thickness burn with
6
skin graft or inhalation injury 93 35 $28189+/-7106
w/o cc or sig trauma
with wound debridement or 69 35 $16312+/-4805
other O.R. proc
ANALYSIS OF skiin graft or inhalation inj 68 39 $149252+/-60786
CANADIAN AND
INTL. RECORDS with cc or sig trauma
Total N = 1,790
©
30
Analysis
Figure MEAN HOSPITAL DAYS FOR FIRE/FLAME, CONTACT WITH HOT OBJECT,
25 AND SCALD BY ADMISSION YEAR
{
Etiology
Contact with
Hot Object
Mean Hospital Days with 95% Cl
Fire/Flame
Scald
1
60
50
40
30 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
20
10
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
26
Admission Year
Total N = 3,033
MEAN CHARGES FOR ETIOLOGY CATEGORIES WITH GREATER THAN 100 VALID CHARGE CASES
3 ANALYSIS
{
BY AGE
4
GROUP
$40,000
Estimated Mean Hospital Charges with 95% Cl
$35,000
$30,000 ANALYSIS
BY AGE
5
ETIOLOGY
$25,000
$20,000
$15,000 HOSPITAL
COMPARISONS
$10,000
$5,000
Scald
(N= 677)
Contact with hot
object (N= 229)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
Etiology Categories with Greater than 100 Valid Charge Cases

Total N = 906
©
31
Analysis
by Age Group 1 - 1.9
Figure Table
27 RACE RACE
28
{
Race No. of Cases
Race
White (44.4%)
Black (22.6%)
White 3,979
1
Hispanic (22.2%)
Other (6.0%)
Asian (4.0%) Black 2,025
Native American
(0.8%)
Hispanic 1,986
ANALYSIS OF Other 539

CONTRIBUTING
2
HOSPITALS
Asian 358
Native American 68
Unknown 432
ANALYSIS OF ALL US
RECORDS
3
Total N = 8,955 (Excluding 432 Unknown/Missing) TOTAL 9,387
ANALYSIS
BY AGE
4
GROUP
Figure Table
28 ETIOLOGY ETIOLOGY
29
{
{
ANALYSIS Categories of
BY AGE Etiology Code
Scald 5,353
5
ETIOLOGY Scald (66.6%)
Contact with Hot Contact with Hot Object 1,844
Object (23.0%)
Fire/Flame (5.2%)
Other, Non Burn
Fire/Flame 414
(1.8%)
Burn, Unspecified
(1.4%)
Other, Non Burn 144
Chemical (1.0%)
Electrical (0.8%)
Radiation (0.1%)
Burn, Unspecified 113
HOSPITAL
Skin Disease (0.1%)
COMPARISONS Inhalation Only Chemical 82
6
(0.1%)
Electrical 61
Radiation 10
Skin Disease 8
ANALYSIS OF Inhalation Only 5

CANADIAN AND
INTL. RECORDS Unknown 1,353
Total N = 8,034 (Excluding 1,353 Unknown/Missing) TOTAL 9,387
©
32
Analysis
Table
{
Total Lived Dead
No 8,446 5.14+/-0.12 8,422 5.12+/-0.12 24 10.65+/-3.51
Yes 80 33.72+/-4.58 72 36.36+/-4.97 8 10.00+/-5.36
Subtotal 8,526 8,494 32
Missing
TOTAL
Table
31
861
9,387
4.61+/-0.34 857
9,351
Total N = 9,387
4.52+/-0.33 4
36
23.5+/-20.18
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
Cellulitis/traumatic Injury 50 10.0 0.6 RECORDS
3
Septicemia 29 5.8 0.4
Line Infection 18 3.6 0.2
ANALYSIS
Surgical Site Infection 14 2.8 0.2 BY AGE
4
Other Airway 12 2.4 0.1 GROUP
Total N = 8,137 (Excluding 1,250 records from non TRACS users due to inconsistencies in reporting complication information)
Table ANALYSIS
5
{
ETIOLOGY

86.22 Excisional debridement of wound, infection, or burn 2,128 19.2
86.28 Nonexcisional debridement of wound, infection or burn 1,375 12.4
86.69 Other skin graft to other sites 1,323 11.0 HOSPITAL
COMPARISONS
6
93.57 Application of other wound dressing 1,302 11.8
INTL. RECORDS
99.29 Injection or infusion of other therapeutic or prophylactic substance 127 1.1
Total N = 9,387
©
33
Analysis
33 (% TBSA) (% TBSA) 34
{
0.1 - 9.9 6,302 3 0.0 0.1 - 9.9 6,305 3.55+/-0.12
10 - 19.9 1,413 4 0.3 10 - 19.9 1,417 7.81+/-0.20
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
247
100
37
12
3
2
1.2
3.8
5.1
14.3
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
250
104
39
14
15.83+/-0.95
26.53+/-2.10
34.94+/-3.47
54.78+/-11.39
2
HOSPITALS 60 - 69.9 12 4 25.0 60 - 69.9 16 49.93+/-16.57
70 - 79.9 9 2 18.2 70 - 79.9 11 58.54+/-21.93
80 - 89.9 3 4 57.1 80 - 89.9 7 64.14+/-19.62
> 90 2 2 50.0 > 90 4 62.5+/-35.78
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
1,214
9,351
6
36
Total N = 9,387
0.5
0.4
Missing or 0%
TOTAL
1,220
9,387
Total N = 9,387
4.60+/-0.26
5.34+/-0.12
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
3,612 1,354 $10861+/-535

627 233 $45668+/-2555
HOSPITAL
COMPARISONS
6
with wound debridement or 229 111 $10457+/-1568
other O.R. proc
ANALYSIS OF skin graft or inhalation injury 169 80 $76913+/-8626
CANADIAN AND
INTL. RECORDS with cc or sig trauma
Total N = 4,926
©
34
Analysis
{
Etiology
Contact with
Hot Object
Fire/Flame
Scald
1
30
25
20
15 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
10
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
30
Admission Year
Total N = 7,611
3 ANALYSIS
{
BY AGE
4
GROUP
$80,000
$70,000
$60,000 ANALYSIS
BY AGE
5
ETIOLOGY
$50,000
$40,000
$30,000 HOSPITAL
COMPARISONS
$20,000
$10,000
Scald
(N= 1,880)
Contact with hot
object (N= 573)
Fire/Flame
(N= 144)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 2,597
©
35
Analysis
Figure Table
31 RACE RACE
36
{
Race No. of Cases
Race
White (49.4%)
Black (21.0%)
White 3,772
1
Hispanic (20.4%)
Other (5.0%)
Native American
(1.0%)
Hispanic 1,560

CONTRIBUTING
2
HOSPITALS
Asian 232
Native American 77
Unknown 356
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
37
{
{
Scald 3,646
5
ETIOLOGY Scald (54.8%)
Fire/Flame (19.1%) Fire/Flame 1,269
Contact with Hot
Object (15.9%)
Other, Non Burn
Contact with Hot Object 1,055
(4.2%)
Electrical (2.3%)
Burn, Unspecified
Other, Non Burn 281
(2.0%)
Chemical (0.8%)
Skin Disease (0.4%)
Electrical 154
HOSPITAL
Inhalation Only
COMPARISONS (0.3%) Burn, Unspecified 134
6
Radiation (0.2%)
Chemical 54
Skin Disease 25
Inhalation Only 19
ANALYSIS OF Radiation 12
CANADIAN AND
©
36
Analysis
Table
{
Total Lived Dead
No 6,970 6.89+/-0.14 6,936 6.86+/-0.14 34 13.67+/-3.84
Yes 226 31.35+/-3.33 183 35.57+/-3.96 43 13.39+/-3.76
Subtotal 7,196 7,119 77
Missing
TOTAL
Table
39
791
7,987
5.89+/-0.68 778
7,897
Total N = 7,987
5.83+/-0.69 13
90
9.38+/-5.18
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
Septicemia 64 9.0 0.9 RECORDS
3
ANALYSIS
Acute Respiratory Distress Syndrome 15 2.1 0.2 BY AGE
4
Surgical Site Infection 15 2.1 0.2 GROUP
Table ANALYSIS
5
{
ETIOLOGY

86.69 Other skin graft to other sites 2,395 15.2
86.28 Nonexcisional debridement of wound, infection or burn 1,299 8.2 HOSPITAL
COMPARISONS
6
86.66 Homograft to skin 1,221 7.7
99.04 Transfusion of packed cells 309 1.0 ANALYSIS OF
86.62 Other skin graft to hand 293 1.9 CANADIAN AND
INTL. RECORDS
97.89 Removal of other therapeutic device 247 1.6
Total N = 7,987
©
37
Analysis
41 (% TBSA) (% TBSA) 42
{
0.1 - 9.9 4,787 2 0.0 0.1 - 9.9 4,789 3.74+/-0.06
10 - 19.9 1,172 0 0.0 10 - 19.9 1,172 9.36+/-0.26
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
344
144
75
45
5
6
1.4
5.9
8.5
11.8
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
349
153
82
51
19.65+/-0.84
34.05+/-2.26
42.04+/-3.02
39.37+/-4.24
2
HOSPITALS 60 - 69.9 33 2 5.7 60 - 69.9 35 66.45+/-6.64
70 - 79.9 20 10 33.3 70 - 79.9 30 51.76+/-7.18
80 - 89.9 9 18 66.7 80 - 89.9 27 51.18+/-15.83
> 90 7 10 58.8 > 90 17 86.47+/-34.01
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
1,261
7,897
21
90
Total N = 7,987
1.6
1.1
Missing or 0%
TOTAL
1,282
7,987
Total N = 7,987
5.12+/-0.26
7.50+/-0.17
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
2,564 961 $12046+/-561

594 208 $47235+/-4577
HOSPITAL
COMPARISONS
6
504 Extensive 3rd degree
223 71 $169542+/-31165
burns with skin grafts
ANALYSIS OF with wound debridement or 201 107 $13334+/-2179
CANADIAN AND
INTL. RECORDS other O.R. proc
Total N = 3,834
©
38
Analysis
{
Etiology
Contact with
Hot Object
35 Fire/Flame
Scald
1
30
25
20
15 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
10
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
34
Admission Year
Total N = 5,970
3 ANALYSIS
{
BY AGE
4
GROUP
$40,000
$35,000
$30,000 ANALYSIS
BY AGE
5
ETIOLOGY
$25,000
$20,000
$15,000 HOSPITAL
COMPARISONS
$10,000
$5,000
Scald
(N= 1,334)
Fire/Flame
(N= 480)
Contact with hot
object (N= 340)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 2,154
©
39
Analysis
Figure Table
35 RACE RACE
44
{
Race No. of Cases
Race
White (59.4%)
Black (19.3%)
White 7,655
1
Hispanic (14.3%)
Other (4.1%)
Native American
(1.0%)
Hispanic 1,840

CONTRIBUTING
2
HOSPITALS
Asian 250
Native American 129
Unknown 569
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
45
{
{
Fire/Flame 5,124
5
ETIOLOGY Fire/Flame(48.0%)
Scald (29.6%) Scald 3,156
Contact with Hot
Object (8.1%)
Other, Non Burn
Contact with Hot Object 869
(7.9%)
Electrical (2.4%)
Burn, Unspecified
Other, Non Burn 848
(2.0%)
Chemical (0.8%)
Radiation (0.5%)
Electrical 256
HOSPITAL
Skin Disease (0.5%)
COMPARISONS Inhalation Only Burn, Unspecified 212
6
(0.2%)
Chemical 87
Radiation 49
Skin Disease 49

CANADIAN AND
©
40
Analysis
Table
{
Total Lived Dead
Inhalation Injury No. of Cases No. of Cases No. of Cases
No 11,297 7.74+/-0.13 11,260 7.71+/-0.13 37 17.86+/-5.89
Yes 557 30.80+/-1.76 502 32.82+/-1.90 55 12.58+/-3.42
Subtotal 11,854 11,762 92
Missing
TOTAL
Table
47
1,603
13,457
6.06+/-0.40 1,588
13,350
Total N = 13,457
5.89+/-0.38 15
107
21.8+/-11.60
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
Cellulitis/traumatic Injury 141 8.0 1.3 RECORDS
3
Psychiatric 45 2.9 0.4
ANALYSIS
Respiratory Failure 45 2.9 0.4 BY AGE
4
Other musculoskeletal 36 2.3 0.3 GROUP
Total Complications 1,567
Table ANALYSIS
5
{
ETIOLOGY

86.66 Homograft to skin 2,284 6.5 HOSPITAL
COMPARISONS
6
99.04 Transfusion of packed cells 1,353 3.9
38.93 Venous catheterization, not elsewhere 1,312 3.7
86.67 Dermal regenerative graft 936 2.7 ANALYSIS OF
97.89 Removal of other therapeutic device 595 1.7 CANADIAN AND
INTL. RECORDS
Total N = 13,457
©
41
Analysis
49 (% TBSA) (% TBSA) 50
{
0.1 - 9.9 7,275 5 0.1 0.1 - 9.9 7,280 4.07+/-0.06
10 - 19.9 1,793 3 0.2 10 - 19.9 1,796 10.28+/-0.22
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
579
291
151
108
7
5
1.2
2.0
3.8
4.4
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
586
297
157
113
20.83+/-0.72
34.31+/-1.49
51.36+/-2.80
55.01+/-4.09
2
HOSPITALS 60 - 69.9 64 8 11.1 60 - 69.9 72 62.15+/-5.80
70 - 79.9 46 4 8.0 70 - 79.9 50 68.72+/-8.71
80 - 89.9 25 18 41.9 80 - 89.9 43 64.30+/-8.33
> 90 18 13 41.9 > 90 31 67.76+/-18.20
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
3,000
13,350
32
107
Total N = 13,457
1.1
0.8
Missing or 0%
TOTAL
3,032
13,457
Total N = 13,457
5.45+/-0.24
8.53+/-0.15
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
3,517 1,395 $16924+/-3875

1,217 433 $44186+/-2350
HOSPITAL
COMPARISONS
6
skin graft or inhalation inj 433 203 $127016+/-17722
with cc or sig trauma
ANALYSIS OF with wound debridement or 380 208 $46159+/-5715
CANADIAN AND
INTL. RECORDS other O.R. proc
Total N = 6,000
©
42
Analysis
{
20 Etiology
Contact with
Hot Object
Fire/Flame
15 Scald
10 1 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
38
Admission Year
Total N = 9,149
3 ANALYSIS
{
BY AGE
4
GROUP
$80,000
$70,000
$60,000 ANALYSIS
BY AGE
5
ETIOLOGY
$50,000
$40,000
$30,000 HOSPITAL
COMPARISONS
$20,000
$10,000
Fire/Flame
(N= 1,910)
Scald
(N= 1,122)
Contact with hot object
(N= 312)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 3,344
©
43
Analysis
Figure Table
39 RACE RACE
52
{
Race No. of Cases
Race
White (69.6%)
Black (13.4%)
White 4,797
1
Hispanic (12.1%)
Other (3.2%)
Asian (1.1%) Black 922
Native American
(0.6%)
Hispanic 833

CONTRIBUTING
2
HOSPITALS
Asian 79
Native American 41
Unknown 336
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
53
{
{
Fire/Flame 2,858
5
ETIOLOGY Fire/Flame (51.3%)
Scald(22.5%) Scald 1,252
Other, Non Burn
(11.9%)
Contact with Hot
Other, Non Burn 660
Object (5.4%)
Burn, Unspecified
(2.9%)
Electrical (2.7%)
Chemical (2.4%)
Radiation (0.5%)
HOSPITAL
Skin Disease (0.4%)
COMPARISONS Inhalation Only Electrical 149
6
(0.1%)
Chemical 132
Radiation 30
Skin Disease 20

CANADIAN AND
©
44
Analysis
Table
{
Total Lived Dead
No 5,840 6.89+/-0.16 5,782 6.82+/-0.16 58 13.56+/-3.84
Yes 312 22.82+/-2.06 269 25.11+/-2.35 43 8.48+/-1.92
Subtotal 6,152 6,051 101
Missing
TOTAL
Table
55
1,078
7,230
5.12+/-0.41 1,065
7,116
Total N = 7,230
5.07+/-0.41 13
114
8.15+/-3.42
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
Pneumonia 69 7.4 1.2 RECORDS
3
ANALYSIS
Other Hematologic 21 2.3 0.4 BY AGE
4
Arrhythmia 19 2.0 0.3 GROUP
Table ANALYSIS
5
{
ETIOLOGY

COMPARISONS
6
INTL. RECORDS
88.38 Other computerized axial tomography 375 2.1
Total N = 7,230
©
45
Analysis
57 (% TBSA) (% TBSA) 58
{
0.1 - 9.9 3,581 5 0.1 0.1 - 9.9 3,586 4.16+/-0.11
10 - 19.9 918 4 0.4 10 - 19.9 922 8.81+/-0.32
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
282
118
85
41
7
3
2.4
3.3
7.6
6.8
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
289
122
92
44
17.29+/-1.02
29.37+/-2.23
39.94+/-3.13
47.11+/-5.32
2
HOSPITALS 60 - 69.9 28 6 17.6 60 - 69.9 34 61.61+/-7.06
70 - 79.9 14 7 33.3 70 - 79.9 21 58.9+/-12.37
80 - 89.9 13 11 45.8 80 - 89.9 24 48.70+/-14.26
> 90 10 20 66.7 > 90 30 36.83+/-11.80
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
2,026
7,116
40
114
Total N = 7,230
1.9
1.6
Missing or 0%
TOTAL
2,066
7,230
Total N = 7,230
4.76+/-0.23
7.39+/-0.18
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
1,657 803 $18979+5452

461 177 $70804+9511
HOSPITAL
COMPARISONS
6
skin graft or inhalation injury 288 135 $46538+8049
skin graft or inhalation inj 244 138 $114428+16558
ANALYSIS OF 504 Extensive 3rd degree

155 68 $242324+51340
CANADIAN AND burns with skin grafts
INTL. RECORDS
Total N = 2,805
©
46
Analysis
{
Etiology
Contact with
Hot Object
Fire/Flame
Scald
1
25
20
15
10 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
5
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
42
Admission Year
Total N = 4,411
3 ANALYSIS
{
BY AGE
4
GROUP
$80,000
$70,000
$60,000 ANALYSIS
BY AGE
5
ETIOLOGY
$50,000
$40,000
$30,000 HOSPITAL
COMPARISONS
$20,000
$10,000
Fire/Flame
(N= 1,224)
Scald
(N= 550)
Contact with hot object
(N= 123)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 1,897
©
47
Analysis
Figure Table
43 RACE RACE
60
{
Race No. of Cases
Race
White (63.0%)
Hispanic (16.6%)
White 11,419
1
Black (14.1%)
Other (3.7%)
Asian (1.7%) Hispanic 3,017
Native American
(0.9%)
Black 2,556

CONTRIBUTING
2
HOSPITALS
Asian 306
Native American 159
Unknown 912
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
61
{
{
Fire/Flame 6,748
5
Other, Non Burn
(10.9%)
Contact with Hot
Other, Non Burn 1,593
Object (5.4%)
Electrical (5.4%)
Chemical (3.7%)
Burn, Unspecified
(3.7%)
Skin Disease (0.4%)
Electrical 785
HOSPITAL
Inhalation Only
COMPARISONS (0.3%) Chemical 541
6
Radiation (0.3%)
Skin Disease 63
Inhalation Only 44
CANADIAN AND
©
48
Analysis
Table
{
Total Lived Dead
No 15,213 7.68+/-0.13 15,049 7.63+/-0.13 164 12.25+/-1.73
Yes 1,139 24.79+/-1.04 961 26.08+/-1.15 178 17.92+/-2.26
Subtotal 16,352 16,010 342
Missing
TOTAL
Table
63
2,681
19,033
6.29+/-0.73 2,644
18,654
Total N = 19,033
6.31+/-0.74 37
379
5.13+/-1.08
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
Respiratory Failure 217 6.4 1.5 RECORDS
3
ANALYSIS
Renal Failure 83 2.5 0.6 BY AGE
4
Table ANALYSIS
5
{
ETIOLOGY

COMPARISONS
6
86.65 Heterograft to skin 1,102 2.3
86.67 Dermal regenerative graft 1,035 2.2 ANALYSIS OF
99.29 Injection or infusion of other therapeutic or prophylactic substance 1,024 2.1 CANADIAN AND
INTL. RECORDS
86.62 Other skin graft to hand 988 2.1
Total N = 19,033
©
49
Analysis
65 (% TBSA) (% TBSA) 66
{
0.1 - 9.9 8,888 11 0.1 0.1 - 9.9 8,899 4.91+/-0.13
10 - 19.9 2,574 20 0.8 10 - 19.9 2,594 9.74+/-0.19
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
802
365
174
108
17
24
19
26
2.1
6.2
9.8
19.4
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
819
389
193
134
17.64+/-0.58
30.18+/-1.18
44.62+/-2.57
50.83+/-3.16
2
HOSPITALS 60 - 69.9 81 30 27.0 60 - 69.9 111 53.85+/-4.27
70 - 79.9 32 26 44.8 70 - 79.9 58 64.72+/-7.86
80 - 89.9 24 33 57.9 80 - 89.9 57 57.43+/-10.89
> 90 13 53 80.3 > 90 66 36.36+/-8.64
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
5,593
18,654
120
379
Total N = 19,033
2.1
1.0
Missing or 0%
TOTAL
5,713
19,033
Total N = 19,033
6.27+/-0.34
8.57+/-0.15
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
4,199 2,193 $13414+/-555

1,350 555 $82887+/-6167
HOSPITAL
COMPARISONS
6
skin graft or inhalatino inj 722 401 $142057+/-10461
ANALYSIS OF 504 extensive 3rd degree

459 211 $332393+/-43773
CANADIAN AND burns with skin graft
INTL. RECORDS
Total N = 7,566
©
50
Analysis
{
20 Etiology
Contact with
Hot Object
Fire/Flame
15 Scald
10 1 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
5
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
46
Admission Year
Total N = 11,033
3 ANALYSIS
{
BY AGE
4
GROUP
$160,000
$140,000
$120,000 ANALYSIS
BY AGE
5
ETIOLOGY
$100,000
$80,000
$60,000 HOSPITAL
COMPARISONS
$40,000
$20,000
Fire/Flame
(N= 2,960)
Scald
(N= 1,533)
Contact with hot
object (N= 404)
Electrical
(N= 365)
Chemical
(N= 247)
Other, non burn Burn, unspecified
(N= 132) (N= 113)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 5,754
©
51
Analysis
Figure Table
47 RACE RACE
68
{
Race No. of Cases
Race
White (63.8%)
Black (16.0%)
White 10,762
1
Hispanic (13.9%)
Other (3.4%)
Native American
(0.9%)
Hispanic 2,346

CONTRIBUTING
2
HOSPITALS
Asian 338
Native American 144
Unknown 801
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
69
{
{
Fire/Flame 6,444
5
Other, Non Burn
(8.6%)
Electrical (6.6%)
Contact with Hot
Object (5.4%)
Chemical (4.9%)
Electrical 885
Burn, Unspecified
(2.5%)
Skin Disease (0.7%)
HOSPITAL
Inhalation Only
6
Radiation (0.2%)
Skin Disease 90
Inhalation Only 39
CANADIAN AND
©
52
Analysis
Table
{
Total Lived Dead
No 14,250 7.95+0.11 14,021 7.86+0.11 229 13.22+1.67
Yes 1,252 23.52+0.96 1,046 25.55+1.08 206 13.26+1.99
Subtotal 15,502 15,067 435
Missing
TOTAL
Table
71
2,155
17,657
5.77+0.33 2,125
17,192
Total N = 17,657
5.68+0.33 30
465
11.53+4.38
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
Wound Infection 208 5.5 1.5 RECORDS
3
Acute Respiratory Distress Syndrome 112 2.0 0.8
ANALYSIS
Renal Failure 104 2.8 0.7 BY AGE
4
Line Infection 90 2.4 0.6 GROUP
Table ANALYSIS
5
{
ETIOLOGY

COMPARISONS
6
86.62 Other skin graft to hand 1,075 2.4
86.65 Heterograft to skin 872 1.0 CANADIAN AND
INTL. RECORDS
38.91 Arterial catheterization 814 1.8
Total N = 17,657
©
53
Analysis
73 (% TBSA) (% TBSA) 74
{
0.1 - 9.9 7,985 21 0.3 0.1 - 9.9 8,006 5.18+/-0.09
10 - 19.9 2,463 14 0.6 10 - 19.9 2,477 10.74+/-0.25
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
790
368
194
86
29
23
33
34
3.5
5.9
14.5
28.3
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
819
391
227
120
18.85+/-0.57
31.03+/-1.18
41.62+/-2.21
47.67+/-4.30
2
HOSPITALS 60 - 69.9 66 35 34.7 60 - 69.9 101 48.28+/-4.57
70 - 79.9 35 47 57.3 70 - 79.9 82 41.43+/-6.57
80 - 89.9 20 43 68.3 80 - 89.9 63 39.20+/-9.11
> 90 8 68 89.5 > 90 76 10.82+/-3.56
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
5,177
17,192
118
465
Total N = 17,657
2.2
2.6
Missing or 0%
TOTAL
5,295
17,657
Total N = 17,657
6.20+/-0.19
8.84+/-0.12
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
3,586 1,853 $14481+879

1,261 513 $77743+6268
HOSPITAL
COMPARISONS
6
skin graft or inhalation injury 943 476 $46628+3805
skin graft or inhalatino inj 823 448 $123465+9518

455 204 $244790+19930
INTL. RECORDS
Total N = 7,068
©
54
Analysis
{
Etiology
Contact with
Hot Object
14 Fire/Flame
Scald
1
12
10
6 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
4
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
50
Admission Year
Total N = 10,300
3 ANALYSIS
{
BY AGE
4
GROUP
$80,000
$70,000
$60,000 ANALYSIS
BY AGE
5
ETIOLOGY
$50,000
$40,000
$30,000 HOSPITAL
COMPARISONS
$20,000
$10,000
Fire/Flame
(N= 2,788)
Scald
(N= 1,430)
Electrical
(N= 404)
Contact with hot
object (N= 362)
Chemical
(N= 278)
Other, non burn
(N= 130)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 5,392
©
55
Analysis
Figure Table
51 RACE RACE
76
{
Race No. of Cases
Race
White (67.2%)
Black (17.4%)
White 11,845
1
Hispanic (9.8%)
Other (3.0%)
Native American
(0.8%)
Hispanic 1,732

CONTRIBUTING
2
HOSPITALS
Asian 295
Native American 147
Unknown 794
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
77
{
{
BY AGE Fire/Flame 6,924
Etiology Code
5
Scald (21.9%)
Scald 3,116
Other, Non Burn
(9.2%)
Electrical (6.0%)
Contact with Hot
Object (5.5%) Electrical 848
Chemical (4.6%)
Burn, Unspecified
(2.5%) Contact with Hot Object 774
HOSPITAL Skin Disease (1.0%)
Inhalation Only
6
Radiation (0.3%)
Skin Disease 139
Inhalation Only 44
CANADIAN AND
©
56
Analysis
Table
{
Total Lived Dead
No 14,658 9.23+/-0.13 14,293 8.99+/-0.12 365 18.53+/-1.58
Yes 1,512 24.09+/-0.86 1,215 25.75+/-0.97 297 17.37+/-1.80
Subtotal 16,170 15,508 662
Missing
TOTAL
Table
79
2,251
18,421
6.98+/-0.42 2,209
17,717
Total N = 18,421
6.78+/-0.42 42
704
15.92+/-3.96
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
3
Renal Failure 188 3.8 1.3
ANALYSIS
Line Infection 139 2.8 0.9 BY AGE
4
Table ANALYSIS
5
{
ETIOLOGY

COMPARISONS
6
86.65 Heterograft to skin 1,145 2.2
86.62 Other skin graft to hand 1,137 2.1 ANALYSIS OF
38.91 Arterial catheterization 1,078 2.0 CANADIAN AND
INTL. RECORDS
86.67 Dermal regenerative graft 1,040 1.0
Total N = 18,421
©
57
Analysis
81 (% TBSA) (% TBSA) 82
{
0.1 - 9.9 8,423 35 0.4 0.1 - 9.9 8,458 6.03+/-0.11
10 - 19.9 2,454 39 1.6 10 - 19.9 2,493 12.35+/-0.27
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
846
386
173
89
43
56
54
58
4.8
12.7
23.8
39.5
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
889
442
227
147
21.19+/-0.64
32.99+/-1.22
41.96+/-2.06
48.85+/-3.64
2
HOSPITALS 60 - 69.9 65 52 44.4 60 - 69.9 117 56.55+/-5.54
70 - 79.9 30 41 57.7 70 - 79.9 71 48.50+/-8.04
80 - 89.9 16 46 74.2 80 - 89.9 62 30.96+/-7.70
> 90 18 92 83.6 > 90 110 5.8+/-1.01
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
5,217
17,717
188
704
Total N = 18,421
3.5
3.8
Missing or 0%
TOTAL
5,405
18,421
Total N = 18,421
7.97+/-0.24
10.23+/-0.14
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
3,392 1,738 $16195+/-813

1,261 501 $93087+/-12204
HOSPITAL
COMPARISONS
6
skin graft or inhalation injury 1,189 564 $45731+/-4110
skin graft or inhalatino inj 1,097 571 $123006+/-7990

479 244 $345172+/-30576
INTL. RECORDS
Total N = 7,418
©
58
Analysis
{
Etiology
20
Contact with
Hot Object
Fire/Flame
Scald
1
15
10
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
5
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
54
Admission Year
Total N = 10,814
3 ANALYSIS
{
BY AGE
4
GROUP
$140,000
$120,000 ANALYSIS
BY AGE
5
ETIOLOGY
$100,000
$80,000
$60,000 HOSPITAL
COMPARISONS
$40,000
$20,000
Fire/Flame
(N= 2,950)
Scald
(N= 1,387)
Electrical
(N= 386)
Contact with hot
object (N= 361)
Chemical
(N= 273)
Other, non burn
(N= 154)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 5,511
©
59
Analysis
Figure Table
55 RACE RACE
84
{
Race No. of Cases
Race
White (68.5%)
Black (17.6%)
White 8,219
1
Hispanic (7.9%)
Other (3.0%)
Native American
(0.8%)
Hispanic 947

CONTRIBUTING
2
HOSPITALS
Asian 259
Native American 98
Unknown 528
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
85
{
{
Fire/Flame 4,830
5
Other, Non Burn
(11.0%)
Contact with Hot
Object (5.9%)
Electrical (4.6%)
Chemical (3.7%)
Burn, Unspecified
(2.4%)
Skin Disease (1.2%)
Electrical 453
HOSPITAL
Inhalation Only
6
Radiation (0.3%)
Skin Disease 116
Inhalation Only 34
CANADIAN AND
©
60
Analysis
Table
{
Total Lived Dead
No 9,629 10.82+/-0.17 9,225 10.36+/-0.16 404 21.26+/-1.60
Yes 1,266 22.91+/-0.88 952 25.39+/-1.03 314 15.46+/-1.63
Subtotal 10,895 10,177 718
Missing
TOTAL
Table
87
1,628
12,523
7.93+/-0.49 1,592
11,769
Total N = 12,523
7.82+/-0.49 36
754
12.08+/-4.03
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
3
ANALYSIS
Arrhythmia 128 3.1 1.3 BY AGE
4
Line Infection 93 2.3 0.9 GROUP
Table ANALYSIS
5
{
ETIOLOGY

38.93 Venous catheterization, not elsewhere 1,889 4.7 HOSPITAL
COMPARISONS
6
86.65 Heterograft to skin 738 1.8 CANADIAN AND
INTL. RECORDS
Total N = 12,523
©
61
Analysis
89 (% TBSA) (% TBSA) 90
{
0.1 - 9.9 5,503 52 0.9 0.1 - 9.9 5,555 7.32+/-0.13
10 - 19.9 1,651 66 3.8 10 - 19.9 1,717 15.21+/-0.40
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
568
232
97
54
60
64
56
68
9.6
21.6
36.6
55.7
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
628
296
153
122
25.91+/-0.98
39.95+/-2.05
46.06+/-3.98
40.25+/-3.54
2
HOSPITALS 60 - 69.9 26 56 68.3 60 - 69.9 82 30.88+/-5.18
70 - 79.9 8 52 86.7 70 - 79.9 60 16.55+/-4.11
80 - 89.9 11 44 80.0 80 - 89.9 55 15.38+/-3.64
> 90 8 55 87.3 > 90 63 6.46+/-3.25
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
3,611
11,769
181
754
Total N = 12,523
4.8
6.0
Missing or 0%
TOTAL
3,792
12,523
Total N = 12,523
9.18+/-0.31
11.75+/-0.17
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
1,888 958 $21039+/-2945
HOSPITAL
COMPARISONS 507 Non-extensive burns
6
879 328 $103528+/-9033

371 181 $287028+/-36436
INTL. RECORDS
Total N = 4,939
©
62
Analysis
{
Etiology
20 Contact with
Hot Object
Fire/Flame
Scald
1
15
10
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
5
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
58
Admission Year
Total N = 7,462
3 ANALYSIS
{
BY AGE
4
GROUP
$140,000
$120,000 ANALYSIS
BY AGE
5
ETIOLOGY
$100,000
$80,000
$60,000 HOSPITAL
COMPARISONS
$40,000
$20,000
Fire/Flame
(N= 1,941)
Scald
(N= 854)
Contact with hot
object (N= 265)
Electrical
(N= 190)
Chemical
(N= 159)
Other, non burn
(N= 147)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 3,556
©
63
Analysis
Figure Table
59 RACE RACE
92
{
Race No. of Cases
Race
White (71.8%)
Black (16.3%)
White 4,821
1
Hispanic (6.0%)
Other (2.9%)
Native American
(0.9%)
Hispanic 402

CONTRIBUTING
2
HOSPITALS
Asian 141
Native American 58
Unknown 275
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
93
{
{
Fire/Flame 2,801
5
Other, Non Burn
(13.1%)
Contact with Hot
Other, Non Burn 716
Object (5.2%)
Chemical (3.1%)
Burn, Unspecified
(2.5%)
Electrical (2.0%)
Skin Disease (1.9%)
Chemical 169
HOSPITAL
Inhalation Only
COMPARISONS (0.5%) Burn, Unspecified 136
6
Radiation (0.2%)
Electrical 110
Skin Disease 102
Inhalation Only 27
CANADIAN AND
©
64
Analysis
Table
{
Total Lived Dead
No 5,236 12.61+0.26 4,885 12.16+0.25 351 18.80+1.43
Yes 787 21.40+0.96 566 22.95+1.09 221 17.45+1.97
Subtotal 6,023 5,451 572
Missing
TOTAL
Table
95
964
6,987
8.07+0.53 923
6,374
Total N = 6,987
7.82+0.55 41
613
12.70+2.24
1 ANALYSIS OF
CONTRIBUTING
2
{

ANALYSIS OF ALL US
3
Arrhythmia 130 4.4 2.4
ANALYSIS
Other Infection 75 2.6 1.4 BY AGE
4
Pleural Effusion 66 2.3 1.2 GROUP
Table ANALYSIS
5
{
ETIOLOGY

38.93 Venous catheterization, not elsewhere 1,258 5.2 HOSPITAL
COMPARISONS
6
86.28 Nonexcisional debridement of wound, infection or burn 902 3.7
33.22 Fiber-optic bronchoscopy 492 2.0 ANALYSIS OF
INTL. RECORDS
Total N = 6,987
©
65
Analysis
97 (% TBSA) (% TBSA) 98
{
0.1 - 9.9 2,961 61 2.0 0.1 - 9.9 3,022 8.74+/-0.24
10 - 19.9 913 75 7.6 10 - 19.9 988 17.94+/-0.59
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
330
108
44
20
64
68
47
36
16.2
38.6
51.6
64.3
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
394
176
91
56
32.28+/-1.43
37.33+/-2.65
36.41+/-4.36
30.71+/-5.51
2
HOSPITALS 60 - 69.9 9 27 75.0 60 - 69.9 36 12.05+/-3.06
70 - 79.9 7 33 82.5 70 - 79.9 40 19.47+/-5.53
80 - 89.9 2 25 92.6 80 - 89.9 27 4.44+/-2.04
> 90 7 35 83.3 > 90 42 7.78+/-2.85
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
1,973
6,374
142
613
Total N = 6,987
6.7
8.8
Missing or 0%
TOTAL
2,115
6,987
Total N = 6,987
9.85+/-0.36
13.11+/-0.24
4
GROUP Table
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
887 406 $29897+/-5525
HOSPITAL
COMPARISONS
6
444 159 $137211+/-28024

225 107 $225214+/-19180
INTL. RECORDS
Total N = 2,678
©
66
Analysis
{
Etiology
Contact with
Hot Object
25
Fire/Flame
Scald
20
15 1 ANALYSIS OF
CONTRIBUTING
2
10 HOSPITALS
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
62
Admission Year
Total N = 4,179
3 ANALYSIS
{
BY AGE
4
GROUP
$140,000
$120,000 ANALYSIS
BY AGE
5
ETIOLOGY
$100,000
$80,000
$60,000 HOSPITAL
COMPARISONS
$40,000
$20,000
Fire/Flame
(N= 1,126)
Scald
(N= 426)
Contact with hot
object (N= 121)
Other, Non burn
(N= 99)
Chemical
(N= 66)
Skin Disease
(N= 56)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 1,894
©
67
Analysis
Figure Table
63 RACE RACE
100
{
Race No. of Cases
Race
White (76.4%)
Black (14.2%)
White 3,546
1
Hispanic (4.2%)
Other (2.6%)
Native American
(0.5%)
Hispanic 197

CONTRIBUTING
2
HOSPITALS
Asian 98
Native American 21
Unknown 182
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
101
{
{
Fire/Flame 2,006
5
Scald (18.9%) Scald 715
Other, Non Burn
(16.1%)
Contact with Hot
Other, Non Burn 609
Object (5.2%)
Skin Disease (2.3%)
Burn, Unspecified
(2.0%)
Chemical (1.1%)
Inhalation Only
Skin Disease 88
HOSPITAL (0.6%)
COMPARISONS Electrical (0.5%) Burn, Unspecified 76
6
Radiation (0.3%)
Chemical 43
Inhalation Only 22
Electrical 20
CANADIAN AND
©
68
Analysis
Table
HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY
102
{
Total Lived Dead
No 3,440 15.01+/-0.40 2,967 14.34+/-0.41 473 19.23+/-1.39
Yes 618 17.47+/-0.96 378 19.64+/-1.26 240 14.07+/-1.45
Subtotal 4,058 3,345 713
Missing
TOTAL
Table
767
4,825
8.09+/-0.61 707
4,052
Total N = 4,825
7.81+/-0.64 60
773
10.66+/-1.98
1 ANALYSIS OF
CONTRIBUTING
2
TOP TEN COMPLICATIONS
103 HOSPITALS
{

ANALYSIS OF ALL US
Arrhythmia 155 6.8 4.1 RECORDS
3
ANALYSIS
Other Infection 67 2.9 1.8 BY AGE
4
Cardiac arrest 62 2.7 1.6 GROUP
Table ANALYSIS
TOP TEN PROCEDURES
104 BY AGE
5
{
ETIOLOGY

38.93 Venous catheterization, not elsewhere 887 5.3 HOSPITAL
COMPARISONS
6
33.22 Fiber-optic bronchoscopy 346 2.1 ANALYSIS OF
93.57 Application of other wound dressing 344 2.1 CANADIAN AND
INTL. RECORDS
99.04 Transfusion of packed cells 319 1.9
Total N = 4,825
©
69
Analysis
105 (% TBSA) (% TBSA) 106
{
0.1 - 9.9 1,831 91 4.7 0.1 - 9.9 1,922 10.60+/-0.48
10 - 19.9 590 113 16.1 10 - 19.9 703 21.67+/-0.77
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
177
52
23
7
95
70
59
48
34.9
57.4
71.0
87.3
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
272
122
82
55
31.45+/-1.79
35.18+/-3.35
19.56+/-2.91
13.18+/-3.41
2
HOSPITALS 60 - 69.9 6 38 86.4 60 - 69.9 44 14.75+/-4.45
70 - 79.9 6 26 81.2 70 - 79.9 32 5.71+/-1.92
80 - 89.9 2 16 88.9 80 - 89.9 18 3.5+/-1.18
> 90 5 26 83.9 > 90 31 4.45+/-1.13
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
1,353
4,052
191
773
Total N = 4,825
12.4
16.0
Missing or 0%
TOTAL
1,544
4,825
Total N = 4,825
11.16+/-0.53
14.41+/-0.33
4
GROUP Table
MEAN CHARGES FOR TOP FIVE DRGs
107
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY
472 230 $153502+/-13608
HOSPITAL
COMPARISONS
6
262 95 $124968+/-17574

180 75 $301689+/-37052
INTL. RECORDS
Total N = 1,675
©
70
Analysis
{
Etiology
40 Contact with
Hot Object
Fire/Flame
30 Scald
20
10 1 ANALYSIS OF
CONTRIBUTING
2
0 HOSPITALS
-10
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
66
Admission Year
Total N = 2,916
3 ANALYSIS
{
BY AGE
4
GROUP
$120,000 ANALYSIS
BY AGE
5
ETIOLOGY
$100,000
$80,000
$60,000 HOSPITAL
COMPARISONS
$40,000
$20,000
Fire/Flame
(N= 849)
Scald
(N= 289)
Contact with hot
object (N= 106)
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS

Total N = 1,244
©
71
Analysis
by Age Group 80 and over
Figure Table
67 RACE RACE
108
{
Race No. of Cases
Race
White (79.5%)
Black (13.0%)
White 2,775
1
Hispanic (3.0%)
Other (2.3%)
Native American
(0.4%)
Hispanic 103
CONTRIBUTING
2
HOSPITALS
Asian 63
Native American 14
Unknown 104
ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Figure Table
109
{
{
Fire/Flame 1,374
5
Scald (19.9%) Other, Non Burn 588
Other, Non Burn
(19.9%)
Contact with Hot
Scald 588
Object (7.1%)
Burn, Unspecified
(2.2%)
Skin Disease (2.1%)
Chemical (0.9%)
Inhalation Only
HOSPITAL (0.7%)
COMPARISONS Electrical (0.3%) Skin Disease 63
6
Radiation (0.2%)
Chemical 28
Inhalation Only 20
Electrical 10
CANADIAN AND
INTL. RECORDS Unknown 640
©
72
Analysis
Table
HOSPITAL DAYS: LIVED/DIED BY INHALATION INJURY
110
{
Total Lived Dead
No 2,395 14.39+/-0.37 1,851 14.20+/-0.42 544 15.04+/-0.79
Yes 452 12.13+/-0.83 184 18.62+/-1.67 268 7.69+/-0.69
Subtotal 2,847 2,035 812
Missing
TOTAL
Table
747
3,594
8.43+/-0.93 678
2,713
Total N = 3,594
7.91+/-0.98 69
881
12.28+/-2.75
1 ANALYSIS OF
CONTRIBUTING
2
111 HOSPITALS
{

ANALYSIS OF ALL US
3
Cardiac arrest 61 3.9 2.3
ANALYSIS
Other Cardiovascular 53 3.4 1.0 BY AGE
4
Septicemia 49 3.1 1.8 GROUP
Total N = 2,659 (Excluding 935 records from non TRACS users due to inconsistencies in reporting complication information)
Table ANALYSIS
TOP TEN PROCEDURES
112 BY AGE
5
{
ETIOLOGY

38.93 Venous catheterization, not elsewhere 646 5.7 HOSPITAL
COMPARISONS
6
87.03 Computerized axial tomography of head 350 3.1
99.04 Transfusion of packed cells 308 2.7
86.28 Nonexcisional debridement of wound, infection or burn 285 2.5 ANALYSIS OF
38.91 Arterial catheterization 274 2.4 CANADIAN AND
INTL. RECORDS
96.04 Insertion of endotracheal tube 251 2.2
Total N = 3,594
©
73
Analysis
113 (% TBSA) (% TBSA) 114
{
0.1 - 9.9 1,189 107 8.3 0.1 - 9.9 1,296 11.82+/-0.45
10 - 19.9 392 174 30.7 10 - 19.9 566 21.44+/-0.77
1 ANALYSIS OF
CONTRIBUTING
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
87
27
3
128
83
56
46
59.5
75.5
91.8
93.9
20 - 29.9
30 - 39.9
40 - 49.9
50 - 59.9
215
110
61
49
21.67+/-1.73
14.20+/-1.98
12.77+/-2.58
5.63+/-1.32
2
HOSPITALS 60 - 69.9 4 30 88.2 60 - 69.9 34 4.09+/-1.15
70 - 79.9 5 30 85.7 70 - 79.9 35 3.88+/-1.13
80 - 89.9 2 18 90.0 80 - 89.9 20 2.1+/-0.94
> 90 0 15 100.0 > 90 15 2.2+/-0.66
ANALYSIS OF ALL US
3 ANALYSIS
BY AGE
Missing or 0%
TOTAL
999
2,713
194
881
Total N = 3,594
16.3
24.5
Missing or 0%
TOTAL
1,193
3,594
Total N = 3,594
9.48+/-0.63
13.07+/-0.32
4
GROUP Table
MEAN CHARGES FOR TOP FIVE DRGs
115
{

ANALYSIS Charges
BY AGE
5
ETIOLOGY 506 Full thickness burn with
267 140 $26454+/-3214
HOSPITAL
COMPARISONS
6
176 56 $103814+/-11787
ANALYSIS OF 505 Extensive 3rd Degree

138 68 $32248+/-12569
CANADIAN AND Burn W Skin Graft
INTL. RECORDS
Total N = 1,177
©
74
Analysis
{
Etiology
Contact with
Hot Object
30
Fire/Flame
25 Scald
20
15
10
1 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
ANALYSIS OF ALL US
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RECORDS
Figure
70
Admission Year
Total N = 2,172
3 ANALYSIS
{
BY AGE
4
GROUP
$120,000
$100,000
ANALYSIS
BY AGE
5
ETIOLOGY
$80,000
$60,000
HOSPITAL
COMPARISONS
6
$40,000
$20,000
ANALYSIS OF
Fire/Flame Scald CANADIAN AND
(N= 576) (N= 252) INTL. RECORDS

Total N = 828
©
75
Analysis
by Etiology 4
Analysis
by Etiology Fire/Flame Injuries
Although every form of thermal injury has the potential of damaging or destroying the skin, different burn etiolo-
gies behave much differently. By stratifying the National Burn Repository by burn etiology allows us to predict compli-
cations, length of stay and risk of death. Comparing overall outcomes among American and Canadian burn centers is
meaningless unless the individual populations are stratified not only by age and % total body surface areas, but also by
burn etiology.There are various types of burns ranging from flames, scalds, chemical and contact
That each carries its own risk of morbidity and mortality.This is apparent when the patients in the National Burn Repository are
stratified by etiology.The stratification for burn types are burns caused by fire,hot liquids,contact with hot objects and electrical sources.
The most lethal type of thermal injury is that caused by flame. Most flame burns are non-work related accidents (70%)
that occur in the home (70%).
Figure Table
1 71 CIRCUMSTANCE OF INJURY CIRCUMSTANCE OF INJURY

116
{
{
Circumstance of Injury No. of Cases
Categories of Accident, Non-Work Related 26,346
ANALYSIS OF Circumstance
CONTRIBUTING of Injury
Accident, Work Related 4,466
2
HOSPITALS Accident, Non-
Work Related
(70.2%) Accident, Recreation 2,652
Accident, Work
Related (11.9%)
Accident, Other 1,426
Recreation
(7.1%)
Other (3.8%)
Accident, Unspecified 1,034
ANALYSIS OF ALL US Accident,
RECORDS
Unspecified Suspected Self Inflicted 814
(2.8%)
3
Suspected Self
Inflicted (2.2%) Suspected Assualt/Abuse 548
Suspected
Assualt/Abuse
(1.5%) Suspected Arson 163
Suspected
Arson (0.4%) Suspected Child Abuse 86
Suspected Child
Abuse (0.2%)
ANALYSIS Unknown 4,371
BY AGE
4
GROUP Total N = 37,535 (Excluding 4,371 Unknown/Missing) Total 41,906

72 E849 CODE E849 CODE 117
{
{
ANALYSIS Place of Occurrence No. of Cases
BY AGE
5
ETIOLOGY Place of Home 25,096
Occurrence -
E 849 Code
Other Specified Place 2,736
Home (69.6%)
Other Specified
Place (7.6%) Industrial 2,684
Industrial (7.4%)
Recreation and
Sport (6.5%)
Recreation and Sport 2,357
HOSPITAL
Street/Highway
COMPARISONS Street/Highway 2,005
6
(5.6%)
Public Building
(1.5%)
Farm (1.0%) Public Building 549
Residential
Institution Farm 359
(0.8%)
Mine/Quarry
(0.1%) Residential Institution 273
ANALYSIS OF
CANADIAN AND Mine/Quarry 22
INTL. RECORDS
Unspecified 5,825
©
78
Analysis
The overall complication rate for flame burns is 15%.When stratified by age, there is a bimodal distribution of the
rate of complications.The peak incidence of complications are in the 0 – 1 year (15%) and those with age > 70 (24%).
Figure
73 PERCENT OF PATIENT WITH CLINICALLY RELEVANT COMPLICATIONS BY AGE GROUP
{
25%
1
% of Patients with a Clinically Related
20%
Complication
15% ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
10%
5%
ANALYSIS OF ALL US
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
information or cases without a known age)

80+
Total N = 38,209 (Excluding 3,697 cases from non TRACS users due to inconsistencies in reporting complication 3 ANALYSIS
BY AGE
4
Table GROUP
COMPLICATION RATE BY AGE GROUP
118
{
No Complication Complication
Age Category No. of Cases No. of Cases Complication Rate
0-.9 177 30 14.5 ANALYSIS
BY AGE
5
1-1.9 338 43 11.3 ETIOLOGY
2-4.9 1,028 132 11.4
5-15.9 4,315 465 9.7
16-19.9 2,423 241 9.0
20-29.9 5,476 771 12.3
30-39.9 5,136 887 14.7 HOSPITAL
COMPARISONS
6
40-49.9 5,387 1,048 16.3
50-59.9 3,651 857 19.0
60-69.9 2,052 573 21.8
70-79.9 1,449 448 23.6
80 and Over 986 296 23.1
Subtotal 32,418 5,791 15.2 ANALYSIS OF
CANADIAN AND
Missing 886 16 1.8 INTL. RECORDS
Total 33,304 5,807 14.8
Total N = 39,111 (Excluding 2,795 cases from non TRACS users due to inconsistencies in reporting complication information)
©
79
Analysis
The most common reported complications of flame burns are pneumonia (10%), urinary tract infection (6%), and
respiratory failure (6%). Line infections occur in flame burns at a rate of 2%. Excisional debridement and skin grafting
are the most common procedures performed on flame burns occurring at a rate of 19% and 13% respectively.
1
Table
119
{

ANALYSIS OF
CONTRIBUTING
Pneumonia 1753 10.3 4.5
2
HOSPITALS Urinary Tract Infection 1065 6.2 2.7
ANALYSIS OF ALL US Wound Infection 835 4.9 2.1
RECORDS
3
ANALYSIS Total Complications 17,045
BY AGE
4
GROUP Total N = 39,111 (Excluding 2,795 cases from non TRACS users due to inconsistencies in reporting complication information)
Table
TOP TEN PROCEDURES
120
{
ANALYSIS
BY AGE
5
ETIOLOGY
HOSPITAL
COMPARISONS 86.28 Nonexcisional debridement of wound, infection or burn 8,842 5.6
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
38.93 Venous catheterization, not elsewhere classified
93.57 Application of other wound dressing
38.91 Arterial catheterization
86.65 Heterograft to skin
86.67 Dermal regenerative graft
99.04 Transfusion of packed cells
8,309
5,812
4,424
3,825
3,768
3,660
5.3
3.7
2.8
2.4
2.4
2.3
Total N = 41,906
©
80
Analysis
The average length of stay for all flame burns is 13 days (13 days for survivors and 17 days for non-survivors).
When flame burns are stratified by the presence of smoke inhalation, the length of stay obviously increases (25 days with
smoke inhalation and 11 days without). Flame burns with smoke inhalation that survive have an average length of stay
of 28 days while those that die have a length of stay of 15 days. When flame burns are stratified by %TBSA, the sur-
vivors obviously have an increasing length of stay as burn size increases, ranging from 6 days for burn size of 0-9 % to
158 days for burn size > 90%.
Table
1
{
Total Lived Dead ANALYSIS OF

CONTRIBUTING
2
Inhalation Injury Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM HOSPITALS
No 33,550 10.87+0.10 32,254 10.51+0.09 1,296 19.62+0.78
Yes 6,628 24.81+0.42 4,971 28.20+0.51 1,657 14.72+0.66
Subtotal 40,178 37,225 2,953
Missing 1,728 13.43+0.58 1,615 13.40+0.60 113 13.93+2.44 ANALYSIS OF ALL US
RECORDS
3
TOTAL 41,906 38,840 3,066
Total N = 41,906
ANALYSIS
Table BY AGE
4
HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP (%TBSA) GROUP
122
{
Total Lived Dead

% TBSA Cases Mean +/- SEM Cases Mean +/- SEM Cases Mean +/- SEM
ANALYSIS
0.1 - 9.9 20,769 5.99+0.07 20,563 5.91+0.07 206 14.67+1.25 BY AGE
5
ETIOLOGY
10 - 19.9 8,518 13.84+0.16 8,170 13.49+0.15 348 22.11+1.36
20 - 29.9 3,317 24.36+0.39 2,975 24.84+0.41 342 20.17+1.30
30 - 39.9 1,712 35.38+0.71 1,374 38.77+0.76 338 21.65+1.64
40 - 49.9 1,006 43.32+1.14 735 52.30+1.29 271 19.07+1.62
50 - 59.9 639 45.68+1.68 382 64.90+2.03 257 17.18+1.79 HOSPITAL
COMPARISONS
6
60 - 69.9 485 50.14+2.37 248 80.06+3.17 237 18.94+2.08
70 - 79.9 346 40.18+3.03 120 92.87+5.62 226 12.20+1.63
80 - 89.9 313 38.87+3.65 82 114.98+8.88 231 12.18+1.67
> 90 329 21.27+3.30 31 157.89+21.06 298 7.98+1.53
Subtotal 37,434 13.74+0.11 34,680 13.48+0.12 2,754 17.04+0.51 ANALYSIS OF
Missing or 0% 4,472 8.36+0.25 4,160 7.91+0.23 312 14.16+1.83 CANADIAN AND
INTL. RECORDS
TOTAL 41,906 38,840 3,066
Total N = 41,906
©
81
Analysis
When the burns are stratified by age, mortality rate increases above 50% for burn size > 60%TBSA with and with-
out smoke inhalation for those under 60 years of age (54% and 66% respectively). In the older age group (> 60 years)
mortality is above 50% for burn size 40-60 %TBSA when smoke inhalation injury is absent.When smoke inhalation is
present, the mortality is above 50% for smaller burn sizes of 20-40 %TBSA.
Table
MORTALITY RATE FOR MATRIX OF MAIN PREDICTORS
123
{
1
TBSA Category Age Inhalation Injury Lived Died Mortality Rate
0.1-19.9 0-59.9 No 21660 63 0.3
0.1-19.9 0-59.9 Yes 1843 89 4.6
0.1-19.9 60 and Over No 3065 225 6.8
ANALYSIS OF 0.1-19.9 60 and Over Yes 517 150 22.5
CONTRIBUTING
2
HOSPITALS 20-39.9 0-59.9 No 2830 108 3.7
20-39.9 0-59.9 Yes 822 164 16.6
20-39.9 60 and Over No 355 215 37.7
20-39.9 60 and Over Yes 124 168 57.5
ANALYSIS OF ALL US 40-59.9 0-59.9 No 599 106 15.0
RECORDS
3
40-59.9 0-59.9 Yes 390 185 32.2
40-59.9 60 and Over No 33 98 74.8
40-59.9 60 and Over Yes 24 116 82.9
60 and Over 0-59.9 No 208 251 54.7
ANALYSIS 60 and Over 0-59.9 Yes 225 440 66.2
BY AGE
4
GROUP 60 and Over 60 and Over No 6 101 94.4
60 and Over 60 and Over Yes 3 141 97.9
TOTAL 32,704 2,620 7.4
ANALYSIS Total N = 35,324 (Excluding 6,582 Unknown/Missing)

BY AGE
5
ETIOLOGY
HOSPITAL
COMPARISONS
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
©
82
Analysis
When flame burns are stratified by gender and BAUX Score, there is no significant difference in mortality in males
and females with BAUX scores <30 and >120. Flame burns are more common among males (77%) versus females
(23%). Interestingly, there appears to be a survival advantage of men over woman for all BAUX scores between 30–120
(exception BAUX 90-99.9).The reason for this difference due to gender should be investigated further.
Figure Female
74 Male
{
100%
80%
1
60%
ANALYSIS OF
CONTRIBUTING
2
40% HOSPITALS
20%
ANALYSIS OF ALL US
RECORDS
3
0-9.9 10- 20- 30- 40- 50- 60- 70- 80- 90- 100- 110- 120- 130- 140
19.9 29.9 39.9 49.9 59.9 69.9 79.9 89.9 99.9 109.9 119.9 129.9 139.9 +
Table
NUMBER OF CASES IN BAUX SCORE CATEGORIES BY GENDER
124 ANALYSIS
{
BY AGE
4
GROUP
Female Male
0-9.9 570 5 883 11
10-19.9 681 4 2,680 13
ANALYSIS
20-29.9 961 9 4,581 21 BY AGE
5
30-39.9 1,046 21 4,439 25 ETIOLOGY
40-49.9 1,209 30 4,667 49

50-59.9 1,228 36 4,250 66
60-69.9 920 59 3,064 113
70-79.9 720 95 2,052 157
HOSPITAL
80-89.9 530 148 1,272 190 COMPARISONS
90-99.9
100-109.9
110-119.9
120-129.9
130-139.9
140 and Over
Total
324
91
33
13
2
0
8,328
130
136
115
74
61
112
1,035
639
292
100
29
9
3
28,960
270
242
230
186
153
187
1,913
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
©
83
Analysis
by Etiology Scald Injuries
Scald injury is another significant cause of morbidity and mortality. Most scald burns are non-work related accidents
(75%), and 81% of these injuries occur in the home.
Figure Table
125
{
Circumstance of Injury No. of Cases
1
Circumstance Accident, Non-Work Related 19,940
of Injury
Accident, Non- Accident, Work Related 3,477
Work Related
(74.5%)
Accident, Work Accident, Unspecified 1,033
Related (13.0%)
Accident,
Unspecified Other 881
(3.9%)
ANALYSIS OF
Other (3.3%)
CONTRIBUTING Suspected Child Abuse 757
2
Suspected Child
HOSPITALS Abuse (2.8%)
Suspected Suspected Assualt/Abuse 423
Assualt/Abuse
(1.6%)
Accident, Accident, Recreation 207
Recreation
(0.8%)
Suspected Self Suspected Self Inflicted 41
Inflicted (0.2%)
ANALYSIS OF ALL US Suspected
Arson (0.0%)
Suspected Arson 1
RECORDS
3
Unknown 3,393
ANALYSIS
BY AGE
4
GROUP
76 E849 CODE E849 CODE 126
{
{
Place of Occurrence No. of Cases
ANALYSIS
BY AGE Place of Home 21,867
5
ETIOLOGY Occurrence -
E849 Code
Industrial 2,142
Home (80.8%)
Industrial (7.9%)
Public Building Public Building 956
(3.5%)
Other Specified Other Specified Place 882
Place (3.3%)
Street/Highway
HOSPITAL (2.4%) Street/Highway 661
COMPARISONS Residential
6
Institution
(1.1%) Residential Institution 301
Recreation and
Sport (0.7%)
Farm (0.1%)
Recreation and Sport 202
Mine/Quarry
(0.0%) Farm 36
Mine/Quarry 1
ANALYSIS OF
CANADIAN AND
INTL. RECORDS
Unspecified 3,105
©
84
Analysis
The overall complication rate for scald injury is 6% and is significantly less than fire related burns. Different from
flame injury, there is a linear increase in the rate of complications as age increases.The complication rate increases from
3.5% in the 0-9 year group to 21% in those over 80.
Figure
{
20%
1
20%
Complication
15%
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
10%
5%
ANALYSIS OF ALL US
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

80+
Total N = 27,433 (Excluding 2,720 cases from non TRACS users due to inconsistencies in reporting complication 3 ANALYSIS
BY AGE
4
Table GROUP
127
{
0-.9 1,896 72 3.7 ANALYSIS
BY AGE
5
1-1.9 4,835 178 3.6 ETIOLOGY
2-4.9 3,172 160 4.8
5-15.9 2,766 71 2.5
16-19.9 1,113 42 3.6
20-29.9 3,022 162 5.1
30-39.9 2,682 207 7.2 HOSPITAL
COMPARISONS
6
40-49.9 2,662 247 8.5
50-59.9 1,696 194 10.3
60-69.9 897 131 12.7
70-79.9 571 101 15.0
80 and Over 439 117 21.0
Subtotal 25,751 1,682 6.1 ANALYSIS OF
CANADIAN AND
Missing 530 5 0.9 INTL. RECORDS
Total 26,281 1,687 6.0
©
85
Analysis
The most common complications in scald patients are cellulitis/wound infection (24%), urinary tract infection
(11%), and pneumonia (6%). Line infection is not usually seen in scalds. Excisional debridement and skin grafting are the
most common procedures performed on scald burns, occurring at a rate of 23% and 15% respectively.
Table
128
{
1 ANALYSIS OF
CONTRIBUTING
Top Ten Complications Count
Cellulitis/traumatic Injury
Urinary Tract Infection
Wound Infection
Pneumonia
521
329
211
190
% of All Complications
16.8
10.6
6.8
6.1
% of Patients with Complication
1.9
1.2
0.8
0.7
2
HOSPITALS
Fluid/electrolyte 73 2.4 0.3
ANALYSIS OF ALL US
RECORDS Renal Failure 73 2.4 0.3
3 ANALYSIS
BY AGE
Arrhythmia
Total Complications
Table
72
3,096
2.3 0.3
4
GROUP TOP TEN PROCEDURES
129
{

86.22 Excisional debridement of wound, infection, or burn 10301 22.9
ANALYSIS
BY AGE 86.69 Other skin graft to other sites 6899 15.3
5
ETIOLOGY
HOSPITAL
COMPARISONS 38.93 Venous catheterization, not elsewhere classified 1365 3.0
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
86.65 Heterograft to skin
86.62 Other skin graft to hand
86.6 Free skin graft
Total N = 30,153
1152
910
650
2.6
2.0
1.4
©
86
Analysis
The average length of stay for all scald burns is 7 days (7 days for survivors and 20 days for non-survivors). When
scald burns are stratified by %TBSA, the survivors obviously have an increasing length of stay as burn size increases rang-
ing from 5 days for burn size of 0-9% to 55 days for burn size >90%.
Table
HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP (%TBSA)
130
{
% TBSA
0.1 - 9.9
10 - 19.9
Cases
20,754
5,102
Total
Mean +/- SEM
4.98+0.05
9.42+0.13
Cases
20,702
5,032
Lived
Mean +/- SEM
4.91+0.04
9.25+0.13
Cases
52
70
Dead
Mean +/- SEM
30.25+5.87
21.9+2.62
1 ANALYSIS OF
CONTRIBUTING
2
20 - 29.9 1,160 16.62+0.40 1,106 16.39+0.39 54 21.18+3.28 HOSPITALS
30 - 39.9 383 25.94+1.14 352 26.99+1.13 31 14.03+5.37

40 - 49.9 133 34.62+2.47 112 38.71+2.72 21 13.04+3.21
50 - 59.9 60 40.65+4.46 47 47.72+5.07 13 15.07+5.12
ANALYSIS OF ALL US
60 - 69.9 34 44.26+9.08 24 59.58+11.47 10 7.5+2.77 RECORDS
70 - 79.9
80 - 89.9
> 90
Subtotal
Missing or 0%
21
9
14
27,670
2,483
53.47+14.52
38.33+15.93
21.35+9.25
6.90+0.06
5.11+0.18
11
4
5
27,395
2,469
83.72+23.28
76.00+25.55
54.6+18.56
6.77+0.06
5.06+0.18
10
5
9
275
14
20.2+9.36
8.2+3.45
2.88+1.13
19.99+1.68
12.85+4.95
3 ANALYSIS
BY AGE
4
GROUP
TOTAL 30,153 29,864 289
Total N = 30,153
ANALYSIS
BY AGE
5
ETIOLOGY
HOSPITAL
COMPARISONS
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
©
87
Analysis
When scald burns are stratified by BAUX Score, there is no apparent advantage in survival due to gender. It is inter-
esting that the distribution of scald burns is more balanced than in flame burns (41% female to 59% male).
Figure Female
78 Male
{
1
80%
60%
ANALYSIS OF 40%
CONTRIBUTING
2
HOSPITALS
20%
ANALYSIS OF ALL US
0-9.9 10- 20- 30- 40- 50- 60- 70- 80- 90- 100- 110
RECORDS 19.9 29.9 39.9 49.9 59.9 69.9 79.9 89.9 99.9 109.9 +
3
Table
NUMBER OF CASES IN BAUX SCORE CATEGORIES BY GENDER
131
{
ANALYSIS
BY AGE
4
GROUP
Female Male
0-9.9 3,180 2 4,354 2
10-19.9 2,339 2 2,964 4

ANALYSIS
BY AGE 20-29.9 1,427 3 2,276 4
5
ETIOLOGY
30-39.9 1,203 4 1,963 3
40-49.9 1,199 5 1,984 6
50-59.9 915 3 1,514 12
HOSPITAL 60-69.9 593 9 947 9

COMPARISONS
6
70-79.9 462 14 515 28
80-89.9 364 10 246 20
90-99.9 173 25 99 11
100-109.9 43 28 25 21
ANALYSIS OF
CANADIAN AND
110- and Over 8 26 12 27
INTL. RECORDS
Total 11,906 131 16,899 147
©
88
Analysis
by Etiology Contact with Hot Object Injuries
Most contact burns are non-work related accidents (71%), and 72% of these injuries occur in the home.
Figure Table
132
{
{
Circumstance
of Injury
Accident, Non-
Work Related
(71.4%)
Accident, Work
Circumstance of Injury
Accident, Non-Work Related
Accident, Work Related
Accident, Recreation
No. of Cases
5,448
732
575
1 ANALYSIS OF
CONTRIBUTING
2
Related (9.6%)
Accident, HOSPITALS
Recreation
(7.5%) Other 430
Other (5.6%)
Accident,
Unspecified Accident, Unspecified 241
(3.2%)
Suspected Child
Abuse (1.6%) Suspected Child Abuse 121
Suspected ANALYSIS OF ALL US
Assualt/Abuse RECORDS
Suspected Assualt/Abuse 57
3
(0.7%)
Suspected Self
Inflicted (0.3%)
Suspected Self Inflicted 25
Unknown 907
Total N = 7,629 (Excluding 907 Unknown/Missing) Total 8,536

ANALYSIS
BY AGE
4
GROUP
80 E849 CODE E849 CODE 133
{
Place of Occurrence
{
No. of Cases
ANALYSIS
Place of Home 5,424
Occurrence - BY AGE
5
E 849 Code ETIOLOGY
Home (71.7%)
Street/Highway 559
Street/Highway
(7.4%) Industrial 532
Industrial (7.0%)
Recreation and
Sport (6.3%) Recreation and Sport 478
Other Specified
Place (4.7%) Other Specified Place 355 HOSPITAL
Public Building COMPARISONS
6
(1.9%)
Residential Public Building 146
Institution
(0.5%)
Farm (0.4%)
Residential Institution 37
Mine/Quarry
(0.0%) Farm 30
Mine/Quarry 1
ANALYSIS OF
CANADIAN AND
Unspecified 974 INTL. RECORDS
©
89
Analysis
The overall complication rate for contact burns is 4.5%. In contrast to flame injury, and like scalds, there is an in-
creasing rate of complications stratified by age. Complication rates range from 1% in 0-0.9 year olds to 22% in those
with age > 80.
Figure
{
1
25%
20%
Complication
ANALYSIS OF
CONTRIBUTING
15%
2
HOSPITALS
10%
ANALYSIS OF ALL US
5%
RECORDS
3 ANALYSIS
BY AGE
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

80+
Total N = 7,603 (Excluding 933 cases from non TRACS users due to inconsistencies in reporting complication
4
GROUP Table
134
{
ANALYSIS 0-.9 753 12 1.6
BY AGE
5
ETIOLOGY 1-1.9 1,702 15 0.9
2-4.9 980 14 1.4
5-15.9 750 23 2.0
16-19.9 254 17 6.3
20-29.9 650 41 5.9
HOSPITAL 30-39.9 590 36 5.8
COMPARISONS
6
40-49.9 623 45 6.7
50-59.9 465 41 8.1
60-69.9 209 32 13.3
70-79.9 137 34 19.9
80 and Over 141 39 21.7
ANALYSIS OF Subtotal 7,254 349 4.6
CANADIAN AND
INTL. RECORDS Missing 92 1 1.1
Total 7,346 350 4.5
Total N = 7,696 (Excluding 840 cases from non TRACS users due to inconsistencies in reporting complication information)
©
90
Analysis
The most common complications in scald patients are cellulitis/wound infection (26%), all other infections (10%),
and respiratory failure (3.5%). In the broad category of other infections, pneumonia and urinary tract infections are each
responsible for 3% of complications. Line infection is not a commonly reported complication of contact burns. Exci-
sional debridement and skin grafting are the most common procedures performed on contact burns, occurring at a rate
of 24% and 15% respectively.
Table
135
{
Top Ten Complications

Cellulitis/traumatic Injury
Wound Infection
Other Infection
Pneumonia
Count
92
65
27
21
15.2
10.7
4.5
3.5
1.1
0.8
0.3
0.2
1 ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
Other Musculoskeletal/integumentary 15 2.5 0.2
ANALYSIS OF ALL US
Arrhythmia 14 2.3 0.2 RECORDS
Renal Failure
Total Complications
13
605
2.1 0.2
Total N = 7,696 (Excluding 840 cases from non TRACS users due to inconsistencies in reporting complication information) 3 ANALYSIS
BY AGE
4
GROUP
Table
TOP TEN PROCEDURES
136
{
ANALYSIS
BY AGE
5
Top Ten Procedures Codes Count % of All Procedures ETIOLOGY
COMPARISONS
6
86.62 Other skin graft to hand 405 2.0
38.93 Venous catheterization, not elsewhere classified 367 2.7
86.91 193 1.4 ANALYSIS OF
CANADIAN AND
86.6 Free skin graft 177 1.3 INTL. RECORDS
Total N = 8,536
©
91
Analysis
The average length of stay for all contact burns is 6 days (6 days for survivors and 17 days for non-survivors). Con-
tact burns commonly involve a small surface area with 94% involving less than 10%TBSA.There were no contact burns
reported above 60% TBSA (13 with 30-39%, 1 with 40-49%, 1 with 50-59%).They are associated with less mortality
(1%) in all age groups.
Table
HOSPITAL DAYS: LIVED/DIED BY BURN SIZE GROUP (%TBSA)
137
{
1 ANALYSIS OF
CONTRIBUTING
% TBSA
0.1 - 9.9
10 - 19.9
20 - 29.9
Cases
7,228
364
52
Total
Mean +/- SEM
5.43+0.15
15.72+0.80
18.90+2.43
Cases
7,186
341
46
Lived
Mean +/- SEM
5.35+0.15
15.92+0.83
19.65+2.58
Cases
42
23
6
Dead
Mean +/- SEM
18.46+3.11
12.91+3.48
13.16+7.56
2
HOSPITALS
30 - 39.9 13 28.76+6.93 10 35.1+7.89 3 7.66+5.23
40 - 49.9 1 51 1 51 0 .
50 - 59.9 1 82 0 . 1 82
60 - 69.9 0 . 0 . 0 .
ANALYSIS OF ALL US 70 - 79.9 0 . 0 . 0 .
RECORDS
3
80 - 89.9 0 . 0 . 0 .
> 90 1 1 0 . 1 1
Subtotal 7,660 6.07+0.15 7,584 5.96+0.15 76 16.52+2.29
Missing or 0% 876 5.80+0.30 866 5.73+0.30 10 11.9+4.28
TOTAL 8,536 8,450 86
ANALYSIS
BY AGE
4
GROUP Total N = 8,536
ANALYSIS
BY AGE
5
ETIOLOGY
HOSPITAL
COMPARISONS
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
©
92
Analysis
by Etiology Electrical Injuries
Electrical injury can be devastating if it is a high voltage and relatively benign if it is from a low voltage source.The
spectrum of electrical injury is included in this stratification and this must be considered when viewing this data. As ex-
pected, most electrical injuries are work-related accidents (63%) and occur at an industrial setting 44% of the time.
Figure Table
138
{
{
Place of
Occurrence -
E 849 Code
Industrial
(43.6%)
Home (24.5%)
Circumstance of Injury
Accident, Work Related
Accident, Non-Work Related
Accident, Unspecified
No. of Cases
2,178
974
114
1 ANALYSIS OF
CONTRIBUTING
2
Other Specified HOSPITALS
Place (12.9%)
Street/Highway
(9,2%) Other 96
Public Building
(4.7%)
Recreation and
Accident, Recreation 64
Sport (3.0%)
Farm (1.0%) Suspected Self Inflicted 16
Residential ANALYSIS OF ALL US
Institution
RECORDS
(0.8%) Suspected Assualt/Abuse 2
3
Mine/Quarry
(0.3%)
Suspected Child Abuse 1
Unknown 367

ANALYSIS
BY AGE
4
GROUP
83 E849 CODE E849 CODE 139
{
Place of Occurrence
{
No. of Cases
ANALYSIS
Circumstance Industrial 1,388
of Injury BY AGE
5
ETIOLOGY
Accident, Work
Related (63.2%) Home 781
Accident, Non-
Work Related Other Specified Place 411
(28.3%)
Accident,
Unspecified Street/Highway 294
(3.3%)
Other (2.8%)
Accident,
Public Building 149 HOSPITAL
COMPARISONS
6
Recreation
(1.9%) Recreation and Sport 96
Suspected Self
Inflicted (0.5%)
Suspected Farm 31
Assualt/Abuse
(0.1%)
Suspected Child
Residential Institution 26
Abuse (0.0%)
Mine/Quarry 8
ANALYSIS OF
CANADIAN AND
Unspecified 628 INTL. RECORDS
©
93
Analysis
Electrical injury occurs most commonly in males between 30-39.9 years of age.Approximately 9% of patients with
electrical injuries experience complications.When complications are stratified by age, a bimodal distribution is evident
with peaks at ages 16-29.9 (12%) and 50-59.9 (10%).
Figure
{
1 12%
% of Patients with a Clinically
10%
Related Complication
8%
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS 6%
4%
2%
ANALYSIS OF ALL US
RECORDS
3
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
Total N = 3,004 (Excluding 808 cases from non TRACS users due to inconsistencies in reporting complication
ANALYSIS Table
BY AGE COMPLICATION RATE BY AGE GROUP
140
4
GROUP
{
ANALYSIS 0-.9 15 1 6.2
BY AGE
1-1.9 49 2 3.9
5
ETIOLOGY
2-4.9 118 1 0.8
5-15.9 185 25 11.9
16-19.9 102 14 12.1
HOSPITAL
20-29.9 546 75 12.1
COMPARISONS 30-39.9 638 67 9.5
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
40-49.9
50-59.9
60 and Over
Subtotal
Missing
Total
639
326
101
2,719
53
2,772
55
35
10
285
0
285
7.9
9.7
9.0
9.5
0.0
9.3
©
94
Analysis
Pneumonia (9%), wound infection (8%), and compartment syndrome (6%) are the three most common complica-
tions. Interestingly, renal failure was not reported as one of the top ten complications. Low incidence of renal failure
may be due to the increased attention to fluid management at burn centers in recent years. Excisional debridement and
skin grafting are the most common procedures performed on electrical burns, occurring at a rate of 18% and 10% re-
spectively.
Table
141
{
Top Ten Complications Count

Pneumonia
Wound Infection
Compartmental Syndrome
63
53
42
9.1
7.7
6.1
2.1
1.7
1.4
1 ANALYSIS OF
CONTRIBUTING
2
Cellulitis/traumatic Injury 41 5.9 1.3 HOSPITALS

Arrhythmia 28 4.1 0.9 ANALYSIS OF ALL US
RECORDS
3
ANALYSIS
BY AGE
4
GROUP
Table
TOP TEN PROCEDURES
142
{
ANALYSIS
Top Ten Procedures Codes Count % of All Procedures BY AGE
5
ETIOLOGY
86.28 Nonexcisional debridement of wound, infection or burn 573 5.0 HOSPITAL
COMPARISONS
38.93 Venous catheterization, not elsewhere classified 406 3.6
93.57 Application of other wound dressing
86.62 Other skin graft to hand
99.04 Transfusion of packed cells
38.91 Arterial catheterization
86.6 Free skin graft
389
257
233
205
182
3.4
2.3
2.0
1.8
1.6
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
Total N = 3,812
©
95
Analysis
Electrical burns are clearly a disease affecting the male gender.This is likely due to the high number of men em-
ployed as electricians or construction workers.
1
Figure Female
FREQUENCY OF RECORDS BY AGE CATEGORIES AND GENDER
85 Male
{
ANALYSIS OF 1,000
CONTRIBUTING
2
HOSPITALS
800
600
Cases
ANALYSIS OF ALL US
RECORDS
3
400
200
ANALYSIS 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+
BY AGE
4
GROUP
Age Categories
Total N = 3,747 (Excluding 65 Unknown/Missing)
ANALYSIS
BY AGE
5
ETIOLOGY
HOSPITAL
COMPARISONS
6ANALYSIS OF
CANADIAN AND
INTL. RECORDS
©
96
5 Hospital
Comparisons
The analysis on the next three pages provides that the rates and means are unadjusted and thus do not
outcomes comparisons for fire/flame injuries take into consideration other patient characteristics that
across burn centers. The figures compare unadjusted have been widely accepted to impact outcomes like in-
mortality rate, unadjusted length of stay, and unadjusted halation injury and age.Without proper ‘risk-adjustment’,
charges by burn centers. Furthermore, the burn centers hospital comparison analysis has limited actionable value.
are grouped into categories based on annual volume cal- Additionally, remain aware that the inherent data quality
culated using data submitted to the NBR in 2005-2008. issues of unaudited and non-standardized registry data
Low volume centers reported an average of fewer than would undermine any strong conclusions (some facilities
100 initial admissions a year (n=13), medium volume reported over 600 cases without a mortality).
centers reported an average of 100-299 initial admissions Despite these limitations there is still value in the figures
a year (n=36), and high volume centers reported volume that follow.The value is twofold:1) stimulate the burn care
of 300 or more initial admissions a year (n=21). Burn research community to drive the understanding of vari-
centers were not included in this analysis if they did not ability in burn care, and 2) motivate burn centers to rein-
submit data between 2005-2008 and if they had fewer vigorate their focus on data quality so when risk-adjusted
than 100 cases with valid data given the variables of inter- analyses are properly conducted, strong conclusions can be
est. It should be noted that to protect against burn center made.A variety of other sectors in the American health-
identification, all burn center identifiers were removed care system are actively utilizing hospital comparisons to
from this analysis, making it impossible to connect the re- drive quality improvement projects and making these
sults to any given burn center. comparisons public.Although they represent only the be-
When interpreting the figures, one should be aware ginning, these analyses are a step in that direction.
©
99
Hospital
Comparisons
Figure 86 compares burn center mortality rates in fire/flame cases admitted between 2005 and 2008.The esti-
mated mortality rate for each hospital is accompanied with 95% confidence intervals which are represented by the red
lines extending from the red diamond. Each blue bar represents the mean percent TBSA for fire/flame cases from one
burn center during the corresponding time frame.The left y-axis provides the scale percent TBSA and the right y-axis
provides the scale for mortality rate. Data from an additional 18 reporting centers since last year strengthens the data in
the low and medium volume centers: low volume centers went from 6 to 13 reporting centers, and medium volume
centers increased from 26 to 36.The tempting conclusions that could be drawn from this analysis are overshadowed by
the unaudited data entered into the database at each center. However, it is clear that variability in unadjusted mortality
rates do exist across burn centers, with one or two outliers in each volume grouping.
Mortality Percentage with 95% Cl
1 35
30
25
20
15
10
0
Mortality Rate
Mean TBSA
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
HIGH VOLUME
2005-2008 FIRE/FLAME INJURIES -- MORTALITY RATE
ANALYSIS OF ALL US
RECORDS
3
Total N = 20,523
ANALYSIS
Facilities
BY AGE
4
GROUP
MEDIUM VOLUME
ANALYSIS
BY AGE
5
ETIOLOGY
{
Figure
86
HOSPITAL
COMPARISONS
6
LOW VOLUME
ANALYSIS OF
100
90
80
70
60
50
40
30
20
10
CANADIAN AND
INTL. RECORDS Mean Percent Total Burn Surface Area
©
100
Hospital
Comparisons
Figure 87 compares mean hospital charges for fire/flame cases admitted between 2005 and 2008 across burn
centers with data in the NBR.There are fewer burn centers in this analysis (n=30) because some centers do not
report charge information.The relatively low mean charges for the high volume centers may be attributable to
the fact that cost outliers are mitigated by the higher volume. However, there is also the possibility that the high
volume centers are more cost effective per person. One very consistent finding from year to year is that there
does not seem to be a relationship between charges and mean TBSA.
Mean Hospital Charges with 95% Cl

$600,000
$500,000
$400,000
$300,000
$200,000
$100,000
Mean Charges
Mean TBSA
1
HIGH VOLUME
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
2005-2008 FIRE/FLAME INJURIES -- MEAN CHARGES
ANALYSIS OF ALL US
RECORDS
Facilities
Total N = 6,773
3 ANALYSIS
BY AGE
4
GROUP
MEDIUM VOLUME
ANALYSIS
BY AGE
5
ETIOLOGY
{
Figure
87
HOSPITAL
COMPARISONS
6
LOW VOLUME
ANALYSIS OF
CANADIAN AND
INTL. RECORDS
100
90
80
70
60
50
40
30
20
10
Mean Percent Total Burn Surface Area
©
101
Hospital
Comparisons
Figure 88 compares mean hospital length of stay for fire/flame cases admitted between 2005 and 2008 across burn
centers with data in the NBR.The range of mean length of stays across each burn center admission volume category
seem to be roughly equivalent.
Mean Length of Stay with 95% Cl
1
35
30
25
20
15
10
5
Mean TBSA
Mean LOS
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
HIGH VOLUME
2005-2008 FIRE/FLAME INJURIES -- MEAN LENGTH OF STAY
ANALYSIS OF ALL US
RECORDS
3
Total N = 20,523
ANALYSIS
Facilities
BY AGE
4
GROUP
MEDIUM VOLUME
ANALYSIS
BY AGE
5
ETIOLOGY
{
Figure
88
HOSPITAL
COMPARISONS
6
LOW VOLUME
ANALYSIS OF
100
90
80
70
60
50
40
30
20
10
CANADIAN AND
INTL. RECORDS Mean Percent Total Burn Surface Area
©
102
Analysis
of Canadian
and International Records
6
This year’s NBR report includes 1,938 cases from More than 60% of the 40,000 U.S. hospitalizations
3 Canadian and 1 international burn center. Despite for burn injury each year are now admitted to the
being the 9th largest country, just ahead of the United 125 hospitals with specialized burn centers. Burn
States in land area, Canada is the world’s 41’st most centers now average 200 such admissions a year,
populated with 33,212,696 residents (July 2008 est.) while the other 5,000 US hospitals average less than
after Morocco (38) Algeria (39) and Afghanistan (40). three burn admissions per year.The ABA has more
Comparisons between countries are obviously con- than 3,500 members in the United States, Canada,
trary to the overriding message of the NBR; however Europe, Asia, and Latin America, and Canadian burn
there seems to have been enough data submitted to centers are represented by a special interest group
the NBR to arrive at some generalizations. during the annual meeting of the ABA.We would
encourage all participating burn centers to submit
There are a total of 1938 cases available for analysis their registry data to the NBR.
in this 10 year period.The number of cases per year
remained steady through 2005, with a sharp up tick in
the last three years.
Analysis
of Canadian and International Records
The data in figure 89 is remarkably similar to that in the last report. Interestingly the burn incidence by age group and
gender shows a marked skew towards females younger than 5 years of age. More than 19% of all burns in women occur be-
fore the age of 5, while only 7% of male burns occur in the same years.This discrepancy also occurs in the USA data analy-
sis, but not as strongly.This is likely the result of the increased incidence of burns occurring in men during high-risk
behaviors during the middle years. 24% of all burns occurred in women as compared with 31% of cases in the USA.
Figure Female
AGE GROUP BY GENDER
89 Male
{
300
1 200
Cases
ANALYSIS OF
CONTRIBUTING
2
HOSPITALS
100
ANALYSIS OF ALL US 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+
RECORDS
3 ANALYSIS 143
Table
AGE GROUP BY GENDER
Age Categories
Total N = 1,935 (Excluding 3 unknown/missing)
{
BY AGE
4
GROUP
Gender
Total Female Male
Age Categories Count Column N % Count Column N % Count Column N %
0-.9 28 1.4 16 3.4 12 .8
ANALYSIS
BY AGE
1-1.9 86 4.4 35 7.5 51 3.5
5
ETIOLOGY 2-4.9 78 4.0 38 8.2 40 2.7
5-15.9 175 9.0 36 7.8 139 9.4
16-19.9 137 7.1 28 6.0 109 7.4
20-29.9 327 16.9 62 13.4 265 18.0
30-39.9 267 13.8 39 8.4 228 15.5
HOSPITAL
COMPARISONS
40-49.9 347 17.9 83 17.9 264 17.9
6
50-59.9 241 12.4 58 12.5 183 12.4
60-69.9 129 6.7 27 5.8 102 6.9
70-79.9 78 4.0 24 5.2 54 3.7
80 and over 42 2.2 17 3.7 25 1.7
Subtotal 1,935 99.8 463 99.8 1,472 99.9
ANALYSIS OF
CANADIAN AND Missing 3 .2 1 .2 2 .1
INTL. RECORDS Total 1,938 100 464 100 1,474 100
Total N = 1,938
©
106
Analysis
of Canadian and International Records
Burn etiology is likewise similar between other countries and the USA. Fire/flame (53%), scald (24%), and electrical
injury (5%) make up the majority of injuries. Mortality rate as shown in table 145 has not changed over time. Overall
mortality is 3.4% with a range from 2.1% to 4.9%. Mortality is very comparable to that reported by the USA participat-
ing burn centers.There was one survivor in the >90% TBSA burn category and data was missing in 7 cases.
Figure Table
144
{
{
1
E tiology
Fire/F lame
(53.4% )
S cald (24.1% )
Fire/Flame 943
E lectrical Scald 431
(5.6% )
Contact with Electrical 104
Hot Object
(5.4% )
Contact with Hot Object 99 ANALYSIS OF
Chemical CONTRIBUTING
2
(3.4% )
Other, Non Chemical 64 HOSPITALS
B urn (3.3% )
B urn, Other, Non Burn 60
Unspecified
(2.8% ) Burn, Unspecified 49
S kin Disease
(1.3% ) Skin Disease 24
Radiation
(0.2% ) Inhalation Only 3 ANALYSIS OF ALL US
RECORDS
3
Radiation 2
Unknown 159
Total N = 1,779 (Excluding 159 unknown/missing) Total 1,938
ANALYSIS
Table Table BY AGE
4
LIVED/DIED BY BURN GROUP
LIVED/DIED BY ADMISSION YEAR
145 GROUP SIZE (%TBSA) 146
{
%TBSA
Lived Died
No. of Cases No. of Cases Mortality Rate
Lived Died
{
Admission No. of No. of Mortality ANALYSIS
0.1 - 9.9 999 4 0.4
Year Cases Cases Rate BY AGE
5
10 - 19.9 291 8 2.7 ETIOLOGY
2002 231 8 3.3
20 - 29.9 101 3 2.9
30 - 39.9 44 7 13.7 2003 191 8 4.0
40 - 49.9 19 4 17.4
50 - 59.9 24 4 14.3 2004 208 6 2.8
HOSPITAL
60 - 69.9 12 4 25.0 COMPARISONS
6
2005 283 6 2.1
70 - 79.9 1 11 91.7
80 - 89.9 0 6 100.0 2006 493 21 4.1
> 90 1 7 87.5
Subtotal 1,492 58 3.7 2007 370 11 2.9
Missing or 0% 381 7 1.8 ANALYSIS OF
2008 97 5 4.9 CANADIAN AND
TOTAL 1,873 65 3.4 INTL. RECORDS
Total N = 1,938 Total N = 1,938
©
107
Appendix
Appendix A
Improving the data quality in the NBR has been a focal point for the past few years.The launch of
TRACS Version 5.0 has done a great deal towards 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 vari-
ables 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
• 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
• 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 because gender and reporting hospital number are required fields for a case to be included in this
analysis.The remaining variables were excluded from analysis because they are not uniformly reported by non-
TRACS users.
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110
Appendix A
Table 147 provides the count of cases with valid and missing data for a select number of variables from the mini-
mum data standard. The values for total burn size and total deep burn are potentially skewed in that previous version of
the TRACS software used 0 as a default value thus it was not know if the true TBSA was 0 or unknown. Improving the
quality of the data in the NBR should remain a focus of burn centers.
DATA COMPLETENESS BY VARIABLE

Table
147 }
Valid Missing Pct. Missing
Total deep burn (include 0 as missing) 46,945 80,071 63.0
Description of event 55,189 71,827 56.5
Interhospital transfer to hospital 72,711 54,305 42.8
Cause of Death 2,982 2,049 40.7
DRG Code 75,902 51,114 40.2
State in which injury occurred 80,124 46,892 36.9
Total ICU days 93,516 33,500 26.4
Circustances of Injury 93,690 33,326 26.2
Primary payor source 93,801 33,215 26.2
Total burn size (include 0 as missing) 94,363 32,653 25.7
Site at which injury occurred (E 849 code) 107,748 19,268 15.2
Inahaltion Injury 111,209 15,807 12.4
Year of discharge or death 117,705 9,311 7.3
Year of Injury 118,316 8,700 6.8
Etiology of injury code (E-code) 122,679 4,337 3.4
Discharge status (alive or dead) 122,939 4,077 3.2
Total Hospital Days 123,610 3,406 2.7
Patient Age 124,776 2,240 1.8
Year of arrival at reporting hosiptal 127,016 0 0.0
Hospital discharge disposition 12,7016 0 0.0
©
111
Appendix A
Figure 91 shows the mean percent of missing variables from the minimum data standard per case by admission year.
Improving record completeness remains a key performance improvement area.
DATA QUALITY EXPRESSED AS MEAN PERCENT OF MISSING VARIABLES Figure

FROM MINIMUM DATA SET PER RECORD BY ADMISSION YEAR 91 }
25
20
Percent of Missing Variables
15
10
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Admission Year
Total N= 127,016
©
112
Appendix A
Figure 92 provides the mean percent (blue box) of missing variables from the minimum data standard per case by burn
center.The light green bars represent the volume of cases included in this Annual Report from burn centers. It does not appear
that case volume is related to data quality and there is considerable variation in the data quality across burn centers.
No. of Cases
10,000
12,000
2,000
4,000
6,000
8,000
{
Figure
92
DATA STANDARD PER RECORD BY FACILITY
DATA QUALITY EXPRESSED AS MEAN PERCENT OF MISSING VARIABLES OF THE MINIMUM
Total N = 127,016
Facilities
Percent Missing
Case Volume
10
15
20
25
30
35
40
45
50
5
©
113
Appendix B
The following is a list of hospitals that have contributed to the NBR in any given year. We extend our thanks for
their contribution and ongoing support of this endeavor.
Alabama
UAB Burn Center
University of South Alabama Regional Burn and Wound Center
Arizona
Arizona Burn Center at Maricopa Medical Center
Arkansas
Arkansas Children’s Hospital Burn Center
California
Bothin Burn Center, St. Francis Memorial Hospital
Community Regional Burn Center
Inland Counties Regional Burn Center
Santa Clara Valley Medical Center Regional Burn Center
Shriners Hospital for Children, Northern California
The Grossman Burn Center
Torrance Memorial Burn Center
UC Davis Regional Burn Center
UCI Regional Burn Center
USCD Regional Burn Center
Southern California Regional Burn Center at LAC and USC Medical Center
Colorado
University of Colorado Hospital Burn Center
Western States Burn Center, North Colorado Medical Center
Connecticut
Bridgeport Hospital Burn Center
District of Columbia
The Burn Center at Washington Hospital Center
Florida
Orlando Regional Medical Center
Shands Burn Center at the University of Florida
Tampa Bay Regional Burn Center
University of Miami Jackson Memorial Burn Center
Georgia
The Joseph M. Still Burn Center
Illinois
Loyola University Medical Center
Sumner L. Koch Burn Center, Stroger Hospital
University of Chicago Burn Center
Indiana
St. Joseph’s Burn Center
Wishard Health Services
Iowa
University of Iowa Burn Center
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114
Appendix B
Kansas
Burnett Burn Center, Kansas University Hospital
Via Christi Regional Medical Center
Louisiana
Louisiana State University Health Sciences Center-Shreveport
Maryland
Johns Hopkins Bayview Medical Center, Baltimore Regional Burn Center
Massachusetts
Brigham - Women’s Hospital Burn Center
Massachusetts General Hospital
Shriners Hospital for Children, Boston
Michigan
Children’s Hospital of Michigan
Detroit Receiving Hospital Burn Center
Spectrum Health Regional Burn Center
University of Michigan Health Systems
Minnesota
Miller Dwan Burn Center
Hennepin County Medical Center Burn Center
Regions Hospital Burn Center
Mississippi
Delta Regional Medical Center
Missouri
George David Peak Memorial Burn Care Center
Nebraska
Nebraska Medical Center
St. Elizabeth Regional Burn Center
Nevada
Lion’s Burn Center, University Medical Center
New Jersey
Saint Barnabas Burn Center
New York
Clark Burn Center, University Hospital
Nassau University Medical Center
Strong Regional Burn 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, University of North Carolina Hospitals
Wake Forest University Baptist Medical Center Burn Center
Ohio
Children’s Hospital Medical Center of Akron
MetroHealth Medical Center
Nationwide Children’s Hospital
Ohio State University Medical Center
©
115
Appendix B
Shriners Hospital for Children, Cincinnati
The University Hospital Burn Center, Cincinnati
Oregon
Oregon Burn Center
Pennsylvania
Lehigh Valley Hospital Burn Center
St. Christopher’s Hospital for Children
Temple University Hospital Burn Center
The Mercy Hospital of Pittsburg Burn Center
The Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center
Western Pennsylvania Hospital Burn Center
Rhode Island
Rhode Island Hospital Burn Center
Tennessee
Erlanger Health Systems Burn Center
Firefighters Regional Burn Center
Vanderbilt University 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 Blocker Burn Center
U.S.Army Institute of Surgical Research
Utah
University of Utah Hospital Burn Center
Washington
University of Washington Burn Center, Harborview Medical Center
Wisconsin
Columbia St. Mary’s Hospital Regional Burn Center
University of Wisconsin Hospitals and Clinics
Canada and Other International Contributors

Firefighter’s Burn Treatment Unit, Edmonton,Alberta
Hamilton Firefighters Burn Unit Hamilton Health Sciences, Hamilton, Ontario
Hospital for Sick Children,Toronto, Ontario
Hotel Dieu du CHUM, Montreal, Quebec
Ross Tilley Burn Centre, Sunnybrook and Women's College Health Sciences Centre,Toronto, Ontario
Uppsala University Hospital, Uppsala, Sweden
©
116
Appendix C
SPECIAL FEATURE
From Qualitative Contemplation to Relational

Database: One Approach to Harnessing the National
Burn Repository
James C. Jeng, MD
Admittedly, trying to figure out how to actually thoracic surgery or eye surgery procedures would
complete a research project based on the ABA- be vanishingly small.
National Burn Repository (NBR) is a bit daunt- Armed with this solid visual sense of the “flat data”
ing for the first-time scholar. Once the NBR Advi- in the Ops_Access table, the galvanizing next step is
sory Committee has signed off on the feasibility of your to harness the “relational” nature of NBR data. Start
NBR query and you receive the optical disk containing to think of deeper questions only addressed by seek-
the entire database, how best to proceed? ing additional nuances, caveats, and qualifications
By example, consider one of the included tables: lurking in the web of relationships to other tables of
Ops_Access, a data table that has not been previously the database. Linking them all together is the com-
spotlighted in this series of NBR-Glimmers. As of the mon record-number “tag” found in each and every
2005 call for data, this table contained over 406,000 table.
In executing this act of data/information rela-
individual ICU and operating room procedures that
tionship, we can then tumble to many tantalizing
our burn patients have been collectively subjected to.
analyses. What link exists between the number/
It is a breathtaking amount of information and a chal-
complexity of critical care procedures and improve-
lenge to globally contemplate. Figure 1 qualitatively
ments in burn outcomes? Does analysis of trauma
summarizes the scope and diversity of procedures by and neurosurgery operations offer a handle on
representing them with my “mind’s eye” image of the epidemiology of the dreaded combined burn-
glowing orbs in the firmament of the heavens, sized trauma victim? Do patterns in prevalence of cardiac
according to prevalence of the tabulated procedures. and peripheral arterial surgery in burns reflect the
This is an abstract, psychedelic image, but it captures cardiovascular health of the general population or
the contemplative mental exercise I am suggesting, our ability to keep older patients with big burns
very aptly. alive? Do trends in the incidence and complexity of
Delving into the Ops_Access data table, start with plastic surgical procedures suggest a step-up in the
a columnar “sort by” description (right-click) to reach of our rehabilitative capabilities? What are the
group all entries of identical name. A bird’s-eye sense relative cost-benefit implications of various opera-
of the sum-total reported procedures can then be tions and procedures in the burn population?
achieved by rapid scrolling through the column’s With developed questions in hand, completion
entirety. Freshly armed with these impressions, I of your essay is a matter of constructing a Microsoft
arrived at the included imagery with procedures of Access® (Microsoft, Redmond, WA) query and
different surgical disciplines sized as icons with an then subjecting the query results to statistical anal-
appropriate “footprint”. Sensibly, these images are ysis for presence, absence, and degree of signifi-
“logarithmic” in scale. Otherwise the icons for cance. These steps are difficult (but not impossible)
to learn without hands-on coaching. A far easier
approach is to collaborate with a statistician from
your institution, or an experienced member of our
From the Washington Hospital Center, Washington DC. burn community at large—a very friendly and help-
Address correspondence to James C. Jeng, MD, Washington Hospital ful group of professionals.
Center 110 Irving St, NW, Room 3855, Washington, DC 20010.
Copyright © 2008 by the American Burn Association. Only through the relational prism of the multi-
1559-047X/2008 ple, interlocking NBR data tables can light be shed
DOI: 10.1097/BCR.0b013e31815f3887 on the most compelling and evocative questions.
117 2
©American Burn Association, National Burn Repository® 2009.Version 5.0.All Rights Reserved Worldwide.
Appendix C
Figure 1. This is an abstract “mind’s eye” interpretation of the prevalence of different procedures found in the Ops_Access table
of the NBR database. In rank order of frequency, they include: burn surgery, procedures in ICU, plastic and reconstructive,
trauma surgery, general surgery, orthopedics, eye surgery, and thoracic surgery.
The beauty, however, is that it is all there . . . sim- on these and other burn care-related topics are en-
ply for the asking. The National Burn Repository is couraged to secure permission from the American
a community asset of the American Burn Associa- Burn Association central office via Web-based ap-
tion. Those interested in pursuing scholarly work plication at http://www.ameriburn.org.
Reprinted from J Burn Care Res. 2007. Jan-Feb; 28(1): 143-4.
©
118
Appendix C
THIS PAGE INTENTIONALLY LEFT BLANK
©
119
Appendix C
SPECIAL FEATURE
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
James C. Jeng, MD, FACS,* Bart Phillips, BS†
Not since the beginning of the orchestrated National quality and move onto an era of utility beyond: “It is
Burn Repository (NBR) publicity effort last year have what it is.” This month’s write-up gives our reader-
we focused on the pressing issue of ameliorating our ship a glimpse “under the hood” at the spinning gears
quality of data. There is no better approach than to of the database before and after the roll out of version
have as guest author, B.P., who is a leading behind- 5 of the data collection software that all our member
the-scenes principal of the national database ma- burn units will be using (Figures 1 and 2).
chinery. In conclusion, this month’s write up is an effort to
Looking back at the serialized glimmers from the affirm to the readership and research users of the
NBR, the contemplative reader will notice a constant NBR that the many stewards shepherding the data-
side bar commentary on the need to improve data base take constant data quality improvement very se-
riously.
The NBR is a community asset of the American Burn
From the *Burn Center at Washington Hospital Center, Washington
DC; and †American College of Surgeons, Chicago, Illinois. Association. Those interested in pursuing scholarly
Address correspondence to James Jeng, MD, 110 Irving Street. NW, work on data quality, database process, or other burn-
Rm 3B-55, Washington DC 20010. E-mail: james.c.jeng@medstar.net care related topics are encouraged to secure permission
Copyright © 2008 by the American Burn Association.
1559-047X/2008 from the American Burn Association central office via
DOI: 10.1097/BCR.0b013e318166740f Web-based application at http://www.ameriburn.org.
National Burn Registry Submission Process

Before NTRACS Version 5.0
Ongoing October 15th thru December 2nd January 14th thru February 8th thru April and May
December 2nd thru January 14th February 8th February 29th
National Burn Registry Submission Process

After NTRACS Version 5.0
December and
January
Ongoing October thru January and April

Early December February
December and
January
Figure 1. The workflow as data is entered into the system, preened, vetted, and then warehoused. The imminent release of a
uniform data dictionary and “constrained” drop-down menus with which to populate data entry fields are big steps forward-off
this chart. Do notice, however, that with the new software, data validation (ie removing logically inconsistent entries) is moved
upstream so that illogical information never makes it into the working database.
2
©
120
Appendix C
J
Details of Data Flow for the NBR
NTRACS data loaded into main

database by DI Removal of Orphan Records
NTRACS Hospitals ABA DI
Collector and Homegrown Removal of Duplicates Records
Collector Hospitals DI TCs DI
Hospitals’ data are converted into
Flagging of Repeat Admissions
Homegrown Hospitals TCs DI standard NTRACS format by TCs
and then loaded into main Flagging of Missing Variables
database by DI
TCs perform quality control
Annual Report is distribute at National

Conference Analysis performed to support the
Annual Report
Benchmark Reports are distribute one
month after National Conference Analysis performed to support the
Benchmark Reports
ABA distributes Reports TCs perform data analysis
Figure 2. A more granular look at the processes within each node of the annual National Burn Repository (NBR) exercise.
Particularly instructive is the glimpse at the underpinnings of data validation. Most of the big categories under which “bad data”
fall are illustrated.
©
121
Appendix C
SPECIAL FEATURE
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
James C. Jeng, MD, FACS,* Jimmy Parks, MS, RN,† Bart L. Phillips, BS‡
One of the cardinal sins of statistical analysis in biomed- A “fishing expedition” would begin with Figure 1,
ical research is the “fishing expedition” for “meaningful or a similar refinement of this graphic representation
differences” in data sets. The hallmark of this ill-advised of the NBR data. Every little pattern of rise and fall
analytic exercise is to query experimental results or da- would then be grist for fitting a post hoc story to
tabase information without a prior logical hypothesis to “explain” its occurrence. There is an immediate and
test; one is only interested in finding a “P value ⬍ .05” obvious lack of intellectual honesty in this approach.
that can then have a story-line fitted in a post hoc fash- Rather, our readership is encouraged to start with
ion. We are certain that our readership is sophisticated Table 1 and choose a watershed event in the recent
to the extent that none would fall prey to this abuse of history of burn prevention to study. Render a hypoth-
the concept of statistical significance. Be that as it may, a esis that would be expected to be reflected in the
precautionary tale is worthwhile fodder for this month’s database as a result of that watershed event. Recruit a
Glimmer from the NBR (National Burn Repository). statistician collaborator and construct a much more
Jimmy Parks, current chair of the American Burn granular graphic and/or tabular analysis of the NBR
Association Prevention Committee was asked to sketch data. Then, subject your hypothesis to sensible statis-
the watershed events—both positive and negative—in tical tests of significance. Once this is done, all that
recent history vis-à-vis burn prevention (Table 1). Bart remains is to assemble a thoughtful scientific manu-
Phillips, our database research methodologist from the script surrounding the results so that the burn com-
American College of Surgeons, chimes in again with an munity at large can share in the discovery and/or
illustrative visual portrayal of the NBR data for this cur- implications.
rent essay (Figure 1). In this graph, the raw number of The request for NBR data through the American
database entries for deciles of burn injury size is simply Burn Association has some degree of safeguards built
plotted against injury year to create a three-dimensional in to avoid “fishing expeditions” by virtue of the need
topography map. to state a working hypothesis. In the end, however, it
remains the responsibility of each and every user of
From the *The Burn Center at Washington Hospital Center, our database to ensure the intellectual integrity of
Washington, DC; †The Burn Center at Arkansas Children’s their methodology and reports to the burn literature.
Hospital, Little Rock, Arkansas; ‡The American College of
Surgeons, Chicago, Illinois. The National Burn Repository is a community asset
Address correspondence to James C. Jeng, MD, FACS, Washington of the American Burn Association. Those interested in
Hospital Center, 110 Irving St. NW, Rm 3B-55, Washington, pursuing scholarly work on this and other burn care-
DC 20010. E-mail: james.c.jeng@medstar.net
Copyright © 2008 by the American Burn Association. related topics are encouraged to secure permission from
1559-047X/2008 the American Burn Association central office via Web-
DOI: 10.1097/BCR.0b013e31817108c9 based application at http://www.ameriburn.org.
Reprinted from J Burn Care Res. 2007. May-Jun; 28(3): 380-1.

4
©
122
Appendix C
J
Table 1. Recent watershed events possibly affecting the incidence of burn injuries
Fuel injectors replace carburetors By the early 1990s almost all cars sold in the United States and Canada had fuel injectors instead of
carburetors. The change was gradual, but you should see a gradual decrease in the number of large
burns related to working on an automobile.
Children’s sleepwear standards In 1996, the CPSC lowered a flammability standard for children’s sleepwear. Some burn centers have
changed in 1996 said they have seen increases in clothing-related flame burns since then.
Candle sales increase A quick look at candle sales show a jump in the 1990s, but I couldn’t easily find the hard numbers.
The CPSC says there are significantly more fire deaths related to candles so I’m sure they have
some sales data we could dig up to compare with candle-related burns.
Candle sales increase, part II Also interesting but probably more of a research project would be the coincidence of candle-related
injuries during power outages. We could possibly look at the dates of the big outage in the
Northeast (a few years ago?) and other major outages.
Fire safe cigarette law in New York I think NY Burn Centers are following data related to this but perhaps you can dig some out of
effective June 28, 2004 NBR. We would like to look state to state as the laws went into effect there but that would be a
chore.
CPSC require all lighters be child We know the number of fire deaths related to children playing with lighters has come down.
resistant 1994
Figure 1. Admission year, TBSA, and record count.
©
123
Appendix C
SPECIAL FEATURE
The Noise Floor, Signal-to-Noise Ratio, and

Demonstrating That Burn Care is Getting Better:
A Glimmer from the National Burn Repository
James C. Jeng, MD, FACS,* Michael J. Schurr, MD, FACS,† Bart Phillips, BS‡
One of the most fundamental concepts in engineer-

ing and physical science disciplines is that of signal-
to-noise ratio, often abbreviated “S/N.” Basically,
when measuring or quantifying phenomena of inter-
est, it is desirable to have the “signal” of interest stand
out sharply against the background random noise so
that accurate measurements can be made. When this
doesn’t happen, scientists and engineers speak of the
signal being “lost” in the “noise floor.”
The goal of these “Glimmers” is to encourage our
readership to mine the National Burn Repository
(NBR) for information as a commonplace activity.
Towards that goal, a helpful warning about the
S/N problem and steady words of encouragement
are a timely and worthwhile purpose for this
month’s installment. Contemplate Figures 1, 2 and
please read on. Figure 1. Global mortality from National Burn Repos-
Two of the authors are actively practicing surgeons itory data for reporting years 1997 to 2007, broken
who are both approaching their second full decade of down by gender, EDA ⴝ edited date of admission.
caring for burn victims. From that experiential point
of view, there is simply no doubt that the state of the
science and the state of the art of burn care is tangibly Figure 1 presents raw, essentially unfiltered data
better than when we were nascent surgeons. The two from 1997 to 2007 about mortality rate-segregated
included figures demonstrate that NBR data support- into males and females, with a total of 185,182
ing progressive improvements in burn care may records represented. Obviously, there is improving
sometimes be lost in the noise floor and require steps survivorship for females-even without aid of rigorous
to increase the S/N so that our better results stand statistical analysis. Although we likewise expect a pos-
out sharply and convincingly. itive trend for males, this signal seems lost in the noise
floor with such a simplistic analysis scheme. Figure 2
presents the same raw data for the same time period,
From the *Burn Center at Washington Hospital Center, but now segregated into small, medium, and large
Washington DC; †Division of General Surgery, University of burns. All signals now seem to have been lost in the
Wisconsin-Madison, Madison, Wisconsin; and ‡American
College of Surgeons, Chicago, Illinois. noise floor, even though we simply have no doubt
Address correspondence to James C. Jeng, MD, FACS, The Burn that burn care is getting better.
Center at Washington Hospital Center, 110 Irving St. NW, When the engineer or physical scientist is faced
Washington DC 20010. E-mail: james.c.jeng@medstar.net
Copyright © 2008 by the American Burn Association. with a noise floor problem-when the S/N is poor-
1559-047X/2008 noise filtration is the common and successful tool
DOI: 10.1097/BCR.0b013e31817de28c used to get at the meaningful signal. Likewise,
Reprinted
5 from J Burn Care Res. 2007. Jul-Aug; 28(4): 542-3.
©
124
Appendix C
J
users of the NBR must be prepared to carefully,

methodically consider their logic of how to “clean”
their raw data and construct sensible noise filtration
so that the S/N ration is good. An example of a
sensible filtration would be to take into account the
increasing incidence of obesity and diabetes mellitus in
the general American population, and its impact on
burn mortality.
S/N problems . . . commonplace in any research
discipline. By and large, they are easily ameliorated by
noise filtration. Don’t let the noise floor dissuade any
of us from seeing the NBR as the goldmine of
information that it truly is. The NBR is a community
asset of the American Burn Association. Those inter-
ested in pursuing scholarly work on this and other burn
Figure 2. Global mortality from National Burn Repository re-related topics are encouraged to secure permission
data for reporting years 1997 to 2007, broken down into from the American Burn Association central office via
three burn size groupings, EDA ⴝ edited date of admission. Web-based application at http://www.ameriburn.org.
©
125
Appendix C
SPECIAL FEATURE
Leveraging the Unique Expertise of Our Clinical

Colleagues: A Real-World Example for Collaborative
Harnessing of the National Burn Repository
James C. Jeng, MD,* Shmuel Shoham, MD†
This month’s Glimmer from the National Burn Re- baseline experience is vis-à-vis infectious disease for
pository (NBR) takes a decidedly practical turn and the burn population. This is critical to appropriately
illustrates how the burn unit in Washington DC is frame our nascent prospective work. Dr. Shoham’s
moving ahead with burn database research in tandem particular research interest focuses on fungal infec-
with the section of infectious diseases. A leap in aca- tions, an area with much work left unfinished in the
demic productivity is for the asking if we are all brave burn population.1
enough to extend a welcoming hand beyond the con- After acquiring permission to query the latest ver-
fines of our burn centers to our internal medicine sion of the NBR from the American Burn Associa-
colleagues. tion, Dr. Shoham abstracted the general distribution
Major burn victims are amongst the sickest in our of 23,517 infectious complications graphically (Fig-
hospitals. Most of all burn physicians and nurses be- ure 1). Several illustrative points have “shook out” of
come reasonably adept in the core competencies of our ongoing daily discussions from this launching
medical intensive care. However, consultants in car- point. To wit: 1) approximately 3% of the infectious
diology, nephrology, infectious diseases, gastroen- complications involve Dr. Shoham’s particular area of
terology, endocrinology, neurology, and other expertise, fungal infections—a very large raw number
specialties possess clinical finesse that our service- of cases, 2) in the pie chart, infections have been
able, albeit “pedestrian,” skill-sets are sometimes grouped in a fashion that makes sense to an infectious
lacking. Real synergy in patient care happens when disease expert but was not intuitively arrived at by the
we find medical specialists who are willing to view burn burn surgeon, 3) several follow-on questions about
physiology as unique, and requiring non-traditional non-fungal infections have been spurred by mutually
approaches. This month’s co-author, Shmuel Sho- contemplating this global “birds-eye” view, and 4)
ham, is our infectious disease consultant and em- we will need the help of medical student volunteers to
braces this collaborative approach. manually abstract the non-uniform data (pre-TRACS
Dr. Shoham has been able to integrate his clinical v.5), a time-consuming task, before moving forward.
recommendations with our established burn unit One example of questions synthesized from an
practices of antibiotic parsimony, very large dose/ infectious disease consultant’s point of view is
short duration antimicrobials, and continuous adjust- whether the distribution of infection types would
ment of aminoglycoside dosing given the large, dy- be different for the four geographic areas intrinsic
namic volumes of distribution we encounter. to the NBR data (ie, NW, SW, NE, SE United
In addition to designing prospective clinical studies States). If so, a statement could be made that in-
together, we have begun in earnest to examine the fectious disease in burn injuries is not a homoge-
NBR for an understanding of what the aggregate nous problem but is subject to strong local influ-
ences. The downstream therapeutic implications of
such a conclusion are tantalizing.
From the *Burn Center and †Division of Infectious Diseases, Another collaboratively generated question is
Department of Medicine, Washington Hospital Center,
Washington DC. whether the bacterial species information could be
Address correspondence to James C. Jeng, MD, Washington teased out of the NBR data. Although species name
Hospital Center, 110 Irving St. NW, Rm 3B-55, Washington are not spelled out for each entry in the NBR, there
DC 20010.
Copyright © 2008 by the American Burn Association. may be statistical legitimacy in using a representative
1559-047X/2008 approach/logic for the extant species data; please re-
DOI: 10.1097/BCR.0b013e3181848c99 fer to the past NBR Glimmer that describes logical
7
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126
Appendix C
J
systems that we can’t possibly be conceited enough to

believe we can study it all alone. Reach out to your
consultants-both clinically and with respect to your
efforts in database science. The expansion of possibil-
ities and insights will significantly leverage what we
can deduce from the NBR.
The NBR is a community asset of the American
Burn Association. Those interested in pursuing schol-
arly work on any burn-care related topics are encour-
aged to secure permission from the American Burn
Figure 1. Distribution of 23,517 infectious complications. Association central office via Web-based application
at http://www.ameriburn.org.
stratagems and extrapolations in using the NBR.2

This perseverant attitude was my contribution to our REFERENCES
academic partnership. 1. Ballard J, Edelman L, Saffle J, et al. Positive fungal cultures in
As a community of database researchers, our col- burn patients: a multicenter review. J Burn Care Res 2008;
lective achievements will be limited if we choose to be 29:213–21.
2. Howard PA, Jeng JC, Miller SF. Is the glass really half empty?
excessively self-sufficient. The biology of burn inju- A closer look at the TBSA data in the National Burn Repos-
ries is so complex and involves so many physiologic itory. J Burn Care Res 2007;28:542–3.
©
127
Appendix C
SPECIAL FEATURE
From Psychedelic Data Visualization to Hypothesis:

All-At-Once Contemplation of Vast Amounts of
Information From the National Burn Repository
James C. Jeng, MD,* Bart Phillips, BS†
Perhaps the knottiest problem facing current and To our contemplation, the following questions
potential researchers mining the National Burn Re- arise: 1) is there a population-based or systems-based
pository (NBR) is quite simply “how can I possibly reason that mortality rate spiked across burn units of
even begin to make sense of millions of data points?” nearly all sizes in the 2001 to 2003 epoch? 2) Do
This month’s Glimmer from the NBR illustrates one larger burn units generally have lower mortality? 3)
effective approach to this apparent dilemma of data Historically, how much random variation in mortality
visualization. rate occurs over successive years? Is there a pattern
Data visualization is a somewhat young field that is that needs to be explained at a public health level? 4)
now making tremendous leaps forward. There is a Do closely spaced contour lines (eg, steep contours
current flurry of interdisciplinary collaborations be- along the x axis at year ⫽ 2002 and at year ⫽ 2007)
tween database science, computer graphics, basic and represent a tell-tale for artifact? 5) Is there a “sweet-
applied sciences (including medicine and surgery), spot” for burn unit size (⬃30 beds) where mortality
and basic and applied mathematics. Any one of our rates seem to be the lowest year in and year out? Is this
readership would be fascinated to glimpse into what is observation real or a confounding artifact? If real,
current in this arena. In print, the career-long work of what might be some potential factors?
Edward R. Tufte is iconic.1 Electronically, examination The above concepts were conjured up after star-
of the current year’s program at the SIGGRAPH meeting at the contour plot for quite a while and keep-
ing (www.siggraph.org) is similarly enlightening. ing an absolutely open mind while free-associating
When dealing with stupendous amounts of in- thoughts. Granted, many of these interpretations
formation, one sensibly needs to fall back upon the won’t stand up to rigorous testing. However, some un-
power of data visualization techniques to come away expected and radical interpretations just might, and
with an all-at-once grasp of the potential message(s). form the basis of true discovery. With an open mind, this
Figure 1 portrays one of the more easily accessible exercise should result in as many unique interpretations
data visualization methods— contour mapping of as there are students of the NBR data. How else could
multivariate data. The complex relationship between millions of data points be effectively digested if not by
mortality rate, size of burn unit (by number of beds), harnessing the raw unbridled power of our visual cortex?
and year of admission is visualized. The NBR is a community asset of the American
Burn Association. Those interested in pursuing schol-
arly work on this and other burn care-related topics
From *The Burn Center at Washington Hospital Center, are encouraged to secure permission from the Amer-
Washington DC; and †American College of Surgeons, Chicago,
Illinois. ican burn Association central office via Web-based
Address correspondence to James C. Jeng, MD, 110 Irving St. NW, application at http://www.ameriburn.org.
Rm 3B-55, Washington, District of Columbia, 20010. (E-mail:
james.c.jeng@medstar.net)
Copyright © 2008 by the American Burn Association. REFERENCE
1559-047X/2008 1. Tufte ER. Envisioning information. Cheshire, CT: Graphics
DOI: 10.1097/BCR.0b013e31818b9f0b Press; 1990.
Reprinted from J Burn Care Res. 2007. Nov-Dec; 28(6): 791-3.

8
©
128
Appendix C
J
Figure 1. Contour plot of mortality rate vs burn beds, admission year.
©
129
Appendix C
THIS PAGE INTENTIONALLY LEFT BLANK
©
130
Appendix D
Selected List of Peer-Reviewed Publications Utilizing NBR Data
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 dietitian's analysis of the strengths and weaknesses of the available data in the National
Burn Repository. J Burn Care Res. 2008 Jan-Feb;29(1):97-101.
Chung JY, Kowal-Vern A, Latenser BA, Lewis RW 2nd. Cement-related injuries: review of a series, the Na-
tional Burn Repository, and the prevailing literature. J Burn Care Res. 2007 Nov-Dec;28(6):827-34. Review.
Guagliardo MF, Jeng JC, Browning S, Bilodeau ME, Dimick A, Hickerson W, 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.
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.
Jeng JC;Advisory Committee to the National Burn Repository. "Open for business!" a primer on the schol-
arly 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 unit's perspective, it's 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 Ver-
sion 5 Collection Software-A Glimmer From the National Burn Repository. J Burn Care Res. 2008
March/April;29(2):291-292.
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 reim-
bursement 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-re-
lated group 483 adequately estimate resource use and hospital costs? J Trauma. 2004 Oct;57(4):861-6.
©
131
Appendix D
Kagan RJ, Gamelli R, Saffle JR. DRG 504: the effect of 96 hours of mechanical ventilation on resource uti-
lization. J Burn Care Res. 2007 Sep-Oct;28(5):664-8.
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.
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.
McGwin G Jr, George RL, Cross JM, Rue LW. Improving the ability to predict mortality among burn pa-
tients. 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.
Moss LS. Outpatient management of the burn patient. Crit Care Nurs Clin North AM. 2004 Mar;16(1):109-
17. Review.
Modjarrad K, McGwin G Jr, Cross JM, Rue LW 3rd.The descriptive epidemiology of intentional burns in
the United States: an analysis of the National Burn Repository. Burns. 2007 Nov;33(7):828-32. Epub 2007
May 24.
Price LA,Thombs B, Chen CL, Milner SM. Liver disease in burn injury: evidence from a national sample of
31,338 adult patients. J Burns Wounds. 2007 Jun 12;7.
Santaniello JM, Luchette FA, Esposito TJ, Gunawan H, Reed RL, Davis KA, Gamelli RL.Ten year experi-
ence of burn, trauma, and combined burn/trauma injuries comparing outcomes. J Trauma. 2004
Oct;57(4):696-700; discussion 700-1.
Thombs BD. Patient and injury characteristics, mortality risk, and length of stay related to child abuse by
burning: evidence from a national sample of 15,802 pediatric admissions.Ann Surg. 2008 Mar;247(3):519-23.
Thombs BD, Bresnick MG. Mortality risk and length of stay associated with self-inflicted burn injury: evi-
dence from a national sample of 30,382 adult patients. Crit Care Med. 2008 Jan;36(1):118-25.
Thombs BD, Bresnick MG, Magyar-Russell G.Who attempts suicide by burning? An analysis of age patterns
of mortality by self-inflicted burning in the United States. Gen Hosp Psychiatry. 2007 May-Jun;29(3):244-50.
Thombs BD, Singh VA, Halonen J, Diallo A, Milner SM.The effects of preexisting medical comorbidities on
mortality and length of hospital stay in acute burn injury: evidence from a national sample of 31,338 adult pa-
tients. Ann Surg. 2007 Apr;245(4):629-34.
©
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NATIONAL BURN

FIRE/FLAME INJURIES REPRESENT 40% OF THE CASES IN

SCALD INJURIES REPRESENT 30% OF THE CASES IN THIS

CONTACT WITH HOT OBJECT INJURIES REPRESENT 9%

ELECTRICAL INJURIES REPRESENT 4% OF THE CASES IN THIS

CHEMICAL INJURIES REPRESENT 3% OF THE CASES IN THIS

American Burn Association National Burn Repository Advisory Committee

Sidney F. Miller, MD, FACS, Chair Barbara A. Latenser, MD, FACS

American Burn Association Staff

Susan M. Browning, MPH

Bart Phillips, Senior Consultant

American Burn Association National Burn Repository Advisory Committee ..................................................ii

1) Analysis of Contributing Hospitals ..................................................................................................................1

2) Analysis of All US Records Included in the Report ........................................................................................7

3) Analysis by Age Group....................................................................................................................................26

Table 21: Etiology

Table 59: Mean Charges for Top Five DRGs

Figure 60: Etiology

Table 127: Complication Rate by Age Group

5) Hospital Comparisons ....................................................................................................................................98

6) Analysis of Canadian and International Records..............................................................................................105

US Burn Care ABA Verified

East North South West

1999 2000 2001 2002 2003 2004

26,897 records were submitted in 2008 for this report

Race No. of Cases

Total N= 121,110 (Excluding 5,906 Unknown/Missing)

Total N= 119,285 (Excluding 7,731 Unknown/Missing)

.1-9.9 10-19.9 20-29.9 30-39.9 40-49.9 50-59.9 60-69.9

% TBSA - (Full+ Partial Thickness)

Inhalation Only 285

Total N = 100,187 (Excluding 26,829 Unknown/Missing) Total 127,016

Total N = 82,797 (Excluding 44,219 Cases)

Figure PLACE OF OCCURRENCE - PLACE OF OCCURRENCE - Table

Total N = 93,690 (Excluding 33,326 Unknown/Missing) Total 127,016

Discharge Disposition No. of Cases Valid Pct.

Death 5,031 4.0

CONTRIBUTING 2001 10.7+/-0.4 10+/-0.2

2000 5.9 4.3

Burn Size (% TBSA)

Total N = 91,647 (Excluding 35,369 Unknown/Missing)

COMPLICATIONS: FREQUENCY OF TOP TEN CLINICALLY RELEVANT COMPLICATIONS

Total N = 96,912 (Excluding 23,771 cases from non TRACS centers)

Total N = 96,912 (Excluding 23,771 cases from non TRACS centers)

Figure 0 Ventilator Days

Total N = 82,206 (Excluding 44,810 cases from non TRACS centers)

Total N = 118,919 (Excluding 8,097 Unknown/Missing)

Total N = 104,805 (Excluding 22,211 Unknown/Missing)

No Inhalation Injury Inhalation Injury

30-39.9 13,160 80 670 45

Total 94,423 2,592 5,987 1,803

TBSA Category Age Inhalation Injury Lived Died Mortality Rate

0.1-19.9 60 and Over Yes 615 163 21.0

20-39.9 0-59.9 No 5,185 177 3.3

40-59.9 0-59.9 Yes 494 208 29.6

40-59.9 60 and Over No 60 144 70.6

60 and Over 0-59.9 No 427 375 46.8

60 and Over 0-59.9 Yes 300 505 62.7

60 and Over 60 and Over Yes 13 147 91.9

TOTAL 81,784 3,539 4.1

Insurance No. of Cases Pct.

Government-Medicare 10,565 8.3

Other Government 1,864 1.5