Invited Commentary: ‘The Timing of Operative Intervention for Pediatric Burn Patients in Malawi’—Heeding the Call for Safer and more Effective Approaches to Early Excision for Major Burn Injury among Children in Low‐Resource Settings

Abstract

We commend Davis et al. for their study regarding early excision for burn injury among children in Malawi [1]. The authors reviewed records of 2502 burn-injured children and found that the odds of mortality were higher for those who underwent excision within 72 h of injury compared to those who underwent excision later. Younger children had the highest odds of mortality. These data add to similar findings published by the same group [2] and a review performed by Wong et al. [3]. However, early excision is frequently performed safely and effectively in low-resource settings [3,4]. These disparate findings are likely the result of, to some degree, selection and information bias and residual confounding. Shy of randomization, it is difficult to fully account for the multitude of factors that contribute to successful early excision including overall health, injury severity, adequacy of resuscitation, service delivery, and resource availability.Regardless, Davis et al. highlight the complexities and risks associated with early excision for burn-injured children. Therefore, we should consider opportunities to enhance the safety and effectiveness of this strategy, which has repeatedly demonstrated improved outcomes compared to delayed excision [5]. This would be, perhaps, most important in lower-volume centers, those not focused on the care of children, and those with fewer resources. Guidelines developed by International Society for Burn Injuries and Interburns provide excellent guidance for delivering burn care in low-resource settings. However,