Ann. Medit. Burns Club - vol. 6 - n. 2 - June 1993

ANALYSIS OF 1005 BURN PATIENTS TREATED IN OUR CENTRE

Haberal M., Ugar N., Bayraktar U., Ener Z.

Turkish Transplantation and Burn Foundation, Ankara, Turkey

SUMMARY. Over a period of 12 years 1005 patients were admitted to the bum unit at the Hacettepe University Hospital, Ankara. Of these patients, 66.3% were male and 42.4% were under the age of 14 years. Flame injuries and scalds accounted respectively for 52.5% and 44.3% of the injuries caused by thermal agents excluding electricity. Electrical bums affected a relatively high number of the patients, with a rate of 20. 1 %. The majority of the burns occurred at home. The overall mortality rate was 34.4%.

Introduction

Burns still constitute one of the leading causes of death due to accidents. Moreover, severe non-fatal bums can be considered to be the most devastating injury, resulting in emotional and physical scarring. In order to overcome this problem, which threatens public health, prevention is much more essential than the establishment of high-technology burn units. The first step in prevention is the investigation of the epidemiological pattern of the bums suffered by the people in a region. The present study thus aims to evaluate the epidemiological pattern of the in-patients treated in the Bum Unit at the Hacettepe University Hospital, which has been one of the leading centres in our region, since its establishment by the senior author of this paper.

Materials and methods

Between 1 January 1979 and 31 December 1991, 1005 burned patients were admitted to our burn unit. The data obtained from the charts of the patients were analysed in order to find out the distribution of the patients according to age, sex and socioeconomic level, as well as the distribution of the bums according to place of occurrence, complications and mortality rate.
All the patients were treated according to a treatment protocol. This protocol consists of resuscitative measures with fluid and electrolyte therapy according to the modified Parkland formula, dialysis and surgical procedures, as well as various topical treatment methods including the application of silver-nitrate incorporated amniotic membrane (1, 2,3).

Fig. 1A Fig. 1A

Results

In a period of 12 years 1005 patients with moderate or major bums were admitted to our burn unit. Of these patients, 339 (33.7%) were female and 666 (66.3%) were male. 426 (42.4%) of the patients were under the age of 15 years (Fig. IA and 113).

Fig. 1B Distribution according to age Fig. 1B Distribution according to age

The socioeconomic level of the patients was found to be low, middle and high in 29.7%, 63.5% and 6.8% of the patients, respectively (Fig. 2).

Fig. 2 Sociocconomical level Fig. 2 Sociocconomical level

Since the incidence of electrical bum injuries in these series was found to be very high, when compared with the other series in the literature, the causes of the bums were investigated in two groups consisting of electrical burn injuries and non-electrical thermal injuries (Fig. 3).

Fig. 3 1979-December 31, 1991 Fig. 3 1979-December 31, 1991

Electrical bum injuries were encountered in 208 (20.1%) patients. In the non-electrical burns group, flame burns represented 52.5% of the injuries, including burns secondary to LPG explosion (9.9%). Scalding was found to be the second leading cause of thermal injuries, with 35.6%, 5.9% and 2.8% of the burns being caused by hot water, hot milk and hot meals, respectively. The remaining thermal injuries were due to chemical materials (1.8%), hot metals (0.6%) and hot olive oil (0.8%) (Fig. 4).

Fig. 4 Causes of the non-electrical bums Fig. 4 Causes of the non-electrical bums

The majority of the bums were domestic injuries (64.0%), while 25.4% of the bums were occupational and 10.6% occurred in other places. The overall mortality rate was 34.4%. Nonelectrical thermal injuries resulted in death in 303 (38.0%) patients, compared to 21.6% of deaths in the electrical bums group. The mortality rate of burns caused by hot milk was found to be the highest, with a rate of 61.7 %. The most frequent cause of death in both groups was sepsis. The most important complications in the electrical bums groups were amputations (25.0%) and acute renal failure (14.4%), whereas gastrointestinal complications were frequently encountered in other bums.

Discussion

Bums are still one of the most important problems that threaten our public health. In the present study, children were found to be more frequently affected by burns. This finding correlates with that in reports from other countries (4, 5, 6, 7, 9). Since the socioeconomic levels of the families of the patients correspond approximately to the socioeconomic status of our country, socioeconomic status cannot be considered a strong risk factor in our series, in contrast to previous reports by several investigators (8, 9).The number of electrical burn injuries in our series was higher than in other countries (4, 5, 6). In the light of our previous studies, this may be  attributed to the greater risk of being injured by electricity in our country (3, 10, 11). However the rate may be aggravated by the fact that our bum unit is one of the leading centres for electrical injuries. Distribution of the burns due to other causes correlates with that in other countries (4, 5, 6, 9).
Most of the burns in the present study occurred at home. This finding concurs with that of several investigators from other countries (4, 5, 9). Although the patients were treated by all modern treatment materials and methods, including emergency haemodialysis, the mortality rates were found to be very high when compared with those in other studies (4, 5, 6, 9). This may be attributable to the late admission of the patients to hospital, which delayed wound management and fluid and electrolyte treatment, and led to the development of sepsis and acute renal failure. The mortality rate in bums caused by hot milk was the highest in our series. This may be due to the fact that milk proteins constitute a rich media for bacterial growth, if not removed immediately. The mortality rate in electrical burn injuries was found to be relatively lower than that in other kinds of bums, because of the relatively rapid admission of the patients.
This epidemiological study stresses how the importance of bums is underestimated by the authorities and physicians who are responsible for burn prevention and management. Educational programmes for burn prevention should be designed and caried out urgently. A special organization for the management of major burns should be established in order to decrease the mortality and morbidity rates in our country.

RESUME. Pendant une période de 12 années 1005 patients ont été hospitalisés chezie Centre des Brûlés de l'Hôpital Universitaire Hacettepe. De ces patients 66,30% étaient du sexe masculin et 42,4% étaient âgés de moins de 14 ans. Les brûlures par feu et les ébouillantements constituaient respectivement 52,5% et 44,31'X des accidents thermaux, excepté ceux causés par l'électricité. Les brûlures électriques ont atteint un numéro relativement élevé des patients (20,1%). La plupart des brûlures se sont produites dans l'environnement domestique. Le taux complessif de mortalité était 34,4%.

BIBLIOGRAPHY

  1. Haberal M.: Early care of minor and moderate Bums. In Davis C.A. (Ed.): "Bums Emergency and Acute Care", 29- 38, Univ. California, 1984.
  2. Haberal M., Oner Z., Bayraktar U., Bilgin N.: The use of silver nitrate incorporated amniotic membrane as a temporary dressing. Bums, 13: 159, 1987.
  3. Haberal M.: Electrical burns: a five-year experience. J. Trauma, 26: 103, 1986.
  4. EI Danaf A., Alshlash, Filobbos P., Rasmi M., Salem S.: Analysis of 105 patients admitted over a 2-year period to a10 modern bums unit in Saudi Arabia. Bums, 17: 62, 199 1.
  5. Lindblad B.E., Terkelsen C.J.: Domestic bums in children Bums, 16: 254,1990.
  6. Tejerina C., Reig A., Codina L, Safont J., Bacna R, Mirabet V.: An epidemiological analysis of bum patients hospitalize in Valencia, Spain during 1989. Bums, 18: 15, 1992.
  7. Elberg L, Schorder H., Glent-Masden L. et al.: Burns: Epidemiology and effect of a prevention programme. Burns, 13:391,1987.
  8. Locke J.A., McKay, Rossignol, Burke J.F.: Socioeconomical factors and the incidence of hospitalized burn injuries in Now England Counties, USA. Burns, 16: 273, 1990,
  9. Clark W.R. Jr, Lerner D.: Two years hospitalized burned patients in Central New York. J. Trauma, 18: 24, 1978.
  10. Haberal M., Oner Z., Gulay H. et al: Severe electrical injury and rehabilitation. Ann. Medit. Burns Club, 1: 121, 1988.
  11. Haberal M., Kaynaroglu V., Oner Z., et al.: Epidemiology of electrical bums in our center. Ann. Medit. Bums Club, 2: 14, 1989.

 

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