A retrospective study analysing mortality and outcomes in the paediatric burns intensive care unit at the Chris Hani Baragwanath Academic Hospital, Johannesburg

Internationally, thermal burns account for 300 000 mortalities per year, of which 180 000 are estimated to occur in lowto middleincome countries. [1,2] In South Africa (SA), 2.8/100 000 children die annually from thermal injuries and burns remain the third most common cause of external trauma and subsequent mortality in children younger than 18 years. [3,4] In the SA context, the incidence and patterns of burn injuries have been noted to be attributed largely to urbanisation and urban migration, disorganised development, inaccessible electrical supply, unsafe energy sources, poverty and overcrowding. [5] A retrospective study by Jugmohan et al.[6] identified the risk factors for mortality in paediatric burn victims at the Chris Hani Baragwanath Academic Hospital (CHBAH) as age below 5 years, burn injury with a total body surface area (TBSA) >30%, presence of inhalational injury and admission to the paediatric intensive care unit (PICU). Informal observations in our unit suggested that worse outcomes and higher mortality were associated with patients transferred to us from referral centres than seen in direct admissions from the emergency department. It was reasoned that this may be due to patients being transferred fairly long after the burn occurred and that burn injuries were more extensive. Literature review revealed no studies that compared the outcomes between direct admissions and patients transferred from a referral centre, which prompted us to analyse the outcomes in these patient groups formally. Methods The Johnson & Johnson Paediatric Burns Unit at CHBAH treats state-sector patients from Soweto and surrounds as well as from distant referral sites, often accepting patients from centres in provinces outside our referral area. The referral and admission criteria are in line with the guidelines of the American Burn Association. [7,8] The study aimed to compare the outcomes (defined as the proportion of mortalities versus discharges) of patients who had been admitted directly from the emergency department or referred locally from Soweto with those of patients transferred to our unit from other healthcare institutions. To this end, case data from 1 January 2013 to 31 December 2017 were retrieved from the patient registry of the paediatric burns unit. The total number of admissions to the unit and also the number of admissions to the paediatric burns intensive care unit (PBICU) over the 5-year period were determined. Patients older than 10 years and re-admissions into the PBICU were excluded. Admission and demographic data were used to differentiate between patients admitted directly from the emergency department and those transferred from referral centres outside of Soweto. Direct admissions were defined as patients from within our institution’s catchment area and included both patients who arrived at hospital Background. Data on mortalities related to paediatric burns in South Africa are scarce and outcomes in transferred and direct admissions into paediatric intensive care units have not been compared. Objectives. To describe the demographic profile, aetiology and extent of injuries in patients treated at the paediatric burns intensive care unit (PBICU) at the Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg and to compare outcomes of direct admissions and patients transferred to the unit. Methods. This was a retrospective cohort study of all patients younger than 10 years admitted to the PBICU at CHBAH from January 2013 to December 2017. Statistical differences between groups were analysed using log-rank analysis and Kaplan–Meier curves were used to determine survival. Results. Of the 2 506 admissions into the general ward and ICU over the 5-year study period, 428 admissions were to the PBICU. A total of 109 deaths occurred (25.47% of PBICU admissions), with an overall mortality of 4.4%. Of the total number of deaths (n=109), 58 (53.21%) were among direct admissions and 51 (46.79%) among transferred patients. The mortality rate in the respective groups was 18.58% (direct admissions) and 43.97% (transferred patients). The survival rate was significantly different between the two groups (p<0.01). Conclusion. A favourable outcome was more likely in direct admissions than in transferred patients. With standardised protocols for management of severe burns and stable availability of resources, improvements in outcome are expected.