Increasing medical burden of child abuse

Scalds among children in Kuwait

In a prospective study of 560 children treated for burns as in-patients over a period of four-and-a-half years in specialized hospitals responsible for the majority of burn cases in Kuwait, 388 patients (69%) had sustained scalds. The mean age of these 388 children, between 0 to 12 years, was 3.02 +/- 2.08, and male to female ratio 1.5 to 1. They were categorized into three age groups, first, up to 1 year comprised 17.5% cases, who were solely dependent on parents or childminder; second 2 to 5 years of age, who were inquisitive, independent, pre-school children, and constituted the majority of cases (73%), and third 6 to 12 years who were 9.5% school children. The pre-school children (2-5 years) thus formed a highly vulnerable group in the country. Accidents (99.4%) occurred at home and the kitchen being the commonest place. The hot water from pan and pots in the kitchen was the most common etiologic factor in 229 cases (59%), followed by tea/coffee 20.7%, soup 9.0%, hot oil 6.7%, and milk 4.6% patients. The most common circumstance was the child upsetting the pan of hot fluid in the kitchen. The mean total body surface areas of second and third degree burns were 14.21 +/- 9.66 (range 1 to 60%). The average length of stay in the hospital was 16.90 +/- 15.74 days, varying from one to 109 days. Thirty-nine children were ill prior to burn, and the commonest disease was respiratory tract infection. Three patients (0.8%) with 3rd degree burns were treated with primary excision and grafting, and 137 (35.3%) needed secondary skin grafting for residual burn wounds. Four patients (1%) died, one due to burn shock, two due to septicemia and one due to multiorgan failure. There is need for general awareness through public education, which may lead to the prevention of significant number of such accidents.

Eight years experience of a regional burns unit in Saudi Arabia: clinical and epidemiological aspects

A retrospective analysis of 435 consecutive admissions to a regional burns unit over an 8-year period is presented. The majority were domestic accidents, while a few were suicidal and two were due to child abuse. Scalds were commoner than flame burns, 70.6 per cent were children under 12 years, 12.4 per cent had > 40 per cent TBSA affected, 66.9 per cent were deep partial or full thickness burns, 24.4 per cent had signs of shock on admission, 13.6 per cent had smoke inhalation injury. In spite of these known adverse factors the overall outcome was satisfactory, with a case fatality rate of 7.4 per cent and a residual disability rate of 10.8 per cent. Good initial resuscitation, a low infection rate (18.4 per cent) and the ready availability of appropriate surgical intervention (35.6 per cent), with good intensive care support, could account for the satisfactory outcome.