Epidemiological characteristics of burn injuries in Iraq: A burn hospital-based study

This study was conducted to determine the epidemiological and clinical characteristics of burn injuries, estimate the case fatality rate for burn patients, and determine the main determinants of the associated death among burn patients who were admitted to Baghdad Burn Hospital, Medical City Teaching Hospitals, Baghdad, Iraq during 2015. This study involved a retrospective review of medical records of all burn patients who were admitted to Baghdad Burn Hospital in 2015. Data were collected using a special form and included information on demographic characteristics and burn characteristics and outcomes. A total of 676 patients with burn were included in this study, who constituted 75% of admitted patients. The remaining was admitted for treatment of old scars. About one third of patients (37.0%) aged 21–30 years, 67.1% were males, 34.8% were military personnel, and 60.7% of the patients had primary school education. About 71.6% of patients were burned by flame and 23.4% were burned by hot fluid. Half of patients had a second degree burns. Almost half of patients had 11–20% of their body surface area affected. About 13% of patients died, mainly due to multiple organs failure (53.3%), septicemia (44.4%), and shock (2.2%). In conclusion, young adults and children, males, and low educated patients represent the majority of admitted burn cases in Iraq. Flame and scalds were the most important causes of burn. More than one tenth of patients died mostly due to septicemia and multi-organ failure.     

Agreement of clinical assessment of burn size and burn depth between referring hospitals and burn centres: A systematic review

BackgroundThe quality of burn care is highly dependent on the initial assessment and care. The aim of this systematic review was to investigate the agreement of clinical assessment of burn depth and %TBSA between the referring units and the receiving burn centres.MethodsIncluded articles had to meet criteria defined in a PICO (patients, interventions, comparisons, outcomes). Relevant databases were searched using a predetermined search string (November 6th 2021). Data were extracted in a standardised fashion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for test accuracy was used to assess the certainty of evidence. The QUADAS-2 tool was used to assess the risk of bias of individual studies as ‘high’, ‘low’ or ‘unclear’.ResultsA total of 412 abstracts were retrieved and of these 28 studies with a total of 6461 patients were included, all reporting %TBSA and one burn depth. All studies were cross-sectional and most of them comprising retrospectively enrolled consecutive cohort. All studies showed a low agreement between %TBSA calculations made at referring units and at burn centres. Most studies directly comparing estimations of %TBSA at referring institutions and burn centers showed a proportion of overestimations of 50% or higher. The study of burn depth showed that 55% were equal to the estimates from the burn centre. Most studies had severe study limitations and the risk of imprecision was high. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low (GRADE ⊕⊕ОО) for %TBSA and very low (GRADE ⊕ООО) for burn depth and resuscitation.ConclusionOverestimation of %TBSA at referring hospitals occurs very frequently. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low for burn size and very low for burn depth. The findings suggest that the burn community has a significant challenge in educating and communicating better with our colleagues at referring institutions and that high-quality studies are needed.     

Outpatient burn data: An untapped resource

Introduction

The National Burn Repository (NBR) currently only contains inpatient data from participating United States burn centres. However, the majority of the patients treated in burn centres are managed as outpatients. Unfortunately, this significant demographic is not represented in the NBR annual report. The purpose of this study is to compare the difference in aetiology and demographics between inpatient and outpatient burn patients. In addition, the workload demands for data entry of inpatient and outpatient records in the burn registry will be compared.

Methods

Outpatient and inpatient burn data at an American Burn Association-Verified Burn Center were prospectively collected during fiscal year 2008. Data collected included age, burn size and aetiology of burn. Aetiology was also stratified by age group. Inpatient data were compared with outpatient data with Fisher's exact test. The amount of time taken to enter inpatients’ and outpatients’ data parameters in the TRACS v5.0 database was also recorded.

Results

Data were collected for 241 inpatients and for 543 outpatients during fiscal year 2008. No significant differences in gender or race were found between the two groups. When comparing demographics, outpatients tended to be younger (26 ± 19 years vs. 32 ± 22 years, p = 0.01) with a smaller burn size (2.5 ± 7% vs. 6.8 ± 12%, p < 0.001) and a lower frequency of full-thickness burns (17% vs. 41%, p < 0.001).Of the patients managed as an outpatient, a total 29.7% were eventually admitted to the hospital. Just over half of those (16.7%) initially managed in the outpatient setting were admitted for a planned surgical procedure. The other 13% were admitted for pain control and wound-care issues.Injury was more likely to be caused by flame in inpatients (p < 0.001). Scald injuries were more common in the outpatient setting (34% vs. 27%), but this difference did not reach statistical significance (p = 0.079). Outpatients were more likely to be injured with a contact burn (p < 0.0001). Outpatient injury was more likely to be work-related than inpatient injury (p = 0.0497), but less likely to be related to recreational activity (p = 0.006) or arson/abuse/assault (p = 0.0158). An experienced TRACSv5.0 user required 11 ± 0.6 min to enter an inpatient record and 6 ± 0.6 min to enter an outpatient record in the system (p = 0.002).

Conclusions

Inpatient injury is more likely to be caused by flame, whereas outpatient injury is more likely to be caused by scald and contact burns. Work-related burn is more likely to be treated in the outpatient setting. Outpatient burn data also take less time to enter. Since significant differences in aetiology exist, outpatient data should be reported separately from inpatient data in order to understand the full spectrum of burn aetiology. The NBR and other registries should be modified to track outpatient burn data and outcomes.     

Epidemiology and outcome analysis of 1359 intensive care burn patients: A 14-year retrospective study in a major burn center

AimsGlobally, burn-related morbidity and mortality still remain high. In order to identify regional high-risk populations and to suggest appropriate prevention measure allocation, we aimed at analyzing epidemiological characteristics, etiology and outcomes of our 14-year experience with an intensive care unit (ICU) burn patient population.MethodsA retrospective observational study was conducted including patients treated between March 2007 and December 2020 in our intensive care burn unit. Demographic, clinical and epidemiological data were collected and analyzed.ResultsA total of 1359 patients were included. 68% of the subjects were males and the largest age group affected entailed 45–64-year-old adults (34%). Regarding etiology, flame and contact burns were the most common in all age groups. Mean affected total body surface area (TBSA) was 13 ± 14.5% in all subjects. Most of the burns occurred domestically or during recreational activities. Mean hospital stay was 17.77 ± 19.7 days. The average mortality was 7.7%. The mortality rate showed an overall decreasing trend whilst burn severity remained consistent from 2007 to 2020.ConclusionsDespite consistent burn severity presentations of annual ICU admissions, burn injury mortality showed a decreasing trend, which was in part attributed to substantial progress in burn care and treatment and improved burn prevention awareness. Statistically significant age and gender differences could be detected with regard to burn etiology and seasonality, as well as outcomes, which highlight the importance of individualized primary prevention programs.     

Epidemiology of childhood burn: yield of largest community based injury survey in Bangladesh

In terms of mortality, morbidity and disability, burns are emerging as a major child health problem in Bangladesh. This trend is similar to many other developing countries. To develop effective burn prevention programmes, information on its magnitude and determinants is necessary. The purpose of this study was to document the magnitude and determinant of childhood burns in Bangladesh, based on a population-based survey which was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. To facilitate data collection, face-to-face interviews were conducted. The rate of non-fatal burn among children under 18 years of age was calculated as 288.1 per 100,000 children-year. The highest incidence (782.1/100,000 children-year) was found among the 1-4 years age group. About 46% of non-fatal burn injuries occurred between 9 a.m. and 3 p.m. The incidence of childhood burn was found to be more than four times higher in rural children than urban children. Ninety percent (90%) of the childhood burns occurred at homes and the kitchen was the most common place. The rate of disability due to burn was 5.7 per 100,000 children per year. The rate of fatal burn was 0.6 per 100,000 per year among all children. The study findings confirmed that childhood burn was a major childhood illness in Bangladesh. An urgent and appropriate prevention programme is required to prevent these unwanted morbidities, disabilities and deaths due to burn.     

Characteristics of 1494 pediatric burn patients in Shanghai

To analyze the epidemiological characteristics of pediatric burn patients in Shanghai and to determine the targets for a pediatric burn prevention program, a retrospective review of all medical records of acute pediatric burn patients (age相似文献   

Epidemiology of operative burns at Kijabe Hospital from 2006 to 2010: Pilot study of a web-based tool for creation of the Kenya Burn Repository

Introduction

In order to implement effective burn prevention strategies, the WHO has called for improved data collection to better characterize burn injuries in low and middle income countries (LMIC). This study was designed to gather information on burn injury in Kenya and to test a model for such data collection.

Methods

The study was designed as a retrospective case series study utilizing an electronic data collection tool to assess the scope of burn injuries requiring operation at Kijabe Hospital from January 2006 to May 2010. Data were entered into a web-based tool to test its utility as the potential Kenya Burn Repository (KBR).

Results

174 patients were included. The median age was 10 years. There was a male predominance (59% vs. 41%). Findings included that timing of presentation was associated with burn etiology (p = 0.009). Length of stay (LOS) was associated with burn etiology (p < 0.001). Etiology differed depending on the age group, with scald being most prominent in children (p = 0.002).

Conclusions

Burn injuries in Kenya show similarities with other LMIC in etiology and pediatric predominance. Late presentation for care and prolonged LOS are areas for further investigation. The web-based database is an effective tool for data collection and international collaboration.     

Mucormycosis following burn injuries: A systematic review

IntroductionMucormycosis is an opportunistic fungal infection with a high mortality rate. Though typically associated with diabetes and other conditions that affect innate immune function, infections can also be precipitated by conditions such as trauma and burns. Burn patients are particularly susceptible to fungal infections due to the immune dysfunction that often accompany their wounds. Indeed case series have described mucormycosis to occur in patients with burn injuries, however the factors contributing to mortality have not been well described. Thus, the purpose of our review was to identify factors contributing to morbidity and mortality in burn patients with Mucormycosis.MethodsA systematic review of the literature of mucormycosis infection in burn injury patients was performed on Pubmed and Google Scholar using the keywords: Mucor, Mucorales, Mucormycosis, Mucormycotina, Zygomycosis and burn or thermal injury. Clinical trials, observational studies, case reports, and case reviews were included if they provided information regarding mortality in adult and pediatric burn patients diagnosed with mucormycosis, review articles, non-English articles, and articles without patient information were excluded. No time limit was placed on our review. Individual patient data was stratified based on mortality. Statistical analysis was performed to investigate the relationship between patient risk factors and mortality, and the Oxford Level of Evidence was used to evaluate study quality.Results46 articles were included in our final review, encompassing 114 patients. On average, survivors had a total body surface area (TBSA)% of 46 (SD 19.8) while non-survivors had a TBSA of 65% (SD 16.4), and this difference was significant (p < .001). Patients with disseminated mucormycosis experienced an 80% mortality rate compared to 36% mortality rate in patients with localized disease (p < .001). We found no statistically significant difference in mean age (p > .05), diabetes (p > .05), mean delay in diagnosis (p > .05), time to antifungal therapy (p > .05), or type of therapy used (p > .05) between survivors and non-survivors. Our review was limited by the lack of prospective, controlled trials; thus, our review primarily consists of case reports.ConclusionDisseminated infections and higher TBSA both increased the risk of mortality in burn patients with mucormycosis, while diabetes did not increase mortality risk. The severity of the initial injury and infection locations must be taken into consideration to inform patient prognosis.     

Epidemiology of burns in Iran during the last decade (2000-2010): review of literature and methodological considerations

The approach to burn prevention, to be effective in a particular area, should be based on sound knowledge of etiological patterns of burns injuries and must take into account the geographical variations and socioeconomic differences in burn epidemiology. Although many articles are published on burns epidemiology in Iran, a holistic view of burn epidemiology in Iran is not well presented in literature. In this study, a wide literature review was made on articles published regarding burns injuries in Iran. Pubmed, Embase, Scopus, and Iranian scientific information (SID) databases were searched for information on epidemiology of burns in Iran during the years 2000-2010. During the investigation we found that few Farsi journals were not indexed in SID during the earlier years of the decade, so to increase the chance of capturing necessary information these were checked by hand. As the second source, available data from the Iranian National Home Injury Registry Database (INHIRD) during two Iranian calendar years in the period 2001-2003 were used to extract necessary information. The results of this review helped in defining the magnitude of the burns problem, exploring the role of gender and age in burns, defining the agents causing burns, burn extent, burn mortality and place of injury occurrence. Some areas with paucity of information as well as methodological pitfalls in published research were identified and discussed.     

Pre-hospital emergency burn management in Shanghai: Analysis of 1868 burn patients

Background

There are few studies reporting the level of pre-hospital emergency management of burn patients and related influencing factors in China. This study is a summary of our investigation on emergency education and people's awareness about pre-hospital emergency management of burn patients in Shanghai, China, and analyses key factors influencing pre-hospital emergency management of burn patients.

Methods

The survey was conducted by questionnaire in burn patients who sought initial clinical visits at the Burn Center of Changhai Hospital (Shanghai, China) between November 2009 and December 2010, including demographic data, burn conditions, pre-hospital emergency management and education about emergency burn management. Data were statistically treated by SPSS software.

Results

Altogether 1868 effective questionnaire forms were collected; 33.9% of these burn patients received cooling treatment before admission and 32.2% of them used ‘folk remedies’ or antibiotics to treat the wound surface. Only 12.2% of these burn patients had received education about the knowledge of emergency management, mainly through public media (38.2%), relatives and friends (24.6%), Internet (15.8%), workplace (11.4%) and schools (10.1%). The result of logistic regression analysis showed that emergency education, especially via Internet and workplace, played an important role in pre-hospital emergency management, and that different channels of emergency education affected different age groups of people: network and unit education mainly affected young adults, while relatives and friends mainly affected elderly people. In addition, educational level was an important factor favourably affecting ‘cooling therapy’.

Conclusions

The level of emergency burn management and related education is relatively low in China at present, and it is therefore necessary to intensify education about pre-hospital emergency management to raise the level of emergency burn management. At the same time, more attention should be paid to age- and population-specific education. Finally, universal emergency education should be included in the national basic education as a long-term strategy.     

Epidemiology and outcome of 121 cases of chemical burn in East Azarbaijan province, Iran

AIM: To explore the epidemiology, mechanisms, complications, morbidity and mortality associated with chemical burns. METHODS: Data from 121 cases of chemical burn treated in our department over a 5-year period were compared. Data were obtained by prospective proforma. RESULTS: A mean 7.98% of total body surface area was burned. This series had a male:female ratio of 10:1, with a mean age 35.3 years. Young men experiencing work-related accidents were the most frequent victims. The majority of chemical burns occurred away from home (98.3%), particularly in the working environment (78.5%); 111 (91.7%) burns were accidental and 10 (8.3%) constituted criminal assault. Tar was the most frequent agent involved, followed by acid, and the hands were the most frequent site of injury. Most burns were small and of second degree; 10.7% of cases involved serious ocular damage. The mean hospital stay was 10 days, and the mortality rate was 1.7%. CONCLUSIONS: Constant safety education for the public and professional training for workers would reduce the incidence of chemical burns. Prevention strategies must be coordinated on a national level.     

Trauma mechanisms and injury patterns in pediatric burn patients

The objective of this study was to evaluate the frequency, severity, exact patterns and mechanisms of burn injuries in children.The patient records of children with acute burns admitted to the University Children‘s Hospital of Zurich were retrospectively reviewed over an 11 year period.The age group with the highest risk, were children under the age of five (69%). Boys were overrepresented in all age groups, but the gender imbalance increased with age.Infants and toddlers were mainly injured by scalds and contact burns. Conversely, almost three quarters of injuries over the age of 9 were caused by flame. The majority of scald injuries was a result of pulling down hot liquids. The typical distribution of this accident scenario involved mainly the face, trunk and arms.More than half of all flame injuries occurred due to fire accelerants. 55% of children were passively involved while other children throwing flammable substances into a fire. Most of these injuries involved the face and arms.This study shows that burn etiology is age dependent. Additionally, our results demonstrate the diversity of burn accidents and their resulting injuries. These findings may help better specify target groups and subjects for prevention.     

Measures for preventing early postburn damage improve survival rate of burn patients

Aim: To define the role of measures for preventing early postburn damage in improving the survival rate of burn patients. Methods: 12 568 burn cases admitted to our institute were chronologically divided into three groups (stages). Total burn surface area (TBSA), survival rate, incidence of burn shock, systemic infection and organ damage as well as the main treatments adopted in the recent decade were analyzed retrospectively. Results: Incidence of burn shock, systemic infection and organ damage were significantly lower, and the total survival rate and the survival rate in patients with different TBSA were markedly higher in the third stage of the study as compared with those in the first and the second stages. The incidence of organ damage in patients treated with delayed fast fluid infusion, early extensive escharectomy, early enteral feeding, early intervention for inhalation injury and intervention to prevent gut bacterial translocation were also significantly lower than in those without the intervention resources. Conclusion: Measures for preventing early postburn damage play an important role in improving the survival rate of burn patients.     

Incidence of childhood burn injuries and modifiable household risk factors in rural Ghana: A cluster-randomized,population-based,household survey

BackgroundWe aimed to determine the incidence of childhood burn injuries in rural Ghana and describe modifiable household risk factors to inform prevention initiatives.MethodsWe performed a cluster-randomized, population-based survey of caregivers of children in a rural district in Ghana, representing 2713 households and 14,032 children. Caregivers were interviewed regarding childhood burn injuries within the past 6 months and household risk factors.Results357 households were sampled. Most used an open fire with biomass fuel for cooking (85.8%). Households rarely cooked in a separate kitchen (10%). Stove height was commonly within reach of children under five years (<1 m; 96.0%). The weighted annualized incidence of CBI was 63 per 1000 child-years (6.4% of children per year); reported mean age was 4.4 years (SD 4.0). The most common etiology was flame burn. Older age (OR 0.89, 95% CI 0.8–1.0) and households with an older sibling ≥12 years (OR 0.58, 95% CI 0.3–1.3) seemed to be associated with lower odds of CBI.ConclusionsChildhood burn injury is common in rural Ghana. Opportunities exist to reduce the risk of childhood burn injury childhood burns in rural settings by supporting the transition to safer cooking arrangements, child barrier apparatuses in homes without older children, and/or development of formal childcare programs.     

Epidemiology of paediatric burn injuries in Hamadan,Iran

Burn injuries are prevalent worldwide, especially in developing countries; and they are significant paediatric injuries in Iran. This study was performed to analyse the epidemiology and aetiology of paediatric burns in Hamadan province in the west part of Iran from March 2004 to March 2007. The incidence rate of child hospitalisation for burns was 33.4 per 100 000 person-years. The median age was 3 years with 69% of the patients under 4 years. The male-to-female ratio of incidence rate for all age groups was 1.52. Scald was the leading cause in almost all age groups and caused 266 (71.7%) burns. Correlation analysis showed that younger children are more vulnerable to scald injury. The mean body surface area (BSA) of burns was 16.36 (SD = 11.42) in all cases. Flame was more fatal than other causes of burns. The total fatality rate in this study was 3.5%. Epidemiological findings reveal that scald, age, gender and residence in rural area are the major issues that should be discussed in considering childhood burns. Prevention efforts should focus on the reduction of scald injuries during food preparation or hot liquid spillage. These efforts should target rural infants, toddlers and boys.     

Burn care in relation to burn epidemiology in Italy

Aim

Burn centres are ‘hubs’ of referral for large areas and should be organised in a network optimised for the needs of their area. Burn centres’ organisation and activity in Italy are analysed with reference to burn epidemiology in the country.

Methods

A questionnaire was submitted to Italian burn centres concerning organisation, activity and epidemiology of burns treated in 2008.

Results

A total of 2067 patients were admitted to a burn centre in 2008; 50% of burns were due to flames (21% alcohol); and 25% of patients were <14 years old. Overall mortality was 5.3%. 144 beds in 15 burn centres were available (seven reserved for children; bed/inhabitants ratio, 1/414,.023). However, distribution is not uniform in the country. Bed rotation was 14.4 patients/bed, and hospital stay varied from 11.7 days for <20% total body surface area (TBSA) burns to >120 days for burns >70%. About half (57%) of patients admitted had less than 20%TBSA burns, 32% had 20-50% TBSA burns, 7% from 50% to 70% and 4% over 70% TBSA. A national network coordinating burn centre activity is lacking.

Conclusions

Italy seems to have less availability of beds for burn care than other countries, and distribution and organisation of the network may be improved. The high prevalence of child burns should be noticed and this makes prevention campaigns advisable.     

Epidemiology and outcomes of burn injuries at a tertiary burn care center in Bangladesh

Globally, burns are among some of the most devastating injuries and account for more than 265,000 deaths worldwide. In Bangladesh alone, nearly 3000 people die annually from burn-related injuries. This study was conducted at the National Institute of Burn and Plastic Surgery in Dhaka, Bangladesh in June of 2016. Data included conducting surveys of hospitalized burn patients (N = 66) and a chart review of deceased burn patients (N = 88). In addition to reporting on the demographic profile of patients, information was also obtained on clinical measures during hospitalization. For non-fatal burns, high risk groups included young adult males (early 30s) of lower socioeconomic status. Among children, the most vulnerable group was found to be children less than eight years old. The most common non-fatal types of burn injuries were flame (35%), electrical (31%) and scald (24%). Discharged patients had an average hospital stay of around 30 days with half of all patients requiring surgical intervention, thus indicating the severity of those cases and the need for resource-intensive care. Among the discharged patient population, factors significantly associated with a longer duration of hospital stay included severity of injury, not having received prior treatment before admission and whether or not patients required surgery during hospitalization.Among the mortality cases, the high-risk groups also included young adult males and children of around eight years of age. The average total body surface area (TBSA) sustained in these cases was 46.4%, with 65% of deaths attributable to complications from flame burns.These findings highlight the frequency and severity of burn injuries, identify vulnerable population groups and list common causes of burns in this large developing country of 160 million people. Furthermore, these findings may be applicable to the epidemiology and outcome of burns in similar low and middle income countries.     

Elderly burn prevention: a novel epidemiological approach

OBJECTIVE: To develop burn prevention strategies for the elderly population in Hong Kong using a novel epidemiological approach. METHODS: Medical records of all patients aged 60 or above who were admitted to our hospital in a 6-year period were reviewed and demographic data, injury characteristics, details of management and outcome were obtained. Selected interviews were undertaken to determine the exact mechanisms of injury and further details of the medical and social background. RESULTS: Fifty-nine elderly patients were identified from the medical records with under half (42%) aged 75 and above. Male to female ratio was 1:1.68. Three-quarters of the injuries occurred at home, principally in the kitchen and bathroom. Two-thirds of the burns were scalds. Forty-eight percent of the admitted patients had surgery. Thirty-seven patients (or next of kin) were interviewed further. Of the subgroup only 12% had received appropriate first aid and 27% had treatment delayed for over 24 h before seeking medical help. The majority of patients had little or no formal education and one quarter were living alone. CONCLUSION: We identified common scenarios of elderly burns which could be used to focus prevention strategies.     

结直肠肛管癌3197例流行病学分析

目的 探讨近年来结直肠肛管癌的发病情况及其变迁. 方法收集1993～2007年间收治的结直肠肛管癌患者发病资料,进行分组和统计比较.结果 共收治3197例患者,发病中位年龄为男性58,女性54岁.按发病时间先后,每5年为1组,患者例数明显增加,中位发病年龄由53岁上升至57岁;男女患者的比例为1.46:1,各组间无明显差异;直肠癌比例由64.45% 下降至54.99%,左、右半结肠比例分别由18.38%和14.51%上升至23.81%和19.64%.结论 结直肠癌发病年龄女性较男性提前.15年来年轻患者比例下降,高龄患者增加,发病年龄后移.男性患者居多,性别比例变化不明显.发病部位以直肠为主,但所占比例明显下降.     

Changes in burn mortality in Bangladesh: Findings from Bangladesh Health and Injury Survey (BHIS) 2003 and 2016

Purpose

This paper is focused to reflect the changes in burn mortality and events leading to fatal burn injuries.