Abstract
Barbequing can result in devastating burn injuries with unsafe practices. This study aims to characterize the demographics, injury characteristics, and outcomes of grill-related burns and identify ways of burn prevention. A retrospective review of patients admitted to a single-institution, metropolitan burn center from January 1, 2017, to July 1, 2023. Data included demographics, burn injury characteristics, and outcomes. Each Grill Cohort patient was matched to 3 nongrill controls by mBaux score and burn location. Of 2355 patients, 69 (2.9%) met Grill Cohort inclusion criteria. The Grill Cohort had 55 (79.7%) males and an average age of 41.7 ± 17.5 years old. In the Grill Cohort, 25 (36.2%) patients had positive blood alcohol, 8 (11.6%) tested positive for amphetamines, and 5 (7.2%) for cocaine at the time of admission. A total of 61 (88.4%) Grill Cohort burns involved the upper extremity, 43 (62.3%) the head/neck, 34 (49.3%) the lower extremity, and 30 (43.5%) the trunk. Compared with the Control Cohort, the Grill Cohort had smaller proportions of patients who were undomiciled (P < .01) or had a history of mental illness (P < .001). Grill-related burns had a greater proportion of flash/flame burns (P < .001). This study suggests that middle-aged, domiciled males without psychiatric comorbidities are more likely to make preventable grilling errors resulting in burn injuries. Prevention strategies targeting this demographic group should emphasize the risks of grilling while intoxicated, proper handling of propane tanks and lighter fluid, and the use of flash/flame-resistant gear protecting the upper extremities and head/neck.
Keywords: grilling, burns, epidemiology, injury prevention
INTRODUCTION
Grilling is a popular American pastime. A 2015 poll conducted by the Heart, Patio, and Barbecue Association (HPBA) found that 75% of Americans own a grill or smoker, with the majority of owned grills being gas grills (62%).1 Approximately 63% of grill owners participate in grilling year-round, with 43% using their grills at least once a month during the winter. Overall, grilling is a ubiquitous activity in America with partakers commonly reporting that it is an enjoyable way to entertain family members and friends.
However, failure to take appropriate safety precautions while grilling can result in devastating trauma, such as burns injuries.2 Fortunately, burns associated with grilling may be avoided through the implementation of evidence-based injury prevention strategies. Identifying the characteristics of grill-related burn injuries and their common causes is paramount to first developing effective preventive education. However, despite grilling’s widespread popularity, there is no US study to date that has investigated the epidemiology of burns associated with grilling.
Furthermore, there is limited information regarding alcohol and substance intoxication in the setting of grill-related burn injuries. As outdoor barbecues are often social gatherings, alcohol consumption is commonly associated with grilling. Alcohol intoxication can increase susceptibility to both accidental and intentional injuries by impairing visual, psychomotor, and cognitive functioning. One study found that alcohol intoxication was associated with increased abdominal injury severity among road-accident victims, attributing this finding to blunted senses and slower response times due to alcohol.3 It has been approximated that up to 50%−70% of patients sustaining traumatic injuries in the United States have positive blood alcohol at the time of admission, with an estimated 40%−50% of trauma patients having preinjury drug use.4 Therefore, a better understanding of the role that alcohol and drug use play in the incidence of grill-related burns can help identify a key area for injury prevention.
There is a dearth of information regarding potential socioeconomic status (SES) disparities in the incidence of grill-related burn injuries. SES deprivation is associated with an overall increased risk for burn injuries due to a myriad of factors, including poor quality of housing, crowded living conditions, greater exposure to burn hazards, smoking, and low educational level.5 However, there is a need to further evaluate these disparities in the context of grill-related burns. Identifying the group of people most susceptible to these burns is critical to gauging their level of health literacy and also ensuring that injury prevention strategies reach their appropriate demographic to be most effective in reducing injury incidence.
To address these gaps in the literature, adult and pediatric patients with grill-related burn injuries admitted to a single-institution, large urban burn center were analyzed. The objectives of this study are to describe the demographics, injury characteristics, and outcomes of grill-related burns and to compare them with other burn injuries of similar severity and location. Data obtained from this study can be used in the development and implementation of improved injury prevention strategies.
MATERIALS AND METHODS
Study population and data collection
A retrospective review from January 1, 2017, to July 1, 2023, at a single-institution’s burn center located in a large urban area. This study received Institutional Review Board (IRB) approval. The initial list of patients, provided by the center’s data organizer, was screened by author D.C. for meeting inclusion criteria and data collection. Data collection was performed using the burn center’s electronic medical record system on password-encrypted computers compliant with Health Insurance Portability and Accountability Act (HIPAA) guidelines.
Data selection
Inclusion criteria included adult and pediatric patients who received inpatient hospitalization burn care for grill-related burn injuries at the burn center. Exclusion criteria included patients who were evaluated at the center but were not admitted, as well as patients admitted for Stevens–Johnson syndrome or toxic epidermal necrolysis.
Study variables
Patient demographic variables included age, sex, race/ethnicity, health insurance, housing status, and patient comorbidities (mental illness, tobacco use, and diabetes mellitus [DM]) (Table 1). Burn injury characteristics included burn etiology, specific mechanism of injury, burn location, number of burns involving multiple locations, TBSA, deepest burn depth, and presence of inhalation injury. For each patient, a modified Baux (mBaux) score, a predictor of mortality following burn injury, was calculated using the following formula: mBaux score = TBSA + age + [17 × R] (R = 1 for inhalational injury, R = 0 for no inhalational injury). Patient care and hospitalization characteristics included date of admission, total hospital length-of-stay (LOS), intensive care unit (ICU) admission, blood alcohol level, urine toxicology results, number of burn admissions managed purely nonoperatively, number of surgeries, type of surgery, and number of nonsurvivable burns. Postdischarge characteristics included readmission status.
Table 1.
Study Variables
| Variable | Response |
|---|---|
| Age (y) | |
| Sex | Male, female |
| Race/ethnicity | Non-Hispanic White, Black, Asian, Hispanic/Latino, Other |
| Health insurance | Private, Medicare, medical, dual private and governmental sponsored, uninsured |
| Housing status | Domiciled, undomiciled |
| Comorbidities | Mental illness, tobacco use, diabetes mellitus |
| % TBSA | |
| Inhalational injury | Yes, no |
| mBaux Score | |
| Deepest burn depth | Unspecified partial thickness, superficial partial thickness, deep partial thickness, full thickness, unknown |
| Burn location | Head/neck, upper extremity, lower extremity, trunk |
| Burn injuries involving multiple locations | Yes, no |
| Burn injury etiology | Flash/flame, scald, contact, electrical, blast, other |
| Specific mechanism of injury | |
| Date of admission | |
| Blood alcohol level (mg/dL) | |
| Urine toxicology results | Amphetamines, cocaine |
| Total hospital length-of-stay (days) | |
| ICU admission status | Yes, no |
| Burns managed purely nonoperatively | Yes, no |
| Type of surgery | Debridement, skin grafting, epithelial autologous suspension spray therapy |
| Number of surgeries | |
| Nonsurvivable burns | Yes, no |
| Readmission status | Yes, no |
Patients were categorized into 2 groups depending on whether they were admitted for grill-related (G Cohort) burns or other burns. Each G Cohort patient was matched to 3 nongrill controls (Control Cohort) based on mBaux score and burn injury location. Randomization was used when more than 3 control patients met matching criteria for a particular G Cohort patient. The qualifying control patients were assigned a number and a random number generator was used to choose the matched control corresponding to that G Cohort patient.
Statistical analysis
Patient demographics, burn injury, patient care, and hospitalization characteristics were analyzed with descriptive statistics. Continuous variables were reported as mean values with standard deviations (SD). Statistically significant differences between cohorts were compared with Student’s t-tests. Categorical variables were reported as percentages. Two-proportion Z-tests were performed to compare significant differences in proportion between cohorts. Chi-square analysis was performed when the expected frequency of each categorical response was at least 5. P-values less than .05 were considered to be statistically significant.
RESULTS
Patient demographics
Of 2355 patients, 69 (2.9%) met the inclusion criteria comprising the G Cohort. The G Cohort consisted of 55 (79.7%) males and 14 (20.3%) females (Table 2). The Control Cohort was composed of 132 (63.8%) males and 75 (36.2%) females for a total of 207 patients. The G Cohort had a significantly greater proportion of male patients compared with the Control Cohort (79.7% vs 63.8%, P < .01).
Table 2.
Patient Demographics
| Characteristics | Grill cohort (N = 69) | Control cohort (N = 207) | P-value |
|---|---|---|---|
| Average age (y), n (SD) | 41.7 (17.5) | 43.0 (18.6) | .61 |
| Pediatric, n (%) | 5 (7.2%) | 19 (9.2%) | .31 |
| Sex, n (%) | <.05 * | ||
| Male | 55 (79.7%) | 132 (63.8%) | <.01 ** |
| Female | 14 (20.3%) | 75 (36.2%) | <.01 ** |
| Race/ethnicity, n (%) | |||
| Non-Hispanic White | 17 (24.6%) | 65 (31.4%) | .14 |
| Black | 5 (7.2%) | 20 (9.7%) | .27 |
| Asian | 2 (2.9%) | 16 (7.7%) | .08 |
| Hispanic/Latino | 35 (50.7%) | 74 (35.7%) | <.05 * |
| Other or unknown | 10 (14.5%) | 32 (15.5%) | .42 |
| Health insurance, n (%) | |||
| Private | 21 (30.4%) | 47 (22.7%) | .10 |
| Public | 41 (59.4%) | 142 (68.6%) | .08 |
| Dual private-public | 2 (2.9%) | 4 (1.9%) | .32 |
| Uninsured | 5 (7.2%) | 14 (6.8%) | .44 |
| Housing status, n (%) | <.01 ** | ||
| Domiciled | 61 (88.4%) | 146 (70.5%) | <.01 ** |
| Undomiciled | 8 (11.6%) | 61 (29.5%) | <.01 ** |
| Comorbidities, n (%) | |||
| Mental illness | 4 (5.8%) | 48 (23.2%) | <.001 *** |
| Smoking | 17 (24.6%) | 51 (24.6%) | .50 |
| Diabetes mellitus | 11 (15.9%) | 27 (13.0%) | .27 |
P < .05;
P < 0.01;
P < 0.001.
The G Cohort had 5 (7.2%) pediatric patients and the Control Cohort had 19 (9.2%), with no significant differences between cohorts (P = .31) (Table 2). The average age of the G Cohort was 41.7 (SD: 17.5) years old, and the average age of the Control Cohort was 43.0 (SD: 18.6) years old, with no significant differences between cohorts (P = .61).
The G Cohort comprised of 35 (50.7%) Hispanic/Latino, 17 (24.6%) Non-Hispanic White, 5 (7.2%) Black, 2 (2.9%) Asian, and 10 (14.5%) patients of “Other” race/ethnicity (Table 2). The Control Cohort comprised of 74 (35.7%) Hispanic/Latino, 65 (31.4%) Non-Hispanic White, 20 (9.7%) Black, 16 (7.7%) Asian, and 32 (15.5%) patients of “Other” race/ethnicity. The G Cohort had a significantly greater proportion of Hispanic/Latino patients (50.7% vs 35.7%, P < .05) compared with the Control Cohort.
Regarding health insurance, in the G Cohort, 41 (59.4%) patients had governmental-sponsored insurance (Medicare or Medicaid), 21 (30.4%) had private insurance, 2 (2.9%) had dual private and governmental-sponsored insurance, and 5 (7.2%) were uninsured (Table 2). In the Control Cohort, 142 (68.6%) patients had governmental-sponsored insurance, 47 (22.7%) had private insurance, 4 (1.9%) had dual private and governmental-sponsored insurance, and 14 (6.8%) were uninsured, with no significant differences between cohorts (P = .08, .10, .32, .44).
In terms of housing status, 61 (88.4%) G Cohort patients were domiciled and 8 (11.6%) were undomiciled (Table 2). In the Control Cohort, 146 (70.5%) patients were domiciled and 61 (29.5%) were undomiciled. The G Cohort had a significantly greater proportion of domiciled patients (88.4% vs 70.5%, P < .01) and a significantly smaller proportion of undomiciled patients (11.6% vs 29.5%, P < .01).
Regarding patient comorbidities, in the G Cohort, a total of 17 (24.6%) patients reported tobacco use, 11 (15.9%) had a history of DM, and 4 (5.8%) had a history of mental illness (Table 2). In the Control Cohort, 51 (24.6%) patients reported tobacco use, 48 (23.2%) had a history of mental illness, and 27 (13.0%) had a history of DM. The G Cohort had a significantly smaller proportion of patients with a history of mental illness (5.8% vs 23.2%, P < .001) compared with the Control Cohort.
Burn injury characteristics
The average TBSA of the G Cohort was 14.4% (SD: 14.9), and the average mBaux score was 57.6 (SD: 24.5) (Table 3). The average TBSA for the Control Cohort was 13.0% (SD: 14.9), and the average mBaux score was 57.6 (SD: 24.4). There were no significant differences in TBSA (P = .48) or mBaux score (P = 1.00) between cohorts. A total of 6 (8.7%) patients in the G Cohort and 20 (9.7%) patients in the Control Cohort experienced inhalational injury, with no significant difference in the incidence of inhalational injury between cohorts (P = .41).
Table 3.
Burn Injury Characteristics
| Characteristics | Grill cohort (N = 69) | Control cohort (N = 207) | P-value |
|---|---|---|---|
| Average % TBSA, (SD) | 14.4 (14.9) | 13.0 (14.9) | .48 |
| Inhalational injury, n (%) | 6 (8.7%) | 20 (9.7%) | .41 |
| mBaux score | 57.6 (24.5) | 57.6 (24.4) | 1.00 |
| Season of burn injury, n (%) | |||
| June–August | 20 (29.0%) | 48 (23.2%) | .17 |
| December–February | 8 (11.6%) | 64 (30.9%) | <.001 *** |
| Burn location, n (%) | .82 | ||
| Head/neck | 43 (62.3%) | 119 (57.5%) | .24 |
| Upper extremity | 61 (88.4%) | 168 (81.2%) | .08 |
| Lower extremity | 34 (49.3%) | 98 (47.3%) | .39 |
| Trunk | 30 (43.5%) | 104 (50.2%) | .17 |
| Burn injuries involving multiple locations, n (%) | 57 (82.6%) | 165 (79.7%) | .30 |
| Deepest burn depth, n (%) | .61 | ||
| Unspecified partial thickness | 8 (11.6%) | 30 (14.5%) | .27 |
| Superficial partial thickness | 14 (20.3%) | 29 (14.0%) | .11 |
| Deep partial thickness | 29 (42.0%) | 87 (42.0%) | .50 |
| Full thickness | 18 (26.1%) | 61 (29.5%) | .29 |
| Burn etiology, n (%) | |||
| Flash/flame | 55 (79.7%) | 107 (51.7%) | <.001 *** |
| Scald | 0 (0.0%) | 42 (20.3%) | <.001 *** |
| Contact | 9 (13.0%) | 18 (8.7%) | .15 |
| Electrical | 0 (0.0%) | 18 (8.7%) | <.01 ** |
| Blast | 3 (4.3%) | 7 (3.4%) | .36 |
| Other | 2 (2.9%) | 15 (7.2%) | .10 |
P < .05;
P < .01;
P < .001.
In the G Cohort, a total of 20 (29.0%) burn injuries occurred during the summer months (June–August), while 8 (11.6%) occurred during the winter months (December–February) (Table 3). In the Control Cohort, a total of 48 (23.2%) burns occurred during the summer months, while 64 (30.9%) burns occurred during the winter months. The G Cohort had a significantly smaller proportion of burn injuries that occurred during the winter (11.6% vs 30.9%, P < .001).
In the G Cohort, a total of 61 (88.4%) patients presented with burn injuries affecting the upper extremity, 43 (62.3%) the head/neck region, 34 (49.3%) the lower extremity, and 30 (43.5%) the trunk, with 57 (82.6%) total patients who presented with burns involving multiple locations (Table 3). In the Control Cohort, a total of 168 (81.2%) patients presented with burn injuries that involved the upper extremity, 119 (57.5%) the head/neck region, 104 (50.2%) the trunk, and 98 (47.3%) the lower extremity, with 165 (79.7%) total patients who presented with burns involving multiple locations. There was no significant association between burn location and cohort (P = .82).
Regarding burn etiology, 55 (79.7%) burns in the G Cohort were due to flash/flame, 9 (13.0%) were due to contact, and 3 (4.3%) were due to blast (Table 3). There were no electrical or scald burns, and 2 (2.9%) burns were due to “Other” etiology. More specifically, a total of 24 (34.8%) burns were due to propane tank explosion, 18 (26.1%) were related to lighter fluid use with 5 (7.2%) of them due to using gasoline or ethanol as substitutes, 16 (23.2%) were due to general flame injury, 9 (13.0%) were due to contact burns, and 2 (2.9%) were due to chemical burns related to grill cleaning solution (Table 4). In the Control Cohort, 107 (51.7%) burns were due to flash/flame, 18 (8.7%) were due to contact, 42 (20.3%) were due to scald, 18 (8.7%) were due to electrical, 7 (3.4%) were due to blast, and 15 (7.2%) burns were due to “Other” etiology (Table 3). The G Cohort had a significantly greater proportion of flame/flash burns (79.7% vs 51.7%, P < .001) and significantly smaller proportions of scald (0.0% vs 20.3%, P < .001) and electrical burns (0.0% vs 8.7%, P < .01) compared with the Control Cohort.
Table 4.
Sources of Grilling Errors Resulting in Burn Injuries
| Source | N (%) |
|---|---|
| Propane tank explosion | 24 (34.8%) |
| Related to lighter fluid use | 18 (26.1%) |
| Using ethanol/gasoline substitutes | 5 (7.2%) |
| General flame injury | 16 (23.2%) |
| Contact burns | 9 (13.0%) |
| Chemical burns related to grill cleaning solution | 2 (2.9%) |
Regarding deepest burn depth, in the G Cohort, 8 (11.6%) burns were unspecified partial thickness (PT), 14 (20.3%) were superficial PT (SPT), 29 (42.0%) were deep PT (DPT), and 18 (26.1%) were full thickness (FT) (Table 3). In the Control Cohort, 30 (14.5%) burns were unspecified PT, 29 (14.0%) were SPT, 87 (42.0%) were DPT, and 61 (29.5%) were FT. There was no significant association between deepest burn depth and cohort (P = .61).
Patient care and hospitalization characteristics
The average hospital LOS for the G Cohort was 11.9 (SD: 10.8) days and 36 (52.2%) patients were admitted to the ICU (Table 5). The average hospital LOS for the Control Cohort was 15.9 (SD: 22.4) days and 95 (45.9%) patients were admitted to the ICU. There were no significant differences in hospital LOS (P = .15) or ICU admission status (P = .18) between cohorts.
Table 5.
Hospitalization and Patient Care Characteristics
| Characteristics | Grill cohort (N = 69) | Control cohort (N = 207) | P-value |
|---|---|---|---|
| Average hospital length-of-stay (days), n (SD) | 11.9 (10.8) | 15.9 (22.4) | .15 |
| Positive blood alcohol, n (%) | 25 (36.2%) | 80 (38.6%) | .36 |
| Urine toxicology | |||
| Amphetamines | 8 (11.6%) | 56 (27.1%) | <.01 ** |
| Cocaine | 5 (7.2%) | 12 (5.8%) | .33 |
| ICU admission, n (%) | 36 (52.2%) | 95 (45.9%) | .18 |
| Readmission, n (%) | 3 (4.3%) | 21 (10.1%) | .07 |
| Nonsurvivable burns, n (%) | 2 (2.9%) | 12 (5.8%) | .17 |
| Burns managed nonoperatively, n (%) | 38 (55.1%) | 108 (52.2%) | .34 |
| Average number of surgeries, n (SD) | 1.4 (0.7) | 2.0 (1.9) | .10 |
| Type of surgery, n (%) | |||
| Debridement | 30 (96.8%) | 90 (90.9%) | .14 |
| Skin grafting | 23 (74.2%) | 84 (84.8%) | .09 |
| Epithelial autologous suspension spray therapy | 2 (6.5%) | 2 (2.0%) | .11 |
P < .05;
P < .01;
P < .001.
In the G Cohort, a total of 25 (36.2%) patients had positive blood alcohol at the time of admission, 8 (11.6%) tested positive for amphetamines, and 5 (7.2%) for cocaine (Table 5). In the Control Cohort, a total of 80 (38.6%) patients had positive blood alcohol at the time of admission, 56 (27.1%) tested positive for amphetamines, and 12 (5.8%) for cocaine. The G Cohort had a significantly smaller proportion of patients who tested positive for amphetamines (11.6% vs 27.1%, P < .01).
In the G Cohort, a total of 38 (55.1%) patients were treated purely nonoperatively (Table 5). Among the 31 (44.9%) G Cohort patients who underwent surgical management for their burn injuries, 30 (96.8%) patients underwent surgical debridement, 23 (74.2%) underwent skin grafting, and 2 (6.5%) underwent epithelial autologous suspension spray therapy, with an average of 1.4 (SD: 0.7) surgeries per patient. In the Control Cohort, a total of 108 (52.2%) patients were treated purely nonoperatively with no significant differences between cohorts (P = .34). Among the 99 (47.8%) Control Cohort patients who underwent surgical management for their burn injuries, 90 (90.9%) patients underwent surgical debridement, 84 (84.8%) underwent skin grafting, and 2 (2.0%) patients underwent epithelial autologous suspension spray therapy, with an average of 2.0 (SD: 1.9) surgeries per patient.
In the G Cohort, 3 (4.3%) patients were readmitted after discharge and 2 (2.9%) had nonsurvivable burns (Table 5). In the Control Cohort, 21 (10.1%) patients were readmitted after discharge and 12 (5.8%) had nonsurvivable burns. There were no significant differences in readmission rate (P = .07) or mortality rate (P = .17) between cohorts.
DISCUSSION
This study sought to investigate patients hospitalized due to grill-related burn injuries at a large metropolitan burn center over a 6.5-year period. No US study to date has explored the etiology of grill-related burns as well as potential SES disparities that may exist in the incidence of these particular injuries. Overall, this study reports several key findings regarding the epidemiology of grill-related burns, highlighting specific sources of grilling errors resulting in burn injury and identifying the target demographic who may benefit most from injury prevention campaigns.
Foremost, our study reported that patients admitted for grill-related burn injuries were predominantly male, which is consistent with findings from similar studies and also with the overall cultural gendering of grilling in America.6,7 Grilling, which is associated with an open flame and being in the outdoors, is traditionally considered to be a more masculine activity in the United States.8 Interestingly, it is thought that outdoor grilling first grew in popularity in America during the postwar period because it had proposedly allowed males to be involved with their family while simultaneously partaking in a masculine activity.8 However, more recently, it has been reported that a greater number of females are taking an interest in grilling.9 As the current study only investigates those who were burn-injured while grilling and not the total demographic of those partaking in grilling, in the future, there may be a more equal distribution by sex of those who sustain grill-related burns. Additionally, our study reported that the average age of patients admitted for grill-related burns was in the early 40s. Considering that a large proportion of individuals occupying this age group includes those with children and parents are traditionally in charge of handling grills at family barbecues, these findings were not surprising.
Moreover, as grilling mostly takes place outdoors, it was not unusual to see that a smaller proportion of grill-related burns occurred during the winter months compared with control burns. However, the majority of the grill-related burns treated at our center did not necessarily occur during summer months, and this may be because more people are using their grills year-round as reported by the 2015 HPBA poll results.1 In addition, our burn center is located in a geographic region characterized as having relatively mild winter climates, which could explain why grill-related burns were not observed to be an injury occurring exclusively during summer months.
Furthermore, a large majority of patients who presented with grill-related burns were domiciled. This observation was accordant with related studies reporting that grilling injuries are more likely to occur in the home setting, such as the backyard.7
Our study also demonstrated that a smaller proportion of patients admitted for grill-related burn injuries had a history of mental illness compared with other burns. A number of studies in the literature have shown that mental illness is strongly associated with socioeconomic inequalities; low-SES individuals and households are often exposed to greater negative life stressors, such as financial, social, employment, and other health struggles, which contribute to disparities in psychiatric health outcomes.10 Therefore, our findings regarding psychiatric comorbidities in conjunction with our findings regarding housing and insurance status may together potentially indicate that grill-related burns are less likely to impact lower-SES individuals. However, it is difficult to make conclusions from our study and further investigation is warranted.
Overall, our study suggests that grill-related burns are more likely to impact middle-aged, health-insured, domiciled males without psychiatric comorbidities, and grill injury prevention strategies should focus on reaching this target audience. This could be achieved by displaying grilling safety precautions on billboard signs located in middle-income communities, in appliance and grocery stores selling grilling equipment, on the grilling appliances themselves, and in parks where family barbecues might commonly take place.
In addition to identifying the target demographic, our study also provides insight into specific mechanisms and characteristics of grill-related burn injuries that may be valuable when designing effective evidence-based prevention initiatives.
Regarding treatment, over half of the grill-related burn injuries admitted at our burn center were managed nonoperatively. These findings are consistent with a similar pediatric study conducted in New South Wales, Australia, which showed that most charcoal barbeque burns were managed nonoperatively, such as with bedside debridement and wound dressings.7 A possible explanation for this finding is that grill-related injuries, on average, may result in relatively less severe or deep burns.
Our study further demonstrated that a majority of grill-related burns impacted the upper extremities and head/neck region, with 82.6% of admissions involving multiple locations. Burn injuries in the upper extremities, particularly of the hands, can lead to serious functional impairments and impact return to employment.11 Visible and physical deformities in the head/neck region resulting from scarring or other burn sequelae, such as contractures, can result in serious psychosocial consequences.12 Therefore, preventing burns associated with grilling is important because, as our study suggests, they are most likely to impact areas of the body that carry high functional and psychosocial importance.
Our study also identified common sources of grilling errors that result in burn injury, and prevention strategies should increase awareness of these hazards as well as ways to avoid them. A large majority of grill-related burn injuries were due to flash/flame followed by contact. Based on these findings, injury prevention education should underscore the importance of taking safety precaution when handling propane tanks to prevent explosions and flash burns. Additionally, proper ways of adding and storing lighter fluid should be addressed with clear warnings against using highly flammable substitutes, such as gasoline and ethanol. Finally, the use of flash and flame-resistant protective gear, in addition to gloves, should be highly encouraged. Such protective equipment should ideally provide sufficient coverage, particularly to the upper extremities and head/neck region.
Furthermore, according to our findings regarding alcohol and substance use in the setting of grill-related burns, injury prevention campaigns should strongly warn against grilling while inebriated or drug-intoxicated. More than one-third of patients admitted with grill-related burns had positive blood alcohol at the time of admission, suggesting that impaired judgment and psychomotor skills due to alcohol may have rendered these individuals more susceptible to making harmful grilling errors.13 What is even more concerning is the proportion of grill burn patients who tested positive for highly addictive stimulants (amphetamines and cocaine). A study investigating trauma and substance use found that amphetamines were associated with not only higher rates of major traumatic injuries but also longer hospital LOS.14 Unfortunately, despite being linked to worse health outcomes, the abuse of drugs, licit and illicit, has risen by over 13% in the last 2 decades.14 Thus, our study draws further attention to the public health concern of prevalent substance abuse as, in addition to grill-related burns, it is likely to play a role in the incidence of other equally devastating and even more traumatic injuries.
There were limitations to our study, the first of which was that it was a retrospective review in a single institution. Likewise, this study only investigated inpatient admissions; there may have been additional patients with grill-related burn injuries who were not analyzed because they only received outpatient care. Additionally, there are different types of grills and methods of grilling, and this information was not always specified in patient charts. Certain grilling methods or grilling appliances may be associated with a greater or lower risk of burn injuries—an area that can be explored in future research.
CONCLUSION
Our study demonstrates that grilling can not only be an enjoyable activity but also a safe one as long as proper precaution is taken to prevent potential burn injuries. According to our findings, burn injuries related to grilling are more likely to be due to flash/flame, to affect the upper extremities and head/neck region and to impact middle-aged, health-insured, domiciled males without psychiatric comorbidities. To be effective, prevention strategies should demonstrate how to properly store and use propane tanks and lighter fluid, encourage the use of flash/flame-resistant equipment that provides sufficient coverage to the upper extremities and head/neck area, and address the risks of grilling while inebriated or drug-intoxicated. To successfully reach their target demographic, preventive strategies can be implemented on street billboard signs, in grocery/department stores, on grilling appliances, and in parks located in middle-income communities.
Funding:
The contents of this manuscript were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPBU0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.
Footnotes
Conflict of Interest Statement: None declared.
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