Global Characteristics and Outcomes of Massive Burn Injuries

Patients with massive burn injuries represent a unique patient cohort because they are associated with high morbidity and mortality while requiring high care intensity. This study aimed to compare the characteristics and outcomes of patients with massive burns (total body surface area ≥ 40%) versus those without, by utilizing the WHO Global Burn Registry. Descriptive statistics summarized demographic and burn characteristics. Multivariable logistic regression quantified the impact of massive burns on mortality, likelihood of surgical intervention, and functional impairment among survivors. Among 9274 patients in the database, 1828 (19.7%) had massive burns, with a median total body surface area of 55% (interquartile range: 45%-75%). These patients were predominantly managed in low-resource settings (60%) and sustained higher rates of inhalation injury (48% vs. 7%, P < .001) and flame-based burns (83% vs. 40%, P < .001) compared with the non-massive burns cohort. Logistic regression showed that massive burns increased the odds of mortality (OR 7.25, 95% CI 6.08-8.65) and functional impairment (OR 1.36, 95% CI 1.004-1.81), while decreased the odds of undergoing surgical intervention (OR 0.55, 95% CI 0.48-0.62). Massive burns significantly predict higher mortality and long-term functional challenges while reducing the likelihood of surgical intervention. These findings underscore the need for tailored management strategies and comprehensive rehabilitation for this high-risk population, particularly in resource-limited settings.