# Outcomes of Burn Patients Admitted Initially to a Non-Burn Center Intensive Care Unit in Romania: A Retrospective Exploratory Study

## TL;DR

This study examines the survival and outcomes of burn patients initially treated in non-specialized ICUs in Romania, highlighting factors like burn severity and kidney injury that affect survival.

## Contribution

The study provides insights into mortality predictors and care pathways for burn patients in non-burn center settings in a resource-limited country.

## Key findings

- Six-month survival rate was 61.9% with most deaths occurring within 60 days.
- Total body surface area and acute kidney injury were independently associated with mortality.
- Patients transferred to burn centers had significantly higher burn severity.

## Abstract

Background and Objectives: Many burn patients are initially admitted to non-burn center intensive care units (ICUs) due to resource constraints, geographic barriers, or delayed transfer. Their management requires multidisciplinary, phase-specific clinical and assistive practices, yet outcomes from non-specialized centers remain scarce. This study aimed to (1) determine six-month survival among all adult burn patients initially admitted to a non-burn center ICU, (2) identify clinical predictors of mortality, and (3) explore reasons for transfer to burn centers within a resource-limited healthcare setting. Materials and Methods: We conducted a retrospective observational cohort study including 42 adult burn patients initially admitted to the ICU of a regional non-burn hospital in Romania (2019–2024). Of these, 24 were treated entirely in the non-burn center (initially treated in the ICU and then further managed on the same hospital’s wards), and 18 were, after initial ICU stabilization, subsequently transferred to burn centers. Six-month survival was assessed using Kaplan–Meier analysis. Logistic regression and Cox proportional hazards models were used to assess associations with mortality. Clinical trajectories and transfer decisions were also analyzed. Results: Six-month survival was 61.9% (95% CI 48.8–78.5), with most deaths occurring within 60 days. Total body surface area (TBSA) (HR 1.05, 95% CI 1.02–1.08, p < 0.001) and acute kidney injury (AKI) (HR 3.48, 95% CI 1.18–10.29, p = 0.024) were independently associated with mortality. Patients transferred to burn centers had greater TBSA (median 35% vs. 15%, p = 0.003), consistent with severity-driven referral decisions. Conclusions: Among all burn patients initially admitted to a non-burn center ICU, six-month survival was 62%, with TBSA and AKI independently associated with mortality in adjusted analyses. These findings underscore the importance of phase-specific, multidisciplinary care pathways, including early resuscitation, renal and hemodynamic monitoring, coordinated nursing care, rehabilitation planning, and transfer protocols to improve outcomes.