The ABSI is dead, long live the ABSI - reliable prediction of survival in burns with a modified Abbreviated Burn Severity Index
Introduction
The Abbreviated Burn Severity Index (ABSI) created in 1982 by Tobiasen et al. is a simple, effective scoring system to predict a patient’s probability of survival after a burn injury [1]. It consists of five variables [sex, age, inhalation injury, full thickness burn (= 3rd degree burn) and total body surface area burned (TBSA)] that form the Total Burn Score. Each score has an associated probability of survival (Table 1).
The ABSI is one of the most popular and widely used scores worldwide for prediction of mortality attributed to burns [[2], [3], [4]]. A reliable and accurate score to predict a patient’s mortality is indispensable because burn injuries remain the fourth most common injury globally [[5], [6], [7]]. Since the publication of the ABSI in1982, the treatment of thermal injuries has improved, and mortality has decreased significantly due to advances in intensive care management and burn care [[8], [9], [10]]. The question arises whether the ABSI in its current form still predicts a patient’s probability of survival accurately [11]. Data on patient demographics and medical history, originating from the German Burn Registry were analyzed to verify the ABSI´s predictive power and the impact of its variables.
The aim of this study was the re-evaluation of the ABSI’s variables, detection of differences between the predicted and actual mortality and if necessary creation of a modified score, using data from the German Burn Registry collected over a 4-year period.
Section snippets
Study design and setting
The study is based on data available in The German Burn Registry from 01.01.2015 to 31.12.2018. This registry is a multicenter prospectively managed database including a total of 50 hospitals based in Germany (48 hospitals), Switzerland and Austria (one hospital each). The centers remain anonymous. The inclusion criteria defined by the German Burn Registry for adults was admission to the (burn) intensive care unit at any time point. In contrast, in children all inpatients were included in the
Demographics and injury-related data
The datasets of 14,984 patients registered in The German Burn Registry from 2015 to 2018 were included in our study. The overall mortality was 4.1% (N = 610). The number of patients was distributed evenly over the four years, with the exception of 2015 in which a lower number of data sets were entered into the registry since only a smaller number of hospitals participated in the initiation phase of the online registry. [2015: 2067 patients (13.8%), 2016: 4108 patients (27.4%), 2017: 4514
Discussion
In this study, it was shown that the original ABSI by Tobiasen et al. [1] is no longer able to reliably predict the probability of survival due to overestimations of mortality. Patients were assigned a Total Burn Score that was too high, resulting in a predicted survival that underestimated the observed, especially in patients with more severe burns. A large data set from 50 hospitals, collected from 2015 till 2018, was analyzed, reflecting the modern standard in burn care in highly developed
Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declarations of interest
None.
Acknowledgments
The authors thank all hospitals in Germany, Switzerland and Austria participating in the Burn Registry of the German Society for Burn Treatment (DGV) and their persons of authority. A list of the participating hospitals is displayed at https://www.verbrennungsmedizin.de/verbrennungsregister.
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Shared co-first authorship.