Assessing the Outcomes of Major Burns (≥20% TBSA) Utilising the Accessibility/Remoteness Index of Australia (ARIA+) in Queensland, Australia

Jenyu Shaw¹, Elizabeth Vujcich
¹Royal Brisbane And Women’s Hosptial, Herston, Queensland, Australia

Abstract

Background: With evidence that early burn debridement leads to improved outcomes (Ahuja et al. 2016), an organised and timely transfer service must be available in the vast state of Queensland. The Accessibility/Remoteness Index of Australia (ARIA+) is currently utilised to categorise healthcare “remoteness” and inform policy decisions, including transfer funding.

Purpose: To identify if the ARIA+ score predicts outcomes in major burns.

Method: Ethics exemption was obtained for an eight-year retrospective study dating 2014 to 2022. Patient data was accessed via integrated electronic medical records (ieMR). Inclusion criteria comprised of age ≥ 16 at time of injury, burns ≥20% TBSA, and injury postcode within Queensland. Injury postcodes were then assigned an ARIA+ score.

Results: A total of 266 patients met inclusion criteria (males 209 [78.6%], females 57 [21.4%]). Of these, 108 (41.1%) were categorized as ARIA+ 0 (major city), 53 (20.5%) as ARIA+ 1 (inner regional), 61 (23.2%) as ARIA+ 2 (outer regional), 22 (8.4%) as ARIA+ 3 (remote) and 18 (6.8%) as ARIA+ 4 (very remote). There was no relationship between ARIA+ score and time to initial debridement (0=49.3h, 1=59.55h, 2=37.9h, 3=68.81, 4=52.08), hospital LoS (0=28.08d, 1=28.65d, 2=27.67d, 3=32.27d, 4=26.06d), and mortality (0=19.4%, 1=27.8%, 2=14.8%, 3=9.1%, 4=16.7%). There was a positive correlation between increasing ARIA+ remoteness score and intubation rate (0=57.4%, 1=75.9%, 2=67.2%, 3=68.2%, 4=83.3%).

Conclusion: The ARIA+ remoteness score poorly correlates with key outcomes of major burns, including time to initial debridement, hospital LoS, and mortality. Further research analysing other geographical stratification systems aims to better inform transfer policy.

Ahuja, R.B., Gibran, N., Greenhalgh, D., Jeng, J., Mackie, D., Moghazy, A., Moiemen, N., Palmieri, T., Peck, M., Serghiou, M. and Watson, S., 2016. ISBI practice guidelines for burn care. Burns, 42(5), pp.953-1021.

Biography

I am a surgical Senior House Officer currently placed at the Royal Brisbane and Women’s Hospital. I am particularly interested in general surgery, including trauma and burns.