Some aspects of burns and burns research at Birmingham Accident Hospital 1944-93: A.B. Wallace Memorial Lecture, 1994

A review of the international Burn Injury Database (iBID) for England and Wales: descriptive analysis of burn injuries 2003-2011

OBJECTIVE

To describe, for the first time, distribution (by geography, age, sex) and time trends in burn injury in England and Wales over the period that the international Burn Injury Database (iBID) has been in place.

SETTING

Data from the iBID for the years 2003-2011 were used for a retrospective descriptive observational study of specialised services workload and admissions in England and Wales.

PARTICIPANTS

All patients who have been visited or admitted to the burn injury specialised health service of England and Wales during the time period 2003-2011. Data cleaning was performed omitting patients with incomplete records (missingness never exceeded 5%).

OUTCOME MEASURES

Workload, admissions, mortality, length of stay (LOS), geographical distribution, sex differences, age differences, total burn surface area, mechanism of Injury.

RESULTS

During 2003-2011, 81,181 patients attended the specialised burn service for assessment and admission in England and Wales. Of these, 57,801 were admitted to the services. Males accounted for 63% of the total workload in specialised burn injury services, and females for 37%. The median (IQR) burn surface area was 1.5% (3.5%). The most frequent reason for burn injury was scald (38%). The median (IQR) age for all the referred workload for both genders was 21 (40). The overall mortality of the admitted patients was 1.51% and the median (IQR) LOS was 1 (5) days.

CONCLUSIONS

Mortality from burn injuries in England and Wales is decreasing in line with western world trends. There is an observed increase in admissions to burn services but that could be explained in various ways. These results are vital for service development and planning, as well as the development and monitoring of prevention strategies and for healthcare commissioning.

Epidemiology of burns admitted to Ain Shams University Burns Unit, Cairo, Egypt

This study was prospectively carried out on 880 acutely burned patients admitted to the Burn Unit of Ain Shams University in Cairo, Egypt, during the period from the 1 May 1995 to the 31 October 2001, with the objective to analyze the epidemiological features of burned patients in our country. The means of age and percentage total body surface area burned (TBSB) were 27.8+/-2.9 years and 32+/-5.7%, respectively. Most of the patients were city dwellers and were self-referred to the Burn Unit. There were no significant yearly variations in hospital admissions. Seasonal variations in the form of peaks in winter and spring were noticed. Females (53.1%) were more prevalent than males (46.8%). Adults (61%) superceded children (39%). Male children (42.7%) population exceeded female children (35.8%). In contrast, adult females (64.1%) surpassed adult males (57.2%). The commonest burn location was home followed by outdoors then, work locations. Females were most commonly burned at home and mainly suffered from flame and scald burns. Males were most commonly burned in outdoor and work locations than at home and mainly sustained electric and flame burns. There was no difference in the mean percentage TBSB and burn depth in both sexes. Children were mostly burned at home and were mainly victims of scald and flame burns. They had lower rates of full thickness burns compared to adults. Adults were mostly burned in outdoor and work locations and mainly sustained flame and electrical injuries. The results of this study clearly highlighted the specific epidemiological features of burned patients in our area, and thus should provide the necessary information to develop proper burn prevention programs, thereby reducing the frequency of burns and burn-related deaths.

Epidemiological data of patients hospitalized with burns and other traumas in some cities in the southeast of Brazil from 1991 to 1997

This retrospective analysis of burn patients and victims of other forms of trauma from Ribeirão Preto and nearby cities admitted to hospitals in the city of Ribeirão Preto, São Paulo, Brazil, was carried out to determine the frequency of injuries of all types in order to identify the extent of the problem of burns relative to other forms of trauma. Data concerning 921 patients with burns and 60,344 patients with other traumatic injuries hospitalized during the period from 1991 to 1997 are described. Burns corresponded to 1.5% of the total number of traumatic injuries. When data are reported as absolute numbers or as incidence rate of hospitalized burn patients, burns were two times more frequent among men in most age groups. The case fatality ratio due to burns was 8.4% (77 deaths among 921 patients), with a rate of 6.4% for men and 12.2% for women. The case fatality ratio was higher among women than men regardless of the city of residence. The case fatality ratio was 3.2 and 4.4 times greater for men and women burn victims from other towns than for burn victims from Ribeirão Preto, indicating the need for additional equipment and training of medical and paramedical personnel in the initial measures to be taken with burn patients.

Revised estimates of mortality from burns in the last 20 years at the Birmingham Burns Centre

The Birmingham Burns Centre has been regularly presenting its mortality estimates since its pioneering work in 1949 on the use of probit analysis. The last of these estimates that showed a significant improvement in survival was presented in 1971. This improvement was attributed to the introduction of topical 0.5% silver nitrate against Pseudomonas aeruginosa. In the last 20 years, several changes in management of burns have taken place following a better knowledge of its pathophysiology. This study shows our experience from the last 20 years by comparing mortality estimates between two successive 10-year periods i.e., 1979-1988 and 1989-1998. We used probit analysis for deriving lethal area 50 (LA 50) for various age groups. The comparison showed that the mortality curves between the two periods were identical suggesting no improvement in the chances of survival. Since the mortalities were so similar the data were combined. The LA 50s derived from this combined data when compared with our earlier series from 1965 to 1970 also did not show a significant change in mortality. We conclude that in our experience the chances of dying for a given severity of injury have not changed significantly for more than 20 years.

Epidemiology and mortality of burns in the South West of Iran

Burn injuries still produce a significant morbidity and mortality in Iran. This study was carried out to analyze the epidemiology, mortality, and current etiological factors of 2043 burn patients who were admitted to the burn centers in the Fars province during 4 years (1994-1998). There were two burn centers in the Fars province serving 3817036 people over an area of 124,000 km(2). The overall incidence rates of hospitalization and death were 13.4 and 4.6 per 100000 person-years. The mean age was 21.9 years, and 51% of patients were children under 19-years-old. The highest rates of hospitalization and death were observed in the elderly (80 years). Also young females (20-29 years) had a high rate of hospitalization. Thus, 55% of the patients had BBS less than 40%. Burn injuries were more frequent and larger with higher mortality in females than in males (P<0.0001). There was also statistically significant correlation between age groups, gender, and BBS with mortality rate (P<0.0001). Flame was the most common etiology of burns. There was also significant correlation between age groups and type of burns (P<0.0001). Suicide attempts for all the patients > or = 11 years were the cause of 41.3% (256/620) of the burns involving women and of 10.3% (40/388) of the burns involving men. The overall case fatality rate was 34.4%. The mortality rate was significantly higher for self-inflicted burns (78%) than for accidental burns (26.7%). Most of the lesions requiring hospital admission occurred during the winter months. Factors associated with an increase in mortality were suicidal burns, burn size, age, and flame burns. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable.

Epidemiological data and mortality rate of patients hospitalized with burns in Brazil

This retrospective analysis of burn patients in a University Hospital in the state of São Paulo, Brazil, was carried out to characterize this population and to identify the factors that affect the mortality rate. All patients hospitalized from January 1990 to April 1995 (n = 229, 3.6 patients/month) and who terminated treatment were included. Of these, 80.8% (185 patients) were hospitalized within 24 h of the burn. Occupational and/or domestic accidents were responsible for most of the burns (78.6%), which were mainly caused by a direct flame (71.2%). with alcohol being the flammable fluid most frequently used. The average patient treated at the center was a male of 9 years of age or less with 20-40% burned body surface, who received care within 24 h after suffering an accidental alcohol burn and who was hospitalized for < or =30 days. The mortality rate was 18.8% for all patients and increased with burned body surface and age, and for suicide patients. Suicide attempts for all patients > or = 18 years were the cause of 46 .5% (20/43) of the burns involving women and of 8.9% (8/90) of the burns involving men. The mortality rate was significantly higher for self-inflicted burns (42.9%) than for accidental burns (20.2%).

The epidemiology of burns in secondary care, in a population of 2.6 million people

The numbers of residents of the four counties in the west of Anglia and Oxford Region (UK) who were treated for burns (including scalds) in accident and emergency (A&E) departments or admitted to hospital in 1994-95 were obtained from A&E departments and district health authority records. Burns comprised about 1 per cent of the workload in the A&E departments. Using the data from district health authorities, the rate of admission with a main diagnosis of burns to any hospital was 0.14 per thousand population per year. Children under five had the highest rate of admission. Approximately half the patients admitted to hospital with burns were admitted to burns units, a quarter to plastic surgery wards and the rest to different specialties including trauma and orthopaedics, paediatrics, and ophthalmology. The median length of stay was 6 days for burns units and 3 days for plastic surgery units.

First-aid measures for the treatment of burns and scalds

An update on the treatment of injuries caused by fire, hot objects or liquids, using cold water and other materials commonly found in the home