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

Major Burns are life-threatening injuries that cause approximately 2500 deaths per year in Brazil. The Brazilian healthcare system has 80 hospitals with Burn Care Units (BCUs). However, non specialized hospitals also manage major burn injuries. The aim of this study was to evaluate differences in burn management and outcomes between BCUs and hospitals without BCUs.

Patients with an ICD-10 code for a burn injury were identified in a Brazilian discharge database (DATASUS) from 2015 to 2023, were categorized by total body surface area (TBSA). Hospitalizations were compared based on whether they occurred in a BCU or not, adjusting for TBSA, age, and sex.

From 2015 to 2023, there were 22,627 burn injury hospitalizations in Brazil. Of these, 14,187 (62.71%) were treated in Burn Care Units (BCUs), 6553 (28.96%) in non-BCU hospitals with plastic surgery services, and 1887 (8.34%) in non-BCU hospitals without plastic surgery. Mean TBSA was highest in non-BCUs with plastic surgery (42.0%) compared to BCUs (35.2%) and non-BCUs without plastic surgery (34.4%; p < 0.001). Mortality occurred in 9.87% of hospitalizations at BCUs, 7.78% at non-BCUs with plastic surgery, and 4.45% at non-BCUs without plastic surgery. After adjusting for TBSA, age, and sex, non-BCU facilities showed lower odds of mortality (non-BCU with plastic surgery: aOR 0.49, 95% CI 0.44-0.56; non-BCU without plastic surgery: aOR 0.36, 95% CI 0.28-0.47; both p < 0.001). Transfers to other facilities occurred in 1.28% (182/14,187) of BCUs, 16.26% of non-BCUs with plastic surgery, and 29.61% (559/1887) of non-BCUs without plastic surgery. Surgical management rates were highest in BCUs, intermediate in non-BCUs with plastic surgery, and lowest in non-BCUs without plastic surgery.

Hospitalizations in BCUs were associated with lower transfer rates and higher rates of surgical intervention. However, BCUs also reported higher mortality rates, suggesting that they likely provided care to the most severely injured burn patients until their final outcomes, whether recovery or death. Despite non-BCUs with plastic surgery treating burns with higher mean TBSA, BCUs had higher mortality, suggesting that BCUs receive patients with unmeasured risk factors beyond TBSA and serve as referral centers for the most complex cases.