Global Burn Research Articles

The global, regional, and national burden of burns: An analysis of injury by fire, heat, and hot substances in the global burden of disease study 2019

BackgroundBurn caused by exposure to hot substances is a common occurrence but there is little data on prevalence trends and disease burden. This research report the burden of burn injuries globally, regionally, and nationally from 1990 to 2019, identify hotspots, and analyze factors affecting disease burden with data from Global Burden of Disease 2019 survey. MethodsThe Global Burden of Disease 2019 estimated the incidence, death rate, and disease-adjusted life years (DALY) for injuries due to exposure to fire, heat, and hot substances from 1990 to 2019. For comparison, all rates were age standardized. And the estimated annual percentage change (EAPC) was used to reflect the degree of change of the annual rate. ResultsGlobally, there were an estimated 8,378,122 (95 % uncertainty interval [UI]: 6,531,887–10,363,109) burn injuries in 2019, with age-standardized incidence, death, and DALY rates of 118 (95 % UI: 89–147), 1.44 (95 % UI: 1.14–1.72), and 96.6 (95 % UI: 75.03–123.05) per 100,000 people, which were 22 %, 43 %, and 43 % lower than those in 1990, respectively. Regionally, age-standardized incidence rate showed a positive association with Socio-demographic Index (SDI) from 1990 to 2019, whereas age-standardized death and DALY rates were negatively associated with SDI. The variation in the age-standardized incidence rate was intrinsic, and the variation in the age-standardized death rate was related to the human development index in the country. The global burn incidence population was skewed, with peaks mainly in the 5 to 19 years age group, but age-specific death rates and disease burden were higher in the under-5 and older age groups. ConclusionsThe results of this study indicate the need to consider regional differences in burns when allocating health resources. Despite the reduced global burden of burns, incidence and deaths remain high. Moreover, there are significant differences between regions which are associated with the SDI and the human development index. Additionally, differences exist in the age and sex of the affected populations. Although the exact causes require further study, there is no doubt that the prevention of burns requires serious attention.

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.

A global forest burn severity dataset from Landsat imagery (2003–2016)

Abstract. Forest fires, while destructive and dangerous, are important to the functioning and renewal of ecosystems. Over the past 2 decades, large-scale, severe forest fires have become more frequent globally, and the risk is expected to increase as fire weather and drought conditions intensify. To improve quantification of the intensity and extent of forest fire damage, we have developed a 30 m resolution global forest burn severity (GFBS) dataset of the degree of biomass consumed by fires from 2003 to 2016. To develop this dataset, we used the Global Fire Atlas product to determine when and where forest fires occurred during that period and then we overlaid the available Landsat surface reflectance products to obtain pre-fire and post-fire normalized burn ratios (NBRs) for each burned pixel, designating the difference between them as dNBR and the relative difference as RdNBR. We compared the GFBS dataset against the Canada Landsat Burned Severity (CanLaBS) product, showing better agreement than the existing Moderate Resolution Imaging Spectrometer (MODIS)-based global burn severity dataset (MOdis burn SEVerity, MOSEV) in representing the distribution of forest burn severity over Canada. Using the in situ burn severity category data available for the 2013 wildfires in southeastern Australia, we demonstrated that GFBS could provide burn severity estimation with clearer differentiation between the high-severity and moderate-/low-severity classes, while such differentiation among the in situ burn severity classes is not captured in the MOSEV product. Using the CONUS-wide composite burn index (CBI) as a ground truth, we showed that dNBR from GFBS was more strongly correlated with CBI (r=0.63) than dNBR from MOSEV (r=0.28). RdNBR from GFBS also exhibited better agreement with CBI (r=0.56) than RdNBR from MOSEV (r=0.20). On a global scale, while the dNBR and RdNBR spatial patterns extracted by GFBS are similar to those of MOSEV, MOSEV tends to provide higher burn severity levels than GFBS. We attribute this difference to variations in reflectance values and the different spatial resolutions of the two satellites. The GFBS dataset provides a more precise and reliable assessment of burn severity than existing available datasets. These enhancements are crucial for understanding the ecological impacts of forest fires and for informing management and recovery efforts in affected regions worldwide. The GFBS dataset is freely accessible at https://doi.org/10.5281/zenodo.10037629 (He et al., 2023).

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.

Investigation of fire regime dynamics and modeling of burn area over India for the twenty-first century.

The characteristics of the vegetation fire (VF) regime are strongly influenced by geographical variables such as regional physiographic settings, location, and climate. Understanding the VF regime is extremely important for managing and mitigating the impacts of fires on ecosystems, communities, and human activities in forest fire-prone regions. The present study thereby aimed to explore the potential effects of the confounding factors on VF in India to offer actionable and achievable solutions for mitigating this concurring environmental issue sustainably. A global burn area (250m) data (Fire-CCIv5.1) and fire radiative power (FRP) were used to investigate the dynamics of VF across seven different divisions in India. The study also used the maximum and minimum temperatures, precipitation, population density, and intensity of human modification to model forest burn areas (including grassland). The Coupled Model Intercomparison Project-6 (CMIP6) was used to predict the burn area for 2030 and 2050 future climate scenarios. The present study accounted for a sizable increasing trend of VF during 2001-2019 period. The highest increasing trend was found in central India (513 and 343 km2year-1 in the forest and crop fire, respectively), followed by southern India (364 km2year-1 in forest fire), and upper Indo-Gangetic plain (128 km2year-1 in crop fire). The FRP has varied significantly across the divisions, with the north-eastern Himalayas exhibiting the highest FRP hotspot. The maximum and minimum temperatures have the greatest influence on forest fires, according to Random Forest (RF) modeling. The estimated pre-monsoonal burn area for 2050 and 2050 future scenarios suggested a more frequent forest fire occurrence across India, particularly in southern and central India. A comprehensive forest fire control policy is therefore essential to safeguard and conserve forest cover in the regions, affected by forest fire periodically.

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.

Global Burn Prevention: Ukraine.

Burn injury accounts for a large proportion of surgically treatable disease. It is estimated that over 180,000 flame burn deaths occur annually across the globe, with roughly 95% occurring in low- or middle-income countries (LMIC). Within these countries children account for a disproportionately high number of burn injuries. As such, the WHO has identified burn prevention as a topic of interest, with an increased need in low- and middle-income countries. Here we describe the creation and implementation of a burn prevention program in Ukraine. We instituted a five-step burn prevention initiative consisting of; data gathering, program design, implementation, outcome evaluation, program maintenance, and expansion. The burn prevention initiative has been adopted nationally leading to policy change. Active education and an information campaign were used to target pediatric scald injuries and improve first aid care. The authors have successfully implemented a targeted multi-faceted, national, burn prevention program within Ukraine. The described approach may be used as a guide and adapted to create similar prevention programs within other countries or regions. At this time the Russo-Ukrainian War has caused an abrupt hold on our role in the prevention program and left the healthcare system in havoc. Moving forward, our team is prepared to reevaluate the impact of the war on social life and the medical system and aid in redesigning the prevention program when appropriate.

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.

Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care.

Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.

762 A Systematic Review of Surgical Simulation in Burn Surgery: Education, Assessment, and Management

Abstract Introduction Proper assessment and management of burn patients requires practical knowledge and timely interventions in a high-stakes setting. Although much of burn care emphasizes critical care, nuances exist among this patient population, creating challenges for surgeons-in-training. As a result, low- and high-fidelity burn simulations have become increasingly popular means to educate burn care physicians and their teams in a safe environment without compromising care or endangering patients. The aim of this report is to systematically review the literature for existing simulations related to burn care. Methods A systematic review was conducted using the following databases: PubMed, Scopus, Embase, Web of Science, and Cochrane. Inclusion criteria were peer-reviewed articles about surgical simulation models related to burn care and surgery. Skills and techniques taught, assessment methods, model type, fidelity, and equipment were extracted from included studies. Conference proceedings, reviews, non-English and non-burn-specific literature were excluded. Results Our search criteria identified 2,585 articles, 16 of which met inclusion criteria. Simulation methods included 7 simulation courses (43.8%), 6 synthetic benchtop models (37.5%), 2 augmented/virtual reality interfaces (12.5%), and 2 iOS applications (12.5%). There were no burn-specific animal or cadaveric models. Model fidelities included 9 (56.3%) high-, 3 (18.8%) medium-, and 4 (25.0%) low-fidelity. The most common topics included in the simulations were burn wound assessment/management (n=10, 62.5%), escharotomy (n=6, 37.5%), fluid management (n=2, 12.5%), electrical burns (n=1, 6.2%), skin graft harvest (n=1, 6.2%), tangential excision (n=1, 6.2%), and cricothyrotomy (n=1, 6.2%). Conclusions Burn management requires an expansive breadth of intensive care knowledge and surgical expertise combined with a distinct, burn-specific skill set. A paucity exists in the literature for augmented/virtual reality and animal/cadaver models unique to burn care and surgery. Our review identified a need to expand simulator options to improve training in skin grafting, burn reconstruction, and burns-specific intensive care management. Applicability of Research to Practice Given the rapidly expanding emphasis on remote learning in the post-COVID era, developing accessible surgical simulation infrastructure adjacent to clinical training may better prepare global burn providers for the complexity of burn care.

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.

The Global Macroeconomic Burden of Burn Injuries.

Standardized estimates of global economic losses from burn injuries are lacking. The primary objective of this study was to determine the global macroeconomic consequences of burn injuries and their geographic distribution. Using the Institute of Health Metrics and Evaluation database (2009 and 2019), mean and 95% uncertainty interval (UI) data on incidence, mortality, and disability-adjusted life-years (DALYs) from injuries caused by fire, heat, and hot substances were collected. Gross domestic product (GDP) data were analyzed together with DALYs to estimate macroeconomic losses globally using a value of lost welfare approach. There were 9 million global burn cases (95% UI, 6.8 to 11.2 million) and 111,000 deaths from burns (95% UI, 88,000 to 132,000 deaths) in 2019, representing a total of 7.5 million DALYs (95% UI, 5.8 to 9.5 million DALYs). This represented welfare losses of $112 billion (95% UI, $78 to $161 billion), or 0.09% of GDP (95% UI, 0.06% to 0.13%). Welfare losses as a share of GDP were highest in low- and middle-income countries (LMICs) of Oceania (0.24%; 95% UI, 0.09% to 0.42%) and Eastern Europe (0.24%; 95% UI, 0.19% to 0.30%) compared with high-income country regions such as Western Europe (0.06%; 95% UI, 0.04% to 0.09%). Mortality-incidence ratios were highest in LMIC regions, highlighting a lack of treatment access, with southern sub-Saharan Africa reporting a mortality-incidence ratio of 40.1 per 1000 people compared with 1.9 for Australasia. Burden of disease and resulting economic losses because of burn injuries are substantial worldwide and are disproportionately higher in LMICs. Possible effective solutions include targeted education, advocacy, and legislation to decrease incidence and investing in existing burn centers to improve treatment access.

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.

Establishment of a core outcome set for burn care research: development and international consensus

ObjectiveTo develop a core outcome set for international burn research.DesignDevelopment and international consensus, from April 2017 to November 2019.MethodsCandidate outcomes were identified from systematic reviews and stakeholder interviews. Through a...

FIRE SEVERITY ASSESSMENT OF AN ALPINE FOREST FIRE WITH SENTINEL-2 IMAGERY

Abstract. Fire is a common phenomenon in many forests and is considered an important ecological tool. Fire severity mapping presents an effective way to assess post-fire management intervention and is helpful in environmental and climate change research. The objective of this study was to determine the severity of a forest fire event that occurred from 24th to 27th October 2019 at Taibon Agordino using Sentinel-2A satellite images and creating a severity map suitable as a decision-making tool for post-fire management intervention. The Sentinel-2A satellite data was classified into the following five classes: Unburned, Low Severity, Moderate Severity, High Severity, and Shadow with the non-parametric Random Forest (RF) classifier, and the resulting classified image was validated using validation sites. The RF classifier was applied first to the ten original band reflectance of Sentinel-2. In a second step, additional variables were added to the classification, namely the digital elevation model (DEM), the slope, and five vegetation indices (i.e., Differenced Normalized Burn Ratio (dNBR), Relative Differenced Normalized Burn Ratio (RdNBR), Differenced Bare Soil Index (dBSI), Global Environmental Monitoring Index (GEMI) and Burn Area Index (BAI)) The inclusion of vegetation indices and DEM-related variables increased the classification accuracy from 99.26% to 99.61% and the overall accuracy from 70.51% to 83.33%. In the classification with the ten original band reflectance, the variable of importance plot ranked the Red-Edge-3, Red, and SWIR 1 band reflectance as the top three most important input features, while for the classification with 17 variables, RdNBR, DEM and dNBR were the top three most important input features.

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.