Chemical burns

This study reports the incidence and nature of chemical burns admitted to a large regional burns unit between 1 January 1981 and 31 December 1987. Of the 3251 patients admitted, 100 had sustained chemical burns; although they only comprised 3.1 per cent of the workload they accounted for 16.5 per cent of all industrial burning accidents. The victims were mainly male adults of working age. Alkaline materials caused 37 per cent of the accidents, 26 per cent attributable to caustic soda; acids caused a further 27 per cent, hydrofluoric acid accounting for half of these. The nature of the chemical was unknown in 13 per cent of the cases; this, together with the fact that workers were often unaware that they were using hazardous substances gives cause for concern. The methods for managing a diverse range of chemical burns are described.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Respiratory complications following severe burns—a study of pathological findings

Between 1974 and 1976, 480 patients were admitted to the Intensive Care Unit for Burns, Plastic and Hand Surgery of the Professional Association Accident Clinic at Ludwigshafen-Oggersheim. The injuries either occurred in industry or were domestic accidents. Post mortem examinations of 167 cases were carried out to determine the type of burns, the degree and extent/area, as well as the age of the patients. About 50 per cent of the cases were patients between 21 and 40 years, i.e. complicating basic diseases were eliminated. The extent/area of second and third degree burns covered mainly 30 to 60 per cent of the body surface. All patients received the same type of treatment in accordance with the modified scheme by Muir and Barclay (1974). Histological and statistical examinations of the lungs reviewed at post mortem showed, as the significant respiratory complication during the first post-traumatic week, the picture of the shock lung. The development of the morphological picture of the shock lung in the chronological sequence following the burn injury will be illustrated.     

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.     

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.     

Self-inflicted burns

Of 3371 patients admitted to the Vall D'Hebron Burns Center, Barcelona, between the years 1983 and 1991 inclusive, 67 patients had attempted self-inflicted burns (1.98 per cent). Over 75 per cent of these patients had previous psychiatric illness and 20 per cent had previously attempted suicide. The mean age was 38 years and the overall mortality rate was 30 per cent. Over 71 per cent were male patients.     

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.     

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.     

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.     

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.     

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.     

Survival rates of patients hospitalized in French burns units during 1985

This survey analyses data from 17 French burn units with respect to age, severity of injury and survival of patients admitted to hospital during 1985. Of the 2398 patients treated, more than half were between 15 and 50 years old. About 90 per cent of the patients had burns covering less than 50 per cent of the body surface area. The overall mortality rate was 11.8 per cent. The LD50 for the 2398 patients was a burned surface area of approximately 60 per cent of the total body surface area. The LD50 for patients less than 30 years old was a burn covering just over 80 per cent of the total body surface. The survival rate as a function of the Baux index was also analysed.     

Burn injury and management in Liberia

Burn care in developing countries remains a challenge. This paper reviews the acute burn care of 21 patients admitted during a 1-year period to a hospital in Liberia. Lack of supplies and education, coupled with the local belief system, reflect on patient management. The study population to falled 21 patients, ranging from 1 to 62 years of age. TBSA burns ranged from 2 to 60 per cent (mean 21 per cent), 61 per cent of patients were grafted. The time between burn and graft varied between 5 and 96 days (mean 29.8). Graft take varied between 40 and 100 per cent (mean 81 per cent). Of the grafted patients 66.6 per cent received blood (average 732 ml). At the time of presentation 61.9 per cent of patients had other illness. The average number of hospital days was 37.9 (range 2–76). The mortality rate was 14.2 per cent. When managing burns in a developing country, adaption of a simple, clearly defined method of treatment, together with education of the caregivers, is suggested. As in the developed world, however, prevention is the critical factor.