Work

A Prospective Observational Study to Determine the Efficacy of a Theatre Prioritisation Tool in Optimal Utilisation of Limited Theatre Time for Deep Burn Injury in a Resource-Restricted Setting

Year: 2025

Type: article

Abstract: Background: Routine early surgery for all deep burns in low-resource settings is not currently achievable. We designed and implemented a simple triage strategy that selected patients to be prioritised for early surgery based on a more urgent need and greater potential benefit. The primary outcome was the ability to perform surgery in the priority group within three days of the decision. Methods: This was a prospective, descriptive study undertaken at a tertiary hospital in Pietermaritzburg, South Africa. All patients referred to the Grey’s Hospital Burn Service were triaged into either priority or non-priority groups. Priority designation was based on total burn surface area (TBSA) > 15%, the presence of sepsis, or limb-threatening injury. Data related to demographic information, injury, and outcomes were collected and managed using REDCap electronic data capture tools. Results: There were 191 admissions with 42 (22%) meeting priority criteria. The priority group had larger burns (TBSA 25 [Interquartile range 15–30] vs. 8 [3–15]%) and included all septic injuries. We provided early surgery within a median of 1.4 (interquartile range 0.5–3.3) days of the decision for surgery being made. A total of 75% of patients were operated within 72 h of the decision, and 43% within 10 days of injury. The system identified a sicker cohort, as evidenced by high mortality, ICU admission, and acute kidney injury rates. In the non-priority group, reported outcomes were more positive, but with a high injury-to-discharge days per percentage TBSA. Conclusions: This simple triage strategy represents a novel approach for prioritising access to burn surgery in a setting where global surgery standards are desirable but not always possible. We were able to identify the high-risk groups and provide surgery within acceptable time frames. Future research should be aimed at refining this triage system and improving outcomes in the priority group.

Source: European Burn Journal

DOI: 10.3390/ebj6040055

Authors: Nikki Leigh Allorto, Reitze Rodseth, David Gray Bishop

Institution: University of KwaZulu-Natal

Language: English

Topic: Burn Injury Management and Outcomes

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,172