STATISTICAL AND EPIDEMIOLOGICAL DATA OF 800 BURN PATIENTS IN A S-YEAR PERIOD

lliopoulou E, Lohaitis A., Poulikakos L., Bei A.,

Department of Plastic and Reconstructive Surgery and Burns, Unit of Peripheral Hospital Kat-Kifissia, Athens, Greece

SUMMARY. This study is an analysis of statistical and epidemiological data in a series of 800 bum patients hospitalized in the period 1983-1987. The parameters recorded and studied were: 1) number of admissions; 2) classification according to sex, age, extent and thickness of burns and causative agent; 3) outcome of the burn disease, as well as the mortality rate in various groups, depending on the extent of the burn and the age of patients. The results stress that male burn patients outnumber female by 2.11, despite women's slight preponderance in the general population (1:1.03), and that the largest group of patients comprises those with minor bums (290 patients with 10%. 292 with 20% T13SA) and who are comparatively younger (103 cases in the group of 20-30 years, 166 cases in the group of 30-40 years). The data coincide with those presented by loannovich and al., excluding the fact that our Department treats patients over 15 years of age. The mortality rate has decreased in all groups, but is still no less than 11.7%. The ratio of men to women who died of burns was L4: 1.

Greece is a country of 131,986 kM2, with a population of about 9.8 million. Bum victims are treated in departments of General Surgery, as well as in a few specialized centres with special beds and equipment. Our Department admits and handles about 54% of burns victims from all over the country. As a general rule, treatment follows a concrete therapeutic model (Muir-Barclay), i.e. administration of great quantities of homogenized dry plasma starting from the first post-burn hours.

Our study deals with the following:

1. number of burn victims admitted to our Unit over the aforementioned period: 800
2. classification of patients according to sex, age, thickness, extent of lesion, causing agent and outcome
3. mortality rate of patients according to age and extent of burns
4. comparision with data from the international literature, as far as the mortality rate is concerned.

Our conclusions are the following:

• the curves of the diagrams mortality-age and mortality-extent of bum attain their peaks in higher ages and larger extents of lesion
• mortality rate in this series is 11.7%, which is lower than the overall mortality rates of other countries, such as Nigeria (26.9%) (1), Turkey (35.7%) (3), Finland (27%) (5) and U.S.A. (24.5%) (9), but is higher than in other countries (China, U.S.A.) in more extensive burns and burns in the elderly
• due to lack of more sophisticated data the calculation of probability of survival and LA50 has not been feasible
• a drastic improvement of the survival indices has been observed following the application of up-to-date therapeutic models. Out of the 94 cases with fatal outcome 47 (50%) occurred during the period 1983-1984 and the remaining 47 during the following period (1985-1987).

Material and methods

During the period mentioned above 800 burn victims were handled in our Unit. The male to female ratio was 2.3:1 (561 men, 239 women).
These patients were classified in seven age groups (up to 20 yrs of age, 20-30 yrs, 30-40 yrs, 40-50 yrs 50-60 yrs, 60-80 yrs, 80-100 yrs). According to the extent of TBSA, our patients were divided into 9 groups:

1. Gr. 1: 290 patients, 0-10% TBSA, age 20-100 yrs, 230 men, 60 women, 5 deceased, mortality rate 1.7%
2. Gr. 2: 292 patients, 10-20% TBSA, age 20- 100 yrs, 188 men, 104 women, 25 deceased, mortality rate 8.5%
3. Gr. 3: 106 patients, 20-30% TBSA, age 20-100 yrs, 88 men, 18 women, 13 deceased, mortality rate 12.26%
4. Gr. 4:  yrs, 20 30%
5. Gr. 5:  yrs, 10 34.7%
6. Gr. 6: 18 patients, 50-60% TBSA, age 30-80 yrs, 13 men, 5 women, 7 deceased, mortality rate 38.8%
7. Gr. 7: 13 patients, 60-70% TBSA, age 20-100 yrs, 9 men, 4 women, 8 deceased, mortality rate 61 ~ 5%
8. Gr. 8: 12 patients, 70-80% TBSA, age 30-100
   4: 40 patients, 30-40% TBSA, age 20-100 men, 20 women, 12 deceased, mortality rate
   5: 23 patients, 40-50% TWA, age 20-100 men, 13 women, 8 deceased, mortality rate yrs, 8 men, 4 women, 10 deceased, mortality rate 83.3%
9. Gr. 9: 6 patients, 80-100% TBSA, age 30-60 yrs, 3 men, 3 women, 6 deceased, mortality rate 100%.

The main causing agent was flame or scalding (96.5%), the rest being electrical current (2.5%), chemical substances (0.9%) and sun exposure (0.1%).
The outcome was satisfactory in minor burns or burns of moderate severity (30%) with the exception of elderly patients (39 deceased in the age group 60-80 yrs, and 24 in the group of patients over 80 years of age). Out of the total number of deceased patients (94) 8 died during the first 24 hrs, 13 on the second day post-burn, 23 on the third day, 14 on the fourth day and 36 after the tenth day post-burn. The overall mortality rate was 11.7% and the causes of death were non-reversible shock in 10 cases, cardiac-pulmonary insufficiency in 35 cases, sepsis in 35 cases and renal insufficiency in 14 cases.
A more concrete record of cases with fatal outcome according to age, extent of TBSA and thickness is given below.

• Age up to 20 yrs: 1 deceased, 70% TBSA, whole thickness
• Age up to 30 yrs: 10 deceased 3 with 40% TBSA, whole thickness 4 with 80% TBSA, whole and partial thickness 3 with 95% TBSA, whole and partial thickness
• Age up to 40 yrs: 6 deceased 1 with 20% TBSA, whole thickness 1 with 60% TBSA, whole thickness 1 with 70% T13SA, whole thickness 1 with 80% TBSA, whole thickness 2 with 95% TBSA, whole and partial thickness
• Age up to 60 yrs: 14 deceased 3 with 30% TBSA, whole and partial thickness 3 with 40% TBSA, whole and partial thickness 3 with 50% TBSA, whole and partial thickness 2 with 60% TBSA, whole and partial thickness 2 with 70% T13SA, partial thickness 1 with 95% TBSA, partial thickness
• Age up to 80 yrs: 39 deceased 4 with 10% TBSA, whole and partial thickness 12 with 20% TBSA, whole and partial thickness 4 with 30% TBSA, whole and partial thickness 5 with 40% TBSA, whole and partial thickness 4 with 50% TBSA, whole and partial thickness 4 with 60% TBSA, whole and partial thickness
• Age up to 100 yrs: 24 deceased 1 with 10% TBSA, whole thickness 12 with 20% TBSA, whole and partial thickness 6 with 30% TBSA, whole and partial thickness 1 with 40% TBSA, whole thickness 1 with 50% TBSA, whole thickness 2 with 60% TBSA, whole and partial thickness 1 with 80% TBSA, whole and partial thickness

Greece is marching on the way of the development of the National Health System. Despite medical changes and amelioration of treatment of bum victims, considerable organizational and material -technical deficiencies still persist. A brief demographic analysis of the Greek population is necessary. The most populous group in our country is that of young people of 15-19 yrs (7.6%) = 751,664, ratio men to women being 1.06: 1; the elderly (80-90 yrs) comprise 4.5% = 152,434 with ratio men to women being 1: 1.4. The ratio men-women for all the population is 1: 1.03 (6,7).
Death cannot be prevented but can and must be delayed. Statistics concerning mortally do not provide enough data on the real situation of burn victims or the course of the disease (10). Therefore, comparisons between different groups of patients with nothing in common but characteristics of their burn and age cannot lead us to realistic and real conclusions over the vast field of the burn disease. One of our main problems in our effort to assess probabilities of survival in the Greek population has been a lack of statistical data, excluding loannovich's study. Extent, depth and type of burn in relation to the age of the patient are of paramount importance in the early assessing of probability of survival. But they are not enough, and further data on pre-existing diseases, concomitant injuries, development of ARDS, sepsis and other burn complications have not been meticulously recorded.

Our study comprises 800 patients handled in our Unit over the period 1983-1987 (561 men, 239 women). The data of this study (age, sex, depth and extent of burn, cause and outcome) do not vary substantially from those of the international literature. The great majority of our patients belonged to the age group 20-60 yrs. The relative incidence rate of men to women is 2.11 while relative mortality tends to balance men to women IA:L The causing agent was mainly flame and scalding (96.5%), the remaining 3.5% consisting of electrical current, chemical agents and exposure to sun. Thickness and extent are presented in relation to age. Largest numbers are crowded in the groups of 10% and 20~/o TBSA. As for the thickness concerned in the group of 10%, full-thickness burns are preponderant (which was the main reason, apart from the location, why they were admitted to our Unit). An obvious preponderance of partial-thickness burns is observed in the rest of the groups.
The outcome of burns as it appears in this study does not present significant deviations from the international data. Death is due to shock, respiratory failure from ARDS, cardiovascular insufficiency, sepsis and renal insufficiency. Out of 94 deceased patients, 63 (67%) were old (70-95 yrs of age). The ratio men to women (60:34) was L7:1. All burns victims over 80 yrs of age and over 40% TBSA were female. However our total data indicate that there is no discordance with Glasheen, who stresses that men are more prone to bums, especially in the group 20-29 yrs of age (2).
The ambition of the authors of this study is nothing more than to give an outline of our overall results, and to trace a path to more meticulous and sophisticated analyses in the future.

RÉSUMÉ. Nous analysons les données statistiques et épidémiologiques d'une série de 800 patients brûlés hospitalisés pendant la période 1983-1987. Nous avons étudié les paramètres suivants: 1) le numéro des cas; 2) la classification selon le sexe, l'âge, la superficie et la profondeur des brûlures, et l'étiologie de la lésion; 3) le cours de la maladie et le taux de mortalité dans les divers groupes des patients, en relation à la superficie de la brûlure et à l'âge. Les résultats indiquent que les patients brûlés mâles sont plus nombreux que les patients femelles, avec un rapport de 2.3: 1, malgré la légère prépondérance des femmes dans la population nationale (1: 1.03), et que le groupe plus grand des patients est composé des cas avec brûlures mineures (290 patients avec 10% TBSA, et 292 avec 20%) et des patients rélativement jeunes (103 cas dans le groupe 20-30 ans, 166 cas dans le groupe 30-40 ans). Les données correspondent à celles de loannovich et al., à l'exception du fait que dans notre Division nous ne soignons que les patients âgés de plus de 15 ans. Le taux de mortalité est diminué pour tous les groupes, mais il reste toujours à 11.7%. Le rapport des décédés hommes: femmes a été 1.4:1.

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