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Published on: February 23, 2024
Estimating mortality risk in burn patients admitted at Rwanda's largest referral hospital
Ian Shyaka1, Elizabeth Miranda2,3, Lotta Velin2,4
1Department of Plastic Surgery, Rwanda Military Hospital Kigali, Rwanda.
Insights
Mortality prediction scores for burn patients are feasible in low-income settings like Rwanda. Systematic data collection is crucial for accurate burn injury outcome predictions.
Area of Science:
- Global Health
- Trauma Surgery
- Burn Care Research
Background:
- Burns disproportionately affect low- and middle-income countries, with Sub-Saharan Africa experiencing high mortality rates.
- Existing mortality prediction indexes, widely used in high-income countries, require validation in resource-limited settings.
- This study addresses the need to assess the reliability of these indexes in Rwanda's unique healthcare context.
Purpose of the Study:
- To analyze in-hospital mortality rates among burn patients in Rwanda.
- To evaluate the applicability and accuracy of established mortality estimation indexes in a low-income setting.
- To identify factors influencing burn patient outcomes in the region.
Main Methods:
- Retrospective analysis of burn patients admitted to the University Teaching Hospital in Kigali, Rwanda (2005-2019).
- Data collection from the burn unit logbook, including patient demographics and burn characteristics.
- Calculation of descriptive statistics, association between burn characteristics and mortality using Fisher's exact test and Wilcoxon rank test.
- Application of mortality estimation indexes: Baux score, Lethal Area 50 (LA50), and point of futility using logistic regression for patients with complete age and Total Body Surface Area (TBSA) data.
Main Results:
- Out of 1093 admitted patients, 49% had complete data for analysis.
- Median age was 3.4 years, median TBSA was 15%, and median Baux score was 24.
- Overall in-hospital mortality was 13%. LA50 for the Baux score was 89.9, and the point of futility was a Baux score of 104.
Conclusions:
- Mortality estimation indexes utilizing age and TBSA are practical for use in low-income countries.
- Enhanced systematic data collection is recommended to improve the precision of mortality risk calculations in burn care.
- Findings support the potential for adapting established burn outcome prediction tools to resource-limited environments.
Background:
Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn victims die from their injuries. Mortality prediction indexes are used to estimate outcomes after provided burn care, which has been used in burn services of high-income countries over the last 60 years. It remains to be seen whether these are reliable in low-income settings. This study aimed to analyze in-hospital mortality and to apply mortality estimation indexes in burn patients admitted to the only specialized burn unit in Rwanda.
Methods:
This retrospective study included all patients with burns admitted at the burn unit (BU) of the University Teaching Hospital in Kigali (CHUK) between 2005 and 2019. Patient data were collected from the BU logbook. Descriptive statistics were calculated with frequency (%) and median (interquartile range, IQR). Association between burns characteristics and in-hospital mortality was calculated with Fisher's exact test, and Wilcoxon rank, as appropriate. Mortality estimation analysis, including Baux score, Lethal Area 50 (LA50), and point of futility, was calculated in those patients with complete data on age and TBSA. LA50 and point-of-futility were calculated using logistic regression.
Results:
Among the 1093 burn patients admitted at the CHUK burn unit during the study period, 49% (n=532) had complete data on age and TBSA. Their median age, TBSA, and Baux score were 3.4 years (IQR 1.9-17.1), 15% (IQR 11-25), and 24 (IQR 16-38), respectively. Overall, reported in-hospital mortality was 13% (n=121/931), LA50 for Baux score was 89.9 (95% CI 76.2-103.7), and the point-of-futility was at a Baux score of 104.
Conclusion:
Mortality estimation indexes based on age and TBSA are feasible to use in low-income settings. However, implementation of systematic data collection would contribute to a more accurate calculation of the mortality risk.
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