Burn Mortality Prediction Scores (BURN-PRED)

Comparative Performance of ABSI, Revised Baux Score, and Modified Ryan Score for In-Hospital Mortality Prediction in Hospitalized Burn Admissions: A Retrospective Cohort Study

This retrospective observational cohort study evaluates hospitalized burn admissions treated at the Burn Center of Gaziantep City Hospital between October 2023 and February 2026. The study aims to compare the ability of three burn severity scoring systems, the Abbreviated Burn Severity Index (ABSI), Revised Baux score, and modified Ryan score, to predict in-hospital mortality.

Electronic medical records were reviewed for demographic characteristics, burn-related variables, inhalation injury, burn depth, intensive care admission, mechanical ventilation, sepsis, surgical procedures, length of hospital stay, and survival status at hospital discharge. The primary outcome is in-hospital mortality. The predictive performance of the scoring systems will be evaluated using receiver operating characteristic analysis and logistic regression.

Study Overview

• Status: Completed
• Conditions: Burn Injury; In-Hospital Mortality
• Intervention / Treatment: Other: Retrospective Prognostic Score Assessment

Detailed Description

Burn injuries are associated with substantial morbidity, mortality, intensive care use, prolonged hospitalization, and surgical burden. Early identification of patients at high risk of death may support clinical triage, intensive care planning, resource allocation, and communication with patients' families.

This study is a single-center, retrospective, observational cohort study conducted at the Burn Center of Gaziantep City Hospital, a tertiary referral burn center serving southern Türkiye and cross-border regions. The study includes hospitalized burn admissions treated between October 2023 and February 2026.

A total of 1315 burn admission records were screened. Admissions transferred to another facility before final clinical outcome assessment and admissions in which treatment was refused were excluded. After applying eligibility criteria, 1082 hospitalized burn admissions were included in the primary analysis cohort.

The study evaluates the prognostic performance of the Abbreviated Burn Severity Index (ABSI), Revised Baux score, and modified Ryan score for predicting in-hospital mortality. ABSI is calculated using age, sex, total body surface area burned, inhalation injury, and full-thickness burn status. Revised Baux score is calculated using age, total body surface area burned, and the presence of inhalation injury. The modified Ryan score is calculated using age category, total body surface area burned category, inhalation injury, and third-degree burn status.

The primary outcome is in-hospital mortality, defined as death occurring during the index hospitalization. Secondary evaluations include associations between mortality and selected clinical variables, including inhalation injury, sepsis, intensive care admission, mechanical ventilation, number of surgical procedures, and length of hospital stay.

The discriminative performance of prognostic scores will be assessed using receiver operating characteristic analysis. Area under the curve, confidence intervals, optimal cut-off values, sensitivity, and specificity will be reported. Associations between score increments and mortality will be examined using univariable logistic regression.

• Study Type: Observational
• Enrollment (Actual): 1082

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Gaziantep
    • Gaziantep, Gaziantep, Turkey (Türkiye), 27470
      • Gaziantep City Hospital Burn Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of hospitalized burn admissions treated at the Burn Center of Gaziantep City Hospital, a tertiary referral burn center, between October 2023 and February 2026. The cohort includes burn admissions with documented in-hospital outcomes and sufficient electronic medical record data for calculation of ABSI, Revised Baux score, and modified Ryan score.

Description

Inclusion Criteria: Hospitalized burn admissions treated at the Burn Center of Gaziantep City Hospital between October 2023 and February 2026.

Admissions with a documented in-hospital outcome of discharge alive or death. Admissions with available electronic medical records for age, sex, total body surface area burned, burn depth, inhalation injury, and core clinical variables.

Exclusion Criteria: Admissions transferred to another facility before final clinical outcome assessment.

Admissions in which treatment was refused. Admissions without sufficient electronic medical record data for calculation of the prognostic scores or assessment of the primary outcome.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Hospitalized Burn Admissions; Hospitalized burn admissions treated at the Burn Center of Gaziantep City Hospital between October 2023 and February 2026 and included in the retrospective primary analysis cohort. Prognostic scores, including ABSI, Revised Baux score, and modified Ryan score, were calculated from routinely recorded electronic medical data. No intervention was assigned by the study protocol.

Other: Retrospective Prognostic Score Assessment; ABSI, Revised Baux score, and modified Ryan score were retrospectively calculated using routinely collected electronic medical record data from hospitalized burn admissions. These scores were evaluated for their ability to predict in-hospital mortality. No drug, device, procedure, or treatment intervention was assigned by the study protocol.; Other Names: ABSI; Revised Baux score; Modified Ryan score

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
In-Hospital Mortality	In-hospital mortality was defined as death occurring during the index hospitalization for burn injury. Mortality status was determined from electronic hospital records and was used as the primary outcome for evaluating the prognostic performance of burn severity scoring systems.	From hospital admission to hospital discharge or in-hospital death, assessed up to 240 days.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Area Under the Receiver Operating Characteristic Curve for the Abbreviated Burn Severity Index	The Abbreviated Burn Severity Index was calculated using age, sex, total body surface area burned, inhalation injury, and full-thickness burn status recorded in electronic hospital records. Higher scores indicate greater burn severity and higher predicted mortality risk. Predictive discrimination for in-hospital mortality was evaluated using the area under the receiver operating characteristic curve. The area under the curve ranges from 0.0 to 1.0, with higher values indicating better discriminative performance.	Score variables were obtained from admission and early hospitalization records; in-hospital mortality was assessed from hospital admission to discharge or in-hospital death, up to 240 days.
Area Under the Receiver Operating Characteristic Curve for the Revised Baux Score	The Revised Baux score was calculated using age, total body surface area burned, and the presence of inhalation injury. Higher scores indicate greater burn severity and higher predicted mortality risk. Predictive discrimination for in-hospital mortality was evaluated using the area under the receiver operating characteristic curve. The area under the curve ranges from 0.0 to 1.0, with higher values indicating better discriminative performance.	Score variables were obtained from admission and early hospitalization records; in-hospital mortality was assessed from hospital admission to discharge or in-hospital death, up to 240 days.
Predictive Performance of the Modified Ryan Score	The predictive performance of the modified Ryan score for in-hospital mortality was evaluated using receiver operating characteristic analysis. Area under the curve, 95% confidence interval, optimal cut-off value, sensitivity, and specificity were calculated.	Score variables were obtained from admission and early hospitalization records; in-hospital mortality was assessed from hospital admission to discharge or in-hospital death, up to 240 days.
Association of Selected Clinical Factors With In-Hospital Mortality	The association of selected clinical factors, including inhalation injury, sepsis, intensive care admission, mechanical ventilation, number of surgical procedures, and length of hospital stay, with in-hospital mortality was evaluated using appropriate statistical analyses.	Clinical factors and mortality status were assessed from hospital admission to hospital discharge or in-hospital death, up to 240 days.

Collaborators and Investigators

• Sponsor: Gaziantep City Hospital
• Investigators: Principal Investigator: Bekir Suat Kurkcuoglu, Gaziantep City Hospital

Publications and helpful links

General Publications

• Osler T, Glance LG, Hosmer DW. Simplified estimates of the probability of death after burn injuries: extending and updating the baux score. J Trauma. 2010 Mar;68(3):690-7. doi: 10.1097/TA.0b013e3181c453b3.
• Ryan CM, Schoenfeld DA, Thorpe WP, Sheridan RL, Cassem EH, Tompkins RG. Objective estimates of the probability of death from burn injuries. N Engl J Med. 1998 Feb 5;338(6):362-6. doi: 10.1056/NEJM199802053380604.
• Tobiasen J, Hiebert JM, Edlich RF. The abbreviated burn severity index. Ann Emerg Med. 1982 May;11(5):260-2. doi: 10.1016/s0196-0644(82)80096-6. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): October 7, 2023
• Primary Completion (Actual): February 28, 2026
• Study Completion (Actual): February 28, 2026

Study Registration Dates

• First Submitted: June 22, 2026
• First Submitted That Met QC Criteria: July 1, 2026
• First Posted (Actual): July 8, 2026

Study Record Updates

• Last Update Posted (Actual): July 8, 2026
• Last Update Submitted That Met QC Criteria: July 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: In-hospital mortality; Prognostic score; Retrospective cohort; Inhalation injury; Revised Baux score; ABSI; Modified Ryan score; Burn mortality; Total body surface area burned; ROC analysis
• Additional Relevant MeSH Terms: Wounds and Injuries; Burns
• Other Study ID Numbers: GCH-BURN-SCORES-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No