How the world manages acute burns: insights from an international survey of 106 burn units across 50 countries

Background: There is considerable variability in the management of acute burns globally, including differences between low- and middle-income countries (LMIC) and high-income countries (HIC). This study aimed to describe global surgical burn care practices through an international survey, providing insight into diagnostic, debridement, and coverage techniques and their timing.
Methods: An online survey was developed and distributed to burn surgeons worldwide, focusing on the management of four patient cases and standard practices. The survey was developed and tested in collaboration with burn care experts, and distributed via email. One respondent per hospital performing burn surgery was permitted to prevent duplication. Data were analysed using descriptive statistics, Fisher’s exact tests and Chi-square tests, with responses categorised by country and regional economic status.
Results: Burn surgeons from 106 burn units across 50 countries completed the survey, achieving a 44% response rate. Early surgical debridement (<48h) was most commonly referred to as standard care, although definitions of early grafting differed. LMICs and HICs differed in the availability of diagnostic tools, enzymatic debridement, and wound coverage techniques. Further regional differences were observed among HICs in Europe, North America, and Oceania, highlighting diverse approaches to burn care worldwide.
Conclusion: This study offers a global overview of acute surgical burn management, showing both universally common practices and significant regional variations between LMICs, HICs, and continents. The broad heterogeneity in surgical timing and techniques highlights the need for further research.

The survey used in this study can be found in this repository.