A three decade analysis of factors affecting burn mortality in the elderly

This study's objective was to identify variables that affect the mortality of elderly burn patients and to assess their changes over time. A retrospective review was conducted on all patients 75 or older (n = 201) admitted to a university-based burn center between 1972 and 2000. Variables examined were age, sex, TBSA, ABSI, inhalation injury, timing from burn to operative intervention, the number of surgical procedures, the number of pre-morbid conditions, and mortality. There were 95 fatalities. TBSA strongly correlated with mortality (p < 0.0001). Adjusting for TBSA and inhalation injury, mortality significantly decreased (p = 0.04, odds ratio = 0.58). Mortality significantly increased with inhalation injury (p < 0.01). Fatality risk increased by 400% with inhalation injury. Absence of inhalation injury was not significant with respect to mortality in the 1970s, however there was a significant decrease (p = 0.02) in mortality without an inhalation injury in the 1980s and 1990s. ABSI was strongly predictive of mortality (p < 0.0001). On average there was a 200% increase in mortality per unit increase of ABSI. The elderly are 58% less likely to die from burns now as compared to the 1970s. Although mortality rose with increasing TBSA equally in each decade, the absolute risk of mortality decreased over time. This data suggests major strides have been made in burn care, however similar success has not been achieved with inhalation injuries.     

A study of burn injuries in the elderly in a regional burn centre

We evaluated the epidemiology and outcome of 94 elderly burn patients of age 60 years or older treated in a local burn centre over a period of 6 years. There were 44 males and 50 females with a male to female ratio of 0.88 and an average age of 73.8+/-9 years. The mean extent of burn was 13.3+/-18.4% total body surface area (TBSA) with 14 patients (15%) suffering from a burn size >20% TBSA. The vast majority of injuries (90%) occurred at home. Scalds resulted in 62 admissions (66%) and flame burns accounted for another 29 admissions (31%). The burns predominantly involved the extremities and the trunk. Four patients had inhalation injuries and required admission to the Intensive Care Unit for ventilatory support. The majority of patients (60%) did not require any operations. The mean hospital stay of the survivors was 30.1+/-34.1 days and 35% of them stayed less than 2 weeks. Fifty-five patients (59%) had at least one pre-existing medical problem requiring long-term medication and 41 patients (44%) were living alone. Sixty-three patients (67%) presented more than 8 h after the burn injuries and 34 patients (36.2%) had no first aid treatment of their burn wounds. In addition, 40 patients (42.5%) had their wounds treated inappropriately. Seven patients died in this series which yielded a mortality rate of 7.4%. The outcomes of early versus late excision and grafting were also analyzed.     

Factors affecting early and long-term outcomes after completion pneumonectomy

Objective: To identify factors that affect operative mortality and morbidity and long-term survival after completion pneumonectomy. Methods: We retrospectively reviewed the charts of consecutive patients who underwent completion pneumonectomy at our cardiothoracic surgery department from January 1996 to December 2005. Results: We identified 69 patients, who accounted for 17.8% of all pneumonectomies during the study period; 22 had benign disease and 47 malignant disease (second primary lung cancer, n = 19; local recurrence, n = 17; or metastasis, n = 11). There were 50 males and 19 females with a mean age of 60 years (range, 29–80 years). Postoperative mortality was 12% and postoperative morbidity 41%. Factors associated with postoperative mortality included obesity (p = 0.005), coronary artery disease (p = 0.03), removal of the right lung (p = 0.02), advanced age (p = 0.02), and renal failure (p < 0.0001). Preoperative renal failure was the only significant risk factor for mortality by multivariate analysis (p = 0.036). Bronchopleural fistula developed in seven patients (10%), with risk factors being removal of the right lung (p = 0.04) and mechanical stump closure (p = 0.03). Overall survival was 65% after 3 years and 46% after 5 years. Long-term survival was not affected by the reason for completion pneumonectomy. Conclusion: Although long-term survival was acceptable, postoperative mortality and morbidity rates remained high, confirming the reputation of completion pneumonectomy as a challenging procedure. Significant comorbidities and removal of the right lung were the main risk factors for postoperative mortality. Improved patient selection and better management of preoperative renal failure may improve the postoperative outcomes of this procedure, which offers a chance for prolonged survival.     

Comparison of on pump and off pump coronary surgery: risk factors for neurological outcome

Objective: Cerebrovascular accidents (CVA) are devastating complications after coronary artery bypass grafting (CABG). The reported incidence of neurological complications after conventional CABG (CCABG) is 3–6%. Off-pump coronary bypass grafting (OPCAB) has been associated in recent studies to a decreased morbidity and risk of perioperative stroke. Nevertheless, uncertainty still surrounds the relative benefits of OPCAB. We investigated whether, in our experience, OPCAB was associated with lower neurological morbidity than conventional CABG approach. Methods: Eight thousand and two patients underwent isolated CABG at our institution between January 1998 and January 2005. OPCAB operation was performed on 1415 patients. Data were prospectively collected. A multiple logistic regression analysis was used to evaluate the influence of the two different surgical techniques on the neurological outcomes. Results: Patients in the OPCAB group were significantly older (66.2 vs 63.5%, p < 0.0001), had a higher incidence of renal injury (5.4 vs 2.4%, p < 0.0001), and were more redo interventions (6.95 vs 1.53%, p < 0.0001). The CCABG patients were more urgent at operation (5.46 vs 3.26, p = 0.0007), were less hypertensive (57.6 vs 63% of the patients, p = 0.0003) more diabetics (22 vs 20.6%, NS), and had an ejection fraction less than 0.40 (10.4 vs 9.6%, NS). CVA incidence was similar in both groups (Type I outcome: OPCAB = 0.70% vs CCABG = 0.68%, p = 0.91; Type II outcome OPCAB = 0.70% vs CCABG = 0.83%, p = 0.63). Conclusions: In our experience patients undergoing CCABG were not exposed to a grater risk of neurological adverse events when compared to OPCAB patients.     

Immunohistochemistry-detected microscopic tumor spread affects outcome in en-bloc resection for T3-chest wall lung cancer

Objective: This study is aimed at analyzing the effect of immunohistochemistry-detected microscopic tumor spread on long-term survival after en-bloc lung and chest wall resection for T3-chest wall non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed 47 patients (mean age 64.4 ± 7.1 years, range 48–77) who underwent radical en-bloc lung and chest wall resection for NSCLC between 1987 and 2000. Resection margins, invasion depth, and lymph nodes were re-assessed by immunohistochemistry with AE1/AE3 anti-cytokeratin and anti-CEA monoclonal antibodies. Results: Operative mortality and morbidity were 2.1% and 34%, respectively. At immunohistochemistry analysis, five patients (10.6%) revealed microinfiltration of the resection margins that was significantly correlated with the development of local recurrence (p < 0.005). Nodal micrometastases were found in 4 out of 33 N0 patients (12.1%), and correlated with distant relapse (p < 0.001). Overall and disease-free survivals were significantly influenced by N-status (p < 0.001), especially after re-evaluation of micrometastases (p < 0.0001), and resection margins microinfiltration (p < 0.0001) being these last two the only significant prognostic factors at Cox regression analysis. Five-year overall survival in radically resected patients was 73%. Conclusions: In this study immunohistochemical analysis allowed to identify patients at higher risk of recurrence following en-bloc resection for T3-chest wall NSCLC.     

Factors affecting mortality and epidemiological data in patients hospitalised with burns in Diyarbakir, Turkey

BACKGROUND: Burns continue to be responsible for significant morbidity and mortality in developing countries. In this study we aimed to determine the factors affecting mortality and epidemiological data by examining the records of burned patients. METHOD: The hospital records of 980 patients who were hospitalised in the Burns Unit at Dicle University Hospital (DUH) between June 1994 and July 1999 were examined for factors affecting mortality. Factors evaluated included gender, age, burn type, degree and extent of burn, prognosis and length of hospitalisation (LH). We investigated the relationship (if any) between the demographic data, degree and extent of burns and mortality and morbidity rates. RESULTS: The study group consisted of 325 males (33.2%) and 655 females (66.8%). Of the patients 738 (75.3%) were children (age under 15 years), 217 (22.1%) were younger adults (age 15-50 years), and 25 (2.6%) were older adults (age over 50 years). The mean age was 11.2 +/- 14.01 years (range 15 days-95 years). Of the burns 618 (63.1%) were scalds, 199 (20.3%) burns from a flame and 163 (16.6%) electrical burns. The mean extent of burn was 24.3 +/- 14.5% (range 1-95%). Seven hundred and eighty-seven (80.3%) of the study group made a full recovery, 131 (13.4%) were discharged from hospital after partial recovery, and 62 (6.3%) died. The mean LH was 11.33 +/- 8.8 days (range 1-67 days). There was a positive correlation between burn extent and mortality (r = 0.35, p < 0.0001) and between age and type of burn (r = 0.60, p < 0.0001). While scalds had the highest frequency among children, flame and electrical burns were most common in the adult and older adult groups. There was also a positive correlation between degree and type of burn (r = 0.32, p = 0.0001), scalds tending to be more superficial while flame and electrical burns were generally more serious. Deaths of patients with extensive burns usually occurred in the first 5 days following injury due to acute renal failure and hypovolaemic shock, while deaths from moderate and minor burns usually occurred after 7 days and were due to wound infection and sepsis. CONCLUSION: We found positive correlations between age and type of burn, degree and type of burn, and the extent of burn and mortality. The overall mortality rate for our unit was 6.3%.     

Epidemiology and outcomes of burn injuries at a tertiary burn care center in Bangladesh

Globally, burns are among some of the most devastating injuries and account for more than 265,000 deaths worldwide. In Bangladesh alone, nearly 3000 people die annually from burn-related injuries. This study was conducted at the National Institute of Burn and Plastic Surgery in Dhaka, Bangladesh in June of 2016. Data included conducting surveys of hospitalized burn patients (N = 66) and a chart review of deceased burn patients (N = 88). In addition to reporting on the demographic profile of patients, information was also obtained on clinical measures during hospitalization. For non-fatal burns, high risk groups included young adult males (early 30s) of lower socioeconomic status. Among children, the most vulnerable group was found to be children less than eight years old. The most common non-fatal types of burn injuries were flame (35%), electrical (31%) and scald (24%). Discharged patients had an average hospital stay of around 30 days with half of all patients requiring surgical intervention, thus indicating the severity of those cases and the need for resource-intensive care. Among the discharged patient population, factors significantly associated with a longer duration of hospital stay included severity of injury, not having received prior treatment before admission and whether or not patients required surgery during hospitalization.Among the mortality cases, the high-risk groups also included young adult males and children of around eight years of age. The average total body surface area (TBSA) sustained in these cases was 46.4%, with 65% of deaths attributable to complications from flame burns.These findings highlight the frequency and severity of burn injuries, identify vulnerable population groups and list common causes of burns in this large developing country of 160 million people. Furthermore, these findings may be applicable to the epidemiology and outcome of burns in similar low and middle income countries.     

Effect of growth hormone therapy in burn patients on conservative treatment

Evaluation of growth hormone therapy in burns is limited and none is reported from developing countries where burns still carry high mortality. We analysed serial observations on the clinical and biochemical profiles in 13 patients with second and third degree burns who received recombinant human growth hormone (rhGH) (0.5 IU/kg body wt) for 2 weeks in addition to standard conservative treatment and in 9 patients who were managed with standard conservative treatment only. The two groups of patients had burns, comparable in extent and severity. Additional rhGH treatment resulted in improved wound healing (p<0.001), delayed separation of eschars (p<0.01), increase in haemoglobin (p<0.05), serum albumin (p<0.01), calcium (p<0.05), phosphorus (p<0.001), glomerular filtration rate (p<0.05) and 7 fold elevation in IGF-1. Also, a reduction in weight loss (p<0.01), nitrogen production rate (p<0.05), catabolic index (p<0.01), duration of sepsis (p<0.01) and hospital stay by 40% (p<0.01) was noted with rhGH therapy. Transient hypercalcemia (3 patients), albuminuria (2 patients) and elevated blood glucose (one patient) were noted in the rhGH treated group not necessitating any specific therapy. Mortality in rhGH treatment group was 8.3% compared to 44.5% in the “no rhGH” treatment group. These observations suggest significant benefits of short term rhGH treatment in burn patients on conservative management.     

Epidemiological analysis of patients with burns in third‐line hospitals in Turkey

Burns are a major health problem worldwide. Burn injury resulting from making contact with hot objects, direct or indirect contact with flame, and exposure to chemical agents or electric current is usually preventable. In this study, epidemiological data of the patients who had been hospitalised in the burn unit was assessed. The records of 1453 patients who were admitted to the burn unit of Diyarbakir Gazi Yaşargil Training and Research Hospital between July 2008 and April 2018 were retrospectively examined. Out of 1453 cases, 81.7% (1187) were children and 18.3% (266) were adults, 58.3% of the cases were male (847) and 41.7% (606) were females. Patients had a mean age of 11 ± 5 years (1‐81 years). The most common cause of burns was contact with hot liquids (82.86%) while other causes were flame burns (12.04%), electrical contact burn (3.02%) contact with chemical substances (2.06%). Most of the cases were found to have burned 10% to 20% of the body surface. Localization was most frequently seen in the lower extremity and less frequently in the upper limb, trunk, head and neck, and perineal regions. The majority of burn injuries are preventable. Therefore, epidemiological studies in the field of burns will provide vital preventive information to develop strategies to reduce injury frequency and spend on health. Because burns are a social problem, prevention efforts require social co‐operation. Promotional meetings in schools are important to increase family‐school cooperation to inform children of school age, to give lectures and first aid measures to rural areas.     

Burn first aid in Western Australia—Do healthcare workers have the knowledge?

Burn injuries treated with adequate immediate first aid are associated with more favourable outcomes, limiting tissue damage and subsequent morbidity including the need for surgery. Cool running water at a temperature of between 10–15 °C for 20 to 30 minutes is considered adequate burn first aid treatment. A prospective audit of all new patients (n = 227) with burns, attending the minor burn facility at Royal Perth Hospital showed only 88 (39%) patients received appropriate first aid. Fifty percent of patients receiving inappropriate first aid, had this delivered by his or her primary health care contact. This study aims to determine the knowledge of burns first aid among healthcare workers (HCW) and compare this to the general population. A customized survey was performed, four sample cases were included with 4 possible answers in a multiple choice format. All case studies asked the participant to record immediate first aid management. On a case by case basis, burn first aid knowledge was fair but overall knowledge very poor, only 18.8% of respondents achieving 4 correct responses. The uptake of first aid courses was high among HCW at 75% but particularly low among the NHCW at 28%. Our study has shown the value of performing such a course, with a statistically significant (p = 0.00) difference between participants who had completed a first aid course and those that had not. The purpose of this study was to quantify knowledge of burns first aid with a view to providing directed education, studies have shown the success of multimedia campaigns. It has been shown that good first aid improves the outcome for the burn patient and this study demonstrates that participation in a first aid course improves knowledge. It is justifiable to progress toward compulsory first aid courses which include first aid of the burns patient to improve outcomes for the community as a whole.     

Intestinal ischaemia following cardiac surgery: a multivariate risk model

Objective: Intestinal ischaemia following cardiac surgery is a serious complication, which carries a high mortality rate. Several studies have examined pre-operative and intra-operative risk factors. We aimed to develop a multivariate risk model to identify those patients at highest risk of intestinal ischaemia. Methods: Data was prospectively collected for 10,976 consecutive cardiac surgery patients from our institution between April 1997 and March 2004. Fifty (0.5%) patients developed post-operative intestinal ischaemia. A forward stepwise multivariate logistic regression analysis was undertaken to identify predictors of developing intestinal ischaemia. Intra-operative and post-operative variables were censored at the time of onset of intestinal ischaemia. Results: The predictors of post-operative intestinal ischaemia were: post-op inotrope and dialysis support (OR 6.7; p < 0.001), post-op ventilation >48 h (OR 5.1; p < 0.001), age at operation (OR 1.06 [for each additional year]; p < 0.001), post-op atrial fibrillation (OR 2.3; p = 0.014) and blood loss in intensive care unit (ICU) >700 ml (OR 2.0; p = 0.037). The predictive ability of this model was very good with an area under the receiver operating characteristic curve of 0.93. In-hospital mortality for the patients who developed intestinal ischaemia was 94% (47/50) compared to 3.6% (390/10,926) for the other patients (p < 0.001). Conclusions: Although the incidence of intestinal ischaemia following cardiac surgery is low, the prognosis for these patients is very poor. We have identified several risk factors, and developed a multivariate prediction tool, which may be useful in identifying patients at high-risk of developing intestinal ischaemia.     

Effect of risk-adjusted, non-dialysis-dependent renal dysfunction on mortality and morbidity following coronary artery bypass surgery: a multi-centre study

Objective: As little is known about the impact of non-dialysis-dependent renal dysfunction on short- and mid-term outcomes following coronary surgery we have conducted a large multi-centre study comparing patients with no history of renal dysfunction to those with preoperative renal dysfunction. Methods: Data was prospectively collected on 19,625 consecutive patients undergoing isolated coronary surgery between 1997 and 2003 from four institutions. Sixty-seven patients had a history of dialysis support prior to coronary surgery, and were excluded from the main analysis of the study. The remaining 19,558 patients were divided into two groups based on preoperative serum creatinine level, patients with preoperative renal dysfunction with serum creatinine levels >200 μmol/L without dialysis support and control patients with preoperative serum creatinine levels <200 μmol/L. Case-mix was accounted for by developing a propensity score, which was the probability of belonging to the non-dialysis-dependent renal dysfunction group, and included in the multivariable analyses. Results: There were 19,172 patients with preoperative serum creatinine levels <200 μmol/L and 386 patients with serum creatinine levels >200 μmol/L without dialysis support. The propensity score included sex, body mass index, co-morbidity factors (respiratory disease, diabetes, cerebrovascular disease, hypertension, and hypercholesterolemia), ejection fraction, left main stem stenosis, emergency status, prior cardiac surgery, off-pump surgery, and the logistic EuroSCORE. After adjusting for the propensity score, patients with preoperative non-dialysis-dependent renal dysfunction had significantly higher in-hospital mortality (adjusted odds ratio 3.0, p < 0.001), stroke (adjusted odds ratio 2.0, p = 0.033), atrial arrhythmia (adjusted odds ratio 1.5, p = 0.003), prolonged ventilation (adjusted odds ratio 2.1, p < 0.001), and post-op stay > 6 days (adjusted odds ratio 2.6, p < 0.001). One thousand one hundred and eighty-three (6.1%) deaths occurred during 58,062 patient-years follow-up. After adjusting for the propensity score, the adjusted hazard ratio of mid-term mortality for non-dialysis-dependent renal dysfunction was 2.7 (p < 0.001). Conclusions: Patients undergoing coronary surgery with non-dialysis-dependent renal dysfunction have significantly increased perioperative morbidity and mortality. Mid-term survival is also significantly reduced at 5-years.     

Epidemiology of burns presenting to an emergency department in Shiraz,South Iran

A retrospective study of 1493 burn patients attending the Ghotbeddin emergency burn center in Shiraz, South Iran during the 1 year period 2001-2002 was undertaken in order to describe the epidemiological features of burns in Shiraz. The following results were obtained: the mean age of attendees was 21.84+/-19.05 with an overall male to female ratio of 1.12. 41.2% of patients were children under 15 years with a M/F ratio of 1.36. The main causes of burns were scalds (53%) followed by flame (25%). The frequency of scalds was much higher among children (70%). The majority of accidents (81%) occurred at home, 5.2% occurred in workplace and domestic accidents were more frequent among women. The mean total body surface area (TBSA) burned was 7.4+/-14.3%. Extensive TBSA had a significant association with flame burns and sex, showing that female patients have higher risk for more extensive burns. Finally, there was a significant seasonal variation for burns, with most burns occurring in winter months.     

A retrospective analysis of 1083 Turkish patients with serious burns

A total of 1083 burn cases hospitalised at a burn center between August 1988 and the end of 1997 were studied retrospectively to determine the factors and demographic features associated with burn injury in Turkey. The means for patient age and percent total body surface area (TBSA) burned were 18.1 years and 31.2%, respectively (medians were 14.0 years and 25.0%, respectively). Burn injuries were more common in winter and spring, and most occurred in the home. The majority of patients were city dwellers, and had been referred from public hospitals. There was a predominance of male patients (71.9%) in the study population, but the proportions of children and adults were equal. Almost half of the males and the majority of the females were children/students. The vast majority of female adults were housewives, and most of the men were employed outside the home. More than half of the patients suffered second-degree burns, and the others all had deeper burn injuries. The most frequent cause of burn in the study population was flame. Children mainly suffered from scalding, and adults from flame and electrical burns. There were no differences between the sexes regarding depth of burn; whereas percentage total burned surface area was higher in females. Children had a lower mean TBSA and lower rate of third-degree burns. Mortality rate of the study population was 33.5%. The study results identified various risk factors and the groups at high risk for serious burns and indicated some ways that prevention programmes can be improved.     

A Pilot Study of Body Composition and Bone Mineral Density in Healthy Men From Argentina

A precise assessment of bone mineral density (BMD) and body composition can be performed using dual-energy X-ray absorptiometry (DXA). Values of body composition for males would be useful to evaluate the occurrence of alterations in body composition in a number of diseases. The objectives of this study were to establish BMD and body composition values in healthy men and to analyze age-related changes. BMD and body composition of total body and subareas were determined in 116 healthy men (aged 20–79 yr) using DXA. Comparison between 20–29- and 70–79-yr-old men showed that older subjects were shorter (p < 0.03), and had a higher body mass index (p < 0.01). Fat mass increased (+46.7%; p < 0.001) especially in the trunk. Lean mass (LM) decreased (−9.4%; p < 0.05) mainly in the arms and legs. Bone mineral content (BMC) and BMD decreased (−15.3% [p < 0.001], −6.3% [p < 0.05], respectively). Correlation was observed between BMC and LM (r = 0.7, p < 0.01). Values of BMD and body composition in healthy men were obtained. A relation was observed between bone mass and body composition, suggesting that the age-related decrease in LM may be associated to bone mass loss. Further studies should be conducted to elucidate the role of body composition in the occurrence of osteoporosis in men.     

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the firs, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0–10 years old (40 per cent) and moderate to major burns in the age group 21–30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.     

Determinants of Changes in Bone Density: A 5-Year Follow-Up Study of Adult Male Monozygotic Twins

The relative importance of determinants in bone mineral density (BMD) in adult men is partly unclear. Our goals were to investigate the effects of familial aggregation and behavioral factors on the change in BMD during a 5-yr follow-up. Subjects (n = 140) were 70 exposure-discordant monozygotic twin pairs (age 35–69 yr). BMD was measured with the same dual-energy X-ray absorptiometry scanner at baseline and at the 5-yr follow-up. A variety of covariates were used including physical examination and interview data. Multivariate linear regression was used. The mean annual decrease in femoral BMD was 0.2%. The mean lumbar BMD was unchanged, although 8–17% of subjects had a decrease of more than 5%. Familial aggregation explained 14% of the changes in femoral BMD and 19% in lumbar BMD. The stability of BMD in the follow-up was high, both for individuals (intraclass correlation coefficient [ICC] = 0.90–0.94) and for co-twins in a pair (ICC = 0.77–0.84). In femoral BMD, use of alcohol (p = 0.006), coffee (p = 0.046), and beta-blockers (p = 0.043) led to increases, whereas smoking led to a decrease (p < 0.01). We concluded that frequent increases in BMD, influenced by beta-blockers, partly explain the minor mean changes during follow-up; however, about every 10th subject had a significant decrease. Overall, familial effects played a dominant role in BMD changes in adult men.     

The effect of burn mechanism on pediatric mortality in Malawi: A propensity weighted analysis

IntroductionThe burden of global trauma disproportionately affects low- and middle-income countries, with a high incidence in children. Thermal injury represents one of the most severe forms of trauma and is associated with remarkable morbidity and mortality. The predictors of burn mortality have been well described (age, % total body surface area burn [TBSA], and presence of inhalation injury). However, the contribution of the burn mechanism as a predictor of burn mortality is not well delineated.MethodsThis is a retrospective analysis of prospectively collected data, utilizing the Kamuzu Central Hospital (KCH) Burn Surveillance Registry from May 2011 to August 2019. Pediatric patients (≤12 years) with flame and scald burns were included in the study. Basic demographic variables including sex, age, time to presentation, %TBSA, surgical intervention, burn mechanism, and in-hospital mortality outcome was collected. Bivariate analysis comparing demographic, burn characteristics, surgical intervention, and patient outcomes were performed. Standardized estimates were adjusted using inverse-probability of treatment weights (IPTW) to account for confounding. Following weighting, logistic regression modeling was performed to determine the odds of in-hospital mortality based on burn mechanism.ResultsDuring the study period, 2364 patients presented to KCH for burns and included in the database with 1794 (75.9%) pediatric patients. Of these, 488 (27.6%) and 1280 (72.4%) were injured by flame and scald burns, respectively. Males were 47.2% (n = 230) and 59.2% (n = 755) of the flame and scald burn cohorts, respectively (p < 0.001.) Patients presenting with flame burns compared to scald burns were older (4. 7 ± 3.1 vs. 2.7 ± 2.3 years, p < 0.001) with greater %TBSA burns (17.8 [IQR 10–28] vs 12 [IQR 7–20], p < 0.001). Surgery was performed for 42.2% (n = 206) and 19.9% (n = 140) of the flame and scald burn cohorts, respectively (p < 0.001.) Flame burns had a 2.6x greater odds of in-hospital mortality compared to scald burns (p < 0.001) after controlling for sex, %TBSA, age, time to presentation, and surgical status.ConclusionIn this propensity-weighted analysis, we show that burn mechanism, specifically flame burns, resulted in a nearly 3-fold increase in odds of in-hospital mortality compared to scald burns. Our results emphasize flame and scald burns have major differences in the inflammatory response, metabolic profile over time, and outcomes. We may further utilize these differences to develop specialized treatments for each burn mechanism to potentially prevent metabolic dysfunction and improve clinical outcomes.