Outcomes of burns patients in a developing country: A single centre’s experience
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i10.1029Keywords:
LA50, Outcomes, Burns, MortalityAbstract
Background. Pelonomi Tertiary Hospital is the only hospital in the Free State Province with a burns unit. We do not have official data to assess our performance in the management of burns.
Objective. To determine the Lethal Area 50 (LA50) index for the Pelonomi Tertiary Hospital’s burns unit. Furthermore, to determine the morbidity that affects burns patients at the institution, and the factors associated with outcomes.
Methods. We used Redcap to capture demographic and clinical data of burn patients admitted to our institution between January 2014 and December 2018. Logistic regression was used to determine significant predictors of the outcomes. The LA50 was calculated by performing a probit regression of survival by total body surface area (TBSA). We used SAS 9.4 statistics software package.
Results. Our study had a male preponderance, with 59.7% (601) male, 39.9% (401) female and 0.4% (4) missing sex. We had a mean age of 19.4 years, of which 53.38% (n=537) were paediatric patients and 46.32% (n=469) adults. The mean length of hospital stay was 16.88 days. Our LA50 was 37%, and the overall mortality was 14.63%, with a mean age of 33.96, a mean TBSA of 43.3% and a mean revised Baux score of 80.55 for the mortality group. The paediatric group had a 5.03% (n=27) mortality rate, with 88.88% of these being children under 5 years with an LA50 of 45%, and the adult group had a 25.56% (n=120) mortality rate with an LA50 of 34%. Factors associated with mortality were age (p<0.0001), TBSA (p<0.0001), female sex (p=0.4126), full-thickness burns (p=0.7160) and burns to the head (p=0.9038). The leading cause of injury was hot water (46.5% of patients), followed by fire at 38.6%. HIV was the leading comorbidity, affecting 6.9% (n=67) of patients, followed by hypertension at 4.67% (n=47), and 2.58% (n=26) of patients had epilepsy. The leading complication was sepsis, affecting 14.67% (n=144) of patients. The average waiting time between admission and skin graft was 25.29 days, and for debridement was 3.57 days.
Conclusion. The epidemiology of burn patients and working conditions at Pelonomi Tertiary Hospital are similar to other burn units in the country; however, our mortality rate is higher than at most centres. The LA50 is low, but in keeping with the rest of Africa, and our predictors of mortality are in keeping with those found in other studies in other parts of the world.
References
Mock C, Peck M, Peden M, Krug E. A WHO plan for burn prevention and care. Geneva: World Health Organization, 2008. http://www.who.int/ violence_injury_prevention (accessed 30 January 2019).
Allorto NL, Wall S, Clarke DL. Quantifying capacity for burn care in South Africa. Burns Open
;2(4):188-192. https://doi.org/10.1016/j.burnso.2018.07.002
Alipour J, Mehdipour Y, Karimi A. Epidemiology and outcome analysis of 3030 burn patients with an ICD-10 approach. Ann Burns Fire Disasters 2020;33(1):3.
Sheridan RL. Critical care of the burn patient: Current concepts in adult critical care. Mount Prospect: Society of Critical Care Medicine, 2015. https://www.sccm.org/getattachment/50ab9630-4902-4d32-ad4e-47e531942b4e/Critical-Care-of-the-Burn-Patient (accessed 23 February 2019).
Williams FN, Branski LK, Jeschke MG, Herndon DN. What, how, and how much should patients with burns be fed? Surg Clin North Am 2011;91(3):609-629. https://doi.org/10.1016/j.suc.2011.03.002
Hashmi M, Kamal R. Management of patients in a dedicated burns intensive care unit (BICU) in a developing country. Burns 2012;39:393-500.
Browning JA, Cindass R. Burn debridement, grafting, and reconstruction. StatPearls Treasure Island (FL): StatPearls Publishing; 2021.. https://www.ncbi.nlm.nih.gov/books/NBK551717/ (accessed 20 May 2021).
Vorstandlechner V, Pauzenberger R, Happak W, et al. Are we bound to our scores? A 74-year-old patient with an abbreviated burn severity index of 14. Ann Burns Fire Disasters 2018;31(2):94-96.
Smith MT, Allorto NL, Clarke DL. Modified first world mortality scores can be used in a regional South African burn service with resource limitations. Burns 2016;42(6):1340-1344. https://doi.org/10.1016/j.burns.2016.03.024
Sheridan RL, Hinson MI, Liang MH, et al. Long-term outcome of children surviving massive burns. JAMA 2000;283(1):69-73. https://doi.org/10.1001/jama.283.1.69
Kershavarzi A, Kardeb S, Pourdavood A, Mohamadpour M, Dehghankhalili M. Determinants of the Lethal Area 50 Index (LA50) in burn patients admitted to a tertiary referral burn center in Southern Iran. Bull EmergTrauma 2018;6(1):59-63. https://doi.org/10.29252/beat-060109
Bull JP, Squire JR. A study of mortality in a burns unit: Standards for the evaluation of alternative methods of treatment. Ann Surg 1949;130(2):160-173. https://doi.org/10.1097/00000658-194908000- 00002
Ahmadabadi A, Khadem-Rezaiyan M, Sedaghat A, et al. Lethal area 50 percent (LA50) or standardised mortality ratio (SMR): Which one is more conclusive? Burns 2018;44(6):1468-1474. https://doi. org/10.1016/j.burns.2018.04.003
Allorto NL, Zoepke S, Clarke DL, Rode H. Burn surgeons in South Africa: A rare species. S Afr Med J 2016;106(2):186-188. https://doi.org/10.7196/SAMJ.2016.v106i2.9954
Jeschke MG, Pinto R, Cosford SR, Amini-Nik S. Threshold age and burn size associated with poor outcomes in the elderly after burn injury. Burns 2016;42(2):276-281. https://doi.org/ 10.1016/j. burns.2015.12.008
Scheven D, Barker P, Govindasamy J. Burns in rural Kwa-Zulu Natal: Epidemiology and the need for community health education. Burns 2012;38(8):1224-1230. https://doi.org/10.1016/j.burns.2012.04.001
Blom L, Klingberg A, Laflamme L, Wallis L, Hasselberg M. Gender differences in burns: A study from emergency centres in the Western Cape, South Africa. Burns 2016;42(7):1600-1608. https://doi. org/10.1016/j.burns.2016.05.003
Jugmohan B, Loveland J, Doedens L, Moore RL, Welthagen A, Westgarth-Taylor CJ. Mortality in paediatric burns victims: A retrospective review from 2009 to 2012 in a single centre. S Afr Med J 2016;106(2):189-192. https://doi.org/10.7196/SAMJ.2016.v106i2.8942
Den Hollander D, Albert M, Strand A, Hardcastle TC. Epidemiology and referral patterns of burns admitted to the Burns Centre at Inkosi Albert Luthuli Central Hospital, Durban. Burns 2014;40(6):1201-1208. https://doi.org/10.1016/j.burns.2013.12.018
Christofides C, Moore R, Nel M. Baux score as a predictor of mortality at the CHBAH Adult Burns Unit. J Surg Res 2020;251:53-62. https://doi.org/10.1016/j.jss.2020.01.018
Allorto NL, Oosthuizen GV, Clarke DL, Muckart DJ. The spectrum and outcome of burns at a regional hospital in South Africa. Burns 2009;35(7):1004-1008. https://doi.org/10.1016/j.burns.2009.01.004
Tyson AF, Boschini LP, Kiser MM, et al. Survival after burn in a sub-Saharan burn unit: Challenges and opportunities. Burns 2013;39(8):1619-1625. https://doi.org/10.1016/j.burns.2013.04.013
Mobayen M, Farzan R, Dadashi A, Rimaz S, Aghebati R. Effect of early grafting on improvement of lethal area index (LA50) in burn patients: A 7-year investigation in a burn referral centre in the North of Iran. Ann Burns Fire Disasters 2017;30(3):189.
Khashaba HA, Al-Fadhli AN, Al-Tarrah KS, Wilson YT, Moiemen N. Epidemiology and outcome of burns at the Saud Al Babtain Burns, Plastic Surgery and Reconstructive Center, Kuwait: Our experience over five years (from 2006 to 2010). Ann Burns Fire Disasters 2012;25(4):178.
Aghazadeh AM, Lotfi M, Ghahramanian A, Ahadi F. Lethal area 50 in patients with burn injuries in North West, Iran. J Caring Sci 2018;7(1):53. https://doi.org/10.15171/jcs.2018.009
Saffle JR, Davis B, Williams P, American Burn Association Registry Participant Group. Recent outcomes in the treatment of burn injury in the United States: A report from the American Burn Association Patient Registry. J Burn Care Rehabil 1995;16(suppl_3_pt_1):219-232. https://doi.org/10.1097/00004630-199505000-00002
House I, Street K. Mid-year population estimates 2017. Pretoria: StatsSA, 2018. https://www.statssa.
gov.za/publications/P0302/P03022018.pdf (accessed 20 January 2022).
Edge JM, Van der Merwe AE, Pieper CH, Bouic P. Clinical outcome of HIV positive patients with
moderate to severe burns. Burns 2001;27(2):111-114. https://doi.org/10.1016/s0305-4179(00)00090-5
James J, Hofland HC, Borgstein ES, Kumiponjera D, Komolafe OO, Zijlstra EE. The prevalence of HIV infection among burn patients in a burns unit in Malawi and its influence on outcome. Burns 2003;29(1):55-60. https://doi.org/10.1016/s0305-4179(02)00236-x
Sheyo M. Clinical outcome of burns in HIV positive patients in Lusaka, Zambia. Med J Zambia 2012;39(4):1-6.
Faurie MP, Allorto NL, Aldous C, Clarke DL. A closer look at burn injuries and epilepsy in a developing world burn service. S Afr J Surg 2015;53(4):48-50.
Rakkolainen I, Lindbohm JV, Vuola J. Factors associated with acute kidney injury in the Helsinki burn Centre in 2006 - 2015. Scand J Trauma Resusc Emerg Med 2018;26(1):1-0. https://doi.org/10.1186/ s13049-018-0573-3
Rashidi HH, Sen S, Palmieri TL, Blackmon T, Wajda J, Tran NK. Early recognition of burn-and trauma-related acute kidney injury: A pilot comparison of machine learning techniques. Sci Rep 2020;10(1):1-9. DOI https://doi.org/10.1038/s41598-019-57083-6
Brusselaers N, Agbenorku P, Hoyte-Williams PE. Assessment of mortality prediction models in a Ghanaian burn population. Burns 2013;39(5):997-1003. https://doi.org/10.1016/j.burns.2012.10.023
Johnson UU, Ibeanusi SE, Kejeh BM. Audit of admissions and outcome of patients with burns in the intensive care unit of a tertiary hospital in Port Harcourt, Nigeria. J Adv Med Pharma Sci 201817(1):1- 9. https://doi.org/10.9734/JAMPS/2018/41743
Fazeli S, Karami-Matin R, Kakaei N, Pourghorban S, Safari-Faramani R, Safari-Faramani B. Predictive factors of mortality in burn patients. Trauma Monthly 2014;19(1):e14480. https://doi.org/10.5812/ traumamon.14480
Haiphong L, ZhiHui Y, JiangLin T, et al. Epidemiology and outcome analysis of 6325 burn patients: A five-year retrospective study in a major burn center in Southwest China. Sci Rep 2017 6;7(1):46066. https://doi.org/10.1038/srep46066
Knowlin L, Stanford L, Moore D, Cairns B, Charles A. The measured effect magnitude of comorbidities on burn injury mortality. Burns 2016;42(7):1433-1438. https://doi.org/10.1016/j.burns.2016.03.007 40. Tarim MA. Factors affecting mortality in burn patients admitted to intensive care unit. Eastern J Med 2013;18(2):72.
Zavlin D, Chegireddy V, Boukovalas S, et al. Multi-institutional analysis of independent predictors for
burn mortality in the United States. Burns Trauma 2018;6. https://doi.org/10.1186/s41038-018-0127-y
Chong SJ, Kok YO, Tay RX, Ramesh DS, Tan KC, Tan BK. Quantifying the impact of inhalational burns: A prospective study. Burns Trauma 2018 Sep 4;6:26 No Pagination Specified. https://doi.org/10.1186/s41038-018-0126-z
Lam NN, Hung NT, Duc NM. Prognosis value of revised Baux score among burn patients in developing country. Int J Burns Trauma 2021;11(3):197.
Heng JS, Clancy O, Atkins J, et al. Revised Baux score and updated Charlson comorbidity index are independently associated with mortality in burns intensive care patients. Burns 2015;41(7):1420-1427. https://doi.org/10.1016/j.burns.2015.06.009
Prasad A, Thode Jr HC, Singer AJ. Predictive value of quick SOFA and revised Baux scores in burn patients. Burns 2020;46(2):347-351. https://doi.org/10.1016/j.burns.2019.03.006
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377-381.
Harris PA, Taylor R, Minor BL, et al. The REDCap Consortium: Building an international community of software platform partners. J Biomed Inform 2019;95:103208.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Khanani Mathonsi, Emmanuel Arko-Cobbah
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
