Analysis of Reasons and Locations of Burns on Hands

During the period 1971–76, 1055 patients with fresh burns were treated at our hospital. Of these, 461 (88 females, 373 males) had sustained burns on altogether 783 hands. This amounts to 45% of the total number of fresh burns. In 322 cases both hands were involved, amounting to 31% of all cases of fresh burns, or 70% of all patients with burned hands. Whereas 82% of patients with hand burns had injuries to both hands, only 10% had sustained an injury to the right hand alone and 8% to the left hand alone. Cases of burns limited to the hands alone accounted for only 4.7% of all burn injuries. The main cause of burn injuries was thermal accident—most often steam explosions and the spraying of scalding liquids. The total number of hands injured by thermal agents totalled 707. i.e. 90% of all burned hands. Most of these were deep skin burns. Chemical agents were mainly responsible for this type of burn, whereas electrical burns were chiefly full thickness skin injuries. Analysis of the location of burns showed that 643 (82%) hands of the altogether 783 injuries sustained involved the wrist, 620 (79%) the metacarpus. 684 (87%) of the fingers. Some 321 hand burns (41%) were of a circumferential nature. A majority of burned hands were injured on the dorsal surface. The burn injuries of hands in 246 (53%) persons were connected with their professional work.     

Thermal burn and electrical injuries among electric utility workers, 1995-2004

This study describes the occurrence of work-related injuries from thermal-, electrical- and chemical-burns among electric utility workers. We describe injury trends by occupation, body part injured, age, sex, and circumstances surrounding the injury. This analysis includes all thermal, electric, and chemical injuries included in the Electric Power Research Institute (EPRI) Occupational Health and Safety Database (OHSD). There were a total of 872 thermal burn and electric shock injuries representing 3.7% of all injuries, but accounting for nearly 13% of all medical claim costs, second only to the medical costs associated with sprain- and strain-related injuries (38% of all injuries). The majority of burns involved less than 1 day off of work. The head, hands, and other upper extremities were the body parts most frequently injured by burns or electric shocks. For this industry, electric-related burns accounted for the largest percentage of burn injuries, 399 injuries (45.8%), followed by thermal/heat burns, 345 injuries (39.6%), and chemical burns, 51 injuries (5.8%). These injuries also represented a disproportionate number of fatalities; of the 24 deaths recorded in the database, contact with electric current or with temperature extremes was the source of seven of the fatalities. High-risk occupations included welders, line workers, electricians, meter readers, mechanics, maintenance workers, and plant and equipment operators.     

Epidemiology of work-related burn injuries: experience of a state-managed workers' compensation system

BACKGROUND: Population-based incidence rates of work-related burn injuries and associated risk factors specific to anatomic sites and degree of burn are not known. METHODS: Using a state-managed workers' compensation database, we estimated incidence rates of work-related burn injuries and identified high-risk occupations and associated exposures. RESULTS: The annual incidence rate of occupational burn was 26.4 per 10,000 workers, with the highest rate observed in the manufacturing sector for males and in the service sector for females. Welders, cooks, laborers, food service workers, and mechanics had higher incidence rates of burn injury compared with other occupations. Wrist and hand burns accounted for a majority of burn injuries, with females experiencing greater incidence of these distal upper extremity burns (8.9 in females and 6.7 in males per 10,000 workers, respectively). Third-degree burns (incidence rate, 1.3 per 10,000 workers) were also most frequently observed in the upper extremities compared with other anatomic sites. The majority of wrist and hand burns were caused by hot liquids/ objects, whereas the majority of eye burns were associated with chemical exposures. Younger cooks and food service workers were at greater risk of burn than older coworkers. CONCLUSION: Specific occupations are associated with degree of burn, anatomic site, and exposures. This information will be useful for targeted intervention among high-risk occupations and work groups.     

A review of the specialties that care for inpatient burns and smoke inhalation in the English counties of Lancashire and South Cumbria

Prevention is by far the best strategy to minimise the burden of burns and smoke inhalation injuries on public health. However, it is inevitable that some injuries will occur despite the best attempts to prevent them. We must, therefore, optimise treatment in order to restore individuals to the best possible condition. Previous experience has shown that a wide range of specialties, many of which are untrained in burn care medicine, are involved in the care of inpatient burns/smoke inhalation victims in the UK. In light of this, a local review of which specialties care for such injuries was conducted for the population of Lancashire and South Cumbria in the north-west of England. Using population-based health authority data from 1997 to 1999, all Hospital Episodes relating to a primary diagnosis of burns or smoke inhalation were ascertained. The results showed that 41% of all burns episodes were treated by specialties other than burns/plastics. The short lengths of stay in non-plastics/burns specialties suggest that relatively minor injuries are being admitted to these units. Analysis of smoke inhalation injuries showed admission to various different specialties. Admission to burn services ensures that key specialties are available for the care of complex burn injuries. These multidisciplinary teams include burn nurses, burn surgeons and burn anaesthetists/intensivists. From the data available, it was not possible to assess the appropriateness of admission of burns and smoke inhalation injuries to the various branches of medicine. In order to assess appropriateness, we need information on severity of injury and outcome of treatment in each specialty. Further research in this area is required since it is concerning that many burns/smoke inhalation injuries are being treated by specialties with no formal training in burn care medicine. This may have major implications for service planning alongside changes in referral patterns.     

Burns represent a significant proportion of the total serious trauma workload in England and Wales

Traumatic injury is the leading cause of death in the first four decades of life. However, current estimates for traumatic injury rates fail to take into account burns. The aim of this work was to estimate the contribution of burns to serious traumatic injury in England and Wales. We have determined population-based burns rates using the International Burn Injury Database (iBID, www.ibidb.org) which collects data from regional burn centres, and non-burns rate using data from the Trauma Audit and Research Network (TARN) which collects data from emergency departments (ED, www.TARN.ac.uk). Due to incomplete national coverage of TARN, non-burns rates were estimated using data from 94 EDs that contributed data to TARN. Both non-burn and burns rates were calculated nationally and for each regional burn service catchment area (n=17). Only serious injuries (≥72 h admission or death) were included. Burns rate was 4.7 and non-burns rate 82.7 per 100,000 per year nationally. Burns therefore contributed 5.4% of all serious traumatic injuries. Contribution of burns in different regional burn service catchment areas was between 1.5% and 12%. This data suggests that burns contribute significantly to the overall trauma workload, and should be carefully considered in healthcare planning and policy.     

Accidental contact burns of the upper limb in children with obstetric brachial plexus injury

The denervated limb of the child with obstetrical brachial plexus injury is theoretically at risk of contact burns. A prospective study was designed to document the incidence and clinical presentation of these burn injuries in a series of 127 birth palsy cases. The study group included 90 Erb's and 37 total plexus palsy cases. Accidental burns occurred in 11% of total palsy cases and 1% of the Erb's palsy group. All injuries were contact burns and confined to the denervated limb. When the circumstances of the burn injury where investigated, it was concluded that injury to the denervated limb was either due to poor motor control, insensibility or a combination of both factors. Finally, treatment and prevention of these injuries are discussed.     

Economic burden of burn injuries in the Netherlands: A 3 months follow-up study

IntroductionBurn care has rapidly improved in the past decades. However, healthcare innovations can be expensive, demanding careful choices on their implementation. Obtaining knowledge on the extent of the costs of burn injuries is an essential first step for economic evaluations within burn care. The objective of this study was to determine the economic burden of patients with burns admitted to a burn centre and to identify important cost categories until 3 months post-burn.Patients and methodsA prospective cohort study was conducted in the burn centre of Maasstad Hospital Rotterdam, the Netherlands, including all patients with acute burn related injuries from August 2011 until July 2012. Total costs were calculated from a societal perspective, until 3 months post injury. Subgroup analyses were performed to examine whether the mean total costs per patient differed by age, aetiology or percentage total body surface area (TBSA) burned.ResultsIn our population, with a mean burn size of 8%, mean total costs were €26,540 per patient varying from €742 to €235,557. Most important cost categories were burn centre days (62%), surgical interventions (5%) and work absence (20%). Flame burns were significantly more costly than other types of burns, adult patients were significantly more costly than children and adolescents and a higher percentage TBSA burned also corresponded to significantly higher costs.Discussion and conclusionMean total costs of burn care in the first 3 months post injury were estimated at €26,540 and depended on age, aetiology and TBSA. Mean total costs in our population probably apply to other high-income countries as well, although we should realise that patients with burn injuries are diverse and represent a broad range of total costs. To reduce costs of burn care, future intervention studies should focus on a timely wound healing, reducing length of stay and enabling an early return to work.     

Work-related burns in South Wales 1995-96

The aim of this work was to evaluate the epidemiology of occupational burns referred to the Welsh Regional Burns Unit from 1st January 1995 to 31st December 1996. Three hundred and twenty-four patients were identified as having sustained occupational burns and the case notes of 319 were available for review. Data on age, sex, occupation, aetiology, percentage and site of burn, treatment, complications and length of hospital stay were recorded. Twenty percent of all burns referred to our unit occurred in the workplace, the majority of whom were male (male:female 11:1), with a mean age of 34 years. Patients presented late to our unit in 35% of cases, with an average delay of 5 days. Chemical burns predominated (23%), followed by flame (14%) and scald (14%). Small burns (< or =1% TBSA) were seen in 70% of all patients. Five patients had burns involving >15% TBSA. One hundred and seventy-five patients were admitted, of whom 79 required surgery. The length of stay ranged from 1-110 days (mean 8.5), with an average follow-up for all patients of 3.5 months. One patient died as a result of his burn injury. In conclusion, occupational burn injuries continue to account for a significant proportion of all burn injuries, affecting mainly young males in physical occupations. Despite Health and Safety guidance, chemical burns are the predominant cause and more needs to be done to educate those working with chemicals to prevent injury.     

Management of acute calvarial burns in children

BACKGROUND: Although rare, head burns involving the calvarium are a serious complication of burns and electrical injury, and present therapeutic challenges to the surgical burn care team. We evaluated our experiences and compared available strategies to address this challenge. METHODS: Records of all burned children between January 1986 and December 2000 were reviewed. Twenty-seven children (15 boys and 12 girls) with scalp burns extending at least into the outer table of bone were identified and compared with a matched group of 30 patients admitted for acute thermal burns without skull injury. RESULTS: Flame burn was the injury mechanism in 78% of these patients and electrical injury was the injury mechanism in 22%. The incidence of calvarial burns in our patient population was 1.2% for thermal burns and 5.6% for electrical injuries during the study period. The age distribution was biphasic, with maximums in infancy for thermal burns and in puberty for electrical injuries. Eight of 27 patients (29.6%) developed full-thickness calvarial bone defects. In 23 patients, calvarial burn wound coverage was achieved with bone debridement and immediate or delayed placement of autograft skin. In four patients (all with electrical injury), local scalp flaps were required for closure. The length of hospital stay and overall number of acute operative procedures significantly increased for patients with calvarial burns. CONCLUSION: Acute calvarial burns are safely managed by bone debridement in combination with staged autografting or early flap coverage. Although flap coverage reduces the number of required procedures, the extensive wound size in thermal burns restricts acute flap procedures primarily to electrical injuries. Compared with patients without skull injury, length of hospital stay and the number of acute operative procedures are tremendously increased in patients with calvarial burns.     

Modern concepts of treatment and prevention of electrical burns

Electric injuries account for 1,000 deaths in the United States, with a mortality rate of 3--15%. As the widespread use of electricity and injuries from it increase, all health professionals involved in burn care must appreciate its physiological and pathological effects as well as management of electrical current injury. Electric current exists in two forms: alternating current and direct current. The effects of electricity on the body are determined by seven factors: (1) type of current, (2) amount of current, (3) pathway of current, (4) duration of current, (5) area of contact, (6) resistance of the body, and (7) voltage. Electrical accidents can be divided into less than 1,000 V (low-voltage accidents) and greater than 1,000 V (high-voltage accidents). In any electrical accident, the witness must turn off the power source and initiate treatment at the scene of the injury. Low-voltage electric burns almost exclusively involve either the hands or oral cavity. Surgical treatment will vary with the severity of the injury.Burns caused by contact with a high-voltage alternating electric circuit conforms to two types: burns from an electric arc and burns from an electric current. High-voltage electric current injuries have a wide variety of systemic manifestations, including neurologic complications, cardiovascular and pulmonary manifestations, vascular damage, and abdominal, bone, eye and joint complications. An organized approach to the management of these complications is outlined in this article. The best treatment of burn injuries remains prevention. Because the majority of burn injuries are due to occupational electrical injuries, the regional burn centers must work effectively with industry to prevent these potentially life-threatening accidents.     

E-cigarette burn injuries: Comprehensive review and management guidelines proposal

IntroductionElectronic cigarettes (EC) have been reported to be associated with burns secondary to explosions of the device or battery, or contact from overheating, resulting in flame, contact or chemical burns. In addition to this, there have also been reported cases of soft tissue and bony trauma with or without associated burns.Using collective evidence, this review aims to summarise all reported burns associated with ECs, and its implications on immediate management with a particular focus on surgical treatment.MethodsA search was conducted on PubMed, EMBASE and Medline for all case reports, case series and letters to editors published since 2014, using terms “electronic cigarette”, “e-cigarette”, “vaping” and “burn”. The search was repeated by the co-author to avoid bias and a review of the bibliographies of each paper was conducted to ensure all relevant cases were included. The mechanisms, type and severity of burn injury, and management and treatment outcomes of the patients were recorded.Exclusion criteria included non-English articles, explosions with no associated burn and publications with insufficient information.Results90 patients from 19 case series or case reports were included. With the exception of one study, gender was recorded with a male predominance (95.6%). Mean age is 30.1 years (range 18–59). The most common type of burn was flame. However, there were reports of chemical burns associated with ECs. The mean total body surface area (TBSA) affected was 4.9% (range 1–27.25%) with the majority of burns being mixed partial and full thickness.22 patients underwent excision and autologous skin grafting within range of three to 21 days. One patient had a full thickness contact burn excised and closed, one patient received a xenograft following debridement and one had biosynthetic skin dressing.42 patients were managed conservatively with dressings or ointments.DiscussionIn this review over a three-year period (2015–2017), 90 cases of EC related burn injuries were reported, however, this is likely an underestimation of the problem.The suggested mechanism for EC related injuries is battery malfunction. ECs are powered by Lithium ion batteries which are susceptible to “thermal runaway” reactions, which result in device overheating with potential for subsequent explosion. We explain hypothesized triggers for these reactions and mechanisms of other injuries associated with ECs such as chemical burns and blast injury.ConclusionEC-associated burn injury results in combined thermal and chemical burns, which should be managed in tandem. Explosion injuries sustained whilst using the device may result in both facial trauma or inhalation injury and therefore should be reviewed with a high index of clinical suspicion.It is noted that there is no agreed standard for management for such burns by specialist bodies in the UK. We suggested a treatment algorithm to provide guidance for the burn injuries associated with ECs.     

Etiology and outcome of burns in Tabriz, Iran. An analysis of 2963 cases.

BACKGROUND AND AIMS: Burn injuries still produce a significant morbidity and mortality in Iran. A 3-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of patients in Tabriz. MATERIAL AND METHODS: Two thousand nine hundred sixty + three patients were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn. There is one burn center in the East Azarbygan province serving 3.3 million people over an area of 47,830 sq.km. RESULTS: The overall incidence rates of hospitalization and death were 30.5% and 5.6% per 100000 person years. The mean patient age was 22 years, and the male: female ratio was 1.275. There were 555 deaths altogether (18.7%). The highest incidence of burns was in the 1-9 age group (29.2%). Patients with less than 40 percent of burned surface constituted 79.8% of injuries. The most common cause of burns was kerosene accident in adults and scald injuries in children. The mean length of hospitalization was 13 days. The mean body surface area burned was larger with higher mortality in females than in males (p < 0.001). Inhalation injuries were strongly associated with large burns and were present in all flame-burn fatalities. CONCLUSION: In our opinion, social factors are the main drive leading to an unacceptably high rate of burn injuries in our societies. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable; educational programs might reduce the incidence of burn injuries.     

Multiple trauma and the burn patient

Multiple trauma greatly complicates the care of the burn patient, whereas a burn often complicates the diagnosis and treatment of the trauma patient. One hundred seventy-six of 3,550 consecutive acute burn admissions received nonburn trauma. The majority of injuries were sustained in motor vehicle accidents (70), escaping fire (32), electrical burns with falls (24), scald burns associated with assault (22), and explosions (18). Eighty patients received orthopedic injuries, including major (47), minor (25), and multiple (28) fractures, 10 dislocations, and 4 open joints. Soft-tissue injury occurred in 91 patients, head injury in 30, thoracic trauma in 27, and abdominal injury in 15. Unstable orthopedic injuries were major contributors to morbidity. Early internal and external fixation permitted optimal mobilization and wound care. Awareness of the potential for multiple injuries and the team approach to these injuries are the most important factors in appropriate care.     

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.     

Comparison of combat and non-combat burns from ongoing U.S. military operations

BACKGROUND: Military burns result from either combat or non-combat causes. We compared these etiologies from patients involved in ongoing conflicts to evaluate their impact and provide prevention recommendations. METHODS: All military patients with significant burns treated at the United States Army Institute of Surgical Research from April 2003 to May 2005 were reviewed. Injuries were categorized as having resulted from combat or non-combat causes. Demographics, burn severity and pattern, mortality, and early outcomes were compared. RESULTS: There were 273 burn patients seen with 63% injured in combat. A high early rate of non-combat injuries was noted. Feedback on non-combat burn prevention was provided to the combat theater, and the incidence of non-combat burns decreased. Mean age and time from injury to admission did not differ. The majority of combat injuries resulted from explosive device detonation. Waste burning, ammunition handling, and gasoline caused most non-combat injuries. Combat casualties had more associated and inhalation injuries and greater full-thickness burn size; total body surface area burned was equivalent. The hands and the face were the most frequently burned body areas. Mortality was 5% in combat and 2% in non-combat patients. The majority of survivors in both groups returned to military duty. CONCLUSIONS: The disparity in full-thickness burn size and incidence of inhalation and associated injuries resulted from differing mechanisms of injury, with explosions and penetrating trauma more common in combat wounds. Despite the severity of combat burns, mortality was low and outcomes generally good. Non-combat burns are preventable and have decreased in incidence.     

Nandrolone decanoate safely combats catabolism in burned patients: A new potential indication after recall

IntroductionThe hyper-catabolic state is a devastating pathophysiological response to severe injury, infection or burns. Nandrolone decanoate (ND) is a potent anabolic steroid have many clinical indications, but not investigated in burn injuries yet.Patients and methodsA prospective randomized control study included 40 burned patients who were treated in Burn unit from burn injuries ranged from 20 to 40%. Both groups are objectively assessed, clinically and laboratory during treatment period till full recovery from burns’ injury. Recall assessment of the drug safety after many years is achieved.ResultsND showed highly significant results supporting its use in combating catabolic insults in burns patient. Both clinical findings and laboratory findings are correlated and highly support the use of ND in burns as new effective and safe long-lasting indication.ConclusionThis study results showed preservation of lean body mass and protein partition, as well as the near normal nitrogen balance in burn patients. Study proposes that nandrolone decanoate could be used in safe and effective way to combat hypercatabolic impact in burn injury.     

Chemical burns: A review

Chemical burns form a significant percentage of mortality from burns and total burns cases reported. There are over 65,000 chemicals available on the market, a large number of which can cause tissue damage. Despite this, they are often mismanaged. The severity of the chemical burn is dictated by the substance responsible, the percentage burn, the concentration, time since exposure, subsequent management and regional skin properties. Burns can be caused by both acids and alkalis. Acid burns cause eschars which limit the extent of the burn. Alkali burns therefore tend to be deeper. Like all burns, the patient should be resuscitated according to the Adult Trauma Life Support guidelines. Copious irrigation forms the mainstay of treatment. Neutralising agents are present for certain chemicals but their use should not delay the irrigation process which may take several hours. We look at the most common chemicals encountered in daily life and explore special considerations when dealing with resulting burns. Chemical burns are often associated with other injuries such as inhalation injury, so it is essential that the patient is considered holistically and all other injuries considered before concentrating all efforts on the chemical burn alone.     

Epidemiology of burn injuries presenting to North Carolina emergency departments in 2006–2007

Approximately 600,000 burns present to Emergency Departments each year in the United States, yet there is little systematic or evidence-based training of Emergency Physicians in acute burn management. We retrospectively accessed the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) database to identify all thermal burns and electrical injuries with associated thermal burns presenting to 92% of North Carolina Emergency Departments over a 1-year period. Results: 10,501 patients met inclusion criteria, 0.3% of all state-wide reported ED visits. Ninety-two percent of burn visits were managed exclusively by Emergency Physicians without acute intervention by burn specialists, including 87% of first degree, 82% of second degree, and 53% of third degree injuries. Only 4.3% were admitted; 4.3% were transferred to another institution. Fifty-five percent were male; 33% were aged 25–44 and 33% presented on weekends. Conclusion: This is the first state-wide study of burn injury and identifies Emergency Physicians as the major providers of acute burn care. Ninety-two percent of 10,501 burn visits, including the majority of severe injuries, were managed exclusively by Emergency Physicians. This supports a need for improved, evidence-based training of Emergency Physicians in the acute management of burns of all types.