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Risk factors of mortality among pediatric burn patients: a systematic review and meta-analysis
Xitong Zhao1, Zhaohan Zhuang1, Yuxin Jia1
1Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Insights
Pediatric burn mortality is linked to 10 risk factors, including burn size and inhalation injury. Understanding these factors is key for improving outcomes in children with severe burns.
Area of Science:
- Pediatric Burn Care
- Clinical Epidemiology
- Public Health
Background:
- Pediatric burn injuries are a major global health concern, causing significant morbidity and mortality.
- Identifying mortality risk factors in pediatric burn patients is crucial for clinical management and prevention.
- This study systematically reviews and analyzes risk factors for mortality in this population.
Purpose of the Study:
- To synthesize existing evidence on risk factors for mortality in pediatric burn patients.
- To identify key prognostic indicators influencing survival rates.
- To inform clinical practice and public health strategies for burn prevention and treatment.
Main Methods:
- A systematic literature search was performed across major databases (PubMed, Embase, Web of Science, Cochrane Library).
- Data from 28 studies (5 cohort, 23 case-control) involving 97,599 pediatric burn cases were extracted and analyzed.
- Random-effects models were used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs), with sensitivity and subgroup analyses conducted.
Main Results:
- Ten significant risk factors for pediatric burn mortality were identified.
- Factors increasing mortality risk include larger total burn surface area (TBSA), flame etiology, inhalation injury, and mechanical ventilation.
- Factors associated with decreased mortality risk include female gender, younger age, urban residence, and surgery.
Conclusions:
- This meta-analysis highlights ten critical risk factors associated with mortality in pediatric burn patients.
- Findings underscore the importance of considering TBSA, age, gender, burn etiology, inhalation injury, surgery, mechanical ventilation, residence, burn characteristics, and length of stay in risk assessment.
- Future multicenter prospective studies are recommended to mitigate heterogeneity and bias in current research.
Background:
Pediatric burn injuries remain a significant cause of morbidity and mortality worldwide. Identifying risk factors associated with mortality in this vulnerable population is critical for improving clinical outcomes and guiding preventive strategies. This systematic review and meta-analysis aimed to synthesize existing evidence on the risk factors of mortality among pediatric burn patients.
Methods:
A comprehensive search was conducted across PubMed, Embase, Web of Science, and Cochrane Library databases from inception to December 2024. Two reviewers independently screened studies, extracted data, and assessed quality. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Sensitivity analysis and subgroup analysis were performed to assess the robustness of the findings and identify potential sources of heterogeneity.
Results:
Our meta-analysis incorporated 28 clinical studies comprising 5 cohort studies and 23 case-control studies, encompassing a total of 97,599 pediatric burn cases. The following ten parameters were identified as significant prognostic factors influencing mortality risk in pediatric burn patients-(I) total burn surface area (TBSA): extreme-value analysis (OR =1.17, 95% CI: 1.11-1.23; P<0.001), 10% (OR =12.65, 95% CI: 3.04-52.66; P<0.001), 25% (OR =58.44, 95% CI: 16.69-204.64; P<0.001); (II) age: extreme-value analysis (OR =0.93, 95% CI: 0.88-0.99; P=0.03), 4-year (OR =0.39, 95% CI: 0.19-0.80; P=0.01); (III) gender (female vs. male): (OR =1.41, 95% CI: 1.18-1.70; P<0.001); (IV) burn etiology (flame vs. scald): (OR =2.51, 95% CI: 2.09-3.02; P<0.001); (V) inhalation injury: (OR =5.01, 95% CI: 2.52-9.97; P<0.001); (VI) surgery: (OR =0.06, 95% CI: 0.01-0.31; P<0.001); (VII) mechanical ventilation: (OR =11.56, 95% CI: 4.97-26.87; P<0.001); (VIII) residence (urban vs. rural): (OR =0.43, 95% CI: 0.25-0.75; P=0.003); (IX) burn characteristic (non-accidental burns vs. accidental burns): (OR =2.15, 95% CI: 1.19-3.87; P=0.01); (X) length of stay (LOS): (OR =3.13, 95% CI: 1.91-5.13; P<0.001).
Conclusions:
Our meta-analysis identified 10 risk factors associated with mortality in pediatric burn patients. Implementing multicenter prospective clinical studies may represent an effective strategy to address the current limitations of heterogeneity and bias in existing research.
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