Towards more efficient burn care: Identifying factors associated with good quality of life post-burn
Background: As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quali...
| Main Authors: | , , , , , , , , |
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| Format: | Journal Article |
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Pergamon Press
2015
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| Online Access: | http://hdl.handle.net/20.500.11937/54847 |
| _version_ | 1848759477500641280 |
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| author | Finlay, V. Phillips, M. Allison, Garry Wood, F. Ching, D. Wicaksono, D. Plowman, S. Hendrie, D. Edgar, D. |
| author_facet | Finlay, V. Phillips, M. Allison, Garry Wood, F. Ching, D. Wicaksono, D. Plowman, S. Hendrie, D. Edgar, D. |
| author_sort | Finlay, V. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. Method: A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n = 106) was used to validate the predictive merit of the nomogram. Results and discussion: Male gender (p = 0.02), conservative management (p = 0.03), upper limb burn (p = 0.04) and high BSHS-B score within one month of burn (p < 0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. Conclusion: For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery. |
| first_indexed | 2025-11-14T10:00:30Z |
| format | Journal Article |
| id | curtin-20.500.11937-54847 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:00:30Z |
| publishDate | 2015 |
| publisher | Pergamon Press |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-548472017-11-10T01:59:17Z Towards more efficient burn care: Identifying factors associated with good quality of life post-burn Finlay, V. Phillips, M. Allison, Garry Wood, F. Ching, D. Wicaksono, D. Plowman, S. Hendrie, D. Edgar, D. Background: As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. Method: A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n = 106) was used to validate the predictive merit of the nomogram. Results and discussion: Male gender (p = 0.02), conservative management (p = 0.03), upper limb burn (p = 0.04) and high BSHS-B score within one month of burn (p < 0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. Conclusion: For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery. 2015 Journal Article http://hdl.handle.net/20.500.11937/54847 10.1016/j.burns.2015.06.018 Pergamon Press restricted |
| spellingShingle | Finlay, V. Phillips, M. Allison, Garry Wood, F. Ching, D. Wicaksono, D. Plowman, S. Hendrie, D. Edgar, D. Towards more efficient burn care: Identifying factors associated with good quality of life post-burn |
| title | Towards more efficient burn care: Identifying factors associated with good quality of life post-burn |
| title_full | Towards more efficient burn care: Identifying factors associated with good quality of life post-burn |
| title_fullStr | Towards more efficient burn care: Identifying factors associated with good quality of life post-burn |
| title_full_unstemmed | Towards more efficient burn care: Identifying factors associated with good quality of life post-burn |
| title_short | Towards more efficient burn care: Identifying factors associated with good quality of life post-burn |
| title_sort | towards more efficient burn care: identifying factors associated with good quality of life post-burn |
| url | http://hdl.handle.net/20.500.11937/54847 |