A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India

Abstract Background None of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demogr...

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Main Authors: Amol Dhopte, Rahul Bamal, Vinay Kumar Tiwari
Format: Article
Language:English
Published: Oxford University Press 2017-09-01
Series:Burns & Trauma
Subjects:
Online Access:http://link.springer.com/article/10.1186/s41038-017-0095-7
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author Amol Dhopte
Rahul Bamal
Vinay Kumar Tiwari
author_facet Amol Dhopte
Rahul Bamal
Vinay Kumar Tiwari
author_sort Amol Dhopte
collection DOAJ
description Abstract Background None of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demographic and clinical risk factors for mortality in pediatric burns in an effort to decrease the mortality in these patients. Methods A prospective analytical study was conducted in patients up to the age of 18 years admitted for burn injuries in a tertiary care burn center in India from January to December 2014. Clinical and demographic data was collected through questionnaire-interview and patient follow-up during their stay in the hospital. Univariate and multivariate firth logistic regression was used to identify various risk factors for mortality in pediatric burns. Results A total of 475 patients were admitted during the study period. Overall mortality was 31.3% (n = 149) in this study. Mean age of the patients who died was 8.68 years. Of the 149 deaths, 74 were males and 75 were females (male to female ratio = 0.98). Mean total body surface area (TBSA) involved of the patients who expired was 62%. Inhalational injury was seen in 15.5% (n = 74) of pediatric burn admissions. Mortality was significantly higher (74.3%) in patients with inhalation injury. Mortality was highest in patients with isolates of Acinetobacter + Klebsiella (58.3%), followed by Pseudomonas + Klebsiella (53.3%), Acinetobacter (31.5%), and Pseudomonas (26.3%) (p < 0.0005). Factors found to be significant on univariate firth analysis were older age, female gender, suicidal burns, higher TBSA, presence of inhalation injury, increased depth of burn, and positive microbial cultures. On multivariate analysis, higher TBSA was identified as an independent risk factor for mortality. The adjusted odds ratios for TBSA involvement was 21.706 (25.1-50%), 136.195 (50.1-75%), and 1019.436 (75.1-100%), respectively. Conclusion TBSA is the most important factor predicting mortality in pediatric burns. The higher the TBSA, the higher is the risk of mortality. Other significant risk factors for mortality are female gender, deeper burns, positive wound cultures, and inhalation injury. Risk of mortality was significantly lower in children who belonged to urban areas, nuclear family, who sustained burn injury in the last quarter of the year, and who stayed in the hospital for longer period.
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spelling doaj.art-d042dae50aba4e97ba07c1e993a0505a2022-12-21T19:20:45ZengOxford University PressBurns & Trauma2321-38762017-09-015111010.1186/s41038-017-0095-7A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North IndiaAmol Dhopte0Rahul Bamal1Vinay Kumar Tiwari2Department of Plastic, Reconstructive and Maxillofacial surgery, Government Medical College and HospitalDepartment of Burns, Plastic and Maxillofacial Surgery, VMMC & Safdarjung HospitalDepartment of Burns and Plastic Surgery, PGIMER & RML HospitalAbstract Background None of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demographic and clinical risk factors for mortality in pediatric burns in an effort to decrease the mortality in these patients. Methods A prospective analytical study was conducted in patients up to the age of 18 years admitted for burn injuries in a tertiary care burn center in India from January to December 2014. Clinical and demographic data was collected through questionnaire-interview and patient follow-up during their stay in the hospital. Univariate and multivariate firth logistic regression was used to identify various risk factors for mortality in pediatric burns. Results A total of 475 patients were admitted during the study period. Overall mortality was 31.3% (n = 149) in this study. Mean age of the patients who died was 8.68 years. Of the 149 deaths, 74 were males and 75 were females (male to female ratio = 0.98). Mean total body surface area (TBSA) involved of the patients who expired was 62%. Inhalational injury was seen in 15.5% (n = 74) of pediatric burn admissions. Mortality was significantly higher (74.3%) in patients with inhalation injury. Mortality was highest in patients with isolates of Acinetobacter + Klebsiella (58.3%), followed by Pseudomonas + Klebsiella (53.3%), Acinetobacter (31.5%), and Pseudomonas (26.3%) (p < 0.0005). Factors found to be significant on univariate firth analysis were older age, female gender, suicidal burns, higher TBSA, presence of inhalation injury, increased depth of burn, and positive microbial cultures. On multivariate analysis, higher TBSA was identified as an independent risk factor for mortality. The adjusted odds ratios for TBSA involvement was 21.706 (25.1-50%), 136.195 (50.1-75%), and 1019.436 (75.1-100%), respectively. Conclusion TBSA is the most important factor predicting mortality in pediatric burns. The higher the TBSA, the higher is the risk of mortality. Other significant risk factors for mortality are female gender, deeper burns, positive wound cultures, and inhalation injury. Risk of mortality was significantly lower in children who belonged to urban areas, nuclear family, who sustained burn injury in the last quarter of the year, and who stayed in the hospital for longer period.http://link.springer.com/article/10.1186/s41038-017-0095-7Pediatric burnsMortalityRisk factorsMicrobiological culturesIndia
spellingShingle Amol Dhopte
Rahul Bamal
Vinay Kumar Tiwari
A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India
Burns & Trauma
Pediatric burns
Mortality
Risk factors
Microbiological cultures
India
title A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India
title_full A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India
title_fullStr A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India
title_full_unstemmed A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India
title_short A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India
title_sort prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in north india
topic Pediatric burns
Mortality
Risk factors
Microbiological cultures
India
url http://link.springer.com/article/10.1186/s41038-017-0095-7
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