20 The Global Burn Registry: A Work in Progress

Introduction Burn injuries remain a significant global health burden, particularly in lower-resource settings. Understanding disparities in outcomes between low-resource and high-resource regions is needed to inform interventions. We hypothesize that burns managed in low-resource countries are an independent risk factor for mortality. Methods We queried the World Health Organization (WHO) Global Burn Registry (GBR) from inception to September 2024. Individuals were stratified based on care in low-resource (LRC) and high-resource countries (HRC). Descriptive statistics between cohorts (LRC vs. HRC) were leveraged to summarize demographics, burn characteristics, facility resources, and hospital care outcomes. Multivariable logistic regression analysis was performed for mortality while controlling for confounding factors. Results There were 9,274 cases with 4,169 (45%) managed in LRC and 5,105 (55%) in HRC. The median age at time of burn injury was 24 years (IQR: 4-40 years). The male population was 54% in LRC and 65% in HRC (P< 0.001). The median total body surface area (TBSA) burned was higher in LRC (20%, IQR: 10-40%) compared to HRC (15%, IQR: 5-25%, P< 0.001). Inhalation injury was also more prevalent in LRC (23%) than in HRC (9%, P< 0.001). Both the median Baux and modified Baux scores were higher for LRC, 50 and 52, respectively, compared to HRC, 41 and 42, respectively (P< 0.001). Flame injuries were significantly higher in LRC (56% vs. 43% HRC, P< 0.001). There was a significantly higher proportion of head and neck, trunk, and lower extremity burn injuries in LRC (P< 0.001). Critical care resources, computer and internet access, operating room availability, rehabilitation capabilities, and specialist capabilities were significantly lower in LRC (P< 0.001). A higher proportion of patients in HRC underwent surgery (61% vs. 40% LRC, P< 0.001). Discharge was significantly higher (82% vs. 59%) in HRC and mortality was significantly lower (11%) compared to LRC (29%, P< 0.001). After adjusting for demographics and burn-related factors, management in an LRC significantly increased the odds of mortality (OR 2.69, 95%CI 2.25-3.24, P< 0.001). Conclusions Individuals treated in LRC had higher mortality, even after adjusting for demographic and burn injury-related characteristics. These findings underscore the need for greater access to specialized care and targeted interventions in low-resource settings to improve burn care. Applicability of Research to Practice Significant disparities in burn care exist between low-resource and high-resource settings, emphasizing the urgent need for targeted interventions. The findings suggest that increasing access to specialized burn care, critical care resources, and surgical interventions in LRC can be potential avenues to reduce mortality rates. Funding for the Study N/A

Introduction Burns involving the lower extremities can severely impact mobility and significantly reduce quality of life. There is a dearth of information on lower extremity burns in low-resource settings, particularly in low- and middle-income countries (LMIC). In high-income countries, conditions like diabetes complicate the management of these injuries and affect recovery potential. We aim to characterize lower extremity burns and evaluate their impact on outcomes on a global scale. It was hypothesized that lower extremity burns are an independent risk factor for mortality and, given amputation rates in high-income countries post-burn, are mostly managed surgically. Methods The WHO Global Burn Registry were analyzed from inception to September 2024. Individuals from high-income countries were excluded. Descriptive analyses were used to stratify patients with lower extremity burns and those without lower extremity burns. Multivariable logistic regressions assessed predictors with the primary outcome of mortality. Secondary outcome measures were surgical intervention and functional impairment at discharge for survivors. Results There were 2,752 individuals who had a lower extremity burn managed in LMICs, representing 66% of total cases (N=4,169). Compared to non-lower extremity burns, individuals with lower extremity burn injuries were older (median ages: 27 years vs. 18 years, P< 0.001), mostly males (51%), consisted of flame injuries (63%), had higher TBSA, more instances of inhalation injury, and had significantly higher Baux and modified Baux Scores (P< 0.001). Most lower extremity burn patients did not undergo surgery (60%) and most were not discharged (51%). The mortality rate for lower extremity burns was 38% compared to 12% for non-lower extremity burns (P< 0.001). There were increased odds of mortality with lower extremity burns (OR 1.67, 95%CI 1.33-2.09) and they led to a significantly higher likelihood of surgical intervention (OR 1.49, 95%CI 1.29-1.73) in multivariable analysis. Conclusions Lower extremity burns in LMICs predisposed patients to require surgical intervention and higher mortality. Understanding the degree of amputations in LMICs will better capture the impact these injuries have on long-term function and quality of life. Applicability of Research to Practice Assessing amputation rates and the availability of prosthetics and rehabilitation services in LMICs is essential for improving long-term outcomes and quality of life. The results could guide policy changes and resource allocation by global health organizations and local governments to address these disparities and improve burn care in low-resource settings. Funding for the Study N/A

BackgroundThere are limited and fragmented data collection systems for burn injury. A global repository may lead to better burn injury estimates and help identify key risk factors. A collaborative effort...

Global epidemiology of geriatric burns, capacities of care, and injury outcomes: Perspectives from the World Health Organization global burn registry

Pregnant women continue to die from preventable causes, the greatest number in low-resource countries, where neglect of Traditional Birth Attendant [TBA] training is adversely affecting women with the least access to family planning or a Skilled Birth Attendant. Consideration for TBAs role to strengthen maternity care in low resource settings is recommended. The scope of the TBA role, appropriate training and supervision remains a challenge. This integrative literature review analysed publications about TBA training programs in low-resource countries. A search strategy was implemented incorporating a five-step framework utilising electronic databases. Twenty- five publications were reviewed. Four themes and eleven sub-themes were identified about "TBA training programs in low-resource countries": (1) Variance in role of TBAs affecting training including subthemes of variance in role, scope and title of TBAs, appointment and remuneration, and articulation of TBA work; (2) Training influenced by where TBAs provide services including areas of high Maternal and Neonatal Mortality, and with low access to health; (3) Educational needs of TBAs, including lack of consensus around specific knowledge and skills, need for culturally appropriate educational needs assessment and importance of education about role of health facilities and referral process; (4) Training and teaching TBAs, including methods, cultural contexts and resources. There is global confusion about TBA's role within maternity services in low-resource countries, including their title, scope of practice, remuneration, specific training needs and required clinical skills. Community engagement to ensure a culturally applicable role for TBAs, appropriate training information and materials is imperative to ensure sustainability and effectiveness. A gap in knowledge exists around measurable outcomes related to training programs. Recommendations are offered to incorporate TBAs into the maternity healthcare system for low resource settings.

To use multivariate analysis to determine risk factors for death among pediatric patients with candidemia and a central venous catheter in place. Retrospective cohort study conducted at Santa Casa Complexo Hospitalar, a 1,200-bed teaching hospital in southern Brazil. All cases of candidemia in pediatric patients (age, <or=13 years) at our medical center over a 9-year period were reviewed. A diagnosis of sepsis was required for inclusion in the study. Severity of illness was confirmed by the presence of hypotension requiring inotropes and according to the following scores: the Pediatric Risk of Mortality (PRISM) II score, the PRISM III score, and the Pediatric Logistic Organic Dysfunction score. The following 2 outcomes were evaluated: early death, defined as death occurring within 7 days after candidemia was diagnosed, and late death, defined as death 8-30 days after candidemia was diagnosed. A total of 61 patients were included in the study, including 14 neonates. Most (63.9%) of these patients were girls, and the median age was 0.3 years. A total of 80.3% of candidemia cases were due to species other than Candida albicans, primarily Candida parapsilosis (32.8% of cases) and Candida tropicalis (24.6% of cases). Using multivariate analysis, we demonstrated that failure to remove the central venous catheter was an independent risk factor for early death among pediatric patients with candidemia. However, patients whose catheters were retained were sicker than patients whose catheters were removed, and catheter removal had no impact on late death. Instead, severity of illness determined using the PRISM III score was also an independent predictor of late death. Results from this study suggest that systematic removal of catheters from pediatric patients with candidemia does not reduce the occurrence of late death.

Gender-based disparities in burn injuries, care and outcomes: A World Health Organization (WHO) Global Burn Registry cohort study

Introduction Hand burn injuries have been well described in high-income countries, but less evidence has been established for low- and middle-income countries (LMIC). Burns to the hand are a significant cause of functional impairment and disability, particularly in LMICs, where access to specialized burn care and rehabilitation is limited. There is a need to provide an overview of hand burn management and outcomes in LMICs. This study analyzes the treatment patterns and outcomes of hand burns in LMICs. We hypothesized that limited access to specialized burn care and surgical interventions in these regions leads to higher rates of physical impairment and mortality among hand burn patients. Methods Hand burns were extracted from the WHO Global Burn Registry from inception to September 2024. Individuals from high-income countries were excluded. Descriptive analysis summarized patient demographics, burn characteristics, and hospital care variables. Multivariable logistic regression was performed to identify factors associated with the need for surgery and poorer outcomes in LMIC settings, including mortality and functional impairment at discharge for survivors. Results There were 4,169 cases from LMICs with 2,121 (51%) hand burns. Patients with hand burns had a significantly higher median age at the time of burn injury (28 vs. 18 years, P&amp;lt; 0.001). Most patients with hand burns in LMICs were male (56%), had flame-based etiologies (67%), had median total body surface area (TBSA) burned of 30% (IQR 15-50%), and sustained a significantly higher proportion of inhalation injury (36%) compared to non-hand burn patients (10%, P&amp;lt; 0.001). Patients with hand burns sustained a significantly higher percentage of burns to the head and neck, trunk, arm, and lower extremities (P&amp;lt; 0.001). Physical impairment at discharge among survivors (non-hand: 8% vs. hand: 13%, P&amp;lt; 0.001) and mortality (non-hand: 16% vs. hand: 42%) was significantly higher (P&amp;lt; 0.001) among patients who sustained a burn to the hand. More patients without hand burns underwent surgery (44% vs. 36%, P&amp;lt; 0.001) and were discharged home (73% vs. 46%, P&amp;lt; 0.001). In multivariable analysis, hand burns were significantly associated with lower odds of surgical intervention (OR 0.86, 95%CI 0.74-0.99). When focusing on survivors, hand burns were significantly associated with higher odds of being discharged home with a physical impairment (OR 1.40, 95%CI 1.06-1.87), but did not confer an increased risk for mortality (P&amp;gt;0.05) when controlling for demographic and clinical features. Conclusions Hand burns in LMICs had disproportionately greater physical impairment at discharge and higher mortality rates compared to non-hand burn injuries. The study underscores that hand burns in LMICs result in poor functional outcomes. Applicability of Research to Practice Implementing interventions that focus on improving surgical capacity and post-burn rehabilitation in LMICs could lead to better outcomes for survivors of hand burns. Funding for the Study N/A

Unveiling Sex Differences in Pediatric Burns Through the World Health Organization (WHO) Global Burn Registry

The Epidemiology and Outcomes of Perineal and Genital Burn Injury in Low- and Middle- Income Countries: A Global Burn Registry Study

We hypothesized that the economic status of a region might influence quality of care and outcome of patients with severe brain trauma. Between January 2001 and December 2005, 13 centres enrolled patients with severe brain trauma. Data on accident, treatment and outcomes were collected prospectively. The regions were classified as 'high income' (Austria, five centres), 'upper middle income' (UMI) (Croatia, Slovakia, six centres) or 'lower middle income' (LMI) (Bosnia, Macedonia, two centres). Data on epidemiology, treatment and outcomes were compared according to this classification. Quality of care was assessed using a new scoring system. A total of 1172 data sets were analysed. Patients from the wealthier regions were significantly older. Low-level falls and traffic accidents contributed to more than two-third of all cases. Violence-related trauma was significantly more frequent in 'middle income' regions. Treatment quality was significantly different; treatment according to guidelines for brain trauma management was provided most frequently for patients from high-income regions. Compared with expected mortality rates, mortality was 6.5% lower in the 'high-income' centres, 2.4% lower in the 'UMI' centres and 13% higher in the 'LMI' centres. Advanced age, poor neurological status, high trauma severity and poor quality of care were associated with significantly lower odds for survival. The association between the economic status and outcome of brain trauma patients was due to the quality of care. Successful implementation of guidelines for brain trauma management requires a well-funded health care system.

Objective: To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods. Methods: A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression. Results: The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively). Conclusions: Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.

e13662 Background: The integration of digital technology has significantly transformed clinical practice, especially in oncology. ONCOassist, an application that integrates content from the NCCN Templates offers professionals quick and up-to-date access to information crucial for cancer treatment. Methods: To analyze and determine whether factors such as the Human Development Index (HDI) or Gross National Income (GNI) influence the adoption of the NCCN Templates, an in-application survey was distributed to health professionals who accessed NCCN content. The survey asked two questions: (1) would respondents use a specific NCCN protocol for a current patient (2) if not, the reasons why they did not utilize it. Finally, how the acceptance of the NCCN Templates was related to HDI or GNI and specialty was analyzed. Results: The survey was responded to by 2522 health professionals from 122 countries. The NCCN Templates were widely accepted (80%) across different geographic and economic contexts, indicating their global applicability and trust. Generally, GNI is categorized by high income, upper middle income, lower middle income, and low income, while HDI includes very high, high, medium, and low income. For the lowest levels of GNI and HDI, there were few responses (1% by GNI and 8% by HDI), and for purposes of this abstract, they were combined with the next highest level, lower middle income, and medium HDI. Using GNI, the rates of using the NCCN Templates in countries with high income (72%) were lower than those with upper-middle income (83%) and lower middle/low income (86%). In a similar inverse tendency, based on HDI, the utilization rates of the NCCN Templates were 70%, 83%, and 86% in countries with very-high, high, and medium/low HDI, respectively. When stratified by specialty, the absolute numbers showed that most respondents belonged to the field of the breast (36%), followed by gastrointestinal (28%) and lung cancers (10%). However, when we analyzed percentages, we observed that the decision-making process regarding protocol adoption was consistent among specialties despite the variance in specialist population size. When we analyzed the reasons for not utilizing NCCN Templates, “Other reasons” was the primary response (51%). Among the remaining answers, using specific local protocols was the primary reason (47% of the remaining), followed by the lack of drug availability (18% of the remaining) and reimbursement issues (18% of the remaining). Conclusions: There was a general acceptance of the NCCN Templates among healthcare professionals globally. The willingness to utilize NCCN Templates content was not strongly determined by the HDI or GNI, suggesting a perception of their utility beyond economic barriers. The protocol has the potential to be used in daily clinical practice, improving decision-making.

Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry

An Accurate and Rapid Color-Based Point-of-Care Assay for the Detection of Severe Anemia in Low Resource Settings