The effect of high energy nutrition supplementation on severe burns outcome at Kigali University Teaching hospital (CHUK)

Abstract

Back ground: Burns are one of the most common forms of trauma, with devastating consequences, prolonged length of hospital stay, increased morbidity and mortality worldwide. This study aims at identifying the impact of high energy nutrition supplementation on the outcome of severe burn patients.

Methods: This is a before and after intervention study, conducted in 2 phases. Phase I, was a retrospective assessment of 30 patients with severe burn admitted and followed at CHUK burn unit for the year 2017. During that period, no specific nutrition supplementation was offered in CHUK burn unit. Phase II, was a post-intervention prospective analysis of 27 patients with severe burn, where, on top of food brought by families, high energy nutrition (plumpy’ nut) was supplemented on daily basis by burn Unit. From March 2018 up to January 2019. The data was collected using a pre- established questionnaire. Analysis done using SPSS version 16.0. Descriptive statistics, student t-test and chi-square test were used where applicable.

Results: The male were predominant in both groups with 56.7% and 55.6% respectively. The majority of patients were children in the age group of 1 to 10 years with 63.4% before intervention and 88.9% after intervention. Scald was the predominant cause of burn in both groups with 53.3% and 77.8% respectively. Partial thickness burn was predominant in both groups with 70% and 74.1% respectively.TBSA between 21% and 30% was predominant for both groups, with 56.6% and 62.9% respectively. Diarrhea was a predominant early side effect on high energy nutrition with 14.8%.Bacilles gram negative (23.3%), klebsiella sp (16.7%), staphylococcus coagulase negative (13.3%) were the predominant isolated pathogens before intervention.Whereas,klebsiella sp(11.1%),pseudomonas aeriginosa(7.4%), staphylococcus aureus(7.4%) were predominant after intervention. The in hospital mortality was predominant in patients with TBSA ranging between 31 and 40% for pre-intervention group (37.5%) and was predominant in patients with TBSA >50% for post-intervention group (66.6%). The overall in hospital mortality was 26.7% for the pre-intervention group and 11.1% for the post-intervention group, with a significant association (P=0.000). The mean length of hospital stay was 35.2 days for the pre-intervention group with Std.Dev of 18.3 and was 22 days for the post-intervention group with Std.Dev of 10, with a significant association(P=0.006).

Conclusion: A wide variety of factors may be linked with overall outcome in severe burns. However, early nutrition supplementation with plumpy ‘nut has contributed significantly to the reduction in length of hospital stay, morbidity and mortality at CHUK burn unit.