Ann. Medit. Burns Club - voL VII - n. I - March 1994

SOME EPIDEMIOLOGICAL DATA REGARDING BURN PATIENTS TREATED DURING 1992 IN ALBANIA

Belba G.J., Andrea A., Dauti I., Osmani X.H., Cano N., Pema L.

Clinic of Plastic Surgery and Burns, U.C.H.T., Tirana, Albania

SUMMARY. The authors give some epidemiological data on bums based in particular on results obtained in 1992. The discussion mainly concerns the aetiological causes of the bums, methods of surgical treatment according to wound depth, hospitalization and the mortality rate. It is imperative to launch a medical propaganda campaign to ensure an aseptic environment and early necrectomy. Some comparative data are also given in relation to other Mediterranean Bums Club member countries.

The Tirana Clinic for Bums and Plastic Surgery is the main centre for the treatment of burns in Albania. Normally, patients are kept for the first 48 hours in their respective country hospitals and are reanimated by a specialist surgeon previously trained in our clinic. After consultation with us, it is decided whether the patients should be hospitalized for much more intensive care in our clinic; alternatively, the country specialists are constantly instructed on how to proceed with treatment according to recommended procedures.During the burn shock phase we prefer to treat patients with Ringer's lactate based on the Parkland formula (1). We regard the septic phase as the most critical, for although the patients are given antibiotics they are exposed to the risk of infection. Even if the clinic is housed in a new building, total asepsis is not guaranteed, and we therefore hesitate to use early necrectomy with immediate grafting of the bum wound. Once the toxic-septic phase is over and necrosis is eliminated, we heal the wound with autograft on granulated tissues in different sessions.The aim of this study is to give some preliminary epidemiological data on the treatment of burns and to compare these with those reported in other Mediterranean Bums Club member countries.

The annual average number of burn patients hospitalized and treated in our country amounts to 16001700 cases. These cover only 15-17% of all cases being treated on an out-patient basis.Two-thirds of the patients are male and one-third female. Half of the patients hospitalized are children; 7375% of the injured children are aged between one and four years, an age when they are very active and not always supervised. Most of the adult cases occurred in the oil industry and steel-works, but not a few came from the domestic environment. For years the mortality rate among burned patients has remained 5-6% on a nationwide scale. The figure is higher in our clinic (9-10%). During 1992 515 patients were hospitalized in our clinic, of whom 342 were male and 173 (33.6%) female. Children aged 0-14 years constituted 263 (51.1%) of the cases.The aetiological agents were boiling liquids (63.9% of cases), flame (24.8%), electricity (6.2%) and chemical agents. (5. 1 %). Most of the burns occurred in the domestic environment (71.8%); accidents at work ranked second (18.6%), while outdoor accidents were third (9.7%).
Table 1 shows case distribution in relation to the surface burned and mortality. Regarding wound depth 319 cases were superficial and first-degree burns; 110 cases were deep second-degree and in some areas third-degree burns, and there were 86 third-degree burns associated with damage to anatomical structures. These last two categories (196 cases) were surgically treated in 165 interventions (55 necrectomies, 98 necrectomies with autografting and 12 combined necrectomies with immediate grafting).

The accident rate is higher in winter months owing to the use of heating appliances.The number of hospitalization days for the 515 cases amounted to 8992, equivalent to an average of 17.4 days per patient. The mortality rate was studied from two aspects: with regard first to the total number of patients, and second to the potential risk of the patients (6, 7). As 49 of the patients died, the overall mortality was 9.5%. We must point out that this finding is true but not significant. In our situation we regarded as at risk cases in which the bums covered 10% 13SA and upward. Table 2 shows that there were 47 deaths out of these 238 patients, with a mortality of 19.7%. Analysing the deaths in patients with burns in 0-9% 13SA (Table I) we find two specific cases: one of the patients was in an alcoholic coma, while the other, a 75year-old man, was diabetic, insulin-dependent, and suffering from deep burns in both legs. Table 1 (10-19%) shows eight other deaths: three of those who died were over 80 years old, while the other five were children who died because of fulminant sepsis, prevalently caused by Pseudomonas aeruginosa. The other deaths were caused by the large burn areas.

The average number of hospitalization days for the 49 deceased patients was 8.1 days for person. Sixteen died during the burn shock phase and the other 31 during the toxic-septic phase. It is evident that some of the deceased patients arrived in our clinic too late. The bacteriological examinations showed 18 cases with Staphylococcus, 11 with Acinetobacter, 8 with Proteus mirabilis, 5 with Klebsiella and 19 with Pseudomonas. In 24 examinations we also found combinations of these bacteria. The presence of Pseudomonas aeruginosa is an indication of high virulence and its incidence remains a problem for burn centres (4).

The above data show a correlation between the domestic environment as a source place for accidents, a high percentage of children burned, and hot liquids as the main burning agent. Spanish and Egyptian authors describe approximately the same findings (2, 3). The short hospitalization period in our clinic can be explained by the prevalence of second-degree burns (61.9%) and the cases ending in exitus. Mortality in our clinic turned out to be higher than that found by Greek and Italian authors (5, 8), but is almost the same as the data given by North African authors (6). It is worth while pointing out that these authors consider only burns of 15% T13SA and over, therefore increasing the mortality percentage. The Libyan author (7) offers only overall mortality (5.5%), but does not comment on it. It is however lower than ours. If we consult the literature in general, we cannot find a constant criterion to calculate mortality in relation to the critical percentage. In view of the reality of the preceding data, it is imperative for us:

• To launch an all-round propaganda campaign about the hazard that burning poses and how to avoid it, especially in the domestic environment;

• To manage strict asepsis, especially in intensive care units and the operation theatre with its surrounding annexes;

• To perform early necrectomy and immediate grafting of the wound with homotransplants, heterotransplants, amnion or temporary synthetic skin dressings until the wound is ready for autograft.

As ours is an underdeveloped country it is our task to improve our results and to approach as nearly as possible the average levels of the other MBC member countries. These achievements would have been more valid and more rapid in conditions of close all-round scientific cooperation.

RESUME. Les auteurs fournissent des données épidémiologiques sur les brûlures basées en particulier sur des résultats obtenus en 1992. La discussion concerne principalement les causes étiologiques des brûlures, les méthodes du traitement chirurgical en rapport à la profondeur de la brûlure, l'hospitalisation et le taux de mortalité. Il faut absolument organiser une campagne de propagande médicale pour réaliser un milieu aseptique et pour effectuer la nécrectomie précoce. Les auteurs présentent en outre des données comparatives qui concernent les autres pays membres du Club Méditerranéen des Brûlures.

BIBLIOGRAPHY

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