The Timing of Operative Intervention for Pediatric Burn Patients in Malawi.

Abstract

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. This is a retrospective analysis of burn patients (<18years 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. We included 2502 patients with a median age of 3years (IQR 1-5) and a male preponderance (56.8%). 411 patients (16.4%) had surgery with a median time to surgery of 18days (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 3days 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. Children who underwent burn excision and/or grafting in the first 3days of hospitalization had a much higher risk of death than patients undergoing surgical intervention later. Delaying operative intervention till >72h for pediatric patients, especially those under 5years old, may confer a survival advantage. More investment is needed in early resuscitation and monitoring for this patient population.