Indication and timing of tracheotomy in burn patients

Indication and timing of tracheotomy in burn patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Indication and timing of tracheotomy in burn patients Wei Zhu, Wei Liu, Yumei Zhang, Wei Luo, Ning Li, Yue Li, Xiaorong Xie, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7189680/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Nov, 2025 Read the published version in European Journal of Medical Research → Version 1 posted 17 You are reading this latest preprint version Abstract Background Tracheotomy is the most common and effective strategy to maintain the airway patency of burn patients. However, the indication and timing of tracheotomy in burn patients were mainly experience-relied and sometimes controversial. Here, we developed classification formula to simply determine the indication and timing of tracheotomy in burn patients. Methods This retrospective study was conducted in all the acute burn patients admitted to a Chinese large burn center from January 1, 2019 to December 31, 2021. The following clinical data was collected from medical records: demographic data, burn causes, burn severity [burn area, Burn Index(BI)], inhalation injury, possible tracheotomy indications, tracheotomy complications and clinical outcomes. Logistic regression analyses were performed to screen possible risk factors and construct classification formulas. Receiver operating characteristic (ROC) curves were used to evaluate the performance by areas under curves (AUCs) and calculate the cut-off value of formulas. Results A total of 951 burn patients were finally enrolled in this study, including 114 patients with tracheotomy and 837 patients without tracheotomy. Furthermore, 18 and 96 cases received emergency and prophylactic tracheotomy, respectively. A classification formula was developed by multivariate logistic regression as follows: Logit(p)=-6.854 + 0.026×Age(years)-0.077×Time (hours from burns to admission) + 0.085×BI (total body) + 0.945×BI (head/face/neck) + Inhalation injury (none:0, mild:1.521, moderate:2.637, severe:4.281). AUCs of the classification formula was 0.972 (95% CI = 0.960–0.984), and higher than that of every individual factor. The cut-off value of classification formula, age, hours after injury, BI of total body and head/face/neck was 0.064, 49.50 years, 14.97 hours, 14.50 and 2.83, respectively. Hours after injury was the only indicator for emergency tracheotomy with AUCs of 0.920 (95% CI = 0.819-1.000) and cut-off value of 32.44 hours. Conclusion The developed formulas had good performance. In clinical practice, burn patients with screened risk factors (age > 49.50, later than 14.97 hours, BI of total body > 14.50, BI of head/face/neck > 2.83, and with inhalation injury) were suspected for tracheotomy and could be further evaluated by the classification formula. If the calculated score was larger than 0.064, tracheotomy was very likely needed and planed tracheotomy would better be performed in 32.44 hours after burns. Together, we provided an alternative strategy for determining the indication and timing of tracheotomy in burn patients. Burns tracheotomy indication timing prediction formula Figures Figure 1 Figure 2 1. Background Airway obstruction is common and emergent for burn patients. Burns could gradually lead to edema in burned and non-burned skins due to increased permeability of vascular in the first 48 hours after injury[ 1 – 3 ]. The subsequent serious swelling in face and neck could easily lead to emergent asphyxia. Furthermore, inhalation injury, including respiratory thermal burns and smoke inhalation, could cause laryngeal edema, vocal cords edema and increased mucosa secretions. The subsequent tissue edema and direct airway injury could result in airway stenosis, obstruction and asphyxia[ 4 , 5 ]. Therefore, it’s crucial to maintain airway patency in the early stage of burns. Studies have shown that tracheotomy is the most effective method of secure artificial airway[ 6 , 7 ]. Tracheotomy in burn patients is very common. Our previous study showed that the incidence of tracheotomy in inhalation injury was 70.12%[ 8 ]. However, the indication and timing of tracheotomy are mainly experience-relied and sometimes controversial in burn patients, as in other critical and emergent settings. First, indication of tracheotomy is obscure and subjective. There is a lack of quantifiable and simple methods[ 9 ]. And it is difficult for clinicians to precisely predict the progression of edema and which patients require tracheotomy in advance. Second, the timing of tracheotomy is also debated. Some studies supported early or prophylactic tracheotomy in burn patients. Smailes et al. found that early tracheotomy in severe burns was associated with earlier active exercise, fewer days of ventilation, shorter length of hospital stay and better physical functional independence[ 10 ]. However, some studies found clinical outcomes were not improved by early tracheotomy. The study by Saffle et al. showed that early tracheotomy did not improve outcome in burn patients[ 11 ]. More important, tracheotomy also has many complications, and either emergency or prophylactic tracheotomy is not perfect and suitable for all the burn patients. When upper airway obstruction suddenly occurs, emergency tracheotomy needs to be immediately performed in awake patients under local anesthesia. Accordingly, the difficulties of tracheotomy are significantly increased because of local edema, coagulation disorders, dysphoria and inadequate preparation. Meanwhile, the risk of serious and even lethal complications, such as hemorrhage, hypoxia, cardiopulmonary arrest, loss of airway and false passage are also increased. In some cases, prophylactic tracheotomy is often encouraged to guarantee safe airway access. However, unnecessary tracheotomy could also increase the risk of dysphagia, dysphonia, laryngotracheal pathology, lung infection and local scar[ 12 ]. Therefore, it is necessary to quantitatively clarify the indication and timing of tracheotomy in burn patients. Previously, we established a machine learning-based decision support system for tracheotomy in burn patients[ 13 ]. However, the system is complicated in practical settings. In this study, we performed a three-year retrospective cohort study to establish a classification formula for simply determining the indication for tracheotomy in burn patients. Meanwhile, a prediction formula for emergent tracheotomy was also developed to aid determine the time of tracheotomy in burn patients. This study could provide an alternative strategy for simply determining the indication and timing of tracheotomy in burn patients. 2. Materials and methods 2.1 Study design and ethic approval This retrospective study was performed in Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), between January 1, 2019 and December 31, 2021. Ethic approval was granted by the Human Medical Ethics Committees of Southwest Hospital (No. KY202121). No personal information of the patients was disclosed during this study. Therefore, written informed consent was not required. 2.2 Inclusion and exclusion criteria Burn patients meeting the following criteria were included: aging older than 18 years, patients who did not undergo tracheotomy or intubation prior to admission, admitted earlier than 7 days after injury. Exclusion criteria included: patients with life-threatening organ dysfunction before burns, patients who discontinued treatment and were discharged against advice, with incomplete clinical data. 2.3 Data extraction The following clinical data were collected from the Burn Specific Database of Southwest Hospital and electronic medical records: demographic data (sex, age, injury time, admission time), burn causes, burn severity (burn area of total body, BI of total body, burn area of head/face/neck, BI of head/face/neck), inhalation injury (none, mild, moderate and severe), possible tracheotomy indications(tracheal intubation, lung infection, amounts of airway secretions, and history of burns in confined space), tracheotomy complications(tracheotomy bleeding, duration of mechanical ventilation, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula, tracheal incision infection, tracheal tube obstruction, tracheal tube falls off, airway stenosis, dysphagia and duration of tracheal tube), and clinical outcomes (mortality, duration of tracheal tube). BI is calculated as the sum of the full-thickness burn area (third-degree burns) and half of the partial-thickness burn area (second-degree burns)[14]. For example, if a patient has 20% total body surface area (TBSA) of full-thickness burns and 10% TBSA of partial-thickness burns, the BI would be 25 (20 + 10/2). Extensive burns or deep burns involving the head, face, or neck are prone to developing peripheral airway edema, leading to airway narrowing, increased airway resistance, and ultimately airway obstruction or asphyxia, which can be life-threatening. Therefore, BI of total body and BI of head/face/neck are distinct components of the formula. Data were independently extracted and cleansed by Wei Liu, Yumei Zhang, Wei Luo, Yue Li and Xiaorong Xie, by using the searching system of database and a standardized data extraction form in Microsoft Excel. If discrepancies or disagreement happened, a third reviewer (Ning Li) verified the medical records to confirm the data and resolve any disagreements. 2.4 Decision and definition of tracheotomy in clinical settings In our center, the decision of tracheotomy was performed by an expert team and patients according to the Chinese guidelines of tracheotomy in burns[15]. In detail, tracheotomy was determined if patients met one of the following cases. A. Patients with deep burns on the head, neck and face, or with hoarseness and sign of fish mouth, or with possibilities of tracheal stenosis or obstruction, or the swelling in neck and face is expected to worsen. B. Patients with annular or semi-circular eschar on the neck and high skin tension. C. Moderate and severe inhalation injury, especially to laryngeal burns or possible laryngeal obstruction. D. Major and severe burns in the early stage and plans of surgery, anesthesia, prone positioning and long-distance transport. E. Patients with low oxygenation index and expected long duration of mechanical ventilation. F. Patients with severe blast lung injury. G. Patients who lost consciousness and had risk of aspiration. H. Patients needing repeated airway nursing owing to amounts of secretions, necrotic tissue in airway. I. Major operations around the face and neck. In this study, emergency tracheotomy was defined as unexpected tracheotomy which was urgently underwent when obvious dyspnea, three retraction signs, rapidly decreased oxygen saturation suddenly occurred. Prophylactic tracheotomy was defined as planned and well-prepared tracheotomy which was performed in advance for patients who was judged to have great probabilities of airway obstruction. 2.5 Surgical procedure of tracheotomy The methods of tracheotomy included traditional surgical tracheotomy and percutaneous dilatational tracheotomy. Traditional surgical tracheotomy was performed as follows. After local anesthesia with 0.5% lidocaine, a longitudinal incision was made downward the lower edge of the cricoid cartilage in 3-4 cm length. Then, trachea was carefully exposed by step-by-step separation and retraction of subcutaneous tissue, superficial fascia, platysma, anterior cervical muscles and isthmus of the thyroid gland with adequate hemostasis. After confirmation of the trachea, an incision was done between the third and fourth tracheal cartilage rings and the cavity of airway was exposed. Lastly, the insertion of tracheal cannula was accomplished and fixed. Percutaneous dilatational tracheotomy was completed using the percutaneous dilatational tracheotomy kit (PW16-S-70, Quanan Medical Equipment Company, Shanghai, China). Briefly, the puncturing site (b Page 4/Line 7-12etween second and third, or third and fourth cartilaginous rings) was confirmed by the extraction of much gas by syringe. Then, a transverse incision was made at the puncturing site in 2 cm length. And the tracheal cannula was quickly inserted by the Seldinger technique and stepwise dilation. 2.6 Statistical analysis The data were analyzed with SPSS 25.0 statistical software. Categorical data are expressed as frequencies and were subjected to the Chi-square test or Fisher’s exact test. Normally distributed continuous data were expressed as 𝑥̅±𝑠 and were subjected to the student’s t-test. Non-normally distributed continuous data were expressed as the median and interquartile range (IQR) (difference between 75th to 25th percentiles) and were subjected to the Mann-Whitney U test. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for tracheotomy and emergent tracheotomy. To determine the performance of classification formula and independent risk factors, the area under curves (AUCs) and the cut-off values of receiver operating characteristic (ROC) curves were calculated. The optimal cut-off value was determined by the maximum of Youden Index. The final sensitivity and specificity of formulas were calculated according to the optimal cut-off value. All the statistical significance was set as 0.05. 3. Results A total of 951 burn patients were finally enrolled in this study, including 114 patients with tracheotomy and 837 patients without tracheotomy. Among 114 patients with tracheotomy, 18 and 96 cases received emergency and prophylactic tracheotomy, respectively. 3.1 Patient features The comparison of patient characteristics between patients with and without tracheotomy were shown in Table 1 and Figure 1. Comparing with patients without tracheotomy, burn patients with tracheotomy had significantly older age (median: 50.00 years vs. 46.00 years, p<0.01), more flame burns (73.70% vs 59.00%, χ 2 =85.541, p<0.01), earlier admission after burns (median: 5.25 hours vs. 15.67 hours, p<0.01 ), larger total burn area (median: 45.00% TBSA vs. 10.00% TBSA, p<0.01 ), higher BI of total body (median:30.17 vs. 6.00, p<0.01), larger burn area of head/face/neck (median: 6.00%TBSA vs. 2% TBSA, p<0.01), higher BI of head/face/neck(median: 4.00 vs. 1.00, p<0.01), more inhalation injury (77.20% vs. 11.60%, χ 2 =366.891, p<0.01). The mortality of tracheotomy group was higher than that of non-tracheotomy group (2.60% vs. 0.00%, χ 2 =22.096, p<0.01). Table 1. Clinical characteristics of burn patients with and without tracheotomy. Characteristics Tracheotomy Total (n=951) Test value P value No(n=837) Yes(n=114) Sex [n (%)] Female 206.00(24.60) 25.00(21.90) 231.00(24.30) 0.392 0.531 a Male 631.00(75.40) 89.00(78.10) 720.00(75.70) Age [years, (median, IQR)] 46.00 (33.00-54.00) 50.00 (37.75-57.25) 46.00 (33.00-55.00) 3.420 0.001 b Burn etiology [n (%)] Flame 494.00(59.00) 84.00(73.70) 578.00(60.80) 58.712 0.000 c Scald 0.00(0.00) 9.00(7.90) 9.0(0.90) Explosive 23.00(2.70) 4.00(3.50) 27.00(2.80) Electric 219.00(26.20) 10.00(8.80) 229.00(24.10) Others 101.00(12.10) 7.00(6.10) 108.00(11.40) Inhalation injury [n (%)] No 748.00(89.40) 26(22.80) 774(81.40) 257.909 0.000 c Mild 80.00(9.60) 46(40.40) 126(13.20) Moderate 7.00(0.80) 26(22.80) 33(3.50) Severe 2.00(0.20) 16(14.00) 18(1.90) Burn area of total body [%, (median, IQR)] 10.00 (5.00-20.00) 45.00 (16.75-76.00) 12.00 (6.00-24.00) 11.766 0.000 b BI of total body (median, IQR) 6.00 (3.00-11.33) 30.17 (12.08-59.50) 7.00 (3.33-13.67) 12.526 0.000 b Burn area of head/face/neck [%, (median, IQR)] 2.00 (0.00-4.00) 6.00 (4.00-8.00) 2.00 (0.00-4.00) 12.857 0.000 b BI of head/face/neck (median, IQR) 1.00 (0.00-2.00) 4.00 (2.33-5.00) 1.00 (0.00-2.33) 13.824 0.000 b Hours from burns to admission [hours, (median, IQR)] 15.67 (0.00-48.00) 5.25 (3.73-8.05) 13.00 (0.00-24.00) -5.411 0.000 b Outcomes [n (%)] Mechanical ventilation 5.00(0.60) 52.00(45.60) 57.00(6.00) 36.087 0.000 a Mortality 0.00(0.00) 3.00(2.60) 3.00(0.30) 0.002 c Abbreviations: IQR, Interquartile range; BI, Burn Index a Chi-square test b Mann-Whitney U test c Fisher’s exact test 3.2 Development of classification formula for tracheotomy in burn patients Possible risk factors for tracheotomy were screened out by univariate ( Table 2 ) and multivariate logistic regression analysis ( Table 3 ). Results showed that age, hours from burns to admission, BI of total body, BI of head/face/neck and inhalation injury were independent risk factors for tracheotomy in burn patients (P<0.05, Table 3 ). Then, a classification formula was developed by multivariate logistic regression as follows. Table 2. Univariate logistic regression analysis of risk factors for tracheotomy in burn patients Risk factors β OR 95% CI P value Lower Upper Age(years) 0.023 1.023 1.010 0.001 0.001 Male 0.150 1.162 0.726 0.531 0.531 Hours from burns to admission(hours) -0.053 0.948 0.930 0.000 0.000 BI of total body 0.093 1.098 1.081 0.000 0.000 BI of head/face/neck 1.173 3.231 2.673 0.000 0.000 Inhalation injury Mild 2.806 16.542 9.705 0.000 0.000 Moderate 4.671 106.857 42.515 0.000 0.000 severe 5.439 230.154 50.283 0.000 0.000 Abbreviations: BI, Burn Index; CI: Confidence Interval Table 3. Multivariate logistic regression analysis of risk factors for tracheotomy in burn patients Risk factors β OR 95% CI P value Lower Upper Age(years) 0.026 1.026 1.004 1.050 0.022 Hours from burns to admission(hours) -0.077 0.926 0.894 0.959 0.000 BI of total body 0.085 1.089 1.063 1.116 0.000 BI of head/face/neck 0.945 2.573 1.977 3.348 0.000 Inhalation injury Mild 1.521 4.576 2.223 9.420 0.000 Moderate 2.637 13.967 3.968 49.165 0.000 severe 4.281 72.327 9.813 533.112 0.000 Abbreviations: BI, Burn Index; CI: Confidence Interval 3.3 Evaluation of classification formula for tracheotomy in burn patients ROC curve of the developed classification formula was shown in Figure 2A . This formula had an AUC of 0.972 (95% CI=0.960-0.984), a sensitivity of 87.50%, and a specificity of 96.50%. The cut-off value was 0.064. Furthermore, ROC curve of every individual risk factor was also plotted ( Figure 2B ). The comparison of performance of every formula was shown in Table 4 . As expected, the developed classification formula had the highest AUC, specificity and sensitivity, compared to any single variable. Table 4. Predicting performance of different factors and final model Characteristics AUC 95% CI Cut-off Sensitivity Specificity Youden Index Age(years) 0.599 0.541-0.656 49.500 0.640 0.544 0.184 Hours from burns to admission(hours) 0.654 0.622-0.687 14.967 0.534 0.939 0.473 Bl of total body 0.861 0.823-0.899 14.500 0.829 0.728 0.557 BI of head/face/neck 0.888 0.850-0.925 2.833 0.922 0.711 0.633 Classification model 0.972 0.960-0.984 0.064 0.875 0.965 0.839 Abbreviations: BI, Burn Index; AUC: Areas under curve; CI: Confidence Interval 3.4 Comparison of the prophylactic and emergency tracheotomy A total of 96 and 18 cases underwent prophylactic and emergency tracheotomy, respectively. Comparing with emergency tracheotomy, the prophylactic tracheotomy had significantly shorter time after burns (median: 7.33 hours vs. 80.00 hours, p<0.01), and higher BI of head/face/neck (3.93±1.81 vs. 2.96±1.96, p<0.05) ( Table 5 ). No significant differences were found with regard to other variables, including mortality (3.10% vs. 0.00%, p=1.000). As to complications of tracheotomy, there were also no significant differences between the two groups in mechanical ventilation, bleeding volume during tracheotomy, duration of mechanical ventilation, airway secretion, tracheal tube duration and prognosis (p>0.05). Table 5. Comparison of burn patients between prophylactic and emergency tracheotomy Characteristics Tracheotomy timing Total (n=114) Test value P value Prophylactic (n=96) Emergency (n=18) Sex [n (%)] Female 23.00(24.00) 2.00(11.10) 25.00(21.90) 0.807 0.369 a Male 73.00(76.00) 16.00(88.90) 89.00(78.10) Age [(years, ( 𝑥 ̅± 𝑠 )] 49.84±14.71 48.11±20.41 49.57±15.65 0.344 0.735 b Etiology [n (%)] Flame 71.00(74.00) 13.00(72.23) 84.00(73.70) 2.070 0.740 c Scald 8.00(8.30) 1.00(5.55) 9.00(7.90) Explosive 4.00(4.10) 0.00(0.00) 4.00(3.50) Electric 7.00(7.30) 3.00(16.67) 10.00(8.80) Others 6.00(6.30) 1.00(5.55) 7.00(6.10) Inhalation injury [n (%)] No 20.00(20.80) 6.00(33.30) 26.00(22.80) 3.590 0.309 c Mild 37.00(38.60) 9.00(50.00) 46.00(40.40) Moderate 24.00(25.00) 2.00(11.10) 26.00(22.80) Severe 15.00(15.60) 1.00(5.60) 16.00(14.00) Burn area of total body [%, (median, IQR)] 42.50 ( 16.25-76.00) 48.00 ( 19.50-71.50) 45.00 (16.75-76.00) 0.132 0.895 d BI of total body (median, IQR) 28.67 (11.08-60.33) 34.33 (16.58-54.50) 30.17 (12.08-59.50) 0.054 0.957 d Burns on head/face/neck [n (%)] 93.00(96.90) 15.00(83.30) 108.00(94.70) 3.190 0.074 a Burn area of head/face/neck [%, (median, IQR)] 6.00 (5.00-8.00) 6.00 ( 3.75.00-7.00) 6.00 ( 4.00-8.00) -0.978 0.328 d BI of head/face/neck (median, IQR) 3.93±1.81 2.96±1.96 3.78±1.86 2.059 0.042 b Hours from burns to admission [hours, (median, IQR)] 5.10 (3.73-8.03) 6.24 (3.86-12.31) 5.25 (3.73-8.05) 0.614 0.539 d Possible indications Lung infection [n (%)] 11.00(11.50) 1.00(5.60) 12.00(10.50) 0.109 0.741 a History of injury in confined space [n (%)] 6.00(6.30) 2.00(11.10) 8.00(7.00) 0.057 0.812 a Long-term mechanical ventilation [n (%)] 44.00(45.80) 8.00(44.40) 52.00(45.60) 0.012 0.914 a Airway secretions [n (%)] Small 94.00(97.90) 16.00(88.90) 110.00(96.50) 1.470 0.225 a Excessive 2.00(2.10) 2.00(11.10) 4.00(3.50) Time after burns [hours, (median, IQR)] 7.33 (4.56-11.60) 80.00 (50.21-142.23) 8.33 (4.88-19.63) 5.646 0.000 d Outcomes Mortality [n (%)] 3.00(3.10) 0.00(0.00) 3.00(2.60) 1.000 c Duration of mechanical ventilation [d, (median, IQR)] 0.00 (0.00-4.44) 0.00 (0.00-2.03) 0.00 (0.00-4.03) -0.465 0.642 d Duration of tracheal tube [d, (median, IQR)] 8.00 (5.00-14.00) 7.50 (6.00-13.75) 8.00(5.00-14.00) -0.148 0.882 d Tracheotomy bleeding [ml, (median, IQR)] 5.00 ( 3.25-5.00) 5.00 (2.75-5.00) 5.00(3.00-5.00) -0.136 0.892 d Abbreviations: IQR, Interquartile range; BI, Burn Index a Chi-square test b Mann-Whitney U test c Fisher’s exact test 3.5 Distribution of time of tracheotomy in burn patients Considering the significant difference of intervals from burns to tracheotomy, the detailed distribution of time of tracheotomy in the prophylactic and emergency tracheotomy were further analyzed ( Table 6 ). Most patients in the prophylactic group received tracheotomy within 24 hours (85/96, 88.50%) after burns. However, most patients in emergency group underwent tracheotomy later 72 hours after burns (11/18, 61.10%), followed by 24 to 48 hours (3/18, 16.70%), and the difference was statistically significant (p=0.000). Table 6. Distribution of intervals from burns to tracheotomy Time after burns Prophylactic (n=96) Emergency (n=18) Total (n=114) χ 2 P value 72 hours 0.00(0.00) 11.00(61.10) 11.00(9.60) 3.6 Prediction formula for emergency tracheotomy in burn patients Univariate logistic regression analysis showed that burn area on head/face/neck, BI of head/face /neck, and time after burns were risk factors for emergency tracheotomy in burn patients (P<0.05). The multivariate logistic regression analysis showed that time after burns (95% CI= 1.048-1.148, p<0.01) was the only independent risk factors for emergency tracheotomy in burn patients ( Table 7 ). The ROC curve of time after burns for predicting emergency tracheotomy had an AUC of 0.920 (95% CI=0.819-1.000), a sensitivity of 88.90%, and a specificity of 95.80% ( Figure 2C ). The optimal cut-off value of time after burns was 32.44 hours. Table 7. Univariate and multivariate logistic regression analysis of risk factors for tracheotomy timing in burn patients Risk factors Univariate analysis Multivariate analysis β OR (95%CI) P value β OR (95%CI) P value Burns on head/face/neck [n (%)] -1.825 0.161(0.030-0.875) 0.034 1.043 2.837(0.078-103.066) 0.569 BI of head/face/neck -0.296 0.744(0.557-0.994) 0.046 -0.023 0.978(0.530-1.802) 0.942 Time after burns (h) 0.087 1.091(1.050-1.133) 0.000 0.092 1.097(1.048-1.148) 0.000 Abbreviations: BI, Burn Index; CI: Confidence Interval 4. Discussion Tracheotomy is the most common and effective strategy to maintain the airway patency of burn patients. However, the indication and timing of tracheotomy in burn patients were still tricky, experience-relied and sometimes controversial. In this study, we not only constructed a classification formula for predicting tracheotomy based on logistic regression, but also analyzed the optimal timing of tracheotomy in burn patients. The classification formula mainly included ages, hours from burns to admission, BI of total body, BI of head/neck/face, and severity of inhalation injury. Time after burns was the only indicator for emergency tracheotomy. Both the classification formula for predicting tracheotomy and intervals for predicting emergency tracheotomy had a good performance with high ROC and with cut-off value of 0.064 and 32.44 hours, respectively. In clinical settings, burn patients with suspected tracheotomy could be further evaluated by the classification formula. If the calculated score was larger than 0.064, tracheotomy was very likely needed and planed tracheotomy would better be performed in 34.44 hours after admission. Therefore, our study provided an alternative strategy for determining the indication and timing of tracheotomy in burn patients. The current indications for tracheotomy were obscure and subjective. Although some obvious indications (e.g. definite airway obstruction and loss of consciousness) gained consensus, some patients with intermediate state of symptoms and signs for tracheotomy would inevitably arise great arguments and controversies. Previously, some researches also provided some methods for this tricky question. Aggarwal et al. found that burn patients with TBSA>60% had high probabilities of repeated surgery and burns on face and neck, and therefore had increased requirement for tracheotomy[16]. Coln et al. held the view that the presence of deteriorating pulmonary status and pneumonia were the primary indicators of the need for tracheotomy in pediatric burns[17]. Prater et al. found that airway edema under bronchoscopy and laryngoscopy detection was the indication for tracheotomy in pediatric burns[18]. Janik et al. constructed a nomogram for tracheotomy in burns based on age, burn area and inhalation injury[19]. However, the performance was not evaluated and some important factors, such as burns on neck/face/head, times after burns and burn depth, were not considered during formula development. In this study, we screened all the possible risk factors for tracheotomy in burn patients according to the expert consensus and previous studies. After logistic regression analysis, we finally screen out five factors and established a formula for predicting tracheotomy in burns. And this classification formula showed a better performance and predicting ability, compared to single factor. Age, hours from burns to admission, BI of total body and head/face/neck, and inhalation injury were predicting factors of tracheotomy in burn patients in this study. The risk of tracheotomy was significantly increased with older age, increased BI of total body and head/face/neck, and aggravation of inhalation injury. Among them, BI of total body and head/face/neck and inhalation injury had dominant predictive ability for tracheotomy. Based on the cut-off value of BI, burn patients with BI of total body greater than 14.50 or BI of head/face/neck greater than 2.83 had high probabilities of tracheotomy. Therefore, burn patients with the above risk factors should be firstly considered for tracheotomy. Then, the final classification formula was used to confirm the necessities of tracheotomy. If the calculated score was larger than 0.098, tracheotomy was very likely needed. Regarding the hours from burns to admission, the early admission of the tracheostomy group may reflect the severity of the burns. Our results showed that the tracheostomy group demonstrated larger burn areas (total body surface area and head/face/neck burn area), higher BI (BI of total body and head/face/neck), and more severe inhalation injuries. The optimal timing of tracheotomy had always been one topic of debate in critically and emergent settings. Current researches on the timing of tracheotomy mainly targeted intensive care unit (ICU) patients with mechanical ventilation. The first large multicenter randomized trial found that early tracheotomy (6 to 8 days after initiation of ventilation) did not significantly decrease the ventilator-associated pneumonia, compared to late tracheotomy (13 to 15 days after initiation)[20]. Moreover, not all the included patients received tracheotomy, and the percentage of tracheotomy was lower in late group than in early group (57% vs. 69%), which implied the difficulty of predicting who needed a tracheotomy in clinics. Therefore, late wait-and-see strategy was favored by Scales et al.[21]. Further TracMan trial found early tracheotomy (within 4 days of ICU admission) did not improve 30-day mortality or other important secondary outcomes[22].However, some clinical trials showed that early tracheotomy could shorten the ventilation duration and ICU stay without impact on morbidity and mortality rates[23,24]. Recent several systematic reviews supported that early tracheotomy was associated with shorter ICU stays, shorter ventilation durations, less sedations and decreased long-term mortality, but not related with short-term mortality[25–28]. However, the ‘timing’ of tracheotomy in burns was different from that in ICU patients with mechanical ventilation. For burn patients, tracheotomy mainly aimed to keep airway patency and the timing of tracheotomy meant when to establish an artificial airway in the injured airways. For ICU patients with mechanical ventilation, tracheotomy aimed to replace the nasotracheal intubation or oral endotracheal tube, and the timing of tracheotomy meant when to open the airway and establish a long-term artificial airway[29,30]. Unfortunately, rare studies concerned the timing of tracheotomy in burn patients. Smailes et al. supported early tracheotomy in burn patients without neck burns to reduce the likelihood of dysphagia, and early closure of neck burns and tracheotomy wounds to reduce local infections in patients with neck burns[31]. A recent study by this group found that early tracheotomy in patients with severe burns is associated with earlier active exercise, fewer days of ventilation, shorter length of hospital stay and better physical functional independence[10]. However, Saffle et al. found that early tracheotomy did not improve clinical outcomes, including ventilator support, incidence of pneumonia, length of stay, or survival[11]. A Japanese nationwide study also did not observe a decreased 28-day mortality in adult severe burns with early tracheotomy[7]. Chinese expert consensus pointed that prophylactic tracheotomy should better be performed before the peak of tissue edema to avoid the unclear anatomy, easy bleeding and difficult operation[15]. Meanwhile, early tracheotomy (3-4 days) was recommended for intubated patients who still needed an artificial airway. In this study, most patients in the prophylactic group received tracheotomy within 24 hours after burns, and most patients in emergency group underwent tracheotomy later 72 hours after burns with median of 80 hours. Similar to previous studies mentioned above, no significant differences were found in mortality and complications of tracheotomy. Considering to the high rate of airway obstruction in emergency tracheotomy and possibly undocumented complications and operation difficulties, prophylactic tracheotomy seemed more favorable, but still needed future confirmation. Furthermore, we also found that time after burns was the only indicator for emergency tracheotomy with the AUC of 0.920 and the cut-off value of 32.44 hours. After 24 hours, the local edema and swelling were gradually worsened to peak before 48-72 hours. During this period, emergent airway obstruction easily happened to patients who needed tracheotomy but did not receive tracheotomy. Thus, the longer the delay in hospital admission following an injury, the more severe the airway obstruction symptoms become, and the greater the chance that an emergency tracheostomy will be necessary to secure the airway. Consequently, we recommend that a planned tracheotomy would better be performed approximately 32.44 hours after the injury for burn patients with a calculated score > 0.064. The rate of tracheotomy-related complications was low in burn patients. The most reported complications included tracheal stenosis, local infection, dysphagia and dysphonia[12,15,31,32]. However, we did not observe any severe complications, which was lower than previous studies[12,31]. Apart from possibly undocumented complications in medical records, the following reasons might also contribute to the low rate of complications. First, percutaneous dilatational tracheotomy was the first-line method of tracheotomy for adult burns in our center. Compared to traditional surgical tracheotomy, percutaneous dilatational tracheotomy had less tissue damage and less surgery steps, leading to the lower rate of complications. This was supported by a previous study[33]. Second, the extubation was performed as early as possible in our center to minimize the duration of endotracheal tube and reduce the risk of tube-related infection, lung infection, and airway stenosis. In our center, the endotracheal tube was removed when the patient’s condition was stable (edema was diminished, oxygenation was satisfactory, sputum was few) and did not need mechanical ventilation and repeated airway lavage. This study still had several limitations. First, tracheostomy is preferred over endotracheal tube to avoid deep sedation in our center. However, nasotracheal/orotracheal intubation is also another option in emergent settings because of its simplified procedure. Both endotracheal tube and tracheostomy are available. Therefore, the tracheostomy mainly indicated artificial airway in this study. Tracheostomy offers advantages in long-term ventilation, secretion clearance, and perioperative stability, whereas endotracheal intubation remains preferable for short-term or emergent scenarios. Airway management in burn patients must balance airway security, duration of ventilation, and risk of complications. Second, this was a single-center retrospective study with some selection bias. For example, our center preferred early prophylactic tracheotomy, which may lead to the active tracheotomy estimation based on the classification formula. Third, some tracheotomy-related complications were possibly not documented in medical records and the follow-up time was short. This might lead to the low rate of complication in this study. Fourth, this formula didn’t mention some absolute tracheotomy indications, such as airway obstruction, coma, etc. Therefore, the conclusion of this study needs to be carefully interpreted and further confirmation in future. 5. Conclusions In conclusion, this study constructed a classification formula for predicting tracheotomy based on logistic regression and analyzed the optimal timing of tracheotomy in burn patients. The classification formula was: Logit(p)=-6.854+0.026×Age(years)-0.077×Time (hours from burns to admission) +0.085×BI (total body) +0.945×BI (head/face/neck) +Inhalation injury (none:0, mild:1.521, moderate:2.637, severe:4.281). All the two predicting formulas showed good predicting performance. According to findings of this study, we recommended that burn patients with screened risk factors (age>49.50, later than 14.97 hours, BI of total body>14.50, BI of head/face/neck>2.83, and with inhalation injury) were suspected for tracheotomy and was further evaluated by the classification formula. If the calculated score was larger than 0.064, tracheotomy was very likely needed and planed tracheotomy would better be performed in 32.44 hours after burns. Therefore, our study provided an alternative strategy for determining the indication and timing of tracheotomy in burn patients. Abbreviations ROC Receiver operating characteristic curves AUCs Areas under curves BI Burn Index IQR Interquartile range CI Confidence Interval ICU Intensive care unit Declarations Ethics approval and consent to participate The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by institutional ethics committee of the Southwest Hospital (NO. KY202121) and individual consent for this retrospective analysis was waived. Consent for publication No personal information of the patients was disclosed during this study. Therefore, written informed consent was not required. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests All authors have no conflicts of interest to declare. Funding This work was supported by grants from National Natural Science Foundation of China (82002036). The funder had no role in study design, data collection and interpretation, or the decision to submit the manuscript for publication. Authors' contributions ZW : Formal analysis, Methodology, Visualization, Writing-Original Draft, LW (Wei Liu): Writing-Original Draft, Data curation, ZYM : Data curation, LW (Wei Luo): Data curation, LN : Resources, Validation, LY : Data curation, XXR :Data curation, YZQ : Resources, Visualization, LGX : Conceptualization, Resources, Project administration, LHS : Conceptualization, Supervision, Writing-Review & Editing, Funding acquisition Acknowledgements Not applicable References Latenser BA. Critical care of the burn patient: the first 48 hours. Crit Care Med 2009;37:2819–26. https://doi.org/10.1097/CCM.0b013e3181b3a08f . Wurzer P, Culnan D, Cancio LC, Kramer GC. 8 - Pathophysiology of Burn Shock and Burn Edema. In: Herndon DN, editor. Total Burn Care (Fifth Edition), Elsevier; 2018, p. 66–76.e3. https://doi.org/10.1016/B978-0-323-47661-4.00008-3 . Chi Y, Liu X, Chai J. A narrative review of changes in microvascular permeability after burn. Ann Transl Med 2021;9:719. https://doi.org/10.21037/atm-21-1267 . Lan X, Huang Z, Tan Z, Huang Z, Wang D, Huang Y. Nebulized heparin for inhalation injury in burn patients: a systematic review and meta-analysis. Burns Trauma 2020;8:tkaa015. https://doi.org/10.1093/burnst/tkaa015 . Schultz MJ, Horn J, Hollmann MW, Preckel B, Glas GJ, Colpaert K, et al. Ventilation practices in burn patients-an international prospective observational cohort study. Burns Trauma 2021;9:tkab034. https://doi.org/10.1093/burnst/tkab034 . 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Burns 2022;48:1599–605. https://doi.org/10.1016/j.burns.2021.10.005 . Saffle JR, Morris SE, Edelman L. Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehabil 2002;23:431–8. https://doi.org/10.1097/00004630-200211000-00009 . Clayton N, Kennedy P, Maitz P. The severe burns patient with tracheostomy: implications for management of dysphagia, dysphonia and laryngotracheal pathology. Burns 2010;36:850–5. https://doi.org/10.1016/j.burns.2009.12.006 . Li H, Zhen N, Lin S, Li N, Zhang Y, Luo W, et al. Deployable machine learning-based decision support system for tracheostomy in acute burn patients. Burns Trauma 2025;13:tkaf010. https://doi.org/10.1093/burnst/tkaf010 . Tan J, Zhou J, Li N, Yuan L, Luo G. A New Resuscitation Formula Based on Burn Index Provides More Reliable Prediction for Fluid Requirement in Adult Major Burn Patients. J Burn Care Res 2021;42:962–7. https://doi.org/10.1093/jbcr/irab013 . Burn and Trauma Branch of Chinese Geriatrics Society, Ming J, Lei P, Duan JL, Tan JH, Lou HP, et al. [National experts consensus on tracheotomy and intubation for burn patients (2018 version)]. Zhonghua Shao Shang Za Zhi 2018;34:782–5. https://doi.org/10.3760/cma.j.issn.1009-2587.2018.11.012 . Aggarwal S, Smailes S, Dziewulski P. Tracheostomy in burns patients revisited. Burns 2009;35:962–6. https://doi.org/10.1016/j.burns.2009.03.005 . Coln CE, Purdue GF, Hunt JL. Tracheostomy in the young pediatric burn patient. Arch Surg 1998;133:537–9; discussion 539–540. https://doi.org/10.1001/archsurg.133.5.537 . Prater ME, Deskin RW. Bronchoscopy and laryngoscopy findings as indications for tracheotomy in the burned child. Arch Otolaryngol Head Neck Surg 1998;124:1115–7. https://doi.org/10.1001/archotol.124.10.1115 . Janik S, Grasl S, Yildiz E, Besser G, Kliman J, Hacker P, et al. A new nomogram to predict the need for tracheostomy in burned patients. Eur Arch Otorhinolaryngol 2021;278:3479–88. https://doi.org/10.1007/s00405-020-06541-3 . Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA 2010;303:1483–9. https://doi.org/10.1001/jama.2010.447 . Scales DC, Ferguson ND. Early vs late tracheotomy in ICU patients. JAMA 2010;303:1537–8. https://doi.org/10.1001/jama.2010.462 . Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan Collaborators. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 2013;309:2121–9. https://doi.org/10.1001/jama.2013.5154 . Croshaw R, McIntyre B, Fann S, Nottingham J, Bynoe R. Tracheostomy: timing revisited. Curr Surg 2004;61:42–8. https://doi.org/10.1016/j.cursur.2003.07.004 . Altman KW, Ha T-AN, Dorai VK, Mankidy BJ, Zhu H. Tracheotomy Timing and Outcomes in the Critically Ill: Complexity and Opportunities for Progress. Laryngoscope 2021;131:282–7. https://doi.org/10.1002/lary.28657 . Deng H, Fang Q, Chen K, Zhang X. Early versus late tracheotomy in ICU patients: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021;100:e24329. https://doi.org/10.1097/MD.0000000000024329 . Chorath K, Hoang A, Rajasekaran K, Moreira A. Association of Early vs Late Tracheostomy Placement With Pneumonia and Ventilator Days in Critically Ill Patients: A Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021;147:450–9. https://doi.org/10.1001/jamaoto.2021.0025 . Wang R, Pan C, Wang X, Xu F, Jiang S, Li M. The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A meta-analysis of randomized controlled clinical trials with trial sequential analysis. Heart Lung 2019;48:46–54. https://doi.org/10.1016/j.hrtlng.2018.09.005 . Hosokawa K, Nishimura M, Egi M, Vincent J-L. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care 2015;19:424. https://doi.org/10.1186/s13054-015-1138-8 . Durbin CG. Indications for and timing of tracheostomy. Respir Care 2005;50:483–7. Lais G, Piquilloud L. Tracheostomy: update on why, when and how. Curr Opin Crit Care 2025;31:101–7. https://doi.org/10.1097/MCC.0000000000001224 . Smailes ST, Ives M, Richardson P, Martin RV, Dziewulski P. Percutaneous dilational and surgical tracheostomy in burn patients: incidence of complications and dysphagia. Burns 2014;40:436–42. https://doi.org/10.1016/j.burns.2013.07.011 . Palmieri TL, Jackson W, Greenhalgh DG. Benefits of early tracheostomy in severely burned children. Crit Care Med 2002;30:922–4. https://doi.org/10.1097/00003246-200204000-00036 . Gravvanis AI, Tsoutsos DA, Iconomou TG, Papadopoulos SG. Percutaneous versus Conventional Tracheostomy in Burned Patients with Inhalation Injury. World J Surg 2005;29:1571–5. https://doi.org/10.1007/s00268-005-7905-y . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7189680","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":497402525,"identity":"b6d43b20-674b-4884-84a5-5b5210b8397e","order_by":0,"name":"Wei Zhu","email":"","orcid":"","institution":"the First Affiliated Hospital of Army Medical University (the Third Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhu","suffix":""},{"id":497402526,"identity":"6209c3ac-f314-4c9a-9255-3da62db39681","order_by":1,"name":"Wei Liu","email":"","orcid":"","institution":"the First 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18:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7189680/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7189680/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40001-025-03460-z","type":"published","date":"2025-11-25T15:58:41+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88773692,"identity":"240b08d9-b07b-4b77-a548-4b9d5ed4c0d9","added_by":"auto","created_at":"2025-08-11 09:58:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":272288,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of clinical features in burn patients with and without tracheotomy. A. Age distribution; B. Distribution of hours from burns to admission; C. Distribution of burn area of total body; D. Distribution of BI of total body; E. Distribution of burn area of head/face/neck; F. Distribution of BI of head/face/neck. BI, Burn Index; The values are presented as the median and interquartile range; *** represented statistical significance at p\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7189680/v1/41368103bdf02f0eda8afc1b.png"},{"id":88777629,"identity":"9a8431ae-1757-4acc-8cc6-c847db409f65","added_by":"auto","created_at":"2025-08-11 10:14:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":118113,"visible":true,"origin":"","legend":"\u003cp\u003eEvaluation of formulas by ROC curve. \u003cstrong\u003eA. \u003c/strong\u003eThe ROC curve of the classification formula for predicting tracheotomy; B. The ROC curves of every individual risk factor for predicting tracheotomy; C. The ROC curve of time after burns for predicting emergency tracheotomy. BI, Burn Index; AUC: Areas under curve.\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7189680/v1/eda32137c0d2afbf15769776.png"},{"id":97178635,"identity":"7be77e91-b646-4e3b-bb96-1fb06641fff6","added_by":"auto","created_at":"2025-12-01 16:11:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2525904,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7189680/v1/616bf606-5401-48d9-b590-7a49c3c395c0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Indication and timing of tracheotomy in burn patients","fulltext":[{"header":"1. Background","content":"\u003cp\u003eAirway obstruction is common and emergent for burn patients. Burns could gradually lead to edema in burned and non-burned skins due to increased permeability of vascular in the first 48 hours after injury[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The subsequent serious swelling in face and neck could easily lead to emergent asphyxia. Furthermore, inhalation injury, including respiratory thermal burns and smoke inhalation, could cause laryngeal edema, vocal cords edema and increased mucosa secretions. The subsequent tissue edema and direct airway injury could result in airway stenosis, obstruction and asphyxia[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, it\u0026rsquo;s crucial to maintain airway patency in the early stage of burns. Studies have shown that tracheotomy is the most effective method of secure artificial airway[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Tracheotomy in burn patients is very common. Our previous study showed that the incidence of tracheotomy in inhalation injury was 70.12%[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, the indication and timing of tracheotomy are mainly experience-relied and sometimes controversial in burn patients, as in other critical and emergent settings. First, indication of tracheotomy is obscure and subjective. There is a lack of quantifiable and simple methods[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. And it is difficult for clinicians to precisely predict the progression of edema and which patients require tracheotomy in advance. Second, the timing of tracheotomy is also debated. Some studies supported early or prophylactic tracheotomy in burn patients. Smailes et al. found that early tracheotomy in severe burns was associated with earlier active exercise, fewer days of ventilation, shorter length of hospital stay and better physical functional independence[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, some studies found clinical outcomes were not improved by early tracheotomy. The study by Saffle et al. showed that early tracheotomy did not improve outcome in burn patients[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. More important, tracheotomy also has many complications, and either emergency or prophylactic tracheotomy is not perfect and suitable for all the burn patients. When upper airway obstruction suddenly occurs, emergency tracheotomy needs to be immediately performed in awake patients under local anesthesia. Accordingly, the difficulties of tracheotomy are significantly increased because of local edema, coagulation disorders, dysphoria and inadequate preparation. Meanwhile, the risk of serious and even lethal complications, such as hemorrhage, hypoxia, cardiopulmonary arrest, loss of airway and false passage are also increased. In some cases, prophylactic tracheotomy is often encouraged to guarantee safe airway access. However, unnecessary tracheotomy could also increase the risk of dysphagia, dysphonia, laryngotracheal pathology, lung infection and local scar[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, it is necessary to quantitatively clarify the indication and timing of tracheotomy in burn patients.\u003c/p\u003e\u003cp\u003ePreviously, we established a machine learning-based decision support system for tracheotomy in burn patients[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, the system is complicated in practical settings. In this study, we performed a three-year retrospective cohort study to establish a classification formula for simply determining the indication for tracheotomy in burn patients. Meanwhile, a prediction formula for emergent tracheotomy was also developed to aid determine the time of tracheotomy in burn patients. This study could provide an alternative strategy for simply determining the indication and timing of tracheotomy in burn patients.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study design and ethic approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was performed in Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), between January 1, 2019 and December 31, 2021. Ethic approval was granted by the Human Medical Ethics Committees of Southwest Hospital (No. KY202121). No personal information of the patients was disclosed during this study. Therefore, written informed consent was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Inclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBurn patients meeting the following criteria were included: aging older than 18 years, patients who did not undergo tracheotomy or intubation prior to admission, admitted earlier than 7 days after injury. Exclusion criteria included: patients with life-threatening organ dysfunction before burns, patients who discontinued treatment and were discharged against advice, with incomplete clinical data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Data extraction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe following clinical data were collected from the Burn Specific Database of Southwest Hospital and electronic medical records: demographic data (sex, age, injury time, admission time), burn causes, burn severity (burn area of total body, BI of total body, burn area of head/face/neck, BI of head/face/neck), inhalation injury (none, mild, moderate and severe), possible tracheotomy indications(tracheal intubation, lung infection, amounts of airway secretions, and history of burns in confined space), tracheotomy complications(tracheotomy bleeding, duration of mechanical ventilation, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula, tracheal incision infection, tracheal tube obstruction, tracheal tube falls off, airway stenosis, dysphagia and duration of tracheal tube), and clinical outcomes (mortality, duration of tracheal tube).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBI is calculated as the sum of the full-thickness burn area (third-degree burns) and half of the partial-thickness burn area (second-degree burns)[14]. For example, if a patient has 20% total body surface area (TBSA) of full-thickness burns and 10% TBSA of partial-thickness burns, the BI would be 25 (20 + 10/2). Extensive burns or deep burns involving the head, face, or neck are prone to developing peripheral airway edema, leading to airway narrowing, increased airway resistance, and ultimately airway obstruction or asphyxia, which can be life-threatening. Therefore, BI of total body and BI of head/face/neck are distinct components of the formula.\u003c/p\u003e\n\u003cp\u003eData were independently extracted and cleansed by Wei Liu, Yumei Zhang, Wei Luo,\u0026nbsp;Yue Li\u0026nbsp;and Xiaorong Xie, by using the searching system of database and a standardized data extraction form in Microsoft Excel. If discrepancies or disagreement happened, a third reviewer (Ning Li) verified the medical records to confirm the data and resolve any disagreements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Decision and definition of tracheotomy in clinical settings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our center, the decision of tracheotomy was performed by an expert team and patients \u0026nbsp;according to the Chinese guidelines of tracheotomy in burns[15]. In detail, tracheotomy was determined if patients met one of the following cases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA. Patients with deep burns on the head, neck and face, or with hoarseness and sign of fish mouth, or with possibilities of tracheal stenosis or obstruction, or the swelling in neck and face is expected to worsen.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eB. Patients with annular or semi-circular eschar on the neck and high skin tension.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eC. Moderate and severe inhalation injury, especially to laryngeal burns or possible laryngeal obstruction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eD. Major and severe burns in the early stage and plans of surgery, anesthesia, prone positioning and long-distance transport.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eE. Patients with low oxygenation index and expected long duration of mechanical ventilation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eF. Patients with severe blast lung injury.\u003c/p\u003e\n\u003cp\u003eG. Patients who lost consciousness and had risk of aspiration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eH. Patients needing repeated airway nursing owing to amounts of secretions, necrotic tissue in airway.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eI. Major operations around the face and neck.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, emergency tracheotomy was defined as unexpected tracheotomy which was urgently underwent when obvious dyspnea, three retraction signs, rapidly decreased oxygen saturation suddenly occurred. Prophylactic tracheotomy was defined as planned and well-prepared tracheotomy which was performed in advance for patients who was judged to have great probabilities of airway obstruction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Surgical procedure of tracheotomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe methods of tracheotomy included traditional surgical tracheotomy and percutaneous dilatational tracheotomy. Traditional surgical tracheotomy was performed as follows. After local anesthesia with 0.5% lidocaine, a longitudinal incision was made downward the lower edge of the cricoid cartilage in 3-4 cm length. Then, trachea was carefully exposed by step-by-step separation and retraction of subcutaneous tissue, superficial fascia, platysma, anterior cervical muscles and isthmus of the thyroid gland with adequate hemostasis. After confirmation of the trachea, an incision was done between the third and fourth tracheal cartilage rings and the cavity of airway was exposed. Lastly, the insertion of tracheal cannula was accomplished and fixed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePercutaneous dilatational tracheotomy\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ewas completed using the percutaneous dilatational tracheotomy kit (PW16-S-70, Quanan Medical Equipment Company, Shanghai, China). Briefly, the puncturing site (b Page 4/Line 7-12etween second and third, or third and fourth cartilaginous rings) was confirmed by the extraction of much gas by syringe. Then, a transverse incision was made at the puncturing site in 2 cm length. And the tracheal cannula was quickly inserted by the Seldinger technique and stepwise dilation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed with SPSS 25.0 statistical software. Categorical data are expressed as frequencies and were subjected to the Chi-square test or Fisher\u0026rsquo;s exact test. Normally distributed continuous data were expressed as 𝑥̅\u0026plusmn;𝑠 and were subjected to the student\u0026rsquo;s t-test. Non-normally distributed continuous data were expressed as the median and interquartile range (IQR) (difference between 75th to 25th percentiles) and were subjected to the Mann-Whitney U test. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for tracheotomy and emergent tracheotomy. To determine the performance of classification formula and independent risk factors, the area under curves (AUCs) and the cut-off values of receiver operating characteristic (ROC) curves were calculated. The optimal cut-off value was determined by the maximum of Youden Index. The final sensitivity and specificity of formulas were calculated according to the optimal cut-off value. All the statistical significance was set as 0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 951 burn patients were finally enrolled in this study, including 114 patients with tracheotomy and 837 patients without tracheotomy. Among 114 patients with tracheotomy, 18 and 96 cases received emergency and prophylactic tracheotomy, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 Patient features\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe comparison of patient characteristics between patients with and without tracheotomy were shown in \u003cstrong\u003eTable 1 and Figure 1.\u0026nbsp;\u003c/strong\u003eComparing with patients without tracheotomy, burn patients with tracheotomy had significantly older age (median: 50.00 years vs. 46.00 years, p\u0026lt;0.01), more flame burns (73.70% vs 59.00%, \u0026chi;\u003csup\u003e2\u003c/sup\u003e=85.541, p\u0026lt;0.01), earlier admission after burns (median: 5.25 hours vs. 15.67 hours, p\u0026lt;0.01 ), larger total burn area (median: 45.00% TBSA vs. 10.00% TBSA, p\u0026lt;0.01 ), higher BI of total body (median:30.17 vs. 6.00, p\u0026lt;0.01), larger burn area of head/face/neck (median: 6.00%TBSA vs. 2% TBSA, p\u0026lt;0.01), higher BI of head/face/neck(median: 4.00 vs. 1.00, p\u0026lt;0.01), more inhalation injury (77.20% vs. 11.60%, \u0026chi;\u003csup\u003e2\u003c/sup\u003e=366.891, p\u0026lt;0.01). The mortality of tracheotomy group was higher than that of non-tracheotomy group (2.60% vs. 0.00%, \u0026chi;\u003csup\u003e2\u003c/sup\u003e=22.096, p\u0026lt;0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Clinical characteristics of burn patients with and without tracheotomy.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTracheotomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=951)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eNo(n=837)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eYes(n=114)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e206.00(24.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e25.00(21.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e231.00(24.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.531\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e631.00(75.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e89.00(78.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e720.00(75.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge [years, (median, IQR)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e46.00\u003c/p\u003e\n \u003cp\u003e(33.00-54.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003cp\u003e(37.75-57.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e46.00\u003c/p\u003e\n \u003cp\u003e(33.00-55.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e3.420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurn etiology [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eFlame\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e494.00(59.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e84.00(73.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e578.00(60.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 50px;\"\u003e\n \u003cp\u003e58.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eScald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e0.00(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e9.00(7.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e9.0(0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eExplosive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e23.00(2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e4.00(3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27.00(2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eElectric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e219.00(26.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e10.00(8.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e229.00(24.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e101.00(12.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e7.00(6.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e108.00(11.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInhalation injury [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e748.00(89.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e26(22.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e774(81.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 50px;\"\u003e\n \u003cp\u003e257.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e80.00(9.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e46(40.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e126(13.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e7.00(0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e26(22.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33(3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e2.00(0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e16(14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e18(1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurn area of total body [%, (median, IQR)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e10.00\u003c/p\u003e\n \u003cp\u003e(5.00-20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e45.00\u003c/p\u003e\n \u003cp\u003e(16.75-76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e12.00\u003c/p\u003e\n \u003cp\u003e(6.00-24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e11.766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of total body (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003cp\u003e(3.00-11.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e30.17\u003c/p\u003e\n \u003cp\u003e(12.08-59.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003cp\u003e(3.33-13.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurn area of head/face/neck [%, (median, IQR)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003cp\u003e(0.00-4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003cp\u003e(4.00-8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003cp\u003e(0.00-4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e12.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of head/face/neck (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003cp\u003e(0.00-2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003cp\u003e(2.33-5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003cp\u003e(0.00-2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e13.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHours from burns to admission [hours, (median, IQR)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e15.67\u003c/p\u003e\n \u003cp\u003e(0.00-48.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e5.25\u003c/p\u003e\n \u003cp\u003e(3.73-8.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e13.00\u003c/p\u003e\n \u003cp\u003e(0.00-24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e-5.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eMechanical ventilation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e5.00(0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e52.00(45.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e57.00(6.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e36.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eMortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e0.00(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e3.00(2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e3.00(0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.002\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: IQR, Interquartile range;\u0026nbsp;BI, Burn Index\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eChi-square test\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Mann-Whitney U test\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u0026nbsp;\u003c/sup\u003eFisher\u0026rsquo;s exact test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Development of classification formula for tracheotomy in burn patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePossible risk factors for tracheotomy were screened out by univariate (\u003cstrong\u003eTable 2\u003c/strong\u003e) and multivariate logistic regression analysis (\u003cstrong\u003eTable 3\u003c/strong\u003e). Results showed that age, hours from burns to admission, BI of total body, BI of head/face/neck and inhalation injury were independent risk factors for tracheotomy in burn patients (P\u0026lt;0.05, \u003cstrong\u003eTable 3\u003c/strong\u003e). Then, a classification formula was developed by multivariate logistic regression as follows.\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"624\" height=\"49\" src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1754670589.gif\" alt=\"image\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Univariate logistic regression analysis of risk factors for tracheotomy in burn patients\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHours from burns to admission(hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of total body\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of head/face/neck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInhalation injury\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e16.542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e9.705\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e106.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e42.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e230.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e50.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: BI, Burn Index; CI: Confidence Interval\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Multivariate logistic regression analysis of risk factors for tracheotomy in burn patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHours from burns to admission(hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e-0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of total body\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of head/face/neck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInhalation injury\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e9.420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e13.967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e49.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e72.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e9.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e533.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: BI, Burn Index; CI: Confidence Interval\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Evaluation of classification formula for tracheotomy in burn patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eROC curve of the developed classification formula was shown in \u003cstrong\u003eFigure 2A\u003c/strong\u003e. This formula had an AUC of 0.972 (95% CI=0.960-0.984), a sensitivity of 87.50%, and a specificity of 96.50%. The cut-off value was\u0026nbsp;0.064.\u0026nbsp;Furthermore, ROC curve of every individual risk factor was also plotted (\u003cstrong\u003eFigure 2B\u003c/strong\u003e). The comparison of performance of every formula was shown in \u003cstrong\u003eTable 4\u003c/strong\u003e. As expected, the developed classification formula had the highest AUC, specificity and sensitivity, compared to any single variable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Predicting performance of different factors and final model\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAUC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCut-off\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSensitivity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecificity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYouden Index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"31\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"31\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.541-0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e49.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"28\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHours from burns to admission(hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.622-0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e14.967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"25\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBl of total body\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.823-0.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e14.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"28\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of head/face/neck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.850-0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"28\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClassification model\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.960-0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"29\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: BI, Burn Index; AUC: Areas under curve; CI: Confidence Interval\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Comparison of the prophylactic and emergency tracheotomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 96 and 18 cases underwent prophylactic and emergency tracheotomy, respectively. Comparing with emergency tracheotomy, the prophylactic tracheotomy had significantly shorter time after burns (median: 7.33 hours vs. 80.00 hours, p\u0026lt;0.01), and higher BI of head/face/neck (3.93\u0026plusmn;1.81 vs. 2.96\u0026plusmn;1.96, p\u0026lt;0.05) (\u003cstrong\u003eTable 5\u003c/strong\u003e). No significant differences were found with regard to other variables, including mortality (3.10% vs. 0.00%, p=1.000). As to complications of tracheotomy, there were also no significant differences between the two groups in mechanical ventilation, bleeding volume during tracheotomy, duration of mechanical ventilation, airway secretion, tracheal tube duration and prognosis (p\u0026gt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Comparison of burn patients between prophylactic and emergency tracheotomy\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTracheotomy timing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n=114)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003eProphylactic\u003c/p\u003e\n \u003cp\u003e(n=96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003cp\u003e(n=18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e23.00(24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e2.00(11.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e25.00(21.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.369\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e73.00(76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e16.00(88.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e89.00(78.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge [(years, (\u003c/strong\u003e\u003cstrong\u003e𝑥\u003c/strong\u003e\u003cstrong\u003e̅\u0026plusmn;\u003c/strong\u003e\u003cstrong\u003e𝑠\u003c/strong\u003e\u003cstrong\u003e)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e49.84\u0026plusmn;14.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e48.11\u0026plusmn;20.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e49.57\u0026plusmn;15.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.735\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEtiology [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eFlame\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e71.00(74.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e13.00(72.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e84.00(73.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.740\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eScald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e8.00(8.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.00(5.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e9.00(7.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eExplosive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e4.00(4.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.00(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e4.00(3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eElectric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e7.00(7.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e3.00(16.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e10.00(8.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e6.00(6.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.00(5.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e7.00(6.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInhalation injury [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e20.00(20.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e6.00(33.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e26.00(22.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.309\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e37.00(38.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e9.00(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e46.00(40.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e24.00(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e2.00(11.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e26.00(22.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e15.00(15.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.00(5.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e16.00(14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurn area of total body [%, (median, IQR)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e42.50 ( 16.25-76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e48.00 ( 19.50-71.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e45.00 (16.75-76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.895\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of total body (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e28.67 (11.08-60.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e34.33 (16.58-54.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e30.17 (12.08-59.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.957\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurns on head/face/neck [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e93.00(96.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e15.00(83.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e108.00(94.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e3.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.074\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurn area of head/face/neck [%, (median, IQR)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;6.00 (5.00-8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;6.00 ( 3.75.00-7.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e6.00 ( 4.00-8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e-0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.328\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of head/face/neck (median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3.93\u0026plusmn;1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e2.96\u0026plusmn;1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e3.78\u0026plusmn;1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e2.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.042\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHours from burns to admission [hours, (median, IQR)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e5.10 (3.73-8.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e6.24 (3.86-12.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e5.25 (3.73-8.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.539\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePossible indications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eLung infection [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e11.00(11.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e1.00(5.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e12.00(10.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.741\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eHistory of injury in confined space [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e6.00(6.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e2.00(11.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e8.00(7.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.812\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eLong-term mechanical ventilation [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e44.00(45.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e8.00(44.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e52.00(45.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.914\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eAirway secretions [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e94.00(97.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e16.00(88.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e110.00(96.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003e0.225\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eExcessive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e2.00(2.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e2.00(11.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e4.00(3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime after burns [hours, (median, IQR)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e7.33 (4.56-11.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e80.00 (50.21-142.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e8.33 (4.88-19.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e5.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eMortality [n (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e3.00(3.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.00(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e3.00(2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e1.000\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eDuration of mechanical ventilation [d, (median, IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e0.00 (0.00-4.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003cp\u003e(0.00-2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003cp\u003e(0.00-4.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e-0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.642\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eDuration of tracheal tube [d, (median, IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e8.00 (5.00-14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e7.50 (6.00-13.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e8.00(5.00-14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e-0.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.882\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eTracheotomy bleeding [ml, (median, IQR)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e5.00 ( 3.25-5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e5.00 (2.75-5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e5.00(3.00-5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e-0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0.892\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: IQR, Interquartile range;\u0026nbsp;BI, Burn Index\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eChi-square test\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Mann-Whitney U test\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u0026nbsp;\u003c/sup\u003eFisher\u0026rsquo;s exact test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Distribution of time of tracheotomy in burn patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsidering the significant difference of intervals from burns to tracheotomy, the detailed distribution of time of tracheotomy in the prophylactic and emergency tracheotomy were further analyzed (\u003cstrong\u003eTable 6\u003c/strong\u003e). Most patients in the prophylactic group received tracheotomy within 24 hours (85/96, 88.50%) after burns. However, most patients in emergency group underwent tracheotomy later 72 hours after burns (11/18, 61.10%), followed by 24 to 48 hours (3/18, 16.70%), and the difference was statistically significant (p=0.000).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Distribution of intervals from burns to tracheotomy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime after burns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProphylactic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=96)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmergency\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=18)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=114)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;24 hours\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e85.00(88.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e2.00(11.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e87.00(76.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 10px;\"\u003e\n \u003cp\u003e59.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e24-48 hours\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e8.00(8.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e2.00(11.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e10.00(8.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e48-72 hours\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e3.00(3.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e3.00(16.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e6.00(5.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;72 hours\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e0.00(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e11.00(61.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e11.00(9.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.6 Prediction formula for emergency tracheotomy in burn patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate logistic regression analysis showed that burn area on head/face/neck, BI of head/face /neck, and time after burns were risk factors for emergency tracheotomy in burn patients (P\u0026lt;0.05). The multivariate logistic regression analysis showed that time after burns (95% CI= 1.048-1.148, p\u0026lt;0.01) was the only independent risk factors for emergency tracheotomy in burn patients (\u003cstrong\u003eTable 7\u003c/strong\u003e). The ROC curve of time after burns for predicting emergency tracheotomy had an AUC of 0.920 (95% CI=0.819-1.000), a sensitivity of 88.90%, and a specificity of 95.80% (\u003cstrong\u003eFigure 2C\u003c/strong\u003e). The optimal cut-off value of time after burns was 32.44 hours.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Univariate and multivariate logistic regression analysis of risk factors for tracheotomy timing in burn patients\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurns on head/face/neck [n (%)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-1.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.161(0.030-0.875)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e2.837(0.078-103.066)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBI of head/face/neck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e-0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.744(0.557-0.994)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.978(0.530-1.802)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime after burns (h)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e1.091(1.050-1.133)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e1.097(1.048-1.148)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: BI, Burn Index; CI: Confidence Interval\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eTracheotomy is the most common and effective strategy to maintain the airway patency of burn patients. However, the indication and timing of tracheotomy in burn patients were still tricky, experience-relied and sometimes controversial. In this study, we not only constructed a classification formula for predicting tracheotomy based on logistic regression, but also analyzed the optimal timing of tracheotomy in burn patients. The classification formula mainly included ages, hours from burns to admission, BI of total body, BI of head/neck/face, and severity of inhalation injury. Time after burns was the only indicator for emergency tracheotomy. Both the classification formula for predicting tracheotomy and intervals for predicting emergency tracheotomy had a good performance with high ROC and with cut-off value of 0.064 and 32.44 hours, respectively. In clinical settings, burn patients with suspected tracheotomy could be further evaluated by the classification formula. If the calculated score was larger than 0.064, tracheotomy was very likely needed and planed tracheotomy would better be performed in 34.44 hours after admission. Therefore, our study provided an alternative strategy for determining the indication and timing of tracheotomy in burn patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe current indications for tracheotomy were obscure and subjective. Although some obvious indications (e.g. definite airway obstruction and loss of consciousness) gained consensus, some patients with intermediate state of symptoms and signs for tracheotomy would inevitably arise great arguments and controversies. Previously, some researches also provided some methods for this tricky question. Aggarwal et al. found that burn patients with TBSA\u0026gt;60% had high probabilities of repeated surgery and burns on face and neck, and therefore had increased requirement for tracheotomy[16]. Coln et al. held the view that the presence of deteriorating pulmonary status and pneumonia were the primary indicators of the need for tracheotomy in pediatric burns[17]. Prater et al. found that airway edema under bronchoscopy and laryngoscopy detection was the indication for tracheotomy in pediatric burns[18]. Janik et al. constructed a nomogram for tracheotomy in burns based on age, burn area and inhalation injury[19]. However, the performance was not evaluated and some important factors, such as burns on neck/face/head, times after burns and burn depth, were not considered during formula development. In this study, we screened all the possible risk factors for tracheotomy in burn patients according to the expert consensus and previous studies. After logistic regression analysis, we finally screen out five factors and established a formula for predicting tracheotomy in burns. And this classification formula showed a better performance and predicting ability, compared to single factor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAge, hours from burns to admission, BI of total body and head/face/neck, and inhalation injury were predicting factors of tracheotomy in burn patients in this study. The risk of tracheotomy was significantly increased with older age, increased BI of total body and head/face/neck, and aggravation of inhalation injury. Among them, BI of total body and head/face/neck and inhalation injury had dominant predictive ability for tracheotomy. Based on the cut-off value of BI, burn patients with BI of total body greater than 14.50 or BI of head/face/neck greater than 2.83 had high probabilities of tracheotomy. Therefore, burn patients with the above risk factors should be firstly considered for tracheotomy. Then, the final classification formula was used to confirm the necessities of tracheotomy. If the calculated score was larger than 0.098, tracheotomy was very likely needed. Regarding the hours from burns to admission, the early admission of the tracheostomy group may reflect the severity of the burns. Our results showed that the tracheostomy group demonstrated larger burn areas (total body surface area and head/face/neck burn area), higher BI (BI of total body and head/face/neck), and more severe inhalation injuries.\u003c/p\u003e\n\u003cp\u003eThe optimal timing of tracheotomy had always been one topic of debate in critically and emergent settings. Current researches on the timing of tracheotomy mainly targeted intensive care unit (ICU) patients with mechanical ventilation. The first large multicenter randomized trial found that early tracheotomy (6 to 8 days after initiation of ventilation) did not significantly decrease the ventilator-associated pneumonia, compared to late tracheotomy (13 to 15 days after initiation)[20]. Moreover, not all the included patients received tracheotomy, and the percentage of tracheotomy was lower in late group than in early group (57% vs. 69%), which implied the difficulty of predicting who needed a tracheotomy in clinics. Therefore, late wait-and-see strategy was favored by Scales et al.[21]. Further TracMan trial found early tracheotomy (within 4 days of ICU admission) did not improve 30-day mortality or other important secondary outcomes[22].However, some clinical trials showed that early tracheotomy could shorten the ventilation duration and ICU stay without impact on morbidity and mortality rates[23,24]. Recent several systematic reviews supported that early tracheotomy was associated with shorter ICU stays, shorter ventilation durations, less sedations and decreased long-term mortality, but not related with short-term mortality[25\u0026ndash;28].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, the \u0026lsquo;timing\u0026rsquo; of tracheotomy in burns was different from that in ICU patients with mechanical ventilation. For burn patients, tracheotomy mainly aimed to keep airway patency and the timing of tracheotomy meant when to establish an artificial airway in the injured airways. For ICU patients with mechanical ventilation, tracheotomy aimed to replace the nasotracheal intubation or oral endotracheal tube, and the timing of tracheotomy meant when to open the airway and establish a long-term artificial airway[29,30]. Unfortunately, rare studies concerned the timing of tracheotomy in burn patients. Smailes et al. supported early tracheotomy in burn patients without neck burns to reduce the likelihood of dysphagia, and early closure of neck burns and tracheotomy wounds to reduce local infections in patients with neck burns[31]. A recent study by this group found that early tracheotomy in patients with severe burns is associated with earlier active exercise, fewer days of ventilation, shorter length of hospital stay and better physical functional independence[10]. However, Saffle et al. found that early tracheotomy did not improve clinical outcomes, including ventilator support, incidence of pneumonia, length of stay, or survival[11]. A Japanese nationwide study also did not observe a decreased 28-day mortality in adult severe burns with early tracheotomy[7]. Chinese expert consensus pointed that prophylactic tracheotomy should better be performed before the peak of tissue edema to avoid the unclear anatomy, easy bleeding and difficult operation[15]. Meanwhile, early tracheotomy (3-4 days) was recommended for intubated patients who still needed an artificial airway. In this study, most patients in the prophylactic group received tracheotomy within 24 hours after burns, and most patients in emergency group underwent tracheotomy later 72 hours after burns with median of 80 hours. Similar to previous studies mentioned above, no significant differences were found in mortality and complications of tracheotomy. Considering to the high rate of airway obstruction in emergency tracheotomy and possibly undocumented complications and operation difficulties, prophylactic tracheotomy seemed more favorable, but still needed future confirmation. Furthermore, we also found that time after burns was the only indicator for emergency tracheotomy with the AUC of 0.920 and the cut-off value of 32.44 hours. After 24 hours, the local edema and swelling were gradually worsened to peak before 48-72 hours. During this period, emergent airway obstruction easily happened to patients who needed tracheotomy but did not receive tracheotomy. Thus, the longer the delay in hospital admission following an injury, the more severe the airway obstruction symptoms become, and the greater the chance that an emergency tracheostomy will be necessary to secure the airway. Consequently, we recommend that a planned tracheotomy would better be performed approximately 32.44 hours after the injury for burn patients with a calculated score \u0026gt; 0.064.\u003c/p\u003e\n\u003cp\u003eThe rate of tracheotomy-related complications was low in burn patients. The most reported complications included tracheal stenosis, local infection, dysphagia and dysphonia[12,15,31,32]. However, we did not observe any severe complications, which was lower than previous studies[12,31]. Apart from possibly undocumented complications in medical records, the following reasons might also contribute to the low rate of complications. First, percutaneous dilatational tracheotomy was the first-line method of tracheotomy for adult burns in our center. Compared to traditional surgical tracheotomy, percutaneous dilatational tracheotomy had less tissue damage and less surgery steps, leading to the lower rate of complications. This was supported by a previous study[33]. Second, the extubation was performed as early as possible in our center to minimize the duration of endotracheal tube and reduce the risk of tube-related infection, lung infection, and airway stenosis. In our center, the endotracheal tube was removed when the patient\u0026rsquo;s condition was stable (edema was diminished, oxygenation was satisfactory, sputum was few) and did not need mechanical ventilation and repeated airway lavage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study still had several limitations. First, tracheostomy is preferred over endotracheal tube to avoid deep sedation in our center. However, nasotracheal/orotracheal intubation is also another option in emergent settings because of its simplified procedure. Both endotracheal tube and tracheostomy are available. Therefore, the tracheostomy mainly indicated artificial airway in this study. Tracheostomy offers advantages in long-term ventilation, secretion clearance, and perioperative stability, whereas endotracheal intubation remains preferable for short-term or emergent scenarios. Airway management in burn patients must balance airway security, duration of ventilation, and risk of complications. Second, this was a single-center retrospective study with some selection bias. For example, our center preferred early prophylactic tracheotomy, which may lead to the active tracheotomy estimation based on the classification formula. Third, some tracheotomy-related complications were possibly not documented in medical records and the follow-up time was short. This might lead to the low rate of complication in this study. Fourth, this formula didn\u0026rsquo;t mention some absolute tracheotomy indications, such as airway obstruction, coma, etc. Therefore, the conclusion of this study needs to be carefully interpreted and further confirmation in future.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn conclusion, this study constructed a classification formula for predicting tracheotomy based on logistic regression and analyzed the optimal timing of tracheotomy in burn patients. The classification formula was: Logit(p)=-6.854+0.026\u0026times;Age(years)-0.077\u0026times;Time (hours from burns to admission) +0.085\u0026times;BI (total body) +0.945\u0026times;BI (head/face/neck) +Inhalation injury (none:0, mild:1.521, moderate:2.637, severe:4.281). All the two predicting formulas showed good predicting performance. According to findings of this study, we recommended that burn patients with screened risk factors (age\u0026gt;49.50, later than 14.97 hours, BI of total body\u0026gt;14.50, BI of head/face/neck\u0026gt;2.83, and with inhalation injury) were suspected for tracheotomy and was further evaluated by the classification formula. If the calculated score was larger than 0.064, tracheotomy was very likely needed and planed tracheotomy would better be performed in 32.44 hours after burns. Therefore, our study provided an alternative strategy for determining the indication and timing of tracheotomy in burn patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eReceiver operating characteristic curves\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAUCs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAreas under curves\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBurn Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterquartile range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence Interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive care unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by institutional ethics committee of the Southwest Hospital (NO. KY202121) and individual consent for this retrospective analysis was waived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo personal information of the patients was disclosed during this study. Therefore, written informed consent was not required.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have no conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from National Natural Science Foundation of China (82002036). The funder had no role in study design, data collection and interpretation, or the decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eZW\u003c/strong\u003e: Formal analysis, Methodology, Visualization, Writing-Original Draft, \u003cstrong\u003eLW\u003c/strong\u003e(Wei Liu): Writing-Original Draft, Data curation, \u003cstrong\u003eZYM\u003c/strong\u003e: Data curation, \u003cstrong\u003eLW\u003c/strong\u003e(Wei Luo): Data curation, \u003cstrong\u003eLN\u003c/strong\u003e: Resources, Validation, \u003cstrong\u003eLY\u003c/strong\u003e: Data curation, \u003cstrong\u003eXXR\u003c/strong\u003e:Data curation, \u003cstrong\u003eYZQ\u003c/strong\u003e: Resources, Visualization, \u003cstrong\u003eLGX\u003c/strong\u003e: Conceptualization, Resources, Project administration, \u003cstrong\u003eLHS\u003c/strong\u003e: Conceptualization, Supervision, Writing-Review \u0026amp; Editing, Funding acquisition\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLatenser BA. 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World J Surg 2005;29:1571\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00268-005-7905-y\u003c/span\u003e\u003cspan address=\"10.1007/s00268-005-7905-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Burns, tracheotomy, indication, timing, prediction formula","lastPublishedDoi":"10.21203/rs.3.rs-7189680/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7189680/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTracheotomy is the most common and effective strategy to maintain the airway patency of burn patients. However, the indication and timing of tracheotomy in burn patients were mainly experience-relied and sometimes controversial. Here, we developed classification formula to simply determine the indication and timing of tracheotomy in burn patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective study was conducted in all the acute burn patients admitted to a Chinese large burn center from January 1, 2019 to December 31, 2021. The following clinical data was collected from medical records: demographic data, burn causes, burn severity [burn area, Burn Index(BI)], inhalation injury, possible tracheotomy indications, tracheotomy complications and clinical outcomes. Logistic regression analyses were performed to screen possible risk factors and construct classification formulas. Receiver operating characteristic (ROC) curves were used to evaluate the performance by areas under curves (AUCs) and calculate the cut-off value of formulas.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 951 burn patients were finally enrolled in this study, including 114 patients with tracheotomy and 837 patients without tracheotomy. Furthermore, 18 and 96 cases received emergency and prophylactic tracheotomy, respectively. A classification formula was developed by multivariate logistic regression as follows: Logit(p)=-6.854\u0026thinsp;+\u0026thinsp;0.026\u0026times;Age(years)-0.077\u0026times;Time (hours from burns to admission)\u0026thinsp;+\u0026thinsp;0.085\u0026times;BI (total body)\u0026thinsp;+\u0026thinsp;0.945\u0026times;BI (head/face/neck)\u0026thinsp;+\u0026thinsp;Inhalation injury (none:0, mild:1.521, moderate:2.637, severe:4.281). AUCs of the classification formula was 0.972 (95% CI\u0026thinsp;=\u0026thinsp;0.960\u0026ndash;0.984), and higher than that of every individual factor. The cut-off value of classification formula, age, hours after injury, BI of total body and head/face/neck was 0.064, 49.50 years, 14.97 hours, 14.50 and 2.83, respectively. Hours after injury was the only indicator for emergency tracheotomy with AUCs of 0.920 (95% CI\u0026thinsp;=\u0026thinsp;0.819-1.000) and cut-off value of 32.44 hours.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe developed formulas had good performance. In clinical practice, burn patients with screened risk factors (age\u0026thinsp;\u0026gt;\u0026thinsp;49.50, later than 14.97 hours, BI of total body\u0026thinsp;\u0026gt;\u0026thinsp;14.50, BI of head/face/neck\u0026thinsp;\u0026gt;\u0026thinsp;2.83, and with inhalation injury) were suspected for tracheotomy and could be further evaluated by the classification formula. If the calculated score was larger than 0.064, tracheotomy was very likely needed and planed tracheotomy would better be performed in 32.44 hours after burns. Together, we provided an alternative strategy for determining the indication and timing of tracheotomy in burn patients.\u003c/p\u003e","manuscriptTitle":"Indication and timing of tracheotomy in burn patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-11 09:58:27","doi":"10.21203/rs.3.rs-7189680/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-19T07:55:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T21:33:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246482078958381025203501256667932523299","date":"2025-08-15T06:58:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T17:38:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-13T15:43:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-10T16:40:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169116529408910176675571319630665485683","date":"2025-08-08T00:49:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"147812860999418739867810205887828663691","date":"2025-08-07T20:21:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173825568334051656431777186875615592510","date":"2025-08-06T14:44:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"45037536577556496032564654474480021604","date":"2025-08-06T07:53:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318483670547333039398276926264446815464","date":"2025-08-05T22:38:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205104784127678421734844068409991369482","date":"2025-08-05T21:53:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89781064376545568204985244488128272463","date":"2025-08-05T16:21:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-05T16:18:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-23T15:10:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-23T12:31:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2025-07-22T17:54:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f9d6d6d3-9164-49b4-9d19-27974acbe399","owner":[],"postedDate":"August 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:05:24+00:00","versionOfRecord":{"articleIdentity":"rs-7189680","link":"https://doi.org/10.1186/s40001-025-03460-z","journal":{"identity":"european-journal-of-medical-research","isVorOnly":false,"title":"European Journal of Medical Research"},"publishedOn":"2025-11-25 15:58:41","publishedOnDateReadable":"November 25th, 2025"},"versionCreatedAt":"2025-08-11 09:58:27","video":"","vorDoi":"10.1186/s40001-025-03460-z","vorDoiUrl":"https://doi.org/10.1186/s40001-025-03460-z","workflowStages":[]},"version":"v1","identity":"rs-7189680","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7189680","identity":"rs-7189680","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}