Expanded burn registry: Epidemiological profile, clinical variables, and multivariate analysis of outcomes in the...

Burns represent a significant global public health problem, imposing a disproportionate burden in low- and middle-income countries. In the Dominican Republic, a previous study in the pediatric population revealed a concerning profile of high mortality and frequent electrical burns, raising critical questions for adults.

To describe the epidemiological profile, identify independent predictors of mortality, and benchmark outcomes against international severity metrics in adult burn patients in the Dominican Republic.

This retrospective cohort study included 1005 adult patients (≥15 years) admitted to the country's main burn reference center (2020-2024). Demographic, clinical, and event-related variables were analyzed. Multivariable logistic regression, probit analysis for LA50, and Kaplan-Meier survival curves were used.

Overall mortality was 32.2%. The cohort was predominantly male (73.4%), with a median age of 37 years. Men sustained mainly electrical burns (37.7%) in occupational settings (48.5%); women, flame burns (64.0%) in the domestic sphere (74.9%). Independent mortality predictors were TBSA ≥ 60% (aOR 29.85, 95% CI 11.37-78.34), complications (aOR 250.00, 95% CI 55.56-1000.00), full-thickness depth (aOR 4.33, 95% CI 2.48-7.58), and inhalation injury (aOR 2.09, 95% CI 0.98-4.46). The LA50 was 48.0% (95% CI 45.0-50.9%). Median survival was 42.0 days, decreasing to 4.0 days for TBSA ≥ 60% and 20.0 days for septic patients (log-rank p < 0.001 and p = 0.012). The leading causes of death were septic shock (40.1%) and respiratory failure (36.1%).

This registry reveals one of the highest global burn mortality rates, driven by extensive injuries and complications. The LA50 of 48.0% and the predominance of sepsis-related deaths underscore the extreme vulnerability of this population and the urgent need for targeted prevention, strengthened clinical protocols, and a prospective national registry to guide interventions and reduce mortality.