The Baux score is dead. Long live the Baux score: A 27-year retrospective cohort study of mortality at a regional burns service

BACKGROUND: To assess trends in mortality after burn injuries treated in a regional specialist burns service between 1982 and 2008. METHODS: Patient and burn-specific information and mortality were collated from written admission ledgers and the hospital coding department for 11,109 patients. The data set was divided into age cohorts (0 -14, 15- 44, 45- 64, and <65 years) and time cohorts (1982-1991, 1992-2000, and 2000 -2008). Lethal area 50 (LA50) was calculated by logistic regression and probit analysis. Mortality was related to the Baux score (age + total %burned surface area) by logistic regression. RESULTS: In the time period 2000 to 2008, the LA50 values with approximate 95%confidence intervals (CIs) were 100%(CI, 85.5-100%) in the 0 to 14 cohort (LA10, 78.3%; CI, 64.1-92.5%), 76.4%(CI, 69.1- 83.8%) in the 15 to 44 cohort, 58.6%(CI, 50.8 - 66.5%) in the 45 to 64 cohort, and 30.8%(CI, 24.7-36.9%) in the <65 cohort. The point of futility (the Baux Score at which predicted mortality is 100%) was 160 and the Baux50 (the Baux score at which predicted mortality is 50%) was 109.6 (CI, 105.9 -113.4) in the 2000 to 2008 cohort. CONCLUSIONS: Mortality is markedly improved over earlier data from this study and other historical series and compares favorably with outcomes published from the US National Burn Repository. The Baux Score continues to provide an indication of the risk of mortality. Survival after major burn injury is increasingly common, and decisions by nonspecialist about initial triage, management, and futility of care should be made after consultation with a specialist burn service.