Experience of Burn Injuries at the Pakistan Institute of Medical Science, Islamabad, Pakistan*

Summary

The objective of this prospective study was to consider the demographical data of burn patients admitted to the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The study was carried out at PIMS from January 2002 to December 2003. Only admitted patients of either sex of age more than 12 yr were included. Patients below 12 yr were excluded. Patients requiring outpatient treatment were also excluded. A total number of 77 males and 65 females fulfilled the criteria. The mean age of the males was 32.2 yr and of the females 24.4 yr, while the male/female ratio was 1/1.18. Burns were commonest during the winter season (42.2%). In 6% of the patients, the burns were due to suicide attempts and in 15% to homicidal intent. The burns were accidental in 79% of cases. The major mechanism in females was stove burst (22%) and in males direct flame (18%). The kitchen was the commonest site of the accident in females (27%). Housewives were the most frequently affected (35%). More married males (39%) were burned than unmarried females (18%). Inhalational injury was present in 23% of the patients. Males had average total body surface area burned of 27.4% compared with 39.5% in females. Eighteen per cent of the deaths occurred among males and 16% among females. This study provides a comprehensive overview of hospitalized burn patients in Pakistan. Prevention is always the rule to be safe from burns but, once they occur, immediate and proper care should be given with aggressive treatment in order to minimize post-burn problems.

Introduction

The objective of this prospective study was to consider the demographical data of burn patients admitted to the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The study was carried out at PIMS from January 2002 to December 2003. Only admitted patients of either sex of age more than 12 yr were included. Patients below 12 yr were excluded. Patients requiring outpatient treatment were also excluded. A total number of 77 males and 65 females fulfilled the criteria. The mean age of the males was 32.2 yr and of the females 24.4 yr, while the male/female ratio was 1/1.18. Burns were commonest during the winter season (42.2%). In 6% of the patients, the burns were due to suicide attempts and in 15% to homicidal intent. The burns were accidental in 79% of cases. The major mechanism in females was stove burst (22%) and in males direct flame (18%). The kitchen was the commonest site of the accident in females (27%). Housewives were the most frequently affected (35%). More married males (39%) were burned than unmarried females (18%). Inhalational injury was present in 23% of the patients. Males had average total body surface area burned of 27.4% compared with 39.5% in females. Eighteen per cent of the deaths occurred among males and 16% among females. This study provides a comprehensive overview of hospitalized burn patients in Pakistan. Prevention is always the rule to be safe from burns but, once they occur, immediate and proper care should be given with aggressive treatment in order to minimize post-burn problemsIn all societies, burns continue to constitute a medical, psychological, and social problem that involves not only the physician and patient but also all society. Burns are a major health problem. The preventable nature of the injury, the social and environmental factors associated with it, and the age groups involved make the study of burns epidemiology necessary. There are a few burn centres in Pakistan that are well equipped, but the majority of patients are still treated in hospitals without established burns units.

The Pakistan Institute of Medical Sciences (PIMS) in Islamabad, Pakistan, is the major tertiary care hospital in the capital but it does not have a burns unit. All the patients are managed by the Department of Plastic Surgery.

Thus a study of burns epidemiology in hospitalized patients is likely to have a bearing on the total picture available from the entire country.

The aim of the study is to analyse the demographical data of this problem and to compare the data with other published reports from neighbouring countries.

Materials and method

This prospective study was conducted at PIMS between January 2002 and December 2003. Only hospitalized patients aged over 12 years were included. Patients below 12 years of age were excluded as they were managed by the Children’s Hospital, Islamabad. Outpatients were excluded. In all, 77 males and 65 females fulfilled the criteria. The data were analysed at the end of the study.

Results

Age and sex distribution

The mean age of the males was 32.2 yr and of the females 24.4 yr. The majority of the patients were young ( Fig. 1 ). The male/female ratio was 1/1.18.

Fig. 1. Age and sex distribution of patients.

Seasonal variations

Burns requiring hospitalization were commonest in winter (42.2%), followed by summer (27.5%), autumn (18.3%), and spring (12.0%).

Medico-legal aspects

In 6% of the patients, the burns were due to attempted suicide, while 15% of cases involved attempted homicide. In 79% of the cases the burns were accidental. Patients whose history was doubtful were placed in the accidental group.

Mechanism of burns

Stove burst was the major mechanism in females (22%), while in males 18% had direct flame injury ( Table I ).

Table I. Mechanism of burns.

Place where burns occurred

The kitchen was the place where burns most commonly occurred (27%), whereas in males the courtyard or workplace was commonest (45%) ( Table II ).

Table II. Place of accident.

Occupation

Housewives were the most frequently affected (35%). Fourteen per cent were dependents or unemployed ( Fig. 2 ).

Fig. 2. Occupation of patients.

Marital status

More married males were burned (39%), while 18% of the females were unmarried ( Fig. 3 ).

Fig. 3. Marital status of patients.

Time interval between injury and admission

Nearly half of the patients presented within 12 h (46%). These included patients from within the city and surrounding areas. Thirty-six per cent presented after 12-24 h, mostly referred from other cities ( Fig. 4 ).

Fig. 4. Time interval between injury and hospitalization.

Hospital stay

The average duration of hospital stay was 40 days (range, 6 h to 5 months).

Body regions affected

The majority of the patients had involvement of the trunk and limbs ( Table III ). Inhalational injury was present in 23% of the patients.

Table III. Body regions affected.

Severity of burns

Males had an average burned TBSA of 27.4% and females 39.5%.

Mortality

The mortality rate was 18% among the males and 16% among the females.

Discussion

Burns continue to be a major environmental factor responsible for significant morbidity and mortality in developing countries.1 The present study presents data from the major hospital in our capital. There is no burn unit in this hospital or in the city. All burn patients are managed by our Department of Plastic Surgery.

In our review, flame was the commonest cause of burns, followed by electrical injuries and scalds, as reported elsewhere. ^{1, 2, 3, 4}In this study, gas explosion and kerosene were most frequently involved. This can be explained by the fact that gas and kerosene are widely used as domestic fuel in Pakistan. Unwise use of kerosene by some people was also noted. The majority of the patients (42%) were burned during the winter, when gas and kerosene were used for fuel and heating. This observation is consistent with other reports. ^{1, 5}In the majority of patients (79%) the burns occurred accidentally, and patients having a doubtful history were also included in the accidental group. Attempted suicide by burning accounted for 6% of the patients in our study, with a female:male ratio of 1:2. This is in contrast to observations in other studies. ^{4, 5}However, this higher ratio in males corresponds to observations in studies carried out in other countries. ^{6, 7, 8}The reason may be that males in this area are the main stress-bearers and the only earning hands in the family. When problems are encountered, it appears that people with a lower level of literacy find it harder to resolve them easily, and they give up during financial crises.

Homicide by the infliction of a burn injury is another important issue that has received little attention in the literature in the past. In the present study 15% were so affected, and this is probably an underestimate of the true figure due to reluctance - for legal reasons - to report the real reason for the injury. The majority of burn injuries reported here occurred at home, the kitchen being the commonest location. This finding is consistent with those of other recent studies.

In our study, the most commonly injured body regions were the trunk and the lower and upper limbs. An important factor was the presence of inhalational injury, noted in 23% of the patients - this was definitely a factor as regards mortality.

It is commonly thought that females are more affected in burn injuries. In contrast, our study showed that burns were more frequent in males than females. However, females were more severely burned than males: the average burn was 27.4% TBSA in males and 39.5% TBSA in females.

In our study, 35% of the patients were housewives and 14% were unemployed or dependent workers. A similar observation was made in other studies. ^{2, 4}The overall mortality in our study was 34%, a similar finding to other studies. ^{9, 10}This is in contrast to the very low mortality noted in some other studies, ^{4, 11}a contrast due to the obvious factor of the specialized care provided at burns centres.

TBSA burned also affected overall mortality. The female:male death ratio in this study was 1:1.1. The high mortality confirms the necessity of specialized burn units.

Conclusion

This study provides a comprehensive overview of hospitalized burn patients in Pakistan. Prevention is always the rule to be safe from burns but, once they occur, immediate and proper care should be given.