Rai Shankar Man, Keswani Sunil, Fisher Mark, Ntirenganya Faustin, Tanveer Ahmed, Vana Luiz Philipe Molina, Carter Jeffery, Junlin Liao, Depetris Nadia, Horwath Briana, Wall Shelley, Leon-Villapalos Jorge, Chong Si Jack, Al-Tarrah Khaled, Nakarmi Kiran, Qiao Liang, Chamania Shobha, Nawar Ahmed, Juan P. Barret, Miranda-Altamirano Rodolfo, Adorno José, Kiyozumi Tetsuro, Pompermaier Laura, Corlew Scott, Matsumura Hajime, Allorto Nikki, Elmasry Moustafa, Olekwu Anthony, Steinvall Ingrid, Luo Gaoxing, Haik Josef, Moiemen Naiem, Potokar Tom, Institut Català de la Salut, [Laura P] Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden. Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. Department of Global Health and Social Medicine Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. [José A] Burn Unit at Regional Hospital of North Wing, Brasília, Brazil. [Nikki A] Pietermaritzburg Burn Service, Nelson Mandela School of Medicine, University of KwaZulu Natal, South Africa. [Khaled A] Albabtain Center for Burns and Plastic Surgery, Alshuwaikh Specialist Health District, Alsabah Health Region, Kuwait. [Barret J] Servei de Cirurgia Plàstica i Cremats, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Jeffery C] Louisiana State University Health Sciences Center, New Orleans, LA, USA, and Vall d'Hebron Barcelona Hospital Campus
Background: Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pan-demic, and whether country acute accent s income, geographical location, COVID-19-transmission pat-tern, and levels of specialization of the burn units affected reallocation of resources and access to burn care.Methods: The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, chi 2 or Fishers exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic.Results: The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedi-cated nursing staff was reduced (< 0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration be-tween burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors.Conclusions: During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care.(c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).