Referral And In-Unit Mortality Patterns Among Adult Acute Burns Patients. The Case Of A Burns Center In The Western Cape, South Africa

Burn centers are meant to manage the most severe burns cases of definite geographic areas. For this purpose, referral criteria are implemented, but their application within health systems are seldom monitored. Likewise, the factors most determinant of in-burns unit mortality are poorly documented, not least in resource-scarce settings. The study’s objective is two-fold: investigate whether admissions to a South African adult burns center follow the referral criteria in place and determine what injury and patient characteristics, some of which are used in the criteria definition, are most strongly associated with in-unit mortality. All patients admitted to the burns center at Tygerberg hospital, Western Cape, during 2015–2016 were included (n=445). Their files were scrutinized to collect standardized information on patient (sex, age, and comorbidity) and injury (body part, inhalation, burn depth and size) characteristics, on treatment received and on mortality (prior to discharge, within 3 months of admission). Thereafter, adherence to the referral criteria was determined and expressed in percentage. The characteristics most significantly associated to in-unit mortality were assessed using logistic regression, expressed as odds-ratios. Nearly half (47.6%) of the patients had a TBSA u003e20% on admission and 97.3% were admitted in adherence with the referral criteria. Anatomical site, wound severity and inhalation injury were the criteria most often identified (90.6%, 44.9% and 37.8% respectively). The in-unit mortality (19.8%) was strongly associated with suffering from inhalation injury, being a female patient, and with burn size (OR=5.3 (CI: 3.1–8.8), OR=2.3 (CI: 1.4–3.6), and OR=1.1 (CI: 1.07–1.12) respectively). The center caters largely for severe burn cases and admission follows the referral criteria. In-unit mortality is common and strongly associated with some wound (size and inhalational) and patient attributes. Those up-to-date results clarify the current situation at the center and may be used for needs assessments.