Ann. Medit. Burns Club - vol. 6 - n. 3 - September 1993

EPIDEMIOLOGICAL STUDY OF SCALDING IN CHILDREN

Reig A., Tejerina C., Baena R, Mirabet V.

Department of Plastic Surgery and Burn Centre, Hospital la Fe, Valencia, Spain


SUMMARY. A retrospective epidemiological study is made of scald bums in patients under age 16 admitted to our Bum Centre during 1988 and 1989. A total of 3711 patients were treated, of whom 302 (8.1%) were hospitalized. Of the latter, 92 (30.4%) were under age 16. In these cases scalding was the cause of lesion in 54 patients (58.7%), corresponding to 26 girls and 28 boys (mean age, 3.6 years); 72.2% were under 6 years of age. The mean burn extent was 13.2% BSA, and the most commonly affected region was the upper limbs (51.8%). Over 90% of the accidents occurred at home. Surgery was performed at least once in 59% of cases. The mean hospital stay was 14.9 days.

Introduction

Burns are still frequent, and the resulting lesions often lead to physical and psychological problems for the patients.
Children represent perhaps the most risk-prone age group in these cases, with scalding being the most common form of lesion. The great majority of these accidents occur at home, and are fundamentally the result of negligence on the part of adults who are frequently present at the time of the accident.
In the present paper an epidemiological study of scald bums in children is carried out in an attempt to identify risk factors and adopt prophylactic measures.

Patients and Methods

Ninety-two case histories were reviewed, corresponding to patients aged 0- 15 years admitted to our Bum entre between 1 January 1988 and 31 December 1989, with the aim of establishing the incidence and cause of scalding among paediatric patients.
During the two years of the study 37 11 patients were attended to; of these, 302 (8. 1 %) were hospitalized. Of these 302 patients, 92 (30.4%) were children under the age of 16 years; in 54 children (58.7%) the lesions were caused by scalding. Fig. 1 reflects bum causes in relation to two age groups: 0-5 years and 6-15 years. In the 0-5 age group, scalding was the cause in 84% of cases; in the 6-15 age group this proportion dropped to 28.5%, being surpassed by fire (30.1%) as the main cause of bums.

Fig. 1 Causes of burns by age. Fig. 1 Causes of burns by age.

Results

Age The mean patient age was 3.6% years. Fig. 2 shows patient distribution by age. Most accidents were found to affect children under 6 years of age (72.2%), 50% being aged 1-2 years.

Fig. 2 Distribution of patients by age. Fig. 2 Distribution of patients by age.

Sex Of the 54 children with scald bums, 26 were girls (48.1%) and 28 boys (51.8%), Girls were more commonly affected among those under 5 years of age, whereas males predominated over age 5. Fig. 3 shows patient distribution by age and sex.

Fig. 3 Distribution by age and sex. Fig. 4 Distribution by burn size.
Fig. 3 Distribution by age and sex. Fig. 4 Distribution by burn size.

Burn extent Scald burns were found to affect an average of 13.2% TBSA (range, 2-35%). Most patients (66.6%) suffered burns that affected less than 10% TBSA, and only one patient suffered burns of over 30% TBSA (Fig. 4). Fig. 5 shows the relationship between burn extent and patient age; the most extensive burns generally affected older children.

Fig. 5 Burn size/age relationship. Fig. 5 Burn size/age relationship.

Burn depth Fig. 6 shows patient distribution according to bum depth. Of the 54 patients considered, 18 (33%) suffered first- and second-degree superficial wounds; 22 (40.7%) presented second-degree superficial burns together with second-degree deep lesions. Ten patients (18.5%) suffered second-degree deep burns associated with third-degree lesions. Four patients (7.4%) presented isolated third-degree burns. The relationship between burn depth and wound extension is shown in Table 1.

Fig. 6 Distribution by burn depth. Fig. 6 Distribution by burn depth.

 

SIZE

0-5% 6-10% 11-20% 21-30% >30% Total
DEPTH  
Ist-2ndS 0 10 8 0 0 18
2ndS-2ndD 3 12 5 1 1 22
2ndD-3rd 5 2 1 2 0 10
3rd 3 1 0 0 0 4
Total 11 25 14 3 1 54
Table 1    BURN DEPTHMURN SIZE RELATIONSHIP

Burn location

Fig. 7 shows patient distribution according to burn location. The upper limbs were the most commonly affected body region (51.8%), both isolatedly and in association with other locations. The second most commonly affected area was the head and neck, these lesions mainly being associated with burns of the upper thorax.
Patients (number)

Fig. 7 Location of burns. Fig. 7 Location of burns.

Aetiology Over 90% of the burns occurred at home, and particularly in the kitchen. Scalding was often caused by hot liquids in cups and dishes (37. 1 %), pots (27.7%) and tea- or coffee-pots (25.9%). Bath water was responsible for 9.3% of scald bums.

Season Bum distribution according to the month of the year is shown in Fig. 8. The accidents were found to be most common m December (24%), followed by August (16.6%) and May (14.8%).
Patients (number)

Fig. 8 Monthly incidence. Fig. 8 Monthly incidence.

Surgical treatinent Fig. 9 shows the number of patients operated on following hospital admission; 59.2% of patients received at least one skin graft operation. In two-thirds of cases surgery was performed during the first two weeks following hospitalization. In the patients aged 0-5 years, successive interventions were required in 12% of cases, versus 25% in those aged 6-15 years. This reflects the greater relative severity of the bums in the older children.

Fig. 9 Number of cases grafted in each week post burn (first grafting). Fig. 9 Number of cases grafted in each week post burn (first grafting).

Hospital stay The mean hospital stay was 14.9 days. In patients aged 0-5 years, the average was 12.3 days, versus 19.7 days for those aged 6-15. This difference also reflects the greater relative severity of the bums in the older children.

Comment

Bums continue to pose problems in modem society, with frequent physical and psychological consequences among the patients affected. A number of studies have shown that bums more often affect younger individuals, particularly those in the 0-5 years age range (Smith and O'Neill, 1984). These children are characteristically at risk of suffering scald bums.
In the present paper we have carried out an epidemiological study of scald burns, in an attempt to define risk factors and thus establish a series of prophylactic measures.
Two risk groups have thus been established among paediatric patients, involving the 0-5 and 6-15 years age ranges. In the younger group the distribution of age, sex, and bum causes and extent all agree with results reported elsewhere (Yiacoumettis and Roberts, 1977; Pegg et al., 1978; Raine and Azmy, 1983). In patients aged 6-15, the results obtained were different, distribution being similar to that observed among adults in terms of both bum type and aetiology. As reported in other studies (Pegg et al.; Green et al., 1984; Langley and Tobin, 1983), most scald burns occurred in the kitchen and affected mainly children under 6 years of age. Cups and dishes containing hot liquids, together with pots and the like were most commonly involved. In our study, hot bath water was responsible for less than 10% of lesions, which contrasts with the results of other works, where the incidence varies between 10 and 20% (Yiacoumettis and Roberts; Smith and O'Neill). No marked seasonal variation in burn incidence was detected in the present study, although it should be pointed out that 24% of burns occurred during the month of December. The results obtained suggest that an information campaign is a prime necessity, and should be carried out on two different levels:

  • Clearly, in the case of children under age 6 years the preventive and educational measures adopted should be aimed at the parents, who should be properly infortned of the risks posed by hot liquids in home environments with small children.
  • Among older children, with less direct control by the parents, the role played by the school and other educational centres is fundamental.

 

RESUME. Cette étude rétrospective des brûlures par ébouillanternent subies par les patients âgés de moins de 16 ans visités dans notre Centre des Brûlés dans la période 1988-89 démontre que sur les 3711 patients de tous les âges traités 302 (8,1%) ont été hospitalisés, dont 92 (30,4%) âgés de moins de 16 ans. Dans ces derniers cas l'ébouillantement représentait la cause de la lésion chez 54 patients (58,7%), dont 26 de sexe féminin et 28 masculin (âge moyen 3,6 ans); les enfants âgés de moins de 6 ans constituaient 72,2% de la totalité. L'extension moyenne des brûlures était 13,2%, et les membres supérieurs étaient la partie du corps la plus fréquemment atteinte (51,8%). Plus de 90% des accidents se sont produits dans la maison. Les jeunes patients ont subi une opération chirurgicale dans 59% des cas et la durée moyenne de l'hospitalisation était 14,9 jours.


BIBLIOGRAPHY

  1. Green A.R., Fairclough J., Sykes P.J.: Epidemiology of bum in childhood. Bums, 10: 368,1984.
  2. Langley J., Tobin P.: Childhood burns. N.Z. Med. J., 96: 681, 1983.
  3. Pegg S.P., Gregory J. J., Hogan P.G. et al.: Burns in childhood: an epidemiological survey. Aust. N.Z. J. Surg., 48:365,1978.
  4. Raine P.AM, Azmy A.: A review of thermal injuries in young children. J. Paed. Surg., 18: 21, 1983.
  5. Smith R.W., O'Neill T.J.: An analysis into childhood burns.Bums, 11: 117, 1984.
  6. Yiacoumettis A., Roberts M.: An analysis of burns in children. Bums, 3: 195, 1977.



 

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