Delayed access to tertiary care as a key determinant of complications in pediatric burns: A retrospective study from Rwanda

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Background Pediatric burn outcomes in low-resource settings are influenced by both injury severity and health system factors, particularly delays in accessing definitive care. However, the impact of pre-admission delays within structured referral systems remains insufficiently characterised. Objective To identify independent risk factors for in-hospital complications among pediatric burn patients in Rwanda, with a focus on modifiable pre-admission factors. Methods A retrospective cohort study was conducted among children aged 0–15 years admitted to a tertiary referral hospital in Rwanda with burns between October 2021 and October 2023. Data on demographics, injury characteristics, time to presentation, and initial treatment were extracted from medical records. Multivariable logistic regression was used to identify predictors of complications. A sensitivity analysis was performed using a binary categorisation of time to presentation (<48 h vs ≥48 h) to address sparse data. Results Among 101 patients (median age 2 years), 33 (32.7%) developed complications. Delayed presentation was the strongest independent predictor. In the primary model, presentation after ≥2 days was associated with increased odds of complications (aOR = 30.70, 95% CI: 3.54–265.98, p = 0.002), although the wide confidence interval indicated imprecision. In sensitivity analysis, delays ≥48 h remained strongly associated with complications (aOR = 17.76, 95% CI: 3.54–89.25, p < 0.0001). Burn size and age were not independent predictors in adjusted analyses. Initial treatment showed a non-significant trend toward increased odds when inadequate or absent. Conclusion Delayed access to tertiary care is a major modifiable determinant of pediatric burn complications in this setting. While the magnitude of effect varies, the association is consistent and clinically significant. These findings highlight the need to strengthen referral systems and improve early burn management at first-contact facilities to reduce preventable complications.

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