Profile of the paediatric burn patient in a Canadian burn centre.

Five hundred and eighty-three children (0-18 years old), consisting of 33.4 per cent of all burn inpatients, were admitted to the University of Alberta Hospitals over an 11-year period (January 1978 to December 1988). Demographic and outcome variables, in addition to aetiological factors, were examined. 48.4 per cent of burns occurred in children less than 4 years of age, with males predominating in every age group (P less than 0.001). Children had smaller burns, a higher incidence of scalds, less inhalation injuries and a lower mortality compared to adult burn patients admitted over the same time period (P less than 0.05). There was a low incidence of confirmed child abuse by burns (1.4 per cent). High-risk environments identified were the home (74.6 per cent of burns) and recreational settings (12.4 per cent of burns), mainly occurring around campfires. Native children were overrepresented in the burn population compared to the general population by a factor of approximately 10:1. Scald prevention, high-risk environments (home and recreational), high-risk populations (male and natives) and unsafe practices with flammable liquids (petrol in particular) should be emphasized in paediatric burn prevention programmes.     

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.     

A policy of early excision and grafting in elderly burn patients shortens the hospital stay and improves survival

Early excision and grafting of the burn wound appears to shorten the hospital stay and decrease mortality in children and adults. However, whether an early surgical approach is safe in elderly burn patients has not been resolved. To answer this question we carried out a prospective study of early surgery in 114 consecutive patients over the age of 50 years. Patients were generally operated on between post-burn days 2 and 5. The mean age of the patients was 68 years, with a burn size of 22 per cent, of which 13 per cent was full thickness skin loss. The mean hospital stay of the surviving patients was reduced by 40 per cent compared to national averages (P less than 0.001). The mortality rate for the entire group of patients was 17 per cent, with 2 deaths in the 65 patients with burns less than 20 per cent total body surface area (TBSA). Although the mortality rate for patients with burns greater than 20 per cent TBSA was 35 per cent, this was less than predicted (P less than 0.05). The improvement in survival appeared to be due to a decrease in the incidence of lethal burn wound infections.     

Aetiology of burn injuries among children aged 0-4 years: results of a case-control study

During the year 1987/1988 a case-control study was conducted, by means of a postal questionnaire, among parents of children aged 0-4 years. Cases (n = 122) were 0-4-year-old Dutch children who visited emergency departments with burn injuries. Controls (n = 213) were a sample of the Dutch population of 0-4-year-old children without burn injuries. Odds ratios based on logistic regression (OR-LR) and 90 per cent confidence intervals (CI (90 per cent) were calculated for a number of putative risk factors. The risk of burns was higher for children with other than Dutch (e.g. Turkish) ethnicity (OR-LR = 5.6; CI (90 per cent) = 2.6-11.9). Children who lived in relatively small houses turned out to have a higher risk of burns (OR-LR = 2.5; CI(90 per cent) = 1.3-4.7). To our surprise, children belonging to lower socioeconomic classes were found to have a decreased risk of burns (OR-LR = 0.3; CI (90 per cent) = 0.1-0.6). Furthermore, among several manipulatable risk factors, the use of an oven window which gets hot while in use appeared to have an increased risk of burns (OR-LR = 2.1; CI(90 per cent) 1.3-3.5). The same holds for the storage of hot drinks in their original pots instead of in vacuum flasks (OR-LR = 2.0; CI (90 per cent) 1.2-3.1). Cooking on a gas stove was found to be another risk factor (OR-LR = 2.5; CI(90 per cent) 1.1-10.0).     

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the firs, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0–10 years old (40 per cent) and moderate to major burns in the age group 21–30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.     

Burn injuries in the Dong Bei area of China: a study of 12,606 cases.

This survey analyses data from nine Chinese burn units with respect to age, causes, severity of burn injury, and survival or death of patients admitted to hospital during the past 10 years (from January 1980 to December 1989). Of 12,606 burned patients treated, 3391 were children (26.9 per cent) and over half the children (52.3 per cent) were up to 4 years old. Almost 60 per cent of the 12,606 patients treated were in the young adult group (15-44 years), and 86.9 per cent of 12,606 patients sustained thermal injuries mainly from fire flames followed by scald injuries (40.7 per cent). About 93 per cent of the patients had burns covering less than 50 per cent of the body surface area. The overall mortality rate was 1.24 per cent. The LD50 for the 12,112 patients less than 60 years old was a burned surface area exceeding 80 per cent of the total body surface area.     

Epidemiology of domestic burns related to products

Of 4357 home accidents in a 1-year period related to products, a total of 338 burn injuries were prospectively studied with respect to age, sex, the time and cause of the burn accident and the product involved in the burn injury. The survey showed the highest incidence (26 per cent) in the age group 0-5 years and that most burns were caused by scalds or contact. The male to female ratio was 1:1. Activities related to cooking and making/drinking hot beverages constitute the majority of the domestic burns. A trend of more burns occurring during the weekends and the dark winter was found, but monthly or seasonal differences were not significant (0.10 less than P less than 0.20 and 0.20 less than P less than 0.30).     

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.     

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.     

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.     

An analysis of childhood burns in Kuwait.

A prospective study of 394 burned children (in-patients) up to the age of 12 years old was carried out for the period from January 1984 to December 1986. They were categorized into three age groups, the infants and toddlers 0-2 years, early childhood 3-6 years and late childhood 7-12 years. In the first two groups scalding was the predominant cause of injury, while in late childhood there were many more flame burns. Ninety-five per cent of the accidents occurred at home and the majority happened in the presence of parents. The presence of parents was not a deterrent to the accident but ensured speedy transport to the hospital. In our review 3 per cent of patients sustained more than 50 per cent BSA burns, there were 12 deaths with a mortality rate of 3 per cent. An intense campaign to make parents aware of the risk factors and their avoidance is required to reduce the number of burn accidents.     

The vulnerabilities of age: burns in children and older adults

BACKGROUND: Both children and older adults are thought to sustain burns serious enough to warrant hospitalization disproportionately more often than other age groups, but the incidence, injury characteristics, and outcome have not been precisely defined. METHODS: Patients hospitalized with a burn diagnosis were identified from hospital discharge data from California, Florida, New Jersey, and New York for the 5-year period 2000-2004. RESULTS: In those states, 60,024 residents were hospitalized with a diagnosis of burn and/or inhalation injury according to the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Using population data from the United States Census 2000, we found that the average annual incidence of hospitalization with a burn diagnosis in these 4 states was 155 per million (per M) (95% confidence interval,153-158). There were 13,453 children under 15 years of age: incidence, 163 per M (range, 157-169). Of these 9508 (70%) were under 5 years of age: incidence, 363 per M (range, 347-379). In contrast, there were 10,686 patients 65 years of age or older: incidence, 214 per M (range, 205-224), of whom 2091 were at least 85 years old: incidence, 347 per M (range, 314-380). The incidence of hospitalization with a burn diagnosis for patients 15 to 64 years of age was 141 per M (range, 138-145). Compared with children younger than 15 years, patients aged 65 years and older more often had flame burns (odds ratio [OR], 2.12), burns of 20% or more of body surface area (OR, 2.41), inhalation injury (OR, 2.88), respiratory failure (OR, 4.48), and death (OR, 16.53), all P < .0001. CONCLUSIONS: Older individuals are the most vulnerable to the morbidity and mortality of burn injury. Prevention strategies targeted to those older than 65 years should be developed.     

Does rapid wound closure improve survival in older patients with burns?

Seventy-five patients more than fifty years of age were admitted for treatment of burns from January 1, 1986, to December 31, 1987, to two community-hospital-based burn units. Patients were managed by a team of burn surgeons at each unit and early excision and grafting was used whenever possible in deep partial-thickness and full-thickness burns. The extent of burn was charted weekly during hospitalization and rate of wound healing was calculated using linear regression analysis. The mean total percent burn was 26.2 per cent (range, 4-85%). The overall mortality rate was 40 per cent. Mortality rate increased sharply by decade from 17.4 per cent for those aged 50-59 years to 100 per cent for the five patients age 90 and more. Excision and grafting were performed in 40 patients; 35 patients were not operated upon. Although hospitalization was somewhat longer in patients treated surgically, survival was better. Excision and grafting should be used when needed to achieve rapid wound closure in patients more than fifty years of age.     

Northeastern Ohio Trauma Study: V. Burn injury

Burn injury cases were identified from a population-based sample of trauma visits to hospital emergency departments in northeastern Ohio during 1977. The 199 cases represented 2.4% of all trauma incidence visits by residents of the five-county study region. Ninety-five per cent of the burn cases were released from the emergency department directly after treatment. The annual incidence rate of emergency department-treated burns was 4.7 per 1,000 population. Incidence rates for males were twice those for females. The age groups with the highest annual incidence rates were those under 5 years of age and 25-34 years (seven and eight cases per 1,000 population, respectively). Most burns occurred at home or the workplace. The youngest employed age group sustained the highest rate of work-related burns. Hot or corrosive substances caused two thirds of all burns; fire and flames caused one fourth.     

Trends in burn admissions in Scotland during 1970–1992

This retrospective study involved analysis of the data of the inpatients discharged with a diagnosis of burns, from various hospitals in Scotland, during the period 1970–1992. There were 51350 such inpatients all over Scotland, with an average annual rate of 2233 cases. Overall burn incidence in actual numbers was 43.7 per cent in < 15 year olds, 41.2 per cent in 15–64 year olds and 15.1 per cent in ≥ 65 year olds. Burn rates per 100 000 population were highest in < 15 year olds and lowest in 16–64 year olds.

The pattern of burn admissions has changed. Since 1987 the highest numbers of burn inpatients were the 16–64 year olds, followed by children, then the elderly. There has been a gradual but sustained fall in burns admissions in all age categories. The downward trend was statistically significant (t = 8.48, 21 d.f., P < 0.001). Though the population of the elderly (≥ 65 year olds) increased by about 13 per cent, the burn admissions and all deaths due to burns did not reveal an upward trend. The population of the old (81 + year olds) increased by 60 per cent during the same period. The incidence of burns was above average when > 80 year olds were considered separately, approaching the levels found in children. However the rate and incidence of burns in the 65–80 year olds resembled that of the younger age group (16–64 year olds).

The total number of deaths due to burns and/or smoke inhalation has declined in all age groups and the decline has been statistically significant (chi-squared = 19.62, 1 d.f., P < 0.001). Maximum number of deaths occurred in ≥ 65 year olds (44 per cent), followed closely by 16–64 year olds (43.5 per cent), and 12.5 per cent of deaths in adolescents and children. The decline was due to improved management of burns and a decrease in the number of patients having large body surface area burns.     

Incidence of burns requiring hospitalization in Finland in 1980

In 1980 there were 1296 emergency hospitalizations for burn injuries in Finland, averaging 27 per 10(5) inhabitants. The incidence varied from 20 to 58 per 10(5) by central hospital district, 70% of the patients were men. The incidence was higher among men than women at all ages. High risk population groups were children aged 0-4 and men aged 80 years and over. The incidence was higher in rural than urban areas. That was true especially among the elderly, whereas the opposite was true among small children. Most (59%) of the burns were caused by hot substances. Open fire caused 16%. The treatment of burns accounted for a total of 23,327 hospital days. The average duration of the emergency hospital stay was 14.3 days. Causes of regional variation and high incidence among old men require further research. The establishment of burn units in high risk areas should be considered.     

Hand burns in children under 5 years of age

In order to evaluate the epidemiology and functional results of hand burns in young children, 92 consecutive patients (126 hand burns) under age 5 years admitted to a Burn Center were reviewed. Scald burns (49 per cent) were most common, followed by flame (34 per cent), contact (14 per cent) and electrical burns (3 per cent). The child was left unattended by an adult in 53 per cent of cases and documented abuse was present in 6 per cent. The mean total body surface area (TBSA) burned was 17 per cent, and 77 patients (85 per cent) had additional burns in other areas (arms 34 per cent, legs 31 per cent, chest 29 per cent and face 27 per cent).

Palmar burns occurred in 24 hands (19 per cent), dorsal in 41 (33 per cent), while both surfaces were burned in 61 (48 per cent). Joints involved included the MP in 96 (76 per cent). PIP in 87 (69 per cent) and DIP in 80 (63 per cent). The depth was superficial partial thickness in 53 (47 per cent), deep partial in 55 (44 per cent), and full thickness in 18 hands (14 per cent); a total of 29 hands were grafted (15 deep partial and 14 full thickness). Escharotomies were required in 12 hands (9 per cent) (9 flame and 3 scald) and partial amputation of digits was required in 3 (2 per cent).

Follow-up was available in 46 hands from 7 to 120 months (mean 39 months). Partial thickness burns (34) healed with normal (32) or near-normal (2) hand function and developmental delay occurred in one patient. Hand function in 12 full thickness burns was normal in 9, decreased in 3 with developmental delay in 2 patients. The number of reoperations required per hand burned after hospital discharge varied with age (2 years and under 1.2 vs. over 2 years 0.6), depth (deep partial 0.4 vs. full thickness 1·6) and surface involved (palmar 1.3 vs. dorsal 0.1 vs. both 1.5), indicating that children under 2 years with full thickness palmar burns are at increased risk of developing burn scar deformities requiring surgical correction. Although 24 total reoperations were required in 25 deep partial and full thickness hand burns, residual burn scar deformities were present in only 2 hands at follow-up (1 boutonniere and I web space contacture).

It is concluded that the overall outcome of hand burns in this age-group is good and developmental delay is rare with proper acute management and prompt surgical correction of burn scar deformities.     

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.     

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.     

An analysis of burn mortality: a report from a Spanish regional burn centre

This paper reports an analysis of the mortality rates and related factors in our Burn Centre, based on 710 patients treated between 1985 and 1988. The average age of the patients was 23.8 years and the average burn size was 14 per cent of the body surface area. Burning injury affected mainly men (66 per cent), and their mortality rate was higher than that of women. The overall mortality rate was 6.6 per cent, the average age of the fatally injured patients being 54 years. We confirm that mortality in burned patients is closely related to: age (51 per cent of the patients were over 60 years of age); burn size (68 per cent of the patients had burns covering more than 30 per cent TBS); burn depth (57.4 per cent had full skin thickness burns); inhalation injury (present in 66 per cent of the fatally injured); and associated risk factors. The main cause of the burning injury was flames, chiefly from domestic accidents. The average survival time for the fatally injured patients was 10 days. Finally, our expected mortality followed a linear regression model, the LA50 for patients with only full skin thickness burns was 50 per cent.