Epidemiology of burns in a teaching hospital in south India

The Epidemiology of Unintentional Burn Case in Sanglah General Hospital, Denpasar, from 2014 to 2018

BACKGROUND: Burn injury is one of the serious public health problems. Many of burn patients end up with experiencing disability (morbidity). Meanwhile, the epidemiology of burn patients in eastern part of Indonesia is rarely reported. AIM: We aimed to investigate the sociodemographic characteristic of burn patients in Sanglah General Hospital as the center referral hospital for eastern part of Indonesia. MATERIALS AND METHODS: Viable data were collected from burn patients admitted to Burn Center of Sanglah Hospital between January 2014 and December 2018. A cross-sectional study design was used with statistical analysis which was performed using IBM Statistics 23 for Windows. RESULTS: A total of 725 subjects were involved in this study. Subjects were divided into two groups of emergency (n = 607, 83.72%) and non-emergency (n = 118, 17.28%). There were 525 (72.4%) burn subjects who were ≥17 years old with combustion caused by flame as the most common case (n = 264, 56.9%), whereas 200 (27.6%) subjects were <17 years old, while the group of age 0–5 years old (n = 115, 57.5%) gave largest proportion admission in pediatric group of scalding as the main cause (n = 100, 69.4%). CONCLUSION: We found that adults and elders had the highest risk of acquiring combustion caused by flame. Scalding was the most burns case found in the pediatric population.

Post-Traumatic Stress Disorder (Ptsd) Following Burn Injuries: A Comprehensive Clinical Review

Burns are a global public health problem with a large number of psychosocial and psychological problems that may ensue after burn injuries. One of the commonest psychological problems seen after burn injuries is depression, anxiety and post-traumatic stress disorder (PTSD). The following paper reviews the existing literature on PTSD following burn injuries. The concept of PTSD is explained for the non-psychiatrist involved in burn rehabilitation. The various psychosocial factors that determine the causation and course of PTSD following burn injuries are discussed. PTSD following burn injuries in special populations like women, children and adolescents, intentional burns and self immolation are also discussed. The role of cultural factors in the development of PTSD are elucidated and future research needs are laid out. PTSD is a very common occurrence after burn injuries and needs a multidisciplinary team evaluation for its management.

Role of systemic antibiotic prophylaxis in acute burns: A retrospective analysis from a tertiary care center

INTRODUCTION

Burns are a worldwide problem with majority of them occurring in low and middle-income countries. The hurdles in treatment of burns in the resource restricted setting are unique and challenging. The role of intravenous antibiotics in reducing mortality and morbidity related to infection and sepsis has not been studied extensively in the Indian sub-continent.

MATERIALS AND METHODS

This was a retrospective study conducted at a tertiary burn care center in India over a period of six months with follow up of one month from the day of burn injury.

RESULTS

Data from a total of 157 patients were collected and analysed. In Prophylaxis group (n = 77), sepsis was detected in 33 patients and 38 patients expired. In No Prophylaxis group (n = 80), sepsis was detected in 37 patients and 40 patients expired. In Inhalational burns subgroup, patients belonging to Prophylaxis group (n = 30) had 20 patients diagnosed with pneumonia while 22 patients did not survive till 30th post burn day. Patients in No Prophylaxis group who had inhalational burns were 38 in number. Pneumonia was diagnosed in 29 of them while 27 did not survive till 30th post burn day. In Pneumonia subgroup, patients belonging to Prophylaxis group had lower mortality rate as compared to No Prophylaxis group.

CONCLUSION

Our study does not support the routine usage of antibiotic prophylaxis in patients with burn injuries, but their administration can be considered in certain specific subgroups like patients with inhalational burns and patients developing pneumonia. Pneumonia is an independent risk factor for mortality when no antibiotic prophylaxis is used in burn patients.

Geospatial Mapping as a Guide for Resource Allocation Among Burn Centers in India

Timely treatment is essential for optimal outcomes after burn injury, but the method of resource distribution to ensure access to proper care in developing countries remains unclear. We therefore sought to examine access to burn care and the presence/absence of resources for burn care in India. We surveyed all eligible burn centers (n = 67) in India to evaluate burn care resources at each facility. We then performed a cross-sectional geospatial analysis using geocoding software (ArcGIS 10.3) and publicly available hospital-level data (WorldStreetMap, WorldPop database) to predict the time required to access care at the nearest burn center. Our primary outcome was the time required to reach a burn facility within India. Descriptive statistics were used to present our results. Of the 67 burn centers that completed the survey, 45% were government funded. More than 1 billion (75.1%) Indian citizens live within 2 hours of a burn center, but only 221.9 million (15.9%) live within 2 hours of a burn center with both an intensive care unit (ICU) and a skin bank. Burn units are staffed primarily by plastic surgeons (n = 62, 93%) with an average of 5.8 physicians per unit. Most burn units (n = 53, 79%) have access to hemodialysis. While many Indian citizens live within 2 hours of a burn center, most centers do not offer ICU and skin bank services that are essential for modern burn care. Reallocation of resources to improve transportation and availability of ICU and skin bank services is necessary to improve burn care in India.

Impact of Ulinastatin on Outcomes in Acute Burns Patients

Burns is a global health problem with significant morbidity and mortality. Ulinastatin, a serine protease inhibitor, has the potential to improve outcomes in burns. A retrospective comparative case note review analysis was performed to assess the impact of ulinastatin on the outcomes in acute burns patients. Acute burns patients, admitted to Masina hospital, Mumbai, from October 2012 to April 2015, who received ulinastatin, were identified from the hospital records. A similarly sized cohort of patients, admitted before the introduction of ulinastatin, was also identified. Relevant data were obtained from archived patient files. The outcomes, mortality and length of hospital stay, were compared across different groups and subgroups. Data of 97 patients, 48 of whom received ulinastatin (ulinastatin group) and 49 of whom did not (control group), were captured. Patients in ulinastatin group had received ulinastatin 100,000 IU, 8 to 12 hourly, during a mean period of 8.8 days, based on clinical judgment, in addition to standard hospital care. The in-hospital mortality was lower (60.4%) in ulinastatin group compared with control group (75.5%). The difference in mortality was statistically significant (50% vs 77.27%; P = .04) in those with 41 to 80% burnt BSA. Mean length of hospital stay, where shorter duration of hospitalization is usually associated with death, was higher in ulinastatin group compared with the control group. Ulinastatin appears to reduce mortality in acute burns patients, especially in those with intermediate extent (40 to 80%) of burnt BSA. It also appears to delay death in those who ultimately succumbed to their burn injuries.

Clinical study of burn patients requiring admission: A single center experience at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences

Background:

Although burns are a major problem in health care, a lot of the variation in risk factors exists from region to region which if uncovered correctly could help take effective prevention measures.

Aims and Objectives:

To assess the 3-year (January 2012 to January 2015) epidemiology of burn injuries admitted to our hospital (primary objective) and to find areas of improvement in burn care (secondary objective).

Materials and Methods:

After obtaining ethical approval data were obtained from the medical record section regarding age, sex, residence, occupation, marital status, socioeconomic status, dates of admission and discharge, circumstances regarding the place, intent, cause, and source of heat. Clinical assessment was done using Wallace's “Rule of Nine” in adult and “Lund and Browder” chart in the pediatric age groups. The interrelationships between clinical and epidemiological variables with burn injury were studied.

Results:

An increasing trend in the admission rates of burn victims noted in last 3 years males (55.47%) outnumbered females (44.52%). The most common age group affected is older children, adolescents, and young adults (between 11 and 30 years). Flame (38.3%) and scald (25.3%) burns contributed to most of the injuries. Females (52.30%) are the major victim of flame burns. Electrical and chemical burns affected only the males suggesting work-related injuries. Trunk (30.8%) is the most severely affected site in all cases. Depression (6.8%) and power line workers (4.7%) seem to be important risk factors in our study. Inability to complete treatment (26.7%) was a major concern in our study.

Conclusions:

This study highlights the need for proper burn care that could be provided at the primary health-care level. The majority of burns were accidental in nature in school going children, young adults, and females. Flame and scald burns were the most common cause. Preventive measures directed toward burn safety and first aid measures may improve the outcome in burn injuries.

Clinical and demographic features of burn injuries in karachi: a six-year experience at the burns centre, civil hospital, Karachi

Burn injuries are a leading cause of morbidity and mortality, with 195,000 deaths annually. This study was conducted to identify the demographics of burn victims and the effect of different variables on the outcome of their injuries. 4016 patients admitted to the Burns Centre, Civil Hospital Karachi from January 2006 to December 2011 were retrospectively analyzed. Demographics, burn injury details and their outcome were recorded in a pre-designed questionnaire. Injuries were categorized as: fire, chemical, scald or electrical. To estimate total body surface area (TBSA) burned in adults, the rule of nines was used. For children and infants, the Lund-Browder chart was employed. SPSS v16.0 software was used for analysis. Frequencies and percentages of all variables, and the measure of central tendencies and dispersion for continuous variables were calculated. Cross tabs were used to assess mortality. Mean age was 28.13 years. More than half of the cases (n=2337, 58.2%) were aged between 16-30 years. Labourers, housewives and students were the most commonly affected groups. Burn injuries by flame/fire and electricity were most common. Most cases were accidental, followed by suicide attempts and homicides. Mean percentage of TBSA affected was 35.49%. Mean duration of hospital stay was 16.45 days. 50.6% of the expired cases were females. The mean age of expired patients was 30.07 while for patients who survived it was 27.01 years. The outcome of burn injuries is related to various demographic factors. Female gender, increasing age, burn injuries following suicide attempts and greater surface area involvement predict poor outcome.

Burn injury characteristics: findings from Pakistan National Emergency Department Surveillance Study

Background

Burn injury is an important yet under-researched area in Pakistan. The objective of this study was to determine the characteristics and associated outcomes of burn injury patients presenting to major emergency departments in Pakistan.

Methods

Pakistan National Emergency Department Surveillance (Pak-NEDS) was a pilot active surveillance conducted between November 2010 and March 2011. Information related to patient demographics, mode of arrival, cause of burn injury, and outcomes was analyzed for this paper. Data were entered using Epi Info and analyzed using SPSS v.20. Ethical approval was obtained from all participating sites.

Results

There were 403 burn injury patients in Pak-NEDS, with a male to female ratio 2:1. About 48.9% of the burn injury patients (n = 199) were between 10 - 29 years of age. There was no statistically significant difference between unintentional and intentional burn injury patients except for body part injured (p-value 0.004) and ED disposition (p-value 0.025). Among 21 patients who died, most were between 40 - 49 years of age (61.9%) and suffered from fire burns (81%).

Conclusion

Burn injuries are a burden on emergency rooms in Pakistan. We were able to demonstrate the significant burden of burn injuries that is not addressed by specialized burn centers.

Descriptive Epidemiology of Unintentional Burn Injuries Admitted to a Tertiary-Level Government Hospital in Nepal

This study describes the epidemiology of unintentional adult burn injury admissions in a tertiary hospital in Nepal, from 2002 to 2013, focusing on gender-specific patterns. Chi-square tests and Wilcoxon Rank Sum tests were performed. There were 819 unintentional burn admissions: 52% were male and 58% younger than 35 years. The median percentage total body surface area burned (interquartile range) was greater in females than in males ( P < .001): 28% (17-40) versus 20% (12-35), and female mortality was higher (32% vs 11%). A higher proportion females were illiterate than males (48% vs 17%). Burns occurred at home (67%), work (28%), and public places (5%); gender-specific patterns were observed. Flame burns accounted for 77%, electricity 13%, and scalds 8%. Kerosene (31%) and biomass (27%) were the major fuels. Cooking, heating, and lighting were the main activities associated with burn injury. Results support interventions to reduce the use of open fires and kerosene and to promote electrical safety.

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.

Forecasting Bed Requirement Using Hospital Records

Purpose: To forecast the bed requirements for a Burns Ward.

Methodology: The existing database of hospital admissions and in-patients was analyzed to plan the bed strength for the Burns Ward ICU and Step-down area. We calculated the mean, the median and the mode and studied the pattern of bed occupancy. Utilizing this data, the bed requirement with the gender mix and adult-paediatric patient complement was derived.

Findings: The average admission rate for Burns was 15.33 patients per month. In the ICU, the daily mean and the median/mode of in-patients was 2.3 and two, while for Step-down in-patients the mean and median/mode was 7.34 and seven. However, a total of 10–12 beds were occupied in the Burns treatment area for 57–30 days of the study period.

Conclusion: Historical data of admissions and bed occupancy enable a realistic prediction of bed requirements for the day to day working of a Burns practice.

Prevention of burns: 13 years' experience in Northeastern India

Burns are noteworthy causes of morbidity and mortality in India. Community-based interventions in the forms of multi-strategic and multi-focussed preventive programs are, however, lacking. This study, undertaken in the remote corner of Northeastern India, aims at reducing the incidence of burns through focussed attention towards sensitising the community with well-structured preventive programmes. Participatory community seminars, shop floor visit to industrial locations, use of print and electronic media and lectures and demonstrations in schools were the tools used in the preventive programmes. Analysis of inpatient and outpatient records of burn-injured patients treated in the Burn Unit and a scoring system in the school education programme helped in the assessment of the impact of Burn Preventive Programs (BPPs). For convenience of assessment, a comparative analysis of the results in early (block I) and later part (block II) of the study period was made. Results showed reduction of admission and also reduction in percent total body surface area (%TBSA) burn in the majority of the patients in block II in comparison to block I. Water was used to extinguish fire in 36.1% patients in block I and 73.4% patients in block II. Water was also used to cool burn wounds by 31% patients in Block I, and by 72% patients in block II. While 80% of the patients made inappropriate topical applications on the wounds in block I, only 34.4% did so in block II. Increased awareness amongst the general population was reflected by reduction of average reporting time in hospital after injury and significant reduction of firecracker burns from 21.5% (block I) to 14.6% (block II). Similarly, improved awareness amongst the students was evident from the improved scoring by the majority of the students and reduction in burns amongst them in the later part of block II. The results indicate that BPP has made a positive impact in society.