Global Burn Registry Research Articles

Unveiling Sex Differences in Pediatric Burns Through the World Health Organization (WHO) Global Burn Registry

IntroductionPediatric burns present a significant global health challenge, particularly in low- and middle-income countries (LMICs). Despite this burden, few studies have explored global sex-based differences in pediatric burns. This study aims to describe pediatric burn incidence, burn care facilities’ capacities, and burn outcomes with a focus on sex, comparing LMICs to HICs. MethodsThis study utilizes the World Health Organization's (WHO) Global Burn Registry (GBR) to analyze pediatric burn cases from 2018 to 2022, examining patient demographics, causes of burns, burn care facilities' capacities, and burn outcomes in relation to sex. Statistical analysis was done by chi-square and logistic regression. ResultsIt was found that female patients were less likely than males to undergo surgical treatment during their hospital stay in low-income countries (adjusted odd ratios = 0.86, 95% CI: 0.45–1.26; p = 0.168) and middle-income countries (adjusted odd ratios = 0.72, 95% Cl: 0.52–0.95; p = 0.002). Additionally, females in both low- (adjusted odd ratios = 2.23, 95% Cl: 1.12–3.53; p = 0.045) and middle-income countries (adjusted odd ratios = 1.72, 95% Cl: 1.12–2.95; p < 0.001) exhibited higher odds of discharging with disability compared to males. ConclusionSex-based differences persist in pediatric burn epidemiology and treatment outcomes. Addressing these differences involves sex-sensitive strategies to mitigate the burden of pediatric burns, particularly in vulnerable populations in low- and middle-income countries. Type of StudyRetrospective observational study. Level of EvidenceLevel III evidence.

The Epidemiology and Outcomes of Perineal and Genital Burn Injury in Low- and Middle- Income Countries: A Global Burn Registry Study

IntroductionThe epidemiology, care, and outcomes of perineal and genital burns (PG) in high-income countries have been previously described, but an analysis of this topic in LMICs has yet to be performed. We use the World Health Organization’s Global Burn Registry to fill this gap. MethodsThe GBR was searched from inception to November 2023 to identify all burn patients, excluding cases from high-income countries. Demographics and mechanism of injury were retrieved. Primary outcomes were length of hospital stay (LOHS), surgical intervention, discharge with physical impairment, and mortality. A multivariate regression analysis was performed controlling for burnt total body surface area (TBSA), age, sex, inhalation injury, mechanism of burn and care center characteristics. ResultsOf 9041 patients identified, 1213 (13.4 %) had PG burns with 136 (1.6 %) isolated to the PG region. PG patients had higher TBSA (p < 0.001) and more inhalation injury (p < 0.001). They had better access to rehabilitation and lower access to theater space for burns (p < 0.001). Multivariable analysis showed that PG patients had longer LOHS (p = 0.001), greater mortality (p < 0.001), were less likely to undergo surgery (p = 0.01) or be discharged home with physical impairment (p = 0.03). ConclusionSimilarities and differences exist between high- and low/middle-income countries in terms of the patterns of injury, care, and recovery in patients with PG burns. The longer LOHS and higher mortality among PG patients, previously reported in high-income countries, are verified. This highlights the importance of greater vigilance when caring for such patients.

Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry

BackgroundThroughout the world, burn injury is a major cause of death and disability. In resource-limited countries, burn injury is one of the leading causes of permanent disability among children who survive traumatic injuries, and burn injury is the fourth leading cause of disability worldwide. This study applied Andersen’s model of health care access to evaluate if patient characteristics (predisposing factors), burn care service availability (enabling factors) and injury characteristics (need) are associated with physical impairment at hospital discharge for patients surviving burn injuries globally. Specifically, access to rehabilitation, nutrition, operating theatre, specialized burn unit services, and critical care were investigated as enabling factors. The secondary aim was to determine whether associations between burn care service availability and impairment differed by country income level. Methods: This is a cross-sectional secondary analysis of prospectively collected data from the World Health Organization, Global Burn Registry. The outcome of interest was physical impairment at discharge. Simple and multivariable logistic regressions were used to test the unadjusted and adjusted associations between the availability of burn care services and impairment at hospital discharge, controlling for patient and injury characteristics. Effect modification was analyzed with service by country income level interaction terms added to the models and, if significant, the models were stratified by income. Results: The sample included 6622 patients from 20 countries, with 11.2% classified with physical impairment at discharge. In the fully adjusted model, patients had 89% lower odds impairment at discharge if the treatment facility provided reliable rehabilitation services compared to providing limited or no rehabilitation services (OR.11, 95%CI.08,.16, p < .01). However, this effect was modified by county income with the strong and significant association only present in high/upper middle-income countries. Sophisticated nutritional services were also significantly associated with less impairment in high/upper middle-income countries (OR=.04, 95% CI 0.203, 0.05, p < .01), but significantly more impairment in lower middle/low-income countries (OR=2.01, 95% CI 1.50, 2.69, p < .01). Patients had 444% greater odds of impairment if treated at a center with specialty burn unit services (OR 5.44, 95%CI 3.71, 7.99, p < .01), possibly due to a selection effect. Discussion: Access to reliable rehabilitation services and sophisticated nutritional services were strongly associated with less physical impairment at discharge, but only in resource-rich countries. Although these findings support the importance of rehabilitation and nutrition after burn injury, they also highlight potential disparities in the quantity or quality of services available to burn survivors in poorer countries.

Characteristics and risk factors for electrical burn injuries: a study based on World Health Organization Global Burn Registry

ObjectiveElectrical burn injuries (EBIs) represent an important subset of burn injuries, but the information on them from the global level is limited. We aimed to investigate the characteristics and risk factors for EBIs reported to the World Health Organization Global Burn Registry. MethodsPatients with EBIs and non-EBIs were identified from the registry. Patient demographics, income of the country, setting of the injury occurred, and outcomes were described and compared. Multivariable analysis was performed to identify risk factors associated with the EBIs and their outcomes. ResultsOf the 9276 patients, 814 (8.8%) were grouped as EBIs. EBIs patients had a median age of 28 years, and they were predominantly males (89.2%). EBIs were more likely to occur in lower-middle- and low-income countries (60.9% versus 43.4%) and in an occupational setting (49.1% versus 6.7%) than the non-EBIs. Older age, male, lower-income, and occupational and public setting were risk factors for EBIs. For EBIs patients, adolescents and young adults, those from low-middle and low-income countries, and those injured by high-voltage electricity were more likely to have more than 15% of the total body surface area. In addition, those from low-middle and low-income countries and those injured by high-voltage electricity were more likely to die. ConclusionThe characteristics of EBIs are significantly different from that of non-EBIs. To prevent EBIs and avoid unpleasant outcomes, particular attention should be given to adolescent boys and young adult men who are employed in electrical jobs in lower-income countries.

Global epidemiology of geriatric burns, capacities of care, and injury outcomes: Perspectives from the World Health Organization global burn registry

BackgroundAn increasing aging population alongside a potentially increasing injury risk emphasizes a critical need for evidence-based burn care regarding preventive and therapeutic strategies tailored to the unique needs of older adults. However, we note a critical gap in understanding geriatric burn trends on a global scale and the care capacity across settings. Thus, this study sought to ascertain the global trend of geriatric burns with a focus on patient demographics, injury characteristics, capacities of care, and injury outcomes. MethodsA retrospective design focusing on older adults aged ≥ 60 years with burns recorded in the World Health Organization Global Burn Registry as of 31st May 2023 was employed. Descriptive statistics were employed to analyze the data. ResultsOf the 9277 records obtained from the Global Burn Registry, 849 participants (9.2%) were aged ≥ 60 years with the majority of these reported from the Eastern Mediterranean (EMRO) and Southeast Asia (SEARO) regions. More females than males were involved in burn injuries with the most common aetiological factor being flame. Most burns occurred in the home/ domestic setting with a seasonal variation (more injuries occurred in December and January). In terms of burn care capacity, the data suggest the availability of specialized services in most settings albeit the AFRO and SEARO regions still lacked the resources to offer specialized burn care. While most injured older adults were discharged home with no physical impairment (395, 46.5%), a substantial number died (250, 29.4%) during hospitalization, particularly in the African (AFRO) region and 111 (11.1%) left the facility against medical advice with the majority from the SEARO region (88). ConclusionBurn injuries in older adults remain a public health issue. On the preventive aspect, the results demonstrate a need to intensify safety in the home or domestic setting, and during festive seasons. Therapeutically, the findings underscore a need to consider the inclusion of more specialist geriatric and palliative care services in the burn management process. Additionally, we identified a need to strengthen burn care capacity in the AFRO and SEARO regions.

Food Security as a Predictor of Global Pediatric Postburn Mortality.

Food security (FS) is defined as access to sufficient and nutritious food. Children, especially those in low- and middle- income countries (LMICs), are disproportionately affected by low FS. We hypothesized high FS would be predictive of decreased pediatric postburn mortality in LMICs. Publicly-available, deidentified datasets were obtained from the World Health Organization's Global Burn Registry (GBR) and Economist Intelligence Unit's Global FS Index (GFSI). The GFSI calculates FS scores annually from intergovernmental organization data reviewed by a panel of experts. FS scores are reported on a 0-100 scale with 100 indicating the highest FS. Patients aged 0-19 years were included; after linking GBR and GFSI datasets, countries with <100 burn patients were excluded. Data were analyzed with descriptive statistics and bivariate analyses. Multiple logistic regression controlling for confounders was used to quantify associations between mortality and FS score. Significance was set at p<0.05. From 2016-2020, there were 2,246 cases including 259 deaths (11.5%) over nine countries. Those who died had a higher median age (7 [IQR 2, 15] vs. 3 [2, 6] years, p<0.001), higher proportion of females (48.6% vs. 42.0%, p=0.048), and lower median FS score (55.7 [IQR 45.3, 58.2] vs. 59.8 [IQR 46.7, 65.7], p<0.001). Increasing FS score was associated with decreased odds of postburn mortality [multivariable odds ratio 0.78 (0.73-0.83), p<0.001]. Increasing FS score was associated with decreased pediatric postburn mortality. International efforts to increase FS in LMICs may help improve pediatric burn patient survival.

32 Food Security as a Predictor of Global Pediatric Postburn Mortality

Abstract Introduction Food security (FS) is defined as access to sufficient and nutritious food. Children are disproportionately affected by low FS. Globally, burns contribute to over 50% of the disability-adjusted life years lost among 0-14 year-old children. Given the significance of nutrition in postburn outcomes, we hypothesized that high FS would be predictive of decreased global postburn mortality in pediatric patients. Methods Publicly-available, deidentified datasets were obtained from the World Health Organization’s Global Burn Registry (GBR) and Corteva Agriculture’s Global FS Index (GFSI). The GFSI calculates a FS score annually from intergovernmental organization data reviewed by a panel of experts. FS score was reported on a scale from 0-100 with 100 indicating the highest FS. The GFSI also groups countries into “Good” (FS score ≥ 60) or “Moderate” (FS Score ≥ 40) FS environments (FSEs). Patients aged 0-19 years were included; after linking GBR and GFSI datasets, countries with &amp;lt; 100 patients were excluded. Descriptive statistics and non-parametric tests were performed on data stratified by FSE. Multiple logistic regression controlling for %TBSA was used to predict mortality with FS score. All statistical analyses were conducted in R version 4.1.2. Results From 2016-2020, there were 2,246 cases over nine countries: Peru (n=839, 37.4%), Tanzania (n=290, 12.9%), India (n=225, 10.0%), Nigeria (n=195, 8.7%), Pakistan (n=181, 8.1%), Kenya (n=166, 7.4%), Nepal (n=145, 6.5%), South Africa (n=105, 4.7%), and Mexico (n=100, 4.5%). Median age was 3.0 [IQR 2.0, 7.0] years with 42.7% female. Median %TBSA was 15.0 [IQR 5.0, 25.0]%. Most injuries were by hot liquid, steam, or gas (n=1,457, 64.9%) followed by flame (n=560, 24.9%). There were 259 deaths (11.5%). Stratified by FSE, 939 cases occurred in “Good” and 1,307 in “Moderate” FSE countries. More flame injuries occurred in Moderate (n=373, 28.5%) vs. Good (187, 19.9%, p&amp;lt; 0.001) FSEs while more hot liquid, steam, or gas injuries occurred in Good (n=688, 73.3%) vs. Moderate (n=769, 58.8%, p&amp;lt; 0.001) FSEs. Mortality was higher in Moderate (n=245, 18.7%) vs. Good (n=14, 1.5%, p&amp;lt; 0.001) FSEs. Regression analysis controlling for %TBSA showed increased FS score was associated with decreased odds of pediatric postburn mortality [multivariable OR 0.77 (95%CI 0.72-0.81), p&amp;lt; 0.001]. Additionally, urban vs. rural patient residence was associated with decreased odds of postburn mortality [multivariable OR 0.36 (95%CI 0.16-0.85), p=0.015]. Conclusions Our study shows that increasing FS score was associated with decreased odds of pediatric postburn mortality. Additionally, mortality and flame injuries were higher in Moderate vs. Good FSE-grouped countries. International efforts to increase FS may improve survival in pediatric burn patients. Applicability of Research to Practice Improving food security is an actionable item that may improve pediatric postburn outcomes regardless of the country’s FSE-grouping.

Global Disparities in Burn Outcomes: Does Gender Predict Mortality in the Global Burn Registry?

IntroductionGlobal burn injury burden disproportionately impacts low- and middle-income countries. Surgery is a mainstay of burn treatment, yet access to surgical care appears to be inequitably distributed for women. This study sought to identify gender disparities in mortality and access to surgery for burn patients in the World Health Organization Global Burn Registry (GBR). MethodsWe queried the World Health Organization GBR for a retrospective cohort (2016-2021). Patients were stratified by sex. Outcomes of interest were in-hospital mortality and surgical treatment. Patient demographics, injury characteristics, outcomes, and health facility resources were compared between sexes with Wilcoxon rank sum test for nonparametric medians, and chi-squared or Fisher’s exact test for nonparametric proportions. Multivariable logistic regressions were performed to assess the relationships between sex and mortality, and sex and surgery. ResultsOf 8445 patients in the GBR from 20 countries (10 low resource), 40% of patients were female, with 51% of all patients receiving surgical treatment during their hospitalization. Female patients had a higher incidence of mortality (24% versus 15%, P < 0.001) and a higher median total body surface area (20% versus 15%, P < 0.001), yet a lower incidence of surgery (47% versus 53%, P < 0.001) following burn injury when compared to males. In multivariable analysis, female sex was independently associated with mortality after controlling for age, time to presentation, smoke injury, percent total body surface area, surgery, and country income status. Female sex was independently associated with surgical care (odds ratio 0.86, P = 0.001). ConclusionsFemale burn patients suffer higher mortality compared to males and are less likely to receive surgery. Further study into this gender disparity in burns is warranted.

Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry.

BackgroundBurn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment.MethodsWe performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021.ResultsThere were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0–18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1–5 years comprised 62% (n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years (n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as “limited” for 23% of pediatric patients.ConclusionsChildren represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.

Implementation of the World Health Organization Global Burn Registry: Lessons Learned.

Burn injuries are a major cause of death and disability globally; however, the true epidemiologic burden is underestimated given the limited and fragmented availability of high-quality burn injury data from many regions. To address this gap, the World Health Organization (WHO) Global Burn Registry (GBR)—a minimum dataset aligned with a centralized registry—was officially launched in 2018 to facilitate hospital-level collection of key prevention, care, and outcome data from burn-injured patients around the world in a standardized manner. However, uptake and use of GBR has been low and inconsistent. Therefore, we aimed to identify and understand the barriers and facilitators to the implementation of the GBR to inform the development of a web-based GBR implementation guide through the Centre for Global Burn Injury Policy and Research and Interburns. We designed and conducted web-based surveys with “GBR users” and “GBR non-users” using purposive sampling. Themes of identified barriers and facilitators focused on awareness of the GBR, stakeholder buy-in, resource constraints, process management, and utility of the registry. The lessons learned could support current and future GBR users to promote and maximize the use of the GBR. To achieve the GBR’s full potential in global burn injury prevention and care, engagement with the GBR should be enhanced through education and promotion, development of a community of practice, tools for data utilization and quality improvement, and periodic re-evaluation.

T2 Global Hospital Infrastructure and Pediatric Burns

IntroductionLow income regions across the world carry the highest proportion and highest mortality burden of pediatric burns. In recent years, attention to remedy these inequities has shifted from isolated mission trips towards building infrastructure for lasting improvements in surgical care. This study aims to investigate disparities in pediatric burn care infrastructure and their relationship to mortality outcomes.MethodsThe multinational Global Burn Registry was queried for all burn cases between January 2018 and August 2021. Burn cases and mortality rates were compared across infrastructure factors by Pearson Chi-Square. Multinomial logistic regression was used to isolate independent modifiable risk factors for mortality controlling for total body surface area of burn (TBSA).ResultsThere were a total of 8537 cases of which 3492 (40.9%) were pediatric. Significantly lower mortality rates were found in facilities with sophisticated nutritional supplementation (p < 0.001), permanent internet connectivity (p < 0.001), reliable critical care access (p < 0.001), reliable burn OR access (p=0.003), dedicated burn unit (p < 0.001), and advanced plastic and reconstructive skills available (p=0.003); there was no significant difference if specialist capabilities in supportive fields (e.g. nephrology, cardiology) were available (p=0.063). Significant disparities were found in the availability of these resources between high and low income countries, as well granular information within low income regions: though blood transfusion access was limited in the African (49.0%) and South-East (50.6%) regions compared to full access in the Americas and Europe (p < 0.001), 100% of cases in the South-East had access to a specialized burn unit compared to 8.1% of cases in Africa. In a multinomial logistic regression controlling for TBSA, the most significant risk factor for mortality was limited critical care availability (OR 15.18, p< 0.001). The most significant protective factor was sophisticated nutritional access (OR 0.40, p=0.024).ConclusionsThis is the first quantitative analysis of disparities in global burn infrastructure and their impact on pediatric mortality. The identification of nutritional support as an independent and significant protective factor suggests that low-cost interventions in hospital nutrition infrastructure merit further study and may realize significant gains in global burn care. Granular information in the variability of regional needs will begin to direct targeted infrastructure initiatives rather than a one-size-fits-all approach in developing nations.

Global Hospital Infrastructure and Pediatric Burns.

Low-income regions carry the highest mortality burden of pediatric burns and attention to remedy these inequities has shifted from isolated mission trips toward building infrastructure for lasting improvements in surgical care. This study aims to investigate disparities in pediatric burn care infrastructure and their impact on mortality outcomes. The multinational Global Burn Registry was queried for all burn cases between January 2018 and August 2021. Burn cases and mortality rates were analyzed by chi-square and multinomial regression. There were a total of 8537 cases of which 3492 (40.9%) were pediatric. Significantly lower mortality rates were found in facilities with sophisticated nutritional supplementation (P < .001), permanent internet connectivity (P < .001), critical care access (P < .001), burn OR access (P = .003), dedicated burn unit (P < .001), and advanced plastic and reconstructive skills (P = .003). Significant disparities were found in the availability of these resources between high- and low-income countries, as well granular information within low-income regions. In a multinomial logistic regression controlling for TBSA, the most significant predictive factors for mortality were limited critical care availability (OR 15.18, P < .001) and sophisticated nutritional access (OR 0.40, P = .024). This is the first quantitative analysis of disparities in global burn infrastructure. The identification of nutritional support as an independent and significant protective factor suggests that low-cost interventions in hospital nutrition infrastructure may realize significant gains in global burn care. Granular information in the variability of regional needs will begin to direct targeted infrastructure initiatives rather than a one-size-fits-all approach in developing nations.

Epidemiology and Outcomes of Cooking- and Cookstove-Related Burn Injuries: A World Health Organization Global Burn Registry Report.

Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally, but there are limited data on cooking behavior patterns to inform prevention and advocacy. Therefore, we aimed to describe the epidemiology, risk factors, and outcomes of these injuries and highlight the potential of the World Health Organization (WHO) Global Burn Registry (GBR). Patients with cooking-related burns were identified in the WHO GBR. Patient demographics, cooking arrangement, injury characteristics, and outcomes were described and compared. Bivariate regression was performed to identify risk factors associated with CSBs. Analysis demonstrated that 25% of patients in the GBR sustained cooking-related burns (n = 1723). The cooking environment and cooking fuels used varied significantly by country income level ([electricity use: LIC 1.6 vs MIC 5.9 vs HIC 49.6%; P < .001] [kerosene use: LIC 5.7 vs MIC 10.4 vs HIC 0.0%; P < .001]). Of cooking-related burns, 22% were cookstove-related burns (CSBs; 311 burns). Patients with CSBs were more often female (65% vs 53%; P < .001). CSBs were significantly larger in TBSA size (30%, IQR 15-45 vs 15%, IQR 10-25; P < .001), had higher revised Baux scores (70, IQR 46-95 vs 28, IQR 10-25; P < .001) and more often resulted in death (41 vs 11%; P < .001) than other cooking burns. Patients with CSBs were more likely to be burned by fires (OR 4.74; 95% CI 2.99-7.54) and explosions (OR 2.91, 95% CI 2.03-4.18) than other cooking injuries. Kerosene had the highest odds of CSB compared to other cooking fuels (OR 2.37, 95% CI 1.52-3.69). In conclusion, CSBs specifically have different epidemiology than cooking-related burns. CSBs were more likely caused by structural factors (eg, explosion, fire) than behavioral factors (eg, accidental movements) when compared to other cooking burns. These differences suggest prevention interventions for CSBs may require distinctive efforts than typically deployed for cooking-related injuries, and necessarily involve cookstove design and safety regulations to prevent fires and explosions.

Gender-based disparities in burn injuries, care and outcomes: A World Health Organization (WHO) Global Burn Registry cohort study

BackgroundWe aimed to describe the gender-based disparities in burn injury patterns, care received, and mortality across national income levels. MethodsIn the WHO Global Burn Registry (GBR), we compared patient demographics, injury characteristics, care and outcomes by sex using Chi-square statistics. Logistic regression was used to identify the associations of patient sex with surgical treatment and in-hospital mortality. ResultsAmong 6431 burn patients (38 % female; 62 % male), females less frequently received surgical treatment during index hospitalization (49 % vs 56 %, p < 0.001), and more frequently died in-hospital (26 % vs 16 %, p < 0.001) than males. Odds of in in-hospital death was 2.16 (95 % CI: 1.73–2.71) times higher among females compared to males in middle-income countries. ConclusionsAcross national income levels, there appears to be important gender-based disparities among burn injury epidemiology, treatment received and outcomes that require redress. Multinational registries can be utilized to track and to evaluate initiatives to reduce gender disparities at national, regional and global levels.

Risk factors for cooking-related burn injuries in children, WHO Global Burn Registry.

ObjectiveTo assess the characteristics of cooking-related burn injuries in children reported to the World Health Organization Global Burn Registry.MethodsOn 1 February 2021, we downloaded data from the Global Burn Registry on demographic and clinical characteristics of patients younger than 19 years. We performed multivariate regressions to identify risk factors predictive of mortality and total body surface area affected by burns.FindingsOf the 2957 paediatric patients with burn injuries, 974 involved cooking (32.9%). More burns occurred in boys (532 patients; 54.6%) than in girls, and in children 2 years and younger (489 patients; 50.2%). Accidental contact and liquefied petroleum caused most burn injuries (729 patients; 74.8% and 293 patients; 30.1%, respectively). Burn contact by explosions (odds ratio, OR: 2.8; 95% confidence interval, CI: 1.4–5.7) or fires in the cooking area (OR: 3.0; 95% CI: 1.3–6.8), as well as the cooking fuels wood (OR: 2.2; 95 CI%: 1.3–3.4), kerosene (OR: 1.9; 95% CI: 1.0–3.6) or natural gas (OR: 1.5; 95% CI: 1.0–2.2) were associated with larger body surface area affected. Mortality was associated with explosions (OR: 7.5; 95% CI: 2.2–25.9) and fires in the cooking area (OR: 6.9; 95% CI: 1.9–25.7), charcoal (OR: 4.6; 95% CI: 2.0–10.5), kerosene (OR: 3.9; 95% CI: 1.4–10.8), natural gas (OR: 3.0; 95% CI: 1.5–6.1) or wood (OR: 2.8; 95% CI: 1.1–7.1).ConclusionPreventive interventions directed against explosions, fires in cooking areas and hazardous cooking fuels should be implemented to reduce morbidity and mortality from cooking-related burn injuries.

74 Epidemiology and Outcomes of Cooking and Cookstove-related Burn Injuries: A World Health Organization (WHO) Global Burn Registry (GBR) Report

Abstract Introduction Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally. A cookstove is any apparatus that provides heat and is used for cooking (e.g., three-stone fire, traditional or improved cookstove). There are limited data on patterns of cooking behaviors and CSBs to inform prevention initiatives and advocacy. We aimed to describe the epidemiology, risk factors and outcomes of cooking-related burns and CSBs, specifically. Methods Patients with cooking and non-cooking related burns from 2018 to 2020 were identified in the World Health Organization (WHO) Global Burn Registry (GBR). Patient demographics, cooking arrangement, injury characteristics [mechanism, total body surface area (TBSA), revised Baux score] and outcomes were described. Differences in proportions and medians were compared. Bivariate regression was performed to identify risk factors associated with occurrence of CSB. Results GBR contained data of 6,965 burn-injured patients from 17 countries; 88% were from middle-income countries. One quarter of burn injuries (1,723 burns) were cooking-related. More than half of cooking-related burns (55%) occurred in females. Median age for cooking-related burns was 11 years (IQR 2–35). Of cooking-related burns, 22% were cookstove-related burns (CSBs; 311 burns). The most common mechanism in CSB was flame (87%), whereas the most common mechanism in other cooking burns was scald (62%). Patients with CSBs were more often female (65% vs 53%; p&amp;lt; 0.001) and much older than patients with other cooking burns (32 years, IQR 22–47 vs 5 years, IQR 2–30). CSBs were significantly larger in TBSA size (30%, IQR 15–45% vs 15%, IQR 10–25%; p&amp;lt; 0.001), had higher revised Baux scores (70, IQR 46–95 vs 28, IQR 10–25; p&amp;lt; 0.001) and more often resulted in death (41 vs 11%; p&amp;lt; 0.001) than other cooking burns (Table1). Patients with CSBs were more likely to be burned by fires (OR 4.74; 95% CI 2.99–7.54) and explosions (OR 2.91, 95% CI 2.03–4.18) than other cooking injuries. Kerosene had the highest odds of CSB than all other cooking fuels (OR 2.37, 95% CI 1.52–3.69). Conclusions Cooking-related burns are common and have different epidemiology than CSBs, specifically (e.g., more often female, older, larger burn size, higher mortality). CSBs were more likely caused by structural factors (e.g., explosion, fire) than behavioral factors (e.g., accidental movements) when compared to other cooking burns.

Global Burn Registry Perspective on Head and Neck Burns.

As exposed regions of the body, the head and neck are at increased risk of burn injury. The cosmetic and functional importance of these anatomical regions means that burns can result in substantial morbidity and mortality. Our objective was to characterize predictive factors for surgery and discharge condition in patients with head and neck burns internationally. We conducted an epidemiological study of all head and neck burns in 14 countries reported in the World Health Organization Global Burn Registry. Multivariate regression was used to identify variables predictive of surgical treatment and discharge condition. We identified 1014 patients who sustained head and neck burns; the majority were adults (60%). Both adults and children admitted to hospital with head and neck burn injuries were less likely to be treated surgically in lower-middle-income countries (LMIC) than in higher-income countries (P < 0.001). Increasing age and greater total surface body area (TBSA) were significant predictors of surgical intervention in children with head and neck burn injuries (P < 0.001). Total surface body area, associated injuries, ocular burns, female sex, and LMIC residency were all significant predictors of mortality in adult patients with head and neck burns (P < 0.050). Conversely, TBSA was the only variable that independently increased the risk of death in children with head and neck burns (P < 0.001). Certain groups are at increased risk of an adverse outcome after admission with a head and neck burn injury. Given the reduced incidence of surgical intervention and the elevated mortality risk in LMICs, global health initiatives should be targeted to these countries.

An Analysis of Factors Associated with Burn Injury Outcomes in Low- and Middle-Income Countries

BackgroundBurn injuries are a major cause of morbidity and mortality within low- and middle-income countries (LMICs). The World Health Organization developed the Global Burn Registry to centralize data collection for the guidance of burn prevention programs. This study analyzed the epidemiologic and hospital-specific factors associated with burn injury outcomes in LMICs and high-income countries (HICs). MethodsA retrospective review was performed using the Global Burn Registry over 3 y. Patients were stratified by income region. Bivariate analyses and stepwise regressions were performed to evaluate patient and hospital demographics and variables associated with injury patterns and outcomes. Outcomes of interest included mortality and length of stay. ResultsOver the study period, data were collected on 1995 patients from 10 LMICs (20 hospitals) and four HICs (four hospitals). Significantly higher mortality was seen in LMICs compared with HICs (17% versus 9%; P < 0.001). There was no significant difference between income regions for injury patterns (P = 0.062) or total body surface area of the burn injury (P = 0.077). Of the LMIC hospitals in this data set, 11% did not have reliable access to an operating theater. ConclusionsHICs had a lower overall mortality even with higher rates of concurrent injuries, as well as longer length of stay. LMIC hospitals had fewer resources available, which could explain increased mortality, given similar total body surface area. This study highlights how investing in health care infrastructure could lead to improved outcomes for patients in low-resource settings.

The Global Burn Registry: A Work in Progress.

In 2018, the World Health Organization (WHO) launched the Global Burn Registry (GBR). Its purpose is to help improve the understanding of burn injury worldwide. The purpose of this study was to identify early findings from this database. The GBR was accessed on January 5, 2020. Cases from centers in low income (LIC) and low-middle-income countries (LMIC) were combined into a low resource (LR) group, and cases in high income (HIC) and upper-middle-income countries (UMIC) were combined into a high resource (HR) group. Statistical analysis was performed with SAS 9.4. Data are expressed as mean ± SEM. Logistic regression was used to identify risk factors for death. Revised Baux Score (RBS) was calculated. Odds ratios are expressed as mean (95% confidence interval). The LA50 was calculated from the regression of death and total burn size (TBSA) for different age groups. At the time of analysis, there were 4307 cases in the GBR treated at 28 facilities in 17 countries (5 HIC, 5 UMIC, 4 LMIC, and 3 LIC). There were 2945 cases (68%) from HR countries and 1362 (32%) from LR countries. The mean age of patients in both LR and HR was similar (24.5 ± 0.5 vs 24.2 ± 0.4 years, P = .58), but LR had larger TBSA burns (30.5 ± 0.7% vs 19.8 ± 0.4% TBSA, P < .0001). There were fewer scald burns and more flame injuries in the LR countries (28.4 ± 1.3% vs 43.3 ± 1.0% and 55.2 ± 1.4% vs 39.0 ± 0.9%, P < .0001). Case fatality and RBS were greater in LR (31.9 ± 1.3% vs 9.4 ± 0.5% and 59.4 ± 1.1% vs 45.3 ± 0.6%, P < .0001). In regression analysis, LR was an independent risk factor for death with an odds ratio of 4.2 (3.2-5.4). The LA50 for HR countries was similar to that calculated from cases in the National Burn Repository of the American Burn Association (ABA NBR). For LR countries, the LA50 was lower for all ages except those 65 and older, ranging from 30% to 43% TBSA. Only a few facilities have contributed data to the GBR so far, with LR countries less represented than HR ones. The proportion of cases in the pediatric age group is much less represented in LR countries than in HR, possibly because many burned children in LR countries do not get burn care at specialized centers. Survival in HR countries is similar to that in North America. The GBR provides early insights into global burn care. Opportunities for improvement are greatest in LR countries. New Innovations may be necessary to increase participation from burn centers in LR countries. This report provides an early look at burn care across the globe based on cases in the GBR. It may inform further efforts to characterize and improve burn care in LR countries.

20 The Global Burn Registry: A Work in Progress

Abstract Introduction In 2018 the World Health Organization (WHO) launched the Global Burn Registry (GBR). Its purpose is to help improve the understanding of burn injury worldwide. The purpose of this study was to identify early findings from this database. Methods The GBR was accessed in September 2019. Cases from centers in low income (LIC) and low-middle income countries (LMIC) were combined into a Low Resource (LR) group, and cases in High Income (HIC) and Upper Middle Income (UMIC) countries were combined into a High Resource group (HR). Statistical analysis was performed with SAS 9.4. Data are expressed as mean ± SEM. Logistic Regression was used to identify risk factors for death. Revised Baux Score (RBS) was calculated as described by Osler (2010). Odds ratios are expressed as mean (95% confidence interval). The LA50 was calculated from the regression of death and total burn size (TBSA) for different age groups. Results At the time of analysis, there were 2,315 cases in the GBR treated at 23 facilities in 15 countries (4 HIC, 5 UMIC, 4 LIMC, and 2 LIC). There were 1,346 cases (58%) from HR countries and 969 (42%) from LR countries. The patients in LR were older than those in HR (26.2 ± 0.6 years vs 20.7 ± 0.6, p&amp;lt; 0.01) and had larger TBSA burns (31.0 ± 0.8 % TBSA vs 16.6 ± 0.4, p&amp;lt; 0.01). There were fewer scald burns and more flame injuries in the LR countries (26 ± 1.4 % vs 54 ± 1.4, and 56 ± 1.6 % vs 32 ± 1.3, p&amp;lt; 0.01). Case fatality and RBS were greater in LR (31.5 ± 1.5 % vs 4.8 ± 0.6 and 61.4 ± 1.3 % vs 38.9 ± 0.9, p&amp;lt; 0.01). In regression analysis, LR was an independent risk factor for death with an odds ratio of 6.3 (4.3 – 9.4). The LA50 for HR countries was similar to those in the National Burn Repository. For LR countries the LA50 was lower for all ages except those 65 and older, ranging from 30–45% TBSA. Conclusions Only a few facilities have contributed data to the GBR so far, with lower resourced countries less represented than higher resourced ones. The proportion of cases in the pediatric age group is much less represented in LR countries than in HR, possibly because many burned children in LR countries do not get burn care at specialized centers. Survival in HR countries is similar to that in North America. The GBR provides early insights into global burn care. Opportunities for improvement are greatest in LR countries. New Innovations may be necessary to increase participation from burn centers in LR countries. Applicability of Research to Practice This report provides an early look at burn care across the globe based on cases in the GBR. It may inform further efforts to characterize and improve burn care in low resourced countries.