Burn epidemiology in the Brisbane and Queensland area

Epidemiology of work-related burn injuries: A ten-year retrospective study of 429 patients at a referral burn centre in the north of Iran

Work-related burns can have a destructive impact; however, knowledge of the epidemiology of work-related burn injuries in Iran is limited. This study aimed to describe epidemiological characteristics of work-related burn injuries in a burn centre in the north of Iran. This study was a retrospective single-centre study of the medical records of work-related burns between 2011 and 2020. Data collection was done using the hospital information system (HIS). The data were analysed by using descriptive statistical methods and SPSS 24.0 software. Of the 9220 cases treated in the burn centre, 429 (4.65%) had work-related burns. There was an increasing trend of work-related burns during the ten years. The mean age of patients was 37.53 (SD = 13.72). Most patients were male (n = 377, 87.9%), with a male-to-female ratio of 7.25/1. The mean total body surface area burn was 23.39% (SD = 20.03). Most work-related burns occurred in the summer season (46.9%, n = 201), and the upper limb was the most common anatomical site of burns (n = 123, 28.7%). The most common mechanism of injury was fire & flames (266, 62.0%). Inhalation injury was observed in 52 (12.1%) patients, and mechanical ventilation was undertaken in 71 (16.6%) patients. The mean length of stay in the hospital was 10.38 (SD = 10.37) days, and the overall mortality rate was 11.2%. The most common activities associated with burns at the time of the incidents were food preparation and serving related (108, 25.2%), followed by welders (n = 71, 16.6%) and electricians (n = 61, 14.2%). This research is the basis for evaluating work-related burns and identifying the causes of these injuries to develop education and prevention programmes, especially for young male workers.

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.

Emergency Care for Burn Patients-A Single-Center Report

Burns, one of the main public health problems, lead to significant mortality and morbidity. Epidemiological studies regarding burn patients in Romania are scarce. The aim of this study is to identify the burn etiology, demographics, clinical characteristics, and outcomes in patients requiring treatment in a regional burn unit.

DESIGN

We performed a retrospective observational study of 2021.

PATIENTS

All patients admitted to our six-bed intensive care unit (ICU) were included.

INTERVENTIONS

The following data were collected for further analysis: demographics, burn pattern (etiology, size, depth, affected body region), type of ventilation, ABSI (Abbreviated Burn Severity Index) score, comorbidities, bioumoral parameters, and hospitalization days.

RESULTS

There were 93 burned patients included in our study that were divided into two groups: alive patients' group (63.4%) and deceased patients' group (36.6%). The mean age was 55.80 ± 17.16 (SD). There were 65.6% male patients, and 39.8% of the patients were admitted by transfer from another hospital. Further, 59 patients presented third-degree burns, from which 32.3% died. Burns affecting >37% of the total body surface area (TBSA) were noticed in 30 patients. The most vulnerable regions of the body were the trunk (p = 0.003), the legs (p = 0.004), the neck (p = 0.011), and the arms (p = 0.020). Inhalation injury was found in 60.2% of the patients. The risk of death in a patient with an ABSI score > 9 points was 72 times higher. Comorbidities were present in 44.1% of the patients. We observed a median LOS (length of stay) of 23 days and an ICU-LOS of 11 days. Logistic regression analysis showed that admission protein, creatinkinase, and leukocytes were independent risk factors for mortality. The general mortality rate was 36.6%.

CONCLUSION

A thermal factor was responsible for the vast majority of burns, 94.6% of cases being accidents. Extensive and full-thickness burns, burns affecting the arms, inhalation injuries, the need for mechanical ventilation, and a high ABSI score represent important risk factors for mortality. Considering the results, it appears that prompt correction of protein, creatinkinase, and leukocytes levels may contribute to improvement in severe burn patients' outcomes.

Incidence of Laryngotracheal Stenosis after Thermal Inhalation Airway Injury

Inhalation injury is independently associated with burn mortality, yet little information is available on the incidence, risk factors, or functional outcomes of thermal injury to the airway. In patients with thermal inhalation injury, we sought to define the incidence of laryngotracheal stenosis (LTS), delineate risk factors associated with LTS development, and assess long-term tracheostomy dependence as a proxy for laryngeal function. Retrospective cohort study of adult patients treated for thermal inhalation injury at a single institution burn critical care unit from 2012 to 2017. Eligible patients' records were assessed for LTS (laryngeal, subglottic, or tracheal stenosis). Patient characteristics, burn injury characteristics, and treatment-specific covariates were assessed. Descriptive statistics, Mann-Whitney U-tests, odds ratio, and chi-square tests compared LTS versus non-LTS groups. Of 129 patients with thermal inhalation injury during the study period, 8 (6.2%) developed LTS. When compared with the non-LTS group, patients with LTS had greater mean TBSA (mean 30.3, Interquartile Range 7-57.5 vs 10.5, Interquartile Range 0-15.12, P = .01), higher grade of inhalation injury (mean 2.63 vs 1.80, P = .05), longer duration of intubation (12.63 vs 5.44; P < .001), and greater inflammatory response (mean white blood cell count on presentation 25.8 vs 14.9, P = .02, mean hyperglycemia on presentation 176.4 vs 136.9, P = .01). LTS patients had a significantly higher rate of tracheostomy dependence at last follow-up (50 vs 1.7%, P < .001). Six percent of patients with thermal inhalation injury develop LTS. LTS was associated with more severe thermal airway injury, longer duration of intubation, and more severe initial host inflammation. Patients with inhalation injury and LTS are at high risk for tracheostomy dependence. In burn patients with thermal inhalation injury, laryngeal evaluation and directed therapy should be incorporated early into multispecialty pathways of care.

Work-Related Burn Injuries in a Tertiary Care Burn Center, 2013 to 2018

The features of work-related burn (WRB) injuries are not well defined in the literature and they vary depending on geographical location. We wanted to describe these characteristics among patients treated in the UNC Burn Center to evaluate the potential impact of commonly accepted prevention efforts. Adults of working age, admitted between January 1, 2013, and December 31, 2018, were identified using our Burn Center Registry. Demographic data, characteristics of injury, course of treatment, and patients' outcomes were described. Differences between work-related and non-work-related injuries were evaluated using the Chi-square test and Student t-test where appropriate. Three thousand five hundred and forty-five patients were included. WRB cases constituted 18% of the study population, and this proportion remained relatively stable during the study timeframe. Young white males were the majority of this group. When compared with non-WRB patients, they were characterized by fewer co-morbidities, decreased TBSA burns, decreased risk of inhalation injury, shorter time of intensive care treatment, shorter lengths of hospital stay, and lower treatment cost. In contrast to non-WRB, among which flame injuries were the main reason for admission, work-related patients most often suffered scald burns. They also had a dramatically increased proportion of chemical and electrical burns, making the latter the most common cause of death in that group. WRB are characterized by a characteristic patient profile, burn etiologies, and outcomes. Learning specific patterns at this group may contribute to optimize work safety regulations and medical interventions.

Trends in burn injuries in Galicia (Spain): An epidemiological study

The treatment of burns is one of the earliest medical activities on record, probably because of the powerful impact of their physical consequences among other sequelae. The aim of the present paper is to perform an epidemiological study of burn patients. The data were obtained by reviewing the medical histories of all those patients admitted or treated in the Outpatients Department of the Burn Unit of our hospital between 2013 and 2017. A sample was gathered of 1401 patients, made up of 716 males (51.11%) and 685 females (48.89%), in a ratio of males to females of 1.05, with a mean age of 40.74 years old. The burns were mainly suffered in a domestic setting (60.96%), mostly as a result of contact with hot liquids. Most of the burns were second degree superficial burns (60.03%), and affected a mean total body surface area (TBSA) of 4.61%. They were most often produced on the hands. It was found that the frequency of burns increased during the summer and during the main mealtimes of the day. These data may be used to make specific plans of prevention, and as a basis for new studies and databases to be made.

Management of severe thermal burns in the acute phase in adults and children

OBJECTIVES

To provide recommendations to facilitate the management of severe thermal burns during the acute phase in adults and children.

DESIGN

A committee of 20 experts was asked to produce recommendations in six fields of burn management, namely, (1) assessment, admission to specialised burns centres, and telemedicine; (2) haemodynamic management; (3) airway management and smoke inhalation; (4) anaesthesia and analgesia; (5) burn wound treatments; and (6) other treatments. At the start of the recommendation-formulation process, a formal conflict-of-interest policy was developed and enforced throughout the process. The entire process was conducted independently of any industry funding. The experts drew up a list of questions that were formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes). Two bibliography experts per field analysed the literature published from January 2000 onwards using predefined keywords according to PRISMA recommendations. The quality of data from the selected literature was assessed using GRADE® methodology. Due to the current paucity of sufficiently powered studies regarding hard outcomes (i.e. mortality), the recommendations are based on expert opinion.

RESULTS

The SFAR guidelines panel generated 24 statements regarding the management of acute burn injuries in adults and children. After two scoring rounds and one amendment, strong agreement was reached for all recommendations.

CONCLUSION

Substantial agreement was reached among a large cohort of experts regarding numerous strong recommendations to optimise the management of acute burn injuries in adults and children.

Epidemiologic Investigation of Burn Patients in Sichuan Province, China

BACKGROUND We investigated the epidemiology of patients admitted to the Burn Center of West China Hospital during 2011-2016, to provide measures for burn prevention. MATERIAL AND METHODS We conducted a retrospective review of patients admitted to the Burn Center of West China Hospital during 2011-2016. We collected information on patient demographics, burn etiology, burn extent, place of injury, education level, and burn knowledge of patients. RESULTS A total of 1323 patients (1033 males and 290 females), mean age 35.4 years (range 10 days to 91 years), were admitted to our burn center. Among all patients, 214 were children aged 0-14 years, 998 were adults aged 15-59 years, and 111 were elderly adults over age 60 years. Scalds were the predominant cause of pediatric burns; however, flame burns were most common among adults and elderly patients. The injury location varied by age, with most burns occurring at work among adults; however, most children and elderly patients were burned at home. Educational levels were lower among adults from rural areas than those from urban areas, but both groups had little first aid knowledge. Furthermore, rural patients had received less vocational education and training than urban patients. CONCLUSIONS There has been a decrease in burn incidence in Sichuan Province. Flame injury should be a focus of attention in all age groups. Prevention programs for adults in the workplace are imperative. Burn prevention programs should continue to improve living conditions, especially for elderly people.

Epidemiological characteristics of burn injuries in Iraq: A burn hospital-based study

This study was conducted to determine the epidemiological and clinical characteristics of burn injuries, estimate the case fatality rate for burn patients, and determine the main determinants of the associated death among burn patients who were admitted to Baghdad Burn Hospital, Medical City Teaching Hospitals, Baghdad, Iraq during 2015. This study involved a retrospective review of medical records of all burn patients who were admitted to Baghdad Burn Hospital in 2015. Data were collected using a special form and included information on demographic characteristics and burn characteristics and outcomes. A total of 676 patients with burn were included in this study, who constituted 75% of admitted patients. The remaining was admitted for treatment of old scars. About one third of patients (37.0%) aged 21-30 years, 67.1% were males, 34.8% were military personnel, and 60.7% of the patients had primary school education. About 71.6% of patients were burned by flame and 23.4% were burned by hot fluid. Half of patients had a second degree burns. Almost half of patients had 11-20% of their body surface area affected. About 13% of patients died, mainly due to multiple organs failure (53.3%), septicemia (44.4%), and shock (2.2%). In conclusion, young adults and children, males, and low educated patients represent the majority of admitted burn cases in Iraq. Flame and scalds were the most important causes of burn. More than one tenth of patients died mostly due to septicemia and multi-organ failure.

Epidemiology and outcome analysis of 6325 burn patients: a five-year retrospective study in a major burn center in Southwest China

Burns are a major cause of injury worldwide. We investigated the epidemiology and outcomes of burn patients in a major burn center in southwest China between 2011 and 2015 to provide guidance for burn prevention. Of the 6,325 included burn patients, 66.8% were male and 34.7% were 0 ~ 6 years old. The incidence of burns peaked in autumn. Scald was the most common cause of burns, which was predominant in patients aged 0 ~ 6 years. The mean total body surface area (TBSA) of burns was 13.4%, and patients with burns ≤10% TBSA comprised 64.1% of all cases. Patients with full-thickness burns accounted for 40.1% of all patients and 81.0% of operated patients; these burns were primarily caused by flame (34.8%), scald (21.0%), and electricity (20.4%). Fifty-six deaths occurred (mortality 0.9%), and risk factors included full-thickness burns, larger TBSA and older age. The median length of stay was 17 days, and major risk factors included more operations, better outcomes and larger TBSA. Our data showed that closer attention should be paid to children under 6 years old, males, incidents in autumn and scald burns to prevent burn injuries. Furthermore, individualized burn prevention and treatment measures based on related risk factors should be adopted.

Recent trends in burn epidemiology worldwide: A systematic review

Burns have been more prevalent among low socioeconomic populations and in less developed regions. Incredible advances in burn care and social development over the recent decades, however, should have placed the incidence and severity of burns in a downwards trend. The aim of this review was to give an overview on current trends in burn epidemiology across the world. Also the socioeconomic development in countries that have published epidemiological data used in this study has been taken into account when comparing the results. There was a worldwide downwards trend of burn incidence, burn severity, length of hospital stay, and mortality rate. These findings were particularly pronounced in very highly developed countries. Data from highly and medium developed countries were more heterogeneous. No studies could be obtained from low and middle income countries. Comparisons between the different studies were compromised by the fact that studies emerged from specialized facilities on one hand and general hospitals on the other. Analyzed studies were also frequently focusing on limited patient populations such as "children" or "elderly". Our findings indicate the need for an international burn database with a minimal data-set in order to obtain objective and comparable results in respect of burn epidemiology.

Variation of surface temperatures of different ground materials on hot days: Burn risk for the neuropathic foot

The purpose of this study is to assess the relationship between ambient temperature and surface temperatures of commonly used building/ground materials, in order to estimate the risk of contact thermal injury. It is an observational study where the air ambient temperature and the surface temperatures of slate, metal, cement, sand, brick and bitumen, were measured, in shaded and unshaded conditions, on cloudy and cloudless days in summer in Adelaide, South Australia. All unshaded surfaces reached temperatures capable of causing significant sole of foot burns given requisite exposure time in both clear and overcast conditions, even with a relatively low ambient temperature. Shade imparted total protection from irreversible thermal injury for all of the ambient temperatures assessed. Although surface temperatures were reduced in overcast conditions, the temperatures recorded were still capable of causing thermal injury. Peripheral neuropathy prolongs heat exposure times, often resulting in significant and complex injury, requiring lengthy treatment and generating potentially poor functional outcomes. This study provides a reference point for the enactment of preventative measures for at risk population groups such a diabetics.

Decadorial of a burn center in Central India

Introduction:

Burn injuries are a serious public health problem. In our study we have identified different epidemiological factors based on 10 years of our experience at a burn unit in central India and recommend some strategies to prevent burn injuries.

Materials and Methods:

This is a retrospective analysis (2001-2010) of database from burn unit of S.S. Medical College, Rewa, India.

Results:

2499 patients with burn injury were analysed. 66.8% and 38.2% patients were females and males respectively, with a median age of 25 years. Flame (80.1%) was most common cause, home (96%) was most common place, traditional Indian stove (28.8%), kerosene lamp (26.7%), hot liquid (12.2%) and kerosene stove (10.4%) were common causes. Median Total Body Surface Area (TBSA) burn was 40.0%; females had significantly greater (P < 0.001) burn than males (median 50% vs 26.0%). High mortality (40.3%) seen; female sex (OR 3.22, 95% CI 2.65-3.92); young age (15-29 year) (OR 3.48, 95% CI 2.45-4.94); flame burn (OR 12.9, 95% CI 1.69-98.32); suicidal burn OR 6.82 95%CI 4.44-10.48) and TBSA > 76% (OR 3099, 95%CI 1302-7380) were significant risk factors for death. Median hospital stays was 8 days; shorter hospital stays seen among TBSA burn > 76% (2 days), suicidal intent (4 days), and those who expired (4 days). Septicemia (45.8%) and burn shock (41%) were the major cause for death.

Conclusions:

Cooking and lighting equipments are major cause of burn injury among females and young age group. Equipment modification to improve safety features and public awareness programs are necessary to reduce burn incidents.

Predictive factors of mortality in burn patients

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.

Validation of predictive factors of dysphagia risk following thermal burns: a prospective cohort study

PURPOSE

The objective of this study was to prospectively evaluate the validity and reliability of a risk factor model developed for use in predicting dysphagia risk within the first 24 h after injury/hospitalisation in patients with thermal burns.

METHOD(S)

Three hundred and fifty six patients with thermal burns, with or without inhalation injury, who were consecutively admitted to and received management at a quaternary state-wide burn center over a 12 month period, were included. Patients were reviewed for dysphagia risk by nursing staff using an established set of predictive factors. If risk factors for dysphagia were present, referral to speech-language pathology was initiated to investigate swallow function.

RESULT(S)

Of the 356 admissions, 83 patients were identified as meeting one or more risk criteria for dysphagia after burn. Of these, 24.9% (n = 30; 8.42% of the total cohort) presented with dysphagia. Using these criteria, sensitivity and specificity for detection of dysphagia risk were high (100% and 83.74%, respectively). The criteria over identify patients who may be at risk of dysphagia and who require dysphagia assessment (positive predictive value = 36.14%). However, as a set of predictors of dysphagia risk when thermal burn is the only complaint, a negative result reassures that a patient does not have dysphagia (negative predictive value = 100%).

CONCLUSION

Overall, the risk factor model provided a valid measure for predicting dysphagia risk. Incorporating these criteria into a dysphagia screening assessment can ensure an evidence-based pathway for early detection and timely referral to speech-language pathology for patients at risk of dysphagia after thermal burns.

Physiological responses to maximal exercise testing and the modified incremental shuttle walk test in adults after thermal injury: a pilot study

The ongoing hypermetabolic response associated with burn injury contributes significantly to loss of function, morbidity, and mortality. Exercise is strongly recommended to assist recovery and overall functional outcome. To date, there have been limited studies investigating the validity and practicality of both maximal laboratory and field tests in adult burns survivors. The objective of this study was to determine the metabolic and ventilatory response to cardiopulmonary maximal exercise testing (CPET) and the modified shuttle walk test (MSWT) in adult burns patients. Fifteen people (13 male) with a mean TBSA of 38.5% (16.0%) underwent both MSWT and CPET within a 5-day period in random order. The majority of participants demonstrated a normal response to CPET. Two participants with a history of inhalation burns demonstrated a respiratory limitation to exercise with desaturation (91 and 89%) at the end of the CPET, which returned to normal within 2 minutes after exercise. The correlation between VO(2peak) as measured via CPET and distance as measured in MSWT was 0.7. Mean results measured in MSWT for maximal heart rate and perceived exertion scores were lower than those achieved with CPET results: 91 and 88%, respectively. There were no adverse events during both the MSWT and CPET. This study demonstrates that after burn injury, CPET and MSWT can be performed safely in the majority of patients early in the postdischarge rehabilitation period. MSWT is likely to be submaximal at 80 to 90% of CPET results but is easy to replicate and cost-effective, thus a viable mechanism for monitoring aerobic capacity.

Mortality after thermal injury: no sex-related difference

BACKGROUND

Young women have been reported to be more likely to survive than men after severe trauma. Girls also have less inflammation and hypermetabolism after major burns. Yet burned women have been found to have a twofold greater risk of death than men. Our aim was to find out if there is a sex-related difference in mortality after thermal injury, particularly in the age group between 16 years and 49 years, when hormonal differences would be most influential.

METHODS

All patients admitted to the Linköping University Hospital Burn Unit with thermal injuries during the years 1993-2008 were included and the variables percentage burned total body surface area (TBSA%), age, type of burn, mechanical ventilation, and year were included in a multiple regression (Poisson log) model.

RESULTS

Of 1,119 patients with thermal injury, 792 (71%) were men. Crude mortality was 5% among men, and 8% among women (p = 0.04). After adjustment for age and TBSA%, there was no correlation between mortality and sex, in any age group. Eight men and four women died in the group of young adults (16-49 years) in which TBSA% correlated with mortality (p < 0.01) but age did not. Mortality was 14% (32 of 221) among the men and 23% (23 of 102) of women in the group of older adults (50 years and older), and both age and TBSA% correlated with mortality (p < 0.001).

CONCLUSIONS

There is no relevant sex-related difference in survival after thermal injury. The conclusion is, however, tempered by the few deaths, particularly among younger adults.

The role of marital status, literacy, and urbanity in suicidal behavior by burns in the province of Khorasan, Iran

A prospective study of all suicidal behaviors by burns requiring hospitalization was conducted in the province of Khorasan, Iran, from March 21, 2005 to March 20, 2006, to examine marital status, urbanity and literacy among these patients. Data were obtained through interviews during the course of hospitalization. A total of 130 patients with suicidal behavior by burns were identified (incidence rate of 2.9 per 100,000). Females had a higher rate of suicidal behavior by burns than males (4.2 vs. 1.6 per 100,000, P < 0.001). The rate of suicidal behavior by burns was higher among single persons than married persons (4.3 vs. 3.5 per 100,000). The rate of suicidal behavior by burns among the rural population was slightly higher than the urban population (3.2 vs. 2.7 per 100,000). The high rate of suicidal behavior by burns among young, married women in Khorasan is a social tragedy.

Prevention-oriented epidemiology of burns in Ardabil provincial burn centre, Iran

In preventing burns, it is essential to know how they occur and which population groups, environments and heating appliances can be targeted for prevention work. The aim of this study was to determine the epidemiological characteristics of burns leading to hospitalisation in the northwest of Iran with a focus on the pre-event phase of injury. Between 2007 and 2008, 237 burn victims hospitalised in Ardabil provincial burn centre were enrolled into a descriptive study. A questionnaire was filled in during hospital stay for all patients, with a focus on obtaining information necessary for prevention purposes. Males constituted 56% of victims. Mean age was 22 years. The most severe burns occurred between the ages of 18 and 32 years, and were mainly flame related. Both in case of flame and non-flame burns, women suffered more severe burns and mortality than men. However, with respect to non-flame burns of which most were scalds, the majority of the severe cases involved children under the age of 5 years. More than 80% of burns occurred at home. The kitchen was the main place of injury in 47% of cases, followed by living rooms in 28%. Nearly 45% of burns were scalds and 47% were flame burns. The main container was the samovar in 37%, followed by kettles in 32% and pots in 22%. The overturning of a container was the major mechanism of contact with hot liquids in 86%. Bumping into a container was the main scenario of a scald injury, constituting nearly 70% of the cases. The difference between flame and non-flame burns in the distribution of burns in extremities was not statistically significant, but head and neck burns were 3.7 times more likely to be caused by flame. The two most important injury patterns, more common among women, were getting burned while using a camping gas stove or while refilling the chamber of kerosene-burning appliances without first extinguishing them. Domestic burns among children and young women are a priority in injury-prevention programmes. Camping gas stoves, valors (traditional dual-purpose heating and cooking appliances) and samovars can be considered as target appliances for burn-specific home-safety-promotion efforts in this area or in similar settings.

Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality

INTRODUCTION

Burn injury is a serious pathology, potentially leading to severe morbidity and significant mortality, but it also has a considerable health-economic impact. The aim of this study was to describe the European hospitalized population with severe burn injury, including the incidence, etiology, risk factors, mortality, and causes of death.

METHODS

The systematic literature search (1985 to 2009) involved PubMed, the Web of Science, and the search engine Google. The reference lists and the Science Citation Index were used for hand searching (snowballing). Only studies dealing with epidemiologic issues (for example, incidence and outcome) as their major topic, on hospitalized populations with severe burn injury (in secondary and tertiary care) in Europe were included. Language restrictions were set on English, French, and Dutch.

RESULTS

The search led to 76 eligible studies, including more than 186,500 patients in total. The annual incidence of severe burns was 0.2 to 2.9/10,000 inhabitants with a decreasing trend in time. Almost 50% of patients were younger than 16 years, and ~60% were male patients. Flames, scalds, and contact burns were the most prevalent causes in the total population, but in children, scalds clearly dominated. Mortality was usually between 1.4% and 18% and is decreasing in time. Major risk factors for death were older age and a higher total percentage of burned surface area, as well as chronic diseases. (Multi) organ failure and sepsis were the most frequently reported causes of death. The main causes of early death (< 48 hours) were burn shock and inhalation injury.

CONCLUSIONS

Despite the lack of a large-scale European registration of burn injury, more epidemiologic information is available about the hospitalized population with severe burn injury than is generally presumed. National and international registration systems nevertheless remain necessary to allow better targeting of prevention campaigns and further improvement of cost-effectiveness in total burn care.

Pediatric burn injuries treated in US emergency departments between 1990 and 2006

OBJECTIVE

The goal was to examine comprehensively the patterns and trends of burn-related injuries in children, adolescents, and young adults treated in US emergency departments between 1990 and 2006.

METHODS

Through use of the National Electronic Injury Surveillance System database, cases of nonfatal burn-related injuries were selected by using diagnosis codes for burns (scalds, thermal, chemical, radiation, electrical, and not specified). Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 10000 individuals <or=20 years of age. Computation of relative risks with 95% confidence intervals was performed.

RESULTS

An estimated 2054563 patients <or=20 years of age were treated in US emergency departments for burn-related injuries, with an average of 120856 cases per year. Boys constituted 58.6% of case subjects. Children <6 years of age sustained the majority of injuries (57.7%), and more than one half of all injuries (59.5%) resulted from thermal burns. The body parts injured most frequently were the hand/finger (36.0%), followed by the head/face (21.1%). Of the 1542913 cases for which locale was recorded, 91.7% occurred at home. The rate of burn-related injuries per 10000 children decreased 31% over the 17-year time period.

CONCLUSIONS

Burn-related injuries are a serious problem for individuals <or=20 years of age and are potentially preventable. Children <6 years of age consistently sustained a disproportionately large number of injuries during the study period. Increased efforts are needed to improve burn-prevention strategies that target households with young children.

The epidemiology of burn injuries in an Australian setting, 2000-2006

OBJECTIVES

To describe presentation characteristics of burn leading to death or hospital treatment (i.e. inpatient admissions and emergency department [ED] presentations) across the state of Victoria, Australia, for the years 2000-2006 inclusive.

METHODS

Data were provided by the Victorian Injury Surveillance Unit (VISU) from three different datasets pertaining to burn deaths, hospital inpatient admissions and non-admitted ED presentations. Population estimates were derived from census data provided by Australian Bureau of Statistics.

RESULTS

During the 7-year period, 178 people died and 36,430 were treated for non-fatal burn injury, comprising 7543 hospital admissions and 28,887 non-admitted ED presentations. Males, children aged less than 5 years of age, and the elderly (> or =65 years of age) were at the highest risk of injury. Contact with heat and hot substances represented the major aetiological factor contributing to thermal injuries accounting for 64% of all hospital admissions and 90% of ED presentations. Temporal trends indicate no change in the population rate of burn deaths or hospital admissions during the study period.

CONCLUSIONS

ED presentations and hospital admissions and deaths have remained the same over this study period, but rates of burn remain high in males, children and the elderly. This could be due to variations in the implementation of government prevention and control programs and the divergence in efficient treatments and clinical practices amongst hospital care providers. Therefore, educational efforts for prevention should be the keystone to minimise the incidence of burns.

A population-based study of the epidemiology of acute adult burn injuries in the Calgary Health Region and factors associated with mortality and hospital length of stay from 1995 to 2004

INTRODUCTION

Trauma resulting from acute burns is relatively common and we wished to study the incidence, outcomes and factors related to mortality and hospital length of stay to identify potential areas of prevention and improve the care of burn-injured patients. To do so, we studied a population of adult burn injury patients from a large area of Canada (the Calgary Health Region (CHR) over a 10-year period. Burn data from this population-based sample has never been published and is not currently included in the American Burn Association Repository report.

METHODS

We extracted data on all adult (>or=18 years) residents of the CHR who suffered a burn injury requiring hospital admission between January 1995 and December 2004. Of particular interest were patient demographics, incidence and mortality rates of the victims as well as any factors that were associated with mortality or increased length of hospital stay.

RESULTS

A total of 928 burn-injured patients were identified. The highest incidence of burn injury admissions in the CHR occurred in 1996 (12.2 burn injury admissions per 100,000 population) and 2004 (12.3 admissions per 100,000 population). The largest number of burn injury admissions occurred during the months of July and August (23.3%), while the fewest occurred during the winter months of February and December (11.9%). Mean patient age was 45.2 years (range 18-97) and 658 (70.9%) were male. The majority of our patients were admitted with second-degree burns (48.7%) and burns of the head and neck were the most prevalent (22.2%). The mean length of hospital stay for burn patients was 20.4 days (range 1-312). Over the course of the 10 years of the study, 9 (1.0%) burn patients died during their hospital stay. In univariate analyses, burn survivors differed significantly from non-survivors with respect to mean age, burn degree, body part burned and year of admission. In adjusted analyses, survivors and non-survivors differed significantly with respect to year and month of admission, degree of burn, patient age and length of stay. Factors significantly associated with increase length of hospital stay included degree of burn, older patient age and hospital site.

CONCLUSIONS

In this Canadian health region, patients who die from burns tend to be older, present to the hospital during the winter months, and suffer more acute burns to the torso or multiple body regions. Additionally, patient length of stay is influenced by older patient age and greater burn thickness.

Elderly burn prevention: A novel epidemiological approach

OBJECTIVE

To develop burn prevention strategies for the elderly population in Hong Kong using a novel epidemiological approach.

METHODS

Medical records of all patients aged 60 or above who were admitted to our hospital in a 6-year period were reviewed and demographic data, injury characteristics, details of management and outcome were obtained. Selected interviews were undertaken to determine the exact mechanisms of injury and further details of the medical and social background.

RESULTS

Fifty-nine elderly patients were identified from the medical records with under half (42%) aged 75 and above. Male to female ratio was 1:1.68. Three-quarters of the injuries occurred at home, principally in the kitchen and bathroom. Two-thirds of the burns were scalds. Forty-eight percent of the admitted patients had surgery. Thirty-seven patients (or next of kin) were interviewed further. Of the subgroup only 12% had received appropriate first aid and 27% had treatment delayed for over 24 h before seeking medical help. The majority of patients had little or no formal education and one quarter were living alone.

CONCLUSION

We identified common scenarios of elderly burns which could be used to focus prevention strategies.

INCREASING NUMBERS OF ADMISSIONS TO THE ADULT BURNS SERVICE AT THE ROYAL ADELAIDE HOSPITAL 2001?2004

BACKGROUND

The purpose of the study was to illustrate the increasing trend in the number of adult burns patients admitted to the Royal Adelaide Hospital and attempt to explain it and to describe the burn patients admitted to the Royal Adelaide Hospital in terms of age, sex, origin, cause and burn size, particularly since the increasing trend began, in an effort to identify a particular group or burn cause, which may make up a large proportion of the increasing numbers.

METHODS

A retrospective review of 1548 acute burn-injured patients using information from the burns unit database between 1996 and 2004 was carried out.

RESULTS

Of 1841 total admissions, 1548 were admitted for acute burn injury. There has been an increase in the number of admissions since 2001 amounting to approximately 20% per annum. The cumulative rise in total admissions 2000-2004 is 107% where the increase in acute burn admission in the same period is 82%. There appears to be no difference whether the patient is from a rural or a metropolitan area. Burns of <10% total body surface area constitute most of the increase and are mainly flame and scald injuries. Chemical and contact burns are proportionately increasing.

CONCLUSION

The increase in acute admissions is mainly due to the increasing presentation of smaller burns to the unit. The statewide rural burn education programme and media exposure following the 2002 Bali bombings may have contributed to the increase in acute admissions.

Burns in Sweden: An analysis of 24538 cases during the period 1987–2004

Burn care is always progressing, but there is little epidemiological information giving a clear picture of the current number of treated burns in Sweden. This study was conducted to provide an update of patients admitted to hospital with burns in Sweden. Data were obtained for all patients who were admitted to hospitals with a primary or secondary diagnosis of burns (ICD-9/10 codes) from 1 January 1987 to 31 December 2004; 24,538 patients were found. Most of the patients were male (69%), giving a male:female ratio of 2.23:1. Children in the age-group 0-4 years old predominated, and accounted for 27% of the study material. The median length of stay was 3 days. Throughout the period 740 patients (3%) died of their burns. Significant reductions in mortality, incidence, and length of stay were seen during the study, which correlates well with other studies. However, most of the reductions were in the younger age-groups. Men accounted for the improved mortality, as female mortality did not change significantly. We think that the improvement in results among patients admitted to hospital after burns is a combination of preventive measures, improved treatment protocols, and an expanding strategy by which burned patients are treated as outpatients.

Study of burn deaths in Nagpur, Central India

A series of 384 victims of burn deaths were reviewed to determine the trends of burn deaths in Nagpur, an urban area of Central India. It was found that deaths due to burning accounted for 21.6% of the total medicolegal deaths. Female (74.2%) predominance was seen in burning with male-female ratio equal to 1:2.9. Most of the victims of burn deaths were between 11-40 years with peak at 21-30 years (47.1%). Married (79.9%) outnumbered unmarried ones in burning. Accidental burning (75%) was the commonest manner of burn deaths followed by suicidal and homicidal burning. Kerosene was the main causative factor for burning with kerosene burner as the commonest causative agent. The kitchen (69.3%) was the commonest place of burning and clothes of the body, particularly the sari as the commonest vehicle of burns.

The role of the bronchial circulation in the acute lung injury resulting from burn and smoke inhalation

Smoke inhalation in burn patients is a serious medical problem around the world. Inhalation injury increases mortality in addition to increasing infections, ventilator-days, and hospital stays. There are also large numbers of patients subjected to smoke inhalation without burns from cooking fires, burning crops and forest fires. The injury results in a fall in arterial oxygenation as a result of airway blockade, increased pulmonary transvascular fluid flux and loss of hypoxic pulmonary vasoconstriction. The changes in cardiopulmonary function are mediated at least in part by reactive oxygen and nitrogen species. Nitric oxide (NO) is generated by both inducible and constitutive isoforms of nitric oxide synthase (NOS). NO combines with superoxide to form reactive nitrogen species such as peroxynitrite. These reactive nitrogen species can be detected by measuring their reaction products such as 3-nitrotyrosine. The latter is elevated in the airway following smoke/burn injury. The control of NO formation involves poly (ADP ribose) polymerase (PARP) and its ability to up-regulate the activity of nuclear transcription factors through ribosylation. Present data also support a major role for the bronchial circulation in the injury since blockade of bronchial blood flow will also minimize the pulmonary injury. The data suggest that cytotoxins or activated cells are formed in the airway and carried to the parenchyma. These materials cause the formation of oedema and a reduction of PaO(2).