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Published on: February 23, 2024
The Timing of Operative Intervention for Pediatric Burn Patients in Malawi
Dylane Davis1, Selena An2, Linda Kayange3
1Department of Surgery, University of North Carolina School of Medicine, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA.
Insights
Early surgery for pediatric burn patients in resource-limited settings increases mortality risk. Delaying operative intervention beyond 72 hours may improve survival, especially for young children.
Area of Science:
- Pediatric surgery
- Burn care
- Global health
Background:
- Optimal timing for operative intervention in pediatric burn patients in resource-limited settings is unclear.
- This study investigates the association between surgical timing and mortality in pediatric burn patients in Malawi.
Purpose of the Study:
- To characterize the association between mortality and the timing of operative intervention.
- To inform clinical practice for pediatric burn management in resource-limited environments.
Main Methods:
- Retrospective analysis of pediatric burn patients (<18 years) from 2011-2022.
- Comparison of outcomes based on timing of excision and/or burn grafting.
- Logistic regression used to determine the adjusted odds ratio of death based on surgical timing.
Main Results:
- 2502 patients included; 16.4% underwent surgery.
- Mortality rate was 17.0% overall, 9.1% in the operative cohort.
- Surgery within 3 days increased mortality risk (OR 5.00), especially for younger children.
Conclusions:
- Early operative intervention (<72 hours) in pediatric burn patients is associated with higher mortality.
- Delaying surgery may offer a survival advantage, particularly for children under 5.
- Increased investment in early resuscitation and monitoring is crucial for this population.
Background:
Defining the optimal timing of operative intervention for pediatric burn patients in a resource-limited environment is challenging. We sought to characterize the association between mortality and the timing of operative intervention at a burn center in Lilongwe, Malawi.
Methods:
This is a retrospective analysis of burn patients (<18 years old) presenting to Kamuzu Central Hospital from 2011 to 2022. We compared patients who underwent excision and/or burn grafting based on the timing of the operation. We used logistic regression modeling to estimate the adjusted odds ratio of death based on the timing of surgery.
Results:
We included 2502 patients with a median age of 3 years (IQR 1-5) and a male preponderance (56.8%). 411 patients (16.4%) had surgery with a median time to surgery of 18 days (IQR 8-34). The crude mortality rate among all patients was 17.0% and 9.1% among the operative cohort. The odds ratio of mortality for patients undergoing surgery within 3 days from presentation was 5.00 (95% CI 2.19, 11.44) after adjusting for age, sex, % total burn surface area (TBSA), and flame burn. The risk was highest for the youngest patients.
Conclusions:
Children who underwent burn excision and/or grafting in the first 3 days of hospitalization had a much higher risk of death than patients undergoing surgical intervention later. Delaying operative intervention till >72 h for pediatric patients, especially those under 5 years old, may confer a survival advantage. More investment is needed in early resuscitation and monitoring for this patient population.
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