Introduction Burn injuries contribute a considerable burden of disease in variable-resource settings, often resulting in mortality. Despite contributing a substantial burden, outcomes from burn injuries in rural Africa are rarely described. The objective of this study was to examine factors associated with mortality from burn injury in rural Africa. Methods A retrospective chart review was conducted for all patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in eastern Africa. Bivariate analysis was used to compare patients who survived the hospital stay with those who did not. Using total body surface area (TBSA), the LD50 (Lethal Dose 50, burn size with a lethality of 50% of patients), and the modified-Baux score were calculated. Due to small sample size, lasso inference techniques for logistic regression were utilized to avoid overfitting a model and to determine relevant risk factors for mortality, by evaluating burn severity, age, sex, location of residence, payer status, time from injury to arrival, distance from hospital, presence of full thickness burns, inhalational injury, and referral status. Results A total 171 burn injury patients were reviewed for this study; two were excluded due to missing data. Among 169 patients, 14.8% (n=25) experienced mortality prior to hospital discharge. Fifty patients suffered an adverse event (29.6%) including: 17 wound infections, 10 urinary tract infections, 10 with sepsis, and 25 with respiratory complications. The LD50 for TBSA was 42%. The LD50 for the modified-Baux score was 81. Non-survivors had higher average TBSA (31.0±5.0% vs 11.5±0.8%; p< 0.01), more inhalational injury (44% vs 2.8%, p< 0.01), full-thickness burns (56.5% vs 23.9%, p< 0.01), and complications (88% vs 19.4%, p< 0.01). Odds of mortality increased 1.06 times for every percent increase in TBSA burn (95%CI: 1.02, 1.11; p< 0.01) and 13.9 times with inhalational injury (95%CI: 3.4, 56.4; p < 0.01). Conclusions Mortality from burn injury represents a substantial portion of patients at a hospital in rural Africa. Factors of larger TBSA and inhalational injury represent the greatest risk.
Introduction Burn injury represents a substantial burden of disease in resource-limited settings. Kenya has no formal trauma system and referral practices for burn injuries are not well understood. The purpose of this study was to determine the factors associated with burn injury referrals in rural Kenya. Methods A retrospective chart review was conducted for patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in southwest Kenya. Bivariate analysis compared referred and non-referred patients. Multivariable logistic regression was used to assess the association between burn severity and odds of referral adjusting for age, gender, insurance, time from injury to arrival and estimated travel time from home to hospital. Results The study included 171 patients with burn injury; 11 patients were excluded due to missing referral data. Of the 160 patients, 31.9% (n=51) were referred. Referral patients had higher average total-body-surface-area burn (23.1±2.4% vs 11.1±1.2%; p<0.001), were more likely to have full thickness burns (41.3% vs 25.5%; p=0.05) and less likely to present to the referral hospital within 24 hours after injury (47.8% vs 73.0%; p=0.005). Referral patients had longer travel time to hospital (90+ min: 52.9% vs. 22.0%, p<0.001). Odds of referral increased 1.62 times (95%CI: 1.19, 2.22) for every 10% increase in total-body-surface-area burn. Conclusion Without a coordinated trauma system, referrals represent a substantial portion of burn injury patients at a hospital in rural Kenya. Referred patients present with more severe burns and experience delays to presentation.
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