Unintentional domestic burns in Iran: Analysis of 125,000 cases from a national register

Background

The aim of this study was to map out some epidemiological aspects of unintentional burn injuries among Iranian victims using a national injury registry data.

Methods

Injury data were taken from a national injury surveillance system over the period 2000–2002. The study population comprised 31.5% of Iran's population. Burn-injury cases were retrieved and analysed.

Results

Of all the grossly 307,000 home injuries reported during the years 2000–2002 in Iran, about 125,000 cases (41%) were unintentional burn injuries. Women comprised 58% of the unintentional burn victims. The mean age among burn victims was 19.18 ± 19 (standard deviation, SD) years. The age-adjusted incidence and mortality rates showed that children had a much higher incidence of domestic burns but the elderly suffered higher fatality in spite of lower incidence in this age group. Overall, 65.2% of the domestic burn injuries occurred in the living rooms or bedrooms followed by 27% in the kitchen. The hands and fingers were injured in 43.6% followed by the lower limbs in 37.6%. According to injury mechanism, scalds were the most common type of burn injuries comprising 77.7% of all burns. Of all the burn victims, 791 died, 48 victims became disabled and the remaining improved or were undergoing therapy when reported.

Conclusion

Burns form a major health problem in Iran. Due to high mortality rate, the elderly need specific attention regarding burn prevention and treatment in this age group. Moreover, in spite of lower fatality, any prevention programme should have a focus on childhood burns mainly due to the overwhelming distribution of burns in children and the young population of Iran.     

Patterns of burn injury in the preambulatory infant

Introduction

This study was undertaken after an increasing trend in young babies presenting with severe burns was observed in Princess Margaret Hospital (PMH) in Perth, Western Australia. The aim was to explore the patterns of these injuries with a view to identifying whether they could be prevented with better parent education.

Method

Inclusion criteria was infants under 6 months of age who sustained a burns injury requiring admission or out-patient treatment in the Burns Unit of PMH between July 2005 and September 2007.

Results

Immobile infants are at significant risk of burns. In infants who are not yet mobile, environmental factors are commonly implicated, with the vast majority of burns sustained in the home. The mechanisms of injuries were scalds (43%), contact burns (39%), sunburn (11%) and TPN burns in premature infants in NICU (7%). TBSA ranged from <0.5% to 30%.

Conclusion

Infants less than 6-month-old are at significant risk of burn; at this age the injury is usually caused by hazards in the home environment. These infants are vulnerable to inadequate first aid and require a large amount of follow-up care. Better parental education may help reduce the number of injuries we see in this age group.     

Characteristics of fatal and hospital admissions for burns in Fiji: a population-based study (TRIP Project-2)

Background

Over 95% of burn deaths are estimated to occur in low-and-middle-income countries. However, the epidemiology of burn-related injuries in Pacific Island Countries is unclear. This study investigated the incidence and demographic characteristics associated with fatal and hospitalised burns in Fiji.

Methods

This cross-sectional study utilised the Fiji Injury Surveillance in Hospital database to estimate the population-based incidence and contextual characteristics associated with burns resulting in death or hospital admission (≥12 h) during a 12-month period commencing 1st October 2005.

Results

116 people were admitted to hospital or died as a result of burns during the study period accounting for an overall annual incidence of 17.8/100,000 population, and mortality rate of 3.4/100,000. Most (92.2%) burns occurred at home, and 85.3% were recorded as unintentional. Burns were disproportionately higher among Fijian children compared with Fijian–Indian children with the converse occurring in adulthood. In adults, Indian women were at particularly high risk of death from self-inflicted burns as a consequence of ‘conflict situations’.

Conclusion

Burns are a significant public health burden in Fiji requiring prevention and management strategies informed by important differences in the context of these injuries among the major ethic groups of the country.     

In the media: Burns as a method of assault

Aim

The aims of this study were to determine whether a change occurred in the pattern of assault burn injury cases hospitalised to the adult state burns unit, Western Australia, from 2004 to mid-year of 2012, and to compare patient and burn characteristics of adult assault burns with those admitted for unintentional burns.

Methods

Study data were obtained from the Royal Perth Hospital (RPH) Burns Minimum Dataset (BMDS). Aggregated data of unintentional burn admissions during the same period were provided by the BMDS data manager to enable comparisons with assault burn patients.

Results

Assault burn admissions during 2004–2012 accounted for approximately 1% of all adult burn hospitalisations. All assault victims were burned by either thermal or scald agents. A high rate of intubation (24%) and ICU admission (1 in 3 cases) was observed in the fire assault group. The six assault cases undergoing intubation were severe burns, median TBSA 50%, most commonly affecting the face, head and torso, half of these cases had inhalational injuries and also required escharotomies.Comparison of admissions by calendar period showed no statistically significant differences in demographic, burn cause or TBSA%. However, statistically significant differences were found for pre-morbid psychiatric history (15% vs. 58%, p = 0.025) and concomitant fractures or dislocations (46% vs. 2%), p = 0.011).

Conclusions

While the proportion of assault burn admissions per total burn admissions steadily increased from 0.4% in 2009 to 1.5% in mid-2012, this proportion did not exceed that peak level observed of 2.1% for 2004.     

A prospective study of burns trauma in children in the University of Calabar Teaching Hospital, Calabar, south-south Nigeria

Background

Burns are among the most devastating injuries seen in the emergency units. The epidemiology varies from one part of the world to another. This communication is a 3-year report of burns in children in an attempt to provide information on the current epidemiology of burns in this centre.

Method

Children admitted into the University of Calabar Teaching Hospital, Calabar with burns were prospectively studied from February 2005 and January 2008.

Results

There were 56 patients (28 males and 28 females). The ages ranged from 9 days and 14 years (mean 3.5 years) and 19 (73.1%) were preschool children. There were 39 (69.6%) who sustained scald injuries while 17 (30.4%) suffered flame injuries. Twenty-six (46.4%) patients sustained burns with total burn surface area above 10%.

Conclusion

Education of the public on burns prevention based on the factors highlighted, establishment of burns support groups dedicated to publicity on prevention and provision of financial aid would sustain strategies when adopted.     

Nationwide web survey of pediatric scalds: Prevalence and the relationship with household vacuum flasks

Objective

To explore the prevalence of pediatric (0–72 months old) scalds, and to clarify its relationship with household vacuum flasks.

A study of energy-related injuries from hospital admissions among children and adults in South Africa

Introduction

Burn and ingestion injuries are common in developing countries because of poor access to safe energy sources, crowded living conditions, and insufficient knowledge of potential risks. The purpose of this study is to understand the scope of burn and ingestion injuries due to various energy source usages in South Africa.

Methods

Patients at 16 regional hospitals throughout South Africa presenting with an energy-related injury between 2006 and 2012 were interviewed to obtain demographics and injury characteristics.

Results

A total of 12,443 patients were included in this study. Children aged 1–2 years predominantly experienced burn and ingestion injuries (21%). Liquid burns (30%) were more common than flame burns (14%). Chi-squared tests show that age was significantly related to degree of burn, type of burn, and severity of burn (p < 0.001). Non-intentional injuries (45%) were more frequent than self-inflicted or assault injuries. Temporal and seasonal injury trends reflect usage patterns. Burn injuries result in longer hospital length of stay than ingestion injuries.

Conclusion

Non-intentional liquid burns and ingestions to infants and babies were most common in this study, with many injuries also occurring among young adults. It is advised that interventions targeting low-income communities be conducted to increase awareness of burn and ingestion injuries.     

Burn prevention programs for children in developing countries require urgent attention: A targeted literature review

Background

Paediatric burns are a significant international public health problem. Developing and developed countries report similar challenges regarding paediatric burn prevention programs. Paediatric burns requiring healthcare often incur significant health and opportunity costs, death or long-term disability. This paper reviews international burn prevention strategies, and considers implementation of effective prevention strategies in South Africa.

Review question

Are there differences between developed and developing countries regarding causes and prevalence of paediatric burns, prevention strategies, and evidence of effectiveness?

Review framework

Implementing effective burn prevention strategies in South Africa.

Method

This systematic literature review identified, and narratively synthesized information from studies reporting population-based initiatives to prevent paediatric burns. Strategies from developing and developed countries were compared. Common strategies were identified, and evidence of effectiveness described.

Findings

30 studies were included from 16 developed/developing countries, reporting similar prevention strategies. Multi-pronged community-based interventions were most effective. Common elements comprised raising awareness of how burns occur, how burns can be prevented, the speed of sustaining significant injuries, and the short- and long-term effects of burns. Burn prevention strategies relevant to South Africa were provision of education in different formats (written, pictorial and verbal) in places frequented by children and parents, monitoring children more closely in hazardous areas (e.g. kitchens), and better planning of homes to reduce hazards.

Conclusion

More work is required to establish effective, sustainable community-wide prevention programs in developed and developing countries. Effective paediatric burn prevention programs for South Africa should acknowledge parent and child literacy, how and where information is best accessed, the need to adapt effective hazard reduction programs to informal settlements, and the importance of legislated minimum safe housing standards. This requires significant commitment from Government, communities and individuals.     

Diminution de l’expression monocytaire de HLA-DR et risque d’infection hospitalière

Objectives

The aim of this bibliographic review is to evaluate the usefulness of the measurement of HLA-DR expression on circulating monocytes (mHLA-DR) in predicting the development of nosocomial infections and unfavourable outcome in critically ill patients.

Data source

References obtained from the medical database PubMed^® in English and in French were reviewed. The keywords included separately or in combination were: HLA-DR antigens, sepsis, trauma, injuries, wounds, burns, stroke, pancreatitis, postoperative, prognostic, immunity, monocytic.

Data extraction

Data in selected articles were reviewed, clinical and basic science research relevant information were extracted.

Data synthesis

Low mHLA-DR expression appears as a marker for monocytic dysfunctions and immunosuppression, temporarily present in the majority of critically ill patients admitted to the ICU (sepsis, trauma injuries, postoperative, burns, pancreatitis and stroke). The decrease in mHLA-DR expression is a predictor of septic complications in all these clinical conditions. However, no predictive threshold value could be determined regarding unfavourable outcome.

Conclusion

The monitoring of mHLA-DR expression could be a biomarker to detect ICU patients at high risk of developing secondary nosocomial infections. Those patients could probably benefit of preemptive strategies to prevent these infections.     

Management of electrical and chemical burns in children

Background

Pediatric electrical and chemical burns are rare injuries, and the care of these patients varies significantly. We reviewed our experience in management of electrical and chemical burns to analyze the clinical course, management, and outcomes.

Methods

A retrospective review was conducted on children with chemical and electrical burns presenting to two large regional pediatric burn centers over a 10-y period (2002–2012). Clinical data including patient demographics, nature of burns, management, and outcomes were collected and analyzed.

Results

There were 50 cases, 25 chemical and electrical burns each. Overall, the mean ± standard deviation age was 6.2 ± 5.6 y, and the mean total body surface area burn was 4.3 ± 3.2%. Chemical burns were larger, had less depth, and shorter length of stay, whereas electrical burns were smaller, deeper, and had a longer length of stay. Two chemical burns and six electrical burns required grafting. Twelve percent of electrical burns required rehabilitation, and 20% required compression garments for hypertrophic scars. Six percent required late surgeries.

Conclusions

Pediatric electric and chemical burns are rare and require specialized care. Graft rates are not high but are mostly noted in electrical burns.     

Skull burns resulting in calvarial defects: cognitive and affective outcomes

Objective

To determine the extent of cognitive and affective difficulties experienced in children with full thickness burns of the calvaria caused by flame and electrical sources.

Methods

Medical records were examined retrospectively to identify patients with full thickness burns of the calvaria. Data were reviewed from the acute period and long term for these patients and their matched controls.

Results

Fourteen children were identified who sustained full thickness burns. The average age of injury was 7.1 ± 7.3 years and average percent TBSA was 39.7 ± 26.3. Of these 14 patients, 8 were under the age of 4 years at the time of injury and suffered flame injuries. Six children were over 11 years old at injury and suffered electrical burns. Imaging was performed on 10 patients acutely and revealed 5 with major brain injury. The youngest patients suffering flame injuries experienced significant difficulty with developmental functioning acutely and a trend towards long-term cognitive difficulty. Older children did not differ from their matched controls at any time.

Conclusions

Children with burns to the calvarium can be at risk for affective and cognitive sequalae. Therefore, we recommend comprehensive neuropsychological evaluations at multiple time points to adequately assess functioning across time.     

Detection of microalbuminuria: A simple test for prognosis in severe burns

Purpose

To evaluate the effectiveness of microalbuminuria monitoring in the management of patients with severe burns.

Methods

Consecutive patients admitted to the burn unit with total body surface area burn between 20% and 50% were examined for microalbuminuria during the hospitalisation. The findings were correlated to different clinical variables usually encountered in this patient category.

Results

Microalbuminuria was found in patients with inhalation injuries (100%), systemic inflammatory response syndrome (SIRS, 88.4%), burn sepsis (95.1%) and postoperatively (94.9%).

Conclusion

Microalbuminuria is the only simple, non-invasive, bedside, immediate and cost-effective test to indicate for occurrence of SIRS, if the other variables were stabilised. It can be measured with every urine void or more often when a urinary catheter is inserted. This will affect our management of patients with severe burns.     

How would you like your tea,vicar?

Introduction

Scald injuries are the commonest cause of paediatric burns leading to hospital admission both in the United Kingdom (National Burn Care Review Committee Report; 2001) and around the world. The cost and significant morbidity resulting from scald injuries reiterates the need for effective prevention campaigns for primary caregivers. The majority of scalds in children occur in the kitchen (49%) at home. Three children a day under the age of 5 (1100/year) are involved in scalds resulting from pulling on a cup of beverage onto themselves. We therefore aim to study the temperature of common beverages made at home and their potential to cause significant thermal injury.

Materials and methods

Common household beverages were formulated to assess the thermal characteristics. Each beverage was made in a standardized environment with constant ambient temperature of 22 °C. Beverages were made in 230 ml ceramic mugs, using boiled water from an electric kettle, instant coffee granules and teabags. Hot milk and hot water were prepared for comparison. Temperature readings were taken from 0 to 10 min. Cooling curves were then plotted.

Results

Milky beverages had the lowest starting temperatures (75–77 °C). Black tea and black coffee remained at temperatures greater than 65 °C despite cooling for 10 min. The addition of sugar did not alter the cooling rate. Similarly there was very little difference in cooling rates for skimmed and full fat milk. Addition of 10 ml rather than 5 ml of milk lowered the starting temperature and increased the cooling rates.

Discussion/conclusion

Hot beverages can cause significant scald injuries especially in the paediatric population. We demonstrated the potential for a full thickness burn despite cooling for 10 min or the addition of cold milk. Thus the complacent attitude surrounding beverages under such conditions should be abolished. Our work also reiterates the need for education amongst caregivers regarding the handling of hot beverages in order to reduce the number of household injuries.     

30 years of burn disasters within the UK: guidance for UK emergency preparedness

Aim

To review casualty profiles of major UK burn disasters over the last 30 years in order to provide guidance to aid burn and emergency service planning and provision so as to improve emergency preparedness for future national disasters.

Methods

A review of published literature was undertaken for disasters within the UK that had occurred between 1980 and 2009. Those producing 10 or more casualties with at least one sustaining cutaneous burns injuries were included. Frequency and extent of burns were recorded and analysed.

Results

In total 37 disasters were included in this study, their frequency of occurrence falling over the 30 years reviewed. Burns tended to make up a small proportion of all casualties and were often relatively small in size with only 3 disasters having more than 5 patients with >10% burns.

Discussion

This paper can help guide appropriate staffing and bed capacity planning for regional burns units and provide realistic figures to guide scenarios for national emergency training exercises. Due to the infrequent nature of major disasters, Critical Care, Trauma Care and Burn Care Networks will all need to be closely integrated and their implementation rehearsed so as to ensure optimal response to a major national disaster.     

Injuries from firearms in hunting activities

Background

Recreational hunting is a very popular sport, and frequently involves firearms. Few studies address the pattern of firearm injuries occurring with hunting and how they differ from firearm injuries not associated with hunting.

Purpose

A nation wide database will provide an overall perspective of the scope of the problem and types of injuries.

Methods

Our data were obtained from the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993–2008 (ICPSR 30543). It was statistically analyzed for demographic and injury patterns using SUDAAN 10™ software. A p < 0.05 was considered to be statistically significant.

Results

There were 1,841,269 ED visits for firearm related injuries 1993–2008; 35,970 were involved in hunting (1.95%). Hunters were older than non-hunters (34.5 vs. 26.7 years, p < 0.0001). Handguns were involved in 48% of the non-hunters and 5.3% of the hunters (p < 0.0001). The injury was unintentional in 99.4% of hunters; for non-hunters 32.1% were unintentional and 60.7% assaults. The majority of the hunting injuries presented to small hospitals (65.9%) while the majority of non-hunting injuries presented to the large (27.0%) and very large (35.0%) hospitals. Hunters were nearly all Caucasian (92%). In hunters, 57% were shot compared to 77% in non-hunters. The most common diagnosis in hunters was a laceration (42%) compared to a puncture in non-hunters (41%). The head and neck accounted for nearly one-half of the injuries in hunters (47%); for non-hunters it was the head and neck (29%) and the leg/foot (24%). Mortality was 0.6% for hunters and 5.3% for non-hunters. The use of alcohol and being involved in antisocial behaviours was much higher in the non-hunters. The estimated incidence of a firearm injury associated with hunting activities was 9 per 1 million hunting days.

Conclusion

Hunters injured by firearms were nearly all Caucasian, older than non-hunters, did not involve handguns, presented to small hospitals, often sustained unintentional injuries and were not shot; most commonly injured in the head and neck, and had an overall mortality of 0.6%. These data can be a reference for future studies regarding hunting injuries associated with firearms.     

Rehabilitation of burn patients: An underestimated socio-economic burden

Purpose

Patients with burns utilise intensive medical care and rehabilitation. Deep dermal burns lead to scar contractures. Virtually no published data exists on costs for treatment of acute burns in comparison to burn sequelae. Our purpose was to collect financial data on burn therapy to estimate the socio-economic burden of thermal injuries.

Methods

German-DRG for in-patient treatment of burns was collected from our burn center. DRG-related T95.- coding served as a search tool for burn associated sequelae. To include rehabilitation costs, data from the largest health care insurance and a workmen compensation fund were acquired.

Findings

Acute burn treatment comprised 92% of costs for intensive care with approximately 4.600 EUR per percent total burned surface area (TBSA). Expenses for non-intensive care patients were significantly lower than for burn sequelae. Rehabilitation expenses were 4.4-fold higher than costs for acute burns including 59% for manual therapy and 37% for auxiliary material.

Conclusions

TBSA multiplied by factor 4600 could serve for cost calculation of severely burned patients. Approximately 0.3 billion EUR in total or 270.000 EUR per patient/year were spent on burn sequelae. Early admission to specialized burn centers is advocated with state-of-the-art treatment to minimize burn sequelae and health care expenses.     

Characteristics of paediatric burns in Sichuan province: epidemiology and prevention

Objective

This study analysed the epidemiology of paediatric burns in Sichuan province, China, for the formulation of prevention programmes for this population.

Methods

A retrospective review was performed of paediatric patients admitted to the Burn Centre of West China Hospital during 2003–2009, including patient demographics, burn aetiology, time and place of burn, rural or urban population, and education level and burn knowledge of the patients’ guardians.

Results

A total of 1387 paediatric burn patients, mean age 3.21 years (range 0–14 years) were admitted. The majority (72.1%) were 0–3 years old, and the male/female ratio was 2.39:1. Most common aetiologies were scalds (81.3%), flames (17.1%), and electricity (1.3%), while chemical burns were rare. The ratio of indoor versus outdoor location was 4.93:1, and the rural/urban ratio was 4.03:1. Burns were classified as: total burn surface area (TBSA) ranging from 0% to 5%, (23.9% of patients); TBSA between 5% and 15% (33.2%); TBSA between 15% and 25% (29.8%); TBSA greater than 25% (13.1%). There was a higher prevalence from April to September, and the peak times were mealtime and bathtime. The education level was lower in the rural group. Both urban and rural groups had little knowledge of first aid for burns.

Conclusions

Burn prevention programmes should promote improved living conditions, with prevention education addressed directly to the guardians of children.     

Sustained high incidence of injuries from burns in a densely populated urban slum in Kenya: An emerging public health priority

Introduction

Ninety-five percent of burn deaths occur in low- and middle-income countries (LMICs); however, longitudinal household-level studies have not been done in urban slum settings, where overcrowding and unsafe cook stoves may increase likelihood of injury.

Methods

Using a prospective, population-based disease surveillance system in the urban slum of Kibera in Kenya, we examined the incidence of household-level burns of all severities from 2006–2011.

Results

Of approximately 28,500 enrolled individuals (6000 households), we identified 3072 burns. The overall incidence was 27.9/1000 person-years-of-observation. Children <5 years old sustained burns at 3.8-fold greater rate compared to (p < 0.001) those ≥5 years old. Females ≥5 years old sustained burns at a rate that was 1.35-fold (p < 0.001) greater than males within the same age distribution. Hospitalizations were uncommon (0.65% of all burns).

Conclusions

The incidence of burns, 10-fold greater than in most published reports from Africa and Asia, suggests that such injuries may contribute more significantly than previously thought to morbidity in LMICs, and may be increased by urbanization. As migration from rural areas into urban slums rapidly increases in many African countries, characterizing and addressing the rising burden of burns is likely to become a public health priority.     

Epidemiology of burns undergoing hospitalization to the National Burns Unit in the Sultanate of Oman: A 25-year review

Aim

The aim of this study was to describe the epidemiology of burns admitted to the National Burns Unit (NBU) in the Sultanate of Oman between 1987 and 2011.

Methods

This is a retrospective review of burn patients admitted to Oman's National Burns Unit (NBU) between 1987 and 2011. The data extracted from the national burn registry. The study describes the admission rate by gender and age groups, occupation, causes of burns, time-to-admission, length of stay and in-hospital mortality of burns between 1987 and 2011.

Results

During a 25-year from 1987 to 2011, there were 3531 burn patients admitted to the National Burns Unit in Oman. The average admission rate to NBU is 7.02 per 100,000 persons per year. On average, males were more likely to be admitted to the NBU than females during the study period (P value < 0.04). Patients aged 1–10 years old constituted 46.6% of caseload during the study period. Flames and scalds caused 88.4% of burns. About half of all patients admitted to the NBU have burns to more than 11% of total body surface area (TBSA). The average stay in hospital was estimated to be 15.3 days per patient. The average in-hospital mortality rate was estimated to be 8.2% per year (range 1.9–22%).

Conclusion

Burns are significant public health issue in the Sultanate of Oman. Children are disproportionately over-represented in this study. Prevention programmes are urgently needed to address this “silent and costly epidemic.”     

Neonatal burns in Lagos,South-Western Nigeria: Epidemiology and outcome of management

Background

Burns in the neonate are rare and result mostly from iatrogenic sources in developed countries. The socioeconomic settings of developing countries are different from those in the developed countries. A review of the epidemiology and management of burns in the neonates in Lagos, Nigeria is presented.

Methods

The case notes of burns in patients less than 29 days-old from 2004 to 2008 in 4 tertiary health institutions in Lagos were retrieved from the Medical Records Department; necessary data were extracted and analyzed.

Results

There were 21 neonates with burns within the study period. The incidence of neonatal burns ranged between 0.5 and 2.5%/year. The mean age was 16.38 ± 1.84 days and the mean BSA of 26.00 ± 5.53%. The etiology of burns was thermal in 19(90.5%) and chemical in 2(9.5%). Hypokalemia was common at early stages of their treatment. Burns were sustained at home in 90.5% of the cases. The mortality rate was 43.5%. Inhalation and thermal injuries were associated with most of the deaths.

Conclusion

Domestic incidents from flames are the commonest causes of neonatal burns in the study environment. These are associated with prolonged morbidity and high mortality rate. Health education, highlighting methods of prevention should be undertaken in the community. Well equipped burn centers should be established to treat burns in all age groups.