Globally, more than 11 million individuals seek medical care for burns each year with most acute care concentrated in hospital emergency departments (EDs).1 Burns remain devastating injuries that cause significant morbidity along with life-altering functional and cosmetic complications.2 It is estimated that 95% of burns occur in low- and middle-income populations.1 Reports have found that homes in low income, predominantly Black and Latinx communities are more likely to have structural hazards that can predispose patients to burns and that complaints from tenants of color to address these hazards are often ignored.3
The upper extremities are the most common area of the body affected by burns.1 Survivors of upper extremity burns can face lifelong disability requiring further procedures and care to address soft tissue defects, contracture, compartment syndrome, and scarring.4 Little is known about the consumer products that contribute to the burden of upper extremity burns in the US. This study provides trends in national estimates of upper extremity burns treated in hospital EDs.
Nonfatal encounters for upper extremity burns from 2003 to 2022 were obtained from the National Electronic Injury Surveillance System-All Injury Program (NEISS), a nationally representative sample of 100 hospital EDs on approximately 500,000 nonfatal injury-related ED visits annually. Data available included age, sex, diagnosis, body region affected, consumer products involved, disposition at discharge, location where the burn occurred, and a case narrative describing the burn. Cases were selected if they contained a diagnosis code for burns on the upper extremities and were excluded if the case narrative did not match database coding. Consumer products were grouped according to the NEISS coding, and the five most common product groups associated with upper extremity burns were reported. All estimates were weighted using sampling weights provided by the NEISS and 95% confidence intervals. Trends in burns presenting to hospital EDs were examined with negative binomial regression, and association between categorical variables was determined with logistic regression. Analyses were computed in Stata version 17 (StataCorp LP, College Station, Texas, United States), and statistical significance was defined as a 2-sided α < 0.05.
A total of 1,029,250 ED visits for upper extremity burns were identified. Rates of ED visits for upper extremity burns remained steady over the past 10 years (Fig. 1). Most cases occurred in males (53.0%; 95% CI, 51.6%–54.4%), non-Hispanic Whites (47.1%; 95% CI, 39.5%–54.8%), persons under the age of 18 (36.9%; 95% CI, 33.3%–40.6%), and at home (68.3%; 95% CI, 63.0%–73.3%) (Table 1). Thermal (63.9%; 95% CI, 62.1%–65.5%) and scald (27.7%; 95% CI, 26.1%–29.4%) burns were most common, and burns were most likely to affect the hands (52.6%; 95% CI, 44.4%–60.8%). Kitchen appliances (18.6%; 95% CI, 15.3%–22.0%), cookware (14.5%; 95% CI, 11.9%–17.1%), and barbeques (6.3%; 95% CI, 5.2%–7.4%) were common products associated with upper extremity burns in addition to grooming devices (5.3%; 95% CI, 4.3%–6.3%) with 10.9% (95% CI, 8.7%–13.7%) of patients admitted for further treatment.
Fig. 1.
Trends in consumer product-related burns on the upper extremities, 2003–2022.
Table 1.
National estimates of upper extremity burns treated in United States hospital emergency departments, 2003–2022.a.
| Sample Cases, No. | No. of Cases (95% CI)b | % of Cases (95% CI)b | |
|---|---|---|---|
| Total | 29,325 | 1,029,250 (886,063–1,172,439) | 100 |
| Sex | |||
| Female | 13,488 | 484,109 (388,657–579,560) | 47.0 (45.6–48.4) |
| Male | 15,836 | 545,064 (436,467–653,660) | 53.0 (51.6–54.4) |
| Missing | 1 | 78 (0–233) | 0.0 (0.0–0.1) |
| Age, y | |||
| <18 | 13,513 | 379,626 (298,345–460,907) | 36.9 (33.3–40.6) |
| 18-25 | 3076 | 123,500 (95,835–151,164) | 12.0 (11.0–13.1) |
| 26-34 | 3420 | 139,220 (109,780–168,659) | 13.5 (12.7–14.4) |
| 35-49 | 4379 | 180,457 (142,335–218,580) | 17.5 (16.3–18.8) |
| 50-64 | 3370 | 137,719 (107,329–168,109) | 13.4 (12.3–14.5) |
| ≥65 | 1567 | 68,729 (54,660–82,798) | 6.7 (6.1–7.3) |
| Race and ethnicityc | |||
| Asian or Pacific Islander | 654 | 14,992 (8343–21,642) | 3.5 (2.4–5.1) |
| Black | 5414 | 134,953 (88,363–181,544) | 31.8 (24.8–39.8) |
| Hispanic | 1087 | 30,596 (12,173–49,019) | 7.2 (4.3–11.9) |
| Native American | 125 | 5952 (1901–10,003) | 1.4 (0.8–2.5) |
| Other | 1211 | 37,990 (19,521–56,460) | 9.0 (6.1–13.0) |
| White | 4930 | 199,711 (141,924–257,498) | 47.1 (39.5–54.8) |
| Type of burn | |||
| Chemical | 853 | 37,283 (28,452–46,115) | 3.6 (3.2–4.1) |
| Electrical | 964 | 29,269 (22,219–36,320) | 2.8 (2.5–3.3) |
| Not specified | 315 | 10,600 (7650–13,550) | 1.0 (0.8–1.3) |
| Radiation | 235 | 9598 (6269–12,927) | 0.9 (0.7–1.2) |
| Scald | 8704 | 285,342 (224,684–346,000) | 27.7 (26.1–29.4) |
| Thermal | 18,254 | 657,158 (528,820–785,495) | 63.9 (62.1–65.5) |
| Location where burns occurred | |||
| Home | 19,990 | 703,329 (556,263–850,394) | 68.3 (63.0–73.3) |
| Public place | 1546 | 55,239 (41,323–69,155) | 5.4 (4.7–6.1) |
| Unknown | 7789 | 270,683 (196,256–345,110) | 26.3 (21.5–31.7) |
| Body part affected | |||
| Elbow | 335 | 10,789 (8348–13,231) | 1.0 (0.8–1.3) |
| Finger | 4819 | 176,780 (153,043–200,518) | 17.2 (14.9–19.5) |
| Hand | 15,298 | 541,109 (456,740–625,479) | 52.6 (44.4–60.8) |
| Lower arm | 6698 | 231,355 (197,519–265,191) | 22.5 (19.2–25.7) |
| Shoulder | 1022 | 30,565 (25,218–35,912) | 3.0 (2.5–3.5) |
| Upper arm | 1311 | 40,755 (34,298–47,212) | 4.0 (3.3–4.6) |
| Wrist | 982 | 36,633 (31,120–42,146) | 3.6 (3.0–4.1) |
| Product | |||
| Kitchen appliances (cooking range, oven, etc) | 5507 | 191,720 (157,350–226,090) | 18.6 (15.3–22.0) |
| Miscellaneous products | 4475 | 146,807 (125,459–168,155) | 14.3 (12.2–16.3) |
| Pots, pans, and cookware | 4273 | 149,385 (122,665–176,106) | 14.5 (11.9–17.1) |
| Grooming devices | 1857 | 54,167 (43,940–64,395) | 5.3 (4.3–6.3) |
| Barbeques | 1662 | 64,639 (53,156–76,122) | 6.3 (5.2–7.4) |
| Disposition | |||
| Treated and released | 25,496 | 916,761 (741,827–1,091,695) | 89.1 (86.3–91.3) |
| Admitted | 3829 | 112,490 (74,419–150,561) | 10.9 (8.7–13.7) |
Data are from the 2003–2022 National Electronic Injury Surveillance System.
Estimates are calculated using survey weights.
Race and ethnicity were collected from hospital records. Excludes 15,904 encounters where race was not recorded. “Other” included multiple races.
Burn characteristics were associated with demographic factors such as sex, race, and age. Women were more likely to have scald burns (OR, 1.90; 95% CI, 1.66–2.18; P < .001). Pediatric upper extremity burns were more common in Black (OR, 2.10; 95% CI, 1.94–2.27; P < .001) and Hispanic (OR, 2.24; 95% CI, 1.96–2.56; P < .001) individuals than White individuals. Compared with other types of burns, electrical burns were most common among children and adolescents (OR, 2.71; 95% CI, 2.36–3.12; P < .001). Compared with white individuals, electrical injuries were more common among black (OR, 1.94; 95% CI, 1.57–2.4; P < .001) and Hispanic (OR, 1.56; 95% CI, 1.10–2.21; P < .05) patients.
This study found that consumer product-related upper extremity burns account for approximately 103,000 ED visits every year. These burns were most likely to be thermal and scald burns from cooking or kitchenware affecting mostly individuals under the age of 18. Electrical burns disproportionately affected Black and Hispanic children and adolescents. Inferior quality of housing including the absence of preventive devices (e.g., smoke alarms) and low-fidelity gas and electrical infrastructure has been previously described as a risk factor for upper extremity burns.1 Successful interventions in reducing consumer product-related burns often require collaboration between healthcare agencies and industry such as the development of safety regulations and standards for the installation of bathtubs and faucets which have reduced associated scald burns by 83%.5 A multifaceted approach that includes provider education, home safety visits, and community awareness may be effective in reducing upper extremity burns at home.
Study limitations include exclusion of upper extremity burns not treated in the ED, using a national ED-based database with possible misclassification, and the absence of information related to some demographic characteristics and clinical outcomes. Understanding the epidemiologic patterns and trends in upper extremity burns is critical to minimizing injury and promoting interventions to improve education, access to care, and regulation of consumer products.
Financial disclosure statement
The authors have no financial interest to declare in relation to the content of this article.
Data access and analysis statement
Mr. Das had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
No artificial intelligence (AI) was used in the study.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
None.
References
- 1.Sasor S.E., Chung K.C. Upper extremity burns in the developing world: a neglected epidemic. Hand Clin. 2019;35(4):457–466. doi: 10.1016/j.hcl.2019.07.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sauerbier M., Ofer N., Germann G., Baumeister S. Microvascular reconstruction in burn and electrical burn injuries of the severely traumatized upper extremity. Plast Reconstr Surg. 2007;119(2):605–615. doi: 10.1097/01.prs.0000246512.47204.da. [DOI] [PubMed] [Google Scholar]
- 3.Stanton E., Biedry J., Rochlin D., Sheckter C.C. Association of structural fires in New York city with inequities in safe heating for immigrant communities. JAMA Netw Open. 2023;6(3) doi: 10.1001/jamanetworkopen.2023.1575. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Smith M.A., Munster A.M., Spence R.J. Burns of the hand and upper limb—a review. Burns. 1998;24(6):493–505. doi: 10.1016/s0305-4179(98)00063-1. [DOI] [PubMed] [Google Scholar]
- 5.Drago D.A. Kitchen scalds and thermal burns in children five years and younger. Pediatrics. 2005;115(1):10–16. doi: 10.1542/peds.2004-0249. [DOI] [PubMed] [Google Scholar]