Epidemiological Characteristics and Prognostic Factors for Mortality in Severe Burns: A 32-Year Analysis (1993-2024) From a National Referral Center in the Dominican Republic.

Abstract

Severe burns represent a major public health burden in middle-income countries. This study describes the epidemiological profile and identifies independent prognostic factors for in-hospital mortality in patients with severe burns treated at the national referral center of the Dominican Republic over a 32-year period. A retrospective cohort study was conducted including 5941 adult patients with severe burns admitted between 1993 and 2024. Epidemiological, clinical, and outcome data were analyzed. Independent predictors of mortality were identified using multivariable logistic regression. The cohort was predominantly male (73.5%) with a median age of 34 years. The most common etiology was flame burns (58.2%). The median total body surface area (TBSA) burned was 25%. The overall mortality rate was 28.2%, remaining stable across four eight-year periods. In the adjusted analysis, the strongest independent predictors of mortality were TBSA ≥ 40% (adjusted odds ratio [aOR] 12.00), age ≥ 65 years (aOR 6.18), the presence of a full-thickness (third-degree) component (aOR 2.69), and female sex (aOR 1.23). Mortality from severe burns remains high and stable over time, driven predominantly by burn extent, depth, and patient age. These findings underscore the critical need to strengthen prehospital care systems and target prevention strategies toward domestic flame and scald risks in similar settings.