Estimating mortality risk in burn patients admitted at Rwanda's largest referral hospital.

BACKGROUND: Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn victims die from their injuries. Mortality prediction indexes are used to estimate outcomes after provided burn care, which has been used in burn services of high-income countries over the last 60 years. It remains to be seen whether these are reliable in low-income settings. This study aimed to analyze in-hospital mortality and to apply mortality estimation indexes in burn patients admitted to the only specialized burn unit in Rwanda. METHODS: This retrospective study included all patients with burns admitted at the burn unit (BU) of the University Teaching Hospital in Kigali (CHUK) between 2005 and 2019. Patient data were collected from the BU logbook. Descriptive statistics were calculated with frequency (%) and median (interquartile range, IQR). Association between burns characteristics and in-hospital mortality was calculated with Fisher's exact test, and Wilcoxon rank, as appropriate. Mortality estimation analysis, including Baux score, Lethal Area 50 (LA50), and point of futility, was calculated in those patients with complete data on age and TBSA. LA50 and point-of-futility were calculated using logistic regression. RESULTS: Among the 1093 burn patients admitted at the CHUK burn unit during the study period, 49% (n=532) had complete data on age and TBSA. Their median age, TBSA, and Baux score were 3.4 years (IQR 1.9-17.1), 15% (IQR 11-25), and 24 (IQR 16-38), respectively. Overall, reported in-hospital mortality was 13% (n=121/931), LA50 for Baux score was 89.9 (95% CI 76.2-103.7), and the point-of-futility was at a Baux score of 104. CONCLUSION: Mortality estimation indexes based on age and TBSA are feasible to use in low-income settings. However, implementation of systematic data collection would contribute to a more accurate calculation of the mortality risk.

Long-term mortality after self-inflicted burns.

BACKGROUND: Those with self-inflicted burns are a small but consistent group among burn patients, with large injuries and conflicting findings regarding their in-hospital mortality. Overall, burn survivors have a shorter life expectancy, as compared with national controls, but long-term mortality after self-inflicted burns is understudied. The aim of this retrospective study was to investigate possible differences in long-term mortality among survivors after self-inflicted and accidental burns. METHODS: All adult patients with burns admitted at the Linköping Burn Centre and discharged alive between 2000 and 2017 were included, and end of follow up was April 26, 2021. Those with unknown survival status at that time were excluded. A Cox proportional hazards regression model, adjusted for age and sex, was used to analyse long term mortality. RESULTS: Among the 930 patients included in this study, 37 had self-inflicted burns. Overall, median follow up period was 8.8 years and crude mortality was 24.7%. After adjustment for age and sex, self-inflicted burns were independently associated with long-term mortality, Hazard Ratio= 2.08 (95% CI 1.13-3.83). Post hoc analysis showed that the effect was most pronounced during the first years after discharge although it was noticeable over the whole study period. CONCLUSION: Long-term risk of mortality after discharge from a burn centre was higher in patients with self-inflicted burns than in patients with accidental burns. The effect was noticeable over the whole study period although it was most pronounced during the first years after discharge.

Who gets burned in Brazil?

Burns are preventable injuries that still represent a relevant public health issue. The identification of risk factors might contribute to the development of specific preventive strategies. Data of patients admitted at the Hospital due to acute burn injuries from May 2017 to December 2019, was extracted manually from medical records. The population was analyzed descriptively, and differences between groups were tested using the appropriate statistical test. The study population consisted of 370 patients with burns admitted to the Hospital burn unit during the study period. The majority of the patients were males (257/370, 70%), median age was 33 (IQR:18-43), median TBSA% was 13 (IQR 6.35-21.5 and range 0-87.5%), and 54% of patients had full thickness burns (n=179). Children younger than 13 years old represented 17% of the study population (n=63), 60% of them were boys (n= 38), and scalds was the predominant mechanism of burn injury (n= 45). No children died, however 10% of adults did (n= 31). Self-inflicted burns were observed in 16 adults (5%), of whom 6 (38%) died during admission, however self-inflicted burns were not observed in children. Psychiatric disorders and substance misuse were frequent in this subgroup. White adults male from urban areas who had not completed primary school degree were the major risk group for burns. Smoking and alcohol misuse were the most frequent comorbidities. Accidental domestic flame burns were the predominant injuries in the adult population and scalds in the pediatric.

Quality indicators in burn care: An international burn care professionals survey to define them.

INTRODUCTION: Quality indicators (QIs) are tools for improving and maintaining the standard of care. Although burn injuries are a major global health threat, requiring standardized management, there is a lack of worldwide accepted quality indicators for burn care. This study aims to identify the best burn care-specific QIs as perceived by worldwide burn practitioners. METHODS: The ISBI Burn Care Committee developed a survey to analyze which burn care- specific QIs were relevant to international burn care professionals. The questionnaire was based on the three dimensions of the Donabedian model (i.e., Structure, Process, and Outcome) to evaluate the quality of care. The study was conducted from April to September 2021 and analyzed and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: According to the 124 worldwide respondents, the most relevant QIs were: access to intensive care, burn surgeons, and dedicated burn care nurses (Structure category), 24-hours access to burn services, local protocols based on documented guidelines (Process category), and in-hospital mortality and incidence of severe infections (Outcome category). CONCLUSIONS: Specific QIs related to structures, clinical processes, and outcomes are needed to monitor the treatment of burn patients globally, assess the efficiency of the provided treatment, and harmonize the worldwide standard of burn care.

Gender-Based Discrimination Among Medical Students: A Cross-Sectional Study in Brazil.

INTRODUCTION: Gender-based discrimination (GBD) creates a hostile environment during medical school, affecting students' personal life and academic performance. Little is known about how GBD affects the over 204,000 medical students in Brazil. This study aims to explore the patterns of GBD experienced by medical students in Brazil. METHODS: This is a cross-sectional study using an anonymous, Portuguese survey disseminated in June 2021 among Brazilian medical students. The survey was composed of 24 questions to collect data on GBD during medical school, formal methods for reporting GBD, and possible solutions for GBD. RESULTS: Of 953 responses, 748 (78%) were cisgender women, 194 (20%) were cisgender men, and 11 (1%) were from gender minorities. 65% (616/942) of respondents reported experiencing GBD during medical school. Women students experienced GBD more than men (77% versus 22%; P < 0.001). On comparing GBD perpetrator roles, both women (82%, 470/574) and men (64%, 27/42) reported the highest rate of GBD by faculty members. The occurrence of GBD by location differed between women and men. Only 12% (115/953) of respondents reported knowing their institution had a reporting mechanism for GBD. CONCLUSIONS: Most respondents experienced GBD during medical school. Cisgender women experienced GBD more than cisgender men. Perpetrators and location of GBD differed for men and women. Finally, an alarming majority of students did not know how to formally report GBD in their schools. It is imperative to adopt broad policy changes to diminish the rate of GBD and its a consequential burden on medical students.

Gender Discrimination, Career Aspirations, and Access to Mentorship Among Medical Students in Brazil.

INTRODUCTION: Gender-based discrimination (GBD) creates a hostile environment that can affect medical students. Mentorship has been recognized as a mitigating factor for GBD. We aimed to investigate the impacts of GBD on career selection and well-being of medical students in Brazil and to explore access to mentorship among these students. METHODS: A cross-sectional study was performed using an anonymous survey in Portuguese. The survey was distributed in June 2021 to students enrolled in Brazilian medical schools. It contained 24 questions, including demographics, episodes of GBD experienced by responders and their impact on professional and personal life, and mentorship access. RESULTS: Of 953 respondents, 748 (78%) were cisgender women, 194 (20%) cisgender men, and 11 nonbinary (1%). Sixty-six percent (625/953) of students reported experiencing GBD, with cisgender women and nonbinary being more likely to experience it than cisgender men (P < 0.001). Responders who experiences GBD report moderate to severe impact on career satisfaction (40%, 250/624), safety (68%, 427/624), self-confidence (68%, 426/624), well-being (57%, 357/625), and burnout (62%, 389/625). Cisgender women were more likely to report these effects than men counterparts (P < 0.01). Only 21% of respondents (201/953) had mentors in their medical schools. CONCLUSIONS: Our findings demonstrate that GBD is widespread among Brazilian medical students affecting their personal and professional lives, and most of them do not have access to a mentor. There is an urgent need to increase access to mentors who could mitigate the adverse effects of GBD and help develop a diverse and inclusive medical workforce.

Discrimination in an "equal country"-a survey amongst Swedish final-year medical students.

BACKGROUND: Discrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden. METHODS: A web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fisher's exact test, and logistic regression. Free-text answers were analyzed thematically using the "Master Suppression techniques" conceptual framework. RESULTS: Of the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41-4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69-24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39-5.27]), and disability (p = 0.02, OR 13.8 [1.58-12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported "large" or "extreme" impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001). CONCLUSIONS: Discrimination appears to be frequent in medical school, even in one of the world's "most equal countries". Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.

Referral of Burn Patients in the Absence of Guidelines: A Rwandan Study.

INTRODUCTION: The management of severe burns and pediatric burns requires an organized system of care delivery, which includes referral guidelines. In Rwanda, the burn unit at the University Teaching Hospital of Kigali (CHUK) is the only dedicated burn unit in the country and admits patients of all ages referred from the other provinces. However, since there are no official referral guidelines, it is unknown whether patients with burns are appropriately referred. This study aims to analyze referral patterns among burn patients admitted at the CHUK burn unit and their adherence to the referral criteria listed by the American Burn Association (ABA), comparing patients transferred to the burn unit from facilities within Kigali and those referred from facilities outside Kigali. METHODS: This retrospective study included all patients with acute burns admitted to the CHUK burn unit with data available on the province of origin from 2005 to 2019. Patients with burns younger than 16 y were defined as pediatric burns, as per the CHUK routines. Characteristics of all burns referred from a facility within Kigali (Pat-K) and facilities outside Kigali (Pat-O) were compared using Fisher's exact test for categorical variables or Wilcoxon rank-sum test for continuous variables. The adherence to ABA referral criteria was assessed for variables with available data, which were total burnt surface area %, burn thickness, cause of burn, and age. RESULTS: The study population consisted of 1093 patients, of which 1064 had data regarding if they were referred from other facilities to CHUK. Overall, the median age was 3 y (2-16 y), with Pat-O being older than Pat-K (P < 0.001). Scalds were the dominant cause of injury in both groups; flame was more common among Pat-O than among Pat-K (in 25.5% versus 10.6%, P < 0.01). Burns of larger size and depth were more common among Pat-O, as compared to the Pat-K group [median total burnt surface area % = 19% versus 15.5%, respectively (P < 0.001); presence of full-thickness burns = 55.6% versus 29.7 %, respectively (P < 0.001)]. Hospitalization was longer and in-hospital mortality higher in Pat-O than in Pat-K [LOS = 42 d (interquartile range 11-164) versus 28 d (interquartile range 9-132), P < 0.05; in-hospital mortality = 18.9% versus 10.1%, P < 0.001]. Among Pat-O, 85% had characteristics that mirrored one or more of the analyzed ABA criteria. CONCLUSIONS: Although there are no clear guidelines, referral patterns indicate that patients are being appropriately referred for specialized burn care in Rwanda. Compared to patients from Kigali, rural patients had larger and more severe injuries, needed more surgical interventions, and had worse outcomes. Most of referred patients matched criteria listed among international referral guidelines. However, the statement of national referral criteria is essential to improve timely access to adequate care.

Sociodemographic Patterns of Pediatric Patients in Specialized Burn Care in Sweden.

Trauma is a leading cause of mortality in children. Burns affect children disproportionally. Although burn incidence and mortality are decreasing, differences in the risk depend on socioeconomic status. The present study aimed to investigate the sociodemographic patterns of pediatric patients (0-17 years) managed at the two burn centers in Sweden, Uppsala, and Linköping, between 2010 and 2020. Method: This retrospective register-based study used hospital records from the two burn centers combined with information from Statistics Sweden plus data regarding number of asylum seekers from the Swedish Migrations Agency. Choropleth maps representing the patients' geographical distribution were created. Information about income levels per geographic area was added. A Wilcoxon signed-rank test was performed to investigate differences in median income levels between the areas where the patients lived, related to Sweden's median income. Results: The study included 2455 patients. Most of the children aged below 5 years (76%) and were boys (60%). The mean percentage of total skin area was 4.2%. There was no significant increment or decrease in the incidence of pediatric burns during the study. Most patients with recorded zip codes lived in areas with an income level below the national median (n = 1974, 83%). Children with asylum status were over-represented compared with residents and/or Swedish citizens. Conclusions: In Sweden, most pediatric burns occur in families that live in areas with low-income levels. Pediatric burns affect children with asylum status disproportionally compared with those who are residents in and/or citizens of Sweden. Prevention strategies should be designed and implemented to alleviate this health inequity.

Evolution of Gender Disparities Among Brazilian Surgical, Anesthesia, and Obstetric Providers.

INTRODUCTION: Since 2010, most graduating physicians in Brazil have been female, nevertheless gender disparities among surgical specialties still exist. This study aims to explore whether the increase in female physicians has translated to increased female representation among surgical specialties in Brazil. METHODS: Data on gender, years of practice, and specialty was extracted from Demografia Médica do Brasil, from 2015 to 2020. The percentage of women across 18 surgical, anesthesia, and obstetric (SAO) specialties and the relative increases in female representation during the study period were calculated. RESULTS: Of the 18 SAO specialties studied, 16 (88%) were predominantly male (>50%). Only obstetrics/gynecology and breast surgery showed a female predominance, with 58% and 52%, respectively. Urology, neurosurgery, and orthopedic surgery and traumatology were the three specialties with the largest presence of men - and the lowest absolute growth in the female workforce from 2015 to 2020. CONCLUSIONS: In Brazil, where significant gender disparities persist, women are still underrepresented in surgical specialties. Female presence is predominant in surgical specialties dedicated to the care of female patients, while it remains poor in those with male patient dominance. Over the last 5 y, the proportion of women working in SAO specialties has grown, but not as much as in nonsurgical specialties. Future studies should focus on investigating the causes of gender disparities in Brazil to understand and tackle the barriers to pursuing surgical specialties.

Is authorship by women in Brazilian academic surgery increasing? A five-year retrospective analysis.

Women remain underrepresented in 80% of Brazilian surgical specialties, however, women representation within the Brazilian academic surgical literature remains unknown. This study aims to evaluate the gender distribution of first and last authors in Brazilian surgical journals. All publications between 2015 and 2019 from the five Brazilian surgical journals with the highest impact factor were reviewed. The first and last authors' names were extracted from each article and a predictive algorithm was used to classify the gender of each author. Authors were further classified by surgical field and geographic region to investigate patterns of female authorship among journals, specialties, and region over the study period. Multivariable logistic regression was then used to identify factors independently associated with female authorship. 1844 articles were analyzed; 23% (426/1844) articles had female first authors, and 20% (348/1748) had female last authors. Acta Cirúrgica Brasileira was observed to have the highest rates for both first and last female authors (37%, 138/371; 26%, 95/370)) and Revista Brasileira de Ortopedia (9%, 48/542; 10%, 54/522) had the lowest rates. Papers with a woman senior author were twice as likely to have a woman first author (OR 1.98, 95% CI 1.51-2.58, p≤0.01). Women's representation in medicine is increasing in Brazil, yet women remain underrepresented as the first and last authors in the Brazilian surgical literature. Our results highlight the importance of senior women mentorship in academic surgery and demonstrate that promoting female surgeon senior authorship through academic and financial support will positively impact the number of female first authors.

Factors Associated With Outcomes After Burn Care: A Retrospective Study in Eastern Democratic Republic of Congo.

In low-income countries, the incidence of burns is high and severe burns are frequently managed at peripheral facilities. Outcome after burn care is poorly studied although it might help identify risk-group and improve treatment strategies. This study aimed to study factors associated with in-hospital outcomes in a burn cohort in the Democratic Republic of Congo. In this retrospective study, we included burn patients admitted to the surgical department at the Hôpital Provincial Général de Référence de Bukavu between January 2013 and December 2018. Differences between groups were tested using χ 2 test or Fisher's exact tests or Wilcoxon rank sum test, as appropriate. Multivariate logistic regression was used to analyze the effect of patients and of burn characteristics on in-hospital mortality, prolongated length of stay (=LOS ≥ 25 days), and occurrence of complications. The study population consisted of 100 patients, mainly young males with the rural origin, moderate-sized but deep burns. Of them, 46 developed complications, 12 died. Median LOS was 25 days (IQR: 15-42). In-hospital death was independently associated with Total Burn Surface Area percentage "TBSA%" (OR = 3.96; 95% CI = 1.67-9.40) and Full-thickness Burns (FTB) (10.68; 1.34-84.74); prolongated LOS with FTB (3.35; 1.07-10.49), and complication with rural origin (5.84; 1.51-22.53), TBSA% (3.96; 1.67-9.40), FTB (4.08; 1.19-14.00), and burns on multiple sites (4.38; 1.38-13.86). In-hospital death was associated with TBSA% and FTB, prolongated LOS with FTB, and complications with burns characteristics and rural origin of the patients. Additional studies are necessary to investigate the effect of provided burn care on outcomes.

Patient Reported Experiences at a Swedish National Burn Centre.

Previous studies have shown that burn patients were satisfied with the received care. Satisfaction was not strongly associated to burns or to psycho-social characteristics, suggesting that other factors, related to burn care specific aspects, may be important. The aim of this study was to analyze the independent effect of provided workload on the general satisfaction in adult patients at a Swedish national Burn Centre. The study population (n = 122) included patients ≥18 years, treated at the Linköping Burn Centre between 2016 and 2017. Experienced burn care was evaluated with the PS-RESKA survey (score range: 0-4), and provided workload was scored with the Burn Scoring System (BSC). Groups were compared with χ 2 test, MW test, or Fisher´s exact test. Multivariable logistic regression analyzed the independent effect of BSC on the outcome High Satisfaction (= score ≥3 to the survey-question: "How would you score your global experience at the Burn Centre?"). In-patients (n = 60) had more often larger burns and required more workload than out-patients (median[IQR]: TBSA% = 6.3 [3-12.3] % vs. 0.7 [0.3-2] %, p < .001; BSC = 65 [25.5-135.5] vs. 6 [4-9], p < .001). Both groups were highly satisfied with the experienced care (mean score [SD] = 3.68 [0.57] vs. 3.41 [0.77], p = .03). Neither characteristics of the patients (age, sex), nor TBSA% nor provided workload (BSC) were independently associated with High Satisfaction. Regardless of burn severity, demographics and provided workload, adult patients with burns were highly satisfied with the experienced burn care. This finding suggested that the reason of the satisfaction was multifactorial.

Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study.

BACKGROUND: The impact of public health policy to reduce the spread of COVID-19 on access to surgical care is poorly defined. We aim to quantify the surgical backlog during the COVID-19 pandemic in the Brazilian public health system and determine the relationship between state-level policy response and the degree of state-level delays in public surgical care. METHODS: Monthly estimates of surgical procedures performed per state from January 2016 to December 2020 were obtained from Brazil's Unified Health System Informatics Department. Forecasting models using historical surgical volume data before March 2020 (first reported COVID-19 case) were constructed to predict expected monthly operations from March through December 2020. Total, emergency, and elective surgical monthly backlogs were calculated by comparing reported volume to forecasted volume. Linear mixed effects models were used to model the relationship between public surgical delivery and two measures of health policy response: the COVID-19 Stringency Index (SI) and the Containment & Health Index (CHI) by state. FINDINGS: Between March and December 2020, the total surgical backlog included 1,119,433 (95% Confidence Interval 762,663-1,523,995) total operations, 161,321 (95%CI 37,468-395,478) emergent operations, and 928,758 (95%CI 675,202-1,208,769) elective operations. Increased SI and CHI scores were associated with reductions in emergent surgical delays but increases in elective surgical backlogs. The maximum government stringency (score = 100) reduced emergency delays to nearly zero but tripled the elective surgical backlog. INTERPRETATION: Strong health policy efforts to contain COVID-19 ensure minimal reductions in delivery of emergent surgery, but dramatically increase elective backlogs. Additional coordinated government efforts will be necessary to specifically address the increased elective backlogs that accompany stringent responses.

Female Leadership in Academic Plastic Surgery: A Comprehensive Analysis.

BACKGROUND: Gender equity remains to be realized in academic plastic and reconstructive surgery. The purpose of this study was to measure the proportion of women in leadership roles in academic plastic and reconstructive surgery to verify where gender gaps may persist. METHODS: Six markers of leadership were analyzed: academic faculty rank, manuscript authorship, program directorship, journal editor-in-chief positions, society board of directors membership, and professional society membership. Descriptive statistics were performed, and chi-square tests were used to compare categorical variables. RESULTS: About 16 percent to 19 percent of practicing plastic surgeons are female, as measured by the percentage of female faculty and American Society of Plastic Surgeons members. Female plastic surgeons comprised 18.9 percent (n = 178) of the faculty from 88 academic plastic surgery institutions, and represented 9.9 percent of full professors and 10.8 percent of chiefs. Nineteen institutions had no female faculty. Women were first authors in 23.4 percent of publications and senior author in 14.7 percent of publications. No journal studied had a female editor-in-chief. Of the examined plastic and reconstructive societies, the proportion of women on the board of directors ranged from 16.7 percent to 23.5 percent. CONCLUSIONS: The proportion of female program directors, first manuscript authors, and board members of certain societies is commensurate with the number of women in the field, suggesting an evolving landscape within the specialty. However, women remain underrepresented in many other leadership roles, heralding the work that remains to ensure gender parity exists for those pursuing leadership roles in the field of plastic and reconstructive surgery.

Systematic media review: A novel method to assess mass-trauma epidemiology in absence of databases-A pilot-study in Rwanda.

OBJECTIVE: Surge capacity refers to preparedness of health systems to face sudden patient inflows, such as mass-casualty incidents (MCI). To strengthen surge capacity, it is essential to understand MCI epidemiology, which is poorly studied in low- and middle-income countries lacking trauma databases. We propose a novel approach, the "systematic media review", to analyze mass-trauma epidemiology; here piloted in Rwanda. METHODS: A systematic media review of non-academic publications of MCIs in Rwanda between January 1st, 2010, and September 1st, 2020 was conducted using NexisUni, an academic database for news, business, and legal sources previously used in sociolegal research. All articles identified by the search strategy were screened using eligibility criteria. Data were extracted in a RedCap form and analyzed using descriptive statistics. FINDINGS: Of 3187 articles identified, 247 met inclusion criteria. In total, 117 MCIs were described, of which 73 (62.4%) were road-traffic accidents, 23 (19.7%) natural hazards, 20 (17.1%) acts of violence/terrorism, and 1 (0.09%) boat collision. Of Rwanda's 30 Districts, 29 were affected by mass-trauma, with the rural Western province most frequently affected. Road-traffic accidents was the leading MCI until 2017 when natural hazards became most common. The median number of injured persons per event was 11 (IQR 5-18), and median on-site deaths was 2 (IQR 1-6); with natural hazards having the highest median deaths (6 [IQR 2-18]). CONCLUSION: In Rwanda, MCIs have decreased, although landslides/floods are increasing, preventing a decrease in trauma-related mortality. By training journalists in "mass-casualty reporting", the potential of the "systematic media review" could be further enhanced, as a way to collect MCI data in settings without databases.

Long-term survival among elderly after burns compared with national mean remaining life expectancy.

INTRODUCTION: As compared to younger adults, older people have a greater risk of domestic accidents, such as burns, and their prognosis is worsened by a diminished physiological ability to face a thermal trauma. The in-hospital mortality is adversely affected by old age and burn size, whereas less is known about the long-term-survival in elderly patients who survive a burn injury. The aim of this study was to investigate if elderly burn patients after discharge from a Swedish National Burn Centre have a shorter remaining life compared to the national population, by using calculated remaining Life Expectancy (rLE). METHODS: In this retrospective study we included all patients who were admitted for burns to the Linköping Burn Centre during 1993-2016 and who were 60 years or older and alive, at the time of discharge. The control group was extracted from Statistics Sweden, the national statistics database, and consisted of all individuals from the Swedish population matched for each patient in the study group, by sex and age at the year of discharge. The proportion who died before reaching the rLE was compared between the study population and the control group by calculating risk ratio. RESULTS: The study group consisted of 111 former patients and 77 of them (69%) died before reaching the rLE, with mean 4.7 years of life lost (YLL), which was 33% more than that (52%) of the control group (RR 1.33, 95% CI 1.18-1.51). Burn related factors, such as TBSA % or FTB % were not found to account for this effect. CONCLUSION: We found that the long-time survival of elderly patients after burns is shorter than that of a national control, the magnitude of which is quantitatively important. The current study does not support that burn related factors account for this effect and the reason should therefore be sought in other factors, such as e.g., co-morbidity or psychosocial issues.