Epidemiology of childhood burns in the critical care medical center of Kinki University Hospital in Osaka, Japan

The objective of the present study was to describe the characteristics of pediatric burns in order to prepare a program for the prevention of severe burn injuries in children. We conducted a retrospective study of burn victims aged 15 years or younger who were hospitalized in our Critical Care Medical Center between 1982 and 1997. There were 73 children with burn injuries hospitalized in our center during the study period. The greatest number were children 1 year old. The average % body surface area burned was 21. 5+/-20.5%. The most important causes of pediatric burns were found to be hot bath water and other hot liquids. Hot bath scalds accounted for about half of the pediatric burns occurring in all age groups, and they were often extensive. Non-bath scalds accounted for about one-third of the pediatric burns and were most frequent in children 2 years and younger. All the injuries sustained at home occurred when a family member was in the house.Similar to many reports from overseas, non-bath scalds were one of the most common causes of burns in this study; however, hot bath scalds were the most important cause.These data are being used to develop a prevention program. We also consider it necessary to educate children and their family members about the dangers of burn injuries.     

Paediatric burns in Kuwait: incidence, causes and mortality

From a prospective study on burn patients admitted at the Burn Center in Kuwait during 1993-2001, 826 paediatric burn cases, in 0-14 years age group, were retrieved to study incidence, causes, and mortality among children. The demographic characteristics, clinical features, and outcome constituted our data file in Statistical Software, SPSS. Overall incidence rate was 17.5/100,000 children aged 0-14 years, being almost twice (34/100,000) among those between 0 and 4 years, constituting 70.8% of all paediatric burns. Scald was the main cause of burn (67%), followed by flame (23%). Mean age (6.4 years) of children with flame burns, was significantly higher (p < 0.001) than those with scalds, or other causes. A positive significant correlation existed between duration of hospital stay and TBSA% (r = 0.56, p < 0.001). Overall mortality rate was 0.23/100,000 children, maximum (0.52/100,000) being in children below 5 years. Among 11 (1.3%) non-survivors, flame burns caused nine fatalities. Multiple logistic regression mooring predicted children aged < 5 years, flame burns and TBSA >or= 70%, (OR = 29.2, p < 0.001), as main contributing factors to fatal outcome among children. Gender and nationality had no influence on incidence or mortality. These findings will hopefully stimulate development of targeted and sustainable interventions for reducing burns occurrence among identified paediatric high-risk groups.     

Epidemiological study of 3341 burns patients during three years in Tehran, Iran

A retrospective study was conducted on 3341 burn patients hospitalized in a burn care center in Tehran, Iran during 1995-98. The mean age was 20.4 years, and 43.5% of patients were children under 15 years old. The mean body surface area burned was 30.6%. There were statistically significant correlations between age groups and total burn surface area (TBSA) burned with mortality rate (p<0.006). Flame was the most common etiology of burns. There was also significant correlation between age groups and causes of burns (p<0.0001). The mean hospital stay was 16.7 days. The overall mortality rate was 19.6. Most of the injuries requiring hospital admission occurred during the winter months. Parents can play an important role in prevention of burns in children who are most susceptible to burns. People with causes identified could be educated in burn prevention, through news and other media.     

Epidemiology of pediatric burn in southern Taiwan

A 5-year retrospective review of 157 pediatric patients admitted to burn center of Kaohsiung Medical University Hospital (Kaohsiung, Taiwan) was undertaken to identify the incidence, mechanism, and agents of pediatric burn. The highest incidence of pediatric burn was in children aged 1-6 years (57.3%), followed by age group 6-14 years (31.8%). Scald burn (75.2%) made up the major cause of this injury and was dominant in each age group compared to non-scald burn. The kitchen/dining area (57.3%) and living room (29.9%) accounted for the most frequent places where pediatric burns occurred. Among the agents of scald burn, hot drink (49.2%) and soup (32.2%) were the two leading causes. There were more pediatric burns reported in colder seasons (38.2% and 33.1% in winter and fall respectively) and during dining time (19.7% in 11 a.m.-1 p.m. and 35.0% in 5 p.m.-8 p.m.). The results of this report may be closely related to special culinary habits (use of chafing-dish and making hot tea) in the south of Taiwan.     

Calculating the optimum temperature for serving hot beverages

Hot beverages such as tea, hot chocolate, and coffee are frequently served at temperatures between 160 degrees F (71.1 degrees C) and 185 degrees F (85 degrees C). Brief exposures to liquids in this temperature range can cause significant scald burns. However, hot beverages must be served at a temperature that is high enough to provide a satisfactory sensation to the consumer. This paper presents an analysis to quantify hot beverage temperatures that balance limiting the potential scald burn hazard and maintaining an acceptable perception of adequate product warmth. A figure of merit that can be optimized is defined that quantifies and combines both the above effects as a function of the beverage temperature. An established mathematical model for simulating burns as a function of applied surface temperature and time of exposure is used to quantify the extent of thermal injury. Recent data from the literature defines the consumer preferred drinking temperature of coffee. A metric accommodates the thermal effects of both scald hazard and product taste to identify an optimal recommended serving temperature. The burn model shows the standard exponential dependence of injury level on temperature. The preferred drinking temperature of coffee is specified in the literature as 140+/-15 degrees F (60+/-8.3 degrees C) for a population of 300 subjects. A linear (with respect to temperature) figure of merit merged the two effects to identify an optimal drinking temperature of approximately 136 degrees F (57.8 degrees C). The analysis points to a reduction in the presently recommended serving temperature of coffee to achieve the combined result of reducing the scald burn hazard and improving customer satisfaction.     

Catecholamine excretion in burns in children

The excretion pattern of adrenaline and noradrenaline in children with burns has been studied and compared with that of a number of controls of similar age. Very high outputs of both catecholamines were found in the more extensively burned children, and the output of adrenaline increased relatively more than did that of noradrenaline, though the output of noradrenaline was always quantitatively greater.

The relatively high output of adrenaline may be related to the environmental temperature in which the children were nursed. The evidence for and possible causes of partial failure of adrenaline production in burns are also discussed.     

Prevention oriented epidemiologic study of accidental burns in rural areas of Ardabil, Iran

PURPOSE OF STUDY: Burns are one of the leading causes of injury-related deaths in Iran. We conducted a study to investigate features of burns in rural areas of Ardabil Province from October 2004 through March 2005, with an aim to providing content for effective prevention programs. BASIC PROCEDURES: This study employed longitudinal prospective methodology. The study population included all patients presenting with burns to local health care facilities during the study period. MAIN FINDINGS: A total of 1179 cases were studied. Most of the cases (59.4%) were females. Mean of age of victims was 22.3+/-19 years in females and 13.6+/-17 years in males. The vast majority (91.2%) of burns occurred at home. More than two-thirds of burns were because of hot liquids or steam. The majority of scald burns resulted during use of heating devices such as samovars, gas stoves, valors and picnic gas stoves. Overturning and spilling of hot liquids were the most common injury mechanisms. PRINCIPLE CONCLUSIONS: Prevention programs should focus on children and adult women. Prevention efforts should target home environments and focus on prevention of scalding burns.     

Analysis of pediatric burns in Nagasaki University from 1983 to 2002

Pediatric burns are frequently observed: twenty-year burn analysis was performed in a single department, and 354 cases, aged 0-6 years old. The major cause of pediatric burns was scalding (68%) and hot water comprised over half of the scald burns. At 1 year old and younger, the total burn surface area (TBSA) was significantly smaller than from 1 to 6 years old (4.8+/-9.56 versus 10.5+/-18.86%, respectively, p<0.001). TBSA of scald burns was significantly greater than contact burns (8.9+/-15.76 versus 0.9+/-2.0%, respectively, p<0.05). Surgery was performed for 65 patients (18%) and 126 patients were hospitalized (34%). Compared to the first decade of analysis, the second decade had fewer patients (222 versus 142 cases) and lower severity (7.4+/-14.6% versus 6.6+/-13.26%, TBSA). Pediatric burns in younger children should be studied closely as to their causes and with further follow-up.     

Epidemiology of burns presenting to an emergency department in Shiraz,South Iran

A retrospective study of 1493 burn patients attending the Ghotbeddin emergency burn center in Shiraz, South Iran during the 1 year period 2001-2002 was undertaken in order to describe the epidemiological features of burns in Shiraz. The following results were obtained: the mean age of attendees was 21.84+/-19.05 with an overall male to female ratio of 1.12. 41.2% of patients were children under 15 years with a M/F ratio of 1.36. The main causes of burns were scalds (53%) followed by flame (25%). The frequency of scalds was much higher among children (70%). The majority of accidents (81%) occurred at home, 5.2% occurred in workplace and domestic accidents were more frequent among women. The mean total body surface area (TBSA) burned was 7.4+/-14.3%. Extensive TBSA had a significant association with flame burns and sex, showing that female patients have higher risk for more extensive burns. Finally, there was a significant seasonal variation for burns, with most burns occurring in winter months.     

Epidemiology of hospitalized burns patients in Taiwan

Previous studies based on either single hospital data or sampling of specific groups of hospitalized burns victims in Taiwan have provided only minimal epidemiological information. The study is designed to provide additional data on the epidemiology of hospitalized burns patients in Taiwan. Data were obtained from the Burn Injury Information System (BIIS), which brings together information supplied by 34 contracted hospitals. The study time course spanned a 2-year period from July 1997 to June 1999. Patient characteristics (age, sex, education level, etc.), causes and severity of injuries, and medical care measures were explored. A total of 4741 patients were registered with BIIS over the study period. The majority of hospitalized patients (67%) were male. The age distribution of burns patients showed peaks occurring at the age groups of 0-5 and 35-44 years. Over the time course of a day, burn injuries occurred more frequently from 10:00 to 12:00 h and 16:00 to 18:00 h. Injuries suspected as the result of suicide, homicide or child abuse accounted for 4.8% of hospitalized cases. More than 48% of the burns occurred in the home. The leading type of burn injury was scalding, followed by naked flame, explosion, electrical burns, and chemical burns due to caustic or corrosive substances. The mean percent total body surface area (%TBSA) for adults was 19%, and for young children was 12%. The average length of hospital stay was 18 days. In conclusion, children under 5 years and adults between 35 and 44 years of age are two high-risk groups for burn injuries. Corresponding to meal preparation time, hot substances such as boiling water, hot soup, etc. are the most common agents responsible for scalds. Prevention programs for reducing the risk of burn injuries during cooking and eating are required, especially for parents with young children.     

Contact burns in children

Forty-seven children under the age of 5 years admitted for contact burns into the Burns Unit of the Birmingham Accident Hospital during the period 1981-88 were reviewed. Contact burns formed only 3.93 per cent of all the thermal injuries seen in this age group for the same period. Most of the children were between 1 and 2 years of age and the hands and face were more frequently burned. The hot electric iron was the commonest cause of burns in the study. Although the sizes of the burns were generally small, the potential scarring and disability were recognized and this influenced the management. The prevention of contact burns from hot electric irons has been discussed and the need to look out for non-accidental injuries emphasized.     

Profile of pediatric burns Indian experience in a tertiary care burn unit

Pediatric burns admitted to the tertiary care burn facility of Kanchi Kamakoti CHILDS Trust Hospital in Chennai (India) were retrospectively analysed between 1992 and 2003. Five hundred and thirty-five burn cases were admitted during these years. These children belonged to the age group of 0-18 years (as WHO has increased the pediatric age group range to 0 to 18 years). The etiology of these burns was looked into and the outcome of these patients in respect to etiology and complications were studied. After analysis, they were classified according to age, sex, TBSA and the occurrence of infection during the course of treatment. The complications that really affected the outcome were looked into and infection ranked first in fatal cases. Inhalation burns were not very common in our group and were associated only with large flame burns, which occur when a child is burnt while the mother commits suicide, or in cases of abuse of female children in a closed room with lots of inflammable upholstery. Scalds were the most common type of burn among children under 4 years of age. Flame burns predominated the older age group. Although there were 13 deaths among the entire group, the majority occurred within the 2-4 years age group. There was no significant gender difference with respect to mortality. Large burn size and infection were the strongest predictors of mortality.     

Risk factors of burns among children in Mongolia

Burn is one of the leading causes of under-5 childhood injuries. Identification of risk factors and awareness level of caregivers could help reduction of burn-related morbidity. The objectives of this study were to identify general perceptions of risk factors of childhood burns, prevalence of burns among under-five Mongolian children, and to assess knowledge and practice of burn care and care seeking behaviors for care givers of those children. A household-based cross-sectional survey was conducted from September to October 2010 including 865 households with 1154 under-5 children. Data were collected by face-to-face interview using semi-structured questionnaire. Of total 1154 children, 291 (25.2%) had burn injury in their life-time. Above half of them had suffered a scald. Majority of burns occurred at home and urban children were at higher risk. The age up to 36 months, boys, and fewer children (<3) in the household were found as significant risk factors for childhood burns. Caregivers' knowledge and practices on childhood burns were generally insufficient; most of them indicated the importance of physical environment at home. We concluded that burns were common among under-5 children, and caregivers' knowledge and practices on burns was inadequate. Specific interventions like "Caregivers education program" encouraging safe domestic environmental conditions should be undertaken to increase their awareness on burn-related issues to reduce childhood burns in Mongolia.     

Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women

Introduction Consumption of coffee and tea, and total intake of caffeine has been claimed to be associated with osteoporotic fracture risk. However, results of earlier studies lack consistency. Methods We examined this relation in a cohort of 31,527 Swedish women aged 40-76 years at baseline in 1988. The consumption of coffee, caffeinated tea and the intake of caffeine were estimated from a self-administered food frequency questionnaire (FFQ). Multivariate-adjusted hazards ratios (HRs) of fractures with 95% confidence intervals (95% CIs) were estimated by Cox proportional hazards models. Results During a mean follow-up of 10.3 years, we observed 3,279 cases with osteoporotic fractures. The highest (>330 mg/day) compared with the lowest (<200 mg/day) quintile of caffeine intake was associated with a modestly increased risk of fracture: HR 1.20 (95% CI: 1.07–1.35). A high coffee consumption significantly increased the risk of fracture (p for trend 0.002), whereas tea drinking was not associated with risk. The increased risk of fracture with both a high caffeine intake and coffee consumption was confined to women with a low calcium intake (<700 mg/day): HR 1.33 (95% CI: 1.07–1.65) with ≥4 cups (600 ml)/day of coffee compared to <1 cup (150 ml)/day. The same comparison but risk estimated for women with a high propensity for fractures (≥2 fracture types) revealed a HR of 1.88 (95% CI: 1.17–3.00). Conclusions In conclusion, our results indicate that a daily intake of 330 mg of caffeine, equivalent to 4 cups (600 ml) of coffee, or more may be associated with a modestly increased risk of osteoporotic fractures, especially in women with a low intake of calcium.     

Multicentre observational study describing the systemic response to small-area burns in children

Background and ObjectivesBurns of less than 10% total body surface area (TBSA) are common injuries in children under five years of age. The inflammatory response to burn injury is well recognised for burns greater than 20% TBSA but has not been described for smaller burns. The aim of this study was to describe the systemic response to burn injury in young children with small-area burns.MethodsThe Morbidity In Small Thermal Injury in Children study (MISTIC) was a multicentre prospective observational cohort study that recruited 625 patients under five years of age with burns of less than 10% TBSA over eighteen months across three sites in England. Prospectively collected data included physical observations and laboratory blood tests taken in hospital as part of routine care. Additional information was sourced from temperature recordings taken at home following discharge.ResultsElevated temperatures were observed in children with scald or contact burns between 2–10% TBSA, with a peak on day one after burn followed by a fall over days four to seven after burn. No temperature rise was seen in children with burns of <2% TBSA. Higher temperature readings were associated with larger burn size, age under two years and male sex. Heart rate and C-Reactive Protein levels showed a peak on day three after burn.ConclusionsAn identifiable systemic inflammatory response to small-area burns in young children is reported. This knowledge can be used to aid in the diagnosis of children with a burn injury who re-present with a pyrexia, and no other symptoms to indicate clinical infection.     

The causes of non-natural deaths in children over a 15-year period in greater Cape Town

This study was undertaken to describe the causes of non-natural death in children aged under 15 years in the Cape Peninsula. Information was abstracted from the official death register kept at the South African Police Mortuary in Cape Town for the period of 1 July 1966-30 June 1981. During the 15-year period 3 248 medicolegal autopsies were performed on children under 15 years of age who had died of non-natural causes. There were significantly higher percentages of Coloureds and Blacks, males, and children aged under 6 years in the sample than in the general population aged under 15 years in the Cape Peninsula. The majority of deaths (54,4%) were caused by road traffic injuries. Other important causes of deaths were burns (12,8%), drowning (11,0%), assault/abuse (5,4%) and poisoning (3,3%). Special attention was paid to the causes of fatal head injuries--head injury alone was given as the cause of death in 819 autopsies (25,2%). The majority of fatal head injuries (72,4%) were also caused by road traffic accidents. This study demonstrates the alarming number of deaths from non-natural causes among children aged under 15 years in the Cape Peninsula. The finding that more than half of these deaths were due to road traffic accidents indicates the impact that successful intervention could have.     

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.