Management of Burn Injuries in Brazil by Total Body Surface Area Affected

Area of Science:

• Trauma Surgery
• Public Health
• Healthcare Management

Background:

• Major burns are critical injuries with significant mortality in Brazil.
• The healthcare system includes Burn Care Units (BCUs) and general hospitals managing burn patients.
• Variations in burn management and outcomes between specialized and non-specialized facilities are not well understood.

Purpose of the Study:

• To compare burn management strategies and patient outcomes between BCUs and hospitals without BCUs in Brazil.
• To identify factors influencing mortality and treatment pathways for major burn injuries across different hospital types.

Main Methods:

• Analysis of a Brazilian national discharge database (DATASUS) from 2015-2023.
• Inclusion of patients with ICD-10 burn injury codes, categorized by Total Body Surface Area (TBSA).
• Comparison of hospitalizations in BCUs versus non-BCUs, adjusting for TBSA, age, and sex.

Main Results:

• Burn Care Units (BCUs) managed 62.71% of 22,627 burn hospitalizations, with lower mean TBSA (35.2%) compared to non-BCUs with plastic surgery (42.0%).
• BCUs had higher mortality rates (9.87%) than non-BCUs (7.78% with plastic surgery, 4.45% without).
• Adjusted analysis revealed lower mortality odds in non-BCUs (aOR 0.49-0.36). BCUs had lower transfer rates (1.28%) but higher surgical intervention rates.

Conclusions:

• BCUs are associated with reduced patient transfers and increased surgical interventions, indicating specialized care.
• Higher mortality in BCUs suggests they manage the most critically ill patients, potentially with unmeasured risk factors.
• Non-BCUs, particularly those with plastic surgery, manage severe burns effectively with lower observed mortality, but BCUs serve as crucial referral centers for complex cases.