|Ann. Medit. Bums Club - vol. VII - n. 3 - Septeniber 1994
BURNS IN PAEDIATRICS: LONG-TERM EFFECTS
OF A PREVENTION CAMPAIGN IN THE CESENA AREA (ITALY)
Arcangeli F, Calisti D, Landi G.
Centro Ustioni, Ospedale Bufalini, Cesena, Italy
SUMMARY. To verify the
long-term results of a campaign for the prevention of bum injuries in paediatric age,
initiated in 1977 throughout the Cesena area (central Italy), a retrospective review was
made of paediatric admissions to the Cesena Bums Centre from 1972 to 1992. The number of
burned children resident in the Cesena area dropped sharply after 1977, reaching a 98%
decrease by 1992. The number of non-resident burned children, taken as a reference control
group, showed a more gradual reduction, showing a smaller decrease of 64% by 1992. These
data reinforce the conviction of the effectiveness of prevention campaigns and educational
programmes involving children, school teachers and social operators.
Burns are still an important medical,
social and economic problem in modern society.
When children are involved, the consequences of burns are generally particularly severe
because in paediatric age functional, aesthetic and psychological sequelae are more
serious than in adults (1, 2, 3, 4).
Children are undoubtedly a special population, exposed to greater risk of burn injuries,
because they have a less acute perception of dangerous situations and a limited ability to
react promptly and properly and because their health and care are mostly dependent on
adults (5, 6).
Their vulnerability to burn injuries is strongly related to the possibility of providing a
safe living environment.
Several epidemiological investigations (7, 8, 9, 10, 11, 12, 13) have stressed that the
high frequency of burns in paediatric age can be reduced by removing the potential hazards
of risky adult behaviour which lead to bum injuries.In 1977 and 1978 we organized in the
Cesena area (central Italy) a campaign for the prevention or burns in the home (14, 15)
with particular regard to pre-school and school age. We gave informative lessons at
nursery, primary and junior secondary schools, showing illustrative materal and special
videos. The local mass media were also used to diffuse knowledge about high-risk
situations and to promote correct behaviour in adults and children. In the years
subsequent to the campaign (from 1980 to 1986) we recorded a marked reduction in the
number of burned children resident in the Cesena area (-90%), while the number of
non-resident burned children admitted to the Cesena Burn Centre, taken as a reference
control group, showed only a small decrease (- 15%). The present study was carried out to
verify the effect of our campaign 15 years later, calculating the trend of burned patients
in paediatric age resident in our area and comparing it with the trend of burned children
non-resident in our area admitted to the Centre in the same period.
Patients and methods
The number of burned children
(patients up to the age of 14 years) resident in the Cesena area assisted every year at
the Cesena Hospital Burns Centre over the last 20 years (from 1972 to 1992) was calculated
and compared with those of burned children not resident in the Cesena area admitted to the
Centre during the same period. The non-resident group, consisting of patients from various
central Italian regions, was taken as a reference control group because the prevention
campaign carried out in 1977 and 1978 did not involve their area of residence.
The criteria for admission to our Centre have been unvaried for the last 20 years:
- partial- and full-thickness burn involving 10% of body
surface area (BSA);
- thermal injuries involving face, hands, feet, perineum,
genitalia and major joints;
- full-thickness burns involving 5% BSA.
The admission trends of burned
children aged 0-14 years from 1972 to 1992 are reported in Fig. 1.
The number of patients resident in our
territory dropped sharply after 1977: there were 48 cases in 1976 (the year immediately
before the campaign), 11 in 1980 (-77%, compared to 1976), five in 1983 (-90%), five in
1986 (-90%), two in 1989 (-96%) and only one in 1992 (-98%).
In contrast, the number of non-resident patients showed an increase in 1980 (+48%,
compared to 1976) and a smaller decrease in 1983 (-3%), 1986 (-15%), 1989 (35%) and 1992
The Cesena Burns Centre is an
intensive care unit which can assist up to ten patients at a time.
Between 1972 and 1992, 3087 patients were admitted to the Centre. Of these, 968 (31%) were
under the age of 14 years (330 resident in the Cesena area and 638 in other regions
of central and southern Italy).
The Cesena Burns Centre is one of 14 operating in Italy, and because of its geographic
position it is a reference point for an area covering the Po Valley, the central Apennines
and the central and southern regions of the Adriatic coast.
A critical evaluation of trends of paediatric admission to the Centre over the last 20
years (Fig.]) allows the following considerations:
- During the first years of activity (from 1972 to 19761977)
the number of children assisted, both resident and non-resident, progressively increased,
with a peak of 48 resident Patients in 1976 and 68 non-resident patients in 1977.
- After this period there was a dramatic reduction in
admissions. This trend persisted in time, reaching a low of 12 non-resident patients and
only one resident patient in 1992.
- The decrease was higher in resident patients (-98%) than in
non-resident patients (-64%).
The fall in the overall number of burned
children admitted, both resident and non-resident, between 1972 and 1992 is probably due
to a general tendency in the reduction of paediatric burn injuries, and should not
automatically be attributed to improved injury prevention programmes. Nevertheless, burns
morbidity in children resident in the Cesena area shows a sharper and more marked
reduction, which we believe is due to the educational prevention activities initiated in
1977 and continued during the following years. Our campaign involved not only the general
public at large but also in particular schoolteachers, social operators and opinion
leaders, who repeatedly promoted and publicized the educational programmes with their
stress on elinunating all situations and behaviour involving bum injury risk. It is
difficult to quantify the true influence of a prevention campaign on the incidence of
burns, because of the many possible variables. However, our data would seem to confirm the
useful and persistent effect of prevention strategies, and they have encouraged us to
continue to be active in the field of burn prevention.
RESUME. Les auteurs, pour
vérifier les résultats à long terme d'une campagne pour la prévention des brûlures en
âge pédiatrique commencée en 1977 dans le territoire de Cesena (Italie centrale), ont
effectué une analyse rétrospective des cas des enfants hospitalisés dans le Centre des
Brûlés de Cesena dans la période 1972-1992. Le numéro d'enfants brûlés résidents
dans le territoire de Cesena a diminué brusquement depuis 1972, avec une décroissance de
98% en 1992, tandis que le numéro d'enfants brûlés non résidents, pris comme groupe de
contrôle, a montré une diminution plus graduelle, avec une décroissance plus limitée
de 64% en 1992. Ces données renforcent l'opinion que les campagnes de prévention et les
programmes éducatifs destinés aux enfants, aux instituteurs et aux assistants sociaux
peuvent être vraiment efficaces.
- Blakeney P., Herndon D.N., Desai M. et al.:
Long-term psychosocial adjustment following bum injury. J. Burn Care Rehabil., 9: 661,
- Beard S.A., Herndon D.N. Desai M.: Adaption of
self-image in burn disfigured children. J. Burn Care Rehabil., 10: 550, 1989.
- Kiinigovd R.: The psychological problems of burned
patients.The Rudy Hermans lecture 1991. Burns, 18: 189-99, 1992.
- Tryfonas G., Gavopoulos S., Limas C. et al.: Burns
in childhood - a ten-year experience in management. Ann. Medit. Burns Club, 5: 15
- Jackson R.H.: "I bambini e gli incendi".
Feltrinelli, Milano, 1980.
- Lariza I.: Incidenti infantili: epideiniologia e
principi preventivi Prospettiva in pediatria, 39: 217, 1980.
- Feck C., Baptiste M.S.: Burns injuries, epidemiology
and prevention. Accid, Anal. Prev., 11: 129, 1979.
- McLoughlin E., Vince C.J., Lee A.M. et al.: Project
burn prevention: outcome and preventions. Am. J. Public Health, 72: 241, 1982.
- Smith R.W., O'Neill T.J.: An analysis into childhood
bums. Burns 11: 117, 1984.
- McLoughlin E., McGuire A:: The causes, cost and
prevention of childhood burn injuries. Am. J. Dis. Child., 144: 677, 1990.
- Cheng J.C.., Leung K.S., Lam Z.C. et al.: An
analysis of 1704 burn injuries in Hong Kong children. Burns, 16: 182, 1990.
- Lindblad B.E., Terkelsten C.T.: Domestic burns among
childi Bums, 16: 254, 1990.
- Ryan C.A., Shankowsky H.A., Tredget E.E.: Profile of
the paedtric burn patient in a Canadian burn centre. Burns, 18: 267-72, 1992.
- Landi G., Arcangeli F., Savini M., Magalotti T.:
Risultati di una campagna preventiva sulla mortaliO da ustioni net territorio Cesenate.
Chron. Derm., 17: 231, 1986.
- Landi G., Arcangeli F.: The pievention of bums in
paediatrics: 10 years activity in the Cesena area. Ann. Medit. Bums Club, 1: 35-7,