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.     

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.     

Extensive deep neck burns

A total of 1402 patients were treated in the Nuffield Burns Unit between 1960 and 1970. There were 51 deaths (3·3 per cent); 40 were anticipated from mortal burns (Bull, 1954), 5 from pulmonary embolism and 1 each from airway burn, diffuse adrenal haemorrhage, septicaemia, coincidental rupture of an aortic aneurysm, toxic nephritis and hepatitis.Of the 1402, 218 (15·8 per cent) had burns involving the neck and adjacent areas; 29 of these 218 had extensive whole skin loss of the neck and adjacent skin.     

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.     

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.     

Acute electrical burns: a 10-year clinical experience

We have reviewed 113 cases of electrical burns treated at the Cook County Hospital Burn Center during the past 10 years. There were 3265 acute burn admissions during this period. the incidence of electrical burns being 3.5 per cent. Low-voltage electrical burns occurred in 82 of the 113 patients (73 per cent). These were caused mostly by household electricity supplies, occurred in children, and were preventable. Arc burns of the perioral region were allowed to heal spontaneously. The surgical management of other arc burns and flash burns was similar to that for most deep burn wounds. The incidence of high-voltage electrical injuries was 27 per cent in our series. Over 50 per cent of these injuries were not work-related. These tended to occur outside the home in young adult males and were also frequently preventable. None of these patients developed acute renal failure. Early surgical debridement of devitalized tissue with allografting, followed by delayed definitive wound closure or amputation prevented septic complications. Early fasciotomy appeared to have little effect on complete limb salvage. Limb loss continues to be the major factor contributing to the high morbidity associated with these injuries. All 113 patients survived. We attribute this to early transfer of patients to our Burn Unit, aggressive fluid resuscitation, continuous haemodynamic and metabolic support, and early surgical intervention.     

Burns during pregnancy

Eight cases of burns during pregnancy were treated in Kuwait during the last 3 years. In all burns above 30 per cent body surface area (BSA), abortion, premature labour and intrauterine fetal death are ever-present complications and the survival of the foetus in burns above 50 per cent BSA is uncommon. Nearly all these complications occur during the first week after the burn. For patients in the second and third trimesters of pregnancy with burns above 50 per cent BSA the prognosis is usually poor unless the pregnancy is terminated within 24-48 h after the burn.     

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.     

A report of 115 consecutive autopsies in burned children: 1966–1980

The overall mortality rate at the Shriners Burns Institute, Galveston Unit, decreased from 14 per cent in 1966, to 2·8 per cent in 1980.In all, 74·8 per cent of the deaths were associated with sepsis, and pulmonary lesions were the most frequent fatal complications (75·6 per cent).The burn wound was the major source of sepsis (62·7 per cent). Pseudomonas, E. coli, Klebsiella, Candida spp. and Staphylococcus aureus were the most common cultured bacteria.After a new standard fluid resuscitation programme, tangential excision and surgical management of the burn wound sepsis were adopted, the fatalities decreased from an average annual mortality rate of 11·5 per cent in the years 1966–1975, to an average annual mortality rate of 2·8 per cent in the period 1976–1980.After the routine antacid and milk diet were adopted (1970), the percentage of stomach and duodenal ulcers found at autopsy decreased from 2·0 per cent to 0·8 per cent, and from 3·5 per cent to 0·5 per cent respectively.The morphological alterations in the lymphoid tissue, reflecting a defect in T-cell function and stimulation of B-cell function, were present up to 114 days post burn.     

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 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.     

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.     

Use of topically applied silver sulphadiazine plus cerium nitrate in major burns

All patients hospitalized between May 1987 and June 1988 suffering from burns covering over 50 per cent of the body surface area were treated by topical application of a cream containing cerium nitrate (0.05 M) and silver sulphadiazine (0.03 M) (CN + SSD). Eleven patients were included in this series, with a mean age of 35 years (range 22-65), a mean total burn size of 78 per cent (range 50-96 per cent) and full skin thickness covering a mean of 48 per cent (range 10-91 per cent). Eight patients survived (73 per cent) (mean age 36 years; mean total burn surface 73 per cent; mean full skin thickness burn surface, 38 per cent). These results are far better than those obtained in our Unit where a survival rate of 34 per cent was obtained in a comparable series of patients treated before 1987. Sixty positive blood cultures were obtained, which included a large variety of organisms with a slight predominance of Staph. aureus, Candida albicans and Ps. aeruginosa. Wound cultures were positive in 72 per cent of swabs and showed a predominance of Ps. aeruginosa (59 per cent of all the strains isolated). Even if CN + SSD appears in this series not to be very efficient in preventing wound colonization and septic complications, it permitted a very high survival rate in the treated patients, taking into account the extreme severity of the injuries. This beneficial effect is probably the consequence of the protective action of the yellow-green eschar formed by CN + SSD.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

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.     

Burns due to cooking oils--an increasing hazard

From July 1967 to June 1981, the proportion of all burns patients admitted to the Royal Brisbane Hospital Burns Unit, who were burnt by hot cooking oil or fat, rose 5.1 per cent during the first five years of the study, to 11.3 per cent during the last four years, probably due mainly to the rising popularity of cooking food in hot oil, but also probably due partly to the changing patterns of how cooking oil is used. Sixty-two of the 112 patients sustaining hot cooking oil or fat burns over the 14-year period, were males (55 per cent), and 50 were females (45 per cent). Patients of all ages were involved, but there was a notable increase in the proportion of 30-39 year-olds and a notable decrease in the proportion of those aged 60 years and older. The vast majority of these burns occurred in the domestic situation, and this majority increased over the 14 years, may be explained by changes in the of industrial cooking. The notable increase in the ratio of deep partial/full thickness burns in the series, over the fourteen years, may be explained by changes in the relative amounts of cooking done with different types of fats and oils, which have differing physico-chemical properties, although the proportion of patients receiving skin grafts did not alter much with time, reflecting the increasing tendency to graft burns. Ninety-six per cent of the patients in the series sustained burns of less than 20 per cent of their body surface area, and the proportion suffering burns of 1 per cent or less in area has risen markedly. No deaths directly resulted, and predisposing factors to burn injury were remarkably absent. The majority of patients sustained burns to their hands, reflecting the situation in which most of these burns occur, that is, spilling a carried vessel of ignited cooking oil. Prevention by greater consumer education is recommended.     

Effects of early hypnosis on the cardiovascular and renal physiology of burn patients

Sixteen patients with body surface area (BSA) burns of 4 per cent to 83 per cent, with whom single hypnotherapeutic interventions were attempted 5·3±3·4 h post burn, were compared to 16 matched controls. Ten physiological parameters related to fluid volume and haemodynamics were recorded on the first two post burn days. The only significant difference discovered was elevated urine output 0–48 h post burn in successfully hypnotized patients (P=0·01). This difference was inversely related (r=?0·94, P=0·009) to burn size from a 10 per cent BSA burn (3·9 litres/48 h) to a 35 per cent BSA burn (1·6 litres/48 h). A statistically suggestive (P=0·13) increase in urine output occurred in patients in whom hypnotic trance induction was unsuccessfully attempted. Patients with BSA burn sizes ≥ 50 per cent, who presented with significant physiological stress and hypovolemia, were found not to be susceptible to hypnotic trance induction, and derived no physiological benefit. Attempted hypnotherapeutic intervention per se, with its psychotherapeutic component, may act only to reduce affective or psychological stress and anxiety. This psychological stress reduction apparently facilitates the loss of retained fluid in patients with small burns by a mechanism which is overwhelmed by the physiological stress of a major burn injury.     

Pattern of burns in child abuse

Cases of burns from child abuse are low because of under-reporting, low index of suspicion, or lack of verity proof. Although the reported incidence of child abuse by burns is 4 to 39 per cent, less than one-half are substantiated. We retrospectively reviewed all burns in children less than 6 years old admitted to our burn center within an 8-year period (1997-2003). Of the 155 children less than 6 years old admitted with burns within the study period, only six cases (3.8%) were confirmed as occurring from abuse. Scald injury was the most common cause of accidental and abuse burns. Burns by child abuse occur mostly from tap water (50%) and usually in children less than 2 years old. Whenever the extremities were involved, the left side was always included. In extreme cases, however, multiple areas of the body were involved with intervening spared sites. The perpetrator was the mother's boyfriend in all cases. Burns in children less than 2 years old left in the care of the mother's boyfriend, involving the left extremity (or extremities), and caused by tap water should prompt the clinician to more actively confirm or exclude abuse.     

Four years' experience of limb replantation in Saudi Arabia: a clinical review

This is a review of 70 patients with traumatic limb and digit amputations treated at King Khalid University Hospital, Riyadh in Saudi Arabia from April 1984 to April 1988. Out of 70 cases 34 were not suitable for replantation. In the remaining 36 patients replantation or revascularization was attempted on 46 units. The data are discussed and compared with other published series. Our net survival rate was 67.4 per cent. The survival rate improved from 62.8 per cent in the first 2 years to 81.8 per cent in the subsequent 2 years. The average hospital stay (34 days) was much longer than that reported from developed countries. The increased emergency workload due to a high incidence of referral of unsuitable cases and the longer hospital stay should be taken into account while establishing a replant service in a developing country. Eighteen cases were followed up for more than 1 year; of these, 61 per cent had good (grade I or grade II) functional recovery. The survival rate and functional recovery improved with increased experience and this is a strong argument in favour of centralizing the replant services.     

Twelve-year experience of the management of ruptured abdominal aortic aneurysm

Background The operative mortality rate for elective repair of asymptomatic abdominal aortic aneurysm (AAA) is falling but the fate of patients with ruptured AAA may have changed little over the past decade. Methods This study was an analysis of a prospectively gathered computerized database. Results In the 12 years to 31 December 1994, 1144 patients underwent (attempted) repair of AAA. In 514 patients (44·9 per cent) who had an operation for ruptured AAA there was no significant change in the mean age, male: female ratio (418:96), or operative mortality rate (35·0 per cent) over the interval of the study. Forty-seven patients died before reaching the operating theatre, giving an ‘intention to operate’ mortality rate of 405 per cent. A further 68 patients (10·8 per cent of all patients who presented with a ruptured AAA) were not offered operation because of poor medical condition (n = 34) or extreme age (n = 34); three patients refused operation. A greater proportion of patients had surgery between 1989 and 1994 (276 of 323, 85·4 per cent) than between 1983 and 1988 (238 of 309, 77·0 per cent) (P <0·01, X² test). Conclusion The proportion of aneurysms operated on for rupture in this unit remains high (almost 50 per cent). The results of surgery for ruptured AAA have not improved in the past 12 years.