K. Albutt1,2, M. Tungotyo3,4, G. Drevin1, S. Ttendo3,4, J. Ngonzi3,4, P. Firth5, D. Nehra1,6 1Harvard Medical School,Program In Global Surgery And Social Change,Boston, MA, USA 2Massachusetts General Hospital,Department Of General Surgery,Boston, MA, USA 3Mbarara Regional Referral Hospital,Mbarara, MBARARA, Uganda 4Mbarara University Of Science And Technology,Mbarara, MBARARA, Uganda 5Massachusetts General Hospital,Department Of Anesthesia, Critical Care And Pain Medicine,Boston, MA, USA 6Brigham And Women’s Hospital,Department Of Surgery,Boston, MA, USA
Introduction: Burn injuries contribute significantly to the global burden of disease with an annual incidence of 33 million cases, of which approximately 95% occur in lower- and middle-income countries. Despite this, there is a lack of high-quality data in this context. The aim of this study was to study the epidemiology, treatment, and outcomes of burn injury amongst patients presenting to a regional referral hospital in Uganda.
Methods: We conducted a retrospective observational study of all patients who were admitted with a burn injury to Mbarara Regional Referral Hospital (MRRH) in western Uganda between August 2013 and January 2017. Patient records were abstracted from the Surgical Services QUality Assurance Database (SQUAD), a validated electronic surgical database that currently enrolls all admitted surgical patients at MRRH. Descriptive statistics were used to characterize the population and multivariable logistic regression was used to identify factors associated with mortality.
Results: During the study period, a total of 375 patients were admitted to MRRH with a burn injury, accounting for 3.4% of surgical and 6.2% of trauma admissions to MRRH. Most burn patients were children, with 59.2% under the age of 5 years (x? = 11.5 years / M = 3.0 years). The average total burn surface area (TBSA) burn was 22.7±15.6%, ranging from 2-100%. The majority of burns were partial thickness / second degree (197, 52.5%) followed by superficial / first degree (26, 6.9%), full thickness / third degree (24, 6.4%), and fourth degree (4, 0.8%). Overall, 47.5% of patients underwent bedside wound care alone whereas 28.0% underwent operative intervention. The most common operations were debridement (87, 60.4%), skin grafting (33, 22.9%), and escharotomy/fasciotomy (6, 4.2%). The average length of stay was 11.7 days. While most patients were discharged (204, 54.4%), others absconded (70, 18.7%), died (44, 11.7%), or were referred (14, 3.7%). Inconsistent record keeping was apparent with a number of records missing TBSA (156, 41.6%), burn depth (125, 33.3%), and burn type/mechanism (204, 54.4%). Burn mortality was significantly predicted by TBSA when controlling for confounders including age, gender, burn depth, and operative intervention (p< 0.001). Notably, mortality was not associated with burn mechanism, anatomic location, or length of stay.
Conclusion: In Uganda, burns contribute significantly to the surgical burden of disease, morbidity and mortality. A detailed understanding of burn injury epidemiology, treatment, and outcomes is essential in facilitating primary prevention, targeting interventions to strengthen capacity, and facilitating provision of safe, timely, and affordable burn care. There is a clear need to improve burn education and standardize reporting given inconsistent record keeping. Burn injury must become a public health priority in Uganda and other low-resource settings.
