Annals ofthe M.B.C - vol. I - n° 1 - September 1987


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.


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.


Fig. 1 (Map of Greece health districts)


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)

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)


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.

Farmers Labourers
Unclassified Total
Total 34 176 40 134 492 78 954
% 3.6 18.4 4.2 14 51.6 8.2 100


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
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


9 27 13 9 58



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.


  1. Feller 1. and Crane K.H.: Planning and designing a burn care facility. Ann Arbor, Michigan 1971.
  2. 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.
  3. Roding Hans: The epidemiology of bum injuries in the German Democratic Republic, Potsdam, Burns, 5, 208-209.
  4. 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.
  5. National Statistical Service of Greece: Statistical yearbook of Greece, Athens 1985.


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