Abstract
Introduction
Kitchen-related burn injuries are common and preventable. To limit the spread of COVID-19, public health orders encouraged the public to stay at home which may have led to an increase in kitchen-related burn injuries.
Objective
To assess adult kitchen-related burns treated in an outpatient setting in general, and especially looking at the impact of the COVID-19 pandemic on the incidence and epidemiology of these burns.
Methods
For this retrospective, population-based study, data were obtained for adult patients who suffered burn injuries resulting in a visit to a Canadian tertiary Burn Clinic between April 2016 and March 2021 specifically looking at demographics, burn etiology, severity and anatomical location and the need for surgery. Separately, we compared the patients before and after the beginning of the COVID-19 pandemic (April 1, 2020).
Results
A total of 1380 burn patients were identified. Of these, 38 % (N = 521) sustained a kitchen-related burn. The median patient age was 40 years (range 18–95) and 282 (54.1 %) were female. The most common etiology and location were scald (76.8 %) and anterior arm (28.5 %), respectively. Thirty-two (6.1 %) patients required admission to the Burn Unit and 26 of these had surgeries. Additionally, 72 (13.8 %) patients had surgery as an outpatient. During the COVID-19 pandemic, East Asian patients saw a significant increase in kitchen burns (p < 0.01).
Conclusion
Over 1/3 of burns at the outpatient burn clinic were kitchen-related. About 94 % of these were treated as outpatient only. The incidence of kitchen-related burns did not change during the COVID-19 pandemic, but we found significant differences in ethnic distribution. These results provide a unique opportunity to focus on communication and education and set up preventative measures.
Keywords: Kitchen burn, Cooking burn, Coronavirus, COVID-19, Pandemic
1. Introduction
Burns are devastating injuries that can cause significant morbidity and mortality, as well as a substantial burden on the health care system in Canada [1], [2], [3]. Each year, 46,000 burn injuries are recorded in Canada, costing the healthcare system $366 million annually [3]. The majority of burn injuries are both predictable and preventable [4]. However, to ensure that appropriate prevention programs are set up, it is important to study the etiology and circumstances of these burn injuries.
Data are scant on kitchen-related burn injuries in developed and Western populations. The epidemiology and outcomes of kitchen burns in a given geographical area are important to evaluate the severity and current management of the problem. The 2017 report from the American Burn Association’s National Burn Repository (NBR) included only 4 Canadian burn centres, which is a relatively small sample size in comparison to the 101 United States burn centres [5], [6]. The NBR report did not include kitchen burns as a separate etiology, yet reported that flame burns and scalds collectively comprised 78 % of all reported burns. Amongst these, it was found that the majority of events were accidental and took place at home [5], implying that kitchen-related burn injuries might form a major preventable health care burden.
In light of the COVID-19 pandemic, British Columbia health officials declared a public health emergency, resulting in various restrictions and recommendations to maintain physical distancing with anyone who is not a part of their household [7], [8]. With gradually tightening restrictions, academic institutions, restaurants and workplaces encouraged students and employees to work from home. All of this led to greater time being spent at home [9], which may increase the likelihood of cooking at home instead of eating out and hence cooking-related burn injuries.
While many publications on the epidemiology and risk factors for burn injuries are available [1], [10], [11], [12], [13], literature on kitchen-related burn injuries in Canada remains scarce. It is important to evaluate epidemiology and trends for kitchen-related burn injuries so that a specialized focus on communication and education can occur for at-risk populations.
The objective of this study was to assess adult kitchen-related burn injuries in the Vancouver Coastal Health (VCH) region from 2016 to 2021, with a special emphasis on looking at the impact of the COVID-19 pandemic on the incidence and epidemiology of these burns. Our hypothesis was that adult kitchen-related burn injuries would comprise a quarter of all burn injuries presented at the outpatient burn clinic. We also hypothesized that the incidence of kitchen injuries would increase significantly during the pandemic.
2. Methods
2.1. Study area and setting
The VCH region is the largest publicly funded regional health authority care system within the province of British Columbia (BC), Canada [14]. VCH serves ethnically and socioeconomically diverse subpopulations, consisting of more than 1 million residents [15]. Within the VCH, the Vancouver General Hospital (VGH) is the only adult Level 1 Burn and Trauma Center [14]. The Intensive Care Unit (ICU), Burns, Trauma, and High Acuity Unit (BTHAU), and Burn Clinic are fully equipped to provide acute and reconstructive care for adult patients with severe burns and wounds. The VGH Burn Clinic provides provincial burn wound consultations and management, scar management and follow-up care to adults with burn injuries. Patient management involves a multidisciplinary team of plastic surgeons, nurses, occupational therapists and physiotherapists [16].
2.2. Patient data
This retrospective, population-based study was approved by the University of British Columbia Clinical Research Ethics Board (REB#: H21–00598). Data were derived entirely from the VGH Burn Clinic database to identify all adult patients (age ≥ 18 years) treated as outpatients for kitchen-related burn injuries (classified using the International Statistical Classification of Diseases [ICD] code T20–32, 10th revision) between April 2016 and March 2021. Exclusion criteria included any patients under 18 years of age at the time of injury, patients who first required admission to the hospital for burn management, and patients not satisfying a threshold for reliable ethnicity identification. Separately, we compared the patients before and during the COVID-19 pandemic (April 2020 – March 2021). Data from this period was compared to the pre-COVID-19 period consisting of the past 4 years.
Key supporting variables in the analysis included patient demographics, burn etiology, severity, Baux Score, and anatomical location. None of our patients had inhalation injuries as they were all outpatients and hence revised Baux Score was not used. Circumstances of injury, the necessity for surgery or admission, and the number of required visits to the Burn Clinic were also assessed. Ethnicity was derived from patient charts and categorized as Caucasian, South Asian, East Asian, Middle Eastern, Latino/Hispanic and Black. Ethnicity was defined based on multiple details including self-identification on chart records, surname analysis, and the photographic record in chart reviews.”
All data were collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools [17], [18].
2.3. Statistical analysis
Kolmogorov-Smirnov test demonstrated that our continuous variables were non-Gaussian. Continuous variables were reported as medians and ranges and examined using a Mann–Whitney U tests, and categorical variables were examined using Pearson’s chi-square tests. Odds ratios were applied as appropriate to compare patient demographics with burn incidence. Two-sided p-values were used for hypothesis testing, and statistical significance was set at p < 0.05. All statistical analyses were performed using the SPSS software package version 27.0 (SPSS Inc., Chicago, IL).
3. Results
3.1. Trends and patient characteristics
Between April 2016 and March 2021, a total of 1380 patients presented to the VGH Burn Clinic and of these, 38 % (N = 521) of patients presented with kitchen-related burn injuries ( Table 1). The median age was 40 years (range 18–95), consisting of 239 males (45.9 %) and 282 females (54.1 %). The median TBSA was 1.0 % and the median Baux score was 42.5. The largest age group was patients 45–64 years old (Fig. 2). We found no significant difference in age groups during the studied period. Five patients fit our exclusion criteria for ethnicity not satisfying a threshold for reliable identification. Patient ethnicity did not reflect provincial demographics19 and showed a majority of kitchen burn patients identified as Caucasian (50.7 %), East Asian (22.8 %), South Asian (12.1 %), Latino/Hispanic (7.7 %), Middle Eastern (5.4 %), Black (1.2 %). Meanwhile, provincial demographics consist of Caucasian (68.0 %), East Asian (15.3 %), South Asian (6.5 %), Latino/Hispanic (1.2 %), Middle Eastern (1.8 %), Black (1.1 %) and other (6.1 %). When ethnicity was segmented by gender, no significant difference was found between patient demographics and provincial demographics (Table 3).19 The majority had burn injuries to their upper extremities (52.0 %) and lower extremities (30.2 %). Scald injuries were most common (76.8 %), followed by contact injuries (13.4 %), flame injuries (9.0 %), chemical injuries (0.6 %) and electrical injuries (0.2 %). These injuries most commonly took place at home (83.7 %) and rarely required admission (6.1 %) or surgery (15.2 %). The majority of kitchen-related burn injuries were treated as outpatient entirely (93.8 %) The median number of visits required to the Burn Clinic before discharge was 2 (range, 1–35).
Table 1.
Characteristics of kitchen-related burn injuries, 2016–2021.
| All burn patients (n = 521) | ||
|---|---|---|
| Mean age (years) | 43.2 | |
| Mean number of visits | 3.2 | |
| TBSA | 2.3 | |
| Baux Score | 45.4 | |
| Sex | ||
| Female | 282 | 54.1 % |
| Male | 239 | 45.9 % |
| Ethnicity | ||
| White | 264 | 50.7 % |
| East Asian | 119 | 22.8 % |
| South Asian | 63 | 12.1 % |
| Latino/Hispanic | 40 | 7.7 % |
| Middle Eastern | 28 | 5.4 % |
| Black | 6 | 1.2 % |
| Body Part Burned | ||
| Anterior Arm | 263 | 28.5 % |
| Posterior Arm | 217 | 23.5 % |
| Anterior Leg | 167 | 18.1 % |
| Posterior Leg | 112 | 12.1 % |
| Face/Scalp | 63 | 6.8 % |
| Abdomen | 44 | 4.8 % |
| Anterior Chest | 35 | 3.8 % |
| Back | 11 | 1.2 % |
| Buttocks | 9 | 1.0 % |
| Back of head | 2 | 0.2 % |
| Burn Type | ||
| Scald | 418 | 76.8 % |
| Contact | 73 | 13.4 % |
| Flame | 49 | 9.0 % |
| Chemical | 3 | 0.6 % |
| Electrical | 1 | 0.2 % |
| Circumstance of Injury | ||
| Home | 436 | 83.7 % |
| Work | 85 | 16.3 % |
| Need For Admission | ||
| Yes | 32 | 6.1 % |
| No | 489 | 93.9 % |
| Need For Surgery | ||
| Yes | 79 | 15.2 % |
| No | 442 | 84.8 % |
Fig. 2.
Impact of COVID-19 on Ethnic Distribution of Kitchen-Related Burn Injuries.
Table 3.
Comparing ethnicity and gender demographics of total kitchen-related burn and British Columbia (BC) population19.
| Ethnicity by Gender | Total | BC Population | p-value | ||
|---|---|---|---|---|---|
| White | 0.265 | ||||
| Male | 121 | 23.3 % | 1881,215 | 35.8 % | |
| Female | 142 | 27.4 % | 1923,570 | 36.6 % | |
| South Asian | 0.244 | ||||
| Male | 27 | 5.2 % | 182,650 | 3.5 % | |
| Female | 36 | 6.9 % | 181,235 | 3.4 % | |
| Middle Eastern | 0.870 | ||||
| Male | 14 | 2.7% | 51,315 | 1.0 % | |
| Female | 14 | 2.7 % | 48,245 | 0.9 % | |
| East Asian | 0.817 | ||||
| Male | 56 | 10.8 % | 393,475 | 7.5 % | |
| Female | 63 | 12.1 % | 461,875 | 8.8 % | |
| Latino/Hispanic | 0.484 | ||||
| Male | 17 | 3.3 % | 33,580 | 0.6 % | |
| Female | 23 | 4.4 % | 36,335 | 0.7 % | |
| Black | 0.092 | ||||
| Male | 1 | 0.2 % | 30,635 | 0.6 % | |
| Female | 5 | 1.0 % | 29,345 | 0.6 % | |
3.2. Impact of COVID-19 pandemic
During the COVID-19 pandemic, a total of 265 presented to the VGH Burn clinic and of these, 45.3 % (N = 120) presented with kitchen-related burn injuries ( Table 2). However, the increase from 36.0 % to 45.3 % (9.3 % increase) did not reach statistical significance (p = 0.06). On the other hand, we found an increase in the frequency of burn injuries at home from 81.3 % to 91.7 % (p = 0.007). We found no significant difference seen during the two periods in regard to patient age, sex, and the median number of visits (p > 0.05).
Table 2.
Comparing characteristics of kitchen-related burn injuries between COVID-19 period and the four years prior to the pandemic.
| Variable | Pre-Pandemic Years | COVID-19 Period | p-value | ||
|---|---|---|---|---|---|
| Total Patients with burns | 1115 | 265 | |||
| Patients with kitchen-related burns | 401 | 36.0 % | 120 | 45.3 % | 0.06 |
| Median age, years | 40 | 442 | 0.67 | ||
| Median number of visits | 2 | 2 | 0.20 | ||
| TBSA, % | 1 | 1 | 0.76 | ||
| Baux Score | 41.5 | 43.5 | 0.96 | ||
| Sex | 0.53 | ||||
| Female | 221 | 55.1 % | 61 | 50.8 % | |
| Male | 180 | 44.9 % | 59 | 49.2 % | |
| Ethnicity | 0.02 | ||||
| White | 218 | 54.4 % | 46 | 38.7 % | |
| East Asian | 80 | 20.0 % | 39 | 32.8 % | |
| South Asian | 50 | 12.5 % | 13 | 10.9 % | |
| Latino/Hispanic | 27 | 6.7 % | 13 | 10.9 % | |
| Other | 26 | 6.5 % | 8 | 6.7 % | |
| Body Part Burned | 0.01 | ||||
| Anterior Arm | 202 | 27.9 % | 61 | 30.5 % | |
| Anterior Leg | 111 | 15.4 % | 56 | 28.0 % | |
| Posterior Arm | 181 | 25.0 % | 36 | 18.0 % | |
| Posterior Leg | 96 | 13.3 % | 16 | 8.0 % | |
| Face/Scalp | 51 | 7.1 % | 12 | 6.0 % | |
| Abdomen | 35 | 4.8 % | 9 | 4.5 % | |
| Chest | 28 | 3.9 % | 7 | 3.5 % | |
| Other | 19 | 2.6 % | 3 | 1.5 % | |
| Burn Type | 0.33 | ||||
| Scald | 318 | 75.5 % | 100 | 81.3 % | |
| Contact | 56 | 13.3 % | 17 | 13.8 % | |
| Other | 47 | 11.1 % | 6 | 4.9 % | |
| Circumstance of Injury | 0.01 | ||||
| Home | 326 | 81.3 % | 110 | 91.7 % | |
| Work | 75 | 18.7% | 10 | 8.3 % | |
| Need for Admission | 0.06 | ||||
| Yes | 29 | 7.2 % | 3 | 2.5 % | |
| No | 372 | 92.8 % | 117 | 97.5 % | |
| Need for Surgery | 0.35 | ||||
| Yes | 64 | 16.0 % | 15 | 12.5 % | |
| No | 337 | 84.0 % | 105 | 87.5 % | |
The distribution of patients according to ethnic groups differed significantly between the pre-pandemic and COVID-19 pandemic (p = 0.02) ( Fig. 1). We found a decrease in incidence among Caucasians from 54 % to 39 %, and an increase in incidence from 20 % to 33 % and 7–11 % among East Asian and Latino/Hispanics, respectively.
Fig. 1.
Patients with Kitchen-Related Burn Injuries by Age and Sex, 2016–2021.
Kitchen burn injuries by sex showed a ratio of practically 1:1 male to female (1.2:1 and 1.03:1), a finding that was stable over the studied period. Subgroup analysis by sex and ethnicity demonstrated that Caucasian males were 2 times more likely than females to get kitchen burns (OR=2.11) (p < 0.05) during the pandemic. On the contrary, East Asian females were 2 times more likely than males to get kitchen burns during the pandemic (OR=2.04) (p < 0.05). Other ethnicities did not have any significant male-to-female odds ratios (p > 0.05).
The median TBSA burned was not significantly different before and during the pandemic (1 % vs 1 %, p = 0.76). Additionally, the fraction of patients requiring admission to the hospital before and during the pandemic (7.2 % and 2.5 %) or surgery (16 % and 12.5 %), respectively did not significantly differ during the pandemic either (p > 0.05). Burn etiology of scald injuries was the most common before and during the pandemic (75.5 % vs 81.3 %, p = 0.33).
4. Discussion
This study provides insights into the incidence and epidemiology of kitchen-related burn injuries in the VCH region over the last five years, while also evaluating the impact of the COVID-19 pandemic on kitchen-related burns. The analyses revealed several major findings. Specifically, over 1/3 of burns at the outpatient burn clinic were kitchen-related with the number being as high as 45.3 % during the pandemic, and the vast majority of these were treated as outpatient only. The incidence of kitchen-related burn injuries has been steadily increasing over the past five years however, there was no statistically significant change during the COVID-19 pandemic (p = 0.06). We found significant differences in the burn injury population when segmented by ethnicity and sex.
Our study supports that VCH has seen a steady increase in the incidence of kitchen-related burn injuries over the past five years. However, no statistically significant change was found between the average of pre-pandemic years and the COVID-19 period (p = 0.06). The median age of patients experiencing kitchen burns was similar to those experiencing burn trauma and requiring in-patient treatment at VGH [19]. Even though the incidence of kitchen-related burn injuries during the COVID-19 pandemic increased from 36 % to 45.3 %, this did not reach statistical significance most likely due to the overall small number of patients. This finding may suggest that although the pandemic was a sensitive time that presumably deterred many from going to the hospital out of fear of COVID-19 exposure, most patients continued to seek medical care. However, as expected, more kitchen-related burn injuries were sustained during the pandemic at home than at work. This is in keeping with prior studies as the kitchen is a common location for burn injuries at home [20].
Overall, 84 % of kitchen-related burn injuries took place at home, with the rest occurring at work. It is important to note that work kitchens pose different risk factors than home kitchen environments. We found no statistically significant difference between the two groups regarding patient demographics, burn etiology, severity, and anatomical location.
While various studies have reported the reduction of burn injuries during COVID-19 lockdown periods [21], [22], [23], kitchen burn epidemiologic studies in the context of COVID-19, are scarce. In general, there has been an increase in scald and contact burns to the upper extremities sustained at home [24]; the results of our study support this finding. Kruchevsky et al. described increased levels of burn injuries sustained by female patients during the lockdown period [23]. Our findings do not reflect this, which may be explained by various reasons. Notably, the differences in a country’s socioeconomic status are known to affect the epidemiology of burn injuries [25]. Another reason could be that developing countries generally have poor kitchen safety measures and a decreased focus on kitchen safety, compared to developed and Western countries [26].
Kitchen-related burn injuries presented with considerable diversity and were not consistent with provincial statistics [27]. Almost 50 % of kitchen burns treated at the outpatient Burn Clinic, were sustained by patients from an ethnicity other than Caucasian. Despite this, provincial statistics only identify about one-quarter of the province’s population as a visible minority [27]. This may provide a unique opportunity to focus on communication and education for targeted ethnic populations.
The incidence of kitchen burns had strong ethnic differences appear during the pandemic. In particular, two ethnic groups emerged in the analysis: Caucasian and East Asian. Though other ethnicities did have differences in demographics, burn severity and circumstance of injury, between the two periods, it was not statistically significant. This may be due to the relatively small sample size, resulting in decreased statistical power.
During the five-year study period, Caucasians were the largest ethnic group, followed by East Asian patients, who encompass roughly 1/5 of kitchen burns. During the pandemic, they saw the largest increase in burn injuries and were the only ethnic group in which females were two times more likely to sustain kitchen burns than males. In contrast, Caucasians were the only ethnic group during the pandemic where males were two times more likely to sustain kitchen burns than females. Other ethnic groups had no significant gender disparity in injury incidence. Prior studies have shown that males are almost twice as more likely to sustain general burn trauma as their female counterparts [20]. This likely stems from a combination of environmental, psychosocial, and socioeconomic factors [28]. This trend was only observed in Caucasian groups and was not observed for non-Caucasian ethnic groups. Possible reasons for this may be that kitchen-related burn injuries are unique burn injuries and may not follow the general trend for burn trauma. This may also be partly explained by the pandemic restrictions, which may have promoted more cooking activity at home. Prior studies have shown that traditional housework roles still prevail and females are more frequently engaged in cooking [29], [30].
Caucasians also saw the largest decline in kitchen burns during the pandemic, followed by South Asians. Possible reasons for this may be due to greater caution practiced when in the kitchen, or relatively minor burn injuries requiring no significant medical attention. Another possibility may be that these groups were presumably deterred from going to seek healthcare out of fear of COVID-19 exposure.
Kitchen-related burn advocacy is necessary to prevent burns, increase awareness and ensure a safe environment. In addition to current advocacy campaigns such as National Burn Awareness Week and National Scald Prevention Campaign, more specialized initiatives may be necessary to encourage patient education and participation. This may include educational programs targeting populations via language-specific literature and communication strategies, those in low socioeconomic regions, or rural locations. These efforts may benefit from taking various forms in the delivery of their messages and leveraging ethnic radio stations, TV channels, social media, or organizing tabling sessions outside local ethnic grocery stores. Efforts should also be made to better understand how these high-risk population groups commonly consume information and tailor prevention campaigns by these means. Given that East Asian females were two times more likely than males to get kitchen burns during the pandemic, an increased focus on female patients is required.
Although cooking burns can affect anyone, prevention campaigns may benefit from providing groups with cultural and age-tailored tips. For example, loose, billowing clothing such as a Japanese Kimono or East Indian saree can easily catch fire and should be worn with extra caution when in the kitchen. Although no significant difference in incidence was seen among different age groups, it is suspected that the etiology of these burns may differ among age groups. Age-tailored education and prevention campaigns may allow for a unique focus. For example, in educating young adults from refraining to participate in dangerous, popular TikTok trends [31], may require a different approach than elderly patients who may be more prone to burn injuries due to impaired vision, lower mobility and age-related deterioration in judgement [32].
Future studies may wish to identify and quantify other factors, like social and economic status, which may be influencing the incidence and reporting of kitchen burns in certain patient populations. We have several limitations to this study. First, our study looks at kitchen-related burn injuries treated at an outpatient clinic and thus, may not capture kitchen-related burn injuries requiring inpatient treatment, excessive resuscitation or those leading to death before healthcare intervention. Second, patients with relatively minor burn injuries who did not seek medical attention likely were not captured in our data. Third, we recognize that race is a social construct without a biological basis, and while a patient’s skin colour may dictate their lived experiences, it should not be confounded with ethnicity. Patients not satisfying a threshold for reliable identification were omitted from the study. This may have resulted in a selection bias for certain patient ethnicities.
5. Conclusion
Given that over one-third of burns at the outpatient burn clinic were kitchen-related, burn advocacy is needed. The incidence of kitchen-related burn injuries did not change during the COVID-19 pandemic, but significant differences were found in the burn injury population when segmented by ethnicity. This study’s findings offer important insight into kitchen-related burn injury patterns and recommendations regarding opportunities for prevention. These results provide a unique opportunity to focus on communication and education and set up preventative measures for future lockdowns.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Conflict of interest statement
The authors declare no potential conflict of interest.
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