Applying quality improvement methods to neglected conditions: Development of the South Asia Burn Registry (SABR)

Objective: South Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia.Results: The South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. It covers the entire spectrum of care provision for burn injury patients from the actual event through their discharge from the healthcare system. SABR investigates locally relevant contextual factors associated with burn injury and health-system requirements for burn patients receiving emergency and inpatient care in resource-constrained settings. It also explores factors associated with burn injury and care provision. SABR will inform better prevention and management efforts in South Asia and help to address healthcare needs of burn injury patients

Pattern of unintentional burns: a hospital based study from Pakistan

Background: Burns are major cause of morbidity and mortality in developing countries. Better understanding of the nature and extent of injury remains the major and only available way to halt the occurrence of the event. The present study was conducted to determine the prevalence of by self and by other unintentional burn, their comparison and the possible mode of acquisition by obtaining the history of exposure to known risk factors. Methods: A cross-sectional questionnaire based survey was conducted in Burns Centre of Civil Hospital Karachi, Pakistan and 324 hospitalized adult patients with unintentional burns were consecutively interviewed during August 2013 to February 2014. Information was collected on socio-demographic profile. The source of burn, affected body part and place of injury acquisition in terms of home, outside or work were also noted. Logistic regression model was conducted using SPSS software. Results: Out of 324 patients, 295 (91%) had unintentional burn by self and 29 (9%) had unintentional burn by others. Male gender were 2.37 times and no schooling were 1.75 times more likely to have self-inflicted unintentional burn. Lower limb and head and neck were less likely to involve in unintentional burn by self. Conclusion: The burden of unintentional burn by self was considerably higher. Male gender and no schooling were found more at risk to have unintentional burn by self

795 Gender-related charateristics of burn injury patients presenting to designated burn centres in South Asia

Background Burn injury causes more than three-fourth deaths in Africa, Eastern Mediterranean and South-East Asia regions effecting females more than males. This study assesses the gender-related burn injury characteristics in South Asia.Methods This prospective study was conducted at two main burn centres in Dhaka, Bangladesh and Karachi, Pakistan from October 2014 – January 2015. All adult (\u3e17 years) burn injury patients were included in the analysis. Gender differences in patient demographics, burn injury characteristics and outcome were compared using Chi-square test for categorical and t-test for continuous variables. Ethical approval was taken from all collaborating and participating sites.Results Of 1470 adult patients, 57.3% were males. Mean age of females was 36.85 ± 14.61 years and of males 33.49 ± 13.52 years. Among females, 81.6% were married and 63.7% among males (p-value\u3c0.001). About 35.2% of females had no/informal education. Eighty% females were housewives and most males were manual-labourers (23.2%). For females, burns were common in kitchen (72.8%) while cooking (49.4%) and for males, industrial area (29.5%) during work (40.5%). Females suffered from flame (52.9%) and scalds (42.6%) while males had electrical burns (17.2%) in addition to flame (38.1%) and scalds (29.8%). Hot liquid was the common cause of burn in females (42%). Total body surface area(%) burnt was more in females(16.88 ± 20.85) compared to males (12.89 ± 17.47) (p-value\u3c0.001). Around one-third of males and females were admitted. About 50% of admitted females and around 30% of admitted males died. The mean duration of stay at the burn centre was higher for females (19.17 ± 23.27) compared to males (13.85 ± 15.29) (p-value 0.0001).Conclusions Compared to males, females with burn injuries are older and married and likely to have burn injury at home. Males are more likely to have burns at work. Females suffered from higher percentage of surface area of burn. There were more deaths in females

Factors associated with emergency department disposition among burn injury patients: Analysis of prehospital and emergency care characteristics using South Asia Burn Registry (SABR) data

Introduction: Improvement in burn injury data collections and the quality of databanks has allowed meaningful study of the epidemiologic trends in burn care. The study assessed factors associated with disposition of burn injury patients from emergency department accounting for pre-hospital care and emergency care.Methods: This prospective observational pilot study of the South Asia Burn Registry project was conducted at selected public sector burn centers in Bangladesh and Pakistan (September 2014 - January 2015). All age groups with an initial presentation to the burn centers were enrolled. Descriptive and regression analysis is presented.Results: A total of 2749 patients were enrolled. The mean age was 21.7 ± 18.0 years, 55.3% were males, and about a quarter were children \u3c 5 years. About 46.9% of the females were housewives. Scald burns were common among children (67.6%) while flame burns were common among adults (44.3%). About 75% of patients were brought in via non-ambulance mode of transport. More than 55% of patients were referrals from other facilities or clinics. The most common first aid given pre-hospital was the use of water or oil. About 25% were admitted for further care. The adjusted odds of being admitted compared to being sent home were highest for children \u3c 5 yrs, those with higher total body surface area burnt, having arrived via ambulance, scald and electrical burn, having an associated injury and inhalational injury.Conclusion: The study provides insight into emergency burn care and associated factors that influenced outcomes for patients with burn injuries

Burns in South Asia: Outcomes from South Asian burn registry (SABR)

Background: South Asian region contributes 59 % to the global mortality due to burns. However, we find a paucity of literature on the outcomes of burns from low- and middle-income countries (LMICs). South Asian Burn Registry (SABR) is a facility-based burns registry that collected data on in-patient burn care. This study assesses factors associated with mortality, length of hospital stay at the burns center, and functional status of burn patients.Methods: Prospective data was collected from two specialized public sector burn centers between September 2014 - January 2015 from Bangladesh and Pakistan. Multivariable logistic, linear, and ordinal logistic regression was conducted to assess factors associated with inpatient-mortality, length of hospital stay, and functional status at discharge, respectively.Results: Data on 883 patients was analyzed. Increased association with mortality was observed with administration of blood product (OR:3, 95 % CI:1.18-7.58) and nutritional support (OR:4.32, 95 % CI:1.55-12.02). Conversely, antibiotic regimens greater than 8 days was associated with decreased mortality (OR:0.1, 95 % CI:0.03-0.41). Associated increase in length of hospital stay was observed in patients with trauma associated with their burn injury, history of seizures (CE:47.93, 95 % CI 12.05-83.80), blood product (CE:22.09, 95 % CI:0.83-43.35) and oxygen administration (CE:23.7, 95 % CI:7.34-40.06). Patients who developed sepsis (OR:6.89, 95 % CI:1.92-24.73) and received blood products during hospitalization (OR:2.55, 95 % CI:1.38- 4.73) were more likely to have poor functional status at discharge.Conclusion: This study identified multiple factors associated with worse clinical outcomes for burn patients in South Asia. Understanding these parameters can guide targeted efforts to improve the process and quality of burn care in LMICs