Jared R Gallaher1, Stephen Mjuweni2, Mansi Shah1, Bruce A Cairns3, Anthony G Charles4. 1. Department of Surgery, University of North Carolina, School of Medicine, CB# 7228, Chapel Hill, NC, USA. 2. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. 3. North Carolina Jaycee Burn Center, Department of Surgery, University of North Carolina, School of Medicine, CB# 7600, Chapel Hill, NC, USA. 4. Department of Surgery, University of North Carolina, School of Medicine, CB# 7228, Chapel Hill, NC, USA; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; North Carolina Jaycee Burn Center, Department of Surgery, University of North Carolina, School of Medicine, CB# 7600, Chapel Hill, NC, USA. Electronic address: anthchar@med.unc.edu.
Abstract
BACKGROUND: This study sought to establish appropriate timing of burn wound excision and grafting in a resource-poor setting in sub-Saharan Africa. METHODS: All burn patients (905 patients) admitted to Kamuzu Central Hospital (KCH) Burn Unit in Lilongwe, Malawi over three years (2011-2014) were studied. RESULTS: 275 patients (30%) had an operation during their admission. In patients who received an operation, median age was 5 years (IQR, 2.7-19) and median total body surface area burn was 15% (IQR, 8-25). 91 patients (33%) had early excision (≤5 days) and 184 patients (67%) had late excision (>5 days). Mortality was significantly greater in the early group (25.3% vs. 9.2%, p=0.001). Controlling for total body surface area burn and age, the adjusted predictive probability of mortality were 0.256 (CI 0.159-0.385) and 0.107 (CI 0.062-0.177) if operated ≤5 and >5 days, respectively (p=0.0114). The odds ratio for mortality if operated >5 days is 0.34 (CI 0.15-0.79, p<0.000). CONCLUSIONS: Early excision and grafting in a resource-poor area in sub-Saharan Africa is associated with a significant increase in mortality. Delaying the timing of early excision and grafting of burn patients in a resource-poor setting past burn day 5 may confer a survival advantage.
BACKGROUND: This study sought to establish appropriate timing of burn wound excision and grafting in a resource-poor setting in sub-Saharan Africa. METHODS: All burn patients (905 patients) admitted to Kamuzu Central Hospital (KCH) Burn Unit in Lilongwe, Malawi over three years (2011-2014) were studied. RESULTS: 275 patients (30%) had an operation during their admission. In patients who received an operation, median age was 5 years (IQR, 2.7-19) and median total body surface area burn was 15% (IQR, 8-25). 91 patients (33%) had early excision (≤5 days) and 184 patients (67%) had late excision (>5 days). Mortality was significantly greater in the early group (25.3% vs. 9.2%, p=0.001). Controlling for total body surface area burn and age, the adjusted predictive probability of mortality were 0.256 (CI 0.159-0.385) and 0.107 (CI 0.062-0.177) if operated ≤5 and >5 days, respectively (p=0.0114). The odds ratio for mortality if operated >5 days is 0.34 (CI 0.15-0.79, p<0.000). CONCLUSIONS: Early excision and grafting in a resource-poor area in sub-Saharan Africa is associated with a significant increase in mortality. Delaying the timing of early excision and grafting of burn patients in a resource-poor setting past burn day 5 may confer a survival advantage.
Authors: Vinita Puri; Nishant A Khare; M V Chandramouli; Nilesh Shende; Sumit Bharadwaj Journal: J Burn Care Res Date: 2016 Sep-Oct Impact factor: 1.845
Authors: Jared R Gallaher; Wone Banda; Anne M Lachiewicz; Robert Krysiak; Bruce A Cairns; Anthony G Charles Journal: World J Surg Date: 2018-10 Impact factor: 3.352
Authors: Kevin J Guzman; Natacha Gemo; Deborah B Martins; Pedro Santos; Daniel A DeUgarte; Fatima Ademo; David Kulber; Celma Issufo Journal: Plast Reconstr Surg Glob Open Date: 2018-08-07
Authors: Megan M Rybarczyk; Jesse M Schafer; Courtney M Elm; Shashank Sarvepalli; Pavan A Vaswani; Kamna S Balhara; Lucas C Carlson; Gabrielle A Jacquet Journal: Afr J Emerg Med Date: 2017-01-28