Introduction
Burn injuries are a significant contributor to mortality in developing countries like India. Accurately predicting mortality among burn patients upon their hospital admission in resource-limited settings aids in assessing patient prognosis and optimizing resource allocation. Prognostic scoring systems for burn victims evaluate the severity of injuries and forecast outcomes, allowing for numerical and scientific risk stratification that can be analyzed statistically. Currently, no scoring system reliably predicts mortality from burns or effectively guides treatment options and the evaluation of new interventions. Existing systems such as the Revised Baux score, Abbreviated Burn Severity Index (ABSI), Ryan et al., Belgium Outcome of Burn Injury (BOBI), Smith et al., and McGwin et al. offer various predictive capabilities.1, 2, 3, 4, 5, 6 Therefore, it is essential to identify the most suitable scoring system for bedside risk assessment and patient counselling, necessitating thorough testing of all available systems to determine the best predictor of outcomes.
Case Report
The study was carried out in a tertiary care hospital in South India after receiving approval from a departmental ethical committee. The subject was a 7-year-old male child with a history of scald burn involving genitalia, bilateral thigh and lower abdomen with partial thickness superficial burns of TBSA ~7%.
Result
The overall mortality of the above patient using Belgium outcome of burn injury (STSG) is as follows:
Total mortality percentage:
Discussion
The World Health Organization (WHO) estimates that burn injuries result in approximately 180,000 deaths annually, predominantly in low- and middle-income countries where resources are limited. Despite advancements in the management of burn injuries that have led to reduced mortality rates, high burn mortality persists in developing nations due to constrained resources.7 In India alone, around 1 million individuals suffer from moderate to severe burns each year. 8
In these countries, burn intensive care unit beds are scarce, largely due to a shortage of trained healthcare professionals and the high costs associated with maintaining such facilities.9, 10 Given the current limitations in bed availability, the implementation of burn scoring systems and prognostic scores is essential for triaging patients based on the severity of their injuries, guiding treatment, managing resources, and providing support to families.11
While numerous predictors of mortality and various scoring systems exist, none can accurately predict outcomes in every scenario. Many of these mortality prediction models have been developed in high-income countries and may not translate effectively to populations in developing regions due to differences in patient demographics, standards of care, and available resources.
Historically, the first significant prognostic factors identified for predicting burn mortality were total body surface area (TBSA) and age, initially proposed by Weidenfeld in 1902.12 These parameters were later validated by Bull and Squire in 1949, and subsequently by Baux in 1963 with the introduction of the Baux score.13 Other scoring systems, such as the Abbreviated Burn Scoring Index (ABSI), Ryan et al., Belgium Outcome of Burn Injury (BOBI), Smith et al., and McGwin et al., have also been developed to assess mortality risk in burn patients.14
Score can be applied on all patients.
Conclusion
BOBI can serve as a predictor of mortality in burn patients and assist in prioritizing patient care for optimal resource allocation in developing nations such as India. However, it’s important to note that the BOBI score alone cannot accurately determine patient outcomes. Standardization of the scoring system is needed to account for variations in population and resources.
