A Single-Centre Review of Outcomes of Delayed Admission to a Burns Unit

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Abstract
Background: Timely admission to a specialised burn unit is considered crucial for optimising outcomes in burn patients. However, the impact of delayed admission on hospital length of stay and clinical outcomes remains unclear, particularly in resource-constrained settings such as South Africa. This retrospective study aimed to determine whether admission to a burn unit more than 24 h after injury was associated with increased length of stay, sepsis, or mortality. Methods: A retrospective case-audit study was conducted at the Chris Hani Baragwanath Academic Hospital Adult Burn Unit, Johannesburg, from January 2018 to December 2022. Patients were categorised into early (≤24 h) and delayed (>24 h) admission groups. The primary outcome was length of stay; secondary outcomes included sepsis incidence and in-hospital mortality. Results: A total of 123 files were analysed; 71 (58%) were admitted within 24 h. The median length of stay was 14 days, with no statistical difference between the two groups (p = 0.7). The overall mortality rate was 13%, with 68% occurring in the early admission group. Sepsis occurred in 27% of patients. Multivariate analysis revealed that early admission was independently associated with longer length of stay. Conclusions: In this single-centre retrospective case note audit with a limited sample size and significant risk of selection bias, delayed admission to a burn unit was not associated with increased length of stay, mortality, or sepsis. However, these findings should be considered preliminary and require confirmation in larger, prospective studies. The higher rate of surgical intervention in the delayed admission group warrants further investigation.

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