Shyaka Ian, Miranda Elizabeth, Velin Lotta, Mukagaju Francoise, Nezerwa Yves, Ntirenganya Faustin, Furaha Charles, Riviello Robert, Pompermaier Laura
Department of Plastic Surgery, Rwanda Military Hospital Kigali, Rwanda.
Program in Global Surgery and Social Change, Harvard Medical School Boston, MA, USA.
Int J Burns Trauma. 2024 Feb 15;14(1):25-31. doi: 10.62347/YZUI6877. eCollection 2024.
Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn victims die from their injuries. Mortality prediction indexes are used to estimate outcomes after provided burn care, which has been used in burn services of high-income countries over the last 60 years. It remains to be seen whether these are reliable in low-income settings. This study aimed to analyze in-hospital mortality and to apply mortality estimation indexes in burn patients admitted to the only specialized burn unit in Rwanda.
This retrospective study included all patients with burns admitted at the burn unit (BU) of the University Teaching Hospital in Kigali (CHUK) between 2005 and 2019. Patient data were collected from the BU logbook. Descriptive statistics were calculated with frequency (%) and median (interquartile range, IQR). Association between burns characteristics and in-hospital mortality was calculated with Fisher's exact test, and Wilcoxon rank, as appropriate. Mortality estimation analysis, including Baux score, Lethal Area 50 (LA50), and point of futility, was calculated in those patients with complete data on age and TBSA. LA50 and point-of-futility were calculated using logistic regression.
Among the 1093 burn patients admitted at the CHUK burn unit during the study period, 49% (n=532) had complete data on age and TBSA. Their median age, TBSA, and Baux score were 3.4 years (IQR 1.9-17.1), 15% (IQR 11-25), and 24 (IQR 16-38), respectively. Overall, reported in-hospital mortality was 13% (n=121/931), LA50 for Baux score was 89.9 (95% CI 76.2-103.7), and the point-of-futility was at a Baux score of 104.
Mortality estimation indexes based on age and TBSA are feasible to use in low-income settings. However, implementation of systematic data collection would contribute to a more accurate calculation of the mortality risk.
烧伤是一种与贫困相关的疾病，对低收入和中等收入国家的人群影响尤为严重，这些国家发生的烧伤导致的伤害和死亡占比很大。据估计，在撒哈拉以南非洲地区，五分之一的烧伤受害者会因伤死亡。死亡率预测指标用于评估烧伤治疗后的结果，在过去60年里，高收入国家的烧伤服务中一直在使用这些指标。在低收入环境中这些指标是否可靠仍有待观察。本研究旨在分析卢旺达唯一的专业烧伤科收治的烧伤患者的院内死亡率，并应用死亡率估计指标。
这项回顾性研究纳入了2005年至2019年期间在基加利大学教学医院（CHUK）烧伤科收治的所有烧伤患者。患者数据从烧伤科日志中收集。描述性统计采用频率（%）和中位数（四分位间距，IQR）计算。根据情况，使用Fisher精确检验和Wilcoxon秩和检验计算烧伤特征与院内死亡率之间的关联。对年龄和烧伤总面积（TBSA）数据完整的患者进行死亡率估计分析，包括Baux评分、半数致死面积（LA50）和治疗无效点。LA50和治疗无效点使用逻辑回归计算。
在研究期间，CHUK烧伤科收治的1093例烧伤患者中，49%（n = 532）有完整的年龄和TBSA数据。他们的年龄中位数、TBSA和Baux评分分别为3.4岁（IQR 1.9 - 17.1）、15%（IQR 11 - 25）和24（IQR 16 - 38）。总体而言，报告的院内死亡率为13%（n = 121/931），Baux评分的LA50为89.9（95% CI 76.2 - 103.7），治疗无效点的Baux评分为104。
基于年龄和TBSA的死亡率估计指标在低收入环境中是可行的。然而，实施系统的数据收集将有助于更准确地计算死亡风险。
