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Perkins LA, Lee JG, Santorelli JE, Strait E, Smith A, Costantini TW, Doucet JJ, Haines LN. The Scalding Truth: Geospatial Analysis Identifies Communities at Risk for Pediatric Scald Burns. J Surg Res 2024; 300:336-344. [PMID: 38843720 DOI: 10.1016/j.jss.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/21/2024] [Accepted: 05/08/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Pediatric scald burns account for 12% of all U.S. burn center admissions and are the most common type of burn in children. We hypothesized that geospatial analysis of burn registry data could identify specific geographic areas and risk factors to focus injury prevention efforts. METHODS The burn registry of a U.S. regional burn center was used to retrospectively identify pediatric scald burn patients ages 0-17, from January 2018 to June 2023. Geocoding of patient home addresses with census tract data was performed. Area Deprivation Index (ADI) was assigned to patients at the census block group level. Burn incident hot spot analysis to identify statistically significant burn incident clusters was done using the Getis Ord Gi∗ statistic. RESULTS There were 950 pediatric scald burn patients meeting study criteria. The cohort was 52% male and 36% White, with median age of 3 y and median total body surface area of 1.5%; 23.8% required hospital admission. On multivariable logistic regression, increased child poverty levels (P = 0.004) and children living in single-parent households (P = 0.009) were associated with increased scald burn incidence. Geospatial analysis identified burn hot spots, which were associated with higher ADI (P < 0.001). Black patients were more likely to undergo admission compared to White patients. CONCLUSIONS Geospatial analysis of burn registry data identified geographic areas at high risk of pediatric scald burn. ADI, poverty, and children in single-parent households were the greatest predictors of injury. Addressing these inequalities requires targeted injury prevention education, enhanced outpatient support systems and more robust community resources.
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Affiliation(s)
- Louis A Perkins
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California.
| | - Jeanne G Lee
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
| | - Eli Strait
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
| | - Alan Smith
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
| | - Jay J Doucet
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
| | - Laura N Haines
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
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Bagheri T, Fatemi MJ, Hoveidamanesh S, Ghadimi T, Asgari M, Rahbar A, Rahbar H, Momeni M. Epidemiology and Etiology of Pediatric Burns in Iran. J Burn Care Res 2024; 45:292-296. [PMID: 36350587 DOI: 10.1093/jbcr/irac140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 02/17/2024]
Abstract
Pediatric burns have long-term physical, psychological, economic, and social consequences for the patient and family. This study was designed to investigate the epidemiology, causes, and mechanism of pediatric burns in Iran, considering the impact the cultural and environmental differences of countries have on burn incidence. This study is a survey study that was performed from 2016 to 2017 on patients referred to Shahid Motahari hospital. Patients in the study included hospitalized children aged 0-18 years who themselves or their parents were able to answer questions. Questions were answered in the categories of the demographic characteristics of the child and parents, epidemiological characteristics of the burn, information on socio-economic and education status, and the underlying causes of the accident. Most burns occurred in the age group less than two years of age and in boys. The most common cause of burns was hot liquids. Collision with containers containing hot liquids inside the kitchen, collision with containers containing hot liquids outside the kitchen space, and overturning containers containing hot liquids were the most common mechanisms of burns. Flame burns were the most common cause of burns in school-age children. Half of the parents had an elementary level or lower education. Economic, social, and cultural conditions of families, parents' education, and access to preventive education are related to the extent and mechanism of burns. Paying attention to epidemiology and recognizing the main causes of child burns plays an important role in designing and planning preventive measures.
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Affiliation(s)
- Tooran Bagheri
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Tayyeb Ghadimi
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Arya Rahbar
- McMaster University, Hamilton, Ontario, Canada
| | - Hossein Rahbar
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Department of General Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
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Holm S, Tell K, Karlsson M, Huss F, Pompermaier L, Elmasry M, Löfgren J. Sociodemographic Patterns of Pediatric Patients in Specialized Burn Care in Sweden. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4246. [PMID: 35506021 PMCID: PMC9049026 DOI: 10.1097/gox.0000000000004246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED Trauma is a leading cause of mortality in children. Burns affect children disproportionally. Although burn incidence and mortality are decreasing, differences in the risk depend on socioeconomic status. The present study aimed to investigate the sociodemographic patterns of pediatric patients (0-17 years) managed at the two burn centers in Sweden, Uppsala, and Linköping, between 2010 and 2020. METHOD This retrospective register-based study used hospital records from the two burn centers combined with information from Statistics Sweden plus data regarding number of asylum seekers from the Swedish Migrations Agency. Choropleth maps representing the patients' geographical distribution were created. Information about income levels per geographic area was added. A Wilcoxon signed-rank test was performed to investigate differences in median income levels between the areas where the patients lived, related to Sweden's median income. RESULTS The study included 2455 patients. Most of the children aged below 5 years (76%) and were boys (60%). The mean percentage of total skin area was 4.2%. There was no significant increment or decrease in the incidence of pediatric burns during the study. Most patients with recorded zip codes lived in areas with an income level below the national median (n = 1974, 83%). Children with asylum status were over-represented compared with residents and/or Swedish citizens. CONCLUSIONS In Sweden, most pediatric burns occur in families that live in areas with low-income levels. Pediatric burns affect children with asylum status disproportionally compared with those who are residents in and/or citizens of Sweden. Prevention strategies should be designed and implemented to alleviate this health inequity.
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Affiliation(s)
- Sebastian Holm
- From the Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Katinka Tell
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Matilda Karlsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Fredrik Huss
- From the Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
- Department of Reconstructive Surgery, Karolinska University Hospital, Sweden
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Hunter MA, Schlichting LE, Rogers ML, Harrington DT, Vivier PM. Neighborhood risk: Socioeconomic status and hospital admission for pediatric burn patients. Burns 2020; 47:1451-1455. [PMID: 33934909 DOI: 10.1016/j.burns.2020.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Burn injury continues to cause significant morbidity and mortality in the US pediatric population. Many studies using inpatient samples have found a relationship between low socioeconomic status (SES) and burn injury. The purpose of our study was to evaluate the association between SES and the likelihood of admission for Emergency Department (ED) visits for pediatric burn injury. STUDY DESIGN A retrospective database review of pediatric ED visits for burn injury from a statewide hospital system, from January 1, 2005 to December 31, 2014. SES was assigned using an eight factor Neighborhood Risk Index (NRI) created from census block group data, with a higher score indicative of lower SES. The outcome measure was ED visits admitted to inpatient care. RESULTS We analyzed a sample of 1845 pediatric ED visits for burn injuries. Most visits were discharged from the ED (88.4%) while 10.5% were admitted to inpatient care and 1.0% were transferred to another hospital. In a multivariable logistic regression model, patients from high risk areas (>75th percentile NRI) had 1.58 higher odds of inpatient admission compared to patients from low risk areas (<75th percentile NRI; 95% CI: 1.08-2.30), after adjusting for age, gender, ethnicity, distance to the hospital, and previous ED visit for burn injury in the past 30 days. In addition, for every 1-mile increase in distance, a child's likelihood of admission increased by 6% (95% CI: 4-9%). CONCLUSIONS Children with a burn injury from the highest risk socioeconomic areas in Rhode Island had a higher likelihood of inpatient admission. Further research is needed to determine what factors associated with socioeconomic status impact this finding.
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Affiliation(s)
- Mary A Hunter
- Department of Surgery, Rhode Island Hospital, Providence, RI, United States; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, United States.
| | - Lauren E Schlichting
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, United States
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, United States; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - David T Harrington
- Department of Surgery, Rhode Island Hospital, Providence, RI, United States
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, United States; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States; Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, United States
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Padalko A, Cristall N, Gawaziuk JP, Logsetty S. Social Complexity and Risk for Pediatric Burn Injury: A Systematic Review. J Burn Care Res 2020; 40:478-499. [PMID: 30918946 DOI: 10.1093/jbcr/irz059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Social complexity in health outcomes has been attributed to greater risk of injury, adverse health consequences, and early death in a variety of populations. To determine what social complexity factors associated with burn injury in children, a systematic review of the literature was performed. Two different databases (PubMed and SCOPUS) were searched for articles related to environmental and social determinants of burn injury. Selected literature examined social complexity factors to establish the strength of evidence in relation to incidence of burn injury in children. The extent of factors and the most common social complexities were reviewed. The 641 manuscripts found in PubMed and 327 from SCOPUS were initially reviewed for duplication and English language. Subsequently, manuscripts were selected for relevance based on titles followed by abstracts. Forty-seven manuscripts were reviewed in their entirety. The literature supports a relationship between an increased incidence of pediatric burns in lower income families, children with behavioral disorders, fewer years of parental education and children residing in a rural setting. The majority of reports came from Europe followed by Australia, and scattered information from other countries. Social complexity factors in the environment of the child are associated with an increased risk of burn injury in children. The literature supports the influence of lower income, lower parental education, behavioral disorders and living rurally with an increased incidence of injury. By identifying children at increased risk, it is possible to develop targeted burn prevention and education programs to mitigate burn injury.
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Affiliation(s)
- Adam Padalko
- BSc Med Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nora Cristall
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Canada
| | | | - Sarvesh Logsetty
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Canada.,Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Sethi J, Gawaziuk JP, Cristall N, Logsetty S. The Relationship Between Income and Burn Incidence in Winnipeg, Manitoba, Canada: A Population Health Study. J Burn Care Res 2020; 39:645-651. [PMID: 29668999 DOI: 10.1093/jbcr/iry017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burns continue to be a common cause of morbidity around the world, and socioeconomic status has been linked to high-burn risk in developed and developing countries. The purpose of this study was to define in Winnipeg, Manitoba, Canada: 1) demographics of adult patients with severe burns; 2) the relationship between household income and burn incidence; and 3) specific geographic areas that may benefit from targeted burn prevention strategies. We conducted a retrospective study of adult (>18 years) patients in Winnipeg, with burns severe enough to require at least 1 day of hospitalization between 2006 and 2016. Area-level median household income data at two geographic levels were collected from 2011 Census based on patient postal codes. Of 207 patients that met study criteria, 156 (75.4%) were male. Mean age was 44.5 ± 16.9 years, and the most common cause of burns was fire/flame (52.2%). The analysis of income data revealed that lower area-level income groups had a higher incidence of burns, with the lowest income quintile group having 5.4 times higher incidence than highest income quintile group. Spatial analysis software was used to map the incidence rates, and clusters of high-risk burns were identified in and around the city center region. Overall, our study showed an inverse relationship between area-level income and burn injury incidence. The identification and mapping of high incidence hotspots will allow policy makers to target groups who will benefit most from burn prevention strategies.
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Affiliation(s)
- Japandeep Sethi
- College of Medicine, BSc Med Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Nora Cristall
- Manitoba Firefighters' Burn Program, Winnipeg, Manitoba, Canada
| | - Sarvesh Logsetty
- Manitoba Firefighters' Burn Program, Winnipeg, Manitoba, Canada.,Department of Surgery and Children's Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Buja Z, Hoxha E. Burns in Kosovo: Epidemiological and therapeutic aspects of burns treated in University Clinical Center of Kosovo during the period 2003–2012. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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