Analyzing Mortality And The Effect Of Early Excision As A Preliminary Treatment Of Acute Burn Patients In A Limited Resource Setting Using LA50 As An Outcome Measurement.

Abstract

Advances in burn care have led to an overall improvement in mortality in high-income countries, but in low-middle income countries mortality remains relatively high. In a limited resource setting where temporary wound closure options were unavailable, it was determined whether early excision as a preliminary treatment could improve prognosis. A retrospective cohort study was conducted in Cipto Mangunkusumo Hospital Burn Unit to evaluate the outcomes of acute burn patients admitted from January 2013 to December 2018 using mortality and lethal area 50 (LA50), and to compare the outcomes between groups who underwent early excision without skin graft (EEWG), early excision with skin graft (EESG), delayed excision without skin graft (DEWG), or delayed excision with skin graft (DESG). Out of 390 patients available for screening, 256 were eligible for further study. The overall mortality was 17.9% with an increase linear with age and total body surface area (TBSA). The overall LA50 was 49%. Preliminary data showed the highest percentage of deaths in the no treatment group, with no deaths seen in treatment groups EESG and DESG. The odds ratio for mortality in the EEWG group was 2.11 (p-value 0.201, CI95% = 0.65-6.80) compared to the DEWG group. LA50 is more objective compared to crude mortality and enables future internal and external comparison. The highest mortality was in the no treatment group with mortality in the EEWG group higher than in the DEWG, but not statistically different. Early excision without skin grafting as a preliminary procedure may still be considered in a limited resource setting.