Abstract
Burns are a major health problem worldwide. Burn injury resulting from making contact with hot objects, direct or indirect contact with flame, and exposure to chemical agents or electric current is usually preventable. In this study, epidemiological data of the patients who had been hospitalised in the burn unit was assessed. The records of 1453 patients who were admitted to the burn unit of Diyarbakir Gazi Yaşargil Training and Research Hospital between July 2008 and April 2018 were retrospectively examined. Out of 1453 cases, 81.7% (1187) were children and 18.3% (266) were adults, 58.3% of the cases were male (847) and 41.7% (606) were females. Patients had a mean age of 11 ± 5 years (1‐81 years). The most common cause of burns was contact with hot liquids (82.86%) while other causes were flame burns (12.04%), electrical contact burn (3.02%) contact with chemical substances (2.06%). Most of the cases were found to have burned 10% to 20% of the body surface. Localization was most frequently seen in the lower extremity and less frequently in the upper limb, trunk, head and neck, and perineal regions. The majority of burn injuries are preventable. Therefore, epidemiological studies in the field of burns will provide vital preventive information to develop strategies to reduce injury frequency and spend on health. Because burns are a social problem, prevention efforts require social co‐operation. Promotional meetings in schools are important to increase family‐school cooperation to inform children of school age, to give lectures and first aid measures to rural areas.
Keywords: adult, burn, children, rural, urban
1. INTRODUCTION
Burns are an important public health problem affecting all age groups. Burn injury can occur due to contact with hot objects (scalds), direct or indirect contact with flame, chemical exposure, or contact with electric current. Burn injuries (80%‐90%) are observed in developing and low‐middle‐income countries with low awareness for preventing burns. 1 , 2 , 3 , 4 , 5 , 6 More than 300 000 people die from burn injuries each year. 1 Burns cause not only mortality but also psychological and emotional problems. 7 Although the mortality rate has been reduced thanks to the improvements in burn treatment, morbidity remains a major problem. 8 Epidemiological studies can be beneficial in understanding the reasons for burns, developing measures to prevent burns and in terms of management of patients with burns, quality of life, and patient costs. 9 Developing countries with high incidence of burn injuries, in particular, need preventive programs due to the serious economic burden it poses on the spend on health.
This study evaluated sociodemographic data of the inpatients in the burn unit in Diyarbakir, Turkey in order to determine the etiology of the burns and contribute to the development of preventive measures.
2. MATERIALS AND METHODS
Demographic and epidemiological data of 1453 in patients who were treated in our hospital's burn unit between July 2008 and April 2018 were retrospectively analysed. Outpatients, patients treated at another centre, or patients with chronic burns were excluded from the study. Age, gender, causes for the burn, burn localizations, degree of burn, total body surface area (TBSA) burned, date of application, place of residence of the patients, hospital follow‐up duration and results of the patient included in the study were recorded.
The causes of burns were classified as boiling (hot water, milk, tea, soup), flame, electricity, chemical burn. TBSA was calculated by the rule of nines. Burn localizations were classified as head–neck, trunk, upper and lower extremities, gluteal, and genital areas. The application dates of the patients were classified as autumn, winter, spring, and summer. The place of residence of the patients was evaluated in two groups: urban and rural.
3. RESULTS
Of the 1453 patients included in our study, 58.3% were male and 41.7% were female. 81.7% of the cases were children and 18.3% were adults. In our study, patient's ages ranged from 1 to 81 years. Mean age was 11 ± 5 years. 52.4% of the cases were encountered in the age group of 0 to 4 years.
The most common cause of burns in our study was contact with hot liquids (scald burns) (82.86%), followed by flame burns (12.04%), electrical burns (3.02%), and chemical burns (2.06%). In our study, burns were mostly in the lower limbs (35.9%), followed by upper limbs (27.9%), trunk (19.9%), head and neck (10.9%), gluteal and genital (5.1%) regions. In our study, 89% of the cases had second degree burns and 11% had third degree burns. TBSA rates of the cases were 0% to 5% (n = 402), 6% to 10% (n = 504), 11% to 19% (n = 337), 20% to 39% (n = 204) ve ≥40% (n = 6). Applications were made in summer (36.7%), spring (31.3%), autumn (20.7%), and winter (10.5%). Out of a total of 1453 cases, 79% lived in rural areas while 21% lived in the city (Table 1).
TABLE 1.
Demographic and clinical characteristics of patient
| Paediatric | Adult | Total | |
|---|---|---|---|
| Patient characteristics n (%) | 1187 (81.7) | 266 (18.3) | 1453 |
| Gender | |||
| Male | 695 (58.5) | 152 (57.1) | 847 (58.3) |
| Female | 492 (41.4) | 114 (42.8) | 606 (41.7) |
| Mean age | 5.4 | 44.7 | 11.4 |
| Cause of burn | |||
| Scald | 1021 (86.01) | 183 (68.79) | 1204 (82.86) |
| Flame | 119 (10.02) | 56 (21.05) | 175 (12.04) |
| Electrical | 32 (2.69) | 12 (4.51) | 44 (3.02) |
| Chemical | 15 (1.26) | 15 (5.63) | 30 (2.06) |
| TSBA % | |||
| 1 to 5 | 237 (20.05) | 165 (62.03) | 402 (27.6) |
| 6 to 10 | 261 (21.98) | 243 (91.35) | 504 (34.7) |
| 11 to 19 | 285(24.01) | 52 (19.54) | 337 (23.2) |
| 20 to 39 | 133 (11.20) | 71 (26.69) | 204 (14.1) |
| ≥40 | 4 (0.33) | 2 (0.75) | 6 (0.4) |
| Localization | |||
| Lower limbs | 421 (35.46) | 102 (38.34) | 523 (35.99) |
| Upper limbs | 332 (27.96) | 74 (27.81) | 406 (27.94) |
| Trunk | 247 (20.80) | 53 (19.92) | 290 (19.95) |
| Head and neck | 130 (10.95) | 29 (10.90) | 159 (10.94) |
| Gluteal | 57 (4.80) | 18 (6.76) | 75 (5.16) |
| Application | |||
| Summer | 441 (37.15)93(34.96) | 534 (36.7) | |
| Spring | 390 (32.85) | 65 (24.43) | 455 (31.3) |
| Autumun | 242 (20.38) | 59 (22.18) | 301 (20.7) |
| Winter | 104 (8.76) | 49 (18.42) | 153 (10.5) |
| Location | |||
| Rural | 913 (76.91) | 235 (88.34) | 1148 (79) |
| Urban | 274 (23.08) | 31 (11.65) | 305 (21) |
The length of stay in the hospital varied from 1 to 41 days, with average length of hospital stay being as follows:
TBSA 0% to 5%: 7.6 days.
TBSA 6% to 10%: 9.1 days.
TBSA 11% to 19%: 14.3 days.
TBSA 20% to 39%: 20.3 days.
TBSA ≥40%: 35.7 days (Table 2).
TABLE 2.
Average length of hospital stay of patients
| TBSA (%) | Mean hospitalisation time (d) |
|---|---|
| 0 to 5 | 7.6 (1‐20) |
| 6 to 10 | 9.1 (4‐40) |
| 11 to 19 | 14.3 (7‐40) |
| 20 to 39 | 20.3 (10‐45) |
| ≥40 | 35.7 (21‐63) |
4. DISCUSSION
Burns—although about 90% of the cases are preventable—are still one of the most common causes of injury. 10 In epidemiological studies conducted in burn centres, mean age of the patients with burns was reported to be 37.4 to 30.38 years. 11 , 12 It has been reported that severe burns are more common in the 18 to 40 age group. 9 In our study, 82% of the patients in the burn unit were children therefore the mean age was low (11 ± 5 years); mean age results of our study suggest that the burn injuries are more severe in adults and that they are followed in burn centres, not in burn units, since they require intensive care follow‐up. As in our study, burns have been reported to be more common in men. 13 , 14 It is believed that adult men are more exposed to burn injuries as they work in more dangerous jobs than women, and that male children are more adventurous and curious than females.
The causes of burns differ by age, gender, and sociocultural structure. In some studies, the most common cause of burns was electric shock, 15 while in others it was reported as flame burns 12 and in others such as our study, it was reported as a scald burns. 5 , 13 , 16 , 17 In studies where child burns were examined, burns were reported to be mostly due to scald and flame burns. As in our study, it was stated that scald burns are more common in children younger than 5 years old. 1 , 3 , 17 , 18 It has been reported that the incidence of burns in children younger than 5 years increase due to the fact that young children are not aware of the dangers, are curious and are very active, and are in more contact with the stove, fireplace, hot kitchen appliances, and hot liquids. 4 , 16 , 19 , 20 It has been stated that the families' awareness on the causes and prevention of burns as well as increasing the in‐house safety measures have an important role in reducing scald burns. 2 In a study conducted in Iran, it was reported that scald burns are the most common in children younger than 10 years, whereas flame burns are more common in adolescents. 11 The results of our study suggest that the number of child burns will decrease by keeping hot foods and beverages out of the reach of children. Since hot liquids are poured downward, scald burns have been reported to involve the upper and lower extremities, as in our study. 3 , 7 In our study, the most common burn area was extremities, followed by trunk. This may be due to the fact that the majority of cases are children who have a larger body surface area than adults. Forbinake et al stated in their study that the upper limbs contacted with the hot objects more due to the protection reflex; therefore, the most burnt body parts were the upper limbs. 15 As in our study, flame burns were reported as the second most common cause of burns in children and adults. 3 , 21 , 22 It has been reported that flame burns are most commonly seen in the head and neck region as the flame moves upward. 7 Men usually experience flame burns in the workplace, women in the kitchen while cooking, and children who are left alone in the kitchen while cooking in the house. As in our study, it was stated that electrical burns are relatively less common though cause more severe burns. 23 Adult electric burns usually result from accidents in the workplace and to a lesser extent at home. 3 , 24 In our study, electrical burns mostly occurred in the workplace, but pediatrical electrical burns were also detected within the home setting as a result of contact with the household electrical outlets. Explosions and chemical burns have been reported to occur mostly in the workplace and experienced by men in the head and neck area. 7 In our study, chemical burns were seen in the facial area as a result of antifreeze or air conditioner blasts in young people, while in advanced age, it was more commonly encountered in the lower limbs due to the unconscious use of herbs as an alternative treatment for advanced rheumatic diseases.
Although burn injury is seen every season, Li et al has reported the most frequent encounter in summer, as in our study. 3 More burn injury cases have been reported in summer resulting from people wearing thinner clothes, exposing the neck, upper, and lower limbs more to flammable materials. 23 The results of our study suggest that 79% of the cases with burns live in rural areas, with children, whose parents work in the land, being alone at home thus increasing the burn incidence. The study by Li et al held air conditioners and electrical appliances responsible for the burns encountered in autumn due to their increased use in this season. 10 Similarly, in our study, more burn cases were observed in autumn due to air conditioner or antifreeze blasts.
The length of hospital stay for burns varies depending on the extent of TBSA. Hwee et al reported the average length of hospital stay in their study as follows:
TBSA <10%:8.9 days.
TBSA 10% to 20%:12.9 days.
TBSA 20% to 30%:25.1 days.
TBSA 30% to 40%:30.2 days.
TBSA 41%:39.4 days. 25
In another study, the average length of hospital stay for burn incidents was reported as 12 days. 1 The results of our study were in accordance with those of Hwee et al, demonstrating that the average length of hospital stay increased as the extent of TBSA increased.
Reflecting the epidemiology of burns in a single centre in one of the largest province in the southeast of Turkey was the limitation of our study. Outpatients were excluded from the study. Multicentre studies are needed to examine the epidemiological data of burn injuries.
5. CONCLUSION
The most common burn injury is scald burns. The majority of burns can be prevented by keeping hot liquids or objects out of the reach of children in locked containers that cannot be opened by them. Adult burns generally result from the incidents in the workplace. Burns incidences can be reduced by taking occupational safety measures, providing occupational safety training, and using protective equipment. Instructing elderly patients not to apply alternative treatment without consulting to a physician will decrease burns incidences. Movies or advertisements informing of the protective measures through television and the internet can play an effective role in reducing burns incidences. Promotional meetings in schools are important to increase family‐school cooperation to inform children of school‐age, to give lectures and first aid measures to rural areas.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
Bahçe ZŞ, Öztaş T. Epidemiological analysis of patients with burns in third‐line hospitals in Turkey. Int Wound J. 2020;17:1439–1443. 10.1111/iwj.13426
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