Annals of Burns and Fire Disasters - vol. VIII - n. 4 - December 1995

BURNS IN RISK PROFESSIONS

Burn and Plastic Surgery Centre
Pirogov Emergency Medical Institute, Sofia, Bulgaria

SUMMARY. This paper considers twenty years (1974-93) in the activity of the Pirogov Burns and Plastic Surgery Centre in Bulgaria in relation to burns in professions with particular burn risks. An analysis is made of distribution of burns by occupation, sex, age and sex, body surface area burned, anatomical region affected, seasonal period, and time of day. An analysis is also made of the mortality rate.

The Pirogov Burn and Plastic Surgery Centre is the Republican Centre for bum treatment in Bulgaria, admitting burn patients from Sofia and its surroundings, as well as country patients with large and severe bums. Over a 20-year period (1974-93) 6732 adult patients with bums were admitted to the Centre. Of these 3350 (49.76%) sustained their burn injuries at work (Fig. 1), in contrast with the data of other authors who indicate a significantly higher incidence of household bum injuries. Case distribution by profession showed that the highest number of patients, 462 (13.79%), worked in the electric industry, followed by machine building (9.25%), transport (8.09%) and others (Fig. 2). Military personnel, who accounted for 812 patients (12.06%) of all burn patients hospitalized, were placed in a separate group. Of these, 36 (4.43%) had sustained burns in relation to combat training while the others were injured in construction or domestic activities. Flame was the most frequent causative agent in this group; the bums were usually not extensive, and the mortality rate was 3.33%.
The commonest causative agents of bums sustained at work were electricity (605 cases: 18.06%), followed by burning petrol (573: 17.10%) and flame (370: 11.04%) (Fig. 3). In most cases the causative agent corresponded to the patients' professional profile: in persons working in the electric industry, electrical burns accounted for the majority of burn injuries (88.96%); in persons working in the foodprocessing industry, boiling water or steam (66.73%); and in the chemical industry, chemical compounds.
Case distribution by sex shows 2906 males and 444 females (male/female ratio: 6.55:1). This index depends on the number of cases examined and the contingencies involved. The male-female ratio varies in different authors: 213:113 (65.3%:33.7 %);2 23: l;6 67.55%:32.45% ;7 2.3A.0.1 The greater number of males affected at work is explained by their more active participation in professions with a high bum risk, e.g. transport, metallurgy, and the electric industry, in which females are less directly involved, their participation being restricted to auxiliary, supportive roles. The male/female ratios in the spheres of transport, metallurgy and the electric industry were respectively 53.20:1, 29.00:1 and 13.98A. Females predominated in the food-processing industry (2.00: 1) and the services sphere (1.93: 1).
Case distribution by age and sex (Fig. 4) shows that younger adult males were exposed to a higher risk of burns (52.38% of the contingencies studied concerned males aged up to 30 years against 27.48% females). Our observations are confirmed by several authors.',`,` The higher number of young adult men injured at work could be explained by a low level of qualification and failure to observe labour security requirements. The mean age of the patients was 32.20±11.89 years for men and 38.56±11.98 years for women.

Fig. 1 - Percentage of occupational and household accidents in the patients. Fig. 2 - Distribution of patients by profession.

With regard to body surface area (BSA) burned, there was a predominance of burns in up to 5% BSA (37.62%), 6-10% BSA (23.26%), and 11-20% BSA (17.79%), i.e. patients with burns in up to 20% BSA accounted for 78.67% of all cases. Out of the 3350 hospitalized patients, 1982 (59.16%) underwent operations.

Fig. 3 - Distribution of burn-causative agents. Fig. 4 - Distribution of patients by age and sex. Fig. 5 - Burn total areas versus deep burns. Fig. 6 - Mortality rates for some professional groups of patients.

Of these the number of patients with operatively covered wounds up to 5% was 1320 (66.60%), up to 10% 17.10%, and up to 20% 7.52%, i.e. patients with up to 20% BSA burns operated on accounted for 91.22% of all cases (Fig. 5).
The anatomical regions most frequently affected by thermic agents were the hand (15.04%), followed by the forearm (11.80%) and the leg (19.37%); the commonest operations were on the leg (19.37%), hand (17.95%) and forearm (11.70%). Some authors have reported frequent hand injuries .3,12 The eyes were affected to some degree in 9% of the patients. Burn localization varied in relation to the patients' professions: in electrical workers the hands or face were most frequently affected, while the body or lower extremities were the commonest bum localization in workers in the food-processing industry.
Occupational burns occurred mostly in the summer (June-August). The seasonal factor is most apparent among workers in the agriculture, transport or construction fields. No such tendency exists for workers in the electric, chemical and machine-building industries.
Case distribution by day of week shows that the bum rate increased gradually through the week, reaching a peak towards the weekend (Friday). However, among electrical industry workers, the burn accident peak was midweek (Wednesday).
With regard to round-the-clock rhythms, burns occurred most frequently between 7 and 9 a.m. and between 4 and 6 p.m., i.e. when beginning to work and when fatigue begins to accumulate.
Of all the patients hospitalized for occupational burn treatment, 332 died (mortality rate, 9.91%). This was highest among transport workers (11. 8 1 %) and workers in the electrical industry (7.53%) (Fig. 6).

1. Over a 20-year period 3350 adults with occupational burn injuries were admitted for treatment to our Burns and Plastic Surgery Centre. Workers in the electrical industry presented the highest burn risk.
2. The risk of burns was higher in men than in women (6.55:1).
3. The seasonal factor had a varying effect in different professional groups. The majority of burn cases occurred at the weekend, and at the beginning or end of working days.
4. There was a predominance of burns in up to 5% BSA. Operative activity was 59.16%.
5. The overall mortality rate was 9.91%, the highest being among transport workers (11. 8 1 %).

RESUME. Les auteurs considèrent vingt ans (1974-93) de l'activité du Centre de Brûlures et de Chirurgie Plastique Pirogov en Bulgarie par rapport aux brûlures dans les professions ayant un risque particulier de brûlure. Ils analysent la distribution des brûlures par rapport à l'occupation, le sexe, l'âge et le sexe, la surface corporelle brûlée, la région anatomique atteinte, la période de l'année, et l'heure du jour. Ils analysent en outre le taux de mortalité.

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