Abstract：
BACKGROUND: 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.
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.
摘要：
背景：严重烧伤和小儿烧伤的管理需要有组织的护理交付系统，其中包括转诊指南。在卢旺达,基加利大学教学医院（CHUK）的烧伤室是该国唯一的专用烧伤室，可容纳来自其他省份的所有年龄段的患者。然而,由于没有官方的转介指引，目前尚不清楚是否适当转诊烧伤患者。这项研究旨在分析在CHUK烧伤单位住院的烧伤患者的转诊模式及其对美国烧伤协会（ABA）列出的转诊标准的遵守情况。比较从基加利境内设施转移到烧伤病房的患者和从基加利以外设施转诊的患者。
方法：这项回顾性研究包括了2005年至2019年入住CHUK烧伤病房的所有急性烧伤患者，并提供了原籍省的数据。年龄小于16岁的烧伤患者被定义为小儿烧伤，根据CHUK例程。使用分类变量的Fisher精确检验或连续变量的Wilcoxon秩和检验比较了基加利内设施（Pat-K）和基加利外设施（Pat-O）的所有烧伤的特征。使用现有数据评估变量对ABA转诊标准的依从性，即总燃烧表面积%，烧伤厚度,烧伤的原因，和年龄。
结果：研究人群包括1093名患者，其中1064人有关于他们是否从其他机构转交给CHUK的数据。总的来说,中位年龄为3岁（2-16岁），Pat-O年龄大于Pat-K（P<0.001）。烫伤是两组受伤的主要原因；Pat-O中的火焰比Pat-K中的火焰更常见（分别为25.5％和10.6％，P<0.01)。较大尺寸和深度的烧伤在Pat-O中更常见，与Pat-K组[中位数总烧伤表面积%=19%对15.5%，分别（P<0.001）；全层烧伤的存在分别为55.6％和29.7％，分别(P<0.001)]。Pat-O的住院时间更长，住院死亡率高于Pat-K[LOS=42d（四分位距11-164）与28d（四分位距9-132），P<0.05；住院死亡率分别为18.9%和10.1%，P<0.001]。在Pat-O中,85%具有反映一个或多个分析的ABA标准的特征。
结论：虽然没有明确的指导方针，转诊模式表明,在卢旺达,患者被适当转诊接受专业烧伤治疗.与来自基加利的患者相比，农村患者受伤更大更严重，需要更多的手术干预，结果更糟。大多数转诊患者符合国际转诊指南中列出的标准。然而,国家转诊标准的声明对于改善及时获得适当护理至关重要。
方法：这项回顾性研究包括了2005年至2019年入住CHUK烧伤病房的所有急性烧伤患者，并提供了原籍省的数据。年龄小于16岁的烧伤患者被定义为小儿烧伤，根据CHUK例程。使用分类变量的Fisher精确检验或连续变量的Wilcoxon秩和检验比较了基加利内设施（Pat-K）和基加利外设施（Pat-O）的所有烧伤的特征。使用现有数据评估变量对ABA转诊标准的依从性，即总燃烧表面积%，烧伤厚度,烧伤的原因，和年龄。
结果：研究人群包括1093名患者，其中1064人有关于他们是否从其他机构转交给CHUK的数据。总的来说,中位年龄为3岁（2-16岁），Pat-O年龄大于Pat-K（P<0.001）。烫伤是两组受伤的主要原因；Pat-O中的火焰比Pat-K中的火焰更常见（分别为25.5％和10.6％，P<0.01)。较大尺寸和深度的烧伤在Pat-O中更常见，与Pat-K组[中位数总烧伤表面积%=19%对15.5%，分别（P<0.001）；全层烧伤的存在分别为55.6％和29.7％，分别(P<0.001)]。Pat-O的住院时间更长，住院死亡率高于Pat-K[LOS=42d（四分位距11-164）与28d（四分位距9-132），P<0.05；住院死亡率分别为18.9%和10.1%，P<0.001]。在Pat-O中,85%具有反映一个或多个分析的ABA标准的特征。
结论：虽然没有明确的指导方针，转诊模式表明,在卢旺达,患者被适当转诊接受专业烧伤治疗.与来自基加利的患者相比，农村患者受伤更大更严重，需要更多的手术干预，结果更糟。大多数转诊患者符合国际转诊指南中列出的标准。然而,国家转诊标准的声明对于改善及时获得适当护理至关重要。
