Annals of Burns and Fire Disasters - vol. XV - n. 1 - March 2002

Home heating injuries in an urban burn centre

Ugolini K.R.¹, Hughes W.B.²

¹ Department of Surgery, Albert Einstein Medical Center, Philadelphia PA, USA
² Director Burn Center, Temple University Hospital, Philadelphia

SUMMARY.This is a retrospective analysis of nine burn patients admitted to the Temple University Hospital Burn Center for home-heating radiator injuries between January 2000 and January 2001. There was a prevalence of elderly men in this population and an average TBSA burned of 4.6%. Two case reports are presented.

Introduction

In 1999, it was reported that there was an average of 4,500 fire and burn deaths per year.1 According to an annual survey of fire departments by the National Fire Protection Association and the Annual Vital and Health Statistics report, 3,750 of these deaths were from house fires. There surveys also reported that 750 of these deaths were from other sources, including but not limited to burns from residential radiators and space heaters. It has been reported that radiator injuries cause also a substantial morbidity in children.2 Our experience has portrayed a much older burn victim. It has been this burn centre’s experience that the profiles of these patients are similar and that the circumstances of the injurious event can be predicted and thus prevented.

Methods

We performed a retrospective analysis of nine patients seen in an urban burn centre from January 2000 to January 2001. Seven patients were admitted directly to the burn intensive care unit and one died in the emergency department. One patient’s burns were managed on an out-patient basis. To be included in the study, a patient had to sustain at least a second-degree burn from prolonged contact with a residential radiator or space heater. Specific criteria investigated were patient’s age, living conditions, gender, injury location, %TBSA involved, injury severity, length of hospital stay, and the total cost of hospital care. Attention was also paid to disposition upon discharge.

Case report 1

JD was a 79-yr-old man who lived with his daughter and grandchildren. His past medical history was significant for mild dementia along with Shy-Drager syndrome. Prominent features of this Parkinsonian syndrome include vertigo and fainting spells with true loss of consciousness secondary to orthostatic hypotension and autonomic dysfunction. JD was in the bathroom one night and was found lying against the bathroom radiator by his daughter. He had sustained a 9%TBSA second- and third-degree burn over his back and left arm, which required skin grafting for closure. The aetiology of the fall was presumed to be related to his Shy-Drager syndrome. Length of stay and cost of stay were 39 days and $298,184. He was discharged to a rehabilitation facility with the plan to return home with his daughter when he was fully recovered. The daughter was assessed by staff to be competent and, after the incident, better educated as to her father’s safety needs.

Case report 2

RP was a 77-yr-old man with a history of recurrent atrial fibrillation and hypertension. His medications included a antihypertensive but no medication for atrial fibrillation. He was found by his son at home, where he lived alone, lying against a radiator. Contact with the radiator had been long enough for the patient to sustain a 4% TBSA second- and third-degree burn over his flank, which was skin grafted (Fig. 1).

Upon arrival in the emergency department, an EKG showed the patient to be in atrial fibrillation, a rhythm the patient had not been in for some time by report of his son. Syncopal work-up showed no other potential causes for the episode and the arrhythmia was presumed to be the aetiology for the fall. Shortly after admission, the patient’s rhythm converted back to normal sinus without intervention. The patient was not anticoagulated due to his risk of falling. Length of stay and cost of stay were 23 days and $175,213. He was discharged to a nursing home where he currently resides.

Results

Between the months of January 2000 and January 2001 nine patients were seen for burn injury secondary to prolonged contact with a home-heating device. Except for a 2-month-old infant and a 31-yr-old alcoholic, all subjects were between the ages of 62 and 86 yr (average age was 63 yr including the infant and young woman, and 76.6 yr excluding them). There was a preponderance of male victims (67%) over female (33%). Two of these elderly patients had fallen against a radiator and were unable to get up secondary to prior debilitating medical conditions. Four elderly were found unconscious against radiators and one woman unknowingly pressed against a space heater with her face while she slept (Fig. 2). The 2-month-old infant was left unattended next to a heating device and the 31-yr-old alcoholic was intoxicated when she passed out on one. Living conditions varied among victims. The infant was cared for by her single mother, while multiple family members lived with and cared for the alcoholic. Of the seven elderly patients, four lived alone and three lived with at least one other family member. Of those elderly that lived alone, each had a relative or friend checking up on him or her at least daily.

Almost all regions of the body were represented with injuries. Areas burned included head, face, neck, shoulders, upper extremities, hands, back, flank, and lower extremities. Most patients had multiple injured sites. TBSA ranged from 4 to 9% (mean TBSA, 4.6%) with both second- and third-degree burns in each case. All patients required split-thickness skin grafts for definitivive wound management.

Length of stay ranged from 0 days to 39 days with a mean of 12.3 days. Total cost of hospital care ranged from $48,467 to $298,184 with an average cost of $134,349.

Discussion

Burn injuries from radiators and home heating devices are a significant cause of morbidity and mortality in the elderly population (77% of these types of admissions at Temple University Burn Center were above the age of 60). Profiles of the victims of prolonged radiator contact were extremely similar. Except for two, the patients’ ages ranged from 62 to 86 years. All nine individuals were dependent on other people for activities of daily living; the infant, the alcoholic, and each elderly person were all at times disoriented and helpless. Even the elderly healthy enough to live alone had a family member visiting daily. The patient profile is so uniform that safety education and warnings should be targeted to those caring for both children and disabled dependents. In households that include members of these high-risk populations, measures should be taken to prevent these injuries. According to Harper et al.,3 the use of shelving or a protective grill to enclose the radiator can reduce the contact temperature of the radiator to 43 °C. The regenerative cell layer of the skin is destroyed at temperatures greater than 45 °C. Homeowners and landlords can install low surface temperature radiators for the same contact temperature reduction. Replacement of the bathroom radiator with a heated towel rack high on the bathroom wall and encasement of exposed pipes are two more ideas mentioned in this report.3

Each patient’s living situation was thoroughly investigated prior to discharge. The patient was only discharged to an environment judged safe by the staff. The infant was discharged from the custody of her mother to that of her grandmother, with whom she now lives. Two of the seven elderly passed away before they could return home, a mortality of 22%. Three patients now reside in a nursing home and three returned to their pre-admission home under closer supervision by family members and with more assistance from outside sources. None lived alone after the burn.

The average TBSA burned was 4.6%. The average cost to care for this burn was $134,349. As issues of cost containment grow in the medical field, our attention should be shifted even more toward injury prevention. By alerting the elderly and their caretakers with information about burn and fire safety, awareness can be heightened, prevention can be initiated, and costs can be decreased.

RESUME. Les Auteurs ont effectue tine analyse retrospective de neuf patients brules traites dans le Temple University Hospital Burn Center atteints de britlures causèes par des appareils pour le chauffage domestique entre janvier 2000 et janvier 2001. Cette population presentait tine prevalence d'hommes ages et une surface totale corporelle brulè de 4,6%. Deux cas sont prèsentès.

Bibliography

1. Burn Incidence and Treatment in the United States, Philadelphia Burn Foundation Fact Sheet, Adult Burn Facts, 1999.
2. Home radiator burns among inner-city children, MMWR Morbidity and Mortality Weekly Report; 45(38): 814-5, 27 Sept. 1996.
3. Harper R.D., Dickson W.A.: Domestic central heating radiators: a cause for concern in all age groups. Burns; 22: 217-20, 1996.