EPIDEMIOLOGICAL ANALYSIS OF PATIENTS ADMITTED TO THE BURNS CENTRE IN VALENCIA DURING THE YEAR 1992

Ann. Medit. Burns Club - vol. VI - n. 4 - December 1993
EPIDEMIOLOGICAL ANALYSIS OF PATIENTS ADMITTED TO THE BURNS CENTRE IN VALENCIA DURING THE YEAR 1992

Serna Ballester C., Terren Ruiz J., Pous Serrano S., Dolz Lago J.F., Calvo Medina V., Mirabet Ippolito V.

Departamento de Cirugia PIàstica y Grandes Quemados, Hospital Universitario La Fe, Valencia, Spain

SUMMARY. We have performed a retrospective analysis of patients admitted to the Burns Centre of La Fe Hospital in Valencia (Spain) daring the year 1992 (152 cases, 110 men and 42 women). Regarding age, 38% of the patients were aged under 15 yr and 7.2% were over 60. The most frequent cause of burns was flame (49.3%), which caused both small and extensive wounds. The part of the body most frequently affected was the arm, so important in everyday work.

Introduction

It is important to identify the epidemiological factors that cause burns.
In recent years wider public knowledge and the interest of the industrial sector and insurance companies have exerted great pressure on institutions for burn care and firefighter organizations in order to accelerate education about the importance of burns and their prevention.
This continues to be a real problem for a variety of reasons: home accidents, industries with insufficient safety resources, or, as happens on the Spanish East Coast, the use of explosive materials in local public festivities.

Materials and methods

We have performed a retrospective analysis of the 1 patients admitted to the Burns Centre in La Fe Hospital (Valencia), between January and December, 1992, corresponding to a total of 152 patients.
The statistical analysis was performed using an MS-DOS computer provided with a statistical package. We obtained the classical measurements it contained (mean, standard deviation, etc.) and applied the chi-square test to the results to find the statistical significance.

Results

Age (Fig. 1)

Fig. 1 Distribution by age groups

The most frequently affected group was that of patients aged from 0 to 5 yr (30.3%), followed by patients aged 21 to 30 yr (15.8%). The least affected patients were those in the 41-50 yr age group (5.9%). 7.2% of the patients were aged above 60 yr.

Sex (Fig. 2)

Out of the 152 patients, 110 were men (72.4%) and 42 women (27.6%). More men were seen in all age groups except that aged 51 to 60 yr, in which the numbers of patients of both sexes were the same, and that over 60 yr, in which there were more women. extent, although we can see in Fig. 5 that men represent the majority in all groups.

Fig. 2 Distribution by age and sex groups

Depth of burn (Fig. 3)

None of the 152 patients presented superficial burns: 38 (25.0%) had partial-thickness burns, 36 (23.7%) and deep dermal burns and 78 (51.3%) fullthickness burns.

Fig. 3 Grade of burn

Body surface area burned (Fig. 4)

Most of the patients (52.0%) presented burn of limited extent, i.e. up to 10% TBSA. However, only 27 patients (17.7%) had more than 30% TBSA burned (considered to be extensive burns). There is no statistical significance between sex and burn

Fig. 4 Distribution by body surface burned

Fig. 5 Distribution by sex and body surface burned

Aetiology (Fig. 6)

We have studied several factors as the cause of burns: flame, scalding, gunpowder, electricity, contact and other causes. The commonest cause was flame (49.3%), followed by scalding (33.6%). Gunpowder was the cause in 8.6% of cases. Regarding sex (Fig. 7), it was seen that only men are affected by burns caused by gunpowder and by contact. This relation has a statistical significance (p<0.05).

Fig. 6 Distribution by aetiology

Fig. 7 Aetiology by sex

Fig. 8 Average age by aetiology

Fig. 8 shows how scalding affects younger patients (mean age 7.8 yr). Flame affects adults (mean age 35.2 yr), as with contact burns (mean age 30.7 yr). Gunpowder produced burns mainly in young people (mean age 23.5 yr), and electricity in teenagers (mean age 17.9 yr).
Flame (Fig. 9) was the commonest cause in the three degrees of burn that our patients presented, followed in frequence by scalding. Electricity produced more partial-depth burns than gunpowder, although the relation aetiology-burn depth has no statistical significance.

Fig. 9 Aetiology by kradi,

Flame produced burns of all extents (Fig. 10), the same as scalding, although this did not produce burns from 31 to 50%. Electricity caused burns equal to or less than 10%, and 21 to 30%. Gunpowder was the origin of not only small but also extensive burns; contact with hot solids caused only limited burns. The relationship between aetiology and burn extent is statistically significant (p<0.05).

Fig. 10 Distribution by aetiology and burn cause

Localization (Fig. 11)

The most frequent localization of burns considered in isolation was the head and neck (11 patients). However, most of the burns had several localizations. If we consider several isolated locations, the most affected were the arms (106 patients). Respiratory burns (21 patients) were always associated with burns in other body sites.

Fig. 11 Localizations and Associations

Table 1 shows the relationship between the origin of the burn and its localization. There is a significant relation (p<0.05) between burns in the arms (associated with other sites) and their cause, the most important being flame (52.8%), followed by scalding (2 1. 1 %), gunpowder (7.3 %) and electricity (4. 1 %).

Table 1 Localization by causes

There is also a significant relation (p<0.05) with burns in the head and neck, flame being the most frequent cause (48%).
There is no significant relation between aetiology and burns in the trunk, legs and genitals (not only when isolated but also when associated with other sites).
There is a significant relation (p<0.05) between aetiology and respiratory burns (which are always associated). The two most frequent causes of respiratory burns are flame (14.6%) and gunpowder (2.4%).
Discussion

Although a multifactorial protocol was introduced in Spain to improve the epidemiological control of burns, at the beginning of 1992, this still continues to be a problem.
If we compare our results of 1992 with those obtained by Tejerina et al. in 1989, we can see that even with greater public awareness and with more domestic and labour precautions, there are still too many accidents causing severe burns. All this leads to functional and aesthetic deficits with repercussions on the patient's work and his psychological and social conditions.
We have compared the results of our analysis with those of 1989 in the same Bums Centre, and we have made the following findings:

The number of patients treated was similar, 146 in 1989 and 152 in 1992. They represent about 8% of all burn patients treated in one year.

Young people were the most affected population in both periods, as in other studies (Silverstein, 1986; Clark, 1987). About 38% of patients were aged under 15 yr in 1992, compared to 31.4% in 1989, as in the results of Elberg (1987).

Lyngdorf (1986) confirms the studies of 1989 and 1992, in which children mainly were scalded and older people usually affected by flame. Both circumstances occur in domestic accidents.

Electrical burns happen in the industrial environment, although occasionally there are domestic accidents affecting mainly children, which is the reason for the low mean age (17.9 yr) found in 1992.

The same applies to gunpowder burns, which affect the same population of young people using fireworks for fun. However, accidents producing serious burns always occur in factories where these products are manufactured.

RESUME. Nous avons effectué une analyse rétrospective des patients hospitalisés dans le Centre des Brûlés à Valence (Espagne) pendant 1992 (152 cas, 110 hommes et 42 femmes). Pour ce qui concerne l'âge, 38 % des patients étaient âgés de moins de 15 ans et 7.2% de plus de 60. La cause des brûlures la plus fréquente était le feu, qui provoquait des lésions et petites et étendues. La partie du corps le plus fréquemment atteinte était le bras, tellement important dans le travail quotidien.

BIBLIOGRAPHY

Clark W.R., Fromm B.: Burn mortality: experience at a regional burn unit and literature review. Acta Chir. Scand. Suppl.,537:1,1987.

Elberg J. et al.: Burns: epidemiology and the effect of a prevention programme. Bums, 13: 391, 1987.

Lyngdorf R: Epidemiology of severe burns injuries. Bums, 12:491,1986.

Silverstein P., Lack B.O.: Epidemiology and prevention. In: "The Art and Science of Bum Care", Boswick J.A. (ed.), Aspen, New York, 1987.

Tejerina C. et al.: An epidemiological study of burn patients hospitalized in Valencia, Spain during 1989. Bums, 18: 1, 1992.