E. Khvatova1, C. Chidiac2, C. Long Azad3, D. Rhee2 1Johns Hopkins University Bloomberg School Of Public Health, International Health, Baltimore, MD, USA 2Johns Hopkins University School Of Medicine, Pediatric Surgery, Baltimore, MD, USA 3Johns Hopkins University School Of Medicine, Plastic Surgery, Baltimore, MD, USA
Introduction: Burn injuries are considered one of the leading causes of injuries, with an estimated 6 million occurring in lower-resource countries. Timely surgical intervention can lower mortality among burn patients but can leave patients with functional limitations, significantly affecting one's quality of life. Understanding impairment risk factors is crucial for optimizing resource allocation and treatment efficacy. This study assesses factors at both the patient and facility levels that influence impairment rates among surgical burn patients within Middle-Income Countries (MICs).
Methods: We performed a retrospective analysis of surgical patients discharged from a MIC facility in the WHO Global Burns Registry from 2017-2021. Patients who underwent surgery and survived to discharge were included. The primary outcome of interest was impairment status at discharge. We assessed the effects of country income status, WHO region, patient demographics, mechanism and severity of burn, and facility characteristics on outcome. Multivariate logistic regression was performed to determine adjusted risk factors for impairment.
Results: A total of 3,768 patients were included in our study, of which 1,235 (32.74%) were treated in a Lower Middle-Income Country (LMIC) and 2,537 (67.26%) in an Upper Middle Income Country (UMIC). Overall impairment rates were 13.12% in LMIC and 15.88% in UMIC (p =0.025). Facilities in UMIC were less likely to be privately owned (2.8% vs. 68.83%, p<0.001) or to have reliable access to physiotherapy (88.49% vs. 90.04%, p<0.001), but more UMIC facilities had full capacity for blood transfusion (99.92% vs. 29.07%, p<0.001) and sophisticated nutritional capabilities (88.45% vs. 21.70%, p<0.001). In multivariate analysis, country income status was not associated with impairment (OR=0.69, p=0.218). Patients in facilities with reliable access to physiotherapy and sophisticated nutritional capabilities were less likely to suffer from impairment by 95% (OR=0.05, p<0.001) and 88% (OR=0.11, p<0.001), respectively. Patients being treated in facilities with full blood transfusion capabilities were more likely to suffer from impairment (OR=19.77, p<0.001).
Conclusion: The study findings show that in burn patients who require surgery for treatment in middle-income countries, reliable access to physiotherapy and nutritional services may play an essential role in minimizing long-term impairment in this population. Further research is needed to understand the roles of these services as well as blood transfusions in impairment in order to optimize outcomes in burn patients globally.
