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December 2021

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The need for an Australasian burns critical care standardised data collection tool

Anthony Holley, Brett Droder, Michael Reade, Jeffrey Lipman, David Pilcher, Edward Litton, Nermin Karamujic, Kevin Laupland, Kirsten Vallmuur, Anthony Delaney, Jeremy Cohen

Crit Care Resusc 2021; 23 (4): 361-363

Correspondence:anthony.holley@health.qld.gov.au

https://doi.org/10.51893/2021.4.POV

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  • Author Details
  • Competing Interests
    None declared
  • References
    1. Moore L, Clark DE. The value of trauma registries. Injury 2008; 39: 686-95.
    2. Skarsgard ED. The value of patient registries in advancing pediatric surgical care. J Pediatr Surg 2018; 53: 863-7.
    3. Arts DGT, De Keizer NF, Scheffer GJ. Defining and improving data quality in medical registries: a literature review, case study, and generic framework. J Am Med Inform Assoc 2002; 9: 600-11.
    4. Cleland H. Thermal burns — assessment and acute management in the general practice setting. Aust Fam Physician 2012; 41: 372-5.
    5. Moore EC, Pilcher DV, Bailey MJ, et al. The Burns Evaluation and Mortality Study (BEAMS): predicting deaths in Australian and New Zealand burn patients admitted to intensive care with burns. J Trauma Acute Care Surg 2013; 75: 298-303.
    6. Henschke A, Lee R, Delaney A. Burns management in ICU: Quality of the evidence: a systematic review. Burns 2016; 42: 1173-82.
    7. Sayers A, Ben-Shlomo Y, Blom AW, Steele F. Probabilistic record linkage. Int J Epidemiol 2016; 45: 954-64.
    8. Chorostowska-Wynimko J, Wencker M, Horváth I. The importance of effective registries in pulmonary diseases and how to optimize their output. Chron Respir Dis 2019; 16: 1479973119881777.
    9. Australian Institute of Health and Welfare. Injury in Australia: burns and other thermal causes [website]. Canberra: AIHW, 2021. https://www.aihw.gov.au/reports/injury/burns-and-other-thermal-causes (viewed Oct 2021).
    10. Zia N, Latif A, Mashreky SR, et al. Applying quality improvement methods to neglected conditions: development of the South Asia Burn Registry (SABR). BMC Res Notes 2019; 12: 64.
    11. Kruger E, Kowal S, Bilir SP, et al. Relationship Between Patient Characteristics and Number of Procedures as well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository. J Burn Care Res 2020; 41: 1037-44.
    12. Azadmanjir Z, Jazayeri SB, Habibi Arejan R, et al. The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care. Spinal Cord Ser Cases 2020; 6: 17.
    13. Behrendt CA, Björck M, Schwaneberg T, et al. Editor’s choice — recommendations for registry data collection for revascularisations of acute limb ischaemia: a Delphi consensus from the International Consortium of Vascular Registries. Eur J Vasc Endovasc Surg 2019; 57: 816-21.
    14. Breckenridge K, Bekker HL, Gibbons E, et al. How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting. Nephrol Dial Transplant 2015; 30: 1605-14.
We undertook an analysis of the critical care burns data collections currently available in Australasia. The intention of this study was to determine the relevance of available datasets addressing information pertaining to the critical care burns population.

Clinical registries maintain databases for prescribed patient populations and facilitate reliable benchmarking. The collection of prospective information may be used to improve understanding of conditions and enhance the quality of care delivered. 1 The combination of registry data at a national or international level generates large datasets that facilitate the study of patient outcomes and institutional comparisons in relatively rare conditions. 2 Patients eligible to be included in a registry need to fulfil specific inclusion criteria based on predetermined accepted definitions. 3

Annually in Australia, about 1% of the population sustains a thermal injury. 4 Severe burn patients require admission to specialised intensive care units (ICUs) and are at risk of considerable morbidity and mortality. 5 There is little high quality evidence to guide clinical practice, 6 which may potentially explain the substantial variation in approach and outcomes. 7, 8  There is a paucity of critical care burns data collection, and we contend that current datasets are inadequate to inform critical care management and facilitate ICU comparisons.

A comprehensive online search resulted in the Burns Registry of Australia and New Zealand (BRANZ) and the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD) being identified as the most authoritative organisations collecting data for burns and critical care within Australasia respectively. Both registries cover all admissions across Australian and New Zealand ICUs and burns units.

The Burns Outcomes from Intensive Care (BOICE), a single centre Australian database, was identified and used as a foundation for comparison, with permission of the authors at the Royal North Shore Hospital, Sydney, New South Wales. We interrogated ANZICS APD and BRANZ to determine important critical care information available in BOICE but not included in these registries. Data dictionaries from each database were collected and analysed, enabling a comparison with the BOICE data dictionary. Each field was ranked on three criteria, including matching, comparable and non-matching variables. Matching fields were defined by the variables matching in clinical context and the permissible values being identical. Comparable fields were defined by having a similar clinical context; however, the permissible values differ and may require manipulation to be compatible. Missing fields were defined by variables that were absent when compared with the BOICE data dictionary.

During the 2017–2018 financial year, the ANZICS APD recorded over 170 000 unique critical care episodes with 183 adult ICUs across Australia and New Zealand contributing to the collection. During the 2017–2018 period, BRANZ recorded 3549 patients admitted to burns units, with 17 specialist burns units contributing to the registry. The Australian Institute of Health and Welfare reported that 2.9% of thermal injuries for the 2017–2018 financial year required time in the ICU. 9  During the 2017–2018 period, BOICE recorded 27 patient admissions (Associate Professor Anthony Delaney, Staff Specialist Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia; personal communication). There are a wide range of international burn registries with varied data element collections. 10 The National Burn Repository generates an annual report produced by the American Burn Association which provides the characteristics and clinical course of burn patient admissions submitted across the United States and internationally. This is a highly inclusive database, but it lacks comprehensive critical care data. 11
Table 1 provides a comparison of the current Australasian registries recording burn patients and the suitability of critical care data retrieved. Compared with BOICE, six of 114 (5.3%) fields in the ANZICS APD and nine of 114 (7.9%) fields in the Australian and New Zealand Burns Association (ANZBA) matched. Of 114 fields, 28 (24.6%) in the ANZICS APD and 23 (20.2%) in BRANZ were comparable. Furthermore, 80/114 (70.2%) fields were missing in the ANZICS APD and 82/114 (72%) fields were deemed missing in BRANZ. This represents a significant shortfall in the current registries regarding data collection for severe burns cases in intensive care settings. The total fields included were calculated by adding the number of matching and comparable fields in each registry, as non-matching fields cannot be used to link data elements in a proposed data linkage of these three datasets. The main intention is to demonstrate that many of the desired fields could not be found in existing Australasian registries (Table 1).
A dedicated critical care burns registry should ideally include information on patient demographic characteristics, circumstances resulting in the burn injury, pre-hospital evaluation, and resuscitation. The extent of the burn, emergency management and in-hospital interventions, physiological perturbations, complications and patient outcomes should also be included in this registry. There also exists a range of procedures and complications, such as escharotomies and inhalation injury, which are unique to thermal injury and should be recorded.

The options to be considered in order to generate a reliable critical care registry include the addition of critical care burns data to one of the pre-existing registries. There also exists the potential to utilise probabilistic linkage 7 to deliver a more complete critical care burns dataset. However, this presents technical and governance challenges and would still require the addition of data elements to one or both existing registries. Therefore, we propose the development of a dedicated burns critical care database specifically to inform the intensive care management of this small but important group of patients. Non-interventional studies, conducted through the well established mechanism of patient registries, are a valuable approach to close data gaps where it is challenging to conduct randomised controlled trials. 8 The approach to selecting the data elements for inclusion could employ the Delphi method, as utilised by other groups dealing with specific patient cohorts. 12, 13, 14 We propose that a feasibility or pilot collection should then be undertaken over a 12-month period to ensure the development of a useful critical care burns data collection tool. This should include the standardisation of the burns registry function, a minimum dataset, a data dictionary, and uniform data quality monitoring and reporting.
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