Epidemiology of hospitalized burns patients in Taiwan

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

Burn epidemiology: a basis for burn prevention

An appreciation of the causes of burn injury is essential in order to direct burn prevention programs. Toward this goal, 1,564 patients treated at the UCI Burn Center were studied. There were 699 patients admitted acutely and 865 outpatients. The most common cause of thermal injury in both adults and children was scalding. In children scald burns accounted for 42% of the total number of children treated. In children under 4 years old scalds caused 75% of all burn injuries, most in the kitchen. Flammable liquids were responsible for the majority of the severe burns in the adult group (19% of acute admissions). Housefires, while accounting for only 5% of the adults treated, were responsible for 44% of the adult deaths. Continued public education in safety practices at home especially in the kitchen and bath, and with automobiles and outdoor stoves and fires is recommended, as well as planned escapes from homes and use of smoke detectors.     

Bath scalds in children in the south-east of Scotland.

Scalds caused by domestic hot tap water constitute a significant but preventable hazard in childhood. We have reviewed some of the factors contributing to such injuries, and the experience of a regional paediatric burn unit in their treatment. There were 91 children with bath water scalds and 667 children with thermal injuries from other sources included in this study. In the former group, scalds were more common on the limbs, including the hands and feet. Scalds involving over 40% of body surface area were more common in children with bath water injuries; however, there was no difference between the groups with regard to hospital stay or requirement for skin grafting. Parents ran the bath responsible for scald production in most cases, but single parenthood did not appear to be a risk factor. First aid application made no significant difference to eventual burn area or hospital stay. It appears from this study that reduction of domestic hot water temperature is necessary. Statutory control is likely to offer the best solution to the problem of domestic hot tap water scalds in childhood.     

Poverty,population density,and the epidemiology of burns in young children from Mexico treated at a U.S. pediatric burn facility

Introduction

Children 5 and younger are at risk for sustaining serious burn injuries. The causes of burns vary depending on demographic, cultural and socioeconomic variables. At this pediatric burn center we provided medical care to children from Mexico with severe injuries. The purpose of this study was to understand the impact of demographic distribution and modifiable risk factors of burns in young children to help guide prevention.

Analysis of 12,661 pediatric burns in Wuhan institute of burns: A retrospective study of fifteen years

BackgroundBy analyzing the epidemic characteristics of pediatric burns in a burn center serving large areas of Hubei Provence and partly surrounding provinces around Wuhan City, the aim of this study is to provide better strategies for the prevention and care for pediatric burns.MethodsPediatric burn patients who were younger than 13 years old in Wuhan Third Hospital from 2004 to 2018 were included. Demographic and clinical data were collected, analyzed and compared among groups.Results12,661 pediatric burns, mean aged 2.37 ± 2.30 y, were admitted during the 15 years, with 7973 boys (62.97%) and 4688 girls (37.03%). By age groups, infant (<3y), preschool (>3−6y) and school children (>6−13y) accounted for 81.12% (10,270 cases), 12.08% (1530 cases) and 6.80% (861 cases) respectively. The most cause of injury was scalds (11,232, 88.71%), followed by flame burns (917, 7.24%), electric burns (201, 1.59%), contact burns (127, 1.00%), firework or firecracker (124, 0.98%), chemical burns (40, 0.32%) and hot crush injury (20, 0.16%). The mean age of firework or firecracker burns was 6.19 ± 2.83y, electric burns 5.18 ± 3.31y, flame burns 4.73 ± 3.53y, hot crush injury 3.85 ± 2.37 y, contact burns 3.66 ± 3.35y, chemical burns 3.03 ± 2.50y, and scald 2.06 ± 1.91y. Over half cases (57.34%) were small burns less than 10% total burn surface area (TBSA) and the larger TBSA, the fewer number of patients. The mortality rate was 0.11% and correlated with TBSA, age and etiology. The mean length of stay (LOS) was 12.63 ± 11.91 days and highly correlated with etiology and TBSA. The mean hospital cost was 11210.76 ± 21248.87 RMB (about 1600 USD) or 1626.91 ± 3957.59 RMB (about 230 USD) per % TBSA, which was correlated with depth of burn, TBSA, etiology, LOS and age.ConclusionPediatric burns in central China was still common and even increasing. Majority of the pediatric burn victims were boys under three years old, while the mean ages of different etiologies varied from about 2–6 years old. Education and prevention aiming the high risks are the key point to decrease pediatric burns.     

Etiology and outcome of pediatric burns in Tabriz, Iran

A 3-year prospective study of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of pediatric burns. One thousand one hundred sixty patients under the age of 14 years identified and stratified by age, sex, burn size, presence or absence of inhalation injury, and cause of burn. The mean patient age was 2.2 years, and the male:female ratio was 1.6:1. There were 74 deaths overall (6.4%), the majority of which (44) were among children under 5 years of age. Except for burn incidence, there were no significant differences between males and females. The mean burn size was 19%, and was significantly larger for nonsurvivors than survivors (50.3% versus 16.8%; P<0.001). Inhalation injuries were strongly associated with large burns, and were present in all flame-burn fatalities. Scalds were the most common type of burn among children under 5 years of age; flame burns predominated in older children. There were 39 deaths related to scalds. Large burn size was the strongest predictor of mortality followed by the presence of inhalation injury and the length of time to intravenous access.     

Hospitalized Pediatric Burns in North China: A 10-year epidemiologic review

Retrospective surveys of all hospitalized pediatric burns under the age of 15 years were conducted in 18 hospitals from 5 provinces and municipal cities of North China between 2001 and 2010. A total of 17 770 patients were included in this study. The epidemiological characteristics of hospitalized pediatric burns and influencing factors of length of hospital stay and hospitalization cost were analyzed. In this study, children accounted for 43.57% of all hospitalized burns, with a gradually increasing trend (P = 0.003). Among children hospitalized burns, the percentage of children younger than three years was 69.9%, with an upward trend (P < 0.001). The ratio of male to female was 1.53:1. Scald burns accounted for 89.79% and 71.54% had burns of <10% total body surface area, with increasing trends (P ≤ 0.001). The medians of length of hospital stay and hospitalization cost were eight days and 2469 RMB yuan respectively. The most important factors affecting length of hospital stay and hospitalization cost were burned surface area, surgery and treatment outcome. Children under three years of age, boys and children with a small area of mild scald burns should be made the focus of childhood burn prevention. Improving the medical insurance system for children is urgently needed.     

Burns: epidemiology and the effect of a prevention programme

Epidemiological data concerning 1391 patients hospitalized at the Burns Unit, Odense University Hospital during a 17-year period are presented. The annual incidence showed a steady downward trend of 3 per cent per year. Scald and fire were the most important causes of burn injuries. Among children a significant reduction in burns due to scalds and electrical or corrosive injuries was noted. The rate of injury among adults and the elderly was constant. These results might reflect an intensive information campaign in the media, revisions of laws and regulations and improvements in the safety of household products, especially directed towards thermal injuries among smaller children.     

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

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

Epidemiology of minor and moderate burns in rural Ardabil,Iran

Epidemiology of minor burns is not well defined worldwide. The aim of this study was to examine epidemiological features of minor and moderate burn events that could be beneficial for prevention purposes. The study was conducted in Ardabil province in north-west Iran in 2005–2006. A total of 1700 minor and moderate burns were studied using a pretested questionnaire. Using the SAS 9.1 statistical program analyses were made. Females comprised the majority of cases (n = 1000, 58.8%) and children, aged six and younger, made up 36.4% of burn victims. The majority of burns were caused by hot water and tea with the primary containers being kettles in 37.8%, cups or glasses in 24.2%, pots in 13.6% and samovars in 7.9%. Samovars, gas stoves, valors and picnic gas stoves were the primary heating devices involved in burns. In 56% of the cases, overturning of liquid containers was the primary injury mechanism of scalds. 43% had a second-degree burn with a mean total body surface area of 1.3%. This study provides possible beneficial information for burn prevention in the Ardabil area and other similar settings.     

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   

Comparable results of epidemiology of children with burns among different decades in a burn unit in JinZhou, China

Objective

The aim of this study was to compare the epidemiological results of children with burns among different decades from 1970 to 2008.

Methods

The clinical data of all children with burns younger than 14 years admitted between 1970 and 2008 were compared among different decades using Statistical Package for Social Sciences (SPSS).

Results

Of all patients with burns, children accounted for 28.6%, despite differences in different decades (18.7-31%). In all children with burns, greater than 80% were accounted by children with mild and moderate burns, and by scalds, in which greater than 80% was caused by hot water. The proportion of scald gradually increased from 60% in the 1970s to 88% in 21st century. The increase in the number in the infant group was the direct cause for the decline of the average age of children injured over time. The case fatality rate in all children with burns was 0.7%, despite significant differences in different decades.

Conclusion

Current prevention strategies should be aimed at the ‘susceptible group’, namely infants, scald injuries and hot water scald, in particular, according to the epidemiologic characteristics of this study. Prevention methods from government, mass media and schools to the family is a tremendous need for the further development of prevention of paediatric burns in the future.     

Paediatric burn prevention: an epidemiological approach

OBJECTIVE: To study the mechanism of burn in hospitalized paediatric burn patients in order to develop a focused burn prevention campaign. METHODS: Acute paediatric burn patients were identified from the unit admission records. Detailed medical records were reviewed to identify the key demographic and management information including the country of residence, age, gender, extent of injury, specific treatment and hospital stay. Parents were then contacted to provide detailed information about the mechanism of the accident, first aid given, living density and parent's educational level. RESULTS: Two hundred and eighty-four admissions were identified in a 5-year period. Two hundred and twenty-four of these patients came from a defined regional population served by the hospital. The median age of patients was 3 and male to female ratio 1:0.74. The most common age group for burns was 1-2 years. The most common type of burns were scalds. Domestic burns accounted for 84.7% of admissions. Median burn area was 4% of the total body surface area with a range of 0.2-45%. Fifty percent of patients had no first aid treatment prior to presentation at the hospital. More accidents happened in homes with a high living density and the majority of parents had both completed secondary education. The most dangerous location in the house was the living room, followed by the bathroom, kitchen then bedroom. The majority of burns were related to hot drinks, followed by hot food and then bathing. CONCLUSION: Detailed investigation of burn incidents can reveal repeated mechanisms of injury, which direct the focus of preventive strategies.     

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.     

Infants under 1 year of age have a significant risk of burn injury

A wealth of data exists concerning paediatric burn epidemiology in general, but very little exists specifically in infants under 1 year of age, a special group in which mobility begins to develop. A retrospective study of all burn admissions of infants under 1 year old to The Welsh Centre for Burns from January 2003 to January 2006 was performed. During the 3-year period there were 104 new burns cases identified which represents 11.8% of all paediatric admissions. 63.5% (66) were treated as inpatients and 36.5% (38) treated as out-patients. Burns increased in frequency with increasing age and occurred mainly in the home. Scalds were the commonest type of burn in 65% (68) whilst the second most common was contact burns which accounted for 30% (31). The most common source of scald was from cups containing hot drinks (39%) and the most common source of contact burn was radiators/hot water pipes (30%). The mean TBSA was 2.3%, (range 0.5-38%). The frequency of burns in the under 1 year old population highlights a need for emphasis of burn prevention directed to this group. Special attention is needed to look at the specific aetiology of these burns. Starting points for prevention should address the number of burns surrounding hot drinks and bottle warming practices in the case of scalds and the dangers of household radiators and hot water pipes in the case of contact burns.     

A systematic review of the features that indicate intentional scalds in children

Background

Most intentional burns are scalds, and distinguishing these from unintentional causes is challenging.

Aim

To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds.

Methods

We performed an all language literature search of 12 databases1950–2006. Studies were reviewed by two paediatric/burns specialists, using standardised methodology. Included: Primary studies of validated intentional or accidental scalds in children 0–18 years and ranked by confirmation of intentional or unintentional origin. Excluded: neglectful scalds; management or complications; studies of mixed burn type or mixed adult and child data.

Results

258 studies were reviewed, and 26 included. Five comparative studies ranked highly for confirmation of intentional/unintentional cause of injury. The distinguishing characteristics were defined based on best evidence. Intentional scalds were commonly immersion injuries, caused by hot tap water, affecting the extremities, buttocks or perineum or both. The scalds were symmetrical with clear upper margins, and associated with old fractures and unrelated injuries. Unintentional scalds were more commonly due to spill injuries of other hot liquids, affecting the upper body with irregular margins and depth.

Conclusions

We propose an evidence based triage tool to aid in distinguishing intentional from unintentional scalds, requiring prospective validation.     

Childhood burns in Israel: a 7-year epidemiological review

INTRODUCTION: Understanding the etiology of severe burns injuries and identifying high risk groups are essential for allotting resources for prevention and treatment. The objective of this study was to develop a profile of severe childhood burns in Israel. METHODS: A retrospective study of children (ages 0-14) hospitalized with a burn, between 1998 and 2004. Data from all five burn units in Israel was retrieved from the National Trauma Registry. RESULTS: Two thousand seven hundred and five children were hospitalized with burns (51% of all burn admissions). Infants (ages 0-1) had the highest prevalence (45%). Scalds caused 68% of burns. Burn extent in 83% of the patients was less than 20% TBSA, 3% suffered 40%TBSA burns. Surgical intervention increased from 6% in 1998 to 21% in 2002. Non-Jewish children sustained proportionally more burn injuries (48%). Among Jewish children an increase in burn injuries was noted on Thursdays and Fridays. CONCLUSION: Infants, boys and non-Jewish children were found to be at greatest risk for a burn injury, while older children were at higher risk for severe burns. Prevention programs should target these high risk groups, with an emphasis on the unique characteristics of each group. Policy makers should reassess the benefits of a pediatric burn unit in Israel. The increase in rates of surgical intervention should be further investigated.     

Analysis of pediatric burns in Nagasaki University from 1983 to 2002

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

Public perception of household risks for pediatric burn injuries and assessment of management readiness

IntroductionChildren are uniquely vulnerable to injury because of near-complete dependence on caregivers. Unintentional injury is leading cause of death in children under the age of 14. Burns are one of the leading causes of accidental and preventable household injuries, with scald burns most common in younger children and flame burns in older ones. Education is a key tool to address burn prevention, but unfortunately these injuries persist. Critically, there is a paucity of literature investigating adult comprehension with respect to potential risks of household burns. To date, no study has been performed to assess management readiness for these types of injuries without seeking medical care.MethodsQualtrics™ surveys were distributed to laypersons via Amazon Mechanical Turk. Demographics were self-reported. The survey was divided into two parts, management knowledge, and risk identification. The management part involved a photograph of a first-degree pediatric burn injury and required identification of the degree of injury and three potential initial managements. The risk-identification section required correctly identifying the most common mechanisms of burn injury for different age groups followed by general identification of 20 household burn risks. Survey responses were analyzed using two-tailed Student's t-tests and chi-square analyses, univariate and multivariate analysis, and linear regression.ResultsOf the 467 respondents, the mean age was 36.57 years, and was 59.7% (279) male. Only 3.2% of respondents were able to correctly identify all 20 potential risks listed in our survey. Additionally, only 4.5% of respondents correctly identified all three appropriate initial management options (cool water, sterile gauze, and over-the-counter analgesics) without misidentifying incorrect options. However, 56.1% of respondents were able to select at least one correct management option. For image-based injury classification, the most common response was incorrectly second-degree with 216 responses (42.2%) and the second-most common response was correctly first-degree with 146 responses (31.3%). Most respondents claimed they would not seek medical attention for the injury presented in the photograph (77.7%). When comparing the responses of individuals with children to those without, there were no statistically significant differences in ability to assess household risks for pediatric burns. For the entire population of respondents, the mean score for correctly identifying risks was 38%.ConclusionThis study revealed a significant gap in public awareness of household risks for pediatric burns. Furthermore, while most individuals would not seek medical care for a first-degree pediatric burn injury, they were readily available to identify proper initial management methods. This gap in knowledge and understanding of household pediatric burn injuries should be addressed with increased burn injury prevention education initiatives and more parental counseling opportunities.