Abstract
BACKGROUND:
Burn injuries represent a significant global public health concern, disproportionately affecting vulnerable populations, particularly young children. Despite the severity of the issue, no comprehensive epidemiological studies have been conducted in Georgia to date.
AIM:
This study aimed to fill this existing gap by analyzing the frequency, distribution, and outcomes of pediatric burn injuries.
MATERIALS AND METHODS:
A retrospective, observational study was conducted using data from the national electronic hospitalization registry maintained by the National Center for Disease Control and Public Health (NCDC) from 2017 to 2024. All hospitalized patients aged 0–17 years diagnosed with burn injuries were included. Key variables included demographic characteristics, burn etiology, injury severity, length of hospital stay, outcome related variables and seasonal distribution. Seasonal variation was analyzed using one-way ANOVA and Tukey’s HSD test.
RESULTS:
A total of 5,268 pediatric cases were identified. Most patients were male (58.4%) and under one year of age (51.5%). Thermal burns accounted for 90.9% of cases, with second- and third-degree burns the most frequent. Nearly half of the patients were discharged within 24 hours, while 28.5% required hospitalization over seven days. Significant seasonal peaks occurred in December and July, especially among children aged 0–5 years (p < 0.05).
CONCLUSION:
This first national-level study highlights the high burden of pediatric burn injuries and outlines key epidemiological patterns in Georgia. Findings emphasize the importance of seasonally targeted prevention strategies. Future studies should incorporate more detailed epidemiological data to support effective, evidence-based interventions.
Keywords: Burn injuries, Pediatric burns, Epidemiology of burns
Abstract
შესავალი:
დამწვრობით გამოწვეული დაზიანებები, საზოგადოებრივი ჯანდაცვის უმნიშვნელოვანესი პრობლემაა. ამ ტიპის დაზიანებებისთვის განსაკუთრებით მოწყვლად ჯგუფს ადრეული ასაკის ბავშვები წარმოადგენენ.
მიუხედავად პრობლემის სიმძიმისა, საქართველოში დღემდე არ არის ჩატარებული ბავშვთა პოპულაციაში დამწვრობით გამოწვეული დაზიანებების ეპიდემიოლოგიური კვლევა.
კვლევის მიზანი:
კვლევის მიზანს წარმოადგენს, საქართველოში 0–17 წლის ასაკის ბავშვებში, დამწვრობების ეპიდემიოლოგიური მახასიათებლების (მათ შორის სიხშირის, გავრცელების, შედეგების და სხვა) შესწავლა და ანალიზი.
მეთოდოლოგია:
, რეტროსპექტული, ობსერვაციული კვლევის საფუძველზე შესწავლილ იქნა საქართველოს დაავადებათა კონტროლისა და საზოგადოებრივი ჯანმრთელობის ეროვნული ცენტრის, ჰოსპიტალიზაციის ბაზის ელექტრონული რეგისტრი. კვლევამ მოიცვა 2017–2024 წლებში დამწვრობის დიაგნოზით ჰოსპიტალიზირებული ყველა პედიატრიული შემთხვევა. სტატისტიკური ანალიზისთვის გამოყენებული იქნა შემდეგი ძირითადი ცვლადები: დემოგრაფიული მახასიათებლები, დამწვრობის ეტიოლოგია, დაზიანების სიმძიმე, ჰოსპიტალიზაციის ხანგრძლივობა, ჰოსპიტალიზაციის გამოსავალი და სეზონური განაწილება. სეზონური ვარიაცია შეფასდა დისპერსიული ანალიზით (one-way ANOVA) და Post hoc Tukey-ს HSD ტესტით.
შედეგები:
სულ იდენტიფიცირებულ იქნა 5,268 პედიატრიული შემთხვევა. პაციენტების უმეტესობა იყო მამრობითი სქესის (58.4%) და 1 წლამდე ასაკის (51.5%). შემთხვევათა 90.9%-ს აღენიშნებოდა თერმული დამწვრობები, ხოლო ყველაზე ხშირად გვხვდებოდა მეორე და მესამე ხარისხის დამწვრობები. პაციენტთა თითქმის ნახევარი ჰოსპიტლიდან გაეწერა პირველი 24 საათის განმავლობაში, მაშინ როდესაც შემთხვევათა 28.5% -ის ჰოსპიტალში დაყოვნების პერიოდი შეადგენდა შვიდ დღეზე მეტს. მნიშვნელოვანი სეზონური პიკები გამოვლინდა დეკემბერსა და ივლისში, განსაკუთრებით 0–5 წლის ასაკის ბავშვებში (P< 0.05).
დასკვნა:
ჩატარებული კვლევა წარმოადგენს პირველ ეროვნულ კვლევას, რომლის შედეგადაც მოხდა პედიატრიულ ასაკში დამწვრობით გამოწვეული დაზიანებების ძირითადი ეპიდემიოლოგიური მახასიათებლების დადგენა საქართველოში. კვლევის ჩატარების შედეგად გამოვლინდა ქვეყანაში არსებული ბავშვთა ასაკის დამწვრობების მაღალი ტვირთი. მიგნებები ასევე ცხადყოფს სეზონურად მორგებული პრევენციული ღონისძიებების მნიშვნელობას. გასათვალისწინებელია, რომ ეფექტიანი და მტკიცებულებებზე დაფუძნებული უსაფრთხოების ზომების დასანერგად, მომავალში აუცილებელია დაიგეგმოს ისეთი კვლევები, რომლებიც მოიცავენ უფრო დეტალურ და სიღრმისეულ ეპიდემიოლოგიურ მონაცემებს.
Abstract
Введение:
травмы, вызванные ожогами, являются серьезной проблемой общественного здравоохранения. Особенно уязвимой группой для этого вида травм являются малолетние дети. Несмотря на серьезность проблемы, до настоящего времени в Грузии не проводилось эпидемиологического исследования травм, вызванных ожогами, среди детского населения.
Цель исследования:
Целью исследования является изучение и анализ эпидемиологических характеристик (включая частоту, распространенность, последствия и т.д.) ожогов у детей в возрасте 0–17 лет в Грузии.
Методология:
На основе ретроспективных обсервационных исследований был изучен электронный реестр базы данных о госпитализации Национального центра по контролю заболеваний и общественного здравоохранения Грузии. В исследование были включены все случаи госпитализации детей с диагнозом ожога в период с 2017 по 2024 год. Для статистического анализа были использованы следующие основные переменные: демографические характеристики, этиология ожогов, тяжесть травмы, продолжительность госпитализации, исход госпитализации и сезонное распределение. Сезонные колебания оценивались с помощью дисперсионного анализа (one-way ANOVA) и HSD теста Post hoc Tukey.
Результаты:
Было выявлено в общей сложности 5268 педиатрических случаев. Большинство пациентов были мужского пола (58,4%) и в возрасте до 1 года (51,5%). В 90,9% случаев наблюдались термические ожоги, а чаще всего встречались ожоги второй и третьей степени. Почти половина пациентов были выписаны из больницы в течение первых 24 часов, в то время как в 28,5% случаев пребывание в больнице составляло более семи дней. Значительные сезонные пики были выявлены в декабре и июле, особенно у детей в возрасте 0–5 лет (Р< 0,05).
Заключение:
Проведенное исследование является первым национальным исследованием, в результате которого были выявлены основные эпидемиологические характеристики ожоговых травм в педиатрическом возрасте в Грузии. Исследование выявило высокую распространенность ожогов у детей в стране. Полученные результаты также свидетельствуют о важности профилактических мер с учетом сезонных колебаний. Следует иметь в виду, что для внедрения эффективных и научно обоснованных мер безопасности необходимо планировать исследования на будущее, которые будут включать более подробные и углубленные эпидемиологические данные.
Introduction
Burn injuries represent a common and widespread public health issue. Although the global incidence of burn injuries has been gradually declining, these injuries remain a significant public health concern due to their potential to cause severe physical, psychological, and socioeconomic consequences [19] [18]. Burns continue to disproportionately affect vulnerable populations and pose ongoing challenges in both prevention and long-term care—especially in low-resource settings, where limitations in healthcare infrastructure are presented [12][1, 3].
Numerous epidemiological studies have demonstrated, that burn injuries significantly impact the pediatric population. Although the specific epidemiological characteristics of burn injuries may vary depending on a country’s cultural practices, traditions, and socioeconomic conditions, children under the age of five consistently represent the most affected group across the majority of studies. In some reports, this age group accounts for about 40% to 60% of all burn injury cases [3, 20, 21].
According to data from the Institute for Health Metrics and Evaluation (IHME) published in 2021, the estimated mortality rate from exposure to fire, heat, and hot substances in Georgia is 2.7 deaths per 100,000 population. Among 26 Eastern European countries, Georgia ranked seventh in terms of death rate. Across the region, rates varied from as high as 6.0 to as low as 0.4 per 100,000 population [15]. To the best of our knowledge, no comprehensive epidemiological study has been conducted in Georgia to date to examine the patterns, distribution, and characteristics of burn injuries, despite the considerable public health importance of the issue and the existing knowledge gap in the field.
It is important to emphasize that burn injuries are largely preventable [14, 23]. This highlights the need for identifying and evaluating key risk factors as a critical component of effective public health strategies. Given that the prevalence and causes of burn injuries may vary significantly across different countries and regions, it is essential to conduct context-specific assessments to understand the underlying social, environmental, and behavioral determinants. Tailored preventive interventions—designed to address the unique needs and vulnerabilities of specific populations—are vital to further reducing the incidence of burn injuries and mitigating their long-term impact.
The aim of this study is to provide the first comprehensive epidemiological analysis of pediatric burn injuries in Georgia. One of the main objectives is to analyze the distribution, underlying risk factors, and clinical outcomes of burn injuries among the pediatric population. By establishing baseline data, the study aims to inform the development of context-specific prevention strategies and contribute to improving pediatric burn care nationwide. An additional aim is to identify and define key variables and data elements that should be prioritized in future surveillance efforts. Establishing such a framework is essential for enabling more accurate, systematic, and comprehensive epidemiological studies in the country.
Materials and Methods
A retrospective, observational study was conducted from 01.01.2017 to 31.12.2024. This study incorporated all hospitalized patients between the ages of 0 and 17 years who were diagnosed with burn injuries, identified according to the ICD-10 (WHO classification system for diseases) codes from T20 to T32 (See Supplementary Table S1).
The data for our study was retrieved from electronic databases of the National Center for Disease Control and Public Health (NCDC), specifically an electronic module called “Form 066- Hospitalization Module”, which is a standardized medical record used in Georgian healthcare to document the clinical information pertaining to a patient’s admission, diagnosis, treatment, and discharge. The electronic module captures information on all hospitalizations nationwide. Consequently, our analysis includes all patients hospitalized in Georgia in 2017–2024 diagnosed with thermal, chemical or any other types of burn injuries.
Data Variables and Grouping Criteria:
1. Demographic Characteristics: Demographic data included age, gender, and geographic distribution. For detailed analysis, the pediatric cohort was stratified into four developmental age groups: Infants and toddlers (0–1 years): Limited mobility and awareness. Preschool-aged children (2–5 years): Increased mobility and curiosity, with limited risk perception. School-aged children (6–12 years): Growing independence and exposure to external environments. Adolescents (13–17 years): Greater autonomy and risk-taking behaviors. This stratification enables targeted analysis of burn mechanisms and outcomes by developmental stage, supporting age-specific prevention strategies. The region of residence was classified in two ways: a) By area type: urban or rural, based on official administrative definitions.
b) By geographic region: a 13-category system comprising Georgia’s 12 administrative regions of Georgia (Tbilisi, Adjara, Guria, Imereti, Kakheti, Kvemo Kartli, Mtskheta-Mtianeti, Racha-Lechkhumi and Kvemo Svaneti, Samegrelo-Zemo Svaneti, Samtskhe-Javakheti, Shida Kartli, and Abkhazia) and an additional “Overseas” category for non-residents. For regional comparisons we calculated age-specific hospitalization rates per 100,000 children (0–17 years) using mid-year population denominators from the National Statistics Office of Georgia (GEOSTAT).
2. Burn Types: burn injuries were classified by etiology into three categories: thermal burns (including scalds, flame, and contact injuries), chemical burns, and electrical/other causes. Classification was based on ICD-10 external cause codes (X00–X19), covering burns and corrosions, which were used to extract relevant data from the database.
3. Burn Severity (Depth): Burn depth was classified using internationally recognized standards: first-degree burns/ Superficial (epidermal involvement only), Second-degree burns/Partial-thickness (superficial or deep dermal layers), Third-degree burns/ Full-thickness (complete destruction of the epidermis and dermis), and Fourth-degree burns (extending into subcutaneous tissue, muscle, or bone).
4. Hospitalization data: Collected variables included date of admission; length of hospital stay (LOS) and outcome. LOS was grouped into five categories: I) 1 day (24 hours); II) 2–3 days (short term stays); III) 4–7 days; IV) 8–15 days; V) 15 + days.
5. Seasonal variation: To evaluate temporal trends, burn injury cases were analyzed by both season and month of admission. Seasons were defined as follows: spring (March–May), summer (June–August), autumn (September–November), and winter (December–February). In addition, a monthly breakdown was performed to identify more specific fluctuations in burn incidence throughout the year.
To examine seasonal variation in pediatric burn cases in Georgia, we conducted a retrospective analysis of monthly aggregated hospitalization data from 2017 to 2024.
The data were analyzed using one-way Analysis of Variance (ANOVA), implemented in SPSS v26. Separate analyses were performed for different types of burns (thermal, chemical, based on ICD-10 classification) and age groups (0–1, 2–5, 6–12, and 13–17 years). The month of admission (coded from 1 to 12) was treated as a categorical independent variable, while the number of monthly cases served as the dependent variable. Prior to conducting ANOVA, assumptions of normality and homogeneity of variances were evaluated using the Shapiro–Wilk and Levene’s tests, respectively. In cases where ANOVA revealed significant variation (p < 0.05), post-hoc comparisons were performed using Tukey’s Honestly Significant Difference (HSD) test to identify specific month-to-month differences. Monthly case counts were aggregated across all available years, excluding missing or incomplete data. One-way ANOVA was applied to test for significant differences in mean monthly burn cases. Post-hoc Tukey HSD tests were used to identify specific months with significantly different case numbers. Seasonal patterns were interpreted based on ANOVA results, post-hoc comparisons, and visual examination of peak months. Descriptive statistics, including mean, median, and standard deviation, were used to summarize continuous variables. Categorical variables, such as age groups, gender, burn type, and burn depth, were compared using Pearson’s Chi-square test to assess associations. The ANOVA test was applied specifically to evaluate seasonality in burn incidence. Statistical significance was set at p < 0.05 for all analyses. All statistical analyses were performed using SPSS software, version 26.
This study was approved by the Ethics Committee of the National Center for Disease Control and Public Health (IRB # 2022–053). The need for informed consent was waived due to the retrospective use of de-identified data.
Results
Over the 8-year period from January 2017 to December 2024, 11,472 burn injury cases were recorded. Of these, 5,268 cases (45.9%) involved pediatric patients aged 0 to 17 years, forming the study sample. Although yearly fluctuations occurred, the overall trend in burn cases declined, with the most significant drop in 2020 (−63.99%), and minor increases in 2021 (+3.66%) and 2023 (+6.65%). A full summary of annual changes is presented in Table 1.
Table 1.
Annual Changes in the Number of Burn Injury Cases Over the study period
| Year | Number of cases | Annual percentage Change (%) |
|---|---|---|
| 2017 | 1279 | - |
| 2018 | 1077 | −15.79% |
| 2019 | 1064 | −1.21% |
| 2020 | 383 | −63.99% |
| 2021 | 397 | 3.66% |
| 2022 | 346 | −12.83% |
| 2023 | 369 | 6.65% |
| 2024 | 353 | −4.34% |
Demographic Characteristics
Among the 5,268 pediatric burn cases, 3,077 (58.4%) were male and 2,191 (41.6%) were female, yielding a male-to-female ratio of approximately 1.4:1. The mean age was 3.39 years (± 4.04), with a median of 1.0 year and a mode of 1 year, indicating a predominance of injuries among very young children. The 0–1 year age group accounted for the largest share of cases (51.5%, n = 2,715), followed by 2–5 years (27.0%, n = 1,424), 6–12 years (16.0%, n = 841), and 13–17 years (5.5%, n = 288). Male patients outnumbered females across all age groups. Geographic data were available for 3,450 cases, as urban/rural residence was consistently recorded only from 2019 onward. Of these, 59.3% (n = 2,047) resided in urban areas and 40.7% (n = 1,403) in rural areas. Figure I show regional variation in age-specific hospitalization rates for pediatric burns in 2023 (per 100,000 children in the corresponding age group), with the highest rates in Kakheti, followed by Racha-Lechkhumi and Kvemo Svaneti, and Mtskheta-Mtianeti, indicating a disproportionate burden in these regions. Additional demographic details by age, gender, and residence are provided in Table 2.
Figure I:
Age specific hospitalization rates for pediatric burn injuries per 100,000, corresponding age group population, by region, Georgia, 2023
Table 2.
Demographic distribution of pediatric burn cases by age, sex, residence, and burn type, Georgia 2017–2024
| Variables | Sub-category | Thermal Burns | Chemical Burns | Other | Total N (%) |
|---|---|---|---|---|---|
| Age Group | 0–1 | 2517 | 149 | 49 | 2715 (51.5%) |
| 2–5 | 1265 | 122 | 37 | 1424 (27.0%) | |
| 6–12 | 750 | 69 | 22 | 841 (16.0%) | |
| 13–17 | 256 | 29 | 3 | 288 (5.5%) | |
| Gender | Male | 2795 | 203 | 79 | 3077 (58.4%) |
| Female | 1993 | 166 | 32 | 2191 (41.6%) | |
| Place of Residence | Urban | 1874 | 118 | 55 | 2047 (59.3%) |
| Rural | 1304 | 61 | 38 | 1403 (40,7%) |
Types and depth of burns
Thermal burns were the most common cause, comprising 90.9% (n = 4,788) of all cases. Chemical burns accounted for 7.0% (n = 369), while other causes (including electrical burns)—represented 2.1% (n = 111). The distribution of burn depth was as follows: First-degree: 7.2% (n = 380); Second-degree: 38.7% (n = 2,041); Third-degree: 35.8% (n = 1,887); Fourth-degree: 2.1% (n = 111). Second- and third- degree burns were the most frequently observed overall, particularly in thermal burn cases. In contrast, first-degree burns were most commonly associated with chemical burns.
Anatomical distribution analysis showed that the trunk was the most commonly affected region, followed by the shoulder and upper limb. Burns involving multiple regions or unspecified sites ranked third, while the hip and lower limb were fourth. The head and neck were the least frequently affected. Age-specific analysis indicated that younger children had a higher proportion of severe burns (second- and third-degree). A consistent male predominance was observed across all burn depths. A significant association was found between burn depth and age group (Pearson’s Chi-square test, p = 0.0001), indicating that younger children more often sustained superficial burns, while older children experienced a higher proportion of deeper burns. Detailed data about burn depth by gender, age group, burn type, and affected body regions are available in Table 3.
Table 3.
Distribution of Burn Severity by Age Group, Gender, Burn Type, and Affected Body Area
| Variables | Sub-category | I degree N (%) |
II Degree N (%) |
III Degree N (%) |
Unspecified N (%) |
Other N (%) |
Total N | p-value |
|---|---|---|---|---|---|---|---|---|
| Age Group | 0–1 | 155 (5.7%) | 1085 (40.0%) | 1015 (37.4%) | 411 (15.1%) | 49 (1.8%) | 2715 | p=0.0001 |
| 2–5 | 125 (8.8%) | 510 (35.8%) | 492 (34.6%) | 260 (18.3%) | 37 (2.6%) | 1424 | ||
| 6–12 | 71 (8.4%) | 333 (39.6%) | 276 (32.8%) | 139 (16.5%) | 22 (2.6%) | 841 | ||
| 13–17 | 29 (10.1%) | 113 (39.2%) | 104 (36.1%) | 39 (13.5%) | 3 (1.0%) | 288 | ||
| Gender | Male | 204 (6.6%) | 1178 (38.2%) | 1097 (35.7%) | 519 (16.9%) | 79 (2.6%) | 3077 | p=0.0001 |
| Female | 176 (8.0%) | 863 (39.4%) | 790 (36.1%) | 330 (15.1%) | 32 (1.5%) | 2191 | ||
| Types of Burns | Thermal | 27 (0.6%) | 2039 (42.6%) | 1880 (39.3%) | 842 (17.6%) | 0 (0.0%) | 4788 | p=0.0001 |
| Chemical | 353 (95.7%) | 2 (0.5%) | 7 (1.9%) | 7 (1.9%) | 0 (0.0%) | 369 | ||
| Other | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 111 (100%) | 111 | ||
| Body parts injured | Head and Neck (T20) | 8 (1.7%) | 293 (61.4%) | 167 (35.0%) | 9 (1.9%) | 0 (0.0%) | 477 | p= 0.0001 |
| Trunk (T21) | 5 (0.5%) | 475 (45.4%) | 561 (53.6%) | 6 (0.6%) | 0 (0.0%) | 1047 | ||
| Shoulder and Upper Limb (T22) | 4 (0.4%) | 591 (62.2%) | 354 (37.3%) | 1 (0.1%) | 0 (0.0%) | 950 | ||
| Wrist and Hand (T23) | 4 (0.6%) | 310 (49.9%) | 303 (48.8%) | 4 (0.6%) | 0 (0.0%) | 621 | ||
| Hip and Lower Limb (T24) | 5 (0.7%) | 342 (47.9%) | 360 (50.4%) | 7 (1.0%) | 0 (0.0%) | 714 | ||
| Ankle and Foot (T25) | 350 (73.1%) | 5 (1.0%) | 122 (25.5%) | 2 (0.4%) | 0 (0.0%) | 479 | ||
| Multiple body regions (T29) | 4 (0.5%) | 23 (2.7%) | 18 (2.1%) | 817 (94.8%) | 0 (0.0%) | 862 | ||
| Other parts of the body (T26; T27; T28; T30; T31) | 0 (0.0%) | 2 (1.7%) | 2 (1.7%) | 3 (2.5%) | 111 (94.1%) | 118 |
Anatomical distribution of burns
Analysis of the burn injury cases based on ICD-10 coding revealed that the trunk (T21) was the most frequently affected body region, accounting for 19.9% of all reported burns. This was followed by burns involving the shoulder and upper limb (T22), which constituted 18.0% of the cases. Burns involving multiple body regions (T29) represented 16.4%, indicating a significant proportion of cases with extensive injury distribution. Injuries to the hip and lower limb (T24) ranked fourth, comprising 13.6% of cases. Burns of the wrist and hand (T23) were recorded in 11.8% of cases, while both ankle and foot (T25) and head and neck (T20) injuries were equally represented, each accounting for 9.1%. Less frequently affected areas included the eye and adnexa (T26), reported in 1.0% of cases, followed by internal organs (T28) at 0.5%, and the respiratory tract (T27) at 0.1%. Burns involving unspecified body regions (T30) were also rare, comprising 0.1% of the total. (Table 3)
Length of hospital stay (LOS)
Length of hospital stay (LOS) was analyzed for all 5,268 pediatric burn cases. The mean LOS was 5.56 days (± 7.02), with a median of 2.00 days and a mode of 1 day, indicating a right-skewed distribution. Patients were categorized into five groups based on LOS: • 1 day: 49.6% (n ≈ 2,611) • 2–3 days: 5.1% (n ≈ 271) • 4–7 days: 16.8% (n ≈ 887) • 8–15 days: 20.7% (n ≈ 1,088) • Over 15 days: 7.8% (n ≈ 411).
Almost half of all patients (49.6%) were discharged after a single day of hospitalization, a pattern consistent across age groups, genders, and burn types. Hospital stays longer than 7 days occurred in 28.5% of cases, with infants and toddlers (0–1 years), and preschool-aged children (2–5 years) more frequently represented in longer LOS categories (>8 days) than older children. Male and female patients showed similar LOS patterns. Thermal burns were the most common injury type among both short-term and long-term admissions. A detailed analysis of LOS by demographic and burn characteristics is presented in Table 4.
Table 4.
Distribution of Length of hospital Stay by Age Group, Gender, and Burn Type
| Variables | Sub-category | LOS 1 Day N (%) |
2–3 Days N (%) |
4–7 Days N (%) |
8–15 Days N (%) |
15+ Days N (%) |
Total (N) |
|---|---|---|---|---|---|---|---|
| Age Group | 0–1 | 1300 (47.9%) | 141 (5.2%) | 540 (19.9%) | 569 (21.0%) | 165 (6.1%) | 2715 |
| 2–5 | 688 (48.3%) | 71 (5.0%) | 213 (15.0%) | 309 (21.7%) | 143 (10.0%) | 1424 | |
| 6–12 | 462 (54.9%) | 45 (5.4%) | 98 (11.7%) | 154 (18.3%) | 82 (9.8%) | 841 | |
| 13–17 | 161 (55.9%) | 14 (4.9%) | 36 (12.5%) | 56 (19.4%) | 21 (7.3%) | 288 | |
| Gender | Male | 1521 (49.4%) | 160 (5.2%) | 543 (17.6%) | 623 (20.2%) | 230 (7.5%) | 3077 |
| Female | 1090 (49.7%) | 111 (5.1%) | 344 (15.7%) | 465 (21.2%) | 181 (8.3%) | 2191 | |
| Types of burns | Thermal | 2346 (49.0%) | 239 (5.0%) | 815 (17.0%) | 1001 (20.9%) | 387 (8.1%) | 4788 |
| Chemical | 228 (61.8%) | 13 (3.5%) | 46 (12.5%) | 67 (18.2%) | 15 (4.1%) | 369 | |
| Other | 37 (33.3%) | 19 (17.1%) | 26 (23.4%) | 20 (18.0%) | 9 (8.1%) | 111 |
Clinical Outcomes
Among evaluated 5,268 pediatric burn patients, 4,839 (91.9%) were discharged after completion of treatment. 379 patients (7.2%) were transferred to other medical facilities, and 36 cases (0.7%) were discharged against medical advice. There were 14 deaths (0.27%) recorded during the study period. Mortality was highest among children under 5 years of age, with 5 deaths in the 0–1 year group and 5 in the 2–5 years group. The remaining deaths occurred in 6–12 years (n = 2) and 13–17 years (n = 2) groups. All fatalities were coded under ICD-10 T29.0 (burns and corrosions of multiple body regions, unspecified degree). The leading external cause of death was contact with hot fluids (X12), accounting for 9 of 14 deaths, followed by exposure to electric transmission lines (W85) in 3 cases, and flammable material ignition (X04, X02) in 2 cases.
Seasonality
One-way ANOVA was conducted in SPSS on monthly aggregated data to assess seasonal differences in the pediatric burns. Thermal burns (91.6% of cases) showed significant monthly variation (F (11, 84) = 3.5, p =0.001), with post-hoc Tukey HSD tests indicating higher case counts in December (494) and July (420) compared to May (360) and June (350) (p < 0.05). Chemical burns (6.4%) showed no significant monthly differences (F (11, 84) = 1.2, p = 0.30), though a slight peak was observed in December (34 cases). Age groups 0–1 year (44.9%) and 2–5 years (33.7%) exhibited significant monthly variation (F (11, 84) = 3.2, p = 0.002; F (11, 84) = 3.0, p = 0.003), with December peaks (247 and 185 cases, respectively) significantly higher than in May–June (p < 0.05). Age groups 6–12 years (13.4%) and 13–17 years (9.0%) showed weaker variation (p ≈ 0.10–0.15). These findings highlight pronounced seasonal peaks for thermal burns, especially among children aged 0–5 years, with December and July being the highest-risk months (Table 5, Figure II).
Table 5.
Seasonal Variation in Pediatric Burn Cases by Month, ANOVA Results (2017–2024)
| VARIABLE | F-STATISTIC (DF = 11, 84) | P-VALUE | INTERPRETATION |
|---|---|---|---|
| THERMAL BURNS | 3.48 | 0.001 | Significant peaks in July and December |
| CHEMICAL BURNS | 1.21 | 0.290 | No significant monthly variation |
| AGE GROUP (0–1 YEARS) | 3.23 | 0.002 | Significant peak in December |
| AGE GROUP (2–5 YEARS) | 3.01 | 0.003 | Significant peak in December |
| AGE GROUP (6–12 YEARS) | 1.80 | 0.100 | Weak peak in December |
| AGE GROUP (13–17 YEARS) | 1.60 | 0.150 | Weak peak in December |
Figure II.
Monthly distribution of pediatric burn hospitalizations by age group, 2017–2024
Note: Analysis base on aggregated monthly counts
Discussion
Burn injuries are one of the most frequent causes of injuries and reason of hospitalization among pediatric population worldwide. Morbidity as well as mortality rates for these types of injuries are higher in developing countries compared to developed ones [12, 14].
Global data consistently shows that males are more susceptible to injuries across childhood and adolescence compared to females [8, 16] [17]. The epidemiological studies about pediatric burn injuries similarly demonstrate a higher incidence among boys compared to girls [6]. This trend is likely due to greater involvement in risk-prone behaviors and activities which is commonly observed among males. The same pattern was evident in our study: with a male-to-female ratio of 1.4:1.
A recent study about global trends for pediatric burn injuries has shown that most affected countries for burn injuries are low and middle-income countries [8]. Most vulnerable age group for this type of injury is children under 5 years, especially the ones from 0–2-year-old age group. The age distribution of burn injuries in our study revealed a clear predominance among infants and toddlers (0–1 years), who accounted for 51.5% of all cases, followed by children aged 2–5-years, who made up 27% of cases. Together, these two groups represented the majority of pediatric burn injuries. This early age group’s high vulnerability may be attributed to limited mobility, lack of hazard awareness, and complete dependence on caregiver supervision. This pattern is commonly observed in other similar studies as well [5]. For example, a study conducted in Sweden on pediatric burn injuries found that more than 70% of the injured children were under 3 years old [4]. A six-year retrospective, epidemiological study conducted in central China reported a corresponding age distribution, with the average age of pediatric burn patients being 3 years [6]. These findings highlight the need for targeted prevention efforts focused on home safety and caregiver education during early childhood. The next, most vulnerable age group from our study were children aged 6–12 years, constituting 16% of cases. For school-aged children, both preventive and educational initiatives should be considered and implemented. These programs should target not only parents but also the children themselves. Integrating safety education into school curricula could be highly effective. Additionally, public education on proper first aid techniques is essential. Prompt and appropriate first aid can significantly improve recovery outcomes and prevent further injury. Promoting basic first aid knowledge across all sectors of society should be a public health priority.
A comprehensive 11-year analysis on the Global Burden of Disease (GBD) caused by fire, heat, and hot substances has shown that the burden of burn injuries—as well as associated morbidity and mortality—has significantly decreased worldwide. This positive trend can be attributed to the implementation of preventive strategies and improvements in injury-specific care [7].
Our study has revealed, that the incidence of burn injuries has sharply declined over the eight-year study period in Georgia as well. Between 2017 and 2020, the number of pediatric burn cases decreased by approximately 70.1%, declining from 1,279 cases in 2017 to 383 cases in 2020. One potential explanation for this marked decrease is the COVID-19 pandemic. During the pandemic, both global and local (Georgian) lockdowns were implemented, resulting in parents spending more time at home. It is plausible that increased parental supervision led to a reduction in childhood burn injuries. Alternatively, it is possible that caregivers avoided seeking medical attention for minor burn cases due to fear of contracting the virus in healthcare settings. Interestingly, the number of burn injuries has remained relatively low even after the pandemic, compared to the significantly higher rates observed during the first three years of the study. From 2021 through 2024, reported cases varied slightly between 397 and 353, indicating a relatively stable trend with a modest, continued decrease. This pattern suggests that the factors contributing to the initial reduction may have had a lasting impact beyond the pandemic period. As no formal preventive measures have been introduced during this period, further investigation is warranted to understand the underlying factors contributing to this sustained decline. Such insights could inform future strategies to maintain or even further reduce burn injury incidence.
Thermal burns and specifically scald burns are widely recognized as the primary cause of pediatric burn injuries in both developed and developing countries [1, 4, 5, 11–13]. This trend is supported by a recent multinational analysis, which found that scalds accounted for approximately 62% of pediatric burn cases [17]. Our study revealed an even higher proportion, with scald-related thermal burns comprising 90.9% of all pediatric burn injuries.
The analysis of our study revealed clear seasonal trends in pediatric burn hospitalizations, particularly for thermal burns and children under 5 years of age. The most prominent peaks occurred in December and July, likely reflecting a combination of environmental, behavioral, and societal factors. The December peak may be attributed to increased exposure to heating devices (e.g., stoves, electric heaters, open fires), which are often used inappropriately or without adequate safety measures in colder households. Additionally, festive activities during the winter holidays may involve candles, fireworks, and cooking-related hazards—all of which increase the risk of burns in young children. These winter-month injury peaks are consistent with findings from other studies conducted in both developed and developing countries. For example, a study from Switzerland found that scald injuries peaked in January, whereas flame-related burns were more common in May and August [11]. By comparison, a winter predominance was observed in underdeveloped minority areas of Guangxi, China, where both scalds and flame burns were the leading etiologies, reflecting regional climatic and lifestyle influences [10]. The July peak may be linked to children spending more time at home or outdoors during school holidays, often without consistent adult supervision. Increased interaction with hot surfaces (e.g., grills, sun-heated materials) and liquids, as well as water-related hazards (e.g., burns from hot water in outdoor taps or hoses left in the sun), are likely contributors. Comparable seasonal peaks were reported in studies from Beijing and southeast Turkey, where the majority of cases occurred during spring and summer months [22] [2]. In Beijing, burns peaked in May, while in southeast Turkey, most cases were reported between May and October. In contrast to these findings, a study conducted in Sarajevo found no significant seasonal variation in pediatric burn injuries [24].
Interestingly, chemical burns in our cohort did not display notable seasonal variation. This suggests that their occurrence may be less influenced by environmental or calendar-based factors and more related to year-round risks, such as unsupervised access to household chemicals.
The pronounced seasonality in younger age groups (0–1 and 2–5 years) is consistent with known developmental patterns: young children are more likely to explore their environment without understanding danger and are physically more vulnerable to injury from thermal sources.
These findings highlight the need for seasonally targeted burn prevention strategies, especially in the home environment. Public health messaging campaigns and parental education programs could be particularly effective if launched before the winter and summer months.
The observed U-shaped distribution of hospital length of stay (LOS) likely reflects a combination of systemic and clinical factors. Contextual aspects of Georgia’s healthcare organization and insurance reimbursement policies may influence discharge patterns, especially for minor cases, while variation in burn severity among pediatric patients contributes to longer hospitalizations in severe cases.
This pattern emphasizes the importance of interpreting administrative data within its health-system context and of distinguishing short observation admissions from clinically complex hospitalizations. From a public health perspective, these findings highlight the need for prospective clinical studies that integrate burn severity and treatment complexity indicators to better understand LOS patterns, optimize hospital resource allocation, and strengthen injury prevention strategies.
Epidemiological studies confirm that it is very important to collect proper epidemiological information/variables of burn injuries in order to plan proper preventive measures [20].
To enhance the quality and utility of national burn injury surveillance, it is recommended that hospitals systematically collect and report more comprehensive epidemiological data associated with risk factors for burn injuries. Key variables that should be included are the Total Body Surface Area (TBSA) affected, the location and time of injury, causative agents (e.g., specific liquid or material), whether and what type of first aid was administered, etc.
Access to such comprehensive and standardized data would enable the design and execution of more in-depth epidemiological studies in the future. These, in turn, could inform the development and implementation of more effective, targeted, and evidence-based prevention strategies.
In addition, as it is well known, in 2017 the World Health Organization (WHO) established the Global Burn Registry [9][17]. The registry offers the statistical information about burn injuries from 20 countries already. It would be highly beneficial for our country to join this registry in order to contribute to global efforts in assessing the magnitude of the burn injury problem and to gain access to internationally developed preventive strategies.
Limitations
A key limitation of this study is the lack of complete and essential epidemiological variables in the database on which the analysis was based. Important data points—such as Total Body Surface Area (TBSA) affected, location and timing of the injury, first aid measures administered, among others—were missing. These variables are critical for conducting a comprehensive epidemiological analysis of burn injuries, identifying contributing risk factors, and developing effective, targeted prevention strategies. One contributing factor to this limitation is the absence of standardized data collection protocols in hospitals; medical personnel are neither informed nor mandated to record these variables systematically. As a result, the available epidemiological information remains insufficient.
Additionally, this study focused exclusively on hospitalized burn cases and did not capture milder injuries managed at home or in outpatient settings. However, it is reasonable to assume that achieving full coverage of all burn injuries—including those not requiring hospitalization presents a significant worldwide challenge. Comprehensive data collection on burn injuries that do not require hospitalization is difficult due to underreporting and the fact that many cases are managed in informal or non-centralized settings.
Strength of the Study
A key strength of this study is its large scope and comprehensive approach. It is the first national-level study to examine pediatric burn injuries over an eight-year period. This long-term and wide-ranging analysis provides important information about how burn injuries affect children of different age groups and regions across the country. By using the complete national hospitalization database, the study includes all recorded cases, which makes the results more accurate and representative of the whole population. In addition, the long study period made it possible to analyze seasonal trends in burn injuries, offering useful insights into patterns related to specific times of the year, which may help guide prevention efforts
Conclusion
This study presents the first comprehensive analysis of pediatric burn injuries in Georgia, covering an eight-year period (2017–2024). The findings highlight a substantial burden, particularly among infants and toddlers (0–1 years), who accounted for over half of all cases. Thermal burns—especially scalds—were the leading cause, with a high proportion of second- and third-degree injuries requiring intensive care. The study has demonstrated that pediatric burn hospitalizations show clear seasonal peaks in December and July, mainly due to thermal burns among children under 5. These findings suggest that seasonally focused prevention efforts, before winter and summer, are essential to reduce burn risks in young children. Implementing targeted prevention, improving caregiver education, and establishing data collection protocols for key burn injury indicators are crucial for better surveillance, prevention, and policy planning.
Although this study provides fundamental and reliable evidence on pediatric burn injuries, its potential for informing targeted prevention is limited due to the absence of key epidemiological variables such as the time and location of injury, the context of the incident, and the application of first aid. Future studies should be designed with a more detailed and context-specific approach, including the collection of such variables, to support the development of more effective, data-driven preventive strategies.
Supplementary Material
Acknowledgments
This work was supported by the NIH-Fogarty International Trauma Training Program, iCREATE: Increasing Capacity for Research in Eastern Europe, administered by the University of Iowa in collaboration with the Cluj School of Public Health. (National Institutes of Health, Fogarty International Center, Award No: 2D43TW007261)
Footnotes
Conflict of Interest
The authors declare no conflicts of interest related to the conduct, authorship, or publication of this study.
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