The Occurrence and Seasonal Variation of Accelerant-Related Burn Injuries in Central Florida

Profile of patients with burns according to seasonal changes

OBJECTIVE

In this study, the aim was to discuss the effects of seasonal changes on the patient profile and number of patients hospitalised at our burn centre.

METHOD

All cases of burns that occurred between 1 January 2014 and 1 January 2020 at our hospital were investigated.

RESULTS

In total, 1417 patients were investigated, 799 of whom were male (56.4%) and 618 (43.6%) were female. The number of patients with burns in the 1-4 years age group was the highest of all the age groups. Scald burns and electrical burns were mostly observed in the spring; flame burns were mostly observed in the winter, and hot object contact and chemical burns were mostly observed in the summer. When considered in total, burn cases were mostly observed in spring and autumn.

CONCLUSION

Understanding seasonal epidemiology of burn injuries can facilitate seasonal injury prevention campaigns and education efforts. Burn centres can also allocate resources appropriately, according to the patient volume and possible burn outcomes for each season.

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.

A Regional Analysis of Potentially Preventable Injuries Sustained From Burning Garbage and Yard Waste

Due to high prevalence in the south, understanding the injury pattern, healthcare burden, and cost of burn injuries associated with burning yard and trash debris are important for effective prevention. This 5-year retrospective, single-center study included patients sustaining an open flame burn injury due to burning brush or trash. Based on primary residence of the 136 patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment, and 18% did not have access. The median (Q1 and Q3) age and total body surface area (TBSA) burned was 50 (32, 66.5) years and 5% (2.5, 12), respectively, with 36% having some portion of full-thickness injury. One-third had some form of substance use. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 hospital days utilized (~6.6% of available bed-days per study period). Twenty-five percent were discharged with a paired functional status worse than pre-injury. Patients with some degree of pre-injury function limitations had a 3-fold higher length of stay (10 vs 3 days; P = .023). Patients with lower pre-injury functionality had almost four times higher mortality (23.7% vs 6.3%; P = .085). There were 9 (6.7%) deaths with an average (±SD) of 74.3 ± 13.1 years of age, median of 33% (31, 43) TBSA, and median full-thickness TBSA of 32% (21, 44). Total hospital charges exceeded $32.6 million with a median of $32,952.26 ($8,790.48, $103,113.95) per patient. Focusing future outreach efforts on education and resource availability may prevent future waste-burning injuries.

Burns During Coronavirus Disease 19 Lockdown: a Multi-Center Retrospective Study in Israel

The coronavirus disease 2019 (COVID-19) pandemic forced many countries into lockdowns to limit the spread of infection. Israel's containment measures included school closures, mobility restrictions, and workforce reductions. Our study evaluated the effect of COVID-19 on the occurrence and patterns of burn injuries. The study data was obtained via retrospective chart review of burn patients treated between March 15, 2020 and April 30, 2020, namely the period of strict national lockdown. This data was compared against data from paralleling periods between 2017 and 2019. A total of 686 patients were treated for burn injuries in the two study periods. Age group analysis revealed an increased ratio of pediatric patients aged 0-3 years during the lockdown (55.91% vs 40.79%, P = .002). In contrast, there were fewer patients presenting with burn injuries in the 7-16 and 17-29 age groups (9.66% vs 3.15%, P = .017; 16.46% vs 7.09%, P = .007, respectively). During both study periods, scald injuries were the most common burn etiology and burn injuries occurred most often at home. This predominance was further pronounced during the lockdown (71.65% vs 58.68%, P = .007; 90.55% vs 74.60%, P = .0001, respectively). The lockdown period underlined the danger faced by pediatric patients in their household environment. This danger was possibly compounded by an improper level of adult supervision as parents transitioned to remote work. These findings can educate us about factors that render burn injuries more likely not only during lockdowns, but also during regular times, thus shaping the development of burn prevention practices.

Seasonal effects on the mechanisms of burn injuries

Objective: This study aimed to evaluate seasonal effects on the mechanisms of burn injuries in patients requiring hospitalization.

Material and Methods: A retrospective evaluation was made using the information of 419 hospitalized burns patients, including demographic data, degree and percentage of burn injury, cause and mechanism of burn injury, morbidity and mortality. Burn mechanisms were grouped as thermal burns (flame, boiling liquid, contact), chemical burns and electrical burns. When calculating the percentage of body surface area burned, the rule of nines was applied. Seasonal classification was made appropriate to the northern hemisphere.

Results: According to the seasons, the most burns were seen in spring months (n= 130, 31.0%). In the examination of the mechanism of burn injury, the most common type of injury was boiling liquid in 159 patients followed by flame injury in 146 patients. There was an increase in electrical and chemical burns in spring and summer. A statistically significant difference was determined between the types of burns according to the seasons (p= 0.024). The burn injury occurred as a result of a workplace accident in 82 cases, the majority of which were in autumn, and summer, and the difference in the seasons was determined to be statistically significant (p= 0.045). There was a statistically significant increase in the exposure of individuals aged >65 years to boiling liquid burns in winter and summer months (p= 0.014).

Conclusion: The results of this study showed a seasonal effect on the types of burn injuries. A higher rate of thermal burns was expected to be found in winter, but this was not the case in patients with indications for hospitalization, as chemical and electrical burns in workplace accidents were seen more frequently in warmer seasons of spring and summer. In this context, burns units should be prepared for patient profiles to vary according to the season.

Trends in Burn Injuries in Northern Israel During the COVID-19 Lockdown

Coronavirus disease 2019 obliged many countries to apply lockdown policies to contain the spread of infection. The restrictions in Israel included limitations on movement, reduction of working capacity, and closure of the educational system. The present study focused on patients treated at a referral center for burns in northern Israel. Their goal was to investigate temporal variations in burn injuries during this period. Data were retrospectively extracted from the medical records of burn patients treated at our hospital between March 14, 2020 and April 20, 2020 (ie, the period of aggravated lockdown). Data from this period were compared with that from paralleling periods between 2017 and 2019. During the lockdown and paralleling periods, 178 patients were treated for burn injuries, of whom 44% were under 18. Although no restrictions were enforced during the virus outbreak period with regard to seeking medical care, we noticed a decrease in the number of patients admitted to the emergency room for all reasons. Of particular interest was a 66% decrease in the number of adult burn patients (P < .0001). Meanwhile, among the pediatric population, no significant decrease was observed. Nonetheless, subgroups with higher susceptibility to burn injuries included children aged 2 to 5 years (56.3% vs 23.8%, P = .016) and female patients from all pediatric age groups (57.1% vs 25%, P = .027). These findings may be explained by the presumably busier kitchen and dining areas during the lockdown. Overall, the study results can assist with building a stronger understanding of varying burn injuries and with developing educational and preventive strategies.

Accelerant-related burns and drug abuse: Challenging combination

BACKGROUND

Accelerants are flammable substances that may cause explosion when added to existing fires. The relationships between drug abuse and accelerant-related burns are not well elucidated in the literature. Of these burns, a portion is related to drug manufacturing, which have been shown to be associated with increased burn complications.

OBJECTIVES

1) To evaluate the demographics and clinical outcomes of accelerant-related burns in a Provincial Burn Centre. 2) To compare the clinical outcomes with a control group of non-accelerant related burns. 3) To analyze a subgroup of patients with history of drug abuse and drug manufacturing.

METHODS

Retrospective case control study. Patient data associated with accelerant-related burns from 2009 to 2014 were obtained from the British Columbia Burn Registry. These patients were compared with a control group of non-accelerant related burns. Clinical outcomes that were evaluated include inhalational injury, ICU length of stay, ventilator support, surgeries needed, and burn complications. Chi-square test was used to evaluate categorical data and Student's t-test was used to evaluate mean quantitative data with the p value set at 0.05. A logistic regression model was used to evaluate factors affecting burn complications.

RESULTS

Accelerant-related burns represented 28.2% of all burn admissions (N=532) from 2009 to 2014. The accelerant group had higher percentage of patients with history of drug abuse and was associated with higher TBSA burns, ventilator support, ICU stay and pneumonia rates compared to the non-accelerant group. Within the accelerant group, there was no difference in clinical outcomes amongst people with or without history of drug abuse. Four cases were associated with methamphetamine manufacturing, all of which underwent ICU stay and ventilator support.

CONCLUSIONS

Accelerant-related burns cause significant burden to the burn center. A significant proportion of these patients have history of drug abuse.

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

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

[Secondary plastic and reconstructive measures following deep-dermal burn injuries : Negligent use of bioethanol]

One representative case of burns caused by the negligent use of bioethanol, which was treated at our burns centre is used to illustrate the severity and depth of the burn injuries as well as the complexity of the further long-term course of treatment including complex secondary-reconstructive techniques.

Risk Factors for Inpatient Hospital Admission in Pediatric Burn Patients

Purpose

Our objective was to determine the risk factors for inpatient admission of pediatric burn patients.

Materials & methods

This cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the years of 2003, 2006, 2009, and 2012 to estimate the risk factors for inpatient admission for pediatric patients who sustained a burn injury. Patients who sustained a burn between the ages of 1 and 18 years were included.

Results

A total of 43,453 patients met inclusion criteria. Of those, 42.3% were Caucasian, 20.1% were African American, and 19.3% were Hispanic. Males comprised 63.5% of the studied population. The month of July was associated with a 31.8% increased chance (p=.011) of being admitted to hospital for a pediatric burn. It was found that patients being admitted had a 32.2% increased chance (p=.002) of a fluid and electrolyte abnormality and a 61.0% increased chance (p=.027) of drug abuse. 

Conclusions

Pediatric burn patients are more likely to be admitted to the hospital having a fluid and electrolyte abnormality, having a drug abuse status, and/or during the month of July.

Domestic bioethanol-fireplaces--a new source of severe burn accidents

BACKGROUND

Bioethanol-fueled fireplaces are popular interior home decoration accessories. Although their safety is promoted frequently, actual presentations of severe burn injuries in our burn intensive care unit (ICU) have focused the authors on safety problems with these devices. In this article we want to explore the mechanisms for these accidents and state our experiences with this increasingly relevant risk for severe burn injuries.

MATERIALS AND METHODS

The computerized medical records of all burn intensive care patients in our burn unit between 2000 and 2014 were studied. Since 2010, 12 patients with bioethanol associated burn injuries were identified. Their data was compared to the values of all patients, except the ones injured by bioethanol fireplaces that presented themselves to our burn ICU between the years 2010 and 2014.

RESULTS

At time of admission the bioethanol patients had a mean ABSI-score of 4.8 (+/- 2.2 standard deviation (SD)). A mean of 17 percent (+/- 9.1 SD) body surface area was burned. Involvement of face and hands was very common. An operative treatment was needed in 8 cases. A median of 20 days of hospitalization (range 3-121) and a median of 4.5 days on the ICU (range 1-64) were necessary. No patient died. In most cases the injuries happened while refilling or while starting the fire, even though safety instructions were followed. In the control group, consisting of 748 patients, the mean ABSI-score was 5.6 (+/- 2.7 SD). A mean of 16.5 percent (+/- 10.1 SD) body surface area was burned. Treatment required a median of 3 days on the burn ICU (range 1-120). Regarding these parameters, the burden of disease was comparable in both groups.

CONCLUSION

Bioethanol-fueled fireplaces for interior home decoration are a potential source for severe burn accidents even by intended use.

Health Impact Assessment of Cyclone Bejisa in Reunion Island (France) Using Syndromic Surveillance

Introduction

On January 2, 2014, Cyclone Bejisa struck Reunion Island (France). This storm led to major material damages, such as power outages, disturbance of drinking water systems, road closures, and the evacuation of residents. In this context, the Regional Office of French Institute for Public Health Surveillance in Indian Ocean (Cire OI) set up an epidemiological surveillance in order to describe short-term health effects of the cyclone.

Methods

The assessment of the health impact was based mainly on a syndromic surveillance system, including the activity of all emergency departments (EDs) and the Emergency Medical Service (EMS) of the island. From these data, several health indicators were collected and analyzed daily and weekly. To complete this assessment, all medical charts recorded in the EDs of Reunion Island from January 2, 2014 through January 5, 2014 were reviewed in order to identify visits directly and indirectly related to the cyclone, and to determine mechanisms of injuries.

Results

The number of calls to the EMS peaked the day of the cyclone, and the number of ED visits increased markedly over the next two days. At the same time, a significant increase in visits for trauma, burns, and carbon monoxide poisoning was detected in all EDs. Among 1,748 medical records reviewed, eight visits were directly related to the cyclone and 208 were indirectly related. For trauma, the main mechanisms of injury were falls and injuries by machinery or tools during the clean-up and repair works. Due to prolonged power outages, several patients were hospitalized: some to assure continuity of care, others to take care of an exacerbation of a chronic disease. An increase in leptospirosis cases linked to post-cyclone clean-up was observed two weeks after the cyclone.

Conclusion

Information based on the syndromic surveillance system allowed the authors to assess rapidly the health impact of Cyclone Bejisa in Reunion Island; however, an underestimation of this impact was still possible. In the near future, several lines of work will be planned by the authors in order to improve the assessment.

VilainP, PagèsF, CombesX, Marianne Dit CassouPJ, Mougin-DamourK, Jacques-AntoineY, FilleulL. Health impact assessment of Cyclone Bejisa in Reunion Island (France) using syndromic surveillance. Prehosp Disaster Med. 2015;30(2):1-8

To everything there is a season: impact of seasonal change on admissions, acuity of injury, length of stay, throughput, and charges at an accredited, regional burn center

PURPOSE

Although previous studies have investigated the impact of weather and temporal factors on incidence of trauma admissions, there is a paucity of data describing the effect of seasonal change on burn injury. The purpose of this study was to examine the impact of the changing seasons on admissions to and resource utilization at an accredited burn center, with the goal of optimizing patient throughput and matching supply with demand.

METHODS

We performed a retrospective review of all burn admissions to an accredited, regional burn center, from Summer 2009 through Spring 2010. Patients were segregated into the seasonal cohorts of Summer, Fall, Winter, and Spring, based on admission date. Patient demographics included age, gender, mechanism of injury, and total body surface area (TBSA) injured. Main outcome measures included length of intensive care unit (ICU) stay, length of stay (LOS), and hospital charges, which served as a proxy for resource utilization (nursing, wound, and critical care; access to operating room (OR); inpatient rehabilitation). Groups were compared by T tests, with statistical significance assigned to P values <0.05.

RESULTS

Seven hundred thirty patients were admitted to the burn center during this annual period, with a mean age of 31.6 years and a TBSA of 8.9%. Although Spring had the greatest the number of admissions at 219 (30%), patients from Summer and Winter had the largest burns, longest length of ICU and hospital stays, and highest hospital charges (P < 0.05). Furthermore, variability of these parameters, as measured by standard deviation, was greatest during Summer and Winter, serving to reduce throughput via uneven demand on resources. Highest throughput occurred during the Spring, which had the highest admission-to-LOS ratio. No differences were observed in age, gender, and incidence of electrical injuries, across the 4 seasons.

CONCLUSIONS

Summer and winter were the peak seasons of resource utilization at our burn center, in terms of length and variability of ICU and hospital stays, as well as total hospital charges. Such seasonal change may be related to acuity of burn injury but not number of burn admissions. To improve operational efficiency and maximize patient throughput, resource allocation should be structured to anticipate seasonal changes, so that supply of services matches demand.

Seasonality of child homicide

OBJECTIVE

To determine whether there is seasonal variation (by season and month of year) in homicides among young children.

STUDY DESIGN

Homicide deaths in children<or=5 years (n=797), as identified in death certificates from 5 states (Indiana, Ohio, Missouri, Oklahoma, and Washington), were analyzed for a seasonality effect in the years 1999-2006. Season and month of calendar year were used as categorical variables. A chi2 goodness of fit test was used to compare observed and expected proportions of homicides for the entire population. Stratified analyses of children dying before age 2 years and those dying between 2 and 5 years of age were also conducted.

RESULTS

The occurrence of homicide was proportional to the time interval in each category (P=.05). For the total population, there was no statistically significant variation between the expected and observed percentage of homicides by either season or month of calendar year (P=.46 and P=.74, respectively). For the stratified analyses, there was no statistically significant variation between expected and observed percentages of homicides by either season or month of calendar year for either population.

CONCLUSION

There is no seasonality to child homicides by month of year or season of year among young children in the examined population.