Re-evaluation of the Effect of Age on In-hospital Burn Mortality in a Resource-Limited Setting

Abstract

Background: This global burden of burn injury is suffered disproportionately by people in low-income and middle-income countries, where 70% of all burns occur. Models based in high-income countries to prognosticate burn mortality treat age as a linearly increasing risk factor. It is unclear whether this relationship is similar in resource-limited settings. Methods: We analyzed patients from the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi, from 2011 to 2019. We examined the relationship between burnassociated mortality and age using adjusted survival analysis over 60 d, categorized into four groups: (1) younger children <5 y; (2) older children 5-17 y; (3) adults 18-40 y; and (4) older adults >40 y. Results: A total of 2499 patients were included. Most patients were <5 y old (n ¼ 1444) with only 133 patients >40 y. Older adults had the highest crude mortality at 34.6% and older children with the lowest at 13%. Compared to younger children, the hazard ratio adjusted for sex, percent total body surface area, and operative intervention was 0.59 (95% confidence interval, 0.44, 0.79) for older children and 0.55 (95% confidence interval, 0.40, 0.76) for adults. Older adults were statistically similar to younger children. Conclusions: We show in this cohort study of burn-injured patients in a resource-limited environment that the relationship between mortality and age is not linear and that the use of age-categorized mortality prediction models is more accurate in delineating mortality characteristics. Categorizing age based on local burn epidemiology will help describe burn mortality characteristics more accurately, leading to better-informed management strategies aimed at attenuating burn mortality for different populations.

Preoperative Anxiety and Postoperative Pain in Children with Burn Patients and Their Correlation Analysis

“…Regarding skin trauma, elderly patients are more likely to bear the skin pain caused by it and are also more susceptible to skin trauma. It is easy to adapt to the pain after surgery, which is consistent with the results of the present research (26,27).…”

The Timing of Operative Intervention for Pediatric Burn Patients in Malawi

“…Our study also showed that the youngest pediatric patients had a higher mortality risk with early excision and grafting. We previously showed that infants and toddlers have a higher mortality rate than older children in Malawi, even when controlling for burn size [19]. Our study proves that mortality is higher in younger pediatric burn patients who undergo early excision in this resource‐limited setting.…”

The effect of COVID-19 on burn management and outcomes in a resource-limited setting

“…Age was treated as a categorical variable based on previous data from our center. [15] Reliable burn depth data is not available, so the presence of a flame burn was used as a surrogate for deeper burns. We then systematically used a change-in-effect methodology, removing potential confounders if they did not significantly change the relationship (< 10% change) between pandemic presentation and mortality.…”