Acta, vol. 48 - 2006

EPIDEMIOLOGY AND THERAPEUTIC ASPECTS OF BURN INJURIES IN SLOVAKIA (1993-2003)

Babik J.¹, Sopko K.¹, Orság J.¹, Koller J.²

¹Department of Burns and Reconstructive Surgery, 1st Private Hospital Kosice-Saca, and
²Department of Burns and Reconstructive Surgery, Komensky University, Faculty Hospital,
Bratislava-Ruzinov, Slovakia

SUMMARY. The authors analyze the epidemiology and trend of thermal injuries in Slovakia since 1990. The article includes statistics from both of the burn injury workplaces in Bratislava and Kosice. The article contains conclusions and proposals for preventive measures which have contributed to the decrease of thermal injuries in Slovakia since 2000.

Key words: epidemiology of burn injuries, burn injuries ěn children, prevention of thermal injuries

INTRODUCTION

Today burn injuries still present a serious problem within accident incidence of the Slovakian population. Despite significant improvements of transportation, great advancements in resuscitation and surgical interventions, burn injuries pose a high risk in adults as well as in children (Tab. 1). In 2003, 1649 patients with thermal injuries were hospitalized in Slovakia out of which 31% were children. Thermal injuries cannot be evaluated without an overall summary of the development of accident incidence in the Slovakian population. Consequently we also list a summary of emergency surgeries, overall statistical summary of injuries, statistics of polytrauma, and burn injuries statistics.

According to the Institute of Medical Information and Statistics, in 2003, 65,475 patients required emergency surgery in Slovakia. In 78% cases the cause was an accident (4). 3.21% of all injuries were burn injuries. The work is based on a retrospective study and statistical analysis of thermal injuries according to the Institute of Medical Information and Statistics in Bratislava, based on data from the Department of Burns and Reconstructive Surgery of Kosice-Saca Hospital, and from the Department of Burns and Reconstructive Surgery of the Faculty Hospital, Bratislava-R0inov.

MATERIAL AND METHOD

Based on the results from the years 1990, 2004 and data from 1993 till 2003, we have established the trend and distribution of thermal injuries within the Slovakian population, average extent of burns, age groups and the death rate. We used the analyzed data from both of the burn injury departments. Data of overall Slovakian trend of injuries were supplied by the Institute of Medical Information in Bratislava.

RESULTS

The accident incidence in Slovakia has an increasing trend, and according to the Institute of Medical Information and Statistics, it has almost doubled since 1990. In 1990, 25,691 patients sought emergency surgery, while in 2003 the figure was 65,475. and accidents were the cause in almost 78% of the cases (Tab. 2).

However, since 2000 thermal injuries ěn Slovakia have decreased: in the 1990s the average was 2100 hospitalized patients per year, from 2000 to 2003 the number of patients with thermal injuries gradually dropped to 1649. and in 2004 to 1630 (Tab. 3).

The incidence of burn injuries in Slovakia (2003) was divided according to the individual counties, as shown in Table 4. Burn injuries reached a maximum in eastern Slovakia, where the number of hospitalized patients was 792. The prevalence of accidents in eastern regions is mainly due to injuries in socially and economically weaker areas and injuries of the Roma people. the majority of whom live in this region.

The causes of thermal injuries in Slovakia are almost identical with the prevalence of thermal injuries in other European countries (1).

The first most common cause of thermal injuries is scalding by hot liquid, which is a cause in 65% of all hospitalized patients. The second most common cause is burning and explosion, present in 2590 of all injuries. Electrical injury is a cause in 5%r of cases, chemicals in 2.5°k of cases, while 2.5% of cases are other, unidentified causes of thermal injuries.

The epidemiology of injuries in children has a similar progression as in other countries in Europe, where injured children represent 30% of hospitalized patients; in our country it is between 27% and 31%.

Gender-based epidemiology shows higher percentage in males than in females: the difference amounts to 18%.

The mortality rate after thermal injuries has significantly decreased since specialized workplaces were gradually established. Up to 1970, prior to the establishment of die Burn Centre in Kosice, the death rate was 19%. Nowadays it has decreased to 3%. It is important to stress here that during fires and other disasters every year up to 90 people die immediately: however, these cases are not involved in the statistic of hospitalized patients. The death rate is higher in socalled risk age groups: children under 3 years and in adults older than 60 years. The mortality rate is higher in males, amounting to 80% of all deaths. This is due not only to the prevalence of injuries in males but also to the greater extent of the burns.

A statistical survey of hospitalized patients with bum injuries in Kosice-Saca and Ruzinov is shown in Table 5, 6 and 7. We analyzed in detail the years 2003 and 2004.

In 2003 in Slovakia 1916 patients were hospitalized with burn injuries, 27% of which were children. The Burn Department in Kosice-Saca hospitalized 651 patients in 2003; 73 were severe injuries, extending from 24% to 90% of the body surface, with an average of 21%. From the total, 128 patients were children. Thirteen patients died as a result of the burn injury in the above year, one was a child. In 2004 we hospitalized 703 patients: some of these were patients with other skin loss injuries and patients who underwent reconstruction after an injury. The total number of children was 147. As a result of injuries and complications ten patients died, out of which three were children. Eighty-three patients had injuries with the extent of injury exceeding 20% of the body surface.

The Burn Department in Ruzinov hospitalized 399 patients in 2003, including 78 patients with severe injuries. Twelve patients died. 1n 2004, Ruzinov hospitalized 380 patients. Seventy-nine of them sustained severe injuries and of these 33 were long-term ventilated. The number of children injured and admitted to the Department was 58. Fifteen patients died as a result of the injury and complications. none of them being a child (2).

The average treatment time on both workplaces for the listed time was 11-14 days: see Table 7.

The Burn and Recoil structive Surgery Department in Ruzinov participates in the teaching and research of the Medical Faculty of Komensky University in Bratislava. It also has a tissue bank, which plays a significant role in this area within Europe.

Since 1993 we have registered only two burn mass accidents in Slovakia. In 1996 a microcelh1lose-based plant is the military area in Kezmarok exploded and went on fire, involving 18 soldiers, of whom 5 died. In 1995 there was an explosion of stock gas in the VSZ (Kosice Steel Company), when only two employees suffered burn injuries but 400 suffered carbon monoxide poisoning (3).

This was one of the reasons why the Burn Department ěn Saca made the decision to build a hyperbaric centre, with a 15-section hyperbaric chamber. The chamber provides treatment after acute poisoning, anaerobic infections as well as a treatment of chronic defects, ischemic diseases, diabetic wounds and acute hearing defects. Since its installation in 2003 it has served more than 400 patients in 4200 sessions.

The Burn Department in Saca. which is an external component of the education at the Medical Faculty of P. J. Safárik University and also part of the private hospital since 1999, built and started up the laser centre and the tissue bank. It also divided the departments into burn and reconstructive sections, which can serve for aesthetic operations as well.

DISCUSSION

This retrospective study evaluates the development of thermal injuries in Slovakia and compares it with the overall development of accident incidence in Slovakia. The presented statistical and epidemiological data, which arc partially adopted from the data of Institute of Medical Statistics and Information. show an overall increase of accident incidence in Slovakia from 1993 till 2003. The greatest part of the increase is due to traffic accidents on Slovakian roads. In contrast, number of thermal injuries decreased. The causes of thermal injuries in Slovakia are almost identical with the incidence of thermal injuries in other European countries. The same applies to the incidence in children.

The decrease of the mortality rate was caused by significant improvements of emergency care, transport and treatment of burn injuries (see Tab. 1). However, the most significant decrease was achieved by timely necrectomy, skin transplantation, and aggressive treatment of infections and not least by the use of allografts and xenografts. The analysis of thermal injury causes within the listed time also changed. While severe injuries in industry and work-related injuries predominated originally. today household injuries predominate, caused mainly by hot liquids striking at particular age groups children up to three years and people aged 60 years and above. Here, the severe injuries are caused by scalding, burning of the clothing, accidents during cooking, starting a fire and burning of grass.

Thermal injuries, numbering 3.190 of all injuries. are slightly decreasing. The average number of thermal injuries in the beginning of die 1990s was 2000 per year; in 2004 it decreased to 1640. This is reflected in die number of admitted patients with thermal injuries in the Bratislava and Kosice Departments, where we noted a decrease of admitted patients not only due to fewer bum injuries in Slovakia, but also due to the medical system reformation which-with its system of reirnbursementobliges the surgical and trauma departments to keep less severe burn injuries in care. However, this strategy also has a negative impact in the form of greater number of complications during treatment, which consequently have to be addressed at both of the specialized workplaces.

Nevertheless, we can add that the decreased number of thermal injuries despite an overall increase of accident incidence in Slovakia is a consequence of:

• better general knowledge of population about the risks of burn injuries,
• greater activity of clinical workplaces in the field of prevention,
• significant improvement of preventive measures in factories with hot operations.
• improved communication and cooperation of peripheral and regional hospitals,
• improvement of social and economical situation of population which results into better fitting of kitchens, bathrooms etc.

Statistical follow up of injuries has several important functions, allowing:

• better targeting of prevention (removal of dangerous operations),
• better planned distribution of emergency rooms and specialized workplaces,
• better typology of injury pathophysiology.

REFERENCES

1. Boecks WD. Progress in Burn Injury Treatment. Acco. Leuven (Belgium), 1990, p. 27-37.
2. Koller. J., Orsag, M., Ondriasova, L., Graffinger, L, Bukovcan, P,Analysis of 1119 burn injuries treated at the Bratislava Burn Department dining alive sear period, Acta Chir Plast., 36, 1994. p. 67-70.
3. Simko, S. Babik, J. Medicěna Katastrof - Hromadmé nestastia. Marlin: Osveta, 1997, p. 91-103.
4. UStav zdravotnickych injformaci^ a statistiky Neodkladnŕ chirurgickŕ /,,mw, pri niektorych choroback r SR 2003. Bratislava 2004, Vol. 2004, p. 7-1 s.

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