Work-related burns: a 6-year retrospective study

During the 6 years from July 1984 to May 1990, 193 patients (30.2 per cent of all patients) were admitted to our regional adult burn centre, for treatment of work-related burn injuries. The median age of patients was 32.5 years (range 18-64 per cent), and 94 per cent were males. Fifty-nine per cent of the patients came from metropolitan Toronto, and 40 per cent from rural Ontario. Most of the patients (97.3 per cent) were referred to the burn centre within 24 h of their injury. The most common aetiology was electrical injury (29.5 per cent), followed by flame (24.4 per cent), contact (10.4 per cent), flash (9.8 per cent), tar and asphalt (9.3 per cent), scald (7.8 per cent), chemical (5.1 per cent), steam (4.7 per cent) and grease (1 per cent). Within the electrical burn group, about one-half were flash burns, one-quarter were clothing fire injuries, and one-quarter were contact injuries. These occupational burns tended to be extensive injuries. The median body surface area (BSA) was 16.5 per cent, with a median full thickness (FT) component of 5.0 per cent. The average length of stay was 20.0 days. Inhalation injury requiring intubation occurred in 14.8 per cent of patients. Sepsis--confirmed by positive blood cultures--developed in 14 per cent of the patients, at an average time of 8.8 days postburn. Staphylococcus aureus was the commonest organism isolated from blood cultures. Pneumonia occurred in 6.3 per cent of patients. A total of 207 surgical procedures was performed on 113 of the 193 patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mortality of burn injuries in Jordan

Three hundred and ninety patients who died following fire burns and scalds between 1973 and 1982 were subjected to autopsy examination at the departments of Forensic Medicine in the Ministry of Health and Jordan University Hospital. Flame burns caused 82 per cent of the deaths. Most of the burn injuries occurred at home and most of the accidents may have been avoidable. Seventy-six per cent of the patients were children and young adults (0–29 years). Suicide caused 13·5 per cent of the deaths. The most common causes of death were septicaemia and hypovolaemia.     

Epidemiological survey of burns treated in Ankara, Turkey and desirable burn-prevention strategies

From 1 January 1979 to 31 December 1993, 1109 patients were admitted to our burn unit located at Hacettepe University. Of the patients, 638 (57.5 per cent) were children (under the age of 16 years). The male to female ratio was 1.4: 1 in children, and was approximately 2.6: 1 for patients over 16 years of age. Of the 638 paediatric patients, 67 (10.5 per cent) sustained electrical burns. The causes of injury in the remaining 571 cases (89.5 per cent) were hot liquids in 379 (66.4 per cent of the non-electrical burns), flame in 190 (33.3 per cent) and contact burns in two (0.3 per cent). Of the scalds, 296 (78.1 per cent of the scalds), 52 (13.7 per cent), 22 (5.8 per cent) and nine (2.4 per cent) were caused by hot water, milk, meal and oil respectively. Of the flame burns, 21 (11.1 per cent) were due to LPG explosions.

Of the 471 adult patients (over 16 years), 159 (33.8 per cent) were injured by electricity. The causes of non-electrical burn injuries were: hot liquid in 25, flame in 274, chemical agents in four, contact in four, and other causes in four. Although our centre is located in Central Anatolia, 41.8 per cent of all patients were referred from the other six regions of Turkey. Of the 1109 inpatients, 645 (58.2 per cent) were injured in Central Anatolia, 279 (25.2 per cent) in the Black Sea Region, 55 (5.0 per cent) in the Mediterranean Region, 18 (1.6 per cent) in the Marmara Region, 34 (3.1 per cent) in the Aegean Region, 52 (4.7 per cent) in Southeastern Anatolia and 26 (2.3 per cent) in Eastern Anatolia. Approximately two-thirds of the patients (419) required one or more surgical interventions, including debridement and grafting, as well as amputation. The most important early complications were acute renal failure (148 patients −13.3 per cent), sepsis (660 patients −59.5 per cent) and gastrointestinal haemorrhage (seven patients −0.6 per cent). The overall mortality rate was 34.4 per cent. The epidemiological pattern of the burns showed that emergency measures should be taken to prevent scalding accidents to children throughout the country, and for electrical burns in adults, particularly those living in the Black Sea Region. In establishing, implementing and directing prevention programmes, regional differences should be taken into consideration.     

Clinical forensic evidence in burns: rescuer burns

In the literature no systematic study is available on rescuer burn for victims of burn injury. This is a retrospective study of nine patients (five admitted and four outpatients) were treated in this hospital as rescuer burns in 3.5 years. All nine patients were males. Average age of the patient treated on outpatient basis was 47 years (ranging between 44 and 52) and total burn area ranged for 1–4%. Average age of the five patients treated on inpatient basis was 32.6 years (ranging between 30 and 34). The total burn area ranged from 14.5 to 38%. During the period of study, in addition to nine rescuer burns, one patient sustained burn before the rescue attempt due to the victim hugging the rescuer.

Based on the study of patterns of burn, these patients were found to have three grades of burn injury: Grade 1—upper extremity involvement only. (A) only one upper extremity involvement, (B) both upper extremities involvement, Grade 2—upper extremity/extremities and face involvement, Grade 3—upper extremity/extremities, face–neck, adjacent chest and lower extremity involvement.     

Epidemiological analysis of deaths caused by burns in Osaka, Japan

By referring to all of the death cards recorded for the year of 1978 in the whole area of Osaka Prefecture, we examined deaths due to burn injuries, electric injury and heatstroke, and obtained the following results.

1. 1. Of the total 41 737 deaths, externally induced death took place in 3207 cases (8 per cent), and death due to burn injuries including electric shock and heatstroke took place in 215 cases (2–60 cases against 100 000 population), accounting for 6.7 per cent of all externally induced deaths. In those aged under 40 years, externally induced death ranked highest as the cause of death, and burn injury was one of the chief causes.

2. 2. The sex ratio of burn-induced death was 3: I for males and females, respectively. However, if burn injuries resulting from social factors and suicide were excluded, the sex ratio was not significantly different at 1-3:1. The causes of injury were work accidents, suicide and other accidents at a rate of I: 2: 3.

3. 3. The monthly incidence of injuries was larger in winter when there were many cases of on-the-spot death due to fire, but there was no significant difference in the monthly incidence of post-treatment death.

4. 4. Of the 215 cases, 158 (73–5 per cent) died on the spot, while only 57 cases died after treatment. There were apparent regional differences in the total casualties. Post-treatment death probably occurred in 30 per cent of the total deaths induced by burn injuries.

5. 5. Medical institutions receiving burn victims could be divided into private and public ones at a nearly equal ratio. Public institutions took a significantly larger proportion of this type of casualty than following road accidents.

6. 6. Supplementary investigations revealed that two to three times as many people died at the scene of the accident than died after treatment from severe burns, this amounted to 140 cases a year in the whole area of Osaka Prefecture.

     

Survival in major burn injuries treated by one bathing in cerium nitrate.

Sixty-four patients aged 16-74 years with total body surface area burns (TBSA) ranging from 30 to 90 per cent, were given one bathing in 0.04 M cerium nitrate within 4 h of admission to hospital. Of 21 patients aged 16-30 years, one died (aged 28 with 90 per cent TBSA), and of those aged 31-74 years, two died, one (aged 50 years with 55 per cent TBSA) had multiple internal injuries, the other (aged 51 years with 55 per cent TBSA) had a pulmonary embolism at day 19. Two risk scores, developed from data on 11,200 burn patients treated by standard methods (Roi et al. 1983), were applied to the analysis of risk for 59 patients for whom both total burn surface (TB) and full thickness (FT) areas had been recorded. About 20 patients bore risk of 0.8 or greater on the FT scale and 1.0 on the TB scale, yet instead of 80 per cent deaths among these, only two died. No FT assessment had been made on the multiple injury death whose TB risk score was 0.66. Such survival results in high-risk patients should encourage the use of cerium nitrate for treating serious burn injury.     

Cryopreserved cadaveric allografts for treatment of unexcised partial thickness flame burns: clinical experience with 12 patients

Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservarive treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision.

Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at −180°C for 30–48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required.

It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days.

Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.     

Prognostic factors in electrical burns: A review of 101 patients

Purpose

Electrical burn wounds are among the most devastating of burns, with wide-ranging injuries. We aimed to document the factors affecting the mortality rate of patients presenting with electrical burn wounds to our regional burn centre.

Methods

This retrospective study was conducted on 101 patients from January 2009 to June 2012. Factors were classified under 11 topics and evaluated according to their relationship with the mortality rate.

Results

The major causes of death in burn victims were multiple organ failure and infection. Twenty-six percent of the 101 patients died, all of whom were male. One (1.4%) of the patients who survived was female; 73 (98.6%) survivors were male. The mean age in the deceased group was statistically higher than that of the other patients (32.7 vs. 35.6 years; P < 0.05). All-cause mortality was 2.79 times higher for larger burns (>25% total body surface area). The values for creatine kinase, creatine kinase-MB, total body surface area of burn, hospitalised period in the intensive care unit and intubation rate were significantly higher in the exitus group. Renal injury requiring haemofiltration was associated with an almost 12-fold increased risk for mortality. There was no statistically significant difference between patients regarding surgical interventions.

Conclusion

Electrical injury remains a major cause of mortality and long-term disability among young people. Our data demonstrated several risk factors associated with increased mortality rate in patients with electrical burn wounds.     

Trends in burn admissions in Scotland during 1970–1992

This retrospective study involved analysis of the data of the inpatients discharged with a diagnosis of burns, from various hospitals in Scotland, during the period 1970–1992. There were 51350 such inpatients all over Scotland, with an average annual rate of 2233 cases. Overall burn incidence in actual numbers was 43.7 per cent in < 15 year olds, 41.2 per cent in 15–64 year olds and 15.1 per cent in ≥ 65 year olds. Burn rates per 100 000 population were highest in < 15 year olds and lowest in 16–64 year olds.

The pattern of burn admissions has changed. Since 1987 the highest numbers of burn inpatients were the 16–64 year olds, followed by children, then the elderly. There has been a gradual but sustained fall in burns admissions in all age categories. The downward trend was statistically significant (t = 8.48, 21 d.f., P < 0.001). Though the population of the elderly (≥ 65 year olds) increased by about 13 per cent, the burn admissions and all deaths due to burns did not reveal an upward trend. The population of the old (81 + year olds) increased by 60 per cent during the same period. The incidence of burns was above average when > 80 year olds were considered separately, approaching the levels found in children. However the rate and incidence of burns in the 65–80 year olds resembled that of the younger age group (16–64 year olds).

The total number of deaths due to burns and/or smoke inhalation has declined in all age groups and the decline has been statistically significant (chi-squared = 19.62, 1 d.f., P < 0.001). Maximum number of deaths occurred in ≥ 65 year olds (44 per cent), followed closely by 16–64 year olds (43.5 per cent), and 12.5 per cent of deaths in adolescents and children. The decline was due to improved management of burns and a decrease in the number of patients having large body surface area burns.     

Burn injuries in the Dong Bei area of China: a study of 12,606 cases.

This survey analyses data from nine Chinese burn units with respect to age, causes, severity of burn injury, and survival or death of patients admitted to hospital during the past 10 years (from January 1980 to December 1989). Of 12,606 burned patients treated, 3391 were children (26.9 per cent) and over half the children (52.3 per cent) were up to 4 years old. Almost 60 per cent of the 12,606 patients treated were in the young adult group (15-44 years), and 86.9 per cent of 12,606 patients sustained thermal injuries mainly from fire flames followed by scald injuries (40.7 per cent). About 93 per cent of the patients had burns covering less than 50 per cent of the body surface area. The overall mortality rate was 1.24 per cent. The LD50 for the 12,112 patients less than 60 years old was a burned surface area exceeding 80 per cent of the total body surface area.     

镇江地区五年来职业烧伤回顾性调查

对镇江地区1986～1991年221例职业烧伤病例进行了分析总结。本组平均年龄31.2岁,男性占83.4%,79.6%的病人在伤后24 h 内入院。首位致伤原因为火焰(33%)。平均烧伤面积17.1%,平均Ⅲ度面积8.1%。8.1%的病人并发吸人性损伤。本组死亡率为1.8%。平均住院时间34.3天,平均住院费用3千余元。文章强调对职业烧伤的现场急救和正确的早期处理,讨论了降低职业烧伤发病率的初步设想,旨在为劳保部门和其它地区职业烧伤研究提供参考。     

An analysis of 1704 burn injuries in Hong Kong children

Over a 12-month period, 1704 children less than 15 years old with burn injuries seen in the accident and emergency departments of seven major regional hospitals in Hong Kong were analysed with respect to their epidemiological data. The age group with the highest risk for injury was 0-4 years (57 per cent) and with a maximum at 1-2 years of age. Boys showed a significantly higher incidence of burns than girls at any age. Ninety-three per cent of the accidents occurred at home and 92 per cent were scalds caused by hot water and other fluids. In the great majority of patients the total body area of burn did not exceed 5 per cent. Younger children had a higher incidence of burns involving the head, face and anterior trunk, 39 per cent of the 0-4 year age group required hospital admission. During the winter months, the children tended to suffer from deeper burns.     

An investigation of the prevalence of psychological morbidity in burn-injured patients

Research on the psychological impact of burn injuries has concentrated on major burns, while small burns have been largely neglected. In a prospective study, 45 patients with burn injuries ranging from 1 per cent or less up to 40 per cent total body surface area were assessed using semi-structured interviews within 2 weeks of sustaining the burn, and followed-up at approximately 3 months postburn to investigate the prevalence of mental health problems. The prevalence of clinically significant levels of anxiety, intrusions and avoidance remained similar at 2 weeks and 3 months postburn, however, the prevalence of depression and Post Traumatic Stress Disorder (PTSD) increased 6- and 4-times, respectively, by 3 months. Patients with small burn injuries of 1 per cent or less also experienced clinically significant levels of psychological difficulties postburn. The implications for the identification of patients at risk of future psychological morbidity are discussed.     

The total number of burn injuries in a Scandinavian population—a prospective analysis

During the period 1 September 1982 to 31 August 1983 the total number of burn injuries in the municipality of Copenhagen was recorded prospectively. The social changes and the constitution of the population are illustrated.

The total number of burn injuries showed a decrease of 33 per cent compared to the investigation in 1974/75. Scalds are still the most frequent cause of burn accidents, small children are especially vulnerable. Seventy-two per cent of all accidents occurred at home. Only a few patients required ‘antishock’ therapy. No patients with work-related burn injuries died.

Preventive measures have eliminated or reduced the number of some types of thermal injury.     

镇江地区五年来职业烧伤回顾性调查

对镇江地区１９８６～１９９１年２２１例职业烧伤病例进行了分析总结。本组平均年龄３１．２岁，男性占８３．４％，７９．６％的病人在伤后２４ｈ内入院。首位致伤原因为火焰（３３％）。平均烧伤面积１７．１％，平均Ⅲ度面积８．１％。８．１％的病人并发吸入性损伤。本组死亡率为１．８％。平均住院时间３４．３天，平均住院费用３千余元。文章强调对职业烧伤的现场急救和正确的早期处理，讨论了降低职业烧伤发病率的初步设想，旨在为劳保部门和其它地区职业烧伤研究提供参考。     

Peripheral neuropathy in burn patients

Neuropathy in burn patients is frequently overlooked. This study aimed at looking for neuropathies among burn patients. It included 55 burn patients, whether symptomatic or asymptomatic, with variable depths of burn at different stages. Their ages ranged from 8 to 55 years with a mean age of 23.6 ± 11.1 years. All patients were submitted to clinical examination, electromyographic and motor conduction velocities of burned and unburned limbs. Serum electrolyte, blood urea and creatinine were measured for all patients. Sixteen patients (29 per cent) had peripheral neuropathy. Only six had symptoms and signs of peripheral neuropathy. The most frequently diagnosed neuropathy in this study was mononeuritis multiplex in nine patients (56 per cent), then generalized distal axonal neuropathy in five patients (31 per cent) and entrapment neuropathy in two patients (13 per cent). In patients with mononcuritis, 29 nerves were affected, 24 nerves related to the site of the burn and five nerves were away from the site of the burn. All the entrapment neuropathy developed after wound healing. Age above 20 years, electric burns, burns involving full thickness of the skin and a surface area of more than 20 per cent were associated with a significantly higher prevalence of neuropathy. Other parameters were not found to be significant in the development of neuropathy.     

Occupational burn injuries

The epidemiology of occupational burns injuries in a well-defined population is analysed. Although a total of 371 persons sustained an injury, only a few were inpatients and just one required anti-shock treatment. The mean burn surface area was 0.66 per cent and 14 patients had full thickness burn injuries. There were no deaths. Men were found to be more prone than women to injury, especially young workers. The distribution by categories of work and causes of burn are illustrated. Scalds and contact burns were dominant, particularly in restaurants. The work by the National Labour Inspection is acknowledged.     

The total number of burn injuries in a Scandinavian population: a repeated estimate

From 1965 to 1975 the population of Copenhagen decreased from 700 000 to 560 000 inhabitants. Small children under 6 years still constitute 6 per cent of the population but the percentage of old people over 60 years increased from 21 to 29 per cent.As a result of a thorough study of the case records of all outpatients treated at each of the outpatient casualty wards in Copenhagen, the total number of burn injuries treated as outpatients in the area during 1974 and 1975 has been recorded and compared with the number treated during 1964 and 1965.In spite of a 75 per cent increase in the total number of all types of injuries treated, the number of burn injuries treated is unchanged, and the number of severe burn injuries has decreased considerably. Burn injuries sustained by small children now constitute only 16 per cent of all burns, compared to 23 per cent previously.The conclusion is drawn that the pursuant prophylaxis which was practised has been effective, and also that the public has become generally familiar with the use of cold water as the best first aid remedy for burns.     

Profile of the paediatric burn patient in a Canadian burn centre.

Five hundred and eighty-three children (0-18 years old), consisting of 33.4 per cent of all burn inpatients, were admitted to the University of Alberta Hospitals over an 11-year period (January 1978 to December 1988). Demographic and outcome variables, in addition to aetiological factors, were examined. 48.4 per cent of burns occurred in children less than 4 years of age, with males predominating in every age group (P less than 0.001). Children had smaller burns, a higher incidence of scalds, less inhalation injuries and a lower mortality compared to adult burn patients admitted over the same time period (P less than 0.05). There was a low incidence of confirmed child abuse by burns (1.4 per cent). High-risk environments identified were the home (74.6 per cent of burns) and recreational settings (12.4 per cent of burns), mainly occurring around campfires. Native children were overrepresented in the burn population compared to the general population by a factor of approximately 10:1. Scald prevention, high-risk environments (home and recreational), high-risk populations (male and natives) and unsafe practices with flammable liquids (petrol in particular) should be emphasized in paediatric burn prevention programmes.