Epidemiology of burns due to domestic flammable agents

Aetiology of bioethanol related burn accidents: A qualitative study

BACKGROUND

Since insight into the motivation of behaviour in bioethanol related burn accidents is lacking, this study aimed to qualitatively examine influencing factors in bioethanol related burn accidents. In order to identify target points for effective burn prevention.

METHODS

Patients previously admitted with bioethanol related acute non-intentional burn injury to the three Dutch burn centres were eligible. One interviewer conducted fourteen semi-structured interviews. Interviews were transcribed and coded by two independent researchers. Conclusions were drawn based on generalised statements on the concerned topics.

RESULTS

Four overall themes in influencing factors were found, namely 1) motivation; including non-designated use and impaired judgement, 2) knowledge and education; including unknown product and properties and information overload, 3) risk perception; including poor recognisability of risks and preferred trial and error and 4) thresholds; including easy availability and unclear liability.

CONCLUSION

Trust in consumers may be over-estimated, as proper use cannot be expected. To prevent future bioethanol related burn incidents, thresholds for obtaining and using bioethanol should be increased, safe alternatives to ignite open fires and wood stoves should be provided and knowledge and warnings should be improved.

A Review of Petrol Burns in Australia and New Zealand

Petrol-related thermal burns cause significant morbidity and mortality worldwide and it has been established that they affect young males disproportionately. Beyond this, we sought to identify the difference in the characteristics and outcomes of burns between males and females in an international population. Such differences may highlight areas for future preventative strategies. The Burns Registry of Australia and New Zealand was used. Petrol burns that resulted in a hospital admission in those 16 years or older between January 2010 and December 2019 were included. A total of 2833 patients were included. The median age was 35 years with most patients being male (88%). Burns from a campfire or burnoffs were most common. Females were more likely to suffer burns due to assault or from deliberate self-harm. The total body surface area affected by burns was higher for females than males (10% vs 8%). Furthermore, females more frequently required ICU admission, escharotomies, and had a longer hospital length of stay. The unadjusted mortality rate for females was more than double the rate for males (5.8% vs 2.3%). This international study demonstrates that whilst men more frequently suffer petrol burns, women suffer more severe burns, require more intensive and longer hospitalizations and have a higher mortality rate. These findings may inform changes in preventative health policies globally to mitigate against these concerning findings.

Lethal Area 50 in Patients with Burn Injuries in North West, Iran

Introduction: In view of their considerably high rates of mortality and morbidity, burns are still viewed as one of the most important health-threatening environmental hazards imposing a significant burden on the health care system in low and middle-income countries. This study seeks to determine the lethal area fifty percent (LA50) in all burn patients admitted over a period of five years and the factors influencing mortality in burn injuries. Methods: This study was a cross-sectional carried out from 2010 to 2014 in Sina Hospital of Tabriz, 1226 participant including 319 women, 346 men, 272 girls, and 289 boys were selected through stratified sampling. The demographic and clinical data of patients ( their age, gender, burn type, TBSA, the season and consequences of burning) were all extracted and then analyzed, using descriptive statistics (measures of central tendency and variability) and inferential statistics(chi-square and linear regression)at a significance level of 0.05. The LA50 was calculated through determining the relationship between the total body surface area and mortality rate (The extent of the body burns measured and recorded based on Lando Chart in hospitals). Results: The highest (47.6%) and the lowest (3.8%) rates of burns were observed among those aged below 16 and above 65, respectively. The majority of the participants were residents of cities (55.4%), married (34.6%), illiterate (56.6%), and housewives (14.8%). Most burns were caused by accidents (98.4%) at home (90.6%). Most patients had suffered first- and second-degree burns (68.4%), with no inhalation damages (99.5%). Hot liquids were the main culprit in most of the burns (58.7%) and the upper extremities were the most frequently affected areas (34.8%). There was .99 rise in mortality for every percent increase in TBSA, and there seemed to be a significant relationship between the age level and the eventual outcome- the higher the age, the more likely for the incident to end in death.LA50 was also determined 43.73 percent for five years. Finally, the study findings showed that female gender, TBSA and age are associated with death from burn. Conclusion: Given the high LA50 index at this center, it is of high priority in our country to enhance the public knowledge and the quality of the care provided for the burn patients. Patients at risk including women, children, elderly and extensive burns should be considered.

Gasoline-related injuries and fatalities in the United States, 1995-2014

This descriptive study examines twenty years of gasoline-related fatalities and emergency department treated injuries in the United States, based on data from the US Consumer Product Safety Commission. Thermal burns consistently accounted for the majority (56%) of gasoline-related injuries and for most (82%) gasoline-related deaths, and were commonly (57-71%) associated with the use of gasoline as an accelerant. Poisoning accounted for 13% of injuries and 17% of deaths. The primary poisoning injury pattern was ingestion; the primary fatality pattern was inhalation, with about half of those associated with deliberate abuse. The estimated number of ingestions decreased from 60 to 23% of poisoning-related injuries, while injuries associated with inhalation abuse increased from 6 to 23%. Chemical burns and dermatitis were less represented in the injury data and were primarily associated with gasoline spills or splashes. Gasoline cans reportedly ignited or exploded in about 5% of thermal burn injuries and fatalities. While mandatory requirements for child resistant closures on gasoline cans (a primary intervention) have potentially impacted poisonings, the use of flame mitigation devices to address thermal injuries, if successful, would be a secondary intervention, and could address only a small percentage (about 5%) of injuries and deaths.

Methylated spirit burns: an ongoing problem

OBJECTIVE

Despite many educational campaigns we still see burns caused by methylated spirit every year. We undertook a retrospective study to analyse the impact of this problem.

METHODS

We retrospectively collected data of all patients with burns caused by methylated spirit over twelve years from 1996 to 2008. Our main endpoints were: incidence, age, mechanism of injury, total body surface area (TBSA) burned, burn depth, need for surgery and length of hospital stay.

RESULTS

Ninety-seven patients with methylated spirit burns were included. During the study period there was no decrease in the number of patients annually admitted to the burn unit with methylated spirit burns. 28% of the patients (n=27) were younger than eighteen years old, 15% (n=15) were ten years old or younger. The most common cause of burns was carelessness in activities involving barbecues, campfires and fondues. Mean TBSA burned was 16% (SD 12.4). 70% (n=68) had full thickness burns. 66% (n=64) needed grafting. Mean length of hospital stay was 23 days (SD 24.7).

CONCLUSIONS

The use of methylated spirit is an ongoing problem, which continues to cause severe burns in adults and children. Therefore methylated spirit should be banned in households. We suggest sale only in specialised shops, clear labelling and mandatory warnings.

Paediatric burns in Kuwait: Incidence, causes and mortality

From a prospective study on burn patients admitted at the Burn Center in Kuwait during 1993-2001, 826 paediatric burn cases, in 0-14 years age group, were retrieved to study incidence, causes, and mortality among children. The demographic characteristics, clinical features, and outcome constituted our data file in Statistical Software, SPSS. Overall incidence rate was 17.5/100,000 children aged 0-14 years, being almost twice (34/100,000) among those between 0 and 4 years, constituting 70.8% of all paediatric burns. Scald was the main cause of burn (67%), followed by flame (23%). Mean age (6.4 years) of children with flame burns, was significantly higher (p < 0.001) than those with scalds, or other causes. A positive significant correlation existed between duration of hospital stay and TBSA% (r = 0.56, p < 0.001). Overall mortality rate was 0.23/100,000 children, maximum (0.52/100,000) being in children below 5 years. Among 11 (1.3%) non-survivors, flame burns caused nine fatalities. Multiple logistic regression mooring predicted children aged < 5 years, flame burns and TBSA >or= 70%, (OR = 29.2, p < 0.001), as main contributing factors to fatal outcome among children. Gender and nationality had no influence on incidence or mortality. These findings will hopefully stimulate development of targeted and sustainable interventions for reducing burns occurrence among identified paediatric high-risk groups.

Burn epidemiology in the Brisbane and Queensland area

AIM

The aim was to evaluate changes in patterns of injury and whether mortality rates have decreased.

METHOD

The database over 20 years from 1982 to 2002 and the 6 years 1997 to 2003 was studied.

RESULTS

4523 admissions. 73.7% males, 26.3% females. Monthly and seasonal admissions showed little fluctuation. 52.8% in the 21-40 years age group, 19.7% under 20 years, 19.4% in the 41-60 years group and 8.1% over 60 years. TBSA: 80.4% under 20%, 12.6-21% to 40%, 3.3-41% to 60% and 3.4% were over 61%. Causes: flame 56%, scalds 26%, contact 9%, chemical 5%, electrical 2%, friction 1% flash burns 1%. Fifty five percent at home, 20% work, 13% motor vehicles and 11% leisure. Fifteen percent had significant inhalation injuries and 81% required intubation. Mortality rate for 6 years was 2.1%. In 1972-1996 of 4096 burns was 3.6% and 3.4% in 1993-1996.

CONCLUSION

Little change in patterns of injury. Burns less than 20% predominate. The majority were under 40 years. Inhalation injury, large burns and elderly were major causes of morbidity and mortality. Mortality rate is falling.

Thermal injuries due to paint thinner

This study was designed to evaluate the epidemiology and outcome of burn injuries due to paint thinner in a local burn center. During a 10-year period, 32 patients were admitted to our Burn Unit for paint thinner thermal burn. Patients were reviewed regarding the age, sex, etiologic factors, extent and localization of burn, treatment methods, length of hospitalization, and results. There were 30 males and 2 females. The mean age of patients was 25.9 +/- 11 years. The most common etiologic factor was kindling a fire with paint thinner. The mean extent of burn was 33.6 +/- 24% of the total body surface area. All patients sustained burn injury on the face, arms, and hands and five patients among them had extended burn areas on the trunk and/or lower extremity. The mean length of hospitalization for the survivors was 34.5 +/- 21.6 days. Twenty-eight patients were treated by early excision and split-thickness skin grafting. In four patients, burn wounds were healed by conservative management. Five patients with burn size of over 75% of the total body surface area died. In conclusion, paint thinner may be the cause of a catastrophic thermal injury and should not be used for the purpose of kindling fire.

Flammable liquid burns in children

OBJECTIVES

To document and describe the effects of flammable liquid burns in children. To identify the "at risk" population in order to tailor a burns prevention programme.

DESIGN, PATIENTS AND SETTING

Retrospective study with information obtained from the departmental database of children treated at the burns centre at The Royal Children's Hospital, Brisbane between August 1997 and October 2002.

MAIN OUTCOME MEASURES

Number and ages of children burned, risk factors contributing to the accident, injuries sustained, treatment required and long-term sequelae.

RESULTS

Fifty-nine children sustained flammable liquid burns (median age 10.5 years), with a clear preponderance of males (95%). The median total body surface area burned was 8% (range 0.5-70%). Twenty-seven (46%) of the patients required debridement and grafting. Hypertrophic scars occurred in 56% of the children and contractures in 14%, of which all of the latter required surgical release. Petrol was the causative liquid in the majority (83%) of cases.

CONCLUSIONS

The study identified the population most at risk of sustaining flammable liquid burns were young adolescent males. In the majority of cases these injuries were deemed preventable.

Trash and brush burning: an underappreciated mechanism of thermal injury in a rural community

Open-fire injuries associated with burning trash or brush result in a significant number of burn admissions annually. Trash- and brush-burning injuries are more prevalent in rural environments where open burning is an acceptable practice of waste disposal. These injuries are not "unavoidable accidents" but follow a predictable injury pattern. Understanding this injury pattern is paramount to effective prevention. The purpose of this work is to describe the epidemiology of burn injuries associated with burning trash or brush. Charts were retrospectively reviewed for all trash and brush burning injuries from July 1989 to December 2000. One hundred ninety-four injuries were identified, accounting for one fifth of all flame admissions for the study period. Persons most at risk for these burn injuries were males between the ages of 25 to 45, followed by males ages 16 to 24. Accelerant use was identified in over 80% of these injuries. The median cost for admission was $9,363.00 US dollars. Cost was significantly related to age, percent body surface area burned, and operative intervention. Brush and trash burning can lead to costly injuries especially when accelerants are used. Additional research is needed to explore the cultural and social influences associated with these injuries to target effective prevention.

Thermal Injury in the Elderly: When is Comfort Care the Right Choice?

The factors contributing to a higher mortality rate in elderly thermal injury victims are not well delineated. The purpose of this study is to determine the impact of the initial injury, medical comorbidities, and burn size on patient outcome and to determine a level of injury in this population when comfort care is an appropriate first choice. Individual medical records of patients over 65 years of age admitted to our burn center over a 10-year interval were reviewed for patient demographics, mechanism of injury, total body surface area (TBSA) burned, medical comorbidities, use of Swan-Ganz catheters, evidence of inhalation injury, level of support, and patient outcome. The mechanisms of thermal injury were flame (68%), scald (21%) and electrical or chemical contact (11%). Twenty-six preventable bathing, cooking, and smoking-related injuries were seen (33%). The average TBSA was 25 per cent. Average length of stay varied depending on outcome. The overall mortality rate for this group was 45 per cent. Patients older than 80 years with 40 per cent or greater TBSA burned had a 100 per cent mortality rate despite aggressive treatment. Burn wound size correlated better with probability of poor outcome than age. Thermal injuries in the elderly are becoming more important with the aging of our population. Underlying medical problems—specifically chronic obstructive pulmonary disease—do play a role in increased patient morbidity and mortality. This study shows that age greater than 80 years in combination with burns greater than 40 per cent TBSA are uniformly fatal despite aggressive therapy. We believe that delaying the start of comfort-only measures in this situation only prolongs the pain and suffering for the patient, the family, and the physician.

Preventable burns associated with the misuse of gasoline

Gasoline is intended for use as a motor fuel, but the universal availability of gasoline in the home encourages misuse as a solvent, insecticide, accelerant or cleaning solution. The careless or inappropriate use of gasoline may result in burn injury. We examined the circumstance of gasoline-related injury in a population admitted to one burn centre to determine the potential for burn prevention efforts. A retrospective review of all burn admissions to one centre for the years 1978 to 1996 demonstrated hat 1011 of 4339 acute admissions (23.3%) were gasoline-related. This group had an average total burn size of 29.8% total body surface (TBSA) and an average full thickness injury of 14.4% TBSA. There were 144 fatalities resulting from gasoline-associated burn injury. Where such determination could be made, the use of gasoline was judged to be inappropriate or unsafe in 687 of 788 cases (87.1%). Ninety of 144 fatalities (62.5%) were associated with inappropriate or unsafe use of gasoline. The careless or inappropriate use of gasoline poses significant risk of burn injury. The indoor use of gasoline, as well as use of gasoline for purposes other than as a motor fuel, should be strongly discouraged.

Burn injuries caused by chip-pan fires: the Edinburgh experience

Thirty-two patients were admitted to the South-East Scotland Burn Unit over a 4-year period (1990-94), with burns sustained as a consequence of chip-pan fires. This represented 7 per cent of all admissions to the unit. Fourteen patients came from the Edinburgh city area, and 18 from surrounding countries. There were 14 males and 18 females, and an average age of 51.6 years. The average burn surface area was 4.7 per cent. Eighteen patients had burns to their hands, this being the most common area involved. Fourteen patients were managed conservatively, and 18 needed operative intervention. The patients spent an average of 19.4 days in hospital, and they required 46.3 days for complete healing to take place. Prevention by increased community awareness and widespread education is necessary to minimize the incidence, morbidity and cost of this relatively common and preventable type of burn.

Thermal trauma resulting from motor vehicle operation or maintenance

Burn injury may result from the operation or maintenance of motor vehicles. We reviewed the experience of one burn center with injuries related to motor vehicle use over the 6 year period 1987-1992. One hundred and fifty patients with motor vehicle related burns were identified comprising 11.3% of all admissions for this period. The mean extent of burn injury was 22.8% total body surface area with a mean full thickness (third degree) burn size of 11.7%. The average hospital length of stay was 42.41 days. The most common mechanisms of injury were collisions resulting in fire (n = 48), carburetor priming (n = 37) and scalding from radiator fluid contact (n = 27). Burns resulting from vehicle operation or maintenance are costly and potentially preventable.

Burns in Abidjan, Cote d'Ivoire

Burns are frequent in Côte d'Ivoire with about 700 cases yearly registered in the three Teaching Hospitals of Abidjan (Yopougon, Treichville and Cocody). Unfortunately, no specialized substructure is equipped for treating these patients in the country. The aim of the retrospective study carried out during 1993 in the Burns Care Unit of the Teaching Hospital of Cocody is to illustrate the epidemiology of burns in a poorly developed country in West Africa. Faced with many problems and especially a lack of space, the burns care unit is fighting to become a burns centre, which may become functional in 1995. Regarding studies from other countries, the results from our service are comparable to those obtained in poorly developed countries, they are different from those notified in countries with a higher socioeconomic level where substructures and financial means allow more appropriate care. The Abidjan Burns Centre aims to improve the current preventive activities and to provide burned people with the best possible care.

Burn injuries and characteristics of burn patients in New South Wales, Australia

This study describes the burn injuries and characteristics of patients admitted to the major adult burn unit in New South Wales, Australia. Data were collected from the medical records of all patients admitted in the 30-month study period (184 persons, 143 (78 per cent) males, 41 (22 per cent) females). The findings identified that patients were most likely to be males, aged between 25 and 34 years, who experienced a 11-20 per cent total surface burn area flame injury whilst using an accelerant in a domestic environment. Patients were more likely to smoke tobacco, drink alcohol to hazardous levels and take prescribed psychotropic medications than the general population. Preburn morbid conditions were prevalent, especially in the females. The actions of patients who had sustained a non-intentional burn commonly indicated a lack of understanding of the danger of certain equipment or the combustibility and volatility of some materials and flame. Prevention appears to be the most effective way to reduce burn injury through education of at-risk groups. However, because of the multicausality identified in the study, other preventive measures, such as improvement in product safety design, are suggested. Some similarities and differences with studies reported from Australia and overseas are noted.

Hot water burns in Cape Town

Scalds are common in South Africa and accounted for 21.6 per cent of the admissions to the Burns Unit of the University of Cape Town. Two hundred and forty adult patients (160 males, 80 females) with a mean age of 34.2 years were admitted for treatment of scalds between 1985 and June 1992. One hundred and thirteen sustained their scalds accidentally while 127 patients were assaulted with hot water. Epilepsy accounted for 11 per cent of the accidental burns. The head and neck was involved in 16.8 per cent of accidental burns and in 84.9 per cent of assaults. A quarter of the scalds to the trunk and limbs were caused by assault compared with 75 per cent caused by accidents. Beta haemolytic streptococcus was the second commonest organism isolated from the burn wound (57 patients). In 19 per cent of these patients a weekly course of penicillin and erythromycin did not eradicate the streptococcus and clindamycin was required. Accidental scalds usually affect the lower body and limbs whereas assault with hot water commonly involves the head and neck. Streptococcus is a common organism in the Burns Unit and is becoming more difficult to eradicate.

Primus stove burns in Cape Town: a costly but preventable injury

The management and outcome was evaluated in 33 patients during an 18-month period, who sustained burns as a result of working with a primus stove. There were 17 females and 16 males with an average age of 32.5 years. Twenty-nine patients were black skinned and four were coloured skinned. The average burn surface area was 16.8 per cent and the burns were deep dermal in all; 48 per cent of patients also had areas of full thickness skin loss. Twenty-seven patients were burned in more than one anatomical area. Patients spent an average of 24 days in the burns unit and all patients required tangential excision and skin grafting at least once. The average number of units of blood required was four. Only one patient died. Primus stove burns occurred in people of poor social circumstances. Primus stove burns place a heavy burden on the economic resources available. Prevention is the key to management.

Burn injuries in boating accidents

We report a series of burn injuries sustained on boats and admitted to Stoke Mandeville Hospital over a 4-year period. Nine patients are presented, aged between 27 and 65 years. Total body surface area burned ranged from 1.5 to 83 per cent. The causes of the injuries, and the factors leading to the accidents which caused them, are discussed. Interviews with a number of private boat owners and hirers revealed an inadequate level of fire and safety precautions taken. There is at present no legal requirement for private boats to carry five fighting equipment. We believe there is a need for definition of the minimum legal level of such equipment to be carried on board. Increased awareness of correct fuel storage and handling requirements is felt to be important, especially with the increasing popularity of boating as a leisure and sporting activity.

Two years in burn care, an analysis of 12,423 cases

This is a retrospective study analysing 12,423 patients treated at our institution from 1 July 1988 to 30 June 1990. Burn incidence and mode of treatment were classified according to age and sex, as well as causative agent, place of the accident, length of treatment and outcome. 96.6 per cent of the patients were surgically treated, about 41 per cent of the patients were under 14 years of age. The most frequent cause of injury was related to meal preparation, with more than two-thirds of the accidents occurring at home. Only large or complicated burns (1094-8.8 per cent) were admitted, with 49 deaths occurring during this period. We conclude that children and younger adults are at greater risk of being burned and preventative measures should be oriented towards the prevention of such accidents.