The effect of pre-existing malnutrition on pediatric burn mortality in a sub-Saharan African burn unit.

Autor: Grudziak J; Department of Surgery, University of North Carolina at Chapel Hill, United States; Kamuzu Central Hospital, Lilongwe, Malawi., Snock C; Department of Nutrition and Dietetics, University of North Carolina Hospitals, United States., Mjuweni S; Kamuzu Central Hospital, Lilongwe, Malawi., Gallaher J; Department of Surgery, University of North Carolina at Chapel Hill, United States; Kamuzu Central Hospital, Lilongwe, Malawi., Cairns B; Department of Surgery, University of North Carolina at Chapel Hill, United States., Charles A; Department of Surgery, University of North Carolina at Chapel Hill, United States; Kamuzu Central Hospital, Lilongwe, Malawi. Electronic address: anthchar@med.unc.edu.
Jazyk: angličtina
Zdroj: Burns : journal of the International Society for Burn Injuries [Burns] 2017 Nov; Vol. 43 (7), pp. 1486-1492. Date of Electronic Publication: 2017 Apr 19.
DOI: 10.1016/j.burns.2017.03.022
Abstrakt: Introduction: Nutritional status predicts burn outcomes in the developed world, but its effect on burn mortality in the developing world has not been widely studied. In sub Saharan Africa, burn is primarily a disease of children, and the majority of children in sub-Saharan Africa are malnourished. We therefore sought to determine the prevalence and effect of malnutrition on burn mortality at our institution.
Methods: This is a retrospective review of children aged 0-5, with anthropomorphic measurements available, who were admitted to our burn unit from July 2011 to May 2016. Age-adjusted Z scores were calculated for height, weight, weight for height, and mid-upper arm circumference (MUAC). Following bivariate analysis, we used logistic regression to construct a fully adjusted model of predictors of mortality.
Results: Of the 1357 admitted patients, 839 (61.2%) were aged 0-5. Of those, 512 (62.9%) had one or more anthropomorphic measurements available, and were included in the analysis. 54% were male, and the median age was 28 months. The median TBSA was 15%, with a majority of burns caused by scalds (77%). Mortality was 16%. Average Z-score for any of the indicators of malnutrition was -1.45±1.66. TBSA (OR: 1.08, 95% CI: 1.06, 1.11), decreasing Z-score (OR: 1.19, 95% CI: 1.00, 1.41), and flame burn (OR: 2.51, 95% CI: 1.40, 4.49) were associated with an increase in mortality.
Conclusion: Preexisting malnutrition in burn patients in sub-Saharan Africa increases odds of mortality after controlling for significant covariates. Survival of burn patients in this region will not reach that of the developed world until a strategy of aggressive nutritional support is implemented in this population.
(Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.)
Databáze: MEDLINE
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