SUMMARY. Burn injuries related to domestic fire are well generally reported, but burns caused by the flames of liquid-alcohol-burning chafing-dish stoves are rarely reported. Most Chinese people like to eat very hot dishes, especially in the cold winter period. The liquid-alcohol-burning chafing-dish stove is one of the most popular and convenient tools for Chinese people cooking such dishes, and liquid alcohol is always used as fuel, with the result that China has the highest rate of such burns in the world. Data from the burn unit at the 477th PLA Hospital in China were studied to find the number of admissions due to this kind of burn. During the period 1989-2000, out of 1856 admissions to our burns department, 169 (9.1%) were due to flame burns caused by an alcohol-burning chafing-dish stove. Of the 169 victims, 105 (62.1%) were adults, 23 (13.0%) were elderly, and 42 (24.9%) were children. The distribution of cases in relation to total body surface area (TBSA) involvement was 108 cases (63.9%) with TBSA burns of 0-5%, 46 (27.2%) with 6-10% TBSA, and 15 (8.9%) with Ž 11% TBSA. Most flame burn injuries of this type were caused by misuse of the alcohol-burning stove. The annual number of flame burn admissions declined during 1989-2000 owing to a decrease in the use of such stoves and the increase of stoves burning solid alcohol. Further educational and legislative measures are required to prevent this type of burn.
Burns are assuming ever greater importance as a cause of ill health in the developing nations. The major factors include gross ignorance of fire prevention and the persistence of traditional old customs. The majority of burns are domestic, and fire is the predominant cause.1 Burn injuries related to domestic fire have well been reported in many articles,1-6 but burns caused by the flames of liquid-alcohol-burning chafing-dish stoves have rarely been the object of attention. Most Chinese people like eating very hot dishes, especially in cold winters, and the liquid-alcohol-burning chafing-dish stove is one of the most popular and convenient tools for Chinese people cooking such dishes. But the use of liquid alcohol as a fuel is very dangerous. Consequently, China has the highest rate of liquid-alcohol-burning chafing-dish-related burn injuries in the world. There has previously been no report and no investigation concerning factors relevant to burns caused by flames from the liquid-alcohol-burning chafing dish stove in such cases, which mostly occur in China. This prompted us to perform a retrospective study of a case series over the past 11 years. One of the primary aims of the study is to raise public awareness concerning burn prevention.
One hundred and sixty-nine patients suffering from burns caused by the flames of alcohol-burning chafing-dish stoves were admitted to the 477th PLA Military Hospital in Hubei Province, China, over the 11-year period from December 1989 to December 2000. The clinical notes of 169 patients were available for review and only these patients were included in the study. Data analysis from the case notes included the patient’s sex, age, and socio-economic status, the mechanism of injury, the time and season of injury, the distribution and extent of the burn, treatment, and prognosis. All data were entered into a computer database and analysed.
All 169 victims were burned by the flames of a liquid-alcohol-burning chafing-dish stove. Of the 169 victims, 132 were injured while having dinner at a restaurant or at home; of the others, nine were waiters and twenty-eight were waitresses, injured when adding liquid alcohol to a restaurant stove.
Sex, age, and socio-economic status
Of the 169 victims, 91 were male (53.8%) and 78 were female (46.2%). One hundred and five (62.1%) were adults, 22 (13.0%) were elderly (60 yr and above), and 42 (24.9%) were children. The distribution of the patients’ ages is shown in Table I. Among the victims, there were 17 factory workers, 18 farmers, 46 businessmen, 35 students, 24 officers, 28 waitresses, 9 babies, and 9 waiters (Table II). <% createTable "Table I ","Distribution of patients by age",";Age (yr);<10;10-20;20-40;40-60;>60@;Number of patients;19;41;48;39;22","",4,300,true %> <% createTable "Table II","Distribution of socio-economic status",";Socio-economic status;Army officers;Businessmen;Students;Factory workers;Farmers;Waitresses;Waiters;Children@;Number of patients;24;46;35;17;18;28;9;9","",4,300,true %>
Incidence by season and mechanism of injury
A seasonal variation was observed, with the majority of cases (124 patients, 73.4%) occurring in winter (Fig. 1). This is the coldest season in China and a period when people use alcohol-burning chafing-dish stoves much more than in other seasons. The majority of cases (116 patients, 68.6%) occurred at a restaurant during dinner, while the remaining cases (53 patients, 31.4%) occurred at home. Most cases occurred when 95% liquid alcohol was added to an alcohol-burning chafing-dish stove when the temperature of the stove was high enough to ignite the alcohol, causing burns in people in the immediate vicinity of the stove. <% immagine "Fig. 1","gr0000001.gif","Seasonal distribution.",230 %>
Site of body burned, depth, and percentage of TBSA
The burn wounds were predominantly located in the face and neck (146 cases, 86.4%). Of the 169 victims, 45 sustained burns in both upper extremities (Fig. 2). One hundred and seventeen victims (69.2%) sustained superficial partial-thickness burn, 50 (29.6%) had deep partial-thickness burn, and one patient had full-thickness burns (Table III). The percentage of TBSA burned area ranged from 0.5 to 11.0 (mean percentage, 3.2 ± 2.3).
<% immagine "Fig. 2","gr0000002.gif","Sites of body burned.",230 %>
<% createTable "Table III","Distribution of depth of burn wounds",";Depth of burn;Superficial;Deep second degree;Full thickness@;Number of patients (percentage);117 (69.2);50 (29.6);1 (0.6)","",4,300,true %>
Treatment and length of hospital stay
Of the 169 victims, 123 (72.8%) recovered completely after exposure treatment and 17 (10.1%) needed to change dressings after a period of exposure treatment. Twenty-nine (17.2%) received tangential excision or escharectomy and early skin autograft, while the remaining 22, with deep partial-thickness burns, received a delayed procedure because the patients were unwilling to undergo an operation. Out of all the victims, 106 stayed in hospital for less than two weeks, while 60 stayed for more than a month. The mean and median lengths of hospital stay were respectively 18.0 ± 12.5 days and 12 days (range, 7-43 days).
Prognosis and trend
All the victims recovered completely and were discharged. Eleven patients developed blisters in the healed burn wounds and 26 developed mild itching in healed areas.
From the viewpoint of cosmetology, 41 victims (24.3%) were dissatisfied with the appearance of their burn scars, pigmentation, or other abnormalities such as hypertrophic scars, especially in the face and neck. The quality of life of many of the victims was much worse during the post-injury period than prior to injury. The annual number of the burn admissions showed a decreasing trend in the period 1989-2000 (Fig. 3). <% immagine "Fig. 3","gr0000003.gif","Trend in number of patients.",230 %>
Burn injuries related to domestic fire have been well reported in many articles.1-6 Most burn injuries occur as a result of domestic accidents and are therefore preventable.4 Burns are becoming more and more important as a cause of ill health in the developing nations. The majority of burns, as already said, are domestic, with fire being the predominant cause.1 Owing to the comparative rarity of the liquid-alcohol-burning chafing-dish stove in countries in the western world, this type of burn is rarely reported there. In contrast, most Chinese people like eating very hot dishes, especially in cold weather, and this type of chafing dish is very popular. The fuel used is always liquid alcohol - a very dangerous practice - and this explains why China has the highest rate of such burns in the world. The data in this study, from the burns department at the 477th PLA Hospital, China, were reviewed in order to assess the number of admissions due to flame burns from alcohol-burning chafing-dish stoves.
The population of the study demonstrated distinct demographic characteristics. The two sexes were equally represented (ratio, 1:1). Of the 169 victims, 105 (62.1%) were adults (18-60 yr), 22 (13.0%) were elderly (60 yr and above), and 42 (24.9%) were children (< 14 yr). These figures are not surprising, as many adults like eating very hot dishes in restaurants in China, while the elderly and children seldom go to restaurants for a meal. Among the 169 victims, there were more businessmen, students, waitresses, and army officers than other people. As businessmen, students, and officers have many more opportunities to go to a restaurant for dinner than other people, they are more exposed to the risk of flame burns from liquid-alcohol-burning chafing dishes. Restaurant waitresses are particularly liable to this kind of burn.
The predominant incidence of this type of burn was in winter (124 patients, 73.4%). There is a greater likelihood in the cold season of using chafing dishes, since winter is the season when Chinese people tend to eat hot dishes more than in other seasons.
Most of the accidents happened very rapidly, in less than 2 seconds, so that the victims were able to move away quickly, resulting in a very short time contact with the flame and resultant superficial or deep-partial thickness burns. For this reason most of victims (117, 69.2%) sustained superficial partial-thickness burned wounds, 50 (29.6%) had deep partial-thickness burns, and only one had full-thickness burns. The full-thickness burns occurred when the victim’s clothes caught fire, following contact with flames from the stove.
As might be expected, the burn wounds were predominantly located in the face and neck (146 cases, 86.4%). This is because the face and neck were in close proximity to the stove, unprotected by clothes, and thus very vulnerable. Most other body sites were protected by very thick winter clothes, and were therefore seldom injured.
Most of the victims recovered completely in less than two weeks through the exposure method - as said, most of them had only superficial thickness burns. Twenty-nine patients (17.2%) received tangential excision or escharectomy and early skin autograft. The median time of hospital stay was 12 days (range, 7 to 43 days). Physicians and patients should not underestimate the risks involved in such wounds - the onset of infection can change a superficial thickness burn to a deep second-degree burn, or deep second-degree burn to full-thickness skin loss, resulting in burn scars and other abnormalities such as hypertrophic scars in the face, neck, and hands. From the viewpoint of cosmetology, there were severe sequelae that influenced the quality of the victims’ lives - the quality of life of many victims was much worse after the burn than before.
The annual number of burn admissions has shown a decreasing trend, owing to a reduction in China in the use of the liquid-alcohol-burning chafing dish and to improved safety measures, as also to the fact that solid fuel is now preferred in many restaurants. The decreasing trend in the number of burn patients in our study was similar to that observed by Sarhadi,5 who found that in the period 1981-1993, of the 2771 admissions to a burn unit, 1181 (43%) were due to flame burns and that the annual number of flame burn admissions declined. In the Glasgow region in Scotland 50% of domestic fires leading to non-fatal burn or death were caused by misuse of smoking materials. The annual number of fire fatalities when reviewed for a longer period (1973-1995) also showed a decreasing trend. This differs from the study of Duncanson,3 who showed that age-standardized hospitalization rates for fire-related injury over the period 1988-1995 in New Zealand hospitals were stable, with an overall admission rate of 5.45 hospitalizations per 100,000 persons per year.
This study reveals some interesting fact related to burns caused by flames from liquid-alcohol-burning chafing-dish stoves, including the mechanism of the injuries, the socio-economic status of the victims, the site of the burns, etc. Because of Chinese people’s predilection for hot dishes and their widespread use of this type of chafing dish, it is estimated that 10,000 such burn injuries occur every year. For the purpose of prevention of these injuries, two recommendations are made: 1. people should be warned about the dangers associated with the use of liquid alcohol as a cooking fuel, and safer ignition fluids ought to be popularized - the use of the liquid-alcohol-burning chafing-dish stove should be forbidden in China and a substitute device should be designed; 2. safety measures should be reinforced, especially in restaurants and hotels.
RESUME. Les brulures domestiques sont en gdn6ral bien documentdes mais les brulures caus6es par les flammes du poelon de table aliment6 a alcool liquide ont 6t6 rarement 6tudi6es. Les Chinois aiment manger des mets tres chauds, particulierement pendant la saison froide, et le poelon de table aliment6 a alcool liquide est commundment utilis6 en Chine pour r6chauffer les aliments, employant I'alcool liquide, avec le rdsultat que la Chine pr6sente le taux le plus 61ev6 du monde pour ce qui concerne ce type de brtilure. Les Auteurs ont 6tudi6 les donn6es du 477eme h6pital PLA en Chine pour 6valuer le num6ro des hospitalisations dues a ce type de brulure. Pendant la pdriode 1989-2000, sur les 1856 patients brulds hospitalis6s dans le centre des br616s des Auteurs, 169 (9,1 %) 6taient atteints de brulures caus6es par les flammes du poelon de table aliments a alcool liquide. Sur ces 169 patients, 105 (62,1%) dtaient adultes, 23 (13,0%) agds plus de 60 ans et 42 (24,9%) enfants. La distribution des cas par rapport a la surface corporelle totale (SCT) br616e 6tait de 108 cas (63,9%) atteints de brulures dans 0-5% SCT, 46 (27,2%) dans 6-10% SCT et 15 (8,9%) dans >_ 11% SCT. La plupart de ces brulures dtaient provoqu6es par 1'emploi erron6 du poelon. Le num6ro annuel des patients hospitalis6s atteints de brulures dues aux flammes diminuait dans la periode 1989-2000 A cause de la r6duction de 1'emploi de cc type de poelon et de Femploi plus diffus du poelon aliment6 a alcool solide. Les Auteurs considerent en conclusion des mesures informatives et 16gislatives pour pr6venir cc type de brulure.