Flame burns involving kerosene pressure stoves in India

The author has analysed 339 patients with extensive burns admitted to a teaching hospital and found them to be most common in poor socioeconomic groups with low incomes, poor housing and illiteracy. Thermal injuries afflicted 89 per cent of the patients and were generally accidental and occurred in homes with floor-level cooking: chemical and electrical burns (the remaining 11 per cent) were uncommon. Kerosene pressure stove accidents were a common cause of thermal burns and occurred in 65 per cent of the patients. These were reported in both sexes but were 3.5 times more common in females. Mishandling of kerosene pressure stoves was the commonest cause and occurred in 65.7 per cent of the patients and the next most common cause was wearing loose garments. Kerosene pressure stove accidents occurred commonly in the age group 16–35 years and were rare in other age groups. These burns were relatively more extensive, deep and carried a high mortality.     

Survey of 1000 admissions to a burns unit SSKM hospital,Calcutta

A series of 1000 cases treated in our Burns Unit in Calcutta is reported. Of those, 688 cases (68·8 per cent) were between the ages 11 to 50 years, 274 (27·4 per cent) were children below 10 years and the remaining 38 (3·8 per cent) were above 50 years. Out of the children, 180 were boys and 94 girls. In the adult group there were 354 males and 372 females. Mortality rate was 20·4 per cent in this series. This high figure is due to the high rate of suicide; 74 out of 204 deaths were due to suicidal burns. In these cases, burns were extensive and deep in nature and the patients have no will to live. In the remaining 130 cases, the burns were caused by domestic or industrial accidents. Overall mortality rate was much lower than when the burns cases were treated in general wards along with surgical and medical cases.This paper brings out the importance of having a separate burns unit for acute burns cases, where specially trained nursing staff and doctors look after the patients.     

Epidemiological survey of burns treated in Ankara, Turkey and desirable burn-prevention strategies

From 1 January 1979 to 31 December 1993, 1109 patients were admitted to our burn unit located at Hacettepe University. Of the patients, 638 (57.5 per cent) were children (under the age of 16 years). The male to female ratio was 1.4: 1 in children, and was approximately 2.6: 1 for patients over 16 years of age. Of the 638 paediatric patients, 67 (10.5 per cent) sustained electrical burns. The causes of injury in the remaining 571 cases (89.5 per cent) were hot liquids in 379 (66.4 per cent of the non-electrical burns), flame in 190 (33.3 per cent) and contact burns in two (0.3 per cent). Of the scalds, 296 (78.1 per cent of the scalds), 52 (13.7 per cent), 22 (5.8 per cent) and nine (2.4 per cent) were caused by hot water, milk, meal and oil respectively. Of the flame burns, 21 (11.1 per cent) were due to LPG explosions.

Of the 471 adult patients (over 16 years), 159 (33.8 per cent) were injured by electricity. The causes of non-electrical burn injuries were: hot liquid in 25, flame in 274, chemical agents in four, contact in four, and other causes in four. Although our centre is located in Central Anatolia, 41.8 per cent of all patients were referred from the other six regions of Turkey. Of the 1109 inpatients, 645 (58.2 per cent) were injured in Central Anatolia, 279 (25.2 per cent) in the Black Sea Region, 55 (5.0 per cent) in the Mediterranean Region, 18 (1.6 per cent) in the Marmara Region, 34 (3.1 per cent) in the Aegean Region, 52 (4.7 per cent) in Southeastern Anatolia and 26 (2.3 per cent) in Eastern Anatolia. Approximately two-thirds of the patients (419) required one or more surgical interventions, including debridement and grafting, as well as amputation. The most important early complications were acute renal failure (148 patients −13.3 per cent), sepsis (660 patients −59.5 per cent) and gastrointestinal haemorrhage (seven patients −0.6 per cent). The overall mortality rate was 34.4 per cent. The epidemiological pattern of the burns showed that emergency measures should be taken to prevent scalding accidents to children throughout the country, and for electrical burns in adults, particularly those living in the Black Sea Region. In establishing, implementing and directing prevention programmes, regional differences should be taken into consideration.     

Chemical burns: our 10-year experience.

A review of 173 patients with chemical burns admitted to our burn unit was carried out during the years 1976-85. Most burns were work related (83 per cent). The majority of patients were men aged 21-50 years (mean age = 29.6 years). The mean total body surface area involved was 3.6 per cent (range = 1-30 per cent). The mean length of stay in hospital was 6.3 days (range = 1-52 days). The extremities were involved in 68 per cent of the patients. The more common aetiological agents were bromine and its compounds (36 per cent), then acids (21 per cent), alkalis and organic substances (14.5 per cent each). The severest burns were caused by the inorganic substances. Delayed admission was most characteristic of the bromine and alkali burns. Complications included local infection (19 cases), systemic infection (two cases), inhalation injury (two cases), tissue necrosis (one case) and corneal erosion (one case). There were no deaths. Increased awareness of the hazardous potential of chemicals should help reduce the incidence of chemical burns.     

The nursing home patient—a burn prone person. An epidemiological study

During the 6 years between 1980 and 1985, 39 nursing home patients were admitted to the Ilvidovre Burns Unit in Copenhagen with accidental burns. These patients accounted for 20 per cent of all burn patients above the age of 69 years admitted during this period. The median age of the patients was 80 years. Two-thirds of them suffered from burns of less than 15 per cent of their total body surface area. The mortality rate was 64 per cent. All patients were burned in single-person accidents, most often while sitting alone in their own living room, and smoking materials were involved in 85 per cent of the injuries. Senility, hemiplegia and other neurological diseases with tremor or paresis were frequently present in the victims.

Several preventive measures are proposed, including smoking under supervision, use of flame-resistant aprons of adequate size. Flame-resistant materials in chairs, etc.. and installation of smoke detectors in rooms where patients smoke. A possible relation between the marked incidence of these accidents during weekends or holidays, at a time when staff numbers are reduced in the nursing homes, is discussed.     

Mortality of burn injuries in Jordan

Three hundred and ninety patients who died following fire burns and scalds between 1973 and 1982 were subjected to autopsy examination at the departments of Forensic Medicine in the Ministry of Health and Jordan University Hospital. Flame burns caused 82 per cent of the deaths. Most of the burn injuries occurred at home and most of the accidents may have been avoidable. Seventy-six per cent of the patients were children and young adults (0–29 years). Suicide caused 13·5 per cent of the deaths. The most common causes of death were septicaemia and hypovolaemia.     

Epidemiology of industrial burns in Brisbane

A retrospective epidemiological study of industrial burns admitted to the Royal Brisbane Hospital was conducted over a period of 7 years. A total of 182 patients were included in this survey--173 males (95 per cent) and 9 females (5 per cent). The proportion of industrial burns has decreased from 31.5 per cent to 18.5 per cent of total admissions to the burns unit over the past 10 years. Fifty per cent of the burns occurred in males less than 30 years old. The average age was 31 years. Two-thirds of the burns covered less than 10 per cent of the body and 84 per cent covered less than 20 per cent. While scalds were the commonest cause of industrial burns in our study (19.4 per cent), flame burns with clothing ignited caused the most extensive burns. Face and hands were the most common sites involved. Burns to these regions were mainly caused by flame and electrical burns. Eye burns comprised 5.5 per cent of the sample and were due to chemicals, gas explosions and electric flash. Twenty-six patients (14 per cent) suffered respiratory injury. Only one patient out of our series of 182 died. Progress has been made in industrial safety in the past few years but carelessness and human error still take their toll.     

Flame burns disasters from kerosene appliance explosions in Lagos, Nigeria

A study of 55 cases of burns admitted to the Lagos University Teaching Hospital in the month of March 1984 revealed that 96 per cent were caused by flame burns due to explosions that occurred during the use of kerosene appliances for cooking and lighting. Thirty-four (62 per cent) were children, while 21 (38 per cent) were adults. In each of seven families, two or more people were affected. The overall mortality was 44 per cent, of which the larger contribution of 30 per cent was in children. By comparison, in the two preceding months there was a total of 17 and 20 burns admissions respectively. The mortality rate was 16 per cent while in March 1983 there was no death among the six paediatric admissions. Investigations showed that the explosions occurred due to petrol contamination of the kerosene before delivery to the domestic users. Appropriate precautions by kerosene suppliers and users, and health education can help prevent similar disasters in the future.     

Burn injuries in Lagos

Eighty-nine cases of burns admitted to the Lagos University Teaching Hospital during an 8-year period (1968–1975) have been studied. The age incidence ranged from 1 day to 54 years. Fifty cases (56·2 per cent) occurred in children below the age of 15 years. Thirty-nine (43·8 per cent) were adults, aged 15 years and above. Sixty-three cases (70·8 per cent) were domestic accidents. There was a mortality rate of 13·5 per cent. There was severe morbidity in the surviving cases, the average admission period in 73 cases being 37 days and the average total healing time in 57 cases being 54 days. The most troublesome late complications were contractures, hypertrophic or keloid scars and failure of repigmentation. Gram-negative bacteria accounted for 64 per cent of the incidence of wound sepsis.Health education has an important role to play in the prevention of burn accidents both in the home and in industry. In particular, it is suggested that cooking above floor level and closer supervision of children should reduce the incidence of domestic bums in younger children, while stricter factory inspection, with rigorous enforcement of industrial safety laws, should reduce the incidence of industrial burn accidents in the working adult population.     

Two years in burn care, an analysis of 12 423 cases

This is a retrospective study analysing 12 423 patients treated at our institution from 1 July 1988 to 30 June 1990. Burn incidence and mode of treatment were classified according to age and sex, as well as causative agent, place of the accident, length of treatment and outcome. 96.6 per cent of the patients were surgically treated, about 41 per cent of the patients were under 14 years of age. The most frequent cause of injury was related to meal preparation, with more than two-thirds of the accidents occurring at home. Only large or complicated burns (1094-8.8 per cent) were admitted, with 49 deaths occurring during this period. We conclude that children and younger adults are at greater risk of being burned and preventative measures should be oriented towards the prevention of such accidents.     

An epidemiological study of burn patients hospitalized in Valencia, Spain during 1989.

A retrospective study has been made of the patients hospitalized in the Burn Centre of La Fe Hospital in Valencia (Spain) during 1989. Of the 1825 patients seen during this period, 146 (8 per cent) were admitted to hospital. The mean patient age was 31.42 years, 68.5 per cent of the patients were male; 34.1 per cent were children under the age of 15 years and 15 per cent were over 60 years old. Fire was the most common cause of burns (50 per cent), and produced the most extensive lesions. Electrical current and firm contact with hot surfaces caused deeper burns. Thermal lesions were most frequently produced within the domestic environment. Burns caused by fire affected mainly the head and neck, scalding tended to involve the trunk and electrical current caused injury to the limbs. Half the hospital admissions were discharged within 15 days. Most of the lesions requiring hospital admission occurred during the winter months.     

150 bicycle injuries in children: a comparison with accidents due to other causes

One hundred and fifty bicycle accidents seen at the Children's Hospital, Sheffield over a 6-month period from mid-August 1979 were analysed and 9.3 per cent of the cases were admitted. Twenty-two per cent had fractures, 20 per cent had soft tissue injuries of face or scalp, 8 children having damaged their teeth. Of the accidents 17.3 per cent were due to hitting an obstruction, 30.7 per cent were due to loss of control on a hill or corner and 8 per cent were of mechanical origin. Eighty-eight per cent had cycling experience of a year or more, and 32.7 per cent had had previous cycling accidents.Comparison with other types of accidents previously studied at the hospital, involving skateboards, playground equipment or road traffic accidents affecting child pedestrians, showed that by far the most serious were those involving child pedestrians. The injuries from bicycle accidents were similar in severity to those involving skateboards.     

Burns in patients over 60 years old: epidemiology and mortality.

Epidemiology and mortality among burn patients over age 60 years who were admitted to the Burn Centre of La Fé Hospital (Valencia, Spain) between 1 January 1988 and 1 January 1991 have been studied. A total of 443 patients (7.8 per cent of all presenting patients) were hospitalized during this 3-year period; of these, 69 (15.5 per cent) were over 60 years old. There were 40 females and 29 males (mean age, 72.2 years). Mean burn area was 21.6 per cent of total body surface, and the most commonly involved regions were the lower limbs (81 per cent). Fire flames were the most common cause of burns (65.2 per cent) and produced the most extensive lesions. Eight-five per cent of the accidents occurred at home, and winter was the season of highest incidence. Patient mortality was 33.3 per cent, the most common causes of which were hypovolaemic shock during the first 24 h and pneumonia in the later stages.     

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.     

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 problems and prevention of burns in developing countries

Burns are rapidly assuming greater importance as a cause of ill health in the developing nations. The major factors include gross ignorance of fire prevention, the quick spread of slums and the persistence of old traditional customs and beliefs. One hundred and forty-one new cases of burns were treated at the University of Calabar Teaching Hospital (UCTH) in a 2-year period from January 1984 to December 1985. A large proportion of the patients (91, or 64.5 per cent) were minor burns, while 40 (28.4 per cent) were serious burns, and 10 patients (7.1 per cent) suffered major burns. Thirteen patients (9.2 per cent) left hospital against medical advice or absconded without completing their treatment. There were six deaths (4.3 per cent), most of the deaths occurred in the major burns group. Lack of drugs and intravenous fluids, delay in bringing the patients to hospital, ignorance, superstition and old cultural and traditional beliefs contributed to the morbidity and mortality. Most of the burn injuries were caused by domestic accidents and were therefore preventable.     

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.     

Work-related burns: a 6-year retrospective study

During the 6 years from July 1984 to May 1990, 193 patients (30.2 per cent of all patients) were admitted to our regional adult burn centre, for treatment of work-related burn injuries. The median age of patients was 32.5 years (range 18-64 per cent), and 94 per cent were males. Fifty-nine per cent of the patients came from metropolitan Toronto, and 40 per cent from rural Ontario. Most of the patients (97.3 per cent) were referred to the burn centre within 24 h of their injury. The most common aetiology was electrical injury (29.5 per cent), followed by flame (24.4 per cent), contact (10.4 per cent), flash (9.8 per cent), tar and asphalt (9.3 per cent), scald (7.8 per cent), chemical (5.1 per cent), steam (4.7 per cent) and grease (1 per cent). Within the electrical burn group, about one-half were flash burns, one-quarter were clothing fire injuries, and one-quarter were contact injuries. These occupational burns tended to be extensive injuries. The median body surface area (BSA) was 16.5 per cent, with a median full thickness (FT) component of 5.0 per cent. The average length of stay was 20.0 days. Inhalation injury requiring intubation occurred in 14.8 per cent of patients. Sepsis--confirmed by positive blood cultures--developed in 14 per cent of the patients, at an average time of 8.8 days postburn. Staphylococcus aureus was the commonest organism isolated from blood cultures. Pneumonia occurred in 6.3 per cent of patients. A total of 207 surgical procedures was performed on 113 of the 193 patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

An analysis of 1704 burn injuries in Hong Kong children

Over a 12-month period, 1704 children less than 15 years old with burn injuries seen in the accident and emergency departments of seven major regional hospitals in Hong Kong were analysed with respect to their epidemiological data. The age group with the highest risk for injury was 0-4 years (57 per cent) and with a maximum at 1-2 years of age. Boys showed a significantly higher incidence of burns than girls at any age. Ninety-three per cent of the accidents occurred at home and 92 per cent were scalds caused by hot water and other fluids. In the great majority of patients the total body area of burn did not exceed 5 per cent. Younger children had a higher incidence of burns involving the head, face and anterior trunk, 39 per cent of the 0-4 year age group required hospital admission. During the winter months, the children tended to suffer from deeper burns.     

Gunpowder-related burns.

Gunpowder misuse is a frequent cause of burn injury in our area. The injuries are mostly minor lesions which may be treated on an outpatient basis, the more serious injuries need surgical treatment. Experience of the management of these burns is reported by reviewing 123 clinical charts of patients admitted between 1983 and 1990. The most frequent victims are teenage males who are involved mainly in accidents in the street. The most serious burns followed work-related accidents, with a fatal outcome in 47 per cent of the patients. The serious burns are usually deep dermal or full skin thickness. A common pattern affects groins, genitalia, hypogastrium and hands, and are produced when fireworks ignite in the pockets of the patient's trousers. The management of these lesions does not differ from burns caused by other agents, although attention should be paid to the presence of associated lesions, chiefly to eyes, ears and hands, due to the shockwave and shrapnel.