Burns in Israel: Etiologic, Demographic, and Clinical trends—A 9-Year Updated Comprehensive Study, 2004–2010 versus 2011–2019

Abstract

Based on the Israeli National Trauma Registry (INTR) data, this study reports etiological, demographic, and clinical trends and includes all admissions to burn and trauma centers across Israel from 2011 to 2019 and compares these with 2004 to 2010 rates. From 2011 to 2019, 5,710 patients were admitted to burn centers across Israel. Children aged 0 to 1 years (25.9%), non-Jews (40.7%), and males (67.2%) remain the main groups of the burn casualties. Most of the casualties sustained 1 to 9% total body surface area (TBSA) burns with various depths. Scalds were less fatal than fire/flame-related casualties (<1 vs. 11.5%). Fewer surgical procedures were conducted for burns under 9% TBSA compared with greater TBSA. The percentage of TBSA and burn depth were found to be the most significant predictor of mortality among all age groups (>200 times increased risk with full-thickness burns >30% TBSA burn) and correlated with prolonged length of stay (>7 days).

Burn injuries are a major global health crisis and serve as the fourth leading cause of trauma worldwide with the majority impacting lower socioeconomic populations. ^{1 2} According to the World Health Organization (WHO), it is estimated that each year, approximately 11 million people afflicted with burn injuries seek medical care. ³ Burn injuries can cause severe physical and psychological morbidity requiring extensive rehabilitation. ^{4 5} Consequently, burns impose a significant economic health care burden due to required operative and/or medical management, extended hospital stays, multiple rehospitalizations, and admission to intensive care units (ICUs). ^{6 7 8}

According to the Israeli National Trauma Registry (INTR), burns account for approximately 3% of all hospitalized trauma cases in Israel. There are five specialized burn centers in Israel, all of which are situated in one of the six level-I trauma centers (TCs) located strategically across the country, within an area of approximately 20,770 km ² . ⁹ Burn patients, particularly those with severe burn injuries, are typically referred to one of these centers for optimal management. ¹⁰ Israel utilizes approximately 0.387 burn beds per population of 100,000 similar to the 0.361 burn beds per 100,000 in the United States.

According to the current American Burn Association recommendations, annual hospitalization rates of burn patients in Israel are high enough to warrant the establishment of additional burn centers. ¹¹ The availability, number of beds, and burn management guidelines also vary substantially across burn facilities in Israel. Given Israel's complicated geopolitical climate, the Israeli health care system must also be prepared to cope with mass casualty events. All of these arguments serve to justify the need to establish additional burn centers within the country. ^{9 12}

Earlier publications reported burn injuries in Israel for the years 1997 to 2003 and 2004 to 2010. ^{10 11} Focusing on etiologic, demographic, and clinical data, the current study provides an updated analysis for the years 2011 to 2019 and compares results to the 2004 to 2010 period. Identifying populations who are at the highest risk for hospitalization may help with the development of suitable strategies to address hazards for specific burn injuries for primary prevention. Accidental burns, accounting for a considerable portion of all burns, may be reduced with the implementation of effective preventative strategies that target at risk groups. ¹³

Methods

A retrospective cohort study was performed utilizing data from the INTR for hospitalized patients between January 1, 2011, and December 31, 2019. This study received approval from the Sheba Medical Center Institutional Review Board (IRB; SMC 5138–18). The comprehensive data provided by INTR included hospitalized trauma patients from all 6 level-I TCs and 15 level-II TCs in Israel. The INTR includes all hospitalized trauma patients with an International Classification of Disease-Ninth Revision-Clinical Modification (ICD-9-CM) diagnosis code 800–989.9 who were admitted to the Emergency Department (ED) and hospitalized, died in the ED, or were transferred to or from another hospital. The registry does not include casualties who died at the scene, on the way to the hospital, or following admission 72 hours or more after the event. Under the guidance of a trauma director, trained trauma registrars recorded the data from each TC. Before data analysis, electronic files were transferred to the INTR where data quality checks were conducted.

Burn injury patients who were admitted to the hospital with a diagnostic injury code (ICD-9-CM) between 940 and 949 and an Abbreviated Injury Score code that started with 912.XXX were included in this study. Patients hospitalized in one of the following five burn centers in Israel were included: Sheba Medical Center (Ramat Gan), Rambam Medical Center (Haifa), Hadassah Medical Center (Jerusalem), Rabin Medical Center (Petah Tikva), and Soroka Medical Center (Beer Sheba). These centers are geographically dispersed throughout the country and thus are considered representative of all population groups within Israel.

Study Variables

Patient demographic characteristics, nature of the injury, management, and posttreatment outcomes were obtained from the registry for further analysis. The demographic variables included age, gender, and ethnicity. Injury characteristics included burn etiology, burn depth (first and second/third degree), and percentage of total body surface area (%TBSA). Depth and %TBSA were categorized as follows: (1) all first degree (in which %TBSA is irrelevant) and second/third degree with 1 to 9% TBSA, (2) second/third degree with 10 to 19% TBSA, (3) second/third degree with 20 to 29% TBSA, and (4) second/third degree with 30 + % TBSA. Hospital resource utilization variables included length of hospital stay (LOS), admission to ICU, and operative intervention. Outcomes included mortality and discharge to home or rehabilitation.

Statistical Analysis

Descriptive data were analyzed using the Chi-squared ( χ ² ) test. Wilcoxon's nonparametric test was performed for variables with abnormal distribution. Logistic regression model was performed to predict the risk of mortality. Nominal two-sided p -values of ≤0.05 was considered statistically significant. Data were then compared with the previously published data for the years 2004 to 2010. ⁹ Statistical analyses were performed using SAS software, version 9.4 (SAS Institute, Cary, NC).

Results

During the current study period (2011–2019), 5,710 burn patients were hospitalized in one of Israel's five burn centers compared with 5,269 patients during the previously period (2004–2010). ⁹

Demographic Characteristics

The majority of hospitalized burns patients were male in both the previous and current study at 67.3 and 67.2%, respectively. Additionally, age distribution for all of burns patients were comparable across both study periods, with infants (aged 0–1 years), constituting the highest proportion of injuries and comprising 24.1 and 25.9% of the burn patients from the previous and current periods, respectively. Older persons, aged more than 65 years, were least represented among the burn injuries and similarly comprised only 4.1% from the 2004 to 2010 cohort and 5.5% from the 2011 to 2019 cohort. In Israel, the majority of the population is Jewish (74.3% in 2018). ¹⁴ However, disproportionate to their ratio in the population (25.7%), the non-Jewish population comprised 40.7% of the burns patients ( Table 1 ).

Table 1. Demographic, injury and hospital resource characteristics, comparison between periods 2004–2010 and 2011–2019.

	Previous period (2004–2010)	Recent period (2011–2019)	p -Value
	n (%)	n (%)
Total	5,269 (100.0)	5,710 (100.0)
Gender
Males	3,543 (67.3)	3,836 (67.2)	NS
Females	1,725 (32.7)	1,874 (32.8)
Ethnicity			<0.0001
Jews	3,156 (59.9)	3,294 (57.7)
Non-Jews	2,084 (39.6)	2,324 (40.7)
Unknown	29 (0.6)	92 (1.6)
Age (y)			0.0004
0–1	1,270 (24.1)	1,480 (25.9)
2–4	751 (14.3)	741 (13.0)
5–9	416 (7.9)	401 (7.0)
10–14	260 (4.9)	284 (5.0)
15–24	806 (15.3)	804 (14.1)
25–64	1544 (29.3)	1689 (29.6)
65+	218 (4.1)	311 (5.4)
311 (5.4)	4 (0.1)	0 (0.0)
Etiology
Scalds	2,620 (49.7)	3,068 (53.7)	<0.0001
Fire/flame	1,312 (24.9)	1,238 (21.7)	<0.0001
Chemical	414 (7.9)	398 (7.0)	NS
Explosion	239 (4.5)	258 (4.5)	NS
Hot object	333 (6.3)	338 (5.9)	NS
Electrical	118 (2.2)	111 (1.9)	NS
Unknown	233 (4.5)	299 (5.2)	NS
Setting
Home	3,016 (57.2)	3,798 (66.5)	<0.0001
Other a	2,253 (42.8)	1,912 (33.5)
Occupational injury	694 (13.2)	720 (12.6)	NS
Burn degree and %TBSA
Second/third degree 1–9%  + first degree	3,664 (69.5)	3,603 (63.1)	<0.0001
Second/third degree 10–19%	850 (16.1)	1,305 (22.9)	<0.0001
Second/third degree 20–29%	237 (4.5)	331 (5.8)	0.003
Second/third degree 30 + %	430 (8.2)	425 (7.4)	NS
Unknown	88 (1.7)	46 (0.8)
Inhalation injury	140 (2.7)	81 (1.4)	<0.0001
Additional injury	548 (10.4)	564 (9.9)	NS
LOS
1–7 days	2,955 (56.3)	3,013 (52.8)	0.0002
8+ days	2,293 (43.7)	2,695 (47.2)
ICU	653 (12.4)	960 (16.8)	<0.0001
Underwent surgery	1,043 (19.8)	911 (16.0)	<0.0001
In-hospital mortality	196 (3.7)	196 (3.4)	NS

Abbreviations: ICU, intensive care unit; LOS, length of hospital stay; NS, not significant; TBSA, total body surface area.

^aOther includes industrial location, street/road, public building, residential institution, playground/outdoors, army base, school, and other.

Scalds and fire/flame are the primary causes of childhood burns. Among Jewish infants (aged 0–1 years), scalds cause 89.0% of burn hospitalizations and decrease to 61.5% among children aged 10 to 14 years. While scalds contribute to 81.4% of burns among non-Jewish infants (aged 0–1 years), they were the cause of only 38.2% of burns among older children (aged 10–14 years; Fig. 1 ). Among non-Jewish infants aged 0 to 1 years, 9.0% of burns were caused by fire/flame, compared with 1.8% among Jewish infants ( p  < 0.0001). Similarly, in comparison to Jewish toddlers (aged 2–4 years) and children (aged 5–9 and 10–14 ), the proportion of fire/flame-related burns was more significant for non-Jewish toddlers (14.3 and 8.8%; p  = 0.02) and children aged 5 to 9 (26.3 and 11.4%; p  = 0.0002) and aged 10 to 14 years (38.2 and 18.9%; p  = 0.0004; Fig. 1 ).

Fig. 1.

Distribution of burn hospitalizations by etiology, age, and ethnicity.

Etiology and Injury Characteristics

The most common etiology for burn injuries was attributed to scalds which constituted over half of all burn-related hospitalizations (55.1 and 51.9% of the Jewish and non-Jewish population, respectively) followed by fire/flame which accounted for 21.7% of all cases (20.4 and 23.4% of the Jewish and non-Jewish population, respectively; Table 1 ; Fig. 2 ). Among the non-Jewish population, the percentage of chemical burns increased from 4.9 to 7.1% in this study ( p  < 0.0001) and decreased within the Jewish population from 9.8 to 6.8% of burn hospitalizations ( p  < 0.0001; Fig. 2 ).

Fig. 2.

Distribution of burn hospitalizations by etiology, ethnicity, and period.

Burn injuries attributed to scalds demonstrated a significant proportional increase from the previous study period (49.7 and 53.7%; p  < 0.0001) and remained the most frequent cause of burn injuries. In contrast, a reduction in fire/flame-related burns was reported (24.9 and 21.7%, p  < 0.0001). No statistical differences were observed for chemical burns (7.9 and 7.0%), hot object injuries (6.3 and 5.9%), explosions (4.5 and 4.5%), and electrical burns (2.2 and 2.0%) between the previous and current study periods, respectively ( Table 1 ).

The etiology distribution of childhood burns varied across age groups. Among all burn injuries due to scald or hot objects, the proportional majority occurred in patients who were 0 to 4 years of age at 59.2 and 43.8%, respectively, and were similar for both study periods. Conversely, all other causes of burn injuries including fire/flame, chemical burns, explosions, and electrical burns were proportionally most commonly observed among 25- to 64-year-old patients ( Fig. 3 ).

Fig. 3.

Distribution of burn hospitalizations by etiology, age, and period.

The majority of burns occurred at home at 66.5%, demonstrating an increase from 57.2% ( p  < 0.0001; Table 1 ). Home injuries not only increased for scalds (74.1 and 82.3%, p  < 0.0001) but also significantly increased for fire/flames (47.8 and 55.3%, p  = 0.0002), explosions (33.9 and 49.2%, p  = 0.0005), and hot object burns (49.0 and 63.0%, p  = 0.0002; Fig. 4 ). Electrical and chemical home burns did not significantly increase.

Fig. 4.

Distribution of home burn injuries by etiology and study period.

While work-related burns constituted 12.6% of all burn hospitalizations, 46.9% of electrical burns and 42.5% of chemical burns were occupational injuries. No statistical differences regarding burn-related occupational injuries were detected between the two periods.

A reduction in second/third-degree burns with 1 to 9% TBSA (including other minor burn incidence referred as first-degree burns in which %TBSA is irrelevant) was reported (69.5 and 63.1%; p  < 0.0001). In contrast, an increase in second/third-degree burns with 10 to 19% TBSA was observed (16.1 and 22.9%; p  < 0.0001) as was noted for second/third-degree burns of 20 to 29% TBSA (4.5 and 5.8%; p  = 0.003; Table 1 ).

During both study periods, roughly 90% of the patients sustained a burn injury only, while approximately 10% were diagnosed with additional injuries. A significant reduction in inhalation injuries was reported, from 2.7% from 2004 to 2010 to 1.4% from 2011 to 2019 ( p  < 0.0001).

Hospital Resource Utilization

The median LOS was 6 days during the prior study period (2004–2010) and demonstrated an increase to 7 days during the current period ( p  = 0.03). There was a significant increase in the proportion of patients hospitalized for greater than 7 days (43.7 and 47.2%; p  = 0.0002). A statistically significant increase in admissions to the ICU was also reported from 12.4% during the previous study period to 16.8% ( p  < 0.0001; Table 1 ).

A significant reduction in the proportion of patients who required surgical intervention was observed between the two study periods from 19.8 to 16.0% ( p  < 0.0001; Table 1 ). Operative intervention was less commonly performed within the current study period for explosion-related accidents (35.6 vs. 20.5%, p  = 0.0002) and for fire/flame-related etiologies (29.9 vs. 26.4%, p  = 0.052). A proportional reduction in surgical intervention was also observed for patients afflicted with burn injuries due to scalds from 12.2% in the 2004 to 2010 study period to 8.8% in 2011 to 2019 ( p  < 0.0001; Fig. 5 ). Additionally, a positive correlation was noted between the %TBSA and proportion of injuries requiring operative intervention. Between 2011 and 2019, surgical treatment was reported in 8.9% of the burn patients with first degree and second/third degree with 1 to 9% TBSA, 17.8% for second/third degree with 10 to 19% TBSA, 34.7% for second/third degree with 20 to 29% TBSA, and 55.5% for patients with second/third degree with 30 + % TBSA. Except for patients with 30 + % TBSA, the percentage of patients undergoing surgical intervention significantly decreased in comparison to the previous period (11.7, 26.5, and 46.4% for 1–9%, 10–19%, and 20–29% TBSA, respectively).

Fig. 5.

Distribution of surgical interventions by etiology and study period.

Mortality

Burn-related mortality rates have remained stable between the two study time periods. Between 2011 and 2019, 3.4% of burn patients died within the hospital compared, whereas 3.7% patients died between 2004 and 2010 ( Table 1 ). The proportion of patients who died within the hospital also increased with age with 11 (0.4%) children aged 0 to 14 years, 13 (1.6%) young adults aged 15 to 24 years, 108 (6.4%) patients aged 25 to 64 years, and 64 (20.6%) among older adults aged 65 years and older. Between 2011 and 2019, 11.5% of casualties with fire/flame-related burns died. In comparison, mortality was less than 1% among patients with scalds. Among casualties hospitalized with electrical burns, 7.2% died while 6.2% died following explosion-related burns.

Logistic regression was performed to predict in-hospital mortality and was adjusted for the level of burn degree and TBSA, age, gender, race, additional injury, inhalation injury, etiology, and study period. The greatest predictor of mortality was burn degree and TBSA. Patients with second/third degree and 30+ TBSA had an increased risk of mortality of 200-fold (222.4, 95% confidence interval [CI]: 120.8–409.5) in comparison to 1 to 9% TBSA and all first-degree burns. Patients suffering from second/third-degree burns and 20 to 29% TBSA had a 19.5-fold increased risk (95% CI: 9.6–39.6) and second/third degree and 10 to 19% TBSA had a 6.0-fold mortality risk (95% CI: 3.1–11.4). In comparison to children aged 0 to 14 years, adolescents and young adults (aged 15–24 years) had 2.2 times greater risk of mortality (95% CI: 1.2–4.1) and adults (aged 25–64 years) had a 5.0-fold risk of mortality (95% CI: 3.1–8.3). Compared with scalds, the risk of mortality was four times greater for fire/flame-related burns (4.0, 95% CI: 2.5–6.5) and 2.6-fold increased risk for explosions (95% CI: 1.4–5.1). Interestingly, the risk of mortality was 1.4 times greater for females in comparison to males (95% CI: 1.0–1.9).

Discussion

While patients who present with a burn injury constitute a relatively small percentage of hospitalized trauma cases, their in-hospital mortality is greater than other trauma casualties. ¹⁵ Hence, it is important to consider the causes of burn-related mortality and identify the populations at the highest risk. Consequently, this study aimed to provide updated data on hospitalized patients afflicted with burn injuries in Israel and establish a mortality prediction model. Specifically, this study examines the most frequent etiologies of burns, severity of injury, hospitalization course, populations most at risk for hospitalization, and risk of mortality following burn injury in Israel.

In our most recent review of the data, younger children, notably between 0 and 1 years of age, constituted the majority of burn injuries in Israel and represented a similar proportion of cases compared with the prior study period between 2004 and 2010. Additionally, this age distribution remains relatively consistent with previous reports from TC registries in other countries, with developing countries reporting that slightly older children aged 2 to 5 years more frequently sustain burn injuries. ^{5 16 17 18 19 20 21 22 23}

Scalds are the most frequent etiology for burn injuries among children which remains similar to previously reported data. ^{9 21} A relatively high proportion of fire/flame-related burn injuries is also still present, despite demonstrating a decreasing trend. Children under the age of 5 years are at a relatively higher risk of sustaining unintentional thermal injuries as a result of the significant cognitive and developmental changes experienced during this time period. ^{24 25 26} Hot water outlets and hot liquids are often the primary causes of burns in this age group. ^{21 27 28} Consequently, parental supervision and better education are warranted to reduce the risk and severity of injury. ^{26 29 30 31} Gender distribution remained the same between both study periods with males comprising the vast majority of burn patients and representing approximately 67% of all cases. Studies in the literature have reported equivocal findings regarding gender distributions and their association with mortality for patients presenting with burn injuries, with a trend toward increased burns sustained by males. ^{32 33 34} Occupational and risky recreational activities are risk factors exposing males to various burns. Since males are more prone to undertaking high-risk activities, adult males are likely at greater risk for sustaining burn injuries. ^{9 24}

Despite a Jewish majority in Israel, the non-Jewish minority population comprised 40.7% of hospitalized burns patients, exhibiting a disproportionally high rate of burn injuries. ¹⁴ Prior evidence suggests that families coming from a low socioeconomic stratum, such as Ultra-Orthodox Jewish communities, Arabs, and Bedouins, are more prone to burn injuries. ^{35 36} Socioeconomic factors, such as race, household income, and education, have been shown to be associated with risk of burn injury. In Edelman's literature review, non-Whites, low-income households, and lower level education were, generally, positively correlated with risk of burn injury. ³⁷ This may be attributed to a relative lack in parental education, substandard housing conditions with poor access to water and/or electricity, and crowding more often observed in lower socioeconomic households. ^{35 37}

Bedouin families represent a small religious and cultural minority within Israel and often come from low socioeconomic backgrounds. Bedouins also utilize distinctive cooking appliances and follow unique cooking and heating practices that involve open fires. ³⁸ The combination of lower socioeconomic status observed in this community (e.g., overcrowding) and use of open fires contribute to an increased susceptibility of burn injuries observed in Bedouin children. ^{38 39}

Interestingly, the Orthodox Jewish children may be at increased risk for scald injuries in part due to their weekly observance of the Sabbath. In fact, previous data from the INTR show a higher percentage of burn hospitalizations among children living in communities with a higher Ultra-Orthodox Jewish population. ⁴⁰ During the Jewish Sabbath, which is observed Friday evening until Saturday evening, families cook and warm water utilizing an electric heating plate. ⁴¹ Children are at increased risk of sustaining scald burns known as “Shabbes burns” that are associated with this stainless-steel urn. ⁴² Ensuring that the water temperature does not exceed approximately 120°F is one prevention strategy that should be implemented to reduce the risk of mortality and severe morbidity associated with Shabbes burns. ^{42 43}

While scalds were the primary cause of burn injury in our unique study population, the most common etiologies have also been attributed to fire/flames in the literature. ^{17 19 44 45} Groohi et al reported that flames were the primary etiology of burn injury and accounted for the vast majority of cases in Iran. ¹⁷ Bailey et al also established that fire/flames most frequently caused burn injury at a tertiary burn center within Bangladesh. ⁴⁵ Nevertheless, it is important to note that the etiological distribution likely varies depending on age group (e.g., scalds remain the most common cause of burn injury in children). ²⁹ The disparity observed may also be attributed in part to theological and cultural practices within Jewish faith such as the prohibited use of fire on Sabbath day. Another possible cause for scalds in Israel may be due to poor compliance with regulatory requirements involving the installation of water temperature control devices within the household.

A significant reduction in surgical interventions was observed compared with the previous study period between 2004 and 2010 (19.8 vs. 16%; p  < 0.0001). This reduction in operative procedures performed among patients with second/third-degree burns and TBSA less than 30% may be attributed to the robust development of novel wound dressings and early debridement agents (e.g., the Bromelain-based enzymatic debridement), as well as improved management guidelines, for burn injuries. ^{46 47 48} These advancements have been associated with a reduction in blood loss, requirement for surgical excision, wound infection, and hospital length of stay for deep-partial and full-thickness burns. ^{47 49 50 51}

While the etiology of injury, severity of the burn, and demographics impact the risk of burn-associated mortality, the overall in-hospital mortality rates among burn patients did not significantly change from the prior study. Consistent with the literature, we identified the following two negative prognostic factors associated with increased mortality rates: (1) severity of the burn (i.e., %TBSA and depth of burn) and (2) older population (>70 years). ^{18 20 52 53 54 55} Though scalds represented the most common etiology for burn injuries, they also exhibited the lowest mortality rate (0.46%). The type of burn injury sustained may influence postoperative morbidity and mortality which is partially dictated by the degree of inflammation, hypermetabolism, and acute-phase responses observed postinjury. Kraft et al demonstrated that compared with flame-related burns, scalds were associated with significantly less inflammatory, hypermetabolic, and acute-phase responses. Ultimately, scald-related burn injuries resulted in less morbidity and mortality. ⁵⁶ Our results corroborate findings established in this study, as adults with “occupational burns” due to explosions, electricity, and fire/flames demonstrated greater mortality rates (6.2, 7.2, and 11.5%, respectively). These burns are typically more severe and associated with multitrauma (i.e., inhalation injuries and organ failure). ^{56 57}

When assessing the LOS of patients hospitalized for over 7 days, during 2011 to 2019, we observed a statistically significant increase (43.7 and 47.2%; p  = 0.0002). ⁵⁸ The increase in LOS may also possibly be attributed to the decrease in surgical interventions observed between 2011 and 2019. Although we were unable to properly evaluate the nonoperative approaches taken, we did anecdotally observe more aggressive nonoperative protocols employed in the prior study period. Conservative burn management may theoretically be associated with longer hospital stays when compared with a more aggressive management approach for two burns that are otherwise the same. Moving forward, earlier discharge of patients with close follow-up in the ambulatory care setting could potentially reduce the LOS with no expected change in the rate of infection or mortality. ⁵⁹

Lastly, it is important to consider the influence that the novel coronavirus disease 2019 (COVID-19) pandemic has had on the epidemiology of burn injuries. Kruchevsky et al examined the impact of COVID-19 on burn injuries in Northern Israel at the beginning of the pandemic during a government-issued lockdown. They reported a significant reduction in total adult admissions for burn-related injuries and no significant change in total ED admissions for children who sustained burn injuries. ⁶⁰ The significant decline in hospital admissions for adults can be attributed to the restrictions that were imposed on the workplace. Consequently, fewer cases of work-related burn injuries occurred. Conversely, children typically sustain burn injuries within the home; thus, no significant difference in burn-related hospital admissions was observed. ^{60 61}

Limitations

No study is without its own set of limitations. This study utilized data from the INTR, a national database from all five burn centers in Israel which was used to provide an updated comprehensive review of burn admissions. The established data, however, may underestimate the number of patients who presented with milder burns, such as those treated in the ED, but not hospitalized, admitted to hospitals without a burn unit, managed in other health care facilities, or those who did not report or present for medical care. Nevertheless, this study likely accounted for all moderate-to-severe burn casualties that required hospitalization.

Conclusion

This study further establishes that the non-Jewish population, children, and males are still at greatest risk for burn injuries in Israel. Contrary to the previously reported study, an increase in LOS and relative percentage of ICU-admitted patients were noted between 2011 and 2019. However, burn patients underwent fewer surgical procedures for less-severe burns which may be related to the development of novel dressings and other debridement therapies. Future studies should be aimed at delineating potential solutions to reducing the number of burn injuries, as well as their associated morbidity and mortality. The ongoing development of preventative strategies to target at-risk groups will continue to remain crucial to minimizing burn-related injuries in the future.