Annals of Burns and Fire Disasters - vol. XII - n° 4 - December 1999

ANALYSES AND OUTCOME OF 835 BURN INJURY ADMISSIONS TO THE BURN UNIT, KING FAHD HOSPITAL, AL-KHOBAR, SAUDI ARABIA

Fadaak RA,¹ Balial S.G.,² Hegazi M,¹ AI-Hoqail R.,¹ AI-Awad N. ¹

College of Medicine and Medical Sciences, King Faisal University, Dammam, Saudi Arabia
¹ Department of Surgery
² Department of Family and Community Medicine


SUMMARY. The objective of this study was to determine the magnitude of the problem of burns suffered by patients admitted to the burns unit at King Fahd Hospital of the University (KFLIU) in Saudi Arabia and to suggest possible measures to reduce their incidence.
Burn patients reporting to the KFHU emergency room and admitted to the burns unit during the period between May 19:~3 and April 1994 were analysed. A total of 835 (558 males, 277 females) burn patients were admitted over the 11 yr. Of these, 65.2% (546) were Saudis and the rest non -Saudis. The age ofthe injured ranged from 2 months to 80 yr; children aged under 5 yr (pre-school) constituted 39.0% (324) of all cases. Of the children, 58.3% (183) were male. The hospital stay ranged from as short as zero (deceased) to 21 months (a male child aged 3.5 yr). Domestic burns accounted for the ma ority of cases in the 11 -yr period (87.0%). The lowest annual rate of domestic burns was 80%, during the year 1985, and the highest 93%, in 1993. Scalding, in the majority of cases due to hot liquids, accounted for 52.4% (439) ofall burns, followed by flame, 36.9% (309), electricity, 4.4% (37), and chemical burns, 2.4% (20). The causes ofthe remaining 32 burns (3.8%) were not specified in the patient's record. The total body surface area affected ranged from 1 % to 100~'(,. Of' all the burn patients admitted to the unit, 7.0% (59) discharged themselves against medical advice. The mortality rate was 5.9% (49 deaths). This study showed that pre-school children formed a sizeable proportion of the injured, a finding that underlines the special attention required by this age group. Burns by hot liquids (water, coffee, tea, soup, oil) were the commonest, which again stresses the need for more attention in the home. A health education programme directed towards safety against domestic burns has much to commend it.

Introduction

Burn injuries, irrespective of their source, may cause great disfigurement and psychosocial disturbances in those who survive the ordeal. Prevention must remain a goal if suffering is to be reduced. Most studies agree that domestic accidents cause the majority of burn injuries, and prevention should therefore start at home. Saudi Arabia is no exception to the rule, and the Studies available confirm the predominance of fires in the home. Most such fires are preventable if routine safety measures are followed.
The incidence of burns in Saudi Arabia is not exactly known. In this hospital-based study we tried to add the experience gained at King Fahd Hospital of the University to available Saudi literature in order to enlighten the authorities concerned regarding the most probable causes of burns and to suggest methods of prevention.
The study is a preliminary analysis of the victims of burn injuries admitted to the burn unit at King Fahd Hospital of' the University in the 11-yr period May 1983-April 1994.

Methods

The study retrospectively analysed the records of all burn patients admitted to the burn unit over the ll-yr period. All patients seen in the emergency room and diagnosed as having only minor burns were given treatment and sent home to be followed up in the out-patients department. The remaining patients who met the following criteria were admitted: more than 15% of total body surface area (TBSA) burned in adults and more than 10% in children when superficial, or more than 3% when deep or when critical areas (hands, feet, face, and perineum) were involved, irrespective of the percentage of T13SA, or when the burn was associated with other diseases or injuries. Any patient with a possibility of inhalation burn or with burns caused by electricity or chemical substances was admitted, irrespective of the percentage of TBSA burned.

Results

During the 11-yr period a total of 835 burned patients were admitted. Their sex and nationalitv are shown in Table I. Two-thirds (66.8%) were male. Saudi nationals constituted 61.5% of the males and 38.5% of the females.

Sex Nationality

Total

Saudi

Non-Saudi

Male

335 (61.5%)

223 (76.9%)

558 (66.8%)

Female

210 (38.5%)

67 (23.1%)

277 (33.2%)

Total

545 (65.3%)

290 (34.7%)

835

Table I - Distribution of patients by sex and nationality

Children under 5 yr of age were the most frequently affected, constituting approximately 39% of the total number (Table II). The 25-34-yr age group ranked next in frequency (23.2%).

Age group
(yr)

Sex Total

Male

Female

< 5

189 (33.9%)

135 (48.7%)

324 (38.8%)

5-14

59 (10.6%)

40 (14.4%)

99 (11.9%)

15-24

63 (11.3%)

31 (11.2%)

94 (11.3%)

25-34
35-44

149 (26.7%)
73 (13.1%)

45 (16.2%)
15 (5.4%)

194 (23.2%)
88 (10.5%)

45-54

17 (3.0%)

2 (0.7%)

19 (2.3%)

55-64
65-74

3 (0.5%)
3 (0.5%)

6 (2.2%)
1 (0.4%)

9 (1.1%)
4 (0.5%)

> 74

2 (0.4%)

2 (0.7%)

4 (0.5%)

Total

558 (66.8%)

277 (33.2%)

835

Mean* (SE) age

19.5 (0.63)

13.6 (0,82)

 

Range

0.17 - 80

0.17 - 80

 
p value = 0.000031

Table II - Distribution of patients by sex and age group

Children aged less than 15 yr constituted slightly more than 50% of the total number. The elderly (over 64 yr of age) were the least represented age group in both sexes. Male patients were on average older than female patients. The difference was statistically significant (p = 0.000031). Scalds due to hot liquids were the commonest type of injury in both males (48.0%) and females (67.9%), with a total rate of 54.6%. Flame burns ranked second after scalds with a total of 37.4% (Table III).

Sex Type of burn

Total

Scald

Flame

Ch

Electrical

Male

263 (48.0%)

230 (41.2%)

20 (3.6%)

538 (66.8%)

538 (66.8%)

Female

188 (67.9%)

82 (29.6%)

3 (1.1%)

277 (33.2%)

277 (33.2%)

Total

456 (54.6%)

312 (37.4%)

23 (2.8%)

44 (5.3%)

835

Table III - Types of burn by sex

The majority of the children (62.1%) aged less than 5 yr presented scald burns, which constituted the single commonest cause of burns in all age groups (54.6%).
The other three causes of burns (flame, chemicals, electricity) were the most frequent agents in the 25-34-yr age group, flame being responsible for 36.9% of the injuries, chemicals for 47.8%, and electricity for 31.8% (T able IV). Although flame ranked only second as a cause of injury it caused the severest burns. Of the 67 patients with burns in more than 50% T13SA, flame was responsible in 51 cases (76.1%).

Age group
(yr)

Type of burn

Total

Scalds

Flame

Chemicals

Electrical

< 5

283 (62.1%)

32 (10.3%)

2 (8.7%)

7 (15.9%)

324 (38.8%)

5-14

55 (12.1%)

41 (13.1%)

-

3 (6,7%)

99 (11.9%)

15-24

37 (8.1%)

45 (14.4%)

4 (17.4%)

8 (18.2%)

94 (11.3%)

25-34

54 (11.8%)

115 (36.9%)

11 (47.8%)

14 (31.8%)

194 (23.2%)

35-44

15 (3.3%)

56 (17.9%)

6 (26.1%)

11 (25.0%)

88 (10.5%)

45-54

8 (1.8%)

10 (3.2%)

-

1 (2.3%)

19 (2.3%)

55-64

3 (0.7%)

6 (1.9%)

- -

9 (1.1%)

65-74

1 (0.2%)

3 (1.0%)

- -

4 (0.5%)

> 74

-

4 (1.3%)

- -

4 (0.5%)

Total

456 (54.6%)

312 (37.4%)

23 (2.8%)

44 (5.3%)

835

Table IV - Types of burn by age group

The mortality rate was 5.9% (49 patients), the majority of deaths occurring in the 25-44-yr age group. Approximately 82% of these patients had suffered burns in more than 50.0% T13SA. The overall percentage of domestic burns during the study period was 87%.

Discussion

Burns are recognized as an important cause of ill health in developing nations. Several studies agree that domestic accidents cause most burn injuries, and prevention should therefore start in the home. In this study home burns accounted for approximately 87% of the cases considered. Reports from Saudi Arabia and other Arab countries showed rates close to this: Jeddah, 85%; Kuwait, 78.6%; Jordan, 88%; Assiut (Egypt), 94%; Buraidah, 73.4%.
Flame burn was found to be the commonest cause of burn in several studies, including Gizan, Kuwait, and Jordan. In Assiut, for example, the flame injury rate was 68%, while that of scalds was 30%. In the present study scalds were the commonest form of injury, as in reports from Jeddah and Alexandria. In the present study electricity (5.3%) and chemicals (2.8%) were the least common causes, but they still represented a higher incidence than in the above-mentioned countries.
We did not analyse these burns in terms of cause, time of occurrence, and seasonal variations. A prospective study, which we intend to carry out in the near future, would be more accurate.
The majority of the few studies from Saudi Arabia and other surrounding Arab countries reported very similar incidence rates for children with scald burns (50-62%), which constitute the major cause in this age group, particularly in those aged less than 5 yr. Children of this age move around a lot inside the house and are curious. They are consequently more prone to injury, especially boys. Burns affecting children under 12 yr of age accounted for almost one-quarter of all surgical patients admitted to a hospital in China, and 65% of these were boys.It is widely recognized that the great majority of these accidents could be prevented if parents were made more aware of the hazards present in the domestic environment.
The incidence of burns in the elderly (> 65 yr) was very low. This is consistent with reports from the abovementioned countries, where the range was 1 to 2% (except in Alexandria, where the incidence in this age group was 10.2%. It is a traditional and religious belief that the elderly should be cared for and looked after. Males accounted for more than 66.8% (females, 33.2%), a figure also similar to that found in previous studies, (except in Alexandria, where the reverse was true).
What can be done to reduce the number of these injuries? Very little, unless awareness of hazards in the home becomes part of a family's everyday life rather an occasional, transient reminder on television or in newspapers. It is not easy to apply prevention measures. Problem identification is a pre-requisite to the formulation of prevention programmes. An important way of raising the awareness of the risks of scald injury is through the education of children at school and through the mass media.

 

RESUME. Les Auteurs se proposent d'évaluer l'ampleur du problème des patients brûlés hospitalisés dans l'Hôpital Roi Fahd de l'Université (Arabie Saoudite) et ils présentent des mesures possibles pour réduire leur fréquence. Ils ont analysé tous les cas des patients brûlés qui se sont présentés au service des urgences et hospitalisés dans l'unité des brûlures pendant la période mai 1983avril 1994 (835 patients, dont 558 mâles et 277 femelles). L'âge moyen de ces patients variait entre 2 mois et 80 ans. Les enfants âgés de moins de 5 ans, c'est-à-dire d'âge préscolaire, constituient 324 (39,0%) de tous les cas. De ces enfants 183 (58,3%) étaient mâles. La période d'hospitalisation variait entre zéro (patients décédés) et 21 mois (un garçon de 31/2 ans). Les brûlures domestiques constituaient la majorité des brûlures (87,0%) pendant la période considérée. Le taux domestique le plus bas (80%) s'est verifié en 1985 et le plus haut (93%) en 1993. L'ebouillantement, causé dans la plupart des cas par les liquides chauds, ont causé 439 (52,4%) de toutes les brûlures, les flammes 309 (36,9%), l'électricité 37 (4,4%) et les substances chimiques 20 (2,4%). Dans les autres cas la cause n'a pas été spécifiée. La surface totale corporelle brûlée variait entre 1% et 100%. De tous les patients hospitalisés dans l'unité des brûlures 59 (7%) ont laissé l'hôpital de propre initiative, contre le conseil des médecins. Le taux de mortalité était 5,9% (49 décès). Cette étude a montré que les enfants dâge préscolaire constituent une considérable proportion des enfants brûlés, ce qui impose une attention particulière pour cette catégorie des enfants. Les brûlures causées par les liquides chauds (eau, café, thé, soupe, huile) étaient les plus communes, ce qui souligne l'importance de la vigilance dans la maison. Les programmes d'éducation sanitaire qui visent à la défense contre les brûlures domestiques sont d'importance fondamentale.


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This paper was received on 20 July 1999.
Address correspondence to:
Dr. Hussein A. Fadaak
P.O. Box 2903, Al-Khobar 31952, Saudi Arabia.

 




 

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