Mortality risk factors in war-related pediatric burns: A comparative study among two distinct populations

Previously, the majority of wars were fought on remote battlefields between opposing armies due to conflicts preventing civilians from sustaining war-related burn injuries (WRBI). In recent years, WRBI has had a tremendous harmful impact on the pediatric population. This study aimed to investigate the demographics, causes, mechanisms of burns, surgical procedures, the major and minor risk factors affecting mortality, and outcomes of pediatric WRBI amidst the Syrian refugees and the Turkey neighborhood population, treated at our Burn Center.

Out of the 852 filled records, the retrospective cohort was performed with inclusion of 707 pediatric burn patients, 469 Turkey, and 238 Syrian participants, with age 0-17 years. Included in the study were patients admitted to our institution from December 2013 to May 2016, with at least 12 months of consistent follow-up. Independent variables of each patient collected data included age, gender, weight, ethnicity, locations patients coming from, season and reason of burn, type of burn, grade of burn, burnt body regions, total body surface area (TBSA), body surface area (BSA), burnt surface area (BuSA), time delay until admission, and presence of infection at time of admission. The dependent variables were hospitalization periods, surgical procedures of escharotomy, fasciotomy, and grafting, recorded final patient status, and mortality.

Syrian children with WRBI (direct-blastic, indirect-unintentional) suffered from higher BSA (mean=0.91m², p=0.001) than the Turkish children with non-intentional burns (0.89m², p=0.001), P=0.001. There was a significant relationship between causes of burns, such as hot liquids, fire/flames and blastic injuries among the Syrian (52.9%, 27.3%, p=0.000) and the Turkish (86.4%, 7.6% P=0.000) populations, respectively. Although most of the Turkey residents suffered more from hot liquid burns than the Syrians (86.4% vs 52.9%), the majority of mortality occurred with fire/flames and blastic injuries, which was higher among the Syrians (10.10%, p=0.001) than the Turkish (2.80% p=0.001). Mortality corresponded with complex and third-degree burns, ranking higher in the Syrian (100%) than in the Turkish (23.3%), which, in turn, related to hospital length of stay (Syrian mean: 9.79, p=0.001; Turkish mean: 7.83, p=0.839).

Our analysis showed that flame/fire and blast burns were severe and fatal in more pediatric Syrian victims than the Turkey residents due to the severity of war inflicted burned wounds, the living conditions at the refugee camps, and the tent cities. Our present study is significant as our data would alert authorities to predict pediatric WRBI risk factors, burn survivals and casualties, and thus plan strategies to promote training programs for burn management of two distinct populations to reduce risk factors of burn mortality. Burnt surface area (BuSA) is a new parameter we derived to predict mortality risk factors in WRBI.