Annals of the MBC - vol. 3 - n' 4 - December 1990


Poppi V., Schiavon R, Nicoli Aldini N., Righini S.

Istituto Ortopedico "Rizzoli", Bologna, Italia

SUMMARY. Using data from the Emilia-Romagna Region concerning bum patients admitted to hospital in the period 1980-86, a clinical and epidemiological analysis was carried out based on the evaluation of certain parameters, with the purpose of assessing the overall incidence of the burn pathology, the adequacy of care and the possible need for a different organizational approach. It is difficult to understand the long mean duration of hospitalization for the kind of traumatic pathology presented by the burn, a duration not related to any specific individual factor. An explanation of the phenomenon may be the effect that the treatment of bums in nonspecialized facilities has on the clinical course, the duration of hospitalization, the evolution of the disease and consequently on the economic and social cost.


The care required by a burn patient depends not only on an appropriate medical protocol but also on an efficiently based organizational system. At present these two components do not always in fact coexist, and it is precisely on the care and organizational level that the greatest shortcomings occur, as the majority of burn patients are not treated in specialized structures specifically created for bum therapy, which are the only ones capable of providing care of the necessary quality. In order to verify the validity of this assumption it was decided to make a preliminary definition of the burn problem within the geographical dimension of a single Region, Emilia-Romagna, as an example of a situation, still however to be accuratelv ascertained, that is more or less common to all the Regions of Italy. This preliminary investigation ~Nas the purpose of the present paper.

Materials and methods

The riles for statistical (1) the Emilia-Romagna 1 iii(iciiiioioii)c ()b,,ci-\~ition Station) kept in 1980-86 lor all patients, discharged froni hospitals in the first 7 or 10 days (depending on the year of survey) of every month. The 22 12 files of burn patients in this period provided a series of data about hospitalization (duration, type and department of' therapy), personal and administrative data (age. sex, Local Health Unit (LHU) of origin. 1-Ht of hospitalization, etc.) and clinical data (site of- burn, depth of lesion, modality of trauma), which though incomplete (there is no reference for example to ille extent of the burned area and there are no electi-i,,~.ii or chemical burns) we believe are sufTicient for the purposes of our investigation. The statistical reliabilit~ of the values obtained was verified by calculation of the standard deviation and Student's test.


About 1000 bum patients are hospitalized every year in the Emilia-Romagna Region (one every 600 admissions). It may therefore be assumed that the overall annual number of burns, including those treated on an out-patient basis, is in the range of 4000-4500 (Tab. 1).

Sex. There is a constantly higher admission rate among males (61%)

Age. Distribution by age group, on the basis of ial conditions (preschool age; school age; spec ic soc, adolescence and youth; working age; retirement age), indicates a high rate of burns in the first 12 years of life (24.6% of the total number), particularly if related to the percentage of this age group in the overall population. It thus becomes clear. for example, that the risk of suffering a burn in the first 5 years of life is twice as great as in other periods of life (Tab. 2).

Anatomic site. The lower limbs are in absolute terms the part of the body most exposed to bums 0 8%), followed by the eye (I I (Vo), the head and face (10%), the hand (9.31%), the upper limbs (8.2%) and the trunk (7.2%). The remaining 33% of burns are in various anatomic sites. The fact that about two thirds of the burns are limited to a single anatomic site and only a third inNol\c more than one site suggests, in the lack of specific information regarding the extent ofthe hUrned surfaces, that burns c\tcnding over more than 30% of body surface area (the conventionally accepted extent in the adult to distinguish serious burns from slight hurns) i-cpic-,cm no more than 15% of all burns.

Mortality'. The 38 deaths recorded in the 7 years of the survey (and the 19 estimated annual cases) represent 1.6% of all bum patients admitted. The duration of hospitalization before death was less than 40 days in just over one third (36.8) of deceased patients. This suggests that at least in a certain number of cases of mortality the cause was not the bum and its direct complications but the onset of other less direct complications. A more evaluation of bum-induced mortality moreover also take into consideration precise should deaths occurring on the scene of the accident or without any period of previous hospital admission.

Place of the accident. This was indicated only in a quarter of the files. The place of the accident was the work environment (23%), the home (26%), the street (2%) and other places (49%).

L1W of originILHU of hospitalization. The distribution of hospitalization in the Region appears to be fairly homogeneous in the Provinces and proportional to the population of each, with a mean rate of 28.3 admissions for bums per 100,000 inhabitants (maximum in the Province of Forli, 36; minimum in the Province of Ravenna, 19). These figures however probably express the care xxload>> in each Province rather than the bum rate per Province, inasmuch as the LHU of origin and the LHU of hospitalization are the same only in 50% of cases.

Departments of hospitalization. The bum patients were admitted to 83 Departments in all, comprising 14 different specializations. 80% of the patients were however admitted to just 5 kinds of specialized Department, with a clear prevalence of Dermatology (37.6% of admissions) and General Surgery (19.5%), followed at a distance by Plastic Surgery (4.2%), Eye Unit (4.4%) and Paediatrics (3.1%).

Average no. of bed days

Hospitalization. Throughout the Region, in the period considered, the overall annual number of days of hospitalization still corresponds, though with a certain progressive drop in the number of admissions, to 30,000-35,000 (calculated) and to 120,000-125,000 (estimated), with a mean hospitalization time, which has remained constant, of 136.5 days per burn patient, i.e. about 4.5 months (Graph 1). The mean duration of hospitalization was 89 days for patients with first-degree burns, 117 days for patients with second-degree bums, and 234 days for patients with third-degree burns. The burn illness does not therefore appear to be treated as an acute pathology but as a chronic disease, if one considers that the length of hospitalization was more than 40 days in over 80% of the cases and more than 6 months in 24%.


The hum disease is part of the general field of traumatology, with its characteristic peculiarities as regards both treatment and the structural and organizational problems involved, because of the enormous variety of clinical, prognostic and therapeutic situations that each individual bum entails. Obviously a simple scald of minor extent and depth will require a different commitment from a serious bum that necessitates the application of all the therapeutic principles that have asserted themselves over the last decades (complete and early reanimation, early surgical treatment and active and passive physiotherapy in order to protect vital functions, avoidance of acute phase complications and prevention of late complications). The choice between out-patient, hospital and intensive care must also be regulated by the diversity of the conditions. All this ,however presupposes an extensive awareness of the problem, together with practical experience. On the ibasis of the results of our own investigation and of those who we trust will continue it further in more complete fashion, we therefore think it is important to reconsider the relationship between the relatively few Centres which, because of the skill of the staff and the quality of the facilities, are in a position to provide correct care for the relatively few bum patients who arrive there, and the great number of patients who frequently do not receive treatment appropriate to their condition. These Centres, in our opinion, cannot therefore exhaust their activity and experience internally - they must also express themselves by arousing the awareness of the administrative and political authorities in the organization of burn patient care in the territories for which they are responsible and in the integration of university teaching with training and refresher courses for medical students and also for qualified medical staff, offering a series of practical guidelines, in view of the fact that the normal curriculum of studies does not include any specific teaching on burns. Much has been done for the severely burned patient, but much still has to be done for bum patients

  1980 1981 1982 1983 1984 1985 1986
N of records 535 438 280 265 247 218 226

male %

63.5 59.8 60.0 63.3 60.7 60.0 59.7

female %

36.5 40.2 40.0 36.7 39.3 40.0 40.3
Estimated N of patients 1605 1314 1120 1060 988 872 904
Estimated bed days 73000 60000 41000 35000 32000 29000 31000
Averange of bed days per year 137 138 148 133 129 134 138
Table 1 Survey sample of patients admitted for burns in the hospitals in the Emilia Romagna region in 1980-1986


0 - 5 years 4.5% 16.9% 104
6 - 12 years 7.9% 7.7% 112
13 - 20 years 11.2% 9.7% 124
21 - 50 years 41.0% 37.0% 119
51 - 65 years 20.2% 15.8% 174
over 65 15.0% 11.8% 224

Table 2 Age distribution of burned patients in the Emilia Romagna region in 1980-1986 







TOTAL 6.5 89 29.9 117 14.4 234 100 119
DERMATOLOGY 40.9 88 39 121 37 208 36.8 150
SURGERY 22.9 83 28 112 9.4 160 19.5 107
BURNS UNIT 9 128 14.5 118 33 272 10.8 143
PLASTIC SURGERY 0 0 0 0 2 190 4.2 147
ORTHOPAEDICS 2.0 50 0.7 214 0.9 263 2.7 135
EYE UNIT 1.3 195 0 0 0.3 30 4.4 102
PAEDIATRICS 9 42 3 54 0.3 270 3.1 62
OTHER 14.5 97 14.5 118 15 265 118.5 151

Table 3 depth of burn and different speciality departments


RÉSUMÉ. Les Auteurs ont utilisé les données relevées dans la Région Emilia-Romagna chez les patients brûlés hospitalisés pendant la période 1980-1986 pour effectuer une analyse clinico-épidémiologique basée sur l'évaluation de certains paramètres afin d'évaluer la fréquence complessive de cette pathologie, la qualité de l'assistance et la nécessité éventuelle d'un divers aménagement organisationnel. Il est difficile de comprendre la durée moyenne très longue de l'hospitalisation pour une pathologie traumatique comme la brûlure parce qu'elle n'est pas corrélée avec aucun facteur spécifique individuel. La recherche des motifs qui contribuent à ce phénomène a souligné les effets que le traitement de la brûlure dans une structure non spécialisée peut avoir sur le cours de la maladie, la période d'hospitalisation, l'évolution de la pathologie et en conséquence le coût économico-social.


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  2. Bowser B.H., Caldwell F.T., Baker J.A., Walls R.C.: Statistical methods to predict morbidity and mortality: self-assessment techniques for bum units. Bums incl. Therm. Ini., 9: 318-26, 1983.
  3. Helm P.A., Walker S.C., Peyton S.A.: Return to work following hand burns. Arch. Phys. Med. Rehabil., 67: 297-8, 1986.
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  5. Stoddard F.J., Norman D.K., Murphy J.M.: A diagnostic outcome study of children and adolescents with severe burns. J. Trauma, 29: 471-7, 1989.


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