Epidemiological analysis of deaths caused by burns in Osaka, Japan

By referring to all of the death cards recorded for the year of 1978 in the whole area of Osaka Prefecture, we examined deaths due to burn injuries, electric injury and heatstroke, and obtained the following results.

1. 1. Of the total 41 737 deaths, externally induced death took place in 3207 cases (8 per cent), and death due to burn injuries including electric shock and heatstroke took place in 215 cases (2–60 cases against 100 000 population), accounting for 6.7 per cent of all externally induced deaths. In those aged under 40 years, externally induced death ranked highest as the cause of death, and burn injury was one of the chief causes.

2. 2. The sex ratio of burn-induced death was 3: I for males and females, respectively. However, if burn injuries resulting from social factors and suicide were excluded, the sex ratio was not significantly different at 1-3:1. The causes of injury were work accidents, suicide and other accidents at a rate of I: 2: 3.

3. 3. The monthly incidence of injuries was larger in winter when there were many cases of on-the-spot death due to fire, but there was no significant difference in the monthly incidence of post-treatment death.

4. 4. Of the 215 cases, 158 (73–5 per cent) died on the spot, while only 57 cases died after treatment. There were apparent regional differences in the total casualties. Post-treatment death probably occurred in 30 per cent of the total deaths induced by burn injuries.

5. 5. Medical institutions receiving burn victims could be divided into private and public ones at a nearly equal ratio. Public institutions took a significantly larger proportion of this type of casualty than following road accidents.

6. 6. Supplementary investigations revealed that two to three times as many people died at the scene of the accident than died after treatment from severe burns, this amounted to 140 cases a year in the whole area of Osaka Prefecture.

     

The total number of burn injuries in a Scandinavian population: a repeated estimate

From 1965 to 1975 the population of Copenhagen decreased from 700 000 to 560 000 inhabitants. Small children under 6 years still constitute 6 per cent of the population but the percentage of old people over 60 years increased from 21 to 29 per cent.As a result of a thorough study of the case records of all outpatients treated at each of the outpatient casualty wards in Copenhagen, the total number of burn injuries treated as outpatients in the area during 1974 and 1975 has been recorded and compared with the number treated during 1964 and 1965.In spite of a 75 per cent increase in the total number of all types of injuries treated, the number of burn injuries treated is unchanged, and the number of severe burn injuries has decreased considerably. Burn injuries sustained by small children now constitute only 16 per cent of all burns, compared to 23 per cent previously.The conclusion is drawn that the pursuant prophylaxis which was practised has been effective, and also that the public has become generally familiar with the use of cold water as the best first aid remedy for 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.     

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.     

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)     

The Total Number of Burn Injuries in a Scandinavian Population

The treatment of burn injuries must be on two fronts. Within surgical treatment great advances have been made, and the next improvements must doubtless be made in the form of better prophylaxis.

There is an ample literature on this subject, but most analyses are based upon the study of in-patients, while little is known about the total frequency of burn injuries in a general population.

In the municipality of Copenhagen the treatment of burns has been centralized for 50 years, and the municipality comprises a well-defined geographical area with a population of 700,000 who must be considered representative of the whole of Denmark.

For social and insurance reasons even the slightest injuries are treated by doctors, and there is a possibility of recording all persons who have sought medical aid for burn injuries.

Burn injuries entail 8 deaths per annum, while 230 persons require admissions, 650 patients are treated in the out-patient department for burns and 1400 in other casualty wards, while the general practitioners treat 600 burn injuries every year.

Out of 85,000 annual injuries, burns make up 2.7%, and a total of 2900 persons, or 0.4% of the population, seek medical aid for burn injuries every year.

Two-thirds of the burn injuries occur in the homes and one-third in the workplaces. 23% of the victims are children under 5 years of age, in spite of the fact that children of this age make up only 6% of the population. 10% are school children and 60% are adults. In the age range over 60 only 6% sustain burn injuries, although this age group constitutes 21% of the Copenhagen population.

The causes of the various burn injuries are analysed. 55% are scalds, 21% are fire burns, 16% are contact burns, and 2% electricity accidents. Corrosions are found in 6%.

The prevention applies particularly to young children who should not be allowed to play in the kitchen or washing place. The accidents in workplaces can hardly be reduced. After conversion of the present figures to apply per 1 million of the population, they are compared with the findings of previous authors whose materials are characterized by being derived from in-patients and thus include a larger number of children and a larger number of burns caused by fire. Our material includes only a few children whose clothes have caught fire; most of these cases are due to playing with matches.     

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.     

Sampling events in space and time: a case study of burn injuries

We describe the sampling plan used to estimate the number of burn injuries seen at emergency departments of hospitals in New England. We present the rationale for each of the options considered and the implications of each. The chosen plan included all 256 hospitals, but used a different systematic one-day-in-ten sample for each of ten subgroupings of the hospitals. The findings suggest that over 47,000 injuries or almost 400 per 100,000 population were seen at New England Emergency Departments in a 1-year period. This incidence is 60 per cent higher than pre-project estimates would have suggested. From the variability of the data in the sample, we calculate that our estimate is probably no more than 3 per cent under or over the 'correct' rate that would have been obtained by a full non-sampling approach, costing almost 10 times as much. Additional support for our strong belief in the accuracy of the sample-based estimate is provided by the fact that if we had used the same sampling approach to estimate the number of hospitalized burn injuries, our estimate would have been in error by only 124 or 4 per cent from the total 3276 obtained by 100 per cent sampling of hospitalization records.     

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.     

The relationship of bacteremia to levels of transferrin,albumin and total serum protein in burn patients

The mean serum concentration of transferrin in 54 burn patients with injuries ≥ 45 per cent was 205 ± 4 mg/dl, the mean concentration of albumin was 32 ± 0–04g/dl, and the mean level of total protein was 6-0 ± 0–06 g/dl during the first 6 weeks post burn. These patients had a 20 per cent risk of associated bacteremia when transferrin levels were below 205 mg/dl, but only a 9 per cent risk with higher levels (P<0?025). There was a 13 per cent risk of developing bacteremia with albumin levels of 3–5 g/dl, compared to a 7 per cent risk with higher levels (P<0?1). The risk of associated bacteremia to levels of total serum protein less than 5-5 g/dl was 13 per cent compared to 10 per cent for higher concentrations (not significant). The increased incidence of bacteremia in burn patients with low levels of transferrin is probably related to the nutritional status of the patient.     

Thoracic injuries in traffic accidents and non-traffic accidents

Traffic accidents differ from non-traffic accidents where the injuries are concerned. With the males two thirds of the thoracic injuries happened in non-traffic accidents and one third in road accidents; with the females, the relation was reversed. In thirteen per cent of the traffic accidents and in twenty-five per cent of the non-traffic accidents there were only thoracic injuries, in the other cases there were multiple injuries. Blunt damages of the thorax occurred in the majority of both kinds of accidents, penetrating injuries were less common. Closed rib fractures happened twice as often in traffic accidents as in accidents at work. Compound fractures of the ribs were three times as frequent in non-traffic accidents as in traffic accidents. In thirty-five per cent of road accidents and in twenty-two per cent of non-traffic accidents the injuries were of an intrathoracal kind. Of all the three hundred and thirty thorax injured patients thirty-four did not survive their injuries, twenty-nine due to traffic accidents, and five due to non-traffic accidents.     

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.     

Burns in motor vehicle accidents

Burns received as a result of motor vehicle accidents (MVA's) create special problems in their care, as they are frequently severe and are often associated with other injuries. One hundred seventy-eight consecutive patients with burns sustained in an MVA were studied. The mean TBSA burn was 33.9%. The mortality was 24.7%, but the mean burn size in this fatal group was almost doubled at 63.9%. The injury most commonly associated with death was inhalation injury (in 36.3%). Thirty-six per cent of the patients sustained other injuries in addition to their burn, the most frequent of which was to the musculoskeletal system (67 injuries). Multiple trauma had little effect on mortality unless severe, but fractures especially complicated burn wound care unless surgically stabilized. Current methods of management are presented along with our approach to multiply injured burn patients.     

Scutting: a dangerous pastime?

Scutting is a pastime which has taken place in Dublin for many years. To scutt is to gain a ride on the back of a moving vehicle holding onto it by any means possible. Injuries sustained while scutting have never previously been reported.

A total of 38 children presented at the Accident and Emergency Department of The Children's Hospital, Temple Street during the period January 1985 to July 1987 with injuries sustained while scutting. The injuries were analysed with regard to type, pattern, severity and outcome; nine children died from their injuries and 34.2 per cent of the children were admitted to hospital with an average stay of 5 days. All of those admitted alive made a full recovery.

Comparison is made with other more everyday sensible pastimes and with road traffic accidents involving children. Scutting is shown to be the most dangerous pastime and is responsible for more deaths than any other type of road traffic accident involving children. Suggestions are made to stop this pastime taking place.     

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.     

An investigation of the prevalence of psychological morbidity in burn-injured patients

Research on the psychological impact of burn injuries has concentrated on major burns, while small burns have been largely neglected. In a prospective study, 45 patients with burn injuries ranging from 1 per cent or less up to 40 per cent total body surface area were assessed using semi-structured interviews within 2 weeks of sustaining the burn, and followed-up at approximately 3 months postburn to investigate the prevalence of mental health problems. The prevalence of clinically significant levels of anxiety, intrusions and avoidance remained similar at 2 weeks and 3 months postburn, however, the prevalence of depression and Post Traumatic Stress Disorder (PTSD) increased 6- and 4-times, respectively, by 3 months. Patients with small burn injuries of 1 per cent or less also experienced clinically significant levels of psychological difficulties postburn. The implications for the identification of patients at risk of future psychological morbidity are discussed.     

Fatal road accidents in Birmingham: Times to death and their causes

The intervals between injury and death in the 254 fatalities after road traffic accidents in Birmingham during 1969 and 1970 were analysed and correlated with other data. Sixty-three per cent were pedestrians and 23 per cent were passengers and drivers of vehicles. In round figures, about a third of the series died within half an hour, a half by 2 hours, two-thirds by 24 hours, and three-quarters by 2–4 days. The patterns of survival-time could be divided into three phases. There was an early steep decline, with 36 per cent dying during the first half-hour and 44 per cent within 1 hour of the accidents. This was followed by a longer stage during which the rate of dying decreased progressively in logarithmic fashion. The cumulative tolls were 51 per cent by 2 hours, 58 per cent by 4 hours, 68 per cent by 24 hours, and 83 per cent by 7 days. The curve then flattened into a prolonged tail. Between 7 and 28 days another 10 per cent died, making 93 per cent by 28 days. The remaining 7 per cent succumbed during the subsequent weeks and months, 3 patients surviving longer than a year.

Fifty-six per cent of vehicle occupants and 40 per cent of pedestrians died within an hour of injury, and the excess of rapid deaths among vehicle occupants was mainly due to a higher proportion of rupture of the aorta. All the ruptured aortae in vehicle occupants occurred after accidents at night or the early hours of the morning. Many of the affected drivers and passengers had consumed alcohol and their injuries were more rapidly lethal than after accidents at other times. Serious cerebral trauma dominated all groups of road users and multiple injuries were common. Included among the fatality tail was a group of subjects, mainly pedestrians, with relatively modest injuries who might have survived had they not developed pulmonary embolism, respiratory infection, or other complications.     

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.     

Epidemiology of domestic burns related to products

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

Parameters and criteria in the evaluation of the "necessity" of a burn center in an industrial and residential high-density region: northwestern Lombardy

This study, performed at Ospedale di Circolo in Varese, stresses the high frequency of burn injuries in northwestern Lombardy and the high risk of new accidents; we also want to emphasize that the burn centers available in Lombardy are not sufficient, and according to the data that has been collected, they would be unable to cope with the projected number of accidents that could be associated with burn injuries.