Zámecníková, Stetinsky J., Tymonová J., Kadlcík M.

Burn Center of the FNsP Hospital, Ostrava, Czech Republic

SUMMARY. The authors have analyzed the data files of 580 child patients up to 15 years of age who were hospitalized at the Burn Center of the FNsP Hospital in Ostrava in the years 1999 - 2003. The authors focused on mechanisms of burn injury in relation to the age of a child as well as extent, depth, localization, and local treatment of the injury. The data file was divided to four age groups: up to two years of age 2 - 5 years of age, 5 - 10 years of age, and 10- 15 years of age. As regards the mechanisms of injury. the authors have analyzed scalding by hot liquids, burns due to contact with a hot object, burns due to electric current, explosion, and injury caused by burning clothing. Injury by scalding prevails to a very significant degree in the youngest children. In the second age group the incidence of burn following contact with hot objects increases, as does the percentage of children injured by burning of clothing in children aged 5 10. The older children have increased prevalence of injuries caused by explosions. The greatest average extent of an injury is from burning of clothing. Most of the areas are burned deeply, localized in more areas of the body, and almost half of the cases required surgical intervention. Scalding comes second in terms of average extent of an injury. More than half of the injured areas are superficial, and areas of injury are different in the individual age groups. We addressed about a fifth of the cases surgically The explosion of combustible materials caused a smaller extent of injury, on average, taking third place. The injuries were predominantly superficial, most commonly involving the head, trunk, and upper extremities. In none of the cases it was necessary for us to operate. Burn injuries caused by contact with hot objects are of a smaller extent. More than half of the burned areas are deep. localized most commonly in the upper extremities Surgical intervention was necessary in more than half the cases. In terms of average extent of an injury; the smallest burn injuries are caused by electric current. However, these injuries are deep, and surgical intervention was necessary in all cases.

Key words: mechanisms of injury, extent of injury, depth of burn, localization of burn, local treatment

INTRODUCTION

  Burn injury in children is one of the five most common causes of death. In the Czech Republic about 550 - 650 children are hospitalized every year (1).

  In our data file we have analyzed 580 children up to 15 years of age. These children were hospitalized at the Burn Center of the FNsP Hospital in Ostrava in the years 1999 - 2003. We have followed the mechanism of the injury in relation to age, extent, depth, and localization, as well as local treatment in relation to the mechanism of injury.

  Of the 580 children, 365 were boys. constituting 63% of all of the hospitalized children. We have divided the data file into 4 age groups. The youngest age group, children up to 2 years of age, contained 314 children, which is 54% of the data file. 131 children were in the second group aged 2 - 5 (23 %), 66 of the hospitalized children were aged 5 - 10 (11 %o), and 69 children aged 10 - 15 formed 12% of the data file.

RESULTS

Dependence of mechanism of injury on age

  In all of the age groups, the most common mechanism of injury is scalding by hot liquids and food. In children up to 2 years of age, it is the cause of 9190 of the burn injuries. In children aged 2 - 5 it still prevails with 80%. However, burn injury by contact with hot objects increases and constitutes 15% of the cases. In children aged 5 - 10, 67% of injuries are caused by scalding and 15% of injuries are caused by burning of clothing. In the group aged 10 - 15, injury by scalding only represents about 48% of cases; however injury by explosion represents 20% (Table 1).

  We analyzed in terms of percentage the role of different liquids in the most common cause of injury: scalding. The youngest children were most commonly burned by coffee, children up to 10 years of age by tea, the oldest children by hot water (Table 2).

Dependence of extent and depth on the mechanism of injury

  The highest average extent of injury is caused by burning of the clothing (11.95%° of the body surface). Scalding causes the second highest average extent of injury (7.65% of body surface). Burns from explosions follow. with injury to 3.42% of the body surface, and burns caused by contact with a hot object caused injury to 2.66% of the body surface. The smallest average size injury of 0.39% of the body surface is caused by burns from electric current (Table 3).

  The highest average extent of injury is caused by burning of the clothing. Most of the burns are deep. with an overall extent between 10.58% and 13.389° in the individual age groups. This mechanism of injury did not occur in the youngest age group (Table 4).

  In children with scalding the average size of injury in individual age groups was between 5.92% and 7.879°. More than half of the burned area was superficial of 1st to 2nd degree (Table 5).

  Burns caused by explosion of combustibles, gunpowder, or fireworks are third in terms of average burn size. Most of the burned areas are superficial. We did not treat any cases of children under 2 years of age in our data files (Table 6).

  Burns by hot objects are the fourth most common cause and range in the individual age groups between 2.31 °lc and 4.06% in terms of average extent. More than half of the areas are deep (Table 7).

  Burns from electric current have the smallest average extent of all of the mechanisms. In individual groups it reaches between 0.25 % and 0.58%. All the areas are deep, II b to III degree (Table 8).

Dependence of injury localization on the mechanism of injury

  In younger children with scalding, injury to the trunk prevails, followed by injuries to the upper limbs and head. l1 similar pattern is found in the second and third age groups, though here the third most common injury site is tile lower limbs rather than the head. The most common injury site is the lower limbs in older children. Older children also suffer more by injuries to the genitalia (Table 9).

  In all age groups burns by contact with hot object (Table 10) as well as electric current (Table 11) arc most commonly localized on the upper limbs.

  Burning of clothing causes injuries to more parts of the body. None of the localization prevails (Table 12).

  In injuries caused by explosion of combustibles prevail injuries to the head, upper limbs and trunk, though Lo a different extent in each age group (Table 13).

Dependence of local treatment on the mechanism of injury

  Therapy of burns can be conservative, with the use of xenotransplants, antibacterial ointments, hydroactive colloidal gels, or necrolytic, or surgical including escharotomy, fasciotomy, necronectomy, abrasion by hypergranulation, dermo-epidermal grafts, application of Integra, excision. suture, and closure of defect by a local or free flap. In our data file we have researched the nØ for surgical intervention in relation to the mechanism of injury.

  In children injured by scalding, surgery was necessary in about one fifth of the cases. In children injured by a contact with hot objects it was required in a third to half of the cases. There were differences in various age groups. After burns by electric current, surgery was always necessary; in contrast, after burns by explosion surgical intervention was not necessary in any of the cases. 1n injuries by burning of the clothing, surgical intervention was necessary in 40 50°k. of all cases (Table 14).

CONCLUSION

  Among the hospitalized children there were more boys than girls, and more than half of the children were in the youngest age group of up to 2 years of age. In all of the age groups, the most common mechanism of burn injury is scalding by hot liquids and food. In the youngest age group if was the cause of injury in 91% of the cases, in the second group in 80%. In this category, the cause of burn injury by contact with n hot object increased to 15%.ln children aged 5 10 years scalding occurred in 67% of the cases, while 15% were injured by burning of clothing. In the oldest age group of children, injury by scalding represented only 48% of cases, and 20% were caused by explosion of combustible materials and fireworks.

  We noted that the biggest average extent of injury is caused by burning of clothing. Most of the areas were burned deeply, localized to more areas on the body. and surgery was necessary in almost half of all cases. In teens of the average extent of burn injury, scalding was in second place. More dean half of the areas were superficial. while the most common localization varied according to age. Surgery was necessary in one fifth of the cases. We noted that the extent of injury after explosions was not great: mainly superficial and maximal degree was II b. The most commonly injured body parts were the head, hunk. and upper limbs. Surgical ìntervention was not necessary in any of the cases. Burns caused by contact with a hot object usually have a relatively smaller extent; however more than half of the areas are injured deeply, mostly localized in the upper extremities. Surgical intervention was needed in lass than half of the cases. Burns by electric current have a smaller average extent: however, they are always deep and mostly localized in the upper extremities. Surgery was necessary in all cases.

REFERENCE

1. Celko, AM. Detské úrazy a popáleniny. Praha: Galén, 2002

Address for correspondence: