Burn injuries in the Dong Bei area of China: a study of 12,606 cases

A Review of Petrol Burns in Australia and New Zealand

Petrol-related thermal burns cause significant morbidity and mortality worldwide and it has been established that they affect young males disproportionately. Beyond this, we sought to identify the difference in the characteristics and outcomes of burns between males and females in an international population. Such differences may highlight areas for future preventative strategies. The Burns Registry of Australia and New Zealand was used. Petrol burns that resulted in a hospital admission in those 16 years or older between January 2010 and December 2019 were included. A total of 2833 patients were included. The median age was 35 years with most patients being male (88%). Burns from a campfire or burnoffs were most common. Females were more likely to suffer burns due to assault or from deliberate self-harm. The total body surface area affected by burns was higher for females than males (10% vs 8%). Furthermore, females more frequently required ICU admission, escharotomies, and had a longer hospital length of stay. The unadjusted mortality rate for females was more than double the rate for males (5.8% vs 2.3%). This international study demonstrates that whilst men more frequently suffer petrol burns, women suffer more severe burns, require more intensive and longer hospitalizations and have a higher mortality rate. These findings may inform changes in preventative health policies globally to mitigate against these concerning findings.

Harborview burns--1974 to 2009

BACKGROUND

Burn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974-2009) at the Harborview Burn Center in Seattle, WA, USA.

METHODS AND FINDINGS

14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved.

CONCLUSIONS

1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate.

INCREASING NUMBERS OF ADMISSIONS TO THE ADULT BURNS SERVICE AT THE ROYAL ADELAIDE HOSPITAL 2001?2004

BACKGROUND

The purpose of the study was to illustrate the increasing trend in the number of adult burns patients admitted to the Royal Adelaide Hospital and attempt to explain it and to describe the burn patients admitted to the Royal Adelaide Hospital in terms of age, sex, origin, cause and burn size, particularly since the increasing trend began, in an effort to identify a particular group or burn cause, which may make up a large proportion of the increasing numbers.

METHODS

A retrospective review of 1548 acute burn-injured patients using information from the burns unit database between 1996 and 2004 was carried out.

RESULTS

Of 1841 total admissions, 1548 were admitted for acute burn injury. There has been an increase in the number of admissions since 2001 amounting to approximately 20% per annum. The cumulative rise in total admissions 2000-2004 is 107% where the increase in acute burn admission in the same period is 82%. There appears to be no difference whether the patient is from a rural or a metropolitan area. Burns of <10% total body surface area constitute most of the increase and are mainly flame and scald injuries. Chemical and contact burns are proportionately increasing.

CONCLUSION

The increase in acute admissions is mainly due to the increasing presentation of smaller burns to the unit. The statewide rural burn education programme and media exposure following the 2002 Bali bombings may have contributed to the increase in acute admissions.

Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention

Burn prevention requires adequate knowledge of the epidemiological characteristics and associated risk factors. While much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs), such as the United States, due to sustained research on the descriptive epidemiology and risk factors, the same cannot be said of developing or low- and middle-income countries (LMICs). To move from data to action and assist preventive efforts in LMICs, a review of the available literature was conducted to assess the current status of burn preventive efforts. A MEDLINE search (1974-2003) was conducted on empirical studies published in English on the descriptive epidemiology, risk factors, treatment, and prevention of burns in LMICs. Review of the 117 identified studies revealed basically the same descriptive epidemiological characteristics but slightly different risk factors of burns including the presence of pre-existing impairments in children, lapses in child supervision, storage of flammable substances in the home, low maternal education, and overcrowding as well as several treatment modalities and preventive efforts including immediate application of cool water to a burned area. Continuous evaluation of promising interventions and those with unknown efficacy that have been attempted in LMICs, along with testing interventions that have proven effective in HICs in these LIMC settings, is needed to spearhead the move from data to action in preventing burns in LMICs.

Evaluation of a bi-layer wound dressing for burn care

Severe burns remain a significant cause of morbidity and mortality despite the availability of numerous therapies. We assessed the wound healing and skin-cooling properties of a DRDC hydrogel/polyurethane wound dressing using different pre-clinical models. Our results show that 85% of partial-thickness, non-contaminated porcine wounds treated with our dressing healed within 6 days. In contrast, 85% of the wounds treated with commercial dressings healed within 8 days. Application of a moist DRDC dressing (to simulate a condition of exudate absorption) on a scald burn covering 25% of the dorsal area in rats reduced skin temperature by 1.70 +/- 0.14 degrees C for 5 min, the skin temperature being comparable to that of control burned rats after 20 min. The application of a moist DRDC dressing did not induce significant differences in body temperatures compared with that of burned animals without dressing coverage throughout the 90-min experiment. While no change in body temperatures were observed when standard dressings (i.e., not pre-moistened) were applied, skin temperature increased gradually. These data show that our dressing is effective in promoting faster healing of the treated wound; and providing a transient, but beneficial cooling effect to the skin contact-site, without the adverse effect of inducing whole-body hypothermia.

A global study of hospitalized paediatric burn patients

The global incidence of hospitalized paediatric burn patients is unknown. In order to determine a working estimate of the size of the problem, one approach is to extrapolate from relevant published studies. A literature search of the Medline database was performed to identify epidemiological papers published since 1990, which addressed paediatric burn admissions. Extrapolation from population-based studies allowed global figures to be estimated. The highest incidence of hospitalized paediatric burns patients is in Africa, the lowest in the Americas. Europe, the Middle East and Asia share similar figures, but the considerably larger population of Asia indicates that it bears over half of the world's paediatric burn population. It is unfortunate that despite many published studies describing burn admission, few meet criteria that allow for comparative epidemiological data. More attention needs to be focused on uniformity in data collection and presentation to enhance the value of the data available.

An epidemiologic study of elderly burn patients in Ain Shams University Burn Unit, Cairo, Egypt

Recent statistics from Egypt indicate that elderly persons comprise 5.8% of the general population. Elderly patients remain a high-risk group in all burn units. This prospective study investigated geriatric burn patients (defined as 60 years and older) who were present at our center between May 1995 and October 2001. Of the 4220 patients who were present during this period, 97 (2.3%) were elderly, and 63 (7.1%) of the 880 total admitted were geriatrics. Of the 97 elderly burn patients who were present during the study period, 31 died (mortality rate 31.9%). Other epidemiological data, including duration of hospitalization, seasonal and day/hour variation in burn incidence and burn causes and accident site are presented. Ideas for management and prevention are also presented.

Mortality rates among 5321 patients with burns admitted to a burn unit in China: 1980-1998

A retrospective study was conducted on 5321 burn patients hospitalized in a burn center in Jinzhou, China during the period 1980-1998. Of the 5321 patients, 57.8% were between 15 and 44 years old and 3.4% were > or =60 years old. Ninety-six percent had burns covering less than half of body surface area and 31.7% had only full thickness skin burn. The number of patients in the 1990s was three times that of the 1980s. Overall mortality rate was 0.86%. LA(50) for total body burn area (TBSA) and only full thickness skin burn (FTSB) was 94 and 87%, respectively. The high survival rate, may relate primarily to the low percentages of older patients and of patients with severe burns. Inhalation injuries, infection and MOD are the main causes of deaths in our patients and would be key targets to improve clinical care and in future study.

Comparable results between standardization methods and regression analysis in predicting mortality rate among samples with burns

This report suggests an alternative statistical model for estimating the mortality rate of samples of patients with burns. Three direct standardization methods were applied to nine samples (48,379 patients) selected randomly from the medical literature, and compared with the technique of three regression models, The results showed the similar mortality rates in these samples using the three different methods for standardization in comparison to the rates of LA(50) using three regression models. Of the different standardization methods used to measure the of mortality rate, standardization of death rate for age and area burned may be the best method to objectively evaluate the results of burns care, if combined with LA(50) using regression analysis. Furthermore, the values of LA(50) and 95% Cl in a sample are changed with different regression models. It is necessary to specify the regression model, 95% Cl or correlation coefficient of LA(50) in probit analysis or linear regression, respectively, when LA(50) of one sample is compared with that of another.

Correlation between standardized death rate for area and LA(50)

In order to investigate the relationship between standardized death rate for area and 50% mortality rate for burn area (LA(50)), correlation analysis, curve estimation and linear regression were performed with the variables. The results showed that: (1) there was a similarity in sort order of standardized death rate in control groups of samples, compared with the experimental group; (2) there were significant differences between the sort order from low to high mortality rate of standardized death rate in control groups for burn area, compared with the sort order in the experimental group; (3) there was a similarity (P<0.05) in low to high sort order for standardized death rate compared with high to low sort order for LA(50) in the experimental group; and (4) there was an extraordinarily significant correlation (P<0.0001) between linear regression analysis and curve estimation for the standardized death rate and LA(50) using a Pearson correlation. The observation that there was a significant relation between the sort orders in standardized death rate and LA(50) shows that the standardized death rate for area can reflect accurately mortality in each of samples.

The importance of initial management: a case series of childhood burns in Vietnam

The success of treatment of childhood burns is critically dependent on how well the initial management is performed. In this case series of 695 children with burns transferred to the National Burn Institute (NBI) in Hanoi from peripheral hospitals, the initial management of each patient was assessed for the following initial management measures: removal of the cause and immediate cooling with water at the accident site; and pain relief, dry dressing, administration of oxygen, and adequate fluid replacement at the peripheral hospital. Overall, 61 of the 695 children died, but of the 95 patients who received all of these initial management measures, all survived. There were no cases of irreversible shock, acute renal failure, or multiple organ failure in the patients who received adequate initial management. Provision of adequate initial management was also significantly protective against septicaemia. Thus in this group of subjects who survived until admission, effective initial management significantly reduced the risk of death and other complications such as irreversible shock, septicaemia and multiple organ failure.

Epidemiology of elderly patients' burns in the South West of France

A retrospective study of 716 patients aged 60 years and above (324 men, 392 women) was undertaken in order to determine quality control in burns management in the South West of France. The following epidemiological data was obtained: high hospitalization rate (7 per cent of the general admissions); monthly and seasonal periodicity; predominance of indoor accidents (86 per cent) with domestic accidents being more frequent in women (63 vs. 37 per cent). Outdoor accidents were mainly recreational and were five times more frequent in men than in women. The overall mortality was 39 per cent and was influenced by the burns extent, depth, predisposing factors and early management. More burns occurred in urban areas (53 per cent) but mortality was higher in patients from rural areas (62 vs. 38 per cent). It was observed that delay in management, especially fluid resuscitation of patients from the rural areas, was partly responsible for this outcome. Propositions were made to diffuse more information on the importance of early management of burns in rural areas.

Burns mortality and hospitalization time--a prospective statistical study of 352 patients in an Asian National Burn Centre

A prospective study of 352 patients in an Asian National Burn Centre has been used to develop statistical predictive models for mortality and hospitalization time. The patients are largely of Asian origin. Total burn surface area (% TBSA) and presence of respiratory burns are significant independent predictors of mortality in the multiple logistic regression analysis with an accuracy of 98.3 per cent. Age is not a significant predictor of mortality in our patients. Age, % TBSA, full thickness % TBSA and respiratory burns are significant independent predictors of length of stay in hospital with a R2 value of 0.57 in the multiple linear regression analysis. There were 16 deaths, many of whom had developed multiple complications, common causes of which were sepsis, bronchopneumonia, DIVC and multiorgan failure. The final causes of death were septicaemic shock in 10 patients, extensive burns in four patients, ARDS in one patient and bleeding peptic ulcer in one patient. The development of these two mortality and morbidity predictive models is the first step in the evaluation of our results. These models have to be tested against a future set of patients. After confirmation they will aid in patient management, clinical audit, patient and family counselling. They will also serve as baseline standards for evaluation of new therapies, assist us in the allocation of resources and identifying the at-risk population for improvements in therapy.

Hot water burns in Cape Town

Scalds are common in South Africa and accounted for 21.6 per cent of the admissions to the Burns Unit of the University of Cape Town. Two hundred and forty adult patients (160 males, 80 females) with a mean age of 34.2 years were admitted for treatment of scalds between 1985 and June 1992. One hundred and thirteen sustained their scalds accidentally while 127 patients were assaulted with hot water. Epilepsy accounted for 11 per cent of the accidental burns. The head and neck was involved in 16.8 per cent of accidental burns and in 84.9 per cent of assaults. A quarter of the scalds to the trunk and limbs were caused by assault compared with 75 per cent caused by accidents. Beta haemolytic streptococcus was the second commonest organism isolated from the burn wound (57 patients). In 19 per cent of these patients a weekly course of penicillin and erythromycin did not eradicate the streptococcus and clindamycin was required. Accidental scalds usually affect the lower body and limbs whereas assault with hot water commonly involves the head and neck. Streptococcus is a common organism in the Burns Unit and is becoming more difficult to eradicate.

A clinical study of electrical injuries

Over a period of 10 years (January 1983 to December 1992), 173 patients with electrical burns were admitted to our Burn Center, constituting 6.8 per cent of acute admissions. There is a relative abundance of data in the medical literature concerning electrical burns, clearly depicting the local characteristics and peculiarities in different countries or societies. Our purpose is to present some statistical, epidemiological data from a Burn Center in China which has a multitudinous population, as well as to compare our data with that from other countries. Our data show that prevention and early wound management of electrical burns are very important in decreasing this incidence and the subsequent tissue amputation rate.

Assault inflicted by hot water

Assault inflicted by hot water is uncommon although such injuries have been reported from many parts of the world. The patient characteristics, burn distribution and outcome in 127 patients who had been intentionally assaulted with hot water during a 7 1/2 year period are reported. More than half of the males were assaulted by their wives. The female was often assaulted by her spouse or another family member. Most patients came from lower socioeconomic groups. The average burn surface area was 13.7 per cent (range 1-45 per cent). The upper part of the body was much more frequently burned than the pelvic and lower limb areas (12 per cent). Males (94) were assaulted more commonly than females (33). Eighty-four patients suffered partial skin thickness burns requiring debridement and skin grafting. The average hospital stay was 17 days (range 1-61 days). Upper body hot water burns in adults should raise the possibility of assault in the minds of attending medical personnel, especially where predisposing factors exist (alcohol abuse, lower socioeconomic strata, poor education). Most patients sustain partial skin thickness burns and will require debridement and grafting. Psychosocial factors require investigation and professional intervention.

Burns in Madras, India: an analysis of 1368 patients in 1 year

Analyses were made of 1368 patients who attended Kilpauk Medical College Hospital, Madras with burns between 1 May 1987 and 30 April 1988. Nine hundred and sixty-five patients were admitted, of whom 505 died. The peak age incidence was in young adults (11-30 years; 58.9 per cent of all burns). Three quarters of the patients came from the low family income group, 39.5 per cent were illiterate and 86.2 per cent of burns occurred in the home. Of those admitted 81 per cent of the injuries were flame burns; in 31.3 per cent the burn affected more than half of the body surface. Of the 505 deaths 94.8 per cent were the result of flame burns (at least 323 being caused by kerosene), and 20.4 per cent were suicide. Most of the deaths (91 per cent) occurred in the first 5 days. The urgent need for burn prevention in the Madras area is discussed.