Global Hospital Infrastructure and Pediatric Burns

Abstract

Abstract Low-income regions carry the highest mortality burden of pediatric burns and attention to remedy these inequities has shifted from isolated mission trips toward building infrastructure for lasting improvements in surgical care. This study aims to investigate disparities in pediatric burn care infrastructure and their impact on mortality outcomes. The multinational Global Burn Registry was queried for all burn cases between January 2018 and August 2021. Burn cases and mortality rates were analyzed by chi-square and multinomial regression. There were a total of 8537 cases of which 3492 (40.9%) were pediatric. Significantly lower mortality rates were found in facilities with sophisticated nutritional supplementation (P < .001), permanent internet connectivity (P < .001), critical care access (P < .001), burn OR access (P = .003), dedicated burn unit (P < .001), and advanced plastic and reconstructive skills (P = .003). Significant disparities were found in the availability of these resources between high- and low-income countries, as well granular information within low-income regions. In a multinomial logistic regression controlling for TBSA, the most significant predictive factors for mortality were limited critical care availability (OR 15.18, P < .001) and sophisticated nutritional access (OR 0.40, P = .024). This is the first quantitative analysis of disparities in global burn infrastructure. The identification of nutritional support as an independent and significant protective factor suggests that low-cost interventions in hospital nutrition infrastructure may realize significant gains in global burn care. Granular information in the variability of regional needs will begin to direct targeted infrastructure initiatives rather than a one-size-fits-all approach in developing nations.