Variations in outcomes following burn injury and admission to an Australian or New Zealand intensive care unit: A retrospective data linkage cohort study

INTRODUCTION: The Burns Registry of Australia and New Zealand (BRANZ) has been used to identify significant variation in burn injury management and outcomes across Australia and New Zealand. This study aimed to assess variation in clinical outcomes in critically ill burns patients by linking BRANZ with the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). METHODS: This was a retrospective cohort study of adult patients with acute burn injuries admitted to intensive care units (ICUs) between January 2014 and January 2024. The primary outcome was days alive following discharge from the tertiary burns hospital at day 90 (DAOH90). Secondary clinical outcomes included ventilator-free days at day 28 (VFD28) and in-hospital mortality. Surgical data such as time to first theatre and technique were collected. Data relating to ICU management were unavailable. Mixed-effects regression models identified the most important predictors of outcomes and changes over time. RESULTS: There were 1697 patients included in the final analysis. The median total body surface area (TBSA) burnt was 16% (IQR 7-32), and median DAOH90 was 72 days (IQR 48-82). After adjustment for age, sex, inhalational injury, and TBSA, only one hospital had statistically significantly fewer mean DAOH90 than the adjusted cohort mean (51 days, 95% CI 29-69 compared to 72 days, 95% CI 70-75, respectively). DAOH90 did not change significantly over time and variation in surgical management did not affect outcomes. CONCLUSIONS: This bi-national data linkage study demonstrates inter-hospital variation in outcomes among burn injured patients admitted to intensive care in Australia and New Zealand. These differences were not explained by injury severity or surgical management, highlighting the need for more granular ICU and systems-level data to inform evidence-based burn critical care.