EPIDEMIOLOGY OF BURNS IN ASSIUT PROVINCE, EGYPT, DURING THE LAST TWO YEARS

EI-Sonbaty M.A., El-Oteify M.

Department of Plastic Surgery, Faculty of Medicine, Assiut University, Egypt

SUMMARY. Between January 1988 and January 1990, 559 bum patients were admitted to the Burn Units of Assiut El-Shamla General Hospital and Assiut University Hospital. A retrospective study was carried out to analyse the age, sex distribution, bum aetiological factors, modality of treatment, hospital stay and mortality rate. It was found that males and females were equally affected by bum accidents. Children were involved in 50.9% of the cases. The burn was due to flame (67.9%), hot liquids (29.9%), electricity (1.2%) and chemicals (1%). The number of deaths was 201 (33.5%). The causes of this high mortality are discussed.

The patient with a major bum has suffered one of the most severe forms of trauma. The number of victims may vary from country to country. In Assiut city we have two Bum Units, which receive approximately 300 patients with bum injury as in-patients every year. These patients are treated according to the classic methods, and we introduce fluids according to the Parkland formula (Baxter, 1981). Skin grafting is carried out when the bum wound has eliminated eschar and is covered with granulation tissue.

The aim of this study is to assess the efficiency of this kind of treatment and to collect epidemiological data which may help in preparing a prevention programme against bum accidents.

From January 1988 to January 1990, 599 bum patients were treated in the Bum. Units of Assiut El-Shamla General Hospital and Assiut University Hospital. Of these 300 were females and 299 were males.
The ages of the patients ranged from a few months to 80 years. Children less than 12 years of age were the most commonly affected group of patients (50.9%), followed by the age group from 12-30 years (32.4%) (Fig. 1).

Regarding aetiological agents,. the bum was due to flame in 67.9% of the cases, hot liquids (29.9%), electricity (1.2%) and chemicals (1%) (Fig. 2).

The home was the commonest place where bum accidents occurred (94.3%), followed by the street (3 . 3%) and the place of work (2.4%).
The extent of bum as a percentage of BSA was up to 10% in 15.4% of the cases; it ranged from 11 % to 20% in 2 3.7%, from 2 1 % to 40% in 32.4% and from 41% upward in 28.7% (Fig. 3).

In comparing times of injury, we found that there was a high frequency of bum accidents during winter months. This may be attributed to the frequent use of fire for heating (Fig. 4).

The total cumulative hospital stay was 11,459 days, with an average of 19 days per patient. The longest hospital stay was 313 days for a female patient aged 26 years with bums involving 40% of the body surface, who was admitted to the EI-Shamla Bum Unit. Our average period of hospital stay was relatively a short one, which may be due to the high mortality rate (33.5%), when the mean hospital stay was 6 days, and to the early discharge of the less severe cases for out-patient follow-up and observation.Comparing the number of deaths in relation to the extent of bum, it was found that there was no mortality in patients with bums in less than 10% BSA and that as the percentage of bum increased, the mortality rate also increased until it reached 100% in patients with a bum extent more than 60% BSA (Fig. 5).

The causes of the high mortality in our bum patients (33.5%) may be attributed to:

1. the high number of children involved (50.9%) whose burns, in contrast to other reports (Lyngdorf et al., 1986, Barisoni et al., 1987, loannovich et al., 1987 and Jiz et al., 1989), were caused by flames (55%) more frequently than by hot liquids (45%);
2. the high percentage BSA burned: 22% of our patients had a bum size more than 50% BSA;
3. the high incidence of sepsis in the burn wound, especially by Gram-negative bacilli and Staphylococcus aureus organisms;
4. the common use of highly flammable synthetic clothes which increase both the extent and the depth of bum.

The high incidence of flames as a cause of bums in our patients can be explained by the wide use of the "Chinese stove" (Fig. 6). The high number of accidents occurring because of this type of stove suggests that it must be regarded as intrinsically very hazardous. We would make the comment that this stove contains no safety measures to prevent accidents. Obviously many of the accidents arose from lack of awareness of the hazardous nature of the equipment. We therefore hope that the data which we present will be helpful to increase public awareness of the situation. We would also suggest that the manufacturers consider the possibility of modifying the design of the equipment to make it safer to use.

In order to prevent this life-threatening event, measures should be taken by health-care officials and physicians to educate the public in bum prevention through every available means of communication.

RÉSUMÉ. Dans la période janvier 1988/janvier 1990, 599 brúlés ont été hospitalisés chez les Unités de Brúlés de Mópital Général El-Shamla a Assiut et de Mópital Universitaire á Assiut. Les Auteurs ont effectué une étude rétrospective pour analyser certains aspects de ces patients: l'áge, la distribution sexuelle, les facteurs étiologiques des brúlures, la modalité de la thérapie, la période de I'hospitalisation et le taux de mortalité. lls ont trouvé que les brúlures affectaient de la méme maniére les personnes du sexe masculin et féminin. Les enfants constituaient 50,9% des cas. Les causes des brúlures étaient: les flarmnes (67,9%), les liquides chauds (29,9%), l'électricité (1,2%) et les substances chimiques (I%). Le numéro des décés était 201 (33,5%). Les causes du taux élevé de rnortalité sont discutées.

1. Barisoni D., Bortolani A., Marchi A.: Epidemiology and prevention of burns in children. Annals of the MBC, 1: 27-28, 1988.
2. Baxter G.R.: Guidelines for fluid resuscitation, J. Trauma, 21, 8: 667-668, 1981.
3. Jiz F, Kaddoura I., Saba M.: Statistical retrospective analysis of burn patients admitted to AUBMC between 1982-87 (Towards a changing future in bum management). Annals of the MBC, 2: 8-11, 1989.
4. loannovich I., Alexakis D., Ponayotou R, Siamaga E., Papastratis G.: Epidemiological data on bum injuries in Greece. A statistical evaluation. Annals of the MBC, 1: 23-28, 1988.
5. Lyngdorf R, Srenen B., Thomsen M.: The total number of bum injuries in a Scandinavian population - a prospective analysis. Burns, 12: 567-579, 1986.