The Timing of Operative Intervention for Pediatric Burn Patients in Malawi

Abstract

Background Defining the optimal timing of operative intervention for pediatric burn patients in a resource-limited environment is challenging. We sought to characterize the association between mortality and the timing of operative intervention at a burn center in Lilongwe, Malawi. Methods This is a retrospective analysis of burn patients (\18 years old) presenting to Kamuzu Central Hospital from 2011 to 2022. We compared patients who underwent excision and/or burn grafting based on the timing of the operation. We used logistic regression modeling to estimate the adjusted odds ratio of death based on the timing of surgery. ResultsWe included 2502 patients with a median age of 3 years (IQR 1-5) and a male preponderance (56.8%). 411 patients (16.4%) had surgery with a median time to surgery of 18 days (IQR 8-34). The crude mortality rate among all patients was 17.0% and 9.1% among the operative cohort. The odds ratio of mortality for patients undergoing surgery within 3 days from presentation was 5.00 (95% CI 2.19, 11.44) after adjusting for age, sex, % total burn surface area (TBSA), and flame burn. The risk was highest for the youngest patients. Conclusions Children who underwent burn excision and/or grafting in the first 3 days of hospitalization had a much higher risk of death than patients undergoing surgical intervention later. Delaying operative intervention till [72 h for pediatric patients, especially those under 5 years old, may confer a survival advantage. More investment is needed in early resuscitation and monitoring for this patient population.

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

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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.

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