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Ul Ain N, Bhatti DS, Mehmood M, Khan H. Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan. Cureus 2024; 16:e59619. [PMID: 38832197 PMCID: PMC11145362 DOI: 10.7759/cureus.59619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Burn injuries pose significant challenges to both patients and healthcare systems globally. This retrospective observational study, conducted at the burn center in a tertiary care hospital in Rawalpindi, Pakistan, aimed to delineate the patterns of burn injuries and correlate them with demographic and clinical presentations. A total of 99 patients were included, with 54 males and 45 females, ranging in age from three months to 70 years. Flame burns were the most common type (n=69), with the majority being accidental (n=87). Limbs were the most frequently affected body parts (n=32), often with lesser-degree burns (n=28). Notably, self-inflicted injuries were predominantly observed in males (n=7), while assault cases were more common in females (n=4). Statistical analysis revealed significant associations between the degree of burn and the body parts affected, as well as between the mode of injury and the affected body parts. Burn injuries due to assault or self-infliction tended to have higher morbidity rates, often resulting in fatalities. Additionally, the cause of burn injury showed significant associations with the affected body parts, with contact and electric burns affecting limbs and chemical burns mainly affecting the head and face. These findings underscore the need for targeted burn prevention programs, emphasizing first aid education and addressing specific risk factors in high-risk groups and settings. By implementing preventive strategies and evaluating their effectiveness, the burden of burn injuries can be reduced, leading to improved patient outcomes and quality of life.
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Affiliation(s)
- Nur Ul Ain
- Plastic and Reconstructive Surgery Department, Rawalpindi Medical University, Rawalpindi, PAK
- Plastic and Reconstructive Surgery Department, PostGraduate Medical Institute, Lahore, PAK
| | - Dujanah S Bhatti
- Surgery Department, Rawalpindi Medical University, Rawalpindi, PAK
| | - Muzna Mehmood
- Surgery Department, Rawalpindi Medical University, Rawalpindi, PAK
| | - Husnain Khan
- Plastic and Reconstructive Surgery Department, Rawalpindi Medical University, Rawalpindi, PAK
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Perkins M, Abesamis GM, Cleland H, Gabbe BJ, Tracy LM. Association between gender and outcomes of acute burns patients. ANZ J Surg 2020; 91:83-88. [PMID: 33289226 DOI: 10.1111/ans.16426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Burn injuries are a complex and serious public health concern. Where the total body surface area of the burn exceeds 50%, mortality rates as high as 48% have been reported. While the association between gender and burn injury outcomes has been explored, findings are inconsistent. METHODS Adult patients (>15 years) admitted between 1 July 2009 and 30 June 2018 to intensive care units of burn centres that provide specialist burn care in Australia and New Zealand were included. Raw mortality rates were examined and a multivariable Cox proportional hazards regression was used to investigate the association between gender and time to in-hospital death. RESULTS There were 2227 eligible burn injury admissions. Men comprised the majority (77.6%). The proportion of women who died in hospital was greater than men and the adjusted odds of in-hospital mortality were 34% lower in men (odds ratio 0.66; 95% confidence interval (CI) 0.45-0.98). The unadjusted rate of in-hospital mortality for men was 44% lower than women (hazard ratio 0.56; 95% CI 0.41-0.76). After adjusting for confounders, there was no association between gender and survival time (hazard ratio 0.76; 95% CI 0.54-1.06). CONCLUSION After adjustment for key differences in case-mix between men and women, there was an association between gender and in-hospital mortality and no association between gender and time to death. Our findings indicate that the worse outcomes observed for women are associated with different age and patterns of injury, and provide further information to direct and inform targeted prevention measures for vulnerable populations.
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Affiliation(s)
- Monica Perkins
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gerald M Abesamis
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, Victoria, Australia
- UP-PGH Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Lethal area 50 percent (LA50) or standardized mortality ratio (SMR): Which one is more conclusive? Burns 2018; 44:1468-1474. [DOI: 10.1016/j.burns.2018.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
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Elsous A, Ouda M, Mohsen S, Al-Shaikh M, Mokayad S, Abo-Shaban N, Hamad AAR. Epidemiology and Outcomes of Hospitalized Burn Patients in Gaza Strip: A Descriptive Study. Ethiop J Health Sci 2016; 26:9-16. [PMID: 26949311 PMCID: PMC4762954 DOI: 10.4314/ejhs.v26i1.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Burns are serious health problems and leading causes of mortality and morbidity in the Eastern Mediterranean Region. This study aimed to overview the epidemiological profile and to present outcomes among hospitalized burn patients in AL Alamy burn center in Gaza. METHODS This was a cross-sectional retrospective study of medical records of hospitalized patients from July 2013 to June 2014. Descriptive analysis for studied variables was applied and P ≤ 0.05 considered statistically significant. RESULTS One humdred eighty nime admissions, 60.8% were males and 63% were under 10 years old. Burn patients in the age range between 19-40 years represented 25.9%. Most common burn injuries were accidental (86.2%), located at home (88.9%), caused by scald (66.1%) and by fire flame (23.8%). On admission, the majority of cases presented with second degree burn (45.5%) or mixed burn (38.6%). The mean TBSA was 11.86 (SD ± 10.78) ranging from 1% to 75% whereas, the mean hospital length of stay was 11.45 (SD ± 12.60) ranging from 1 to 115 days. Total in hospital mortality rate was 2.1% and length of stay was significantly associated with TBSA (P < 0.001). CONCLUSION Young children below 10 years seem to be at a higher risk for burn injuries. A significant improvement in burn patients care is observed and practiced and in hospital mortality rate is better compared to neighbouring countries. Preventive programs focusing on safety measures, especially for mothers working in the home, should be implemented urgently to save our children.
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Affiliation(s)
- Aymen Elsous
- Quality Improvement and Infection Control Office. Shifa Medical Complex, Gaza Strip, Palestine
| | - Mahmoud Ouda
- Quality Improvement and Infection Control Office. Shifa Medical Complex, Gaza Strip, Palestine
| | - Samah Mohsen
- Quality Improvement and Infection Control Office. Shifa Medical Complex, Gaza Strip, Palestine
| | - Mohammed Al-Shaikh
- Quality Improvement and Infection Control Office. Shifa Medical Complex, Gaza Strip, Palestine
| | - Siham Mokayad
- Quality Improvement and Infection Control Office. Shifa Medical Complex, Gaza Strip, Palestine
| | - Nafiz Abo-Shaban
- Department of Plastic Surgery, Al Alamy Burn Center, Shifa Medical Complex, Gaza Strip, Palestine
| | - Abed Al-Rahman Hamad
- Department of Applied Medical Technology, Al Aqsa University, Gaza Strip, Palestine
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Steinvall I, Elmasry M, Fredrikson M, Sjoberg F. Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: An exploratory review. Burns 2015; 42:28-40. [PMID: 26700877 DOI: 10.1016/j.burns.2015.10.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/27/2022]
Abstract
Standardised Mortality Ratio (SMR) based on generic mortality predicting models is an established quality indicator in critical care. Burn-specific mortality models are preferred for the comparison among patients with burns as their predictive value is better. The aim was to assess whether the sum of age (years) and percentage total body surface area burned (which constitutes the Baux score) is acceptable in comparison to other more complex models, and to find out if data collected from a separate burn centre are sufficient for SMR based quality assessment. The predictive value of nine burn-specific models was tested by comparing values from the area under the receiver-operating characteristic curve (AUC) and a non-inferiority analysis using 1% as the limit (delta). SMR was analysed by comparing data from seven reference sources, including the North American National Burn Repository (NBR), with the observed mortality (years 1993-2012, n=1613, 80 deaths). The AUC values ranged between 0.934 and 0.976. The AUC 0.970 (95% CI 0.96-0.98) for the Baux score was non-inferior to the other models. SMR was 0.52 (95% CI 0.28-0.88) for the most recent five-year period compared with NBR based data. The analysis suggests that SMR based on the Baux score is eligible as an indicator of quality for setting standards of mortality in burn care. More advanced modelling only marginally improves the predictive value. The SMR can detect mortality differences in data from a single centre.
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Affiliation(s)
- Ingrid Steinvall
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Moustafa Elmasry
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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Fazeli S, Karami-Matin R, Kakaei N, Pourghorban S, Safari-Faramani R, Safari-Faramani B. Predictive factors of mortality in burn patients. Trauma Mon 2014; 19:e14480. [PMID: 24719826 PMCID: PMC3955925 DOI: 10.5812/traumamon.14480] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/02/2013] [Accepted: 10/12/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Burn injuries impose a considerable burden on healthcare systems in Iran. It is among the top ten causes of mortality and a main cause of disability. OBJECTIVES This study aimed to examine factors influencing mortality in burn patients admitted to the main educational tertiary referral hospital in Kermanshah. PATIENTS AND METHODS All patients admitted to the Imam Khomeini Hospital (from March 2011 to March 2012), due to thermal burn injuries were included in the study. We applied multiple logistic regressions to identify risk and protective factors of mortality. Also we calculated lethal area fifty percent (LA50), as an aggregate index for hospital quality. RESULTS During the study period, 540 burn patients were admitted. Male to female ratio was 1.12:1. Twenty three percent of the patients were less than 15 years-old. Median of age was 25 years (Inter Quartile Range, 16 - 37). Overall, probability of death was 25.8%. Lethal area fifty percent (LA50) was 50.82 (CI 95%: 47.76 - 54.48). In the final model, after adjustment of sex, age, total body surface area (TBSA), cause of burn and it's severity, female gender (P < 0.05), age ≥ 60 years (in comparison with age less than 15 years, P < 0.05) and larger burn size (P < 0.0001) were identified as the main risk factors of death in these patients. CONCLUSIONS Findings showed that the main risk factors of death were female gender, burn size and old age. Directing more attention to these vulnerable patients is required to reduce mortality and improve patient survival.
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Affiliation(s)
- Shahram Fazeli
- Department of Surgery, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Reza Karami-Matin
- Department of Surgery, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Neda Kakaei
- Department of Surgery, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Samira Pourghorban
- Department of Surgery, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Roya Safari-Faramani
- Department of Biostatistics and Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
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Al Ibran E, Mirza FH, Memon AA, Farooq MZ, Hassan M. Mortality associated with burn injury - a cross sectional study from Karachi, Pakistan. BMC Res Notes 2013; 6:545. [PMID: 24354896 PMCID: PMC3878253 DOI: 10.1186/1756-0500-6-545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 12/13/2013] [Indexed: 11/10/2022] Open
Abstract
Background Burn injuries are a major cause of medico legal deaths in Pakistan. The present study was conducted with the aim to assess the mortality rate related to different types of burns injuries. Findings This was an observational prospective cross sectional study conducted in Burns Ward of Civil Hospital, Karachi during a period of two years from January 1st 2010 to December 31st, 2011. Data was collected over a questionnaire containing demographic variables as well as date of burn, date of the death (if patient expired), total body surface area involved, cause and manner of burn. The data was statistically analyzed by SPSS v. 16. A total of 1979 patients were admitted to the department during the study period. Out of them, 715 died, hence a mortality rate of 36.12%. Out of the 715 patients, 380 (53.1%) were males and 335 (46.9%) were females. Mortality was highest in age-group 16–30 years (n = 395, 55.2%). Majority of the deaths were accidental (n = 685, 95.8%). Fire burns was found to be the most common cause of death (n = 639, 89.3%). 35% (n = 252) of the patients who died had more than 60% of total body surface area involved in burns. Conclusion Measures must be taken to inform the general population of the possible causes of these injuries, and to enable the people to be prepared to face any such circumstances.
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Affiliation(s)
| | | | - Akhtar Amin Memon
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
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Hussain A, Choukairi F, Dunn K. Predicting survival in thermal injury: A systematic review of methodology of composite prediction models. Burns 2013; 39:835-50. [DOI: 10.1016/j.burns.2012.12.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 11/13/2012] [Accepted: 12/06/2012] [Indexed: 12/26/2022]
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Othman N, Kendrick D. Epidemiology of burn injuries in the East Mediterranean Region: a systematic review. BMC Public Health 2010; 10:83. [PMID: 20170527 PMCID: PMC2841676 DOI: 10.1186/1471-2458-10-83] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 02/20/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Burn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organization's East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken. METHODS Medline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations. RESULTS Seventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%. CONCLUSION Burn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.
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Affiliation(s)
- Nasih Othman
- School of Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- School of Community Health Sciences, University of Nottingham, Nottingham, UK
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Galeiras R, Lorente JA, Pértega S, Vallejo A, Tomicic V, de la Cal MA, Pita S, Cerdá E, Esteban A. A model for predicting mortality among critically ill burn victims. Burns 2008; 35:201-9. [PMID: 19019556 DOI: 10.1016/j.burns.2008.07.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 07/07/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a model for predicting mortality among burn victims. METHODS All casualties admitted to our intensive care burn unit (ICBU) with a diagnosis of thermal or inhalation injury were studied. Age, total and full-thickness body surface area (BSA) burned, presence of inhalation injury, gender, mechanism of injury, delay to ICBU admission and mechanical ventilation during the first 72 h were recorded. The 851 participants were randomly divided into derivation (671) and validation (180) sets. From univariate and multivariate logistic regression analyses a mortality predictive equation was derived. RESULTS Mortality was 17.6%. In univariate analysis, all variables were significantly associated with mortality except mechanism of injury and delay to ICBU admission. In multivariate analysis, age, total and full-thickness BSA burned, female gender and early mechanical ventilation were independently associated with mortality. CONCLUSIONS We propose a mortality predictive equation for burned victims. In this model, MV and not inhalation injury is a mortality risk factor.
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Abstract
OBJECTIVE There is evidence that females have a better outcome in intensive care units (ICUs) when compared with males. The aim of the present study was to compare hospital course and physiologic markers between severely burned pediatric females and males. SUMMARY BACKGROUND DATA One-hundred eighty-nine children sustaining a >or=40% total body surface area burn were divided into females (n = 76) and males (n = 113). METHODS : Patient demographics, clinical parameters, and mortality were noted. Muscle protein synthesis was determined by stable isotope technique. Resting energy expenditure (REE) was measured by indirect calorimetry and body composition by dual x-ray absorptiometry. Serum hormones, proteins, and cytokines were determined. Cardiac function and liver size were determined by repeated ultrasound measurements. RESULTS There were no significant differences between females and males for mortality, demographics, burn size, nutritional intake, or concomitant injuries. ICU stay was in females: 29+/-3 days whereas the stay in males was 38+/-3 days, P < 0.05. Females had a significant attenuated loss in muscle protein net balance (females: -0.028+/-0.001% vs. males: -0.05+/-0.007%) and an increase in lean body mass (Delta females: 5+/-4% vs. Delta males: -1+/-3%), P < 0.05. Percent-predicted REE was significantly decreased in females compared with males, P < 0.05. Systemic inflammatory markers and stress hormone levels were significantly decreased in females, P < 0.05. Cardiac and liver dysfunction were significantly attenuated in females compared with males, P < 0.05. CONCLUSIONS Female burned patients exert an attenuated inflammatory and hypermetabolic response compared with males. This decrease is reflected in improved muscle protein net balance and preservation of lean body mass, which are associated with shortened hospital stay.
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Sharma PN, Bang RL, Al-Fadhli AN, Sharma P, Bang S, Ghoneim IE. Paediatric burns in Kuwait: Incidence, causes and mortality. Burns 2006; 32:104-11. [PMID: 16406370 DOI: 10.1016/j.burns.2005.08.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 08/11/2005] [Indexed: 11/29/2022]
Abstract
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.
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