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 Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 20  |  Issue : 1  |  Page : 68-71

Profile of acute thermal burn admissions to the intensive care unit of a tertiary burn care center in India


Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Date of Web Publication13-May-2013

Correspondence Address:
Neha Chauhan
Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.111791

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  Abstract 

Aim: To analyze the profile of acute thermal burn patients admitted to intensive care unit of a tertiary burn care center in India. Materials and Methods: Acute thermal burn patients admitted to the burn intensive care unit during June, August and December 2011 representative of summer, monsoon and winter season were included in this study. Observations: Overall 416 patients were admitted during this period. A total of 162 patients fulfilled the study criteria. Females outnumbered male victims. Patients in the age group of 20-40 years were most affected. Burns in females involve greater total body surface area (TBSA). Liquefied petroleum gas stoves, kerosene oil stoves and kerosene oil lamps are the most common causes of burns reporting to our center. Average distance travelled by patients to reach this hospital was 69.4 kilometers. Ten percent of the female thermal burn victims were pregnant and 3% were lactating. Discussion: An education program is needed to make the population aware of various etiological factors causing burns and their prevention. Safer means and practices should be adopted in kitchen. Local health care facility should play a major and proactive role in managing burns. Burn care needs to be decentralized for better management.

Keywords: Acute thermal burn admissions, tertiary burn center, India


How to cite this article:
Chauhan N, Kumar S, Sharma U. Profile of acute thermal burn admissions to the intensive care unit of a tertiary burn care center in India. Indian J Burns 2012;20:68-71

How to cite this URL:
Chauhan N, Kumar S, Sharma U. Profile of acute thermal burn admissions to the intensive care unit of a tertiary burn care center in India. Indian J Burns [serial online] 2012 [cited 2019 Oct 15];20:68-71. Available from: http://www.ijburns.com/text.asp?2012/20/1/68/111791


  Introduction Top


Burn is the second major cause of trauma related deaths after road traffic accidents. [1] Burn is a major problem in India but the exact incidence has not been reported yet. Burn profile closely follows the socioeconomic flux of a country. [2] Judicious extrapolation suggests that India, with a population of over 1 billion, has 700,000 to 800,000 burn admissions annually. [3] The exact number of burns is difficult to determine because of lack of a central burn registry system in India. The aim of this study was to analyze the profile of acute thermal burn admissions to the burn intensive care unit of our hospital.


  Materials and Methods Top


This was a prospective observational study. Acute thermal burn patients admitted to the burn intensive care unit of Vardhaman Mahavir Medical College and Safdarjung hospital, New Delhi during June, August and December 2011 representative of summer, monsoon and winter season in northern India were included in this study. This is one of the largest burn care unit in India with a 15 bed intensive care unit, 17 bed step-down intensive care unit and 32 bed burn ward.

Inclusion criteria

  • Acute thermal burn (<72 h) admitted to burn intensive care unit.
Exclusion criteria

  • Electrical/Scald/Chemical burns
  • Thermal burns presenting after 72 h of burns
  • Brought dead patients.
The following parameters were analyzed

  • Sex distribution
  • Age distribution
  • Percentage of total body surface area involved
  • Religion distribution
  • Time between burn and admission
  • Mode of injury (Accidental/Homicidal/Suicidal)
  • Mechanism of injury
  • Distribution of patients according to the state to which they belonged
  • Average distance travelled by the patients to reach the hospital
  • Reproductive status of women
  • Mortality rate.

  Observations and Results Top


Overall 416 patients were admitted during this period. A total of 162 patients fulfilled the study criteria and were therefore included in this study. The distribution of patients in the various months was as follows - 51 in June, 48 in August and 53 in December.

Sex distribution: Out of the 162 thermal burn patients admitted during the study period, a total of 96 females and 66 male patients were admitted. The ratio of females to males was 1.45: 1.

Age distribution: Majority of victims (67%) were between 20-40 years of age. In this group, a total of 43.2% (70 patients) were young adults aged between 20-30 years. Only 4.3% victims were children less than 10 years. Only one patient admitted during this period was older than 60 years of age. [Table 1] shows the distribution of patients in various age-groups.
Table 1: Age-wise distribution

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Percentage of total body surface area (TBSA) involved: Females suffered burns to a larger total body surface area as compared to males. Seventy-six percent of females suffered burns more than 50% TBSA in comparison to fifty one percent of male patients suffering burns greater than 50% TBSA. [Table 2] shows the distribution of patients according to the total body surface area.
Table 2: Percentage of total body surface area involved

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Religion-wise distribution: Eighty eight percent of the patients were Hindus and nine percent were Muslims. Sikhs and Christians formed a minor proportion of the victims. There was no co-relation between burns and any religion but in all groups females were more commonly affected than males.

Time between burn and admission: Only seven of the 162 patients admitted to our burn unit presented within an hour of the burn. Majority of the admissions (28.4%) were between 4-8 hours after burns. Eighty seven percent of the patients were dehydrated at the time of admission. [Table 3] shows the time between burn and admission.
Table 3: Time interval between burn and admission

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Mode of injury (Accidental/Homicidal/Suicidal): Majority (82.7%) of the patients had suffered accidental thermal burns. Twelve percent of these burns were suicidal and 4.3% were homicidal [Table 4].
Table 4: Mode of injury

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Causes of thermal burn injury: One hundred and three patients (63.5%) suffered burns while working in the kitchen. The most common cause of these burns was liquefied petroleum gas cylinders followed by kerosene oil stoves and lamps. [Table 5] enlists the various causes of thermal burns in our study group.
Table 5: Causative agents of burns

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Distribution of patients according to the state to which they belonged: Thirty patients (18.5%) belonged to Delhi proper. Forty-five patients (27.8%) were from the near capital region. Thirty-six percent patients (59 patients) were from the nearby state of Uttar Pradesh. Eighty-five percent patients were initially treated at a local facility and then referred to our centre. Distribution from the other states is shown in [Table 6].
Table 6: State-wise distribution of patients

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Average distance travelled by the patients to reach the hospital: Average distance travelled by patients to reach the hospital was 69.4 km. [Table 7] shows the distances travelled by the patients to reach our center.{Table 7}

Reproductive status of women: Ten percent female thermal burn victims were pregnant and 3% were lactating. The average total body surface involved in burns of the pregnant females was 69.3% which was higher than that of non-pregnant admissions (TBSA-60.6%).

Mortality rate: The average mortality rate was 65.4% in the study group.


  Discussion Top


Epidemiological studies are important to analyze the burden, distribution and causes of burns in a particular region. These studies form the basis of disease prevention programs, hence their significance. According to the current study, females are more susceptible to burns than males (female:male ratio was1.45:1). This is because women are involved more with fire in our society as they work in the kitchen and because of their clothing style which comprises of flowing dupatta or sari. This is in contrast to the literature from western countries where males suffer burns more frequently than females, [4],[5] most of them being industrial in nature.

The age-group of 20-40 years was most frequently involved mainly because this is the group of people which is actively involved both in indoor and outdoor work. Children less than 10 years and elderly greater than 60 years are rarely involved in thermal burns because they do not work in kitchen/industries. As per this study, females suffered a greater percentage TBSA burns than males which could be because of their flowing dressing style. There was no religion-wise co-relation of burns. But in all religions, females were more susceptible than males.

Only seven of the 162 patients presented within an hour of burn. Maximum number of patients presented between 4-8 hours after injury, 85% of the patients being initially treated at other hospitals. One hundred and forty one (87.5%) of the patients were dehydrated at the time of admission, an indicator of initial poor resuscitation. Majority (82.7%) of the burns were accidental. In this group the commonest causes of burns were liquefied petroleum gas cylinders and kerosene oil stoves which are used as fuel for cooking food. Kerosene oil lamp (dibiya) is the third common cause of accidental thermal burns, indicating that many parts of this region are still devoid of adequate electricity. Amongst suicidal burns, family/marital discord, unemployment and drug abuse were the most common precipitating factors. Homicidal burns were related to dowry and marital/family discord. This indicates that women still do not enjoy a good status in our primarily patriarchal society.

Only 18.5% (30 patients) patients belonged to Delhi proper. Rest of them belonged to the neighboring states. Most of the patients presenting to our hospital travelled distances between 50-100 kilometers with an average of 69.4 kilometers. The mortality rate was 65.4% which is primarily due to the fact that most of our patients were from far off places, inadequately managed at the primary care centers and had very extensive burns. This mortality rate was higher than in the series of Subrahmanyam [6] (56.5%) in Solapur, Maharashthra; Bilwani et al., [7] (58.26%) in Ahmedabad, Gujarat; Jayaraman et al., [8] (52.33%) in Chennai, Tamil Nadu; Gupta et al., [9] (48.33%) in Jaipur and Sarma et al., [10] (18.3%) in Digboi, Assam. It was lower than the observations of Puri [11] (90.2%) in Mumbai, Maharashtra.


  Conclusions Top


From our study, we conclude that kitchen is still the most common place of occurrence of thermal burns in India accounting for 63.5% thermal burns sustained in this study group. Stringent measures need to be taken both at individual and administrative level to make the traditional Indian kitchen safer. Cooking appliances should have good quality control and all unauthorized products must be banned. Media should be utilized to create general awareness in public regarding how to prevent fire and measures to deal with it once it has taken place.

The significance of educating masses in prevention of suicidal burns cannot be understated. Women need to be empowered better and the society needs a major reformation in its outlook towards women to prevent dowry related burns.

Most of our patients come from far off places due to lack of burn care facility in periphery. There is a need to increase availability of burn care facility in the periphery and to upgrade the existing facilities so that primary care can be provided adequately and at the earliest. Moreover, critical care to the patients should be extended up to transfer by the referring hospitals, so that the crucial period of resuscitation is not lost.

In places having inadequate supply of electricity, unsafe means of lighting like kerosene oil lamps should be discouraged in favor of safer alternatives.

Burn notification and prevention should be taken up as a serious issue because of its devastating consequences not only for the individual and family but for the entire burn care community which is left helpless in cases of extensive burns.

Further epidemiological studies over a longer period are needed to define the profile of the thermal burn patients in India in a better way.

 
  References Top

1.Goel A, Shrivastava P. Post-burn scars and scar contractures. Indian J Plast Surg 2010;43:S63-71.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Forjuoh SN. Burns in low and middle income countries: A review of available literature on descriptive epidemiology, risk factors, treatment and prevention. Burns 2006;32:529-37.  Back to cited text no. 2
    
3.Ahuja RB, Bhattacharya S. Burns in the developing world and burn disasters. BMJ 2004;329:447.  Back to cited text no. 3
    
4.Iliopoulou E, Michelakis D, Michail A, Lochaitis A. Statistical and epidemiological data of 1840 burn patient admissions (1993-2001). Ann Burns Fire Disasters 2003;16:69-73.  Back to cited text no. 4
    
5.Song C, Chua A. Epidemiology of burn injuries in Singapore from 1997 to 2003. Burns 2005;31:S18-26  Back to cited text no. 5
    
6.Subrahmanyam M. Epidemiology of burns in a district hospital in Western India. Burns 1996;22:439-42.  Back to cited text no. 6
    
7.Bilwani PK, Gupta R. Epidemiological profile of burn patients in LG Hospital, Ahmedabad. Indian J Burns 2003;11:63-4.  Back to cited text no. 7
    
8.Jayaraman V, Ramakrishnan MK, Davies MR. Burns in Madras, India: An analysis of 1368 patients in one year. Burns 1993;19:339-44.  Back to cited text no. 8
    
9.Gupta M, Guta OK, Yaduwanshi RK, Upadhyaya J. Burn epidemiology: The pink city scene. Burns 1993;19:47-51.  Back to cited text no. 9
    
10.Sarma BP, Sarma N. Epidemiology, morbidity, mortality and treatment of burn injuries: A study in a peripheral industrial hospital. Burns 1994;20:253-5.  Back to cited text no. 10
    
11.Puri V. A retrospective analysis of suicidal burns in Indian women. Indian J Plast Surg 2000;33:73-7.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


This article has been cited by
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Amol Dhopte,Rahul Bamal,Vinay Kumar Tiwari
Burns & Trauma. 2017; 5(1)
[Pubmed] | [DOI]



 

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