Re-evaluation of the Effect of Age on In-hospital Burn Mortality in a Resource-Limited Setting.
Age
Burn
Injury
Sub-Saharan Africa
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
17
04
2020
revised:
05
08
2020
accepted:
26
08
2020
pubmed:
12
10
2020
medline:
26
1
2021
entrez:
11
10
2020
Statut:
ppublish
Résumé
This 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. We 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. A 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. We 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.
Sections du résumé
BACKGROUND
This 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.
METHODS
We 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.
RESULTS
A 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.
CONCLUSIONS
We 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.
Identifiants
pubmed: 33039634
pii: S0022-4804(20)30658-2
doi: 10.1016/j.jss.2020.08.074
pmc: PMC7736210
mid: NIHMS1636349
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
265-271Subventions
Organisme : FIC NIH HHS
ID : D43 TW009340
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
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