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)

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.

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:

1. partial- and full-thickness burn involving 10% of body surface area (BSA);
2. thermal injuries involving face, hands, feet, perineum, genitalia and major joints;
3. 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 (-64%).

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:

1. 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.
2. 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.
3. 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.

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