Annals
ofthe M.B.C - vol. I - n° 1 - September 1987
EPIDEMIOLOGICAL DATA ON BURN INJURIES IN
GREECE A STATISTICAL EVALUATION
loannovich J., Alexakis D., Panayotou
.R, Siamaga E., Papastratis G.
Center of Plastic Surgery and Microsurgery - General State Hospital of Athens, Greece
SUMMARY. 4114 burn patients
were treated during 1986 in 60 hospitals in Greece (65.2% of all hospitals) and the
results of this survey are analyzed. The distribution of burns is directly related to the
density of the population. There is a higher incidence in male patients, in children 1-5
years (chiefly scalds) and the age group of 20-40 years. With regard to occupation
it is highest in labourers and craftsmen. The main cause of bums is scalds followed by
fire bums and sunburns. The majority were minor burns (60.5%) while extensive burns
amounted
to 14.8%. This survey proves the absolute necessity for the immediate construction of two
burn units in Greece, one of which is already in progress in Athens.
Introduction
Greece is an Eastern Mediterranean country with an area of 131,990 kin' and a
population of 9,846,600 inhabitants, according to the census of 1981 and the statistical
estimation of 1987 (5).
The country's geographic peculiarity is the great number of islands, which with an area of
25,166.24 kM2 correspond to 19% of the total surface area of Greece.
The economically active population is 3,454,761 inhabitants amounting to 35.25% of the
population. With respect to occupation farmers predominate with 41%, followed by craftsmen
and labourers with 30%. Civil servants and other clerical workers represent 15% of the
economically active population.
It is therefore evident that Greece should be considered as an agricultural country with
major and jninor industries still under development.
The country is divided into 9 Health Districts which are in a sense medically independent
(Fig. 1). In every one of these districts there is at least one Central Hospital, offering
almost full cover for every main speciality and two or more district hospitals providing
limited medical cover.
Four out of the nine districts are the most densely populated (Fig. 2), the remaining five
having an evenly balanced but more sparse distribution (Districts No. 3-5-6-7).
District No. 7 includes Athens which together with the harbour of Piraeus is inhabited by
40% of the total population.
District No. 3 includes Salonica, the second biggest city of the country.
District No. 5 is considered the most industrialized and agriculturally flourishing area,
followed by district No. 6, the Peloponnese.

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Fig. 1 (Map of Greece health districts) |
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Material
In January 1987, a questionnaire was sent to all the General Hospitals of the country
concerning the care of burn victims for the year 1986. There are 92 General Hospitals with
21,131 beds and the number of admissions for 1986 was 634,110 patients. Since then we have
received 60 replies (65.2%) giving information for 13,737 beds and for a total of 410,834
treated patients (64.8%). Of this total 4114 patients were treated for burns. This number
includes almost all severe burns for 1986 and represents over 65% of the total number of
burns for that year. These results can be explained by checking the 1 Ist of the hospitals
which did not answer. It was a lucky coincidence that only one district hospital did not
answer while the rest of the hospitals were those offering limited medical cover.
It should be noted that in Greece there is also private medicine, including private
clinics in which a certain number of burns will have been treated. These will thus have
escaped our data. However, due to the high cost of treatment of extensive burns, those
treated in private clinics will have been chiefly minor burns.
Distribution of burns
The distribution of burn patients in each district is related directly to the density
of the population (Fig. 2, Fig. 3). It should be noticed that district No. 5 has a
relatively high percentage of bum victims, a fact that can be explained by the
industrialisation of the area. The statistical evaluation of the sex and age of the
patients has revealed a higher incidence of male patients in every group except those over
60 years of age, a fact obviously due to the higher life expectancy of women (Fig. 4). Two
age groups show a higher incidence. The group of 1-5 years of age, as expected, shows a
high incidence of scalds, as in most countries (2, 4).
The high incidence of the 20-40 years of age group is obviously due to occupational
injuries since it is the most active group professionally. Unfortunately there were no
data available referring to the place of injury in order to make a distinction between
home, work and road traffic accidents.
 |
Fig. 4 (distribution
according to age and sex) |
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|
Fig. 2 (Distribution of
population) |
Fig. 3 (Geographical
distribution 4117 burns) |
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Causes of Burns
In Greece scalds are the main cause of burn injuries (64.5%) followed by
fire injuries with 24.2% and sunburn ' s with 11.5%. Adding these three groups together,
the result is 81.1% of all thermal injuries. This number is in accordance with the
statistics of
other countries, but is should be pointed out that Greece has a high incidence of
sunburns, obviously due to its climate (3, 4).
It is also of interest that electrical burns are fewer than expected. A possible
explanation is the correct preventive measures which have been imposed by the public
organization of electricity for the last 20 years. On the contrary it seems that there are
inadequate prophylactic measures for corrosive chemicals, shown by the relatively high
incidence of chemical burns (6.18%).

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Fig. 5 (Causes of burns) |
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Occupation
The distribution of burns
according to occupation was calculated in 954 bum victims of known occupation.
Statistically this is a random sample
(Tab. 1).
Labourers and craftsmen show the highest incidence of burns, a result that should be
considered as an urgent sign for the establishment of prophylactic measures, in major and
minor industry. The majority of the burns treated during 1986 in Greek hospitals were
minor burns (under 10%) amounting to 60.5% of the total. Bums of limited extent (11-20%)
amoun'ted to 24.7% of the total and extensive bums (over 21%) amounted to 14.8% of the
total.
|
Professionals
Managers
Administrators |
Clerical
workers |
Tradesmen
and
Salesmen |
Farmers |
Labourers
and
Craftsmen |
Unclassified |
Total |
Total |
34 |
176 |
40 |
134 |
492 |
78 |
954 |
% |
3.6 |
18.4 |
4.2 |
14 |
51.6 |
8.2 |
100 |
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Table
1 DISTRIBUTION ACCORDING
TO OCCUPATION |
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Burn facilities
From the results of the questionnaire it is obvious that, with the exception of district
No. 6 whicb can only treat burns up to 40% of body surface area, from a purely medical
point of view the central hospitals of the main districts are capable of treating all
categories of burns (Tab. 2). Unfortunately up to now, only one hospital in Salonica and
two hospitals in Athens have had the fundamental nursing facilities for specialized burn
care.
|
Hospitals unable
to admit |
Hospitals
under 20% |
able under 40% |
to treat
over 40% |
Total No.
of hospitals |
1 st district |
|
1 |
|
1 |
2 |
2nd district |
|
|
3 |
|
3 |
3rd district |
|
6 |
4 |
3 |
13 |
4th district |
|
1 |
2 |
|
3 |
5th district |
|
2 |
|
1 |
3 |
6th district |
|
5 |
2 |
|
7 |
7th district |
8 |
7 |
|
4 |
19 |
8th district |
|
3 |
1 |
|
4 |
9th district |
1 |
2 |
1 |
|
4 |
Total |
9 |
27 |
13 |
9 |
58 |
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Table
2 DISTRIBUTION OF HOSPITALS ACCORDING TO THEIR ADEQUACY FOR THE TREATMENT
OF BURNS |
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Conclusions
In conclusion this epidemiological
survey reveals that the frequency, the distribution according to age, sex grid occupation,
and the cause and extent of burns are in accordance with similar statistical data of other
European countries and with the prospective calculation of burn injuries according to
Feller and Crane (1971) (1).
It also reveals that
preventive measures, including education of the public through the media, must be enforced
by the state to reduce the incidence, chiefly of scalds and chemical burns. It can be seen
too that it is absolutely necessary that two burn units should be built as soon as
possible, one in Athens and one in Salonica.
This necessity has been
recognized by the state and a burns unit is already under construction in an Athens
hospital.
RÉSUMÉ. La Grèce
est pays à l'est du bassin Méditerranéen, d'une superficie de 131.990 KM2 et d'une population de 9.800.000 habitants, selon
le recensement de 1981 et une estimation de 1987.
Géographiquement, c'est un pays très particulier, à cause de ses nombreuses îles, qui
couvrent 19% de la superficie totale. L'économie di pays est basée sur une population
active composée de 41% d'agriculteurs, 30% d'artisans et de travailleurs, 15% d'employés
et des services publiques.
En janvier 1987, nous avons envoyé un questionnaire concernant des soins des brûlés à
tous les hôspitaux du pays. Il y a 92 hopitaux avec 16.000 lits admettant dans l'ensemble
chaque année 365.000 patients.
Nous avons reçu 54 réponses (59%), ce qui correspond à une capacité de 10.000 lits et
à un total de 300.000 malades soignés. En 1986 les brûlés traités ont été de 3.651.
Dans cet exposé, l'ensemble des patients brûlés est statistiquement évalué selon leur
âge, la cause de l'accident et l'importance de la lésion. La variation annuelle des
blessures par brûlure, la comparaison du métier des victimes et les évaluations futures
afin de créer un nombre approprié de Centres font objet de discussion.
BIBLIOGRAPHY
- Feller 1. and Crane K.H.: Planning and
designing a burn care facility. Ann Arbor, Michigan 1971.
- Green Roger, Fairclough Colin and
Sykes Philip L: Epidemiolo gy of burns in Childhood. Welsh Bums Centre, St. Lawrence
Hospital, Chepstow, Burns (1984), 10, 368-371.
- Roding Hans: The epidemiology of bum
injuries in the German Democratic Republic, Potsdam, Burns, 5, 208-209.
- Lyngdorf P., Srenen B. and Thomsen M.:
The total number of bum injuries in a Scandinavian population - a prospective analysis.
University of Copenhagen, Denmark, Burns (1986) 12, (8), 567-579.
- National Statistical Service of
Greece: Statistical yearbook of Greece, Athens 1985.
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