• J. Surg. Res. · Feb 2021

    Re-evaluation of the Effect of Age on In-hospital Burn Mortality in a Resource-Limited Setting.

    • Jared Gallaher, Laura N Purcell, Wone Banda, Trista Reid, and Anthony Charles.
    • Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: jared_gallaher@med.unc.edu.
    • J. Surg. Res. 2021 Feb 1; 258: 265-271.

    BackgroundThis global burden of burn injury is suffered disproportionately by people in low-income and middle-income countries, where 70% of all burns occur. Models based in high-income countries to prognosticate burn mortality treat age as a linearly increasing risk factor. It is unclear whether this relationship is similar in resource-limited settings.MethodsWe analyzed patients from the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi, from 2011 to 2019. We examined the relationship between burn-associated mortality and age using adjusted survival analysis over 60 d, categorized into four groups: (1) younger children <5 y; (2) older children 5-17 y; (3) adults 18-40 y; and (4) older adults >40 y.ResultsA total of 2499 patients were included. Most patients were <5 y old (n = 1444) with only 133 patients >40 y. Older adults had the highest crude mortality at 34.6% and older children with the lowest at 13%. Compared to younger children, the hazard ratio adjusted for sex, percent total body surface area, and operative intervention was 0.59 (95% confidence interval, 0.44, 0.79) for older children and 0.55 (95% confidence interval, 0.40, 0.76) for adults. Older adults were statistically similar to younger children.ConclusionsWe show in this cohort study of burn-injured patients in a resource-limited environment that the relationship between mortality and age is not linear and that the use of age-categorized mortality prediction models is more accurate in delineating mortality characteristics. Categorizing age based on local burn epidemiology will help describe burn mortality characteristics more accurately, leading to better-informed management strategies aimed at attenuating burn mortality for different populations.Copyright © 2020 Elsevier Inc. All rights reserved.

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