Multidimensional Prognostic Assessment in Burn Patients: An Integrative Systematic Review of Clinical Scoring Systems and Their Limitations

Abstract

Background:
Accurate prognostic assessment in burn patients is essential for guiding clinical management and resource allocation. Several clinical scoring systems have been proposed, but their comparative performance across populations remains uncertain.
Objective:
To evaluate the performance, applicability, and limitations of clinical scoring systems for predicting mortality and severity in burn patients.
Methods:
A PRISMA-based integrative systematic review was conducted. A total of 4,403 records were identified across multiple databases. After screening and eligibility assessment, 17 studies were included, comprising cohort studies and meta-analyses. Methodological quality was assessed using the Newcastle-Ottawa Scale and an AMSTAR-style approach.
Results:
The Revised Baux Score demonstrated consistently high predictive accuracy for mortality (AUC 0.84-0.99), with strong external validation (AUC 0.96). However, reduced performance was observed in high-risk subgroups. The Abbreviated Burn Severity Index (ABSI) showed robust evidence, with a pooled association with mortality (OR 1.72; 95% CI 1.48-2.00) and significant correlation with length of hospital stay. The Revised Baux Score outperformed general critical care scores such as qSOFA (AUC ~0.99 vs 0.68-0.73). In some populations, modified ABSI demonstrated improved specificity. Inhalation injury was a strong independent predictor of mortality (OR 13.16). Comorbidities and dynamic clinical variables further influenced outcomes.
Conclusions:
Burn prognosis is multidimensional and cannot be defined by a single model. The Revised Baux Score remains the most practical and widely applicable tool, while ABSI provides strong complementary evidence. Integration of clinical scores with physiological and patient-specific factors offers the most accurate approach for outcome prediction.