Estimates of the Probability of Death from Burn Injuries

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Abstract
The article by Ryan et al. (Feb. 5 issue)1 concerning estimates of the probability of death from burn injuries raises three issues. Assessing the probability of death is useful when mortality is a relevant end point. This is not the case in patients with burns covering 20 percent of body-surface area or less and no associated problems, such as inhalation injury. In this study, such patients constituted 77.5 percent of the total population of 1665 patients, and the mortality rate in this subgroup was 0.46 percent. Including these very-low-risk patients adds no useful information. The model should be restricted to patients with a greater risk of this end point, which could change the weight given to the variables. Furthermore, there were only 22 patients with a high probability of death (87 percent), with a lower boundary of the 95 percent confidence interval of 78 percent. This can be interpreted as equivalent to a probability of error of 22 percent if one assumes that these patients will die. We think that this number is too small to allow reliable estimates of mortality.

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