Identification of the high-risk population for serious burn injuries

The incidence of serious burn injuries has been determined for the Commonwealth of Virginia during a 21-month period. The data set included all patients with burn injuries who entered the hospital and were considered serious enough to require inpatient treatment. The risk for burn injury was calculated by age, race and sex. Examination of the data identified a high-risk population that was prone to serious burn injuries. The demographic characteristics of the burn population has been correlated with their socio-economic status.     

Epidemiology of flame burn injuries

This study examines the epidemiology of flame burn injuries in 173 patients treated in four regional burn centres. During this study, recurring and predictable burn accident scenarios were found identifying who was being burned, the circumstances surrounding the burn injury, the burn victim's response to the flame burn situation and the role of garments in the burn injury. This data base should now provide a sound basis for targeted educational programmes on the population that is prone to burn injury.     

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.     

Socioeconomic factors and the incidence of hospitalized burn injuries in New England counties, USA

This study demonstrates that readily available socioeconomic data routinely collected by the US Census can be used to estimate the incidence of burn injuries within the 66 counties of the populous six-state New England region of the USA. The burn data were collected during the National Burn Demonstration Project and included New England residents admitted for hospital care of burns sustained between 1 July 1978 and 30 June 1979. Linear regression analysis revealed strong associations between calculated burn rates and a number of socioeconomic variables. Associations with five such variables are described, including per capita income, percentage of persons below poverty level, percentage of residences built prior to 1940, percentage of adults with 16 years or more of education, and percentage of persons moving since 1975 with previous residence in the same county. Estimates of burn incidence for counties, together with a previously reported study at the level of census tracts for a major Standard Metropolitan Statistical Area, can be used to reduce the time and cost of burn injury case reporting by health care providers or case-finding efforts for large population groups, and can be used to predict the effectiveness of social and economic programmes and policies that improve the overall well-being of county populations.     

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.     

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.     

Incidence and pattern of burn injuries among children with disabilities

BACKGROUND: Burn injuries are an important cause of severe morbidity and mortality among children. However, the epidemiology of burns among disabled children has received little attention. METHODS: Burn injuries were identified for children aged less than 12 years using International Classification of Diseases, Ninth Revision, Clinical Modification codes in Ohio Medicaid claims data. Using FY2002 Ohio Medicaid claims data, incidences and relative risks of burn injuries for disabled and nondisabled children were calculated by age, gender, and race or ethnicity. Logistic regression was used to analyze risk factors for burn injuries. RESULTS: There were 4,307 burn injuries identified in the FY2002 Ohio Medicaid claims database. The incidence of burn injuries for disabled children was significantly higher than for nondisabled children (103.00 per 10,000 vs. 77.41 per 10,000, respectively; p < 0.001). Children aged 1 or 2 years had the highest incidence of burn injuries, regardless of disability status. For disabled children, the incidence of burn injuries decreased after 2 years of age and leveled out at approximately 100 per 10,000 children after 3 years of age. However, for nondisabled children, the incidence of burn injuries decreased until 6 years of age, after which it leveled out at approximately 40 per 10,000 children. After controlling for potentially confounding factors, the risk of burn injuries was significantly higher for disabled than nondisabled children (odds ratio = 1.80; 95% confidence interval, 1.50-2.17). CONCLUSIONS: Disabled children had a significantly higher incidence of burn injuries than nondisabled children did. The risk of burn injuries, even after controlling for demographic factors, was significantly higher for disabled children than nondisabled children.     

Organ donation from burn-injured patients—a national perspective

Background

There is a discrepancy between publically available data from the United Network for Organ Sharing (UNOS) database and perception of the incidence of mortally burn-injured patients serving as organ donors. In the last 5 y, a single burn center referred several patients who went on to successfully donate multiple organs. However, UNOS data indicate very few referrals of patients with burn injuries nationwide. This discrepancy in UNOS-reported occurrences versus institutional experience prompted this work.

Methods

UNOS data from 1988–2012 was examined for causes of death related to thermal injury, electrical injury, inhalation injury, or carbon monoxide poisoning. The National Burn Repository was examined for burn center death rates and patient characteristics of those with reported nonsurvivable burn injuries. Finally, a national survey queried the clinical experiences and educated opinions of burn center directors, transplant surgeons, and organ procurement organization (OPO) representatives regarding organ donation in the burn-injured population.

Results

Between 42% and 52% of those surveyed responded. Survey data indicate that at least 61 patients with burn-related injuries have served as organ donors in the past 5 y alone, versus 23 identified in 24 y of UNOS data. Survey data also indicate that inhalation injuries were the most common burn-related injuries seen before successful organ procurement. Kidneys were the most commonly donated organs, but all major organs and tissues were represented in the experiences of surgeon and organ procurement organization respondents. Up to 10% surgeon respondents believe that patients with burn injuries should not be referred for possible organ donation.

Conclusions

There are more organs donated by patients with mortal burn injuries than currently available UNOS data would suggest. Survey data suggest that these patients should be able to contribute successfully to the supply of organs needed by those on transplant waiting lists, but remain inconsistently recognized as such a resource. Knowledge about long-term organ and tissue viability from burn-injured patients is lacking, and should be the focus of future research.     

Epidemiological analysis of deaths caused by burns in Osaka, Japan

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

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

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

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

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

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

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

     

Epidemiology of burns at the Italian Red Cross Hospital in Baghdad

This study describes the epidemiology and patterns of moderate to severe burn injuries (%BSA>or=20-90) treated at the Italian Red Cross Hospital in Baghdad, Iraq, during the medical mission of the tenth Italian Red Cross Contingent, from 3 April to 19 May 2004. Burn injuries sustained by members of the civilian population admitted to the Burns Unit, irrespective of age and sex, are analysed (n=48). Differences in risk distribution between different segments of the population are reported and typical injury patterns are identified. The six injury patterns identified are labelled "child scaldings", "domestic accidents", "unsafe working conditions", "suicide attempts", "injuries among children in role-play" and "war related injuries". The results show that burn injury incidence is particularly high for women and children. There is a pronounced difference between genders after adulthood (age 15 and up). The mortality rate is higher in females. Most of the burns occurred in the home: a public health education campaign might help reduce the incidence of these injuries.     

Burn mortality in Iraq

Mortality rates are important outcome parameters after burn, and can serve as objective end points for quality control. Causes of death after severe burn have changed over time. In a prospective study, eight hundred and eighty-four burn patients were admitted to the Burns and Plastic surgery Hospital in Sulaimani-Kurdistan region of Iraq in 2009. Age, gender, nationality, cause of burn, extent of injury, cause of death and mortality rate were tabulated and analyzed, 338 (38.2%) were male and 546 (61.8%) were female. The highest number of cases occurred in January, with the highest short period incidence occurring in April. Out of 884 cases, 260 persons died. Burn injuries were more frequent and larger with higher mortality in females than in males. Flame was the major cause of burns. Self-inflicted burns were noted mainly in young women. A large number of burns which affect children and females, occur in the domestic setting and could have been prevented. Therefore, it is necessary to implement programs for health education relating to prevention of burn injuries focusing on the domestic setting.     

Paediatric burn injuries in New England, USA

The authors analysed a subset of data from the New England Regional Burn Program (NERBP) to describe the epidemiology of burn injuries for children aged from birth to 19 years in the six-state New England area of the USA. The subset of the NERBP data analysed pertained to residents of the six New England states who were admitted to hospital for the treatment of a burn injury sustained between 1 July 1978 and 30 June 1979. Analysis of the data revealed that 1128 (41 per cent) of the 2742 hospitalized burns identified occurred to persons between the ages of birth and 19 years, yielding an overall burn incidence rate of 30.7 burns per 100,000 person-years. Children aged from birth to 2 years sustained a higher burn rate, 96.7 burns per 100,000 child-years, than did children in any other age category. The burn rate for males was higher than the rate for females in each age category, as were the rates for black children compared to white children. Children in Massachusetts experienced the highest overall burn rate among the six New England states; the lowest rate occurred in New Hampshire. Overall, 63 per cent of the burns occurred in a residential setting. The most common activities related to burn injury were food preparation and food consumption, which accounted for 471 (42 per cent) of the burn injuries.     

The aetiology of burns in developed countries: review of the literature

This article reviews the literature on the incidence and aetiology of burn injuries. Burn injuries are among the most serious injuries man can incur. Although prevention of burn injuries has been given a good deal of attention in the past, it has never been subjected to a systematic approach which could result in a thorough knowledge of the incidence and the major risk factors and risk groups. The methodological limitations of the studies carried out in this field are striking. For instance, none of the studies of risk factors has used a control population for comparison. No figures are available on the total number of burn injury patients in the Netherlands. Estimates are derived from the situation in other countries, which yields an incidence of four per 1000 per year. Scalds are relatively common in the 0-4-year category. This is usually assumed to be caused by the stage of development of motor and cognitive skills, coupled with incorrect assumptions about these skills by parents. Men are found to be more often the victims of burns than women. Coffee and tea are assumed to be risk factors. The supposed risk factors and risk groups need to be investigated in a controlled epidemiological study, in order to allow establishment of preventive measures.     

Work-related burn injuries in Ontario,Canada: has anything changed in the last 10 years?

BACKGROUND: Many burn injuries occur in the workplace. Previous research from this institution 10 years ago analyzed the incidence and nature of occupation-related burns admitted to our facility. PURPOSE: To compare the current incidence and patterns of work-related burn injuries treated at our adult regional burn center (Current group) with the findings of a similar study 10 years ago (Early group). METHODS: Retrospective study of all burn center admissions between 5 December 1998 and 31 December 2000 was completed. The data from the Early and Current groups was analyzed using the Chi-square test of homogeneity. RESULTS: During the study period, 355 patients were hospitalized. After exclusions, 100 occupational burn cases were identified (28%). The mean age of patients was 39+/-12 years, 90% were male. The mean total body surface area (TBSA) burn was 11+/-13.7%. The most common mechanism of burn was electrical (32%), followed by flame (22%), scald (17%), tar (14%), contact (8%), and chemical (7%). Four patients (4%) died of their injuries. There were no significant differences between the Current group and the Early group in terms of incidence, age, gender, occupation, mechanism of burn, or mortality. CONCLUSION: In the past 10 years no change was found in the incidence or pattern of work-related burn injuries treated at this institution. This suggests that existing prevention strategies have not been effective.     

Suicide by self-inflicted burns – A persistent psychiatric problem

Self-inflicted burns are a relatively uncommon but profound attempt at suicide. Twenty years ago, we first reviewed our experience with self-inflicted burns. With this current study, we sought to determine whether there had been any change in the incidence or outcomes of self-inflicted burns. All burn patients admitted between January 1, 2012, and December 31, 2021, with self-inflicted burns were compared with all other admissions. The frequency of self-inflicted burns and confounding risk factors of patients with self-inflicted burns remained unchanged. A large proportion (87.4 %) of the patients had psychiatric disease. They also had larger burns and higher mortality than accidental burns. Unexpectedly, logistic regression analysis that controlled for age, total percent total body surface area (TBSA) burn, sex, and inhalation injury revealed that those patients with self-inflicted burns had 72 % lower odds of dying than the general population. In conclusion, there has been no improvement in the incidence of self-inflicted burns. They result in very severe injuries, but when age, burn size, gender, and inhalation injury are controlled for, they have at least as good a chance for survival as the general burn population.     

Epidemiology and prevention of fatal head injuries in Germany – trends and the impact of the reunification

Summary A review of the data published on the epidemiology of traumatic brain injuries (TBI) reveals that the data of almost all studies are drawn from local or regional series. Nationwide data are rarely available, or are extrapolated from regional data. In Germany, there has been a nationwide mortality register with ICD-9-coded diagnoses since 1968. In addition, it has been compulsory since 1994 that all hospitals in Germany provide ICD-9 data on all admissions and discharges.Based on data provided by the Federal Bureau of Statistics (Statistisches Bundesamt) in Wiesbaden, all head injuries between 1972 and 1998 were analyzed according to ICD-9 and after 1998 according to the updated ICD-10. The data of hospitalized cases and fatal cases were correlated with population data to calculate incidences and mortality rates. Age-group specific data were also available and analyzed.Head injuries in Germany accounted in 1998 for 19.59% of all injuries. The incidence is 337/100,000. The incidence rate of serious head injury is 33.5/100,000. Mortality decreased continuously from 27.2/100,000 in 1972 to 9.0/100,000 in 2000. The mortality is highest in the group older than 75 years. 68.4% of persons with head injury die before admission to a hospital.After the reunification in 1989/1990, the number of fatal head injuries showed a temporary increase. The number of patients treated in-hospital remained essentially unchanged (276/564 patients in 1998). The majority of hospitalized patients suffered minor head injury.Conclusion: Analysis of the admission/discharge data of all German hospitals reveals surprising inside views of age group-related incidence and mortality rates of head injuries in this country. Future research should be focused on patients with minor head injuries who account for nearly 200,000 cases of in-hospital treatment.     

Pediatric burn injuries in Tehran, Iran

The objective of this study was to identify the epidemiologic features of pediatric burn injuries in western Tehran. Study subjects included all children up to the age of 15 years who were treated as inpatients at the Tohid Burn Center in Tehran between April 1995 and March 1998. Among the 3341 burns admitted to the Center over the 3-year study period, 1454 (43.5%) occurred in children less than 16 years of age. The overall case fatality rate for children was 16%, while the annual burn incidence rates ranged from 22.7 to 17.8 burns per 100000 child-years. The overall gender ratio (boys/girls) was 2.6. Children less than 2 years of age had the highest burn incidence and burn mortality rates. These findings will be used as a basis for developing targeted preventive programs to protect Iranian children from burns.     

Paediatric burns in Iceland. Hospital admissions 1982-1995, a populations based study

Epidemiological data of 290 children admitted to the Paediatric Department, University Hospital of Iceland, over a 14 year period, 1982-1995, are presented. The sex ratio boys/girls was 1.6. 72.8% were children four years and younger. Hot fluids was the most common cause of burn injuries, mostly caused by geothermal hot water. Only one child suffered from electricity burn injuries and none from corrosives. Most of the accidents occurred at home (81.4%). A decreasing number of children suffering from electricity and corrosive burn injuries reflects heightened awareness and improved safety in the home. We found a significant increase in the incidence of hot fluid burn injuries in Icelandic children compared to previous studies. This calls for preventive measures with regard to geothermal and other hot water burns in Icelandic children.     

Comparative statistical methods in the analysis of burn victims

Data on 70 burn patients aged 60 years or more who were treated at a regional burn centre were analysed using both univariate and multivariate methods. The univariate analyses provide information on ways in which individual patient characteristics are independently related to mortality and morbidity. These analyses result in simplistic understandings of the role each variable plays in subsequent patient outcomes but no information is provided on how these measures interact with one another. Even probit analysis, while providing useful estimates of mortality rates, traditionally considers only one variable at a time or must duplicate the procedure for separate subgroups of the sample. However, discriminant analysis permits the assessment of the overall contribution of various factors that are mutually present. Additionally, these techniques provide a mechanism to predict individual outcomes for each patient. The present study demonstrates that discriminant analysis of information easily available at the time of burn injury is useful in predicting mortality but not morbidity. The fact that morbidity is not predicted suggests the search for other factors that predispose a patient to subsequent complications.     

Epidemiology and mortality of adult burns in Catalonia.

Burn injuries still produce significant morbidity and mortality in developed countries. The incidence of burns in Catalonia is similar to other countries, with 31.2 per 100000 person/year referred to a specialized unit for definitive treatment. The Burn Center of the Vall d'Hebron hospital system is located at the General Hospital. It is the only facility for burns in the state of Catalonia. The catchment population is 6 million people, with 1814 +/- 89 burned patients treated in the emergency room per year and 396 +/- 15 of them admitted per year. Overall mortality is 3.49%. Inhalation injury and ARDS have a low incidence in our series with a high mortality. Factors associated with an increase in mortality are contact burns, inhalation injury, age and burn size. Pre-existing conditions did not affect survival in our series and 75% of all deaths occurred in the first week. Patients were treated with early serial debridement and cerium nitrate sulfadiazine, with results comparable to others in the literature. Mortality rates were compared to the Abbreviated Burn Severity Index, with a disparity in results, advocating the necessity to find a better and more applicable prognostic test for the outcome of burn injuries.