807 - The Impact of Pre-Existing Nutritional Status on Morbidity and Mortality in a Pediatric Burn Injury Cohort in Northern Tanzania

Publication Number: 807.6650

Kajsa Vlasic, University of Utah School of Medicine, Salt Lake City, UT, United States; Theresia Mwakyembe, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania; Francis M. Sakita, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania; Irma Fleming, University Of Utah Burn Center, Salt Lake City, UT, United States; Giavonni M.. Lewis, University of Utah Health, Salt Lake City, UT, United States; Getrude M. Nkini, KCMC-Duke Collaboration, Moshi mjini, Kilimanjaro, Tanzania; Nancy S. Mmary, KCMC-Duke Collaboration, Kilimanjaro, Kilimanjaro, Tanzania; Deus Evarist. Marandu, KCMC-Duke Collaboration, Moshi, Kilimanjaro, Tanzania; Nora Fino, University of Utah School of Medicine, Salt Lake City, UT, United States; Melissa H.. Watt, University of Utah, School of Medicine, Population Health Sciences, Salt Lake City, UT, United States; Catherine Staton, Duke University School of Medicine, Durham, NC, United States; Blandina Theophil. Mmbaga, Kilimanjaro Clinical Research Institute, Moshi, Kilimanjaro, Tanzania; Elizabeth M. Keating, University of Utah, Salt Lake City, UT, United States

Background: Burn injuries disproportionately impact children in low- and middle-income countries (LMICs), with the highest incidence in Sub-Saharan Africa. High mortality rates due to burn injury in pediatric patients in LMICs and high prevalence of malnutrition in pediatric patients in Sub-Sharan Africa have been previously described. There is limited information characterizing the association of nutritional status on burn-associated morbidity and mortality in pediatric patients in LMICs. We hypothesize that poor pre-existing nutrition in pediatric patients presenting with burn injuries in a low-income setting is associated with worse outcomes.

Objective: This study aimed to describe the association of nutritional status of pediatric burn injury patients on arrival to the emergency department (ED) of a tertiary referral hospital in Northern Tanzania with ICU admission, morbidity, and in-hospital mortality.

Design/Methods: This was a retrospective observational study using data from a pediatric injury registry at Kilimanjaro Christian Medical Centre (KCMC). We included patients less than 18 years of age with a burn injury that occurred within 30 days of presentation to the KCMC ED. We evaluated morbidity using the previously validated Glasgow Outcome Scale-Extended for Pediatrics (GOS-E). Association testing was performed in STATA. Age-adjusted Z scores for height and weight were calculated with a WHO Anthro calculator application. MUAC-for-age was calculated with an online calculator, based on 2007/2017 WHO data.

Results: We enrolled 133 pediatric burn injury patients from November 2020 to August 2024. Of those patients, 65 (49%) were male, the average age was 3.5 years (SD = 3.4 years), and the overall in-hospital mortality rate was 22.6%. 45.1% of patients had burn injury > 20% TBSA, 27.8% had burn injury 10-19% TBSA, and 27.1% had burn injury < 10% TBSA. The average weight-for-age Z score was 0 (SD=1.4), height-for-age Z score was -0.2 (SD=1.9), BMI-for-age Z score was 0.1 (SD=1.9), and MUAC-for-age Z score was 0.8 (SD=1.5). No significant differences were observed in the age-adjusted height, weight, BMI, and MUAC categories in association with ICU admission, in-hospital mortality, or morbidity.

Conclusion(s): While the in-hospital mortality rate of pediatric burn patients in our cohort was high, our findings suggest our population’s level of nutrition is not significantly impacting morbidity and mortality outcomes as expected. Further analysis with a larger cohort is needed to better understand the impact of pre-existing nutrition on pediatric burn injury outcomes in Northern Tanzania and other LMIC settings.

Table 1. Impact of Pre-Existing Nutrition Status on ICU Admission, In-Hospital Mortality, and Morbidity
Table 1 - Impact of Pre-Existing Nutrition Status on ICU Admission, In-Hospital Mortality, and Morbidity.pdf