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Annals of Surgery

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This study developed a scoring system that stratifies burn patients at the time of hospital admission according to risk of developing heterotopic ossification (HO), the development of abnormal bone in the soft tissue. HO in burns is an uncommon but severely debilitating problem with a poorly understood mechanism and no fully effective prophylactic measures. Data were obtained from the Burn Model System National Database for 3,693 subjects with burn dates between 1994 and 2010. The primary outcome was diagnosis of HO at hospital discharge. Logistic regression analysis was used to determine significant demographic and medical predictors of HO. A risk scoring system was created in which point values were assigned to predictive factors and final risk score is correlated with the percent risk of developing HO. The model was internally and externally validated. The mean age of the subjects was 42.5  years, the mean total body surface area (TBSA) burned was 18.5  percent, and 74.9 percent were men. TBSA and the need for grafting of the arm, head/neck, and trunk were significant predictors of HO development. A 13-point risk scoring system was developed using these significant predictors. The model c-statistic is 0.92. The risk scoring system demonstrated evidence of internal and external validity. An online calculator was developed to facilitate translation of knowledge to practice and research. This HO risk scoring system identifies high-risk burn patients suitable for diagnostic testing and interventional HO prophylaxis trials.


Schneider, Jeffrey C., Simko, Laura C., Goldstein, Richard, Shie, Vivian L., Chernack, Betty, Levi, Benjamin, Jayakumar, Prakash, Kowalske, Karen J., Herndon, David N., Gibran, Nicole S., Ryan, Colleen M.