Psycho-Socio-Cultural Determinants of Delayed Presentation for Specialized Burn Care and Their Clinical Consequences: A Mixed Observational Study

<b>Background</b>: Burn injuries have both physical and psychological impacts on patients. Factors such as personal beliefs, prior experiences, and geographic, economic, or cultural barriers, as well as fear of hospitals, can contribute to delays in seeking specialized care. When combined with inadequate first aid or the inappropriate use of pharmaceutical or traditional remedies, these delays may worsen burn severity, prolong healing, and negatively affect quality of life. From a clinical perspective, delayed presentation following burn injury has been linked to burn wound progression, which increases the risk of local infection, hypertrophic scarring and prolonged functional impairment. <b>Methods</b>: This analytical cross-sectional study was conducted at the Clinical Emergency Hospital of Bucharest between January and September 2025. The primary objective was to characterize adult burn patients presenting more than 24 h after injury (Group A) and to describe self-reported psychosocial/behavioral characteristics and explore unadjusted patterns among delayed presenters. Data were collected from medical records and a structured questionnaire administered to delayed presenters. A secondary descriptive comparison was performed with patients presenting within 24 h (Group B) to provide contextual reference. <b>Results</b>: The majority of patients were male (62.2%) and of working age (18-65 years, 82.4%). Thermal burns from domestic accidents were most common (58.8%), with scalds predominating. Second-degree burns were the most frequent (60.5%), primarily affecting the upper and lower limbs. Mean total body surface area (TBSA) was low (2.86 ± 1.91%), although higher values were observed in radiation burns and closed-space accidents. More than half of the patients did not receive any first aid, while the remainder used various pharmaceutical or natural products, some of which were inappropriate for burn treatment. The main reasons for delaying specialized care were the expectation that injuries would heal spontaneously, negligence, and fear of the hospital. In contrast, escalating pain, edema, and family insistence were the primary motivators for seeking professional medical attention. Delayed presentation was associated with older burn lesions, higher burn severity and an increased likelihood of hospitalization or refusal of recommended admission. <b>Conclusions</b>: Burn injuries predominantly affect working-age males and most frequently arise from domestic thermal accidents. Delayed presentation and inadequate first aid are common and influenced by behavioral, social, and demographic factors. Targeted public education, improved first aid practices, and timely healthcare-seeking are essential to reduce burn severity and improve patient outcomes.