Factors Associated With Early Versus Late Mortality Following Pediatric Burn Injury in a Resource-Limited Setting

Abstract

Introduction: Although burn injury survival has improved significantly in high-income countries (HICs) over the past 3 decades, low- and middle-income countries (LMICs) continue to experience high mortality rates. Prior studies have attributed burn mortality to factors, such as total body surface area burned, inhalation injury, and under-resuscitation, primarily focusing on late deaths in HICs. This study examines the characteristics of early versus late burn deaths in LMICs. Methods: We conducted a retrospective analysis of pediatric patients admitted to the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi. Bivariable analyses, followed by a multivariable logistic regression analysis, were performed to evaluate factors influencing early mortality (death within 3 days of burn injury). Results: Among the 2315 patients analyzed, 397 (17.1%) died, with 109 (27.4%) classified as early deaths. The median age was 2 years (IQR 2–7), and there was a slight male preponderance in both early and late death cohorts. The estimate plot demonstrated bimodal peaks in mortality within one and 7 days postinjury. Multivariable logistic regression revealed that patients who did not receive adequate fluid resuscitation within 24 h of injury were significantly more likely to experience early death (aOR 2.96, 95% CI 1.20–7.29, and p = 0.02). The predictive probabilities showed a significant decrease in mortality with increased length of stay in the burn unit. Conclusion: Adequate fluid resuscitation within 24 h is crucial for improving survival and may mitigate early mortality in pediatric patients with burn, emphasizing the need for targeted treatment protocols in resource-limited settings.