The effect of COVID-19 on burn management and outcomes in a resource-limited setting. Issue 7 (November 2022)

• Record Type: Journal Article
• Authors: Gallaher, Jared; Abid, Mustafa; Kayange, Linda; Purcell, Laura; Charles, Anthony
• Is Part Of: Burns. Volume 48:Issue 7(2022)
• Page Start: 1584
• Page End: 1589
• Publication Date: 2022-11
• Subjects: Trauma -- Burn -- Sub-Saharan Africa -- COVID-19 -- Pandemic; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2022.08.004
• Languages: English
• ISSNs: 0305-4179

Abstract

Abstract: Introduction: Optimal burn care includes fluid resuscitation and early excision and grafting. During the COVID-19 pandemic, resource-constrained environments were susceptible to interruptions in burn care. We sought to characterize pre- and intra-pandemic burn-associated outcomes at a busy tertiary hospital in Malawi. Methods: This is a retrospective analysis of burn patients that presented to Kamuzu Central Hospital Lilongwe from 2011 through December 2021. We compared patients based on whether they presented pre- or intra-pandemic, starting on March 11, 2020, the date of official WHO designation. Comparing these cohorts, we used modified Poisson modeling to estimate the adjusted risk of undergoing an operation and the risk of death. Results: We included 2969 patients, with 390 presenting during the pandemic. Patient factors were similar between the cohorts. More patients underwent surgery pre-pandemic (21.1 vs 10.3 %, p < 0.001) but crude mortality was similar at 17.3 % vs. 21.2 % (p = 0.08). The RR of undergoing surgery during the pandemic was 0.45 (95 % CI 0.32, 0.64) adjusted for age, sex, % TBSA, flame burns, and time to presentation. During the pandemic, the risk ratio for in-hospital mortality was 1.23 (95 % CI 1.01, 1.50) adjusted for age, sex, % TBSA, surgical intervention, flame burns, and time to presentation. Conclusions: During the pandemic, the probability of undergoing burn excision or grafting was significantly lower for patients, independent of the severity. Consequently, the adjusted risk of mortality was higher. To improve patient outcomes, efforts to preserve operative capacity for burn patients during periods of severe resource constraint are imperative. Highlights: Significantly more patients underwent surgery for burn injury pre-pandemic (21.1 vs 10.3 %, p < 0.001). The adjusted risk ratio of undergoing surgery during the pandemic was 0.45 (95 % CI 0.32, 0.64). Crude mortality was similar but the adjusted risk ratio for in-hospital death was 1.23 (95 % CI 1.01, 1.50).